Margarita, 60-year-old female with a history of coronary artery disease presents to the emergency department with severe chest pain, shortness of breath, and sweating. She has a history of hypertension and is currently on medications to manage her condition. On examination, the patient is anxious hypotensive (BP 80/60 mmHg, tachycardic (HR 110 bpm), and has a weak, thready pulse. Her skin is cool and clammy, and her breathing is shallow. She appears pale and has decreased urine output.

Based on the patient's presentation, what type of shock is the patient most likely experiencing, and what stage of shock is she in?

Hypovolemic shock, Stage I

Neurogenic shock, Stage I

Septic shock, Stage III

Cardiogenic shock, Stage II

Answer and Explanation

The Correct Answer is D

A. Hypovolemic shock, Stage I: Hypovolemic shock results from fluid loss (e.g., hemorrhage or dehydration) and usually presents with hypotension and tachycardia, but the context of severe chest pain and coronary artery disease makes hypovolemia less likely as the primary cause.

B. Neurogenic shock, Stage I: Neurogenic shock typically occurs after spinal cord injury, presenting with hypotension and bradycardia. This patient is tachycardic and anxious, making neurogenic shock unlikely.

C. Septic shock, Stage III: Septic shock is associated with infection and systemic inflammatory response. While hypotension is present, there is no indication of infection, fever, or leukocytosis, and the onset is acute rather than gradual.

D. Cardiogenic shock, Stage II: Cardiogenic shock arises from inadequate cardiac output, often due to acute myocardial infarction. The patient’s hypotension, tachycardia, weak thready pulse, cool clammy skin, shallow breathing, decreased urine output, and history of coronary artery disease indicate Stage II (compensatory) cardiogenic shock.

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Free Nursing Study Resources

Correct Answer is ["B","D","E"]

Explanation

A. Increased BUN/Creatinine: Elevated BUN and creatinine levels reflect impaired renal function and reduced glomerular filtration. These findings are laboratory consequences of acute tubular necrosis rather than initiating causes. They help confirm kidney injury but do not trigger tubular damage.

B. Ischemia: Prolonged renal hypoperfusion leads to oxygen deprivation of tubular cells, resulting in cellular injury and necrosis. Common causes include hypotension, shock, or severe blood loss. Ischemia is one of the most frequent underlying mechanisms of acute tubular necrosis.

C. Anemia: Anemia reduces oxygen-carrying capacity but does not directly cause tubular cell necrosis. While severe anemia may contribute to overall tissue hypoxia, it is not a primary or direct cause of acute tubular necrosis.

D. Sepsis: Sepsis causes systemic inflammation, hypotension, and impaired microcirculation, all of which reduce renal perfusion. Inflammatory mediators further damage renal tubular cells. This combination places patients at high risk for developing acute tubular necrosis.

E. Nephrotoxins: Exposure to nephrotoxic substances such as aminoglycosides, contrast media, or heavy metals can directly injure renal tubular cells. Toxic damage disrupts cellular metabolism and integrity, leading to necrosis. Nephrotoxins are a common non-ischemic cause of acute tubular necrosis.

A. systemic infection B. fluid is too warm C. fluid is too cold. D. peritonitis

Correct Answer is D

Explanation

A. Systemic infection: While systemic infections can cause fever and chills, the combination of abdominal pain, nausea, and signs localized to the peritoneal cavity is more indicative of a localized complication rather than a generalized infection.

B. Fluid is too warm: Warm dialysate may cause mild discomfort or flushing, but it is unlikely to produce chills, nausea, or significant abdominal pain. Temperature-related discomfort is usually transient and less severe.

C. Fluid is too cold: Cold dialysate can cause cramping or shivering, but persistent abdominal pain accompanied by nausea and systemic signs like chills suggests a pathological process rather than a simple temperature issue.

D. Peritonitis: Peritonitis is a common complication of peritoneal dialysis, characterized by abdominal pain, tenderness, nausea, and often fever or chills. Prompt recognition is essential to initiate treatment and prevent serious complications.

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Naxlex Comprehensive Predictor Exams

What is the cause of Acute Tubular Necrosis? (Select one or more answers)

Correct Answer is ["B","D","E"]

Explanation

When caring for the patient who is on peritoneal dialysis and complains of abdominal pain, chills, and nausea, the nurse knows these signs may be an Indication of

Correct Answer is D

Explanation

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