PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-

drome
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1. The nurse is caring for a client in shock C. Adrenergic drugs

who is deteriorating. The nurse is infusing
IV fluids and giving medications as ordered. Adrenergic drugs are the
What type of medications is the nurse most main medications used to
likely giving to this client? treat shock due to their action
on the receptors of the sym-
A. Hormone antagonist drugs pathetic nervous system.
B. Antimetabolite drugs
C. Adrenergic drugs
D. Anticholinergic drugs

2. A nurse is evaluating a mechanically ven- A. Organ damage

tilated client in the intensive care unit to
identify improvement in the client's condi- When the body is unable
tion. Which outcome does the nurse note to counteract the effects of
as the result of inadequate compensatory shock, further system failure
mechanisms? occurs, leading to organ dam-
age and ultimately death. Liv-
A. Organ damage er dysfunction may occur as
B. Unsteady gait one of the organs that fail.
C. Weight loss Weight fluctuations may oc-
D. Liver dysfunction cur if the client retains fluid
or is administered a diuretic.
Large fluctuations are not not-
ed between shifts. The client's
unsteady gait is not a result of
an inadequate compensatory
mechanism with shock but a
result of immobility.

3. Which drug is a vasodilator used in the B. Nitroglycerin

treatment of shock?
Nitroglycerin is a vasodila-
A. Norepinephrine tor used to reduce preload
B. Nitroglycerin and afterload and reduce oxy-
C. Dopamine gen demand of the heart.
D. Dobutamine Dopamine and dobutamine
are sympathomimetic and are
used to improve contractility,
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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increase stroke volume, and
increase cardiac output. Nor-
epinephrine is a vasoconstric-
tor used to increase blood
pressure by vasoconstriction.

4. Shock occurs when tissue perfusion is in- B. blood pressure

adequate to deliver oxygen and nutrients
to support cellular function. When caring By the time the blood pres-
for patients who may develop indicators of sure drops, damage has al-
shock, the nurse is aware that the most im- ready been occurring at the
portant measurement of shock is: cellular and tissue levels.
Therefore, the patient at risk
A. Renal output for shock must be monitored
B. Blood pressure closely before the blood pres-
C. Heart rate sure drops.
D. Breath sounds

5. A client is receiving support through an B. The right foot is cooler than

intra-aortic balloon counterpulsation. The the left foot
catheter for the balloon is inserted in the
right femoral artery. The nurse evaluates the When a client has an in-
following as a complication of the therapy: tra-aortic balloon counterpul-
sation, he or she is at risk
A. Bilateral pedal pulses are 1+ for circulatory problems in the
B. The right foot is cooler than the left foot leg in which the catheter has
C. The balloon deflates prior to systole been inserted. In this case,
D. Vesicular breath sounds are audible in it is the right leg. A compli-
the lung periphery cation would be a right foot
that is cooler than the left foot.
Pedal pulses of 1+ bilaterally
would not be a complication
of this therapy but of other
problems. The balloon is sup-
posed to deflate prior to sys-
tole. It is normal for vesicular
breath sounds to be audible in
the lung periphery.

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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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6. A nurse educator is teaching a group of C. An older adult man with
nurses about assessing critically ill clients end-stage renal disease and
for multiple organ dysfunction syndrome an infected dialysis access
(MODS). The nurse educator evaluates un- site
derstanding by asking the nurses to identify
which client would be at highest risk for MODS may develop when
MODS. It would be the client who is expe- a client experiences septic
riencing septic shock and is shock. Those at increased
risk for MODS are older
A. A middle-aged woman with metastatic clients, clients who are mal-
breast cancer and a BMI of 26 nourished, and clients with
B. A young female adolescent who de- coexisting disease.
veloped shock from tampon use during
menses
C. An older adult man with ESRD and an
infected dialysis site
D. An 8 y/o boy who underwent an appen-
dectomy and then incurred an iatrogenic
infection

7. The nurse receives an order to administer A. 5% Albumin

a colloidal solution for a patient experienc-
ing hypovolemic shock. What common col- Typically, if colloids are used
loidal solution will the nurse most likely ad- to treat tissue hypoperfusion,
minister? albumin is the agent pre-
scribed. Albumin is a plasma
A. 5% Albumin protein; an albumin solution
B. 6% hetastarch is prepared from human plas-
C. 6% dextran ma and is heated during pro-
D. Blood products duction to reduce its poten-
tial to transmit disease. The
disadvantage of albumin is its
high cost compared to crys-
talloid solutions. Hetastarch
and dextran solutions are not
indicated for fluid administra-
tion because these agents in-
terfere with platelet aggrega-

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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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tion. Blood products are not
indicated in this situation.

