A 92-year-old woman is brought unconscious to the emergency room from a nursing home. Her blood pressure is 70/30 mm Hg. She is febrile (102°F) and breathing rapidly (tachypneic). Laboratory studies demonstrate an elevated white blood cell count with 92% segmented neutrophils. Urinalysis reveals gram-negative organisms. Which of the following types of shock most likely accounts for this patient's signs and symptoms?
Anaphylactic
Cardiogenic
Hypovolemic
Neurogenic
Septic
The Correct Answer is E
A. Anaphylactic: Anaphylactic shock results from a severe allergic reaction, leading to widespread vasodilation, hypotension, and bronchospasm. There is typically a rapid onset following exposure to an allergen, and fever or leukocytosis is not a hallmark, making it less likely in this patient.
B. Cardiogenic: Cardiogenic shock is caused by failure of the heart to pump effectively, often due to myocardial infarction or severe arrhythmias. While hypotension and tachypnea occur, fever, leukocytosis, and evidence of infection (gram-negative organisms in urine) point toward an infectious etiology rather than primary cardiac failure.
C. Hypovolemic: Hypovolemic shock results from fluid or blood loss, leading to hypotension and tachycardia. It does not typically cause fever or leukocytosis, and there is no indication of hemorrhage in this patient, making it an unlikely explanation.
D. Neurogenic: Neurogenic shock arises from disruption of sympathetic nervous system control, often after spinal cord injury, leading to hypotension and bradycardia. Fever and leukocytosis are not characteristic, and the patient’s infection markers suggest a different etiology.
E. Septic: Septic shock is a distributive shock caused by a severe systemic infection. This patient’s hypotension, tachypnea, fever, elevated WBC count with neutrophilia, and gram-negative organisms in the urine are classic features of sepsis leading to septic shock. The clinical picture of infection-induced vasodilation and multiorgan stress makes septic shock the most likely cause.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Basophils:Basophils are circulating granulocytes involved in allergic reactions and parasitic infections. They release histamine and other mediators but do not form multinucleated giant cells or participate directly in granuloma formation in the lungs.
B. Endothelial cells:Endothelial cells line blood vessels and are involved in vascular permeability and inflammation. They do not differentiate into multinucleated giant cells and are not a source of granulomatous structures.
C. Eosinophils:Eosinophils are primarily involved in parasitic infections and allergic responses. While they may be present in some inflammatory infiltrates, they do not fuse to form the multinucleated giant cells seen in granulomatous lung disease.
D. Macrophages:Multinucleated giant cells in granulomas are derived from activated macrophages. These macrophages fuse in response to persistent antigens, such as Mycobacterium tuberculosisor fungi, and coordinate a chronic inflammatory response to contain pathogens that are difficult to eradicate.
E. Neutrophils:Neutrophils are the first responders in acute inflammation and are effective in phagocytosing bacteria. They do not fuse to form multinucleated giant cells, which are a hallmark of chronic granulomatous inflammation.
Correct Answer is D
Explanation
A. Deep venous thrombosis:Deep venous thrombosis is the formation of a clot in the deep veins of the lower extremities. It affects the venous system rather than the arterial system, and it does not produce the plaque-laden, irregular arterial surface described in this case.
B. Fatty streak:Fatty streaks are early, flat lesions of atherosclerosis composed primarily of lipid-laden foam cells within the intima. They appear smooth and yellow, lacking the ulceration, thrombus, and irregular surface characteristic of advanced or complicated atherosclerosis.
C. Pulmonary saddle embolus:A pulmonary saddle embolus refers to a large thrombus lodged at the bifurcation of the main pulmonary arteries. It is not related to chronic arterial plaque formation or luminal irregularity in the aorta.
D. Severe complicated atherosclerosis:Complicated atherosclerosis occurs when plaques progress to include ulceration, thrombosis, calcification, and fibrosis. The “cobblestoned” luminal surface, yellow-white plaques, ulcerations, and superimposed thrombus observed in this patient are hallmarks of advanced, complicated atherosclerotic disease.
E. Varicose vein:Varicose veins are dilated, tortuous superficial veins, most commonly in the lower extremities. They are venous abnormalities and do not affect the abdominal aorta or produce a plaque-laden, ulcerated luminal surface.
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