EMT Chapter 13 Shock

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

B

All of the following conditions should make you suspect shock, EXCEPT:
Select one:
A. anaphylaxis
B. spinal injury
C. ischemic stroke
D. severe infection

C

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

A

Distributive shock occurs when:
A. temporary but severe vasodilation causes a decrease in blood supply to the brain.
B. severe bleeding causes tachycardia in order to distribute blood to the organs faster.
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.

D

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. decompensated shock.
B. septic shock.
C. pump failure.
D. a local infection

B

Capillary sphincters are:
Select one:
A. under complete control of the voluntary portion of the nervous system.
B. circular muscular walls that regulate blood flow through the capillaries.
C. capable of dilating in order to increase perfusion to crucial body organs.
D. responsible for constricting to compensate for decreased cell perfusion.

B

Hypovolemic shock caused by severe burns is the result of a loss of:
A. plasma
B. whole blood
C. platelets
D. red blood cells

A

In an acute injury setting, neurogenic shock is commonly accompanied by:
A. tachycardia
B. hypothermia
C. diaphoresis
D. hypovolemia

B

Neurogenic shock occurs when:
A. there is too much blood to fill a smaller vascular container.
B. the spinal cord is severed and causes massive hemorrhaging.
C. failure of the nervous system causes widespread vasodilation.
D. massive vasoconstriction occurs distal to a spinal cord injury.

C

One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is:
A. pyruvic acid
B. lactic acid
C. carbon dioxide
D. carbon monoxide

C

Pulmonary edema and impaired ventilation occur during:
A. cardiogenic shock
B. septic shock
C. neurogenic shock
D. anaphylactic shock

A

Shock is the result of:
A. the body's maintenance of homeostasis.
B. hypoperfusion to the cells of the body.
C. temporary dysfunction of a major organ.
D. widespread constriction of the blood vessels.

B

To protect vital organs, the body compensates by directing blood flow away from organs that are more tolerant of low flow, such as:
A. the skin
B. the heart
C. the lungs
D. the brain

A

Which of the following clinical signs is unique to anaphylactic shock?
A. Dizziness
B. Pallor
C. Hypotension
D. Wheezing

D

Which of the following injuries would MOST likely cause obstructive shock?
A. Cardiac tamponade
B. Spinal cord injury
C. Liver laceration
D. Simple pneumothorax

A

Which of the following is the ONLY action that can prevent death from a tension pneumothorax?
A. Positive-pressure ventilation with a bag-valve mask
B. Decompression of the injured side of the chest
C. Early admission of high-flow oxygen
D. Rapid administration of intravenous fluids

B

Which of the following patients is in decompensated shock?
A. A 23-year-old restless male with cool, clammy skin and tachycardia
B. A 28-year-old female with pale skin and rapid, shallow respirations
C. A 20-year-old female with absent radial pulses and dilated pupils
D. A 32-year-old male with anxiety and a systolic blood pressure of 110 mm Hg

C

Which of the following statements regarding anaphylactic shock is correct?
A. Anaphylactic shock occurs immediately after a person is sensitized to an allergen.
B. Sensitized people will experience less severe reactions upon subsequent exposure.
C. Subsequent exposure after sensitization often produces a more severe reaction.
D. Anaphylactic shock is caused by immune system failure due to a toxic exposure.

C

Which of the following would MOST likely result in hemorrhagic shock?
A. Repeated diarrhea
B. Liver laceration
C. Severe vomiting
D. Excessive sweating

B

When assessing a patient with signs and symptoms of shock, it is MOST important to remember that:
A. irreversible shock often responds well to a prompt blood transfusion.
B. multiple fractures are the most common cause of hypovolemic shock.
C. blood pressure may be the last measurable factor to change in shock.
D. the patient's respirations are deep during the early stages of shock.

