NCLEX Critical Care & Shock questions
The PrepScore bank has 94 Critical Care & Shock questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Take action and Recognize cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Shock state differentiation (hypovolemic/cardiogenic/distributive/obstructive), burn fluid resuscitation (Parkland), anaphylaxis, ARDS, mechanical ventilation basics, ICU sedation/analgesia, code blue + post-resuscitation, neurogenic shock, septic shock bundle, ICU multi-patient priority.
Three worked questions
Q1. A 22-year-old male is in the urgent care clinic when he develops sudden facial swelling, hives, wheezing, and difficulty swallowing 10 minutes after eating a meal containing peanuts (known allergen). Vitals: BP 86/52, HR 130, RR 28, SpO2 92%. He is alert but anxious. Which intervention is the FIRST-LINE priority?
- A. Administer IM epinephrine 0.3–0.5 mg in the anterolateral thigh and prepare to repeat in 5–15 minutes if symptoms persist
- B. Administer IV diphenhydramine 50 mg first to address the histamine-mediated urticaria and angioedema during the early phase of the reaction
- C. Administer IV methylprednisolone 125 mg as the initial step to suppress the inflammatory response driving the anaphylaxis cascade
- D. Apply a nebulized albuterol treatment as the priority airway intervention before any systemic medications during this acute event
Show answer and rationale
Answer: Administer IM epinephrine 0.3–0.5 mg in the anterolateral thigh and prepare to repeat in 5–15 minutes if symptoms persist
Anaphylaxis treatment is IM epinephrine FIRST (the only intervention that reverses upper airway swelling and hypotension simultaneously). Antihistamines, steroids, and bronchodilators are adjuncts that do NOT replace epinephrine — delaying epi is the leading cause of anaphylaxis fatalities.
Q2. A 67-year-old male arrives in the ED with fever, hypotension, tachycardia, and altered mental status. The triage nurse activates the sepsis pathway with the goal of completing the 1-hour bundle on time. Which interventions are PART of the Surviving Sepsis Campaign 1-hour bundle? Select all that apply.
- A. Measure lactate level at the time of sepsis recognition
- B. Obtain blood cultures BEFORE administration of broad-spectrum antibiotics
- C. Administer broad-spectrum antibiotics within 1 hour of recognition
- D. Begin crystalloid bolus 30 mL/kg for hypotension or lactate ≥ 4 mmol/L
- E. Begin vasopressors (norepinephrine) if hypotension persists despite the fluid bolus
- F. Administer corticosteroids (hydrocortisone 200 mg/day) to ALL septic patients regardless of vasopressor requirement
Show answer and rationale
Answer: Measure lactate level at the time of sepsis recognitionObtain blood cultures BEFORE administration of broad-spectrum antibioticsAdminister broad-spectrum antibiotics within 1 hour of recognitionBegin crystalloid bolus 30 mL/kg for hypotension or lactate ≥ 4 mmol/LBegin vasopressors (norepinephrine) if hypotension persists despite the fluid bolus
Surviving Sepsis 1-hour bundle: lactate, blood cultures BEFORE antibiotics, broad-spectrum antibiotics, crystalloid 30 mL/kg for hypotension or lactate ≥ 4, vasopressors if hypotension persists. Corticosteroids are NOT part of the bundle — reserved for refractory shock requiring escalating vasopressor support.
Q3. A 45-year-old female inpatient receives IV contrast for an abdominal CT. Within 5 minutes she develops urticaria, hoarseness, tongue swelling, and difficulty breathing. Vitals: BP 80/48, HR 132, RR 32, SpO2 89%. She is alert but in acute distress. Which is the MOST APPROPRIATE initial action?
