MED SURG SHOCK QUESTIONS WITH ANSWERS & RATIONALES 2023-2024
Chapter 26: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
1. Shock syndrome
... [Show More] can best be described as a
a. physiologic state resulting in hypotension and tachycardia.
b. generalized systemic response to inadequate tissue perfusion.
c. degenerative condition leading to death.
d. condition occurring with hypovolemia that results in irreversible hypotension.
ANS: B
Shock is a complex pathophysiologic process that often results in multiple organ dysfunction syndrome and death. All types of shock eventually result in ineffective tissue perfusion and the development of acute circulatory failure.
2. Hypovolemic shock that results from an internal shifting of fluid from the intravascular space to the extravascular space is known as
a. absolute hypovolemia.
b. distributive hypovolemia.
c. relative hypovolemia.
d. compensatory hypovolemia.
ANS: C
Hypovolemia results in a loss of circulating fluid volume. A decrease in circulating volume leads to a decrease in venous return, which results in a decrease in end-diastolic volume or preload.
3. The nursing measure that can best enhance large volumes of fluid replacement in hypovolemic shock is
a. insertion of a large-diameter peripheral intravenous catheter.
b. positioning the patient in the Trendelenburg position.
c. forcing at least 240 mL of fluid each hour.
d. administering intravenous lines under pressure.
ANS: A
Measures to facilitate the administration of volume replacement include insertion of large-bore peripheral intravenous catheters; rapid administration of prescribed fluids; and positioning the patient with the legs elevated, trunk flat, and head and shoulders above the chest.
4. The main cause of cardiogenic shock is
a. an inability of the heart to pump blood forward.
b. hypovolemia, resulting in decreased stroke volume.
c. disruption of the conduction system when re-entry phenomenon occurs.
d. an inability of the heart to respond to inotropic agents.
ANS: A
Cardiogenic shock is the result of failure of the heart to effectively pump blood forward. It can occur with dysfunction of the right or the left ventricle or both. The lack of adequate pumping function leads to decreased tissue perfusion and circulatory failure.
5. Which of the following hemodynamic parameters supports the diagnosis of cardiogenic shock?
a. Increased right atrial pressure
b. Decreased pulmonary artery wedge pressure
c. Increased cardiac output
d. Decreased cardiac index ANS: D
Assessment of the hemodynamic parameter of patients in cardiogenic shock reveals a decreased cardiac output and a cardiac index less than 2.2 L/min/m2.
6. With anaphylactic shock, which mechanism results in a decreased cardiac output?
a. Peripheral vasodilation
b. Increased cardiac output
c. Decreased alveolar ventilation
d. Fluid retention resulting in congestive heart failure ANS: A
Peripheral vasodilation results in decreased venous return. This decreases intravascular volume and the development of relative hypovolemia. Decreased venous return results in decreased stroke volume and a fall in cardiac output.
7. Which of the following drugs promotes bronchodilation and vasoconstriction?
a. Solu-Medrol
b. Gentamicin
c. Atropine
d. Epinephrine ANS: D
Epinephrine is given in anaphylactic shock to promote bronchodilation and vasoconstriction and inhibit further release of biochemical mediators.
8. The patients at highest risk for neurogenic shock are those who have had
a. a stroke.
b. a spinal cord injury.
c. Guillain-Barr syndrome.
d. a craniotomy.
ANS: B
The most common cause is spinal cord injury (SCI). Neurogenic shock may mistakenly be referred to as spinal shock. The latter condition refers to loss of neurologic activity below the level of SCI, but it does not necessarily involve ineffective tissue perfusion.
9. A patient has been on the medical floor for 1 week after a vaginal hysterectomy. A urinary catheter was inserted. Complete blood cell count results have revealed escalating white blood cell counts. The patient is transferred to the critical care unit when her condition deteriorates. Septic shock is diagnosed. A pulmonary artery catheter is placed. Which of the following hemodynamic values would you expect to find?
a. Cardiac output of 8 L/min
b. Right atrial pressure of 17 mm Hg
c. Pulmonary artery wedge pressure of 23 mm Hg
d. Systemic vascular resistance of 1100 ANS: A
Increased cardiac output and decreased systemic vascular resistance are classic signs of septic shock.
10. A patient has been on the medical floor for 1 week after a vaginal hysterectomy. A urinary catheter was inserted. Complete blood cell count results have revealed escalating white blood cell counts. The patient is transferred to the critical care unit when her condition deteriorates. Septic shock is diagnosed. Which of the following is the pathophysiologic mechanism that results in septic shock?
a. Bacterial toxins lead to vasodilation.
b. Increased white blood cells are released to fight invading bacteria.
c. Microorganisms invade organs such as the kidneys and heart.
d. An increase of white blood cells leads to decreased red blood cell production and anemia.
ANS: A
The syndrome encompassing severe sepsis and septic shock is a complex systemic response that is initiated when a microorganism enters the body and stimulates the inflammatory or immune system. Shed protein fragments and the release of toxins and other substances from the microorganism activate the plasma enzyme cascades (complement, kinin and kallikrein, coagulation, and fibrinolytic factors), as well as platelets, neutrophils, monocytes, and macrophages. [Show Less]