SHOCK: NCLEX REVIEW QUESTIONS

Question 1

A nurse educator is teaching a group of nurses about assessing critically ill clients for multiple organ dysfunction syndrome (MODS). The nurse educator evaluates understanding by asking the nurses to identify which client would be at highest risk for MODS. It would be the client who is experiencing septic shock and is

a) An older adult man with end-stage renal disease and an infected dialysis access site
b) An 8-year-old boy who underwent an appendectomy and then incurred an iatrogenic infection
c) A young female adolescent who developed shock from tampon use during menses
d) A middle-aged woman with metastatic breast cancer and a BMI of 26

1. MODS may develop when a client experiences what kind of shock?
2. Those at increased risk for MODS are (3)

Answer 1

An older adult man with end-stage renal disease and an infected dialysis access site

Explanation:
MODS may develop when a client experiences septic shock. Those at increased risk for MODS are

1. older clients,
2. clients who are malnourished, and
3. **clients with coexisting disease. **

Question 2

Which of the following is a clinical manifestation of cardiac tamponade?

a) Hypertension
b) Narrowing pulse pressure
c) Widening pulse pressure
d) Bradycardia

Answer 2

b) Narrowing pulse pressure

Pulse Pressure = Systolic - Diastolic

Question 3

Pulse Pressure = Systolic - Diastolic

1.

Answer 3

A high pulse pressure may be a strong predictor of heart problems and, especially for older adults, if your pulse pressure is greater than 60 it is considered a risk factor for cardiovascular disease. Generally, a pulse pressure greater than 40 mm Hg is abnormal.

A pulse pressure lower than 40 may mean you have poor heart function,

while a higher pulse pressure may mean your heart’s valves are leaky (valve regurgitation).

Question 4

A client has developed shock as the result of the MVA. His treatment is focused on preventing the development of more than one type of shock and to minimize the effects of the type of shock he is demonstrating. Which of the following is NOT a category of shock?

a) None of the options are correct
b) Hepatic
c) Circulatory
d) Cardiogenic

Answer 4

b) Hepatic

The main categories of shock are hypovolemic, circulatory/distributive, and cardiogenic, depending on the cause

Question 5

A nurse knows that the major clinical use of dobutamine (Dobutrex) is to:

a) increase cardiac output.
b) prevent sinus bradycardia.
c) treat hypertension.
d) treat hypotension.

1. Med to treat Sinus Bradycardia
2. Med to treat hypotension

Answer 5

a) increase cardiac output.

**Dobutamine increases cardiac output **for clients with acute heart failure and those undergoing cardiopulmonary bypass surgery.

1. Physicians may use epinephrine hydrochloride, another catecholamine agent, to treat sinus bradycardia.
2. Physicians use many of the catecholamine agents, including epinephrine, isoproterenol, and norepinephrine, to treat acute hypotension.

They don’t use catecholamine agents to treat hypertension because catecholamine agents may raise blood pressure.

Question 6

You are caring for a client in shock who is deteriorating. You are infusing IV fluids and giving medications as ordered. What type of medications are you most likely giving to this client?

a) Hormone antagonist drugs
b) Antimetabolite drugs
c) Adrenergic drugs
d) Anticholinergic drugs

Answer 6

Adrenergic drugs
Explanation:
Adrenergic drugs are the main medications used to treat shock. This makes options A, B, and D incorrect. (

Question 7

Choice Multiple question – Select all answer choices that apply.
Which of the following vasoactive medications may be used in the treatment of cardiogenic shock? Select all that apply.

a) Norepinephrine (Levophed)
b) Amrinone (Inocor)
c) Milrinone (Primacor)
d) Phenylephrine (Neo-Synephrine)
e) Vasopressin (Pitressin)

Answer 7

• Norepinephrine (Levophed)
• Milrinone (Primacor)
• Amrinone (Inocor)
Explanation:
Vasoactive agents that may be used in managing cardiogenic shock include

Levophed, Adrenalin, Primacor, Inocor, Pitressin, and Neo-Synephrine.

Each of these medications stimulates different receptors of the sympathetic nervous system. (less)

Question 8

A client is experiencing septic shock and infrequent bowel sounds. To ensure adequate nutrition, the nurse administers

a) A continuous infusion of total parenteral nutrition
b) Isotonic enteral nutrition every 6 hours
c) A full liquid diet
d) An infusion of crystalloids at an increased rate of flow

Answer 8

A continuous infusion of total parenteral nutrition
Explanation:
Nutritional supplementation is initiated within 24 hours of the start of septic shock. If the client has reduced peristalsis, then parenteral feedings will be required. Full liquid diet and enteral nutrition require the oral route and would be contraindicated if the client is experiencing decreased peristalsis. Increasing the rate of crystalloids does not provide adequate nutrition. (less

Question 9

Parenteral feedings

Port of entry (2)

Answer 9

1. Parenteral nutrition (PN) is feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulae that contain nutrients such as glucose, amino acids, lipids and added vitamins and dietary minerals. It is called total parenteral nutrition (TPN)
2. It may be called** peripheral parenteral nutrition** (PPN) when administered through vein access in a limb, rather than through a central vein.

