Critical Care Nursing Flashcards

A patient develops hypotension, tachycardia, warm flushed skin, and a widened pulse pressure following a severe anaphylactic reaction. This presentation is most characteristic of:

Answer: Distributive shock

Distributive shock, as seen in anaphylaxis, is caused by massive vasodilation leading to a relative hypovolemia with warm skin and widened pulse pressure.

According to current Surviving Sepsis Campaign guidelines, which fluid is recommended as first-line resuscitation for a patient in septic shock?

Answer: Crystalloid solution at 30 mL/kg

Current guidelines recommend 30 mL/kg of crystalloid (normal saline or lactated Ringer's) within the first 3 hours of sepsis recognition as the first-line resuscitation fluid.

A patient remains hypotensive despite receiving 30 mL/kg of IV fluid resuscitation for septic shock. Which vasopressor is the recommended first-line agent?

Answer: Norepinephrine

Norepinephrine is the first-line vasopressor for septic shock because its potent alpha-adrenergic activity effectively counteracts the vasodilation characteristic of septic shock.

A patient post-cardiac surgery develops hypotension, tachycardia, cool extremities, decreased urine output, and an elevated pulmonary capillary wedge pressure (PCWP) of 22 mmHg. These findings are consistent with:

Answer: Cardiogenic shock

Cardiogenic shock is characterized by decreased cardiac output (poor peripheral perfusion) and elevated filling pressures (high PCWP) due to failure of the heart as a pump.

A critically ill patient's serum lactate measures 6 mmol/L. The nurse interprets this finding as indicating:

Answer: Tissue hypoperfusion with anaerobic metabolism

A serum lactate above 4 mmol/L indicates anaerobic metabolism resulting from inadequate tissue oxygen delivery, which is commonly seen in shock states.

A patient develops urticaria, stridor, hypotension, and angioedema minutes after receiving IV contrast dye. What is the FIRST treatment the nurse should administer?

Answer: Epinephrine 0.5 mg IM (1:1000 solution)

Epinephrine IM is the life-saving first-line treatment for anaphylaxis; it reverses bronchospasm, reduces angioedema, and restores vascular tone.

The nurse is monitoring fluid resuscitation in a patient with 40% total body surface area (TBSA) burns. Which parameter BEST indicates adequate resuscitation?

Answer: Urine output of 0.5–1 mL/kg/hour

Urine output of 0.5–1 mL/kg/hour is the gold standard for assessing adequate fluid resuscitation in burn patients, as it reflects end-organ (renal) perfusion.