Shock States and Fluid Resuscitation Practice Questions
18 free Shock States and Fluid Resuscitation 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.
What type of shock is characterised by a critical decrease in circulating volume, resulting in reduced venous return and cardiac output?
- A Cardiogenic shock
- B Distributive shock
- C Hypovolemic shock
- D Obstructive shock
Correct answer: Hypovolemic shock
Hypovolemic shock results from a critical decrease in circulating volume, such as bleeding or fluid loss, causing reduced venous return and cardiac output.
During initial fluid resuscitation for hemorrhagic shock, what is the first-choice fluid to be administered?
- A Hypotonic saline such as 0.45% sodium chloride
- B Isotonic crystalloids such as 0.9% saline
- C Colloid solutions such as albumin used alone
- D Hypertonic dextrose solution given as a bolus
Correct answer: Isotonic crystalloids such as 0.9% saline
Isotonic crystalloids are the first-line fluids for volume restoration in hypovolemic/hemorrhagic shock before blood products as needed.
What are the 'four phases' of fluid therapy in a patient with septic shock?
- A A single fluid bolus is given, then all fluids are stopped permanently
- B Resuscitation, optimization, stabilization, and evacuation/de-resuscitation
- C Diuretics are started immediately after the very first fluid bolus is given
- D Fluids are administered and never removed once they have been given
Correct answer: Resuscitation, optimization, stabilization, and evacuation/de-resuscitation
In septic shock, fluid therapy is viewed in phases: resuscitation, optimization, stabilization, and evacuation (or de-resuscitation) of excess fluid.
What type of shock is characterised by warm, flushed skin, low systemic vascular resistance (SVR), and high cardiac output in the initial phase?
- A Cardiogenic shock
- B Neurogenic shock
- C Obstructive shock
- D Distributive (septic) shock
Correct answer: Distributive (septic) shock
Distributive shock (such as septic) is characterised by vasodilation (low systemic vascular resistance), high or normal cardiac output early on, and warm skin in the initial phase.
In a patient with cardiogenic shock, which intervention is less likely to be appropriate as the first action?
- A Administer inotropic agent
- B Aggressive large-volume isotonic fluid bolus
- C Provide oxygenation and ventilation support
- D Continuous monitoring and hemodynamic support
Correct answer: Aggressive large-volume isotonic fluid bolus
In cardiogenic shock, giving large volumes of fluid may worsen pulmonary congestion. Priorities include oxygen, inotropes, and careful monitoring.
What is the immediate fluid strategy recommended for a trauma patient with suspected hemorrhagic shock presenting with a systolic blood pressure of 75 mmHg and heart rate of 125 bpm?
- A Withhold all fluids and wait for blood transfusion only
- B Bolus 20 mL/kg isotonic saline (about 2 L) immediately
- C Give hypotonic saline to shift water into the cells
- D Administer vasopressors alone without any fluid resuscitation
Correct answer: Bolus 20 mL/kg isotonic saline (about 2 L) immediately
In initial hemorrhagic shock resuscitation, administration of ~2 L of isotonic saline or ~20 mL/kg boluses is recommended.
What is a key risk of over-administering crystalloids during shock resuscitation?
- A Worsening intracellular hypovolemia and cell shrinkage
- B Severe hyperkalemia from potassium-rich fluids
- C Intravascular volume overload with tissue edema
- D A sustained increase in plasma oncotic pressure
Correct answer: Intravascular volume overload with tissue edema
Excessive crystalloid administration in shock can lead to fluid extravasation into tissues and worsen organ function by edema and intravascular overload.
In a patient in septic shock receiving fluid resuscitation, which laboratory finding indicates inadequate perfusion?
- A Decreased lactate level
- B Increased urine output
- C Rising serum lactate (lactic acidosis)
- D Decreasing heart rate to 60 bpm
Correct answer: Rising serum lactate (lactic acidosis)
Rising lactate indicates anaerobic metabolism due to inadequate perfusion, a key marker in shock.
How do crystalloids differ from colloids in terms of their effect on intravascular volume?
- A Each liter of crystalloid remains entirely intravascular
- B Crystalloids leak into interstitial space rapidly
- C Crystalloids cause increased oncotic pressure
- D Colloids leak more than crystalloids
Correct answer: Crystalloids leak into interstitial space rapidly
Crystalloids quickly equilibrate and about 1 L may boost intravascular volume by only ~200-300 mL because much moves into the interstitial space.
Why might the central venous pressure (CVP) trend downward despite isotonic saline therapy in a patient with hypovolemic shock?
