PRETEST

OBSTRUCTIVE SHOCK

1. Which of the following is the primary cause of obstructive shock?

a) Blood loss
b) Cardiac tamponade
c) Severe infection
d) Dehydration
Rationale: Obstructive shock occurs due to physical obstruction of blood flow, with common causes including
cardiac tamponade, pulmonary embolism, and tension pneumothorax.

2. Which of the following is NOT a common symptom of obstructive shock?

a) Hypotension
b) Distended neck veins
c) Bradycardia
d) Tachycardia
Rationale: Obstructive shock typically leads to tachycardia (increased heart rate) as the body attempts to
compensate for low blood flow. Bradycardia is not common in obstructive shock.

3. In obstructive shock caused by a pulmonary embolism, which of the following occurs?

a) Fluid accumulation in the lungs

b) Blockage of blood flow in a pulmonary artery
c) Inflammation of the lung tissue
d) Collapse of the trachea
Rationale: A pulmonary embolism is a blockage of one of the pulmonary arteries, often caused by blood
clots, which can lead to obstructive shock.

4. Which of the following interventions is most appropriate for a patient with tension pneumothorax
causing obstructive shock?

a) Intravenous antibiotics
b) Needle decompression
c) Blood transfusion
d) Mechanical ventilation
Rationale: Tension pneumothorax is relieved by inserting a needle to decompress the chest and release
trapped air, which allows the lungs to re-expand.

5. Which of the following is the primary goal in the treatment of obstructive shock?

a) Increase cardiac output

b) Decrease fluid volume
c) Treat the underlying obstruction
d) Reduce inflammation
Rationale: The main goal is to remove or relieve the obstruction causing the shock, such as treating a
pulmonary embolism, draining pericardial effusion, or decompressing tension pneumothorax.

POST TEST
OBSTRUCTIVE SHOCK

1. What is the typical volume of fluid in the pericardial sac under normal conditions?

a) 20 mL
b) 30 mL
c) 40 mL
d) 50 mL
Rationale: The pericardial sac normally contains about 20 mL of fluid, which acts as a lubricant to reduce
friction between the heart and the surrounding structures during heartbeats.

2. A patient with obstructive shock due to cardiac tamponade is most likely to exhibit which of the
following signs?

a) Muffled heart sounds

b) Clear lung sounds
c) Fever and chills
d) Bounding pulses
Rationale: In cardiac tamponade, fluid accumulates in the pericardium, leading to muffled heart sounds due
to pressure on the heart.

3. A 72-year-old female patient is brought to the emergency department with sudden onset of chest pain,
difficulty breathing, and confusion. Upon assessment, her vital signs reveal a blood pressure of 85/55 mmHg,
a heart rate of 130 bpm, and an oxygen saturation of 82% on room air. She has a history of deep vein
thrombosis (DVT) and recent leg swelling. What is the most likely cause of her symptoms?

a) Cardiac tamponade
b) Pulmonary embolism
c) Aortic dissection
d) Tension pneumothorax
Rationale: The patient’s history of DVT and presentation with sudden chest pain, difficulty breathing, and low
oxygen saturation strongly suggest a pulmonary embolism, where a blood clot travels to the lungs and
obstructs blood flow, leading to obstructive shock.

4. Which of the following clinical signs is most likely in obstructive shock due to a tension
pneumothorax?

a) Paradoxical chest movement

b) Tracheal deviation toward the unaffected side
c) Bilateral wheezing
d) Hemoptysis
Rationale: In tension pneumothorax, the accumulation of air in the pleural space causes increased pressure,
pushing the trachea toward the unaffected side. Paradoxical chest movement is seen in flail chest, while
wheezing and hemoptysis are not typical of tension pneumothorax.

5. Which condition is LEAST likely to cause obstructive shock?

a) Pulmonary embolism
b) Aortic dissection
c) Cardiac tamponade
d) Myocardial infarction
 Rationale: Myocardial infarction (MI) leads to cardiogenic shock rather than obstructive shock. Obstructive
shock is caused by conditions like PE, cardiac tamponade, or aortic dissection, which obstruct blood flow to
or from the heart.

PRETEST

CARDIOGENIC SHOCK

1. Cardiac output is very important for determining if a patient is in cardiogenic shock. What is a normal
cardiac output in an adult?
a. A. 2-5 liters/minute
b. B. 1-3 liters/minute
c. C. 4-8 liters/minute
d. D. 8-10 liters/minute

Rationale: The answer is C. Cardiac output is the amount of blood the heart pumps per minute. The heart’s
cardiac output should be anywhere from 4-8 liters of blood per minute.

