NSG 430 EXAM 4 QUESTIONS WITH
CORRECT ANSWERS
Vasopressors may be used in the treatment of shock. Explain why. ✅vasopressors are
a class of drugs that induce vasoconstriction and increase the MAP
In shock, MAP is insufficient to maintain adequate tissue perfusion
While monitoring Ms. B's ABGs, the nurse notes that her PaO2 is < 60 mmHg and her
PaCO2 is >50 mmHg. What do these findings indicate, and why have they occurred?
note: previous lab data - pt is in respiratory alkalosis ✅Hypovolemic shock
body's compensatory mechanisms lead to changes in ABGs, as shock progresses,
respiratory compensation fails as the number of alveoli that are perfused decreases and
gas exchange is impaired
the result is a decrease in PaO2 level and an increase in PaCO2 level
Ms. B has been given large amounts of colloids IV. Hemodynamic monitoring indicates
higher-than-normal central venous pressure and pulmonary artery pressure. What do
these findings indicate? ✅in pts w/shock who are receiving IV colloids, slighltly higher
than normal CVP and PAO measurements are sometimes desirable and may indicate
that vascular volume is being restored
You're working on a neuro unit. Which of your pts below are at risk for developing
neurogenic shock? SATA
a. 36 yo w/SCI at L4
b. 42 yo w/spinal anesthesia
c. 25 yo w/SCI above T6
D. 55-year-old who reports seeing green halos while taking digoxin ✅b. 42 yo w/spinal
anesthesia
c. 25 yo w/SCI above T6
any pt who has had cervical or upper thoracic SCI, receiving spinal anesthesia, or
taking drugs to affect ANS or SNS is at risk
T/F: the PNS loses the ability to stimulate nerve impulses in pts who are experiencing
neurogenic shock. This leads to hemodynamic changes ✅FALSE
the SNS loses the ability to stimulate nerve impulses in pts who are experiencing
neurogenic shock
,A 42 yo male pt is admitted with SCI. The pt is experiencing severe hypotension and
bradycardia. The pt is dx w/neurogenic shock. Why is hypotension occurring in this pt
w/neurogenic shock ✅the pt's ANS has lost the ability to regulate the diameter of the
blood vessels and vasodilation is occurring
the vessels are relaxed and this causes massive vasodilation. Systemic vascular
resistance will decrease and hypotension will occur
You receive a pt in the ER who has sustained a cervical SCI. You know this pt is at risk
for neurogenic shock. What hallmark s/s, if experienced by this pt, would indicate the pt
is expereincing neurogenic shock? SATA
a. BP 69/38
b. HR 170bpm
c. BP 250/120
d. HR 29
e. warm and dry extremities
f. cool and clammy extremities
g. temp 104.9F
h. temp 95F ✅a, d, e, h
Hallmark s/s of neurogenic shock: hypotension, bradycardia, hypothermia, warm/dry
extremities (d/t vasodilation and blood pooling)
In neurogenic shock, a pt will experience a decrease in tissue perfusion. This deprives
the cells of oxygen that make up the tissues and organs. Select all the mechanims, in
regard to pathophysiology, of why this is occurring?
a. loss of vasomotor tone
b. incr SVR
c. decrease in cardiac preload
d. increase in cardiac afterload
e. decrease in venous blood return to the heart
f. venous blood pooling in the extremities ✅a, c, e, f
massive vasodilation is occurring in the body and this is d/ the loss of vasomotor tone.
This will DECREASE SVR and BP will fall. There is pooling of venous blood in the
extremities bc there isnt any pressure to push it back to the heart = decr in venous
blood return to the heart. When this occurs it will decrease cardiac preload.
Youre providing care to a pt experiencing neurogenic shock d/t an injury at T4. As the
nurse, you know what is a pt safety priority? ✅keeping the pt's spine immobilized
want to prevent further damage or perfusion issues to the spinal cord
, A pt in neurogenic shock is ordered IV fluids d/t severe hypotension. During
administration of the fluids the nurse iwll monitor the pt closesly and immediately report?
a. increase in BP
b. high CVP and PAWP
c. UO of 300 mL in the past 5hrs
d. MAP 85 mmHg ✅B. High CVP and PAWP
this would indicate the pt is in fluid volume overload. If fluids are ordered to help
increase the BP, they should be used w/extreme caution bc fluid overload can occur
-w/neuro shock pts usually have normal BP
A pt w/neurogenic shock is experiencing a HR of 30 bpm. What medication does the
nurse antificpate will be ordered by the physician STAT? ✅atropine
this will quickly incr the HR and block the effects of the parasympathetic system on the
body
Your pt in neurogenic shock is not responding to IV fluids. The pt is started on
vasopressors. What option below, if found in your pt, would indicate the med is
working?
a. decreased CVP
b. MAP 90
c. serum lactate 6mmol/L
d. blood pH 7.20 ✅b. MAP 90
MAP of 85-90mmHg will help maintain tissue perfusion and indicates the vasopressor is
working to maintain tissue perfusion. It does this by causing vasoconstriction
You're developing a nursing plan of care for pt w/neurogenic shock. As the nurse, you
know that d/t venous blood pooling from vasodilation a DVT can occur in this type of
shock. A pt goal is that the pt will be free from the development of a DVT. Select all the
nursing interventions below that can help the pt meet this goal:
a. perform ROM exercises daily
b. place pillow underneath pt knees prn
c. administer anticoagulants as scheduled per physician's order
d. apply compression stockings daily ✅A, C, D
option b is not correct bc it would impede blood flow and incr the risk of DVT. The
correct answers help prevent DVT
Your pt is having a sudden and severe anaphylactic reaction to a medication. You
immediately stop the meidcation and call a rapid response. The pt's BP is 80/52, HR
CORRECT ANSWERS
Vasopressors may be used in the treatment of shock. Explain why. ✅vasopressors are
a class of drugs that induce vasoconstriction and increase the MAP
In shock, MAP is insufficient to maintain adequate tissue perfusion
While monitoring Ms. B's ABGs, the nurse notes that her PaO2 is < 60 mmHg and her
PaCO2 is >50 mmHg. What do these findings indicate, and why have they occurred?
