Shock
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
A. 30 minutes
Which of the following statements regarding anaphylactic shock is correct? A. Subsequent exposure after sensitization often produces a more severe reaction. B. Anaphylactic shock is caused by immune system failure due to a toxic exposure. C. Sensitized people will experience less severe reactions upon subsequent exposure. D. Anaphylactic shock occurs immediately after a person is sensitized to an allergen.
A. Subsequent exposure after sensitization often produces a more severe reaction.
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: Choose one answer. A. apply direct pressure to the wound. B. administer 100% supplemental oxygen. C. assess the rate and quality of his pulse. D. immediately evaluate his airway.
A. apply direct pressure to the wound.
When assessing a patient with signs and symptoms of shock, it is MOST important to remember that: A. blood pressure may be the last measurable factor to change in shock. B. the patient's respirations are deep during the early stages of shock. C. irreversible shock often responds well to a prompt blood transfusion. D. multiple fractures are the most common cause of hypovolemic shock.
A. blood pressure may be the last measurable factor to change in shock.
One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is: A. carbon dioxide B. carbon monoxide C. pyruvic acid D. lactic acid
A. carbon dioxide
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: A. cardiogenic hypoperfusion. B. a ruptured aortic aneurysm. C. severe septic hypoperfusion. D. acute myocardial infarction.
A. cardiogenic hypoperfusion
Pulmonary edema and impaired ventilation occur during: A. cardiogenic shock B. neurogenic shock C. septic shock D. anaphylactic shock
A. cardiogenic shock
When treating an 80-year-old patient who is in shock, it is important to remember that: A. changes in gastric motility may delay gastric emptying, which increases the risk for vomiting. 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. compensation from the respiratory system usually manifests with increased tidal volume.
A. changes in gastric motility may delay gastric emptying, which increases the risk for vomiting.
Hypovolemic shock caused by severe burns is the result of a loss of: A. plasma B. red blood cells C. whole blood D. platelets
A. plasma
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? Choose one answer. A. rapid transport to a trauma center B. full immobilization of her spine C. 100% oxygen administration D. application of the pneumatic antishock garment (PASG)
A. rapid transport to a trauma center
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.
A. reassess his condition in 5 minutes.
A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer high-flow oxygen and give him epinephrine via intramuscular injection. Upon reassessment, you determine that his condition has not improved. You should: A. repeat the epinephrine injection after consulting with medical control. B. transport him immediately and provide supportive care while en route. C. consider that he may actually be experiencing an acute asthma attack. D. request a paramedic unit that is stationed approximately 15 miles away.
A. repeat the epinephrine injection after consulting with medical control.
Shock due to severe infection is called ________. A. septic shock B. neurogenic shock C. hypovolemic shock D. anaphylactic shock
A. septic shock
Which of the following clinical signs is unique to anaphylactic shock? A. wheezing B. dizziness C. pallor D. hypotension
A. wheezing
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 mm Hg, 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.
As you approach a patient lying at the side of the roadway, you observe severe bleeding from the leg. What should your first action be? A. Open the airway. B. Control the bleeding. C. Administer oxygen. D. Check for a pulse
B. Control the bleeding.
When should nonlifesaving interventions be performed for your multisystem trauma patient? A. During the primary assessment B. En route to the hospital C. Immediately after the injuries are discovered D. Prior to transport
B. En route to the hospital
Which of the following patients is in decompensated shock? A. a 32 year old male with anxiety and a systolic BP of 110 B. a 20 year old female with absent radial pulses and dilation pupils C. a 23 year old restless male with cool, clammy skin and tachycardia D. a 28 year old female with pale skin and rapid, shallow respirations
B. a 20 year old female with absent radial pulses and dilation pupils
Which of the following MOST accurately describes septic shock? Choose one answer. A. viral infection of the blood vessels, vascular damage, and vasoconstriction B. bacterial damage to the vessel wall, leaking blood vessels, and vasodilation C. widespread vasoconstriction and plasma loss due to a severe viral infection D. bacterial infection of the nervous system with widespread vasodilation
B. bacterial damage to the vessel wall, leaking blood vessels, and vasodilation
Which of the following injuries would most likely cause obstructive shock? A. spinal cord injury B. cardiac tamponade C. simple pneumothorax D. liver laceration
B. cardiac tamponade
Your assessment of an unresponsive patient reveals that her breathing is inadequate. Your MOST immediate action should be to: A. move her to the ambulance stretcher. B. check her airway for obstructions. C. administer high-flow oxygen. D. ventilate her with a bag-valve mask.
B. check her airway for obstructions.
Neurogenic shock occurs when: A. massive vasoconstriction occurs distal to a spinal cord injury B. failure of the nervous system causes widespread vasodilation C. the spinal cord is severed and causes massive hemorrhage D. there is too much blood to fill a smaller vascular container
B. failure of the nervous system causes widespread vasodilation
Cardiogenic shock may result from all of the following, EXCEPT: A. heart attack. B. increased preload. C. increased afterload. D. poor contractility.
