Davis Advantage - SIRS and Types of Shock
A clinician is determining brain death in a patient. Which of the following supports the conclusion of brain death? A) Absence of corneal reflexes B) Presence of gag reflex C) Presence of caloric response D) Presence of simple motor responses only
A
A clinician is ordering atropine, an anticholinergic agent, for a patient in shock. Which type of shock is suspected? A) Neurogenic B) Cardiogenic C) Anaphylactic D) Septic
A
A clinician suspects disseminated intravascular coagulation (DIC) in a patient. Which of the following would support this conclusion? A) Elevated D-dimer B) Reduced prothrombin time (PT) C) Thrombocytosis D) Less blood loss from wound than expected
A
A condition associated with increased bleeding and clotting is ______________. A) Disseminated intravascular coagulation B) Acute respiratory distress C) Kidney failure D) Liver failure
A
A nurse comments that a patient is displaying an overwhelming immune response to trauma. Which acronym would apply to the nurse's statement? A) SIRS B) CARS C) MODS D) APACHE
A
A nurse is reviewing hypovolemic shock causes. Which of the following is an unlikely cause of hypovolemic shock? A) SIADH release B) Internal hemorrhaging C) Crushing injury in lower extremities preventing blood return D) Severe dehydration
A
A patient has developed adult respiratory distress syndrome. Which of the following has been shown to improve survival? A) Mechanical ventilation B) Steroids C) Surgical resection of lungs D) Opioids
A
As a result of toxins and inflammatory mediators released in septic shock, vasodilation and capillary permeability _____________. A) Increase B) Decrease
A
If DIC is present, fibrin degradation products are _____________. A) Increased B) Decreased
A
If DIC is present, then clotting times are _____________. A) Increased B) Decreased
A
If the kidneys fail, then BUN _____________. A) Increases B) Decreases
A
In this stage of shock, a decrease in blood pressure is detected, which activates the sympathetic nervous system. Activation of RAAS also occurs, as the response is similar to the alarm stage of the stress response. A) Initial B) Progressive C) Irreversible
A
In this type of shock, the cornerstone of treatment is epinephrine, either intramuscular or IV administration. Glucocorticoids are also a standard treatment. Intubation may be necessary. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
A
This type of shock is manifested by IgE-mediated massive degranulation of mast cells in response to an allergen. Chemical signals result in pronounced vasodilation and bronchospasm. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
A
A child is brought to the emergency department suffering from suspected anaphylactic shock due to bee sting. What are the immediate treatments considered? SATA A) IV epinephrine B) Beta-blockers C) IV saline administration D) Glucocorticoids E) Antihistamines
A, C, D, E
A patient is in the initial stages of shock. Which of the following can be expected? SATA A) Increased heart rate B) Activation of the parasympathetic nervous system (PNS) C) Activation of the RAAS D) Peripheral vasoconstriction E) Decreased GI blood flow
A, C, D, E
Which of the following are criteria for systemic inflammatory response syndrome (SIRS)? SATA A) Heart rate (HR) > 90 beats per minute B) Hypoventilation C) Hyperthermia (body temperature above 38°C) D) Leukocytosis (white blood cells [WBC] count greater than 12,000 per cubic millimeter) E) Hypothermia (body temperature less than 36°C)
A, C, D, E
A nurse is monitoring a patient in shock. Which of the following levels are likely to be elevated? A) Blood pressure B) Serum BUN and Creatinine C) Tissue perfusion D) PaO2 levels
B
A patient falls from an outdoor deck located on the second floor of a building and injures his back. The patient is displaying signs of shock. The clinician suspects that neurogenic shock may be present. Which of the following patient assessment results would indicate neurogenic shock? A) Tachycardia and hypotension B) Bradycardia and hypotension C) Bronchodilation D) Vision and hearing impairment
