Chapter 15

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Chapter: Chapter 15: Shock and Multiple Organ Dysfunction Syndrome
Multiple Choice
1. An understanding of the pathophysiologic rationale behind shock is something every nurse

needs to have. Which of the following statements best describes the pathophysiology for shock?
A) Blood is shunted from vital organs to peripheral areas of the body.
B) Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
C) Circulating blood volume is decreased.
D) Hemorrhage occurs as a result of trauma.
Ans: B
Chapter: 15
Client Needs: D-4
Cognitive Level: Comprehension
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 1
Page and Header: 313, Overview of Shock
Feedback: Shock is a life-threatening condition with a variety of underlying causes. Shock is

caused when the cells have a lack of adequate blood supply and are deprived of oxygen and
nutrients. Option A is incorrect; blood is shunted from peripheral areas of the body to the vital
organs. Options C and D can be true statements, depending on the type of shock, but they are not
the best answers to describe the pathophysiologic rationale for shock.
2. You are assessing your patient. When prioritizing the patient's care, you recognize that your
patient is at risk for hypovolemic shock when
A) fluid circulating in the blood vessels decreases.
B) cardiac output is increased.
C) blood pressure increases.
D) pulse is fast and bounding.
Ans: A
Chapter: 15
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Objective: 4
Page and Header: 322, Hypovolemic Shock
Feedback: Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac

