Shock NCLEX Questions, Nclex Questions for Shock -
Critical Care, Sepsis NCLEX, Ch 67: shock, SIRS, MODS
EXAM QUESTIONS VERIFIED ANSWERS LATEST
UPDATE 2025/2026 RATED A+
A patient is admitted to the emergency department after sustaining abdominal injuries and a broken
femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently. Vital
signs upon admission are temperature 98 F (36 C), heart rate 130 beats/minute, respiratory rate 34
breaths/minute, blood pressure 50/40 mmHg. The healthcare provider suspects which type of shock?
a.) Hypovolemic
b.) Cardiogenic
c.) Neurogenic
d.) Distributive - CORRECT ANSWERS a.) Hypovolemic
1. A patient with septic shock has a urine output of 20 mL/hr for the past 3 hours. The pulse
rate is 120 and the central venous pressure and pulmonary artery wedge pressure are low.
Which of these orders by the health care provider will the nurse question?
a. Give furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 150 mL/hr.
c. Administer hydrocortisone (SoluCortef) 100 mg IV.
d. Prepare to give drotrecogin alpha (Xigris) 24 mcg/kg/hr. - CORRECT ANSWERS ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient
with septic shock. The other orders are appropriate.
DIF: Cognitive Level: Application REF: 1724-1726 | 1731 | 1733
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
,What will the nurse identify as symptoms of hypovolemic shock in a patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Temperature of 97.6°F (36.4°C)
2. Restlessness
3. Decrease in blood pressure of 20 mm Hg when the patient sits up
4. Capillary refill time greater than 3 seconds
5. Sinus bradycardia of 55 beats per minute - CORRECT ANSWERS Correct Answer: 2,3,4
Rationale 1: Fever will increase oxygen demands but is unrelated to hypovolemic shock unless
prolonged fever has caused severe dehydration, reducing the circulating blood volume. Hypovolemic
shock reduces temperatures by peripheral shunting of blood away from the extremities and reducing
the core metabolic rate.
Rationale 2: Due to decreased blood flow to the brain and peripheral areas when blood is shunted to
maintain the vital organs, cerebral hypoxia occurs, leading to a change in mental status.
Rationale 3: Orthostatic hypotension is a manifestation of hypovolemic shock.
Rationale 4: Due to decreased blood flow to the brain and peripheral areas when blood is shunted to
maintain the vital organs, capillary refill time will be reduced.
Rationale 5: Bradycardia is not present. The compensatory response is to increase the heart rate to
circulate the blood faster to make up for the fluids that are not present in hypovolemic shock.
Why are the manifestations of most types of shock the same regardless of what specific events or
condition caused the shock to occur?
A. The blood, blood vessels, and heart are directly connected to each other so that when one is affected,
all three are affected.
B. Because blood loss occurs with all types of shock, the most common first manifestation is
hypotension.
C. Every type of shock interferes with oxygenation and metabolism of all cells in the same sequence.
D. The sympathetic nervous system is triggered by any type of shock and initiates the stress response. -
CORRECT ANSWERS ANS: D
,Rationale: Most manifestations of shock are similar regardless of what starts the process or which
tissues are affected first. These common manifestations result from physiologic adjustments
(compensatory mechanisms) in an attempt to ensure continued oxygenation of vital organs. These
adjustment actions are performed by the sympathetic nervous system triggering the stress response and
activating the endocrine and cardiovascular systems.
2. A patient with shock of unknown etiology whose hemodynamic monitoring indicates BP
92/54, pulse 64, and an elevated pulmonary artery wedge pressure has the following
collaborative interventions prescribed. Which intervention will the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Give nitroprusside (Nipride) unless systolic BP <90 mm Hg.
d. Administer dobutamine (Dobutrex) to keep systolic BP >90 mm Hg. - CORRECT ANSWERS
ANS: A
The patient's elevated pulmonary artery wedge pressure indicates volume excess. A
normal saline infusion at 250 mL/hr will exacerbate this. The other actions are
appropriate for the patient.
DIF: Cognitive Level: Application REF: 1719 | 1721-1722 | 1735
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The patient's
central venous pressure (CVP) reading is 2, blood pressure is 90/50 mmHg, lung sounds are clear, and
jugular veins are flat. Which of these actions is most appropriate for the nurse to take?
a.) Slow the IV infusion rate
b.) Administer dopamine
c.) No interventions are needed at this time
d.) Increase the IV infusion rate - CORRECT ANSWERS d.) Increase the IV infusion rate
, Which vital sign change in a client with hypovolemic shock indicates to the nurse that the therapy is
effective?
