Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 50: Shock, Multiple Organ Dysfunction Syndrome, and Burns in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. What is the most common type of shock in children?a. Hypovolemicb. Cardiogenicc. Neurogenicd. SepticANS: AHypovolemic shock, the most common type of shock in children, is associated with a reduction in the intravascular volume relative to the vascular space. It is most frequently caused by dehydration and trauma.PTS: 1 DIF: Cognitive Level: Remembering 2. Hypotension is likely to occur when an infant or child is greater than _____ % dehydrated.a. 2b. 5c. 7d. 10ANS: DHypotension typically develops when dehydration is greater than 10% in the infant or child or greater than 6% in the adolescent.PTS: 1 DIF: Cognitive Level: Remembering 3. A healthcare professional assesses that a child’s capillary refill time is 4 sec. What does the healthcare professional evaluate that finding to mean?a. The child is in shock.b. The child must have septic shock.c. The child has compensated shock.d. This finding is normal.ANS: ANormal capillary refill time is <2 sec (brisk). A refill time of 4 sec in prolonged and indicates a perfusion deficit possibly from shock. In septic shock, the capillary refill time may be normal or faster than normal due to vasodilation.PTS: 1 DIF: Cognitive Level: Applying 4. A 2-year-old is in shock. The healthcare professional assesses the child’s heart rate as 52 beats/min. What action by the healthcare professional is most appropriate?a. Get an ECG.b. Increase the intravenous rate.c. Sedate the child.d. Begin CPR.ANS: DBradycardia often indicates impending cardiovascular collapse or cardiac arrest and is the most common terminal cardiac rhythm observed in children. The normal resting heart rate in a toddler is 80 to 120 beats/min, so a heart rate of 52 beats/min is too slow. The provider would assess perfusion and if the heart rate does not rise, begin CPR. The provider would not take the time to order an ECG. There is no reason to increase the fluid rate, or sedate the child at this moment.PTS: 1 DIF: Cognitive Level: Applying 5. A child has a burn injury. What does the healthcare provider assess for when determining the child’s chance of surviving?a. Immunosuppressionb. Hypermetabolismc. Inhalation injuryd. Hypertrophic scarringANS: CThe leading cause of death in children after burn injury, as in adults, is an inhalation injury. Inhalation injuries cause approximately 50% of all deaths in children with burns. Burn victims do have immune dysfunction, hypermetabolism, and scarring, but those do not contribute to the majority of pediatric burn deaths.PTS: 1 DIF: Cognitive Level: ApplyingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. A child is in cardiogenic shock and the parents ask why the child has hepatomegaly and periorbital edema. What explanation by the healthcare professional is best?a. Mass vasodilation as a result of chemical mediators released from the myocardiumb. Low cardiac output and systemic venous congestionc. Tissue damage to the myocardium, causing increased capillary permeabilityd. Reduced renal perfusion, stimulating the RAAS systemANS: BCardiogenic shock is generally associated with low cardiac output and systemic venous congestion, leading to signs of fluid backup into organs and tissues. The professional would explain that this is the cause of the hepatomegaly and edema. It is not the result of mass vasodilation, tissue damage, or the RAAS system activation.PTS: 1 DIF: Cognitive Level: Understanding 7. Approximately 80% of all hospital-acquired infections in children are a result of which type of organism?a. Bacteriab. Virusesc. Fungid. RickettsiaANS: AIn adults and children, approximately 40% of all hospital-acquired infections are linked to gram-negative infections, 40% to gram-positive infections, and 21% each to viruses and fungi.PTS: 1 DIF: Cognitive Level: Remembering 8. A student asks the healthcare professional to explain reperfusion injuries. What explanation by the professional is best?a. Tissue damage that can occur with blood transfusionsb. Tissue destruction during rewarming in frostbitec. Damage from restored blood flow and exposure to oxygend. Fluid overload from intravenous therapy that is too rapidANS: CReperfusion (reoxygenation) injury is associated with cell damage caused by the restoration of blood flow and physiologic concentrations of oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions. It is not related to blood transfusions, rewarming specifically, or fluid overload.PTS: 1 DIF: Cognitive Level: Understanding 9. The healthcare professional plans care for a child in shock. What are the primary goals for the treatment of shock?a. Maximizing oxygen delivery and minimizing oxygen demandb. Maintaining hydration and adequate urinary outputc. Supporting all facets of the cardiovascular systemd. Maintaining all vital signs within normal functioning rangesANS: AThe primary goals of the treatment of shock are maximizing oxygen delivery and minimizing oxygen demand. The other goals are desirable, but do not take priority over maximizing oxygen delivery and minimizing demand. If those goals are met, the others will be as a result.PTS: 1 DIF: Cognitive Level: Remembering 10. To determine a child’s response to fluid therapy for shock, the healthcare professional should monitor which measurements as the priority?a. Hematocrit and hemoglobin levelsb. Urine output and specific gravityc. Blood pressure and pulsed. Arterial blood gases and heart rateANS: BMonitoring of the volume of urine output and specific gravity is most useful in determining the child’s response to fluid therapy.PTS: 1 DIF: Cognitive Level: Remembering 11. A 33-pound child is in shock. Which fluid bolus should the healthcare professional prepare to administer to this child?a. Hypotonic fluid, 150 mLb. Hypotonic fluid, 300 mLc. Isotonic fluid, 150 mLd. Isotonic fluid, 300 mLANS: DIn general, isotonic crystalloids (salt-containing solutions, such as normal saline or lactated Ringer solution) or colloids (protein-containing fluids, such as albumin or blood) are administered in boluses of 20 mL/kg. This child weighs 33 pounds, or 15 kg. 15 × 20 = 300. Hypotonic fluids are not used.PTS: 1 DIF: Cognitive Level: ApplyingCopyright © 2019,
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