Shock NCLEX practice questions

Shock NCLEX Leave the first rating Students also studied Terms in this set (35) Science MedicineEmergency Medicine Save NCLEX Style Bur...100 terms akrrissman84Preview Shock NCLEX Questions, Nclex Que...201 terms felicia_ramnandan P Preview Nclex Questions for Shock - Critical ...32 terms karmageniePreview RN rea 114 term amr A patient is in the compensatory stage of shock. Which of the following findings should the nurse expect?

• MAP < 60
• Lactic acid 10 mmol/L
• Cool, clammy skin and narrowed pulse pressure
• Unresponsive with anuria
• Cool, clammy skin and narrowed pulse pressure
• SNS "fight or flight" is activated --> sweating helps cool down the body
• RAAS system is activated --> to help regulate BP and fluid balance
• PP = systolic - diastolic: cardiogenic shock will have narrowed pulse pressure

which means there is decreased SV A patient is admitted after a motor vehicle accident with internal bleeding and signs of hypovolemic shock. Which of the following orders should the nurse question?

• Administer lactated Ringer's 30 mL/kg
• Administer norepinephrine before starting fluids
• Obtain type and crossmatch
• Insert two large bore IV lines
• Administer norepinephrine before starting fluids
• Vasopressors like norepinephrine are NOT used before volume is replaced

Which hemodynamic parameter is expected in a patient with cardiogenic shock?

• Low CVP, Low PAWP
• High SVR, High CVP, Low CO
• High ScvO2, Low SVR
• Normal CVP, Low afterload
• High SVR, High CVP, Low CO
• Decreased contractility --> decreased SV and CO d/t increased preload (CVP

and increased afterload (SVR)

A nurse is caring for a patient with suspected septic shock. What is the priority nursing action?

• Wait for blood culture results before starting

antibiotics

• Administer broad-spectrum antibiotics within 1 hour
• Start vasopressors immediately
• Place the patient in Trendelenburg position
• Administer broad-spectrum antibiotics within 1 hour
• Obtain cultures, then start broad-spectrum abx. Once results come back, abx

may be changed to treat specific infection A patient with spinal cord injury above T5 is hypotensive and is bradycardic. Which shock type is suspected?

• Cardiogenic shock
• Anaphylactic shock
• Neurogenic shock
• Septic shock
• Neurogenic shock
• Neurogenic shock = bradycardia + hypotension + warm skin (vasodilation)

You are assessing a patient with signs of shock. The patient has jugular vein distension, pulmonary crackles, and a CVP of 20 mmHg. Which type of shock is most likely?

• Cardiogenic shock
• Hypovolemic shock
• Neurogenic shock
• Septic shock
• Cardiogenic shock
• Normal CVP is 3-6. Elevated CVP leads to fluid overload (JVD), RHF, and pulm

HTN (crackles) Which medication is the first-line treatment for anaphylactic shock?

• Diphenhydramine
• Epinephrine
• Methylprednisolone
• Albuterol
• Epinephrine

A patient with sepsis is receiving IV fluids, but their MAP remains <65. What should the nurse anticipate next?

• Discontinue fluids
• Start vasopressors (e.g., norepinephrine)
• Administer corticosteroids
• Begin blood transfusion
• Start vasopressors (e.g., norepinephrine)
• Start vasopressors if hypotension persists after fluid challenge

During a fluid resuscitation, how does a nurse determine if the patient is responding to treatment?

• Increase in CVP and urine output
• Decrease in serum potassium
• Decrease in respiratory rate only
• Skin becomes flushed and warm
• Increase in CVP and urine output

Which findings would indicate a patient is entering the progressive stage of shock?

