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Rasmussen College MDC 4 Exam 2
Questions and Answers |
100% Verified Answers
Question 1
A 68-year-old male is admitted with septic shock. Initial vital
signs: BP 82/46 mmHg, HR 118 bpm, RR 24/min, temperature
39.2°C (102.6°F). The nurse anticipates which priority
intervention?
A. Administer norepinephrine immediately
B. Obtain blood cultures and administer broad-spectrum
antibiotics
C. Give 30 mL/kg crystalloid fluid bolus
D. Start dopamine infusion at 5 mcg/kg/min
Correct Answer: C
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Rationale: The Surviving Sepsis Campaign guidelines recommend
initial fluid resuscitation with 30 mL/kg crystalloid for septic
shock within the first 3 hours. Antibiotics (B) should be given within
1 hour but after blood cultures are obtained. Vasopressors (A
and D) are initiated after fluid resuscitation if hypotension
persists.
Question 2
A patient in hypovolemic shock has a pulmonary artery catheter
in place. Which hemodynamic finding would the nurse expect?
A. Increased pulmonary artery wedge pressure (PAWP)
B. Decreased central venous pressure (CVP)
C. Increased cardiac output (CO)
D. Decreased systemic vascular resistance (SVR)
Correct Answer: B
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Rationale: In hypovolemic shock, decreased intravascular volume
leads to decreased CVP (normal 2-6 mmHg), decreased PAWP
(normal 4-12 mmHg), decreased CO, and increased SVR
(vasoconstriction). Option A is incorrect because PAWP
decreases. Option C is incorrect because CO decreases. Option
D is incorrect because SVR increases.
Question 3
Scenario: A 55-year-old female with cardiogenic shock is
receiving dobutamine at 5 mcg/kg/min. The nurse assesses the
patient and notes BP 90/50 mmHg, HR 110 bpm, and urine
output 20 mL over 2 hours. What is the priority nursing action?
A. Increase dobutamine as prescribed
B. Assess for jugular venous distension
C. Prepare for intra-aortic balloon pump insertion
D. Administer furosemide 40 mg IV push
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Correct Answer: B
Rationale: The patient shows signs of worsening shock (low urine
output despite dobutamine). Assessment for JVD indicates fluid
status and right heart function. Dobutamine is an inotrope but
also causes vasodilation. The low urine output may indicate
inadequate perfusion or worsening heart failure. Furosemide (D)
would be contraindicated if the patient is volume depleted. IABP
(C) may be needed but assessment comes first.
Question 4
Which vasoactive medication requires the nurse to monitor for
extravasation and have phentolamine available at the bedside?
A. Dobutamine
B. Milrinone
C. Norepinephrine
D. Vasopressin
Rasmussen College MDC 4 Exam 2
Questions and Answers |
100% Verified Answers
Question 1
A 68-year-old male is admitted with septic shock. Initial vital
signs: BP 82/46 mmHg, HR 118 bpm, RR 24/min, temperature
39.2°C (102.6°F). The nurse anticipates which priority
intervention?
A. Administer norepinephrine immediately
B. Obtain blood cultures and administer broad-spectrum
antibiotics
C. Give 30 mL/kg crystalloid fluid bolus
D. Start dopamine infusion at 5 mcg/kg/min
Correct Answer: C
,Page 2 of 62
Rationale: The Surviving Sepsis Campaign guidelines recommend
initial fluid resuscitation with 30 mL/kg crystalloid for septic
shock within the first 3 hours. Antibiotics (B) should be given within
1 hour but after blood cultures are obtained. Vasopressors (A
and D) are initiated after fluid resuscitation if hypotension
persists.
Question 2
A patient in hypovolemic shock has a pulmonary artery catheter
in place. Which hemodynamic finding would the nurse expect?
A. Increased pulmonary artery wedge pressure (PAWP)
B. Decreased central venous pressure (CVP)
C. Increased cardiac output (CO)
D. Decreased systemic vascular resistance (SVR)
Correct Answer: B
,Page 3 of 62
Rationale: In hypovolemic shock, decreased intravascular volume
leads to decreased CVP (normal 2-6 mmHg), decreased PAWP
(normal 4-12 mmHg), decreased CO, and increased SVR
(vasoconstriction). Option A is incorrect because PAWP
decreases. Option C is incorrect because CO decreases. Option
D is incorrect because SVR increases.
Question 3
Scenario: A 55-year-old female with cardiogenic shock is
receiving dobutamine at 5 mcg/kg/min. The nurse assesses the
patient and notes BP 90/50 mmHg, HR 110 bpm, and urine
output 20 mL over 2 hours. What is the priority nursing action?
A. Increase dobutamine as prescribed
B. Assess for jugular venous distension
C. Prepare for intra-aortic balloon pump insertion
D. Administer furosemide 40 mg IV push
, Page 4 of 62
Correct Answer: B
Rationale: The patient shows signs of worsening shock (low urine
output despite dobutamine). Assessment for JVD indicates fluid
status and right heart function. Dobutamine is an inotrope but
also causes vasodilation. The low urine output may indicate
inadequate perfusion or worsening heart failure. Furosemide (D)
would be contraindicated if the patient is volume depleted. IABP
(C) may be needed but assessment comes first.
Question 4
Which vasoactive medication requires the nurse to monitor for
extravasation and have phentolamine available at the bedside?
A. Dobutamine
B. Milrinone
C. Norepinephrine
D. Vasopressin
