NUR 2755 Multidimensional Care IV (MDC4)
Final Exam Complete Questions with Verified
Answers & Detailed Rationales | Latest 2025–
2026 Edition | Rasmussen University
Q1. A patient is admitted to the emergency department with suspected septic
shock. Which of the following is the nurse's priority intervention?
A) Obtain a complete blood count (CBC)
B) Administer broad-spectrum antibiotics within 1 hour
C) Place the patient in Trendelenburg position
D) Obtain a chest X-ray
Answer: B — Administer broad-spectrum antibiotics within 1 hour
Rationale: In septic shock, the Surviving Sepsis Campaign guidelines
recommend administering broad-spectrum antibiotics within 1 hour of
recognition. Early antibiotic administration is associated with reduced mortality.
While obtaining labs and imaging are important, antibiotic administration is the
priority intervention.
Q2. A patient with a severe myocardial infarction is showing signs of cardiogenic
shock. Which hemodynamic parameter is most consistent with cardiogenic shock?
A) Elevated cardiac output with low systemic vascular resistance
B) Decreased cardiac output with elevated systemic vascular resistance
C) Elevated cardiac output with elevated systemic vascular resistance
D) Decreased cardiac output with decreased systemic vascular resistance
Answer: B — Decreased cardiac output with elevated systemic vascular
resistance
Rationale: Cardiogenic shock is characterized by decreased cardiac output due
to pump failure, with compensatory elevated systemic vascular resistance (SVR)
from vasoconstriction. This is in contrast to distributive shock (e.g., septic shock),
which presents with decreased SVR.
,Q3. A client is treated in the emergency department for shock of unknown
etiology. What is the nurse's first action?
A) Attach a cardiac monitor
B) Obtain a blood pressure
C) Check level of consciousness
D) Administer oxygen
Answer: D — Administer oxygen
Rationale: The first action in managing any type of shock is to administer
oxygen to ensure adequate tissue oxygenation. Airway, breathing, and circulation
(ABCs) take priority. While monitoring and assessing are important, oxygen
administration is the immediate priority.
Q4. Burn shock is primarily caused by which pathophysiological mechanism?
A) Cardiogenic failure due to myocardial depression
B) Massive fluid shifts of plasma, electrolytes, and proteins into the burn
wound
C) Vasodilation from systemic inflammatory response
D) Obstructive mechanism from eschar formation
Answer: B — Massive fluid shifts of plasma, electrolytes, and proteins into the
burn wound
Rationale: Burn shock is a form of hypovolemic shock caused by massive fluid
shifts of plasma, electrolytes, and proteins from the intravascular space into the
burn wound and surrounding tissues. This leads to hypovolemia and the inability of
the circulatory system to meet the metabolic demands of tissues.
Q5. A patient is diagnosed with obstructive shock secondary to cardiac tamponade.
Which pathophysiological mechanism best describes obstructive shock?
A) Cardiac function is impaired due to obstruction preventing the heart from
pumping blood out
B) The heart muscle fails to contract effectively
,C) Blood volume is insufficient to fill the vascular space
D) Widespread vasodilation causes maldistribution of blood flow
Answer: A — Cardiac function is impaired due to obstruction preventing the
heart from pumping blood out
Rationale: Obstructive shock occurs when cardiac function is impaired due to
an obstruction that prevents the heart from effectively pumping blood out. Causes
include cardiac tamponade, pulmonary embolism, and tension pneumothorax.
The obstruction impairs ventricular filling or outflow.
Q6. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg.
Which medication would the nurse anticipate administering first?
A) Dobutamine
B) Norepinephrine
C) Epinephrine
D) Dopamine
Answer: B — Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor recommended for septic
shock to maintain a MAP ≥ 65 mmHg. It acts as a potent vasoconstrictor to
increase systemic vascular resistance and improve perfusion to vital organs.
Q7. A nurse is caring for a patient in the compensatory stage of shock. Which
finding would the nurse expect?
