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Emergency and Critical Care Nursing

Types and Management of Shock Practice Questions

20 free Types and Management of Shock practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.

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Question 1 of 20 Medium

Which characteristic most clearly distinguishes hypovolemic shock from distributive shock?

  1. A High cardiac output with warm, vasodilated extremities
  2. B Reduced circulating volume causing low preload and stroke volume
  3. C Myocardial pump failure with high systemic vascular resistance
  4. D Vasodilation occurring despite a normal intravascular volume

Correct answer: Reduced circulating volume causing low preload and stroke volume

Hypovolemic shock is caused by actual volume loss leading to reduced preload and stroke volume.

Question 2 of 20 Medium

A 70-year-old patient with massive anterior wall myocardial infarction presents with hypotension, oliguria, cool extremities, and elevated pulmonary capillary wedge pressure. Which type of shock is most likely?

  1. A Distributive shock
  2. B Hypovolemic shock
  3. C Cardiogenic shock
  4. D Obstructive shock

Correct answer: Cardiogenic shock

Cardiogenic shock occurs due to primary cardiac pump failure resulting in low cardiac output and signs of poor perfusion.

Question 3 of 20 Medium

A patient with sepsis from a severe bacterial infection develops hypotension, warm flushed skin, and a high cardiac output. What type of shock is described?

  1. A Hypovolemic shock
  2. B Cardiogenic shock
  3. C Distributive shock
  4. D Obstructive shock

Correct answer: Distributive shock

Distributive shock (septic shock) is characterized by profound vasodilation, relative intravascular volume loss, warm extremities, and high cardiac output.

Question 4 of 20 Easy

Which of the following is the first priority nursing intervention in hypovolemic shock from suspected internal hemorrhage?

  1. A Immediate administration of intravenous vasodilators
  2. B Large-bore IV access with crystalloid fluid resuscitation
  3. C High-dose inotropes given before any fluid replacement
  4. D Withholding fluids until diagnostic imaging is completed

Correct answer: Large-bore IV access with crystalloid fluid resuscitation

In hypovolemic shock, the primary treatment is rapid volume replacement via large-bore IV and crystalloids/blood products to restore circulating volume and perfusion.

Question 5 of 20 Medium

In cardiogenic shock, which hemodynamic change is expected?

  1. A Low pulmonary capillary wedge pressure with high output
  2. B High pulmonary capillary wedge pressure with low cardiac output
  3. C Low systemic vascular resistance with warm extremities
  4. D Increased circulating volume with preserved contractility

Correct answer: High pulmonary capillary wedge pressure with low cardiac output

Cardiogenic shock involves pump failure leading to increased filling pressures (PCWP) and reduced cardiac output.

Question 6 of 20 Medium

A nurse is caring for a patient in septic (distributive) shock. Which goal is most appropriate?

  1. A Maintain a mean arterial pressure of at least 65 mmHg with fluids and vasopressors
  2. B Withhold vasopressors until blood pressure drops below 80/60 mmHg
  3. C Give diuretics to correct the warm, vasodilated extremities
  4. D Delay fluid resuscitation until blood culture results return

Correct answer: Maintain a mean arterial pressure of at least 65 mmHg with fluids and vasopressors

In distributive shock (sepsis), a key goal is to restore perfusion pressure via fluids and vasopressors while treating the underlying cause.

Question 7 of 20 Medium

A trauma patient who has lost more than 40% of blood volume will likely show which clinical sign?

  1. A Bradycardia with warm, well-perfused skin
  2. B Narrow pulse pressure, heart rate above 120, and oliguria
  3. C Hypotension accompanied by bounding peripheral pulses
  4. D Hypertension with flushed, vasodilated skin

Correct answer: Narrow pulse pressure, heart rate above 120, and oliguria

In major hypovolemia (>40% blood loss) clinical signs include tachycardia, narrow pulse pressure, hypotension, and low urine output.

Question 8 of 20 Medium

Which statement about management differences between cardiogenic and hypovolemic shock is correct?

  1. A Both shock types require aggressive fluid boluses without caution
  2. B Cardiogenic shock needs cautious fluids, while hypovolemic shock needs fluids first-line
  3. C Cardiogenic shock resolves with fluids alone, without inotropic support
  4. D Hypovolemic shock is best managed with vasodilators as first-line therapy

Correct answer: Cardiogenic shock needs cautious fluids, while hypovolemic shock needs fluids first-line

Hypovolemic shock requires volume resuscitation as the first step; in cardiogenic shock, additional fluids may worsen pulmonary edema, so careful fluid management is required.

Question 9 of 20 Medium

A patient is suspected to have neurogenic (distributive) shock from a high spinal cord injury. Which classic hemodynamic feature is expected?

  1. A Tachycardia with a narrow pulse pressure
  2. B Relative bradycardia, hypotension, and warm dry skin
  3. C Hypertension with bounding peripheral pulses
  4. D Cold clammy skin with severe compensatory tachycardia

Correct answer: Relative bradycardia, hypotension, and warm dry skin

Neurogenic shock typically presents with hypotension, relative bradycardia, and warm dry skin.

Question 10 of 20 Medium

Which lactate value trend is concerning in a patient with shock?

  1. A A normal lactate that is steadily decreasing
  2. B An elevated lactate above 2 mmol/L that is rising over time
  3. C A lactate consistently held below 1 mmol/L
  4. D A single elevated lactate that normalises within minutes

Correct answer: An elevated lactate above 2 mmol/L that is rising over time

Elevated and rising lactate indicates worsening tissue hypoperfusion and anaerobic metabolism in shock.

Question 11 of 20 Medium

For distributive (septic) shock, which of the following nursing interventions is essential?

