RASMUSSEN UNIVERSITY
SC H OOL OF NU RSING
NUR 2755 Exam 2: Multidimensional
Care IV (MDC 4)
Course: NUR 2755 - Multidimensional
Care IV
Exam: Examination 2
Questions: 100 Multiple Choice
Academic Year: 2026 - 2027
L a t est 2 02 6 /2 02 7 Up d a t e | Quest ions a nd Ver ified Answer s
, NUR 2755 Exam 2: Multidimensional Care IV | Rasmussen University | 2026/2027
Section 1: Shock States (Q1-Q25)
Q1: A 45-year-old patient arrives in the emergency department after a motor vehicle collision. Blood pressure is
78/50 mmHg, heart rate is 130 bpm, and skin is cool and diaphoretic. Which type of shock is this patient most
likely experiencing?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: This patient presents with classic signs of hypovolemic shock following trauma: hypotension (BP 78/50), tachycardia (HR
130), and cool, diaphoretic skin indicating peripheral vasoconstriction due to decreased circulating volume. The mechanism involves
hemorrhage from the collision causing reduced preload, decreased stroke volume, and compensatory sympathetic activation.
Cardiogenic shock would present with pulmonary congestion and elevated jugular venous pressure. Distributive shock typically causes
warm, flushed skin due to vasodilation. Obstructive shock is caused by mechanical obstruction to blood flow such as cardiac
tamponade or massive pulmonary embolism.
Q2: A nurse is caring for a patient in hypovolemic shock. Which laboratory finding would the nurse expect to
see as a compensatory mechanism?
A. Decreased serum aldosterone level
B. Elevated blood urea nitrogen (BUN)-to-creatinine ratio [CORRECT]
C. Decreased serum cortisol level
D. Elevated serum sodium with low potassium
Correct Answer: B
Rationale: In hypovolemic shock, the kidneys activate the renin-angiotensin-aldosterone system (RAAS) in response to decreased
renal perfusion. Aldosterone promotes sodium and water retention in the distal tubules, which concentrates the urine and leads to an
elevated BUN-to-creatinine ratio (typically greater than 20:1), a condition known as prerenal azotemia. Serum aldosterone would be
increased, not decreased. Cortisol would also increase as part of the stress response. While aldosterone does cause sodium retention
and potassium excretion, the hallmark laboratory finding is the elevated BUN-to-creatinine ratio reflecting renal hypoperfusion
rather than simple electrolyte shifts.
Q3: A patient with septic shock has a blood pressure of 82/48 mmHg despite receiving 30 mL/kg of crystalloid
fluids. Which medication should the nurse anticipate being administered next?
A. Dobutamine (Dobutrex)
B. Norepinephrine (Levophed) [CORRECT]
C. Nitroprusside (Nipride)
D. Methylprednisolone (Solu-Medrol)
Correct Answer: B
Rationale: According to the Surviving Sepsis Campaign guidelines, norepinephrine is the first-line vasopressor for septic shock that is
refractory to initial fluid resuscitation (30 mL/kg crystalloid). Norepinephrine is a potent alpha-1 agonist with some beta-1 activity,
making it effective at increasing systemic vascular resistance and maintaining organ perfusion pressure. Dobutamine is primarily an
inotrope used for cardiogenic shock or when cardiac output is severely compromised. Nitroprusside is a vasodilator and is
contraindicated in hypotension. Corticosteroids such as methylprednisolone may be considered later if the patient remains refractory
to both fluids and vasopressors, but they are not the next step.
Q4: A nurse is assessing a patient who was admitted with anaphylactic shock. Which finding indicates that the
nurse should administer epinephrine immediately?
, A. Blood pressure 100/70 mmHg with urticaria on the chest
B. Stridor, angioedema of the face and neck, and blood pressure 70/40 mmHg [CORRECT]
C. Heart rate 110 bpm with pruritus on the forearms
D. Respiratory rate 22 breaths/min with generalized erythema
Correct Answer: B
Rationale: Stridor, angioedema of the face and neck, and severe hypotension (BP 70/40) indicate life-threatening airway
compromise and cardiovascular collapse, requiring immediate intramuscular epinephrine administration. Epinephrine is the first-line
treatment for anaphylaxis because it provides both alpha-adrenergic vasoconstriction to counteract hypotension and bronchodilation
via beta-2 receptors to relieve airway obstruction. Urticaria with stable blood pressure and pruritus with a normal respiratory rate
represent milder allergic reactions that may be managed with antihistamines and corticosteroids. Stridor is a critical finding indicating
upper airway edema that can rapidly progress to complete airway obstruction.
