1 Exampromax - Stuvia US 2025/2026
BCEN Questions with Detailed Verified
Answers (100% Correct Answers) /Already
Graded A+
Shock
✓✓ impaired tissue perfusion secondary to circulatory failure
Compensated Shock
✓✓ Sympathetic nervous system (release of epi and norepi-
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vasoconstriction), RAAS activation (inc serum NA and fluid), ADH (renal
NA and H2O absorption) and intracellular fluid shift (inc vasc volume)
Exampromax - Stuvia US
Uncompensated Shock
✓✓ edema/third spacing, respiratory decline (crackles and dyspnea
secondary to pulmonary edema), cardiac decline (inadequate venous return
and dysrhythmias), hypo perfusion to non-vital tissues, hypo perfusion to
myocardium and brain
Hypovolemic Shock
✓✓ Traumatic/nontraumatic hemorrhage, fluid shift, non-blood fluid
losses, urinary fluid losses
Fluid Volume Intervention
, 2 Exampromax - Stuvia US 2025/2026
✓✓ crystalloid bolus: NSS is most common-- 1-2L for adults; 20ml/kg
peds
Blood- typically PRBCs (no clotting factors here- just good for volume and
O2)
Massive transfusion: 1:1:1 PRBCs, platelets, and plasma
D5W NOT USED- metabolized too quickly and does not contribute to
volume expansion
Cardiogenic Shock
©, 2025 All rights reserved®
✓✓ Inadequate pump: typically caused by MI, chest trauma, sustained
Exampromax - Stuvia US
dysrhythmia, valve problems, end stage cardiomyopathy
Disruptive Shock
✓✓ Fluid and pump are adequate- but fluid is in the wrong place (pooling,
leaky capillaries)
Types: Anaphylactic, Septic, Neurogenic
Cardiogenic Shock Interventions
✓✓ PEEP (force out pulm edema fluid)
decrease pre-load (Nitro, MSO4, diuretics, semi-fowlers)
decrease afterload (nitro + antihypertensives)
inc contractility (dobutamine, IABP)
treat dysrhythmias
Cardiac cath/angioplasty
, 3 Exampromax - Stuvia US 2025/2026
Anaphylactic Shock
✓✓ Type of Distributive Shock
IGE mediated
IM Epi Q15-20 min
Fluids
Histamine blockers
Albuterol (ensure patent airway)
©, 2025 All rights reserved®
Corticosteroids
Exampromax - Stuvia US
Septic Shock
✓✓ Type of Distributive Shock
Must meet 2 SIRS criteria + known or suspected infection
Considered to be "shock" when pt is hypotensive despite fluid resuscitation
May progress to MODS
Neurogenic Shock
✓✓ Type of Distributive Shock
loss of stimulation of sympathetic (fight or flight) nervous system
(brain/spine injury, spinal anesthesia)
Presents: bradycardia, bradypnea, hypotension, priapism,
warm/dry/flushed skin
Intervention: fluids, vasopressors (phenylephrine), corticosteroids, atropine
Obstructive Shock
, 4 Exampromax - Stuvia US 2025/2026
✓✓ Hypo-perfusion because of resistance to ventricular filling
Causes: pericardial tamponade, tension pneumo, PE
Shock in Peds Pts
✓✓ Typically hypovolemia is most common cause
Assess for dryness
Shock in Geriatric Pts
✓✓ Tachycardia may be masked by some home meds (ie: beta blockers)
©, 2025 All rights reserved®
Also prone to dehydration/hypervolemia (500 cc bolus followed by
Exampromax - Stuvia US
200cc/hr until SBP 100)
Sepsis is also common cause
Cardiac Output
✓✓ HR influenced by PNS (vagus nerve, drugs, conduction abnormalities)
and SNS (stress, pain)
Chonotropes Drug Class
✓✓ drugs that affect HR at SA node
Inotropes Drug Class
✓✓ drugs that affect contractility of the heart