  1. A Give early broad-spectrum antibiotics and monitor fluid status
  2. B Withhold all fluids and rely solely on vasopressor support
  3. C Stop monitoring urine output to reduce patient disturbance
  4. D Use diuretics alone to manage the warm, flushed skin

Correct answer: Give early broad-spectrum antibiotics and monitor fluid status

Early antibiotic therapy is critical in septic shock along with fluid resuscitation and hemodynamic monitoring by nursing staff.

Question 12 of 20 Medium

In hypovolemic shock due to internal bleeding, which lab value would the nurse monitor closely?

  1. A Arterial pH trending toward alkalosis
  2. B Falling hematocrit with rising lactate
  3. C Stable platelet count with normal coagulation
  4. D Rising serum sodium with stable hematocrit

Correct answer: Falling hematocrit with rising lactate

A falling hematocrit reflects volume/red-cell loss from bleeding, and rising lactate signals anaerobic metabolism from hypoperfusion in hypovolemic shock. Platelets, coagulation, and sodium are not the most sensitive markers of ongoing internal hemorrhage.

Question 13 of 20 Medium

Which would be the most appropriate initial vasopressor in cardiogenic shock after ensuring adequate fluid optimization?

  1. A Norepinephrine
  2. B Phenylephrine
  3. C Epinephrine
  4. D Digoxin

Correct answer: Norepinephrine

Norepinephrine is the recommended first-line vasopressor in cardiogenic shock after fluid status is optimized, supporting perfusion pressure with relatively limited tachycardia. Phenylephrine raises afterload, epinephrine increases myocardial oxygen demand, and digoxin is not a vasopressor.

Question 14 of 20 Medium

A patient presents with anaphylactic shock (a subtype of distributive shock). Which immediate intervention is a priority?

  1. A Intramuscular epinephrine with high-flow oxygen
  2. B Oral antihistamines and reassurance only
  3. C Long-term antibiotic therapy
  4. D Delayed airway management after observation

Correct answer: Intramuscular epinephrine with high-flow oxygen

Anaphylactic shock requires immediate intramuscular epinephrine plus high-flow oxygen to reverse vasodilation, support perfusion, and protect the airway. Antihistamines are adjuncts only, antibiotics are irrelevant, and airway management must not be delayed.

Question 15 of 20 Medium

In cardiogenic shock, the nurse observes jugular venous distension (JVD), pulmonary edema on auscultation, and weak pulses. These findings reflect:

  1. A Decreased afterload with elevated cardiac output
  2. B Impaired contractility with backup of blood
  3. C Volume depletion with intense vasoconstriction
  4. D Vasodilation with high cardiac output

Correct answer: Impaired contractility with backup of blood

JVD, pulmonary edema, and weak pulses reflect a failing myocardium: blood backs up into the venous and pulmonary circulation while forward perfusion drops. This is reduced contractility, not high output, volume depletion, or vasodilation.

Question 16 of 20 Medium

Which is a hallmark sign of early compensated shock that the nurse should recognize?

  1. A Profound hypotension with anuria
  2. B Tachycardia, narrowed pulse pressure, restlessness
  3. C Warm flushed skin with bradycardia
  4. D Hypertension with increased urine output

Correct answer: Tachycardia, narrowed pulse pressure, restlessness

Compensated (early) shock features tachycardia, a narrowing pulse pressure, increased respiratory rate, and restlessness or altered mentation before frank hypotension appears. Profound hypotension and anuria indicate decompensation, not early shock.

Question 17 of 20 Medium

In hypovolemic shock, what is an expected change in skin perfusion?

  1. A Warm, flushed, dry skin
  2. B Cool, pale, clammy skin with delayed capillary refill
  3. C Jaundiced skin with bounding pulses
  4. D Mottled warm skin with rapid capillary refill

Correct answer: Cool, pale, clammy skin with delayed capillary refill

Hypovolemia triggers peripheral vasoconstriction, producing cool, pale, clammy skin and delayed capillary refill as blood is shunted to vital organs. Warm or flushed skin is more typical of early distributive shock.

Question 18 of 20 Medium

What distinguishes cardiogenic shock from other types of shock in terms of pulse pressure?

  1. A Widened (large) pulse pressure
  2. B Narrow pulse pressure from reduced stroke volume
  3. C No change in pulse pressure occurs
  4. D Pulse pressure rises as stroke volume falls

Correct answer: Narrow pulse pressure from reduced stroke volume

Cardiogenic shock lowers stroke volume and cardiac output, which narrows the pulse pressure. A widened pulse pressure is not expected, and pulse pressure does not rise as stroke volume falls.

Question 19 of 20 Medium

Which nursing assessment finding is most consistent with distributive shock from spinal cord injury (neurogenic shock)?

  1. A Tachycardia with hypertension and cool skin
  2. B Warm flushed extremities with tachycardia
  3. C Bradycardia, hypotension, and warm skin below injury
  4. D Cool clammy skin with high vascular resistance

Correct answer: Bradycardia, hypotension, and warm skin below injury

Neurogenic shock from spinal cord injury causes loss of sympathetic tone, producing vasodilation, hypotension, warm skin, and often bradycardia rather than the compensatory tachycardia seen in other shock types.

Question 20 of 20 Medium

A patient in shock is receiving a vasopressor. The nurse understands that monitoring which parameter is most critical to evaluate the adequacy of perfusion?

  1. A Skin temperature of the extremities
  2. B Urine output, mental status, and lactate trend
  3. C Resting heart rate measured hourly
  4. D Pulse oximetry waveform amplitude

Correct answer: Urine output, mental status, and lactate trend

Adequacy of perfusion is best judged by end-organ markers: urine output (about 0.5 mL/kg/hr or more), mental status, and a falling lactate. Single parameters such as skin temperature, heart rate, or oximetry are less reliable indicators of tissue perfusion.

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