Hypovolemic Shock
o B. >25%
NCLEX Questions
Hypovolemic shock NCLEX
questions for nursing students!
This quiz will test your
knowledge on hypovolemic
shock. Hypovolemic shock
occurs when the intravascular
system has been depleted of
fluid volume. 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.
There are various types of
shock: cardiogenic, hypovolem
ic, anaphylactic, septic, and ne
urogenic.
Don’t forget to watch the
lecture on hypovolemic
shock before taking the quiz.
Hypovolemic Shock
NCLEX Questions
This quiz contains hypovolemic
shock NCLEX review
questions.
 1. True or False:
Hypovolemic shock occurs
where there is low fluid volume
in the interstitial compartment.*
o True
o False
 2. As the nurse you
know that in order for
hypovolemic shock to occur the
patient would need to lose
__________ of their blood
volume.*
o A. <30%
o True
o C. >15% o False
 6. Select all the
o D. >10%
conditions below that increases
a patient's risk for absolute
 3. If a patient has a
hypovolemic shock:*
blood volume of 5 Liters and
loses 2 Liters, what is the
o  A. Burns
percentage amount of volume
loss this patient has
experienced?* o  B. Vomiting
o A. 25%
o  C. Long
bone fracture
o B. 40%
o  D. Surgery
o C. 30%
o  E. Diarrhea
o D. 10%
o  F. Sepsis
 4. A patient who is
experiencing hypovolemic  7. A patient has a 10%
shock has decreased cardiac loss of their blood volume.
output, which contributes to Select all the signs and
ineffective tissue perfusion. The symptoms this patient may
decrease in cardiac output present with?*
occurs due to?*
o  A. Cool,
o A. An
clammy skin
increase in cardiac preload
o  B. Blood
o B. An
pressure within normal limits
increase in stroke volume
o  C. Anxiety
o C. A
decrease in cardiac preload
o  D. Capillary
refill less than 2 seconds
o D. A
decrease in cardiac contractility
o  E. Urinary
 5. True or False: A output greater than 30 mL/hr
patient with acute pancreatitis is
presenting with Turner and o  F. Mild
Cullen's Sign. This patient is at
tachycardia
risk for absolute hypovolemic
shock.*
 8. During what stage (or
class) of hypovolemic shock
does the sympathetic nervous
system attempt to maintain
cardiac output?*
o A. I
o B. III
o C. IV
o D. II
 9. 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:*
o  A.
Temperature 104.8 'F
o  B. Heart
rate 40 bpm
o  C. Heart
rate 140 bpm
o  D. Anxiety,
restlessness
o  E. Urinary
output 15 mL/hr
o  F. Blood
pressure 70/56
o  G. Pale,
cool skin
o  H. Weak
peripheral pulses
o  I. Blood
pressure 220/106
 10. You're providing
care to a patient who has
experienced a 45% loss of their
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?*
o A. Low
central venous pressure
o B. High
pulmonary artery wedge
pressure
o C. Elevated
mean arterial pressure
o D. Low
systemic vascular resistance
 11. A patient is 1 hour
post-op from abdominal surgery
and had lost 20% of their blood
volume during surgery. The
patient is experiencing signs
and symptoms of hypovolemic
shock. What position is best for
this patient?*
o A. Modified
Trendelenburg
o B.
Trendelenburg
o C. High
Fowler's
o D. Supine
 12. A 35-year-old male
arrives to the emergency room
with multiple long bone
fractures and an internal
abdominal injury. The patient is
anxious. Patient's vital signs
are: Blood pressure 70/54, heart
rate 125 bpm, respirations 30,
oxygen saturation on 2 L nasal
cannula 96%, temperature 99.3
'F, pain 6 on 1-10 scale. During
assessment it is noted the skin is
cool and clammy. The nurse
will make it priority to?*
o A. Collect a
urine sample
o B. Obtain an
EKG
o C. Establish
2 large-bore IV access sites
o D. Place a
warming blanket on the patient
 13. A patient in
hypovolemic shock is receiving
rapid infusions of crystalloid
fluids. Which patient finding
requires immediate nursing
action?*
o A. Patient
heart rate is 115 bpm
o B. Patient
experiences dyspnea and
crackles in lung fields
o C. Patient is
anxious
o D. Patient's
urinary output is 35 mL/hr
 14. A patient has lost
750 mL of blood volume. The
 MD orders Normal Saline
