Cardiogenic Shock

NCLEX Preferences for Chapter 9: Cardiogenic Shock

1. Prioritization of Nursing Interventions: Recognize and prioritize immediate
interventions to stabilize a patient with cardiogenic shock, focusing on airway, breathing,
and circulation (ABCs).
2. Recognizing Signs and Symptoms: Identify early signs of cardiogenic shock (e.g.,
hypotension, tachycardia, cool clammy skin, decreased urine output).
3. Pharmacology: Familiarize with medications used in cardiogenic shock management
(e.g., inotropes, vasopressors) and understand their effects on cardiac output and systemic
perfusion.
4. Nursing Care: Recognize nursing responsibilities when managing a patient with
cardiogenic shock, including monitoring hemodynamic status and administering fluids or
medications as prescribed.



NCLEX-Style Questions and Rationales

1. A patient with cardiogenic shock presents with hypotension, tachycardia, and cold,
clammy skin. What is the priority nursing intervention?
o A) Administer a diuretic to reduce preload.
o B) Encourage oral fluids to increase blood volume.
o C) Place the patient in Trendelenburg position.
o D) Administer oxygen and prepare for advanced airway support.

Answer: D
Rationale: Administering oxygen and ensuring airway support is the priority in
cardiogenic shock to prevent hypoxia, which can exacerbate organ damage. Diuretics are
generally avoided as they may reduce preload further in this context, and Trendelenburg
position does not improve perfusion effectively in cardiogenic shock.

2. Which of the following lab results is most indicative of cardiogenic shock?
o A) Elevated troponin levels
o B) Low white blood cell count
o C) Increased glucose levels
o D) Decreased B-type natriuretic peptide (BNP)

Answer: A
Rationale: Elevated troponin levels are commonly associated with myocardial damage,
which is a primary factor in cardiogenic shock. Elevated troponin may indicate an acute
myocardial infarction, which can lead to cardiogenic shock.

3. A nurse administers dopamine to a patient in cardiogenic shock. Which parameter
is essential to monitor closely?

, o A) Blood glucose level
o B) Serum creatinine level
o C) Urine output
o D) Respiratory rate

Answer: C
Rationale: Dopamine is an inotropic agent that helps increase cardiac output and
improve renal perfusion. Monitoring urine output is crucial to assess the effectiveness of
the drug in maintaining adequate perfusion.

4. A patient with cardiogenic shock is prescribed nitroglycerin. What is the purpose of
this medication?
o A) To increase heart rate
o B) To decrease preload and reduce myocardial oxygen demand
o C) To promote vasoconstriction
o D) To prevent arrhythmias

Answer: B
Rationale: Nitroglycerin is a vasodilator that decreases preload, reducing myocardial
oxygen demand and workload on the heart, which is beneficial in cardiogenic shock.

5. The following hemodynamic findings are noted in a patient with cardiogenic shock:
CVP 18 mmHg, PAWP 25 mmHg, and cardiac output of 2.5 L/min. Which nursing
diagnosis is most appropriate?
o A) Decreased cardiac output
o B) Fluid volume deficit
o C) Activity intolerance
o D) Impaired gas exchange

Answer: A
Rationale: Decreased cardiac output is most appropriate, as the findings indicate reduced
cardiac efficiency and elevated pressures that contribute to poor tissue perfusion, a
hallmark of cardiogenic shock.

6. What finding indicates the effectiveness of treatment in a patient with cardiogenic
shock?
o A) Heart rate of 120 beats per minute
o B) Urine output of 40 mL/hr
o C) Respiratory rate of 30 breaths per minute
o D) Central venous pressure of 25 mmHg

Answer: B
Rationale: Adequate urine output (greater than 30 mL/hr) suggests that renal perfusion is
improving, which is an indicator of effective treatment and stabilization of the patient’s
condition.

, 7. Which clinical manifestation is most concerning in a patient with cardiogenic
shock?
o A) Oxygen saturation of 90%
o B) Weak peripheral pulses
o C) Blood pressure of 78/42 mmHg
o D) Heart rate of 90 beats per minute

Answer: C
Rationale: Hypotension (BP 78/42 mmHg) is extremely concerning as it suggests a lack
of adequate perfusion, which is a critical issue in cardiogenic shock requiring immediate
intervention.

8. A nurse is preparing to administer an inotropic agent to a patient in cardiogenic
shock. Which of the following medications is commonly used for this purpose?
o A) Metoprolol
o B) Furosemide
o C) Dobutamine
o D) Morphine

Answer: C
Rationale: Dobutamine is an inotropic agent that increases myocardial contractility,
which is beneficial in cardiogenic shock to help improve cardiac output and tissue
perfusion.



9. The nurse is caring for a patient with cardiogenic shock and notes a decrease in
blood pressure and increased shortness of breath. Which position should the nurse
place the patient in to reduce cardiac workload?
o A) Trendelenburg position
o B) High Fowler’s position
o C) Supine position
o D) Prone position

Answer: B
Rationale: High Fowler’s position reduces venous return to the heart, which can
decrease cardiac workload. It also improves lung expansion, which helps reduce dyspnea.

10. Which diagnostic test would be most useful to evaluate the severity of heart damage
in a patient with cardiogenic shock?
o A) Electrocardiogram (ECG)
o B) Chest X-ray
o C) Echocardiogram
o D) Complete blood count (CBC)