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Critical care (W 9-10)

Total questions: 190

Worksheet time: 16hrs 50mins

Name
Class
Date
1.

is a clinical syndrome

a)

Shock

b)

Sepsis

c)

Multiple Organ Dysfunction Syndrome

2.

(a)   can progress to organ failure and death unless compensatory mechanisms reverse the process, or clinical interventions are successfully implemented.

3.

(a)   frequently results in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS).

4.

Shock frequently results in

a)

systemic inflammatory response syndrome (SIRS)

b)

multiple organ dysfunction syndrome (MODS)

c)

acute coronary syndrome (ACS)

5.

(a)   ˜begins with cardiovascular system failure

6.

(Shock) Alterations in at least one of four components

a)

Blood volume

b)

Myocardial contractility

c)

Blood flow

d)

Vascular resistance

e)

cardiac output

7.

Initiated by subclinical hypoperfusion that is caused by inadequate CO2, inadequate extraction of oxygen, or both.

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

8.

˜No obvious clinical indications of hypoperfusion are noted in this stage

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

9.

˜Early, reversible

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

10.

˜During this stage, symptoms become apparent, but shock may still be reversed with minimal morbidity if appropriate interventions are initiated.

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

11.

˜The sustained reduction in tissue perfusion initiates a set of neural, endocrine, and chemical compensatory mechanisms in an attempt to maintain blood flow to vital organs.

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

12.

 Stage II: Compensatory (˜Low oxygen tension, Hyperventilation and respiratory alkalosis)

a)

Neural compensation

b)

Endocrine compensation

c)

Chemical compensation

13.

˜Failure compensatory mechanisms

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

14.

˜Profound cardiovascular effects, Increased hypoperfusion, Vasoconstriction.

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

15.

˜Increased capillary hydrostatic pressure.

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

16.

Stage III: Progressive (˜Profound cardiovascular effects, Increased hypoperfusion, Vasoconstriction).

a)

Extremity ischemia

b)

Cellular hypoxia

c)

Lactic acid production

d)

Failure Na+/K+ pump

e)

myocardial infarction

17.

˜Intravascular fluid shifts, Interstitial edema, Decreased circulating intravascular volume.

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

18.

˜Decreased coronary perfusion, Myocardial depressant factor (MDF) released, Decreased myocardial contractility.

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

19.

˜Intravascular fluid shifts (2 answers).

a)

Interstitial edema

b)

Decreased circulating intravascular volume

c)

Myocardial depressant factor (MDF) released

d)

Decreased myocardial contractility

20.

˜Decreased coronary perfusion (2 answers).

a)

Interstitial edema

b)

Decreased circulating intravascular volume

c)

Myocardial depressant factor (MDF) released

d)

Decreased myocardial contractility

21.

˜Prolonged inadequate tissue perfusion, Unresponsive to therapy, Contributes to multiple organ dysfunction and death.

˜

a)

Stage I

b)

Stage II

c)

Stage III

d)

Stage IV

22.

˜Widespread systemic inflammatory response

a)

Multiple Organ Dysfunction Syndrome (MODS)

b)

Systemic Inflammatory Response Syndrome (SIRS)

23.

˜Most frequently associated with sepsis

a)

Multiple Organ Dysfunction Syndrome (MODS)

b)

Systemic Inflammatory Response Syndrome (SIRS)

24.

˜Associated with diverse disorders (Infection, Trauma, Shock, Pancreatitis, and Ischemia).

a)

Multiple Organ Dysfunction Syndrome (MODS)

b)

Systemic Inflammatory Response Syndrome (SIRS)

25.

˜Upsets balance between proinflammatory and anti-inflammatory processes

a)

Multiple Organ Dysfunction Syndrome (MODS)

b)

Systemic Inflammatory Response Syndrome (SIRS)

26.

Systemic Inflammatory Response Syndrome (SIRS) : ˜Associated with diverse disorders

a)

Infection

b)

Trauma / Shock

c)

hepatitis

d)

Pancreatitis

e)

Ischemia

27.

˜Normally localized process becomes systemic

a)

Multiple Organ Dysfunction Syndrome (MODS)

b)

Systemic Inflammatory Response Syndrome (SIRS)

28.

˜Release of mediators. Increased permeability of endothelial wall, Fluid shifts into intravascular spaces, and Depletion of intravascular volume = relative hypovolemia

a)

Multiple Organ Dysfunction Syndrome (MODS)

b)

Systemic Inflammatory Response Syndrome (SIRS)

29.

