Shock that occurs when damaged heart muscle cannot pump enough blood, often after a large myocardial infarction, is cardiogenic shock.
Missing Word
cardiogenic
In cardiogenic shock, contractility falls, so cardiac output and blood pressure drop. Treatment combines restoring coronary blood flow with drugs that support contraction and blood pressure.
Category: Shock Basics
Question 2
Shock caused by a physical blockage in the chest that keeps the heart from filling or pumping, as in cardiac tamponade, is classified as obstructive shock.
Missing Word
obstructive
In obstructive shock the heart muscle may be healthy, but something such as fluid in the pericardial sac prevents filling or ejection. Relieving the blockage is the definitive treatment.
Category: Shock Basics
Question 3
Every type of shock shares one problem: inadequate perfusion, the flow of oxygenated blood through the body's tissues.
Missing Word
perfusion
Perfusion is the delivery of oxygenated blood to tissues. When it stays inadequate, cells become hypoxic and die, and multiple organs can fail.
Category: Shock Basics
Question 4
Shock caused by too little circulating blood volume, as from hemorrhage, severe burns or heavy vomiting and diarrhea, is hypovolemic shock.
Missing Word
hypovolemic
In hypovolemic shock the heart has too little blood to pump, so cardiac output and blood pressure fall. The first priority is to stop the loss, such as controlling bleeding, and restore volume with fluids or blood.
Category: Shock Basics
Question 5
A harsh, high-pitched breathing sound caused by narrowing of the upper airway, a warning sign in anaphylaxis, is called stridor.
Missing Word
stridor
Stridor comes from swelling of the larynx or upper airway and signals that the airway may soon close. Epinephrine is given at once.
Category: Epinephrine and Anaphylaxis
Question 6
For a client with anaphylaxis, the preferred site for an intramuscular epinephrine injection is the anterolateral thigh.
Missing Word
thigh
The large vastus lateralis muscle of the anterolateral thigh absorbs epinephrine quickly, which is why autoinjectors are designed for this site.
Category: Epinephrine and Anaphylaxis
Question 7
Before giving adenosine, the nurse asks about recent coffee, tea or energy drinks, because caffeine blocks adenosine receptors and can make the drug less effective.
Missing Word
caffeine
Caffeine and theophylline are methylxanthines that compete with adenosine at its receptors, so a client who has recently had them may not respond to the usual dose. The nurse documents recent intake and reports it to the provider.
Category: Emergency Dysrhythmia Drugs
Question 8
The IV vasopressor phenylephrine is a pure alpha-1 agonist, so it raises blood pressure without stimulating the heart and can cause reflex bradycardia.
Missing Word
phenylephrine
Phenylephrine constricts vessels through alpha-1 receptors and has little beta effect, so the rise in blood pressure triggers a baroreceptor reflex that slows the heart. Heart rate and blood pressure are monitored closely while it runs.
Category: Vasopressors and Inotropes
Question 9
Life-threatening organ dysfunction caused by a dysregulated body response to infection is called sepsis, and in its most severe form it causes distributive shock.
Missing Word
sepsis
Sepsis is the body's harmful, dysregulated response to an infection, which damages its own tissues and organs. When it leaves the client hypotensive despite fluids, vasopressors are started while antibiotics and source control treat the infection.
Category: Shock Basics
Question 10
During cardiac catheterization for an acute myocardial infarction, a blocked coronary artery can be opened and held open with a stent, a small mesh tube.
Missing Word
stent
A stent keeps a reopened coronary artery from narrowing again. Clients who receive one need antiplatelet therapy afterward to keep clots from forming on it.
Category: Acute Coronary Syndrome Drugs
Question 11
Dopamine is contraindicated in a client with pheochromocytoma, an adrenal medulla tumor that causes episodes of severe hypertension.
Missing Word
pheochromocytoma
A pheochromocytoma releases large amounts of catecholamines, so adding dopamine could cause a dangerous hypertensive crisis. Uncorrected tachydysrhythmias are another contraindication.
Category: Vasopressors and Inotropes
Question 12
A sensation of a pounding, fluttering or racing heartbeat, a common symptom of dysrhythmias and an adverse effect of epinephrine, is called palpitations.
Missing Word
palpitations
Palpitations are the client's awareness of the heartbeat. A client who reports them after an emergency drug such as epinephrine or adenosine is placed on a cardiac monitor and assessed.
Category: Emergency Dysrhythmia Drugs
Question 13
Aspirin for a suspected myocardial infarction is contraindicated in hemophilia, an inherited deficiency of a clotting factor.
Missing Word
hemophilia
Hemophilia already impairs clotting, and aspirin's irreversible platelet inhibition would add to the risk of serious bleeding.
Category: Acute Coronary Syndrome Drugs
Question 14
When no IV can be placed during cardiac arrest, epinephrine can be given by the intraosseous route, through a needle into the bone marrow.
Missing Word
intraosseous
The intraosseous route delivers drugs into the marrow cavity, which drains into the venous circulation, so epinephrine given this way reaches the heart about as quickly as an IV dose. It is used when IV access cannot be obtained quickly.
Category: Epinephrine and Anaphylaxis
Question 15
The preferred blood test for diagnosing myocardial infarction measures cardiac troponin, a contractile regulatory protein that leaks from injured heart muscle cells.
Missing Word
troponin
Troponin is released into the blood when heart muscle cells are damaged, so a rising level confirms myocardial infarction in a client with symptoms of ischemia. Levels are drawn on arrival and repeated, because they may not rise right away.
Category: Acute Coronary Syndrome Drugs