8. During preshock, the compensatory stage C. brain

of shock, the body, through sympathetic
nervous system stimulation, will release The body displays a
catecholamines to shunt blood from one "fight-or-flight" response, with
organ to another. Which of the following or- the release of cate-
gans will always be protected? cholamines. Blood will be
shunted to the brain, heart,
A. lungs and lungs to ensure adequate
B. liver blood supply. The organ that
C. brain will always be protected over
D. kidneys the others is the brain.

9. Hypovolemic shock is characterized by de- D. 3 to 5.1 L

creased intravascular volume. The nurse
understands that shock would occur if the The normal intravascular vol-
intravascular volume decreased by 15% to ume is 4 to 6 L. A reduction
25%. Therefore, for a 70 kg adult, hypov- of 15% to 25% represents a
olemic shock would occur with a minimum loss of a minimum of 600 mL
intravascular volume of: (4L @ 15%) to a maximum of
1,500 mL (6L @ 25%). There-
A. 3.8 to 5.8 L fore 4,000 to 6,000 mL minus
B. 3.5 to 5.5 L 600 to 1,500 mL = 3 to 5.1 L.
C. 3.75 to 5.5 L
D. 3 to 5.1 L

10. When a client is in the compensatory stage D. tachycardia

of shock, which symptom occurs?
A. bradycardia
B. respiratory acidosis
C. urine output of 45 mL/hr
D. tachycardia
The compensatory stage of
shock encompasses a normal
BP, tachycardia, decreased
urinary output, confusion, and
respiratory alkalosis.

11. Which type of shock occurs from an anti- B. anaphylactic

gen-antibody response?
During anaphylactic shock,
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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A. cardiogenic an antigen-antibody reac-
B. anaphylactic tion provokes mast cells
C. neurogenic to release potent vasoactive
D. septic substances, such as hista-
mine or bradykinin, causing
widespread vasodilation and
capillary permeability. Septic
shock is a circulatory state
resulting from overwhelming
infection causing relative hy-
povolemia. Neurogenic shock
results from loss of sym-
pathetic tone causing rel-
ative hypovolemia. Cardio-
genic shock results from im-
pairment or failure of the my-
ocardium.

12. A patient visits a health clinic because of ur- A. epinephrine

ticaria and shortness of breath after being
stung by several wasps. The nurse practi- Epinephrine is given for its
tioner immediately administers which med- vasoconstrictive actions, as
ication to reduce bronchospasm? well as for its rapid effect of
reducing bronchospasm. Be-
A. epinephrine nadryl and Proventil (nebu-
B. prednisone lized) are given to reverse
C. proventil the effects of histamine. Pred-
D. benadryl nisone is given to reduce in-
flammation, if necessary.

13. The nurse is reviewing diagnostic lab work D. WBC 42,000/mm

of a client developing shock. Which labora-
tory result does the nurse note as a key in Septic shock has the highest
determining the type of shock? mortality rate and is caused
by an overwhelming bacteri-
A. Potassium 4.8 mEq/L al infection; thus, an elevated
B. ESR 19 mm/hr WBC can indicate this type of
C. Hemoglobin 14.2 g/dL shock. The other lab values
D. WBC 42,000/mm are within normal limits.
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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14. The nurse is caring for a client with a cen-B. Always perform hand hy-
tral venous line in place for the treatment giene before manipulating or
of shock. Which nursing interventions are accessing the line ports.
essential for the nurse to complete in orderC. Apply clean gloves before
to reduce the risk of infection? Select all accessing the line port.
that apply. D. Maintain sterile technique
when changing the central ve-
A. Perform a 10-second "hub scrub" using nous line dressing.
chlorhexidine and friction in a twisting mo-
tion on the access hub. The following nursing in-
B. Always perform hand hygiene before ma- terventions are essential to
nipulating or accessing the line ports. reduce the risk of infec-
C. Apply clean gloves before accessing the tion: maintain sterile tech-
line port. nique when changing the cen-
D. Maintain sterile technique when chang- tral venous line dressing; al-
ing the central venous line dressing. ways perform hand hygiene
E. Instruct the client to wear a face mask before manipulating or ac-
and gloves while the central venous line is cessing the line ports; apply
in place. clean gloves before access-
ing the line port; and per-
form a 15- to 30-second "hub
scrub" using chlorhexidine or
alcohol and friction in a twist-
ing motion on the access
hub. The latter reduces biofilm
on the hub that may contain
pathogens.

