NSG 233 MED SURG 2 EXAM 2 FULL STUDY
COMPANION 2026
◉ Shock Fluid. Answer: At least two large-gauge IV lines are inserted
to establish access for fluid administration. Because the goal of the
fluid replacement is to restore intravascular volume, it is necessary
to administer fluids that will remain in the intravascular
compartment to avoid fluid shifts from the intravascular
compartment into the intracellular compartment. As discussed
earlier, crystalloid solutions such as lactated Ringer's solution or
0.9% sodium chloride solution are commonly used to treat
hypovolemic shock, as large amounts of fluid must be given to
restore intravascular volume.
◉ Hypovolemic Shock. Answer: Hypovolemic shock, the most
common type of shock, is characterized by decreased intravascular
volume. Body fluid is contained in the intracellular and extracellular
compartments. Intracellular fluid accounts for about two thirds of
the total body water. The extracellular body fluid is found in one of
two compartments: intravascular (inside blood vessels) or
interstitial (surrounding tissues). The volume of interstitial fluid is
about three to four times that of intravascular fluid. Hypovolemic
shock occurs when there is a reduction in intravascular volume by
15% to 30%, which represents an approximate loss of 750 to 1500
mL of blood in a 70-kg (154-lb) person
,◉ Cardiogenic Shock S&S. Answer: Cardiogenic shock occurs when
the heart's ability to contract and to pump blood is impaired and the
supply of oxygen is inadequate for the heart and the tissues. In
cardiogenic shock, cardiac output, which is a function of both stroke
volume and heart rate, is compromised. Patients in cardiogenic
shock may experience the pain of angina, develop arrhythmias,
complain of fatigue, express feelings of doom, and show signs of
hemodynamic instability.
◉ Hemorrhage- Shock. Answer: If the patient is hemorrhaging,
efforts are made to stop the bleeding. This may involve applying
pressure to the bleeding site or surgical interventions to stop
internal bleeding. If the cause of the hypovolemia is diarrhea or
vomiting, medications to treat diarrhea and vomiting are given while
efforts are made to identify and treat the cause. In older adult
patients, dehydration may be the cause of hypovolemic shock.
◉ Shock Septic- Dopamine. Answer: Dopamine, a naturally
occurring precursor of norepinephrine and epinephrine, functions
as a neurotransmitter. Dopamine is useful in hypovolemic and
cardiogenic shock. Adequate fluid therapy is necessary for maximal
pressor (increased blood pressure) effect. Acidosis decreases the
effectiveness of the drug. If fluid therapy alone does not effectively
improve tissue perfusion, vasopressor agents, specifically
norepinephrine or dopamine, may be initiated to achieve a MAP of
65 mm Hg or higher
, ◉ AAA- Tests. Answer: The most important diagnostic indication of
an abdominal aortic aneurysm is a pulsatile mass in the middle and
upper abdomen. Most clinically significant aortic aneurysms are
palpable during routine physical examination; however, the
sensitivity depends upon the size of the aneurysm, abdominal girth
of the patient (i.e., more difficult to find in the patient with obesity),
and the skill of the examiner. A systolic bruit may be heard over the
mass. Duplex ultrasonography or CTA is used to determine the size,
length, and location of the aneurysm. When the aneurysm is small,
ultrasonography is conducted at 6-month intervals until the
aneurysm reaches a size so that surgery to prevent rupture is of
more benefit than the possible complications of a surgical
procedure. Some aneurysms remain stable over many years of
monitoring.
◉ AAA- Post Op. Answer: The patient who has had an endovascular
repair must lie supine for 6 hours; the head of the bed may be
elevated up to 45 degrees after two hours. The patient needs to use a
bedpan or urinal while on bed rest. Vital signs and Doppler
assessment of peripheral pulses are performed initially every 15
minutes and then at progressively longer intervals if the patient's
status remains stable. The access site (usually the femoral artery) is
assessed when vital signs and pulses are monitored. The nurse
assesses for bleeding, pulsation, swelling, pain, and hematoma
formation. Skin changes of the lower extremity, lumbar area, or
buttocks that might indicate signs of embolization, such as
extremely tender, irregularly shaped, cyanotic areas, as well as any
changes in vital signs, pulse quality, bleeding, swelling, pain, or
hematoma, are immediately reported to the primary provider.
