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Shock Nursing NCLEX Questions Quiz

Shock NCLEX questions for nursing students!

This quiz will test your knowledge of shock, including the different types, stages, signs and symptoms, and nursing interventions. Shock occurs when there is inadequate tissue perfusion, meaning the body’s cells are not receiving enough oxygen and nutrients to function properly. If shock is not treated, cellular hypoxia can lead to organ dysfunction, multiple organ dysfunction syndrome (MODS), and death.

There are several types of shock, including hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic shock. Each type of shock has different causes, assessment findings, and treatment priorities that nurses must understand.

Don’t forget to watch the lecture on shock (coming soon) before taking the quiz.

Shock Nursing NCLEX Questions Quiz

1. You’re working on a neuro unit. Which of the patients below are at risk for developing neurogenic shock? Select all that apply:(Required)
2. You’re providing care to a patient experiencing neurogenic shock due to an injury at T4. As the nurse, you know which of the following is a patient safety priority?(Required)
3. A patient in neurogenic shock is ordered intravenous fluids due to severe hypotension. During administration of the fluids, the nurse will monitor the patient closely and immediately report which finding?(Required)
4. Your patient is having a sudden and severe anaphylactic reaction to a medication. You immediately stop the medication and call a rapid response. The patient's blood pressure is 80/52, heart rate 120 bpm, and oxygen saturation 87%. Audible wheezing is noted along with facial redness and swelling. As the nurse, you know the first-line treatment for this patient's condition is:(Required)
5. Your patient is started on an IV antibiotic to treat a severe infection. During the infusion, the patient uses the call light to report a tight sensation in the throat that is making it difficult to breathe. You immediately assess the patient. While auscultating the lungs, you note wheezing. You also notice the patient is scratching the face and arms, and on closer inspection you observe redness and swelling that extends from the face down to the neck and torso. The patient's vital signs are blood pressure 89/62, heart rate 118 bpm, and oxygen saturation 88% on room air. You suspect anaphylactic shock. Select all the appropriate interventions for this patient:(Required)
6. A patient is having an anaphylactic reaction to an IV medication. What is the FIRST action the nurse should take?(Required)
7. What is the BEST position for a patient in anaphylactic shock?(Required)
8. Your patient, who is post-op from gastrointestinal surgery, is presenting with a temperature of 103.6°F, heart rate 120 bpm, blood pressure 72/42, an increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply:(Required)
9. A patient with a fever is lethargic and has a blood pressure of 89/56. The patient's white blood cell count is elevated. The physician suspects the patient is developing septic shock. What other findings indicate this patient is in the "early" or "compensated" stage of septic shock? Select all that apply:(Required)
10. The physician orders a patient in septic shock to receive a large IV fluid bolus. How would the nurse know if this treatment was successful for this patient?(Required)
11. A patient in septic shock is experiencing hyperglycemia. The patient is started on an insulin drip. A blood glucose goal for this patient would be:(Required)
12. If a patient has a blood volume of 5 liters and loses 2 liters, what percentage of blood volume has the patient lost?(Required)
13. One of your patients begins to vomit large amounts of bright red blood. The patient is taking warfarin. You call a rapid response. Which assessment findings indicate this patient is developing hypovolemic shock? Select all that apply:(Required)
14. You're providing care to a patient who has experienced a 45% loss of fluid volume and is experiencing hypovolemic shock. The patient has hemodynamic monitoring, and fluid resuscitation is being attempted. Which finding indicates the patient is still in hypovolemic shock?(Required)
15. A 35-year-old male arrives in the emergency room with multiple long bone fractures and an internal abdominal injury. The patient is anxious. Vital signs are blood pressure 70/54, heart rate 125 bpm, respirations 30, oxygen saturation 96% on 2 L nasal cannula, temperature 99.3°F, and pain rated 6 on a 1–10 scale. During assessment, the patient's skin is cool and clammy. The nurse will make it a priority to:(Required)
16. Which patient below is at MOST risk for developing cardiogenic shock?(Required)
17. You're caring for a patient with cardiogenic shock. Which finding below suggests the patient's condition is worsening? Select all that apply:(Required)
18. 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. Which order below would you question?(Required)
19. 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 IV furosemide. What finding would require immediate nursing action?(Required)
20. Cardiac output is very important for determining if a patient is in cardiogenic shock. What is a normal cardiac output in an adult?(Required)
21. A patient is in hypovolemic shock. Select all the stages that a patient can enter when in shock:(Required)
22. You’re caring for a patient who is experiencing shock. Which lab result below demonstrates that the patient’s cells are using anaerobic metabolism?(Required)
23. During what stage of shock is the body unable to compensate for tissue perfusion, and the body's cells begin to experience hypoxic injury that results in __________ capillary permeability?(Required)
24. Based on this scenario, what stage of shock is this patient most likely experiencing? A 74-year-old patient is extremely confused and does not respond to commands or stimulation. The patient's respiratory rate is 28 and labored, oxygen saturation is 86%, heart rate is 120 bpm, blood pressure is 70/40, mean arterial pressure (MAP) is 50 mmHg, and temperature is 97°F. The patient’s heart rhythm is atrial fibrillation. The patient’s urinary output is 5 mL/hr. The patient’s labs show: blood pH 7.15, serum lactate 15 mmol/L, BUN 55 mg/dL, and creatinine 6 mg/dL. In addition, the patient is starting to have slight oozing of blood around puncture sites.(Required)

