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

Answer and Explanation

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.

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Correct Answer is C

Explanation

Heart rate: 72 beats per minute Stroke volume: 90 mL/contraction

Cardiac output = Heart rate × Stroke volume

Cardiac output = 72 beats/minute × 90 mL/contraction

To simplify the calculation, you can convert the units:

72 beats/minute × 90 mL/contraction = (72 × 90) beats/minute × mL/contraction

Now, perform the multiplication:

72 × 90 = 6,480

Therefore, the cardiac output is 6,480 mL per minute.

The correct answer is:

C. 6,480 mL

A. Give a 2000mL normal saline bolus B. Start insulin drip to maintain blood glucose at 110 to 150 mg/dL. C. Give acetaminophen (Tylenol) 650 mg rectally. D. Give prescribed Antibiotics E. Start norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg.

Correct Answer is D

Explanation

In septic shock, prompt administration of antibiotics is crucial in order to target the underlying infection and prevent further progression of the septic process. Antibiotics help to eradicate the causative organisms and reduce the bacterial load, which can help improve patient outcomes.
While all the options mentioned are important interventions in the management of septic shock, initiating antibiotic therapy is considered a priority in order to address the underlying infection and prevent sepsis-related complications.
A. Giving a 2000 mL normal saline bolus in (option A) is incorrect because: Fluid resuscitation is important in septic shock to restore intravascular volume, but antibiotic therapy takes precedence as it directly targets the underlying infection.
B. Starting an insulin drip to maintain blood glucose at 110 to 150 mg/dL in (option B) is incorrect because Glycemic control is important in septic shock, but it is not the first priority compared to addressing the infection.
C. Giving acetaminophen (Tylenol) 650 mg rectally in (option C) is incorrect because Antipyretic medications can help reduce fever, but they do not address the underlying infection or stabilize the patient's condition.
E. Starting norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg in (option E) is incorrect because: Vasopressor support may be necessary in septic shock to maintain adequate blood pressure, but initiating antibiotics takes priority in order to address the underlying infection.
Therefore, in a patient with septic shock presenting with the given signs and symptoms, the nurse should first implement the intervention of giving the prescribed antibiotics to target the underlying infection.

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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.

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Naxlex Comprehensive Predictor Exams

What is the cardiac output of a patient whose heart rate is 72 beats per minute with a stroke volume of 90 mL/contraction?

Correct Answer is C

Explanation

The patient weighing 147 pounds with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 30, temperature 104° F, and blood glucose 391 mg/dL. Which intervention red by the health care provider should the nurse implement first?

Correct Answer is D

Explanation

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