(SIRS) , ˜Release of mediators

a)

decrease permeability of endothelial wall

b)

Fluid shifts into intravascular spaces

c)

Depletion of intravascular volume = relative hypovolemia

30.

Shock Assessment (•Most sensitive to early changes).

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

31.

Initial stage: Anxiety/restlessness

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

32.

Renal system: Activated renin-angiotensin-aldosterone system

a)

Sodium retention

b)

Water reabsorption

c)

Oliguria

d)

Hypovolemia

33.

Initial stage: Slightly elevated BP and HR (weak thready pulse)

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

34.

Initial stage: Narrow pulse pressure

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

35.

Initial stage: Rapid, deep respirations

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

36.

Late stage: Coma

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

37.

Late stage: hypotension , bradycardia , delayed cap. Refill

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

38.

Late stage: Shallow respirations

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

39.

Late stage: Poor gas exchange

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

40.

Late stage: SPaO 2 reading is inaccurate

a)

Central nervous system

b)

Cardiovascular system

c)

Pulmonary system

d)

Renal system

41.

Decreased bowel sounds, distention, nausea, and constipation, risk of infection /sepsis.

a)

Gastrointestinal (GI) system

b)

Hepatic

c)

Hematological

d)

Integumentary

42.

Leukopenia and Increased susceptibility to infection

a)

Gastrointestinal (GI) system

b)

Hepatic

c)

Hematological

d)

Integumentary

43.

Enhanced clotting/inhibited fibrinolysis

a)

Gastrointestinal (GI) system

b)

Hepatic

c)

Hematological

d)

Integumentary

44.

Depletion of clotting factors

a)

Gastrointestinal (GI) system

b)

Hepatic

c)

Hematological

d)

Integumentary

45.

Clotting in the microcirculation

a)

Gastrointestinal (GI) system

b)

Hepatic

c)

Hematological

d)

Integumentary

46.

Cyanosis-late/unreliable sign

a)

Gastrointestinal (GI) system

b)

Hepatic

c)

Hematological

d)

Integumentary

47.

˜Serum lactate level

a)

Measure of overall state of shock

b)

Indicator of decreased oxygen to cells

c)

Indicator of adequacy of resuscitation

d)

Indicator of hypertension

48.

Glucose

a)

<70 or >100 mg/dL

b)

<80 or >120 mg/dL

c)

<50 or >80 mg/dL

d)

<20 or >60 mg/dL

49.

Blood urea nitrogen

a)

>20 mg/dL

b)

>40 mg/dL

c)

<2.0 mg/dL

d)

<1.2 mg/dL

50.

Creatinine

a)

> 1.2 mg/dL

b)

< 1.2 mg/dL

c)

> 2.2 mg/dL

d)

> 3.5 mg/dL

51.

Sodium

a)

<130 or > 145 mEq/L

b)

<145 or > 165 mEq/L

c)

<120 or > 135 mEq/L

d)

<1.2 or > 2.2 mEq/L

52.

Potassium

a)

<3.5 or >5.3 mEq/L

b)

<3 or >5 mEq/L

c)

<4.5 or >6.3 mEq/L

d)

>3.5 or >5.3 mEq/L

53.

Lactate

a)

> 2.2 mEq/L

b)

> 2 mEq/L

c)

< 2.2 mEq/L

d)

< 2.3 mEq/L

54.

AST

a)

>20 units/L

b)

<20 units/L

c)

>2.0 units/L

d)

<2.0 units/L

55.

LDH

a)

>102 units/L

b)

<20 units/L

c)

>120 units/L

d)

<102 units/L

56.

WBCs

a)

<4500 or> 11,000/microliter

b)

<5400 or> 11,000/microliter

c)

<4500 or> 12,000/microliter

d)

<4000 or> 11,000/microliter

57.

Hemoglobin

a)

<12 g/dL

b)

>12 g/dL

c)

<1.2 g/dL

d)

>1.2 g/dL

58.

Hematocrit

a)

<35%

b)

>35%

c)

<3.5%

d)

<40%

59.

pH

a)

<7.35 or >7.45

b)

<73.5 or >74.5

c)

<7.50 or >7.55

d)

<3.35 or >5.45

60.

PaCO2

a)

<35 or >45 mm Hg

b)

<45 or >55 mm Hg

c)

<3.5 or >4.5 mm Hg

d)

<4.5 or >5.5 mm Hg

61.

PaO2

a)

<80 mm Hg

b)

>80 mm Hg

c)

<8.0 mm Hg

d)

>8.0 mm Hg

62.

HCO3

a)

<22 mEq/L

b)

<2.2 mEq/L

c)

>22 mEq/L

d)

>20 mEq/L

63.

