NUR 2755 Final Exam - Multidimensional Care IV (MDC 4) Rasmussen University | 2026-2027
NUR2755 / NUR 2755 FINAL EXAM (Latest )
Multidimensional Care IV / MDC 4
Rasmussen University | College of Nursing
100 Questions | 8 Sections | Cognitive Mix: 25% Recall / 55% Application / 20% Analysis
Instructions: Select the single best answer for each question. Scenario-based items require application of the nursing process (Assess
→ Diagnose → Plan → Implement → Evaluate) and prioritization frameworks (ABC, CAB, Maslow, acute-vs-chronic). Each item
includes the correct answer and a comprehensive MDC 4 rationale with pathophysiology, assessment findings, nursing interventions, and
2026-2027 Rasmussen course-specific references.
Section 1: Shock States and Emergency Management (Questions Q1–Q15)
Q1: A patient arrives at the ED after a motor vehicle collision with absent radial pulses, weak carotid pulse, and
active bleeding from a femoral laceration. The nurse's first priority action is to:
A. Apply direct pressure to the femoral laceration to control hemorrhage [CORRECT]
B. Obtain a stat 12-lead ECG to assess for cardiac injury
C. Establish two large-bore IVs and infuse lactated Ringer's wide open
D. Insert an oral airway and begin bag-valve-mask ventilation
Correct Answer: A
Rationale: In hemorrhagic (hypovolemic) shock from trauma, the priority is "CAB" - Circulation, Airway, Breathing: stop the
bleeding first before fluid resuscitation, because infusing crystalloid into an actively bleeding patient will simply pump blood out of
the vascular space and worsen hemorrhage (the "leaky bucket" principle). After direct pressure controls external bleeding, large-bore
IV access and fluid resuscitation can proceed. Airway (option D) is critical but in this patient the immediate life threat is
exsanguination. ECG (option B) is deferred until hemorrhage is controlled. The CAB framework reverses traditional ABC for trauma
arrest due to hemorrhage.
Q2: A patient receives IV penicillin and within minutes develops urticaria, wheezing, angioedema of the lips and
tongue, and stridor. Blood pressure is 78/44 mmHg. The nurse's priority action is to:
A. Administer IV diphenhydramine 50 mg and call the provider
B. Administer IM epinephrine 0.3-0.5 mg (1:1,000) immediately [CORRECT]
C. Apply oxygen by nasal cannula and reassess in 5 minutes
D. Slow the penicillin infusion and notify the rapid response team
Correct Answer: B
Rationale: This is anaphylactic shock - a Type I IgE-mediated hypersensitivity with rapid cardiovascular and respiratory collapse.
The first-line, life-saving treatment is IM epinephrine 0.3-0.5 mg of 1:1,000 (1 mg/mL) concentration in the anterolateral thigh
(vastus lateralis) - not subcutaneous (delayed absorption), not IV (risk of arrhythmia). Epinephrine alpha-agonist effects vasoconstrict
to restore BP; beta-2 effects bronchodilate. Diphenhydramine (option A) is adjunctive for hives, not for anaphylaxis with shock.
Oxygen (option C) is supportive but epinephrine is definitive. Slowing the infusion (option D) is dangerous - the trigger must be stopped,
but epinephrine is the priority.
Q3: A patient with septic shock has a mean arterial pressure (MAP) of 56 mmHg despite 30 mL/kg crystalloid
bolus. The nurse anticipates initiation of which vasopressor as first-line per Surviving Sepsis guidelines?
