Chapter 11 - Shock, Sepsis, and Multiple
Organ Dysfunction Syndrome EXAM
QUESTIONS VERIFIED ANSWERS
LATEST UPDATE 2025/2026 RATED A+
Fresh frozen plasma (FFP) is administered to replace:
A.clotting factors.
B.erythrocytes.
C.leukocytes.
D.platelets. - CORRECT ANSWERS A.clotting factors.
Fresh frozen plasma is administered to replace all clotting factors except platelets. Platelets are given
rapidly to help control bleeding caused by low platelet counts.
In distributive shock, the major physiological problem causing the shock is:
A.blood loss and actual hypovolemia.
B.decreased cardiac output.
C.third spacing of fluids into peritoneal space.
D.vasodilation and relative hypovolemia. - CORRECT ANSWERS D.vasodilation and relative
hypovolemia.
Distributive shock presents with widespread vasodilation and decreased systemic vascular resistance
that results in a relative hypovolemia. Blood loss is associated with hypovolemic shock. Decreased
cardiac output is a primary cause of cardiogenic shock. Primary internal sequestration of fluids that
causes internal fluid loss is associated with hypovolemic shock.
A primary goal in all shock states is to:
A.ensure adequate cellular hydration.
B.maintain adequate tissue perfusion.
,C.prevent third spacing of fluids.
D.support mechanical ventilation. - CORRECT ANSWERS B.maintain adequate tissue perfusion.
Care of a patient in shock is directed toward correcting or reversing the altered circulatory component
and reversing tissue hypoxia. Restoring circulating intravascular volume is the priority in improving
tissue perfusion and oxygen delivery.
The majority of cases of cardiogenic shock are caused by:
A.acute myocardial infarction.
B.myocardial depression in sepsis.
C.pulmonary embolism.
D.significant hypovolemia. - CORRECT ANSWERS A.acute myocardial infarction.
The most common cause of cardiogenic shock is an extensive left ventricular myocardial infarction.
Myocardial depression in sepsis is a secondary problem associated with the acidosis/anaerobic
metabolism of septic shock. Pulmonary embolism is a cause of obstructive shock. Fluid loss is the major
cause of hypovolemic shock.
When neurogenic shock occurs, interruption in sympathetic nerve impulses causes:
A.tachycardia.
B.hypertension.
C.hypoventilation.
D.vasodilation. - CORRECT ANSWERS D.vasodilation.
In neurogenic shock, there is an interruption of impulse transmission or blockage of sympathetic
outflow, resulting in vasodilation, inhibition of baroreceptor response, and impaired thermoregulation.
Interruption of sympathetic nerve innervation would result in bradycardia. Interruption of sympathetic
nerve innervation would result in hypotension. Hypoventilation is not a physiological mechanism.
Blood pooling in the capillary bed and arterial blood pressure too low to support perfusion of vital
organs cause:
A.acute respiratory distress syndrome (ARDS).
,B.disseminated intravascular coagulation (DIC).
C.increased cerebral perfusion pressure.
D.multisystem organ failure and/or dysfunction. - CORRECT ANSWERS D.multisystem organ
failure and/or dysfunction.
Maldistribution of blood flow refers to the uneven distribution of flow to various organs and pooling of
blood in the capillary beds. This impaired blood flow leads to impaired tissue perfusion and a decreased
oxygen supply to the cells, all of which contribute to multiple organ failure. Damage to the type II
pneumocytes leads to ARDS. Consumption of clotting factors may cause DIC. Low arterial blood pressure
leads to decreased cerebral perfusion pressure.
The nurse is caring for a patient admitted with severe sepsis. The physician orders include the
administration of large volumes of isotonic saline solution as part of early goal-directed therapy. Which
of the following best represents a therapeutic endpoint for goal-directed fluid therapy?
A.Central venous pressure > 8 mm Hg
B.Heart rate > 60 beats/min
C.Mean arterial pressure > 50 mm Hg
D.Serum lactate level > 6 mEq/L - CORRECT ANSWERS A.Central venous pressure > 8 mm Hg
Early goal-directed therapy includes administration of IV fluids to keep the central venous pressure at 8
mm Hg or greater. Additional therapeutic endpoints include a heart rate at less than 110 beats per
minute and a mean arterial blood pressure at 65 mm Hg or greater. Serum lactate levels are elevated in
sepsis; target levels should be < 2.2 mEq/L.
The nurse is admitting to the ICU a patient in early sepsis. What is the nurse's best understanding of the
patient's nutritional requirements?
A.Total parenteral nutrition is preferred.