Shock NCLEX Questions

  1. You’re working on a neuro unit. Which of the patients below are at risk for developing neurogenic shock? Select all that apply:

A. A 36-year-old with a spinal cord injury at L4.

B. A 42-year-old who has spinal anesthesia.

C. A 25-year-old with a spinal cord injury above T6.

D. A 55-year-old patient who is reporting seeing green halos while taking digoxin.

The answers are B and C. Patients with a cervical or upper thoracic (above T6) spinal cord injury, those receiving spinal anesthesia, or those taking medications that affect the autonomic or sympathetic nervous system are at risk for developing neurogenic shock.

  1. You’re providing care to a patient experiencing neurogenic shock due to an injury at T4. As the nurse, you know which of the following is a patient safety priority?

A. Keeping the head of the bed greater than 45 degrees at all times.

B. Repositioning the patient every thirty minutes.

C. Keeping the patient’s spine immobilized.

D. Avoiding log-rolling the patient during transport.

The answer is C. It is very important to protect the spine when a patient has a spinal cord injury. The nurse wants to prevent further damage or perfusion issues to the spinal cord. Therefore, the patient’s spine should be immobilized. Examples include using a cervical collar, log-rolling the patient, and using a backboard.

  1. A patient in neurogenic shock is ordered intravenous fluids due to severe hypotension. During administration of the fluids, the nurse will monitor the patient closely and immediately report which finding?

A. Increase in blood pressure

B. High central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP)

C. Urinary output of 300 mL in the past 5 hours

D. Mean arterial pressure (MAP) of 85 mmHg

The answer is B. Option B indicates fluid volume overload. Remember that patients in neurogenic shock usually have a normal blood volume. If fluids are ordered to help increase blood pressure, they should be used with extreme caution because fluid overload can occur. An increase in the CVP and PAWP would indicate this, as these pressures reflect the heart’s filling pressures.

  1. Your patient is having a sudden and severe anaphylactic reaction to a medication. You immediately stop the medication and call a rapid response. The patient’s blood pressure is 80/52, heart rate 120 bpm, and oxygen saturation 87%. Audible wheezing is noted along with facial redness and swelling. As the nurse, you know the first-line treatment for this patient’s condition is:

A. IV Diphenhydramine

B. IV Normal Saline Bolus

C. IM Epinephrine

D. Nebulized Albuterol

The answer is C. IM or subcutaneous epinephrine is the first-line treatment for anaphylaxis. Epinephrine causes vasoconstriction (which increases blood pressure and decreases swelling) and bronchodilation (which dilates the airways). This patient’s cardiovascular and respiratory systems are compromised; therefore, epinephrine provides rapid relief during anaphylaxis.

  1. Your patient is started on an IV antibiotic to treat a severe infection. During the infusion, the patient uses the call light to report a tight sensation in the throat that is making it difficult to breathe. You immediately assess the patient. While auscultating the lungs, you note wheezing. You also notice the patient is scratching the face and arms, and on closer inspection you observe redness and swelling that extends from the face down to the neck and torso. The patient’s vital signs are blood pressure 89/62, heart rate 118 bpm, and oxygen saturation 88% on room air. You suspect anaphylactic shock. Select all the appropriate interventions for this patient:

A. Slow down the antibiotic infusion

B. Call a Rapid Response

C. Place the patient on oxygen

D. Prepare for the administration of Epinephrine

The answers are B, C, and D. Option A is incorrect because the nurse should stop the infusion, not slow it down, since it may be causing the anaphylactic reaction. The nurse should call a rapid response, place the patient on oxygen, and prepare to administer epinephrine. Epinephrine is the first-line treatment for anaphylactic shock because it increases blood pressure, decreases swelling, and dilates the airways.