2. Which patient below is at MOST risk for developing cardiogenic shock?

a. A 52-year-old male who is experiencing a severe allergic reaction from shellfish.
b. A 25-year-old female who has experienced an upper thoracic spinal cord injury.
c. A 72-year-old male who is post-op from a liver transplant.
d. A 49-year-old female who is experiencing an acute myocardial infarction.

Rationale: The answer is D. An acute MI (heart attack) is the main cause of cardiogenic shock. It happens
because a coronary artery has become blocked. Coronary arteries supply the heart muscle’s cells with
oxygenated blood. If they don’t receive this oxygenated blood they will die, which causes the heart muscle to
quit working (hence pumping efficiently). When the heart muscle fails to pump efficiently, cardiac output fails
and cardiogenic shock occurs.

3. ________________ is the amount the ventricle stretches at the end of the diastole.
a. Preload
b. Afterload
c. Stroke Volume
d. Contractility

Rationale: The answer is A. Preload is the amount the ventricle stretches at the end of diastole (hence it’s the
amount the ventricles stretches once it’s filled with blood and right before the contraction of the ventricle ….so
it’s the end-diastolic volume).

4. _____________ is the force the heart has to pump against to get blood out of the ventricle.
a. Cardiac output
b. Cardiac index
c. Preload
d. Afterload

Rationale: The answer is D. Afterload is the pressure the ventricle must pump against to squeeze blood out.
In other words, it’s the force the heart has to pump against to get blood out of the ventricle.

5. True or False: If a patient with cardiogenic shock is given a medication that will decrease cardiac
afterload, it will decrease stroke volume.

Answer: FALSE
 Rationale: The answer is FALSE. If a patient with cardiogenic shock is given a medication that will decrease
cardiac afterload, it will INCREASE (not decrease) stroke volume. HOW? Remember afterload is the
resistance the ventricle must pump against to get blood out of the heart. If we DECREASE the resistance the
heart must pump against (make it easier for the heart to squeeze blood out of the ventricle), it will increase
how much blood it will pump out, hence increase the stroke volume.

POST TEST

CARDIOGENIC SHOCK

1. A patient is brought to the emergency department with hypotension, tachycardia, reduced capillary
refill, and oliguria. During the assessment, the nurse determines the patient is experiencing
cardiogenic shock because of which additional finding?
a. Jugular vein distention
b. Dry mucous membranes
c. Poor skin turgor
d. Thirst
Rationale: Jugular vein distention is a manifestation of cardiogenic shock.

2. The nurse is caring for an adult pt who is admitted with chest pain that began four hours ago. Which
test will be most specific in identifying acute heart damage?
a. troponin
b. CPK
c. CK-MB
d. cholesterol
Rationale: Troponin is primarily located in cardiac muscle & can indicate myocardial infarction or unstable
angina. Troponin elevates at two to four hours after myocardial infarction.

3. Which diagnostic tool is most helpful in confirming a diagnosis of cardiogenic shock?

a. Chest X-ray
b. Electrocardiogram (ECG)
c. Echocardiogram
d. Arterial blood gas (ABG) analysis

Rationale: An echocardiogram provides real-time images of the heart's function and can reveal reduced
ejection fraction, valve abnormalities, or other structural causes of cardiogenic shock. A chest X-ray (A) may
show pulmonary edema, but it is not diagnostic. An ECG (B) can reveal ischemia or arrhythmias but does not
confirm shock. ABG analysis (D) may show hypoxia or acidosis, but it also doesn’t confirm the underlying
cause.

4. What is the most appropriate nursing intervention for a patient in cardiogenic shock?
a. Place the patient in Trendelenburg position
b. Administer high-flow oxygen
c. Restrict all fluids
d. Encourage early ambulation

Rationale: Administering high-flow oxygen is crucial in cardiogenic shock to ensure that tissues receive as
much oxygen as possible, given the decreased cardiac output.

