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1

A patient in early shock informs you that he has had severe diarrhea and vomiting over the past four days. Given this history, you would recognize the pathophysiology of the shock is probably related to:

a. the loss of red blood cells.
b. decreased formed elements in the blood.
c. leakage of the capillaries.
d. the loss of plasma volume.

a. the loss of red blood cells.
b. decreased formed elements in the blood.
c. leakage of the capillaries.
d. the loss of plasma volume.

Answer: d
Objective: 10-6
Reference: 336–339

2

A patient with severe gastrointestinal bleeding is in shock. This type of shock is known as:

a. hypovolemic.
b. cardiogenic.
c. hemorrhagic.
d. distributive.

a. hypovolemic.
b. cardiogenic.
c. hemorrhagic.
d. distributive.

Answer: a
Objective: 10-6
Reference: 336–339

3

Which of the following conditions is the most probable cause of cardiogenic shock?

a. Myocardial infarction
b. Severe vomiting and diarrhea
c. Gastrointestinal bleeding
d. Systemic infection

a. Myocardial infarction
b. Severe vomiting and diarrhea
c. Gastrointestinal bleeding
d. Systemic infection

Answer: a
Objective: 10-6
Reference: 339–340

4

The four major categories of shock are:

a. hemorrhagic, distributive, hypoxic, and obstructive.
b. burn, hypovolemic, distributive, and hypoxic.
c. hypoglycemic, obstructive, distributive, and hypovolemic.
d. hypovolemic, cardiogenic, obstructive, and distributive.

a. hemorrhagic, distributive, hypoxic, and obstructive.
b. burn, hypovolemic, distributive, and hypoxic.
c. hypoglycemic, obstructive, distributive, and hypovolemic.
d. hypovolemic, cardiogenic, obstructive, and distributive.

Answer: d
Objective: 10-6
Reference: 336–343

5

Which of the following statements made by a patient’s family member would lead you to suspect that the patient is suffering from hypovolemic shock?

a. “He has had a rash for the past three days.”
b. “He cannot stop throwing up.”
c. “He has been taking an antibiotic for a chest cold.”
d. “He got up this morning and was having a hard time breathing.”

a. “He has had a rash for the past three days.”
b. “He cannot stop throwing up.”
c. “He has been taking an antibiotic for a chest cold.”
d. “He got up this morning and was having a hard time breathing.”

Answer: b
Objective: 10-6
Reference: 336–339

6

The underlying cause of distributive shock is:

a. poor fluid intake.
b. loss of blood volume.
c. a damaged heart that has poor contractility.
d. dilation of blood vessels.

a. poor fluid intake.
b. loss of blood volume.
c. a damaged heart that has poor contractility.
d. dilation of blood vessels.

Answer: d
Objective: 10-6
Reference: 339–341

7

Which of the following conditions could be responsible for causing obstructive shock?

a. Infection throughout the body
b. Loss of blood in the urine
c. Blood clots in the lungs
d. Poor transfer of oxygen at the capillary level

a. Infection throughout the body
b. Loss of blood in the urine
c. Blood clots in the lungs
d. Poor transfer of oxygen at the capillary level

Answer: c
Objective: 10-6
Reference: 342

8

A patient in shock with abdominal pain indicates he noticed lots of blood in the toilet after having a bowel movement this morning. You would recognize the possibility of what type of shock?

a. Septic
b. Hypovolemic
c. Hypoxic
d. Obstructive

a. Septic
b. Hypovolemic
c. Hypoxic
d. Obstructive

Answer: b
Objective: 10-6
Reference: 336–339

9

You are treating a patient with severe chest pain and believe she is in cardiogenic shock. One of your first treatments would be:

a. high-flow oxygen.
b. application of an AED.
c. having the patient take her nitroglycerin.
d. rapid transport in a supine position.

a. high-flow oxygen.
b. application of an AED.
c. having the patient take her nitroglycerin.
d. rapid transport in a supine position.

Answer: a
Objective: 10-9
Reference: 347

10

You approach a patient and notice a large amount of blood on the ground. The patient appears confused, pale, and diaphoretic. Which one of the following should you do first?

a. Apply oxygen.
b. Look for the source of the blood.
c. Assess the patient’s airway.
d. Treat the patient for shock.

a. Apply oxygen.
b. Look for the source of the blood.
c. Assess the patient’s airway.
d. Treat the patient for shock.