- A The fluid is hypertonic and shifts water intracellularly
- B The patient keeps losing volume or fluid isn't reaching the intravascular space
- C CVP always trends downward naturally during fluid treatment
- D A fluid bolus invariably produces an immediate, sustained CVP rise
Correct answer: The patient keeps losing volume or fluid isn't reaching the intravascular space
In hypovolemic shock, if CVP continues to decline despite isotonic fluid, the cause may be ongoing fluid losses or inadequate intravascular refill, indicating the need for further volume correction.
Which sign is least likely to be observed in the compensatory stage of shock?
- A Tachycardia
- B Narrowing pulse pressure
- C Hypotension (systolic < 90 mmHg)
- D Pale, cool skin
Correct answer: Hypotension (systolic < 90 mmHg)
Hypotension is a late sign (progressive stage); in the compensatory stage, the body maintains blood pressure via vasoconstriction—so hypotension indicates more advanced shock.
In a patient with obstructive shock, which additional intervention is required besides fluid resuscitation?
- A Administer large-volume IV fluids as the sole intervention
- B Relieve the obstruction (e.g., needle decompression)
- C Start antihypertensive medications to lower the blood pressure
- D Give hypertonic saline in an attempt to reverse the obstruction
Correct answer: Relieve the obstruction (e.g., needle decompression)
Obstructive shock stems from mechanical impediment to flow; addressing the obstruction (eg, pneumothorax, tamponade) is essential in addition to fluids.
In a patient in septic shock requiring vasopressors despite adequate fluid resuscitation, what phase or condition is likely present?
- A Resuscitation phase, with the patient fully responsive
- B Optimization phase, with hemodynamics steadily improving
- C Refractory vasodilatory or unstable distributive shock
- D Evacuation phase, with excess fluid being removed
Correct answer: Refractory vasodilatory or unstable distributive shock
When hypotension persists despite fluids and vasopressors, the patient may be in refractory vasodilatory shock, a more severe distributive shock state.
For fluid resuscitation in hypovolemic shock, which fluid type is not usually recommended for intravascular volume restoration?
- A 0.9% normal saline
- B Lactated Ringer’s solution
- C 5% dextrose in water (D5W) alone
- D Isotonic crystalloid bolus
Correct answer: 5% dextrose in water (D5W) alone
D5W is hypotonic once glucose metabolises and doesn’t stay intravascular; it is not appropriate for intravascular volume restoration in hypovolemic shock.
In distributive shock (such as anaphylaxis), besides fluid resuscitation, which adjunct intervention is most critical?
- A Strict fluid restriction as the primary intervention
- B Vasopressors or epinephrine, depending on the subtype
- C Simply increasing the IV fluid infusion rate further
- D Induction of therapeutic hypothermia for perfusion
Correct answer: Vasopressors or epinephrine, depending on the subtype
In distributive shock, vasopressors (eg, epinephrine in anaphylaxis) are often required in addition to fluids to restore perfusion.
A patient in the progressive stage of shock presents with mottled skin, oliguria, and rising lactate. What is the most appropriate priority for management?
- A Observe the patient and reassess at a later time
- B Continue minimal maintenance fluids only for now
- C Rapid fluids, vasoactive support, and treat the cause
- D Discontinue all fluids and withhold further therapy
Correct answer: Rapid fluids, vasoactive support, and treat the cause
In the progressive stage, it is essential to rapidly restore perfusion with fluids, vasopressors, and treat the underlying cause to prevent organ failure.
How do colloid solutions (eg albumin) differ from crystalloids regarding shock resuscitation?
- A Colloids stay intravascular longer and expand volume more per unit given
- B Colloids leak faster into interstitial space than crystalloids
- C Colloids do not affect oncotic pressure
- D Colloids are always preferred first-line for hypovolemic shock
Correct answer: Colloids stay intravascular longer and expand volume more per unit given
Colloids remain intravascular longer and expand blood volume more per liter compared to crystalloids; however, they are not always the first line.
What is the phase that acknowledges the need to remove excess fluid if necessary when transitioning a stabilized shock patient from aggressive fluid resuscitation to fluid management?
- A Resuscitation phase
- B Optimization phase
- C Evacuation (or de-resuscitation) phase
- D Initial bolus phase only
Correct answer: Evacuation (or de-resuscitation) phase
After resuscitation and stabilization, the evacuation or de-resuscitation phase involves removing excess fluid (eg, via diuretics, fluid restriction) to avoid fluid overload complications.