Medical emergencies, shock and sepsis

56 NCLEX-RN practice questions on Medical emergencies, shock and sepsis, part of Physiological Adaptation. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium · Select all that apply
A client with chronic kidney disease who missed two dialysis sessions has a serum potassium of 7.0 mEq/L. Which ECG changes does the nurse expect?
1. AProminent U waves
2. BWidened QRS complexes
3. CTall, peaked T waves
4. DST depression with flattened T waves
5. EProlonged PR interval with flattened P waves
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Answer: B, C, E
Analyze cues: rising potassium causes peaked T waves, then PR prolongation and P wave flattening, QRS widening and finally a sine-wave pattern, VF or asystole. U waves and flat T waves belong to hypokalemia.
- A: U waves are a sign of hypokalemia.
- D: These changes are seen with low potassium.
Question 2 · Easy · Select all that apply
The nurse is performing chest compressions on an adult in cardiac arrest while a team member gives breaths. Which actions reflect high-quality CPR?
1. AStop compressions every minute to feel for a carotid pulse
2. BSwitch the person doing compressions about every 2 minutes
3. CKeep any pause in compressions to less than 10 seconds
4. DLean on the chest between compressions to keep the hand position
5. EAllow the chest to recoil fully after each compression
6. FGive one breath every 6 seconds once an advanced airway is placed
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Answer: B, C, E, F
Take action: high-quality CPR means adequate rate and depth, full recoil, minimal interruptions, rotating compressors every 2 minutes and avoiding over-ventilation (one breath every 6 seconds with an advanced airway).
- A: Rhythm and pulse checks are done about every 2 minutes, not every minute.
- D: Leaning prevents full recoil and lowers venous return.
Question 3 · Hard · Matrix
A client with a serum potassium of 7.2 mEq/L and peaked T waves has several prescriptions. For each treatment, indicate its main action.
For each row, choose: Protects the heart / Moves potassium into cells / Removes potassium from the body
1. Sodium zirconium cyclosilicate by mouth
2. Hemodialysis
3. Calcium gluconate IV
4. Nebulized albuterol
5. Regular insulin IV with dextrose
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Answer:
- Sodium zirconium cyclosilicate by mouth: Removes potassium from the body
- Hemodialysis: Removes potassium from the body
- Calcium gluconate IV: Protects the heart
- Nebulized albuterol: Moves potassium into cells
- Regular insulin IV with dextrose: Moves potassium into cells
Generate solutions: severe hyperkalemia is treated in three ways: calcium to protect the heart, insulin with dextrose and albuterol to shift potassium into cells, and binders, diuretics or dialysis to remove it. Shifting is temporary, so removal must follow.
- Sodium zirconium cyclosilicate by mouth: This binder exchanges potassium in the gut for elimination in stool.
- Hemodialysis: Dialysis removes potassium directly from the blood.
- Calcium gluconate IV: Calcium stabilizes the cardiac cell membrane but does not lower potassium.
- Nebulized albuterol: Beta-2 stimulation shifts potassium into cells.
- Regular insulin IV with dextrose: Insulin drives potassium into cells; dextrose prevents hypoglycemia.
Question 4 · Hard · Select all that apply
A client with hyperosmolar hyperglycemic state has been receiving IV fluids and an insulin infusion. Which findings require follow-up?
1. ANew headache and increasing drowsiness
2. BGlucose fell from 880 to 590 mg/dL in the first hour
3. CHeart rate decreased from 124 to 98/min
4. DSerum potassium of 3.1 mEq/L
5. EUrine output of 70 mL/h
6. FNew fine crackles and SpO2 falling to 90% after 4 L of fluid
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Answer: A, B, D, F
Evaluate outcomes: during HHS treatment the nurse watches for fluid overload, a too-rapid fall in glucose and osmolality, neurological decline and hypokalemia. Rising urine output and a slowing heart rate show response.
- C: A falling heart rate shows the volume deficit is correcting.
- E: Adequate urine output shows renal perfusion is restored.
Question 5 · Medium · Select all that apply
A client with a fractured femur after a motor vehicle crash is in the compensatory stage of hypovolemic shock. Which findings does the nurse expect?
1. AHeart rate of 122/min
2. BNarrowing pulse pressure
3. CRestlessness and anxiety
4. DFalling urine output
5. ECool, pale skin
6. FBlood pressure of 76/40 mm Hg
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Answer: A, B, C, D, E
Analyze cues: in compensated shock, tachycardia, narrowing pulse pressure, cool skin, anxiety and low urine output keep blood pressure near normal. Frank hypotension is a late sign of progressive shock.
- F: Marked hypotension means compensation has failed (progressive stage).
Question 6 · Medium · Select all that apply
A 72-year-old woman with diabetes and hypertension calls the cardiac clinic. Which symptoms could indicate an acute myocardial infarction in this client?
1. AShortness of breath while resting