Frequently increase early shock, decrease late shock, increase impairs immune response.

a)

Glucose

b)

Blood urea nitrogen

c)

Creatinine

d)

Sodium

e)

Potassium

64.

increase Hypo perfusion (prerenal failure), increase Gastrointestinal bleeding and catabolism.

a)

Glucose

b)

Blood urea nitrogen

c)

Creatinine

d)

Sodium

e)

Potassium

65.

increase Acute kidney injury.

a)

Glucose

b)

Blood urea nitrogen

c)

Creatinine

d)

Sodium

e)

Potassium

66.

decrease Hemodilution from replacement of excessive hypotonic fluid.

a)

Glucose

b)

Blood urea nitrogen

c)

Creatinine

d)

Sodium

e)

Potassium

67.

increase Hemoconcentration from fluid loss, increase infusion of normal saline; may cause hyperchloremic acidosis.

a)

Chloride

b)

Blood urea nitrogen

c)

Creatinine

d)

Sodium

e)

Potassium

68.

decrease Excessive loss of potassium, increase impaired elimination from acute kidney injury, Observe for cardiac dysrhuthmias.

a)

Chloride

b)

Blood urea nitrogen

c)

Creatinine

d)

Sodium

e)

Potassium

69.

increase Hypoxia leading to anaerobic metabolism and production of lactic acid.

a)

Lactate

b)

AST

c)

LDH

d)

WBCs

e)

Hemoglobin

70.

increase Hepatic impairment

a)

Lactate

b)

AST

c)

LDH

d)

WBCs

e)

Hemoglobin

71.

increase Hepatic impairment, renal impairment, intestinal ischemia, or myocardial infarction.

a)

Hematocrit

b)

AST

c)

LDH

d)

WBCs

e)

Hemoglobin

72.

increase stress response; significant increase indicates infection, decrease late shock due to consumption of ____

a)

Hematocrit

b)

AST

c)

LDH

d)

WBCs

e)

Hemoglobin

73.

decrease blood loss

a)

Hematocrit

b)

AST

c)

LDH

d)

WBCs

e)

Hemoglobin

74.

decrease blood loss, increase dehydration and hemoconcentration.

a)

Hematocrit

b)

AST

c)

LDH

d)

WBCs

e)

Hemoglobin

75.

increase early shock-respiratory alkalosis due to hyperventilation, decrease late shock-metabolic acidosis due to lactic acidosis.

a)

pH

b)

PaCO2

c)

PaO2

d)

HCO3

76.

decrease early shock-respiratory alkalosis due to hyperventilation.

a)

pH

b)

PaCO2

c)

PaO2

d)

HCO3

77.

decrease Hypoxemia; may indicate pulmonary edema or ARDS.

a)

pH

b)

PaCO2

c)

PaO2

d)

HCO3

78.

decrease late shock-metabolic acidosis caused by hypoxia, anaerobic metabolism, and lactic acidosis.

a)

pH

b)

PaCO2

c)

PaO2

d)

HCO3

79.

˜It occurs when the circulating blood volume is inadequate to fill the vascular network.

a)

Hypovolemic Shock

b)

Cardiogenic shock

c)

Obstructive shock

d)

Distributive shock (anaphylactic, neurogenic, septic)

80.

Causes of Hypovolemic Shock

a)

Intravascular volume deficits may be caused by external or internal losses of either blood or fluid.

b)

˜External loss of blood: GI hemorrhage, Surgery, Trauma

c)

˜External loss of fluid: Diarrhea, Diuresis Burns

d)

˜External sequestration of blood fluid: Hemoperitoneum, Hemothorax, Femur or pelvic fracture, Ascites, pleural effusion.

81.

Clinical manifestations of Hypovolemic Shock

a)

increase HR, decrease BP

b)

Tachypnea, and Oliguria

c)

pale skin and Flat neck veins

d)

decrease mental status

e)

decrease SVR

82.

Clinical manifestations of Hypovolemic Shock

a)

Cool

b)

increase hematocrit: if from dehydration

c)

decrease hematocrit: if from blood loss.

d)

decrease CO , PAOP ,PAP  & SV02

e)

increase CO , PAOP ,PAP  & SV02

83.

The nurse admits a 35-year-old patient to the emergency department following a 3-day history of nausea and vomiting. Vital signs assessed by the nurse include a BP of 70/50 mm Hg, HR 145 beats/min, RR 36 breaths/min, and SpO2 of 92% on room air. The nurse recognizes which classification of shock?

a)

Cardiogenic

b)

Anaphylactic

c)

Obstructive

d)

Hypovolemic

84.