A. Vasopressin (Arginine vasopressin)
B. Epinephrine (Adrenalin)
C. Dopamine (Intropin)
D. Norepinephrine (Levophed) [CORRECT]
Correct Answer: D
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,NUR 2755 Final Exam - Multidimensional Care IV (MDC 4) Rasmussen University | 2026-2027
Rationale: Norepinephrine is the Surviving Sepsis Campaign first-line vasopressor for septic shock, titrated to MAP ≥65 mmHg. It
provides potent alpha-1 vasoconstriction with modest beta-1 activity, restoring vascular tone without the profound tachyarrhythmias
associated with dopamine or epinephrine. Vasopressin (option A) is added as a second agent when norepinephrine alone is
insufficient. Epinephrine (option B) is reserved for refractory shock. Dopamine (option C) is no longer first-line due to higher
arrhythmia risk (SOAP-II trial). Continuous arterial pressure monitoring and central line administration are required for any
vasopressor.
Q4: A patient's blood pressure is 110/70 mmHg. Calculate the mean arterial pressure (MAP).
A. 90 mmHg
B. 95 mmHg
C. 83 mmHg [CORRECT]
D. 70 mmHg
Correct Answer: C
Rationale: MAP = (Diastolic × 2 + Systolic) / 3. Calculation: (70 × 2 + 110) / 3 = (140 + 110) / 3 = = 83.3 mmHg.
Normal MAP is 70-100 mmHg; MAP <65 mmHg indicates inadequate perfusion and requires fluid resuscitation or vasopressor
support. MAP determines organ perfusion more reliably than systolic or diastolic alone because it represents the average pressure
driving blood through the circulation over a full cardiac cycle. This is a high-yield MDC 4 calculation and recall item.
Q5: A patient in hypovolemic shock has the following vital signs: HR 132, BP 86/52, RR 28, SpO2 94%, urine
output 15 mL/hr. Which assessment finding indicates the patient is responding to fluid resuscitation?
A. Urine output increasing to 35 mL/hr [CORRECT]
B. Mental status becoming more confused
C. Heart rate increasing to 140 bpm
D. Respiratory rate increasing to 32 breaths/min
Correct Answer: A
Rationale: In hypovolemic shock, adequate resuscitation is monitored by urine output 30-50 mL/hr in adults, decreasing serum
lactate, improving mental status, stabilizing hemodynamics (HR decreasing, BP/MAP rising), and capillary refill <2 seconds. Urine
output is the gold standard indicator of renal perfusion and overall tissue perfusion. Worsening heart rate, respiratory rate,
and mental status (options A, C, D) all indicate deterioration, not response. The nurse continuously tracks these resuscitation markers
during shock management to titrate fluids, blood products, and vasopressors.
Q6: A patient in septic shock is on a norepinephrine infusion titrated to MAP 68 mmHg. The nurse knows that
septic shock pathophysiology includes:
A. Obstruction of the pulmonary artery by an embolus
B. Spinal cord injury causing loss of sympathetic tone
C. Massive vasodilation from systemic inflammatory response and capillary leak [CORRECT]
D. Acute blood loss requiring emergent transfusion
Correct Answer: C
Rationale: Septic shock is distributive shock characterized by massive vasodilation from nitric oxide release and inflammatory
mediators, plus capillary leak from cytokine-induced endothelial damage. The result is profound hypovolemia (relative and
absolute), hypotension, and microcirculatory maldistribution. Treatment: antibiotics (within 1 hour of recognition), 30 mL/kg
crystalloid bolus, vasopressors to maintain MAP ≥65, source control, and lactate monitoring. Hypovolemic shock (option D) is from
blood loss. Neurogenic shock (option B) follows spinal cord injury. Obstructive shock (option A) results from tension pneumothorax,
tamponade, or massive PE. Differentiating shock types is a hallmark MDC 4 competency.
Q7: A patient in the ICU with cardiogenic shock following an MI has a pulmonary artery catheter. Which
hemodynamic profile is most consistent with cardiogenic shock?
