NURS 2873 Exam 2 With Correct
Answers
In a type I hypersensitivity reaction the primary immunologic disorder
appears to be - ANSWER a. binding of IgG to an antigen on a cell surface.
b. deposit of antigen-antibody complexes in small vessels.
c. release of cytokines used to interact with specific antigns.
d. release of chemical mediators from IgE-bound mast cells and basophils.
Shock - ANSWER Decreased tissue perfusion and impaired cellular
metabolism. This results in an imbalance between the supply of and demand
for O2 and nutrients. The exchange of O2 and nutrients at the cellular level is
essential to life. When cells are hypoperfused, the demand for O2 and
nutrients exceeds the supply at the microcirculatory level. Ischemia can
occur, leading to cell injury and death.
Cardiogenic shock - ANSWER Ooccurs when either systolic or diastolic
dysfunction of the heart's pumping action results in reduced cardiac output
(CO), stroke volume (SV), and BP. These changes compromise myocardial
perfusion, further depress myocardial function, and decrease CO and
perfusion.
What is the most common cause of systolic dysfunction? - ANSWER Acute MI
Systolic dysfunction - ANSWER The heart's inability to pump the blood
forward.
,Causes of cardiogenic shock - ANSWER Cardiac tamponade, cardiomyopathy,
MI, dysrhythmias, valvular stenosis, blunt cardiac injury, severe systemic or
pulmonary hypertension, tension pneumothorax
Causes of hypovolemic shock - ANSWER Hemorrhage from surgery, trauma
or GI bleed, vomiting, diarrhea, DI, DM, burns, ascites, fracture of long bones,
ruptured spleen, hemothorax, severe pancreatitis, sepsis, bowel obstruction
Causes of anaphylactic shock - ANSWER Hypersensitivity (allergic reaction) to
a substance. Contrast media, blood or blood products, drugs, insect bites,
anesthetic agents, food or food additives, vaccines, environmental agents,
latex
Causes of neurogenic shock - ANSWER Hemodynamic consequence of spinal
cord injury and/or disease at or above T5, Spinal anesthesia, vasomotor
center depression, severe pain, hypoglycemia, injury
Causes of septic shock - ANSWER Pneumonia, peritonitis, urinary tract,
invasive procedures, indwelling lines and catheters (infection), older adults,
patients with chronic diseases (e.g., diabetes, chronic kidney disease, HF),
patients receiving immunosuppressive therapy or who are malnourished or
debilitated
Causes of obstructive shock - ANSWER Cardiac tamponade, tension
pneumothorax, superior vena cava syndrome, abdominal compartment
syndrome, pulmonary embolism
cardiac tamponade - ANSWER acute compression of the heart caused by fluid
accumulation in the pericardial cavity
Early presentation of cardiogenic shock - ANSWER Similar to acute
decompensated heart failure. May be hypotension and tachycardia.
, Narrowed pulse pressure, increased vascular resistance (increases myocardial
O2 consumption). Tachypnea and crackles because of pulmonary congestion.
Increase in the pulmonary artery wedge pressure (PAWP), stroke volume
variation (SVV), and pulmonary vascular resistance. Cyanosis, pallor,
diaphoresis, weak pulses, cool and clammy skin, decreased urinary output,
anxiety and confusion are other symptoms.
Hypovolemic shock - ANSWER Occurs from inadequate fluid volume in the
intravascular space to support adequate perfusion
Absolute hypovolemia - ANSWER When fluid is lost through hemorrhage,
gastrointestinal (GI) loss (e.g., vomiting, diarrhea), fistula drainage, diabetes
insipidus, or diuresis
Relative hypovolemia - ANSWER Fluid volume moves out of the vascular
space into the extravascular space (e.g., intracavitary space). We call this type
of fluid shift third spacing.
What amount of blood loss results in the SNS mediated response? - ANSWER
15-30% or more. Patient can compensate up to 15% blood loss (750mL).
Hypovolemic SNS response - ANSWER Increase in heart rate, CO, and
respiratory rate and depth. The decreased circulating blood volume causes
decreases in SV, central venous pressure (CVP), and PAWP.