Answer: c
Objective: 10-9
Reference: 346–347

11

Which of the following situations is occurring in the body of a person in shock?

a. The cells are getting glucose and other nutrients but not oxygen.
b. The amount of oxygen reaching the cells is adequate, but carbon dioxide is not being removed.
c. The blood contains an adequate amount of oxygen but not enough nutrients for cells to survive.
d. The cells are not getting enough oxygen, and waste products are accumulating.

a. The cells are getting glucose and other nutrients but not oxygen.
b. The amount of oxygen reaching the cells is adequate, but carbon dioxide is not being removed.
c. The blood contains an adequate amount of oxygen but not enough nutrients for cells to survive.
d. The cells are not getting enough oxygen, and waste products are accumulating.

Answer: d
Objective: 10-1
Reference: 332

12

When performing a primary assessment, the first evidence that the body may be in shock is:

a. skin that is warm and diaphoretic.
b. a radial pulse of 100 beats per minute.
c. hypertension.
d. a slowed respiratory rate.

a. skin that is warm and diaphoretic.
b. a radial pulse of 100 beats per minute.
c. hypertension.
d. a slowed respiratory rate.

Answer: b
Objective: 10-8
Reference: 345

13

Which of the following statements best indicates that the speaker has an understanding of the role of caring for a patient in shock in a prehospital setting?

a. “The job of the prehospital provider is to recognize shock and get the patient to the hospital, where treatment for shock can be started.”
b. “Because shock is a life-threatening condition, it is important to identify its exact cause so that proper care can be given.”
c. “If shock is in the compensatory or early stage, it is not yet life threatening, so you can take your time to carefully assess and treat the patient.”
d. “Because shock is best treated in the hospital, one should provide care to correct problems affecting ABCDs and then rapidly transport the patient.”

The job of the prehospital provider is to recognize shock and get the patient to the hospital, where treatment for shock can be started.”
b. “Because shock is a life-threatening condition, it is important to identify its exact cause so that proper care can be given.”
c. “If shock is in the compensatory or early stage, it is not yet life threatening, so you can take your time to carefully assess and treat the patient.”
d. “Because shock is best treated in the hospital, one should provide care to correct problems affecting ABCDs and then rapidly transport the patient.”

Answer: d
Objective: 10-9
Reference: 345–346

14

A 56-year-old female has struck a tree. Your assessment reveals gurgling respirations, rapid breathing, and cool, diaphoretic skin. You also observe bruising to the chest and abdomen. Which one of the following should you do immediately?

a. Determine her pulse rate.
b. Elevate her feet.
c. Evaluate her for shock.
d. Open and suction her airway.

a. Determine her pulse rate.
b. Elevate her feet.
c. Evaluate her for shock.
d. Open and suction her airway.

Answer: d
Objective: 10-9
Reference: 347–348

15

A patient who sustained blunt trauma to the abdominal and pelvic areas in a very serious collision is probably in which type of shock?

a. Obstructive
b. Cardiogenic
c. Distributive
d. Hypovolemic

a. Obstructive
b. Cardiogenic
c. Distributive
d. Hypovolemic

Answer: d
Objective: 10-6
Reference: 336–339

16

Septic shock is caused by:

a. a failing heart.
b. blood loss.
c. an infection.
d. a collapsed lung.

a. a failing heart.
b. blood loss.
c. an infection.
d. a collapsed lung.

Answer: c
Objective: 10-6
Reference: 340–341

17

Which of the following lists of assessment findings indicates that a trauma patient may be in compensated shock?

a. Anxious, pulse 104, BP 134/88 mmHg, pale and cool skin
b. Slightly confused, pulse 116, BP 90/60 mmHg, warm skin that is flushed
c. Confused and anxious, pulse 144, BP 82/palp, cool skin that is mottled
d. Confused, pulse 44, BP 110/68, cool and cyanotic skin

a. Anxious, pulse 104, BP 134/88 mmHg, pale and cool skin
b. Slightly confused, pulse 116, BP 90/60 mmHg, warm skin that is flushed
c. Confused and anxious, pulse 144, BP 82/palp, cool skin that is mottled
d. Confused, pulse 44, BP 110/68, cool and cyanotic skin

Answer: a
Objective: 10-5
Reference: 335

18

You are reassessing a patient who has sustained blunt trauma to the chest. Which one of the following reassessment findings best indicates that the patient is deteriorating and is in the decompensating phase of shock?

