Chapter 13 - Shock

Question 1

A 20-year-old male has a large laceration to his wrist. He is holding a blood-soaked towel over the wound, but it continues to bleed rapidly. You should:

Select one:

A. wrap the towel with pressure bandages.
B. apply a tourniquet proximal to the wrist.
C. administer high-flow supplemental oxygen.
D. apply pressure to the brachial artery.

Answer 1

B. apply a tourniquet proximal to the wrist.

Question 2

A 25-year-old unrestrained female struck the steering wheel with her chest when her car hit a tree while traveling at a high rate of speed. She has signs and symptoms of shock, which you suspect are the result of intrathoracic bleeding. Which of the following interventions will provide this patient with the greatest chance for survival?

Select one:

A. Intravenous fluid administration
B. High-flow oxygen administration
C. Rapid transport to a trauma center
D. Full immobilization of her spine

Answer 2

C. Rapid transport to a trauma center

Question 3

As you approach a patient lying at the side of the roadway, you observe severe bleeding from the leg. What should your first action be?

Select one:

A. Check for a pulse.
B. Control the bleeding.
C. Open the airway.
D. Administer oxygen.

Answer 3

B. Control the bleeding

Question 4

Distributive shock occurs when:

Select one:

A. severe bleeding causes tachycardia in order to distribute blood to the organs faster.

B. temporary but severe vasodilation causes a decrease in blood supply to the brain.

C. an injury causes restriction of the heart muscle and impairs its pumping function.

D. widespread dilation of the blood vessels causes blood to pool in the vascular beds.

Answer 4

D. widespread dilation of the blood vessels causes blood to pool in the vascular beds.

Question 5

Foods, medications, and insects are common causes of ________.

Select one:

A. septic shock
B. anaphylactic shock
C. psychogenic shock
D. neurogenic shock

Answer 5

B. anaphylactic shock

Question 6

Hypovolemic shock caused by severe burns is the result of a loss of:

Select one:

A. platelets.
B. plasma.
C. red blood cells.
D. whole blood.

Answer 6

B. plasma.

Question 7

In an acute injury setting, neurogenic shock is commonly accompanied by:

Select one:

A. hypothermia.
B. diaphoresis.
C. tachycardia.
D. hypovolemia.

Answer 7

A. hypothermia.

Question 8

Inadequate circulation of blood throughout the body is called ________.

Select one:

A. hypotension
B. shock
C. hypoxia
D. perfusion

Answer 8

B. shock

Question 9

Pulmonary edema and impaired ventilation occur during:

Select one:

A. neurogenic shock.
B. anaphylactic shock.
C. septic shock.
D. cardiogenic shock.

Answer 9

D. cardiogenic shock.

Question 10

Shock due to severe infection is called ________.

Select one:

A. neurogenic shock
B. septic shock
C. hypovolemic shock
D. anaphylactic shock

Answer 10

B. septic shock

Question 11

To protect vital organs, the body compensates by directing blood flow away from organs that are more tolerant of low flow, such as:

Select one:

A. the heart.
B. the skin.
C. the lungs.
D. the brain.

Answer 11

B. the skin.

Question 12

What are the three components of the “perfusion triangle”?

Select one:

A. Heart, brain, lungs
B. Heart, blood vessels, blood
C. Arteries, veins, capillaries
D. Plasma, red blood cells, platelets

Answer 12

B. Heart, blood vessels, blood

Question 13

When assessing a patient with signs and symptoms of shock, it is important to remember that:

Select one:

A. irreversible shock often responds well to a prompt blood transfusion.

B. multiple fractures are the most common cause of hypovolemic shock.

C. the patient’s respirations are deep during the early stages of shock.

D. blood pressure may be the last measurable factor to change in shock.

Answer 13

D. blood pressure may be the last measurable factor to change in shock.

Question 14

When should non-lifesaving interventions be performed for your multisystem trauma patient?

Select one:

A. Prior to transport
B. During the primary assessment
C. En route to the hospital
D. Immediately after the injuries are discovered

Answer 14

C. En route to the hospital

Question 15

When treating an 80-year-old patient who is in shock, it is important to remember that:

Select one:

A. medications older patients take for hypertension often cause an unusually fast heart rate.

B. changes in gastric motility may delay gastric emptying, which increases the risk of vomiting.

C. the older patient’s central nervous system usually reacts more briskly to compensate for shock.

D. compensation from the respiratory system usually manifests with increased tidal volume.

Answer 15

B. changes in gastric motility may delay gastric emptying, which increases the risk of vomiting.

Question 16

Which of the following injuries would MOST likely cause obstructive shock?

Select one:

A. Cardiac tamponade
B. Spinal cord injury
C. Liver laceration
D. Simple pneumothorax

Answer 16

A. Cardiac tamponade

Question 17

Which of the following is the ONLY action that can prevent eventual death from a tension pneumothorax?