B
A patient in shock is not responding to fluid replacement or vasopressor administration. Which type of shock might the patient be experiencing? A) Cardiogenic B) Septic C) Anaphylactic D) Hypovolemic
B
A patient presents with shock. An intra-aortic balloon pump device is used for treatment. Which type of shock is the patient most likely experiencing? A) Neurogenic B) Cardiogenic C) Anaphylactic D) Hypovolemic
B
If ARDS occurs, then surfactant levels _____________. A) Increase B) Decrease
B
If a patient is suffering ARDS, then PO2 _____________. A) Increases B) Decreases
B
If shock occurs, the kidneys experience _____________ in blood flow. A) Increases B) Decreases
B
In this stage of shock, decreased perfusion of kidney, liver, and GI tract develop. Decreased urination and buildup of waste products in the blood occurs. A) Initial B) Progressive C) Irreversible
B
In this type of shock, disruption of the sympathetic nervous system, as occurs in spinal cord or brain injury, causes widespread vasodilation. The body is unable to compensate for decreases in blood pressure as expected because of disruption of the sympathetic nervous system. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
B
In this type of shock, parasympathetic-drive bradycardia must be counteracted. Atropine, an anticholinergic agent, may be given. Vasoconstrictors and fluid may be administered to maintain blood pressure. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
B
Which of the following characteristics will be present if the patient is experiencing "warm shock"? A) The patient will complain of feeling too hot and begin to remove clothing. B) The patient appears pink and the skin feels warm to the touch. C) The patient's only sign is an elevated temperature. D) The patient has decreased blood pressure.
B
Which type of shock occurs when the heart is unable to meet the body's demands and systolic blood pressure drops below 90 mm Hg for 30 minutes? A) Septic B) Cardiogenic C) Neurogenic D) Vasogenic
B
Which of the following signs and symptoms are indications of the body's attempt to compensate for hypovolemic shock? SATA A) Bradycardia B) Pale, cool skin C) Elevated respirations D) Decreased urine output E) Peripheral vasodilation
B, C, D
Which of the following are general signs and symptoms of shock? SATA A) Bradycardia B) Hypotension C) Increased respiratory rate D) Tachycardia E) Oliguria
B, C, D, E
A patient arrives at the emergency department in a state of hypovolemic shock. Fluid replacement is initiated. Which of the does the clinician expect to increase as the patient is treated and begins recovery? SATA A) Heart rate B) Blood pressure C) Urine output D) Respiratory rate E) Renal perfusion
B, C, E
A nurse is caring for several patients. Of the following, which patient should the nurse be most concerned about developing sepsis? A) Postmyocardial infarction patient B) Patient with anterior cruciate ligament (ACL) tear surgery follow-up C) Renal transplant patient on immunosuppressants D) Patient with systemic lupus erythematosus
C
A nurse is reviewing a patient's arterial blood gas values. Which of the following would be most indicative of adult respiratory distress syndrome? A) Partial pressure of oxygen is 90 mm Hg and partial pressure of carbon dioxide is 35 mm Hg B) Partial pressure of oxygen is 80 mm Hg and partial pressure of carbon dioxide is 30 mm Hg C) Partial pressure of oxygen is 60 mm Hg and partial pressure of carbon dioxide is 50 mm Hg D) Partial pressure of oxygen is 90 mm Hg and partial pressure of carbon dioxide is 40 mm Hg
C
A patient has been evaluated and is believed to be in a period of compensatory anti-inflammatory response syndrome (CARS). Which of the following is the correct interpretation? A) The patient is displaying elevated immune response to injury. B) The patient has developed sepsis. C) The patient is at increased risk for infection. D) The patient is heading into adult respiratory distress syndrome.
