It be what it be

All of the following stress-induced hormones increase blood glucose except a. antidiuretic hormone. b. cortisol. c. growth hormone. d. norepinephrine.

A

Many of the responses to stress are attributed to activation of the sympathetic nervous system and are mediated by a. norepinephrine. b. cortisol. c. glucagon. d. ACTH.

A

Selye's three phases of the stress response include all of the following except a. initiation. b. resistance. c. alarm. d. exhaustion.

A

The effects of excessive cortisol production include a. immune suppression. b. hypoglycemia. c. hypovolemia. d. inflammatory reactions.

A

The consequences of the release of inflammatory mediators in MODS: (select all) A. vasodilation B. hypovolumia C. increased vasopermeability D. myocardial depression E. decreaed urine output F. hypermetabolism

A, C, D, F

Shock develops in a person after being stung by a bee. Which of the following types of shock is most likely? A. Anaphylactic B. Neurogenic C. Cardiogenic D. Septic

A. Anaphylactic

Which of the following is NOT one of the clinical manifestations of MODS? A. Bradycardia B. Dyspnea C. Altered mental status D. Tachypnea

A. Bradycardia

Which is caused by insufficient intravascular fluid? A. Hypovolemic shock B. Septic shock C. Anaphylactic shock D. Neurogenic shock

A. Hypovolemic shock

Which of the following is TRUE regarding MODS? A. Progressive dysfunction of one organ system B. Uncontrolled inflammatory response C. Another term for sepsis D. A cause of low mortality

B. Uncontrolled inflammatory response

Which is not a result of impaired oxygen use from shock? A. activation of the inflammatory response B. increased pH C. decrease in circulatory volume D. decrease in pH.

B. increased pH

Indicators that an individual is experiencing stress include all of the following except a. tachycardia. b. diaphoresis. c. peripheral vasoconstriction. d. pupil constriction.

D

Which of the following normally is not secreted in response to stress? a. Norepinephrine b. Cortisol c. Epinephrine d. Insulin

D

Which of the following types of shock is NOT related to low systemic vascular resistance? A. Septic B. Neurogenic C. Anaphylactic D. Cardiogenic

D. Cardiogenic

Which of the following is NOT one of the results of gluconeogenesis in shock? A. Increased lactic acid B. Increased uric acid C. Impairment of the immune system D. Decreased edema

D. Decreased edema

Which of the following is NOT one of the three positive feedback loops in shock? A. Activation of the clotting cascade B. Decreased circulatory volume C. Lysosomal enzyme release D. Increased diffusion

D. Increased diffusion

Which is caused by widespread vasodilation that occurs from imbalanced PNS and SNS stimulation of vascular smooth muscle? A. Hypovolemic shock B. Septic shock C. Anaphylactic shock D. Neurogenic shock

D. Neurogenic shock

Cortisol is a stress hormone released from the adrenal medulla. True/False

F

High-stress situations are always physiologically harmful. True/False

F

Stress rarely causes long-term physiologic disorders. True/False

F

10. What are the primary goals for the treatment of shock? a. Maximizing oxygen delivery and minimizing oxygen demand b. Maintaining hydration and adequate urinary output c. Supporting all facets to the cardiovascular system d. Maintaining all vital signs within normal functioning ranges

a. Maximizing oxygen delivery and minimizing oxygen demand Rationale: The primary goals of the treatment of shock are maximizing oxygen delivery and minimizing oxygen demand.

13. As the result of the inability to concentrate urine, children are at risk for dehydration before which age? a. 2 years c. 6 years b. 4 years d. 8 years

a. 2 years Rationale:Children younger than 2 years lack the ability to concentrate urine because of the immaturity of the renal system and are therefore at increased risk for dehydration

7. Approximately 80% of all hospital-acquired infections in children are a result of which typeof organism? a. Bacteria b. Viruses c. Fungi d. Rickettsia

a. Bacteria Rationale: In adults and children, approximately 40% of all hospital-acquired infections are linked to gram-negative infections, 40% to gram-positive infections, and 20% to viruses, fungi, or rickettsia microorganisms.

1. What is the most common type of shock in children? a. Hypovolemic b. Cardiogenic c. Neurogenic d. Septic

a. Hypovolemic Rationale: Hypovolemic shock, the most common type of shock in children, is associated with a reduction in the intravascular volume relative to the vascular space.

