Pathophysiology: Chapter 50: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Children

Question 1

What is the most common type of shock in children?

a. Hypovolemic c. Neurogenic
b. Cardiogenic d. Septic

Answer 1

ANS: A
Hypovolemic shock, the most common type of shock in children, is associated with a
reduction in the intravascular volume relative to the vascular space.

Question 2

Hypotension is likely to occur when an infant or child is greater than _____ % dehydrated.

a. 2 c. 7
b. 5 d. 10

Answer 2

ANS: D
Hypotension typically develops when dehydration is greater than 10% in the infant or
child or greater than 6% in the adolescent.

Question 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

Answer 3

ANS: B
The child with hypovolemic shock demonstrates signs of inadequate blood flow to some
tissue 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.

Question 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

Answer 4

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.

Question 5

What is the cause of appropriately 50% of the deaths in children who have experienced a
burn injury?
a. Immunosuppression 
b. Hypermetabolism
c. Inhalation injury 
d. Hypertrophic scarring

Answer 5

ANS: C
The 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.
Although the other options are factors, they are not responsible for 50% of the deaths.

Question 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
system to retain sodium and water

Answer 6

ANS: B
Evidence of an adequate or high central venous pressure, including hepatomegaly and
periorbital edema, is observed in cardiogenic shock. This selection is the only option that
accurately identifies the cause of these symptoms.

Question 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

Answer 7

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
rickettsial microorganisms.

Question 8

Which cytokines are antiinflammatory mediators?

a. Interleukin (IL)–1, IL-6, and tumor necrosis factor–alpha (TNF-)
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

Answer 8

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.

Question 9

What type of injury is associated with cellular injury caused by the restoration of blood
flow and physiologic concentrations of oxygen to cells that have been exposed to injurious
but nonlethal hypoxic conditions?
a. Hypoxic c. Reperfusion
b. Hyperoxygenation d. Ischemic
.

Answer 9

ANS: C
Reperfusion (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

Question 10

What are the primary goals for the treatment of shock?

a. Maximizing oxygen delivery and minimizing oxygen demand
b. Maintaining hydration and adequate urinary output
c. Supporting all facets to the cardiovascular system
d. Maintaining all vital signs within normal functioning ranges

Answer 10

ANS: A
The primary goals of the treatment of shock are maximizing oxygen delivery and
minimizing oxygen demand. Although the other options are desirable, they are each
associated with the primary goals related to oxygen delivery and demand.

Question 11

To determine a child’s response to fluid therapy for shock, the nurse should monitor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
a. Hematocrit and hemoglobin levels 
b. Urine output and specific gravity
c. Blood pressure and pulse 
d. Arterial blood gases and heart rate

Answer 11

ANS: B
Monitoring of the volume of urine output and specific gravity is most useful in
determining the child’s response to fluid therapy.

Question 12

For children who are experiencing shock, crystalloids and colloids are generally
administered in boluses of how many milliliters per kilogram (ml/kg)?
a. 5 c. 15
b. 10 d. 20

Answer 12

ANS: D
In 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.

Question 13

As the result of the inability to concentrate urine, children are at risk for dehydration
before which age?
a. 2 years c. 6 years
b. 4 years d. 8 years

Answer 13

ANS: A
Children younger than 2 years lack the ability to concentrate urine because of the
immaturity of the renal system and are therefore at increased risk for dehydration.

Question 14

What causes renal failure after electrical burns in children?

a. Cytokines are released after the damaged tissue.
b. Immature kidneys are unable to compensate for the electrical burn.
c. Cardiac output is reduced.
d. Myoglobin is released from damaged muscles.

Answer 14

ANS: D
The release of myoglobin may occlude the kidney tubules and result in renal failure. This
selection is the only option that accurately describes the correlation between electrical
burns and renal failure.

Question 15

Compared with the ebb phase, characteristics of the catabolic flow phase in metabolism
after a burn injury in a child include which process?
a. Reduced oxygen consumption
b. Elevation of catecholamines
c. Impaired circulation
d. Cellular shock

Answer 15

ANS: B
After the resolution of the shock and the restoration of circulating volume, the metabolic
response shifts to a catabolic (flow) phase. A state of hypermetabolism ensues,
characterized by increased oxygen consumption and the elevation of catecholamines,
glucocorticoids, and glucagon. This selection is the only option that accurately compares
the characteristics of the ebb and flow phases.

Question 16

What advantage do impregnated silver dressings have for patients with burn injuries?

a. Impregnated silver dressings contain natural-occurring collagens.
b. They require only one dressing change every other day.
c. Removal is less painful.
d. Impregnated silver dressings are cost effective.

Answer 16

ANS: C
Impregnated silver dressings not only kill bacteria but most are processed with a special
layer, making them less painful to remove. Some of these products can be left on the
wound for up to 2 weeks, allowing for less frequent dressing changes. The other options
are related to a new extracellular matrix (ECM) product that is now being researched for
repair and remodeling of damaged tissues.

Question 17

What is the most serious outcome resulting from limited glycogen stores in children who
have been seriously burned?
a. Poor wound healing      
b. Increased morbidity 
c. Decreased immunity       
d. Loss of adipose tissue stores

Answer 17

ANS: B
Glycogen stores are limited in children, making it hard for them to meet the increased
energy demands of the burn. This prolonged metabolic dysfunction may lead to the loss of
lean body mass. The most serious affect is increased morbidity; that is, the risk of
additional illnesses will impede recovery. The remaining options do not represent the most
serious outcome of limited glycogen stores resulting from severe burns.

Question 18

What is the normal range of respirations for an infant (in breaths per minute)?

a. 18 to 25 c. 27 to 37
b. 20 to 28 d. 30 to 53

Answer 18

ANS: D
Although the other ranges may be normal for some age groups, the normal respiratory
range for infants is 30 to 53 breaths per minute.

Question 19

While awake, what is the normal heart rate for toddlers (in beats per minute)?

a. 100 to 205 c. 98 to 140
b. 100 to 180 d. 80 to 120

Answer 19

ANS: C
Although the other ranges may be normal for some age groups, the normal heart rate range
for toddlers during waking hours is 98 to 140 beats per minute.