Hypovolemic Shock Management (2 answers)

a)

˜Identify underlying cause

b)

˜Restore circulating volume

c)

Pharmacological

d)

Mechanical

85.

Hypovolemic Shock Management (Appropriate fluid selection) 2 answers 

a)

Blood

b)

Isotonic crystalloids

c)

Urine output

d)

Laboratory results

86.

Hypovolemic Shock Management (Appropriate fluid replacement)

a)

Blood pressure (MAP 65-70 mm Hg)

b)

Hemodynamic values

c)

Urine output

d)

Laboratory results

e)

Isotonic crystalloids

87.

˜Heart fails to act as an effective pump, decreased cardiac output; impaired perfusion.

a)

Cardiogenic Shock

b)

Hypovolemic shock

c)

Obstructive shock

d)

Distributive shock

88.

Causes of Cardiogenic Shock

a)

Right ventricular Myocardial infraction

b)

Cardiomyopathy

& Myocarditis

c)

Severe heart failure

d)

Valvular dysfunction

e)

Dysrhythmias

89.

Cardiogenic Shock (Clinical manifestations)

a)

Incease HR

b)

Incease BP

c)

Chest pain

d)

Tachypnea

e)

Oliguria

90.

Cardiogenic Shock (Clinical manifestations)

a)

Decrease mentation

b)

Left ventricular failure

c)

Right ventricular failure

d)

Low CO , PAP, PAOP, Svo2

 High SVR

e)

Flat neck veins

91.

Cardiogenic Shock Management (2 answers)

a)

Pharmacological

b)

Mechanical

c)

˜Identify underlying cause

d)

˜Restore circulating volume

92.

Cardiogenic Shock Management (Pharmacological)

a)

Increase preload

b)

Increase cardiac output

c)

Decrease afterload

93.

Cardiogenic Shock Management (Diuretics, venous vasodilators)

a)

Decrease preload

b)

Increase cardiac output

c)

Decrease afterload

94.

Cardiogenic Shock Management (Positive inotropes)

a)

Decrease preload

b)

Increase cardiac output

c)

Decrease afterload

95.

Cardiogenic Shock Management (Arterial vasodilators)

a)

Decrease preload

b)

Increase cardiac output

c)

Decrease afterload

96.

Cardiogenic Shock Management (Mechanical)

a)

IABP

b)

VAD

c)

IAPB

97.

The nurse is caring for a patient being treated with an intraaortic balloon pump. Which intervention is most important to include in the patient’s plan of care?

a)

Turning side to side every 2 hours

b)

Assessing peripheral pulses

c)

Padding bony prominences

d)

Applying splint to affected limb

98.

Pulmonary edema impaired gas exchange, intervention (collaboration management)

a)

diuretics

b)

preload reducers, high flow oxygen

c)

CPAP or BiPAP

d)

mechanical ventilation

e)

Administration of positive inotropes

99.

Decreased cardiac output, intervention (collaboration management)

a)

diuretics

b)

surgical correction of structural defect (if indicated)

c)

percutaneous coronary, intervention (if indicated)

d)

intraaortic balloon pump

e)

Administration of positive inotropes

100.

Ventricular Failure/Structural Abnormalities

a)

Decreased cardiac output/ stroke volume

b)

Increase cardiac output/ stroke volume

101.

inotropic médications used in Cardiogenic Shock

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine & Epinephrine

d)

Milrinone

e)

Morphine

102.

2-5 micrograms/kg/min, titrated up to 20 micrograms/kg/min

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Milrinone

e)

Epinephrine

103.

3-5 micrograms/kg/min, titrated up to 20-50 micrograms/kg/min as needed

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Milrinone

e)

Epinephrine

104.

2 micrograms/kg/min, titrated to response

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Milrinone

e)

Epinephrine

105.

0.1 - 0.5 micrograms/kg/min

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Milrinone

e)

Epinephrine

106.

inotropic medications used in cardiogenic shock (comments): Inotrop and potential vasodilator; lowers blood pressure; give as individual agent as long as systolic blood pressure (SBP) equal or bigger than 90. can use with dopamine.

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Epinephrine

e)

Milrinone

107.

0.5 micrograms/kg/min

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Milrinone

e)

Epinephrine

108.

inotropic medications used in cardiogenic shock (comments): Inotrop and vasoconstriction; increases left ventricular end-diastolic pressure and causes tachycardia. can use with dobutamine.

