In the plan of care, the most important intervention for a patient experiencing shock is assessing:
Respirations rate.
Heart rate.
Blood pressure.
Temperature.
The Correct Answer is C
A) Respirations rate:
Respiratory rate is an important vital sign to monitor in patients with shock, as respiratory distress can indicate inadequate oxygenation. However, blood pressure is generally considered more critical to assess initially in the context of shock because it directly reflects tissue perfusion and oxygen delivery.
B) Heart rate:
Heart rate is an important vital sign to monitor in patients with shock, as tachycardia (rapid heart rate) may indicate the body's compensatory response to maintain cardiac output and tissue perfusion. However, blood pressure is generally considered more critical to assess initially in the context of shock because it directly reflects tissue perfusion and oxygen delivery.
C) Blood pressure.
In shock, the body's vital organs are not receiving adequate blood flow and oxygen, leading to a life-threatening condition. While all vital signs are important to monitor in a patient experiencing shock, blood pressure is typically considered the most critical because it reflects the perfusion pressure—the force driving blood through the circulatory system to deliver oxygen and nutrients to the body's tissues. A decrease in blood pressure can indicate inadequate tissue perfusion and impending organ failure. Therefore, timely assessment and monitoring of blood pressure are essential for identifying and managing shock effectively.
D) Temperature:
Temperature monitoring is important in assessing for signs of infection or other systemic issues that may contribute to shock, such as sepsis. However, blood pressure is generally considered more critical to assess initially in the context of shock because it directly reflects tissue perfusion and oxygen delivery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","E"]
Explanation
A. The medication will relieve wheezing: Albuterol is a short-acting beta agonist bronchodilator that works by quickly relaxing the smooth muscles of the airways, leading to rapid bronchodilation. This helps relieve symptoms such as wheezing, shortness of breath, and chest tightness commonly associated with asthma exacerbations.
B. The medication will reduce inflammation: Albuterol is not primarily indicated for reducing inflammation in asthma. While it can help alleviate symptoms of bronchospasm, it does not target the underlying inflammation associated with asthma.
C. The medication will increase the amount of mucus: Albuterol does not increase mucus production. In fact, it is a bronchodilator medication that primarily targets airway smooth muscle relaxation and bronchodilation to improve airflow and relieve symptoms.
D. The medication will decrease coughing episodes: Albuterol can help decrease coughing episodes by relieving bronchospasm and improving airflow. However, its primary mechanism of action is bronchodilation rather than directly targeting coughing.
E. The medication will open the airways: Albuterol works by stimulating beta-2 adrenergic receptors in the airway smooth muscles, resulting in relaxation of these muscles and dilation of the bronchial tubes. This action helps to open the airways, allowing for improved airflow and easier breathing.
Correct Answer is ["B","C","E"]
Explanation
A. At high doses, to treat anaphylaxis: Dopamine is not used to treat anaphylaxis. Anaphylaxis is typically managed with medications such as epinephrine, antihistamines, and corticosteroids.
B. At high doses, to increase cardiac output: Dopamine is a medication commonly used in the treatment of shock, particularly in cases of hypotension. At higher doses, dopamine acts as a positive inotrope and increases cardiac contractility, thereby improving cardiac output and increasing blood pressure.
C. At low doses, to cause increased blood flow to the kidneys: At lower doses, dopamine primarily acts on dopaminergic receptors in the renal vasculature, leading to vasodilation of the renal blood vessels and increased renal perfusion. This can help improve renal blood flow and urine output, making it beneficial in cases of renal hypoperfusion or acute kidney injury.
D. At low doses, to treat anaphylaxis: Dopamine is not used to treat anaphylaxis at any dose. Anaphylaxis is managed with medications such as epinephrine, which acts on multiple receptors to reverse the systemic effects of the allergic reaction.
E. To cause vasoconstriction and increase blood pressure: Dopamine can also cause vasoconstriction, particularly at higher doses. This effect is mediated through its action on alpha-adrenergic receptors, leading to peripheral vasoconstriction and an increase in systemic vascular resistance, which in turn helps increase blood pressure.
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