A) Decreased heart rate
B) Increased heart rate with bounding pulses
C) Decreased respiratory rate
D) Cool, clammy skin
Answer: D — Cool, clammy skin
Rationale: In the compensatory stage of shock, the body attempts to maintain
perfusion through sympathetic nervous system activation. Findings
include tachycardia, cool and clammy skin (due to vasoconstriction), tachypnea,
and decreased urine output. Heart rate is increased, not decreased.
, Q8. Which laboratory finding is most indicative of disseminated intravascular
coagulation (DIC) in a patient with septic shock?
A) Elevated platelet count
B) Elevated D-dimer and decreased fibrinogen
C) Decreased PT and PTT
D) Elevated fibrinogen
Answer: B — Elevated D-dimer and decreased fibrinogen
Rationale: DIC is characterized by elevated D-dimer (indicating fibrinolysis)
and decreased fibrinogen (due to consumption). Platelet count is decreased, PT
and PTT are prolonged, and fibrinogen is consumed. These findings reflect the
widespread clotting and subsequent hemorrhage seen in DIC.
Q9. A patient in septic shock has a lactate level of 6.2 mmol/L. What is the
significance of this finding?
A) It indicates adequate tissue perfusion
B) It indicates tissue hypoxia and poor perfusion
C) It is a normal finding in septic shock
D) It indicates liver dysfunction
Answer: B — It indicates tissue hypoxia and poor perfusion
Rationale: Elevated serum lactate (> 2 mmol/L) in septic shock indicates tissue
hypoxia and inadequate perfusion. Lactate is produced during anaerobic
metabolism when oxygen delivery to tissues is insufficient. A lactate level of 6.2
mmol/L is significantly elevated and indicates severe tissue hypoperfusion.
Q10. A nurse is administering intravenous fluids to a patient with hypovolemic
shock. Which assessment finding indicates that fluid resuscitation is effective?
A) Decreased urine output
B) Increased urine output ≥ 0.5 mL/kg/hour
C) Decreased blood pressure
D) Increased heart rate
Final Exam Complete Questions with Verified
Answers & Detailed Rationales | Latest 2025–
2026 Edition | Rasmussen University
Q1. A patient is admitted to the emergency department with suspected septic
shock. Which of the following is the nurse's priority intervention?
A) Obtain a complete blood count (CBC)
B) Administer broad-spectrum antibiotics within 1 hour
C) Place the patient in Trendelenburg position
D) Obtain a chest X-ray
Answer: B — Administer broad-spectrum antibiotics within 1 hour
Rationale: In septic shock, the Surviving Sepsis Campaign guidelines
recommend administering broad-spectrum antibiotics within 1 hour of
recognition. Early antibiotic administration is associated with reduced mortality.
While obtaining labs and imaging are important, antibiotic administration is the
priority intervention.
Q2. A patient with a severe myocardial infarction is showing signs of cardiogenic
shock. Which hemodynamic parameter is most consistent with cardiogenic shock?
A) Elevated cardiac output with low systemic vascular resistance
B) Decreased cardiac output with elevated systemic vascular resistance
C) Elevated cardiac output with elevated systemic vascular resistance
D) Decreased cardiac output with decreased systemic vascular resistance
Answer: B — Decreased cardiac output with elevated systemic vascular
resistance
Rationale: Cardiogenic shock is characterized by decreased cardiac output due
to pump failure, with compensatory elevated systemic vascular resistance (SVR)
from vasoconstriction. This is in contrast to distributive shock (e.g., septic shock),
which presents with decreased SVR.
,Q3. A client is treated in the emergency department for shock of unknown
etiology. What is the nurse's first action?
A) Attach a cardiac monitor
B) Obtain a blood pressure
C) Check level of consciousness
D) Administer oxygen
Answer: D — Administer oxygen
Rationale: The first action in managing any type of shock is to administer
oxygen to ensure adequate tissue oxygenation. Airway, breathing, and circulation
(ABCs) take priority. While monitoring and assessing are important, oxygen
administration is the immediate priority.
