NSG 232 Exam #2 Questions with Verified Solutions Graded A+
When caring for a patient in acute septic shock, the nurse would anticipate- - Answers -Infusing
large amounts of intravenous fluids.
Septic shock is characterized by- - Answers -a decreased circulating blood volume.
What is the cornerstone of therapy for septic shock? - Answers -Volume expansion with the
administration of intravenous fluids.
Ventricular assist devices are useful for- - Answers -cardiogenic shock.
What common drug is beneficial for anaphylactic shock? - Answers -Diphenhydramine (Benadryl)
When caring for a critically ill patient who is being mechanically ventilated, the nurse will
astutely monitor for which clinical manifestation of multiple organ dysfunction syndrome
(MODS)? - Answers -Decreased respiratory compliance
Clinical manifestations of MODS include symptoms of- - Answers -respiratory distress, signs
and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin,
decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated
intravascular coagulation (DIC), and changes in glucose metabolism.
The many deleterious effects of shock are all related to- - Answers -inadequate perfusion and
oxygenation of every body system.
What happens to BUN and creatinine in the case of cardiogenic shock? - Answers -They are
increased as a result of renal hypoperfusion.
Patients in septic shock require- - Answers -large amounts of fluid replacement.
Nitrates and β-adrenergic blockers are most often used in the treatment of - - Answers -patients
in cardiogenic shock.
Hyperglycemia in the absence of diabetes can be an indicator of? - Answers -possible onset of
sepsis. People with no prior diabetic history who present with hyperglycemia may be going into
septic shock.
What is the primary precipitating factor in septic shock? - Answers -Infection leading to an
inflammatory response
What is the primary precipitating factor for neurogenic shock? - Answers -trauma to spinal cord.
What happens in neurogenic shock? - Answers -spinal cord injury leads to loss of sympathetic
tone, resulting in massive vasodilation.
What is the precipitating factor for cardiogenic shock? - Answers -loss or inadequate ventricular
,function leading to poor cardiac output.
What is the precipitating factor for hypovolemic shock? - Answers -Loss of blood or flood from
vasculature.
Dobutamine is an inotropic drug given specifically to improve- - Answers -cardiac output (CO).
The key factor in describing any type of shock is_ - Answers _ inadequate tissue perfusion.
What are some precipitating factors of Neurogenic shock? - Answers _Spinal cord injury,
epidural block, severe pain
What are some precipitating factors of Cardiogenic shock? - Answers _Acute MI, Ventricular
dysrhythmias
What are some precipitating factors of Anaphylactic shock? - Answers _Insect bites, vaccines,
allergens
What are some precipitating factors of Septic shock? - Answers _UTI, pneumonia,
immunosuppression
What are some precipitating factors of hypovolemic shock? - Answers _Burns, hemhorrage,
ruptured spleen, severe vomiting and diarrhea, ascites
What are some precipitating factors of obstructive shock? - Answers _Abdominal compartment
syndrome, pulmonary embolism
Which shock is characterized by increased systemic vascular resistance (SVR), decreased CO,
and decreased pulmonary artery wedge pressure (PAWP)? - Answers _Hypovolemic shock
In SEPTIC shock, bacterial endotoxins cause vascular changes that result in_ - Answers
_DECREASED systemic vascular resistance with INCREASED cardiac output.
What are two common characteristics of NEUROGENIC shock? - Answers _Bradycardia and
hypotension
ABSOLUTE hypovolemia results when_ - Answers _fluid is lost through hemorrhage, GI loss
(vomiting/diarrhea), fistula drainage, diabetes insipidus, or diuresis.
RELATIVE hypovolemia results when_ - Answers _fluid volume moves out of the vascular space
into the extravascular space. (Third spacing)
Sinus arrhythmia can be caused by what? When do you treat? How? - Answers - sleep, COPD
respirations
- tx only if symptomatic
- maybe pacemaker
,What can cause a premature atrial complex? (4) - Answers - caffeine, ETOH, anxiety,
hyperthyroid
- if CCD, beta blockers will help slow down conduction
How is atrial flutter classified? - Answers By atrial defibs/QRS complexes.
5 - 1 or 3-1, etc.
