Chapter 48: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Adults
MULTIPLE CHOICE
1. What is the final outcome of impaired cellular metabolism?
a.
Cellular alterations in the heart and brain
b.
Buildup of cellular waste products
c.
Cellular alterations in the vasculature structures and kidneys
d.
Impairment of urine excretion
ANS: B
The 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. Of the options available, this selection is the only accurate outcome.
PTS: 1 REF: Page 1669
2. Which clinical manifestation of septic shock confirms an elevation in immune system
re- sponse?
a.
Tachycardia c. Low respiratory rate
b.
Increased white blood cell count d. Hypothermia
ANS: B
Clinical manifestations common in septic shock are fever, high heart rate, high respiratory
rate, or elevations in immune responses, such as increased white blood cells and circulating
blood glucose.
PTS: 1 REF: Page 1671
3. The release of catecholamine by the adrenal glands compensate for which initial effects of
hy- povolemic 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: C
Compensatory mechanisms (see Figure 48-3) initially offset hypovolemia. Heart rate and sys-
temic vascular resistance increase as a result of catecholamine release by the adrenal glands,
which boosts cardiac output and tissue perfusion pressures. Compelled by a decrease in capil-
lary hydrostatic pressures, interstitial fluid moves into the vascular compartment. The liver
and spleen add to blood volume by disgorging stored red blood cells and plasma. In the kid-
neys, renin (through several intermediaries) stimulates aldosterone release and the retention
of sodium and therefore water, whereas antidiuretic hormone (ADH), or vasopressin, from the
posterior pituitary gland increases water retention. Data on the compensation of ADH, how-
ever, show that as shock worsens, ADH in plasma decreases.
PTS: 1 REF: Page 1672
, 4. Hypovolemic shock begins to develop when intravascular volume has decreased by what per-
centage?
a. 5 c. 15
b. 10 d. 20
ANS: C
Hypovolemic shock begins to develop when intravascular volume has decreased by approxi-
mately 15%.
PTS: 1 REF: Page 1672
5. What type of shock develops as a result of the overstimulation of the parasympathetic nervous
system or the understimulation of the sympathetic nervous system?
a.
Septic c. Anaphylactic
b.
Cardiogenic d. Vasogenic
ANS: D
Only vasogenic shock refers to a widespread and massive vasodilation resulting from an im-
balance between parasympathetic and sympathetic stimulation of vascular smooth muscle.
PTS: 1 REF: Pages 1673-1674
6. What is the clinical hallmark of neurogenic shock as a result of the overstimulation of
the parasympathetic nervous system?
a.
Vasoconstriction c. Increased metabolism
b.
Vasodilation d. Respiratory distress
ANS: B
Neurogenic shock refers to a widespread and massive vasodilation that results from an imbal-
ance between parasympathetic and sympathetic stimulation of vascular smooth muscle. None
of the other options are related to this condition.
PTS: 1 REF: Page 1673
7. Which form of shock is often more severe than other forms because of its sudden, rapid sys-
temic vasodilation?
a.
Septic c. Anaphylactic
b.
Hypovolemic d. Neurogenic
ANS: C
Anaphylactic shock is often more severe than other types of shock because the hypersensitiv-
ity reaction, which triggers vasodilation, has other pathophysiologic effects that rapidly in-
volve the entire body. This action is not associated with the other options.
PTS: 1 REF: Pages 1674-1675
8. What type of shock is related to a decrease in systemic vascular resistance?
a.
Septic c. Hypovolemic
b.
Cardiogenic d. Heart failure
ANS: A
Clinical manifestations of only septic shock are persistent low arterial pressure, low systemic
vascular resistance from vasodilation, and an alteration in oxygen extraction by all cells.
MULTIPLE CHOICE
1. What is the final outcome of impaired cellular metabolism?
a.
Cellular alterations in the heart and brain
b.
Buildup of cellular waste products
c.
Cellular alterations in the vasculature structures and kidneys
d.
Impairment of urine excretion
ANS: B
The 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. Of the options available, this selection is the only accurate outcome.
PTS: 1 REF: Page 1669
2. Which clinical manifestation of septic shock confirms an elevation in immune system
re- sponse?
a.
Tachycardia c. Low respiratory rate
b.
Increased white blood cell count d. Hypothermia
ANS: B
Clinical manifestations common in septic shock are fever, high heart rate, high respiratory
rate, or elevations in immune responses, such as increased white blood cells and circulating
blood glucose.
PTS: 1 REF: Page 1671
3. The release of catecholamine by the adrenal glands compensate for which initial effects of
hy- povolemic 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: C
Compensatory mechanisms (see Figure 48-3) initially offset hypovolemia. Heart rate and sys-
temic vascular resistance increase as a result of catecholamine release by the adrenal glands,
which boosts cardiac output and tissue perfusion pressures. Compelled by a decrease in capil-
lary hydrostatic pressures, interstitial fluid moves into the vascular compartment. The liver
and spleen add to blood volume by disgorging stored red blood cells and plasma. In the kid-
neys, renin (through several intermediaries) stimulates aldosterone release and the retention
of sodium and therefore water, whereas antidiuretic hormone (ADH), or vasopressin, from the
posterior pituitary gland increases water retention. Data on the compensation of ADH, how-
ever, show that as shock worsens, ADH in plasma decreases.
PTS: 1 REF: Page 1672
, 4. Hypovolemic shock begins to develop when intravascular volume has decreased by what per-
centage?
a. 5 c. 15
b. 10 d. 20
ANS: C
Hypovolemic shock begins to develop when intravascular volume has decreased by approxi-
mately 15%.
PTS: 1 REF: Page 1672
5. What type of shock develops as a result of the overstimulation of the parasympathetic nervous
system or the understimulation of the sympathetic nervous system?
a.
Septic c. Anaphylactic
b.
Cardiogenic d. Vasogenic
ANS: D
Only vasogenic shock refers to a widespread and massive vasodilation resulting from an im-
balance between parasympathetic and sympathetic stimulation of vascular smooth muscle.
PTS: 1 REF: Pages 1673-1674
6. What is the clinical hallmark of neurogenic shock as a result of the overstimulation of
the parasympathetic nervous system?
a.
Vasoconstriction c. Increased metabolism
b.
Vasodilation d. Respiratory distress
ANS: B
Neurogenic shock refers to a widespread and massive vasodilation that results from an imbal-
ance between parasympathetic and sympathetic stimulation of vascular smooth muscle. None
of the other options are related to this condition.
PTS: 1 REF: Page 1673
7. Which form of shock is often more severe than other forms because of its sudden, rapid sys-
temic vasodilation?
a.
Septic c. Anaphylactic
b.
Hypovolemic d. Neurogenic
ANS: C
Anaphylactic shock is often more severe than other types of shock because the hypersensitiv-
ity reaction, which triggers vasodilation, has other pathophysiologic effects that rapidly in-
volve the entire body. This action is not associated with the other options.
PTS: 1 REF: Pages 1674-1675
8. What type of shock is related to a decrease in systemic vascular resistance?
a.
Septic c. Hypovolemic
b.
Cardiogenic d. Heart failure
ANS: A
Clinical manifestations of only septic shock are persistent low arterial pressure, low systemic
vascular resistance from vasodilation, and an alteration in oxygen extraction by all cells.
