Chapter 66: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A 78-kg patient with septic shock has a pulse rate of 120 beats/min with low central venous
pressure and pulmonary artery wedge pressure. Urine output has been 30 mL/hr for the past 3
hours. Which order by the health care provider should the nurse question?
a. Administer furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Give hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine to keep systolic blood pressure (BP) above 90 mm Hg.
ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient with
septic shock. Patients in septic shock require large amounts of fluid replacement. If the patient
remains hypotensive after initial volume resuscitation with minimally 30 mL/kg, vasopressors
such as norepinephrine may be added. IV corticosteroids may be considered for patients in
septic shock who cannot maintain an adequate BP with vasopressor therapy despite fluid
resuscitation.
DIF: Cognitive Level: Apply (application) REF: 1600
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. A nurse is caring for a patient whose hemodynamic monitoring indicates a blood pressure of
92/54 mm Hg, a pulse of 64 beats/min, and an elevated pulmonary artery wedge pressure
(PAWP). Which intervention ordered by the health care provider should the nurse question?
a. Elevate head of bed to 30 degrees.
b. Infuse normal saline at 250 mL/hr.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
, d. Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.
ANS: B
The patient’s elevated PAWP indicates volume excess in relation to cardiac pumping ability,
consistent with cardiogenic shock. A saline infusion at 250 mL/hr will exacerbate the volume
excess. The other actions will help to improve cardiac output, which should lower the PAWP
and may raise the BP.
DIF: Cognitive Level: Apply (application) REF: 1600
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
3. A patient with massive trauma and possible spinal cord injury is admitted to the emergency
department (ED). Which assessment finding by the nurse will help confirm a diagnosis of
neurogenic shock?
a. Inspiratory crackles c. Cool, clammy extremities
b. Heart rate 45 beats/min d. Temperature 101.2°F (38.4°C)
ANS: B
Neurogenic shock is characterized by hypotension and bradycardia. The other findings would
be more consistent with other types of shock.
, DIF: Cognitive bLevel: bUnderstand b(comprehension) REF: b 1590
bTOP: b Nursing bProcess: bAssessment MSC: b NCLEX: bPhysiological
bIntegrity
4. An bolder bpatient bwith bcardiogenic bshock bis bcool band bclammy. bHemodynamic
bmonitoring bindicates ba bhigh bsystemic bvascular bresistance b(SVR). bWhich bintervention
bshould bthe bnurse banticipate?
a. Increase bthe brate bfor bthe bdopamine binfusion.
b. Decrease bthe brate bfor bthe bnitroglycerin binfusion.
c. Increase bthe brate bfor bthe bsodium bnitroprusside binfusion.
d. Decrease bthe brate bfor bthe b5% bdextrose bin bnormal bsaline b(D5/.9 bNS) binfusion.
ANS: b C
Nitroprusside bis ban barterial bvasodilator band bwill bdecrease bthe bSVR band bafterload, bwhich bwill
bimprove bcardiac boutput. bChanges bin bthe bD5/.9 bNS band bnitroglycerin binfusions bwill bnot
bdirectly bdecrease bSVR. bIncreasing bthe bdopamine bwill btend bto bincrease bSVR.
DIF: Cognitive bLevel: bApply b(application) REF: 1599
TOP: b Nursing bProcess: bPlanning MSC: b NCLEX: bPhysiological bIntegrity
5. After breceiving b2 bL bof bnormal bsaline, bthe bcentral bvenous bpressure bfor ba bpatient bwho bhas
bseptic bshock bis b10 bmm bHg, bbut bthe bblood bpressure bis bstill b82/40 bmm bHg. bThe bnurse bwill
banticipate ban border bfor
a. furosemide b. c. b norepinephrine b.
b. nitroglycerin b. d. b sodium bnitroprusside b.
ANS: b C
When bfluid bresuscitation bis bunsuccessful, bvasopressor bdrugs bare bgiven bto bincrease bthe
bsystemic bvascular bresistance b(SVR) band bblood bpressure band bimprove btissue bperfusion.