output is decreased, blood pressure decreases, and pulse is fast but weak.
3. You are admitting a patient with a diagnosis of a gastrointestinal bleed who is in the
compensatory stage of shock. You know that an early sign that accompanies initial shock is
what?
A) Increased urine output
B) Decreased heart rate
C) Hyperactive bowel sounds
D) Cool, clammy skin
Ans: D
Chapter: 15
Client Needs: D-4
Cognitive Level: Analysis
Objective: 2
Page and Header: 315, Stages of Shock
Feedback: In the compensatory stage of shock, the body shunts blood from the organs, such as
the skin and kidneys, to the brain and heart to ensure adequate blood supply. As a result, the
patient's skin is cool and clammy. Also in this compensatory stage, blood vessels vasoconstrict,
the heart rate increases, bowel sounds are hypoactive, and the urine output decreases.
4. You are caring for a patient in liver failure who is exhibiting signs and symptoms of
hypovolemic shock. You anticipate that the physician will order the administration of a
crystalloid for the management of this patient. Which crystalloid fluid is most commonly used to
treat hypovolemic shock?
A) Lactated Ringer's
B) Albumin
C) Dextran
D) 3% NaCl
Ans: A
Chapter: 15
Client Needs: D-2
Objective: 5
Feedback: Crystalloids are electrolyte solutions used for the treatment of hypovolemic shock.
Lactated Ringer's and 0.9% sodium chloride are isotonic crystalloid fluids commonly used to
manage hypovolemic shock. Dextran and albumin are colloids, but Dextran, even as a colloid, is
not indicated for the treatment of hypovolemic shock. 3% NaCl is a hypertonic solution and is
not isotonic.
5. A patient is receiving dopamine, a vasoactive drug used for shock, to increase her stroke
volume. What should the nurse be aware of when monitoring a vasoactive drug?
A) The drug should be discontinued immediately after blood pressure increases.
B) The drug dose should be weaned down prior to discontinuing.
C) The drug may cause respiratory alkalosis.
D) The drug reduces oxygen demands of the heart.
Ans: B
Chapter: 15
Client Needs: D-2
Objective: 6
Page and Header: 322, General Management Strategies in Shock
Feedback: When vasoactive medications are discontinued, they should never be stopped
abruptly because this could cause severe hemodynamic instability, perpetuating the shock state.
This makes option A incorrect. Options C and D are incorrect; vasoactive drugs do not cause
respiratory alkalosis or reduce oxygen demands on the heart.
6. A nurse in the ICU receives report from the nurse in the emergency department about a new
patient being admitted with a neck injury he received while diving into a lake. The emergency-
department nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and
his skin is warm and dry. What does the ICU nurse recognize that that patient is probably
experiencing?
A) Anaphylactic shock
B) Neurogenic shock
C) Septic shock
D) Hypovolemic shock
Ans: B
Chapter: 15
Client Needs: A-2
Objective: 3
Page and Header: 331, Circulatory Shock
Feedback: Neurogenic shock can be caused by spinal cord injury. In this case, it resulted from
diving into waters of unknown depth. The patient will present with a low blood pressure;
bradycardia; and warm, dry skin due to the loss of sympathetic muscle tone and increased
parasympathetic stimulation. Option A is incorrect; anaphylactic shock is caused by an
identifiable offending agent such as a bee sting. Option C is incorrect; septic shock is caused by
bacteremia in the blood and presents with a tachycardia. Option D is incorrect; hypovolemic
shock presents with tachycardia and a probable source of blood loss.
7. Patients who are in shock have special needs, including nutritional needs. What are these
special nutritional needs directly related to?
A) The use of albumin as a food source by the body because of the need for increased caloric
intake
B) The loss of fluids due to stress ulcers and decreased stomach acids due to increased
parasympathetic activity
C) The release of catecholamines that creates an increase in metabolic rate and caloric
requirements
D) The increase in gastrointestinal function during shock and the resulting diarrhea
Ans: C
Chapter: 15
Client Needs: A-1
Objective: 7
Feedback: Nutritional support is an important aspect of care for patients in shock. Patients in
shock may require 3,000 calories daily. This caloric need is directly related to the release of
catecholamines and the resulting increase in metabolic rate and caloric requirements.
Option A is a good answer, but all body proteins are used during times of great stress, which
results in generalized muscle wasting. Option B is incorrect; the special nutritional needs of
shock are not related to increased parasympathetic activity but related to increased sympathetic
activity. Option D is incorrect; gastrointestinal function does not increase during shock; it
decreases.
8. You are transferring a patient who is in the progressive stage of shock into ICU from your
medical-surgical unit. You are aware that the shock affects many organ systems and that nursing
management of the patient will focus on what?
A) Reviewing the cause of shock and trying to limit the progression
B) Assessing and understanding shock and the significant changes in assessment data to guide
the plan of care
C) Giving the prescribed treatment but shifting focus to providing family time as the patient is
unlikely to survive
D) Giving progressive care to the patient and family using critical pathways for shock therapy
Ans: B
Chapter: 15
Client Needs: A-1
Objective: 8
Feedback: Nursing care of patients in the progressive stage of shock requires expertise in
assessing and understanding shock and the significance of changes in assessment data. Early
interventions are essential to the survival of patients in shock; thus, suspecting that a patient may
be in shock and reporting subtle changes in assessment are imperative. Option A is incorrect;
reviewing the cause of shock and trying to limit the progression is important, but it must be
followed by a plan of care. Option C is incorrect; it is important during the progressive of shock
to give the prescribed treatment, but the patient still has a chance of survival; providing family
time in important, but patient survival is still the priority. Option D is incorrect; giving
progressive care to the patient and family is not defined, and using critical pathways for shock
therapy sounds good, but there is no information in the stem of the question that indicates we are
using a critical pathway. This answer is designed to distract the test-taker.
9. When caring for a patient in shock, one of the major nursing goals is to reduce the risk that
the patient will develop complications from shock. What does this require the nurse to do?
A) Provide an accurate diagnosis, plan of care, and appropriate interventions to allow the patient
the best chance for survival
B) Keep the physician updated with the most accurate information; in shock the nurse is often
powerless to help.
C) Monitor for significant changes and evaluate patient outcomes on a scheduled basis focusing
on blood pressure and skin temperature
D) Understand the underlying mechanisms of shock, recognize the subtle and more obvious
signs, and then provide rapid assessment and response
Ans: D
Chapter: 15
Client Needs: D-3
Objective: 4
Page and Header: 313, Introduction
Feedback: Shock is a life-threatening condition with a variety of underlying causes. It is critical

