Patho

anaphylactic shock

Severe allergic reaction

The progressive stage of hypovolemic shock is characterized by a. tachycardia. b. hypertension. c. lactic acidosis. d. cardiac failure.

ANS: A In the progressive stage of hypovolemic shock, the patient is anxious and confused, with decreased blood pressure and heart rate greater than 120 beats/minute. In this stage of shock, the blood pressure is decreased. Lactic acidosis does not occur in the progressive stage of hypovolemic shock. Cardiac failure is not likely to occur in the earlier stages of hemorrhagic shock.

Low cardiac output in association with high preload is characteristic of ________ shock. a. hypovolemic b. cardiogenic c. anaphylactic d. septic

ANS: B In cardiogenic shock, preload is high and cardiac output is low. In hypovolemic shock, preload and cardiac outputs are both low. In anaphylactic shock, blood volume may be normal. Septic shock is associated with infections.

Positive inotropic drugs work by increasing (Select all that apply.) a. contractility. b. cardiac output. c. tissue perfusion. d. myocardial oxygen demand. e. vascular resistance.

ANS: A, B, C, D Positive inotropic drugs are used to manage shock by increasing contractility, cardiac output, and tissue perfusion; these drugs also increase myocardial oxygen demand. These drugs may contribute to a decrease in vascular resistance, which decreases the workload of the heart.

Histamine

A chemical that is responsible for the symptoms of an allergy

cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with a. perfumes. b. incompatible blood products. c. animal proteins or dander. d. antibiotics.

ANS: D Anaphylactic shock is most frequently associated with antibiotic therapy. Contact with perfumes is not the most frequent cause of anaphylactic shock. Incompatible blood products do not lead to anaphylactic shock. Animal dander may lead to an anaphylactic reaction, but does so less commonly than antibiotics.

Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock? a. Cardiogenic b. Hypovolemic c. Anaphylactic d. Septic

ANS: D The overproduction of nitric oxide is seen in septic shock as a result of the release of immune cytokines. Nitric oxide is not seen in cardiogenic shock. Hypovolemic shock is not associated with the overproduction of nitric acid. The pathophysiologic process of anaphylactic shock is not associated with the overproduction of nitric oxide.

hypovolemic shock

shock resulting from blood or fluid loss

Crystalloids

substances in a solution that diffuse through a semipermeable membrane

The effect of nitric oxide on systemic arterioles is a. vasodilation. b. vasoconstriction. c. not significant. d. opposed by nitrate drugs.

ANS: A Nitric oxide causes vasodilation in the systemic arterioles. Vasoconstriction is not associated with nitric oxide. There is a significant effect on the systemic arterioles related to nitric oxide. The effects of nitric oxide are not known to be opposed by nitrate drugs.

Administration of which therapy is most appropriate for hypovolemic shock? a. Crystalloids b. Vasoconstrictor agents c. Inotropic agents d. 5% dextrose in water

ANS: A TEST BANK FOR PATHOPHYSIOLOGY 6TH EDITION BY BANASIK NURSINGKING.COM NURSINGKING.COM Crystalloids are solutions that contain electrolytes. Isotonic solutions, such as lactated Ringers, are commonly used crystalloid solutions. These solutions are preferred for volume resuscitation, because they remain in the extracellular space and are more effective in increasing blood volume. Vasoconstrictor agents are contraindicated in hypovolemic shock. Isotonic crystalloids are the most appropriate fluid for volume resuscitation. Isotonic fluids are preferred over glucose or hypotonic electrolyte solutions.

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock? a. Cardiogenic b. Hypovolemic c. Anaphylactic d. Neurogenic

ANS: C Exposure to a specific antigen causes receptors on mast cells and basophils to cross-link and activate histamine. The release of histamine along with other vasoactive chemicals produces bronchoconstriction. Cardiogenic shock is not associated with histamine release. Hypovolemic shock is not associated with histamine release. Histamine release does not occur with neurogenic shock.

. In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing? a. Class I, Initial Stage b. Class II, Compensated Stage c. Class III, Progressive Stage d. Class IV, Refractory Stage

ANS: B In compensated stage hemorrhage (Class II), the blood loss is between 750 and 1500 mL. Blood pressure remains normal when the patient is supine but decreases upon standing. In initial stage hemorrhage (Class I) blood loss is up to 750 mL, and the patient's vital signs remain normal. Class III hemorrhage (progressive stage) is blood loss of 1500 and 2000 mL. Vital signs are changing. Severe Class IV hemorrhage (refractory stage) occurs when more than 2000 mL is lost. The patient is lethargic, with severe hypotension

A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock? TEST BANK FOR PATHOPHYSIOLOGY 6TH EDITION BY BANASIK NURSINGKING.COM NURSINGKING.COM a. Cardiogenic b. Septic c. Anaphylactic d. Neurogenic

ANS: B Patients presenting with septic shock may have fever and hypotension. In addition, lactic acidosis may be present because of tissue hypoxemia. Presentation of cardiogenic shock is not inclusive of fever or lactic acidosis. Patients in anaphylactic shock do not have fever or lactic acidosis, and may have normal vital signs initially. Neurogenic shock may result from depression of the vasomotor center in the medulla.

