Deck 8: Care of the Patient Experiencing Acute Coronary Syndrome

Question 1

Which solution would be the most appropriate initial volume replacement for a patient with severe GI bleeding?
1) 200 mL of normal saline (NS) per hour for 5 hours
2) A liter of Ringer's lactate (RL) over 15 minutes
3) Two liters of D₅W over half an hour
4) 500 mL of 0.45% normal saline (1/2 NS) over half an hour

Answer 1

2
Explanation: 1. This is not an adequate amount of fluid replacement.
2. The patient requires immediate infusion of an adequate amount of fluid. Fluid resuscitation begins with 500 to 1,000 mL of an isotonic solution.
3. This is a hypotonic solution and would not help with fluid resuscitation.
4. This is a hypotonic solution and would not help with fluid resuscitation.

Question 2

What should the nurse identify as symptoms of hypovolemic shock in a patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Temperature of 97.6°F (36.4°C)
2) Restlessness
3) Decrease in blood pressure of 20 mm Hg when the patient sits up
4) Capillary refill time greater than 3 seconds
5) Sinus bradycardia of 55 beats per minute

Answer 2

2, 3, 4
Explanation: 1. Fever will increase oxygen demands but is unrelated to hypovolemic shock unless prolonged fever has caused severe dehydration, reducing the circulating blood volume. Hypovolemic shock reduces temperatures by peripheral shunting of blood away from the extremities and reducing the core metabolic rate.
2. Due to decreased blood flow to the brain and peripheral areas when blood is shunted to maintain the vital organs, cerebral hypoxia occurs, leading to a change in mental status.
3. Orthostatic hypotension is a manifestation of hypovolemic shock.
4. Due to decreased blood flow to the brain and peripheral areas when blood is shunted to maintain the vital organs, capillary refill time will be reduced.
5. Bradycardia is not present. The compensatory response is to increase the heart rate to circulate the blood faster to make up for the fluids that are not present in hypovolemic shock.

Question 3

Which complication is being avoided when the nurse warms intravenous fluids to be used in a rapid infuser?
1) Hemorrhagic shock
2) Hypothermia
3) Sepsis
4) Cardiogenic shock

Answer 3

2
Explanation: 1. Hemorrhagic shock is caused by a loss of cells or blood volume and is not a result of infusing fluids too quickly.
2. Hypothermia can result when providing room temperature fluids at a faster pace than the body can warm them.
3. Bacterial contamination can be avoided by sterile technique, and sepsis is not caused by the rate or temperature of the fluid being administered.
4. Cardiogenic shock results from poor ventricular functioning, not from the temperature of the intravenous fluids being administered too rapidly.

Question 4

The nurse recognizes that which symptom predisposes a patient to develop hypovolemic shock?
1) Decreased cardiac output
2) Severe constipation, causing watery diarrhea
3) Ascites
4) Syndrome of inappropriate ADH (SIADH)

Question 5

Which life-threatening complication should the nurse anticipate developing in the patient being treated for hypovolemic shock? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Fluid volume overload
2) Renal insufficiency
3) Cerebral ischemia
4) Gastric stress ulcer
5) Pulmonary edema

Question 6

A patient is brought to the emergency department with manifestations of anaphylactic shock. What should the nurse assess as possible causes for this disorder? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Recent bee sting
2) Ingestion of drugs
3) History of latex allergy
4) Recent diagnostic imaging tests
5) Recent myocardial infarction

Question 7

A patient is experiencing an anaphylactic reaction to a medication. Why should the nurse be concerned that the patient is developing distributive shock?
1) The release of histamine causes vasodilation with plasma leakage.
2) Sympathetic innervation is interrupted.
3) Microorganisms overwhelm the vascular system.
4) Parasympathetic innervation functions are unopposed.

