Cardiogenic shock NCLEX questions for nursing students!
This quiz will test your knowledge on cardiogenic shock. Cardiogenic shock occurs when the heart has experienced some type of injury that leads the heart to pump insufficiently. This causes the cardiac output to fall below the parameters needed to maintain tissue perfusion. This leads to cell hypoxia and eventually multiple organ dysfunction syndrome (MODS) and death.
Don’t forget to watch the lecture on cardiogenic shock before taking the quiz.
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Cardiogenic Shock NCLEX Questions
1. A patient is being treated for cardiogenic shock. Which statement below best describes this condition? Select all that apply:
A. “The patient will experience an increase in cardiac output due to an increase in preload and afterload.”
B. “A patient with this condition will experience decreased cardiac output and decreased tissue perfusion.”
C. “This condition occurs because the heart has an inadequate blood volume to pump.”
D. “Cardiogenic shock leads to pulmonary edema.”
The answers are: B and D. Cardiogenic shock occurs when the heart can NOT pump enough blood to meet the perfusion needs of the body. The cardiac output will be DECREASED, which will DECREASE tissue perfusion and cause cell injury to organs/tissues. In this condition, the heart is WEAK and can’t pump blood out of the heart. This can be due to either a systolic (contraction) or diastolic (filling) issue along with a structural or dysrhythmia issue. In cardiogenic shock, there is NOT an issue with blood volume, but there is a problem with the heart itself.
2. Cardiac output is very important for determining if a patient is in cardiogenic shock. What is a normal cardiac output in an adult?
A. 2-5 liters/minute
B. 1-3 liters/minute
C. 4-8 liters/minute
D. 8-10 liters/minute
The answer is C. Cardiac output is the amount of blood the heart pumps per minute. The heart’s cardiac output should be anywhere from 4-8 liters of blood per minute.
3. ________________ is the amount the ventricle stretches at the end of diastole.
C. Stroke Volume
The answer is A. Preload is the amount the ventricle stretches at the end of diastole (hence it’s the amount the ventricles stretches once it’s filled with blood and right before the contraction of the ventricle ….so it’s the end-diastolic volume).
4. Cardiac output is equal to the heart rate multiplied by the stroke volume. Treatment for cardiogenic shock includes medications that increase cardiac output. One of the factors that help determine cardiac output is stroke volume. Select all the factors that determine stroke volume?
A. Cardiac Index
C. Pulmonary capillary wedge pressure
E. Heart rate
The answers are B, D, and F. Cardiac output is determined by the person’s heart rate times the stroke volume. Stroke volume is the amount of blood pumped from the left ventricle with each BEAT (50-100 ml). It’s determined by the preload, afterload, and contractility of the heart. These factors in a patient with cardiogenic shock can be manipulated with medications to increase the cardiac output.
5. _____________ is the force the heart has to pump against to get blood out of the ventricle.
A. Cardiac output
B. Cardiac index
The answer is D. Afterload is the pressure the ventricle must pump against to squeeze blood out. In other words, it’s the force the heart has to pump against to get blood out of the ventricle.
6. True or False: If a patient with cardiogenic shock is given a medication that will decrease cardiac afterload, it will decrease stroke volume.
The answer is FALSE. If a patient with cardiogenic shock is given a medication that will decrease cardiac afterload, it will INCREASE (not decrease) stroke volume. HOW? Remember afterload is the resistance the ventricle must pump against to get blood out of the heart. If we DECREASE the resistance the heart must pump against (make it easier for the heart squeeze blood out of the ventricle), it will increase how much blood it will pump out, hence increase the stroke volume.
7. Which patient below is at MOST risk for developing cardiogenic shock?
A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish.
B. A 25-year-old female who has experienced an upper thoracic spinal cord injury.
C. A 72-year-old male who is post-op from a liver transplant.
D. A 49-year-old female who is experiencing an acute myocardial infarction.
The answer is D. An acute MI (heart attack) is the main cause of cardiogenic shock. It happens because a coronary artery has become blocked. Coronary arteries supply the heart muscle’s cells with oxygenated blood. If they don’t receive this oxygenated blood they will die, which causes the heart muscle to quit working (hence pumping efficiently). When the heart muscle fails to pump efficiently, cardiac output fails and cardiogenic shock occur.
8. You’re caring for a patient with cardiogenic shock. Which finding below suggests the patient’s condition is worsening? Select all that apply:
A. Blood pressure 95/68
B. Urinary output 20 mL/hr
C. Cardiac Index 3.2 L/min/m2
D. Pulmonary artery wedge pressure 30 mmHg
The answer is B and D. When answering this question look for values that are abnormal and that point to worsening tissue perfusion (urinary output should be 30 mL/hr or greater….if it’s lower than this it show the kidneys are not being perfused) and worsening cardiac output (the blood pressure and cardiac index are within normal limits BUT pulmonary artery wedge pressure is NOT). A pulmonary artery wedge pressure (also called pulmonary capillary wedge pressure) is the pressure reading of the filling pressure in the left atrium. A normal PAWP is 4-12 mmHg and if it’s >18 mmHg this indicates cardiogenic shock. If it reads high, that means there is back-flowing of blood into the heart and lungs (hence the left ventricle is failing to pump efficiently and increasing the pressure in the left atrium).