A. High cardiac output, high PCWP, low SVR
B. Low cardiac output, low PCWP, low SVR
NUR2755 / NUR 2755 FINAL EXAM (Latest 2026/2027) - MDC 4 Page 2
,NUR 2755 Final Exam - Multidimensional Care IV (MDC 4) Rasmussen University | 2026-2027
C. High cardiac output, low PCWP, low SVR
D. Low cardiac output, high pulmonary capillary wedge pressure (PCWP), high SVR [CORRECT]
Correct Answer: D
Rationale: Cardiogenic shock results from pump failure - the heart cannot generate adequate cardiac output. Hemodynamic
profile: low cardiac output, high PCWP (because blood backs up behind the failing left ventricle into the pulmonary vasculature),
and high SVR (compensatory vasoconstriction from sympathetic activation). Treatment: inotropes (dobutamine, milrinone),
intra-aortic balloon pump or Impella, revascularization. Septic shock (option C) is high CO, low PCWP, low SVR. Hypovolemic shock
(option B) is low CO, low PCWP, low SVR. Neurogenic shock (option A - though not exactly) shows low SVR with bradycardia. PAC
hemodynamic interpretation is foundational MDC 4 critical care content.
Q8: A patient presents to the ED after a fall from a horse with a suspected spinal cord injury at T6. Vital signs:
HR 48, BP 84/52, warm dry skin below the level of injury. The nurse identifies this as:
A. Neurogenic shock from loss of sympathetic tone [CORRECT]
B. Hypovolemic shock from internal bleeding
C. Anaphylactic shock from insect sting
D. Septic shock from a contaminated wound
Correct Answer: A
Rationale: Neurogenic shock occurs with spinal cord injury at T6 or above due to loss of sympathetic outflow below the lesion.
Classic triad: hypotension, bradycardia, and warm/dry skin below the level of injury (unopposed parasympathetic tone).
Treatment: IV fluids, vasopressors (norepinephrine or phenylephrine for alpha-1 vasoconstriction), and atropine for symptomatic
bradycardia. Hypovolemic shock (option B) causes tachycardia and cool/clammy skin. Septic shock (option D) causes tachycardia and
fever or hypothermia. Anaphylactic shock (option C) has urticaria and bronchospasm. The bradycardia with warm skin differentiates
neurogenic from other shock states.
Q9: A patient is admitted with hypovolemic shock from vomiting and diarrhea. The nurse understands that
compensation for shock is mediated primarily by the:
A. Baroreceptor reflex alone without endocrine involvement
B. Parasympathetic nervous system (vagus nerve)
C. Sympathetic nervous system and renin-angiotensin-aldosterone system [CORRECT]
D. Hepatic gluconeogenesis pathway
Correct Answer: C
Rationale: Shock compensation involves the sympathetic nervous system (tachycardia, vasoconstriction, increased contractility)
and the renin-angiotensin-aldosterone system (RAAS) (sodium and water retention, vasoconstriction via angiotensin II), plus
ADH release for water retention. Baroreceptors in the carotid and aortic arch detect pressure drop and trigger SNS outflow.
Compensation cannot be sustained indefinitely; if the cause is not corrected, the patient progresses to decompensated (irreversible)
shock with multi-organ dysfunction syndrome. Understanding compensation guides early recognition of shock before hemodynamic
collapse.
Q10: A patient with hemorrhagic shock receives 4 units of PRBCs and 2 units of FFP. Which electrolyte imbalance
requires ongoing monitoring during massive transfusion?
A. Hypomagnesemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia from citrate toxicity [CORRECT]
Correct Answer: D
Rationale: Massive transfusion (>10 units PRBCs in 24 hours or 4 units in 1 hour) risks hypocalcemia because the anticoagulant
citrate in banked blood binds ionized calcium. Citrate is normally metabolized by the liver, but rapid transfusion overwhelms hepatic
clearance, producing hypocalcemia, hypotension, and prolonged QT interval. Monitor ionized calcium and administer calcium
gluconate as ordered. Other complications: hypothermia (use blood warmer), hyperkalemia (from stored RBC lysis, not
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, NUR 2755 Final Exam - Multidimensional Care IV (MDC 4) Rasmussen University | 2026-2027
hypokalemia - option B is opposite), acid-base disturbances, and dilutional coagulopathy (treat with FFP and platelets in a 1:1:1
ratio). Massive transfusion protocol (MTP) is critical MDC 4 content.
