Deck 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome

Question 1

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

Answer 1

Decreased cardiac index

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.

Answer 2

disruption of the mucosal barrier from hypoperfusion.

Question 3

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.

Answer 3

relative hypovolemia.

Question 4

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.

Question 5

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.

Question 6

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

Question 7

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

Question 8

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.

Question 9

A vasoconstrictor used to treat shock is

A) adrenaline.
B) Nipride.
C) Dobutrex.
D) adenosine.

Question 10

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.

Question 11

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.

Question 12

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

A) Epinephrine
B) Vasopressors
C) Diphenhydramine (Benadryl) IV
D) Corticosteroids

Question 13

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

Question 14

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.

Question 15

Immunoglobulin E (IgE)-mediated anaphylactic shock occurs as a result of

A) direct activation of mast cells.
B) laryngeal edema.
C) an antigen entering on a repeat exposure, triggering a secondary immune response.
D) the systemic inflammatory response.

Question 16

Which of the following drugs promotes bronchodilation and vasoconstriction?

A) Solu-Medrol
B) Gentamicin
C) Atropine
D) Epinephrine

Question 17

An inflammatory biochemical that is secreted in response to endotoxin or noninfectious agents is

A) arachidonic acid metabolite.
B) platelet-activating factor.
C) tumor necrosis factor.
D) the complement system.

Question 18

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.

Question 19

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.

Question 20

When SIRS is the result of infection,it is called

A) inflammation.
B) anaphylaxis.
C) sepsis.
D) pneumonia.

Question 21

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

Question 22

Profound weight loss in patients with SIRS or MODS is the result of

A) hypometabolism.
B) hypermetabolism.
C) hyperglycemia.
D) intolerance to enteral feedings.

Question 23

Laboratory values for DIC show abnormalities in

A) liver function tests.
B) tests for renal function.
C) platelet counts.
D) blood glucose levels.

Question 24

One theory suggests that organ dysfunction in MODS occurs in a sequential or progressive pattern.Place the following organs in the order in which they are affected:
1)Bone marrow
2)Cardiac
3)Gut
4)Kidneys
5)Liver
6)Lungs

A) 6, 5, 2, 1, 3, 4
B) 5, 4, 6, 1, 2, 3
C) 6, 5, 3, 4, 2, 1
D) 6, 3, 4, 5, 2, 1

Question 25

Which of the following historical findings would indicate a high risk for latex allergy?

A) Allergic reaction to anesthetics
B) Eczema of the hands
C) Congenital urologic disorder
D) Asthma
E) Health care worker

Question 26

The most common site for sepsis and septic shock is

A) the respiratory system.
B) the gastrointestinal system.
C) the genitourinary system.
D) the circulatory system.

Question 27

The key to treatment of septic shock is finding the cause of the infection.Which of the following cultures are obtained before antibiotic therapy is initiated?

A) Blood cultures x 2
B) Wound cultures
C) Urine cultures
D) Sputum cultures
E) CBC with differential

Question 28

Which medication is not recommended in the treatment of shock-related lactic acidosis?

A) Glucose
B) Sodium bicarbonate
C) Vasoconstrictor
D) Large quantity of crystalloids fluids

Question 29

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

Question 30

Evidence-based guidelines for the treatment of septic shock include which of the following?

A) Fluid resuscitation to maintain central venous pressure at 8 mm Hg or greater
B) Low-dose dopamine for renal protection
C) High-dose corticosteroids
D) Administration of activated protein C
E) Achieve central venous oxygen saturation of 70% or more