2. BUnusual tiredness for the past several days
3. CNausea with an indigestion-like discomfort
4. DAching in the jaw or between the shoulder blades
5. EChest pain that is reproduced by pressing on one rib
6. FChest pain that eases when she sits up and leans forward
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Question 7 · Medium · Matrix
The nurse responds to several people who are choking. For each person, indicate the first intervention the nurse should use.
For each row, choose: Abdominal thrusts / Chest thrusts / Encourage coughing
1. An adult at dinner who clutches the throat and cannot speak
2. An adult with obesity whose abdomen the nurse cannot reach around
3. A woman at 36 weeks of pregnancy who cannot speak or breathe
4. An adult who coughs forcefully and says 'it went down the wrong way'
5. A 10-year-old who is silent and cannot breathe
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Question 8 · Hard · Select all that apply
A client in status epilepticus has received two doses of IV lorazepam 4 mg, 5 minutes apart, and is still having tonic-clonic seizures. Which actions should the nurse take next?
1. ACheck a point-of-care blood glucose
2. BGive levetiracetam tablets with a small sip of water
3. CPrepare the prescribed IV fosphenytoin loading dose
4. DHold the arms and legs firmly to stop the jerking
5. EPlace a padded tongue blade between the teeth
6. FGive a third and fourth dose of lorazepam before any other drug
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Question 9 · Medium · Matrix
A cardiac arrest team checks the rhythm of a pulseless client. For each rhythm, indicate whether a shock (defibrillation) is indicated.
For each row, choose: Shockable / Not shockable
1. Polymorphic ventricular tachycardia (torsades de pointes) with no pulse
2. Organized rhythm at 80/min with no palpable pulse
3. Asystole confirmed in two leads
4. Ventricular fibrillation
5. Ventricular tachycardia with no pulse
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Question 10 · Hard · Matrix
A client has chest pain with ST elevation in leads II, III and aVF and in right-sided lead V4R. BP is 88/54 mm Hg, neck veins are distended and lungs are clear. For each intervention, indicate whether it is indicated or contraindicated.
For each row, choose: Indicated / Contraindicated
1. Give sublingual nitroglycerin
2. Give IV furosemide for the distended neck veins
3. Prepare the client for percutaneous coronary intervention
4. Give a bolus of 0.9% sodium chloride
5. Have the client chew non-enteric-coated aspirin 324 mg
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Question 11 · Easy · Matrix
The nurse reviews four clients who show signs of shock. For each client, indicate the type of shock most likely present.
For each row, choose: Hypovolemic / Cardiogenic / Distributive
1. Has warm, dry skin and a heart rate of 50/min after a T4 spinal cord injury
2. Has crackles and a new S3 a few hours after a large anterior MI
3. Vomited a large amount of bright red blood from bleeding esophageal varices
4. Is wheezing with diffuse hives after a bee sting
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Question 12 · Hard · Select all that apply
A client with an acute ischemic stroke, last known well 2 hours ago, is being considered for IV alteplase. Which findings should the nurse report as possible reasons the client cannot receive it?
1. ATook a dose of apixaban 3 hours ago
2. BHad major abdominal surgery 6 days ago
3. CBP stays at 194/112 mm Hg after two doses of IV labetalol
4. DPlatelet count of 82,000/mm3
5. EHas a NIH Stroke Scale score of 12
6. FIs 84 years old
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Question 13 · Easy · Select all that apply
A few minutes after IV contrast is injected for a CT scan, a client says, "Something is wrong." Which findings indicate an anaphylactic reaction that needs emergency treatment?
1. AA hoarse voice with high-pitched noise on inspiration
2. BMild redness around the IV insertion site
3. CBlood pressure of 80/48 mm Hg
4. DA warm, flushed feeling and metallic taste during the injection
5. EHives spreading over the trunk with swollen lips
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Question 14 · Medium · Select all that apply
A client with a saline lock is eating lunch when the client develops throat tightness, wheezing and hives after a bite of shrimp. BP is 78/40 mm Hg. Which actions should the nurse take?
1. ACall the rapid response team
2. BGive the prescribed epinephrine IM into the anterolateral thigh
3. CHelp the client stand and walk to the treatment room
4. DStart a rapid IV bolus of 0.9% sodium chloride through the saline lock
5. EApply high-flow oxygen
6. FGive oral diphenhydramine as the first drug
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Question 15 · Hard · Matrix
A client is 3 days after an anterior myocardial infarction. For each finding, indicate the complication it most likely suggests.
For each row, choose: Heart failure / Pericarditis / Cardiac tamponade
1. Muffled heart sounds, distended neck veins and falling BP
2. Sharp chest pain that eases when sitting up and leaning forward
3. Crackles at both lung bases and a new S3
