NUR 265 Advanced Medical-Surgical Nursing Actual
Practice Review Exam 100 Questions with 100%
Correct Answers Latest 2026-2027 Update – Galen
College of Nursing
Section 1: Shock & Hemodynamics (Questions 1–15)
1. A patient in septic shock has a mean arterial pressure (MAP) of 58 mmHg
despite fluid resuscitation. Which vasopressor is the first-line choice?**
- A) Dobutamine
- B) Norepinephrine
- C) Epinephrine
- D) Vasopressin
Answer: B) Norepinephrine – Norepinephrine is the first-line vasopressor for
septic shock. It increases MAP through vasoconstriction with minimal effect
on heart rate. Dobutamine is an inotrope used for cardiogenic shock.
Epinephrine and vasopressin are second-line agents.
2. Which hemodynamic finding is typically expected in the early
(hyperdynamic) phase of septic shock?
- A) Low cardiac output
- B) High Systemic Vascular Resistance (SVR)
- C) Cool, clammy skin
,- D) Increased Cardiac Index
Answer: D) Increased Cardiac Index – In the early (hyperdynamic) phase of
septic shock, there is vasodilation with increased cardiac output (warm
shock). Cardiac index is elevated. SVR is decreased, and skin is warm and
flushed.
3. A patient is in the compensatory stage of hypovolemic shock. Which
assessment finding would the nurse expect?
- A) Hypotension
- B) Bradycardia
- C) Tachycardia with narrowing pulse pressure
- D) Cool, clammy skin with mottling
Answer: C) Tachycardia with narrowing pulse pressure – In the compensatory
stage of hypovolemic shock, the body attempts to maintain cardiac output
through tachycardia and peripheral vasoconstriction, resulting in a narrowing
pulse pressure.
4. A patient in septic shock has a lactate level of 4.8 mmol/L and a MAP of 58
mmHg despite 30 mL/kg crystalloid resuscitation. What is the priority nursing
intervention?
- A) Administer broad-spectrum antibiotics
- B) Start norepinephrine infusion
,- C) Obtain blood cultures
- D) Administer additional fluid bolus
Answer: B) Start norepinephrine infusion – When MAP remains below 65
mmHg despite fluid resuscitation, vasopressors should be initiated.
Norepinephrine is the first-line vasopressor in septic shock.
5. A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m². Which
medication would the nurse anticipate administering?
- A) Norepinephrine
- B) Dobutamine
- C) Vasopressin
- D) Phenylephrine
Answer: B) Dobutamine – Dobutamine is an inotrope that increases cardiac
contractility and cardiac output, making it the preferred agent for cardiogenic
shock with low cardiac index.
6. Which assessment finding indicates that a patient in shock is transitioning
from the compensatory to the progressive (decompensated) stage?
- A) Tachycardia
- B) Narrowing pulse pressure
- C) Metabolic acidosis
, - D) Cool, clammy skin
Answer: C) Metabolic acidosis – As shock progresses, anaerobic metabolism
leads to lactic acidosis. This indicates that compensatory mechanisms are
failing and the patient is entering the progressive stage.
7. A patient with anaphylactic shock is experiencing difficulty breathing and
stridor. What is the priority nursing action?**
- A) Administer diphenhydramine
- B) Administer epinephrine
- C) Start an IV line
- D) Apply oxygen via nasal cannula
Answer: B) Administer epinephrine – Epinephrine is the first-line treatment
for anaphylactic shock. It causes bronchodilation, vasoconstriction, and
decreases mediator release from mast cells.
8. In neurogenic shock, which hemodynamic finding would the nurse expect?
- A) Hypertension and tachycardia
- B) Hypotension and bradycardia
- C) Hypertension and bradycardia
- D) Hypotension and tachycardia
Practice Review Exam 100 Questions with 100%
Correct Answers Latest 2026-2027 Update – Galen
College of Nursing
Section 1: Shock & Hemodynamics (Questions 1–15)
1. A patient in septic shock has a mean arterial pressure (MAP) of 58 mmHg
despite fluid resuscitation. Which vasopressor is the first-line choice?**
- A) Dobutamine
- B) Norepinephrine
- C) Epinephrine
- D) Vasopressin
Answer: B) Norepinephrine – Norepinephrine is the first-line vasopressor for
septic shock. It increases MAP through vasoconstriction with minimal effect
on heart rate. Dobutamine is an inotrope used for cardiogenic shock.
Epinephrine and vasopressin are second-line agents.
2. Which hemodynamic finding is typically expected in the early
(hyperdynamic) phase of septic shock?
- A) Low cardiac output
- B) High Systemic Vascular Resistance (SVR)
- C) Cool, clammy skin
,- D) Increased Cardiac Index
Answer: D) Increased Cardiac Index – In the early (hyperdynamic) phase of
septic shock, there is vasodilation with increased cardiac output (warm
shock). Cardiac index is elevated. SVR is decreased, and skin is warm and
flushed.
3. A patient is in the compensatory stage of hypovolemic shock. Which
assessment finding would the nurse expect?
- A) Hypotension
- B) Bradycardia
- C) Tachycardia with narrowing pulse pressure
- D) Cool, clammy skin with mottling
Answer: C) Tachycardia with narrowing pulse pressure – In the compensatory
stage of hypovolemic shock, the body attempts to maintain cardiac output
through tachycardia and peripheral vasoconstriction, resulting in a narrowing
pulse pressure.
4. A patient in septic shock has a lactate level of 4.8 mmol/L and a MAP of 58
mmHg despite 30 mL/kg crystalloid resuscitation. What is the priority nursing
intervention?
- A) Administer broad-spectrum antibiotics
- B) Start norepinephrine infusion
,- C) Obtain blood cultures
- D) Administer additional fluid bolus
Answer: B) Start norepinephrine infusion – When MAP remains below 65
mmHg despite fluid resuscitation, vasopressors should be initiated.
Norepinephrine is the first-line vasopressor in septic shock.
5. A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m². Which
medication would the nurse anticipate administering?
- A) Norepinephrine
- B) Dobutamine
- C) Vasopressin
- D) Phenylephrine
Answer: B) Dobutamine – Dobutamine is an inotrope that increases cardiac
contractility and cardiac output, making it the preferred agent for cardiogenic
shock with low cardiac index.
6. Which assessment finding indicates that a patient in shock is transitioning
from the compensatory to the progressive (decompensated) stage?
- A) Tachycardia
- B) Narrowing pulse pressure
- C) Metabolic acidosis
, - D) Cool, clammy skin
Answer: C) Metabolic acidosis – As shock progresses, anaerobic metabolism
leads to lactic acidosis. This indicates that compensatory mechanisms are
failing and the patient is entering the progressive stage.
7. A patient with anaphylactic shock is experiencing difficulty breathing and
stridor. What is the priority nursing action?**
- A) Administer diphenhydramine
- B) Administer epinephrine
- C) Start an IV line
- D) Apply oxygen via nasal cannula
Answer: B) Administer epinephrine – Epinephrine is the first-line treatment
for anaphylactic shock. It causes bronchodilation, vasoconstriction, and
decreases mediator release from mast cells.
8. In neurogenic shock, which hemodynamic finding would the nurse expect?
- A) Hypertension and tachycardia
- B) Hypotension and bradycardia
- C) Hypertension and bradycardia
- D) Hypotension and tachycardia