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Epinephrine

e)

Milrinone

109.

inotropic medications used in cardiogenic shock (comments): Vasoconstrictor and inotrope; preferred as a single agent over dobutamine if SBP smaller than 70. can use combined with dobutamine.

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Epinephrine

e)

Milrinone

110.

inotropic medications used in cardiogenic shock (comments): Inotrope and vasoconstriction; second-tier choice because it causes acidosis and dysrhuthmias.

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Epinephrine

e)

Milrinone

111.

inotropic medications used in cardiogenic shock (comments): Inotrope and vasoconstriction; lowers blood pressure. second tier to dobutamine.

a)

Dobutamine

b)

Dopamine

c)

Norepinephrine

d)

Epinephrine

e)

Milrinone

112.

˜Physical impairment to adequate circulatory blood flow

a)

Hypovolemic shock

b)

Cardiogenic shock

c)

Obstructive shock

d)

Distributive shock

113.

˜Widespread vasodilation and decreased systemic vascular resistance, Relative hypovolemia

a)

Hypovolemic shock

b)

Cardiogenic shock

c)

Obstructive shock

d)

Distributive shock

114.

Obstructive Shock (Causes)

a)

˜Impaired diastolic filling: Cardiac tamponade Tension pneumothorax Constrictive pericarditis Compression of great veins

b)

˜Increased right ventricular afterload: Pulmonary embolism (PE) Severe pulmonary hypertension

c)

˜Increased intrathoracic pressure Increased left ventricular afterload: Aortic dissection Systemic embolization Aortic stenosis Abdominal hypertension

d)

˜Decrease right ventricular afterload: Pulmonary embolism (PE) Severe pulmonary hypertension

115.

Obstructive Shock, Clinical manifestation

a)

bradycardia, Tachypnea, hypotension, JVD, Dysrhythmia

b)

Muffled heart tones (cardiac tamponade), crackles

c)

Reduced capillary refill, cool pale skin

d)

Unilateral absence of breath sounds  (tension pneumothorax)

e)

Tracheal deviation (tension pneumothorax)

116.

Obstructive Shock, Clinical manifestation

a)

polyuria, Altered mental status

b)

Ripping chest pain, pulse differences  & widened mediastinum (aortic dissection)

c)

Pulsus Paradoxus

d)

Pul.embolism (JVD, peripheral edema, and hepatomegaly

 (Right ventricular failure)

117.

 Obstructive Shock, Clinical manifestations (Pulsus paradoxus)

a)

is an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration.

b)

The normal fall in pressure is less than 10 mm Hg.

c)

When the drop is more than 10 mm Hg, it is referred to as pulsus paradoxus.)

d)

is an abnormally large increase in systolic blood pressure and pulse wave amplitude during inspiration.

118.

Obstructive Shock Management

a)

Remove the obstruction as quickly as possible)

b)

Removal of offending agent

c)

Reverse the effects of mediators (steroids )

d)

Promote adequate tissue perfusion  (IVF)

119.

Obstructive Shock Management

a)

For cardiac tamponade; pericardiocentesis to remove accumulated fluid around the heart

b)

For tension pneumothorax—insert large bore needle or chest tube to allow for lung reexpansion

c)

For pulmonary embolus: administer thrombolytics

d)

Positioning of spinal-blocked patients

120.

Types of Distributive Shock

a)

Neurogenic

b)

Anaphylactic

c)

Septic

d)

Cardiogenic

121.

˜Interruption of sympathetic nervous system impulse transmission

a)

Neurogenic

b)

Anaphylactic

c)

Septic

122.

˜Introduction of an antigen into a sensitive individual initiating an antigen-antibody response, Release of vasoactive mediators, Histamine.

a)

Neurogenic

b)

Anaphylactic

c)

Septic

123.

Distributive Shock—Anaphylactic (Causes)

a)

Upper spinal cord injury

b)

Spinal anesthesia

c)

Nervous system damage

d)

Vasomotor depression

e)

Severe allergic reaction

124.

Distributive Shock—Neurogenic (Causes)

a)

Upper spinal cord injury

b)

Spinal anesthesia

c)

Nervous system damage

d)

Vasomotor depression

e)

Impaired diastolic filling

125.

Distributive Shock—Anaphylactic (˜Clinical manifestations)

a)

˜Wheezing, stridor , SOB,  cough , hoarseness, dysphonia , chest tightness, nasal congestion , running nose 

b)

˜Urticaria, angioedema, flushing

c)

Abdominal cramps, nausea/vomiting, diarrhea

d)

˜Hypotension, tachycardia, palpitations, dizziness, syncope, anxiety

e)

˜Lethargy and increase LOC

126.

