“Exam 2 is 50 points with 50 multiple choice questions: Respiratory, Neuro, Trauma/Shock, ABGs, F & E.”
From Moodle: Neuro/trauma/shock content
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Review of CN functions and testing, Review of A&P of brain and functions, peripheral nervous system Cerebral vascular circulation, Neuro assessment findings, Diagnostic testing/procedures
Concepts of ICP monitoring
Cerebral perfusion pressure and what it means Nursing care r/t IICP
Hemorrhagic injury Infectious disease
Review concepts r/t trauma, shock, SCI, Review types of shock
Systemic Inflammatory Response Syndrome (SIRS)
Defined as 2 or more of the following- Fever > 100.4°F or < 96.8°F, HR > 90 bpm, RR >20 bpm, or PaCO 2 < 32 mm Hg, WBC >12,000 or < 4,000, at least one organ dysfunction.
Cause: nonspecific and can be ischemia, inflammation, trauma, infection, or combination.
Infection is inflammatory response to bacterial invasion in tissue. Bacteremia is bacteria in blood, but this doesn’t always lead to SIRS
Sepsis is systemic response to infection, defined as presence of SIRS criteria (above), in addition to a documented or presumed infection (positive culture, usually Gram +), mental status changes, significant edema, hyperglycemia without DM.
SIRS severe sepsis meets sepsis criteria (above) plus organ dysfunction, hypoperfusion, or sepsis-induced hypotension - sbp < 90 or decrease of 40 mm Hg from baseline in absence of other causes (cardiac decline), urine output < 0.5/hr > 2 hours despite fluid resuscitation & high creatinine (renal failure); hyperbilirubinemia & absent bowel sounds (GI/liver failure); high lactate levels (cell hypoperfusion); high INR > 1.5, thrombocytopenia- platelets
< 100,000 (possible DIC onset).
Septic shock criteria: “persistent hypotension (sbp < 60) and perfusion abnormalities despite adequate fluid resuscitation.”
Multiple Organ Dysfunction Syndrome (MODS): state where organ function is not capable of maintaining homeostasis.
Potential complications: ARDS, nosocomial pneumonia, IV catheter–related bacteremia, electrolyte abnormalities, hyperglycemia, anemia, disseminated intravascular coagulation (DIC).
Nursing:
Stat lactate level & blood cultures, start antibiotic admin. ASAP.
Assess: systemic tissue perfusion (circulation checks: color, temp, pulses), breathing (SpO2, lung sounds, resp. effort), vital signs changes (monitor CVP), urine output, catheter-rel. signs of infection.
Monitor labs: repeated lactate levels, H&H, electrolytes, glucose, creatinine and UO, CRP (C reactive protein elevated), ABGs (sodium bicarb low, PaO2 low).
Interventions: monitor fluid status/urine output; infection prevention; improve myocardial oxygenation (goal to keep MAP at 65) (may need O2 or ventilator); administer blood products, crystalloid or colloid IVF, epi, vasopressors, ionotropics, sodium bicarb; stress ulcer and DVT prevention (turning, mobility); nutrition (increased needs); Accucheck glucose control.
Neuro and Shock Questions
1) A client who had a CVA was admitted to the ICU yesterday. The nurse observes that the client is becoming lethargic and is unable to articulate words when speaking. What does the nurse do next?
A. Check the client’s blood pressure and apical heart rate.
B. Elevate the back rest to 30 degrees and notify the health care provider.
C. Place the client in a supine position with a flat back rest, and observe.
D. Assess the client’s white blood cell count and differential.
2) The nurse is caring for a client admitted to the intensive care unit after incurring a basilar skull fracture. Which complication of this injury does the nurse monitor for?
A. Aspiration
B. Hemorrhage
C. Pulmonary embolus
D. Myocardial infarction
3) A client who has a head injury is transported to the emergency department. Which assessment does the emergency department nurse perform immediately?
A. Pupil response
B. Motor function
C. Respiratory status
D. Short-term memory
4) A client who has a severe head injury is placed in a drug-induced coma. The client’s husband states, “I do not understand. Why are you putting her into a coma?” How does the nurse respond?
A. “These drugs will prevent her from experiencing pain when positioning or suctioning is required.”
B. “This medication will help her remain cooperative and calm during the painful treatments.”
C. “This medication will decrease the activity of her brain so that additional damage does not occur.”
D. “This medication will prevent her from having a seizure and will reduce the need for monitoring intracranial pressure.”
