Medical Surgical Nursing Exam Test Question and Answers
SHOCK [DEFINITION]
Answer: Inadequate tissue perfusion and inadequate removal of carbon dioxide and wastes leading to
hemodynamic, metabolic and cellular problems.
- ETIOLOGY- maldistributive (ex, aseptic, anaphylactic), Low blood flow (cardiogenic, hypovolemic)
- MAIN SIGNS: tachycardia, hypotension, tissue acidosis
S/S of SHOCK
Answer: EARLY= - COMPENSATORY MECHANISMS- vasoconstriction, shunting of blood (cold skin,
cramps, increased breathing),
- Hypotension, Tachycardia, Tissue Acidosis
- Uncompensated: multi-organ dysfunction LATE= MODS: sustained --> impaired gas exchange [crackles,
dyspnea]; weak peripheral pulses, ischemia of distal extremities, organ dysfunction
S/S of HYPOPERFUSION = decreased urine output, weak peripheral pulses, decreased LOC
RAAS-
Answer: DEFINITION= hormone system that regulates blood pressure and fluid volume
TRIGGER= decreased blood flow (i.e. Shock)
EFFECT= [renin (kidneys) --> angiotensin (liver- converted by ACE from the lungs causing
vasoconstriction)--> aldosterone (adrenal cortex of kidneys) leads to increased sodium and water
reabsorption] ==>
- INCREASE IN BLOOD PRESSURE DUE TO VASOCONSTRICTION (Angiotensin) and WATER RETENTION
(aldosterone)
SHOCK TREATMENT
Answer: 1) RESTORE BREATHING 2) RELIEVE ANXIETY, 3) RESTORE FLUID VOLUME (increase CO)
GOAL= maintain tissue perfusion and BP/ Treatment based on cause. i.e. cardiogenic?
- maintain fluid balance = IV, monitor I/Os,
- reduce Myocardial Oxygen demand = rest
- watch for complications= check perfusion,
Vital signs, breath sounds. monitor neurological status (LOC every hour, restlessness, confusion)
PHARM:
- Sympathomimetic Drugs: ( mimic the SNS) - include vasopressors, which increase blood pressure via
vasoconstriction and increase systemic vascular resistance (i.e. epinephrine) . FLUID RESUCITATION
MUST BE ACHIEVED PRIOR TO VASOPRESSORS
SHOCK ASSESSMENT CONSIDERATIONS
Answer: - Breathing = check crackles and dyspnea (shunting blood from the lungs and increased vascular
permeability can increase fluid to lungs and impair lung functioning)
- Peripheral Hypoperfusion= cyanosis, pallor, cool and clammy, increased cap refill
- Cardiovascular= tachycardia (wouldn't show if patient is on beta blockers), weak peripheral pulses
(uncompensated),
- DURING TREATMENT= maintain MAP at 60-65 mmhg;
- SIGNS OF INADEQUATE PERFUSION= decreased Urine output; increased serum lactate levels.
decreased LOC (checked every hour) urine output les than 0.5ml/kg/hr is bad.weak peripheral pulses
, CARDIOGENIC SHOCK
Answer: DEFINITION: Shock due to inadequate cardiac output due to heart's systolic or diastolic
dysfunction
ETIOLOGY=
- SYSTOLIC- inability of heart to pump blood forward can be from - systemic HTN, pulmonary HTN,
Damage to Heart (ie blunt injury, MI)
- DIASTOLIC= inability of heart to fill completely before contraction can be caused from cariomyapothies
or cardiac tamponade.
S/S= pulmonary congestion (tachypnea, crackles), high blood pressure (narrowed pulse pressure); signs
of decreased perfusion
LAB STUDIES= cardiac enzymes, troponin, chest xray, ECG
CARDIOGENIC SHOCK TREATMENT
Answer: GOAL OF TREATMENT= Balance oxygen supply and demand
- Restore blood flow = thrombolytic therapy, angioplasty and stenting, valve replacement,
revascularization,
- Reduce workload on heart = vasodilators (reduce after load) , rest, diuretics (reduces preload), reduce
heart rate (Beta blockers)
- nursing= assessment, IV, rest,
SEPTIC SHOCK
Answer: DEFINITION= immune response from microbes (antigens) in the blood
ETIOLOGY = trigger hyperimmune response(release f mediators) --> clots --> block blood flow -->
inadequate perfusion
S/S = shock (tachycardia, tachypnea,) , Infection (Increased WBC (>12,000 abc) or (<4,000, increased
temperature)
TREATMENT
- meds: XIgris (redces inflammation and increases fibrinolysis) ; Antibiotics (first determine whats
causing it)
- NURSING ACTIONS= assessment; oxygen treatment, get blood culture
ANAPHYLACTIC SHOCK
Answer: DEFINITION: shock caused by severe allergic reaction causing a hyper allergic response which
involves humoral immunity (activation of WBS (i.e. mast cells) causing release of mediators such as
histamine that cause rxn.
PHYSIOLOGY: immune response --> vasodilation --> increase cap permeability --> drop in blood pressure
S/S= SUDDEN ONSET OF SYMPTOMS including, edema and itching, bronchoconstriction, wheezing,
angioedema, skin changes (swelling, puririts, erythema, hives (uticaria)) other symptoms of shock (ie-
cardiovascular and nuero changes)
TREATMENT= Initial PRIORITY KEEP PATENT AIRWAY (mechanical ventilation or supplementary oxygen) .