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A 78-kg patient with septic shock has a pulse rate of 120 beats/min with low central venous
pressure and pulmonary artery wedge pressure. Urine output has been 30 mL/hr for the past 3
hours. Which order by the health care provider should the nurse question?
a. Administer furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Give hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine to keep systolic blood pressure (BP) above 90 mm Hg.
ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient with
septic shock. Patients in septic shock require large amounts of fluid replacement. If the patient
remains hypotensive after initial volume resuscitation with minimally 30 mL/kg, vasopressors
such as norepinephrine may be added. IV corticosteroids may be considered for patients in
septic shock who cannot maintain an adequate BP with vasopressor therapy despite fluid
resuscitation.
DIF: Cognitive Level: Apply (application) REF: 1600
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
2. A nurse is caring for a patient whose hemodynamic monitoring indicates a blood pressure of
92/54 mm Hg, a pulse of 64 beats/min, and an elevated pulmonary artery wedge pressure
(PAWP). Which intervention ordered by the health care provider should the nurse question?
a. Elevate head of bed to 30 degrees.
b. Infuse normal saline at 250 mL/hr.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
, d. Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.
ANS: B
The patient’s elevated PAWP indicates volume excess in relation to cardiac pumping ability,
consistent with cardiogenic shock. A saline infusion at 250 mL/hr will exacerbate the volume
excess. The other actions will help to improve cardiac output, which should lower the PAWP
and may raise the BP.
DIF: Cognitive Level: Apply (application) REF: 1600
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
3. A patient with massive trauma and possible spinal cord injury is admitted to the emergency
department (ED). Which assessment finding by the nurse will help confirm a diagnosis of
neurogenic shock?
a. Inspiratory crackles c. Cool, clammy extremities
b. Heart rate 45 beats/min d. Temperature 101.2°F (38.4°C)
ANS: B
Neurogenic shock is characterized by hypotension and bradycardia. The other findings would
be more consistent with other types of shock.
, DIF: Cognitive bLevel: bUnderstand b(comprehension) REF: b 1590
bTOP: b Nursing bProcess: bAssessment MSC: b NCLEX: bPhysiological
bIntegrity
4. An bolder bpatient bwith bcardiogenic bshock bis bcool band bclammy. bHemodynamic
bmonitoring bindicates ba bhigh bsystemic bvascular bresistance b(SVR). bWhich bintervention
bshould bthe bnurse banticipate?
a. Increase bthe brate bfor bthe bdopamine binfusion.
b. Decrease bthe brate bfor bthe bnitroglycerin binfusion.
c. Increase bthe brate bfor bthe bsodium bnitroprusside binfusion.
d. Decrease bthe brate bfor bthe b5% bdextrose bin bnormal bsaline b(D5/.9 bNS) binfusion.
ANS: b C
Nitroprusside bis ban barterial bvasodilator band bwill bdecrease bthe bSVR band bafterload, bwhich bwill
bimprove bcardiac boutput. bChanges bin bthe bD5/.9 bNS band bnitroglycerin binfusions bwill bnot
bdirectly bdecrease bSVR. bIncreasing bthe bdopamine bwill btend bto bincrease bSVR.
DIF: Cognitive bLevel: bApply b(application) REF: 1599
TOP: b Nursing bProcess: bPlanning MSC: b NCLEX: bPhysiological bIntegrity
5. After breceiving b2 bL bof bnormal bsaline, bthe bcentral bvenous bpressure bfor ba bpatient bwho bhas
bseptic bshock bis b10 bmm bHg, bbut bthe bblood bpressure bis bstill b82/40 bmm bHg. bThe bnurse bwill
banticipate ban border bfor
a. furosemide b. c. b norepinephrine b.
b. nitroglycerin b. d. b sodium bnitroprusside b.
ANS: b C
When bfluid bresuscitation bis bunsuccessful, bvasopressor bdrugs bare bgiven bto bincrease bthe
bsystemic bvascular bresistance b(SVR) band bblood bpressure band bimprove btissue bperfusion.
