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A nurse is providing care for a client experiencing obstructive shock. Which of the following diagnoses should the nurse expect?

A.

Cardiac tamponade

B.

Third spacing

C.

Ruptured aneurysm

D.

Cardiomyopathy

Answer and Explanation

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 D

Explanation

A. The conversion of RNA into DNA is a critical step in the HIV lifecycle, but it does not directly lead to opportunistic infections; instead, it allows the virus to integrate into the host’s genome.

B. Having reverse transcriptase enzyme is a characteristic of retroviruses like HIV that facilitates replication, but it does not cause opportunistic infections directly.

C. HIV containing a single strand of genetic material is a feature of its classification as a retrovirus but is not related to the risk of opportunistic infections.

D. The ability of HIV to target and destroy CD4 lymphocytes is the key reason for opportunistic infections. CD4 cells are crucial for the immune response, and their depletion leads to immunosuppression, making the client susceptible to infections that would not typically affect an individual with a healthy immune system.

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