a. Pulse of 96 beats per minute
b. Blood pressure of 88/50
c. Blood oozing from an abdominal laceration
d. Skin that is cool and dry

a. Pulse of 96 beats per minute
b. Blood pressure of 88/50
c. Blood oozing from an abdominal laceration
d. Skin that is cool and dry

Answer: b
Objective: 10-5
Reference: 335

19

Which of the following statements about irreversible shock is correct?

a. Even with treatment, death will result.
b. If the pupils are dilated, the patient is in irreversible shock.
c. In irreversible shock, the radial pulse is weak but the carotid pulse stays strong.
d. To survive, the patient must get to the hospital quickly to receive IV fluids.

a. Even with treatment, death will result.
b. If the pupils are dilated, the patient is in irreversible shock.
c. In irreversible shock, the radial pulse is weak but the carotid pulse stays strong.
d. To survive, the patient must get to the hospital quickly to receive IV fluids.

Answer: a
Objective: 10-5
Reference: 335–336

20

Shock is defined as:

a. inadequate blood pressure and pulse.
b. decreased amount of circulating blood for any reason.
c. multiple organ failure.
d. a state of inadequate tissue perfusion.

a. inadequate blood pressure and pulse.
b. decreased amount of circulating blood for any reason.
c. multiple organ failure.
d. a state of inadequate tissue perfusion.

Answer: d
Objective: 10-1
Reference: 329–330

21

The cardiovascular system is composed of the:

a. heart, aorta, and venae cavae.
b. blood vessels, plasma, and the lungs.
c. heart, blood vessels, and blood.
d. heart, lungs, and blood.

a. heart, aorta, and venae cavae.
b. blood vessels, plasma, and the lungs.
c. heart, blood vessels, and blood.
d. heart, lungs, and blood.

Answer: c
Objective:10-2
Reference: 331

22

Which of the following is not a characteristic of the heart?

a. It has four chambers and two sides.
b. It pumps oxygen-poor blood to the lungs through the pulmonary veins.
c. It pumps blood throughout the body through the systemic circuit.
d. It is about the size of a clenched fist.

a. It has four chambers and two sides.
b. It pumps oxygen-poor blood to the lungs through the pulmonary veins.
c. It pumps blood throughout the body through the systemic circuit.
d. It is about the size of a clenched fist.

Answer: b
Objective: 10-2
Reference: 332

23

Which of the following statements correctly describes cardiac output?

a. It is the combination of stroke volume and heart rate.
b. It is the amount of blood pumped in each heartbeat.
c. Increased cardiac output can lead to shock.
d. Reduced stroke volume always means reduced cardiac output.

a. It is the combination of stroke volume and heart rate.
b. It is the amount of blood pumped in each heartbeat.
c. Increased cardiac output can lead to shock.
d. Reduced stroke volume always means reduced cardiac output.

Answer: a
Objective: 10-4
Reference: 332

24

The key components of blood are:

a. red blood cells, platelets, hemoglobin, and water.
b. white blood cells, plasma, proteins, and fat.
c. red blood cells, white blood cells, platelets, and plasma.
d. hemoglobin, water, platelets, and plasma.

a. red blood cells, platelets, hemoglobin, and water.
b. white blood cells, plasma, proteins, and fat.
c. red blood cells, white blood cells, platelets, and plasma.
d. hemoglobin, water, platelets, and plasma.

Answer: c
Objective: 10-3
Reference: 332–334

25

The degree to which hemoglobin is full of oxygen is called:

a. hemoglobin.
b. oxygen saturation.
c. hematocrit.
d. oxygen capacity.

a. hemoglobin.
b. oxygen saturation.
c. hematocrit.
d. oxygen capacity.

Answer: b
Objective: 10-3
Reference: 333

26

Hemorrhage can result in all of the following except:

a. decreased respirations.
b. decreased ability to oxygenate tissues.
c. decreased nutrients to tissues.
d. increased heart rate.

a. decreased respirations.
b. decreased ability to oxygenate tissues.
c. decreased nutrients to tissues.
d. increased heart rate.

Answer: a
Objective: Supplemental
Reference: 337–338

27

In shock, the body’s reactions to a decreased amount of oxygen reaching the cells include:

a. the release of epinephrine, increased stroke volume, and slowed respiratory rate.
b. increased stroke volume, increased heart rate, and increased peripheral resistance.
c. slowed respiratory rate, shunting of blood from the skin, and decreased pulse rate.
d. increased stroke volume, decreased pulse rate, and shunting of blood from the skin.

a. the release of epinephrine, increased stroke volume, and slowed respiratory rate.
b. increased stroke volume, increased heart rate, and increased peripheral resistance.
c. slowed respiratory rate, shunting of blood from the skin, and decreased pulse rate.
d. increased stroke volume, decreased pulse rate, and shunting of blood from the skin.