C

Temporary, widespread vasodilation and syncope caused by a sudden nervous system reaction MOST accurately describes:
A. Vasovagal shock
B. Neurogenic shock
C. Psychogenic shock
D. Neurologic shock

C

When perfusion to the core of the body decreases:
A. Blood is shunted away from the skin.
B. Decreased cardiac contractility occurs.
C. Blood is diverted to the gastrointestinal tract.
D. The voluntary nervous system releases hormones.

A

Which of the following statements regarding oxygenation and ventilation is correct?
A. Oxygenation without adequate ventilation can occur in climbers who quickly ascend to an altitude of lower atmospheric pressure.
B. Oxygenation is the movement of air into and out of the lungs, whereas ventilation is the exchange of gases.
C. In carbon monoxide (CO) poisoning, ventilation is impaired because CO binds to oxygen very quickly.
D. In mines or confined places, where oxygen levels are low, ventilation may continue despite adequate oxygenation.

D

A 56-year-old male is found semiconscious by his wife. Your assessment reveals that his respirations are rapid and shallow, his pulse is rapid and irregular, and his blood pressure is low. The patient's wife states that he complained of left arm pain and nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this patient's present condition is:
A. Severe septic hypoperfusion.
B. Cardiogenic hypoperfusion.
C. A ruptured aortic aneurysm.
D. Acute myocardial infarction.

B

The partial pressure of oxygen in the alveoli is _______ mm Hg, while the partial pressure of carbon dioxide in the alveoli is _______ mm Hg.
A. 90, 50
B. 104, 40
C. 88, 30
D. 70, 28

B

You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should:
A. Assess the rate and quality of his pulse.
B. Apply direct pressure to the wound.
C. Administer 100% supplemental oxygen
D. Immediately evaluate his airway.

B

Intrapulmonary shunting occurs when:
A. Any impairment in circulatory function causes a reduced ability for oxygen and carbon dioxide to diffuse across the alveolar-capillary membrane.
B. A decrease in respiratory rate and depth causes carbon dioxide accumulation in the alveoli and an overall decrease in blood oxygen levels.
C. The presence of pulmonary surfactant causes a decrease in alveolar surface tension, thus impairing the exchange of gases in the lungs.
D. Blood coming from the right side of the heart bypasses nonfunctional alveoli and returns to the left side of the heart in an unoxygenated state.

D

You and your partner are caring for a critically injured patient. Your partner is controlling severe bleeding from the patient's lower extremities as you attempt ventilations with a bag-mask device. After repositioning the mask several times, you are unable to effectively ventilate the patient. You should:
A. Continue attempted ventilations and transport immediately.
B. Begin ventilations using the mouth-to-mask technique.
C. Hyperextend the patient's head and reattempt ventilations.
D. Suction the patient's airway for 30 seconds and reattempt ventilations.

B

Patients develop septic shock secondary to:
A. Weak vessel tone due to nervous system damage.
B. Failure of the blood vessels to adequately dilate.
C. Poor vessel function and severe volume loss.
D. An infection that weakens cardiac contractions.

C

You are ventilating a patient with a stoma; however, air is escaping from the mouth and nose. To prevent this, you should:
A. Thoroughly suction the stoma.
B. Ventilate with less pressure.
C. Thrust the jaw forward.
D. Seal the mouth and nose.

D

Which of the following patients should you place in the recovery position?
A. A 31-year-old semiconscious male with low blood sugar and adequate breathing
B. A 24-year-old unconscious female who overdosed and has a reduced tidal volume
C. A 40-year-old conscious female with a possible neck injury and regular respirations
D. A 19-year-old conscious male with a closed head injury and normal respirations

A

The hypoxic drive—the primary stimulus to breathe for patients with certain chronic respiratory diseases—is influenced by:
A. Low blood carbon dioxide levels.
B. Low blood oxygen levels.
C. High blood carbon dioxide levels.
D. High blood oxygen levels.

B

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:
A. advise her that she needs to go to the hospital.
B. provide emotional support regarding her sister.
C. obtain baseline vital signs and a medical history.
D. determine if she was injured when she fainted.

D

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 100% supplemental oxygen, you should:
A. allow him to drink plain water.
B. obtain a repeat blood pressure in 5 minutes.
C. prepare for immediate transport.
D. perform a head-to-toe exam.

