Ch. 20 (shock)

In the adult, hemorrhagic hypovolemic shock is classified as moderate if the loss is______________ to_____________ ml.

1500; 2000

Which type of shock is characterized by generalized vasodilation and peripheral pooling of blood?

Anaphylactic Neurogenic Septic

Severe allergy to peanuts

Anaphylactic shock

End-stage heart failure

Cardiogenic shock

What is the pathophysiologic phenomenon underlying disseminated intravascular coagulation (DIC)?

Clotting that leads to bleeding

P.J. is tolerating the rhythm well with no symptoms. Which of the following actions would be appropriate to take at this time?

Continue monitoring and assessing for symptoms.

At the time of admission, a blood sample is taken to determine whether P.J. has suffered an MI. Which of the following laboratory findings would indicate MI?

Elevated troponin I

Activation of the renin-angiotensin system in shock causes

Fluid retention

Uncontrolled massive bleeding causes what type of shock?

Hypovolemic

Acute blood loss

Hypovolemic shock

Burns

Hypovolemic shock

Prolonged vomiting or diarrhea

Hypovolemic shock

What is the underlying problem common among all types of shock?

Inadequate cellular oxygenation

Circulatory shock is best defined as

Inadequate tissue perfusion

The shift to anaerobic metabolism in shock results in

Increased lactate production

Which describes a pathologic manifestation of neurogenic shock?

Loss of sympathetic activation of arteriolar smooth muscle -lesions

Spinal anesthesia

Neurogenic shock

Spinal cord injury

Neurogenic shock

Overwhelming infection

Septic shock

K.C. is discharged on an ACE inhibitor medication. These drugs decrease mortality. What other group of drugs also accomplishes this?

Specific beta-blockers

For the patient in hypovolemic shock, what compensatory mechanism will help preserve adequate circulation?

The renin-angiotensin-aldosterone cascade.

A patient experiencing an acute myocardial infarction (MI) is given a drug to lyse the clot in the coronary artery. What is the best explanation for the sudden development of a serious arrhythmia once circulation is restored?

The return of oxygen perfusion resulted in reperfusion injury.

The vasoactive mediators released in septic shock contribute to increase

Vascular permeability

The physiologic responses occurring in compensatory shock are primarily from

activation of the sympathetic nervous system

Chest pain that occurs at rest and is not relieved within 15 minutes is indicative of

acute coronary syndrome,

One morning at about 4:00 am, P.J. is awakened from sleep with chest pain and shortness of breath. The pain is much more severe than his usual anginal pain and radiates to the jaw and left arm. He is diaphoretic and pale. His wife calls for emergency assistance, and P.J. is transported to the local emergency department. Upon admission, the ECG shows significant ST-segment elevation, which indicates

acute coronary syndrome.

thrombolytic drug, tissue plasminogen activator (tPA). This agent is used because

acute ischemia is usually caused by a thrombus in the coronary artery.

echocardiogram demonstrates extreme septal hypertrophy, and so his collapse on the basketball court is attributed to

an acute aortic outflow obstruction.

An increased serum lactate level (lactic acidosis) is commonly used as a marker of

anaerobic metabolism.

Mortality rates are lowest for shock and highest for shock.

anaphylactic; septic

Increased SOB, reduced activity tolerance. no cardiac history. bp 110/60 and HR is 92 BPM . there is grade IV systolic murmur that radiates to the neck....

aortic stenosis.

The ejection fraction is calculated

as the stroke volume divided by the end-diastolic volume.

Unstable angina

associated with clot formation on a plaque and produces symp- toms of acute coronary syndrome, which would not predictably disappear with rest

Hemodynamic monitoring allows the assessment of the adequacy of cardiac output in an individual, called the ____________________ ______________, which is cardiac output adjusted for the patient's size.

cardiac index

The common finding in all types of circulatory shock is

cellular hypoxia.

P.J. should be counseled to seek medical care immediately when

chest pain occurs at rest or is not relieved within 15 minutes.

Dextran, albumin, and hetastarch are classified as .

colloids

Septic shock is characterized by an abnormally low systemic vascular resistance because of

cytokine-induced production of nitric oxide

Acute renal failure is a potential complication of shock due to _____________perfusion, producing _____________cells.

decreased; hypoxic or ischemic

Septic shock is often associated with infection with gram-negative bacteria because of their release of

endotoxin

a heart rate of 64 beats/min and a PR interval of 0.22 second. The QRS is normal, and there is one P wave for each QRS. This rhythm is termed

first-degree heart block

Effective control of P.J.'s blood pressure is important for all of the following reasons, except A. high blood pressure is a risk factor for atherosclerosis. B. high blood pressure increases the left ventricular afterload. C. high blood pressure reduces the coronary artery perfusion pressure. D. high blood pressure contributes to the development of left ventricular hypertrophy.

high blood pressure reduces the coronary artery perfusion pressure.

significant left ventricular hypertrophy but no evidence of ischemia. His heart rate is 60 beats/min, and his blood pressure is 116/70 mm Hg. Considering these findings and the above scenario, K.K. should be evaluated for

hypertrophic cardiomyopathy.

Types of shock categorized by abnormal distribution of cardiac output (distributive shock) include all of the following, except A. hypovolemic shock. B. septic shock. C. anaphylactic shock. D. neurogenic shock.

hypovolemic shock.

In the early compensated stage of circulatory shock, blood pressure is maintained because of

increased systemic vascular resistance.

The ST elevation is noted only in leads II, III, and aVF, indicating that the affected area of the heart is the

inferior wall of the left ventricle.

K.K.'s family should be advised that his disorder

is genetic and family members should be evaluated.

bilateral fine crackles in the bases bilaterally, indicating

left-sided heart failure.

An ejection fraction of 0.40 indicates

mild systolic dysfunction

Therapeutic interventions for P.J. are focused on increasing the oxygen supplied to the heart and decreasing the heart's demand for oxygen. Measures that reduce demand include using

morphine sulfate

In cardiogenic shock, compensatory mechanisms, working via the RAAS, increase cardiac ______________and, therefore,_______________

preload; workload

The immune system propagates further tissue damage in the ____________stage of shock

progressive

A reduced oxygen extraction rate as indicated by a high systemic venous oxygen saturation is associated with

septic shock.

Chest pain that occurs predictably with activity and disappears with rest is consistent with

stable angina.

P.J. has noticed that his chest pain is occurring with increasing frequency, and less activity is required to initiate the symptoms; however, the pain subsides quickly with rest and one or two nitroglycerin tablets. These symptoms are consistent with a diagnosis of:

stable angina.

In the stage of refractory shock, patients are_________ to treatment interventions.

unresponsive

Variant angina is

usually associated with vascular spasm and occurs unpredictably, often at rest.