infusion. Using the 3:1 rule,
how much crystalloid solution
should be prescribed by the
doctor?*
o A. 2,250 mL
of Normal Saline
o B. 250 mL
of Normal Saline
o C. 375 mL
of Normal Saline
o C. 1,225 mL
of Normal Saline
 15. You're providing an
in-service to new nurse
graduates on the fluid treatment
for hypovolemic shock. You ask
the participants to list the types
of crystalloid solutions used in
hypovolemic shock. Which
responses are INCORRECT?
Select all that apply:*
o  A. Albumin
o  B. Lactated
Ringer's
o  C. Normal
Saline
o  D.
Hetastarch
 16. Select all the fluid
types below that are considered
colloids?*
o  A. Fresh
Frozen Plasma
o  B. Albumin
o  C. Normal
Saline
o  D. Lactated
Ringer's
o  E.
Hetastarch
o  F. Platelets
 17. Which statement is
true about colloid solutions?
Select all that apply:*
o  A. These
solutions are made up of large
molecules that cannot diffuse
through the capillary wall, so
more fluid stays in the
intravascular space longer when
compared with the action of a
crystalloid solution.
o  B. These
solutions can diffuse through
the capillary wall so less fluid
stays in the intravascular system
when compared to the action of
a crystalloid solution.
o  C. The
nurse should monitor for an
anaphylactic reaction when
these products are administered.
o  D. These
fluids are considered hypertonic
solutions.
 18. A patient is
receiving large amounts of
fluids for aggressive treatment
of hypovolemic shock. The
nurse makes it PRIORITY to?*
o A. Rapidly
infuse the fluids
o B. Warm the
fluids
o C. Change
tubing in between bags
o D. Keep the
patient supine
 19. The patient with
hypovolemic shock is in need of
clotting factors. Which type of
fluid would best benefit this
patient?*
o A. Platelets
o B. Albumin
o C. Fresh
Frozen Plasma
o D. Packed
Red Blood Cells
Submit
(NOTE: When you hit submit,
it will refresh this same page.
Scroll down to see your
results.)
Hypovolemic Shock
NCLEX Questions
1. True or False: Hypovolemic
shock occurs where there is low
fluid volume in the interstitial
compartment.
Answer: FALSE Hypovolemic
shock occurs where there is low
fluid volume in the
INTRAVASCULAR (not
interstitial) system.
2. As the nurse you know that in
order for hypovolemic shock to
occur the patient would need to
lose __________ of their blood
volume.
A. <30%
B. >25%
C. >15%
D. >10%
The answer is C. As the nurse
you know that in order for
hypovolemic shock to occur the
patient would need to lose 15%
or more of their blood volume.
3. If a patient has a blood
volume of 5 Liters and loses 2
Liters, what is the percentage
amount of volume loss this
patient has experienced?
A. 25%
B. 40%
C. 30%
D. 10%
The answer is B. This patient
has lost 40% of blood volume.
Based on this amount of fluid
loss, this patient would be in
class III (stage 3 of
hypovolemic shock). Class III
occurs when volume loss is 30-
40% or 1,500-2,000 mL in an
adult.
4. A patient who is experiencing
hypovolemic shock has
decreased cardiac output, which
contributes to ineffective tissue
perfusion. The decrease in
cardiac output occurs due to?
A. An increase in cardiac
preload
B. An increase in stroke volume
C. A decrease in cardiac preload
D. A decrease in cardiac
contractility
The answer is C. Because there
is a major depletion of volume
in the intravascular system,
there will be a decrease in the
amount of venous return to the
heart (this is the amount of
blood draining back to the
heart). Hence, this will lead to a
DECREASE in preload.
Remember preload is the
amount the ventricles stretch
once their filled with blood. The
ventricle won’t be stretching too
much because there isn’t
enough fluid to fill them. This
will decrease stroke volume and
in turn decrease cardiac output.
5. True or False: A patient with
acute pancreatitis is presenting
with Turner and Cullen’s Sign.
This patient is at risk for
absolute hypovolemic shock.
The answer is FALSE: The
statement should read: A patient
with acute pancreatitis is
presenting with Turner and
Cullen’s Sign. This patient is at
risk for RELATIVE (not
