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Cardiogenic Shock
A nurse is assessing a client in cardiogenic shock. Which symptom would the nurse most likely observe?
Correct Answer:
c) decreased urine output
Rationale:
Decreased urine output is a hallmark symptom of cardiogenic shock due to reduced perfusion to the kidneys. Cardiogenic shock causes cool, clammy skin, weak pulses, and hypotension as the heart fails to pump blood effectively to meet the body's needs (Thiele et al., 2015).
A client with a myocardial infarction is at risk of developing cardiogenic shock. Which intervention should the nurse prioritize?
Correct Answer:
b) monitor for hypotension and tachycardia
Rationale:
Early identification of hypotension and tachycardia is crucial for recognizing the development of cardiogenic shock. These signs indicate reduced cardiac output and compensatory mechanisms. While ambulation and diet are important in recovery, monitoring for shock is a priority in the acute phase (Brunner & Suddarth's Textbook of Medical-Surgical Nursing).
Which medication would a nurse anticipate administering to a client in cardiogenic shock to improve cardiac contractility?
Correct Answer:
c) dobutamine
Rationale:
Dobutamine is an inotropic agent that increases cardiac contractility and output, making it a primary medication used in cardiogenic shock to enhance heart performance. Furosemide is a diuretic, nitroglycerin is a vasodilator, and lisinopril is an ACE inhibitor; none are primarily used to improve contractility in cardiogenic shock (Harjola et al., 2015).
A client with cardiogenic shock is being treated with an intra-aortic balloon pump (IABP). What is the primary purpose of this device?
Correct Answer:
b) decrease myocardial oxygen consumption
Rationale:
The IABP works by inflating during diastole to improve coronary artery perfusion and deflating during systole to decrease the workload on the heart and reduce myocardial oxygen consumption. It is not used to increase vascular resistance, provide pacing, or directly promote diuresis (Brunner & Suddarth's Textbook of Medical-Surgical Nursing).
The nurse is monitoring a client with cardiogenic shock. Which hemodynamic parameter is expected to be decreased?
Correct Answer:
c) cardiac output
Rationale:
In cardiogenic shock, the heart's inability to pump effectively leads to a decreased cardiac output. CVP and PAWP may be elevated due to fluid overload and poor contractility, while SVR is often increased as a compensatory mechanism to maintain blood pressure (Hollenberg, 2011).
A client in cardiogenic shock is receiving norepinephrine. The nurse knows the primary purpose of this medication is to:
Correct Answer:
a) increase blood pressure through vasoconstriction
Rationale:
Norepinephrine is a vasopressor used to increase blood pressure by causing vasoconstriction, which is essential in maintaining perfusion during cardiogenic shock. It does not directly promote diuresis, reduce myocardial oxygen demand, or dilate coronary arteries (Levy et al., 2018).
Which assessment finding would indicate that a client is progressing from compensated to decompensated cardiogenic shock?
Correct Answer:
b) increased jugular venous distension
Rationale:
Jugular venous distension reflects increased central venous pressure and right-sided heart failure, indicating decompensated cardiogenic shock. Increased heart rate can be compensatory, increased urine output is unexpected in shock, and elevated blood pressure usually occurs early in compensatory mechanisms (Brunner & Suddarth's Textbook of Medical-Surgical Nursing).
A nurse is educating a client with a history of cardiogenic shock. Which lifestyle modification is most critical to prevent recurrence?
Correct Answer:
b) following a low-fat, heart-healthy diet
Rationale:
A heart-healthy diet is crucial to prevent the recurrence of myocardial infarctions and cardiogenic shock, as it helps manage cholesterol, blood pressure, and weight. While other options are also important, diet plays a central role in cardiac health (Brunner & Suddarth's Textbook of Medical-Surgical Nursing).
The nurse suspects a client with cardiogenic shock is developing pulmonary edema. Which assessment finding supports this suspicion?
Correct Answer:
c) frothy sputum
Rationale:
Frothy sputum is a classic sign of pulmonary edema, indicating fluid accumulation in the alveoli, which can occur in cardiogenic shock due to left ventricular failure. Clear lung sounds and a decreased respiratory rate are not associated with pulmonary edema, and tachycardia is more likely than bradycardia (Brunner & Suddarth's Textbook of Medical-Surgical Nursing).
A nurse is teaching a client with cardiogenic shock about signs of worsening heart function. Which statement indicates a need for further education?
Correct Answer:
b) “shortness of breath when lying down is expected and does not need to be reported.”
Rationale:
Shortness of breath when lying down (orthopnea) is a significant symptom that should be reported, as it indicates worsening heart failure and fluid overload. The other statements correctly identify symptoms requiring medical attention (Brunner & Suddarth's Textbook of Medical-Surgical Nursing).
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