A nurse is caring for a client who is being treated for acute myocardial infarction. The nurse knows that some clients with acute MI go on to develop cardiogenic shock, which can be fatal. Based on the nurse's understanding of this condition, the nurse knows to look for which of the following signs of cardiogenic shock?
a. Muscle and/or joint pain
b. Hypotension of less than 100 mmHg systolic for more than 15 minutes
c. Oliguria and poor peripheral pulses
d. Hot, flushed extremities
c. Oliguria and poor peripheral pulses
rationale: Cardiogenic shock is a serious complication that can develop following cardiac surgery or an injury to the heart, such as a myocardial infarction. Cardiogenic shock develops when the body cannot get blood to the tissues and organs because of a problem with the heart. Signs and symptoms are associated with decreased tissue perfusion and include low blood pressure (SBP<90 mmHg or 30 mmHg lower than the client's baseline), poor peripheral pulses, tachycardia, tachypnea, pulmonary congestion, disorientation and confusion, cool extremities, and decreased urine output.
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