5) The nurse is preparing to administer prescribed mannitol, an osmotic diuretic, to a client with a subdural hematoma with dilation of the ipsilateral pupil. To maintain cerebral perfusion, the nurse knows to:
A. Maintain systolic blood pressure > 90 mm Hg
B. Discontinue a barbiturate-induced coma before drug administration.
C. Administer the drug by slow infusion
D. Keep the patient supine
6) A client with a head injury is being given midazolam (Versed) while on mechanical ventilation. Which action does the nurse implement for this client?
A. Monitor for seizures.
B. Assess for urinary output.
C. Provide a clear liquid diet.
D. Administer an analgesic.
7) The nurse is planning the discharge of a client who has sustained a moderate head injury and is experiencing personality and behavior changes. The client’s wife states, “I am concerned about how different he is. What can I do to help with the transition back to our home?” How does the nurse respond?
A. “Be firm and let him know when his behavior is unacceptable.”
B. “Minimizing the number of visitors will help stabilize his personality.”
C. “Developing a routine will help provide him with a structured environment.”
D. “He will return to his normal emotional functioning in 6 to 12 months.”
8) A patient has ICP monitoring with an intraventricular catheter. A priority nursing intervention for the patient is
A. aseptic technique to prevent infection
B. constant monitoring of ICP waveforms
C. removal of CSF to maintain normal ICP
D. sampling CSF to determine abnormalities
9) The nurse recognizes Cushing's triad in the patient with a traumatic brain injury (TBI) with which changes in vital signs?
A. Increased pulse, irregular respiration, increased BP
B. decreased pulse, irregular respiration, increased pulse pressure
C. increased pulse, decreased respiration, increased pulse pressure
D. decreased pulse, increased respiration, decreased systolic BP
10) A client’s mean arterial pressure is 60 mm Hg and intracranial pressure is 20 mm Hg. Based on the client’s cerebral perfusion pressure, what should the nurse anticipate for this client?
A. Impending brain herniation
B. Poor prognosis and cognitive function
C. Probable complete recovery
D. Unable to tell from this information
11) A nurse assesses a client with a spinal cord injury at level T5. The client’s blood pressure is 184/95 and the client presents with a flushed face and blurred vision. Which action should the nurse take first?
A. Initiate oxygen via a nasal cannula.
B. Place the client in a supine position.
C. Palpate the bladder for distention.
D. Administer a prescribed beta blocker.
12) An emergency room nurse initiates care for a client with a cervical spinal cord injury who arrives via emergency medical services. Which action should the nurse take first?
A. Assess level of consciousness.
B. Obtain vital signs.
C. Administer oxygen therapy.
D. Assess respiratory status.
13) An unconscious patient was diagnosed with a basilar skull fracture after being hit in the head with a baseball bat. The nurse notes ecchymosis behind both ears and clear fluid draining from his ears and nose. Which of the following interventions should be done first?
A. Place the patient in a left lateral position
B. Check the fluid for dextrose with a dipstick
C. Suction the nose to maintain airway patency
D. Insert nasal and ear packing with sterile gauze
14) A nurse plans care for a client with a halo fixator. Which interventions should the nurse include in this client’s plan of care? (Select all that apply.)
A. Tape a halo wrench to the client’s vest.
B. Assess the pin sites for signs of infection.
C. Loosen the pins when sleeping.
D. Decrease the client’s oral fluid intake.
E. Assess the chest and back for skin breakdown.
15) A nurse assesses a client who experienced a spinal cord injury at the T5 level 12 hours ago. Which manifestations should the nurse correlate with neurogenic shock? (Select all that apply.)
A. Heart rate of 34 beats/min
B. Blood pressure of 185/65 mm Hg
C. Urine output less than 30 mL/hr
D. Decreased level of consciousness
E. Increased oxygen saturation
16) A patient with a TBI is being cared for in the ICU. The nurse knows early signs of increasing ICP include (select all that apply)
A. Cushing's triad
B. Vomiting
C. Lehtargy
D. Dilated pupil with sluggish response to light
17) A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?
