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Critical care questions
Chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
1. A nurse in the icu is planning the care of a client who is being treated for shock.
What statement best describes the pathophysiology of this client's health problem?
A. Blood is shunted from vital organs to peripheral areas of the body.
B. Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
C. Circulating blood volume is decreased with a resulting change in the osmotic
pressure gradient.
D. Hemorrhage occurs as a result of trauma, depriving vital organs of adequate
perfusion.
Ans: b
Rationale: shock is a life-threatening condition with a variety of underlying causes.
Shock is caused when the cells do not have an adequate blood supply and are
deprived of oxygen and nutrients. In cases of shock, blood is shunted from peripheral
areas of the body to the vital organs. Hemorrhage and decreased blood volume are
associated with some, but not all, types of shock.
Pts: 1 ref: p. 274
Nat: client needs: physiological integrity: physiological adaptation
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: understand not:
multiple choice
2. In an acute care setting, the nurse is assessing an unstable client. When
prioritizing the client's care, the nurse should recognize that the client is at risk for
hypovolemic shock in which of the following circumstances?
A. Fluid volume circulating in the blood vessels decreases.
B. There is an uncontrolled increase in cardiac output.
C. Blood pressure regulation becomes irregular.
D. The client experiences tachycardia and a bounding pulse.
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Ans: a
Rationale: hypovolemic shock is characterized by a decrease in intravascular volume.
Cardiac output is decreased, blood pressure decreases, and pulse is fast, but weak.
Pts: 1 ref: p. 285
Nat: client needs: physiological integrity: physiological adaptation
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: analyze
Not: multiple choice
3. The emergency nurse is admitting a client experiencing a gi bleed who is
believed to be in the compensatory stage of shock. What assessment finding would be
most consistent with the early stage of compensation?
A. Increased urine output
B. Decreased heart rate
C. Hyperactive bowel sounds
D. Cool, clammy skin
Ans: d
Rationale: in the compensatory stage of shock, the body shunts blood from the organs,
such as the skin and kidneys, to the brain and heart to ensure adequate blood supply.
As a result, the client's skin is cool and clammy. Also in this compensatory stage, blood
vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the
urine output decreases.
Pts: 1 ref: p. 276
Nat: client needs: physiological integrity: physiological adaptation
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: analyze
Not: multiple choice
4 . The nurse is caring for a client who is exhibiting signs and symptoms of
hypovolemic shock following injuries from a motor vehicle accident. In addition to
normal saline, which crystalloid fluid should the nurse prepare to administer?
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A. Lactated ringer
B. Albumin
C. Dextran
D. 3% nacl
Ans: a
Rationale: crystalloids are electrolyte solutions used for the treatment of hypovolemic
shock. Lactated ringer and 0.9% sodium chloride are isotonic crystalloid fluids
commonly used to manage hypovolemic shock. Dextran and albumin are colloids, but
dextran, even as a colloid, is not indicated for the treatment of hypovolemic shock.
The 3% nacl is a hypertonic solution and is not isotonic.
Pts: 1 ref: p. 282
Nat: client needs: physiological integrity: pharmacological and parenteral therapies
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: apply
Not: multiple choice
5. A client who is in shock is receiving dopamine in addition to iv fluids. What principle
should inform the nurse's care planning during the administration of a vasoactive
drug?
A. The drug should be discontinued immediately after blood pressure increases.
B. The drug dose should be tapered down once vital signs improve.
C. The client should have arterial blood gases drawn every 10 minutes during
treatment.
D. The infusion rate should be titrated according the client's subjective sensation
of adequate perfusion.
Ans: b
Rationale: when vasoactive medications are discontinued, they should never be
stopped abruptly because this could cause severe hemodynamic instability,
perpetuating the shock state. Subjective assessment data are secondary to objective
Downloaded by NELSON KIIRU ()
Critical care questions
Chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
1. A nurse in the icu is planning the care of a client who is being treated for shock.
What statement best describes the pathophysiology of this client's health problem?