Q5: A patient with cardiogenic shock secondary to acute myocardial infarction has the following hemodynamic
parameters: cardiac output 3.0 L/min, systemic vascular resistance (SVR) 1800 dynes/sec/cm5, and pulmonary
artery wedge pressure (PAWP) 25 mmHg. Which nursing intervention is the priority?
A. Administer a fluid bolus of 500 mL normal saline
B. Prepare the patient for intra-aortic balloon pump (IABP) therapy [CORRECT]
C. Apply warming blankets to increase body temperature
D. Initiate high-flow oxygen via non-rebreather mask
Correct Answer: B
Rationale: This patient demonstrates cardiogenic shock with elevated PAWP (25 mmHg, normal 6-12), indicating pulmonary
congestion from left ventricular failure, elevated SVR (1800, normal 800-1200) reflecting compensatory vasoconstriction, and low
cardiac output (3.0 L/min, normal 4-8). An intra-aortic balloon pump is indicated because it provides both afterload reduction
(deflation during systole) and coronary artery perfusion augmentation (inflation during diastole). Fluid boluses are contraindicated
because PAWP is already elevated, which would worsen pulmonary edema. Warming blankets are inappropriate because
compensatory vasoconstriction is a response to low cardiac output, and increasing body temperature would increase metabolic
demand. Oxygen is supportive but does not address the underlying mechanical circulatory failure.
Q6: A 28-year-old patient presents with a tension pneumothorax after a stab wound to the chest. Blood pressure
is 60/40 mmHg, heart rate is 140 bpm, and jugular venous distension is noted. Which type of shock is this
patient experiencing?
A. Hypovolemic shock
B. Obstructive shock [CORRECT]
C. Distributive shock
D. Cardiogenic shock
Correct Answer: B
Rationale: Tension pneumothorax causes obstructive shock because the accumulating intrapleural pressure compresses the great
vessels and heart, mechanically obstructing venous return and cardiac output. The classic presentation includes hypotension,
tachycardia, jugular venous distension (from impaired venous return), absent breath sounds on the affected side, and tracheal
deviation. Unlike hypovolemic shock, the total blood volume may be normal, but the mechanical obstruction prevents effective
circulation. Unlike cardiogenic shock, the primary problem is not pump failure but rather external compression of cardiovascular
structures. Treatment requires immediate needle decompression followed by chest tube insertion.
Q7: The nurse is monitoring a patient in the progressive stage of shock. Which clinical manifestation indicates
that the patient is transitioning from compensatory to progressive shock?
A. Decreasing blood pressure that no longer responds to fluid resuscitation [CORRECT]
B. Increasing urine output and decreasing heart rate
C. Warm, dry skin with bounding peripheral pulses
D. Respiratory alkalosis with a PaCO2 of 30 mmHg
Correct Answer: A
, Rationale: In the progressive (decompensated) stage of shock, compensatory mechanisms begin to fail. Blood pressure that no longer
responds to fluid resuscitation indicates that the patient has transitioned from the compensatory stage, where blood pressure was
maintained through tachycardia and vasoconstriction, to the progressive stage where tissue hypoperfusion and lactic acidosis are
worsening. Urine output would decrease (not increase) due to renal hypoperfusion. Skin would become cool and mottled (not warm
and dry) as perfusion worsens. Metabolic acidosis (not respiratory alkalosis) would develop as anaerobic metabolism produces lactic
acid. Recognizing this transition is critical because it signals the need for aggressive interventions including vasopressors and possible
mechanical support.
Q8: A patient in distributive shock from neurogenic causes has sustained a spinal cord injury at T6. Which
clinical finding differentiates neurogenic shock from other forms of distributive shock?
A. Warm, dry skin below the level of injury with bradycardia [CORRECT]
B. Cool, clammy skin with tachycardia
C. Hypertension with bounding peripheral pulses
D. Fever and tachypnea with flushed skin
Correct Answer: A
Rationale: Neurogenic shock results from disruption of the sympathetic nervous system below the level of spinal cord injury, causing
loss of vasomotor tone (vasodilation) and unopposed parasympathetic activity (bradycardia). The clinical hallmarks are hypotension
with warm, dry skin (due to vasodilation without sympathetic-mediated vasoconstriction) and bradycardia (unopposed vagal tone).
This differs from septic shock, which typically causes tachycardia due to systemic inflammation, and anaphylactic shock, which also
produces tachycardia from histamine release. The T6 level is significant because it is above the major splanchnic sympathetic
outflow, affecting vascular tone in the lower extremities and abdominal viscera.