Dromotropes Drug Class
BCEN Questions with Detailed Verified
Answers (100% Correct Answers) /Already
Graded A+
Shock
✓✓ impaired tissue perfusion secondary to circulatory failure
Compensated Shock
✓✓ Sympathetic nervous system (release of epi and norepi-
©, 2025 All rights reserved®
vasoconstriction), RAAS activation (inc serum NA and fluid), ADH (renal
NA and H2O absorption) and intracellular fluid shift (inc vasc volume)
Exampromax - Stuvia US
Uncompensated Shock
✓✓ edema/third spacing, respiratory decline (crackles and dyspnea
secondary to pulmonary edema), cardiac decline (inadequate venous return
and dysrhythmias), hypo perfusion to non-vital tissues, hypo perfusion to
myocardium and brain
Hypovolemic Shock
✓✓ Traumatic/nontraumatic hemorrhage, fluid shift, non-blood fluid
losses, urinary fluid losses
Fluid Volume Intervention
, 2 Exampromax - Stuvia US 2025/2026
✓✓ crystalloid bolus: NSS is most common-- 1-2L for adults; 20ml/kg
peds
Blood- typically PRBCs (no clotting factors here- just good for volume and
O2)
Massive transfusion: 1:1:1 PRBCs, platelets, and plasma
D5W NOT USED- metabolized too quickly and does not contribute to
volume expansion
Cardiogenic Shock
©, 2025 All rights reserved®
✓✓ Inadequate pump: typically caused by MI, chest trauma, sustained
Exampromax - Stuvia US
dysrhythmia, valve problems, end stage cardiomyopathy
Disruptive Shock
✓✓ Fluid and pump are adequate- but fluid is in the wrong place (pooling,
leaky capillaries)
Types: Anaphylactic, Septic, Neurogenic
Cardiogenic Shock Interventions
✓✓ PEEP (force out pulm edema fluid)
decrease pre-load (Nitro, MSO4, diuretics, semi-fowlers)
decrease afterload (nitro + antihypertensives)
inc contractility (dobutamine, IABP)
treat dysrhythmias
Cardiac cath/angioplasty
, 3 Exampromax - Stuvia US 2025/2026
Anaphylactic Shock
✓✓ Type of Distributive Shock
IGE mediated
IM Epi Q15-20 min
Fluids
Histamine blockers
Albuterol (ensure patent airway)
©, 2025 All rights reserved®
Corticosteroids
Exampromax - Stuvia US
Septic Shock
✓✓ Type of Distributive Shock
Must meet 2 SIRS criteria + known or suspected infection
Considered to be "shock" when pt is hypotensive despite fluid resuscitation
May progress to MODS
Neurogenic Shock
✓✓ Type of Distributive Shock
loss of stimulation of sympathetic (fight or flight) nervous system
(brain/spine injury, spinal anesthesia)
Presents: bradycardia, bradypnea, hypotension, priapism,
warm/dry/flushed skin
Intervention: fluids, vasopressors (phenylephrine), corticosteroids, atropine
Obstructive Shock
, 4 Exampromax - Stuvia US 2025/2026
✓✓ Hypo-perfusion because of resistance to ventricular filling
Causes: pericardial tamponade, tension pneumo, PE
Shock in Peds Pts
✓✓ Typically hypovolemia is most common cause
Assess for dryness
Shock in Geriatric Pts
✓✓ Tachycardia may be masked by some home meds (ie: beta blockers)
©, 2025 All rights reserved®
Also prone to dehydration/hypervolemia (500 cc bolus followed by
Exampromax - Stuvia US
200cc/hr until SBP 100)
Sepsis is also common cause
Cardiac Output
✓✓ HR influenced by PNS (vagus nerve, drugs, conduction abnormalities)
and SNS (stress, pain)
Chonotropes Drug Class
✓✓ drugs that affect HR at SA node
Inotropes Drug Class
✓✓ drugs that affect contractility of the heart
Dromotropes Drug Class
