EMT CH. 10 Shock Quiz Q's

A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer 100% oxygen and give him epinephrine via subcutaneous injection. Upon reassessment, you determine that his condition has not improved. You should: Choose one answer. A. transport him immediately and provide supportive care while en route. B. repeat the epinephrine injection after consulting with medical control. C. consider that he may actually be experiencing an acute asthma attack. D. request a paramedic unit that is stationed approximately 15 miles away.

Repeat the epinephrine injection after consulting with medical control

A 70-year-old female was recently discharged from the hospital following a total hip replacement. Today, she presents with restlessness, tachycardia, and a blood pressure of 100/64 mm Hg. Her skin is warm and moist. You should be MOST suspicious that she is experiencing: A. pump failure. B. a local infection. C. decompensated shock. D. septic shock.

Septic shock.

anaphylactic shock

Severe shock caused by an allergic reaction.

psychogenic shock

Shock caused by a sudden temporary reduction in blood supply to the brain that causes fainting (syncope).

hypovolemic shock

Shock caused by fluid or blood loss.

cardiogenic shock

Shock caused by inadequate function the heart, or pump failure.

septic shock

Shock caused by severe infection, usually a bacterial infection.

obstructive shock

Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.

When treating a patient who exhibits signs and symptoms of shock, which of the following actions would not be appropriate? A) Provide high flow oxygen via nonrebreather mask. B) Control external breathing. C) Splint all suspected extremity fractures. D) Request ALS back-up.

Splint all suspected extremity fractures.

All of the following conditions would make you suspect shock, EXCEPT: A. anaphylaxis. B. heart attack. C. severe infection. D. tachycardia.

Tachycardia

When the body senses a state of hypoperfusion, the sympathetic nervous system releases epinephrine, the effects of which include: A. tachypnea. B. tachycardia. C. vasodilation. D. restlessness.

Tachycardia

myocardial contractility

The ability of the heart to contract.

Hypovolemic shock occurs when: Choose one answer. a. at least 10% of the patient's blood volume is lost. b. the clotting ability of the blood is enhanced. c. the patient's systolic blood pressure is less than 100 mm Hg. d. the body cannot compensate for rapid blood loss.

The body cannot compensate for rapid blood loss

compensated shock

The early stage of shock, in which the body can still compensate for blood loss.

irreversible shock

The final stage of shock, resulting in death.

afterload

The force or resistance against which the heart pumps.

The Golden Period is the first 60 minutes after:

The injury occurs

decompensated shock

The late stage of shock when blood pressure is falling.

autonomic nervous system

The part of the nervous system that regulates involuntary functions, such as heart rate, blood pressure, digestion, and sweating.

preload

The precontraction pressure in the heart as the volume of blood builds up.

edema

The presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affected area.

The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia: Choose one answer. a. usually have an altered mental status or decreased level of consciousness. b. do not present with slurred speech or weakness to one side of the body. c. always take oral medications to maintain normal blood glucose levels. d. are typically alert and attempt to communicate with health care providers.

Usually have an altered mental status or decreased level of consciousness

Signs and Symptoms of Septic Shock

WARM SKIN tachycardia low BP

Which of the following clinical signs is unique to anaphylactic shock? A. pallor B. dizziness C. wheezing D. hypotension

Wheezing

Distributive shock occurs when: A. an injury causes restriction of the heart muscle and impairs its pumping function. B. severe bleeding causes tachycardia in order to distribute blood to the organs faster. C. temporary but severe vasodilation causes a decrease in blood supply to the brain. D. widespread dilation of the blood vessels causes blood to pool in the vascular beds.

Widespread dilation of the blood vessels causes blood to pool in the vascular beds.

In anaphylactic shock, the combination of poor oxygenation and poor perfusion is a result of: A. widespread vasodilation B. low volume C. massive vasoconstriction D. pump failure

Widespread vasodilation

A collection of fluid between pericardial sac and myocardium caused by blunt force trauma to chest/ type of obstructive shock

cardiac tamponade/pericardial tamponade

Signs and Symptoms of Cardiogenic Shock

chest pain irregular weak pulse/low BP cyanosis cool clammy skin anxiety rales in breathing pulmonary edema/possibly short of breath

Causes of Obstructive Shock

mechanical obstruction of cardiac muscle leading to pump failure

type of obstructive shock caused by damage to lungs allowing air to escape into chest cavity and apply pressure to structures in mediastinum such as the heart

tension pneumothorax

In infants and children, a capillary refill time (CRT) that is greater than ______ second(s) is a sign of poor peripheral perfusion. A. 1 B. 2 C. 3 D. 4

2

Most patients who die of anaphylaxis do so within the first __________ following exposure. Choose one answer. A. 30 minutes B. 60 minutes C. 90 minutes D. 5 minutes

30 minutes

When treating shock patients frequently check vitals every:

5 minutes

At what systolic blood pressure should you recognize that an adult patient is in decompensated shock? A. 80 mmHg. B. 70 mmHg. C. 90mmHg. D. 100mmHg.

