Galen College of Nursing NUR 265
Exam 4 (pdf) | 2026/2027 |
Advanced Medical Surgical
Nursing Q&A
Course
Galen College of Nursing NUR 265
1. A patient develops hypovolemic shock after significant blood loss. Which assessment
finding should the nurse expect?
A. Bradycardia and warm skin
B. Hypotension and tachycardia
C. Hypertension and bounding pulses
D. Decreased respiratory rate and flushed skin
Answer: B. Hypotension and tachycardia
Rationale: Hypovolemic shock results from inadequate circulating volume. The body initially
compensates through sympathetic activation, producing tachycardia and peripheral
vasoconstriction. As shock progresses, blood pressure falls and tissue perfusion deteriorates.
2. A patient in septic shock has a blood pressure of 82/46 mm Hg despite initial fluid
administration. Which intervention should the nurse anticipate?
A. Administration of a vasopressor
B. Fluid restriction
C. Administration of a beta blocker
D. Immediate ambulation
Answer: A. Administration of a vasopressor
Rationale: Persistent hypotension after appropriate fluid resuscitation in septic shock generally
requires vasopressor therapy to restore vascular tone and maintain adequate organ perfusion.
3. Which finding is most concerning for worsening tissue hypoperfusion in a patient with
shock?
A. Urine output of 15 mL/hr
B. Heart rate of 92/min
C. Respiratory rate of 18/min
D. Warm hands after receiving fluids
,Answer: A. Urine output of 15 mL/hr
Rationale: Reduced urine output is an important indicator of decreased renal perfusion. In an
adult, urine output below approximately 0.5 mL/kg/hr is generally concerning and should prompt
further assessment.
4. A patient develops shock after a myocardial infarction. Which type of shock is most
likely?
A. Neurogenic
B. Cardiogenic
C. Hypovolemic
D. Anaphylactic
Answer: B. Cardiogenic
Rationale: Cardiogenic shock occurs when the heart cannot pump enough blood to meet tissue
demands. A large myocardial infarction can significantly impair ventricular contractility and
cardiac output.
5. Which assessment finding is particularly associated with cardiogenic shock?
A. Pulmonary crackles and worsening dyspnea
B. Dry mucous membranes only
C. Severe polyuria
D. Warm, flushed skin with bradycardia
Answer: A. Pulmonary crackles and worsening dyspnea
Rationale: Left ventricular failure can cause blood to back up into the pulmonary circulation,
resulting in pulmonary edema, crackles, hypoxemia, and respiratory distress.
6. A patient with anaphylaxis develops wheezing, hypotension, and facial swelling. Which
medication should the nurse prepare to administer immediately?
A. Epinephrine
B. Furosemide
C. Metoprolol
D. Warfarin
Answer: A. Epinephrine
Rationale: Intramuscular epinephrine is the first-line treatment for anaphylaxis. It rapidly
counteracts airway edema, bronchoconstriction, and cardiovascular collapse.
7. Which finding would be most characteristic of neurogenic shock?
,A. Hypertension with tachycardia
B. Hypotension with relative bradycardia
C. Severe tachycardia with cool skin
D. Pulmonary edema with hypertension
Answer: B. Hypotension with relative bradycardia
Rationale: Neurogenic shock can occur after spinal cord injury and results from loss of
sympathetic vascular tone. Unlike many other shock states, bradycardia may accompany
hypotension.
8. A patient with suspected sepsis has altered mental status, hypotension, tachycardia, and
elevated lactate. What is the nurse's priority?
A. Delay treatment until culture results return
B. Initiate the prescribed sepsis-management interventions promptly
C. Encourage oral fluids only
D. Place the patient in a quiet room and reassess tomorrow
Answer: B. Initiate the prescribed sepsis-management interventions promptly
Rationale: Sepsis can progress rapidly to organ dysfunction and shock. Early recognition,
cultures when indicated, antimicrobial therapy, fluid resuscitation, and hemodynamic support are
critical components of management.
9. Which laboratory finding is particularly useful as an indicator of impaired tissue
perfusion in a critically ill patient?
