A nurse is assisting in providing care for a client who has obstructive shock. Which of the following diagnoses should the nurse expect?
Third spacing
Cardiac tamponade
Cardiomyopathy
Ruptured aneurysm
The Correct Answer is B
A. Third spacing involves the abnormal accumulation of fluid in extracellular spaces and is more commonly associated with hypovolemic or distributive shock, not obstructive shock.
B. Cardiac tamponade is a classic cause of obstructive shock, where the accumulation of fluid in the pericardial sac compresses the heart, leading to decreased cardiac output and obstructed blood flow.
C. Cardiomyopathy is a disease of the heart muscle that can lead to heart failure but is typically associated with cardiogenic shock, not obstructive shock.
D. A ruptured aneurysm would most likely cause hypovolemic shock due to blood loss, not obstructive shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Consuming clear liquids up to the time of surgery is generally not allowed due to the risk of aspiration during anesthesia.
B. Tongue studs and other jewelry should be removed before surgery to prevent injury or interference with medical equipment.
C. Taking morning vitamins before surgery is typically not permitted unless specifically allowed by the healthcare provider, as they can affect anesthesia or surgical outcomes.
D. Allowing the client to keep her hearing aids in until the last possible moment helps with communication, reduces anxiety, and ensures the client can hear important information during pre-operative preparations.
Correct Answer is D
Explanation
A. Disagreements about staffing issues should be addressed through appropriate channels, but they do not typically require an incident report.
B. The absence of advanced directives is a concern that needs to be addressed, but it does not constitute an incident that requires reporting.
C. A staff member not arriving for their shift is a staffing issue but does not require an incident report unless it directly affects client care.
D. Missing dentures are considered a loss of personal property, which requires documentation through an incident report to ensure accountability and to initiate a search or compensation process.
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