B.Enteral nutrition initiated within the first 24 to 48 hours is critical.
C.The caloric needs of the patient in sepsis are significantly lower.
D.Early enteral feeding may lead to diarrhea, delaying wound healing. - CORRECT ANSWERS
B.Enteral nutrition initiated within the first 24 to 48 hours is critical.
Early enteral nutrition within 24 to 48 hours of admission to an intensive care unit is supported by
evidence and recommended in patients with severe sepsis, septic shock, or both. Enteral nutrition is the
, preferred route of administration, as this method assists the intestinal mucosa in maintaining its barrier
function. The caloric needs of a patient in sepsis are high and require increased caloric intake. Early
enteral feeding decreases diarrhea.
Which statement correctly represents hemodynamic values associated with the initial stages of septic
shock state?
A.Low heart rate; high blood pressure
B.High heart rate; low right atrial pressure
C.High PAOP; low cardiac output
D.High SVR; normal blood pressure - CORRECT ANSWERS B.High heart rate; low right atrial
pressure
In septic shock, inflammatory mediators damage the endothelial cells that line blood vessels, producing
profound vasodilation and increased capillary permeability. Initially this results in a high heart rate,
hypotension, and low SVR, and subsequently in low right atrial pressure.
Which statement correctly reflects crystalloid fluid replacement therapy in shock states?
A.Lactated Ringer's should not be infused if lactic acidosis is severe.
B.3 mL of crystalloid is administered to replace 10 mL of blood loss.
C.Administration of colloids is preferred over crystalloids.
D.Solutions of 0.45% normal saline are used routinely in shock - CORRECT ANSWERS
A.Lactated Ringer's should not be infused if lactic acidosis is severe.
LR solutions contain lactate, which the liver converts to bicarbonate. If liver function is normal, this will
counteract lactic acidosis. However, LR should not be infused if lactic acidosis is severe. Three mL of
crystalloid is administered to replace every 1 mL of blood loss. There is no evidence to support colloid
administration being more beneficial than crystalloid administration in shock states. Hypotonic solutions
such as 0.45% normal saline are not administered in shock states as these solutions rapidly leave the
intravascular space, causing interstitial and intracellular edema.
The nurse admits a patient to the coronary care unit in cardiogenic shock. The nurse anticipates
administering which medication in an effort to improve cardiac output?
A.Dopamine (Intropin)
Organ Dysfunction Syndrome EXAM
QUESTIONS VERIFIED ANSWERS
LATEST UPDATE 2025/2026 RATED A+
Fresh frozen plasma (FFP) is administered to replace:
A.clotting factors.
B.erythrocytes.
C.leukocytes.
D.platelets. - CORRECT ANSWERS A.clotting factors.
Fresh frozen plasma is administered to replace all clotting factors except platelets. Platelets are given
rapidly to help control bleeding caused by low platelet counts.
In distributive shock, the major physiological problem causing the shock is:
A.blood loss and actual hypovolemia.
B.decreased cardiac output.
C.third spacing of fluids into peritoneal space.
D.vasodilation and relative hypovolemia. - CORRECT ANSWERS D.vasodilation and relative
hypovolemia.
Distributive shock presents with widespread vasodilation and decreased systemic vascular resistance
that results in a relative hypovolemia. Blood loss is associated with hypovolemic shock. Decreased
cardiac output is a primary cause of cardiogenic shock. Primary internal sequestration of fluids that
causes internal fluid loss is associated with hypovolemic shock.
A primary goal in all shock states is to:
A.ensure adequate cellular hydration.
B.maintain adequate tissue perfusion.
,C.prevent third spacing of fluids.
D.support mechanical ventilation. - CORRECT ANSWERS B.maintain adequate tissue perfusion.
Care of a patient in shock is directed toward correcting or reversing the altered circulatory component
and reversing tissue hypoxia. Restoring circulating intravascular volume is the priority in improving
tissue perfusion and oxygen delivery.
The majority of cases of cardiogenic shock are caused by:
A.acute myocardial infarction.
B.myocardial depression in sepsis.
C.pulmonary embolism.
D.significant hypovolemia. - CORRECT ANSWERS A.acute myocardial infarction.
The most common cause of cardiogenic shock is an extensive left ventricular myocardial infarction.
Myocardial depression in sepsis is a secondary problem associated with the acidosis/anaerobic
metabolism of septic shock. Pulmonary embolism is a cause of obstructive shock. Fluid loss is the major
cause of hypovolemic shock.
When neurogenic shock occurs, interruption in sympathetic nerve impulses causes:
A.tachycardia.
B.hypertension.
C.hypoventilation.
