A 40-year-old female patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). The nurse suspects that the patient may be experiencing neurogenic shock in addition to hypovolemic shock, based on which one of the following?
Cool, clammy skin.
BP of 82/40 mm Hg.
Heart rate of 48 beats/min.
Shortness of breath.
The Correct Answer is C
Neurogenic shock is a type of distributive shock that occurs due to the loss of sympathetic nervous system tone after a spinal cord injury or other traumatic brain injuries. This loss of sympathetic tone leads to vasodilation and decreased systemic vascular resistance, resulting in inadequate perfusion to vital organs.
One of the hallmark signs of neurogenic shock is bradycardia (a heart rate less than 60 beats/min) due to the unopposed parasympathetic activity. The parasympathetic system becomes dominant when sympathetic activity is impaired. Therefore, a heart rate of 48 beats/min in this patient suggests the possibility of neurogenic shock.
A. Cool, clammy skin in (option A) is incorrect because Cool, clammy skin is a characteristic of hypovolemic shock, where reduced blood volume leads to vasoconstriction to redirect blood flow to vital organs.
B. BP of 82/40 mm Hg in (option B) is incorrect because: Hypotension is a common finding in both neurogenic shock and hypovolemic shock. A low blood pressure reading alone does not specifically indicate neurogenic shock.
D. Shortness of breath in (option D) is incorrect because Shortness of breath is not specific to neurogenic shock but can occur in various types of shock, including hypovolemic shock. It may result from inadequate oxygenation or impaired respiratory function due to the underlying condition or associated injuries.
Therefore, the heart rate of 48 beats/min suggests the possibility of neurogenic shock in addition to hypovolemic shock in this patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
This pathway represents the normal sequence of electrical impulses that coordinate the contraction and relaxation of the heart chambers.
The electrical signal originates from the sinoatrial (SA) node, which is often referred to as the natural pacemaker of the heart. It is located in the right atrium and generates the electrical impulses that initiate each heartbeat. From the SA node, the electrical signal travels to the atrioventricular (AV) node, which is located at the junction between the atria and ventricles.
After passing through the AV node, the electrical impulse travels through the bundle of His (also known as the atrioventricular bundle) and divides into the right and left bundle branches. These branches continue the conduction pathway and deliver the electrical signal to the Purkinje fibers.
The Purkinje fibers spread the electrical impulse rapidly throughout the ventricles, stimulating the contraction of the ventricular muscle and allowing for efficient pumping of blood out of the heart.
Therefore, the correct sequence of the normal conduction pathway in the heart is:
A. SA node - AV node - bundle of His - bundle branches - Purkinje fibers.
Correct Answer is A
Explanation
The ABG results show a pH of 7.50, PaCO2 of 29 mmHg, and HCO3 of 23 mEq/L, indicating respiratory alkalosis. In respiratory alkalosis, there is a decrease in PaCO2 (hypocapnia), which can be caused by excessive ventilation.
To address the respiratory alkalosis, the nurse should decrease the respiratory rate. This would help reduce the amount of ventilation provided and allow the patient to retain more carbon dioxide (CO2), thereby increasing the PaCO2 levels and restoring acid-base balance.
B. Leaving the ventilator at the current settings in (option B) is incorrect because it may exacerbate respiratory alkalosis as it would maintain the same level of ventilation.
C. Increasing the tidal volume (VT) in (option C) is incorrect because it would not address the respiratory alkalosis. Tidal volume refers to the volume of air delivered with each breath, while the issue in this case is excessive ventilation leading to hypocapnia.
D. Increasing the FiO2 (fraction of inspired oxygen) in (option D) is incorrect because it is not indicated based on the given ABG results. The oxygenation (PaO2) level is within normal limits (80 mmHg), suggesting adequate oxygenation.
It is important to consult with the healthcare provider or respiratory therapist for further guidance on adjusting the ventilator settings based on the patient's condition and response to therapy.
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