90 mm Hg

homeostasis

A balance of all systems of the body.

shock

A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion.

hypothermia

A condition in which the internal body temperature falls below 95 degrees Fahrenheit (35 degrees Celsius), usually as a result of prolonged exposure to cool or freezing temperatures.

distributive shock

A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.

Neurogenic shock is caused by: A. a radical change in the size of the vascular system B. massive vasoconstriction C. low volume D. fluid collecting around the spinal cord causing compression of the cord

A radical change in the size of the vascular system

aneurysm

A swelling or enlargement of a part of an artery, resulting from weakening of the arterial wall.

Hypothermia occurs when the core body temperature falls below: Choose one answer. a. 95°F (35°C). b. 90°F (32°C). c. 88°F (31°C). d. 98°F (37°C).

A) 95°F (35°C)

Which of the following patients is in decompensated shock? A. a 20-year-old female with absent radial pulses and dilated pupils B. a 23-year-old restless male with cool, clammy skin and tachycardia C. a 28-year-old female with pale skin and rapid, shallow respirations D. a 32-year-old male with anxiety and a systolic blood pressure of 110 mm Hg

A) A 20-year-old female with absent radial pulses and dilated pupils

When perfusion to the core of the body decreases: A) blood is shunted away from the skin. B) the voluntary nervous system releases hormones. C) decreased cardiac contractility occurs. D) blood is diverted to the gastrointestinal tract.

A) Blood is shunted away from the skin.

Classic signs and symptoms of hypoglycemia include: Choose one answer. a. cool, clammy skin; weakness; tachycardia; and rapid respirations. b. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations. c. warm, dry skin; irritability; bradycardia; and rapid respirations.

A) Cool, clammy skin; weakness; tachycardia; and rapid respirations.

Clinical signs of compensated shock include all of the following, EXCEPT: A. cool and clammy skin. B. absent peripheral pulses. C. restlessness or anxiety. D. rapid, shallow breathing

Absent peripheral pulse

anaphylaxis

An unusual or exaggerated allergic reaction to foreign protein or other substances.

Noncardiovascular causes of shock are respiratory failure/insufficiency and? A. sepsis B. metabolism C. anaphylaxis D. hypovolemia

Anaphylaxis

You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should: A. immediately evaluate his airway. B. apply direct pressure to the wound. C. assess the rate and quality of his pulse. D. administer 100% supplemental oxygen.

Apply direct pressure pressure to the wound

A construction worker fell approximately 30 feet. He is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50 mmHg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, the MOST appropriate treatment for this patient includes: Choose one answer. A. oxygen via nonrebreathing mask, blankets for warmth, and elevation of his head. B. assisted ventilation, thermal management, and elevation of the lower extremities. C. oxygen via nonrebreathing mask, thermal management, and elevation of his legs. D. assisted ventilation, preventing hyperthermia, and elevating his lower extremities.

B) Assisted ventilation, thermal management, and elevation of the lower extremities

Signs and Symptoms of Neurogenic Shock

BRADYCARDIA Low BP SIGNS OF NECK INJURY

Activated charcoal is given to patients who have ingested certain substances because it: Choose one answer. a. induces vomiting and empties the stomach. b. binds to the substance and prevents absorption. c. is a direct antidote for many toxic substances. d. decreases absorption of poisons into the lungs.

Binds to the substance and prevents absorption

Intrapulmonary shunting occurs when: A. blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state. B. a decrease in respiratory rate and depth causes carbon dioxide accumulation in the alveoli and an overall decrease in blood oxygen levels. C. any impairment in circulatory function causes a reduced ability for oxygen and carbon dioxide to diffuse across the alveolar-capillary membrane. D. the presence of pulmonary surfactant causes a decrease in alveolar surface tension, thus impairing the exchange of gases in the lungs.

Blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state.