9. A patient with cardiogenic shock has a blood pressure of 70/38. In addition, the patient is experiencing dyspnea with a respiratory rate of 32 breaths per minute and has an oxygen saturation of 82% on room air. On auscultation, you note crackles throughout the lung fields. You notify the physician. What order below would you ask for an order clarification?
A. Dopamine IV stat
B. Normal saline IV bolus stat
C. Furosemide IV stat
D. Place patient on CPAP (continuous positive airway pressure)
The answer is B. This patient with cardiogenic shock is experiencing a decrease in cardiac output (hence the blood pressure), so an order for Dopamine can help provide a positive inotropic effect (increase the contractility of the heart which will increase stroke volume and cardiac output). The patient is also experiencing pulmonary congestion due to the cardiogenic shock. The heart is failing to pump blood forward, so it is backing up in the lungs. This is leading to an increased respiratory rate, dyspnea, and low oxygen saturation. The order for Furosemide (which is a diuretic) will help remove the extra fluid volume from the lungs and the CPAP (continuous positive airway pressure) will help with oxygenation. The nurse would question the order for a normal saline IV bolus. This bolus would add more fluid to the lungs and further congest the fluids.
10. You’re assessing your patient with cardiogenic shock, what signs and symptoms do you expect to find in this condition? Select all that apply:
A. Warm, flushed skin
B. Prolonged capillary refill
C. Urinary output >30 mL/hr
D. Systolic blood pressure <90 mmHg
E. Crackles in lung fields
D. Decreased BUN and creatinine
G. Strong peripheral pulses
H. Chest pain
The answers are B, D, E, F, and H. Signs and symptoms of cardiogenic shock will be related to LOW cardiac output and decreased perfusion to organs/tissues. Capillary refill will be prolonged >2 seconds, urinary output will be <30 mL/hr, systolic blood pressure will be <90 mmHg, pulmonary edema will present with fluid in the lungs (hence crackles in the lungs), dyspnea, and chest pain (due to decreased blood flow to the heart muscle).
11. A patient is receiving treatment for an acute myocardial infarction. The nurse is closely monitoring the patient for signs and symptoms associated with cardiogenic shock. Which value below is associated with cardiogenic shock?
A. Cardiac index 1.5 L/min/m2
B. Pulmonary capillary wedge pressure (PCWP) 10 mmHg
C. Central venous pressure (CVP) 4 mmHg
D. Troponin <0.01 ng/mL
The answer is A. A patient who has experienced an acute myocardial infarction is at risk for cardiogenic shock. A normal cardiac index should be 2.5-4 L/min/m2. Cardiac index is the specific cardiac output based on the patient’s size. Any number less than 2.2 L/min/m2 can be associated with cardiogenic shock. All the other values are within normal limits. PCWP would be >18 mmHg in cardiogenic shock, and CVP would be high.
12. A patient who has cardiogenic shock is experiencing labored breathing and low oxygen levels. A STAT chest x-ray is ordered. The x-ray results show pulmonary edema. The physician orders Furosemide IV. What finding would require immediate nursing action?
A. Blood pressure 98/54
B. Urinary output 45 mL/hr
C. Potassium 1.8 mEq/L
D. Heart rate 110 bpm
The answer is C. Furosemide (Lasix) is a diuretic which wastes potassium. The nurse would want to ensure the potassium level is normal (3.5 to 5 mEq/L) before administering IV Furosemide. The nurse would need to notify the physician of the potassium level so supplementation can be provided.
13. They physician orders a Dobutamine IV drip on a patient in cardiogenic shock. After starting the IV drip, the nurse would make it priority to monitor for?
A. Rebound hypertension
B. Ringing in the ears
C. Worsening hypotension
D. severe headache
The answer is C. Dobutamine increases contractility and cardiac output, BUT causes vasodilation due to the way it acts on receptors and this may make hypotension WORSE. The patient may be started on norepinephrine or dopamine if worsening of hypotension occurs.
14. Which medications below are used in cardiogenic shock that provide a positive inotropic effect on the heart? Select all that apply:
B. Sodium Nitroprussidde
The answers are C and E. Dobutamine and Dopamine are vasopressors that have a POSITIVE inotropic effect on the heart. This means these medications increase the strength of the heart’s contractions (increases contractility), which increases stroke volume.
15. A patient with cardiogenic shock has an intra-aortic balloon pump. As the nurse you know that during ________ the balloon deflates and during _____ the balloon inflates in a section of the aorta.
A. systole, diastole
B. diastole, systole
C. inspiration, expiration
D. expiration, inspiration
The answer is A. An intra-aortic balloon pump is a balloon attached to the catheter inside a section of the aorta. It will inflate and deflate during systole (contraction) and diastole (relaxation). When the balloon deflates during systole it creates a suction-like pressure that will draw blood out of the weak heart and into the coronary arteries and systemic circulation (hence increasing cardiac output and blood supply to the heart muscle). When the balloon inflates during diastole it will create pressure that will push blood into the coronary arteries (hence further increasing blood supply to the heart muscle).
16. You’re precepting a new nurse. You ask the new nurse to list the purpose of why a patient with cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the new nurse understands the purpose of an intra-aortic balloon pump? Select all that apply:
A. “This device increases the cardiac afterload, which will increase cardiac output.”
B. “This device will help increase blood flow to the coronary arteries.”
C. “The balloon pump will help remove extra fluid from the heart and lungs.”
D. “The balloon pump will help increase cardiac output.”
The answers are B and D. An intra-aortic balloon pump increases coronary artery blood flow and cardiac output.
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