A nurse and a newly licensed nurse are providing care for a client who has distributive shock. How should the nurse explain the pathophysiology of distributive shock to the newly licensed nurse?
"Distributive shock occurs due to increased systemic vascular resistance."
"Distributive shock occurs due to systemic vasodilation."
"Distributive shock occurs due to loss of myocardial contractility."
"Distributive shock occurs due to loss of blood volume."
The Correct Answer is B
A. Increased systemic vascular resistance is typically associated with hypovolemic or cardiogenic shock, not distributive shock.
B. Distributive shock is characterized by systemic vasodilation, which leads to a decrease in systemic vascular resistance and results in inadequate tissue perfusion despite normal or increased cardiac output.
C. Loss of myocardial contractility is related to cardiogenic shock, not distributive shock.
D. Loss of blood volume is a characteristic of hypovolemic shock, whereas distributive shock occurs even when blood volume is normal due to vasodilation.
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Correct Answer is C
Explanation
A. Abuse refers to the mistreatment of a patient, which does not apply to this scenario as the issue was an error rather than intentional harm.
B. Battery involves intentional and wrongful physical contact with another person; while the wrong medication is harmful, it was not an intentional act of violence.
C. Malpractice is the correct choice because it involves negligence in the professional duties of a healthcare provider, resulting in harm to a patient. The nurse failed to adhere to the standard of care by administering the incorrect medication.
D. Assault refers to the threat of harm or the act of creating fear of harm in another person, which is not applicable in this scenario since the nurse did not threaten the client.
Correct Answer is B
Explanation
A. Fluid overload is not an allergic reaction but rather a complication of transfusion related to the volume of fluid administered, thus diphenhydramine would not be appropriate.
B. Urticaria, or hives, is a common mild allergic reaction that can occur during blood transfusions. Administering diphenhydramine can help prevent or treat this response.
C. Hemolysis is a serious reaction involving the destruction of red blood cells, often due to blood type incompatibility; it is not alleviated by antihistamines.
D. Fever can occur during transfusions but is typically due to non-specific immune reactions and does not respond to diphenhydramine.