NCLEX Shock Review
Updated October 27, 2026
Shock is a frequent NCLEX-RN topic in Physiological Adaptation, and it often appears in prioritization questions. Shock means the tissues aren’t getting enough blood flow and oxygen. Recognizing it early, before blood pressure falls, is the key nursing skill. Here are the high-yield points, followed by free practice questions.
Follow your facility’s protocols, such as sepsis bundles and rapid response criteria.
Types of shock
| Type | Cause | Examples |
|---|---|---|
| Hypovolemic | Loss of blood or fluid | Hemorrhage, severe vomiting or diarrhea, burns |
| Cardiogenic | The heart can’t pump well enough | Heart attack, heart failure |
| Septic (distributive) | Infection causing widespread vasodilation | Pneumonia, urinary tract infection |
| Anaphylactic (distributive) | Severe allergic reaction | Bee sting, drug or food allergy |
Early vs. late signs
| Early | Late |
|---|---|
| Restlessness, anxiety | Confusion, decreased responsiveness |
| Rising heart rate | Low blood pressure |
| Faster breathing | Very low urine output |
| Cool, pale skin (warm and flushed early in septic shock) | Cold, mottled skin |
A rising heart rate and restlessness often come before a drop in blood pressure.
Priority actions
- Airway, breathing and circulation first; give oxygen as ordered.
- Get IV access and give fluids or blood as ordered.
- For anaphylaxis, give epinephrine first, as ordered.
- Monitor vital signs, urine output (report output below about 30 mL/hour in adults), mental status and lab values such as lactate.
Free shock practice questions
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Which is an early sign of hypovolemic shock?Answer: CRestlessness and a rising heart rate are early compensating signs. Low blood pressure, mottled skin and unresponsiveness come later.
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A client is stung by a bee and develops wheezing, hives and low blood pressure. Which medication is the priority?Answer: AEpinephrine is the first-line treatment for anaphylaxis. Antihistamines and bronchodilators may be added but don't replace epinephrine.
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Which client is at greatest risk of cardiogenic shock?Answer: BA large heart attack can damage the heart muscle so it can't pump enough blood, causing cardiogenic shock.
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A client with suspected sepsis has a urine output of 15 mL per hour for the past 2 hours. What should the nurse do?Answer: DUrine output below about 30 mL per hour suggests poor kidney perfusion and worsening shock. Report it promptly.
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In early septic shock, the client's skin may be:Answer: AEarly septic shock causes widespread vasodilation, so the skin may be warm and flushed. As shock progresses, it becomes cool and mottled.
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Which position is commonly used for a client in hypovolemic shock, unless contraindicated?Answer: BLying flat with the legs elevated can help blood return to the heart. Follow the provider's orders and facility protocol, especially if a head or spinal injury is possible.
Pass the NCLEX-RN on your first try
- All 178 questions across the eight Client Needs categories of the 2026 NCLEX-RN test plan
- An explanation for every answer, with the guideline, drug label or priority rule behind it
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