  1. A patient is having an anaphylactic reaction to an IV medication. What is the FIRST action the nurse should take?

A. Administer Epinephrine

B. Call a Rapid Response

C. Stop the medication

D. Administer a breathing treatment

The answer is C. The first step is to immediately remove the allergen by stopping the medication. Then, call a rapid response. The nurse should maintain the airway and begin CPR, if needed, until help arrives.

  1. What is the BEST position for a patient in anaphylactic shock?

A. Lateral recumbent

B. Supine with legs elevated

C. High Fowler’s

D. Semi-Fowler’s

The answer is B. This position increases venous return to the heart, which helps increase cardiac output and blood pressure.

  1. Your patient, who is post-op from gastrointestinal surgery, is presenting with a temperature of 103.6°F, heart rate 120 bpm, blood pressure 72/42, an increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT. Which findings below indicate that the patient is progressing to septic shock? Select all that apply:

A. Blood pressure of 70/34 after the fluid bolus

B. Serum lactate less than 2 mmol/L

C. Patient needs norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement

D. Central venous pressure (CVP) of 18

The answers are A and C. To determine if the patient is progressing to septic shock, think about the hallmark findings associated with this condition. Septic shock is characterized by persistent hypotension (SBP <90 mmHg) that does not respond to IV fluids (refractory hypotension). The patient requires vasopressors (such as norepinephrine) to maintain a MAP greater than 65 mmHg, and the serum lactate is greater than 2 mmol/L. A serum lactate greater than 2 indicates the tissues and organs are not receiving enough oxygen because tissue perfusion is poor due to hypotension. A CVP of 18 mmHg is elevated (normal is 2–8 mmHg). This indicates fluid overload, not progression to septic shock.

  1. A patient with a fever is lethargic and has a blood pressure of 89/56. The patient’s white blood cell count is elevated. The physician suspects the patient is developing septic shock. What other findings indicate this patient is in the “early” or “compensated” stage of septic shock? Select all that apply:

A. Urinary output of 60 mL over 4 hours

B. Warm and flushed skin

C. Tachycardia

D. Bradypnea

The answers are B and C. In the early (compensated) stage of septic shock, the patient is in a hyperdynamic state. This differs from other types of shock, such as hypovolemic or cardiogenic shock, where vasoconstriction occurs. In septic shock, vasodilation occurs, leading to warm, flushed skin during the early stage. In the late stage, however, the skin becomes cool and clammy. Tachycardia and tachypnea (not bradypnea) also occur early as compensatory mechanisms. Oliguria (Option A) occurs during the late or uncompensated stage when the kidneys begin to fail.

  1. The physician orders a patient in septic shock to receive a large IV fluid bolus. How would the nurse know if this treatment was successful for this patient?

A. The patient’s blood pressure changes from 75/48 to 110/82.

B. Patient’s CVP of 2 mmHg

C. Patient’s skin is warm and flushed.

D. Patient’s urinary output is 20 mL/hr.

The answer is A. In septic shock, the initial treatment is to improve tissue perfusion with IV fluids. If fluids do not increase blood pressure and maintain perfusion, vasopressors are used next. In septic shock, increased capillary permeability causes fluid to leak from the intravascular space, leading to hypovolemia. This decreases blood pressure and reduces blood flow to the tissues and organs. An increase in blood pressure to a normal range indicates the IV fluids are effective.

  1. A patient in septic shock is experiencing hyperglycemia. The patient is started on an insulin drip. A blood glucose goal for this patient would be:

A. <110 mg/dL

B. <80 mg/dL

C. >200 mg/dL

D. <180 mg/dL

The answer is D. If a patient is experiencing hyperglycemia, an insulin drip may be ordered to control blood glucose levels. Hyperglycemia impairs the immune system and delays healing. The blood glucose goal for this patient is less than 180 mg/dL.

