Types of Shock
Hypotension during anaphylactic shock is caused primarily by: A) vascular damage. B) relative hypovolemia. C) cardiac muscle injury. D) capillary leakage.
B) relative hypovolemia.
Signs of compensated shock in the infant or child include all of the following, EXCEPT: A) abnormal mentation. B) tachycardia and pallor. C) prolonged capillary refill. D) decreased peripheral perfusion.
A) abnormal mentation.
In addition to IV fluids, treatment for a patient in neurogenic shock may include: A) atropine. B) amiodarone. C) epinephrine 1:1,000. D) low-dose dopamine.
B) amiodarone.
Signs of neurogenic shock include all of the following, EXCEPT: A) bradycardia. B) flushed skin. C) diaphoresis. D) hypothermia.
C) diaphoresis.
Spinal cord injuries that cause neurogenic shock generally produce: A) cool, clammy skin distal to the site of the spinal cord injury. B) reflex tachycardia due to sympathetic nervous system stimulation. C) flaccid paralysis and complete loss of sensation distal to the injury. D) signs and symptoms that are identical to those of hypovolemic shock.
C) flaccid paralysis and complete loss of sensation distal to the injury.
Unlike other types of shock, a child in cardiogenic shock would MOST likely present with: A) an enlarged spleen. B) unlabored tachypnea. C) increased work of breathing. D) a primary cardiac dysrhythmia.
C) increased work of breathing.
A loss of normal sympathetic nervous system tone causes: A) neurogenic shock. B) obstructive shock. C) profound vasoconstriction. D) a reduced absolute blood volume.
A) neurogenic shock.
Which of the following statements regarding toxic shock syndrome (TSS) is correct? A) TSS is a condition that is exclusive to females. B) Patients with TSS may show signs of liver failure. C) Most cases of TSS occur in the absence of a fever. D) Group B Streptococcus is a causative agent in TSS.
B) Patients with TSS may show signs of liver failure.
A characteristic sign of neurogenic shock caused by a spinal injury is: A) pink, warm, dry skin above the level of the injury. B) an absence of sweating below the level of the injury. C) a reflex tachycardia secondary to vascular dilation. D) irregular breathing secondary to brainstem insult.
B) an absence of sweating below the level of the injury.
Distributive shock occurs when: A) central vasoconstriction forces blood from the core of the body. B) blood pools in expanded vascular beds and tissue perfusion decreases. C) microorganisms attack the blood vessels, resulting in vasodilation. D) a significant decrease in cardiac contractility causes decreased perfusion.
B) blood pools in expanded vascular beds and tissue perfusion decreases.
Epinephrine is used to treat patients in anaphylactic shock because of its effects of: A) vasodilation and bronchoconstriction. B) bronchodilation and vasoconstriction. C) increased heart rate and automaticity. D) parasympathetic nervous system blockade.
B) bronchodilation and vasoconstriction.
Plasma protein fraction (Plasmanate) is especially useful for patients with: A) hyponatremia. B) burn shock. C) dehydration. D) blood loss.
B) burn shock.
Intrinsic causes of cardiogenic shock include: A) pleural effusion. B) cardiomyopathy. C) pulmonary embolus. D) tension pneumothorax.
B) cardiomyopathy.
When an adult patient with hemorrhagic shock loses more than 40% of his or her blood volume: A) blood flow is diverted away from the skin to the liver, kidneys, and lungs. B) cardiovascular deterioration cannot be reversed by compensatory mechanisms. C) vital organ damage can be repaired if a blood transfusion is started promptly. D) immediate IV fluid replacement can rapidly restore adequate tissue perfusion.
B) cardiovascular deterioration cannot be reversed by compensatory mechanisms.
A patient with hemorrhagic shock would be expected to have: A) warm, flushed skin. B) flattened jugular veins. C) a widened pulse pressure. D) an increased hematocrit.
B) flattened jugular veins.
A patient with cardiogenic shock and pulmonary edema should be positioned: A) in the Trendelenburg position. B) in a semi-Fowler's position. C) supine with the legs elevated. D) in a lateral recumbent position.
B) in a semi-Fowler's position.
Spinal shock is a condition that: A) generally affects the sensory nerves but spares the motor nerves. B) is usually temporary and results from swelling of the spinal cord. C) typically manifests within 24 to 36 hours following a spinal injury. D) results in permanent neurologic deficits in the majority of patients.