COMPANION 2026
◉ Shock Fluid. Answer: At least two large-gauge IV lines are inserted
to establish access for fluid administration. Because the goal of the
fluid replacement is to restore intravascular volume, it is necessary
to administer fluids that will remain in the intravascular
compartment to avoid fluid shifts from the intravascular
compartment into the intracellular compartment. As discussed
earlier, crystalloid solutions such as lactated Ringer's solution or
0.9% sodium chloride solution are commonly used to treat
hypovolemic shock, as large amounts of fluid must be given to
restore intravascular volume.
◉ Hypovolemic Shock. Answer: Hypovolemic shock, the most
common type of shock, is characterized by decreased intravascular
volume. Body fluid is contained in the intracellular and extracellular
compartments. Intracellular fluid accounts for about two thirds of
the total body water. The extracellular body fluid is found in one of
two compartments: intravascular (inside blood vessels) or
interstitial (surrounding tissues). The volume of interstitial fluid is
about three to four times that of intravascular fluid. Hypovolemic
shock occurs when there is a reduction in intravascular volume by
15% to 30%, which represents an approximate loss of 750 to 1500
mL of blood in a 70-kg (154-lb) person
,◉ Cardiogenic Shock S&S. Answer: Cardiogenic shock occurs when
the heart's ability to contract and to pump blood is impaired and the
supply of oxygen is inadequate for the heart and the tissues. In
cardiogenic shock, cardiac output, which is a function of both stroke
volume and heart rate, is compromised. Patients in cardiogenic
shock may experience the pain of angina, develop arrhythmias,
complain of fatigue, express feelings of doom, and show signs of
hemodynamic instability.
◉ Hemorrhage- Shock. Answer: If the patient is hemorrhaging,
efforts are made to stop the bleeding. This may involve applying
pressure to the bleeding site or surgical interventions to stop
internal bleeding. If the cause of the hypovolemia is diarrhea or
vomiting, medications to treat diarrhea and vomiting are given while
efforts are made to identify and treat the cause. In older adult
patients, dehydration may be the cause of hypovolemic shock.
◉ Shock Septic- Dopamine. Answer: Dopamine, a naturally
occurring precursor of norepinephrine and epinephrine, functions
as a neurotransmitter. Dopamine is useful in hypovolemic and
cardiogenic shock. Adequate fluid therapy is necessary for maximal
pressor (increased blood pressure) effect. Acidosis decreases the
effectiveness of the drug. If fluid therapy alone does not effectively
improve tissue perfusion, vasopressor agents, specifically
norepinephrine or dopamine, may be initiated to achieve a MAP of
65 mm Hg or higher
, ◉ AAA- Tests. Answer: The most important diagnostic indication of
an abdominal aortic aneurysm is a pulsatile mass in the middle and
upper abdomen. Most clinically significant aortic aneurysms are
palpable during routine physical examination; however, the
sensitivity depends upon the size of the aneurysm, abdominal girth
of the patient (i.e., more difficult to find in the patient with obesity),
and the skill of the examiner. A systolic bruit may be heard over the
mass. Duplex ultrasonography or CTA is used to determine the size,
length, and location of the aneurysm. When the aneurysm is small,
ultrasonography is conducted at 6-month intervals until the
aneurysm reaches a size so that surgery to prevent rupture is of
more benefit than the possible complications of a surgical
procedure. Some aneurysms remain stable over many years of
monitoring.
◉ AAA- Post Op. Answer: The patient who has had an endovascular
repair must lie supine for 6 hours; the head of the bed may be
elevated up to 45 degrees after two hours. The patient needs to use a
bedpan or urinal while on bed rest. Vital signs and Doppler
assessment of peripheral pulses are performed initially every 15
minutes and then at progressively longer intervals if the patient's
status remains stable. The access site (usually the femoral artery) is
assessed when vital signs and pulses are monitored. The nurse
assesses for bleeding, pulsation, swelling, pain, and hematoma
formation. Skin changes of the lower extremity, lumbar area, or
buttocks that might indicate signs of embolization, such as
extremely tender, irregularly shaped, cyanotic areas, as well as any
changes in vital signs, pulse quality, bleeding, swelling, pain, or
hematoma, are immediately reported to the primary provider.