A. Elevated serum lactate
B. Decreased cholesterol
C. Increased HDL
D. Mildly elevated calcium
Answer: A. Elevated serum lactate
Rationale: Elevated lactate may reflect increased anaerobic metabolism resulting from
inadequate oxygen delivery or impaired utilization. Trends can help evaluate response to
resuscitation.
10. A patient with multiple traumatic injuries is admitted after a motor vehicle collision.
Which assessment should occur first?
A. Detailed dietary history
B. Airway and cervical-spine assessment
C. Family medical history
D. Discharge planning
, Answer: B. Airway and cervical-spine assessment
Rationale: Trauma assessment follows the principle of addressing immediately life-threatening
problems first. Airway management takes priority while protecting the cervical spine when
spinal injury is possible.
11. A trauma patient has severe respiratory distress, absent breath sounds on one side,
hypotension, and tracheal deviation. Which condition should the nurse suspect?
A. Simple rib fracture
B. Tension pneumothorax
C. Pulmonary embolism only
D. Atelectasis
Answer: B. Tension pneumothorax
Rationale: Tension pneumothorax causes progressive accumulation of air under pressure within
the pleural space. It can compress the lung and major vessels, producing respiratory distress,
hypotension, and potentially obstructive shock. Immediate decompression is required.
12. Which finding suggests a possible spinal cord injury following trauma?
A. Bilateral lower-extremity paralysis
B. Mild thirst
C. Increased appetite
D. Warm hands after exercise
Answer: A. Bilateral lower-extremity paralysis
Rationale: New motor or sensory deficits following trauma are concerning for spinal cord
injury. Neurologic status should be assessed frequently and spinal precautions maintained when
indicated.
13. A patient with a suspected cervical spine injury requires repositioning. What is the
safest approach?
A. Turn the patient's head independently
B. Use logrolling with appropriate spinal precautions
C. Allow the patient to sit upright independently
D. Flex the patient's neck to improve comfort
Answer: B. Use logrolling with appropriate spinal precautions
Rationale: Logrolling helps maintain spinal alignment while repositioning a patient who may
have spinal injury. The head, neck, and torso should remain aligned.
Exam 4 (pdf) | 2026/2027 |
Advanced Medical Surgical
Nursing Q&A
Course
Galen College of Nursing NUR 265
1. A patient develops hypovolemic shock after significant blood loss. Which assessment
finding should the nurse expect?
A. Bradycardia and warm skin
B. Hypotension and tachycardia
C. Hypertension and bounding pulses
D. Decreased respiratory rate and flushed skin
Answer: B. Hypotension and tachycardia
Rationale: Hypovolemic shock results from inadequate circulating volume. The body initially
compensates through sympathetic activation, producing tachycardia and peripheral
vasoconstriction. As shock progresses, blood pressure falls and tissue perfusion deteriorates.
2. A patient in septic shock has a blood pressure of 82/46 mm Hg despite initial fluid
administration. Which intervention should the nurse anticipate?
A. Administration of a vasopressor
B. Fluid restriction
C. Administration of a beta blocker
D. Immediate ambulation
Answer: A. Administration of a vasopressor
Rationale: Persistent hypotension after appropriate fluid resuscitation in septic shock generally
requires vasopressor therapy to restore vascular tone and maintain adequate organ perfusion.
3. Which finding is most concerning for worsening tissue hypoperfusion in a patient with
shock?
A. Urine output of 15 mL/hr
B. Heart rate of 92/min
C. Respiratory rate of 18/min
D. Warm hands after receiving fluids
,Answer: A. Urine output of 15 mL/hr
Rationale: Reduced urine output is an important indicator of decreased renal perfusion. In an
adult, urine output below approximately 0.5 mL/kg/hr is generally concerning and should prompt
further assessment.
4. A patient develops shock after a myocardial infarction. Which type of shock is most
likely?
A. Neurogenic
B. Cardiogenic
C. Hypovolemic
D. Anaphylactic
Answer: B. Cardiogenic
Rationale: Cardiogenic shock occurs when the heart cannot pump enough blood to meet tissue
demands. A large myocardial infarction can significantly impair ventricular contractility and
cardiac output.
