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Shock: Multiple Choice Questions and Answers for Nursing Students, Exams of Nursing

A series of multiple choice questions and answers related to shock, a critical medical condition characterized by inadequate tissue perfusion. It covers various types of shock, including hypovolemic, cardiogenic, septic, and neurogenic shock, and explores their causes, symptoms, and treatment approaches. The questions are designed to test understanding of shock pathophysiology, assessment, and management, making it a valuable resource for nursing students preparing for exams or clinical practice.

Typology: Exams

2024/2025

Available from 11/15/2024

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ORIGINAL 2025 UPDATED VERSION, (Exam 4: Shock NCLEX ) QUESTIONS
AND ANWERS 100%CORRECT
A patient has a spinal cord injury at T4. Vital signs include falling blood pressure and bradycardia. The nurse
recognizes that the patient is experiencing
a. a relative hypervolemia
b. an absolute hypovolemia
c. neurogenic shock from low blood flow
d. neurogenic shock from massive vasodilation
b
A 78 year old man has confusion and temperature of 104. He is a diabetic with purulent drainage from his right heel.
After an infusion of 3 L of normal saline solution, his assessment findings are BP 84/40, HR 110, RR 42 and shallow,
CO 8L/min, and PAWP 4 mm Hg. This patient's symptoms are most likely indicative o
a. sepsis
b. septic shock
c. multiple organ dysfunction syndrome
d. systemic inflammatory response syndrome
b
c
Appropriate treatment modalities for the management of cardiogenic shock include (Select all that apply)
a. dobutamine to increase myocardial contractility
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ORIGINAL 2025 UPDATED VERSION, (Exam 4: Shock NCLEX ) QUESTIONS

AND ANWERS 100%CORRECT

A patient has a spinal cord injury at T4. Vital signs include falling blood pressure and bradycardia. The nurse recognizes that the patient is experiencing

a. a relative hypervolemia

b. an absolute hypovolemia

c. neurogenic shock from low blood flow

d. neurogenic shock from massive vasodilation

b

A 78 year old man has confusion and temperature of 104. He is a diabetic with purulent drainage from his right heel. After an infusion of 3 L of normal saline solution, his assessment findings are BP 84/40, HR 110, RR 42 and shallow, CO 8L/min, and PAWP 4 mm Hg. This patient's symptoms are most likely indicative o

a. sepsis

b. septic shock

c. multiple organ dysfunction syndrome

d. systemic inflammatory response syndrome

b

c

Appropriate treatment modalities for the management of cardiogenic shock include (Select all that apply)

a. dobutamine to increase myocardial contractility

b. vasopressors to increase systemic vascular resistance

c. circulatory assist devices such as an intraaortic balloon pump

d. corticosteroids to stabilize the cell wall in the infarcted myocardium

e. trendelenburg positioning to facilitate venous return and increase preload

d

The most accurate assessment parameters for the nurse to use to determine adequate tissue perfusion in the patient with MODS are

a. blood pressure, pulse, and respirations

b. breath sounds, blood pressure, and body temperature

c. pulse pressure, level of consciousness, and pupillary response

d. level of consciousness, urine output, and skin color and temperature

d

What is the key factor in describing any type of shock?

a. hypoxemia

b. hypotension

c. vascular collapse

d. inadequate tissue perfusion

A 70 year old patient is malnourished, has a history of type 2 DM, and is admitted from the nursing home with pneumonia and tachypnea. For which kind of shock should the nurse closely monitor this patient?

a. septic shock

b. neurogenic shock

c. cardiogenic shock

d. anaphylactic shock

a

d

e

In the compensatory stage of hypovolemic shock, to what organs does blood flow decrease after the sympathetic nervous system activates α -adrenergic stimulation? (Select all that apply)

a. skin

b. brain

c. heart

d. kidneys

e. gastrointestinal tract

b

Which hemodynamic monitoring description of the identified shock is accurate?

a. tachycardia with hypertension is characteristic of neurogenic syndrome

b. increased pulmonary artery wedge pressure (PAWP) and a decreased cardiac output occur in cardiogenic shock

c. anaphylactic shock is characterized by increased systemic vascular resistance, decreased CO, and decreased PAWP

d. in septic shock, bacterial endotoxins

d

As the body continues to try to compensate for hypovolemic shock, there is increased angiotensin II from the activation of the renin-angiotensin-aldosterone system. What physiologic change occurs related to the increased angiotensin II?

a. vasodilation

b. decreased BP and CO

c. aldosterone release results in sodium and water excretion

d. antidiuretic hormone release increases water reabsorption

a

c

f

The patient is in the compensatory stage of shock. What manifestations indicate this to the nurse? (Select all that apply)

a. pale and cool

b. unresponsive

c. lower BP than baseline

d. moist crackles in the lungs

e. hyperactive bowel sounds

a. start 100 mL of normal saline at 500 mL/hr

b. obtain blood cultures before starting IV antibiotics

c. draw blood for hematology and coagulation factors

d. administer high-flow oxygen (100%) with a non-rebreather mask

b

What abnormal finding should the nurse expect to find in early compensatory shock?