˜Follows invasion of a host by a microorganism, Progressive˜Follows invasion of a host by a microorganism, Progressive

a)

Neurogenic

b)

Anaphylactic

c)

Septic

127.

Distributive Shock—Neurogenic 

a)

Immobilization of spinal injuries

b)

Positioning of spinal-blocked patients

c)

IV fluids for hypotension

d)

Vasopressors (only after volume is replaced)

e)

fast rewarming to prevent further vasodilation

128.

Distributive Shock—Neurogenic (˜Clinical manifestations)

a)

Bradycardia with hypotension

b)

Warm, dry, and flushed skin

c)

Hypothermia due to impaired thermoregulation

d)

Decrease mentation

129.

Distributive Shock—Anaphylactic (˜Goals of treatment, Removal of offending agent)

a)

do not stop any meds

b)

remove the stinger 

c)

flush skin

d)

antivenom

e)

gastric lavage

130.

Distributive Shock—Anaphylactic (˜Goals of treatment)

a)

Removal of offending agent

b)

Reverse the effects of mediators (steroids )

c)

Promote adequate tissue perfusion  (IVF)

d)

Early goal-directed therapyv

131.

Distributive Shock—Septic (cause)

a)

Immunosuppression

b)

Significant bacteremia

c)

Severe allergic reaction

132.

Distributive Shock—Septic (˜Clinical manifestations)

a)

Metabolic acidosis

b)

Acute encephalopathy

c)

Oliguria

d)

Hypoxemia

e)

Hypothermia due to impaired thermoregulation

133.

Distributive Shock—Septic (˜Clinical manifestations)

a)

Coagulation disorders

b)

Hypotension

c)

Decreased skin perfusion/mottling

d)

Petechiae

e)

Bradycardia with hypotension

134.

Distributive Shock—Septic (Clinical manifestation)

a)

˜Tachycardia, bouncing pulse, slow cap. Refill, Hypotension (late Sx)

b)

˜Flushed skin

c)

˜Increase U/O

d)

˜Fever or hypothermia (early SX)

e)

˜Edema

135.

Distributive Shock—Septic (Clinical manifestation)

a)

Leukopenia (late Sx) or leukocytosis

b)

thrombocytopenia, hyperbilirubimia, and hyperlactatemia ,

c)

Low creatinine & CRP

d)

˜Hyperglycemia

e)

˜arterial hypoxemia  

136.

Distributive Shock—Septic ( Management – Prevention)

a)

Hand hygiene

b)

Aseptic technique

c)

Identification infection risk

d)

Alert

137.

Distributive Shock—Septic ( Management – Treatment)

a)

Antibiotic therapy

b)

Early goal-directed therapy

c)

First 6 hours

d)

Slow rewarming to prevent further vasodilation

138.

Distributive Shock—Septic ( Management – Treatment)

a)

ACTH

b)

Glycemic control

c)

Temperature control

d)

Immobilization of spinal injuries

139.

Comparison of different types of shock (symptoms): Hypotension, tachycardia, weak thready pulse cool, pale, moist skin U/O decreased.

a)

Hypovolemic

b)

Cardiogenic

c)

Neurogenic

d)

Anaphylacitc

e)

Septic

140.

Comparison of different types of shock (symptoms): Hypotension, tachycardia, weak thready pulse cool, pale, moist skin U/O less than 30 ml/hr crackles, tachypnea.

a)

Hypovolemic

b)

Cardiogenic

c)

Neurogenic

d)

Anaphylacitc

e)

Septic

141.

Comparison of different types of shock (symptoms): Hypotension, tachycardia, cough, dyspnea pruritus, urticaria restlessness, decreased LOC.

a)

Hypovolemic

b)

Cardiogenic

c)

Neurogenic

d)

Anaphylacitc

e)

Septic

142.

Comparison of different types of shock (symptoms): Hypotension, bradycardia, warm dry skin.

a)

Hypovolemic

b)

Cardiogenic

c)

Neurogenic

d)

Anaphylacitc

e)

Septic

143.

Comparison of different types of shock (symptoms): Hypotension, tachycardia, full warmbounding pulse, tachypnea pink, warm, flushed skin decreased U/O, fever.

a)

Hypovolemic

b)

Cardiogenic

c)

Neurogenic

d)

Anaphylacitc

e)

Septic

144.

Comparison of different types of shock (symptoms): Decreased CO, Increased SVR

a)

Hypovolemic & Cardiogenic

b)

Neurogenic

c)

Anaphylacitc & Septic

145.