A. Vomiting continues
B. Intracranial pressure (ICP) is increased
C. The client needs mechanical ventilation
D. Blood is anticipated in the cerebral spinal fluid (CSF)
18) A client is admitted to the ER for head trauma is diagnosed with an epidural hematoma. The underlying cause of epidural hematoma is usually related to which of the following conditions?
A. Laceration of the middle meningeal artery
B. Rupture of the carotid artery
C. Thromboembolism from a carotid artery
D. Venous bleeding from the arachnoid space
19) The patient is newly diagnosed with encephalitis caused by herpes simplex virus (HSV) infection. What is essential for you to do?
A. Administer penicillin.
B. Administer acyclovir.
C. Perform a Glasgow Coma Scale assessment.
D. Facilitate a magnetic resonance imaging (MRI) study.
20) You have just admitted a patient with bacterial meningitis to the medical-surgical unit. The patient complains of a severe headache with photophobia and has a temperature of 102.60 F orally. Which collaborative intervention must be accomplished first?
A. Administer codeine 15 mg orally for the patient’s headache.
B. Infuse ceftriaxone (Rocephin) 2000 mg IV to treat the infection.
C. Give acetaminophen 650 mg orally to reduce the fever.
D. Give furosemide 40 mg IV to decrease intracranial pressure.
21) The nurse is caring for multiple clients in the emergency department. The client with which condition is at highest risk for distributive shock?
A. Severe head injury from a motor vehicle accident
B. Diabetes insipidus from polycystic kidney disease
C. Ischemic cardiomyopathy from severe coronary artery disease
D. Vomiting of blood from a gastrointestinal ulcer
22) The nurse is assessing a client who has hypovolemic shock. Which laboratory value indicates that the client is at risk for acidosis?
A. Decreased serum creatinine
B. Increased serum lactic acid
C. Increased urine specific gravity
D. Decreased partial pressure of arterial carbon dioxide
23) A client brought to the emergency department after a motor vehicle accident is suspected of having internal bleeding. Which question does the nurse ask to determine whether the client is in the early stages of hypovolemic shock?
A. “Are you more thirsty than normal?”
B. “When was the last time you urinated?”
C. “What is your normal heart rate?”
D. “Is your skin usually cool and pale?”
24) A client who has acidosis resulting from hypovolemic shock has been prescribed intravenous fluid replacement. Which fluid does the nurse prepare to administer?
A. Normal saline
B. Ringer’s lactate
C. 5% dextrose in water
D. 5% dextrose in 0.45% normal saline
25) The nurse is monitoring a client in hypovolemic shock who has been placed on a dopamine hydrochloride drip. Which manifestation is a desired response to this medication?
A. Decrease in blood pressure
B. Increase in heart rate
C. Increase in cardiac output
D. Decrease in mean arterial pressure
26) The nurse is caring for a client who has hypovolemic shock. After administering oxygen, what is the priority intervention for this client?
A. Administer an aminoglycoside.
B. Initiate a dopamine hydrochloride drip.
C. Administer crystalloid fluids.
D. Initiate an intravenous heparin drip
27) The nurse is administering prescribed sodium nitroprusside (Nipride) intravenously to a client who has shock. Which nursing intervention is a priority when administering this medication?
A. Ask if the client has chest pain every 30 minutes.
B. Assess the client’s blood pressure every 15 minutes.
C. Monitor the client’s urinary output every hour.
D. Observe the client’s extremities every 4 hours.
28) The nurse is caring for a client who has had an anaphylactic event. Which priority question does the nurse ask to determine whether the client is experiencing distributive shock?
A. “Is your blood pressure higher than usual?”
B. “Are you having pain in your throat?”
C. “Have you been vomiting?”
D. “Are you usually this swollen?”
29) A client who has septic shock is admitted to the hospital. What priority intervention does the nurse implement first?
A. Obtain two sets of blood cultures.
B. Administer the prescribed IV vancomycin.
C. Obtain central venous pressure (CVP) measurements.
D. Administer the prescribed IV norepinephrine (Levophed).
30) The nurse is assessing a client who was admitted for treatment of shock. Which manifestation indicates that the client’s shock is caused by sepsis?
A. Hypotension
B. Pale clammy skin
C. Anxiety and confusion
D. Oozing of blood at the IV site
31) A client was admitted 2 days ago with early stages of septic shock. Today the nurse notes that the client’s systolic blood pressure, pulse pressure, and cardiac output are decreasing rapidly. Which intervention does the nurse do first?