A. Urine output increase from 5 mL/hr to 25 mL/hr
B. Pulse pressure decrease from 35 mm Hg to 28 mm Hg
C. Respiratory rate increase from 22 breaths/min to 26 breaths/min
D. Core body temperature increase from 98.2 F (36.8 C) to 98.8 F (37.1 C) - CORRECT ANSWERS
ANS: A
Rationale: During shock, the kidneys and baroreceptors sense an ongoing decrease in MAP and trigger
the release of renin, antidiuretic hormone (ADH), aldosterone, epinephrine, and norepinephrine to start
kidney compensation, which is very sensitive to changes in fluid volume. Renin, secreted by the kidney,
causes decreased urine output. ADH increases water reabsorption in the kidney, further reducing urine
output. These actions compensate for shock by attempting to prevent further fluid loss. This response is
so sensitive that urine output is a very good indicator of fluid resuscitation adequacy. If the therapy is
not effective, urine output does not increase.
Which laboratory finding should cause the nurse to suspect that a patient is developing hypovolemic
shock?
1. Serum sodium of 130 mEq/L (130 mmol/L)
2. Metabolic acidosis validated by arterial blood gases
3. Serum lactate of 3 mmol/L
4. SvO2 greater than 80% - CORRECT ANSWERS Correct Answer: 2
Rationale 1: The sodium level in hypovolemic shock is elevated above the normal values of 135 to 145
mEq/L, not reduced.
Rationale 2: Metabolic acidosis is present due to an accumulation of carbonic acid, leaving a bicarbonate
deficit from decreased tissue perfusion.
Rationale 3: Serum lactate is greater than 4 mmol/L as a result of tissue ischemia, hypoxia, and
breakdown from decreased blood flow with hypovolemic shock.
Rationale 4: SvO2 (mixed venous oxygen saturation) would be less than 60% due to decreased
circulating blood volume or decrease in cells to carry the oxygen. Therefore, O2 is carried less efficiently
and decreased, not increased.
Critical Care, Sepsis NCLEX, Ch 67: shock, SIRS, MODS
EXAM QUESTIONS VERIFIED ANSWERS LATEST
UPDATE 2025/2026 RATED A+
A patient is admitted to the emergency department after sustaining abdominal injuries and a broken
femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently. Vital
signs upon admission are temperature 98 F (36 C), heart rate 130 beats/minute, respiratory rate 34
breaths/minute, blood pressure 50/40 mmHg. The healthcare provider suspects which type of shock?
a.) Hypovolemic
b.) Cardiogenic
c.) Neurogenic
d.) Distributive - CORRECT ANSWERS a.) Hypovolemic
1. A patient with septic shock has a urine output of 20 mL/hr for the past 3 hours. The pulse
rate is 120 and the central venous pressure and pulmonary artery wedge pressure are low.
Which of these orders by the health care provider will the nurse question?
a. Give furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 150 mL/hr.
c. Administer hydrocortisone (SoluCortef) 100 mg IV.
d. Prepare to give drotrecogin alpha (Xigris) 24 mcg/kg/hr. - CORRECT ANSWERS ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient
with septic shock. The other orders are appropriate.
DIF: Cognitive Level: Application REF: 1724-1726 | 1731 | 1733
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
,What will the nurse identify as symptoms of hypovolemic shock in a patient?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Temperature of 97.6°F (36.4°C)
2. Restlessness
3. Decrease in blood pressure of 20 mm Hg when the patient sits up
4. Capillary refill time greater than 3 seconds
5. Sinus bradycardia of 55 beats per minute - CORRECT ANSWERS Correct Answer: 2,3,4
Rationale 1: Fever will increase oxygen demands but is unrelated to hypovolemic shock unless
prolonged fever has caused severe dehydration, reducing the circulating blood volume. Hypovolemic
shock reduces temperatures by peripheral shunting of blood away from the extremities and reducing
the core metabolic rate.
Rationale 2: Due to decreased blood flow to the brain and peripheral areas when blood is shunted to
maintain the vital organs, cerebral hypoxia occurs, leading to a change in mental status.
