Question 1

A student is perplexed that in a patient with multiple organ dysfunction syndrome (MODS), no infectious source has been found. What statement by the healthcare professional best describes this phenomenon?

Accepted Answer

The loss of intestinal barrier function leads to the systemic spread of bacteria and/or endotoxin from the gut (systemic endotoxemia). This phenomenon is called translocation of bacteria. This "gut hypothesis" provides a possible explanation for the fact that an infectious focus is not always found in individuals with MODS. The gut hypothesis is not related to death of organs, maldistribution of blood flow, or massive inflammation.

Question 2

Four patients are in the intensive care unit with different types of shock. Which patient would the healthcare professional assess as the priority?

Accepted Answer

Anaphylactic shock is characterized by massive vasodilation and widespread inflammation that can lead to death in minutes if treatment is not instituted immediately. If all else is equal, the healthcare professional should assess the patient with anaphylactic shock first.

Question 3

What stimulates the respiratory burst and production of highly toxic free radicals in the multiple organ dysfunction syndrome (MODS)?

Accepted Answer

The accumulation of activated neutrophils in organs is thought to play a key role in the pathogenetic development of MODS. When neutrophils adhere to the endothelium, they undergo a respiratory burst (oxidative burst) and release oxygen radicals. The respiratory burst occurs as the activated neutrophil experiences a sudden increase in oxidative metabolism, producing large quantities of highly toxic oxygen free radicals. Activation of the complement cascade; release of prostaglandins, thromboxanes, and leukotrienes; and activation of the fibrinolytic system do not provide this stimulus.

Question 4

For which type of shock would antihistamines and corticosteroids be prescribed?

Accepted Answer

Only anaphylactic shock responds to the administration of epinephrine to decrease mast cell and basophil degranulation. Antihistamines and steroids are administered to stop the inflammatory reaction. Septic shock specifically requires antibiotics. Hypovolemic shock is treated with large amounts of fluid. Cardiogenic shock requires the use of drugs or devices to improve the pumping ability of the heart.

Question 5

A student asks the professor to explain the basics of vasogenic shock. What statement by the professor is best?

Accepted Answer

Vasogenic shock refers to a widespread and massive vasodilation resulting from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Widespread hypersensitivity is characteristic of anaphylactic shock. Bacteremia and systemic inflammation are seen in septic shock. The inability to pump adequate blood to tissues and end organs describes cardiogenic shock.

Question 6

Hypovolemic shock begins to develop when intravascular volume has decreased by what percentage?

Accepted Answer

Hypovolemic shock begins to develop when intravascular volume has decreased by approximately 15%.

Question 7

What is the clinical hallmark of neurogenic shock as a result of the overstimulation of the parasympathetic nervous system?

Accepted Answer

Neurogenic shock refers to a widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle. Increased metabolism is seen in all forms of shock. Respiratory distress may occur in any form of shock.

Question 8

A patient has an acute burn injury. What type of treatment for shock will the healthcare professional anticipate for this patient?

Accepted Answer

Acute burn injuries can lead to hypovolemic shock from massive fluid losses from the circulating blood volume. The professional anticipates treating hypovolemic shock with fluid resuscitation. Antibiotics would be used in septic shock. A balloon pump would be used in cardiogenic shock. Antihistamines and steroids are used in anaphylactic shock.

Question 9

The release of catecholamine by the adrenal glands provides which compensatory mechanism in hypovolemic shock?

Accepted Answer

The heart rate will increase in shock due to the effects of circulating catecholamines. Fluid moving out of the vascular compartment is deleterious, leading to a relative hypovolemia. Systemic vascular resistance is increased to improve blood pressure. Water excretion is not increased as a result of catecholamine release.

Question 10

A student learns that a fatal burn injury has what effect on interleukins (ILs)?

Accepted Answer

A fatal burn injury has often shown decreased levels of IL-2, which may result in decreased Th1 lymphocytes. This results in a major disruption in cellular immunity and IgG production.

