Chapter 14 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 14  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

1. A nurse in the ICU is planning the care of a patient who is being treated for shock. Which of the following statements best describes the pathophysiology of this patient’s health problem?

  1. A)  Blood is shunted from vital organs to peripheral areas of the body.
  2. B)  Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
  3. C)  Circulating blood volume is decreased with a resulting change in the osmotic pressure

    gradient.

  4. D)  Hemorrhage occurs as a result of trauma, depriving vital organs of adequate perfusion.

Ans: B

Feedback:

Shock is a life-threatening condition with a variety of underlying causes. Shock is caused when the cells have a lack of adequate blood supply and are deprived of oxygen and nutrients. In cases of shock, blood is shunted from peripheral areas of the body to the vital organs. Hemorrhage and decreased blood volume are associated with some, but not all, types of shock.

2. In an acute care setting, the nurse is assessing an unstable patient. When prioritizing the patient’s care, the nurse should recognize that the patient is at risk for hypovolemic shock in which of the following circumstances?

  1. A)  Fluid volume circulating in the blood vessels decreases.
  2. B)  There is an uncontrolled increase in cardiac output.
  3. C)  Blood pressure regulation becomes irregular.
  4. D)  The patient experiences tachycardia and a bounding pulse.

Ans: A

Feedback:

Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac output is decreased, blood pressure decreases, and pulse is fast, but weak.

3. The emergency nurse is admitting a patient experiencing a GI bleed who is believed to be in the compensatory stage of shock. What assessment finding would be most consistent with the early stage of compensation?

  1. A)  Increased urine output
  2. B)  Decreased heart rate
  3. C)  Hyperactive bowel sounds
  4. D)  Cool, clammy skin

Ans: D

Feedback:

In the compensatory stage of shock, the body shunts blood from the organs, such as the skin and kidneys, to the brain and heart to ensure adequate blood supply. As a result, the patient’s skin is cool and clammy. Also in this compensatory stage, blood vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the urine output decreases.

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4. The nurse is caring for a patient who is exhibiting signs and symptoms of hypovolemic shock following injuries suffered in a motor vehicle accident. The nurse anticipates that the physician will promptly order the administration of a crystalloid IV solution to restore intravascular volume. In addition to normal saline, which crystalloid fluid is commonly used to treat hypovolemic shock?

  1. A)  Lactated Ringer’s
  2. B)  Albumin
  3. C)  Dextran
  4. D)  3% NaCl

Ans: A

Feedback:

Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock. Lactated Ringer’s and 0.9% sodium chloride are isotonic crystalloid fluids commonly used to manage hypovolemic shock. Dextran and albumin are colloids, but Dextran, even as a colloid, is not indicated for the treatment of hypovolemic shock. 3% NaCl is a hypertonic solution and is not isotonic.

5. A patient who is in shock is receiving dopamine in addition to IV fluids. What principle should inform the nurse’s care planning during the administration of a vasoactive drug?

  1. A)  The drug should be discontinued immediately after blood pressure increases.
  2. B)  The drug dose should be tapered down once vital signs improve.
  3. C)  The patient should have arterial blood gases drawn every 10 minutes during treatment.
  4. D)  The infusion rate should be titrated according the patient’s subjective sensation of

    adequate perfusion.

Ans: B

Feedback:

When vasoactive medications are discontinued, they should never be stopped abruptly because this could cause severe hemodynamic instability, perpetuating the shock state. Subjective assessment data are secondary to objective data. Arterial blood gases should be carefully monitored, but every10-minute draws are not the norm.

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6. A nurse in the ICU receives report from the nurse in the ED about a new patient being admitted with a neck injury he received while diving into a lake. The ED nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that that patient is probably experiencing?

  1. A)  Anaphylactic shock
  2. B)  Neurogenic shock
  3. C)  Septic shock
  4. D)  Hypovolemic shock

Ans: B

Feedback:

Neurogenic shock can be caused by spinal cord injury. The patient will present with a low blood pressure; bradycardia; and warm, dry skin due to the loss of sympathetic muscle tone and increased parasympathetic stimulation. Anaphylactic shock is caused by an identifiable offending agent, such as a bee sting. Septic shock is caused by bacteremia in the blood and presents with a tachycardia. Hypovolemic shock presents with tachycardia and a probable source of blood loss.

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