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ADVANCED MEDICAL-SURGICAL NURSING
EXAM – CRITICAL THINKING & CASE
ANALYSIS 2026 LATEST RELEASED VERSION
QUESTIONS 1–20: Shock, Perfusion & Hemodynamics
1.
A patient in septic shock remains hypotensive after 30 mL/kg
fluid resuscitation. Which medication should be initiated FIRST?
• A. Dopamine
• B. Dobutamine
• C. Norepinephrine
• D. Epinephrine
Answer: C
Rationale: Norepinephrine is first-line vasopressor in septic
shock to maintain MAP ≥65 mmHg.
2.
Which clinical finding best differentiates septic shock from
hypovolemic shock?
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• A. Hypotension
• B. Tachycardia
• C. Warm, flushed skin early
• D. Decreased urine output
Answer: C
Rationale: Septic shock initially causes vasodilation leading to
warm skin, unlike hypovolemic shock.
3.
A patient with massive GI bleeding develops cool clammy skin
and delayed capillary refill. Which shock stage is present?
• A. Initial
• B. Compensatory
• C. Progressive
• D. Refractory
Answer: B
Rationale: Compensatory stage shows sympathetic activation
with cool clammy skin.
4.
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Which lab value is most concerning in septic shock?
• A. Lactate 5.2 mmol/L
• B. Sodium 134 mEq/L
• C. WBC 11,000/mm³
• D. Hemoglobin 12 g/dL
Answer: A
Rationale: Elevated lactate indicates tissue hypoxia and poor
perfusion.
5.
Which intervention has the highest priority for cardiogenic
shock?
• A. Fluid bolus
• B. Vasodilators
• C. Improve cardiac output
• D. Broad-spectrum antibiotics
Answer: C
Rationale: Cardiogenic shock results from pump failure;
improving contractility is essential.
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QUESTIONS 6–20: Respiratory Failure & Ventilation
6.
Which ABG indicates acute respiratory acidosis?
• A. pH 7.31, PaCO₂ 55, HCO₃⁻ 26
• B. pH 7.48, PaCO₂ 30, HCO₃⁻ 22
• C. pH 7.36, PaCO₂ 48, HCO₃⁻ 28
• D. pH 7.29, PaCO₂ 38, HCO₃⁻ 18
Answer: A
Rationale: Low pH with elevated CO₂ and no metabolic
compensation.
7.
A ventilated patient suddenly develops absent breath sounds
on one side and hypotension. What is the priority?
• A. Increase FiO₂
• B. Suction airway
• C. Suspect tension pneumothorax
• D. Reduce PEEP
ADVANCED MEDICAL-SURGICAL NURSING
EXAM – CRITICAL THINKING & CASE
ANALYSIS 2026 LATEST RELEASED VERSION
QUESTIONS 1–20: Shock, Perfusion & Hemodynamics
1.
A patient in septic shock remains hypotensive after 30 mL/kg
fluid resuscitation. Which medication should be initiated FIRST?
• A. Dopamine
• B. Dobutamine
• C. Norepinephrine
• D. Epinephrine
Answer: C
Rationale: Norepinephrine is first-line vasopressor in septic
shock to maintain MAP ≥65 mmHg.
2.
Which clinical finding best differentiates septic shock from
hypovolemic shock?
,2
• A. Hypotension
• B. Tachycardia
• C. Warm, flushed skin early
• D. Decreased urine output
Answer: C
Rationale: Septic shock initially causes vasodilation leading to
warm skin, unlike hypovolemic shock.
3.
A patient with massive GI bleeding develops cool clammy skin
and delayed capillary refill. Which shock stage is present?
• A. Initial
• B. Compensatory
• C. Progressive
• D. Refractory
Answer: B
Rationale: Compensatory stage shows sympathetic activation
with cool clammy skin.
4.
,3
Which lab value is most concerning in septic shock?
• A. Lactate 5.2 mmol/L
• B. Sodium 134 mEq/L
• C. WBC 11,000/mm³
• D. Hemoglobin 12 g/dL
Answer: A
Rationale: Elevated lactate indicates tissue hypoxia and poor
perfusion.
5.
Which intervention has the highest priority for cardiogenic
shock?
• A. Fluid bolus
• B. Vasodilators
• C. Improve cardiac output
• D. Broad-spectrum antibiotics
Answer: C
Rationale: Cardiogenic shock results from pump failure;
improving contractility is essential.
, 4
QUESTIONS 6–20: Respiratory Failure & Ventilation
6.
Which ABG indicates acute respiratory acidosis?
• A. pH 7.31, PaCO₂ 55, HCO₃⁻ 26
• B. pH 7.48, PaCO₂ 30, HCO₃⁻ 22
• C. pH 7.36, PaCO₂ 48, HCO₃⁻ 28
• D. pH 7.29, PaCO₂ 38, HCO₃⁻ 18
Answer: A
Rationale: Low pH with elevated CO₂ and no metabolic
compensation.
7.
A ventilated patient suddenly develops absent breath sounds
on one side and hypotension. What is the priority?
• A. Increase FiO₂
• B. Suction airway
• C. Suspect tension pneumothorax
• D. Reduce PEEP