- A. Administer IM epinephrine 0.3–0.5 mg in the anterolateral thigh, establish IV access, prepare airway equipment, and give IV fluids; repeat epinephrine in 5–15 min if symptoms persist
- B. Position the patient upright and observe her respiratory status carefully for the next 10 minutes before any medication intervention is initiated
- C. Administer oral diphenhydramine 50 mg with a sip of water and reassess her vital signs in 30 minutes during the routine ED workflow
- D. Discharge her back to her room with instructions to take oral steroids at home if symptoms worsen over the next several hours of recovery
Show answer and rationale
Answer: Administer IM epinephrine 0.3–0.5 mg in the anterolateral thigh, establish IV access, prepare airway equipment, and give IV fluids; repeat epinephrine in 5–15 min if symptoms persist
Contrast-induced anaphylaxis is true anaphylaxis. The first-line treatment is IM epinephrine; antihistamines and steroids are adjuncts. Observation, oral diphenhydramine, and discharge each represent delayed or absent epinephrine — the leading cause of anaphylaxis fatalities.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Hypovolemic = low CVP/PCWP/CO + high SVR + cool/clammy → fluids/blood. Cardiogenic = HIGH CVP/PCWP + low CO + high SVR + crackles/JVD → inotrope (dobutamine) + careful fluids + revascularize. Distributive (septic/anaphylactic/neurogenic) = LOW SVR ± warm → fluids + norepinephrine (for sepsis), epinephrine IM (anaphylaxis), vasopressor (neurogenic). Obstructive (tamponade/tension PTX/PE) = high CVP + narrow PP → relieve obstruction. MAP target ≥ 65.
Inhalation injury signs (facial burns, singed nasal hair, soot, hoarseness, carbonaceous sputum) = early INTUBATION before edema closes airway. CO poisoning: 100% O2 + co-oximetry. Parkland: 4 mL × kg × %TBSA in 24 hr; half in first 8 hr from BURN TIME (not arrival); titrate UO 0.5 mL/kg/hr adult. TBSA: rule of 9s (adult) or Lund-Browder (peds). Cover with clean dry sheet (not ice). Watch circumferential burns → escharotomy.
Anaphylaxis = rapid onset + 2+ systems (skin + respiratory + CV + GI) or hypotension + trigger. FIRST: IM epinephrine 0.3-0.5 mg (1:1000) in anterolateral mid-thigh, repeat q5-15 min. Adjuncts (NOT first-line): high-flow O2 + IV fluids + H1 (diphenhydramine) + H2 (famotidine) + corticosteroid + albuterol. Refractory + beta-blocker → glucagon. Observe 4-12 hr for biphasic. Discharge: autoinjector + allergy referral + medical alert.
Berlin criteria: acute < 1 wk + bilateral infiltrates + non-cardiogenic + P/F ratio (mild 200-300, mod 100-200, severe < 100) on PEEP ≥ 5. Lung-protective ventilation: TV 6 mL/kg PREDICTED body weight + Pplat ≤ 30 + permissive hypercapnia. PEEP titration. Severe (P/F < 150) = prone 16 hr/day + NMBA first 48 hr if dyssynchrony. Conservative fluids. Treat underlying cause.
High pressure alarm: kinked tubing, secretions/plug, biting, bronchospasm, pneumothorax, ETT mainstem, pulmonary edema, decreased compliance. Low pressure alarm: leak, extubation, disconnect. FIRST: assess PATIENT (skin + chest rise + SpO2 + breath sounds + HR), bag with BVM 100% O2 if uncertain. DOPE: Displacement, Obstruction, Pneumothorax, Equipment. Never silence without addressing.
Assess pain (CPOT/BPS) → analgesia first (fentanyl). Both spontaneous awakening + breathing trials daily. Choice of sedation: target RASS 0 to -2, prefer propofol/dexmedetomidine over benzodiazepines (delirium risk). Delirium (CAM-ICU): non-pharm first (orient, sleep, family, mobility); atypical antipsychotic if safety. Early mobility on vent. Family engagement. Reduces ICU mortality + LOS + delirium + vent days.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Critical Care & Shock questions does the bank have?
94 multiple-choice items, plus 10 unfolding cases in the Critical Care & Shock pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Take action and Recognize cues, though every step appears.
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