a. metabolic acidosis

b. increased serum sodium

c. decreased blood glucose

d. increased serum potassium

d

In late refractory shock in a patient with massive thermal burns, what should the nurse expect the patient's laboratory results to reveal?

a. respiratory alkalosis

b. decreased potassium

c. increased blood glucose

d. increased ammonia levels

a

A patient with hypovolemic shock is receiving lactated Ringer's solution for fluid replacement therapy. During this therapy, which laboratory result is most important for the nurse to monitor?

a. serum pH

b. serum sodiumc

c. serum potassium

d. hemoglobin and hematocrit

b

The nurse determines that a large amount of crystalloid fluids administered to a patient in septic shock is effective when hemodynamic monitoring reveals what?

a. CO of 2.6 L/min

b. CVP of 15 mm Hg

c. PAWP of 4 mm Hg

d. Heart rate of 106 bpm

a

When caring for a patient in cardiogenic shock, the nurse recognizes that the metabolic demands of turning and moving the patient exceed the oxygen supply when what change is revealed in hemodynamic monitoring?

a. SvO2 from 62% to 54%

b. CO from 4.2 L/min to 4.8 L/min

c. Stroke volume from 52 to 68 mL/beat

d. SVR from 1300 dyne/sec/cm to 1120 dyne/sec/cm

d

What should the nurse assess the patient for during administration of IV norepinephrine?

a. hypotension

b. marked diuresis

c. metabolic alkalosis

a. skin

b. urine output

c. level of consciousness

d. activities of daily living

e. vital signs, including pulse oximetry

f. peripheral pulses with capillary refill

c

A patient in the progressive stage of shock has rapid, deep respirations. The nurse determines that the patient's hyperventilation is compensating for metabolic acidosis when the patient's arterial blood gas results include which of the following?

a. pH 7.42, PaO2 80 mm Hg

b. pH 7.48, PaO2 69 mm Hg

c. pH 7.38, PaO2 30 mm Hg

d. pH 7.32, PaO2 48 mm Hg

c

d

e

f

Which interventions should be used for anaphylactic shock? (Select all that apply)

a. antibiotics

b. vasodilators

c. antihistamines

d. oxygen supplementation

e. colloid volume expansion

f. crystalloid volume expansion

d

A patient in shock has a nursing diagnosis of fear related to severity of condition and perceived threat of death as manifested by verbalization of anxiety about condition and fear of death. What is an appropriate nursing intervention for this patient?

a. administer antianxiety agents

b. allow caregivers to visit as much as possible

c. call a member of the clergy to visit the patient

d. inform the patient of the current plan of care and its rationale

d

Which statement describing systemic inflammatory response syndrome (SIRS) and/or multiple organ dysfunction syndrome (MODS) is accurate?

a. MODS may occur independently from SIRS

b. all patients with septic shock develop MODS

c. the GI system is often the first to show evidence of dysfunction in SIRS and MODs

a. early enteral feedings

b. surgical removal of necrotic tissue

c. aggressive multiple antibiotic therapy

d. strict aseptic technique in all procedures

b

A patient with a gunshot wound to the abdomen is being treated for hypovolemic and septic shock. To monitor the patient for early organ damage associated with MODS, what is most important for the nurse to assess?

a. urine output

b. breath sounds

c. peripheral circulation

d. central venous pressure

b

Which patient manifestations confirm the development of MODS?

a. upper GI bleeding, glasgow coma scale score of 7, and Hct of 25%

b. elevated serum bilirubin, serum creatinine of 3.8, and platelet count of 15,

c. urine output of 30 mL/hr, BUN of 45, and WBC of 1120

d. respiratory rate of 45, PaCO2 of 60 mm Hg, and chest x-ray with bilateral diffuse patchy infiltrates

a

A nurse is caring for a client who has a prescription for an afterload-reducing medication. The nurse should identify that this medication is administered for which of the following types of shock?

a. cardiogenic

b. obstructive

c. hypovolemic

d. distributive

b

A nurse is planning care for a client who has septic shock. Which of the following actions is the priority for the nurse to take?

a. maintain adequate fluid volume with IV infusions

b. administer antibiotic therapy

c. monitor hemodynamic status

d. administer vasopressor medication

c

A nurse is caring for a client who is experiencing wheezing and swelling of the tongue. Which of the following medications should the nurse anticipate administering first?

