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HESI Exit Exam Question Bank: Shock &
Hemodynamic Monitoring | Critical Care
Nursing NCLEX Prep
Table of Contents
Subtopic 1: Types and Stages of Shock............................................................2
Subtopic 2: Hemodynamic Monitoring Principles & Interpretation...................8
Subtopic 3: Pharmacologic Management in Shock States.............................14
Subtopic 4: Fluid Resuscitation and Volume Management.............................21
Subtopic 5: Shock in Special Populations (Pediatrics, Elderly, Pregnancy).. . .27
Subtopic 6: Laboratory and Diagnostic Evaluation in Shock..........................33
Subtopic 7: Mechanical Support Devices and Shock (e.g., IABP, ECMO, VAD)
.......................................................................................................................40
Subtopic 8: Nursing Management and Prioritization in Shock Scenarios.......46
Subtopic 9: Pharmacologic Management of Shock and Hemodynamic
Instability.......................................................................................................52
Subtopic 10: Complications, Prognostic Indicators, and Multisystem
Involvement in Shock.....................................................................................59
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Subtopic 1: Types and Stages of Shock
Questions 1–20
1. A patient presents with cool, clammy skin, hypotension, and decreased
urine output. Which stage of shock is most likely?
A. Refractory stage
B. Progressive stage
C. Initial stage
D. Compensatory stage
Rationale: The progressive stage of shock is characterized by worsening
hypotension, reduced tissue perfusion, and organ dysfunction—manifested
by cool skin and oliguria.
2. Which type of shock is associated with a widespread vasodilation and
pooling of blood due to a spinal cord injury?
A. Cardiogenic shock
B. Neurogenic shock
C. Septic shock
D. Obstructive shock
Rationale: Neurogenic shock is a distributive type caused by disruption of
sympathetic tone, typically from spinal cord trauma, leading to vasodilation
and hypotension.
3. What clinical feature most clearly differentiates cardiogenic shock from
hypovolemic shock?
A. Tachycardia
B. Hypotension
C. Pulmonary crackles
, 3
D. Cool extremities
Rationale: Pulmonary crackles are specific to cardiogenic shock due to fluid
backup into the lungs from poor cardiac output. Hypovolemic shock lacks
pulmonary congestion.
4. A patient in septic shock is likely to display which hemodynamic pattern?
A. Decreased cardiac output, decreased SVR
B. Increased cardiac output, decreased SVR
C. Increased cardiac output, increased SVR
D. Decreased cardiac output, increased SVR
Rationale: Early septic shock is characterized by a hyperdynamic state: high
cardiac output and low systemic vascular resistance (SVR) due to
vasodilation.
5. What is the earliest sign of hypovolemic shock?
A. Low blood pressure
B. Cool, pale skin
C. Tachycardia
D. Decreased urine output
Rationale: Tachycardia is an early compensatory mechanism in response to
decreased circulating volume to maintain cardiac output.
6. Which shock type is caused by a mechanical obstruction to blood flow,
such as a pulmonary embolism or cardiac tamponade?
A. Septic shock
B. Obstructive shock
C. Neurogenic shock
D. Cardiogenic shock
, 4
Rationale: Obstructive shock results from physical barriers impeding venous
return or cardiac output.
7. What is the hallmark sign of anaphylactic shock?
A. Hypertension
B. Bronchospasm
C. Bradycardia
D. Cold extremities
Rationale: Bronchospasm, due to massive histamine release and airway
constriction, is a classic feature of anaphylaxis.
8. During the compensatory stage of shock, which mechanism helps
maintain perfusion to vital organs?
A. Vasoconstriction
B. Increased capillary permeability
C. Cellular necrosis
D. Decreased myocardial contractility
Rationale: Vasoconstriction redirects blood from non-vital to vital organs like
the brain and heart.
9. What parameter is most useful in identifying the transition from the
progressive to the refractory stage of shock?
A. Tachypnea
B. Increased heart rate
C. Unresponsive to vasopressors and fluids
D. Mild confusion
Rationale: In the refractory stage, the patient shows no response to
aggressive therapy, indicating irreversible organ failure.