C
A patient in a state of hypovolemic shock is most likely to present with which acid-base imbalance? A) Respiratory Acidosis B) Respiratory Alkalosis C) Metabolic Acidosis D) Metabolic Alkalosis
C
A patient with a severe systemic infection is displaying hypoxemia and elevated lactate levels, along with an altered mental state. Which type of shock is the patient most at risk for experiencing? A) Cardiogenic B) Hypovolemic C) Septic D) Neurogenic
C
How many progressive stages are associated with multiple organ dysfunction syndrome? A) Ten B) Two C) Four D) Six
C
In this stage of shock, perfusion is reduced to essential tissues, such as the brain and heart. Widespread cellular hypoxia and anaerobic metabolism also occur. A) Initial B) Progressive C) Irreversible
C
In this type of shock, an infectious organism is actively replicating and producing toxins that disrupt circulation. Hypotension results as venous return is decreased to the heart. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
C
In this type of shock, multiple specialists are involved in the treatment. Appropriate antibiotics are needed, and vasoconstrictors and/or respiratory support may be required. Some cases must be resolved with surgery. Control of hyperglycemia is critical A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
C
What is the term used to describe the period of reduced immunity and increased susceptibility to infection following an injury? A) Disseminated intravascular coagulation B) Multiple organ dysfunction syndrome C) Compensatory anti-inflammatory response syndrome D) Systemic inflammatory response syndrome
C
Which of the following is true in regard to multiple organ dysfunction syndrome (MODS)? A) MODS is easily reversed. B) Most patients postsurgery progress to transient MODS. C) MODS is the leading cause of death in the intensive care unit (ICU). D) The etiology and progression of MODS is clearly understood.
C
Which of the following may appear in anaphylactic shock but be absent in other forms of shock? A) Decreasing blood pressure B) Tachycardia C) Stridor and wheezing D) Underlying systemic infection
C
Which type of shock results from an IgE-mediated allergic reaction? A) Cardiogenic B) Neurogenic C) Anaphylactic D) Hypovolemic
C
A patient has presented with signs and symptoms of systemic inflammatory response syndrome (SIRS). Which of the following are likely to decrease? SATA A) Heart rate B) Respiratory rate C) Gastrointestinal (GI) activity D) Urine output E) Cardiac output
C, D
What are the three stages of shock? SATA A) Comprehensive B) Recurrent C) Initial D) Progressive E) Irreversible
C, D, E
Which of the following may be observed in a patient suffering from shock? SATA A) Inhibition of renin-angiotensin-aldosterone system. B) Increased blood flow to the gastrointestinal tract. C) Activation of the sympathetic nervous system. D) Increased susceptibility to clot formation. E) Decreased kidney perfusion leading to oliguria.
C, D, E
A patient presents at the emergency department in shock. Blood glucose levels are elevated. Which of the following may explain this development relative to the state of shock? A) The patient has Diabetes Mellitus B) The patient has recently eaten C) The patient has increased insulin sensitivity D) The patient has released the stress hormones cortisol and epinephrine
D
If a patient is diagnosed with systemic inflammatory response syndrome (SIRS), which of the following is occurring? A) Shock B) Suppression of SNS activity C) Increased clotting and increased bleeding D) Widespread inflammatory response
D
In adult respiratory distress syndrome, ____________________. A) Hypoventilation is the first sign B) Serum creatinine increases C) Blood urea nitrogen increases D) The lungs have difficulty oxygenating the blood
D
In regard to the shock, which of the following is the correct understanding for the nurse to have in regard to renal function? A) The kidneys are very resilient and can withstand a state of shock for several days. B) Any damage to the kidneys during a state of shock is irreversible. C) Development of even brief episodes of shock is the number one reason for renal transplants. D) Fifteen minutes of shock can begin to cause dysfunction of renal tubules.
D
This type of shock occurs when systolic blood pressure falls to less than 90 mm Hg despite adequate fluid volume and venous return. Baroreceptors detect the fall in blood pressure and activate the sympathetic nervous system. Decreased perfusion of the kidneys activates RAAS, which increases fluid volume within the body. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
D
In this type of shock, fluid replacement is the key treatment. Although initial form of replacement fluid is under debate, most agree that Ringer's lactate or normal saline can be used. Blood transfusions may eventually be necessary. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
E
This form of shock results from decreased blood volume, often as a result of trauma. Inadequate blood returns to the heart, reducing cardiac output and blood pressure. A) Anaphylactic B) Neurogenic C) Septic D) Cardiogenic E) Hypovolemic
E
Order the stages of MODS: A) Tachypnea and hypoxemia B) Death C) Vasopressor dependency, oliguria, ischemic colitis D) Shock with azotemia and coagulation abnormalities E) Increased volume requirements and mild respiratory alkalosis
E, A, D, C, B
