The emergency department nurse provides care for a 50-year-old male patient with septic shock. The nurse recalls that the renin- angiotensin system is activated during which stage of shock?
Initial stage
Progressive stage
Refractory stage
Compensatory stage
The Correct Answer is D
In the compensatory stage of shock, the body initiates various mechanisms to maintain perfusion to vital organs and restore homeostasis. Activation of the renin-angiotensin system is one of the compensatory responses. The decreased blood flow and oxygen delivery to the kidneys stimulate the release of renin from the kidneys. Renin acts on angiotensinogen, converting it into angiotensin I, which is further converted to angiotensin II by the action of angiotensin-converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor and also stimulates the release of aldosterone, leading to sodium and water retention. These mechanisms aim to increase blood pressure and cardiac output and restore fluid balance.
A. The initial stage of shock in (option A) is incorrect because it is characterized by inadequate tissue perfusion and the activation of various compensatory mechanisms, including the release of stress hormones. However, the renin-angiotensin system is not specifically mentioned as activated in this stage.
B. The progressive stage of shock in (option B) is incorrect because it occurs when compensatory mechanisms fail to maintain adequate perfusion, leading to worsening hypoperfusion and organ dysfunction. The renin-angiotensin system continues to be activated during this stage, but it is primarily associated with the compensatory stage.
C. The refractory stage of shock in (option C) is incorrect because it is the stage of severe and prolonged hypoperfusion, where organ failure becomes irreversible. The renin-angiotensin system may still be activated, but it is not the primary focus of this stage.
Therefore, the activation of the renin-angiotensin system occurs during the compensatory stage of shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
In this scenario, the patient's signs and symptoms suggest a state of shock, which can be caused by various factors, such as hypovolemia, cardiac dysfunction, or systemic vasodilation. The first priority in managing a patient in shock is to ensure adequate oxygenation and tissue perfusion. Administering oxygen at 100% per non-rebreather mask helps improve oxygen delivery to the tissues and supports vital organ function.
A. Placing the patient on a continuous cardiac monitor in (option A) is incorrect because it is an important step to monitor the patient's heart rhythm and identify any abnormalities. However, providing oxygen should take priority to address the potential hypoxemia and tissue hypoperfusion.
C. Inserting two 14-gauge IV catheters in (option C) is incorrect because it is crucial for establishing large-bore access for fluid resuscitation and medication administration. While it is an important step, addressing oxygenation takes precedence.
D. Drawing blood to type and crossmatch for transfusions in (option D) is incorrect because it is an important step in managing a patient in shock who may require blood products. However, ensuring adequate oxygenation through oxygen administration is the immediate priority.
Therefore, the nurse should act first on the order to administer oxygen at 100% per non-rebreather mask to support the patient's oxygenation and tissue perfusion.
Correct Answer is C
Explanation
Urine output is an essential indicator of renal perfusion and overall fluid status. In a patient in shock, maintaining an adequate urine output is a crucial goal of fluid resuscitation. A urine output of 0.5 to 1 mL/kg/hour is generally considered adequate in adults. The given value of 35 ml over the last hour suggests that the patient is producing urine, which indicates that fluid resuscitation is effective in restoring perfusion to the kidneys.
A. The patient's mean arterial pressure (MAP) is 50 mm Hg in (option A) is incorrect because While mean arterial pressure is an important hemodynamic parameter, a single value alone may not provide a comprehensive assessment of the patient's response to fluid resuscitation.
B. The patient's GCS score is 9 in (option B) is incorrect because The Glasgow Coma Scale (GCS) assesses the level of consciousness and neurological function but does not directly reflect fluid resuscitation effectiveness.
D. The patient's hemoglobin is within normal limits: (option D) is incorrect because Haemoglobin levels are important for assessing oxygen-carrying capacity but do not directly indicate the effectiveness of fluid resuscitation.
Therefore, the nurse can evaluate that fluid resuscitation for a 70 kg patient in shock is effective by observing a urine output of 35 ml over the last hour.
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