NUR 209 Medical-Surgical Nursing II —
Exam 4 / Final Comprehensive Review
Section 1: Critical Care, Shock, Sepsis and Multiple Organ
Dysfunction Syndrome
Questions 1–20
Question 1.
A nurse assesses a patient who has experienced substantial gastrointestinal bleeding. The patient
appears restless, has cool clammy skin, and has a heart rate of 124 beats/min. Which condition
should the nurse suspect?
A. Improved tissue perfusion
B. Hypovolemic shock
C. Stable essential hypertension
D. Fluid volume excess
Correct Answer: B. Hypovolemic shock.
Rationale: Hypovolemic shock occurs when circulating blood volume decreases significantly,
reducing venous return, cardiac output, and tissue perfusion. Tachycardia, cool clammy skin, and
restlessness are important warning signs.
Question 2.
A patient with an acute myocardial infarction develops hypotension, weak peripheral pulses, cold
extremities, and decreased urine output. Which type of shock is most likely?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Anaphylactic shock
Correct Answer: C. Cardiogenic shock.
,Rationale: Cardiogenic shock occurs when the heart cannot pump sufficient blood to meet the
body's metabolic demands. Extensive myocardial injury can cause severely reduced cardiac
output and systemic hypoperfusion.
Question 3.
A patient with a serious bacterial infection develops hypotension, tachycardia, and warm, flushed
extremities. Which type of shock should the nurse consider?
A. Septic shock
B. Cardiogenic shock
C. Hypovolemic shock from hemorrhage
D. Obstructive shock from tamponade
Correct Answer: A. Septic shock.
Rationale: Sepsis can cause widespread vasodilation and abnormal vascular permeability. Some
patients initially present with warm extremities and bounding pulses before developing more
pronounced circulatory impairment. Septic shock requires additional clinical criteria beyond the
findings described.
Question 4.
A patient with a cervical spinal cord injury has a blood pressure of 78/40 mmHg, heart rate of 42
beats/min, and warm dry skin. Which condition is most likely?
A. Hypovolemic shock
B. Cardiogenic shock
C. Hemorrhagic shock
D. Neurogenic shock
Correct Answer: D. Neurogenic shock.
Rationale: Neurogenic shock results from loss of sympathetic nervous system activity following
certain spinal cord injuries. Hypotension associated with bradycardia and peripheral vasodilation
is characteristic.
Question 5.
Which condition may cause obstructive shock by preventing adequate ventricular filling?
,A. Mild dehydration
B. Cardiac tamponade
C. Chronic constipation
D. Uncomplicated anemia
Correct Answer: B. Cardiac tamponade.
Rationale: Cardiac tamponade occurs when fluid accumulation in the pericardial space restricts
cardiac filling. Reduced venous return and ventricular filling decrease cardiac output and may
cause life-threatening hypotension.
Question 6.
A critically ill patient has a blood pressure of 84/42 mmHg. What is the approximate mean
arterial pressure (MAP)?
A. 42 mmHg
B. 50 mmHg
C. 56 mmHg
D. 84 mmHg
Correct Answer: C. 56 mmHg.
Rationale: The approximate MAP is calculated by adding the systolic pressure to twice the
diastolic pressure, then dividing by three.
\[ MAP=\frac{84+(2\times42)}{3}=56\text{ mmHg} \]
A MAP of 56 mmHg is concerning for inadequate tissue perfusion, particularly in a patient with
signs of shock.
Question 7.
A patient with suspected sepsis develops a respiratory rate of 32 breaths/min, blood pressure of
82/46 mmHg, and new confusion. Which nursing action is the priority?
A. Schedule routine follow-up next week.
B. Encourage the patient to ambulate.
, C. Wait until a fever develops before taking action.
D. Activate an urgent clinical response and initiate sepsis assessment and treatment protocols.
Correct Answer: D. Activate an urgent clinical response and initiate sepsis assessment and
treatment protocols.
Rationale: Hypotension, tachypnea, and altered mental status in the setting of possible infection
indicate serious deterioration. Sepsis and septic shock are medical emergencies requiring timely
evaluation and resuscitation. The 2026 Surviving Sepsis Campaign emphasizes immediate
recognition and treatment.
SCCM
Question 8.
A nurse is preparing for the initial evaluation of a patient with suspected septic shock. Which
action is appropriate when it can be completed without delaying antimicrobial treatment?
A. Obtain ordered blood cultures.
B. Delay all monitoring until the patient develops a rash.
C. Encourage strenuous exercise.
D. Restrict all diagnostic testing.
Correct Answer: A. Obtain ordered blood cultures.
Rationale: Blood cultures help identify the causative organism and guide antimicrobial therapy.
Current sepsis guidance recommends obtaining cultures as soon as possible, ideally before
antimicrobials, without causing harmful treatment delays.
Question 9.
A patient with cardiogenic shock develops severe dyspnea, pulmonary crackles, and decreasing
oxygen saturation. Which complication is most concerning?