A. Insert a Foley catheter to monitor urine output closely.
B. Ask the client’s family to come to the hospital because death is near.
C. Initiate the prescribed dobutamine intravenous drip.
D. Obtain blood cultures before administering the next dose of antibiotics.
32) The nurse is assessing clients in the emergency department. Which client is at highest risk for developing septic shock?
A. 25-year-old man who has irritable bowel syndrome
B. 37-year-old woman who is 20% above ideal body weight
C. 68-year-old woman who is being treated with chemotherapy
D. 82-year-old man taking beta blockers for hypertension
33) The nurse is planning care for a client with late-phase septic shock. All of the following treatments have been prescribed. Which prescription does the nurse question?
A. Enoxaparin (Lovenox) 40 mg subcutaneous twice daily
B. Transfusion of 2 units of fresh frozen plasma
C. Regular insulin intravenous drip per protocol
D. Cefazolin (Ancef) 1 g IV every 6 hours
34) The nurse is assessing a client at risk for shock. The client’s systolic blood pressure is 20 mm Hg lower than baseline. Which intervention does the nurse perform first?
A. Increase the IV fluid rate.
B. Administer oxygen.
C. Notify the health care provider.
D. Place the client in high Fowler’s position.
35) A client recovering from septic shock is preparing for discharge home. What priority information does the nurse include in the teaching plan for this client?
A. “Clean your toothbrush with laundry bleach daily.”
B. “Bathe every other day with antimicrobial soap.”
C. “Wash your hands after changing pet litter boxes.”
D. “Use an electric razor when you shave your face.”
36) The nurse is planning discharge education for a client who had an exploratory laparotomy. Which nursing statement is appropriate when teaching the client to monitor for early signs of shock?
A. “Monitor how much urine you void and report a decrease in the amount.”
B. “Take your temperature daily and report any below-normal body temperatures.”
C. “Assess your radial pulse every day and report an irregular rhythm.”
D. “Monitor your bowel movements and report ongoing constipation or diarrhea.”
37) A client who has a local infection of the right forearm is being discharged. The nurse teaches the client to seek immediate medical attention if which complication occurs?
A. Dizziness on changing position
B. Increased urine output
C. Warmth and redness at site
D. Low-grade temperature
38) The intensive care nurse is caring for an intubated client who has severe sepsis that led to acute respiratory distress. Which nursing intervention is most appropriate during this stage of sepsis?
A. Check blood glucose levels every 4 hours.
B. Monitor intake and urinary output twice each shift.
C. Decrease ventilator rate and tidal volume.
D. Administer prescribed low-dose corticosteroids.
39) The nurse is assessing a client who has septic shock. The following assessment data were collected: Baseline Data Today’s Data
The nurse correlates these findings with which stage of shock?
A. Early
B. Compensatory
C. Intermediate
D. Refractory
40) The nurse is assessing a client who is in early stages of hypovolemic shock. Which manifestations does the nurse expect? (Select all that apply.)
A. Elevated heart rate
B. Elevated diastolic blood pressure
C. Decreased body temperature
D. Elevated respiratory rate
E. Decreased pulse rate
41) A client has septic shock. Which hemodynamic parameters does the nurse correlate with this type of shock? (Select all that apply.)
A. Decreased cardiac output
B. Increased cardiac output
C. Increased blood glucose
D. Decreased blood glucose
E. Increased serum lactate
F. Decreased serum lactate
42) A nurse is caring for a client after surgery who is restless and apprehensive. The unlicensed assistive personnel (UAP) reports the vital signs and the nurse sees they are only slightly different from previous readings. What action does the nurse delegate next to the UAP?
A. Assess the client for pain or discomfort.
B. Measure urine output from the catheter.
C. Reposition the client to the unaffected side.
D. Stay with the client and reassure him or her.
43) A nurse caring for a client notes the following assessments: WBC 3800, blood glucose level 198, and temperature 96.2° F. What action by the nurse takes priority?
A. Document the findings in the client’s chart.
B. Give the client warmed blankets for comfort.
C. Notify the health care provider immediately.
D. Prepare to administer insulin per sliding scale.
44) A nursing home patient presents to emergency room with fever, cloudy urine, and chest pain. Vital signs: 104.7degrees F, HR Afib 150’s, BP 70/40’s. Which of the following is INAPPROPRIATE?