D.vasodilation. - CORRECT ANSWERS D.vasodilation.
In neurogenic shock, there is an interruption of impulse transmission or blockage of sympathetic
outflow, resulting in vasodilation, inhibition of baroreceptor response, and impaired thermoregulation.
Interruption of sympathetic nerve innervation would result in bradycardia. Interruption of sympathetic
nerve innervation would result in hypotension. Hypoventilation is not a physiological mechanism.
Blood pooling in the capillary bed and arterial blood pressure too low to support perfusion of vital
organs cause:
A.acute respiratory distress syndrome (ARDS).
,B.disseminated intravascular coagulation (DIC).
C.increased cerebral perfusion pressure.
D.multisystem organ failure and/or dysfunction. - CORRECT ANSWERS D.multisystem organ
failure and/or dysfunction.
Maldistribution of blood flow refers to the uneven distribution of flow to various organs and pooling of
blood in the capillary beds. This impaired blood flow leads to impaired tissue perfusion and a decreased
oxygen supply to the cells, all of which contribute to multiple organ failure. Damage to the type II
pneumocytes leads to ARDS. Consumption of clotting factors may cause DIC. Low arterial blood pressure
leads to decreased cerebral perfusion pressure.
The nurse is caring for a patient admitted with severe sepsis. The physician orders include the
administration of large volumes of isotonic saline solution as part of early goal-directed therapy. Which
of the following best represents a therapeutic endpoint for goal-directed fluid therapy?
A.Central venous pressure > 8 mm Hg
B.Heart rate > 60 beats/min
C.Mean arterial pressure > 50 mm Hg
D.Serum lactate level > 6 mEq/L - CORRECT ANSWERS A.Central venous pressure > 8 mm Hg
Early goal-directed therapy includes administration of IV fluids to keep the central venous pressure at 8
mm Hg or greater. Additional therapeutic endpoints include a heart rate at less than 110 beats per
minute and a mean arterial blood pressure at 65 mm Hg or greater. Serum lactate levels are elevated in
sepsis; target levels should be < 2.2 mEq/L.
The nurse is admitting to the ICU a patient in early sepsis. What is the nurse's best understanding of the
patient's nutritional requirements?
A.Total parenteral nutrition is preferred.
B.Enteral nutrition initiated within the first 24 to 48 hours is critical.
C.The caloric needs of the patient in sepsis are significantly lower.
D.Early enteral feeding may lead to diarrhea, delaying wound healing. - CORRECT ANSWERS
B.Enteral nutrition initiated within the first 24 to 48 hours is critical.
Early enteral nutrition within 24 to 48 hours of admission to an intensive care unit is supported by
evidence and recommended in patients with severe sepsis, septic shock, or both. Enteral nutrition is the
, preferred route of administration, as this method assists the intestinal mucosa in maintaining its barrier
function. The caloric needs of a patient in sepsis are high and require increased caloric intake. Early
enteral feeding decreases diarrhea.
Which statement correctly represents hemodynamic values associated with the initial stages of septic
shock state?
A.Low heart rate; high blood pressure
B.High heart rate; low right atrial pressure
C.High PAOP; low cardiac output
D.High SVR; normal blood pressure - CORRECT ANSWERS B.High heart rate; low right atrial
pressure
In septic shock, inflammatory mediators damage the endothelial cells that line blood vessels, producing
profound vasodilation and increased capillary permeability. Initially this results in a high heart rate,
hypotension, and low SVR, and subsequently in low right atrial pressure.
Which statement correctly reflects crystalloid fluid replacement therapy in shock states?
A.Lactated Ringer's should not be infused if lactic acidosis is severe.
B.3 mL of crystalloid is administered to replace 10 mL of blood loss.
C.Administration of colloids is preferred over crystalloids.
D.Solutions of 0.45% normal saline are used routinely in shock - CORRECT ANSWERS
A.Lactated Ringer's should not be infused if lactic acidosis is severe.
LR solutions contain lactate, which the liver converts to bicarbonate. If liver function is normal, this will
counteract lactic acidosis. However, LR should not be infused if lactic acidosis is severe. Three mL of
crystalloid is administered to replace every 1 mL of blood loss. There is no evidence to support colloid
administration being more beneficial than crystalloid administration in shock states. Hypotonic solutions
such as 0.45% normal saline are not administered in shock states as these solutions rapidly leave the
intravascular space, causing interstitial and intracellular edema.
The nurse admits a patient to the coronary care unit in cardiogenic shock. The nurse anticipates
administering which medication in an effort to improve cardiac output?
A.Dopamine (Intropin)
