Deck 30: Shock

Question 1

Which of the following hemodynamic assessments can be obtained from a pulmonary capillary wedge pressure measurement?

A) Central venous pressure
B) Right ventricular preload
C) Left ventricular afterload
D) Left ventricular preload

Answer 1

D
The use of PA catheters in children is supported by the American College of Critical Care Medicine for circumstances in which irreversible shock manifesting as poor perfusion, acidosis, and hypotension persists despite the use of therapies directed at the arterial blood pressure, CVP pressure, and oxygen saturation indices. In addition to the measurements obtained directly from the catheter, a number of derived values provide information regarding the homeostatic function of the child, including systemic vascular resistance as a measure of afterload and oxygen consumption and oxygen extraction.

Question 2

During the treatment of sepsis, what intervention may be needed if hypotension persists despite the maximal application of inotropic and vasomotor support?

A) Endotracheal intubation and mechanical ventilation
B) High-frequency oscillatory ventilation
C) Extracorporeal membrane oxygenation
D) Hyperbaric oxygenation

Answer 2

C
Patients remaining in shock despite the supportive therapies may benefit from mechanical cardiac support, such as extracorporeal membrane oxygenation (ECMO).

Question 3

A measure of the resistance or force against which the heart must pump defines which of the following terms?

A) Preload
B) Afterload
C) Inotropy
D) Chronotropy

Answer 3

B
Afterload is a measure of the resistance or force against which the heart must pump.

Question 4

A child has been treated for shock with 60 mL/kg of normal saline. What should be considered at this time?

A) Administer an additional 20 mL/kg bolus of fluids
B) Switch to lactated Ringer's solution
C) Start vasopressors
D) Alternate normal saline and Ringer's solution

Question 5

A 7-year-old patient with dehydration is evaluated in the emergency department. What type of shock is most commonly associated with diabetic ketoacidosis?

A) Hypovolemic
B) Cardiogenic
C) Obstructive
D) Distributive

Question 6

Which of the following microorganisms are likely responsible for neonatal meningitis?
I) Group B Streptococcus
II) Neisseria meningitidis
III) Escherichia coli
IV) Listeria monocytogenes

A) I and IV only
B) II and III only
C) III and IV only
D) I, III, and IV only

Question 7

In which of the following clinical situations may the administration of packed red blood cells be indicated?

A) When a patient demonstrates leukopenia
B) When a patient shows evidence of anemia
C) When the risk of sepsis is present
D) When a patient shows evidence of hypovolemic shock

Question 8

What is the mainstay of therapy for patients with anaphylactic shock?

A) Vasopressin
B) Dopamine
C) Epinephrine
D) IV fluids

Question 9

Which of the following can be obtained from a central venous pressure measurement?

A) Stroke volume
B) Afterload
C) Preload
D) Myocardial contractility

Question 10

A respiratory therapist has intubated a child with septic shock who has also received intravenous fluids and vasopressors. What condition could explain a lack of response to therapy?

A) Administration of the wrong fluid
B) Inadequate dose of vasopressors
C) Hypoxia
D) Adrenal insufficiency

Question 11

Which of the following signs is one of the first to indicate decreased peripheral perfusion in children?

A) Tachycardia
B) Bradycardia
C) Hypotension
D) Dyspnea

Question 12

A respiratory therapist is gathering equipment to intubate a patient with anaphylactic shock who has severe bronchospasm. What is one of the most prominent inflammatory mediators responsible for the increase in airway resistance and fall in the PaO₂?

A) Epinephrine
B) Histamine
C) Interleukin
D) IgE

Question 13

A child is receiving aggressive therapy for septic shock. Which of the following inotropes is the most frequently used under these circumstances?

A) Epinephrine
B) Dopamine
C) Norepinephrine
D) Digitalis

Question 14

Assessment of an infant suspected of having shock reveals skin that is warm, pink, and well perfused. How should the therapist interpret these findings?

A) The infant has hypovolemic shock.
B) The infant has late cardiogenic shock.
C) The patient has decreased cardiac output.
D) The patient may have early septic shock.

Question 15

How should the therapist interpret a capillary refill time of approximately 1 second in a pediatric patient?

A) Adequate cardiac output
B) Increased afterload
C) Inadequate cardiac output
D) Decreased preload

Question 16

A therapist is calculating oxygen delivery for a patient admitted with a diagnosis of shock. Which of the following parameters should the therapist measure?
I. O₂ content
II. PaCO₂
III. RBC level
IV. Cardiac output

A) I, II, and IV only
B) II, III, and IV only
C) I and IV
D) I, II, and III only

Question 17

A child admitted to the emergency department with a diagnosis of shock has a cardiac index of 3.5 L/min/m². How should the therapist interpret this value?

A) This cardiac index is associated with an increased risk of mortality.
B) This cardiac index is in the high range of normal, and it is an indication to wean vasopressors and fluids.
C) This cardiac index is within normal limits but still requires close monitoring because it is in the low range of normal.
D) This cardiac index is normal and no action is required.

Question 18

When cardioversion is indicated, at what point during the cardiac cycle must it be applied?

A) In synchrony with the QRS complex
B) Synchronously with the appearance of the P wave
C) Immediately before the ST segment
D) At any point during the cardiac cycle

Question 19

Which vascular site would provide the most reliable measurement of the beat-to-beat monitoring of the blood pressure in an infant who is suspected of having shock?

A) Any vessel
B) Any peripheral vein
C) A peripheral or central artery
D) A central vein

Question 20

Which of the following types of shock is the most common among children?

A) Hypovolemic
B) Cardiogenic
C) Obstructive
D) Distributive