Hypotension associated with neurogenic and anaphylactic shock is because of a. hypovolemia. b. peripheral pooling of blood. c. poor cardiac contractility. d. high afterload.

ANS: B Profound peripheral vasodilation of both arterioles and veins leads to peripheral pooling of blood and hypotension. Decreased venous return to the heart results in decreased cardiac output and hypotension. Hypovolemia is not the source of the hypotension involved in neurogenic and anaphylactic shock. Cardiac output is generally adequate in neurogenic and anaphylactic shock. Hypotension in neurogenic and anaphylactic shock is not related to high afterload.

A patient who was involved in a fall from a tree becomes short of breath. The lung sounds are absent on one side. This patient is experiencing ________ shock. a. cardiogenic b. obstructive c. hypovolemic d. distributive

ANS: B This type of obstructive shock is the result of a tension pneumothorax and is caused by shifting and compression of mediastinal structures including the heart, which compromise left ventricular filling. Accumulation of air in the pleural space may occur because of trauma. Prompt relief of the obstructive event is necessary to restore cardiac output and prevent cardiovascular collapse. Cardiogenic shock is not related to a traumatic event. Hypovolemic shock results when circulating blood volume is inadequate to perfuse tissues. Distributive shock is characterized by an abnormally expanded vascular space caused by excessive vasodilation.

Which causes of shock are considered to be obstructive? (Select all that apply.) a. Ventricular rupture b. Pulmonary embolus c. Cardiac tamponade d. Tension pneumothorax e. Acute hemorrhage

ANS: B, C, D Pulmonary embolism is a mechanical obstruction of blood flow, which results in elevated right-sided heart pressures but left-sided pressures remain normal. Cardiac tamponade results from an accumulation of fluid in the pericardial sac causing elevation of pressures on both sides of the heart. Tension pneumothorax results in shifting and compression of mediastinal structures including the heart, which compromises left ventricular filling. Ventricular rupture is not associated with obstructive shock. Acute hemorrhage is associated with hypovolemic shock.

A patient experiences anaphylactic shock. The nurse expects to observe which signs and symptoms in the patient? (Select all that apply.) a. Stupor b. Hypotension c. Urticaria d. Angioedema e. Wheezing

ANS: B, C, D, E Anaphylactic shock causes increased heart rate and respiratory rate and hypotension. Anaphylactic shock causes urticaria and pruritus. Angioedema is a symptom of anaphylactic shock. Bronchoconstriction causes wheezing and cyanosis, and laryngeal edema results in hoarseness and stridor. Stupor is not a sign or symptom of anaphylactic shock.

Septic shock is commonly associated with Gram-negative infections and Gram-positive organisms that enter the body through the (Select all that apply.) a. eyes. b. genitourinary tract. c. gastrointestinal tract. d. respiratory tract. e. skin.

ANS: B, C, D, E The most frequent portals of entry for the organisms that cause septic shock are the genitourinary tract, gastrointestinal tract, respiratory tract, and the skin. The eyes are not a common portal of entry

The urinary signs and symptoms of acute renal failure associated with the progressive stage of shock are (Select all that apply.) a. polyuria. b. oliguria. c. decreased blood urea nitrogen. d. increased serum creatinine. e. tachycardia.

ANS: B, D Oliguria is a sign of acute renal failure found in the progressive stage of shock. Increased serum creatinine found in acute renal failure is associated with the progressive stage of shock. Polyuria is not associated with the progressive stage of shock. Increased blood urea nitrogen, not decreased levels, is a sign of acute renal failure that is associated with the progressive stage of shock. Tachycardia is a symptom of the progressive stage of shock, but it is not a urinary symptom.

Tachycardia is an early sign of low cardiac output that occurs because of TEST BANK FOR PATHOPHYSIOLOGY 6TH EDITION BY BANASIK NURSINGKING.COM NURSINGKING.COM a. tissue hypoxia. b. anxiety. c. baroreceptor activity. d. acidosis.

ANS: C A number of compensatory responses are set in motion to restore tissue perfusion and oxygenation in the early stage of shock. Baroreceptors located in the aorta and carotid arteries quickly sense the decrease in pressure and transmit signals to the vasomotor center in the brainstem medulla. The sympathetic nervous system stimulates 1 receptors, which respond by increasing the heart rate in an attempt to increase cardiac output. Tachycardia is not caused initially by tissue hypoxia. An early sign of low cardiac output is not anxiety. Tachycardia does not occur because of acidosis.

