A nurse is assessing a client who has a spinal cord injury. Which of the following assessment findings should the nurse expect with neurogenic shock? (Select all that apply.)
(Select All that Apply.)

Choice A Reason:

Air cannot pass freely into the thoracic cavity through a chest wound is incorrect because air can indeed pass freely into the thoracic cavity through the chest wound in an open pneumothorax.

Choice B Reason:

The air is trapped when it enters the cavity is incorrect because the characteristic feature of an open pneumothorax is that air is not trapped; rather, it enters the thoracic cavity with each inhalation and exits with each exhalation through the chest wound.

Choice C Reason:

Air moves in and out of a wound in the chest wall is correct. In an open pneumothorax, also known as a "sucking chest wound," air can freely move in and out of the thoracic cavity through a wound in the chest wall. This occurs due to the creation of a communication pathway between the external environment and the pleural space, typically caused by a penetrating injury to the chest.

Choice D Reason:

There are no audible sounds in an open pneumothorax is incorrect because in an open pneumothorax, there may be audible sounds associated with the movement of air in and out of the wound, such as a sucking or bubbling sound, depending on the size and location of the wound. These sounds can be clinically significant and aid in the diagnosis of an open pneumothorax.

Choice A Reason:

Metoprolol is incorrect. Metoprolol is a beta-blocker medication commonly used to treat conditions such as hypertension, angina, and heart failure. However, in the context of neurogenic shock following a spinal cord injury, the use of beta-blockers such as metoprolol is generally contraindicated. Beta-blockers antagonize the effects of sympathetic activation, leading to a reduction in heart rate and myocardial contractility, which can exacerbate hypotension and bradycardia, the hallmarks of neurogenic shock. Therefore, the nurse would not anticipate a prescription for metoprolol in the management of neurogenic shock.

Choice B Reason:

Lactated Ringers intravenous fluid is correct. Fluid resuscitation with isotonic crystalloid solutions such as lactated Ringers is essential to restore intravascular volume and improve perfusion.

Choice C Reason:

Furosemide is incorrect. Furosemide is a loop diuretic medication commonly used to treat conditions such as heart failure, edema, and hypertension by promoting diuresis and reducing fluid volume. However, in the context of neurogenic shock, the use of diuretics such as furosemide is generally not indicated unless there is concurrent volume overload. Neurogenic shock is characterized by hypotension due to vasodilation and decreased systemic vascular resistance, often leading to relative hypovolemia rather than volume overload. Therefore, administering furosemide could further decrease intravascular volume, exacerbating hypotension and compromising perfusion. As a result, the nurse would not anticipate a prescription for furosemide in the management of neurogenic shock.:

Choice D Reason:

Dopamine is correct. Dopamine is a vasopressor medication that acts to increase vascular tone and blood pressure by stimulating alpha-adrenergic receptors. It is commonly used in the management of neurogenic shock to augment blood pressure.

Choice E Reason:

Epinephrine is correct. Epinephrine is a potent vasopressor that acts on both alpha and beta-adrenergic receptors, leading to vasoconstriction and increased cardiac output. It is used in the treatment of refractory hypotension in neurogenic shock.