SHOCK And MODS

1. The nursing student ask her preceptor to explain the term MAP. The preceptor is correct in responding that MAP is

This shows if the heart is pumping good enough to get oxygen to the brain

Don't worry about this. As long as the systolic BP is above 90 they are being well profused

The difference between the systolic and diastolic blood pressure

Mean Arterial Pressure. We want this to be 65 or above for adequate perfusion of organs and tissues

2. Recent test show a patient in the progressive stage (MAP of 58) of shock has a GFR of 50 which is a decrease in baseline from 100. What does the nurse assume is happening to the patient?

Glomerularnephritis

Pyelonephritis

Acute Renal Failure

Chronic Renal Failure

3. An 80 year old man with a history of diabetes presents to the ED with a necrotic left leg that is oozing. T 103, BP 80/40, HR 115, RR 36. What does his presentation indicated

Cardiogenic Shock

Septic Shock

Hypovolemic Shock

MODS

4. A patient with shock has a BP of 110/70. What is the pulse pressure and is this sufficient?

40. yes

180 yes

83 yes

30 no

5. A young boy starts to have swelling of the throat and difficulty after eating shrimp in the cafeteria. As the school nurse, what is your first action?

Apply oxygen

Inject epinephrine into the thigh

Administer Levophed STAT

Assess the airway using a tongue blade and penlight

6. Which stage of shock would a patient likely be in if the BP is 122/82, HR 102, RR 24, skin cool and clammy and slightly confused LOC?

Progressive

Compensatory

Initial

Irreversible

7. A patient with Hepatitis C and hepatic encephalopathy has been admitted to the unit where you work. The patient has evidence of asterixis, elevated AST, ALT, and bilirubin, massive ascites, dependent edema, and yellowing of the sclera. The patient is a poor historian, but the wife noted the physician recently increased his lactulose dose. Recent assessments point towards shock. The nurse is correct in assuming the patient has what type of shock?

Neurological

Hypovolemic

Neurogenic

Cardiogenic

Ascites= fluid in the wrong space. The increase in lactulose can also cause diarrhea

Explanation

Ascites= fluid in the wrong space. The increase in lactulose can also cause diarrhea

8. Assessments of your patient reveals BP 85/70, HR 155, T 101.4, rr shallow and audible crackles in the lower lobes bilaterally. What stage of shock is the patient likely experiencing?

Progressive

Compensation

Initial

Irreversible

9. A patient with shock has been ordered colloid fluid replacement (LR) and 250 ml/hr. What assessments regarding fluid replacement is it crucial the nurse make?

Skin Turgor

Capillary refill time bilaterally

Lung auscultation

Inspection of the IV site

10. Recent ABG analysis shows a pH of 7.40, PaCO2 of 38, and HCO3 of 24. What is the correct analysis?

Fully Compensated Metabolic Alkalosis

Partially Compensated metabolic alkalosis

Normal

Respiratory Acidosis

11. Which assessments must be made to determine adequate tissue perfusion for a patient with MODS?

MAP, LOC, PERRLA

LOC, Skin color, temperature, and urine output

BP, Pulse, skin turgor

Mucous membrane assessment, capillary refill, bowel movements

12. Which of the following orders does the nurse know will prevent stress ulcers for a patient with shock receiving parenteral nutrition?

Lasix 20mg IV push

Protonix

Zofran

Turning q 2 hours

13. Which heart rate would the nurse expect to see in a patient after a skiing injury that resulted in injury to the head and spinal cord who has developed shock?

110

150

90

50

14. A patient with shock has a MAP of 50 that is not responding to fluid administration. The patient has an arterial line, a peripheral IV to the R AC, an NG tube, and a femoral central line. Where should the nurse administer the ordered vasoactive medications

Arterial line

Peripheral line

NG tube

Central line

15. Which stage of shock is characterized my normal BP?

Progessive

Initial

Compensatory

Neurogenic

16. Which patient is at greatest risk for shock due to blood loss

A 20 year old male with 1st degree burns to the palms

A 60 year old female with a pelvic fracture

A 16 year old girl with a 3 day history of vomiting and diarrhea

A 25 year old male with epistaxis following a bar fight

17. Which of the following patients have the greatest risk for sepsis?

A 55 year old male admitted to the ICU after a seizure with possible aspiration pneumonia

A 50 year old female undergoing a prophylactic bilateral mastectomy

A 1 year old female child with acute otitis media

18. A patient with hypovolemic shock has been admitted to the unit. What position should the nurse place the patient in to increase perfusions

Trendelenburg

Reverse trendelenburg

Modified trendelenburg

Semi-fowlers

19. Following a MI the patient develops cardiogenic shock. What medications would the nurse expect to be ordered? SATA

Dobutamine

Lasix

Dopamine

Nitroglycerin

Submit

20. SELECT ALL the signs/symptoms of the compensatory stage of shock that apply

Cool and clammy skin

HR 58

BP 122/80

Mild confusion

Decreased urinary output

Submit

Shock and Mods

1. The nursing student ask her preceptor to explain the term MAP. The preceptor is correct in responding that MAP is

2.

What first name or nickname would you like us to use?

2. Recent test show a patient in the progressive stage (MAP of 58) of shock has a GFR of 50 which is a decrease in baseline from 100. What does the nurse assume is happening to the patient?

3. An 80 year old man with a history of diabetes presents to the ED with a necrotic left leg that is oozing. T 103, BP 80/40, HR 115, RR 36. What does his presentation indicated

4. A patient with shock has a BP of 110/70. What is the pulse pressure and is this sufficient?

5. A young boy starts to have swelling of the throat and difficulty after eating shrimp in the cafeteria. As the school nurse, what is your first action?

6. Which stage of shock would a patient likely be in if the BP is 122/82, HR 102, RR 24, skin cool and clammy and slightly confused LOC?

8. Assessments of your patient reveals BP 85/70, HR 155, T 101.4, rr shallow and audible crackles in the lower lobes bilaterally. What stage of shock is the patient likely experiencing?

9. A patient with shock has been ordered colloid fluid replacement (LR) and 250 ml/hr. What assessments regarding fluid replacement is it crucial the nurse make?

10. Recent ABG analysis shows a pH of 7.40, PaCO2 of 38, and HCO3 of 24. What is the correct analysis?

11. Which assessments must be made to determine adequate tissue perfusion for a patient with MODS?

12. Which of the following orders does the nurse know will prevent stress ulcers for a patient with shock receiving parenteral nutrition?

13. Which heart rate would the nurse expect to see in a patient after a skiing injury that resulted in injury to the head and spinal cord who has developed shock?

14. A patient with shock has a MAP of 50 that is not responding to fluid administration. The patient has an arterial line, a peripheral IV to the R AC, an NG tube, and a femoral central line. Where should the nurse administer the ordered vasoactive medications

15. Which stage of shock is characterized my normal BP?

16. Which patient is at greatest risk for shock due to blood loss

17. Which of the following patients have the greatest risk for sepsis?

18. A patient with hypovolemic shock has been admitted to the unit. What position should the nurse place the patient in to increase perfusions

19. Following a MI the patient develops cardiogenic shock. What medications would the nurse expect to be ordered? SATA

20. SELECT ALL the signs/symptoms of the compensatory stage of shock that apply