that the nurse apply the nursing process as the guide for care. Shock is unpredictable and rapidly
changing so the nurse must understand the underlying mechanisms of shock. The nurse must also
be able to recognize the subtle as well as more obvious signs and then provide rapid assessment
and response to provide the patient with the best chance for recovery. Option A is a good answer
but not the best answer; an accurate diagnosis is not as important as understanding the
underlying mechanisms of shock. Option B is incorrect; keeping the physician updated with the
most accurate information is important, but the nurse is in the best position to provide rapid
assessment and response, which gives the patient the best chance for survival. Option C is
incorrect; monitoring for significant changes is critical, and evaluating patient outcomes is
always a part of the nursing process, but the subtle signs and symptoms of shock are as important
as the more obvious signs such as blood pressure and skin temperature.
10. You are caring for a patient in the ICU who is suffering from multiple organ dysfunction
syndrome (MODS). What should your plan of care focus on?
A) Encouraging the family to stay hopeful and educating the family to the fact that, in most
cases, the prognosis is good
B) Encouraging the family to leave the hospital and to take time for themselves as care of
MODS patients may last for years
C) Promoting communication with the patient and family along with addressing end-of-life
issues
D) Discussing organ donation on a number of different occasions to allow the family time to
adjust to the idea
Ans: C
Chapter: 15
Client Needs: D-4
Objective: 1
Page and Header: 333, Multiple Organ Dysfunction Syndrome
Feedback: Promoting communication with the patient and family is a critical role of the nurse
with a patient in progressive shock. It is also important that the health care team address end-of-
life decisions to ensure that supportive therapies are congruent with the patient's wishes. Option
A is incorrect; most cases of MODS result in death. Option B is incorrect; encouraging the
family to leave the hospital and to take time for themselves does allow time for the family to
grieve and make plans, but the life expectancy of patients with MODS is usually measured in
hours and possibly days, but not in years. Option D is incorrect; discussing organ donation
should be offered as an option on one occasion, and then allow the family time to discuss and
return to the health care providers with an answer following the death of the patient.
11. Your patient is in hypovolemic shock. You know that antidiuretic hormone (ADH) plays a
role during hypovolemic shock. What assessment finding will you likely observe related to the
role of the antidiuretic hormone (ADH) during hypovolemic shock?
A) Increased hunger
B) Decreased thirst
C) Decreased urinary output
D) Increased capillary perfusion
Ans: C
Chapter: 15
Client Needs: D-4
Objective: 1
Feedback: During hypovolemic shock, a state of hypernatremia occurs. Hypernatremia