HESI Exit Exam Question Bank: Shock &
Hemodynamic Monitoring | Critical Care
Nursing NCLEX Prep
Table of Contents
Subtopic 1: Types and Stages of Shock............................................................2
Subtopic 2: Hemodynamic Monitoring Principles & Interpretation...................8
Subtopic 3: Pharmacologic Management in Shock States.............................14
Subtopic 4: Fluid Resuscitation and Volume Management.............................21
Subtopic 5: Shock in Special Populations (Pediatrics, Elderly, Pregnancy).. . .27
Subtopic 6: Laboratory and Diagnostic Evaluation in Shock..........................33
Subtopic 7: Mechanical Support Devices and Shock (e.g., IABP, ECMO, VAD)
.......................................................................................................................40
Subtopic 8: Nursing Management and Prioritization in Shock Scenarios.......46
Subtopic 9: Pharmacologic Management of Shock and Hemodynamic
Instability.......................................................................................................52
Subtopic 10: Complications, Prognostic Indicators, and Multisystem
Involvement in Shock.....................................................................................59
, 2
Subtopic 1: Types and Stages of Shock
Questions 1–20
1. A patient presents with cool, clammy skin, hypotension, and decreased
urine output. Which stage of shock is most likely?
A. Refractory stage
B. Progressive stage
C. Initial stage
D. Compensatory stage
Rationale: The progressive stage of shock is characterized by worsening
hypotension, reduced tissue perfusion, and organ dysfunction—manifested
by cool skin and oliguria.
2. Which type of shock is associated with a widespread vasodilation and
pooling of blood due to a spinal cord injury?
A. Cardiogenic shock
B. Neurogenic shock
C. Septic shock
D. Obstructive shock
Rationale: Neurogenic shock is a distributive type caused by disruption of
sympathetic tone, typically from spinal cord trauma, leading to vasodilation
and hypotension.
3. What clinical feature most clearly differentiates cardiogenic shock from
hypovolemic shock?
A. Tachycardia
B. Hypotension
C. Pulmonary crackles
, 3
D. Cool extremities
Rationale: Pulmonary crackles are specific to cardiogenic shock due to fluid
backup into the lungs from poor cardiac output. Hypovolemic shock lacks
pulmonary congestion.
4. A patient in septic shock is likely to display which hemodynamic pattern?
A. Decreased cardiac output, decreased SVR
B. Increased cardiac output, decreased SVR
C. Increased cardiac output, increased SVR
D. Decreased cardiac output, increased SVR
Rationale: Early septic shock is characterized by a hyperdynamic state: high
cardiac output and low systemic vascular resistance (SVR) due to
vasodilation.
5. What is the earliest sign of hypovolemic shock?
A. Low blood pressure
B. Cool, pale skin
C. Tachycardia
D. Decreased urine output
Rationale: Tachycardia is an early compensatory mechanism in response to
decreased circulating volume to maintain cardiac output.
6. Which shock type is caused by a mechanical obstruction to blood flow,
such as a pulmonary embolism or cardiac tamponade?
A. Septic shock
B. Obstructive shock
C. Neurogenic shock
D. Cardiogenic shock
, 4
Rationale: Obstructive shock results from physical barriers impeding venous
return or cardiac output.
7. What is the hallmark sign of anaphylactic shock?
A. Hypertension
B. Bronchospasm
C. Bradycardia
D. Cold extremities
Rationale: Bronchospasm, due to massive histamine release and airway
constriction, is a classic feature of anaphylaxis.
8. During the compensatory stage of shock, which mechanism helps
maintain perfusion to vital organs?
A. Vasoconstriction
B. Increased capillary permeability
C. Cellular necrosis
D. Decreased myocardial contractility
Rationale: Vasoconstriction redirects blood from non-vital to vital organs like
the brain and heart.
9. What parameter is most useful in identifying the transition from the
progressive to the refractory stage of shock?
A. Tachypnea
B. Increased heart rate
C. Unresponsive to vasopressors and fluids
D. Mild confusion
Rationale: In the refractory stage, the patient shows no response to
aggressive therapy, indicating irreversible organ failure.