Question 10

Which positioning strategy should be utilized for the patient diagnosed with hypovolemic shock?

a) Prone
b) Modified Trendelenburg
c) Supine
d) Semi-Fowler’s

Answer 10

Modified Trendelenburg
Explanation:
A modified Trendelenburg position is recommended in hypovolemic shock. **Elevation of the legs promotes the return of venous blood. **

Question 11

Which of the following colloids is expensive but rapidly expands plasma volume?

a) Lactated Ringer’s
b) Dextran
c) Hypertonic saline
d) Albumin

Answer 11

Albumin is a colloid that requires human donors, is limited in supply, and can cause congestive heart failure.

Dextran interferes with platelet aggregation and is not recommended for hemorrhagic shock.

Lactated Ringer’s and hypertonic saline are crystalloids, not colloids

Question 12

A confused client exhibits a blood pressure of 112/84, pulse rate of 116 beats per minute, and respirations of 30 breaths per minute. The client’s skin is cold and clammy. The nurse next

a) Administers oxygen by nasal cannula at 2 liters per minute
b) Contacts the admitting physician
c) Calls the Rapid Response Team
d) Re–assesses the vital signs

Answer 12

Administers oxygen by nasal cannula at 2 liters per minute
Explanation:
The client is exhibiting the compensatory stage of shock. The nurse performs all the listed options. The nurse needs to address physiological needs first by administering oxygen.

Question 13

Adrenergic drugs

1. Also called?
2. Stimulating which part of nervous system?
3. Neurotransmitter?
4. Name (3) life-threatening condtions when this neurotransmitter would be released?

Answer 13

Adrenergic drugs are also called adrenergic amines or sympathomimetic drugs. They are medicines that work by stimulating the sympathetic nervous system (SNS). The SNS is part of the automatic nervous system (ANS). It helps to regulate your body’s reaction to stress or an emergency. During these times, the SNS releases chemicals called neurotransmitters from the adrenal gland. These chemicals act on your body to increase heart rate, sweating, and breathing rate, and decrease digestion. The response by your body is sometimes called the “fight or flight” response.

Adrenergic drugs stimulate the same nerves by either mimicking the action of the neurotransmitter norepinephrine or stimulating its release. They are used for many life-threatening conditions. These include cardiac arrest, shock, or opening the airways during an asthma attack or allergic reaction.

Question 14

Which of the following is a clinical characteristic of neurogenic shock?

a) Bradycardia
b) Tachycardia
c) Moist skin
d) Cool skin

Answer 14

The clinical characteristics of neurogenic shock are signs of parasympathetic stimulation.

It is characterized by dry, warm skin rather than the cool, moist skin seen in hypovolemic shock.

Another characteristic is hypotension with bradycardia, rather than the tachycardia that characterizes other forms of shock.

Question 15

Neugenic Shock

1. Caused by?
2. s/s?

Answer 15

1. Blood flow to spinal column is compromised by injury
2. Hypotension, Bradycardia, Hypovolemia

Question 16

The ICU nurse is required to closely monitor four clients diagnosed with shock. During the shift assessment, the nurse documents the following values for the clients. Which client is most stable?

a) Client A: Heart rate 70 beats per minute, systolic blood pressure (BP) 100 mm Hg, urine output 30 mL/hour
b) Client B: Capillary refill time between 7 and 10 seconds, urine output 35 mL/hour
c) Client C: Heart rate 115 beats per minute, systolic BP 129 mm Hg, urine output 60 mL/hour
d) Client D: Capillary refill time between 5 and 6 seconds, urine output 30 mL/hour

Answer 16

Client C: Heart rate 115 beats per minute, systolic BP 129 mm Hg, urine output 60 mL/hour
Correct
Explanation:

1. The stability of the client’s condition is evidenced by a heart rate between 60 and 120 beats per minute,
2. systolic BP between 90 and 139 mm Hg,
3. urine output greater than 35 to 50 mL/hour, and capillary refill time between 2 and 3 seconds. Therefore, options A, B, and D are incorrect.

Question 17

Morphine sulfate has which of the following effects on the body?

a) Reduces preload
b) Increases afterload
c) No effect on preload or afterload
d) Increases preload

Does Morphine constrict or dilate blood vessels?

Answer 17

In addition to relieving pain, morphine dilates the blood vessels. This reduces the workload of the heart by both decreasing the cardiac filing pressure (preload) and reducing the pressure against which the heart muscle has to eject blood (afterload). (less)

Question 18

You are caring for a client with a stage IV leg ulcer. You are closely monitoring the client for sepsis. What would indicate that sepsis has occurred and that you should notify the physician of immediately?

a) The client’s heart rate is greater than 90 beats per minute.
b) The client feels restless and hungry.
c) The client’s respiratory rate is less than 20 breaths per minute.
d) The client exhibits an increased urinary output.

Answer 18

The client’s heart rate is greater than 90 beats per minute.
Explanation:
A heart rate greater than 90 beats per minute or a respiratory rate greater than 20 breaths per minute will indicate that sepsis has occurred.

Sepsis does not increase the client’s appetite or affect the client’s urinary output.