When assessing a patient with signs and symptoms of shock, it is MOST important to remember that: A. the patient's respirations are deep during the early stages of shock. B. blood pressure may be the last measurable factor to change in shock. C. multiple fractures are the most common cause of hypovolemic shock. D. irreversible shock often responds well to a prompt blood transfusion.

Blood pressure may be the last measurable factor to change in shock.

Pale skin in a child indicates that the: Choose one answer. a. blood vessels near the skin are constricted. b. oxygen content in the blood is decreased. c. child is in severe decompensated shock. d. child's core body temperature is elevated.

Blood vessels near the skin are constricted

cyanosis

Bluish color of the skin resulting from poor oxygenation of the circulating blood.

Which of the following MOST accurately describes septic shock? A. bacterial infection of the nervous system with widespread vasodilation B. widespread vasoconstriction and plasma loss due to a severe viral infection C. bacterial damage to the vessel wall, leaking blood vessels, and vasodilation D. viral infection of the blood vessels, vascular damage, and vasoconstriction

C) Bacterial damage to the vessel wall, leaking blood vessels, and vasodilation

Cardiogenic shock may result from all of the following, EXCEPT: A. heart attack. B. increased afterload. C. increased preload. D. poor contractility.

C) Increased preload

Hypotension in a child with blunt or penetrating trauma is particularly significant because: A. it typically develops earlier in children than it does in adults. B. the most likely cause of the hypotension is respiratory failure. C. it often indicates the loss of half of his or her blood volume. D. most children with hypotension die in the prehospital setting.

C) It often indicates the loss of half of his or her blood volume

One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is: A. lactic acid. B. carbon dioxide. C. pyruvic acid. D. carbon monoxide.

Carbon dioxide

Which of the following injuries would MOST likely cause obstructive shock? A. liver laceration B. cardiac tamponade C. simple pneumothorax D. spinal cord injury

Cardiac tamponade

A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient's wife states that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this patient's present condition is: Choose one answer. A. a ruptured aortic aneurysm. B. severe septic hypoperfusion. C. acute myocardial infarction. D. cardiogenic hypoperfusion.

Cardiogenic hypoperfusion

Pulmonary edema and impaired ventilation occur during: A. neurogenic shock. B. anaphylactic shock. C. septic shock. D. cardiogenic shock.

Cardiogenic shock

Regulation of blood flow is determined by? A. Oxygen intake B. Systolic pressure C. Cellular need D. Diastolic pressure

Cellular need

Neurogenic shock usually results from damage to the spinal cord at the: A. cervical level B. thoracic level C. lumbar level D. sacral level

Cervical level

When treating an 80-year-old patient who is in shock, it is important to remember that: A. compensation from the respiratory system usually manifests with increased tidal volume. B. the older patient's central nervous system usually reacts more briskly to compensate for shock. C. medications older patients take for hypertension often cause an unusually fast heart rate. D. changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.

Changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.

sphincters

Circular muscles that encircle and, by contracting, constrict a duct, tube, or opening.

Capillary sphincters are: A. under complete control of the voluntary portion of the nervous system. B. capable of dilating in order to increase perfusion to crucial body organs. C. responsible for constricting to compensate for decreased cell perfusion. D. circular muscular walls that regulate blood flow through the capillaries.

Circular muscular walls that regulate blood flow through the capillaries.

perfusion

Circulation of blood within an organ or tissue in adequate amounts to meet the cells' current needs.

neurogenic shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.

When assessing breathing for a patient in shock, an increased respiratory rate can be a sign of: A.compensated shock. B. decompensated shock. C. respiratory arrest. D. respiratory failure.

Compensated shock

In an acute injury setting, neurogenic shock is commonly accompanied by: A. hypovolemia. B. tachycardia. C. diaphoresis. D. hypothermia.

D) Hypothermia

Basic causes of shock include: A. poor pump functions B. blood or fluid loss C. blood vessel dilation D. all of the above

D. All of the above: - poor pump functions - blood or fluid loss - blood vessel dilation

You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient is conscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this point, your primary concern should be to: A. advise her that she needs to go to the hospital. B. provide emotional support regarding her sister. C. obtain baseline vital signs and a medical history. D. determine if she was injured when she fainted.

Determine if she was injured when she fainted.

sensitization

Developing a sensitivity to a substance that initially caused no allergic reaction.

