NCLEX-RN

Category - Physiological

A client who was rushed to the emergency department for myocardial infarction is now presenting symptoms of shock. The nurse assigned to this client documented giving morphine for the pain. Further assessment shows increasing difficulty breathing but with the absence of chest pain. The client is most probably experiencing which kind of shock?
  1. Cardiovascular shock
  2. Hypovolemic shock
  3. Anaphylactic shock
  4. Neurogenic shock
Explanation
Answer: C - If there is no chest pain but the client still has increasing difficulty breathing, further evaluation is needed to verify anaphylactic shock. The client may be having an allergic reaction to the morphine. Initial management is to check for bronchospasm or bronchoconstriction to avoid respiratory arrest. The nurse must also monitor for hives or swelling of the tongue, face or hands.
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