Nclex Questions for Shock - Critical Care Test Questions and Answers
Graded A+
What will the nurse identify as symptoms of Answer: 2
hypovolemic shock in a patient? Rationale 1: The sodium level in hypovolemic
Note: Credit will be given only if all correct shock is elevated above the normal values of 135
choices and no incorrect choices are selected. to 145 mEq/L, not reduced.
Standard Text: Select all that apply. Rationale 2: Metabolic acidosis is present due to
1. Temperature of 97.6°F (36.4°C) an accumulation of carbonic acid, leaving a
2. Restlessness bicarbonate deficit from decreased tissue
3. Decrease in blood pressure of 20 mm Hg perfusion.
when the patient sits up Rationale 3: Serum lactate is greater than 4
4. Capillary refill time greater than 3 seconds mmol/L as a result of tissue ischemia, hypoxia,
5. Sinus bradycardia of 55 beats per minute - and breakdown from decreased blood flow with
-Correct Answer: 2,3,4 hypovolemic shock.
Rationale 1: Fever will increase oxygen demands Rationale 4: SvO2 (mixed venous oxygen
but is unrelated to hypovolemic shock unless saturation) would be less than 60% due to
prolonged fever has caused severe dehydration, decreased circulating blood volume or decrease
reducing the circulating blood volume. in cells to carry the oxygen. Therefore, O2 is
Hypovolemic shock reduces temperatures by carried less efficiently and decreased, not
peripheral shunting of blood away from the increased.
extremities and reducing the core metabolic rate.
Rationale 2: Due to decreased blood flow to the
brain and peripheral areas when blood is The nurse recognizes that which patient would be
shunted to maintain the vital organs, cerebral most likely to develop hypovolemic shock? A
hypoxia occurs, leading to a change in mental patient with:
status. 1. Decreased cardiac output
Rationale 3: Orthostatic hypotension is a 2. Severe constipation, causing watery diarrhea
manifestation of hypovolemic shock. 3. Ascites
Rationale 4: Due to decreased blood flow to the 4. Syndrome of inappropriate ADH (SIADH) -
brain and peripheral areas when blood is -Correct Answer: 3
shunted to maintain the vital organs, capillary Rationale 1: Although ECG changes reflect the
refill time will be reduced. effectiveness of the heart's pumping when
Rationale 5: Bradycardia is not present. The circulating the blood, it is not a risk factor for
compensatory response is to increase the heart hypovolemic shock, which reflects a decreased
rate to circulate the blood faster to make up for circulating volume from either blood or fluid
the fluids that are not present in hypovolemic losses within the intravascular system.
shock. Rationale 2: Severe constipation does not affect
the circulating blood volume.
Rationale 3: Third spacing shifts move the fluids
Which laboratory finding should cause the nurse from the intravascular space into the interstitial
to suspect that a patient is developing space, causing a drop in the circulating blood
hypovolemic shock? volume. Therefore, third spacing is a risk factor
1. Serum sodium of 130 mEq/L (130 mmol/L) for the development of hypovolemic shock.
2. Metabolic acidosis validated by arterial blood Rationale 4: Overhydration does not lead to
gases hypovolemic shock. It leads to fluid overload,
3. Serum lactate of 3 mmol/L which might cause cardiogenic shock, congestive
4. SvO2 greater than 80% - -Correct heart failure, and pulmonary edema.
1/9
, Nclex Questions for Shock - Critical Care Test Questions and Answers
Graded A+
infusion of an adequate amount of fluid. Fluid
resuscitation begins with 500 to 1,000 mL of an
Which finding indicates that a patient is isotonic solution.
experiencing increased peripheral resistance and Rationale 3: This is a hypotonic solution and
vasoconstriction? would not help with fluid resuscitation.
