NMNC 4510: Concept Synthesis - Exam
2 Practice Questions with Guaranteed
Pass Solutions 2026 Updated.
-
What is shock - Answer Syndrome characterized by decreased tissue perfusion & impaired
cellular metabolism
•Imbalance in supply/demand for O2 and nutrients
either...
1. Decreased oxygen supply in body
2. Something happened that made metabolic demand skyrocket (infection, sepsis, vasodilation)
Blood pressure is affected by shock, but shock is not blood pressure
which valve disorders are life threatening - Answer aortic
main cause of tricuspid stenosis - Answer Rheumatic fever
main cause of tricuspid regurgitation - Answer IE
main cause of pulmonic stenosis - Answer Congenital
main cause of pulmonic regurgitation - Answer Pulm HTN, TOF
which shock is CO up - Answer septic
What is SIRS - Answer Systemic Inflammatory Response Syndrome
inflammatory state affecting the whole body
body's response to infectious / noninfectious insult
associated with shock
- don't associate SIRS w just infections
,- can happen anytime there is insult to body - local inflammation, vasodilation (brings more
blood cells to insult) - too much vasodilation & capillaries become permeable (plasma water
moves into interstitial space)
(EX) surgery, infection
if SIRS detected early, we can give abx & treat - hopefully prevent shock state
SIRS criteria - Answer - Tachycardia
- WBC > 12,000 or WBC < 4,000
- Inc/dec temp
- RR > 20
- PaCO2 < 32
Which shock states have an increase in Lactate - Answer any shock state, not just sepsis
just the result of anaerobic metabolism
What is MODS - Answer multiple organ dysfunction syndrome
shock state that's progressed to point where multiple organs fail
- Kidneys
- Neuro status decrease
- Resp. Failure
- If we need to support BP (cardiac system is going down)
- Liver (once liver starts to fail, there isn't much we can do)
2+ organs failing - morbidity & mortality increase greatly
Stages of Shock - Answer - Initial Stage
- Compensatory Stage
- Progressive Stage
- Refractory
no clear line separates initial from compensatory and compensatory from progressive
can go from compensatory to refractory or from initial to progressive
,can also go back & forth between them
Initial Stage of Shock - Answer SIRS response (can be present in initial stage or progressive
stage)
- injury has happened, but body has not realized it yet
- metabolic demand increased (or lack of oxygen began)
- cells switch from aerobic to anerobic metabolism (may or may not see rise in Lactate yet)
- SIRS response, but body hasn't caught onto the change
Initial stage is hard to see without invasive monitoring (EX art line - CO, CI) all other markers are
usually okay
RR &HR inc within normal range
(EX) 12 to 17 breaths/min
(EX) 70 to 90
Compensatory Stage of Shock - Answer •Baroreceptors in carotid and aortic bodies activate
SNS in response to ↓ BP, Vasoconstriction while blood to vital organs maintained,↓ Blood to
kidneys activates renin-angiotensin system, ↑ Venous return to heart
•HR increases (in most shock states)
•Vasoconstriction (initially)
•GI Problems (Shunting of blood)
Body caught on that something is going on. Body is trying to get us back into homeostasis
•Vasoconstriction (extremities, to send blood back to vital organs)
•RAAS system= will kick off more vasoconstriction, aldosterone release, AHD release= decrease
in urine output
•In (Most) shock states, you'll see an inc. in HR
•Might have GI problems (N/V)= b/c body doesn't consider GI system as a vital organ= body
shunts blood away from GI system to put it in other organs= if we don't have good perfusion in
GI system, anything in there will be irritating to it= N/V
This is where we might see in increase in lactate. Body is still maintaining, but it needs support
for BP
-We consider it compensated when BP is in normal range (for the patient)= but body has to
work extra hard to get us there
, First sign that we'll see that body is having dysfunction is in ______. system, then _______
system - Answer resp.
then cardiac
Progressive stage of shock - Answer •Hypoperfusion leads to renal tubular ischemia- May
result in acute kidney injury
•Electrolyte dysfunction
•Liver dysfunction
•Renal dysfunction
This is where our compensatory mechanisms fail
•cool and clammy
•weak peripheral pulses
•hypotension (we can't maintain it no more)
•Kidneys= stop making urine
•Fluid might third space into lungs= crackles
•Neuro status= restlessness= moving to obtundent now!
•Mucous barrier of GI system gets ischemic= now good bacteria flora in our gut will cause
problems! (this is how we get necrotizing enterocolitis in neonates- 10% of premature babies)
•This is why patients on a bunch of vasoactive meds, we'll be like hmm should we feed these
pts or not
•We won't be feeding gut, we'll be feeding bacteria
Necrotizing enterocolitis - Answer Like in progressive stage of shock
•Mucous barrier of GI system gets ischemic= now good bacteria flora in our gut will cause
problems! (this is how we get necrotizing enterocolitis in neonates- 10% of premature babies)
If kidneys start to become dysfunctional, we should be concerned about: - Answer electrolytes
Refractory stage of shock - Answer •MODS
•Profound hypotension and hypoxemia
•Tachycardia worsens
•Recovery unlikely
Refractory= means it's not responding to what we're doing
2 Practice Questions with Guaranteed
Pass Solutions 2026 Updated.