stimulates the release of antidiuretic hormone (ADH) by the pituitary gland. ADH causes the
kidneys to retain water further in an effort to raise blood volume and blood pressure. Options A,
B, and C are incorrect; in a hypovolemic state the body shifts blood away from anything that is
not a vital organ, so hunger is not an issue; thirst is increased as the body tries to increase fluid
volume; and capillary profusion decreases as the body shunts blood away from the periphery and
to the vital organs.
12. When caring for a patient at risk for shock, what assessment finding would the nurse
consider a potential sign of shock?
A) Elevated systolic blood pressure
B) Elevated mean arterial pressure
C) Shallow, rapid respirations
D) Bradycardia
Ans: C
Chapter: 15
Client Needs: D-4
Objective: 2
Feedback: A symptom of shock is shallow, rapid respirations. Options A and B are incorrect;
systolic blood pressure drops in shock, and MAP is less than 65 mm Hg. Option D is incorrect;
bradycardia occurs in neurogenic shock; other states of shock have tachycardia as a symptom.
13. You are precepting a new graduate nurse in the ICU. The two of you are caring for a patient
who is receiving large volumes of crystalloid fluid as a result of shock. What would you teach
the new nurse to monitor the patient for symptoms of?
A) Hypothermia
B) Bradycardia
C) Coffee ground emesis
D) Pain
Ans: A
Chapter: 15
Client Needs: D-2
Objective: 5
Feedback: Temperature should be monitored closely to ensure that rapid fluid resuscitation does
not precipitate hypothermia. Intravenous fluids may need to be warmed during the administration
of large volumes. Option B is incorrect; the nurse should monitor the patient for cardiovascular
overload and pulmonary edema when large volumes of intravenous solution are administered.
Option C is incorrect; coffee ground emesis is an indication of a gastrointestinal bleed, not shock.
Option D is incorrect; pain is related to cardiogenic shock.
14. You are caring for a patient in the ICU whose condition is deteriorating. You receive orders
for dopamine, which is an intravenous vasoactive drug. What would be your priority assessment
and interventions specific to the administration of vasoactive medications?
A) Frequent vitals, monitoring the central line site, and providing accurate drug titration
B) Reviewing medications, performing a focused cardiovascular assessment, and providing
patient education
C) Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral
edema
D) Routine vitals, monitoring the peripheral IV site, and providing early discharge instructions
Ans: A
Chapter: 15
Client Needs: D-2
Objective: 6
Feedback: When vasoactive medications are administered, vital signs must be monitored
frequently (at least every 15 minutes until stable, or more often if indicated). Vasoactive
medications should be administered through a central venous line because infiltration and
extravasation of some vasoactive medications can cause tissue necrosis and sloughing. An
intravenous pump should be used to ensure that the medications are delivered safely and
accurately. Individual medication dosages are usually titrated by the nurse, who adjusts drip rates
based on the prescribed dose and the patient's response. Option B is incorrect; reviewing
medications, performing a focused cardiovascular assessment, and providing patient education
are important nursing tasks, but they are not specific to the administration of intravenous
vasoactive drugs. Option C is incorrect; reviewing the laboratory findings, monitoring urine
output, and assessing for peripheral edema are not the priorities for administration of intravenous
vasoactive drugs. Option D is incorrect; the vitals are taken on a frequent basis when monitoring
administration of intravenous vasoactive drugs, vasoactive medications should be administered
through a central venous line, and early discharge instructions would be inappropriate in this
time of crisis.
15. The nurse in the ICU is admitting a 57year-old-man with a diagnosis of possible septic
shock. When the nurse assesses him, she notes that the patient has a normal blood pressure,
increased heart rate, decreased bowel sounds, and his skin is cold and clammy. What would the
nurse suspect?
A) The patient is in the compensatory stage of shock.
B) The patient is in the progressive stage of shock.
C) The patient will stabilize and be released by tomorrow.
D) The patient is in the irreversible stage of shock.
Ans: A
Chapter: 15
Client Needs: A-1
Objective: 2
Feedback: In the compensatory stage of shock, the blood pressure remains within normal limits.
Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to
maintaining adequate cardiac output. Patients display the often-described “fight or flight”
response. The body shunts blood from organs such as the skin, kidneys, and gastrointestinal tract
to the brain and heart to ensure adequate blood supply to these vital organs. As a result, the skin
is cool and clammy, and his bowel sounds are hypoactive. Option B is incorrect; in progressive
shock, the blood pressure drops. Option C is incorrect; in septic shock, the patient's chance of
survival is low and he will certainly not be released within 24 hours. Option D is incorrect; if the
patient were in the irreversible stage of shock, his blood pressure would be very low and his
organs would be failing.
16. You are part of the health care team in the emergency department that is caring for a patient
brought in by paramedics in the irreversible stage of shock. What would be your best nursing
intervention?
A) Provide opportunities for the family to spend time with the patient, and help them to
understand the irreversible stage of shock.
B) Inform the patient's family early that the patient will likely not survive, which allows the
family time to make plans and move forward.
C) Closely monitor fluid replacement therapy, and inform the family that the patient will
probably survive and return to her normal life.
D) Protect the patient's airway, optimize intravascular volume, and support the pumping action
of the heart.
Ans: A
Chapter: 15
Client Needs: A-2
Objective: 4
Feedback: The irreversible (or refractory) stage of shock represents the point along the shock