What can cause a-flutter? - Answers - CAD, PE, HF
- sometimes COPD
When and how do you treat a-flutter? (2) - Answers - if symptomatic
- CCBs, B-blockers, digoxin
- cardioversion is CCD & hypotensive
A-fib is characterized by an atrial rate of? and a ventricle rate of? - Answers 350-600 bpm
vent - 50-180 (more important figure)
After the onset of a-fib, the passage of how much time is significant? - Answers < 48 h -
cardiovert w/ meds or EdMed
> 48 h - if a-sx, need anticoagulant stat
With a junctional rhythm, something has happened to the SA node, thus what is the rate? Where
does it come from? How does that affect the ECG? - Answers - 40-60
- AV node
- inverted or absent P wave
Junctional rhythms are associated w/ what MI? - Answers Inferior wall MI - blood flow to the SA
is impaired
If the pt is PWD w/ a junctional rhythm, it could be from a medication. Which one? - Answers
Metroprolol - hold drug
What should you do to tx a pt w/ a junctional rhythm? (2) - Answers - nothing if they're a-sx
- atropine or pacemaker
What are ECG characteristics of PSVT? - Answers - HR is 150-200
- rhythm is reg. or slightly irregular
, - P wave is often hidden or abnormal
- shortened PR interval
- normal QRS
What is tx for stable PSVT? - Answers Vagal stimulation
- blow into thumb
- push on RNs hands
- bear down
What drug tx for PSVT would be appropriate? - Answers - CCBs, beta blockers
- Amioderone
- EdMed if unstable
What else could be given w/ a PSVT to "reset" the heart? In what dose? - Answers Adenosin -
6mg, 12mg, 12mg
If PVCs are all the same, they are termed: - Answers Unifocal
- <10/min
- not a big deal
Two consecutive PVCs are: - Answers Couplets
- problem! Could lead to v-tach
It's important to see where the PVC is falling b/c: - Answers If it's on the T-wave, it's v-tach.
How can you determine the HR on an ECG tracing? - Answers - count complete complexes (R to
R) in a 6 second strip and x 10
How is v-tach treated? - Answers If stable: amiodorone or lidocaine IV
If unstable: same, followed by cardioversion
How is v-fib treated? - Answers Defibrilation.
- start CPR while waiting on defib.
What is characteristic of idioventricular rhythm? - Answers - wide, weird
- only ventricles are firing (20-40 bpm)
When caring for a patient in acute septic shock, the nurse would anticipate- - Answers -Infusing
large amounts of intravenous fluids.
Septic shock is characterized by- - Answers -a decreased circulating blood volume.
What is the cornerstone of therapy for septic shock? - Answers -Volume expansion with the
administration of intravenous fluids.
Ventricular assist devices are useful for- - Answers -cardiogenic shock.
What common drug is beneficial for anaphylactic shock? - Answers -Diphenhydramine (Benadryl)
When caring for a critically ill patient who is being mechanically ventilated, the nurse will
astutely monitor for which clinical manifestation of multiple organ dysfunction syndrome
(MODS)? - Answers -Decreased respiratory compliance
Clinical manifestations of MODS include symptoms of- - Answers -respiratory distress, signs
and symptoms of decreased renal perfusion, decreased serum albumin and prealbumin,
decreased GI motility, acute neurologic changes, myocardial dysfunction, disseminated
intravascular coagulation (DIC), and changes in glucose metabolism.
The many deleterious effects of shock are all related to- - Answers -inadequate perfusion and
oxygenation of every body system.
What happens to BUN and creatinine in the case of cardiogenic shock? - Answers -They are
increased as a result of renal hypoperfusion.
Patients in septic shock require- - Answers -large amounts of fluid replacement.
Nitrates and β-adrenergic blockers are most often used in the treatment of - - Answers -patients
in cardiogenic shock.
Hyperglycemia in the absence of diabetes can be an indicator of? - Answers -possible onset of
sepsis. People with no prior diabetic history who present with hyperglycemia may be going into
septic shock.
What is the primary precipitating factor in septic shock? - Answers -Infection leading to an
inflammatory response
What is the primary precipitating factor for neurogenic shock? - Answers -trauma to spinal cord.
What happens in neurogenic shock? - Answers -spinal cord injury leads to loss of sympathetic
tone, resulting in massive vasodilation.
What is the precipitating factor for cardiogenic shock? - Answers -loss or inadequate ventricular
,function leading to poor cardiac output.
What is the precipitating factor for hypovolemic shock? - Answers -Loss of blood or flood from
vasculature.
Dobutamine is an inotropic drug given specifically to improve- - Answers -cardiac output (CO).
