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UT Arlington NURS 5315 - Chapter 49 Exam

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Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 49: Shock, Multiple Organ Dysfunction Syndrome, and Burns in AdultsMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. What is the final outcome of impaired cellular metabolism?a. Cellular alterations in the heart and brainb. Buildup of cellular waste productsc. Cellular alterations in the vasculature structures and kidneysd. Impairment of urine excretionANS: BThe common pathway in all types of shock is impairment of cellular metabolism as a result of decreased delivery of oxygen and nutrients, which are frequently coupled with an increased demand, the consumption of oxygen and nutrients, and a decreased removal of cellular waste products. Eventually organ dysfunction and failure do occur. Urine excretion diminishes as the kidneys fail from lack of perfusion or due to hypovolemic shock and volume loss.PTS: 1 DIF: Cognitive Level: Remembering 2. Which clinical manifestation of septic shock confirms an elevation in immune system response?a. Tachycardiab. Increased white blood cell countc. Low respiratory rated. HypothermiaANS: BThe increased WBCs indicate the immune response. Tachycardia occurs as a compensatory mechanism. The respiratory rate will be increased. Temperature will most likely be increased in most patients.PTS: 1 DIF: Cognitive Level: Remembering 3. The release of catecholamine by the adrenal glands provides which compensatory mechanism in hypovolemic shock?a. Interstitial fluid moves out of the vascular compartment.b. Systemic vascular resistance is decreased.c. Heart rate is increased.d. Water excretion is increased.ANS: CThe heart rate will increase in shock due to the effects of circulating catecholamines. Fluid moving out of the vascular compartment is deleterious, leading to a relative hypovolemia. Systemic vascular resistance is increased to improve blood pressure. Water excretion is not increased as a result of catecholamine release.PTS: 1 DIF: Cognitive Level: Remembering 4. Hypovolemic shock begins to develop when intravascular volume has decreased by what percentage?a. 5b. 10c. 15d. 20ANS: CHypovolemic shock begins to develop when intravascular volume has decreased by approximately 15%.PTS: 1 DIF: Cognitive Level: Remembering 5. A student asks the professor to explain the basics of vasogenic shock. What statement by the professor is best?a. The outcome of widespread hypersensitivity to an allergenb. Bacteremia combined with systemic inflammatory responsec. Inability to get adequate blood to tissues and end organsd. Vasodilation from an imbalance between the two nervous systemsANS: DVasogenic shock refers to a widespread and massive vasodilation resulting from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Widespread hypersensitivity is characteristic of anaphylactic shock. Bacteremia and systemic inflammation are seen in septic shock. The inability to pump adequate blood to tissues and end organs describes cardiogenic shock.PTS: 1 DIF: Cognitive Level: Understanding 6. What is the clinical hallmark of neurogenic shock as a result of the overstimulation of the parasympathetic nervous system?a. Vasoconstrictionb. Vasodilationc. Increased metabolismd. Respiratory distressANS: BNeurogenic shock refers to a widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Increased metabolism is seen in all forms of shock. Respiratory distress may occur in any form of shock.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. Four patients are in the intensive care unit with different types of shock. Which patient would the healthcare professional assess as the priority?a. Septicb. Hypovolemicc. Anaphylacticd. NeurogenicANS: CAnaphylactic shock is characterized by massive vasodilation and widespread inflammation that can lead to death in minutes if treatment is not instituted immediately. If all else is equal, the healthcare professional should assess the patient with anaphylactic shock first.PTS: 1 DIF: Cognitive Level: Applying 8. A patient is diagnosed with septic shock. What action by the healthcare professional will address the main underlying pathophysiologic mechanism of this disorder?a. Administer antibiotics as soon as possible.b. Provide high volumes of isotonic fluid.c. Place patient on an intra-aortic balloon pump.d. Give the patient antihistamines and steroids.ANS: ASeptic shock begins when bacteria enter the bloodstream, so the effective treatment for this specific problem is antibiotics. High volumes of fluid may been needed in all types of shock other than cardiogenic. A balloon pump would be beneficial in cardiogenic shock. Antihistamines and steroids would be used in anaphylactic shock.PTS: 1 DIF: Cognitive Level: Applying 9. For which type of shock would antihistamines and corticosteroids be prescribed?a. Septicb. Anaphylacticc. Hypovolemicd. CardiogenicANS: BOnly anaphylactic shock responds to the administration of epinephrine to decrease mast cell and basophil degranulation. Antihistamines and steroids are administered to stop the inflammatory reaction. Septic shock specifically requires antibiotics. Hypovolemic shock is treated with large amounts of fluid. Cardiogenic shock requires the use of drugs or devices to improve the pumping ability of the heart.PTS: 1 DIF: Cognitive Level: Remembering 10. Which condition is best defined as a clinical syndrome involving a systemic response to infection, which is manifested by two or more of the systemic inflammatory response syndrome criteria?a. Bacteremiab. Sepsisc. Septicemiad. Septic shockANS: BOf the options available, only sepsis is best defined as a systemic response to infection that is manifested by two or more criteria of the systemic inflammatory response syndrome.PTS: 1 DIF: Cognitive Level: Remembering 11. The student learns that which mechanism causes organ injury in primary multiple organ dysfunction syndrome (MODS)?a. Impaired immune responseb. Impaired glucose usec. Impaired perfusiond. Impaired ventilationANS: CIn primary MODS, the organ injury is directly associated with a specific insult, most often ischemia or impaired perfusion from an episode of shock or trauma, thermal injury, soft tissue necrosis, or invasive infection. Although MODS can be


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