5. Which of the following is a common early sign of cardiogenic shock?

a. Confusion or altered mental status
b. Peripheral cyanosis
c. Hyperthermia
d. Bounding pulse

Rationale: Altered mental status is an early sign of cardiogenic shock due to decreased cerebral perfusion.
PRETEST

HYPOVOLEMIC SHOCK

​ 1. True or False: Hypovolemic shock occurs where there is low fluid volume in the interstitial
compartment.
​ True
​ 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.*
​ A. <30%
​ B. >25%
​ C. >15%
​ D. >10%
​ 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%
​ 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
​ 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.
​ True
​ False
​

POST TEST

HYPOVOLEMIC SHOCK

1. 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
2. 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
 3. 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
4. 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
5. What is the most important initial intervention for a patient suspected of hypovolemic shock?

A. Administer oxygen
B. Start antibiotics
C. Establish IV access and begin fluid resuscitation
D. Administer pain medication

PRETEST

DISTRIBUTIVE SHOCK
1. Which of the following is a primary characteristic of distributive shock?
A. Decreased cardiac output
B. Vasodilation and decreased systemic vascular resistance
C. Increased pulmonary capillary wedge pressure
D. High peripheral vascular resistance

Rationale: Distributive shock is characterized by widespread vasodilation, leading to decreased systemic vascular
resistance (SVR). This results in hypotension despite normal or increased cardiac output.

2. Which condition is most commonly associated with distributive shock?

A. Myocardial infarction
B. Hemorrhagic shock
C. Septic shock
D. Cardiogenic shock

Rationale: Septic shock is a form of distributive shock caused by severe infections leading to systemic inflammation
and vasodilation. Other forms of distributive shock include neurogenic shock and anaphylactic shock.

3. In a patient with distributive shock, you would expect which of the following vital sign changes?
A. High blood pressure and bradycardia
B. Hypotension and tachycardia
C. Elevated blood pressure and hypothermia
D. Normal blood pressure and bradypnea

Rationale: Patients with distributive shock typically present with hypotension due to vasodilation and compensatory
tachycardia as the body attempts to maintain cardiac output.

4. Which of the following interventions is most critical in managing distributive shock?

A. Administering high doses of inotropes
B. Initiating fluid resuscitation
C. Performing immediate surgery
D. Using corticosteroids
Rationale: The primary management of distributive shock, especially in septic cases, involves fluid resuscitation to
restore intravascular volume and improve perfusion. Inotropes may be considered later if fluid resuscitation alone is
insufficient.

5. In the context of septic shock, which laboratory finding is typically observed?

A. Elevated white blood cell count
B. Decreased blood glucose levels
C. Increased urine output
D. Elevated hemoglobin levels

Rationale: In septic shock, there is often an elevated white blood cell count (leukocytosis) due to the body’s immune
response to infection. Other findings may include metabolic abnormalities, but an elevated white blood cell count is a
classic indicator.

POST TEST

DISTRIBUTIVE SHOCK

1. Which type of distributive shock is most commonly associated with severe infection?
A. Neurogenic shock
B. Cardiogenic shock
C. Septic shock
D. Anaphylactic shock

Rationale: Septic shock occurs as a result of systemic infection, leading to a severe inflammatory response,
vasodilation, and increased capillary permeability.

2. In which of the following conditions can neurogenic shock occur?

A. Severe infection
B. Spinal cord injury
C. Myocardial infarction
D. Pulmonary embolism

Rationale: Neurogenic shock results from damage to the spinal cord, leading to loss of sympathetic tone and
resultant vasodilation below the level of injury.

3. Which assessment finding would be most concerning in a patient suspected of having distributive shock?
A. Systolic blood pressure of 90 mmHg
B. Heart rate of 100 beats per minute
C. Respiratory rate of 20 breaths per minute
D. Urine output of 30 mL/hour

Rationale: A systolic blood pressure of 90 mmHg indicates hypotension, which is a critical sign of shock and
requires immediate intervention to prevent further deterioration.

4. In cases of anaphylactic shock, what is a critical first-line intervention?

A. Administering intravenous fluids
B. Giving epinephrine
C. Performing chest compressions
D. Initiating oxygen therapy

Rationale: Epinephrine is the first-line treatment for anaphylactic shock, as it rapidly counteracts the effects of
histamine, causing vasoconstriction and bronchodilation.

5. What is a common complication of untreated distributive shock?

A. Hypertension
B. Multi-organ failure
C. Hyperglycemia
 D. Dehydration

Rationale: If distributive shock is not treated promptly, it can lead to multi-organ failure due to inadequate perfusion
and oxygenation of tissues, which can be life-threatening.