C

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?
A. rapid transport to a trauma center
B. full immobilization of her spine
C. 100% oxygen administration
D. application of the pneumatic antishock garment (PASG)

A

Activated charcoal is given to patients who have ingested certain substances because it:
A. induces vomiting and empties the stomach.
B. binds to the substance and prevents absorption.
C. is a direct antidote for many toxic substances.
D. decreases absorption of poisons into the lungs.

B

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade?
A. widening pulse pressure
B. diminished breath sounds
C. a rapid, irregular pulse
D. engorged jugular veins

D

Which of the following MOST accurately describes septic shock?
A. viral infection of the blood vessels, vascular damage, and vasoconstriction
B. bacterial damage to the vessel wall, leaking blood vessels, and vasodilation
C. widespread vasoconstriction and plasma loss due to a severe viral infection
D. bacterial infection of the nervous system with widespread vasodilation

B

You are transporting a 33-year-old male who was involved in a motor vehicle crash. You have addressed all immediate and potentially life-threatening conditions and have stabilized his condition with the appropriate treatment. With an estimated time of arrival at the hospital of 20 minutes, you should:
A. reassess his condition in 5 minutes.
B. take his vital signs in 15 minutes.
C. repeat your secondary assessment.
D. arrange for an ALS rendezvous.

A

A 19-year-old male was stung multiple times by fire ants. He is experiencing obvious signs and symptoms of anaphylactic shock. You administer 100% oxygen and give him epinephrine via subcutaneous injection. Upon reassessment, you determine that his condition has not improved. You should:
A. transport him immediately and provide supportive care while en route.
B. repeat the epinephrine injection after consulting with medical control.
C. consider that he may actually be experiencing an acute asthma attack.
D. request a paramedic unit that is stationed approximately 15 miles away.

B

Most patients who die of anaphylaxis do so within the first __________ following exposure.
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 5 minutes

A

Anaphylaxis is MOST accurately defined as a:
A. extreme allergic reaction that may affect multiple body systems.
B. allergic reaction that causes bronchodilation and vasoconstriction.
C. severe allergic reaction that typically resolves without treatment.
D. moderate allergic reaction that primarily affects the vasculature.

A

Classic signs and symptoms of hypoglycemia include:Choose one answer.
A. cool, clammy skin; weakness; tachycardia; and rapid respirations.
B. warm, dry skin; hunger; abdominal pain; and deep, slow respirations.
C. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations.
D. warm, dry skin; irritability; bradycardia; and rapid respirations.

A

Hypovolemic shock occurs when:
A. at least 10% of the patient's blood volume is lost.
B. the clotting ability of the blood is enhanced.
C. the patient's systolic blood pressure is less than 100 mm Hg.
D. the body cannot compensate for rapid blood loss.

D

Cardiogenic shock may result from all of the following, EXCEPT:
A) increased afterload.
B) increased preload.
C) heart attack.
D) poor contractility

B

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:Choose one answer.
A) oxygen via nonrebreathing mask, blankets for warmth, and elevation of his head.
B) assisted ventilation, thermal management, and elevation of the lower extremities.
C) oxygen via nonrebreathing mask, thermal management, and elevation of his legs.
D) assisted ventilation, preventing hyperthermia, and elevating his lower extremities.

B

Cardiogenic shock following AMI is caused by:
A. hypovolemia secondary to severe vomiting.
B. widespread dilation of the systemic vasculature.
C. a profound increase in the patient's heart rate.
D. decreased pumping force of the heart muscle

D

Pale skin in a child indicates that the:
A. blood vessels near the skin are constricted.
B. oxygen content in the blood is decreased.
C. child is in severe decompensated shock.
D. child's core body temperature is elevated.

A

Hypothermia occurs when the core body temperature falls below:
Choose one answer.
A. 95°F (35°C).
B. 90°F (32°C).
C. 88°F (31°C).
D. 98°F (37°C).

A