McCance: Pathophysiology, 6th Edition

Chapter 47: Shock, Multiple Organ Dysfunction Syndrome, and Burns in

Children

Test Bank

TRUE/FALSE

1. Shock is present in children when there are signs of poor systemic perfusion with normal,
low, or high blood pressure.

ANS: T
Shock in children is present when there are signs of poor systemic perfusion, regardless of
the blood pressure—shock may be present with normal, high, or low blood pressure.

REF: p. 1727

2. Hyperglycemia (glucose >150 mg/dl) has been linked with poor survival in children with
head trauma or shock.

ANS: T
Hyperglycemia has been linked with poor survival in critically ill children, such as those with
head injury or shock.

REF: p. 1729

3. Viruses, fungi, or rickettsial microorganisms cause about 40% of nosocomial infections

in children.

ANS: F
In adults and children approximately 40% of all nosocomial infections are linked to gram-
negative infections; 40% to gram-positive infections, and 20% to viruses, fungi, or rickettsial
microorganisms.

REF: p. 1733

4. Reperfusion injury is stimulated by the generation of highly reactive free oxygen radicals
and superoxide.

ANS: T
Reperfusion injury is stimulated by the generation of highly reactive oxygen intermediates
(e.g., free oxygen radicals and superoxide) that damage cell membranes, denature proteins,
and disrupt chromosomes (see Chapter 2).

REF: p. 1737

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Test Bank 47-2

5. The most common type of burn injury in very young children is flame injury.

ANS: F
Scald injuries (e.g., hot water, grease, other) are most common among young children,
whereas flame burns are more prevalent among older children.

REF: p. 1741

6. The same standard rule of nines used for fluid resuscitation in adults is also used for
children.

ANS: F
Use of the standard rule of nines results in inaccurate calculation of the percentage of TBSA
involved in children.

REF: p. 1742

7. Children younger than 2 years have a significantly higher risk for associated morbidity
and mortality after thermal injury.

ANS: T
Children younger than 2 years have a significantly higher risk for associated morbidity and
mortality after sustaining burn injury.

REF: p. 1742

8. Hypotension is a late sign of shock in children.

ANS: T
Hypotension is a late sign of shock in children.

REF: p. 1745

9. Infants are at increased risk for a precipitous drop in core body temperature caused by an
inability to regulate heat loss by shivering.

ANS: T
Infants are at increased risk for a precipitous drop in core body temperature caused by an
inability to regulate heat loss by shivering.

REF: p. 1748

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Test Bank 47-3

10. Scar tissue is metabolically inactive and avascular.

ANS: F
Scar tissue is metabolically active and highly vascular.

REF: p. 1748

MULTIPLE CHOICE

1. The most common type of shock in children is:

a. hypovolemic.
b. cardiogenic.
c. neurogenic.
d. septic.

ANS: A
Hypovolemic shock, the most common type of shock in children, is associated with a
reduction in the intravascular volume relative to the vascular space.

REF: p. 1728

2. When an infant or child is greater than ___% dehydrated, hypotension occurs.

a. 2
b. 5
c. 7
d. 10

ANS: D
Severe volume loss is typically present with greater than 10% dehydration in the infant or
child or greater than 6% dehydration in the adolescent.

REF: p. 1728

3. Excessive skin blood flow may be present in _____ shock.

a. hemorrhagic
b. septic
c. compensated
d. cardiogenic

ANS: B
Excessive skin blood flow with instantaneous (“flash”) capillary refill may be present in
children with anaphylaxis, neurogenic shock, or severe sepsis or septic shock.

REF: p. 1729

4. The most common cause of bradycardia in young children is:

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Test Bank 47-4

a. cardiogenic shock.
b. neurogenic shock.
c. dehydration.
d. hypoxia.

ANS: D
The most common cause of bradycardia in young children is hypoxia.