4. Scratchy, high-pitched sound at the left sternal border
5. Systolic BP drops 16 mm Hg during inspiration
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Question 16 · Hard · Matrix
The nurse on a step-down unit receives reports on five clients. For each client, indicate whether the nurse must act immediately or the client is stable for now.
For each row, choose: Needs immediate action / Stable for now
1. On a heparin infusion after an NSTEMI; new right-sided facial droop
2. Septic shock on norepinephrine; MAP 69 mm Hg, urine 40 mL/h
3. Received IM epinephrine 20 minutes ago for a peanut reaction; voice is now hoarse
4. DKA on an insulin infusion; glucose 230 mg/dL and dextrose just added to the IV
5. Had a tonic-clonic seizure 30 minutes ago; sleepy but rouses to voice, SpO2 96%
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Question 17 · Hard · Select all that apply
A client has return of spontaneous circulation after a cardiac arrest and remains comatose. Which actions should the nurse anticipate?
1. AAccept a systolic BP of 80 mm Hg to avoid fluid overload
2. BKeep SpO2 at 100% with 100% oxygen until the client wakes
3. CHyperventilate to keep PaCO2 at 25 to 30 mm Hg
4. DTitrate oxygen to keep SpO2 at 92% to 98%
5. EWarm the client to keep the temperature above 100.4°F (38°C)
6. FObtain a 12-lead ECG
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Question 18 · Medium · Select all that apply
A client arrives in the emergency department with sudden left arm weakness and slurred speech. Which actions should the nurse take?
1. AFind out the exact time the client was last known well
2. BCheck a point-of-care blood glucose
3. CGive aspirin 325 mg orally before the CT scan
4. DHold neurological checks until the CT result is available
5. ELower the blood pressure to 120/80 mm Hg with IV labetalol
6. FKeep the client NPO until a swallow screen is passed
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Question 19 · Medium · Select all that apply
A client is in cardiac arrest with pulseless electrical activity. Which conditions are reversible causes the team should look for and treat?
1. ATension pneumothorax
2. BHypothermia
3. CHyperkalemia
4. DHypovolemia
5. EHypoxia
6. FHypernatremia
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Question 20 · Medium · Matrix
The nurse is triaging clients with sudden neurological deficits before imaging is done. For each finding, indicate the type of stroke it more strongly suggests.
For each row, choose: Ischemic stroke / Hemorrhagic stroke
1. Has atrial fibrillation and stopped the anticoagulant a month ago
2. Sudden, severe 'worst ever' headache with vomiting
3. Brief episodes of the same arm weakness that resolved twice last week
4. Takes warfarin and the INR is 4.8
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Question 21 · Medium · Select all that apply
The nurse is screening a client with community-acquired pneumonia for sepsis. Which findings are quick SOFA (qSOFA) criteria?
1. ANew confusion noted by the family
2. BSystolic blood pressure of 96 mm Hg
3. CWhite blood cell count of 15,800/mm3
4. DRespiratory rate of 24/min
5. ETemperature of 102.2°F (39°C)
6. FHeart rate of 116/min
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Question 22 · Hard · Matrix
The nurse is preparing drugs for a cardiac arrest. For each drug, indicate when it is used in adult pulseless arrest.
For each row, choose: Any pulseless rhythm / VF or pulseless VT only / Not used in pulseless arrest
1. Epinephrine 1 mg IV every 3 to 5 minutes
2. Adenosine 6 mg rapid IV push
3. Atropine 1 mg IV
4. Amiodarone 300 mg IV bolus
5. Lidocaine 1 to 1.5 mg/kg IV
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Question 23 · Medium
A client with diabetic ketoacidosis is on an IV insulin infusion and 0.9% sodium chloride. The blood glucose has fallen to 245 mg/dL, and the anion gap is still raised. The nurse anticipates a prescription to:
1. ASwitch to subcutaneous insulin immediately
2. BStop the insulin infusion until ketones clear
3. CAdd dextrose to the IV fluid and continue insulin
4. DGive an IV bolus of sodium bicarbonate
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Question 24 · Hard
A client with type 1 diabetes is admitted with DKA. Results: glucose 512 mg/dL, pH 7.14, bicarbonate 9 mEq/L, potassium 3.0 mEq/L (3.5-5.0), creatinine 1.3 mg/dL. Urine output 60 mL/h. The provider has prescribed an IV regular insulin infusion. What should the nurse do first?
1. AStart the insulin infusion at the prescribed rate
2. BHold the insulin and confirm potassium replacement
3. CGive an IV bolus of insulin before the infusion
4. DRequest sodium bicarbonate for the low pH
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Question 25 · Medium
A client with suspected sepsis has a new prescription for IV piperacillin-tazobactam, blood cultures and a lactate level. Which action should the nurse take first?
1. AHang the first antibiotic dose
2. BDraw two sets of blood cultures
3. CSend the serum lactate level
4. DInsert an indwelling urinary catheter
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31 more Medical emergencies, shock and sepsis questions

