Med surg Critical care Shock and sepsis
1. A nurse is discussing the concept of shock with a new graduate nurse. Which statement indicates the
new graduate nurse understood the information?
a. Shock is a physiologic state resulting in hypotension and tachycardia.
b. Shock is an acute, widespread process of inadequate tissue perfusion.
c. Shock is a degenerative condition leading to organ failure and death.
d. Shock is a condition occurring with hypovolemia that results in hypotension.
ANS: B
Shock is an acute, widespread process of impaired tissue perfusion that results in cellular, metabolic,
and hemodynamic alterations. It is a complex pathophysiologic process that often results in multiple-
organ dysfunction syndrome and death. All types of shock eventually result in ineffective tissue
perfusion and the development of acute circulatory failure.
2. The nurse is caring for a patient in hypovolemic shock secondary to cirrhosis of the liver. The nurse
understands that this type of shock results from shifting of fluid into the abdominal cavity. What is the
resulting hypovolemia called?
a. Absolute hypovolemia
b. Distributive hypovolemia
c. Relative hypovolemia
d. Compensatory hypovolemia
ANS: A
Absolute hypovolemia occurs when there is a loss of fluid from the intravascular space. This can result
from an external loss of fluid from the body or from internal shifting of fluid from the intravascular space
to the extravascular space. Fluid shifts can result from a loss of intravascular integrity, increased
capillary membrane permeability, or decreased colloidal osmotic pressure. Relative hypovolemia occurs
when vasodilation produces an increase in vascular capacitance relative to circulating volume.
3. A patient has been admitted with hypovolemic shock due to traumatic blood loss. Which nursing
measure can best facilitate the administration of large volumes of fluid?
a. Inserting a large-diameter peripheral intravenous catheter
b. Positioning the patient in the Trendelenburg position
c. Encouraging the patient to drink at least 240 mL of fluid each hour
d. Administering intravenous fluids under pressure with a pressure bag
ANS: A
Measures to facilitate the administration of volume replacement include insertion of large-bore
peripheral intravenous catheters; rapid administration of prescribed fluids; and positioning the patient
with the legs elevated, trunk flat, and head and shoulders above the chest.
4. The nurse is caring for a patient in cardiogenic shock. The nurse recognizes that the patient's signs and
symptoms are the result of what problem?
, a. Inability of the heart to pump blood forward
b. Loss of circulating volume and subsequent decreased venous return
c. Disruption of the conduction system when reentry phenomenon occurs
d. Suppression of the sympathetic nervous system
ANS: A
Cardiogenic shock is the result of failure of the heart to effectively pump blood forward. It can occur
with dysfunction of the right or the left ventricle or both. The lack of adequate pumping function leads
to decreased tissue perfusion and circulatory failure.
5. The nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameters would the
nurse expect to note to support this diagnosis?
a. Increased right atrial pressure
b. Decreased pulmonary artery wedge pressure
c. Increased cardiac output
d. Decreased cardiac index
ANS: D
Assessment of the hemodynamic parameter of patients in cardiogenic shock reveals a decreased cardiac
output and a cardiac index less than 2.2 L/min/m2.
6. A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse
understands that the patient is probably having an immunoglobulin E (IgE)-mediated response as a
result of what physiologic mechanism?
a. Direct activation of mast cells and basophils
b. Nonimmunologic stimulation of biochemical mediators
c. Repeat exposure to an antigen in the presence of preformed IgE antibodies
d. Activation of the systemic inflammatory response
ANS: C
Immunoglobulin E (IgE) is an antibody that is formed as part of the immune response. The first time an
antigen enters the body, an antibody IgE, specific for the antigen, is formed. The antigen-specific IgE
antibody is then stored by attachment to mast cells and basophils. This initial contact with the antigen is
known as a primary immune response. The next time the antigen enters the body, the preformed IgE
antibody reacts with it, and a secondary immune response occurs.