Q9: A nurse is administering norepinephrine to a patient in septic shock via a central venous catheter. Which
assessment finding requires immediate intervention by the nurse?
A. Heart rate increased from 100 to 110 bpm
B. Blood pressure reading of 180/100 mmHg [CORRECT]
C. Urine output of 30 mL/hr
D. Mean arterial pressure of 65 mmHg
Correct Answer: B
Rationale: A blood pressure of 180/100 mmHg in a patient receiving norepinephrine (a potent alpha-1 agonist vasopressor) indicates
severe hypertension, which places the patient at risk for intracranial hemorrhage, myocardial ischemia, and further end-organ
damage. The nurse should immediately reduce the infusion rate or temporarily discontinue the medication and notify the provider. A
heart rate increase of 10 bpm is an expected response and not alarming. Urine output of 30 mL/hr is adequate and suggests improving
perfusion. A MAP of 65 mmHg is within the target range (typically 65 mmHg or higher) for septic shock resuscitation and does not
require intervention.
Q10: A 32-year-old patient is admitted to the intensive care unit with septic shock secondary to a urinary tract
infection. The nurse understands that which pathophysiological process is primarily responsible for the
vasodilation seen in septic shock?
A. Release of antidiuretic hormone (ADH) from the posterior pituitary
B. Activation of inducible nitric oxide synthase (iNOS) producing excessive nitric oxide [CORRECT]
C. Increased parasympathetic nervous system outflow from the vagus nerve
D. Release of thyroxine (T4) from the thyroid gland increasing metabolic rate
Correct Answer: B
Rationale: In septic shock, bacterial endotoxins and inflammatory cytokines (particularly TNF-alpha, IL-1, and IL-6) activate
inducible nitric oxide synthase (iNOS) in vascular smooth muscle cells, leading to massive production of nitric oxide (NO). Nitric oxide
is a potent vasodilator that activates guanylate cyclase, increasing cyclic GMP and causing smooth muscle relaxation. This excessive
vasodilation is a primary mechanism of the hypotension seen in septic shock. ADH is released in response to hypovolemia but causes
vasoconstriction at high doses, not vasodilation. The parasympathetic nervous system does not play a primary role in septic
vasodilation. Thyroid hormones increase metabolic rate but do not directly cause the profound vasodilation characteristic of sepsis.
SC H OOL OF NU RSING
NUR 2755 Exam 2: Multidimensional
Care IV (MDC 4)
Course: NUR 2755 - Multidimensional
Care IV
Exam: Examination 2
Questions: 100 Multiple Choice
Academic Year: 2026 - 2027
L a t est 2 02 6 /2 02 7 Up d a t e | Quest ions a nd Ver ified Answer s
, NUR 2755 Exam 2: Multidimensional Care IV | Rasmussen University | 2026/2027
Section 1: Shock States (Q1-Q25)
Q1: A 45-year-old patient arrives in the emergency department after a motor vehicle collision. Blood pressure is
78/50 mmHg, heart rate is 130 bpm, and skin is cool and diaphoretic. Which type of shock is this patient most
likely experiencing?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: This patient presents with classic signs of hypovolemic shock following trauma: hypotension (BP 78/50), tachycardia (HR
130), and cool, diaphoretic skin indicating peripheral vasoconstriction due to decreased circulating volume. The mechanism involves
hemorrhage from the collision causing reduced preload, decreased stroke volume, and compensatory sympathetic activation.
Cardiogenic shock would present with pulmonary congestion and elevated jugular venous pressure. Distributive shock typically causes
warm, flushed skin due to vasodilation. Obstructive shock is caused by mechanical obstruction to blood flow such as cardiac
tamponade or massive pulmonary embolism.
Q2: A nurse is caring for a patient in hypovolemic shock. Which laboratory finding would the nurse expect to
see as a compensatory mechanism?
A. Decreased serum aldosterone level
B. Elevated blood urea nitrogen (BUN)-to-creatinine ratio [CORRECT]
C. Decreased serum cortisol level
D. Elevated serum sodium with low potassium
Correct Answer: B
Rationale: In hypovolemic shock, the kidneys activate the renin-angiotensin-aldosterone system (RAAS) in response to decreased
renal perfusion. Aldosterone promotes sodium and water retention in the distal tubules, which concentrates the urine and leads to an
elevated BUN-to-creatinine ratio (typically greater than 20:1), a condition known as prerenal azotemia. Serum aldosterone would be
increased, not decreased. Cortisol would also increase as part of the stress response. While aldosterone does cause sodium retention
and potassium excretion, the hallmark laboratory finding is the elevated BUN-to-creatinine ratio reflecting renal hypoperfusion
rather than simple electrolyte shifts.
