1
Exam 2: NSG4100 / NSG 4100 (New 2025/ 2026 Update)
Nursing Practice - Adult Health III Review| Questions &
Answers| Grade A| 100% Correct (Verified Solutions)- Galen
1. A client is admitted with septic shock. The nurse anticipates which hemodynamic profile?
A. Increased cardiac output, decreased systemic vascular resistance (SVR)
B. Decreased cardiac output, increased SVR
C. Increased cardiac output, increased SVR
D. Decreased cardiac output, decreased SVR
Answer: A. Increased cardiac output, decreased SVR.
Rationale: In early (hyperdynamic) septic shock, cardiac output is often elevated due to tachycardia and
decreased afterload from massive vasodilation, while SVR is low. This is sometimes called "warm shock."
As sepsis progresses, myocardial depression can occur, leading to decreased cardiac output.
2. A client with hypovolemic shock has a central venous pressure (CVP) of 2 mmHg. What should the
nurse do first?
A. Administer a vasopressor
B. Increase the rate of IV fluid resuscitation
C. Place the client in Trendelenburg position
D. Obtain a 12-lead ECG
Answer: B. Increase the rate of IV fluid resuscitation.
Rationale: A low CVP (<2–6 mmHg) indicates low preload due to volume depletion. The priority in
hypovolemic shock is aggressive fluid resuscitation with crystalloids (0.9% NaCl or Lactated Ringer's) or
blood products, depending on the cause.
3. A client in cardiogenic shock has a pulmonary artery wedge pressure (PAWP) of 22 mmHg. The
nurse understands this indicates:
A. Low preload, need for fluids
B. High preload, pulmonary congestion
C. Low afterload
D. Normal left ventricular function
Answer: B. High preload, pulmonary congestion.
Rationale: Normal PAWP is 6–12 mmHg. A high PAWP (>18) indicates elevated left ventricular
end-diastolic pressure and pulmonary venous congestion, which is typical of cardiogenic shock due to
pump failure. Treatment includes diuretics and inotropes, not more fluids.
pg. 1
,2
4. A client is receiving norepinephrine for septic shock. The nurse should monitor for which
complication?
A. Bronchospasm
B. Peripheral tissue ischemia
C. Hyperglycemia
D. Ototoxicity
Answer: B. Peripheral tissue ischemia.
Rationale: Norepinephrine is a potent vasoconstrictor. If extravasation occurs, it can cause severe tissue
ischemia and necrosis. The IV site must be monitored closely. It can also cause end-organ ischemia if
perfusion pressure is inadequate.
5. A client in shock is started on a dobutamine infusion. The expected hemodynamic effect is:
A. Increased heart rate and blood pressure
B. Increased cardiac contractility and decreased SVR
C. Decreased cardiac output and increased SVR
D. Vasodilation only
Answer: B. Increased cardiac contractility and decreased SVR.
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases contractility (positive inotrope) and
has mild vasodilatory effects (decreases SVR). It is used in cardiogenic shock to improve cardiac output
without significantly increasing afterload.
6. A client with anaphylactic shock is receiving IV epinephrine. The nurse knows that epinephrine
works by:
A. Blocking histamine receptors
B. Causing vasodilation
C. Activating alpha-1 receptors (vasoconstriction) and beta-2 receptors (bronchodilation)
D. Decreasing heart rate
Answer: C. Activating alpha-1 (vasoconstriction) and beta-2 (bronchodilation) receptors.
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It reverses vasodilation and
hypotension through alpha-1 agonism, and relieves bronchospasm through beta-2 agonism.
7. A client with a central venous catheter develops sudden dyspnea, chest pain, and hypotension. The
nurse suspects an air embolism. What is the immediate action?
A. Place the client in high-Fowler's position
B. Clamp the catheter and place the client in the left lateral Trendelenburg position
C. Administer a fluid bolus
D. Call a code blue
pg. 2
,3
Answer: B. Clamp the catheter and place the client in the left lateral Trendelenburg position.
Rationale: This position traps air in the right atrium, preventing it from entering the pulmonary artery.
Clamping the catheter prevents further air entry. High-Fowler's position would allow air to travel to the
cerebral circulation.
8. The nurse is monitoring a client with a pulmonary artery catheter. The mixed venous oxygen
saturation (SvO₂) drops from 70% to 52%. This indicates:
A. Improved cardiac output
B. Increased oxygen delivery
C. Increased tissue oxygen extraction due to decreased delivery
D. A normal finding
Answer: C. Increased tissue oxygen extraction due to decreased delivery.