1. Strong bounding pulse with deep red coloring Rationale 4: This is a hypotonic solution and
2. Pale, cool extremities with decreased pulses would not help with fluid resuscitation.
3. Increased venous engorgement with strong
pulses
4. Faster than normal capillary refill time - - Which life-threatening complications would the
Correct Answer: 2 nurse anticipate developing in the patient being
Rationale 1: An increased blood supply would treated for hypovolemic shock?
increase color and bounding pulses as seen with Note: Credit will be given only if all correct
vasodilation (blood engorgement) and is not choices and no incorrect choices are selected.
present with increased peripheral resistance and Standard Text: Select all that apply.
vasoconstriction. 1. Fluid volume overload
Rationale 2: Increased peripheral resistance 2. Renal insufficiency
causes the blood supply to decrease and results 3. Cerebral ischemia
in decreased blood to the tissues, which causes 4. Gastric stress ulcer
pallor and decreased skin temperatures. The 5. Pulmonary edema - -Correct Answer:
pulses would decrease in intensity with a 2,3
decreased blood supply. Rationale 1: Fluid volume overload is not an
Rationale 3: Venous engorgement would not identified complication of hypovolemic shock.
result from vasoconstriction of the arteries. Rationale 2: Renal insufficiency is a serious
Strong pulses would not be present with complication because of the prerenal etiology of
vasoconstriction from increased peripheral hypovolemia.
resistance. Rationale 3: Early identification and correction of
Rationale 4: Capillary refill times are delayed or the fluid volume deficit in hypovolemic shock is
slowed due to decreased blood flow through the necessary to prevent cerebral ischemia.
vessels caused by the vasoconstriction from Rationale 4: Although physiologic stress can
increased peripheral resistance. increase the risk for the development of stress
ulcers, it is not considered one of the common or
life-threatening complications of hypovolemic
Which solution would be the most appropriate shock.
initial volume replacement for a patient with Rationale 5: Pulmonary edema is not an
severe GI bleeding? identified complication of hypovolemic shock.
1. 200 mL of normal saline (NS) per hour for 5
hours
2. A liter of Ringer's lactate (RL) over 15 minutes The nurse, caring for a patient in hypovolemic
3. Two liters of D5W over half an hour shock, will not utilize a hypotonic solution for fluid
4. 500 mL of 0.45% normal saline (1/2 NS) over resuscitation because hypotonic solutions:
half an hour - -Correct Answer: 2 1. Move quickly into the interstitial spaces and
Rationale 1: This is not an adequate amount of can cause third spacing
fluid replacement. 2. Stay longer to expand the intravascular space
Rationale 2: The patient requires immediate but deplete intracellular fluid levels
2/9
Graded A+
What will the nurse identify as symptoms of Answer: 2
hypovolemic shock in a patient? Rationale 1: The sodium level in hypovolemic
Note: Credit will be given only if all correct shock is elevated above the normal values of 135
choices and no incorrect choices are selected. to 145 mEq/L, not reduced.
Standard Text: Select all that apply. Rationale 2: Metabolic acidosis is present due to
1. Temperature of 97.6°F (36.4°C) an accumulation of carbonic acid, leaving a
2. Restlessness bicarbonate deficit from decreased tissue
3. Decrease in blood pressure of 20 mm Hg perfusion.
when the patient sits up Rationale 3: Serum lactate is greater than 4
4. Capillary refill time greater than 3 seconds mmol/L as a result of tissue ischemia, hypoxia,
5. Sinus bradycardia of 55 beats per minute - and breakdown from decreased blood flow with
-Correct Answer: 2,3,4 hypovolemic shock.
Rationale 1: Fever will increase oxygen demands Rationale 4: SvO2 (mixed venous oxygen
but is unrelated to hypovolemic shock unless saturation) would be less than 60% due to
prolonged fever has caused severe dehydration, decreased circulating blood volume or decrease
reducing the circulating blood volume. in cells to carry the oxygen. Therefore, O2 is
Hypovolemic shock reduces temperatures by carried less efficiently and decreased, not
peripheral shunting of blood away from the increased.
extremities and reducing the core metabolic rate.
Rationale 2: Due to decreased blood flow to the
brain and peripheral areas when blood is The nurse recognizes that which patient would be
shunted to maintain the vital organs, cerebral most likely to develop hypovolemic shock? A
hypoxia occurs, leading to a change in mental patient with:
status. 1. Decreased cardiac output
Rationale 3: Orthostatic hypotension is a 2. Severe constipation, causing watery diarrhea
manifestation of hypovolemic shock. 3. Ascites
Rationale 4: Due to decreased blood flow to the 4. Syndrome of inappropriate ADH (SIADH) -
brain and peripheral areas when blood is -Correct Answer: 3
shunted to maintain the vital organs, capillary Rationale 1: Although ECG changes reflect the
refill time will be reduced. effectiveness of the heart's pumping when
Rationale 5: Bradycardia is not present. The circulating the blood, it is not a risk factor for
compensatory response is to increase the heart hypovolemic shock, which reflects a decreased
rate to circulate the blood faster to make up for circulating volume from either blood or fluid
the fluids that are not present in hypovolemic losses within the intravascular system.
shock. Rationale 2: Severe constipation does not affect
the circulating blood volume.
