Shock, sepsis NCLEX-RN Practice Questions

Shock, sepsis NCLEX-RN Practice Questions

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Shock, sepsis NCLEX-RN Practice Questions are designed to strengthen your clinical judgment in high-stakes situations where rapid assessment and evidence-based interventions save lives. In this topic-wise practice set focused on Physiological Adaptation, you’ll apply current sepsis and shock guidelines, interpret hemodynamic trends, prioritize nursing actions, and recognize complications such as ARDS and DIC. These NCLEX-RN level questions integrate pathophysiology with bedside decision-making: fluid resuscitation targets, vasopressor selection, infection source control, antibiotic timing, and monitoring endpoints like MAP and urine output. Ideal for M. Pharma students and nursing graduates, this set challenges you to think critically, act safely, and align with best practices, including sepsis bundle timing, lactate-guided resuscitation, and targeted therapies for septic, cardiogenic, anaphylactic, neurogenic, hemorrhagic, and obstructive shock.

Q1. A client with suspected septic shock presents with fever, tachycardia, hypotension, and warm, flushed skin with bounding pulses. Which finding best explains this presentation?

  • Early distributive shock with peripheral vasodilation and decreased systemic vascular resistance
  • Late septic shock with profound vasoconstriction and increased systemic vascular resistance
  • Cardiogenic shock with reduced cardiac output and high wedge pressure
  • Neurogenic shock with loss of sympathetic tone below the lesion

Correct Answer: Early distributive shock with peripheral vasodilation and decreased systemic vascular resistance

Q2. A client in sepsis has SBP 84 mmHg, MAP 58 mmHg, HR 124/min, RR 28/min, and SpO₂ 90% on room air. Which provider order should the nurse implement first?

  • Begin 30 mL/kg isotonic crystalloid bolus rapidly
  • Obtain a 12-lead ECG
  • Administer subcutaneous heparin prophylaxis
  • Schedule an echocardiogram

Correct Answer: Begin 30 mL/kg isotonic crystalloid bolus rapidly

Q3. Which parameter is the most sensitive bedside indicator that fluid resuscitation is improving end-organ perfusion in septic shock?

  • Improved urine output to ≥0.5 mL/kg/hr
  • Normalized white blood cell count
  • Decreased body temperature
  • Resolution of peripheral edema

Correct Answer: Improved urine output to ≥0.5 mL/kg/hr

Q4. Before administering broad-spectrum IV antibiotics to a client with suspected sepsis, what is the priority nursing action?

  • Obtain two sets of blood cultures from different sites
  • Administer antipyretics for comfort
  • Insert a urinary catheter for strict I&O
  • Start vasopressor therapy immediately

Correct Answer: Obtain two sets of blood cultures from different sites

Q5. A client remains hypotensive after 30 mL/kg crystalloid for septic shock. Which vasopressor is first-line to achieve a MAP ≥65 mmHg?

  • Dopamine
  • Norepinephrine
  • Phenylephrine
  • Epinephrine IM

Correct Answer: Norepinephrine

Q6. A patient develops generalized urticaria, wheezing, stridor, and hypotension after an IV antibiotic. What is the priority medication and route?

  • Intramuscular epinephrine 0.3–0.5 mg (1 mg/mL) to the lateral thigh
  • Oral diphenhydramine 50 mg
  • IV methylprednisolone 125 mg
  • Nebulized albuterol

Correct Answer: Intramuscular epinephrine 0.3–0.5 mg (1 mg/mL) to the lateral thigh

Q7. Which assessment pattern most strongly suggests neurogenic shock after a T6 spinal cord injury?

  • Hypotension, bradycardia, warm dry skin
  • Hypertension, bradycardia, cool pale skin
  • Hypotension, tachycardia, cool clammy skin
  • Hypertension, tachycardia, flushed skin

Correct Answer: Hypotension, bradycardia, warm dry skin

Q8. A client with acute MI develops cardiogenic shock. Which order should the nurse question?

  • Administer 1,000 mL normal saline bolus over 15 minutes
  • Start dobutamine infusion as prescribed
  • Provide supplemental oxygen to maintain SpO₂ ≥94%
  • Prepare for emergent PCI

Correct Answer: Administer 1,000 mL normal saline bolus over 15 minutes

Q9. A trauma client is suspected of having cardiac tamponade. Which constellation of findings most supports this diagnosis?