REF: p. 1730

5. Considering a normal capillary refill time for infants and children is 1.5 to 2 seconds, a
refill time of 3 seconds is associated with a greater than ____% dehydration.
a. 2
b. 5
c. 10
d. 15

ANS: C
If the capillary refill time is 1.5 to 3 seconds in a warm room, a 5% to 10% dehydration is
likely to be present, and a refill time more than 3 seconds is associated with greater than 10%
dehydration.

REF: p. 1730

6. Cardiac output is more closely related to heart rate in children than in adults because the:
a. stroke volume is smaller in children than in adults.
b. capillary refill in children is shorter than in adults.
c. children have a higher percentage of body water than adults.
d. myocardium in the child is thinner than in an adult.

ANS: A
Because the stroke volume is smaller than in adults, the cardiac output of the child is more
closely related to heart rate than stroke volume.

REF: p. 1731; Table 47-2

7. Hypotension may not be observed in an adolescent until the fluid loss approximates ___
% of body weight.
a. 10
b. 15
c. 20
d. 25

ANS: B

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Test Bank 47-5

Isotonic dehydration produces hypotension in the adolescent with a fluid loss equivalent to
7% to 9% of body weight because body water constitutes a smaller percentage of body
weight in older children and adults than in young children.

REF: p. 1731; Table 47-3

8. Which statement is false about how the body compensates for cardiogenic shock in a
child?
a. Splanchnic arteries are constricted to divert blood from the skin, kidneys, and
gut to the heart and brain.
b. Peripheral blood vessels are constricted to raise blood pressure.
c. Adrenergic responses produce tachycardia to increase cardiac output.
d. The renin-angiotensin-aldosterone system retains water to increase blood
volume.

ANS: D
The renin-angiotensin-aldosterone system retains water to increase blood volume if the
compensatory measures are ineffective.

REF: p. 1729

9. In cardiogenic shock, hepatomegaly and periorbital edema occur because:

a. there is mass vasodilation due to chemical mediators released from the
myocardium.
b. there is low cardiac output causing a high central venous pressure.
c. the tissue damage to the myocardium causes increased capillary permeability.
d. low perfusion of the kidneys has stimulated the renin-angiotensin-aldosterone
system to retain sodium and water.

ANS: B
Evidence of an adequate or high central venous pressure, including hepatomegaly and
periorbital edema, is observed.

REF: p. 1733

10. Approximately 80% of all nosocomial infections in children are a result of:
a. bacteria.
b. viruses.
c. fungi.
d. Rickettsia.

ANS: A
In adults and children approximately 40% of all nosocomial infections are linked to gram-
negative infections; 40% to gram-positive infections, and 20% to viruses, fungi, or rickettsial
microorganisms.
REF: p. 1733

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Test Bank 47-6

11. Which cytokines are anti-inflammatory mediators?

a. IL-1, IL-6, and TNF-a
b. IL-8, IL-12, and platelet-activating factor (PAF)
c. IL-24, arachidonic acid metabolites, and nitric oxide
d. IL-4, IL-11, and colony-stimulating factor (CSF)
ANS: D
Anti-inflammatory mediators (IL-4, IL-10, IL-11, and IL-13; transforming growth factor-
beta; CSF; soluble tumor necrosis factor receptor; IL-1 receptor antagonist; and activated
protein C) are related to the prevention of septic shock.

REF: p. 1734

12. _____ injury is cellular injury caused by the restoration of physiologic concentrations of
oxygen to cells that have been exposed to injurious but nonlethal hypoxic conditions.
a. Hypoxic
b. Hyperoxygenation
c. Reperfusion
d. Ischemic

ANS: C
Reperfusion (reoxygenation) injury is cellular injury caused by the restoration or
reperfusion of physiologic concentrations of oxygen to cells that have been exposed to
injurious but nonlethal hypoxic conditions.

REF: p. 1737

13. The most sensitive indicator of inadequate systemic perfusion in children is:
a. metabolic acidosis.
b. hypoxia.
c. urine output.
d. dysrhythmias.

ANS: A
Acidosis and a rise in serum lactate may be the most sensitive indicator of inadequate
systemic perfusion in children.

