Question 8
The AGACNP is managing a patient in the ICU who is being treated for a pulmonary
embolus. Initially the patient was stable, awake, alert, and oriented, but during the last
several hours the patient has become increasingly lethargic. At change of shift, the
oncoming staff nurse appreciates a profound change in the patient’s mental status from
the day before. Vital signs and hemodynamic parameters are as follows: BP 88/54 mm
Hg Pulse 110 bpm Respiratory rate 22 breaths per minute Sa02 93% on a 50% mask
Systemic vascular resistance (SVR) 1600 dynes . sec/cm5 Cardiac index 1.3 L/min
Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most
consistent with which shock state?
A. Hypovolemic
B. Cardiogenic C. Distributive
D. Obstructive

Question 10
Mitch C . is a 39 – year-old male who is brought to the ED by paramedics . According to the
report of a neighbor , Mitch was distraught over a breakup with his fiancee and
attempted to commit suicide by mixing some chemicals from under his kitchen sink and
drinking them ; afterward he changed his mind and knocked on his neighbor’s door
asking for help . Mitch is awake but stuporous , and the neighbor has no idea what he
frank . Visual inspection of his mouth and oropharynx reveals some edema and
erythema . He is coughing and has large amounts of pooling saliva . Mitch is not capable
of answering questions but he appears in pain . Endoscopy reveals full thickness
mucosal injury with mucosal sloughing , ulceration , and exudate . The AGACNP knows
that the appropriate course of treatment must include
A . At least 6 hours of observation in the emergency department B. Periodic
esophagram
C . Aggressive fluid resuscitation D . Esophagogastrectomy