-
What is shock - Answer Syndrome characterized by decreased tissue perfusion & impaired
cellular metabolism
•Imbalance in supply/demand for O2 and nutrients
either...
1. Decreased oxygen supply in body
2. Something happened that made metabolic demand skyrocket (infection, sepsis, vasodilation)
Blood pressure is affected by shock, but shock is not blood pressure
which valve disorders are life threatening - Answer aortic
main cause of tricuspid stenosis - Answer Rheumatic fever
main cause of tricuspid regurgitation - Answer IE
main cause of pulmonic stenosis - Answer Congenital
main cause of pulmonic regurgitation - Answer Pulm HTN, TOF
which shock is CO up - Answer septic
What is SIRS - Answer Systemic Inflammatory Response Syndrome
inflammatory state affecting the whole body
body's response to infectious / noninfectious insult
associated with shock
- don't associate SIRS w just infections
,- can happen anytime there is insult to body - local inflammation, vasodilation (brings more
blood cells to insult) - too much vasodilation & capillaries become permeable (plasma water
moves into interstitial space)
(EX) surgery, infection
if SIRS detected early, we can give abx & treat - hopefully prevent shock state
SIRS criteria - Answer - Tachycardia
- WBC > 12,000 or WBC < 4,000
- Inc/dec temp
- RR > 20
- PaCO2 < 32
Which shock states have an increase in Lactate - Answer any shock state, not just sepsis
just the result of anaerobic metabolism
What is MODS - Answer multiple organ dysfunction syndrome
shock state that's progressed to point where multiple organs fail
- Kidneys
- Neuro status decrease
- Resp. Failure
- If we need to support BP (cardiac system is going down)
- Liver (once liver starts to fail, there isn't much we can do)
2+ organs failing - morbidity & mortality increase greatly
Stages of Shock - Answer - Initial Stage
- Compensatory Stage
- Progressive Stage
- Refractory
no clear line separates initial from compensatory and compensatory from progressive
can go from compensatory to refractory or from initial to progressive
,can also go back & forth between them
Initial Stage of Shock - Answer SIRS response (can be present in initial stage or progressive
stage)
- injury has happened, but body has not realized it yet
- metabolic demand increased (or lack of oxygen began)
- cells switch from aerobic to anerobic metabolism (may or may not see rise in Lactate yet)
- SIRS response, but body hasn't caught onto the change
Initial stage is hard to see without invasive monitoring (EX art line - CO, CI) all other markers are
usually okay
RR &HR inc within normal range
(EX) 12 to 17 breaths/min
(EX) 70 to 90
Compensatory Stage of Shock - Answer •Baroreceptors in carotid and aortic bodies activate
SNS in response to ↓ BP, Vasoconstriction while blood to vital organs maintained,↓ Blood to
kidneys activates renin-angiotensin system, ↑ Venous return to heart
•HR increases (in most shock states)
•Vasoconstriction (initially)
•GI Problems (Shunting of blood)
Body caught on that something is going on. Body is trying to get us back into homeostasis
•Vasoconstriction (extremities, to send blood back to vital organs)
•RAAS system= will kick off more vasoconstriction, aldosterone release, AHD release= decrease
in urine output
•In (Most) shock states, you'll see an inc. in HR
•Might have GI problems (N/V)= b/c body doesn't consider GI system as a vital organ= body
shunts blood away from GI system to put it in other organs= if we don't have good perfusion in
GI system, anything in there will be irritating to it= N/V
This is where we might see in increase in lactate. Body is still maintaining, but it needs support
for BP
-We consider it compensated when BP is in normal range (for the patient)= but body has to
work extra hard to get us there
, First sign that we'll see that body is having dysfunction is in ______. system, then _______
system - Answer resp.
then cardiac
Progressive stage of shock - Answer •Hypoperfusion leads to renal tubular ischemia- May
result in acute kidney injury
•Electrolyte dysfunction
•Liver dysfunction
•Renal dysfunction
This is where our compensatory mechanisms fail
•cool and clammy
•weak peripheral pulses
•hypotension (we can't maintain it no more)
•Kidneys= stop making urine
•Fluid might third space into lungs= crackles
•Neuro status= restlessness= moving to obtundent now!
•Mucous barrier of GI system gets ischemic= now good bacteria flora in our gut will cause
problems! (this is how we get necrotizing enterocolitis in neonates- 10% of premature babies)
•This is why patients on a bunch of vasoactive meds, we'll be like hmm should we feed these
pts or not
•We won't be feeding gut, we'll be feeding bacteria
Necrotizing enterocolitis - Answer Like in progressive stage of shock
•Mucous barrier of GI system gets ischemic= now good bacteria flora in our gut will cause
problems! (this is how we get necrotizing enterocolitis in neonates- 10% of premature babies)
If kidneys start to become dysfunctional, we should be concerned about: - Answer electrolytes
Refractory stage of shock - Answer •MODS
•Profound hypotension and hypoxemia
•Tachycardia worsens
•Recovery unlikely
Refractory= means it's not responding to what we're doing