Q11: A patient in anaphylactic shock receives IM epinephrine 0.3 mg, IV diphenhydramine 50 mg, and IV
methylprednisolone 125 mg. Despite this, the patient remains hypotensive with wheezing. The nurse's next action
is to:
A. Administer a second dose of IM epinephrine in 5-15 minutes if no improvement [CORRECT]
B. Apply cold compresses to reduce angioedema
C. Repeat diphenhydramine 50 mg IV push
D. Administer oral loratadine 10 mg
Correct Answer: A
Rationale: Epinephrine doses can be repeated every 5-15 minutes for persistent anaphylaxis (the half-life is short). If airway
edema or hypotension persists, escalate to IV epinephrine infusion and prepare for intubation. Adjuncts (diphenhydramine,
corticosteroids, H2 blockers like famotidine, albuterol for bronchospasm, glucagon for patients on beta-blockers) address symptoms
but do not reverse the cascade. The patient must be observed for biphasic reaction (recurrence 4-24 hours after initial resolution) -
observe for at least 4-8 hours post-stabilization. Repeat diphenhydramine (option C) and oral loratadine (option D) are inadequate
for ongoing anaphylaxis. Cold compresses (option B) do not address the systemic reaction.
Q12: A patient with septic shock has a central venous pressure (CVP) of 4 mmHg and a lactate of 4.2 mmol/L. The
nurse anticipates the provider will order:
A. Strict fluid restriction to prevent pulmonary edema
B. Beta-blockers to reduce tachycardia
C. Additional crystalloid boluses to target CVP 8-12 mmHg [CORRECT]
D. Diuretics to reduce volume overload
Correct Answer: C
Rationale: In septic shock, Surviving Sepsis targets include CVP 8-12 mmHg (12-15 in ventilated patients), MAP ≥65 mmHg,
urine output ≥0.5 mL/kg/hr, ScvO2 ≥70%, and lactate normalization. CVP of 4 mmHg indicates hypovolemia; lactate 4.2
(normal <2) indicates anaerobic metabolism from tissue hypoperfusion. Treatment: additional 30 mL/kg crystalloid boluses until
CVP target is met, then vasopressors for MAP. Diuretics (option D) and fluid restriction (option A) would worsen hypovolemia.
Beta-blockers (option B) are contraindicated in compensatory tachycardia. Goal-directed therapy reduces mortality.
Q13: A patient in distributive shock has warm extremities, bounding pulses, and a low SVR. The nurse
differentiates this presentation from cardiogenic shock, which typically presents with:
A. Warm extremities, bounding pulses, low SVR
B. Hypotension with high cardiac output
C. Bradycardia with low CVP
D. Cool, clammy extremities with weak pulses and high SVR [CORRECT]
Correct Answer: D
Rationale: Cardiogenic shock presents with cool, clammy extremities (compensatory vasoconstriction), weak thready pulses
(low stroke volume), high SVR (vasoconstriction), jugular venous distension, crackles (pulmonary edema), and narrow pulse
pressure. Distributive shock (septic, anaphylactic, neurogenic) presents with warm extremities, bounding pulses, low SVR due to
vasodilation. Hypovolemic shock presents with cool, clammy skin but low CVP and PCWP. Differentiation by clinical and
hemodynamic profile directs specific treatment: cardiogenic = inotrope/IABP; septic = fluids + norepinephrine; hypovolemic =
volume; neurogenic = vasopressor + atropine.
Q14: A patient is admitted with septic shock and acute respiratory distress syndrome (ARDS). The nurse
anticipates which ventilation strategy as optimal?
