Chapter 49: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Chil-
dren
MULTIPLE CHOICE
1. What is the most common type of shock in children?
a.
Hypovolemic c. Neurogenic
b.
Cardiogenic d. Septic
ANS: A
Hypovolemic shock, the most common type of shock in children, is associated with a reduc-
tion in the intravascular volume relative to the vascular space.
PTS: 1 REF: Page 1703
2. Hypotension is likely to occur when an infant or child is greater than % dehydrated.
a.
2 c. 7
b. 5 d. 10
ANS: D
Hypotension typically develops when dehydration is greater than 10% in the infant or child or
greater than 6% in the adolescent.
PTS: 1 REF: Page 1703
3. A prolonged capillary refill time in children is consistent with the development of what type
of shock?
a.
Hypovolemic c. Compensated
b.
Septic d. Cardiogenic
ANS: B
The child with hypovolemic shock demonstrates signs of inadequate blood flow to some tis-
sue beds and some evidence of organ system dysfunction. The infant or child may be irritable
or lethargic. Respirations will be rapid and may be labored if shock is severe or associated
with myocardial failure. The skin will be mottled, although pallor also may be observed. A
prolonged capillary refill time (>2 seconds) is consistent with the development of septic
shock. This statement is not necessarily true of the other types of shock.
PTS: 1 REF: Page 1704
4. Bradycardia in young children experiencing shock symptoms often suggests which result?
a.
Onset of cardiac dysfunction
b.
Effective management of cardiac dysfunction
c.
Good management of anxiety
d.
Cardiovascular collapse
ANS: D
Bradycardia often indicates impending cardiovascular collapse or cardiac arrest and is the
most common terminal cardiac rhythm observed in children. This selection is the only option
that accurately describes the impact of bradycardia on a child.
, PTS: 1 REF: Page 1704
5. What is the cause of appropriately 50% of the deaths in children who have experienced a
burn injury?
a.
Immunosuppression c. Inhalation injury
b.
Hypermetabolism d. Hypertrophic scarring
ANS: C
The leading cause of death in children after burn injury, as in adults, is an inhalation injury. In-
halation injuries cause approximately 50% of all deaths in children with burns. Although the
other options are factors, they are not responsible for 50% of the deaths.
PTS: 1 REF: Pages 1715-1716
6. In cardiogenic shock, what is the cause of hepatomegaly and periorbital edema?
a.
Mass vasodilation as a result of chemical mediators released from the myocardium
b.
Low cardiac output, causing a high central venous pressure
c.
Tissue damage to the myocardium, causing increased capillary permeability
d.
Low perfusion of the kidneys, stimulating the renin-angiotensin-aldosterone sys-
tem to retain sodium and water
ANS: B
Evidence of an adequate or high central venous pressure, including hepatomegaly and perior-
bital edema, is observed in cardiogenic shock. This selection is the only option that
accurately identifies the cause of these symptoms.
PTS: 1 REF: Page 1704
7. Approximately 80% of all hospital-acquired infections in children are a result of which type
of organism?
a.
Bacteria c. Fungi
b.
Viruses d. Rickettsia
ANS: A
In adults and children, approximately 40% of all hospital-acquired infections are linked to
gram-negative infections, 40% to gram-positive infections, and 20% to viruses, fungi, or rick-
ettsial microorganisms.
PTS: 1 REF: Page 1707
8. Which cytokines are antiinflammatory mediators?
a.
Interleukin (IL)Ð1, IL-6, and tumor necrosis factorÐalpha (TNF-𝛼)
b.
IL-8, IL-12, and platelet-activating factor
c.
IL-24, arachidonic acid metabolites, and nitric oxide
d.
IL-4, IL-11, and colony-stimulating factor
ANS: D
Antiinflammatory mediators include only IL-4, IL-10, IL-11, and IL-13; transforming
growth factor-beta; colony-stimulating factors; soluble TNF receptor; IL-1 receptor
antagonist; and activated protein C.