A. Improved cardiac output
B. Acute pulmonary edema
C. Uncomplicated constipation
Exam 4 / Final Comprehensive Review
Section 1: Critical Care, Shock, Sepsis and Multiple Organ
Dysfunction Syndrome
Questions 1–20
Question 1.
A nurse assesses a patient who has experienced substantial gastrointestinal bleeding. The patient
appears restless, has cool clammy skin, and has a heart rate of 124 beats/min. Which condition
should the nurse suspect?
A. Improved tissue perfusion
B. Hypovolemic shock
C. Stable essential hypertension
D. Fluid volume excess
Correct Answer: B. Hypovolemic shock.
Rationale: Hypovolemic shock occurs when circulating blood volume decreases significantly,
reducing venous return, cardiac output, and tissue perfusion. Tachycardia, cool clammy skin, and
restlessness are important warning signs.
Question 2.
A patient with an acute myocardial infarction develops hypotension, weak peripheral pulses, cold
extremities, and decreased urine output. Which type of shock is most likely?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Anaphylactic shock
Correct Answer: C. Cardiogenic shock.
,Rationale: Cardiogenic shock occurs when the heart cannot pump sufficient blood to meet the
body's metabolic demands. Extensive myocardial injury can cause severely reduced cardiac
output and systemic hypoperfusion.
Question 3.
A patient with a serious bacterial infection develops hypotension, tachycardia, and warm, flushed
extremities. Which type of shock should the nurse consider?
A. Septic shock
B. Cardiogenic shock
C. Hypovolemic shock from hemorrhage
D. Obstructive shock from tamponade
Correct Answer: A. Septic shock.
Rationale: Sepsis can cause widespread vasodilation and abnormal vascular permeability. Some
patients initially present with warm extremities and bounding pulses before developing more
pronounced circulatory impairment. Septic shock requires additional clinical criteria beyond the
findings described.
Question 4.
A patient with a cervical spinal cord injury has a blood pressure of 78/40 mmHg, heart rate of 42
beats/min, and warm dry skin. Which condition is most likely?
A. Hypovolemic shock
B. Cardiogenic shock
C. Hemorrhagic shock
D. Neurogenic shock
Correct Answer: D. Neurogenic shock.
Rationale: Neurogenic shock results from loss of sympathetic nervous system activity following
certain spinal cord injuries. Hypotension associated with bradycardia and peripheral vasodilation
is characteristic.
Question 5.
Which condition may cause obstructive shock by preventing adequate ventricular filling?
,A. Mild dehydration
B. Cardiac tamponade
C. Chronic constipation
D. Uncomplicated anemia
Correct Answer: B. Cardiac tamponade.
Rationale: Cardiac tamponade occurs when fluid accumulation in the pericardial space restricts
cardiac filling. Reduced venous return and ventricular filling decrease cardiac output and may
cause life-threatening hypotension.
Question 6.
A critically ill patient has a blood pressure of 84/42 mmHg. What is the approximate mean
arterial pressure (MAP)?
A. 42 mmHg
B. 50 mmHg
C. 56 mmHg
D. 84 mmHg
Correct Answer: C. 56 mmHg.
Rationale: The approximate MAP is calculated by adding the systolic pressure to twice the
diastolic pressure, then dividing by three.
\[ MAP=\frac{84+(2\times42)}{3}=56\text{ mmHg} \]
A MAP of 56 mmHg is concerning for inadequate tissue perfusion, particularly in a patient with
signs of shock.
Question 7.
A patient with suspected sepsis develops a respiratory rate of 32 breaths/min, blood pressure of
82/46 mmHg, and new confusion. Which nursing action is the priority?
A. Schedule routine follow-up next week.
B. Encourage the patient to ambulate.
, C. Wait until a fever develops before taking action.
D. Activate an urgent clinical response and initiate sepsis assessment and treatment protocols.
Correct Answer: D. Activate an urgent clinical response and initiate sepsis assessment and
treatment protocols.
Rationale: Hypotension, tachypnea, and altered mental status in the setting of possible infection
indicate serious deterioration. Sepsis and septic shock are medical emergencies requiring timely
evaluation and resuscitation. The 2026 Surviving Sepsis Campaign emphasizes immediate
recognition and treatment.
SCCM
Question 8.
A nurse is preparing for the initial evaluation of a patient with suspected septic shock. Which
action is appropriate when it can be completed without delaying antimicrobial treatment?
A. Obtain ordered blood cultures.
B. Delay all monitoring until the patient develops a rash.
C. Encourage strenuous exercise.
D. Restrict all diagnostic testing.
Correct Answer: A. Obtain ordered blood cultures.
Rationale: Blood cultures help identify the causative organism and guide antimicrobial therapy.
Current sepsis guidance recommends obtaining cultures as soon as possible, ideally before
antimicrobials, without causing harmful treatment delays.
Question 9.
A patient with cardiogenic shock develops severe dyspnea, pulmonary crackles, and decreasing
oxygen saturation. Which complication is most concerning?
A. Improved cardiac output
B. Acute pulmonary edema
C. Uncomplicated constipation
