NUR 445: EXAM 4 (#4 TESTBANK)
EXAM QUESTIONS AND ANSWERS
(2) The nurse provides care to a patient who is admitted for a myocardial infarction (MI).
When planning care for this patient, the nurse includes interventions that address which
type of shock?
1. Obstructive
2. Distributive
3. Cardiogenic
4. Hypovolemic - ANSWERS3. Cardiogenic
Rationale: Cardiogenic shock may develop in patients who experiences a myocardial
infarction (MI), as well as in patients with severe valvular dysfunction and severe heart
failure.
The nurse recognizes that which disorder increases the patient's risk for obstructive
shock?
1. Dissecting aneurysm
2. Cardiac tamponade
3. Gastrointestinal bleeding
4. Severe heart failure - ANSWERS2. Cardiac tamponade
Rationale: Obstructive shock is caused by a mechanical barrier to ventricular filling or
ventricular emptying (increased afterload), causing decreased cardiac output. Examples
of disorders resulting in impaired filling include cardiac tamponade and tension
pneumothorax. An example of a disorder resulting in increased afterload is severe
valvular disease.
A nurse working in the intensive care unit (ICU) is caring for a patient in the refractory
stage of shock. The nurse correlates which clinical manifestations to this stage of
shock?
1. A subtle change in heart rate
2. A change from aerobic to anaerobic metabolism
3. The development of hyperglycemia
4. The development of cardiac dysrhythmias - ANSWERS2. A change from aerobic to
anaerobic metabolism
Rationale: In the refractory stage of shock, there is a change from aerobic to anaerobic
metabolism as a result of cellular hypoxia from decreased perfusion
, During the initial stage of shock, which clinical manifestation should the nurse monitor
for when assessing the patient?
1. Lethargy
2. Hypotension
3. Respiratory alkalosis
4. Hypoxia - ANSWERS4. Hypoxia
Rationale: The initial stage of shock is marked by hypoxia caused by decreased DO2 to
the cells. Clinical manifestations are subtle or subclinical, but cellular damage maybe
occurring. Invasive hemodynamic monitoring would note decreased cardiac output.
Without identification and treatment at this stage, shock will progress to the next level.
The nurse correlates which arterial blood gas values to the patient in refractory shock?
1. pH 7.55
2. pH 7.48
3. pH 7.35
4. pH 7.30 - ANSWERS4. pH 7.30
Rationale: This pH indicates an acidotic state. The refractory stage is marked by
prolonged inadequate blood supply to the cells, resulting in cell death and multi system
organ failure. There is a loss of aerobic metabolism, and only extremely inefficient
anaerobic metabolism is available, leading to metabolic and respiratory acidosis
The nurse monitors for which clinical manifestations in a patient in the progressive stage
of shock?
1. Polyuria
2. Absent bowel sounds
3. Severe metabolic alkalosis
4. Full, bounding pulses. - ANSWERS2. Absent bowel sounds
Rationale: The progressive stage of shock is manifested by lethargy/coma, hypotension,
dysrhythmias, anuria, absent bowel sounds, severe metabolic acidosis, respiratory
acidosis, cold extremities, and weak or absent pulses
(11) In monitoring a trauma patient for shock, the nurse differentiates neurogenic shock
fromhypovolemia shock by correlating which of the following data to spinal shock?
1. Tachycardia with increased systemic vascular resistance
2. Tachycardia with decreased systemic vascular resistance
3. Bradycardia with decreased systemic vascular resistance
4. Bradycardia with increased systemic vascular resistance - ANSWERS3. Bradycardia
with decreased systemic vascular resistance
EXAM QUESTIONS AND ANSWERS
(2) The nurse provides care to a patient who is admitted for a myocardial infarction (MI).
When planning care for this patient, the nurse includes interventions that address which
type of shock?
1. Obstructive
2. Distributive
3. Cardiogenic
4. Hypovolemic - ANSWERS3. Cardiogenic
Rationale: Cardiogenic shock may develop in patients who experiences a myocardial
infarction (MI), as well as in patients with severe valvular dysfunction and severe heart
failure.
The nurse recognizes that which disorder increases the patient's risk for obstructive
shock?
1. Dissecting aneurysm
2. Cardiac tamponade
3. Gastrointestinal bleeding
4. Severe heart failure - ANSWERS2. Cardiac tamponade
Rationale: Obstructive shock is caused by a mechanical barrier to ventricular filling or
ventricular emptying (increased afterload), causing decreased cardiac output. Examples
of disorders resulting in impaired filling include cardiac tamponade and tension
pneumothorax. An example of a disorder resulting in increased afterload is severe
valvular disease.
A nurse working in the intensive care unit (ICU) is caring for a patient in the refractory
stage of shock. The nurse correlates which clinical manifestations to this stage of
shock?
1. A subtle change in heart rate
2. A change from aerobic to anaerobic metabolism
3. The development of hyperglycemia
4. The development of cardiac dysrhythmias - ANSWERS2. A change from aerobic to
anaerobic metabolism
Rationale: In the refractory stage of shock, there is a change from aerobic to anaerobic
metabolism as a result of cellular hypoxia from decreased perfusion
, During the initial stage of shock, which clinical manifestation should the nurse monitor
for when assessing the patient?
1. Lethargy
2. Hypotension
3. Respiratory alkalosis
4. Hypoxia - ANSWERS4. Hypoxia
Rationale: The initial stage of shock is marked by hypoxia caused by decreased DO2 to
the cells. Clinical manifestations are subtle or subclinical, but cellular damage maybe
occurring. Invasive hemodynamic monitoring would note decreased cardiac output.
Without identification and treatment at this stage, shock will progress to the next level.
The nurse correlates which arterial blood gas values to the patient in refractory shock?
1. pH 7.55
2. pH 7.48
3. pH 7.35
4. pH 7.30 - ANSWERS4. pH 7.30
Rationale: This pH indicates an acidotic state. The refractory stage is marked by
prolonged inadequate blood supply to the cells, resulting in cell death and multi system
organ failure. There is a loss of aerobic metabolism, and only extremely inefficient
anaerobic metabolism is available, leading to metabolic and respiratory acidosis
The nurse monitors for which clinical manifestations in a patient in the progressive stage
of shock?
1. Polyuria
2. Absent bowel sounds
3. Severe metabolic alkalosis
4. Full, bounding pulses. - ANSWERS2. Absent bowel sounds
Rationale: The progressive stage of shock is manifested by lethargy/coma, hypotension,
dysrhythmias, anuria, absent bowel sounds, severe metabolic acidosis, respiratory
acidosis, cold extremities, and weak or absent pulses
(11) In monitoring a trauma patient for shock, the nurse differentiates neurogenic shock
fromhypovolemia shock by correlating which of the following data to spinal shock?
1. Tachycardia with increased systemic vascular resistance
2. Tachycardia with decreased systemic vascular resistance
3. Bradycardia with decreased systemic vascular resistance
4. Bradycardia with increased systemic vascular resistance - ANSWERS3. Bradycardia
with decreased systemic vascular resistance