Question 11

A student has studied secondary multiple organ dysfunction syndrome (MODS). What substance does the student learn is least likely to stimulate the normal endothelial cells to change to a proinflammatory state?

Accepted Answer

Normal endothelial cells have little interaction with leukocytes except when stimulated by TNF, IL-1, and IL-6. The student would recognize that IL4 is not involved in this process.

Question 12

Which condition does a burn injury create for an extended period?

Accepted Answer

A burn injury induces a hypermetabolic state that persists until wound closure. Fluid and electrolyte imbalances and hypotension can be resolved with rapid treatment, but the hypermetabolic state lasts for an extended period of time.

Question 13

Which condition is best defined as a clinical syndrome involving a systemic response to infection, which is manifested by two or more of the systemic inflammatory response syndrome criteria?

Accepted Answer

Of the options available, only sepsis is best defined as a systemic response to infection that is manifested by two or more criteria of the systemic inflammatory response syndrome.

Question 14

The student learns that which mechanism causes organ injury in primary multiple organ dysfunction syndrome (MODS)?

Accepted Answer

In primary MODS, the organ injury is directly associated with a specific insult, most often ischemia or impaired perfusion from an episode of shock or trauma, thermal injury, soft tissue necrosis, or invasive infection. Although MODS can be associated with impaired immune response, glucose use, and ventilation, the commonality in all cases of primary MODS is impaired perfusion.

Question 15

Blistering of the skin within minutes occurs in which type of burn injury?

Accepted Answer

The hallmark of superficial partial-thickness injury is the appearance of thin-walled, fluid-filled blisters that develop within only a few minutes after injury. First degree burns only involve the epidermis and can be compared to a sunburn. A deep partial thickness burn looks waxy white and may initially be indistinguishable from a full thickness burn until new skin buds and hair appear within 7 to 10 days.

Question 16

Which clinical manifestation of septic shock confirms an elevation in immune system response?

Accepted Answer

The increased WBCs indicate the immune response. Tachycardia occurs as a compensatory mechanism. The respiratory rate will be increased. Temperature will most likely be increased in most patients.

Question 17

Daily evaporative water loss after a burn injury is approximately how many times the normal?

Accepted Answer

Moncrief and Mason determined that daily evaporative water loss after burn injury was in the range of 20 times normal in the early phase, with gradual decreases as wound closure is achieved.

Question 18

A patient is diagnosed with septic shock. What action by the healthcare professional will address the main underlying pathophysiologic mechanism of this disorder?

Accepted Answer

Septic shock begins when bacteria enter the bloodstream, so the effective treatment for this specific problem is antibiotics. High volumes of fluid may been needed in all types of shock other than cardiogenic. A balloon pump would be beneficial in cardiogenic shock. Antihistamines and steroids would be used in anaphylactic shock.

Question 19

What is the final outcome of impaired cellular metabolism?

Accepted Answer

The common pathway in all types of shock is impairment of cellular metabolism as a result of decreased delivery of oxygen and nutrients, which are frequently coupled with an increased demand, the consumption of oxygen and nutrients, and a decreased removal of cellular waste products. Eventually organ dysfunction and failure do occur. Urine excretion diminishes as the kidneys fail from lack of perfusion or due to hypovolemic shock and volume loss.

Question 20

What assessment finding would indicate to the healthcare professional that the patient is no longer in burn shock?

Accepted Answer

The most reliable criterion for adequate resuscitation of burn shock is urine output. Normal urine output is minimally 30 mL/hour. The patient having a normal urine output for 4 hours has shown recovery from burn shock. None of the remaining options are considered as reliable as urine output.

Quiz 49: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Adults

A student is perplexed that in a patient with multiple organ dysfunction syndrome (MODS) , no infectious source has been found. What statement by the healthcare professional best describes this phenomenon?