B. increased preload
All of the following conditions should make you suspect shock, EXCEPT: A. severe infection B. ischemic stroke C. anaphylaxis D. spinal injury
B. ischemic stroke
Inadequate circulation of blood throughout the body is called ________. A. hypotension B. shock C. perfusion D. hypoxia
B. shock
Distributive shock occurs when: A. an injury causes restriction of the heart muscle and impairs its pumping function. B. widespread dilation of the blood vessels causes blood to pool in the vascular beds. C. temporary but severe vasodilation causes a decrease in blood supply to the brain. D. severe bleeding causes tachycardia in order to distribute blood to the organs faster.
B. widespread dilation of the blood vessels causes blood to pool in the vascular beds.
Foods, medications, and insects are common causes of ________. A. psychogenic shock B. septic shock C. anaphylactic shock D. neurogenic shock
C. anaphylactic shock
A 20 year old male has a large laceration to his wrist. He is holding a blood-soaked towel over the wound, but it continues to bleed rapidly. You should: A. apply pressure to the brachial artery B. wrap the towel with pressure bandages C. apply a tourniquet proximal to the wrist D. administer high-flow supplemental oxygen
C. apply a tourniquet proximal to the wrist
Which of the following is the only action that can prevent death from a tension pneumothorax? A. early administration of high-flow oxygen B. positive-pressure ventilation with a bag-valve mask C. decompression of the injured side of the chest D. rapid administration of IV fluids
C. decompression of the injured side of the chest
A 27-year-old male was stabbed in the chest during a disagreement at a poker game. As you approach him, you see that a knife is impaled in his chest. Before you make physical contact with the patient, it is MOST important to: A. ask bystanders what happened. B. call for an ALS ambulance. C. follow standard precautions. D. form a general impression.
C. follow standard precautions.
Shock is the result of: A. temporary dysfunction of a major organ B. widespread constriction of the blood vessels C. hypoperfusion to the cells of the body D. the body's maintenance of homeostasis
C. hypoperfusion to the cells of the body
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
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 mm Hg. 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.
C. prepare for immediate transport
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 90/64 mm Hg. Her skin is hot and moist. You should be MOST suspicious that she is experiencing: A. decompensated shock. B. pump failure. C. septic shock. D. a local infection.
C. septic shock
The actions of hormones, such as epinephrine and norepinephrine stimulates _____________ to maintain pressure in the system and as a result, perfusion of all vital organs. A. an increase in heart rate B. an increase in the strength of cardiac contractions C. vasoconstriction in nonessential areas D. All of the above
D. All of the above
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.
D. Determine if she was injured when she fainted
Clinical signs of compensated shock include all of the following except: A. restlessness or anxiety B. cool and clammy skin C. rapid, shallow breathing D. absent peripheral pulses
D. absent peripheral pulses
Basic causes of shock include: A. poor pump function. B. blood or fluid loss. C. blood vessel dilation. D. all of the above.
D. all of the above
Your patient has a decreased cardiac output and poor myocardial contractility. This will likely lead to ___________. A. septic shock B. neurogenic shock C. hypovolemic shock D. cardiogenic shock
D. cardiogenic shock
Capillary sphincters are: A. Responsible for constricting to compensate for decreased cell perfusion B. capable of dilating in order to increase perfusion to crucial body organs C. under complete control of the voluntary portion of the nervous system D. circular muscular walls that regulate blood flow through the capillaries
D. circular muscular walls that regulate blood flow through the capillaries.
Your patient is in shock, but the body's defense mechanisms are currently able to maintain adequate circulation. This is called ___________. A. irreversible shock B. decompensated shock C. late shock D. compensated shock
D. compensated shock
What are the three components of the "perfusion triangle"? A. Arteries, veins, capillaries B. Plasma, red blood cells, platelets C. Heart, brain, lungs D. Heart, blood vessels, blood
D. heart, blood vessels, blood
In an acute injury setting, neurogenic shock is commonly accompanied by: A. diaphoresis B. hypovolemia C. tachycardia D. hypothermia
D. hypothermia
Which of the following would most likely result in hemorrhagic shock? A. severe vomiting B. repeated diarrhea C. excessive sweating D. liver laceration
D. liver laceration
To protect vital organs, the body compensates by directing blood flow away from organs that are more tolerant of low flow, such as: A. the lungs B. the brain C. the heart D. the skin
D. the skin
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).
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.
a. blood vessels near the skin are constricted.
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.
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.
a. extreme allergic reaction that may affect multiple body systems.
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.
a. usually have an altered mental status or decreased level of consciousness.
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.
b. binds to the substance and prevents absorption.
Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST accurately describes: Choose one answer. a. vasovagal shock. b. psychogenic shock. c. neurologic shock. d. neurogenic shock.
b. psychogenic shock.
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
d. engorged jugular veins
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.
d. the body cannot compensate for rapid blood loss.