Question 8

A patient is demonstrating pulmonary edema, hypotension, and delayed capillary refill. The nurse suspects the patient is experiencing which type of shock?
1) Hypovolemic
2) Cardiogenic
3) Anaphylactic
4) Obstructive

Question 9

The nurse caring for a patient recovering from an acute myocardial infarction plans interventions to reduce the risk of which type of shock?
1) Cardiogenic
2) Hypovolemic
3) Distributive
4) Obstructive

Question 10

A patient experiencing vasodilation is diagnosed with distributive shock. The nurse should assess the patient for which etiologies? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Sepsis
2) Spinal cord injury
3) Anaphylaxis
4) Hemorrhage
5) Pulmonary embolism

Question 11

A patient with cardiomyopathy is demonstrating signs of cardiogenic shock. What should the nurse realize is the cause of this type of shock?
1) Reduced cardiac output
2) Increased stroke volume
3) Reduced blood volume
4) Blood flow blocked in the pulmonary circulation

Question 12

A patient is diagnosed with cardiac tamponade. When planning care, the nurse should include interventions to address which type of shock?
1) Obstructive
2) Hypovolemic
3) Distributive
4) Cardiogenic

Question 13

A patient is being treated for pericarditis. The nurse should plan interventions to prevent the onset of which type of shock?
1) Obstructive
2) Hypovolemic
3) Distributive
4) Cardiogenic

Question 14

Which finding indicates that a patient is experiencing increased peripheral resistance and vasoconstriction?
1) Strong bounding pulse with deep red coloring
2) Pale, cool extremities with decreased pulses
3) Increased venous engorgement with strong pulses
4) Faster than normal capillary refill time

Question 15

The nurse explains the mechanism of a pulmonary embolism to the family of a patient diagnosed with the disorder. Place in order the steps the nurse will use to instruct the family about this disease process.

A) Blood clot causes backup of blood in the right ventricle.
B) Blood clot blocks blood to the left ventricle.
C) Left ventricle does not get enough blood to pump through the body.
D) Amount of blood the heart has to pump to the body drops.
E) Blood pressure drops.
F) Amount of blood going to the body drops.
G) None of the above.

Question 16

The nurse is concerned that a patient is at risk for developing obstructive shock because of which assessment findings? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Age 80
2) History of atrial fibrillation
3) Bacteremia
4) T3 spinal cord injury
5) Latex allergy

Question 17

Why should the nurse caring for a patient in hypovolemic shock avoid a hypotonic solution for fluid resuscitation?
1) Because hypotonic solutions move quickly into the interstitial spaces and can cause third spacing.
2) Because hypotonic solutions stay longer to expand the intravascular space but deplete intracellular fluid levels.
3) Because hypotonic solutions do not stay in the intravascular space long enough to expand the circulating blood volume.
4) Because hypotonic solutions need a smaller bore needle to run at a slower rate to keep the intravascular space low.

Question 18

During an assessment, the nurse is concerned that a patient is developing cardiogenic shock. What did the nurse assess in this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Systolic blood pressure 82 mm Hg
2) Capillary refill 10 seconds
3) Crackles in bilateral lung bases
4) Heart rate 55 and regular
5) Warm, dry skin

Question 19

Which finding indicates that rehydration is complete and hypovolemic shock has been successfully treated in a patient?
1) CVP = 8 mm Hg
2) MAP = 45 mm Hg
3) Urinary output of 0.1 mL/kg/hr
4) Hct = 54%

Question 20

Which laboratory finding should cause the nurse to suspect that a patient is developing hypovolemic shock?
1) Serum sodium of 130 mEq/L (130 mmol/L)
2) Metabolic acidosis validated by arterial blood gases
3) Serum lactate of 3 mmol/L
4) SvO₂ greater than 80%

Question 21

A patient is prescribed vasopressin 0.03 units/minute as treatment for septic shock. What action should the nurse take when providing this medication?
1) Provide the vasopressin infusion in addition to a norepinephrine infusion.
2) Infuse through a peripheral line.
3) Utilize a rapid infuser.
4) Administer with 0.9% normal saline.