Rationale 3: Orthostatic hypotension is a manifestation of hypovolemic shock.
Rationale 4: Due to decreased blood flow to the brain and peripheral areas when blood is shunted to
maintain the vital organs, capillary refill time will be reduced.
Rationale 5: Bradycardia is not present. The compensatory response is to increase the heart rate to
circulate the blood faster to make up for the fluids that are not present in hypovolemic shock.
Why are the manifestations of most types of shock the same regardless of what specific events or
condition caused the shock to occur?
A. The blood, blood vessels, and heart are directly connected to each other so that when one is affected,
all three are affected.
B. Because blood loss occurs with all types of shock, the most common first manifestation is
hypotension.
C. Every type of shock interferes with oxygenation and metabolism of all cells in the same sequence.
D. The sympathetic nervous system is triggered by any type of shock and initiates the stress response. -
CORRECT ANSWERS ANS: D
,Rationale: Most manifestations of shock are similar regardless of what starts the process or which
tissues are affected first. These common manifestations result from physiologic adjustments
(compensatory mechanisms) in an attempt to ensure continued oxygenation of vital organs. These
adjustment actions are performed by the sympathetic nervous system triggering the stress response and
activating the endocrine and cardiovascular systems.
2. A patient with shock of unknown etiology whose hemodynamic monitoring indicates BP
92/54, pulse 64, and an elevated pulmonary artery wedge pressure has the following
collaborative interventions prescribed. Which intervention will the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Give nitroprusside (Nipride) unless systolic BP <90 mm Hg.
d. Administer dobutamine (Dobutrex) to keep systolic BP >90 mm Hg. - CORRECT ANSWERS
ANS: A
The patient's elevated pulmonary artery wedge pressure indicates volume excess. A
normal saline infusion at 250 mL/hr will exacerbate this. The other actions are
appropriate for the patient.
DIF: Cognitive Level: Application REF: 1719 | 1721-1722 | 1735
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The patient's
central venous pressure (CVP) reading is 2, blood pressure is 90/50 mmHg, lung sounds are clear, and
jugular veins are flat. Which of these actions is most appropriate for the nurse to take?
a.) Slow the IV infusion rate
b.) Administer dopamine
c.) No interventions are needed at this time
d.) Increase the IV infusion rate - CORRECT ANSWERS d.) Increase the IV infusion rate
, Which vital sign change in a client with hypovolemic shock indicates to the nurse that the therapy is
effective?
A. Urine output increase from 5 mL/hr to 25 mL/hr
B. Pulse pressure decrease from 35 mm Hg to 28 mm Hg
C. Respiratory rate increase from 22 breaths/min to 26 breaths/min
D. Core body temperature increase from 98.2 F (36.8 C) to 98.8 F (37.1 C) - CORRECT ANSWERS
ANS: A
Rationale: During shock, the kidneys and baroreceptors sense an ongoing decrease in MAP and trigger
the release of renin, antidiuretic hormone (ADH), aldosterone, epinephrine, and norepinephrine to start
kidney compensation, which is very sensitive to changes in fluid volume. Renin, secreted by the kidney,
causes decreased urine output. ADH increases water reabsorption in the kidney, further reducing urine
output. These actions compensate for shock by attempting to prevent further fluid loss. This response is
so sensitive that urine output is a very good indicator of fluid resuscitation adequacy. If the therapy is
not effective, urine output does not increase.
Which laboratory finding should cause the nurse to suspect that a patient is developing hypovolemic
shock?
1. Serum sodium of 130 mEq/L (130 mmol/L)
2. Metabolic acidosis validated by arterial blood gases
3. Serum lactate of 3 mmol/L
4. SvO2 greater than 80% - CORRECT ANSWERS Correct Answer: 2
Rationale 1: The sodium level in hypovolemic shock is elevated above the normal values of 135 to 145
mEq/L, not reduced.
Rationale 2: Metabolic acidosis is present due to an accumulation of carbonic acid, leaving a bicarbonate
deficit from decreased tissue perfusion.
Rationale 3: Serum lactate is greater than 4 mmol/L as a result of tissue ischemia, hypoxia, and
breakdown from decreased blood flow with hypovolemic shock.
Rationale 4: SvO2 (mixed venous oxygen saturation) would be less than 60% due to decreased
circulating blood volume or decrease in cells to carry the oxygen. Therefore, O2 is carried less efficiently
and decreased, not increased.
