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 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.
Correct Answer is C
Explanation
Hemorrhagic shock is characterized by severe blood loss, leading to inadequate tissue perfusion and hypovolemia. The primary goal in the initial management of hemorrhagic shock is to restore intravascular volume and improve tissue perfusion. Administering intravenous fluids, such as normal saline solution, is a critical intervention to address hypovolemia and improve blood pressure.
A. Give Plasmanate 1 unit now in (option A) is incorrect because: Plasmanate is a plasma-derived product used to replace coagulation factors. While it may be necessary to address coagulation abnormalities, administering intravenous fluids to restore volume takes priority over specific blood products.
B. Prepare for endotracheal intubation in (option B) is incorrect because Endotracheal intubation may be required in cases of impending respiratory failure or compromised airway, but it should not be the first action in addressing hypovolemic shock.
D. Type and crossmatch for 4 units of packed red blood cells (PRBCs) in (option D) is incorrect because transferring packed red blood cells is an important intervention to address blood loss and improve oxygen-carrying capacity. However, before administering blood products, it is crucial to stabilize the patient's hemodynamics through fluid resuscitation.
Therefore, in a patient with hemorrhagic shock, the nurse's first priority among the given options is to give normal saline solution of 250 mL/hr to restore intravascular volume and improve tissue perfusion.
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