Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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. 2 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.