What fluid do you use when blood loss is greater than 30%? - ANSWER Blood
or blood products
Labs for hypovolemic shock - ANSWER Hemoglobin and hematocrit levels,
electrolytes, lactate, blood gases, mixed central venous O2 saturation (SvO2),
and hourly urine outputs
Answers
In a type I hypersensitivity reaction the primary immunologic disorder
appears to be - ANSWER a. binding of IgG to an antigen on a cell surface.
b. deposit of antigen-antibody complexes in small vessels.
c. release of cytokines used to interact with specific antigns.
d. release of chemical mediators from IgE-bound mast cells and basophils.
Shock - ANSWER Decreased tissue perfusion and impaired cellular
metabolism. This results in an imbalance between the supply of and demand
for O2 and nutrients. The exchange of O2 and nutrients at the cellular level is
essential to life. When cells are hypoperfused, the demand for O2 and
nutrients exceeds the supply at the microcirculatory level. Ischemia can
occur, leading to cell injury and death.
Cardiogenic shock - ANSWER Ooccurs when either systolic or diastolic
dysfunction of the heart's pumping action results in reduced cardiac output
(CO), stroke volume (SV), and BP. These changes compromise myocardial
perfusion, further depress myocardial function, and decrease CO and
perfusion.
What is the most common cause of systolic dysfunction? - ANSWER Acute MI
Systolic dysfunction - ANSWER The heart's inability to pump the blood
forward.
,Causes of cardiogenic shock - ANSWER Cardiac tamponade, cardiomyopathy,
MI, dysrhythmias, valvular stenosis, blunt cardiac injury, severe systemic or
pulmonary hypertension, tension pneumothorax
Causes of hypovolemic shock - ANSWER Hemorrhage from surgery, trauma
or GI bleed, vomiting, diarrhea, DI, DM, burns, ascites, fracture of long bones,
ruptured spleen, hemothorax, severe pancreatitis, sepsis, bowel obstruction
Causes of anaphylactic shock - ANSWER Hypersensitivity (allergic reaction) to
a substance. Contrast media, blood or blood products, drugs, insect bites,
anesthetic agents, food or food additives, vaccines, environmental agents,
latex
Causes of neurogenic shock - ANSWER Hemodynamic consequence of spinal
cord injury and/or disease at or above T5, Spinal anesthesia, vasomotor
center depression, severe pain, hypoglycemia, injury
Causes of septic shock - ANSWER Pneumonia, peritonitis, urinary tract,
invasive procedures, indwelling lines and catheters (infection), older adults,
patients with chronic diseases (e.g., diabetes, chronic kidney disease, HF),
patients receiving immunosuppressive therapy or who are malnourished or
debilitated
Causes of obstructive shock - ANSWER Cardiac tamponade, tension
pneumothorax, superior vena cava syndrome, abdominal compartment
syndrome, pulmonary embolism
cardiac tamponade - ANSWER acute compression of the heart caused by fluid
accumulation in the pericardial cavity
Early presentation of cardiogenic shock - ANSWER Similar to acute
decompensated heart failure. May be hypotension and tachycardia.
, Narrowed pulse pressure, increased vascular resistance (increases myocardial
O2 consumption). Tachypnea and crackles because of pulmonary congestion.
Increase in the pulmonary artery wedge pressure (PAWP), stroke volume
variation (SVV), and pulmonary vascular resistance. Cyanosis, pallor,
diaphoresis, weak pulses, cool and clammy skin, decreased urinary output,
anxiety and confusion are other symptoms.
Hypovolemic shock - ANSWER Occurs from inadequate fluid volume in the
intravascular space to support adequate perfusion
Absolute hypovolemia - ANSWER When fluid is lost through hemorrhage,
gastrointestinal (GI) loss (e.g., vomiting, diarrhea), fistula drainage, diabetes
insipidus, or diuresis
Relative hypovolemia - ANSWER Fluid volume moves out of the vascular
space into the extravascular space (e.g., intracavitary space). We call this type
of fluid shift third spacing.
What amount of blood loss results in the SNS mediated response? - ANSWER
15-30% or more. Patient can compensate up to 15% blood loss (750mL).
Hypovolemic SNS response - ANSWER Increase in heart rate, CO, and
respiratory rate and depth. The decreased circulating blood volume causes
decreases in SV, central venous pressure (CVP), and PAWP.
What fluid do you use when blood loss is greater than 30%? - ANSWER Blood
or blood products
Labs for hypovolemic shock - ANSWER Hemoglobin and hematocrit levels,
electrolytes, lactate, blood gases, mixed central venous O2 saturation (SvO2),
and hourly urine outputs