Q3: A patient with septic shock has a blood pressure of 82/48 mmHg despite receiving 30 mL/kg of crystalloid
fluids. Which medication should the nurse anticipate being administered next?
A. Dobutamine (Dobutrex)
B. Norepinephrine (Levophed) [CORRECT]
C. Nitroprusside (Nipride)
D. Methylprednisolone (Solu-Medrol)
Correct Answer: B
Rationale: According to the Surviving Sepsis Campaign guidelines, norepinephrine is the first-line vasopressor for septic shock that is
refractory to initial fluid resuscitation (30 mL/kg crystalloid). Norepinephrine is a potent alpha-1 agonist with some beta-1 activity,
making it effective at increasing systemic vascular resistance and maintaining organ perfusion pressure. Dobutamine is primarily an
inotrope used for cardiogenic shock or when cardiac output is severely compromised. Nitroprusside is a vasodilator and is
contraindicated in hypotension. Corticosteroids such as methylprednisolone may be considered later if the patient remains refractory
to both fluids and vasopressors, but they are not the next step.
Q4: A nurse is assessing a patient who was admitted with anaphylactic shock. Which finding indicates that the
nurse should administer epinephrine immediately?
, A. Blood pressure 100/70 mmHg with urticaria on the chest
B. Stridor, angioedema of the face and neck, and blood pressure 70/40 mmHg [CORRECT]
C. Heart rate 110 bpm with pruritus on the forearms
D. Respiratory rate 22 breaths/min with generalized erythema
Correct Answer: B
Rationale: Stridor, angioedema of the face and neck, and severe hypotension (BP 70/40) indicate life-threatening airway
compromise and cardiovascular collapse, requiring immediate intramuscular epinephrine administration. Epinephrine is the first-line
treatment for anaphylaxis because it provides both alpha-adrenergic vasoconstriction to counteract hypotension and bronchodilation
via beta-2 receptors to relieve airway obstruction. Urticaria with stable blood pressure and pruritus with a normal respiratory rate
represent milder allergic reactions that may be managed with antihistamines and corticosteroids. Stridor is a critical finding indicating
upper airway edema that can rapidly progress to complete airway obstruction.
Q5: A patient with cardiogenic shock secondary to acute myocardial infarction has the following hemodynamic
parameters: cardiac output 3.0 L/min, systemic vascular resistance (SVR) 1800 dynes/sec/cm5, and pulmonary
artery wedge pressure (PAWP) 25 mmHg. Which nursing intervention is the priority?
A. Administer a fluid bolus of 500 mL normal saline
B. Prepare the patient for intra-aortic balloon pump (IABP) therapy [CORRECT]
C. Apply warming blankets to increase body temperature
D. Initiate high-flow oxygen via non-rebreather mask
Correct Answer: B
Rationale: This patient demonstrates cardiogenic shock with elevated PAWP (25 mmHg, normal 6-12), indicating pulmonary
congestion from left ventricular failure, elevated SVR (1800, normal 800-1200) reflecting compensatory vasoconstriction, and low
cardiac output (3.0 L/min, normal 4-8). An intra-aortic balloon pump is indicated because it provides both afterload reduction
(deflation during systole) and coronary artery perfusion augmentation (inflation during diastole). Fluid boluses are contraindicated
because PAWP is already elevated, which would worsen pulmonary edema. Warming blankets are inappropriate because
compensatory vasoconstriction is a response to low cardiac output, and increasing body temperature would increase metabolic
demand. Oxygen is supportive but does not address the underlying mechanical circulatory failure.
Q6: A 28-year-old patient presents with a tension pneumothorax after a stab wound to the chest. Blood pressure
is 60/40 mmHg, heart rate is 140 bpm, and jugular venous distension is noted. Which type of shock is this
patient experiencing?
A. Hypovolemic shock
B. Obstructive shock [CORRECT]
C. Distributive shock
D. Cardiogenic shock
Correct Answer: B
Rationale: Tension pneumothorax causes obstructive shock because the accumulating intrapleural pressure compresses the great
vessels and heart, mechanically obstructing venous return and cardiac output. The classic presentation includes hypotension,
tachycardia, jugular venous distension (from impaired venous return), absent breath sounds on the affected side, and tracheal
deviation. Unlike hypovolemic shock, the total blood volume may be normal, but the mechanical obstruction prevents effective
circulation. Unlike cardiogenic shock, the primary problem is not pump failure but rather external compression of cardiovascular
structures. Treatment requires immediate needle decompression followed by chest tube insertion.
