NSG 233 MED SURG III EXAMS 3 4 AND FINAL
2026 STUDY BUNDLE ACTUAL TEST PAPERS
COMPLETE SOLUTIONS VERIFIED
◉ Low blood flow hypovolemic shock. Answer: -absolute
hypovolemia: loss of intravascular fluid volume
-when fluid moves out of the vascular space into the extravascular space
-*burns?
TYPES?
-hemorrhage, vomiting, diarrhea
-fistula drainage, diabetes insipidus
-hyperglycemia, diuresis
MANIFESTATIONS
-anxiety, tachypnea, increased CO, heart rate
-decrease in stroke volume, PAWP, urinary output
-*if loss >30%, blood volume needs replacing
INTERPROFESSIONAL CARE
-*3:1 rule- 3ml of isotonic crystalloid for every 1ml of EBL
◉ Distributive shock: neurogenic shock. Answer: -can occur within 30
minutes of a spinal cord injury at the fifth thoracic vertebra or above.
can last up to 6 weeks.
-can be induced by spinal anesthesia
,-DEFINED: massive vasodilation, leading to pooling of blood in vessels,
tissue hypoperfusion, impaired cellular metabolism
MANIFESTATIONS
-hypotension, bradycardia
-inability to regulate body temperature (heat loss)-> poikilothermia
(taking on temp of environment)
-dry skin
INTERPROFESSIONAL CARE
-*stability for spinal cord injury
-*atropine for hypotension and bradycardia
-monitor for hypothermia
◉ Distributive shock: anaphylactic shock. Answer: -acute life
threatening allergic reaction
-massive vasodilation, release of vasoactive mediators, increased
capillary permeability
MANIFESTATIONS
-anxiety, confusion, dizzy
-sense of impending doom, chest pain
-incontinence
-swelling of lips and tongue, flushing, allergic rxn sx
-*resp distress and circulatory failure
INTERPROFESSIONAL CARE
,-epi, diphenhydramine, famotidine
-*maintain patent airway (bronchodilators, aerosolized epi, ET tube may
be necessary
-*fluid replacement
◉ Distributive shock: septic shock. Answer: -sepsis: systemic
inflammatory response to suspected or documented infection
SEPTIC SHOCK
-sepsis w hypotension despite fluid resuscitation
-inadequate tissue perfusion resulting in hypoxia
MANIFESTATIONS
-increased coagulation and inflammation, decreased fibrinolysis:
formation of microthrombi, obstruction of microvasculature
-hyperdynamic state- increased CO and decreased SVR
-tachypnea, hyperventilation -> *respiratory alkalosis and resp failure
-urine output decreased
-altered neuro status
-GI dysfunction, GI bleed, paralytic ileus
PATHOPHYSIOLOGICAL EFFECTS
-vasodilation
-maldistribution of blood flow
-myocardial dysfunction (decreased EF and ventricular dilation)
INTERPROSFESSIONAL CARE
, -antibiotics within 1st hour!!!
-keep glucose <180
-give PPIs for stress ulcer prophylaxis (pantoprazole)
-DVT: heparin, enoxaparin
-exogenous vasopressin
-*IV corticosteroids: for pts who cannot maintain an adequate BP with
vasopressor therapy despite fluid resuscitation
◉ Obstructive shock. Answer: CAUSES
-SVC syndrome, abdominal compartment syndrome, cardiac tamponade,
tension pneumo, pulmonary embolism
MANIFESTATIONS
-decreased CO, increased afterload
-*need rapid assessments and immediate tx
CARE
-*early recognition and tx
-mechanical decompression
-thrombolytic therapy
-radiation, debulking, removal of mass
-decompressive laparotomy
◉ Stages of shock. Answer: 1) INITIAL
2026 STUDY BUNDLE ACTUAL TEST PAPERS
COMPLETE SOLUTIONS VERIFIED
◉ Low blood flow hypovolemic shock. Answer: -absolute
hypovolemia: loss of intravascular fluid volume
-when fluid moves out of the vascular space into the extravascular space
-*burns?
TYPES?
-hemorrhage, vomiting, diarrhea
-fistula drainage, diabetes insipidus
-hyperglycemia, diuresis
MANIFESTATIONS
-anxiety, tachypnea, increased CO, heart rate
-decrease in stroke volume, PAWP, urinary output
-*if loss >30%, blood volume needs replacing
INTERPROFESSIONAL CARE
-*3:1 rule- 3ml of isotonic crystalloid for every 1ml of EBL
◉ Distributive shock: neurogenic shock. Answer: -can occur within 30
minutes of a spinal cord injury at the fifth thoracic vertebra or above.
can last up to 6 weeks.
-can be induced by spinal anesthesia
,-DEFINED: massive vasodilation, leading to pooling of blood in vessels,
tissue hypoperfusion, impaired cellular metabolism
MANIFESTATIONS
-hypotension, bradycardia
-inability to regulate body temperature (heat loss)-> poikilothermia
(taking on temp of environment)
-dry skin
INTERPROFESSIONAL CARE
-*stability for spinal cord injury
-*atropine for hypotension and bradycardia
-monitor for hypothermia
◉ Distributive shock: anaphylactic shock. Answer: -acute life
threatening allergic reaction
-massive vasodilation, release of vasoactive mediators, increased
capillary permeability
MANIFESTATIONS
-anxiety, confusion, dizzy
-sense of impending doom, chest pain
-incontinence
-swelling of lips and tongue, flushing, allergic rxn sx
-*resp distress and circulatory failure
INTERPROFESSIONAL CARE
,-epi, diphenhydramine, famotidine
-*maintain patent airway (bronchodilators, aerosolized epi, ET tube may
be necessary
-*fluid replacement
◉ Distributive shock: septic shock. Answer: -sepsis: systemic
inflammatory response to suspected or documented infection
SEPTIC SHOCK
-sepsis w hypotension despite fluid resuscitation
-inadequate tissue perfusion resulting in hypoxia
MANIFESTATIONS
-increased coagulation and inflammation, decreased fibrinolysis:
formation of microthrombi, obstruction of microvasculature
-hyperdynamic state- increased CO and decreased SVR
-tachypnea, hyperventilation -> *respiratory alkalosis and resp failure
-urine output decreased
-altered neuro status
-GI dysfunction, GI bleed, paralytic ileus
PATHOPHYSIOLOGICAL EFFECTS
-vasodilation
-maldistribution of blood flow
-myocardial dysfunction (decreased EF and ventricular dilation)
INTERPROSFESSIONAL CARE
, -antibiotics within 1st hour!!!
-keep glucose <180
-give PPIs for stress ulcer prophylaxis (pantoprazole)
-DVT: heparin, enoxaparin
-exogenous vasopressin
-*IV corticosteroids: for pts who cannot maintain an adequate BP with
vasopressor therapy despite fluid resuscitation
◉ Obstructive shock. Answer: CAUSES
-SVC syndrome, abdominal compartment syndrome, cardiac tamponade,
tension pneumo, pulmonary embolism
MANIFESTATIONS
-decreased CO, increased afterload
-*need rapid assessments and immediate tx
CARE
-*early recognition and tx
-mechanical decompression
-thrombolytic therapy
-radiation, debulking, removal of mass
-decompressive laparotomy
◉ Stages of shock. Answer: 1) INITIAL