15. The nursing instructor is discussing shock B. it occurs when arterial

with the senior nursing students. The in- blood flow and oxygen deliv-
structor tells the students that shock ery to tissues and cells are
is a life-threatening condition. What else inadequate
should the instructor tell the students about
shock? Shock is a life-threatening
condition that occurs when
A. it causes respiratory distress syndrome arterial blood flow and oxy-
B. it occurs when arterial blood flow and gen delivery to tissues and
oxygen delivery to tissues and cells are in- cells are inadequate. Respi-
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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adequate ratory distress syndrome can
C. it is a component of any trauma be a complication of shock but
D. it begins when peripheral blood flow is is not necessarily caused by
inadequate shock. Shock does not begin
when peripheral blood flow is
inadequate. Not every trauma
victim goes into shock.

16. The nurse is monitoring the patient in D. Disseminated intravascular

shock. The patient begins bleeding from coagulation (DIC)
previous venipuncture sites, in the in-
dwelling catheter, and rectum, and the Disseminated intravascular
nurse observes multiple areas of ecchymo-coagulation (DIC) may oc-
sis. What does the nurse suspect has devel-
cur either as a cause or
oped in this patient? as a complication of shock.
In this condition, widespread
A. septicemia clotting and bleeding occur
B. Stevens-Johnson syndrome from the ad- simultaneously. Bruises (ec-
minister of antibiotics chymoses) and bleeding (pe-
C. stress ulcer techiae) may appear in the
D. Disseminated intravascular coagulation skin. Coagulation times (e.g.,
(DIC) prothrombin time [PT], acti-
vated partial thromboplastin
time [aPTT]) are prolonged.
Clotting factors and platelets
are consumed and require re-
placement therapy to achieve
hemostasis. The other condi-
tions listed would not result
in bleeding simultaneously at
multiple sites.

17. A client is being cared for in the Neurolog- C. HR 48, BP 90/60

ical Intensive Care Unit following a spinal
cord injury. Which assessment finding indi- The clinical characteristics of
cates that the client may be experiencing neurogenic shock are signs
neurogenic shock? of parasympathetic stimula-
tion. It is characterized by
A. shortness of breath dry, warm skin rather than
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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B. cool, moist skin the cool, moist skin seen in
C. HR 48, BP 90/60 hypovolemic shock. Another
D. HR 120, BP 88/58 characteristic is hypotension
with bradycardia, rather than
the tachycardia that charac-
terizes other forms of shock.
The other signs and symp-
toms are associated with hy-
povolemic shock.

18. A client experiencing vomiting and diarrhea C. Modified Trendelenburg

for 2 days has a blood pressure of 88/56, a
pulse rate of 122 beats/minute, and a respi- The client is experiencing hy-
ratory rate of 28 breaths/minute. The nurse povolemic shock as a result of
places the client in which position? prolonged vomiting and diar-
rhea. The modified Trendelen-
A. Trendelenburg burg position is recommend-
B. Semi-Fowler's ed for hypovolemic shock be-
C. Modified Trendelenburg cause it promotes the return
D. Supine of venous blood. The other
positions may make breathing
difficult and may not increase
blood pressure or cardiac out-
put.

