A nurse is providing care for a client experiencing obstructive shock. Which of the following diagnoses should the nurse expect?
Third spacing
Cardiomyopathy
Cardiac tamponade
Ruptured aneurysm
The Correct Answer is C
A. Third spacing: Third spacing refers to the shifting of fluid from the intravascular space into the interstitial space, leading to decreased circulating volume. While third spacing can contribute to hypovolemic shock, it is not specific to obstructive shock.
B. Cardiomyopathy: Cardiomyopathy is a condition characterized by abnormalities in the heart muscle structure and function. While cardiomyopathy can lead to heart failure, it is not directly associated with obstructive shock.
C. Cardiac tamponade: Cardiac tamponade occurs when fluid accumulates in the pericardial sac, compressing the heart and impairing its ability to fill properly. This condition can lead to obstructive shock due to decreased cardiac output. Signs and symptoms include hypotension, muffled heart sounds, distended neck veins, and pulsus paradoxus.
D. Ruptured aneurysm: A ruptured aneurysm can lead to hypovolemic shock due to acute blood loss. While it can cause significant hemodynamic instability, it is not a characteristic diagnosis of obstructive shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "I notice the ringing when I'm not concentrating on something." This statement suggests that the client notices the tinnitus but does not imply a significant impact on their well-being. It indicates that the tinnitus occurs when the client is not focused on tasks, which may not necessarily affect their overall functioning or well-being.
B. "I am still able to complete my work in a timely manner." This statement indicates that the client can still function adequately in their work despite experiencing tinnitus. While this may suggest some level of coping, it does not directly address the impact of tinnitus on the client's overall well-being.
C. "The ringing in my ears is distracting." This is the correct answer. This statement indicates that the tinnitus is distracting to the client, which suggests that it may affect their concentration, focus, or overall quality of life. The distraction caused by tinnitus can significantly impact daily activities and well-being.
D. "Hopefully a treatment for this ringing in my ears will help." While this statement acknowledges the presence of tinnitus and the desire for treatment, it does not directly address the impact of tinnitus on the client's well-being. It focuses more on the hope for relief through treatment rather than the current impact on their quality of life.
Correct Answer is D
Explanation
A. A client who has coronary artery disease (CAD) and Bell's palsy: Bell's palsy, a condition characterized by sudden, temporary weakness or paralysis of the facial muscles, does not directly increase the risk of complications following CABG surgery. While Bell's palsy may affect facial muscle function, it typically does not impact respiratory function or cardiovascular stability during surgery.
B. A client who has coronary artery disease (CAD) and chronic diverticulitis: Chronic diverticulitis, inflammation or infection of the diverticula in the colon, is not directly related to increased risk for complications following CABG surgery. While diverticulitis may require medical management and dietary modifications, it does not typically affect cardiovascular or respiratory function during surgery.
C. A client who has coronary artery disease (CAD) and chronic allergies: Chronic allergies, while they may cause respiratory symptoms such as nasal congestion or rhinitis, are not typically associated with increased risk for complications following CABG surgery. Allergies alone are unlikely to significantly impact cardiovascular stability or respiratory function during surgery compared to conditions such as COPD.
D. A client who has coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD): A client with CAD and COPD is at the highest risk for complications following coronary artery bypass graft (CABG) surgery. COPD is a chronic respiratory condition characterized by airflow limitation and increased airway resistance, often accompanied by emphysema and chronic bronchitis. These respiratory impairments can significantly impact the client's ability to tolerate anesthesia, mechanical ventilation, and postoperative respiratory function. COPD increases the risk of complications such as atelectasis, pneumonia, exacerbation of COPD, and respiratory failure following CABG surgery.
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