B) is usually temporary and results from swelling of the spinal cord.
The recommended approach for fluid resuscitation of a patient in shock is ___ mL/kg until ______. A) 20, normotension is achieved B) 10, mental status improves C) 20, radial pulses become stronger D) 10, the skin becomes pink and dry
C) 20, radial pulses become stronger
What physiologic effect of anaphylactic shock is seen MOST commonly in patients with neurogenic shock? A) Profound tachycardia B) Decreased cardiac contractility C) Widespread vasodilation D) Fluid leakage into the tissues
C) Widespread vasodilation
Fibrinolysis may be contraindicated in all of the following, EXCEPT: A) major trauma or surgery within the past 4 weeks. B) a history of structural central nervous system disease. C) a history of anaphylactic shock caused by salicylates. D) significant closed head trauma within the past 3 weeks.
C) a history of anaphylactic shock caused by salicylates.
The MOST common cause of cardiogenic shock is: A) untreated hypertension. B) blunt force chest trauma. C) acute myocardial infarction. D) sustained pulmonary hypertension.
C) acute myocardial infarction.
Burn shock is caused by: A) a massive infection that occurs when microorganisms breach burned skin. B) renal failure secondary to excess myoglobin production from burned muscle. C) fluid loss across damaged skin and volume shifts within the rest of the body. D) acute dehydration, and it commonly manifests within 30 minutes after the burn.
C) fluid loss across damaged skin and volume shifts within the rest of the body.
A child in anaphylactic shock: A) should receive 0.1 mg/kg of epinephrine IM. B) is treated primarily with saline fluid boluses. C) may require a low-dose epinephrine infusion. D) should receive epinephrine 1:1,000 via the IV route.
C) may require a low-dose epinephrine infusion.
Relative bradycardia during neurogenic shock occurs because: A) systemic venous pooling of the blood overstimulates the vagus nerve. B) the parasympathetic nervous system does not release acetylcholine. C) the sympathetic nervous system is not stimulated to release catecholamines. D) the brainstem does not receive messages to increase the heart rate.
C) the sympathetic nervous system is not stimulated to release catecholamines.
Which of the following injuries or conditions would cause obstructive shock? A) Severe burns B) Massive sepsis C) Pelvic fracture D) Cardiac tamponade
D) Cardiac tamponade
Which of the following is the BEST indicator of tissue perfusion during compensated shock? A) Systolic blood pressure B) Pulse rate and quality C) Skin color and condition D) Level of responsiveness
D) Level of responsiveness
What type of shock occurs when blood flow becomes blocked in the heart or great vessels? A) Cardiogenic B) Peripheral C) Distributive D) Obstructive
D) Obstructive
Transport of a patient in anaphylactic shock may be delayed for all of the following reasons, EXCEPT: A) aggressive airway control. B) epinephrine administration. C) assessment of lung sounds. D) a secondary assessment.
D) a secondary assessment.
A vagus nerve-mediated form of cardiogenic shock without compensatory vasoconstriction that may be seen following a blast injury would MOST likely present with: A) syncope and hypertension. B) hypertension and bradycardia. C) hypotension and tachycardia. D) bradycardia and hypotension.
D) bradycardia and hypotension.
Initial signs and symptoms of toxic shock syndrome include all of the following, EXCEPT: A) myalgia. B) scleral injection. C) headache and fever. D) cardiac dysrhythmias.
D) cardiac dysrhythmias.
An adult patient presents with a blood pressure of 78/60 mm Hg, a pulse rate of 120 beats/min and irregular, and labored breathing. Further assessment reveals pale, cool, moist skin and diffuse crackles in all lung fields. You should suspect: A) septic shock. B) neurogenic shock. C) hypovolemic shock. D) cardiogenic shock.
D) cardiogenic shock.
When caring for an infant or child who is in compensated shock, you should: A) intubate at the earliest sign of altered mentation. B) administer a 10-mL/kg normal saline fluid bolus. C) assist ventilations to improve tissue oxygenation. D) establish IV or IO access en route to the hospital.
D) establish IV or IO access en route to the hospital.
