ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 17 : Caring for Clients in Shock Questions
Question 1 of 5
The nurse is caring for a client with highly pigmented skin. Which assessment technique is used to evaluate cyanosis?
Correct Answer: B
Rationale: In clients with highly pigmented skin, cyanosis is more accurately detected by inspecting the conjunctiva and oral mucous membranes. The other options do not provide the best assessment for cyanosis.
Question 2 of 5
The seasoned nurse is instructing the new graduate on information obtained from central venous pressure and pulmonary artery pressure. Which statement, made by the seasoned nurse, reflects the most pertinent information regarding circulation?
Correct Answer: B
Rationale: The most pertinent information to share with a new nurse is the information that the pulmonary artery pressure provides essential information about the effectiveness of left ventricle. The left ventricle is most pertinent to circulation. The other information is correct but not as pertinent.
Question 3 of 5
The nurse is initiating intravenous therapy for a client who is in shock. Which ratio of fluid to fluid lost is anticipated?
Correct Answer: C
Rationale: Usually, a ratio of $3 \mathrm{~L}$ of fluid is administered for every $1 \mathrm{~L}$ of fluid lost.
Question 4 of 5
The nurse is caring for an older adult client receiving dopamine therapy for the treatment of shock. For which complication should the nurse monitor?
Correct Answer: D
Rationale: The nurse should monitor an older adult client receiving dopamine therapy for the treatment of shock for a rapid increase in blood pressure. Hyperglycemia, not hypoglycemia, is a potential complication of dopamine therapy. Water intoxication is a potential complication of vasopressin. Photophobia is a potential complication of sympathomimetic vasopressor agents.
Question 5 of 5
The nurse is administering a medication to the client with a positive inotropic effect. Which action of the medication does the nurse anticipate?
Correct Answer: B
Rationale: The nurse realizes that when administering a medication with a positive inotropic effect, the medication increases the force of heart muscle contraction. The heart rate increases not decreases. The central nervous system is not depressed nor is there a dilation of the bronchial tree.