continuum at which organ damage is so severe that the patient does not respond to treatment and
cannot survive. Providing opportunities for the family to spend time with the patient and helping
them to understand the irreversible stage of shock is the best intervention. Option B is a good
answer; informing the patient's family early that the patient will likely not survive does allow the
family to make plans and move forward, but informing the family too early will rob the family of
hope and interrupt the grieving process. Option C is incorrect; the chance of surviving the
irreversible (or refractory) stage of shock is very small, and the nurse needs to help the family
cope with the reality of the situation. Option D is incorrect; with the chances of survival so small,
the priorities shift from aggressive treatment and safety to addressing the end-of -life issues.
17. You are working in the ICU and have just been notified that you are receiving a patient from
the Obstetrics unit who is in hypovolemic shock due to massive blood loss during delivery. You
know that the best choice for fluid replacement for this patient is what?
A) 5% Albumin because it is inexpensive and is always readily available
B) Dextran because it increases intravascular volume and counteracts coagulopathy
C) Whatever fluid that is most readily available in the ICU, due to the nature of the emergency
D) Lactated Ringer's solution because it increases volume, buffers acidosis, and is the best
choice for patients with liver failure
Ans: C
Chapter: 15
Client Needs: D-2
Objective: 5
Feedback: The best fluid to treat shock remains controversial. In emergencies, the “best” fluid is
often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to
maximize intravascular volume. Both crystalloids and colloids can be administered to restore
intravascular volume. There is no consensus regarding whether crystalloids or colloids like
dextran and albumin should be used; however, with crystalloids, more fluid is necessary to
restore intravascular volume. Option A is incorrect; albumin is very expensive and is a blood
product so it is not always readily available for use. Option B is incorrect; dextran does increase
intravascular volume, but it increases the risk for coagulopathy. Option D is incorrect; Lactated
Ringer's is a good solution choice because it increases volume and buffers acidosis but should
not be used in patients with liver failure because the liver is unable to covert lactate to
bicarbonate.
18. You are caring for a trauma patient in the ICU who is in shock. The patient is a 47-year-old,
obese male who was in a motor vehicle accident. You know that patients in shock require excess
energy requirements. What would be the main concern in meeting this patient's elevated energy
requirements?
A) Loss of adipose tissue
B) Loss of skeletal muscle
C) Inability to convert adipose tissue to energy
D) Inability to maintain normal body mass
Ans: B
Chapter: 15
Client Needs: D-4
Objective: 7
Feedback: Nutritional energy requirements are met by breaking down lean body mass. In this
catabolic process, skeletal muscle mass is broken down even when the patient has large stores of
fat or adipose tissue. Loss of skeletal muscle greatly prolongs the patient's recovery time. Loss of
adipose tissue, the inability to convert adipose tissue to energy, or the inability to maintain
normal body mass are not main concerns in meeting nutritional energy requirements for this
patient.
19. You are the nurse in the emergency department who is caring for a patient recently admitted
with a myocardial infarction. The patient's heart is pumping an inadequate supply of oxygen to
the tissue. What would you assess for?
A) Dysrhythmias
B) Increase in blood pressure
C) Decrease in heart rate
D) Decrease in oxygen demands
Ans: A
Chapter: 15
Client Needs: D-4
Objective: 4
Page and Header: 325, Cardiogenic Shock
Feedback: Cardiogenic shock occurs when the heart's ability to pump blood is impaired and the
supply of oxygen is inadequate for the heart and tissues. Symptoms of cardiogenic shock include
angina pain and dysrhythmias. Cardiogenic shock does not exhibit increased blood pressure,
decreased heart rate, or a decrease in oxygen demands.
20. The nurse is caring for a patient admitted with cardiogenic shock. The patient is
experiencing chest pain. There is an order for the administration of morphine for the onset of
chest pain. What is the rationale for administering morphine for this patient?
A) It decreases urine output.
B) It stimulates the patient so he or she is more alert.
C) It decreases gastric secretions.
D) It dilates the blood vessels.
Ans: D
Chapter: 15
Client Needs: D-2
Objective: 4
Feedback: For patients experiencing chest pain, morphine is the drug of choice because it dilates
the blood vessels and controls the patient's anxiety. Morphine would not be ordered to decrease
urine output or to stimulate the patient. The rationale behind using morphine would not be to
decrease gastric secretions.
21. You are caring for a patient at risk of shock. What physiologic response would you know to
look for while assessing for shock?
A) Activation of infectious response
B) Increased blood pressure
C) Hypoperfusion of tissues
D) Temperature
Ans: C
Chapter: 15
Client Needs: D-3
Objective: 1
Feedback: Regardless of the initial cause of shock, certain physiologic responses are common to
all types of shock. These physiologic responses include hypoperfusion of tissues,
hypermetabolism, and activation of the inflammatory response.
22. What does the basic nursing care of patients with shock require?
A) Expertise in understanding causes of shock
B) Understanding of primary prevention of shock
C) Restoring intravascular volume
D) An ongoing systematic assessment
Ans: D
Chapter: 15
Client Needs: D-4
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 1
Feedback: Nursing care of patients with shock requires ongoing systematic assessment. Options
A, B, and C are incorrect; basic nursing care of patients with shock does not require
understanding the causes of shock, understanding the primary prevention of shock, or restoring
intravascular volume.
23. Why are antiarrhythmic medications required in the treatment of shock?