Which of the following statements regarding anaphylactic shock is MOST correct? A. Anaphylactic shock occurs immediately after a person is sensitized to an allergen. B. Sensitized people will experience less severe reactions upon subsequent exposure. C. Anaphylactic shock is the result of immune system failure due to a toxic exposure. D. Each subsequent exposure following sensitization often produces a more severe reaction.

Each subsequent exposure following sensitization often produces a more severe reaction.

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade? Choose one answer. a. widening pulse pressure b. diminished breath sounds c. a rapid, irregular pulse d. engorged jugular veins

Engorged jugular veins

Anaphylaxis is MOST accurately defined as a: Choose one answer. a. extreme allergic reaction that may affect multiple body systems. b. allergic reaction that causes bronchodilation and vasoconstriction. c. severe allergic reaction that typically resolves without treatment. d. moderate allergic reaction that primarily affects the vasculature.

Extreme allergic reaction that may affect multiple body systems

Neurogenic shock occurs when: A. failure of the nervous system causes widespread vasodilation. B. the spinal cord is severed and causes massive hemorrhaging. C. there is too much blood to fill a smaller vascular container. D. massive vasoconstriction occurs distal to a spinal cord injury.

Failure of the nervous system causes widespread vasodilation.

syncope

Fainting.

A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is experiencing signs and symptoms of shock. You should:

Follow appropriate standard precautions.

Causes of Hypovolemic Shock

Hemorrhagic fluid/blood loss -burns can cause plasma loss

Shock is the result of: A. hypoperfusion to the cells of the body. B. the body's maintenance of homeostasis. C. temporary dysfunction of a major organ. D. widespread constriction of the blood vessels

Hypoperfusion to the cells of the body.

In compensated shock, the pulse of the patient usually: A. increases. B. decreases. C. stays the same. D. becomes absent.

Increases

Which of the following would MOST likely result in hemorrhagic shock? A. severe vomiting B. liver laceration C. excessive sweating D. repeated diarrhea

Liver laceration

dehydration

Loss of water from the tissues of the body.

Hypovolemic shock is a result of: A. widespread vasodilation B. low blood volume C. massive vasoconstriction D. pump failure

Low blood volume

Hypovolemic shock caused by severe burns is the result of a loss of: A. plasma. B. platelets. C. whole blood. D. red blood cells.

Plasma

Patients develop septic shock secondary to: A. poor vessel function and severe volume loss. B. an infection that weakens cardiac contractions. C. failure of the blood vessels to adequately dilate. D. weak vessel tone due to nervous system damage.

Poor vessel function and severe volume loss

A 59-year-old male presents with severe vomiting and diarrhea of 3 days' duration. He is confused and diaphoretic, and his radial pulses are absent. His blood pressure is 78/50 mmHg. After applying 100% supplemental oxygen, you should: Choose one answer. A. allow him to drink plain water. B. obtain a repeat blood pressure in 5 minutes. C. prepare for immediate transport. D. perform a head-to-toe exam.

Prepare for immediate transport

Temporary, widespread vasodilation and syncope (fainting) caused by a sudden nervous system reaction MOST accurately describes: A. vasovagal shock. B. neurogenic shock. C. psychogenic shock. D. neurologic shock.

Psychogenic shock

Signs and Symptoms of Anaphylactic Shock

QUICK ONSET mild itching rash burning skin vascular dilation generalized edema especially around face and lips pallor/cyanosis dizziness/fainting sneezing/tightness in chest/cough WHEEZING

A 25-year-old unrestrained female struck the steering wheel with her chest when her car hit a tree while traveling at a high rate of speed. She has signs and symptoms of shock, which you suspect are the result of intrathoracic bleeding. Which of the following interventions will provide this patient with the greatest chance for survival? A) full immobilization of her spine B) application of the pneumatic antishock garment (PASG) C) 100% oxygen administration D) rapid transport to a trauma center

Rapid transport to a trauma center

Signs and Symptoms of Hypovolemic Shock

Rapid weak pulse low BP Cyanosis lips nail beds cool clammy skin dehydration/thirsty INCREASED RESPIRATORY RATE

You are transporting a 33-year-old male who was involved in a motor vehicle crash. You have addressed all immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate treatment. With an estimated time of arrival at the hospital of 20 minutes, you should: Choose one answer. A. reassess his condition in 5 minutes. B. take his vital signs in 15 minutes. C. repeat your secondary assessment. D. arrange for an ALS rendezvous.

Reassess his condition in 5 minutes