The process of change in an individual in response to altered conditions is called a. coping. b. allostasis. c. evolution. d. resistance.

B

Which of the following is NOT a reaction of multiple organ dysfunction syndrome (MODS)? A. Maldistribution of blood flow B. Hypometabolism C. Myocardial depression D. Supply-dependent oxygen consumption

B. Hypometabolism

The following clinical manifestations: low-grade fever, tachycardia, tachypnea, dyspnea, and altered mental status, indicate? A. Burn B. MODS C. Shock D. MI

B. MODS

What is the cause of neurogenic shock? A. Decreased volume B. Massive vasodilation C. Sympathetic overstimulation D. Increased systemic vascular resistance

B. Massive vasodilation

Which results from impaired cellular metabolism caused by uncontrolled septicemia? A. Hypovolemic shock B. Septic shock C. Anaphylactic shock D. Neurogenic shock

B. Septic shock

Allostatic adaptation in response to stress may be considered successful when a. stress hormones are no longer secreted. b. heart rate falls below 100 beats/min. c. homeostasis is restored. d. the stress is no longer present.

C

Which results from widespread hypersensitivity to an allergen? A. Hypovolemic shock B. Septic shock C. Anaphylactic shock D. Neurogenic shock

C. Anaphylactic shock

Which of the following is the appropriate first-line treatment for shock? A. Large amounts of fluid volume B. Medications to increase systemic vascular resistance C. Identify and treat underlying cause D. Enhance cardiac output

C. Identify and treat underlying cause

Which of the following is a TRUE statement regarding cardiogenic shock? A. The most common cause is infection. B. It responds well to multiple treatments. C. Mortality improves with revascularization strategies. D. Compensatory adaptive responses result in hypotension.

C. Mortality improves with revascularization strategies.

A condition where cells, tissues and organs fail to get adequate perfusion from the cardiovascular system is called? A. Burn B. MODS C. Shock D. MI

C. shock

Antidiuretic hormone secretion may increase during physiologic stress leading to an increase in a. blood sugar. b. urine output. c. serum sodium. d. body fluid volume.

D

In stressful circumstances, the brain releases _____, which may improve mood, reduce pain, and induce sleep. a. prolactins b. oxytocins c. dopamines d. endorphins

D

A coping method is functional if it reduces emotional pain. True/False

T

Both positive and negative life events can produce stress. True/False

T

Cortisol decreases the inflammatory response. True/False

T

Most of the hormones released with stress serve to increase blood glucose. True/False

T

Norepinephrine and epinephrine are the primary mediators of the alarm phase of the stress response. True/False

T

Selye called the "fight-or-flight" response an "alarm reaction" to stress. True/False

T

Stress can be defined as a threat to homeostasis. True/False

T

15. Compared with the ebb phase, characteristics of the catabolic flow phase in metabolism after a burn injury in a child include which process? a. Reduced oxygen consumption b. Elevation of catecholamines c. Impaired circulation d. Cellular shock

b. Elevation of catecholamines Rationale: After the resolution of the shock and the restoration of circulating volume, the metabolic response shifts to a catabolic (flow) phase. A state of hypermetabolism ensues, characterized by increased oxygen consumption and the elevation of catecholamines, glucocorticoids, and glucagon.

17. What is the most serious outcome resulting from limited glycogen stores in children who have been seriously burned? a. Poor wound healing b. Increased morbidity c. Decreased immunity d. Loss of adipose tissue stores

b. Increased morbidity Rationale: Glycogen stores are limited in children, making it hard for them to meet the increased energy demands of the burn. This prolonged metabolic dysfunction may lead to the loss of lean body mass. The most serious affect is increased morbidity

6.6. In cardiogenic shock, what is the cause of hepatomegaly and periorbital edema? a. Mass vasodilation as a result of chemical mediators released from the myocardium b. Low cardiac output, causing a high central venous pressure c. Tissue damage to the myocardium, causing increased capillary permeability d. Low perfusion of the kidneys, stimulating the renin-angiotensin-aldosterone system to retain sodium and water

b. Low cardiac output, causing a high central venous pressure Rationale: Evidence of an adequate or high central venous pressure, including hepatomegaly and periorbital edema, is observed in cardiogenic shock.