The MOST common type of exogenous hypovolemic shock is: A) severe diarrhea. B) internal hemorrhage. C) excess plasma loss. D) external bleeding.
D) external bleeding.
In trauma patients with shock, hypothermia: A) decreases internal hemorrhage. B) enhances the shivering response. C) facilitates the process of hemostasis. D) interferes with the coagulation of blood.
D) interferes with the coagulation of blood.
You should be MOST suspicious for cardiogenic shock in an infant or child if: A) he or she appears listless or lethargic. B) his or her heart rate varies with activity. C) his or her heart rate is greater than 150 beats/min. D) perfusion decreases following a fluid bolus.
D) perfusion decreases following a fluid bolus.
A patient in cardiogenic shock without cardiac arrhythmias will benefit MOST from: A) supplemental oxygen. B) a high-dose vasopressor infusion. C) a 250-mL bolus of a crystalloid solution. D) rapid transport to an appropriate hospital.
D) rapid transport to an appropriate hospital.
Etomidate should be avoided as an induction agent in pediatric intubation in the presence of: A) hypovolemia. B) tachycardia. C) hypotension. D) septic shock.
D) septic shock.
The MOST important aspect in the care of a woman with severe vaginal bleeding is: A) controlling the vaginal bleeding. B) administering crystalloid fluid boluses. C) giving oxygen via nonrebreathing mask. D) treating for shock and transporting rapidly.
D) treating for shock and transporting rapidly.
In the absence of IV or IO access, the ____ route is the preferred route for the administration of epinephrine to a patient in anaphylactic shock. A) IM B) ET C) SQ D) intradermal
A) IM
Which of the following types of shock is caused by poor blood vessel function? A) Septic B) Cardiogenic C) Hypovolemic D) Hemorrhagic
A) Septic
Which of the following statements regarding endometritis is correct? A) Untreated endometritis may result in septic shock. B) Endometritis is defined as an enlargement of the uterus. C) Endometritis is most commonly caused by an intrauterine device. D) Endometritis results when endometrial tissue grows outside the uterus.
A) Untreated endometritis may result in septic shock.
An unresponsive patient with signs of anaphylactic shock: A) indicates cerebral hypoxia and hypercarbia. B) requires immediate antihistamine therapy. C) is often unable to be intubated successfully. D) needs hyperventilation with a bag-mask device.
A) indicates cerebral hypoxia and hypercarbia.
For anaphylactic shock, epinephrine should be given via the _____________ route. A) intravenous B) endotracheal C) intramuscular D) subcutaneous
A) intravenous
Which of the following injuries or mechanisms would MOST likely lead to nonhemorrhagic shock? A) Fractures B) Blunt trauma C) Hemothorax D) Severe burns
D) Severe burns
Which of the following clinical signs would differentiate septic shock from hypovolemic shock? A) Severe hypotension B) Altered mental status C) Weak, thready pulse D) Warm or hot skin
D) Warm or hot skin
The MOST common cause of cardiogenic shock is: A) myocardial infarction. B) ventricular aneurysm. C) a sudden dysrhythmia. D) papillary muscle rupture.
A) myocardial infarction.
Distributive shock in children is MOST often the result of: A) sepsis. B) spinal injury. C) heart failure. D) anaphylaxis.
A) sepsis.
A patient with quiet tachypnea is MOST likely experiencing: A) shock. B) asthma. C) alkalosis. D) airway swelling.
A) shock.
The chief clinical manifestation of Addisonian crisis is: A) shock. B) dehydration. C) lower back pain. D) an elevated temperature.
A) shock.
Early distributive shock in children is characterized by: A) warm, flushed skin. B) weak peripheral pulses. C) pallor and diaphoresis. D) gross neurologic deficits.
A) warm, flushed skin.
Which of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock? A) They cause platelets to clump together. B) They do not expand the circulating volume. C) They do not have oxygen-carrying capacity. D) They increase the viscosity of the blood.
C) They do not have oxygen-carrying capacity.
Hypotension that is associated with neurogenic shock is the result of: A) loss of alpha receptor stimulation. B) concomitant internal hemorrhage. C) increased peripheral vascular tone. D) profound peripheral vasoconstriction.
A) loss of alpha receptor stimulation.