Comparison of different types of shock (symptoms): Decreased CO, Decreased SVR

a)

Hypovolemic & Cardiogenic

b)

Neurogenic

c)

Anaphylacitc & Septic

146.

Comparison of different types of shock (symptoms): Decreased CO, Venous & arterial vasodilation, loss sympathetic tone.

a)

Hypovolemic & Cardiogenic

b)

Neurogenic

c)

Anaphylacitc & Septic

147.

General management of shock

a)

Reverse altered circulatory component

b)

Maintain circulatory volume

c)

Fluid

d)

Pharmacotherapy & Mechanical therapy

e)

increase oxygen consumption

148.

Management Fluid Challenge

a)

Rapid infusion of a crystalloid solution, Lactated Ringer’s or normal saline

250 mL up to 2 liters

b)

Risk of Hemodilution of plasma protein and RBCs with possible hypoxia and P. Edema

c)

Blood products, IV access of a 20-gauge and higher, Infuse with only normal saline, Transfusion reaction; keep vein open with normal saline solution

d)

Complications:

Pulmonary edema

Transfusion reaction

e)

Complications:

Heart failure and pulmonary embolism

149.

Management Fluid Challenge

Rapid infusion of a crystalloid solution, Lactated Ringer’s or normal saline

a)

250 mL up to 2 liters

b)

275 mL up to 2 liters

c)

250 mL up to 2.5 liters

150.

Management Fluid Challenge:

Blood products

a)

IV access of a 20-gauge and higher

b)

Infuse with only normal saline

c)

Transfusion reaction; keep vein open with normal saline solution

d)

IV access of a 20-gauge and lower

e)

Oxygenation and mechanical ventilation

151.

Management of Shock

a)

˜Two IV catheter insertion sites, Peripheral (14- or 16-gauge)

+ Central line

b)

˜An upper extremity insertion site is preferred over the femoral vein

c)

˜Multilumen catheters, which provide multiple access ports, allow the concurrent administration of fluid, medication, and blood products

d)

Risk of BRCs with possible hypoxia and P. Edema

152.

Management Fluid Challenge:

Complications of shock

a)

Pulmonary edema

b)

Transfusion reaction

c)

Heart failure

153.

Management of shock (Mechanical ventilation)

a)

Sedation

b)

Neuromuscular blockade

c)

Acetominophen

154.

Management (˜Pharmacological Support) Based on

a)

Cardiac output

b)

Heart rate

c)

Preload, afterload, and contractility

d)

breathing rate

155.

Hemodynamic monitoring for shock pt

a)

Central venous access

b)

periphral venous access

c)

poplititial venous access

156.

Pharmacological Management (˜Cardiac output)

a)

Chronotropic drugs

b)

Dysrhythmia agents

c)

Bradycardia in neurogenic shock may require atropine

d)

Hypovolemic and distributive shock

157.

Pharmacological Management (˜Preload)

a)

Distributive shock —  vasoconstriction

b)

Cardiogenic shock —  venous vasodilators

c)

Hypovolemic and distributive shock — IV fluid challenge

158.

Pharmacological Management (˜Afterload)

a)

Distributive shock —  vasoconstriction

b)

Cardiogenic shock —  venous vasodilators

c)

Cardiogenic shock —  arterial vasodilators

159.

Pharmacological Management (˜Contractility)

a)

Cardiogenic shock —  dobutamine

b)

Beta blockers

c)

Cardiogenic shock —  arterial vasodilators

160.

Cardiac output, heart rate (decrease)

a)

Treat cause

b)

Antidysrhythmics

c)

Vagal maneuver

d)

Cardioversion & Defibirillation

e)

Pacemaker

161.

Cardiac output, heart rate (increase)

a)

Treat cause

b)

Atropnie

c)

Epinephrine

d)

Cardioversion

e)

Pacemaker

162.

Cardiac output, Stroke volume:

Afterload

RV:PVR,

LV:SVR

(To decrease)

a)

Vasodilators: nitroprusside, nitroglycerin, hydralazine

b)

ACE inhibitor or ARB

c)

IABP

d)

Vasopressors: phenylephrine, norepinephrine, epinephrine, vasopressin

163.

Cardiac output, Stroke volume:

Afterload

RV:PVR,

LV:SVR

(To increase)

a)

Vasodilators: nitroprusside, nitroglycerin, hydralazine

b)

ACE inhibitor or ARB

c)

IABP

d)

Vasopressors: phenylephrine, norepinephrine, epinephrine, vasopressin

164.

Cardiac output, Stroke volume:

Contractility

RV: RVSWI

LV: LVSWI

(To increase)

a)

Digoxin

b)

Dobutamine

c)

Milrinone

d)

Calcium channel blockers

165.

