The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus. Initially the patient was stable, awake, alert, and oriented, but during the last several hours the patient has become increasingly lethargic. At change of shift, the oncoming staff nurse appreciates a profound change in the patients mental status from the day before. Vital signs and hemodynamic parameters are as follows BP 8854 mm Hg Pulse 110 bpm Respiratory rate 22 breaths per minute SaO2 93 on a 50 mask Systemic vascular resistance (SVR) 1600 dynes seccm5 Cardiac index 1.3 Lmin Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most consistent with which shock state?

Correct Answer: B

Rationale: The patient's presentation with low blood pressure, tachycardia, tachypnea, decreased oxygen saturation, and altered mental status is most consistent with distributive shock. Distributive shock is characterized by systemic vasodilation and decreased systemic vascular resistance (SVR), leading to inadequate perfusion of tissues and organs despite normal or high cardiac output. In this case, the low SVR (1600 dynes ∙ sec/cm5) and low blood pressure indicate vasodilation. The patient's pulmonary capillary wedge pressure (PCWP) of 8 mm Hg is not consistent with cardiogenic shock, where elevated PCWP would be expected. Additionally, there are no signs of obstructive shock, such as a history of pulmonary embolism but rather clinical findings that suggest distributive shock. Hypovolemic shock would typically present with signs of volume depletion and would be less likely in this patient with stable mental status initially.

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.