Q4. Burn shock is primarily caused by which pathophysiological mechanism?
A) Cardiogenic failure due to myocardial depression
B) Massive fluid shifts of plasma, electrolytes, and proteins into the burn
wound
C) Vasodilation from systemic inflammatory response
D) Obstructive mechanism from eschar formation
Answer: B — Massive fluid shifts of plasma, electrolytes, and proteins into the
burn wound
Rationale: Burn shock is a form of hypovolemic shock caused by massive fluid
shifts of plasma, electrolytes, and proteins from the intravascular space into the
burn wound and surrounding tissues. This leads to hypovolemia and the inability of
the circulatory system to meet the metabolic demands of tissues.
Q5. A patient is diagnosed with obstructive shock secondary to cardiac tamponade.
Which pathophysiological mechanism best describes obstructive shock?
A) Cardiac function is impaired due to obstruction preventing the heart from
pumping blood out
B) The heart muscle fails to contract effectively
,C) Blood volume is insufficient to fill the vascular space
D) Widespread vasodilation causes maldistribution of blood flow
Answer: A — Cardiac function is impaired due to obstruction preventing the
heart from pumping blood out
Rationale: Obstructive shock occurs when cardiac function is impaired due to
an obstruction that prevents the heart from effectively pumping blood out. Causes
include cardiac tamponade, pulmonary embolism, and tension pneumothorax.
The obstruction impairs ventricular filling or outflow.
Q6. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg.
Which medication would the nurse anticipate administering first?
A) Dobutamine
B) Norepinephrine
C) Epinephrine
D) Dopamine
Answer: B — Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor recommended for septic
shock to maintain a MAP ≥ 65 mmHg. It acts as a potent vasoconstrictor to
increase systemic vascular resistance and improve perfusion to vital organs.
Q7. A nurse is caring for a patient in the compensatory stage of shock. Which
finding would the nurse expect?
A) Decreased heart rate
B) Increased heart rate with bounding pulses
C) Decreased respiratory rate
D) Cool, clammy skin
Answer: D — Cool, clammy skin
Rationale: In the compensatory stage of shock, the body attempts to maintain
perfusion through sympathetic nervous system activation. Findings
include tachycardia, cool and clammy skin (due to vasoconstriction), tachypnea,
and decreased urine output. Heart rate is increased, not decreased.
, Q8. Which laboratory finding is most indicative of disseminated intravascular
coagulation (DIC) in a patient with septic shock?
A) Elevated platelet count
B) Elevated D-dimer and decreased fibrinogen
C) Decreased PT and PTT
D) Elevated fibrinogen
Answer: B — Elevated D-dimer and decreased fibrinogen
Rationale: DIC is characterized by elevated D-dimer (indicating fibrinolysis)
and decreased fibrinogen (due to consumption). Platelet count is decreased, PT
and PTT are prolonged, and fibrinogen is consumed. These findings reflect the
widespread clotting and subsequent hemorrhage seen in DIC.
Q9. A patient in septic shock has a lactate level of 6.2 mmol/L. What is the
significance of this finding?
A) It indicates adequate tissue perfusion
B) It indicates tissue hypoxia and poor perfusion
C) It is a normal finding in septic shock
D) It indicates liver dysfunction
Answer: B — It indicates tissue hypoxia and poor perfusion
Rationale: Elevated serum lactate (> 2 mmol/L) in septic shock indicates tissue
hypoxia and inadequate perfusion. Lactate is produced during anaerobic
metabolism when oxygen delivery to tissues is insufficient. A lactate level of 6.2
mmol/L is significantly elevated and indicates severe tissue hypoperfusion.
Q10. A nurse is administering intravenous fluids to a patient with hypovolemic
shock. Which assessment finding indicates that fluid resuscitation is effective?
A) Decreased urine output
B) Increased urine output ≥ 0.5 mL/kg/hour
C) Decreased blood pressure
D) Increased heart rate