5. Which assessment finding is particularly associated with cardiogenic shock?
A. Pulmonary crackles and worsening dyspnea
B. Dry mucous membranes only
C. Severe polyuria
D. Warm, flushed skin with bradycardia
Answer: A. Pulmonary crackles and worsening dyspnea
Rationale: Left ventricular failure can cause blood to back up into the pulmonary circulation,
resulting in pulmonary edema, crackles, hypoxemia, and respiratory distress.
6. A patient with anaphylaxis develops wheezing, hypotension, and facial swelling. Which
medication should the nurse prepare to administer immediately?
A. Epinephrine
B. Furosemide
C. Metoprolol
D. Warfarin
Answer: A. Epinephrine
Rationale: Intramuscular epinephrine is the first-line treatment for anaphylaxis. It rapidly
counteracts airway edema, bronchoconstriction, and cardiovascular collapse.
7. Which finding would be most characteristic of neurogenic shock?
,A. Hypertension with tachycardia
B. Hypotension with relative bradycardia
C. Severe tachycardia with cool skin
D. Pulmonary edema with hypertension
Answer: B. Hypotension with relative bradycardia
Rationale: Neurogenic shock can occur after spinal cord injury and results from loss of
sympathetic vascular tone. Unlike many other shock states, bradycardia may accompany
hypotension.
8. A patient with suspected sepsis has altered mental status, hypotension, tachycardia, and
elevated lactate. What is the nurse's priority?
A. Delay treatment until culture results return
B. Initiate the prescribed sepsis-management interventions promptly
C. Encourage oral fluids only
D. Place the patient in a quiet room and reassess tomorrow
Answer: B. Initiate the prescribed sepsis-management interventions promptly
Rationale: Sepsis can progress rapidly to organ dysfunction and shock. Early recognition,
cultures when indicated, antimicrobial therapy, fluid resuscitation, and hemodynamic support are
critical components of management.
9. Which laboratory finding is particularly useful as an indicator of impaired tissue
perfusion in a critically ill patient?
A. Elevated serum lactate
B. Decreased cholesterol
C. Increased HDL
D. Mildly elevated calcium
Answer: A. Elevated serum lactate
Rationale: Elevated lactate may reflect increased anaerobic metabolism resulting from
inadequate oxygen delivery or impaired utilization. Trends can help evaluate response to
resuscitation.
10. A patient with multiple traumatic injuries is admitted after a motor vehicle collision.
Which assessment should occur first?
A. Detailed dietary history
B. Airway and cervical-spine assessment
C. Family medical history
D. Discharge planning
, Answer: B. Airway and cervical-spine assessment
Rationale: Trauma assessment follows the principle of addressing immediately life-threatening
problems first. Airway management takes priority while protecting the cervical spine when
spinal injury is possible.
11. A trauma patient has severe respiratory distress, absent breath sounds on one side,
hypotension, and tracheal deviation. Which condition should the nurse suspect?
A. Simple rib fracture
B. Tension pneumothorax
C. Pulmonary embolism only
D. Atelectasis
Answer: B. Tension pneumothorax
Rationale: Tension pneumothorax causes progressive accumulation of air under pressure within
the pleural space. It can compress the lung and major vessels, producing respiratory distress,
hypotension, and potentially obstructive shock. Immediate decompression is required.
12. Which finding suggests a possible spinal cord injury following trauma?
A. Bilateral lower-extremity paralysis
B. Mild thirst
C. Increased appetite
D. Warm hands after exercise
Answer: A. Bilateral lower-extremity paralysis
Rationale: New motor or sensory deficits following trauma are concerning for spinal cord
injury. Neurologic status should be assessed frequently and spinal precautions maintained when
indicated.
13. A patient with a suspected cervical spine injury requires repositioning. What is the
safest approach?
A. Turn the patient's head independently
B. Use logrolling with appropriate spinal precautions
C. Allow the patient to sit upright independently
D. Flex the patient's neck to improve comfort
Answer: B. Use logrolling with appropriate spinal precautions
Rationale: Logrolling helps maintain spinal alignment while repositioning a patient who may
have spinal injury. The head, neck, and torso should remain aligned.
