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TESTBANK Chapter Title: Shock
Chapter #: 38
1. Shock syndrome can best be described as a:
1. physiologic state resulting in hypotension and
tachycardia.
2. generalized systemic response to inadequate tissue
perfusion.
3. degenerative condition leading to death.
4. condition occurring with hypovolemia that results in
irreversible hypotension.
2. Hypovolemic shock that results from an internal shifting of
fluid from the intravascular space to the extravascular space is
known as:
1. absolute hypovolemia.
2. distributive hypovolemia.
3. relative hypovolemia.
4. compensatory hypovolemia.
3. The nursing measure that can best enhance large volumes of
fluid replacement in hypovolemic shock is:
1. insertion of a large-diameter peripheral intravenous
catheter.
2. positioning the patient in the Trendelenburg position.
3. forcing at least 240 ml of fluid each hour.
4. administering IV’s under pressure.
4. The main cause of cardiogenic shock is:
1. an inability of the heart to pump blood forward.
2. hypovolemia, resulting in decreased stroke volume.
3. disruption of the conduction system when reentry
phenomenon occurs.
4. an inability of the heart to respond to inotropic agents.
5. Which of the following hemodynamic parameters supports
the diagnosis of cardiogenic shock?
1. Decreased right atrial pressure (RAP)
2. Decreased pulmonary artery wedge pressure (PAWP)
3. Increased cardiac output (CO)
4. Decreased cardiac index (CI)
6. IgE-mediated anaphylactic shock occurs as a result of:
1. direct activation of mast cells.
2. laryngeal edema.
3. an antigen entering on a repeat exposure, triggering a
secondary immune response.
4. the systemic inflammatory response.
Topic: Shock
Cognitive Level: Comprehension
Correct answer: 2
Rationale: Shock syndrome is a generalized systemic
response to inadequate tissue perfusion.
Text Reference: 929
Topic: Shock
Cognitive Level: Comprehension
Correct answer: 3
Rationale: Hypovolemic shock resulting from an internal
shifting of fluid from the intravascular space to the
extravascular space is known as relative hypovolemia.
Text Reference: 931
Topic: Shock
Cognitive Level: Application
Correct answer: 1
Rationale: Measures to enhance volume replacement include
insertion of large-diameter 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.
Text Reference: 933
Topic: Shock
Cognitive Level: Application
Correct answer: 4
Rationale: Assessment of the hemodynamic parameter of
patients in cardiogenic shock reveals a decreased cardiac output
(CO) and a cardiac index (CI) less than 2.2 L/min/m2.
Text Reference: 934
Topic: Shock
Cognitive Level: Comprehension
Correct answer: 1
Rationale: Cardiogenic shock is the result of failure of the
heart to pump blood forward effectively. It can occur with
dysfunction of either the right or the left ventricle, or both. The
lack of adequate pumping leads to decreased tissue perfusion.
Text Reference: 933
Topic: Shock
Cognitive Level: Comprehension
Correct answer: 3
Rationale: With anaphylactic reactions that are IgE-mediated,
the next time an antigen enters the body, the preformed IgE
antibody reacts with it and a secondary immune response
occurs. This reaction triggers the release of biochemical
mediators from the mast cells and basophils and initiates the
cascade of events that precipitate anaphylactic shock.
Text Reference: 936
Copyright © 2003, Elsevier Science (USA). All rights reserved.
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7. With anaphylactic shock, which mechanism results in a
decreased cardiac output?
1. Peripheral vasodilation
2. Histamine release
3. Decreased alveolar ventilation
4. Fluid retention resulting in congestive heart failure
8. Which of the following drugs promotes bronchodilation and
vasoconstriction?
1. Solu-Medrol
2. Gentamicin
3. Atropine
4. Epinephrine
Topic: Shock
Cognitive Level: Comprehension
Correct answer: 1
Rationale: 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.
Text Reference: 937
Topic: Shock
Cognitive Level: Comprehension
Correct answer: 4
Rationale: Epinephrine is given in anaphylactic shock to
promote bronchodilation and vasoconstriction and inhibit
further release of biochemical mediators.
Text Reference: 938
9. The patients at highest risk for neurogenic shock are those
who have had:
1. a stroke.
2. a spinal cord injury.
3. Guillain-Barré syndrome.
4. a craniotomy.
Topic: Shock
Cognitive Level: Comprehension
Correct answer: 2
Rationale: The patients at highest risk for neurogenic shock
are those who have had a spinal cord injury above the level of
T6.
Text Reference: 940
Questions 10-12 refer to the following situation. Ms. H. has
been on the medical floor for 1 week following a vaginal
hysterectomy. A urinary catheter was inserted. CBC results
have revealed escalating white blood cell counts. Ms. H. is
transferred to the critical care unit when her condition
deteriorates. She is diagnosed with septic shock.
10. A pulmonary artery catheter is placed. Which of the
following hemodynamics would you expect to find?
1. CO 8 L/min
2. RAP 17 mm Hg
3. PAWP 23 mm Hg
4. Systemic vascular resistance (SVR) 1100
Topic: Shock
Cognitive Level: Application
Correct answer: 1
Rationale: Increased cardiac output and decreased systemic
vascular resistance are classic signs of septic shock.
Text Reference: 943
11. Which of the following is the pathophysiologic mechanism Topic: Shock
that results in septic shock?
Cognitive Level: Knowledge
1. Bacterial toxins lead to vasodilation.
Correct answer: 1
2. Increased white blood cells are released to fight invading Rationale: The pathophysiologic mechanism that results in
bacteria.
3. Microorganisms invade organs such as the kidneys and
heart.
4. Increase of white blood cells leads to decreased red blood
cell production and anemia.
septic shock is bacterial toxins leading to vasodilation.
Text Reference: 942
Copyright © 2003, Elsevier Science (USA). All rights reserved.
3
12. The medical management of Ms. H.’s condition is aimed
toward:
1. limiting fluids to minimize the possibility of congestive
heart failure.
2. finding and eradicating the cause of infection.
3. discontinuing invasive monitoring as a possible cause of
sepsis.
4. administering vasodilator substances to increase blood
flow to vital organs.
Topic: Shock
Cognitive Level: Application
Correct answer: 2
Rationale: The medical management of Ms. H.’s condition is
aimed toward finding and eradicating the cause of infection.
Text Reference: 944
Copyright © 2003, Elsevier Science (USA). All rights reserved.