REF: p. 1737

14. To determine a child’s response to fluid therapy for shock, the nurse should monitor:
a. hematocrit and hemoglobin levels.
b. urine output and specific gravity.
c. blood pressure and pulse.
d. arterial blood gases and heart rate.

ANS: B

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Test Bank 47-7

Monitoring of the volume of urine output and specific gravity is useful in determining the
child’s response to fluid therapy.

REF: p. 1738

15. In children in shock, crystalloids and colloids are generally administered in boluses of
___ ml/kg.
a. 5
b. 10
c. 15
d. 20

ANS: D
In general, isotonic crystalloids (salt-containing solutions, such as normal saline or lactated
Ringer solution) or colloids (protein-containing fluids, such as albumin or blood) are
administered in boluses of 20 ml/kg.

REF: p. 1738

16. The severity of burn injury is assessed by:

a. amount of fluid lost.
b. circumference of the burn injury.
c. depth of the burn injury.
d. injury to other body systems.

ANS: C
Because burn trauma represents a three-dimensional wound, the severity of injury is assessed
also in relation to the depth of injury.

REF: p. 1742

17. Children younger than _____ years of age lack the ability to concentrate urine.
a. 2
b. 4
c. 6
d. 8

ANS: A
Children younger than 2 years lack the ability to concentrate urine because of the immaturity
of the renal system and are therefore at increased risk for dehydration.

REF: p. 1744

18. What causes renal failure after electrical burns in children?

a. Cytokines released after the damaged tissue
b. Immature kidneys unable to compensate for the electrical burn

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Test Bank 47-8

c. Reduction in cardiac output

d. Myoglobin released from damaged muscles

ANS: D
The release of myoglobin may occlude the kidney tubules and result in renal failure.

REF: p. 1744

19. Compared with the ebb phase, characteristics of the catabolic flow phase in metabolism
after a burn injury in a child include:
a. reduced oxygen consumption.
b. elevation of catecholamines.
c. impaired circulation.
d. cellular shock.

ANS: B
After the resolution of the shock and the restoration of circulating volume, the metabolic
response shifts to a catabolic (flow) phase (Table 47-9). A state of hypermetabolism
ensues, characterized by increased oxygen consumption and elevation of catecholamines,
glucocorticoids, and glucagon.

REF: p. 1744

20. When circulatory collapse prevents using the intravenous route for burn fluid
resuscitation in children, fluids may be given via _____ cannulation.
a. interdermal
b. intra-arterial
c. intraosseous
d. gastrointestinal

ANS: C
Children are good candidates for intraosseous cannulation when traditional venous access
techniques fail.

REF: p. 1746

21. Children are at high risk for pulmonary complications because of:
a. immature lungs.
b. anatomic differences in their airways.
c. decreased immunity.
d. high incidences of pneumonia.

ANS: B
Anatomic differences in the pediatric airway affect the response to pulmonary complications
as well as therapeutic interventions.

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Test Bank 47-9

REF: p. 1746

MATCHING

Match the terms with the corresponding descriptions.

a. Scald burns
b. Contact burns
c. Flame burns
d. Electrical burns
e. Chemical burns

1. Involve flammable liquids such as gasoline

2. Caused by hot grease

3. Results from direct contact with high- and low-voltage current

4. Corrosive agent

5. Cigarette burns and curling irons

1. ANS: C REF: p. 1742

NOT: Flame burns involving flammable liquids, especially gasoline, are most common in
older children.

2. ANS: A REF: p. 1741

NOT: Scald injuries (e.g., hot water, grease, other) are most common among young
children.

3. ANS: D REF: p. 1742

NOT: Electrical burns result from direct contact with high- or low-voltage current.

4. ANS: E REF: p. 1742

NOT: Chemical burns occurring at home may be a result of swallowing corrosive agents.

5. ANS: B REF: p. 1741

NOT: Contact burns also may be intentionally inflicted by contact with cigarettes or other
hot objects such as curling irons.

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