The cardiac ICU nurse is assessing a patient who is in cardiogenic shock. Which hemodynamic manifestations and/or signs and symptoms do the nurse expect? Select all that apply.
Narrowed pulse pressure.
Tachycardia.
Elevated SBP.
Pulmonary congestion.
Pulmonary artery wedge pressure
Correct Answer : A,B,D,E
A. Narrowed pulse pressure: In cardiogenic shock, the cardiac output is compromised, resulting in reduced stroke volume and subsequent narrowed pulse pressure. The pulse pressure is the difference between systolic and diastolic blood pressure.
B. Tachycardia: Tachycardia is a compensatory response in cardiogenic shock, as the body attempts to increase cardiac output to maintain tissue perfusion despite decreased stroke volume. Increased heart rate is a common finding in this condition.
D. Pulmonary congestion: Cardiogenic shock is often associated with impaired left ventricular function, leading to an inadequate pump mechanism. This can result in fluid accumulation and congestion in the pulmonary circulation, leading to pulmonary edema and congestion. Patients may experience symptoms such as dyspnea, crackles on lung auscultation, and increased work of breathing.
E. Elevated pulmonary artery wedge pressure (PAWP): PAWP is a measurement obtained during invasive hemodynamic monitoring. In cardiogenic shock, the impaired left ventricular function leads to increased left atrial pressure, which is reflected by an elevated PAWP. Elevated PAWP indicates increased fluid volume and congestion in the left side of the heart.
C. Elevated SBP in (option C) is incorrect because Elevated systolic blood pressure (SBP) is not a typical finding in cardiogenic shock. Instead, hypotension or decreased blood pressure is commonly observed due to reduced cardiac output.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Auscultate for the presence of bilateral breath sounds.
It's an important check, but it is not the most reliable initial method because breath sounds can sometimes be misleading (for example, sounds may be heard in the stomach or transmitted incorrectly).
B. Use an end-tidal CO₂ monitor to check for placement in the trachea.
It's the correct answer. Continuous waveform capnography or end-tidal CO₂ detection is the most reliable and immediate method to confirm that the endotracheal tube is in the trachea and not in the esophagus. Presence of CO₂ indicates effective airway placement.
C. Observe the chest for symmetrical movement with ventilation.
Chest rise is helpful, but it is not specificboth esophageal and tracheal intubation may show chest movement.
D. Obtain a portable chest radiograph to check tube placement.
It's the gold standard for final confirmation, but it is not the initial bedside method because it takes time.
Correct Answer is A
Explanation
Disseminated intravascular coagulation (DIC) is a condition characterized by both widespread activation of the coagulation system and excessive clotting, leading to the consumption of clotting factors and platelets. This results in a prothrombotic state, which can lead to organ dysfunction and bleeding manifestations.
Elevated D-dimer levels are a characteristic finding in DIC. D-dimer is a fibrin degradation product that is elevated when there is excessive fibrin formation and breakdown. Elevated D-dimer indicates ongoing fibrinolysis and activation of the clotting system.
B. Decreased prothrombin time in (option B) is incorrect because: DIC is characterized by consumption of clotting factors, which can result in prolongation of the prothrombin time (PT) as well as other coagulation tests.
C. Decreased partial thromboplastin time in (option C) is incorrect because Similar to the prothrombin time, the partial thromboplastin time (PTT) can also be prolonged in DIC due to the consumption of clotting factors.
D. Elevated fibrinogen level in (option D) is incorrect because, In DIC, there is consumption of fibrinogen along with other clotting factors. Therefore, elevated fibrinogen levels are not consistent with the pathophysiology of DIC.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today