Stages of shock NCLEX questions for nursing students!
This quiz will test your knowledge on all the stages of shock. Shock occurs when the body has experienced some type of injury or severe infection that cause 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 shock before taking the quiz.
This quiz is part of an NCLEX review series.
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Stages of Shock NCLEX Questions
1. A patient is in hypovolemic shock. Select all the stages that a patient can enter when in shock:
The answers are: B, D, E, and G. There are FOUR stages of shock. They include (in order): Initial, Compensatory, Progressive, and Refractory.
2. During the __________ stage of shock, the signs and symptoms are very subtle. However, cells are experiencing _________ due to the lack of tissue perfusion, which causes the cells to switch from ___________ metabolism to _________ metabolism.
A. Proliferative, hyperoxia, anaerobic, aerobic
B. Initial, hypoxia, aerobic, anaerobic
C. Compensatory, hypoxia, anaerobic, aerobic
D. Fibrotic, hypoxia, aerobic, anaerobic
The answer is B. During the INITIAL stage of shock, the signs and symptoms are very subtle. However, cells are experiencing HYPOXIA (low oxygen), which causes the cells to switch from AEROBIC (with oxygen) metabolism to ANAEROBIC (without oxygen….there is none to really use) metabolism. This will produce a waste product called LACTIC ACID.
3. 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 the loss of tissue perfusion. Remember in shock, the cardiac output is too low to perfuse the cells of the organs and tissue. Therefore, the cells try to compensate by switching from aerobic metabolism to anaerobic, BUT this type of metabolism creates a waste-product called LACTIC ACID. A normal serum lactate is <1 mmol/L and lactic acidosis is >4 mmol/L.
4. During what stage of shock does the body attempt to utilize the hormonal, neural, and biochemical responses of the body?
The answer is D: the compensatory stage.
5. Which statements are INCORRECT about the compensatory stage of shock. Select all that apply:
A. This stage is reversible.
B. During this stage blood is shunted away from the kidneys, lungs, skin, and gastrointestinal system to the brain and heart.
C. During this stage blood flow to the kidneys is reduced, which causes the kidneys to activate the renin-angiotensin system, and this will lead to major vasodilation to the arterial and venous system.
D. One hallmark sign of this stage is that there is an increase in capillary permeability.
E. A patient is at risk for a paralytic ileus during this stage.
The answers are: C and D. These options reflect INCORRECT statements about the compensatory stages and all the other stages are TRUE about this stage. Option C is wrong because although the kidneys activate the RAS, this does NOT lead to vasodilation but VASOCONSTRICTION to the arterial and venous system. Option D is wrong because this is a hallmark sign in the PROGRESSIVE stage not compensatory.
6. During shock, when a patient experiences a drop in cardiac output, the body tries to compensate by stimulating the sympathetic nervous system, which causes the release of _________ and ________. This will lead to?
A. acetylcholine and dopamine, vasodilation
B. epinephrine and norepinephrine, vasodilation
C. dopamine and epinephrine, vasoconstriction
D. norepinephrine and epinephrine, vasoconstriction
The answer is D. When a patient in shock experiences a drop in blood pressure (due to a drop in cardiac output), the baroreceptors (in the carotid and aortic arch) will sense this and stimulate the sympathetic nervous system. The SNS will release the neurotransmitters NOREPINEPHRINE and EPINEPRHINE and this will lead to VASOCONSTRICTION. By causing constriction of the vessels, it will temporarily increase cardiac output by increase the blood pressure and heart rate, which will in turn increase perfusion to cells.
7. When the body is attempting to compensate for shock the adrenal cortex will release aldosterone due to the presence of angiotensin II. Select all the effects aldosterone will have on the body in attempt to increase cardiac output and maintain tissue perfusion:
A. Increase blood volume
B. Causes the kidneys to keep sodium and water
C. Causes the kidneys to excrete sodium and water
D. Cause the urine to have a low osmolality
The answers are A and B. Aldosterone will be released due to the presence of angiotensin II in the body (this is from the kidneys activating the renin-angiotensin system, which will cause major vasoconstriction in hopes of increasing blood pressure and cardiac output and hopefully perfusion to the kidneys). Aldosterone functions to cause the kidneys to KEEP sodium and water, which will INCREASE the blood volume. This will in turn increase the blood return to the heart and increase cardiac output. Because there will be a high amount of sodium in the urine, this will lead the urine to have a HIGH osmolality, which will cause the posterior pituitary gland to release ADH (anti-diuretic hormone). ADH will further cause the kidneys to keep water….in hopes of increasing blood volume even more.
8. During what stage of shock is the body unable to compensate for tissue perfusion and the body’s cell start to experience hypoxic injury that result 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 NOT compensate any longer by utilizing the neural, hormonal and biochemical responses of the body as it did in the previous stage (compensatory). Therefore, the cells are NO longer perfused due to extremely low cardiac output. When the cells are no longer perfused they can’t survive, so they experience HYPOXIC injury, and this results in INCREASED capillary permeability. The cell’s ion pump will fail and lead to cell swelling and death. All the organs (due to the death of their cells) will begin to fail, and if very dynamic treatment is not implemented the patient will enter the last stage of shock, which is the refractory stage. This stage is irreversible.
9. Select all the complications that can arise from the progressive stage of shock:
A. Acute respiratory distress syndrome
B. Extreme edema
C. Elevated ammonia and lactate levels
D. GI bleeding and ulcers
F. Myocardial infraction
G. Acute tubular necrosis
H. Disseminated intravascular clotting
ALL options are correct. All these conditions can occur in the progressive stage of shock. Please watch the lecture to review the progressive stage of shock.
10. TRUE or FALSE: All types of shock during the compensatory (early) stage will cause a patient to experience cold and clammy (moist or sweaty) skin.
FALSE: Patients who have septic shock will actually experience warm and flushed skin during the early (compensatory stage) because of the vasodilation occurring with this type of shock. The other types of shock will have cold and clammy (sweaty) skin due to decreased perfusion to the skin.
11. Which stage of shock is irreversible and unmanageable?
The answer is D.
12. 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 respiratory rate is 28 and labored, oxygen saturation 86%, heart rate 120, blood pressure 70/40, mean arterial pressure 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: blood pH 7.15, serum lactate 15 mmol/L, BUN 55 mg/dL, Creatinine 6 mg/dL. In addition, the patient is now starting to have slight oozing of blood around puncture sites.
The answer is C. This is the progressive stage. There are four stages of shock (in order): initial, compensatory, progressive, and refractory. The patient’s body is experiencing major signs and symptoms of shock. This is not found in the initial stage of shock because the signs and symptoms are subtle. During the compensatory stage, the body (for a while) can compensate so major organs are not showing major signs and symptoms of failure as they are in this scenario (the kidneys are starting to fail based on the BUN, creatinine, urinary output). In addition, the body is no longer compensating because the blood pressure is very low along with the MAP (mean arterial pressure). A big sign is that the patient’s mental status is altered. This represents that the brain is not being perfused very well. The MAP should be 60 or greater to provide adequate perfusion. The MAP here is 50 and this shows us the body is NOT perfusing the organs, so the cells will experience hypoxic injury. The patient is also starting to show early signs and symptoms of DIC due to the slight oozing of blood around puncture sites. The next stage (which is the last) is the refractory and this is where organs have failed or are about too. Death is imminent. This patient is not at that point but is getting close. This patient needs very dynamic treatment in order to survive.
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