Question 1

When SIRS is the result of infection, it is called
A) inflammation.
B) anaphylaxis.
C) sepsis.
D) pneumonia.

Accepted Answer

When SIRS is the result of infection, the term sepsis is used.

Question 2

The gastrointestinal system is a common target organ for MODS related to
A) anorexia.
B) limited or absent food ingestion.
C) disruption of the mucosal barrier from hypoperfusion.
D) a decrease in hydrochloric acid secretion.

Accepted Answer

With microcirculatory failure to the gastrointestinal tract, the gut's barrier function may be lost, which leads to bacterial translocation, sustained inflammation, endogenous endotoxemia, and MODS.

Question 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.

Accepted Answer

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.

Question 4

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.The medical management of the patient's condition is aimed toward
A) limiting fluids to minimize the possibility of congestive heart failure.
B) finding and eradicating the cause of infection.
C) discontinuing invasive monitoring as a possible cause of sepsis.
D) administering vasodilator substances to increase blood flow to vital organs.

Accepted Answer

Effective treatment of severe sepsis and septic shock depends on timely recognition.The diagnosis of severe sepsis is based on the identification of three conditions: known or suspected infection, two or more of the clinical indications of the systemic inflammatory response, and evidence of at least one organ dysfunction.Clinical indications of systemic inflammatory response and sepsis were included in the original American College of Chest Physicians/Society of Critical Care Medicine consensus definitions.

Question 5

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.

Accepted Answer

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.

Question 6

Which of the following drugs promotes bronchodilation and vasoconstriction?
A) Solu-Medrol
B) Gentamicin
C) Atropine
D) Epinephrine

Accepted Answer

Epinephrine is given in anaphylactic shock to promote bronchodilation and vasoconstriction and inhibit further release of biochemical mediators.

Question 7

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.

Accepted Answer

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.

Question 8

Which of the following clinical manifestations is not suggestive of systemic inflammatory response syndrome (SIRS)?
A) Temperature of 37.5° C
B) Heart rate of 95 beats/min
C) Respiratory rate of 24 breath/min
D) White blood cell (WBC) count of 15,000 cells/mm3

Accepted Answer

SIRS occurs when two or more of four clinical manifestations are present in the patient at high risk.These manifestations are temperature less than 36° C or greater than 38° C, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min or PaCO? less than 32 mm Hg, or WBC greater than 12,000 cells/mm³ or less than 4000 cells/mm³ or greater than 10% immature (band forms).

Question 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

Accepted Answer

Increased cardiac output and decreased systemic vascular resistance are classic signs of septic shock.

Question 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.

Accepted Answer

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.

Question 11

A patient is admitted to the intensive care unit after she develops disseminated intravascular coagulation (DIC)after a vaginal delivery.DIC is known to occur in patients with retained placental fragments.What is the result of DIC?
A) Hypersensitive response to an antigen, resulting in anaphylaxis
B) Depletion of clotting factors and excessive fibrinolysis, resulting in simultaneous microvascular clotting and hemorrhage
C) Vasodilatation, resulting in hypotension
D) Septic shock, resulting in vasodilation and decreased perfusion

Accepted Answer

DIC results simultaneously in microvascular clotting and hemorrhage in organ systems, leading to thrombosis and fibrinolysis in life-threatening proportions.Clotting factor derangement leads to further inflammation and further thrombosis.Microvascular damage leads to further organ injury.Cell injury and damage to the endothelium activate the intrinsic or extrinsic coagulation pathways.

Question 12

Signs of hypovolemia in the trauma patient include
A) distended neck veins.
B) a decreased level of consciousness.
C) bounding radial and pedal pulses.
D) a widening pulse pressure.

Accepted Answer

Signs of underperfusion include flattened neck veins, a decreased level of consciousness, weak and thready peripheral pulses, and a narrowed pulse pressure.

