NR 341 Final Exam With Correct Answers
How do you treat Hypovolemic Shock? -correct answers Fluid replacement and reduction of further fluid loss are
the focus of the management of hypovolemic shock.
- 0.9% sodium chloride or lactated ringers
- Whole blood, ***packed RBCs***, plasma, synthetic plasma expanders
- Vasoconstrictors (dopamine, norepinephrine, sodium nitroprusside)
What are the clinical manifestations of Hypovolemic Shock? -correct answers Decreased MAP,
***Tachycardia***, Hypotension, Decreased urinary output, Tachypnea, Narrowing of pulse
pressure, and slow capillary refill
How do you treat Anaphylactic Shock? -correct answers - Allergic transfusion reaction: anxiety,
SOB, hypotension tachycardia, dizzy
Stop the transfusion
- ***Administer epinephrine***, corticosteroids, vasopressors, oxygen, or CPR
- Remove tubing from clients IV access
Initiate an infusion of 0.9% sodium chloride using new tubing
How do you treat Neurogenic Shock and what can nurses do to manage it? (following spinal cord
injury) -correct answers - Ensure proper positioning of the spinal cord
- Monitor for hypotension, bradycardia, dependent edema, and loss of temperature regulation
(abrupt onset of fever), which are common manifestations.
- Monitor for manifestations of VTE (swelling of extremity, absent/decreased pulses, and areas
of warmth and/or tenderness). The client might be on anticoagulants to prevent the development
of lower extremity thrombi.
- Administer norepinephrine and dopamine to treat hypotension
Nursing!
- Treat adverse findings with appropriate medications (vasopressors or atropine) and IV fluids.
- Neurogenic bladder → foley catheter
- ***Cervical collar***
- ***Normal saline***
- ***start norepi MAP >70***
CVP measurement -correct answers Normal CVP is 2-6mmHg
***best indicator ofvolume status***
***Decreased = hypovolemic shock***
***Increased = cardiogenic shock***
, How do you treat and manage Cardiogenic Shock? -correct answers - This is a serious
complication of pump failure that occurs commonly following an MI with injury to greater than
40% of the left ventricle
Manifestations: Tachycardia, hypotension, inadequate urinary output, altered LOC, respiratory
distress (crackles, tachypnea), cool, clammy, skin, decreased peripheral pulses, chest pain
Nursing Care:
- Monitor breath sounds. Assess for crackles or wheezing
Monitor heart sounds
- Administer o2, intubation, & ventilation
- Administer IV morphine, diuretics, and/ or nitroglycerin to decrease preload
- ***Administer IV vasopressors and/or positive inotropes to increase cardiac output and
maintain organ perfusion***
- ***Inotropes → doputamine***
- Continuous hemodynamic monitoring
How do you treat and manage Septic Shock? -correct answers s/s:
- Hypotension, tachycardia, fever
- Administer antibiotic therapy
How do we stabilize a suspected neck injury? -correct answers - Stabilize cervical spine
- C4 injury can cause tetraplegia
What are the clinical manifestations of Flail Chest? (Client involved in a motor vehicle accident)
-correct answers occurs when at least two neighboring ribs, usually on one side of the chest,
sustain multiple fractures, causing instability of the chest wall and paradoxical chest wall
movement. This results in significant limitations in chest wall expansion.
***results from multiple rib fracture***
- Lung caves in on inhalation and balloons out on exhalation
Risk factors
- ***Chest trauma (MVA or CPR)***
Expected Findings
- Unequal chest expansion, paradoxical chest wall movement
- Tachycardia, Chest Pain, Anxiety
- Hypotension, Dyspnea, Cyanosis, Anxiety
Nursing care
- Administer humidified oxygen
- Monitor SaO2 and vital signs
- Review pulmonary function tests
- Assess lung sound, and capillary refill
- Encourage deep breathing
- Positive pressure ventilation
How do you treat Hypovolemic Shock? -correct answers Fluid replacement and reduction of further fluid loss are
the focus of the management of hypovolemic shock.
- 0.9% sodium chloride or lactated ringers
- Whole blood, ***packed RBCs***, plasma, synthetic plasma expanders
- Vasoconstrictors (dopamine, norepinephrine, sodium nitroprusside)
What are the clinical manifestations of Hypovolemic Shock? -correct answers Decreased MAP,
***Tachycardia***, Hypotension, Decreased urinary output, Tachypnea, Narrowing of pulse
pressure, and slow capillary refill
How do you treat Anaphylactic Shock? -correct answers - Allergic transfusion reaction: anxiety,
SOB, hypotension tachycardia, dizzy
Stop the transfusion
- ***Administer epinephrine***, corticosteroids, vasopressors, oxygen, or CPR
- Remove tubing from clients IV access
Initiate an infusion of 0.9% sodium chloride using new tubing
How do you treat Neurogenic Shock and what can nurses do to manage it? (following spinal cord
injury) -correct answers - Ensure proper positioning of the spinal cord
- Monitor for hypotension, bradycardia, dependent edema, and loss of temperature regulation
(abrupt onset of fever), which are common manifestations.
- Monitor for manifestations of VTE (swelling of extremity, absent/decreased pulses, and areas
of warmth and/or tenderness). The client might be on anticoagulants to prevent the development
of lower extremity thrombi.
- Administer norepinephrine and dopamine to treat hypotension
Nursing!
- Treat adverse findings with appropriate medications (vasopressors or atropine) and IV fluids.
- Neurogenic bladder → foley catheter
- ***Cervical collar***
- ***Normal saline***
- ***start norepi MAP >70***
CVP measurement -correct answers Normal CVP is 2-6mmHg
***best indicator ofvolume status***
***Decreased = hypovolemic shock***
***Increased = cardiogenic shock***
, How do you treat and manage Cardiogenic Shock? -correct answers - This is a serious
complication of pump failure that occurs commonly following an MI with injury to greater than
40% of the left ventricle
Manifestations: Tachycardia, hypotension, inadequate urinary output, altered LOC, respiratory
distress (crackles, tachypnea), cool, clammy, skin, decreased peripheral pulses, chest pain
Nursing Care:
- Monitor breath sounds. Assess for crackles or wheezing
Monitor heart sounds
- Administer o2, intubation, & ventilation
- Administer IV morphine, diuretics, and/ or nitroglycerin to decrease preload
- ***Administer IV vasopressors and/or positive inotropes to increase cardiac output and
maintain organ perfusion***
- ***Inotropes → doputamine***
- Continuous hemodynamic monitoring
How do you treat and manage Septic Shock? -correct answers s/s:
- Hypotension, tachycardia, fever
- Administer antibiotic therapy
How do we stabilize a suspected neck injury? -correct answers - Stabilize cervical spine
- C4 injury can cause tetraplegia
What are the clinical manifestations of Flail Chest? (Client involved in a motor vehicle accident)
-correct answers occurs when at least two neighboring ribs, usually on one side of the chest,
sustain multiple fractures, causing instability of the chest wall and paradoxical chest wall
movement. This results in significant limitations in chest wall expansion.
***results from multiple rib fracture***
- Lung caves in on inhalation and balloons out on exhalation
Risk factors
- ***Chest trauma (MVA or CPR)***
Expected Findings
- Unequal chest expansion, paradoxical chest wall movement
- Tachycardia, Chest Pain, Anxiety
- Hypotension, Dyspnea, Cyanosis, Anxiety
Nursing care
- Administer humidified oxygen
- Monitor SaO2 and vital signs
- Review pulmonary function tests
- Assess lung sound, and capillary refill
- Encourage deep breathing
- Positive pressure ventilation