absolute) hypovolemic shock.
Relative hypovolemic shock is
an INSIDE fluid shift from the
intravascular system, which
occurs in cases of acute
pancreatitis. If a patient has
Turner’s Sign (bruising on the
flanks) or Cullen’s Sign
(bruising around the umbilicus)
this can indicate internal
hemorrhage and this places the
patient at risk for RELATIVE
hypovolemic shock. Absolute
hypovolemic shock occurs
when there is an OUTSIDE
fluid shift out of the body from
the intravascular system.
6. Select all the conditions
below that increases a patient’s
risk for absolute hypovolemic
shock:
A. Burns
B. Vomiting
C. Long bone fracture
D. Surgery
E. Diarrhea
F. Sepsis
The answers are: B, D, and E.
Vomiting, diarrhea, and surgery
can all increase the loss of fluid
volume outside the body, which
are absolute hypovolemic shock
types. Burns, long bone
fracture, and sepsis can lead to
an inside fluid shift of fluid
from the intravascular system
and are relative hypovolemic
shock types.
7. A patient has a 10% loss of
their blood volume. Select all
the signs and symptoms this
patient may present with?
A. Cool, clammy skin
B. Blood pressure within
normal limits
C. Anxiety
D. Capillary refill less than 2
seconds
E. Urinary output greater than
30 mL/hr
F. Mild tachycardia
The answers are: B, D, and E.
The body can compensate for a
volume loss of <15% to
maintain cardiac output.
Therefore, the patient will be
asymptomatic until blood loss is
greater than 15% and you would
select normal findings for this
question, which are: blood
pressure within normal limits,
capillary refill less than 2
seconds, urinary output greater
than 30 mL/hr. Anxiety,
cool/clammy skin, and mild
tachycardia may present when
volume loss is higher.
8. During what stage (or class)
of hypovolemic shock does the
sympathetic nervous system
attempt to maintain cardiac
output?
A. I
B. III
C. IV
D. II
The answer is D. During stage 2
or class II of hypovolemic
shock, the cardiac output is
falling even more due to volume
loss. This is when the patient
has lost 15-30% of volume.
During this time the
sympathetic nervous system
will take over and attempt to
maintain cardiac output.
9. 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,
increased respiratory rate,
cool/pale/clammy skin, anxiety,
decreased urinary output
(normal UOP is >30 mL/hr),
weak peripheral pulses
10. You’re providing care to a
patient who has experienced a
45% loss of their 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 is the
measurement of the pressure in
the right atrium and superior
vena cava. If fluid volume is
low (as in hypovolemic shock)
the pressure in this area will
also be low. This indicates the
patient is still in hypovolemic
shock.
11. A patient is 1 hour post-op
from abdominal surgery and
had lost 20% of their blood
volume during surgery. The
patient is experiencing signs
and symptoms of hypovolemic
shock. What position is best for
this patient?
A. Modified Trendelenburg
B. Trendelenburg
C. High Fowler’s
D. Supine
The answer is A. Modified
Trendelenburg position is where
the patient is supine with their
legs elevated at 45 degrees. This
will help increase venous return
to the heart (hence increase
preload), which will help
increase cardiac output.
12. A 35-year-old male arrives
to the emergency room with
multiple long bone fractures and
an internal abdominal injury.
The patient is anxious. Patient’s
vital signs are: Blood pressure
70/54, heart rate 125 bpm,
respirations 30, oxygen
saturation on 2 L nasal cannula
96%, temperature 99.3 ‘F, pain
6 on 1-10 scale. During
assessment it is noted the skin is
cool and clammy. The nurse
will make it 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 major risk for hypovolemic
shock due to the multiple long
bone fractures and an internal
abdominal injury (this can lead
to relative hypovolemic
shock…where fluid is loss
inside the body). The patient is
already showing signs and
symptoms of hypovolemic
shock. Therefore, it should be a
nursing priority to establish IV
access (at least two sites should