A. Give fluids
B. Draw cultures and start antibiotics
C. Place a central line
D. Give nitroglycerin for chest pain
45) A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with cardiogenic shock?
A. Hypertension.
B. Bradycardia.
C. Bounding pulse.
D. Confusion.
46) A patient is demonstrating pulmonary edema, hypotension, and delayed capillary refill. The nurse suspects the patient is experiencing which type of shock?
A. Hypovolemic
B. Cardiogenic
C. Anaphylactic
D. Obstructive
47) A patient, experiencing vasodilation, is diagnosed with distributive shock. The nurse will assess the patient for which etiologies? Select all that apply.
A. Sepsis
B. Spinal cord injury
C. Anaphylaxis
D. Hemorrhage
E. Pulmonary embolism
48) The nurse is concerned that a patient is at risk for developing obstructive shock because of which assessment findings? Select all that apply.
A. Age 80
B. History of atrial fibrillation
C. Bacteremia
D. T3 spinal cord injury
E. Latex allergy
49) The nurse is caring for a patient recovering from a spinal cord injury sustained during a motor vehicle crash. What assessment findings indicate that the patient is developing neurogenic shock?
A. Hypotension
B. Bradycardia
C. Warm dry skin
D. Abdominal cramps
E. Palpitations
50) A patient is experiencing acute respiratory distress after eating an item of a known food allergy. What interventions will the nurse implement when providing emergency care to this patient? Select all that apply.
A. Administer epinephrine 1:1000 intramuscularly.
B. Apply oxygen via face mask as prescribed.
C. Provide diphenhydramine 25 mg intravenous.
D. Administer vasopressin.
E. Prepare to administer antithrombolytic agents as prescribed.
Answers and Rationales
1) B- The client is experiencing signs of increased intracranial pressure (ICP). Raising the head of the bed would help decrease ICP. The health care provider should then be notified immediately so that other interventions to reduce ICP can be instituted. Assessing vital signs and white blood cell count is not the priority at this time.
2) B- This type of fracture may cause hemorrhage from damage to the internal carotid artery. The other problems are not complications of this injury.
3) C- Respiratory malfunctions (hypoxemia, hypercarbia, alterations in pH) can contribute to secondary brain injury in this scenario. The important priority is assessment of respiratory status so that secondary brain injury conditions are avoided. Any condition that causes a 50% decrease in blood flow to the brain will cause loss of consciousness. The other assessments should be performed after effective respiratory functions have been established.
4) C. When intracranial pressure cannot be controlled by other means, clients may be placed in a barbiturate coma to decrease cerebral metabolic demands, decrease formation of vasogenic edema, and produce a more uniform blood supply to the brain. The other responses do not correctly explain the reason for a medication-induced coma. Pain medication should be administered when the client is comatose.
5) A- Mannitol is used for acute reduction in ICP. Lasix, NS or hypertonic solutions are also used for less acute situations, but no dextrose of free water (increases ICP). Caution is needed to keep SBP > 90 and MAP at least 65. Maintaining the HOB elevated 30 degrees with the head and neck neutral position also prevents ICP increase. Patients can be given mannitol while in a barbiturate-induced coma.
6) D- Midazolam (Versed) is a benzodiazepine agent used to sedate patients on vents, especially for autononomic dysreflexia (overstimulation of autonomic nervous system in SCI). Sx: HA, sweating, HTN). Overfilling of the bladder is main cause.
7) C- Developing a home routine that provides structure and repetition is recommended because clients with personality and behavior problems respond best to this type of environment. The client’s personality and emotional functioning will never return to normal. The client may be aggressive, and family members must be aware of potential client reactions.
8) A. Aseptic technique to prevent infection- An intraventricular catheter provides direct access for microorganisms to enter the ventricles of the brain. Constant monitoring of ICP waveforms is not usually necessary, and removal of CSF for sampling or to maintain normal ICP is done only when specifically ordered.
9) B. Cushing's triad consists of three vital sign measures that reflect ICP and its effect on the medulla, hypothalamus, pons, and thalamus. These structures are very deep, so Cushing's triad is a late sign of elevated ICP. Normal ICP is 5 to 15; moderately increased 15-40; severely increased 40 & above. Indicates brain stem compromise; usually treated when consistently stays > 20. VS changes are increased B/P with wide pulse pressure, bradycardia, and abnormal respirations.