A. High tidal volume ventilation (10-12 mL/kg) to maintain PaO2
B. Low tidal volume lung-protective ventilation (6 mL/kg ideal body weight) [CORRECT]
NUR2755 / NUR 2755 FINAL EXAM (Latest 2026/2027) - MDC 4 Page 4
NUR2755 / NUR 2755 FINAL EXAM (Latest )
Multidimensional Care IV / MDC 4
Rasmussen University | College of Nursing
100 Questions | 8 Sections | Cognitive Mix: 25% Recall / 55% Application / 20% Analysis
Instructions: Select the single best answer for each question. Scenario-based items require application of the nursing process (Assess
→ Diagnose → Plan → Implement → Evaluate) and prioritization frameworks (ABC, CAB, Maslow, acute-vs-chronic). Each item
includes the correct answer and a comprehensive MDC 4 rationale with pathophysiology, assessment findings, nursing interventions, and
2026-2027 Rasmussen course-specific references.
Section 1: Shock States and Emergency Management (Questions Q1–Q15)
Q1: A patient arrives at the ED after a motor vehicle collision with absent radial pulses, weak carotid pulse, and
active bleeding from a femoral laceration. The nurse's first priority action is to:
A. Apply direct pressure to the femoral laceration to control hemorrhage [CORRECT]
B. Obtain a stat 12-lead ECG to assess for cardiac injury
C. Establish two large-bore IVs and infuse lactated Ringer's wide open
D. Insert an oral airway and begin bag-valve-mask ventilation
Correct Answer: A
Rationale: In hemorrhagic (hypovolemic) shock from trauma, the priority is "CAB" - Circulation, Airway, Breathing: stop the
bleeding first before fluid resuscitation, because infusing crystalloid into an actively bleeding patient will simply pump blood out of
the vascular space and worsen hemorrhage (the "leaky bucket" principle). After direct pressure controls external bleeding, large-bore
IV access and fluid resuscitation can proceed. Airway (option D) is critical but in this patient the immediate life threat is
exsanguination. ECG (option B) is deferred until hemorrhage is controlled. The CAB framework reverses traditional ABC for trauma
arrest due to hemorrhage.
Q2: A patient receives IV penicillin and within minutes develops urticaria, wheezing, angioedema of the lips and
tongue, and stridor. Blood pressure is 78/44 mmHg. The nurse's priority action is to:
A. Administer IV diphenhydramine 50 mg and call the provider
B. Administer IM epinephrine 0.3-0.5 mg (1:1,000) immediately [CORRECT]
C. Apply oxygen by nasal cannula and reassess in 5 minutes
D. Slow the penicillin infusion and notify the rapid response team
Correct Answer: B
Rationale: This is anaphylactic shock - a Type I IgE-mediated hypersensitivity with rapid cardiovascular and respiratory collapse.
The first-line, life-saving treatment is IM epinephrine 0.3-0.5 mg of 1:1,000 (1 mg/mL) concentration in the anterolateral thigh
(vastus lateralis) - not subcutaneous (delayed absorption), not IV (risk of arrhythmia). Epinephrine alpha-agonist effects vasoconstrict
to restore BP; beta-2 effects bronchodilate. Diphenhydramine (option A) is adjunctive for hives, not for anaphylaxis with shock.
Oxygen (option C) is supportive but epinephrine is definitive. Slowing the infusion (option D) is dangerous - the trigger must be stopped,
but epinephrine is the priority.
Q3: A patient with septic shock has a mean arterial pressure (MAP) of 56 mmHg despite 30 mL/kg crystalloid
bolus. The nurse anticipates initiation of which vasopressor as first-line per Surviving Sepsis guidelines?
A. Vasopressin (Arginine vasopressin)
B. Epinephrine (Adrenalin)
C. Dopamine (Intropin)
D. Norepinephrine (Levophed) [CORRECT]
Correct Answer: D
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Rationale: Norepinephrine is the Surviving Sepsis Campaign first-line vasopressor for septic shock, titrated to MAP ≥65 mmHg. It
provides potent alpha-1 vasoconstriction with modest beta-1 activity, restoring vascular tone without the profound tachyarrhythmias
associated with dopamine or epinephrine. Vasopressin (option A) is added as a second agent when norepinephrine alone is
insufficient. Epinephrine (option B) is reserved for refractory shock. Dopamine (option C) is no longer first-line due to higher
arrhythmia risk (SOAP-II trial). Continuous arterial pressure monitoring and central line administration are required for any
vasopressor.