Rationale: SvO₂ reflects the balance between oxygen delivery and consumption. A drop indicates tissues
are extracting more oxygen because delivery is inadequate (e.g., low cardiac output, anemia,
hypoxemia). Normal SvO₂ is 60–80%.
9. A client in the ICU develops a new fever, hypotension, and altered mental status. Blood cultures are
drawn. The nurse should anticipate initiation of:
A. Broad-spectrum antibiotics within 1 hour of recognition
B. Antipyretics only
C. Vasopressors only
D. Corticosteroids first
Answer: A. Broad-spectrum antibiotics within 1 hour.
Rationale: The Surviving Sepsis Campaign recommends administering broad-spectrum IV antibiotics
within 1 hour of recognizing sepsis or septic shock, as each hour of delay increases mortality. Fluids and
vasopressors are also initiated.
10. (NGN – Bow-Tie)
A client with pneumonia develops septic shock. BP 78/48, HR 128, lactate 4.5 mmol/L. Complete the
diagram.
Actions to Take (Select 2) Condition (Select 1) Parameters to Monitor (Select 2)
□ Administer 30 mL/kg IV crystalloid bolus ○ Cardiogenic shock □ Blood pressure
□ Start norepinephrine infusion ○ Hypovolemic shock □ Serum lactate
pg. 3
, 4
Actions to Take (Select 2) Condition (Select 1) Parameters to Monitor (Select 2)
□ Administer furosemide IV ○ Septic shock □ Urine output
□ Prepare for immediate cardioversion ○ Anaphylactic shock □ Pupil size
Answer:
• Actions: Administer IV crystalloid bolus (30 mL/kg), Start norepinephrine.
• Condition: Septic shock.
• Parameters: Blood pressure, Serum lactate.
11. A client with a history of heart failure is admitted with fluid overload. The nurse notes a CVP of 14
mmHg. What action is appropriate?
A. Start a fluid bolus
B. Administer furosemide as prescribed
C. Place the client flat
D. Increase IV fluids
Answer: B. Administer furosemide as prescribed.
Rationale: CVP >8–12 indicates elevated right ventricular preload, consistent with fluid volume excess.
Diuresis is needed to reduce preload and improve symptoms.
12. A client is receiving vasopressin for septic shock. The nurse understands this drug is used as an
adjunct to norepinephrine because it:
A. Causes vasodilation
B. Increases heart rate
C. Constricts blood vessels and may reduce catecholamine requirements
D. Promotes diuresis
Answer: C. Constricts blood vessels and may reduce catecholamine requirements.
Rationale: Vasopressin is a potent vasoconstrictor used in septic shock when norepinephrine alone is
insufficient. It also has a synergistic effect with norepinephrine. It does not significantly increase heart
rate.
Section 2: Acute Respiratory Failure & ARDS (13–24)
13. A client with ARDS is being ventilated. The nurse understands that low tidal volume ventilation (6
mL/kg ideal body weight) is used to:
A. Increase cardiac output
pg. 4
Exam 2: NSG4100 / NSG 4100 (New 2025/ 2026 Update)
Nursing Practice - Adult Health III Review| Questions &
Answers| Grade A| 100% Correct (Verified Solutions)- Galen
1. A client is admitted with septic shock. The nurse anticipates which hemodynamic profile?
A. Increased cardiac output, decreased systemic vascular resistance (SVR)
B. Decreased cardiac output, increased SVR
C. Increased cardiac output, increased SVR
D. Decreased cardiac output, decreased SVR
Answer: A. Increased cardiac output, decreased SVR.
Rationale: In early (hyperdynamic) septic shock, cardiac output is often elevated due to tachycardia and
decreased afterload from massive vasodilation, while SVR is low. This is sometimes called "warm shock."
As sepsis progresses, myocardial depression can occur, leading to decreased cardiac output.
2. A client with hypovolemic shock has a central venous pressure (CVP) of 2 mmHg. What should the
nurse do first?
A. Administer a vasopressor
B. Increase the rate of IV fluid resuscitation
C. Place the client in Trendelenburg position
D. Obtain a 12-lead ECG
Answer: B. Increase the rate of IV fluid resuscitation.