19. The nurse determines that a patient in C. narrowed pulse pressure

shock is experiencing a decrease in stroke
volume when what clinical manifestation is Pulse pressure correlates
observed? well with stroke volume. Pulse
pressure is calculated by sub-
A. increase in SBP tracting the diastolic mea-
B. increase in DBP surement from the systolic
C. narrowed pulse pressure measurement; the difference
D. decrease in RR is the pulse pressure. Normal-
ly, the pulse pressure is 30
to 40 mm Hg. Narrowing or
decreased pulse pressure is
an earlier indicator of shock
than a drop in systolic BP. De-
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
drome
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creased or narrowing pulse
pressure is an early indication
of decreased stroke volume.

20. Oliguria occurs in the progressive stage of A. Increased capillary per-

shock because the kidneys decompensate. meability and fluid and elec-
Which of the following are signs or symp- trolyte shifts
toms that indicate decompensation? Select B. Increased BUN and serum
all that apply. creatinine
C. bradycardia with a HR of
A. Increased capillary permeability and fluid 60
and electrolyte shifts
B. Increased BUN and serum creatinine In decompensation, the MAP
C. bradycardia with a HR of 60 would be less than 65 mm Hg,
D. a mean arterial BP of 70 and the heart rate would be
E. acid-base imbalance tachycardic or erratic with in-
stances of asystole.

21. Stress ulcers occur frequently in acutely ill B. Lansoprazole

patient. Which of the following medications C. Famotidine (Pepcid)
would be used to prevent ulcer formation? E. Nizatidine
Select all that apply.
Antacids, H2 blockers (Pep-
A. Furosemide cid, Axid), and/or proton
B. Lansoprazole pump inhibitors (Prevacid)
C. Famotidine (Pepcid) are prescribed to prevent ul-
D. Desmopressin cer formation by inhibiting
E. Nizatidine gastric acid secretion or in-
creasing gastric pH. Desmo-
pressin (DDVAP) is used in
the treatment of diabetes in-
sipidus. Furosemide (Lasix) is
a loop diuretic and does not
prevent ulcer formation.

22. The nurse is using continuous central ve- A. 70%

nous oximetry (ScvO2) to monitor the blood
oxygen saturation of a patient in shock. Continuous central venous
What value would the nurse document as oximetry (ScvO2) monitoring
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
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normal for the patient? may be used to evaluate
mixed venous blood oxygen
A. 70% saturation and severity of tis-
B. 60% sue hypoperfusion states. A
C. 40% central catheter is introduced
D. 50% into the superior vena cava
(SVC), and a sensor on the
catheter measures the oxy-
gen saturation of the blood in
the SVC as blood returns to
the heart and pulmonary sys-
tem for re-oxygenation. A nor-
mal ScvO2 value is 70%.

23. Which colloid is expensive but rapidly ex- D. Albumin

pands plasma volume?
Albumin is a colloid that re-
A. LR solution quires human donors, is lim-
B. Dextran ited in supply, and can cause
C. Hypertonic saline congestive heart failure. Dex-
D. Albumin tran interferes with platelet
aggregation and is not rec-
ommended for hemorrhagic
shock. Lactated Ringer solu-
tion and hypertonic saline are
crystalloids, not colloids.

24. The nurse is caring for a motor vehicle ac- C. "The client is in shock be-
cident client who is unresponsive on arrival cause the blood volume has
to the emergency department. The client decreased in the system."
has numerous fractures, internal abdominal
injuries, and large lacerations on the head Shock is a life-threatening
and torso. The family arrives and seeks condition that occurs when
update on the client's condition. A family arterial blood flow and oxy-
member asks, "What causes the body to go gen delivery to tissues and
into shock?" Given the client's condition, cells are inadequate. Hypov-
which statement is most correct? olemic shock, where the vol-
ume of extracellular fluid is
A. "The client is in shock because your significantly diminished due
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 PrepU Chapter 11: Shock, Sepsis, and Multiple Organ Dysfunction Syn-
drome
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loved one is not responding and brain to the loss of or reduced blood
dead." or plasma, frequently occurs
B. "The client is in shock because all periph- with accidents.
eral blood vessels have massively dilated."
C. "The client is in shock because the blood
volume has decreased in the system."
D. "The client is in shock because the heart
is unable to circulate the body fluids."

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