PTS: 1 REF: Page 1707
dren
MULTIPLE CHOICE
1. What is the most common type of shock in children?
a.
Hypovolemic c. Neurogenic
b.
Cardiogenic d. Septic
ANS: A
Hypovolemic shock, the most common type of shock in children, is associated with a reduc-
tion in the intravascular volume relative to the vascular space.
PTS: 1 REF: Page 1703
2. Hypotension is likely to occur when an infant or child is greater than % dehydrated.
a.
2 c. 7
b. 5 d. 10
ANS: D
Hypotension typically develops when dehydration is greater than 10% in the infant or child or
greater than 6% in the adolescent.
PTS: 1 REF: Page 1703
3. A prolonged capillary refill time in children is consistent with the development of what type
of shock?
a.
Hypovolemic c. Compensated
b.
Septic d. Cardiogenic
ANS: B
The child with hypovolemic shock demonstrates signs of inadequate blood flow to some tis-
sue beds and some evidence of organ system dysfunction. The infant or child may be irritable
or lethargic. Respirations will be rapid and may be labored if shock is severe or associated
with myocardial failure. The skin will be mottled, although pallor also may be observed. A
prolonged capillary refill time (>2 seconds) is consistent with the development of septic
shock. This statement is not necessarily true of the other types of shock.
PTS: 1 REF: Page 1704
4. Bradycardia in young children experiencing shock symptoms often suggests which result?
a.
Onset of cardiac dysfunction
b.
Effective management of cardiac dysfunction
c.
Good management of anxiety
d.
Cardiovascular collapse
ANS: D
Bradycardia often indicates impending cardiovascular collapse or cardiac arrest and is the
most common terminal cardiac rhythm observed in children. This selection is the only option
that accurately describes the impact of bradycardia on a child.
, PTS: 1 REF: Page 1704
5. What is the cause of appropriately 50% of the deaths in children who have experienced a
burn injury?
a.
Immunosuppression c. Inhalation injury
b.
Hypermetabolism d. Hypertrophic scarring
ANS: C
The leading cause of death in children after burn injury, as in adults, is an inhalation injury. In-
halation injuries cause approximately 50% of all deaths in children with burns. Although the
other options are factors, they are not responsible for 50% of the deaths.
PTS: 1 REF: Pages 1715-1716
6. In cardiogenic shock, what is the cause of hepatomegaly and periorbital edema?
a.
Mass vasodilation as a result of chemical mediators released from the myocardium
b.
Low cardiac output, causing a high central venous pressure
c.
Tissue damage to the myocardium, causing increased capillary permeability
d.
Low perfusion of the kidneys, stimulating the renin-angiotensin-aldosterone sys-
tem to retain sodium and water
ANS: B
Evidence of an adequate or high central venous pressure, including hepatomegaly and perior-
bital edema, is observed in cardiogenic shock. This selection is the only option that
accurately identifies the cause of these symptoms.
PTS: 1 REF: Page 1704
7. Approximately 80% of all hospital-acquired infections in children are a result of which type
of organism?
a.
Bacteria c. Fungi
b.
Viruses d. Rickettsia
ANS: A
In adults and children, approximately 40% of all hospital-acquired infections are linked to
gram-negative infections, 40% to gram-positive infections, and 20% to viruses, fungi, or rick-
ettsial microorganisms.
PTS: 1 REF: Page 1707
8. Which cytokines are antiinflammatory mediators?
a.
Interleukin (IL)Ð1, IL-6, and tumor necrosis factorÐalpha (TNF-𝛼)
b.
IL-8, IL-12, and platelet-activating factor
c.
IL-24, arachidonic acid metabolites, and nitric oxide
d.
IL-4, IL-11, and colony-stimulating factor
ANS: D
Antiinflammatory mediators include only IL-4, IL-10, IL-11, and IL-13; transforming
growth factor-beta; colony-stimulating factors; soluble TNF receptor; IL-1 receptor
antagonist; and activated protein C.
PTS: 1 REF: Page 1707