The key factor in describing any type of shock is_ - Answers _ inadequate tissue perfusion.
What are some precipitating factors of Neurogenic shock? - Answers _Spinal cord injury,
epidural block, severe pain
What are some precipitating factors of Cardiogenic shock? - Answers _Acute MI, Ventricular
dysrhythmias
What are some precipitating factors of Anaphylactic shock? - Answers _Insect bites, vaccines,
allergens
What are some precipitating factors of Septic shock? - Answers _UTI, pneumonia,
immunosuppression
What are some precipitating factors of hypovolemic shock? - Answers _Burns, hemhorrage,
ruptured spleen, severe vomiting and diarrhea, ascites
What are some precipitating factors of obstructive shock? - Answers _Abdominal compartment
syndrome, pulmonary embolism
Which shock is characterized by increased systemic vascular resistance (SVR), decreased CO,
and decreased pulmonary artery wedge pressure (PAWP)? - Answers _Hypovolemic shock
In SEPTIC shock, bacterial endotoxins cause vascular changes that result in_ - Answers
_DECREASED systemic vascular resistance with INCREASED cardiac output.
What are two common characteristics of NEUROGENIC shock? - Answers _Bradycardia and
hypotension
ABSOLUTE hypovolemia results when_ - Answers _fluid is lost through hemorrhage, GI loss
(vomiting/diarrhea), fistula drainage, diabetes insipidus, or diuresis.
RELATIVE hypovolemia results when_ - Answers _fluid volume moves out of the vascular space
into the extravascular space. (Third spacing)
Sinus arrhythmia can be caused by what? When do you treat? How? - Answers - sleep, COPD
respirations
- tx only if symptomatic
- maybe pacemaker
,What can cause a premature atrial complex? (4) - Answers - caffeine, ETOH, anxiety,
hyperthyroid
- if CCD, beta blockers will help slow down conduction
How is atrial flutter classified? - Answers By atrial defibs/QRS complexes.
5 - 1 or 3-1, etc.
What can cause a-flutter? - Answers - CAD, PE, HF
- sometimes COPD
When and how do you treat a-flutter? (2) - Answers - if symptomatic
- CCBs, B-blockers, digoxin
- cardioversion is CCD & hypotensive
A-fib is characterized by an atrial rate of? and a ventricle rate of? - Answers 350-600 bpm
vent - 50-180 (more important figure)
After the onset of a-fib, the passage of how much time is significant? - Answers < 48 h -
cardiovert w/ meds or EdMed
> 48 h - if a-sx, need anticoagulant stat
With a junctional rhythm, something has happened to the SA node, thus what is the rate? Where
does it come from? How does that affect the ECG? - Answers - 40-60
- AV node
- inverted or absent P wave
Junctional rhythms are associated w/ what MI? - Answers Inferior wall MI - blood flow to the SA
is impaired
If the pt is PWD w/ a junctional rhythm, it could be from a medication. Which one? - Answers
Metroprolol - hold drug
What should you do to tx a pt w/ a junctional rhythm? (2) - Answers - nothing if they're a-sx
- atropine or pacemaker
What are ECG characteristics of PSVT? - Answers - HR is 150-200
- rhythm is reg. or slightly irregular
, - P wave is often hidden or abnormal
- shortened PR interval
- normal QRS
What is tx for stable PSVT? - Answers Vagal stimulation
- blow into thumb
- push on RNs hands
- bear down
What drug tx for PSVT would be appropriate? - Answers - CCBs, beta blockers
- Amioderone
- EdMed if unstable
What else could be given w/ a PSVT to "reset" the heart? In what dose? - Answers Adenosin -
6mg, 12mg, 12mg
If PVCs are all the same, they are termed: - Answers Unifocal
- <10/min
- not a big deal
Two consecutive PVCs are: - Answers Couplets
- problem! Could lead to v-tach
It's important to see where the PVC is falling b/c: - Answers If it's on the T-wave, it's v-tach.
How can you determine the HR on an ECG tracing? - Answers - count complete complexes (R to
R) in a 6 second strip and x 10
How is v-tach treated? - Answers If stable: amiodorone or lidocaine IV
If unstable: same, followed by cardioversion
How is v-fib treated? - Answers Defibrilation.
- start CPR while waiting on defib.
What is characteristic of idioventricular rhythm? - Answers - wide, weird
- only ventricles are firing (20-40 bpm)