  • Hypotension, jugular venous distension, muffled heart sounds
  • Hypertension, crackles, S3 gallop
  • Hypotension, unilateral breath sounds, tracheal deviation
  • Bradycardia, bounding pulses, wide pulse pressure

Correct Answer: Hypotension, jugular venous distension, muffled heart sounds

Q10. Which laboratory finding best correlates with impaired tissue perfusion in sepsis and guides resuscitation?

  • Serum lactate of 5.2 mmol/L
  • Serum creatinine of 0.7 mg/dL
  • Platelet count of 250,000/µL
  • Serum sodium of 140 mEq/L

Correct Answer: Serum lactate of 5.2 mmol/L

Q11. In the management of sepsis, what is the recommended target range for blood glucose control?

  • 140–180 mg/dL
  • 70–110 mg/dL
  • 180–220 mg/dL
  • 100–120 mg/dL

Correct Answer: 140–180 mg/dL

Q12. Which set of coagulation findings is most consistent with disseminated intravascular coagulation (DIC) secondary to sepsis?

  • Prolonged PT/aPTT, low fibrinogen, elevated D-dimer, thrombocytopenia
  • Normal PT/aPTT, high fibrinogen, low D-dimer, thrombocytosis
  • Short PT/aPTT, high fibrinogen, low D-dimer, anemia
  • Prolonged PT/aPTT, high fibrinogen, normal D-dimer, leukocytosis

Correct Answer: Prolonged PT/aPTT, low fibrinogen, elevated D-dimer, thrombocytopenia

Q13. Which is the most appropriate initial fluid for resuscitation in septic shock?

  • Lactated Ringer’s solution
  • 5% dextrose in water
  • Albumin 25%
  • 0.45% sodium chloride

Correct Answer: Lactated Ringer’s solution

Q14. A client on norepinephrine for septic shock requires nursing safety measures. Which action has highest priority?

  • Administer via central venous catheter with continuous blood pressure monitoring
  • Run the infusion by gravity to reduce pressure on the vessel
  • Use a heparin lock to prevent line occlusion
  • Administer the infusion through the same line as antibiotics

Correct Answer: Administer via central venous catheter with continuous blood pressure monitoring

Q15. After a 30 mL/kg bolus, the nurse wants to determine fluid responsiveness without more fluids. Which bedside maneuver is best?

  • Passive leg raise with reassessment of blood pressure or stroke volume
  • Carotid sinus massage
  • Valsalva maneuver
  • Trendelenburg positioning for 30 minutes

Correct Answer: Passive leg raise with reassessment of blood pressure or stroke volume

Q16. The “within 1-hour” sepsis bundle includes which combination of actions?

  • Measure lactate, obtain blood cultures, give broad-spectrum antibiotics, give rapid crystalloid for hypotension or lactate ≥4, start vasopressors if MAP <65
  • Start vasopressors, wait for culture results, give antibiotics if lactate >2, restrict fluids
  • Obtain urine culture only, start insulin infusion, give antipyretics, repeat lactate in 24 hours
  • Begin steroids first, then antibiotics, delay fluids until central line is placed

Correct Answer: Measure lactate, obtain blood cultures, give broad-spectrum antibiotics, give rapid crystalloid for hypotension or lactate ≥4, start vasopressors if MAP <65

Q17. Which client is at highest risk for developing sepsis?

  • 78-year-old with an indwelling urinary catheter and new confusion
  • 24-year-old with a clean ankle sprain
  • 40-year-old scheduled for elective colonoscopy next week
  • 55-year-old with seasonal allergies using antihistamines

Correct Answer: 78-year-old with an indwelling urinary catheter and new confusion

Q18. Blood cultures identify a gram-negative organism sensitive to ceftriaxone. What is the best nursing action regarding antibiotics?

  • Request de-escalation from broad-spectrum therapy to ceftriaxone
  • Continue broad-spectrum coverage indefinitely
  • Stop antibiotics and repeat blood cultures in 72 hours
  • Switch to oral amoxicillin immediately

Correct Answer: Request de-escalation from broad-spectrum therapy to ceftriaxone

Q19. A septic client’s SpO₂ is 86% on room air. What is the priority?