a. methylprednisone

b. diphenhydramine

c. epinephrine

d. dobutamine

b

c

e

A nurse in the emergency department is completing an assessment on a client who is in shock. Which of the following findings should the nurse expect? (Select all that apply)

a. heart rate 60 bpm

b

A 64-yr-old woman is admitted to the emergency department vomiting bright red blood. The patient’s vital signs are blood pressure of 78/58 mm Hg, pulse of 124 beats/min, respirations of 28 breaths/min, and temperature of 97.2°F (36.2°C). Which physician order should the nurse complete first?

a. Obtain a 12-lead ECG and arterial blood gases.

b. Rapidly administer 1000 mL normal saline solution IV.

c. Administer norepinephrine (Levophed) by continuous IV infusion.

d. Carefully insert a nasogastric tube and an indwelling bladder catheter.

b

A 50-yr-old woman with a suspected brain tumor is scheduled for a CT scan with contrast media. The nurse notifies the physician that the patient reported an allergy to shellfish. Which response by the physician should the nurse question?

a. Infuse IV diphenhydramine before the procedure.

b. Administer lorazepam (Ativan) before the procedure.

c. Complete the CT scan without the use of contrast media.

d. Premedicate with hydrocortisone sodium succinate (Solu-Cortef).

c

The nurse is caring for a 29-yr-old man who was admitted 1 week ago with multiple rib fractures, pulmonary contusions, and a left femur fracture from a motor vehicle crash. The attending physician states the patient has developed sepsis, and the family members have many questions. Which information should the nurse include when explaining the early stage of sepsis?

a. Antibiotics are not useful when an infection has progressed to sepsis.

b. Weaning the patient away from the ventilator is the top priority in sepsis.

c. Large amounts of IV fluid are required in sepsis to fill dilated blood vessels.

d. The patient has recovered from sepsis if he has warm skin and ruddy cheeks.

d

The nurse is assisting in the care of several patients in the critical care unit. Which patient is most at risk for developing multiple organ dysfunction syndrome (MODS)?

a. A 22-yr-old patient with systemic lupus erythematosus admitted with a pelvic fracture

b. A 48-yr-old patient with lung cancer admitted for syndrome of inappropriate antidiuretic hormone and hyponatremia

c. A 65-yr-old patient with coronary artery disease, dyslipidemia, and primary hypertension admitted for unstable angina

d. A 82-yr-old patient with type 2 diabetes mellitus and chronic kidney disease admitted for peritonitis related to a peritoneal dialysis catheter infection

a

When caring for a patient in acute septic shock, what should the nurse anticipate?

a. Infusing large amounts of IV fluids

b. Administering osmotic and/or loop diuretics

c. Administering IV diphenhydramine (Benadryl)

d. Assisting with insertion of a ventricular assist device (VAD)

b

A patient's localized infection has become systemic and septic shock is suspected. What medication is expected to treat septic shock refractory to fluids?

a. Insulin infusion

b. Furosemide (Lasix) IV push

c. Norepinephrine administered by titration

d. Administration of nitrates and β -adrenergic blockers

b

The nurse would recognize which clinical manifestation as suggestive of sepsis?

a. Sudden diuresis unrelated to drug therapy

b. Hyperglycemia in the absence of diabetes

c. Respiratory rate of seven breaths per minute

d. Bradycardia with sudden increase in blood pressure

d

After coronary artery bypass graft surgery a patient has postoperative bleeding that requires returning to surgery for repair. During surgery, the patient has a myocardial infarction (MI). After restoring the patient’s body temperature to normal, which patient parameter is the most important for planning nursing care?

a. Cardiac index (CI) of 5 L/min/m

b. Central venous pressure of 8 mm Hg

c. Mean arterial pressure (MAP) of 86 mm Hg

d. Pulmonary artery pressure (PAP) of 28/14 mm Hg

a

A patient with septic shock has a urine output of 20 mL/hr for the past 3 hours. The pulse rate is 120 and the central venous pressure and pulmonary artery wedge pressure are low. Which of these orders by the health care provider will the nurse question?

a. Give furosemide (Lasix) 40 mg IV.

b. Increase normal saline infusion to 150 mL/hr.

c Administer hydrocortisone (SoluCortef) 100 mg IV.

d. Prepare to give drotrecogin alpha (Xigris) 24 mcg/kg/hr.

a

A patient with shock of unknown etiology whose hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure has the following collaborative interventions prescribed. Which intervention will the nurse question?

a. Infuse normal saline at 250 mL/hr.

b. Keep head of bed elevated to 30 degrees.

c. Give nitroprusside (Nipride) unless systolic BP <90 mm Hg.

d. Administer dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.

c

A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which finding by the nurse will help confirm a diagnosis of neurogenic shock?

a. Cool, clammy skin

b. Inspiratory crackles

c. Apical heart rate 48 beats/min

d. Temperature 101.2 F (38.4 C)

d

A patient with cardiogenic shock is cool and clammy and hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which action will the nurse anticipate taking?