1.
A patient with septic shock has a blood pressure of 82/46 mm Hg despite receiving
an initial isotonic fluid bolus. Which intervention should the nurse anticipate next?
A. Administer oral antihypertensive medication
B. Initiate vasopressor therapy
C. Restrict all fluids
D. Administer a loop diuretic
Correct Answer: B. Initiate vasopressor therapy
Rationale: Persistent hypotension after adequate fluid resuscitation is an indication
for vasopressor support. Norepinephrine is commonly used to increase vascular
tone and restore perfusion pressure. Fluid restriction and diuretics would worsen
hypoperfusion at this stage.
2.
Which finding is most concerning for early septic shock?
A. Warm, flushed skin with bounding pulses
B. Bradycardia and hypertension
C. Decreased temperature with hypertension
D. Increased urine output
Correct Answer: A. Warm, flushed skin with bounding pulses
,Rationale: Early distributive septic shock can produce peripheral vasodilation, warm
skin, and bounding pulses. The patient may initially have a relatively preserved or
increased cardiac output. As shock progresses, hypotension and impaired tissue
perfusion become more pronounced.
3.
A patient with suspected sepsis has a serum lactate of 5.2 mmol/L. How should the
nurse interpret this result?
A. It indicates adequate tissue oxygenation
B. It suggests impaired tissue perfusion
C. It confirms chronic kidney disease
D. It indicates respiratory alkalosis
Correct Answer: B. It suggests impaired tissue perfusion
Rationale: Elevated lactate can reflect inadequate oxygen delivery and increased
anaerobic metabolism. In sepsis, an elevated lactate is an important marker of
tissue hypoperfusion and severity of illness. Serial lactate measurements may be
used to evaluate response to treatment.
4.
Which assessment finding is most suggestive of multiple organ dysfunction
syndrome (MODS)?
A. Mild headache
B. Elevated serum creatinine with declining urine output
C. Temporary tachycardia after ambulation
D. Increased appetite
Correct Answer: B. Elevated serum creatinine with declining urine output
Rationale: MODS involves dysfunction of multiple organ systems. Rising creatinine
and declining urine output indicate worsening renal function, which may occur
during prolonged shock. The finding becomes particularly concerning when
accompanied by dysfunction in other systems.
5.
Which patient should the nurse assess first?
A. Patient with septic shock and MAP of 58 mm Hg
B. Patient with chronic anemia and fatigue
C. Patient with stable GI bleeding and hemoglobin of 10 g/dL
D. Patient with controlled hypertension
,Correct Answer: A. Patient with septic shock and MAP of 58 mm Hg
Rationale: A MAP below approximately 65 mm Hg suggests inadequate perfusion in
a critically ill patient. Septic shock can rapidly progress to organ dysfunction.
Immediate assessment and intervention are necessary to restore circulation.
6.
A patient develops hypotension, wheezing, and facial swelling immediately after
receiving an IV antibiotic. Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Anaphylactic
D. Neurogenic
Correct Answer: C. Anaphylactic
Rationale: Anaphylaxis can cause profound vasodilation, capillary leakage,
bronchospasm, and airway edema. Hypotension combined with respiratory
manifestations after exposure to an allergen strongly supports anaphylactic shock.
Epinephrine is the priority medication.
7.
Which medication should the nurse anticipate administering first for severe
anaphylaxis?
A. Epinephrine
B. Furosemide
C. Metoprolol
D. Warfarin
Correct Answer: A. Epinephrine
Rationale: Epinephrine is the first-line medication for life-threatening anaphylaxis.
It produces vasoconstriction, increases blood pressure, and decreases airway
edema while helping reverse bronchospasm. Antihistamines and corticosteroids are
adjunctive rather than substitutes for epinephrine.
8.
Which finding is characteristic of hypovolemic shock?
A. Bounding peripheral pulses
B. Warm flushed skin
C. Tachycardia with weak peripheral pulses
, D. Severe hypertension
Correct Answer: C. Tachycardia with weak peripheral pulses
Rationale: Loss of circulating volume causes decreased venous return and reduced
cardiac output. The body compensates with sympathetic stimulation, producing
tachycardia and peripheral vasoconstriction. Skin is typically cool and pale with
weak pulses.
9.
A patient with hemorrhagic shock has cool skin and increasing confusion. What
does the confusion most likely indicate?
A. Improved cerebral perfusion
B. Decreased cerebral perfusion
C. Hyperglycemia
D. Increased intracranial pressure
Correct Answer: B. Decreased cerebral perfusion
Rationale: Altered mental status can be an early indicator of inadequate cerebral
blood flow. Hemorrhage reduces circulating volume and cardiac output. The
resulting decrease in oxygen delivery can cause confusion, agitation, or decreased
level of consciousness.
10.
Which assessment finding is most consistent with cardiogenic shock?
A. Severe dehydration
B. Pulmonary crackles and hypotension
C. Increased urine output
D. Warm skin and bounding pulses
Correct Answer: B. Pulmonary crackles and hypotension
Rationale: Cardiogenic shock results from inadequate cardiac pumping ability. Blood
backs up into the pulmonary circulation, producing pulmonary edema and crackles.
At the same time, reduced cardiac output causes hypotension and systemic
hypoperfusion.
11.
A patient with cardiogenic shock develops increasing serum creatinine. What does
this finding suggest?