A. Blood is shunted from vital organs to peripheral areas of the body.
B. Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
C. Circulating blood volume is decreased with a resulting change in the osmotic
pressure gradient.
D. Hemorrhage occurs as a result of trauma, depriving vital organs of adequate
perfusion.
Ans: b
Rationale: shock is a life-threatening condition with a variety of underlying causes.
Shock is caused when the cells do not have an adequate blood supply and are
deprived of oxygen and nutrients. In cases of shock, blood is shunted from peripheral
areas of the body to the vital organs. Hemorrhage and decreased blood volume are
associated with some, but not all, types of shock.
Pts: 1 ref: p. 274
Nat: client needs: physiological integrity: physiological adaptation
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: understand not:
multiple choice
2. In an acute care setting, the nurse is assessing an unstable client. When
prioritizing the client's care, the nurse should recognize that the client is at risk for
hypovolemic shock in which of the following circumstances?
A. Fluid volume circulating in the blood vessels decreases.
B. There is an uncontrolled increase in cardiac output.
C. Blood pressure regulation becomes irregular.
D. The client experiences tachycardia and a bounding pulse.
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
Ans: a
Rationale: hypovolemic shock is characterized by a decrease in intravascular volume.
Cardiac output is decreased, blood pressure decreases, and pulse is fast, but weak.
Pts: 1 ref: p. 285
Nat: client needs: physiological integrity: physiological adaptation
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: analyze
Not: multiple choice
3. The emergency nurse is admitting a client experiencing a gi bleed who is
believed to be in the compensatory stage of shock. What assessment finding would be
most consistent with the early stage of compensation?
A. Increased urine output
B. Decreased heart rate
C. Hyperactive bowel sounds
D. Cool, clammy skin
Ans: d
Rationale: in the compensatory stage of shock, the body shunts blood from the organs,
such as the skin and kidneys, to the brain and heart to ensure adequate blood supply.
As a result, the client's skin is cool and clammy. Also in this compensatory stage, blood
vessels vasoconstrict, the heart rate increases, bowel sounds are hypoactive, and the
urine output decreases.
Pts: 1 ref: p. 276
Nat: client needs: physiological integrity: physiological adaptation
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: analyze
Not: multiple choice
4 . The nurse is caring for a client who is exhibiting signs and symptoms of
hypovolemic shock following injuries from a motor vehicle accident. In addition to
normal saline, which crystalloid fluid should the nurse prepare to administer?
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
A. Lactated ringer
B. Albumin
C. Dextran
D. 3% nacl
Ans: a
Rationale: crystalloids are electrolyte solutions used for the treatment of hypovolemic
shock. Lactated ringer and 0.9% sodium chloride are isotonic crystalloid fluids
commonly used to manage hypovolemic shock. Dextran and albumin are colloids, but
dextran, even as a colloid, is not indicated for the treatment of hypovolemic shock.
The 3% nacl is a hypertonic solution and is not isotonic.
Pts: 1 ref: p. 282
Nat: client needs: physiological integrity: pharmacological and parenteral therapies
Top: chapter 11: shock, sepsis, and multiple organ dysfunction syndrome
Key: integrated process: nursing process blm: cognitive level: apply
Not: multiple choice
5. A client who is in shock is receiving dopamine in addition to iv fluids. What principle
should inform the nurse's care planning during the administration of a vasoactive
drug?
A. The drug should be discontinued immediately after blood pressure increases.
B. The drug dose should be tapered down once vital signs improve.
C. The client should have arterial blood gases drawn every 10 minutes during
treatment.
D. The infusion rate should be titrated according the client's subjective sensation
of adequate perfusion.
Ans: b
Rationale: when vasoactive medications are discontinued, they should never be
stopped abruptly because this could cause severe hemodynamic instability,
perpetuating the shock state. Subjective assessment data are secondary to objective
Downloaded by NELSON KIIRU ()
