1
NURSING 20 MED SURG 2 CARDIOVASCULAR SHOCK
AND MULTI-ORGAN FAILURE EXAM TESTBANK
QUESTIONS AND ANSWERS 2026-27 VERSION
1. Explain how shock impacts all body systems.
What is shock?
• A clinical syndrome resulting from inadequate tissue
perfusions, creating an imbalance between delivery and
requirements for oxygen and nutrients that support
cellular function
• Adequate blood flow to the tissues and cells requires an effective
cardiac pump, adequate vasculature or circulatory system, and
sufficient blood volume
• If one of these components is impaired, perfusion to the
tissues is threatened or compromised
• MAP must exceed 65 mm Hg for cells to receive oxygen
and nutrients needed to metabolize energy in amounts
sufficient to sustain life
• If shock is not treated:
o Inadequate blood flow to cells results in poor oxygen and
nutrients
o Cellular hypoxia
o Cell death that progresses to organ dysfunction and eventually
death
,2
• Shock affects all body systems
• During shock, our patients’ bodies struggle to survive and
call upon homeostatic mechanisms to restore blood flow
• Physiologic responses to shock include:
o Activation of the inflammatory response
o Hypermetabolism
o Hypoperfusion of tissues
• The body responds to shock states by activating the
sympathetic nervous system and mounting a hypermetabolic
and inflammatory response
• Failure of compensatory mechanisms to effectively restore
physiologic balance is the final pathway of all shock states and
results in end-organ dysfunction and death
,3
2. Compare and contrast the stages of shock and the clinical
manifestations within affected patients.
• The earlier that interventions are initiated along this continuum,
the greater the patient’s chance of survival
• Current evidence suggests that the window of opportunity that
increases the likelihood of patient survival occurs when aggressive
therapy begins within 3 hours of identifying a shock state,
especially septic shock
Stage 1—Compensatory Shock
• BP WNL (i.e. 120/76)
• Vasoconstriction, increased heart rate, increased contractility
contributes to maintaining adequate cardiac output
• This results from stimulation of the sympathetic nervous system
and subsequent release of catecholamines (e.g., epinephrine,
norepinephrine)
• Patients display the often-described “fight-or-flight” response
• The body shunts blood from organs such as the skin, kidneys, and
gastrointestinal (GI) tract to the brain, heart, and lungs to ensure
adequate blood supply to these vital organs
• As a result, the skin may be cool and pale, bowel sounds are
hypoactive, and urine output decreases in response to the release
of aldosterone and ADH
• Serum sodium and blood glucose levels are elevated in
response to the release of aldosterone and catecholamines
• The result of inadequate perfusion is anaerobic metabolism and
a buildup of lactic acid, producing metabolic acidosis
, 4
• The respiratory rate increases in response to the need to increase
oxygen to the cells and in compensation for metabolic acidosis
• This rapid respiratory rate facilitates removal of excess CO2 but
raises the blood pH and often causes a compensatory
respiratory alkalosis
• The patient may experience a change in affect, feel anxious, or be
confused
• If treatment begins in this stage of shock, the prognosis for the
patient is better than in later stages
Stage 2—Progressive Shock
• BP can no longer compensate
• Mean arterial pressure (MAP) falls below normal limits
• Patient is now hypotensive (i.e. 89/52) – systolic BP of less than
90 mm Hg or a decrease in systolic BP of 40 mm Hg from
baseline
• Mental status is declining
• Delirium should be assessed at a minimum each shift using a
standardized delirium assessment tool, such as the Confusion
Assessment Method (CAM)-ICU
• Overworked heart becomes dysfunctional – heart failure
• Lungs are affected in this stage
• Decreased pulmonary blood flow causes arterial oxygen levels to
decrease and CO2 levels to increase
• Poor oxygenation
• A lack of adequate blood supply leads to dysrhythmias
(check cardiac enzymes & biomarkers) – cardiac troponin I
NURSING 20 MED SURG 2 CARDIOVASCULAR SHOCK
AND MULTI-ORGAN FAILURE EXAM TESTBANK
QUESTIONS AND ANSWERS 2026-27 VERSION
1. Explain how shock impacts all body systems.
What is shock?