Rationale 3: Third spacing shifts move the fluids
Which laboratory finding should cause the nurse from the intravascular space into the interstitial
to suspect that a patient is developing space, causing a drop in the circulating blood
hypovolemic shock? volume. Therefore, third spacing is a risk factor
1. Serum sodium of 130 mEq/L (130 mmol/L) for the development of hypovolemic shock.
2. Metabolic acidosis validated by arterial blood Rationale 4: Overhydration does not lead to
gases hypovolemic shock. It leads to fluid overload,
3. Serum lactate of 3 mmol/L which might cause cardiogenic shock, congestive
4. SvO2 greater than 80% - -Correct heart failure, and pulmonary edema.
1/9
, Nclex Questions for Shock - Critical Care Test Questions and Answers
Graded A+
infusion of an adequate amount of fluid. Fluid
resuscitation begins with 500 to 1,000 mL of an
Which finding indicates that a patient is isotonic solution.
experiencing increased peripheral resistance and Rationale 3: This is a hypotonic solution and
vasoconstriction? would not help with fluid resuscitation.
1. Strong bounding pulse with deep red coloring Rationale 4: This is a hypotonic solution and
2. Pale, cool extremities with decreased pulses would not help with fluid resuscitation.
3. Increased venous engorgement with strong
pulses
4. Faster than normal capillary refill time - - Which life-threatening complications would the
Correct Answer: 2 nurse anticipate developing in the patient being
Rationale 1: An increased blood supply would treated for hypovolemic shock?
increase color and bounding pulses as seen with Note: Credit will be given only if all correct
vasodilation (blood engorgement) and is not choices and no incorrect choices are selected.
present with increased peripheral resistance and Standard Text: Select all that apply.
vasoconstriction. 1. Fluid volume overload
Rationale 2: Increased peripheral resistance 2. Renal insufficiency
causes the blood supply to decrease and results 3. Cerebral ischemia
in decreased blood to the tissues, which causes 4. Gastric stress ulcer
pallor and decreased skin temperatures. The 5. Pulmonary edema - -Correct Answer:
pulses would decrease in intensity with a 2,3
decreased blood supply. Rationale 1: Fluid volume overload is not an
Rationale 3: Venous engorgement would not identified complication of hypovolemic shock.
result from vasoconstriction of the arteries. Rationale 2: Renal insufficiency is a serious
Strong pulses would not be present with complication because of the prerenal etiology of
vasoconstriction from increased peripheral hypovolemia.
resistance. Rationale 3: Early identification and correction of
Rationale 4: Capillary refill times are delayed or the fluid volume deficit in hypovolemic shock is
slowed due to decreased blood flow through the necessary to prevent cerebral ischemia.
vessels caused by the vasoconstriction from Rationale 4: Although physiologic stress can
increased peripheral resistance. increase the risk for the development of stress
ulcers, it is not considered one of the common or
life-threatening complications of hypovolemic
Which solution would be the most appropriate shock.
initial volume replacement for a patient with Rationale 5: Pulmonary edema is not an
severe GI bleeding? identified complication of hypovolemic shock.
1. 200 mL of normal saline (NS) per hour for 5
hours
2. A liter of Ringer's lactate (RL) over 15 minutes The nurse, caring for a patient in hypovolemic
3. Two liters of D5W over half an hour shock, will not utilize a hypotonic solution for fluid
4. 500 mL of 0.45% normal saline (1/2 NS) over resuscitation because hypotonic solutions:
half an hour - -Correct Answer: 2 1. Move quickly into the interstitial spaces and
Rationale 1: This is not an adequate amount of can cause third spacing
fluid replacement. 2. Stay longer to expand the intravascular space
Rationale 2: The patient requires immediate but deplete intracellular fluid levels
2/9