Q4: A patient's blood pressure is 110/70 mmHg. Calculate the mean arterial pressure (MAP).
A. 90 mmHg
B. 95 mmHg
C. 83 mmHg [CORRECT]
D. 70 mmHg
Correct Answer: C
Rationale: MAP = (Diastolic × 2 + Systolic) / 3. Calculation: (70 × 2 + 110) / 3 = (140 + 110) / 3 = = 83.3 mmHg.
Normal MAP is 70-100 mmHg; MAP <65 mmHg indicates inadequate perfusion and requires fluid resuscitation or vasopressor
support. MAP determines organ perfusion more reliably than systolic or diastolic alone because it represents the average pressure
driving blood through the circulation over a full cardiac cycle. This is a high-yield MDC 4 calculation and recall item.
Q5: A patient in hypovolemic shock has the following vital signs: HR 132, BP 86/52, RR 28, SpO2 94%, urine
output 15 mL/hr. Which assessment finding indicates the patient is responding to fluid resuscitation?
A. Urine output increasing to 35 mL/hr [CORRECT]
B. Mental status becoming more confused
C. Heart rate increasing to 140 bpm
D. Respiratory rate increasing to 32 breaths/min
Correct Answer: A
Rationale: In hypovolemic shock, adequate resuscitation is monitored by urine output 30-50 mL/hr in adults, decreasing serum
lactate, improving mental status, stabilizing hemodynamics (HR decreasing, BP/MAP rising), and capillary refill <2 seconds. Urine
output is the gold standard indicator of renal perfusion and overall tissue perfusion. Worsening heart rate, respiratory rate,
and mental status (options A, C, D) all indicate deterioration, not response. The nurse continuously tracks these resuscitation markers
during shock management to titrate fluids, blood products, and vasopressors.
Q6: A patient in septic shock is on a norepinephrine infusion titrated to MAP 68 mmHg. The nurse knows that
septic shock pathophysiology includes:
A. Obstruction of the pulmonary artery by an embolus
B. Spinal cord injury causing loss of sympathetic tone
C. Massive vasodilation from systemic inflammatory response and capillary leak [CORRECT]
D. Acute blood loss requiring emergent transfusion
Correct Answer: C
Rationale: Septic shock is distributive shock characterized by massive vasodilation from nitric oxide release and inflammatory
mediators, plus capillary leak from cytokine-induced endothelial damage. The result is profound hypovolemia (relative and
absolute), hypotension, and microcirculatory maldistribution. Treatment: antibiotics (within 1 hour of recognition), 30 mL/kg
crystalloid bolus, vasopressors to maintain MAP ≥65, source control, and lactate monitoring. Hypovolemic shock (option D) is from
blood loss. Neurogenic shock (option B) follows spinal cord injury. Obstructive shock (option A) results from tension pneumothorax,
tamponade, or massive PE. Differentiating shock types is a hallmark MDC 4 competency.
Q7: A patient in the ICU with cardiogenic shock following an MI has a pulmonary artery catheter. Which
hemodynamic profile is most consistent with cardiogenic shock?