Select one:

A. Rapid administration of intravenous fluids
B. Decompression of the injured side of the chest
C. Early administration of high-flow oxygen
D. Positive-pressure ventilation with a bag-valve-mask

Answer 17

B. Decompression of the injured side of the chest

Question 18

You suspect your patient is in shock. You note the patient’s skin is pale. This is likely due to ___________.

Select one:

A. peripheral vasodilation
B. an increased heart rate
C. hypothermia
D. peripheral vasoconstriction

Answer 18

D. peripheral vasoconstriction

Question 19

Your patient has a decreased cardiac output and poor myocardial contractility. This will likely lead to ___________.

Select one:

A. cardiogenic shock
B. hypovolemic shock
C. septic shock
D. neurogenic shock

Answer 19

A. cardiogenic shock

Question 20

Your patient is in shock, but the body’s defense mechanisms are currently able to maintain adequate circulation. This is called ___________.

Select one:

A. irreversible shock
B. compensated shock
C. decompensated shock
D. late shock

Answer 20

B. compensated shock

Question 21

Neurogenic shock occurs when:

Select one:

A. failure of the nervous system causes widespread vasodilation.

B. the spinal cord is severed and causes massive hemorrhaging.

C. there is too much blood to fill a smaller vascular container.

D. massive vasoconstriction occurs distal to a spinal cord injury.

Answer 21

A. failure of the nervous system causes widespread vasodilation.

Question 22

Perfusion is MOST accurately defined as the:

Select one:

A. effective transfer of oxygen from the venules across the systemic capillary membrane walls.

B. ability of the systemic arteries to constrict as needed to maintain an adequate blood pressure.

C. effective removal of carbon dioxide and other metabolic waste products from the body’s cells.

D. circulation of blood within an organ in adequate amounts to meet the body’s metabolic needs.

Answer 22

D. circulation of blood within an organ in adequate amounts to meet the body’s metabolic needs.

Question 23

The term “shock” is MOST accurately defined as:
A. a decreased supply of oxygen to the brain.
B. cardiovascular collapse leading to inadequate perfusion.
C. decreased circulation of blood within the venous circulation.
D. decreased function of the respiratory system leading to hypoxia.

Answer 23

B. cardiovascular collapse leading to inadequate perfusion.

Question 24

Anaphylactic shock is typically associated with: A. urticaria.
B. bradycardia.
C. localized welts.
D. a severe headache.

Answer 24

A. urticaria.

Urticaria (hives) is typically associated with allergic reactions—mild, moderate, and severe. They are caused by the release of histamines from the immune system. In anaphylactic shock, urticaria is also accompanied by cool, clammy skin; tachycardia; severe respiratory distress; and hypotension.

Question 25

Signs of compensated shock include all of the following, EXCEPT:
A. restlessness or anxiety.
B. pale, cool, clammy skin.
C. a feeling of impending doom.
D. weak or absent peripheral pulses.

Answer 25

D. weak or absent peripheral pulses

In compensated shock, the body is able to maintain perfusion to the vital organs of the body via the autonomic nervous system. Signs include pale, cool, clammy skin; restlessness or anxiety; a feeling of impending doom; and tachycardia. When the body’s compensatory mechanism fails, the patient’s blood pressure falls; weak or absent peripheral pulses indicates this.

Question 26

When treating a trauma patient who is in shock, LOWEST priority should be given to:
A. spinal protection.
B. thermal management.
C. splinting fractures.
D. notifying the hospital.

Answer 26

C. splinting fractures.

Critical interventions for a trauma patient in shock include spinal precautions, high-flow oxygen (or assisted ventilation), thermal management, rapid transport, and early notification of a trauma center. Splinting fractures should not be performed at the scene if the patient is critically injured; it takes too long and only delays transport.

Question 27

Potential causes of cardiogenic shock include all of the following, EXCEPT:
A. inadequate heart function.
B. disease of muscle tissue.
C. severe bacterial infection.
D. impaired electrical system.

Answer 27

C. severe bacterial infection.

Question 28

A 60-year-old woman presents with a BP of 80/60 mm Hg, a pulse rate of
110 beats/min, mottled skin, and a temperature of 103.9°F. She is MOST likely experiencing:
A. septic shock.
B. neurogenic shock.
C. profound heart failure.
D. a severe viral infection.

Answer 28

A. septic shock.

In septic shock, bacterial toxins damage the blood vessel walls, causing them to leak and rendering them unable to constrict. Widespread dilation of the vessels, in combination with plasma loss through the injured vessel walls, results in shock. A high fever commonly accompanies a bacterial infection.

Question 29

A patient with neurogenic shock would be LEAST likely to present with:
A. tachypnea.
B. hypotension.
C. tachycardia.
D. altered mentation.