10) B. Cerebral perfusion pressure (CPP) is the pressure required to perfuse the brain cells and is more reliable than ICP. CPP is the difference between the MAP & ICP: CPP = MAP – ICP. Normal = 70-90; Decreased = <60 mm/Hg (cerebral ischemia, leading to cerebral edema). CPP is maintained by raising the MAP or by lowering the ICP.
11) C
12) D
13) B. Check the fluid for dextrose with a dipstick for the presence of dextrose, which confirms CSF leakage. The nose wouldn’t be suctioned because of the risk for suctioning brain tissue through the sinuses. Nothing is inserted into the ears or nose of a client with a skull fracture because of the risk of infection. Battle’s sign is an ecchymosis discoloration behind the ear in the line of the posterior auricular artery, often associated with a basilar skull fracture.
14) A, B, E
15) A, C, D
16) C. A change or decrease in LOC is the earliest and most sensitive indicator of increased ICP. A decrease in LOC will occur before changes in vital signs, ocular signs, and projectile vomiting occur (increased ICP on medulla). Cri-du- Ca “cry of the cat” occurs in infants.
17) B. Sudden removal of CSF results in pressures lower in the lumbar area than the brain, causing brain herniation; therefore, LP is contraindicated with increased ICP. Vomiting may be caused by reasons other than increased ICP, so
LP isn’t strictly contraindicated. An LP may be performed on clients needing mechanical ventilation. Blood in the CSF is diagnostic for subarachnoid hemorrhage and the diagnosis was obtained before signs and symptoms of ICP.
18) Epidural hematoma is usually caused by laceration of the middle meningeal artery and requires immediate surgery to remove the clot. A subdural hematoma is usually caused by venous bleeding from the arachnoid space and surgery is needed within 24 hr. Intracerebral hemorrhage is inoperable.
19) B. Encephalitis is usually viral, and treated with antiviral acyclovir (Zovirax). Penicillin is used for bacterial meningitis. Because diagnosis is known, treatment of cause is more important than additional assessment. Encephalitis affects cortex and meninges and caused by viruses. S/S: personality/behavioral changes, agitation, restlessness, alterations in consciousness, motor problems, olfactory & taste hallucinations.
20) B. Untreated bacterial meningitis has a 100% mortality rate, so rapid antibiotic treatment is essential. The other interventions will help reduce CNS stimulation and irritation, and should be implemented as soon as possible. Meningitis affects meninges, cranial nerves, and brain tissue and can be bacterial, viral, or fungal. Common in children under5, becoming more prevalent in immunocompromised patients. Diagnosis with CSF analysis. S/S: altered mental status, HA, fever, Meningismus (sx of meningitis without infection), positive Kernig’s sign (nuchal rigidity- flexion of knee and hip causes pain), positive Brudzinski’s sign (involuntary flexion of hip and knee when neck is flexed). Management: antibiotics, dexamethasone, seizure control, fever control, universal precautions.
21) A. Distributive shock is a type of shock that occurs when blood volume is not lost from the body but is distributed to the interstitial tissues, where it cannot circulate and deliver oxygen. Neurally-induced distributive shock may be caused by pain, anesthesia, stress, spinal cord injury, or head trauma. The other clients are at risk for hypovolemic and cardiogenic shock.
22) B. The syndrome of hypovolemic shock results in inadequate tissue perfusion and oxygenation, leading to anaerobic cell metabolism. This increases lactic acid production, resulting in an increase in hydrogen ion production and metabolic acidosis. IV sodium bicarb may be given. Other laboratory values associated with acidosis include increased creatinine (impaired renal function) and increased paCO2. Urine specific gravity is not associated with acidosis.
23) C. The first manifestations of hypovolemic shock result from compensatory mechanisms. Changes in cardiovascular function are the first signs of shock. As shock progresses, changes in skin, respiration, and kidney function progress. The other questions would not identify early stages of shock.
24) B. Ringer’s lactate is an isotonic solution that acts as a volume expander. The lactate acts as a buffer in the presence of acidosis. The other solutions don’t contain buffers that would correct the client’s acidosis. [Show Less]