• A clinical syndrome resulting from inadequate tissue
perfusions, creating an imbalance between delivery and
requirements for oxygen and nutrients that support
cellular function
• Adequate blood flow to the tissues and cells requires an effective
cardiac pump, adequate vasculature or circulatory system, and
sufficient blood volume
• If one of these components is impaired, perfusion to the
tissues is threatened or compromised
• MAP must exceed 65 mm Hg for cells to receive oxygen
and nutrients needed to metabolize energy in amounts
sufficient to sustain life
• If shock is not treated:
o Inadequate blood flow to cells results in poor oxygen and
nutrients
o Cellular hypoxia
o Cell death that progresses to organ dysfunction and eventually
death
,2
• Shock affects all body systems
• During shock, our patients’ bodies struggle to survive and
call upon homeostatic mechanisms to restore blood flow
• Physiologic responses to shock include:
o Activation of the inflammatory response
o Hypermetabolism
o Hypoperfusion of tissues
• The body responds to shock states by activating the
sympathetic nervous system and mounting a hypermetabolic
and inflammatory response
• Failure of compensatory mechanisms to effectively restore
physiologic balance is the final pathway of all shock states and
results in end-organ dysfunction and death
,3
2. Compare and contrast the stages of shock and the clinical
manifestations within affected patients.
• The earlier that interventions are initiated along this continuum,
the greater the patient’s chance of survival
• Current evidence suggests that the window of opportunity that
increases the likelihood of patient survival occurs when aggressive
therapy begins within 3 hours of identifying a shock state,
especially septic shock
Stage 1—Compensatory Shock
• BP WNL (i.e. 120/76)
• Vasoconstriction, increased heart rate, increased contractility
contributes to maintaining adequate cardiac output
• This results from stimulation of the sympathetic nervous system
and subsequent release of catecholamines (e.g., epinephrine,
norepinephrine)
• Patients display the often-described “fight-or-flight” response
• The body shunts blood from organs such as the skin, kidneys, and
gastrointestinal (GI) tract to the brain, heart, and lungs to ensure
adequate blood supply to these vital organs
• As a result, the skin may be cool and pale, bowel sounds are
hypoactive, and urine output decreases in response to the release
of aldosterone and ADH
• Serum sodium and blood glucose levels are elevated in
response to the release of aldosterone and catecholamines
• The result of inadequate perfusion is anaerobic metabolism and
a buildup of lactic acid, producing metabolic acidosis
, 4
• The respiratory rate increases in response to the need to increase
oxygen to the cells and in compensation for metabolic acidosis
• This rapid respiratory rate facilitates removal of excess CO2 but
raises the blood pH and often causes a compensatory
respiratory alkalosis
• The patient may experience a change in affect, feel anxious, or be
confused
• If treatment begins in this stage of shock, the prognosis for the
patient is better than in later stages
Stage 2—Progressive Shock
• BP can no longer compensate
• Mean arterial pressure (MAP) falls below normal limits
• Patient is now hypotensive (i.e. 89/52) – systolic BP of less than
90 mm Hg or a decrease in systolic BP of 40 mm Hg from
baseline
• Mental status is declining
• Delirium should be assessed at a minimum each shift using a
standardized delirium assessment tool, such as the Confusion
Assessment Method (CAM)-ICU
• Overworked heart becomes dysfunctional – heart failure
• Lungs are affected in this stage
• Decreased pulmonary blood flow causes arterial oxygen levels to
decrease and CO2 levels to increase
• Poor oxygenation
• A lack of adequate blood supply leads to dysrhythmias
(check cardiac enzymes & biomarkers) – cardiac troponin I