A) To prevent serious cardiac dysrhythmias
B) All patient with shock have serious cardiac dysrhythmias
C) They are not required
D) To stabilize cardiac afterload
Ans: B
Chapter: 15
Client Needs: D-2
Cognitive Level: Knowledge
Difficulty: Easy
Objective: 6
Feedback: Multiple factors, such as hypoxemia, electrolyte imbalances, and acid–base

imbalances, contribute to serious cardiac dysrhythmias in all patients with shock. Antiarrhythmic
medications are required to stabilize the heart rate. Option A is incorrect; antiarrhythmic
medications treat dysrhythmias, they don't prevent them. Option C is incorrect; they are required.
Option D is incorrect; antiarrhythmic drugs do not stabilize cardiac afterload.
24. In a state of shock, compensatory mechanisms occur in the body. What is a compensatory
mechanism to increase cardiac output during hypovolemic states?
A) Third spacing of fluid
B) Vasodilation
C) Tachycardia
D) Gastric hypermotility
Ans: C
Chapter: 15
Client Needs: D-4
Difficulty: Easy
Objective: 2
Feedback: Tachycardia is a primary compensatory mechanism to increase cardiac output during

hypovolemic states. The third spacing of fluid takes fluid out of the vascular space. Vasodilation
would not increase cardiac output during hypovolemic states. Gastric hypermotility would not
increase cardiac output.
Multiple Selection
25. You are caring for a patient with shock. What cardiac signs or symptoms would indicate
acute organ dysfunction? (Mark all that apply.)
A) Drop in systolic blood pressure greater than 40 mm Hg from baseline blood pressure
B) Hypotension that responds to fluid resuscitation
C) Vasopressor support is not needed
D) Serum lactate greater than 4 mmol/L
E) Mean arterial pressure (MAP) less than 65 mm Hg
Ans: A, D, E
Chapter: 15
Client Needs: D-4
Objective: 3
Feedback: Signs of acute organ dysfunction in the cardiovascular system include systolic blood
pressure less than 90 mm Hg or mean arterial pressure (MAP) less than 65 mm Hg, or drop in
systolic blood pressure greater than 40 mm Hg from baseline blood pressure. Is hypotension
responsive to fluid resuscitation, or is vasopressor support needed? Is the serum lactate greater
than 4 mmol/L? Options B and C are incorrect.
Multiple Choice
26. Patients who survive shock may be discharged home to finish the recovery phase of their
disease process. The home health nurse plays an integral part in monitoring these patients. What
is an important part of the care given by the home health nurse?
A) Providing supervision to home health aides in providing necessary patient care
B) Assisting patient and family to identify and mobilize community resources
C) Providing ongoing medical care during the family's rehabilitation phase
D) Reinforcing the importance of continuous assessment to prevent further episodes of shock
Ans: B
Chapter: 15
Client Needs: D-4
Integrated Process: Caring
Objective: 8
Page and Header: 334, Promoting Home and Community-Based Care
Feedback: The home care nurse reinforces the importance of continuing medical care and helps
the patient and family identify and mobilize community resources. Option A is incorrect; the
home health nurse is part of a team that provides patient care in the home. The nurse does not
directly supervise home health aides. Option C is incorrect; the nurse provides nursing care to
both the patient and family, not just the family. Option D is incorrect; the nurse performs
continuous and ongoing assessment of the patient; he does not just reinforce the importance of
that assessment.
27. Some interventions are used in all types of shock. What is one of these interventions?
A) Aggressive hypoglycemic control
B) Use of hypotonic IV fluids
C) Early enteral nutritional support
D) Maintaining the competence of the vascular system
Ans: C
Chapter: 15
Client Needs: D-4
Objective: 7
Feedback: Other aspects of management may include early enteral nutritional support or
aggressive hyperglycemic control with IV insulin. Option B is incorrect; IV fluids are used to
meet patient needs or are the available fluids at the time. They are not just hypotonic IV fluids.
Option D is incorrect; improvement, not just maintenance, of the competence of the vascular
system is the goal.
28. In all types of shock, nutritional demands increase rapidly as the body depletes its stores of
glycogen. Enteral nutrition is the preferred method of meeting these increasing energy demands.
What is the basis for enteral nutrition being the preferred method of meeting the bodies needs?
A) It increases the possibility of infectious complications of nutritional support.
B) It decreases the energy expended through the functioning of the GI system.
C) It assists in expanding the intravascular volume of the body.
D) It promotes GI function through direct exposure to nutrients.
Ans: D
Chapter: 15
Client Needs: D-4
Objective: 7
Feedback: Parenteral or enteral nutritional support should be initiated as soon as possible.