Cardiogenic shock is characterized by a. hypovolemia. b. reduced systemic vascular resistance. c. reduced cardiac output. d. elevated SvO2.

ANS: C Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that results in inadequate cardiac pumping. The low cardiac output state is associated with a high left ventricular diastolic filling pressure. Cardiogenic shock is not manifested by hypovolemia. Sympathetic activation leads to increases in heart rate, vasoconstriction, and a narrow pulse pressure. Low cardiac output leads to reduced SvO2.

Tumor necrosis factor and interleukin-1 contribute to shock states because they induce production of a. catecholamines. b. clotting factors. c. nitric oxide. d. vasopressin.

ANS: C In septic shock, tumor necrosis factor-, interleukin-1, and other inflammatory mediators induce vascular cells to produce excessive amounts of the vasodilator nitric oxide. Catecholamines are not produced by TNF- and IL-1. The production of clotting factors is not induced by tumor necrosis factor- and interleukin-1. Vasopressin production is not induced by TNF- and IL-1.

In contrast to all other types of shock, the hyperdynamic phase of septic shock is associated with a. high afterload. b. low cardiac output. c. high cardiac output. d. reduced contractility.

ANS: C In the hyperdynamic stage of septic shock, blood pressure falls because of the decreased systemic vascular resistance and decreased venous return. The heart rate and stroke volume increase and cardiac output is higher than normal. In the hyperdynamic phase of septic shock, afterload is not high. Cardiac output is high in the hyperdynamic stage of septic shock. The heart rate and stroke volume increase during the hyperdynamic stage of septic shock.

Sepsis has been recently redefined as a. a systemic infection with viable organisms in the bloodstream. b. a systemic inflammatory response to ischemia. c. a systemic inflammatory response to infection. d. severe hypotension in an infected patient.

ANS: C Systemic inflammatory response syndrome is the body's response to infection or other insults, which result in systemic signs and symptoms of widespread inflammation. Sepsis results from the presence of microorganisms in the bloodstream (bacteremia). Sepsis occurs as a result of bacteremia and is defined as a systemic inflammatory response to infection. Severe hypotension may be the result of sepsis, but it is not the definition.

Improvement in a patient with septic shock is indicated by an increase in a. cardiac output. b. SvO2. c. systemic vascular resistance. d. serum lactate level.

ANS: C Systemic vascular resistance results in intravascular pooling in the venous system. Some portions of tissue are overperfused, and some are underperfused. Improvement in systemic vascular resistance is an indication of improvement in septic shock. In septic shock, the heart rate and stroke volume increase, and cardiac output is higher than normal. In septic shock, SvO2 levels may already be higher than normal. An increase in serum lactate levels may increase levels of acidosis and tissue hypoxia.

Administration of a vasodilator to a patient in shock would be expected to a. decrease vascular resistance. b. increase contractility. c. decrease left ventricular afterload. d. increase tissue perfusion

ANS: C Vasodilators are used to decrease the workload of the heart by decreasing left ventricular afterload. Nitroprusside and nitroglycerin are examples of vasodilators. Dobutamine is used to decrease vascular resistance. Positive inotropic drugs are used to increase contractility. Positive inotropes include -adrenergic agonists, which have the ability to increase tissue perfusion.

A patient experiencing shock may exhibit which signs and symptoms? (Select all that apply.) a. Warm, flushed skin b. Pinpoint pupils c. Pulse of more than 100 beats/minute d. Increased urinary output e. Fast and deep respirations

ANS: C, E A symptom of shock is tachycardia greater than 100 beats/minute. Fast and deep respirations are a compensatory mechanism of shock. Cool, clammy skin is a symptom of shock, not warm, flushed skin. Dilated pupils, not pinpoint pupils, are a symptom of shock. Decreased urinary output and increased urine specific gravity are symptoms of shock.

. A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock. a. cardiogenic b. hypovolemic c. obstructive d. septic

ANS: D In the progressive stage of septic shock, some patients deteriorate to a hypodynamic state. This is characterized by decreased cardiac output and cold, clammy skin as a result of narrowed pulse pressure. Profound hypotension generally occurs which is unresponsive to treatment. Cardiogenic shock is evidenced by decreased cardiac output, elevated left ventricular end-diastolic pressure, S3 heart sounds, and pulmonary edema. Hypotension occurs with hypovolemic shock, but extremities are not likely to be cold and edematous. Cold edematous extremities along with low cardiac output and profound hypotension are not manifestations of obstructive shock.

True or false: A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis.

ANS: F A patient diagnosed with cardiogenic shock who is hyperventilating is at risk for respiratory alkalosis.

True or false: A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic

ANS: F A type of shock that includes brain trauma that results in depression of the vasomotor center is neurogenic shock.

True or false: Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.

ANS: T Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body

True or false: Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.

ANS: T Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.