Question 22

The nurse assesses muffled heart sounds in a patient recovering from thoracic injuries caused by a motor vehicle crash. What should the nurse anticipate being prescribed for this patient?
1) Pericardiocentesis
2) Chest tube insertion
3) Surgical embolectomy
4) Tissue plasminogen activator

Question 23

A patient is brought to the emergency department with hypotension, tachycardia, reduced capillary refill, and oliguria. During the assessment, the nurse determines the patient is experiencing cardiogenic shock because of which additional finding?
1) Jugular vein distention
2) Dry mucous membranes
3) Poor skin turgor
4) Thirst

Question 24

The nurse reviews medications prescribed for a patient being treated for cardiogenic shock. Which medications will the nurse most likely provide to this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Dopamine
2) Norepinephrine
3) Dobutamine
4) Epinephrine
5) Phenylephrine

Question 25

A patient with neurogenic shock is demonstrating bradycardia. What action should the nurse take at this time?
1) Limit patient movement.
2) Prepare to administer crystalloids.
3) Administer phenylephrine as prescribed.
4) Administer atropine as prescribed.

Question 26

A patient receives norepinephrine 30 mcg/min for treatment of refractory shock. Which assessment finding suggests the patient is experiencing peripheral vasoconstriction from the medication? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Decreased peripheral pulses
2) Drop in body temperature
3) Onset of paresthesias
4) Drop in blood pressure
5) Increased cardiac output

Question 27

A patient is receiving phenylephrine 50 mcg/min as treatment for shock. Which assessment finding indicates this medication is effective?
1) Blood pressure 110/68 mm Hg
2) Heart rate 110
3) Respiratory rate 12 and regular
4) Decreased peripheral pulses

Question 28

A patient received 8 units of packed red blood cells as treatment for hypovolemic shock. Which laboratory value should the nurse monitor for this patient?
1) Sodium
2) Calcium
3) Potassium
4) White blood cells

Question 29

A patient receiving treatment for a spinal cord injury is demonstrating signs of neurogenic shock. What should the nurse expect to assess in this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Low mean arterial pressure (MAP)
2) Elevated right atrial pressure (RAP)
3) Increased jugular vein distention (JVD)
4) Decreased central venous pressure (CVP)
5) Reduced pulmonary artery wedge pressure (PAWP)

Question 30

A patient is demonstrating signs of cardiogenic shock. Why should an intra-aortic balloon pump be considered for this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Controls heart rate
2) Decreases afterload
3) Increases coronary perfusion
4) Improves pulmonary perfusion
5) Facilitates blood out of the left ventricle

Question 31

The nurse assesses a mediastinal shift in a patient being treated for injuries from a motor vehicle crash. For which type of shock should the nurse plan care for this patient?
1) Obstructive
2) Distributive
3) Cardiogenic
4) Hypovolemic

Question 32

The nurse is caring for a patient recovering from a spinal cord injury sustained during a motor vehicle crash. What assessment finding indicates that the patient is developing neurogenic shock? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Hypotension
2) Bradycardia
3) Warm, dry skin
4) Abdominal cramps
5) Palpitations

Question 33

A patient is experiencing acute respiratory distress after eating an item of a known food allergy. Which intervention should the nurse implement when providing emergency care to this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Administer epinephrine 1:1000 intramuscularly.
2) Apply oxygen via face mask as prescribed.
3) Provide diphenhydramine 25 mg intravenous.
4) Administer vasopressin.
5) Prepare to administer antithrombolytic agents as prescribed.

Question 34

A patient weighing 220 lbs is prescribed 10 mcg/kg/min of dopamine to improve cardiac output from cardiogenic shock. How many milligrams of dopamine should the patient receive in an hour? Record your answer rounding to the nearest whole number.

Question 35

A patient demonstrates signs of obstructive shock, but the cause has yet to be determined. Which finding indicates the patient is experiencing a pulmonary embolism as the cause for obstructive shock?
1) Chest pain
2) Hypotension
3) Tachycardia
4) Oliguria

Question 36

A patient being treated for cardiogenic shock is being hemodynamically monitored. Which finding is consistent with the patient's diagnosis? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Elevated pulmonary arterial wedge pressure
2) Elevated central venous pressure
3) Elevated systemic vascular resistance index
4) Elevated mean arterial pressure
5) Elevated stroke volume

Question 37

Which assessment finding indicates that an infusion of intravenous epinephrine 4 mcg/min is effective in the treatment of a patient with anaphylactic shock?
1) Reduced wheezing
2) Heart rate 55 and regular
3) Blood pressure 98/50 mm Hg
4) Respiratory rate 28