Enteral nutrition is preferred, promoting GI function through direct exposure to nutrients and
limiting infectious complications associated with parenteral feeding. This makes option A
incorrect. Options B and C are incorrect; enteral feeding does not decrease the energy expended
through the functioning of the GI system or assist in expanding the intravascular volume of the
body.
29. You are the ICU nurse caring for a patient with multiple organ dysfunction syndrome due to
shock. What is a critical part of your role?
A) Providing information and support to family members
B) Preparing the family for a long recovery process
C) Educating the patient regarding the use of supportive fluids
D) Demonstrating necessary skills for the rehabilitation phase of recovery
Ans: A
Chapter: 15
Client Needs: D-4
Objective: 9
Page and Header: 333, Multiple Organ Dysfunction Syndrome
Feedback: Providing information and support to family members is a critical role of the nurse.
Options B, C, and D are incorrect; most patients with multiple organ dysfunction syndrome do
not recover, so there is no rehabilitation phase of recovery as there is no recovery process.
Educating the patient about the use of supportive fluids is a distracter to this test question.
30. The ICU nurse is caring for a patient in shock. What is one of the most important functions
of the nursing role in caring for this patient?
A) Documenting the administration of medications
B) Monitoring for complications and side effects of treatment
C) Reporting adverse effects of treatment
D) Safely administering prescribed fluids
Ans: B
Chapter: 15
Client Needs: D-4
Objective: 8
Feedback: General nursing measures include ensuring safe administration of prescribed fluids
and medications and documenting their administration and effects. An important function of the
nursing role is monitoring for complications and side effects of treatment and reporting them
promptly. Options A, C, and D are all correct answers; however, they are not more important
functions of nursing care than monitoring for complications and side effects of treatment.
Multiple Selection
31. Patients in shock can experience fluid replacement complications. What does the nurse
monitor the patient for? (Mark all that apply.)
A) Hypovolemia
B) Difficulty breathing
C) Cardiovascular overload
D) Pulmonary edema
E) Hypoglycemia
Ans: B, C, D
Chapter: 15
Client Needs: D-4
Objective: 4
Feedback: Fluid replacement complications can occur, often when large volumes are
administered rapidly. Therefore, the nurse monitors the patient closely for cardiovascular
overload, signs of difficulty breathing, and pulmonary edema. Options A and E are incorrect;
hypovolemia is what necessitates fluid replacement, and hypoglycemia is not a concern with
fluid replacement, hyperglycemia is.
Multiple Choice
32. When circulatory shock occurs, there is massive vasodilation causing pooling of the blood in
the periphery of the body. As an ICU nurse caring for a patient in circulatory shock, you know
that the pooling of blood in the periphery leads to what?
A) Increased stroke volume
B) Increased cardiac output
C) Decreased heart rate
D) Decreased venous return
Ans: D
Chapter: 15
Client Needs: D-4
Objective: 1
Feedback: Pooling of blood in the periphery results in decreased venous return. Decreased
venous return results in decreased stroke volume and decreased cardiac output. Decreased
cardiac output, in turn, causes decreased blood pressure and, ultimately, decreased tissue
perfusion. Option C is incorrect; heart rate increases in an attempt to meet the demands of the
body.
Multiple Selection
33. The nursing instructor is discussing shock with a class of junior nursing students. Which
subclassifications of circulatory shock would the instructor discuss? (Mark all that apply.)
A) Anaphylactic
B) Hypovolemic
C) Cardiogenic
D) Septic
E) Neurogenic
Ans: A, D, E
Chapter: 15
Client Needs: D-4
Integrated Process: Teaching/Learning
Objective: 4
Feedback: The varied mechanisms leading to the initial vasodilation in circulatory shock provide
the basis for the further subclassification of shock into three types: septic shock, neurogenic
shock, and anaphylactic shock. Options B and C are incorrect; hypovolemic and cardiogenic
shock are not subclassifications of circulatory shock.
Multiple Choice
34. You are the triage nurse in the emergency department (ED) when a grandfather carries his 4-
year-old grandson into the ED. The child is not breathing, and the grandfather states the boy was
stung by a bee just outside the ED where they were waiting for the mother to get off work. What
characteristics of anaphylactic shock would lead you to believe this is what is happening to the
patient?
A) Rapid onset of acute hypertension
B) Rapid onset of respiratory distress
C) Rapid onset of neurologic compensation
D) Rapid onset of cardiac arrest
Ans: B
Chapter: 15
Client Needs: D-4
Objective: 4
Feedback: Characteristics of severe anaphylaxis usually include rapid onset of hypotension,