A. High cardiac output, high PCWP, low SVR
B. Low cardiac output, low PCWP, low SVR
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,NUR 2755 Final Exam - Multidimensional Care IV (MDC 4) Rasmussen University | 2026-2027
C. High cardiac output, low PCWP, low SVR
D. Low cardiac output, high pulmonary capillary wedge pressure (PCWP), high SVR [CORRECT]
Correct Answer: D
Rationale: Cardiogenic shock results from pump failure - the heart cannot generate adequate cardiac output. Hemodynamic
profile: low cardiac output, high PCWP (because blood backs up behind the failing left ventricle into the pulmonary vasculature),
and high SVR (compensatory vasoconstriction from sympathetic activation). Treatment: inotropes (dobutamine, milrinone),
intra-aortic balloon pump or Impella, revascularization. Septic shock (option C) is high CO, low PCWP, low SVR. Hypovolemic shock
(option B) is low CO, low PCWP, low SVR. Neurogenic shock (option A - though not exactly) shows low SVR with bradycardia. PAC
hemodynamic interpretation is foundational MDC 4 critical care content.
Q8: A patient presents to the ED after a fall from a horse with a suspected spinal cord injury at T6. Vital signs:
HR 48, BP 84/52, warm dry skin below the level of injury. The nurse identifies this as:
A. Neurogenic shock from loss of sympathetic tone [CORRECT]
B. Hypovolemic shock from internal bleeding
C. Anaphylactic shock from insect sting
D. Septic shock from a contaminated wound
Correct Answer: A
Rationale: Neurogenic shock occurs with spinal cord injury at T6 or above due to loss of sympathetic outflow below the lesion.
Classic triad: hypotension, bradycardia, and warm/dry skin below the level of injury (unopposed parasympathetic tone).
Treatment: IV fluids, vasopressors (norepinephrine or phenylephrine for alpha-1 vasoconstriction), and atropine for symptomatic
bradycardia. Hypovolemic shock (option B) causes tachycardia and cool/clammy skin. Septic shock (option D) causes tachycardia and
fever or hypothermia. Anaphylactic shock (option C) has urticaria and bronchospasm. The bradycardia with warm skin differentiates
neurogenic from other shock states.
Q9: A patient is admitted with hypovolemic shock from vomiting and diarrhea. The nurse understands that
compensation for shock is mediated primarily by the:
A. Baroreceptor reflex alone without endocrine involvement
B. Parasympathetic nervous system (vagus nerve)
C. Sympathetic nervous system and renin-angiotensin-aldosterone system [CORRECT]
D. Hepatic gluconeogenesis pathway
Correct Answer: C
Rationale: Shock compensation involves the sympathetic nervous system (tachycardia, vasoconstriction, increased contractility)
and the renin-angiotensin-aldosterone system (RAAS) (sodium and water retention, vasoconstriction via angiotensin II), plus
ADH release for water retention. Baroreceptors in the carotid and aortic arch detect pressure drop and trigger SNS outflow.
Compensation cannot be sustained indefinitely; if the cause is not corrected, the patient progresses to decompensated (irreversible)
shock with multi-organ dysfunction syndrome. Understanding compensation guides early recognition of shock before hemodynamic
collapse.
Q10: A patient with hemorrhagic shock receives 4 units of PRBCs and 2 units of FFP. Which electrolyte imbalance
requires ongoing monitoring during massive transfusion?
A. Hypomagnesemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia from citrate toxicity [CORRECT]
Correct Answer: D
Rationale: Massive transfusion (>10 units PRBCs in 24 hours or 4 units in 1 hour) risks hypocalcemia because the anticoagulant
citrate in banked blood binds ionized calcium. Citrate is normally metabolized by the liver, but rapid transfusion overwhelms hepatic
clearance, producing hypocalcemia, hypotension, and prolonged QT interval. Monitor ionized calcium and administer calcium
gluconate as ordered. Other complications: hypothermia (use blood warmer), hyperkalemia (from stored RBC lysis, not
NUR2755 / NUR 2755 FINAL EXAM (Latest 2026/2027) - MDC 4 Page 3
, NUR 2755 Final Exam - Multidimensional Care IV (MDC 4) Rasmussen University | 2026-2027
hypokalemia - option B is opposite), acid-base disturbances, and dilutional coagulopathy (treat with FFP and platelets in a 1:1:1
ratio). Massive transfusion protocol (MTP) is critical MDC 4 content.