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Study Physiological Adaptation

Medical emergencies, shock and sepsis

A client with chronic kidney disease who missed two dialysis sessions has a serum potassium of 7.0 mEq/L. Which ECG changes does the nurse expect?

The nurse is performing chest compressions on an adult in cardiac arrest while a team member gives breaths. Which actions reflect high-quality CPR?

A client with a serum potassium of 7.2 mEq/L and peaked T waves has several prescriptions. For each treatment, indicate its main action.

A client with hyperosmolar hyperglycemic state has been receiving IV fluids and an insulin infusion. Which findings require follow-up?

A client with a fractured femur after a motor vehicle crash is in the compensatory stage of hypovolemic shock. Which findings does the nurse expect?

A 72-year-old woman with diabetes and hypertension calls the cardiac clinic. Which symptoms could indicate an acute myocardial infarction in this client?

The nurse responds to several people who are choking. For each person, indicate the first intervention the nurse should use.

A client in status epilepticus has received two doses of IV lorazepam 4 mg, 5 minutes apart, and is still having tonic-clonic seizures. Which actions should the nurse take next?

A cardiac arrest team checks the rhythm of a pulseless client. For each rhythm, indicate whether a shock (defibrillation) is indicated.

A client has chest pain with ST elevation in leads II, III and aVF and in right-sided lead V4R. BP is 88/54 mm Hg, neck veins are distended and lungs are clear. For each intervention, indicate whether it is indicated or contraindicated.

The nurse reviews four clients who show signs of shock. For each client, indicate the type of shock most likely present.

A client with an acute ischemic stroke, last known well 2 hours ago, is being considered for IV alteplase. Which findings should the nurse report as possible reasons the client cannot receive it?

A few minutes after IV contrast is injected for a CT scan, a client says, "Something is wrong." Which findings indicate an anaphylactic reaction that needs emergency treatment?

A client with a saline lock is eating lunch when the client develops throat tightness, wheezing and hives after a bite of shrimp. BP is 78/40 mm Hg. Which actions should the nurse take?

A client is 3 days after an anterior myocardial infarction. For each finding, indicate the complication it most likely suggests.

The nurse on a step-down unit receives reports on five clients. For each client, indicate whether the nurse must act immediately or the client is stable for now.

A client has return of spontaneous circulation after a cardiac arrest and remains comatose. Which actions should the nurse anticipate?

A client arrives in the emergency department with sudden left arm weakness and slurred speech. Which actions should the nurse take?

A client is in cardiac arrest with pulseless electrical activity. Which conditions are reversible causes the team should look for and treat?

The nurse is triaging clients with sudden neurological deficits before imaging is done. For each finding, indicate the type of stroke it more strongly suggests.

The nurse is screening a client with community-acquired pneumonia for sepsis. Which findings are quick SOFA (qSOFA) criteria?

The nurse is preparing drugs for a cardiac arrest. For each drug, indicate when it is used in adult pulseless arrest.

A client with diabetic ketoacidosis is on an IV insulin infusion and 0.9% sodium chloride. The blood glucose has fallen to 245 mg/dL, and the anion gap is still raised. The nurse anticipates a prescription to:

A client with type 1 diabetes is admitted with DKA. Results: glucose 512 mg/dL, pH 7.14, bicarbonate 9 mEq/L, potassium 3.0 mEq/L (3.5-5.0), creatinine 1.3 mg/dL. Urine output 60 mL/h. The provider has prescribed an IV regular insulin infusion. What should the nurse do first?

A client with suspected sepsis has a new prescription for IV piperacillin-tazobactam, blood cultures and a lactate level. Which action should the nurse take first?