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NRNP 6566 Week 4 Knowledge Check

1. A 47-year-old male admitted with an infected elbow wound. On his second day in the hospital you find him in his room confused and agitated. Vital signs are as follows: Temperature – 96.2 °F. What is your working diagnosis?
2. A 50-year-old woman is thought to be in septic shock. What physical assessment findings would you expect to find to confirm this type of shock?
3. A 56-year-old man is thought to be in hypovolemic shock. What are the initial interventions for a patient in hypovolemic shock?
4. A 44-year-old man is thought to be in cardiogenic shock. What are the initial interventions needed for a patient in cardiogenic shock?
5. What is the mechanism of action and common side effects of dobutamine, norepinephrine, labetalol, and amiodarone?
6. A 56-year-old Caucasian man is seen in the office as a new patient. He complains of headaches occurring with increasing frequency and attributes them to increased stress at work. He denies any chest pain, shortness of breath, or dyspnea. He smokes one pack cigarettes per day and has two glasses of wine with dinner. Physical exam – obese main (BMI 30) in no apparent distress. BP R arm 168/98 L arm 170/94. HR 64 regular. No thryomegly or lymphadenopathy. Fundascopic exam reveals narrowing of the arteries and arteriovenous nicking. Cardiac exam reveals that his point of maximal impulse (PMI) if displaced 2 cm to the left of the midclavicular line (MCL). No murmurs noted. Lung and abdomen examinations are normal. What tests should be ordered for this patient?
7. A 47-year-old male admitted with an infected elbow wound. On his second day in the hospital, you find him in his room confused and agitated.

• Vital signs are as follows:
• Temperature – 96.2 °F
• Pulse -140 beats per minute
• Respirations – 40 breaths per minute
• Blood Pressure – 90/40 mmHg
• Labs include a WBC count of 3,000
• Pt weighs 185 pounds
• Further assessment of him includes:
  • Urine output of 100cc for the last 8 hours
  • Pulse oximetry of 88% on room air
  • Pallor
• What initial diagnostics should the AGACNP order?

8. A 56 year old Caucasian man is seen in the office as a new patient. He complains of headaches occurring with increasing frequency and attributes them to increased stress at work. He denies any chest pain, shortness of breath, or dyspnea. He smokes one pack cigarettes per day and has two glasses of wine with dinner. Physical exam – obese main (BMI 30) in no apparent distress. BP R arm 168/98 L arm 170/94. HR 64 regular. No thryomegly or lymphadenopathy. Funduscopic exam reveals narrowing of the arteries and arteriovenous nicking. Cardiac exam reveals that his point of maximal impulse (PMI) if displaced 2 cm to the left of the midclavicular line (MCL). No murmurs noted. Lung and abdomen examinations are normal. 
9. How would you explain PMI being displaced 2 cm to the left of the MCL? A 44 year old man is thought to be in cardiogenic shock. What physical assessment findings would you expect to find to confirm this type of shock?

10. What is the difference between dopamine and dobutamine?