neurologic compromise, respiratory distress, and cardiac arrest. Options A, C, and D are
incorrect as the scenario does not indicate the child has acute hypertension, neurologic
compensation, or cardiac arrest.
35. The ICU nurse is caring for a patient in neurogenic shock. What would the nurse know is a
characteristic of neurogenic shock?
A) Hypertension
B) Cool, moist skin
C) Bradycardia
D) Signs of sympathetic stimulation
Ans: C
Chapter: 15
Client Needs: D-4
Objective: 4
Feedback: In neurogenic shock, the sympathetic system is not able to respond to body stressors.
Therefore, 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.
36. Vasoactive medications are given in all forms of shock. Why are these medications used?
A) To increase myocardial resistance
B) To decrease strength of cardiac contractility
C) To maintain hemodynamic stability
D) To initiate vasoconstriction
Ans: D
Chapter: 15
Client Needs: D-2
Objective: 6
Feedback: Vasoactive medications are administered in all forms of shock to improve the
patient's hemodynamic stability when fluid therapy alone cannot maintain adequate MAP.
Specific medications are selected to correct the particular hemodynamic alteration that is
impeding cardiac output. These medications help increase the strength of myocardial
contractility, regulate the heart rate, reduce myocardial resistance, and initiate vasoconstriction.
Therefore options A, B, and C are incorrect.
37. The ICU nurse caring for a patient with shock is administering vasoactive medications as per
orders. The nurse knows that these medications should be what?
A) Administered through a central venous line
B) Titrated by dial-a-flow tubing
C) Given by IV push for rapid onset of action
D) Mixed with enteral feedings
Ans: A
Chapter: 15
Client Needs: D-4
Cognitive Level: Knowledge
Difficulty: Easy
Objective: 6
Feedback: Vasoactive medications should be administered through a central venous line because
infiltration and extravasation of some vasoactive medications can cause tissue necrosis and
sloughing. An IV pump or controller should be used to ensure that the medications are delivered
safely and accurately. Therefore options B, C, and D are incorrect.
38. You are caring for a patient in the irreversible stage of shock. What is an essential part of
your nursing care?
A) Preparing the family for a long recovery process
B) Giving the patient brief explanations of what is happening
C) Avoiding stimulating the patient by touch
D) Keeping visitors to a minimum
Ans: B
Chapter: 15
Client Needs: D-4
Difficulty: Easy
Integrated Process: Caring
Objective: 2
Feedback: As in the progressive stage of shock, the nurse focuses on carrying out prescribed
treatments, monitoring the patient, preventing complications, protecting the patient from injury,
and providing comfort. Offering brief explanations to the patient about what is happening is
essential even if there is no certainty that the patient hears or understands what is being said.
Simple comfort measures, including reassuring touches, should continue to be provided despite
the patient's nonresponsiveness to verbal stimuli. Option A is incorrect; this patient is not
expected to recover. Option D is incorrect; family needs to spend time with a patient who is not
expected to recover.
39. The ICU nurse is caring for a patient in hypovolemic shock. What is a serious complication
the nurse knows to monitor the patient for?
A) Anaphylaxis
B) Decreased oxygen consumption
C) Abdominal compartment syndrome
D) Decreased serum osmolality
Ans: C
Chapter: 15
Client Needs: D-4
Objective: 3
Feedback: Abdominal compartment syndrome (ACS) is a serious complication that may occur
when large volumes of fluid are administered. Option A is incorrect; the scenario does not
describe an antigen-antibody reaction of any type. Option B is incorrect; decreased oxygen
consumption by the body is not a concern in hypovolemic shock. Option D is incorrect; with a
decrease in fluids in the intravascular space, increased serum osmolality would occur.
40. Sepsis is an evolving process, with neither clearly definable clinical signs and symptoms nor
predictable progression. As the ICU nurse caring for a patient with sepsis, you know that tissue
perfusion declines and the patient begins to show signs of organ dysfunction. What signs of end-
organ damage would you expect to become evident?
A) Urinary output increases
B) Skin becomes warm and dry
C) Adventitious lung sounds occur in lung bases
D) Heart and respiratory rates are elevated
Ans: D
Chapter: 15
Client Needs: D-4
Objective: 2
Feedback: As sepsis progresses, tissues become less perfused and acidotic, compensation begins
to fail, and the patient begins to show signs of organ dysfunction. The cardiovascular system also
begins to fail, the blood pressure does not respond to fluid resuscitation and vasoactive agents,
and signs of end-organ damage are evident (eg, renal failure, pulmonary failure, hepatic failure).
As sepsis progresses to septic shock, the blood pressure drops, and the skin becomes cool, pale,
and mottled. Temperature may be normal or below normal. Heart and respiratory rates remain
rapid. Urine production ceases, and multiple organ dysfunction progressing to death occurs.
Therefore, options A and B are incorrect. Option C is incorrect; adventitious lung sounds occur
throughout the lung fields, not just in the bases of the lungs.

Chapter 15

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Chapter 15

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Chapter: Chapter 15: Shock and Multiple Organ Dysfunction Syndrome

1. An understanding of the pathophysiologic rationale behind shock is something every nurse

Feedback: Shock is a life-threatening condition with a variety of underlying causes. Shock is

Feedback: Hypovolemic shock is characterized by a decrease in intravascular volume. Cardiac

Feedback: Shock is a life-threatening condition with a variety of underlying causes. It is critical

Feedback: During hypovolemic shock, a state of hypernatremia occurs. Hypernatremia

23. Why are antiarrhythmic medications required in the treatment of shock?

Feedback: Multiple factors, such as hypoxemia, electrolyte imbalances, and acid–base

Feedback: Tachycardia is a primary compensatory mechanism to increase cardiac output during

Feedback: Parenteral or enteral nutritional support should be initiated as soon as possible.

Feedback: Characteristics of severe anaphylaxis usually include rapid onset of hypotension,

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