Answer: b
Objective: 10-7
Reference: 335

28

In decompensated shock, the failure of body systems in spite of the body’s attempt to oxygenate vital organs becomes apparent as:

a. increased blood pressure and reduced pulse rate.
b. delayed capillary refill and increased respiratory rate.
c. increased pulse rate and decreased blood pressure.
d. increased respiratory rate and reduced level of consciousness.

a. increased blood pressure and reduced pulse rate.
b. delayed capillary refill and increased respiratory rate.
c. increased pulse rate and decreased blood pressure.
d. increased respiratory rate and reduced level of consciousness.

Answer: c
Objective: 10-8
Reference: 335

29

You are caring for a 55-year-old man with significant trauma. His medical history reveals high blood pressure for which he takes a beta blocker. You realize that this group of drugs may:

a. inhibit his heart’s ability to beat faster.
b. cause him to have lower-than-normal blood pressure.
c. diminish his reactions to pain.
d. cause his heart rate to increase.

a. inhibit his heart’s ability to beat faster.
b. cause him to have lower-than-normal blood pressure.
c. diminish his reactions to pain.
d. cause his heart rate to increase.

Answer: a
Objective: 10-7
Reference: 345

30

Which of the following factors must be kept in mind when considering the severity of external bleeding?

a. Signs of shock do not appear until a large amount of blood is lost.
b. A person in poor health cannot tolerate the same amount of blood loss as a healthier person.
c. The amount of blood loss is easily estimated by the amount of blood visible on the snow.
d. Children show signs of shock much more quickly than do adults.

a. Signs of shock do not appear until a large amount of blood is lost.
b. A person in poor health cannot tolerate the same amount of blood loss as a healthier person.
c. The amount of blood loss is easily estimated by the amount of blood visible on the snow.
d. Children show signs of shock much more quickly than do adults.

Answer: b
Objective: 10-7
Reference: 344

31

You get a call for a “serious” injury on the expert trail. As you are skiing up to the patient your first priority is:

a. looking to see how much blood is on the snow.
b. trying to determine how many people may be injured.
c. assessing the scene for rescuer safety.
d. performing a primary survey.

a. looking to see how much blood is on the snow.
b. trying to determine how many people may be injured.
c. assessing the scene for rescuer safety.
d. performing a primary survey.

Answer: c
Objective: 10-9
Reference: 345

32

The smaller branches of the arterial tree that contain a muscular layer that enables changes in vessel diameter are called _______; these vessels ________.

a. resistance vessels; enable the body to control how much blood is directed toward an area based on that area’s metabolic needs
b. distributive vessels; sense oxygen levels and increase heart rate when the brainstem detects dropping O2 levels or rising CO2 levels
c. arterioles; exchange O2 and CO2 and rid the body of waste products
d. metabolic vessels; trigger the release of glucose into the circulatory system

a. resistance vessels; enable the body to control how much blood is directed toward an area based on that area’s metabolic needs
b. distributive vessels; sense oxygen levels and increase heart rate when the brainstem detects dropping O2 levels or rising CO2 levels
c. arterioles; exchange O2 and CO2 and rid the body of waste products
d. metabolic vessels; trigger the release of glucose into the circulatory system

Answer: a
Objective: 10-7
Reference: 332

33

In a healthy adult male, the hematocrit—the amount of red blood cells in the blood—should be:

a. 15–21 percent.
b. 23–30 percent.
c. 35–41 percent.
d. 42–54 percent.

a. 15–21 percent.
b. 23–30 percent.
c. 35–41 percent.
d. 42–54 percent.

Answer: d
Objective: 10-3
Reference: 334

34

You are treating a 42-year-old female exhibiting signs of shock. You do not suspect a spinal injury. To try to improve blood flow to the heart, you should position the patient:

a. supine with her feet elevated 8–12 inches above the level of the heart.
b. flat on her left side.
c. supine with the bed tilted so that her head is lower than her feet.
d. with her head slightly elevated and her arms raised over her head.

a. supine with her feet elevated 8–12 inches above the level of the heart.
b. flat on her left side.
c. supine with the bed tilted so that her head is lower than her feet.
d. with her head slightly elevated and her arms raised over her head.

Answer: a
Objective: 10-9
Reference: 342