be obtained using a large-bore
cannula….18 gauge or higher).
Fluids and possibly blood
products will need to be given
to this patient along with pain
medication etc.
13. A patient in hypovolemic
shock is receiving rapid
infusions of crystalloid fluids.
Which patient finding requires
immediate nursing action?
A. Patient heart rate is 115 bpm
B. Patient experiences dyspnea
and crackles in lung fields
C. Patient is anxious
D. Patient’s urinary output is 35
mL/hr
The answer is B. When
crystalloid fluids are given there
is a risk for fluid volume
overload even though the
patient is hypovolemic,
especially with rapid infusions.
Therefore, the nurse should
monitor the patient for this. If a
patient develops difficulty
breathing (dyspnea) and has
crackles in the lung fields (this
represents edema in the lungs),
fluid is backing up in the lungs.
This requires immediate nursing
action. Option A and C are
expected finding in
hypovolemic shock, and option
D is a normal finding…urinary
output should be >30 mL/hr.
14. A patient has lost 750 mL of
blood volume. The MD orders
Normal Saline infusion. Using
the 3:1 rule, how much
crystalloid solution should be
prescribed by the doctor?
A. 2,250 mL of Normal Saline
B. 250 mL of Normal Saline
C. 375 mL of Normal Saline
C. 1,225 mL of Normal Saline
The answer is A. For crystalloid
solutions (this includes normal
saline and lactated ringer’s), a
3:1 rule is used. This rule states
for every 1 mL of approximate
blood loss 3 mL of crystalloid
solution is given. Therefore, if
the patient loses 750 mL of
blood, the patient would receive
2,250 mL of saline. 750 x 3 =
2,250
15. You’re providing an in-
service to new nurse graduates
on the fluid treatment for
hypovolemic shock. You ask
the participants to list the types
of crystalloid solutions used in
hypovolemic shock. Which
responses are INCORRECT?
Select all that apply:
A. Albumin
B. Lactated Ringer’s
C. Normal Saline
D. Hetastarch
The answers are A and D.
Albumin and Hetastarch are
COLLOID solutions…not
crystalloid. Lactated Ringer’s
and Normal Saline are
considered crystalloid solutions
and are used in the treatment of
hypovolemic shock.
16. Select all the fluid types
below that are considered
colloids?
A. Fresh Frozen Plasma
B. Albumin
C. Normal Saline
D. Lactated Ringer’s
E. Hetastarch
F. Platelets
The answers are B and E. These
are colloid solutions. Options C
and D are considered crystalloid
solutions, and options A and F
are blood products.
17. Which statement is true
about colloid solutions? Select
all that apply:
A. These solutions are made up
of large molecules that cannot
diffuse through the capillary
wall, so more fluid stays in the
intravascular space longer when
compared with the action of a
crystalloid solution.
B. These solutions can diffuse
through the capillary wall so
less fluid stays in the
intravascular system when
compared to the action of a
crystalloid solution.
C. The nurse should monitor for
an anaphylactic reaction when
these products are administered.
D. These fluids are considered
hypertonic solutions.
The answer is C. A patient who
needs clotting factors would
benefit from fresh frozen
plasma (FFP).

The answers are A and C. These

are true statements about colloid
solutions. Options B and D are
incorrect.

18. A patient is receiving large

amounts of fluids for aggressive
treatment of hypovolemic
shock. The nurse makes it
PRIORITY to?

A. Rapidly infuse the fluids

B. Warm the fluids

C. Change tubing in between

bags

D. Keep the patient supine

The answer is B. It is very

important when giving large
amount of fluids that the nurse
ensures the fluids are warm.
WHY? To prevent the patient
from developing hypothermia.
If this develops, clotting
enzymes can become altered
along with leukopenia and
thrombocytopenia. Keep the
patient warm, but not too hot.

19. The patient with

hypovolemic shock is in need of
clotting factors. Which type of
fluid would best benefit this
patient?

A. Platelets

B. Albumin

C. Fresh Frozen Plasma

D. Packed Red Blood Cells