Answer 29

C. tachycardia.

In neurogenic shock, the nerves that control the sympathetic nervous system are compromised. The nervous system is responsible for secreting the hormones epinephrine and norepinephrine, which increase the patient’s heart rate, constrict the peripheral vasculature, and shunt blood to the body’s vital organs. Without the release of these hormones, the compensatory effects of tachycardia and peripheral vasoconstriction are absent.

Question 30

A 20-year-old man was kicked numerous times in the abdomen during an assault. His abdomen is rigid and tender, his heart rate is 120 beats/min, and his respirations are 30 breaths/min. You should treat this patient for:
A. a lacerated liver.
B. a ruptured spleen.
C. respiratory failure.
D. hypovolemic shock.

Answer 30

D. hypovolemic shock.

The patient may have a liver laceration or ruptured spleen—both of which can cause internal blood loss. However, it is far more important to recognize that the patient is in hypovolemic shock and to treat him accordingly.

Question 31

A 33-year-old woman presents with a generalized rash, facial swelling, and hypotension approximately 10 minutes after being stung by a hornet. Her BP is 70/50 mm Hg and her heart rate is 120 beats/min. In addition to high-flow oxygen, this patient is in MOST immediate need of:
A. epinephrine.
B. rapid transport.
C. an antihistamine.
D. IV fluids.

Answer 31

A. epinephrine.

This patient is in anaphylactic shock—a life-threatening overexaggeration of the immune system that results in bronchoconstriction and hypotension. After ensuring adequate oxygenation and ventilation, the MOST important treatment for the patient is epinephrine, which dilates the bronchioles and constricts the vasculature, thus improving breathing and blood pressure, respectively.

Question 32

All of the following are potential causes of impaired tissue perfusion, EXCEPT:
A. increased number of red blood cells.
B. pump failure.
C. low fluid volume.
D. poor vessel function.

Answer 32

A. increased number of red blood cells.

Question 33

A construction worker fell approximately 30 feet. He is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50 mm Hg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, the MOST appropriate treatment for this patient includes:
Select one:
A. oxygen via nonrebreathing mask, thermal management, and elevation of his legs.
B. assisted ventilation, thermal management, and elevation of the lower extremities.
C. assisted ventilation, preventing hyperthermia, and elevating his lower extremities.
D. oxygen via nonrebreathing mask, blankets for warmth, and elevation of his head.

Answer 33

B. assisted ventilation, thermal management, and elevation of the lower extremities.

Question 34

A 70-year-old female was recently discharged from the hospital following a total hip replacement. Today, she presents with restlessness, tachycardia, and a blood pressure of 90/64 mm Hg. Her skin is hot and moist. You should be MOST suspicious that she is experiencing:
Select one:
A. septic shock.
B. a local infection.
C. pump failure.
D. decompensated shock.

Answer 34

A. septic shock.

Question 35

You are dispatched to a residence for a 40-year-old female who fainted. Upon your arrival, the patient is conscious and alert, and states that she is fine. Her husband tells you that she fainted after receiving news that her sister was killed in a car crash. You offer oxygen to the patient, but she refuses to accept it. At this point, your primary concern should be to:
Select one:
A. provide emotional support regarding her sister.
B. advise her that she needs to go to the hospital.
C. determine if she was injured when she fainted.
D. obtain baseline vital signs and a medical history

Answer 35

C. determine if she was injured when she fainted.

Question 36

In infants and children, a capillary refill time that is greater than ______ second(s) is a sign of poor peripheral perfusion.
Select one:
A. 1
B. 2
C. 4
D. 3

Answer 36

B. 2

Question 37

A 59-year-old male presents with severe vomiting and diarrhea of 3 days’ duration. He is confused and diaphoretic, and his radial pulses are absent. His blood pressure is 78/50 mm Hg. After applying supplemental oxygen, you should:
Select one:
A. perform a head-to-toe exam.
B. obtain a repeat blood pressure in 5 minutes.
C. allow him to drink plain water.
D. prepare for immediate transport.

Answer 37

D. prepare for immediate transport.

Question 38

A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer high-flow oxygen and give him epinephrine via intramuscular injection. Upon reassessment, you determine that his condition has not improved. You should:
Select one:
A. transport him immediately and provide supportive care while en route.
B. consider that he may actually be experiencing an acute asthma attack.
C. request a paramedic unit that is stationed approximately 15 miles away.
D. repeat the epinephrine injection after consulting with medical control.

Answer 38

D. repeat the epinephrine injection after consulting with medical control.

Question 39

Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST accurately describes:
Select one:
A. neurogenic shock.
B. neurologic shock.
C. psychogenic shock.
D. vasovagal shock.

Answer 39

C. psychogenic shock.

Question 40

Clinical signs of compensated shock include all of the following, EXCEPT:
Select one:
A. rapid, shallow breathing.
B. restlessness or anxiety.
C. cool and clammy skin.
D. absent peripheral pulses

Answer 40

D. absent peripheral pulses