• Blood pressure stable, lactic acid 2
• HR 90, bounding pulses, SaO2 95%
• SBP <90, MAP <65, crackles, lactic acid 6.2
• Alert and oriented x4, normal ABGs
• SBP <90, MAP <65, crackles, lactic acid 6.2
• Progressive stage occurs when compensatory mechanism starts to fail
• SBP <100, MAP <65, respiratory acidosis
• Normal lactic acid is <2; elevated lactic acid can indicate severe conditions like

sepsis, HF, or kidney failure A 72-year-old male is admitted to the ED with a fever,

confusion, and productive cough. Vital signs:

Temp: 102.4°F (39.1°C)

HR: 122 bpm

BP: 86/54 mmHg

RR: 28

SpO2: 90% on room air

WBC: 18,000

Lactate: 3.5 mmol/L

The patient is warm to touch and flushed, with bounding pulses and capillary refill <2 seconds.What is the priority intervention the nurse should anticipate?

• Administer acetaminophen for fever
• Start norepinephrine to increase MAP
• Obtain blood cultures and administer IV antibiotics
• Administer furosemide for fluid overload
• Obtain blood cultures and administer IV antibiotics
• This patient is in early septic shock (warm phase). The priority is to administer

antibiotics within 1 hour, after obtaining cultures

• If hypotension persists, then administer norepinephrine after fluid resuscitation

A 58-year-old female with a history of myocardial infarction presents with chest pain, dyspnea, and

weakness. On exam:

BP: 82/60 mmHg

HR: 128 bpm, irregular

CVP: 18 mmHg

RR: 30

Crackles in bilateral lungs

SpO2: 86% on 2L nasal cannula

Skin: pale and mottled

Which intervention is most appropriate?

• Administer rapid IV fluid bolus
• Start dobutamine infusion
• Place the patient in Trendelenburg position
• Prepare for peritoneal dialysis
• Start dobutamine infusion
• Cardiogenic shock requires inotropic support
• Dobutamine improves contractility and CO
• Be cautious about administering fluids because this patient has fluid

volume overload (crackles, and high CVP)

A 34-year-old patient with no known allergies is undergoing a CT scan with contrast. Within minutes, the patient complains of chest tightness and difficulty breathing.

HR: 142

BP: 76/48

Stridor and wheezing noted Urticaria and flushing present

O2 saturation: 85% on room air

What is the first action the nurse should take?

• Administer diphenhydramine IV
• Give subcutaneous epinephrine
• Call the physician for intubation orders
• Administer high-flow oxygen and prepare to give IM

epinephrine

• Administer high-flow oxygen and prepare to give IM epinephrine
• Epinephrine IM is 1st line treatment for anaphylaxis
• ABCs = oxygen most important

A 40-year-old trauma patient arrives via ambulance after a motorcycle accident. He is alert but reports severe abdominal pain.

BP: 90/60

HR: 135 bpm

RR: 28

CVP: 2 mmHg

Skin: cool, clammy, pale

Capillary refill: >4 seconds

U/O: 10 mL/hr

Which intervention is the most appropriate initial action?

• Administer norepinephrine
• Begin dopamine infusion
• Start two large bore IVs and administer 30 mL/kg NS
• Perform peritoneal lavage to assess for bleeding
• Start two large bore IVs and administer 30 mL/kg NS

- This patient has hypovolemic shock: low CVP, low BP, tachycardia

• Immediate fluid resuscitation with crystalloids is priority
• Vasopressors like norepinephrine are only used after fluids are ineffective

A 28-year-old male is admitted to the trauma ICU with a cervical spinal cord injury after a diving accident. Vital

signs:

HR: 42 bpm

BP: 78/50

Temp: 95.5°F

Skin: warm, flushed, dry

CVP: 3 mmHg

Patient is alert but lethargic What treatment would the nurse anticipate?

• Atropine and vasopressors
• Administer furosemide
• IV corticosteroids immediately
• Start rapid fluid boluses without monitoring
• Atropine and vasopressors
• Neurogenic shock causes bradycardia and hypotension d/t loss of sympathetic

tone

• Atropine increased HR
• Vasopressor helps raise BP