7. A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse
understands that the decrease in the patient's cardiac output is the result of which mechanism?
a. Peripheral vasodilation
b. Increased venous return
c. Increased alveolar ventilation
d. Decreased myocardial contractility
1. A nurse is discussing the concept of shock with a new graduate nurse. Which statement indicates the
new graduate nurse understood the information?
a. Shock is a physiologic state resulting in hypotension and tachycardia.
b. Shock is an acute, widespread process of inadequate tissue perfusion.
c. Shock is a degenerative condition leading to organ failure and death.
d. Shock is a condition occurring with hypovolemia that results in hypotension.
ANS: B
Shock is an acute, widespread process of impaired tissue perfusion that results in cellular, metabolic,
and hemodynamic alterations. It is a complex pathophysiologic process that often results in multiple-
organ dysfunction syndrome and death. All types of shock eventually result in ineffective tissue
perfusion and the development of acute circulatory failure.
2. The nurse is caring for a patient in hypovolemic shock secondary to cirrhosis of the liver. The nurse
understands that this type of shock results from shifting of fluid into the abdominal cavity. What is the
resulting hypovolemia called?
a. Absolute hypovolemia
b. Distributive hypovolemia
c. Relative hypovolemia
d. Compensatory hypovolemia
ANS: A
Absolute hypovolemia occurs when there is a loss of fluid from the intravascular space. This can result
from an external loss of fluid from the body or from internal shifting of fluid from the intravascular space
to the extravascular space. Fluid shifts can result from a loss of intravascular integrity, increased
capillary membrane permeability, or decreased colloidal osmotic pressure. Relative hypovolemia occurs
when vasodilation produces an increase in vascular capacitance relative to circulating volume.
3. A patient has been admitted with hypovolemic shock due to traumatic blood loss. Which nursing
measure can best facilitate the administration of large volumes of fluid?
a. Inserting a large-diameter peripheral intravenous catheter
b. Positioning the patient in the Trendelenburg position
c. Encouraging the patient to drink at least 240 mL of fluid each hour
d. Administering intravenous fluids under pressure with a pressure bag
ANS: A
Measures to facilitate the administration of volume replacement include insertion of large-bore
peripheral intravenous catheters; rapid administration of prescribed fluids; and positioning the patient
with the legs elevated, trunk flat, and head and shoulders above the chest.
4. The nurse is caring for a patient in cardiogenic shock. The nurse recognizes that the patient's signs and
symptoms are the result of what problem?
, a. Inability of the heart to pump blood forward
b. Loss of circulating volume and subsequent decreased venous return
c. Disruption of the conduction system when reentry phenomenon occurs
d. Suppression of the sympathetic nervous system
ANS: A
Cardiogenic shock is the result of failure of the heart to effectively pump blood forward. It can occur
with dysfunction of the right or the left ventricle or both. The lack of adequate pumping function leads
to decreased tissue perfusion and circulatory failure.
5. The nurse is caring for a patient in cardiogenic shock. Which hemodynamic parameters would the
nurse expect to note to support this diagnosis?
a. Increased right atrial pressure
b. Decreased pulmonary artery wedge pressure
c. Increased cardiac output
d. Decreased cardiac index
ANS: D
Assessment of the hemodynamic parameter of patients in cardiogenic shock reveals a decreased cardiac
output and a cardiac index less than 2.2 L/min/m2.
6. A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse
understands that the patient is probably having an immunoglobulin E (IgE)-mediated response as a
result of what physiologic mechanism?
a. Direct activation of mast cells and basophils
b. Nonimmunologic stimulation of biochemical mediators
c. Repeat exposure to an antigen in the presence of preformed IgE antibodies
d. Activation of the systemic inflammatory response
ANS: C
Immunoglobulin E (IgE) is an antibody that is formed as part of the immune response. The first time an
antigen enters the body, an antibody IgE, specific for the antigen, is formed. The antigen-specific IgE
antibody is then stored by attachment to mast cells and basophils. This initial contact with the antigen is
known as a primary immune response. The next time the antigen enters the body, the preformed IgE
antibody reacts with it, and a secondary immune response occurs.
7. A patient has been admitted with anaphylactic shock due to an unknown allergen. The nurse
understands that the decrease in the patient's cardiac output is the result of which mechanism?
a. Peripheral vasodilation
b. Increased venous return
c. Increased alveolar ventilation
d. Decreased myocardial contractility