Q11: A patient in anaphylactic shock receives IM epinephrine 0.3 mg, IV diphenhydramine 50 mg, and IV
methylprednisolone 125 mg. Despite this, the patient remains hypotensive with wheezing. The nurse's next action
is to:
A. Administer a second dose of IM epinephrine in 5-15 minutes if no improvement [CORRECT]
B. Apply cold compresses to reduce angioedema
C. Repeat diphenhydramine 50 mg IV push
D. Administer oral loratadine 10 mg
Correct Answer: A
Rationale: Epinephrine doses can be repeated every 5-15 minutes for persistent anaphylaxis (the half-life is short). If airway
edema or hypotension persists, escalate to IV epinephrine infusion and prepare for intubation. Adjuncts (diphenhydramine,
corticosteroids, H2 blockers like famotidine, albuterol for bronchospasm, glucagon for patients on beta-blockers) address symptoms
but do not reverse the cascade. The patient must be observed for biphasic reaction (recurrence 4-24 hours after initial resolution) -
observe for at least 4-8 hours post-stabilization. Repeat diphenhydramine (option C) and oral loratadine (option D) are inadequate
for ongoing anaphylaxis. Cold compresses (option B) do not address the systemic reaction.
Q12: A patient with septic shock has a central venous pressure (CVP) of 4 mmHg and a lactate of 4.2 mmol/L. The
nurse anticipates the provider will order:
A. Strict fluid restriction to prevent pulmonary edema
B. Beta-blockers to reduce tachycardia
C. Additional crystalloid boluses to target CVP 8-12 mmHg [CORRECT]
D. Diuretics to reduce volume overload
Correct Answer: C
Rationale: In septic shock, Surviving Sepsis targets include CVP 8-12 mmHg (12-15 in ventilated patients), MAP ≥65 mmHg,
urine output ≥0.5 mL/kg/hr, ScvO2 ≥70%, and lactate normalization. CVP of 4 mmHg indicates hypovolemia; lactate 4.2
(normal <2) indicates anaerobic metabolism from tissue hypoperfusion. Treatment: additional 30 mL/kg crystalloid boluses until
CVP target is met, then vasopressors for MAP. Diuretics (option D) and fluid restriction (option A) would worsen hypovolemia.
Beta-blockers (option B) are contraindicated in compensatory tachycardia. Goal-directed therapy reduces mortality.
Q13: A patient in distributive shock has warm extremities, bounding pulses, and a low SVR. The nurse
differentiates this presentation from cardiogenic shock, which typically presents with:
A. Warm extremities, bounding pulses, low SVR
B. Hypotension with high cardiac output
C. Bradycardia with low CVP
D. Cool, clammy extremities with weak pulses and high SVR [CORRECT]
Correct Answer: D
Rationale: Cardiogenic shock presents with cool, clammy extremities (compensatory vasoconstriction), weak thready pulses
(low stroke volume), high SVR (vasoconstriction), jugular venous distension, crackles (pulmonary edema), and narrow pulse
pressure. Distributive shock (septic, anaphylactic, neurogenic) presents with warm extremities, bounding pulses, low SVR due to
vasodilation. Hypovolemic shock presents with cool, clammy skin but low CVP and PCWP. Differentiation by clinical and
hemodynamic profile directs specific treatment: cardiogenic = inotrope/IABP; septic = fluids + norepinephrine; hypovolemic =
volume; neurogenic = vasopressor + atropine.
Q14: A patient is admitted with septic shock and acute respiratory distress syndrome (ARDS). The nurse
anticipates which ventilation strategy as optimal?
A. High tidal volume ventilation (10-12 mL/kg) to maintain PaO2
B. Low tidal volume lung-protective ventilation (6 mL/kg ideal body weight) [CORRECT]
NUR2755 / NUR 2755 FINAL EXAM (Latest 2026/2027) - MDC 4 Page 4