  1. If a patient has a blood volume of 5 liters and loses 2 liters, what percentage of blood volume has the patient lost?

A. 25%

B. 40%

C. 30%

D. 10%

The answer is B. This patient has lost 40% of the total blood volume. Based on this amount of fluid loss, the patient would be in Class III (Stage III) hypovolemic shock. Class III occurs when blood volume loss is 30–40% (approximately 1,500–2,000 mL in an adult).

  1. One of your patients begins to vomit large amounts of bright red blood. The patient is taking warfarin. You call a rapid response. Which assessment findings indicate this patient is developing hypovolemic shock? Select all that apply:

A. Temperature 104.8°F

B. Heart rate 40 bpm

C. Heart rate 140 bpm

D. Anxiety, restlessness

E. Urinary output 15 mL/hr

F. Blood pressure 70/56

G. Pale, cool skin

H. Weak peripheral pulses

I. Blood pressure 220/106

The answers are C, D, E, F, G, and H. Signs and symptoms of hypovolemic shock include tachycardia, hypotension, an increased respiratory rate, cool, pale, clammy skin, anxiety, decreased urinary output (normal urine output is greater than 30 mL/hr), and weak peripheral pulses.

  1. You’re providing care to a patient who has experienced a 45% loss of fluid volume and is experiencing hypovolemic shock. The patient has hemodynamic monitoring, and fluid resuscitation is being attempted. Which finding indicates the patient is still in hypovolemic shock?

A. Low central venous pressure

B. High pulmonary artery wedge pressure

C. Elevated mean arterial pressure

D. Low systemic vascular resistance

The answer is A. Central venous pressure (CVP) measures the pressure in the right atrium and superior vena cava. When fluid volume is low, as in hypovolemic shock, the CVP is also low. This finding indicates the patient is still experiencing hypovolemic shock.

  1. A 35-year-old male arrives in the emergency room with multiple long bone fractures and an internal abdominal injury. The patient is anxious. Vital signs are blood pressure 70/54, heart rate 125 bpm, respirations 30, oxygen saturation 96% on 2 L nasal cannula, temperature 99.3°F, and pain rated 6 on a 1–10 scale. During assessment, the patient’s skin is cool and clammy. The nurse will make it a priority to:

A. Collect a urine sample

B. Obtain an EKG

C. Establish 2 large-bore IV access sites

D. Place a warming blanket on the patient

The answer is C. This patient is at high risk for hypovolemic shock due to multiple long bone fractures and an internal abdominal injury, which can lead to relative hypovolemic shock (where fluid is lost internally). The patient is already showing signs and symptoms of hypovolemic shock. Therefore, establishing IV access is a nursing priority. At least two large-bore IV sites (18-gauge or larger) should be obtained so fluids, blood products, pain medication, and other treatments can be administered rapidly.

  1. Which patient below is at MOST risk for developing cardiogenic shock?

A. A 52-year-old male who is experiencing a severe allergic reaction to 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 myocardial infarction (MI), or heart attack, is the leading cause of cardiogenic shock. It occurs when a coronary artery becomes blocked. The coronary arteries supply the heart muscle with oxygenated blood. Without adequate oxygen, the heart muscle begins to die, causing it to pump less efficiently. As the heart’s pumping ability decreases, cardiac output falls, leading to cardiogenic shock.

  1. 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 answers are B and D. When answering this question, look for findings that indicate worsening tissue perfusion and cardiac function. Urinary output should be 30 mL/hr or greater. If it is lower, it suggests the kidneys are not being adequately perfused. Although the blood pressure and cardiac index are within normal limits, the pulmonary artery wedge pressure (PAWP) is not. PAWP (also called pulmonary capillary wedge pressure) measures the filling pressure in the left atrium. A normal PAWP is 4–12 mmHg, and a value greater than 18 mmHg is consistent with cardiogenic shock. An elevated PAWP indicates blood is backing up into the heart and lungs because the left ventricle is failing to pump efficiently.

  1. 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. Which order below would you question?

A. Dopamine IV STAT

B. Normal saline IV bolus STAT

C. Furosemide IV STAT

D. Place the patient on CPAP (continuous positive airway pressure)

The answer is B. This patient with cardiogenic shock has decreased cardiac output, as evidenced by the low blood pressure. Dopamine can help increase cardiac contractility, which improves stroke volume and cardiac output. The patient is also experiencing pulmonary congestion because the heart is unable to pump blood forward effectively, causing blood to back up into the lungs. This results in dyspnea, crackles, an increased respiratory rate, and decreased oxygen saturation. Furosemide, a diuretic, helps remove excess fluid from the lungs, while CPAP improves oxygenation. The nurse should question the order for a normal saline IV bolus because it would add more fluid to the circulation and worsen pulmonary congestion.