When administering IV fluid boluses to an elderly patient in shock, it is especially important to monitor his or her: A) lung sounds. B) mental status. C) pulse rate. D) blood pressure.
A) lung sounds.
Which of the following is the MOST accurate definition of distributive shock? A) Widespread dilation of the resistance and capacitance vessels B) Decreased perfusion due to sympathetic nervous system failure C) Sustained constriction of the small venules and small arterioles D) Shunting of blood from the periphery to the body's vital organs
A) Widespread dilation of the resistance and capacitance vessels
The MOST ominous respiratory sign in a patient with anaphylactic shock is: A) diminished lung sounds. B) loud expiratory wheezing. C) diffuse coarse crackles. D) labored tachypnea.
A) diminished lung sounds.
The negative target-organ effects of anaphylactic shock are reversed with: A) epinephrine. B) methylprednisolone. C) diphenhydramine. D) low-dose dopamine.
A) epinephrine.
Shock in the trauma patient should be considered _____________ until proved otherwise. A) hemorrhagic B) distributive C) obstructive D) neurogenic
A) hemorrhagic
If an adult patient is in hypovolemic shock, you should attempt to insert a(n) ______ over-the-needle catheter into the _______. A) 14-gauge, antecubital vein B) 16-gauge, metacarpal vein C) 14-gauge, metacarpal vein D) 18-gauge, external jugular vein
A) 14-gauge, antecubital vein
You have given an 800-mL normal saline bolus to a patient in shock. How much of this fluid will remain in the intravascular space after 20 minutes? A) 320 mL B) 380 mL C) 480 mL D) 600 mL
A) 320 mL
Which of the following signs would you MOST likely observe in a patient with compensated shock? A) Anxiety or agitation B) Dilation of the pupils C) Absent peripheral pulses D) Response to painful stimuli
A) Anxiety or agitation
By which of the following mechanisms do patients with septic shock become hypovolemic? A) Sustained systemic vascular dilation B) Fluid leakage out of the vascular space C) Spontaneous destruction of red blood cells D) Frequent and severe vomiting and diarrhea
B) Fluid leakage out of the vascular space
Which of the following hemodynamic parameters decreases, regardless of the etiology of the shock? A) Pulse rate B) Mean arterial pressure C) Central venous pressure D) Peripheral vascular resistance
B) Mean arterial pressure
The three MOST significant indicators of anaphylactic shock are: A) hives, chest tightness, and restlessness. B) dyspnea, hypotension, and tachycardia. C) pruritus, peripheral swelling, and urticaria. D) dizziness, flushed skin, and abdominal pain.
B) dyspnea, hypotension, and tachycardia.
A patient in shock due to internal bleeding will benefit MOST from: A) oxygen and thermal management. B) limited scene time and rapid transport. C) a comprehensive physical examination. D) two large-bore IV lines of normal saline.
B) limited scene time and rapid transport.
It is important to remember that blood pressure is only one component in the overall assessment of a child because: A) it is an unreliable measurement of perfusion in all children. B) hypotension is seen much earlier in children than in adults. C) blood pressure may remain adequate in compensated shock. D) it generally yields a falsely low reading in agitated children.
C) blood pressure may remain adequate in compensated shock.
Infants and children in shock: A) typically become hypotensive sooner than adults because of a relative decrease in total blood volume. B) generally remain alert for longer periods than adults despite a significant decrease in cerebral perfusion. C) compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance. D) maintain end-organ perfusion longer than adults, making capillary refill time a less reliable perfusion indicator.
C) compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance.
In decompensated shock, systolic blood pressure is: A) less than 90 mm Hg in adult males. B) less than 80 mm Hg in adult females. C) less than the fifth percentile for the age. D) usually undetectable due to vasodilation.
C) less than the fifth percentile for the age.
In contrast to a patient with compensated shock, a patient with decompensated shock would be expected to present with: A) polyuria and weak pulses. B) bounding radial pulses. C) mottled skin and dilated pupils. D) restlessness and pale cool skin.
C) mottled skin and dilated pupils.
Treatment for a patient with neurogenic shock may include all of the following, EXCEPT: A) a vagolytic medication. B) a vasopressor medication. C) prevention of hyperthermia. D) fluid volume to maintain perfusion.
C) prevention of hyperthermia.