Cardiac output, Stroke volume:

Contractility

RV: RVSWI

LV: LVSWI

(To decrease)

a)

Dobutamine

b)

Beta blockers

c)

Calcium channel blockers

166.

Cardiac output, Stroke volume:

Preload

RV: CVP or RAP

LV: PAOP

(To decrease)

a)

Vasodilators: morphine, nitroglycerin 

b)

Diuretics

c)

ACE inhibitor or ARB

d)

Crystalloids

167.

Cardiac output, Stroke volume:

Preload

RV: CVP or RAP

LV: PAOP

(To decrease)

a)

Blood Products

b)

Diuretics

c)

Colloids

d)

Crystalloids

e)

Blood

168.

Right ventricle: central venous pressure / Right Atrial Pressure

Left ventricle: Pulmonary artery occlusion pressure

a)

Preload

b)

Contractility

c)

Afterlaad

169.

Right ventricle: Right ventricular stroke work index

Left ventricle: Left ventricular stroke work index

a)

Preload

b)

Contractility

c)

Afterlaad

170.

Right ventricle: Pulmonary vascular resistance

Left ventricle: Systemic vascular resistance

a)

Preload

b)

Contractility

c)

Afterlaad

171.

Pharmacological Management

a)

Diuretic

b)

Sedatives

c)

Analgesics

d)

Insulin (two consecutive glucose readings are above 180 mg/dL)

e)

Corticosteroids

172.

Pharmacological Management

a)

ACE inhibitor 

b)

Antibiotics

c)

Low–molecular-weight heparin to prevent DVTs

d)

H2-receptor antagonist or protein pump inhibitor to prevent gastric stress ulceration

173.

Management : Body Temperature Regulation

a)

Rapid administration of IV fluids may reduce temperature

b)

Hypothermia

c)

Fluid warmer

d)

Warm blankets

e)

Decrease room temperature

174.

Management : Body Temperature Regulation (Hypothermia)

a)

Depresses cardiac contractility

b)

Impairs cardiac output

c)

Impairs oxygenation

d)

Impairs cardiac input

175.

Management: Nutritional Support (Enteral nutrition)

a)

Within 24 to 48 hours of admission

b)

Early feeding leads to low risk of hypermetabolism, bacterial translocation , diarrhea , and prolonged hospitalization

c)

Preferred route of nutritional support

d)

Hindered by paralytic ileus

e)

Given if enteral nutrition is not tolerated

176.

Management: Nutritional Support (Parenteral nutrition)

a)

Within 24 to 48 hours of admission

b)

Early feeding leads to low risk of hypermetabolism, bacterial translocation , diarrhea , and prolonged hospitalization

c)

Preferred route of nutritional support

d)

Hindered by paralytic ileus

e)

Given if enteral nutrition is not tolerated

177.

Management: Skin Integrity (˜Skin care)

a)

Turn every 4 hours

b)

Protective barrier cream

c)

Pressure-relieving devices

d)

Elevate heels off the surface of the bed

e)

Foley catheter if indicated

178.

Management: Psychological Support

a)

Provide information to patient and family

b)

Advance directive discussions

c)

Patient consultation with psychiatrist 

179.

Physiologic profiles of shock states (Preload, PCWP) ⬇️⬇️

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

180.

Physiologic profiles of shock states (Preload, PCWP) ⬇️ or =

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

181.

Physiologic profiles of shock states (Preload, PCWP) ⬆️⬆️

2 answers

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

182.

Physiologic profiles of shock states (Cardiac Output) ⬇️

2 answers

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

183.

Physiologic profiles of shock states (Cardiac Output) ⬇️ or =

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

184.

Physiologic profiles of shock states (Cardiac Output) ⬇️ *

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

185.

Physiologic profiles of shock states (Afterload, SVR) ⬇️⬇️

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

186.

Physiologic profiles of shock states (Afterload, SVR) ⬆️⬆️

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

187.

Physiologic profiles of shock states (Afterload, SVR) ⬆️

2 answers

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

188.

Physiologic profiles of shock states (Tissue Perfusion) ⬆️

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

189.

Physiologic profiles of shock states (Tissue Perfusion) ⬇️

3 answers

a)

Hypovolemic

b)

Distributive

c)

Cardiogenic

d)

Obstructive

190.

Shock

a)

Inadequate tissue perfusion that results in cellular, metabolic, and hemodynamic derangements.

b)

Imbalance between cellular oxygen supply and demand

c)

Life-threatening response to circulation in alterations

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