A nurse is providing care for a client experiencing obstructive shock. Which of the following diagnoses should the nurse expect?
Cardiac tamponade
Third spacing
Ruptured aneurysm
Cardiomyopathy
The Correct Answer is A
A. Cardiac tamponade is a condition where fluid accumulates in the pericardial space, exerting pressure on the heart and impeding its ability to pump effectively, leading to obstructive shock.
B. Third spacing refers to fluid accumulation in the interstitial spaces but is not a specific diagnosis of obstructive shock.
C. A ruptured aneurysm may lead to hypovolemic shock due to blood loss rather than obstructive shock, which is characterized by physical obstruction to blood flow.
D. Cardiomyopathy is a disease of the heart muscle that affects its ability to pump blood, leading to cardiogenic shock, not obstructive shock.
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Correct Answer is C
Explanation
A. DIC is characterized by a low platelet count due to the consumption of platelets in the coagulation process, not an elevated count.
B. While heparin may be used in the management of DIC in some cases, it is not a lifelong treatment nor a cure for the condition, as DIC results from an underlying condition rather than being a standalone disease.
C. DIC involves the overactivation of the coagulation cascade, leading to the formation of fibrin clots and subsequent consumption of clotting factors and platelets, thus making this statement accurate.
D. DIC is not a genetic disorder but rather a complication often associated with severe infections, trauma, or other conditions, and it is not primarily due to vitamin K deficiency.
Correct Answer is C
Explanation
A. Decreased groin pain is not an indicator of therapeutic response specific to the effects of epinephrine in treating angioedema.
B. While tolerating a second dose of medication with minimal peripheral edema is positive, it does not directly reflect the immediate therapeutic effects of epinephrine.
C. Unlabored respirations indicate improved airway patency and reduced bronchoconstriction, which are key therapeutic outcomes of epinephrine administration in angioedema.
D. Blood pressure returning to premedication levels is beneficial but is not the most immediate indicator of epinephrine's therapeutic effect in managing angioedema.