  1. 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 IV furosemide. 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 that causes potassium loss. The nurse should ensure the potassium level is within the normal range (3.5–5.0 mEq/L) before administering IV furosemide. Because this patient’s potassium level is critically low, the nurse should notify the physician so potassium supplementation can be provided.

  1. 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 each minute. A normal adult cardiac output is 4–8 liters per minute.

  1. A patient is in hypovolemic shock. Select all the stages that a patient can enter when in shock:

A. Proliferative

B. Compensatory

C. Exudative

D. Initial

E. Progressive

F. Fibrotic

G. Refractory

The answers are B, D, E, and G. There are four stages of shock. They include (in order): Initial, Compensatory, Progressive, and Refractory.

  1. You’re caring for a patient who is experiencing shock. Which lab result below demonstrates that the patient’s cells are using anaerobic metabolism?

A. Ammonia 18 µ/dL

B. Potassium 4.5 mEq/L

C. Serum Lactate 9 mmol/L

D. Bicarbonate 23 mEq/L

The answer is C. A patient who is in shock will experience anaerobic metabolism because the cells can no longer use oxygen for energy due to decreased tissue perfusion. Remember, in shock, cardiac output is too low to adequately perfuse the cells of the organs and tissues.

Therefore, the cells attempt to compensate by switching from aerobic metabolism to anaerobic metabolism. However, this process creates a waste product called lactic acid. A normal serum lactate level is <1 mmol/L, and lactic acidosis is typically >4 mmol/L.

  1. During what stage of shock is the body unable to compensate for tissue perfusion, and the body’s cells begin to experience hypoxic injury that results in __ capillary permeability?

A. Refractory, increased

B. Exudative, decreased

C. Compensatory, increased

D. Progressive, increased

The answer is D. During the progressive stage of shock, the body can no longer compensate by utilizing the neural, hormonal, and biochemical responses that were activated during the previous compensatory stage.

As a result, the cells are no longer adequately perfused due to extremely low cardiac output. When cells are not perfused, they cannot survive and begin to experience hypoxic injury, which results in increased capillary permeability. The cell’s ion pumps begin to fail, leading to cell swelling and death.

As cells die, organ function begins to decline. If aggressive treatment is not implemented, the patient will progress to the final stage of shock: the refractory stage. This stage is considered irreversible.

  1. Based on this scenario, what stage of shock is this patient most likely experiencing?

A 74-year-old patient is extremely confused and does not respond to commands or stimulation. The patient’s respiratory rate is 28 and labored, oxygen saturation is 86%, heart rate is 120 bpm, blood pressure is 70/40, mean arterial pressure (MAP) is 50 mmHg, and temperature is 97°F. The patient’s heart rhythm is atrial fibrillation. The patient’s urinary output is 5 mL/hr. The patient’s labs show: blood pH 7.15, serum lactate 15 mmol/L, BUN 55 mg/dL, and creatinine 6 mg/dL. In addition, the patient is starting to have slight oozing of blood around puncture sites.

A. Initial

B. Proliferative

C. Progressive

D. Compensatory

The answer is C. This patient is experiencing the progressive stage of shock. There are four stages of shock (in order): initial, compensatory, progressive, and refractory.

This patient is experiencing major signs and symptoms of shock. These findings are not seen in the initial stage because the signs and symptoms are subtle. During the compensatory stage, the body can temporarily compensate, preventing major organ failure.

However, in this scenario, the kidneys are beginning to fail, as evidenced by the elevated BUN, elevated creatinine, and decreased urinary output. In addition, the body is no longer compensating because the blood pressure and MAP are significantly decreased.

A major finding is the patient’s altered mental status, which indicates decreased cerebral perfusion. The MAP should be 60 mmHg or greater to provide adequate organ perfusion. This patient’s MAP is 50 mmHg, indicating the body is not adequately perfusing the organs, causing the cells to experience hypoxic injury.

The patient is also showing early signs of DIC due to the oozing of blood around puncture sites. The next stage, which is the final stage, is refractory shock, where organ failure has occurred or is imminent and death is likely. This patient has not reached that stage yet but is approaching it. The patient requires immediate and aggressive treatment in order to survive.

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