3. A prolonged capillary refill time in children is consistent with the development of what type of shock? a. Hypovolemic b. Septic c. Compensated d. Cardiogenic

b. Septic Rationale: The skin will be mottled, although pallor also may be observed. A prolonged capillary refill time (>2 seconds) is consistent with the development of septic shock

11. To determine a child's response to fluid therapy for shock, the nurse should monitor ______________________. a. Hematocrit and hemoglobin levels b. Urine output and specific gravity c. Blood pressure and pulse d. Arterial blood gases and heart rate

b. Urine output and specific gravity Rationale: Monitoring of the volume of urine output and specific gravity is most useful in determining the child's response to fluid therapy.

19. While awake, what is the normal heart rate for toddlers (in beats per minute)? a. 100 to 205 c. 98 to 140 b. 100 to 180 d. 80 to 120

c. 98 to 140 Rationale: Although the other ranges may be normal for some age groups, the normal heart rate range for toddlers during waking hours is 98 to 140 beats per minute.

5. What is the cause of appropriately 50% of the deaths in children who have experienced a burn injury? a. Immunosuppression b. Hypermetabolism c. Inhalation injury d. Hypertrophic scarring

c. Inhalation injury Rationale: The leading cause of death in children after burn injury, as in adults, is an inhalation injury

16. What advantage do impregnated silver dressings have for patients with burn injuries? a. Impregnated silver dressings contain natural-occurring collagens. b. They require only one dressing change every other day. c. Removal is less painful. d. Impregnated silver dressings are cost effective.

c. Removal is less painful. Rationale: Impregnated silver dressings not only kill bacteria but most are processed with a special layer, making them less painful to remove.

9. What type of injury is associated with cellular injury caused by the restoration of blood flow and physiologic concentrations of oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions? a. Hypoxic b. Hyperoxygenation c. Reperfusion d. Ischemic

c. Reperfusion Rationale: Reperfusion (reoxygenation) injury is associated with cell damage caused by the restoration of blood flow and physiologic concentrations of oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions.

2. Hypotension is likely to occur when an infant or child is greater than _____ % dehydrated. a. 2 b. 5 c. 7 d. 10

d. 10 Rationale: Hypotension typically develops when dehydration is greater than 10% in the infant or child or greater than 6% in the adolescent

12. For children who are experiencing shock, crystalloids and colloids are generally administered in boluses of how many milliliters per kilogram (ml/kg)? a. 5 b. 10 c. 15 d. 20

d. 20 Rationale: In general, isotonic crystalloids (salt-containing solutions, such as normal saline or lactated Ringer solution) or colloids (protein-containing fluids, such as albumin or blood) are administered in boluses of 20 ml/kg.

18. What is the normal range of respirations for an infant (in breaths per minute)? a. 18 to 25 c. 27 to 37 b. 20 to 28 d. 30 to 53

d. 30 to 53 Rationale: Although the other ranges may be normal for some age groups, the normal respiratory range for infants is 30 to 53 breaths per minute

4. Bradycardia in young children experiencing shock symptoms often suggests which result? a. Onset of cardiac dysfunction b. Effective management of cardiac dysfunction c. Good management of anxiety d. Cardiovascular collapse

d. Cardiovascular collapse Rationale: Bradycardia often indicates impending cardiovascular collapse or cardiac arrest and is the most common terminal cardiac rhythm observed in children. This selection is the only option that accurately describes the impact of bradycardia on a child.

8. Which cytokines are anti-inflammatory mediators? a. Interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-α) b. IL-8, IL-12, and platelet-activating factor c. IL-24, arachidonic acid metabolites, and nitric oxide d. IL-4, IL-11, and colony-stimulating factor

d. IL-4, IL-11, and colony-stimulating factor

14. What causes renal failure after electrical burns in children? a. Cytokines are released after the damaged tissue. b. Immature kidneys are unable to compensate for the electrical burn. c. Cardiac output is reduced. d. Myoglobin is released from damaged muscles.

d. Myoglobin is released from damaged muscles. Rationale: The release of myoglobin may occlude the kidney tubules and result in renal failure.