- Treat Shock = Fluid Volume Maintenance (blood infusions, IV fluid
-PHARM: Initial med: epi (causes vasoconstriction and bronchodilation), Antihistamines (benadryl),
SHOCK [DEFINITION]
Answer: Inadequate tissue perfusion and inadequate removal of carbon dioxide and wastes leading to
hemodynamic, metabolic and cellular problems.
- ETIOLOGY- maldistributive (ex, aseptic, anaphylactic), Low blood flow (cardiogenic, hypovolemic)
- MAIN SIGNS: tachycardia, hypotension, tissue acidosis
S/S of SHOCK
Answer: EARLY= - COMPENSATORY MECHANISMS- vasoconstriction, shunting of blood (cold skin,
cramps, increased breathing),
- Hypotension, Tachycardia, Tissue Acidosis
- Uncompensated: multi-organ dysfunction LATE= MODS: sustained --> impaired gas exchange [crackles,
dyspnea]; weak peripheral pulses, ischemia of distal extremities, organ dysfunction
S/S of HYPOPERFUSION = decreased urine output, weak peripheral pulses, decreased LOC
RAAS-
Answer: DEFINITION= hormone system that regulates blood pressure and fluid volume
TRIGGER= decreased blood flow (i.e. Shock)
EFFECT= [renin (kidneys) --> angiotensin (liver- converted by ACE from the lungs causing
vasoconstriction)--> aldosterone (adrenal cortex of kidneys) leads to increased sodium and water
reabsorption] ==>
- INCREASE IN BLOOD PRESSURE DUE TO VASOCONSTRICTION (Angiotensin) and WATER RETENTION
(aldosterone)
SHOCK TREATMENT
Answer: 1) RESTORE BREATHING 2) RELIEVE ANXIETY, 3) RESTORE FLUID VOLUME (increase CO)
GOAL= maintain tissue perfusion and BP/ Treatment based on cause. i.e. cardiogenic?
- maintain fluid balance = IV, monitor I/Os,
- reduce Myocardial Oxygen demand = rest
- watch for complications= check perfusion,
Vital signs, breath sounds. monitor neurological status (LOC every hour, restlessness, confusion)
PHARM:
- Sympathomimetic Drugs: ( mimic the SNS) - include vasopressors, which increase blood pressure via
vasoconstriction and increase systemic vascular resistance (i.e. epinephrine) . FLUID RESUCITATION
MUST BE ACHIEVED PRIOR TO VASOPRESSORS
SHOCK ASSESSMENT CONSIDERATIONS
Answer: - Breathing = check crackles and dyspnea (shunting blood from the lungs and increased vascular
permeability can increase fluid to lungs and impair lung functioning)
- Peripheral Hypoperfusion= cyanosis, pallor, cool and clammy, increased cap refill
- Cardiovascular= tachycardia (wouldn't show if patient is on beta blockers), weak peripheral pulses
(uncompensated),
- DURING TREATMENT= maintain MAP at 60-65 mmhg;
- SIGNS OF INADEQUATE PERFUSION= decreased Urine output; increased serum lactate levels.
decreased LOC (checked every hour) urine output les than 0.5ml/kg/hr is bad.weak peripheral pulses
, CARDIOGENIC SHOCK
Answer: DEFINITION: Shock due to inadequate cardiac output due to heart's systolic or diastolic
dysfunction
ETIOLOGY=
- SYSTOLIC- inability of heart to pump blood forward can be from - systemic HTN, pulmonary HTN,
Damage to Heart (ie blunt injury, MI)
- DIASTOLIC= inability of heart to fill completely before contraction can be caused from cariomyapothies
or cardiac tamponade.
S/S= pulmonary congestion (tachypnea, crackles), high blood pressure (narrowed pulse pressure); signs
of decreased perfusion
LAB STUDIES= cardiac enzymes, troponin, chest xray, ECG
CARDIOGENIC SHOCK TREATMENT
Answer: GOAL OF TREATMENT= Balance oxygen supply and demand
- Restore blood flow = thrombolytic therapy, angioplasty and stenting, valve replacement,
revascularization,
- Reduce workload on heart = vasodilators (reduce after load) , rest, diuretics (reduces preload), reduce
heart rate (Beta blockers)
- nursing= assessment, IV, rest,
SEPTIC SHOCK
Answer: DEFINITION= immune response from microbes (antigens) in the blood
ETIOLOGY = trigger hyperimmune response(release f mediators) --> clots --> block blood flow -->
inadequate perfusion
S/S = shock (tachycardia, tachypnea,) , Infection (Increased WBC (>12,000 abc) or (<4,000, increased
temperature)
TREATMENT
- meds: XIgris (redces inflammation and increases fibrinolysis) ; Antibiotics (first determine whats
causing it)
- NURSING ACTIONS= assessment; oxygen treatment, get blood culture
ANAPHYLACTIC SHOCK
Answer: DEFINITION: shock caused by severe allergic reaction causing a hyper allergic response which
involves humoral immunity (activation of WBS (i.e. mast cells) causing release of mediators such as
histamine that cause rxn.
PHYSIOLOGY: immune response --> vasodilation --> increase cap permeability --> drop in blood pressure
S/S= SUDDEN ONSET OF SYMPTOMS including, edema and itching, bronchoconstriction, wheezing,
angioedema, skin changes (swelling, puririts, erythema, hives (uticaria)) other symptoms of shock (ie-
cardiovascular and nuero changes)
TREATMENT= Initial PRIORITY KEEP PATENT AIRWAY (mechanical ventilation or supplementary oxygen) .
- Treat Shock = Fluid Volume Maintenance (blood infusions, IV fluid
-PHARM: Initial med: epi (causes vasoconstriction and bronchodilation), Antihistamines (benadryl),