Q7: The nurse is monitoring a patient in the progressive stage of shock. Which clinical manifestation indicates
that the patient is transitioning from compensatory to progressive shock?
A. Decreasing blood pressure that no longer responds to fluid resuscitation [CORRECT]
B. Increasing urine output and decreasing heart rate
C. Warm, dry skin with bounding peripheral pulses
D. Respiratory alkalosis with a PaCO2 of 30 mmHg
Correct Answer: A
, Rationale: In the progressive (decompensated) stage of shock, compensatory mechanisms begin to fail. Blood pressure that no longer
responds to fluid resuscitation indicates that the patient has transitioned from the compensatory stage, where blood pressure was
maintained through tachycardia and vasoconstriction, to the progressive stage where tissue hypoperfusion and lactic acidosis are
worsening. Urine output would decrease (not increase) due to renal hypoperfusion. Skin would become cool and mottled (not warm
and dry) as perfusion worsens. Metabolic acidosis (not respiratory alkalosis) would develop as anaerobic metabolism produces lactic
acid. Recognizing this transition is critical because it signals the need for aggressive interventions including vasopressors and possible
mechanical support.
Q8: A patient in distributive shock from neurogenic causes has sustained a spinal cord injury at T6. Which
clinical finding differentiates neurogenic shock from other forms of distributive shock?
A. Warm, dry skin below the level of injury with bradycardia [CORRECT]
B. Cool, clammy skin with tachycardia
C. Hypertension with bounding peripheral pulses
D. Fever and tachypnea with flushed skin
Correct Answer: A
Rationale: Neurogenic shock results from disruption of the sympathetic nervous system below the level of spinal cord injury, causing
loss of vasomotor tone (vasodilation) and unopposed parasympathetic activity (bradycardia). The clinical hallmarks are hypotension
with warm, dry skin (due to vasodilation without sympathetic-mediated vasoconstriction) and bradycardia (unopposed vagal tone).
This differs from septic shock, which typically causes tachycardia due to systemic inflammation, and anaphylactic shock, which also
produces tachycardia from histamine release. The T6 level is significant because it is above the major splanchnic sympathetic
outflow, affecting vascular tone in the lower extremities and abdominal viscera.
Q9: A nurse is administering norepinephrine to a patient in septic shock via a central venous catheter. Which
assessment finding requires immediate intervention by the nurse?
A. Heart rate increased from 100 to 110 bpm
B. Blood pressure reading of 180/100 mmHg [CORRECT]
C. Urine output of 30 mL/hr
D. Mean arterial pressure of 65 mmHg
Correct Answer: B
Rationale: A blood pressure of 180/100 mmHg in a patient receiving norepinephrine (a potent alpha-1 agonist vasopressor) indicates
severe hypertension, which places the patient at risk for intracranial hemorrhage, myocardial ischemia, and further end-organ
damage. The nurse should immediately reduce the infusion rate or temporarily discontinue the medication and notify the provider. A
heart rate increase of 10 bpm is an expected response and not alarming. Urine output of 30 mL/hr is adequate and suggests improving
perfusion. A MAP of 65 mmHg is within the target range (typically 65 mmHg or higher) for septic shock resuscitation and does not
require intervention.
Q10: A 32-year-old patient is admitted to the intensive care unit with septic shock secondary to a urinary tract
infection. The nurse understands that which pathophysiological process is primarily responsible for the
vasodilation seen in septic shock?
A. Release of antidiuretic hormone (ADH) from the posterior pituitary
B. Activation of inducible nitric oxide synthase (iNOS) producing excessive nitric oxide [CORRECT]
C. Increased parasympathetic nervous system outflow from the vagus nerve
D. Release of thyroxine (T4) from the thyroid gland increasing metabolic rate
Correct Answer: B
Rationale: In septic shock, bacterial endotoxins and inflammatory cytokines (particularly TNF-alpha, IL-1, and IL-6) activate
inducible nitric oxide synthase (iNOS) in vascular smooth muscle cells, leading to massive production of nitric oxide (NO). Nitric oxide
is a potent vasodilator that activates guanylate cyclase, increasing cyclic GMP and causing smooth muscle relaxation. This excessive
vasodilation is a primary mechanism of the hypotension seen in septic shock. ADH is released in response to hypovolemia but causes
vasoconstriction at high doses, not vasodilation. The parasympathetic nervous system does not play a primary role in septic
vasodilation. Thyroid hormones increase metabolic rate but do not directly cause the profound vasodilation characteristic of sepsis.