A young woman experiences a sudden nervous system reaction that produces temporary, generalized vasodilation and causes her to faint. This is MOST descriptive of _____________ shock A) neurogenic B) obstructive C) psychogenic D) hypovolemic
C) psychogenic
Decompensated shock in the adult is characterized by: A) increased tidal volume. B) bounding radial pulses. C) 15% blood loss or more. D) a falling blood pressure.
D) a falling blood pressure.
Common central nervous system manifestations of anaphylactic shock include all of the following, EXCEPT: A) anxiety. B) headache. C) confusion. D) combativeness.
D) combativeness.
Which of the following general statements regarding anaphylactic shock is correct? A) In order to provide appropriate treatment, you must first determine what caused the allergic reaction. B) In the presence of anaphylaxis, intervention takes precedence over identifying the offending antigen. C) Anaphylactic shock would most likely occur following initial exposure to an offending antigen. D) Most patients who carry a prescribed EpiPen are not completely aware of what substances they are allergic to.
B) In the presence of anaphylaxis, intervention takes precedence over identifying the offending antigen.
Which of the following occurs during compensated shock? A) Cerebral hypoperfusion causes pupillary constriction B) Increased rate of breathing causes respiratory alkalosis C) Urine output decreases to less than 20 mL/hour D) Vasomotor failure leads to a drop in systolic blood pressure
B) Increased rate of breathing causes respiratory alkalosis
Which of the following assessment findings should increase your index of suspicion for obstructive shock? A) Low blood pressure B) Jugular venous distention C) Increased lung compliance D) Generalized edema
B) Jugular venous distention
The "platinum 10 minutes" refers to the: A) maximum amount of time to extricate a patient. B) maximum time spent at a scene for a trauma patient. C) amount of time before decompensated shock occurs. D) amount of time taken to perform a rapid assessment.
B) maximum time spent at a scene for a trauma patient.
Cardiogenic shock occurs when: A) blood backs up into the pulmonary circulation. B) more than 40% of the left ventricle has infarcted. C) left ventricular ejection fraction is less than 50%. D) any condition causes an increase in atrial preload.
B) more than 40% of the left ventricle has infarcted.
A child in decompensated shock with hypotension should: A) be intubated to protect his or her airway. B) receive initial fluid resuscitation at the scene. C) be given 25% dextrose to prevent hypoglycemia. D) receive volume expansion with 5% dextrose in water.
B) receive initial fluid resuscitation at the scene.
In hypovolemic shock, lactated Ringer's solution should be: A) mixed with normal saline solution. B) titrated to the patient's physiologic response. C) given until a systolic BP of 110 mm Hg is achieved. D) avoided if the patient's shock is caused by blood loss.
B) titrated to the patient's physiologic response.
Anaphylactic shock is characterized by: A) labored breathing and hypertension. B) wheezing and widespread vasodilation. C) intracellular hypovolemia and hives. D) a deficiency of circulating histamines.
B) wheezing and widespread vasodilation.
If an acutely burned patient is in shock in the prehospital setting: A) it is likely that he or she is experiencing burn shock. B) you should look for another injury as the source of shock. C) administer a 250-mL bolus of normal saline and reassess. D) avoid IV fluids unless the systolic BP is below 80 mm Hg.
B) you should look for another injury as the source of shock.
Which of the following vital signs values are MOST consistent with neurogenic shock? A) Blood pressure, 120/70; pulse, 70; respirations, 14 B) Blood pressure, 160/100; pulse, 40; respirations, 8 C) Blood pressure, 80/60; pulse, 50; respirations, 24 D) Blood pressure, 70/40; pulse, 120; respirations, 26
C) Blood pressure, 80/60; pulse, 50; respirations, 24
The paramedic's MAIN goal in treating a patient with shock is to: A) administer oxygen in a concentration sufficient to maintain an oxygen saturation greater than 95%. B) start two large-bore IV lines and infuse enough isotonic crystalloid solution to maintain adequate tissue perfusion. C) recognize the signs and symptoms of shock in its earliest phase and begin immediate treatment before permanent damage occurs. D) maintain body temperature and elevate the patient's legs 6 to 12 inches in order to improve blood flow to the core of the body.
C) recognize the signs and symptoms of shock in its earliest phase and begin immediate treatment before permanent damage occurs.