  • Apply supplemental oxygen to maintain SpO₂ ≥94%
  • Administer furosemide to reduce pulmonary edema
  • Restrict fluids to prevent fluid overload
  • Place the client in prone position immediately

Correct Answer: Apply supplemental oxygen to maintain SpO₂ ≥94%

Q20. A client with sepsis develops ARDS. Which ventilator strategy is most appropriate?

  • Low tidal volume ventilation (≈6 mL/kg predicted body weight)
  • High tidal volume ventilation (10–12 mL/kg)
  • Zero PEEP to prevent barotrauma
  • Permissive hyperoxia with FiO₂ 100% continuously

Correct Answer: Low tidal volume ventilation (≈6 mL/kg predicted body weight)

Q21. Which combination fulfills qSOFA criteria and suggests high risk of poor outcomes in suspected infection?

  • RR 24/min, altered mentation, SBP 92 mmHg
  • T 38.3°C, HR 110/min, WBC 15,000/µL
  • RR 18/min, SBP 128 mmHg, alert and oriented
  • T 35.8°C, HR 80/min, SBP 110 mmHg

Correct Answer: RR 24/min, altered mentation, SBP 92 mmHg

Q22. A trauma client has profuse external bleeding with hypotension and tachycardia. What is the nurse’s first action?

  • Apply firm direct pressure to the bleeding site
  • Obtain informed consent for surgery
  • Administer prophylactic antibiotics
  • Place the client in high Fowler’s position

Correct Answer: Apply firm direct pressure to the bleeding site

Q23. Which finding indicates progression from sepsis to septic shock?

  • Persistent hypotension requiring vasopressors to maintain MAP ≥65 after adequate fluids and lactate >2 mmol/L
  • Fever of 38.2°C controlled with acetaminophen
  • Leukocytosis resolving after 24 hours
  • Transient orthostatic hypotension with ambulation

Correct Answer: Persistent hypotension requiring vasopressors to maintain MAP ≥65 after adequate fluids and lactate >2 mmol/L

Q24. A client with septic shock remains hypotensive despite adequate fluids and norepinephrine. Which adjunct therapy may be indicated?

  • Low-dose IV hydrocortisone per protocol
  • Oral prednisone taper
  • High-dose methylprednisolone bolus
  • Subcutaneous insulin bolus

Correct Answer: Low-dose IV hydrocortisone per protocol

Q25. In a stable septic client without active bleeding or myocardial ischemia, at which hemoglobin level is RBC transfusion generally recommended?

  • <7 g/dL
  • <9 g/dL
  • <10 g/dL
  • <11 g/dL

Correct Answer: <7 g/dL

Q26. A 70-kg adult with septic shock has a Foley catheter. What minimum urine output indicates adequate renal perfusion?

  • ≥35 mL/hour
  • ≥20 mL/hour
  • ≥70 mL/hour
  • ≥10 mL/hour

Correct Answer: ≥35 mL/hour

Q27. After a 30 mL/kg LR bolus, a septic client’s MAP remains 58 mmHg. What is the next best action?

  • Initiate norepinephrine infusion to target MAP ≥65 mmHg
  • Administer 5% dextrose at 125 mL/hour
  • Give an additional 1 L bolus of hypotonic saline
  • Withhold vasopressors until central line is placed

Correct Answer: Initiate norepinephrine infusion to target MAP ≥65 mmHg

Q28. A patient in anaphylactic shock is on a beta-blocker and remains hypotensive and bronchospastic after IM epinephrine. Which medication is the best adjunct?

  • IV glucagon
  • IV labetalol
  • Oral montelukast
  • Subcutaneous insulin

Correct Answer: IV glucagon

Q29. Which set of findings most likely represents late (cold) septic shock?

  • Cool clammy skin, weak thready pulses, narrow pulse pressure
  • Warm flushed skin, bounding pulses, widened pulse pressure
  • Bradycardia, hypertension, warm dry skin
  • Warm diaphoretic skin, bradypnea, widened pulse pressure

Correct Answer: Cool clammy skin, weak thready pulses, narrow pulse pressure

Q30. Regarding timely antibiotics in sepsis, which statement reflects best nursing practice?

  • Obtain blood cultures promptly but do not delay antibiotics beyond 1 hour
  • Wait for lactate results before starting antibiotics
  • Delay antibiotics until definitive imaging identifies the source
  • Administer narrow-spectrum antibiotics before cultures

Correct Answer: Obtain blood cultures promptly but do not delay antibiotics beyond 1 hour

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