Question 13

The difference between primary and secondary multiple organ dysfunction syndrome (MODS)is that primary MODS is the result of
A) widespread systemic inflammation that results in dysfunction of organs not involved in the initial insult.
B) direct organ injury.
C) disorganization of the immune system response.
D) widespread disruption of the coagulation system.

Accepted Answer

Organ dysfunction may be the direct consequence of an initial insult (primary MODS)or can manifest latently and involve organs not directly affected in the initial insult (secondary MODS).Patients can experience both primary and secondary MODS.Primary MODS results from a well-defined insult in which organ dysfunction occurs early and is directly attributed to the insult itself.

Question 14

Shock syndrome 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.

Accepted Answer

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.

Question 15

Clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult.Which symptom below is indicative of hepatic insufficiency?
A) Elevated serum creatinine
B) Decreased bilirubin
C) Jaundice
D) Decreased serum transaminase

Accepted Answer

Clinical manifestations of hepatic insufficiency are evident 1 to 2 days after the insult.Jaundice and transient elevations in serum transaminase and bilirubin levels occur.Hyperbilirubinemia results from hepatocyte anoxic injury and an increased production of bilirubin from hemoglobin catabolism.

Question 16

A vasoconstrictor used to treat shock is
A) adrenaline.
B) Nipride.
C) Dobutrex.
D) adenosine.

Accepted Answer

Adrenaline is a vasoconstrictor, Nipride is a vasodilator, Dobutrex is an inotrope, and adenosine is an antidysrhythmic.

Question 17

The patients at highest risk for neurogenic shock are those who have had
A) a stroke.
B) a spinal cord injury.
C) Guillain-Barré syndrome.
D) a craniotomy.

Accepted Answer

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.

Question 18

Which medications are not effective in the immediate treatment of acute anaphylaxis?
A) Epinephrine
B) Vasopressors
C) Diphenhydramine (Benadryl) IV
D) Corticosteroids

Accepted Answer

Epinephrine is the first-line treatment of choice for anaphylaxis and should be administered when initial signs and symptoms occur.Several medications are used as second-line adjunctive therapy.Inhaled b-adrenergic agents are used to treat bronchospasm unresponsive to epinephrine.Diphenhydramine (Benadryl)given 1 to 2 mg/kg (25  0-50 mg)by a slow intravenous line is used to block histamine response.Ranitidine, given in conjunction with diphenhydramine at a dose of 1 mg/kg intravenously over 10 to 15 minutes, has been found helpful.Corticosteroids are not effective in the immediate treatment of acute anaphylaxis but may be given with the goal of preventing a prolonged or delayed reaction.

Question 19

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

Accepted Answer

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.

Question 20

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

Accepted Answer

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.

Quiz 26: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome

When SIRS is the result of infection, it is called

The gastrointestinal system is a common target organ for MODS related to

The nursing measure that can best enhance large volumes of fluid replacement in hypovolemic shock is

Hypovolemic shock that results from an internal shifting of fluid from the intravascular space to the extravascular space is known as

Which of the following drugs promotes bronchodilation and vasoconstriction?

The main cause of cardiogenic shock is

Which of the following clinical manifestations is not suggestive of systemic inflammatory response syndrome (SIRS) ?

A patient is admitted to the intensive care unit after she develops disseminated intravascular coagulation (DIC) after a vaginal delivery.DIC is known to occur in patients with retained placental fragments.What is the result of DIC?

Signs of hypovolemia in the trauma patient include

The difference between primary and secondary multiple organ dysfunction syndrome (MODS) is that primary MODS is the result of

Shock syndrome can best be described as a

Clinical manifestations of ischemic hepatitis show up 1 to 2 days after the insult.Which symptom below is indicative of hepatic insufficiency?

A vasoconstrictor used to treat shock is

The patients at highest risk for neurogenic shock are those who have had

Which medications are not effective in the immediate treatment of acute anaphylaxis?

With anaphylactic shock, which mechanism results in a decreased cardiac output?

Which of the following hemodynamic parameters supports the diagnosis of cardiogenic shock?