A. Improved renal perfusion
A patient with septic shock has a blood pressure of 82/46 mm Hg despite receiving
an initial isotonic fluid bolus. Which intervention should the nurse anticipate next?
A. Administer oral antihypertensive medication
B. Initiate vasopressor therapy
C. Restrict all fluids
D. Administer a loop diuretic
Correct Answer: B. Initiate vasopressor therapy
Rationale: Persistent hypotension after adequate fluid resuscitation is an indication
for vasopressor support. Norepinephrine is commonly used to increase vascular
tone and restore perfusion pressure. Fluid restriction and diuretics would worsen
hypoperfusion at this stage.
2.
Which finding is most concerning for early septic shock?
A. Warm, flushed skin with bounding pulses
B. Bradycardia and hypertension
C. Decreased temperature with hypertension
D. Increased urine output
Correct Answer: A. Warm, flushed skin with bounding pulses
,Rationale: Early distributive septic shock can produce peripheral vasodilation, warm
skin, and bounding pulses. The patient may initially have a relatively preserved or
increased cardiac output. As shock progresses, hypotension and impaired tissue
perfusion become more pronounced.
3.
A patient with suspected sepsis has a serum lactate of 5.2 mmol/L. How should the
nurse interpret this result?
A. It indicates adequate tissue oxygenation
B. It suggests impaired tissue perfusion
C. It confirms chronic kidney disease
D. It indicates respiratory alkalosis
Correct Answer: B. It suggests impaired tissue perfusion
Rationale: Elevated lactate can reflect inadequate oxygen delivery and increased
anaerobic metabolism. In sepsis, an elevated lactate is an important marker of
tissue hypoperfusion and severity of illness. Serial lactate measurements may be
used to evaluate response to treatment.
4.
Which assessment finding is most suggestive of multiple organ dysfunction
syndrome (MODS)?
A. Mild headache
B. Elevated serum creatinine with declining urine output
C. Temporary tachycardia after ambulation
D. Increased appetite
Correct Answer: B. Elevated serum creatinine with declining urine output
Rationale: MODS involves dysfunction of multiple organ systems. Rising creatinine
and declining urine output indicate worsening renal function, which may occur
during prolonged shock. The finding becomes particularly concerning when
accompanied by dysfunction in other systems.
5.
Which patient should the nurse assess first?
A. Patient with septic shock and MAP of 58 mm Hg
B. Patient with chronic anemia and fatigue
C. Patient with stable GI bleeding and hemoglobin of 10 g/dL
D. Patient with controlled hypertension
,Correct Answer: A. Patient with septic shock and MAP of 58 mm Hg
Rationale: A MAP below approximately 65 mm Hg suggests inadequate perfusion in
a critically ill patient. Septic shock can rapidly progress to organ dysfunction.
Immediate assessment and intervention are necessary to restore circulation.
6.
A patient develops hypotension, wheezing, and facial swelling immediately after
receiving an IV antibiotic. Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Anaphylactic
D. Neurogenic
Correct Answer: C. Anaphylactic
Rationale: Anaphylaxis can cause profound vasodilation, capillary leakage,
bronchospasm, and airway edema. Hypotension combined with respiratory
manifestations after exposure to an allergen strongly supports anaphylactic shock.
Epinephrine is the priority medication.
7.
Which medication should the nurse anticipate administering first for severe
anaphylaxis?
A. Epinephrine
B. Furosemide
C. Metoprolol
D. Warfarin
Correct Answer: A. Epinephrine
Rationale: Epinephrine is the first-line medication for life-threatening anaphylaxis.
It produces vasoconstriction, increases blood pressure, and decreases airway
edema while helping reverse bronchospasm. Antihistamines and corticosteroids are
adjunctive rather than substitutes for epinephrine.
8.
Which finding is characteristic of hypovolemic shock?
A. Bounding peripheral pulses
B. Warm flushed skin
C. Tachycardia with weak peripheral pulses
, D. Severe hypertension
Correct Answer: C. Tachycardia with weak peripheral pulses
Rationale: Loss of circulating volume causes decreased venous return and reduced
cardiac output. The body compensates with sympathetic stimulation, producing
tachycardia and peripheral vasoconstriction. Skin is typically cool and pale with
weak pulses.
9.
A patient with hemorrhagic shock has cool skin and increasing confusion. What
does the confusion most likely indicate?
A. Improved cerebral perfusion
B. Decreased cerebral perfusion
C. Hyperglycemia
D. Increased intracranial pressure
Correct Answer: B. Decreased cerebral perfusion
Rationale: Altered mental status can be an early indicator of inadequate cerebral
blood flow. Hemorrhage reduces circulating volume and cardiac output. The
resulting decrease in oxygen delivery can cause confusion, agitation, or decreased
level of consciousness.
10.
Which assessment finding is most consistent with cardiogenic shock?
A. Severe dehydration
B. Pulmonary crackles and hypotension
C. Increased urine output
D. Warm skin and bounding pulses
Correct Answer: B. Pulmonary crackles and hypotension
Rationale: Cardiogenic shock results from inadequate cardiac pumping ability. Blood
backs up into the pulmonary circulation, producing pulmonary edema and crackles.
At the same time, reduced cardiac output causes hypotension and systemic
hypoperfusion.
11.
A patient with cardiogenic shock develops increasing serum creatinine. What does
this finding suggest?
A. Improved renal perfusion