note: previous lab data - pt is in respiratory alkalosis ✅Hypovolemic shock
body's compensatory mechanisms lead to changes in ABGs, as shock progresses,
respiratory compensation fails as the number of alveoli that are perfused decreases and
gas exchange is impaired
the result is a decrease in PaO2 level and an increase in PaCO2 level
Ms. B has been given large amounts of colloids IV. Hemodynamic monitoring indicates
higher-than-normal central venous pressure and pulmonary artery pressure. What do
these findings indicate? ✅in pts w/shock who are receiving IV colloids, slighltly higher
than normal CVP and PAO measurements are sometimes desirable and may indicate
that vascular volume is being restored
You're working on a neuro unit. Which of your pts below are at risk for developing
neurogenic shock? SATA
a. 36 yo w/SCI at L4
b. 42 yo w/spinal anesthesia
c. 25 yo w/SCI above T6
D. 55-year-old who reports seeing green halos while taking digoxin ✅b. 42 yo w/spinal
anesthesia
c. 25 yo w/SCI above T6
any pt who has had cervical or upper thoracic SCI, receiving spinal anesthesia, or
taking drugs to affect ANS or SNS is at risk
T/F: the PNS loses the ability to stimulate nerve impulses in pts who are experiencing
neurogenic shock. This leads to hemodynamic changes ✅FALSE
the SNS loses the ability to stimulate nerve impulses in pts who are experiencing
neurogenic shock
,A 42 yo male pt is admitted with SCI. The pt is experiencing severe hypotension and
bradycardia. The pt is dx w/neurogenic shock. Why is hypotension occurring in this pt
w/neurogenic shock ✅the pt's ANS has lost the ability to regulate the diameter of the
blood vessels and vasodilation is occurring
the vessels are relaxed and this causes massive vasodilation. Systemic vascular
resistance will decrease and hypotension will occur
You receive a pt in the ER who has sustained a cervical SCI. You know this pt is at risk
for neurogenic shock. What hallmark s/s, if experienced by this pt, would indicate the pt
is expereincing neurogenic shock? SATA
a. BP 69/38
b. HR 170bpm
c. BP 250/120
d. HR 29
e. warm and dry extremities
f. cool and clammy extremities
g. temp 104.9F
h. temp 95F ✅a, d, e, h
Hallmark s/s of neurogenic shock: hypotension, bradycardia, hypothermia, warm/dry
extremities (d/t vasodilation and blood pooling)
In neurogenic shock, a pt will experience a decrease in tissue perfusion. This deprives
the cells of oxygen that make up the tissues and organs. Select all the mechanims, in
regard to pathophysiology, of why this is occurring?
a. loss of vasomotor tone
b. incr SVR
c. decrease in cardiac preload
d. increase in cardiac afterload
e. decrease in venous blood return to the heart
f. venous blood pooling in the extremities ✅a, c, e, f
massive vasodilation is occurring in the body and this is d/ the loss of vasomotor tone.
This will DECREASE SVR and BP will fall. There is pooling of venous blood in the
extremities bc there isnt any pressure to push it back to the heart = decr in venous
blood return to the heart. When this occurs it will decrease cardiac preload.
Youre providing care to a pt experiencing neurogenic shock d/t an injury at T4. As the
nurse, you know what is a pt safety priority? ✅keeping the pt's spine immobilized
want to prevent further damage or perfusion issues to the spinal cord
, A pt in neurogenic shock is ordered IV fluids d/t severe hypotension. During
administration of the fluids the nurse iwll monitor the pt closesly and immediately report?
a. increase in BP
b. high CVP and PAWP
c. UO of 300 mL in the past 5hrs
d. MAP 85 mmHg ✅B. High CVP and PAWP
this would indicate the pt is in fluid volume overload. If fluids are ordered to help
increase the BP, they should be used w/extreme caution bc fluid overload can occur
-w/neuro shock pts usually have normal BP
A pt w/neurogenic shock is experiencing a HR of 30 bpm. What medication does the
nurse antificpate will be ordered by the physician STAT? ✅atropine
this will quickly incr the HR and block the effects of the parasympathetic system on the
body
Your pt in neurogenic shock is not responding to IV fluids. The pt is started on
vasopressors. What option below, if found in your pt, would indicate the med is
working?
a. decreased CVP
b. MAP 90
c. serum lactate 6mmol/L
d. blood pH 7.20 ✅b. MAP 90
MAP of 85-90mmHg will help maintain tissue perfusion and indicates the vasopressor is
working to maintain tissue perfusion. It does this by causing vasoconstriction
You're developing a nursing plan of care for pt w/neurogenic shock. As the nurse, you
know that d/t venous blood pooling from vasodilation a DVT can occur in this type of
shock. A pt goal is that the pt will be free from the development of a DVT. Select all the
nursing interventions below that can help the pt meet this goal:
a. perform ROM exercises daily
b. place pillow underneath pt knees prn
c. administer anticoagulants as scheduled per physician's order
d. apply compression stockings daily ✅A, C, D
option b is not correct bc it would impede blood flow and incr the risk of DVT. The
correct answers help prevent DVT
Your pt is having a sudden and severe anaphylactic reaction to a medication. You
immediately stop the meidcation and call a rapid response. The pt's BP is 80/52, HR