Rationale: A low CVP (<2–6 mmHg) indicates low preload due to volume depletion. The priority in
hypovolemic shock is aggressive fluid resuscitation with crystalloids (0.9% NaCl or Lactated Ringer's) or
blood products, depending on the cause.
3. A client in cardiogenic shock has a pulmonary artery wedge pressure (PAWP) of 22 mmHg. The
nurse understands this indicates:
A. Low preload, need for fluids
B. High preload, pulmonary congestion
C. Low afterload
D. Normal left ventricular function
Answer: B. High preload, pulmonary congestion.
Rationale: Normal PAWP is 6–12 mmHg. A high PAWP (>18) indicates elevated left ventricular
end-diastolic pressure and pulmonary venous congestion, which is typical of cardiogenic shock due to
pump failure. Treatment includes diuretics and inotropes, not more fluids.
pg. 1
,2
4. A client is receiving norepinephrine for septic shock. The nurse should monitor for which
complication?
A. Bronchospasm
B. Peripheral tissue ischemia
C. Hyperglycemia
D. Ototoxicity
Answer: B. Peripheral tissue ischemia.
Rationale: Norepinephrine is a potent vasoconstrictor. If extravasation occurs, it can cause severe tissue
ischemia and necrosis. The IV site must be monitored closely. It can also cause end-organ ischemia if
perfusion pressure is inadequate.
5. A client in shock is started on a dobutamine infusion. The expected hemodynamic effect is:
A. Increased heart rate and blood pressure
B. Increased cardiac contractility and decreased SVR
C. Decreased cardiac output and increased SVR
D. Vasodilation only
Answer: B. Increased cardiac contractility and decreased SVR.
Rationale: Dobutamine is a beta-1 adrenergic agonist that increases contractility (positive inotrope) and
has mild vasodilatory effects (decreases SVR). It is used in cardiogenic shock to improve cardiac output
without significantly increasing afterload.
6. A client with anaphylactic shock is receiving IV epinephrine. The nurse knows that epinephrine
works by:
A. Blocking histamine receptors
B. Causing vasodilation
C. Activating alpha-1 receptors (vasoconstriction) and beta-2 receptors (bronchodilation)
D. Decreasing heart rate
Answer: C. Activating alpha-1 (vasoconstriction) and beta-2 (bronchodilation) receptors.
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It reverses vasodilation and
hypotension through alpha-1 agonism, and relieves bronchospasm through beta-2 agonism.
7. A client with a central venous catheter develops sudden dyspnea, chest pain, and hypotension. The
nurse suspects an air embolism. What is the immediate action?
A. Place the client in high-Fowler's position
B. Clamp the catheter and place the client in the left lateral Trendelenburg position
C. Administer a fluid bolus
D. Call a code blue
pg. 2
,3
Answer: B. Clamp the catheter and place the client in the left lateral Trendelenburg position.
Rationale: This position traps air in the right atrium, preventing it from entering the pulmonary artery.
Clamping the catheter prevents further air entry. High-Fowler's position would allow air to travel to the
cerebral circulation.
8. The nurse is monitoring a client with a pulmonary artery catheter. The mixed venous oxygen
saturation (SvO₂) drops from 70% to 52%. This indicates:
A. Improved cardiac output
B. Increased oxygen delivery
C. Increased tissue oxygen extraction due to decreased delivery
D. A normal finding
Answer: C. Increased tissue oxygen extraction due to decreased delivery.
Rationale: SvO₂ reflects the balance between oxygen delivery and consumption. A drop indicates tissues
are extracting more oxygen because delivery is inadequate (e.g., low cardiac output, anemia,
hypoxemia). Normal SvO₂ is 60–80%.
9. A client in the ICU develops a new fever, hypotension, and altered mental status. Blood cultures are
drawn. The nurse should anticipate initiation of:
A. Broad-spectrum antibiotics within 1 hour of recognition
B. Antipyretics only
C. Vasopressors only
D. Corticosteroids first
Answer: A. Broad-spectrum antibiotics within 1 hour.
Rationale: The Surviving Sepsis Campaign recommends administering broad-spectrum IV antibiotics
within 1 hour of recognizing sepsis or septic shock, as each hour of delay increases mortality. Fluids and
vasopressors are also initiated.
10. (NGN – Bow-Tie)
A client with pneumonia develops septic shock. BP 78/48, HR 128, lactate 4.5 mmol/L. Complete the
diagram.
Actions to Take (Select 2) Condition (Select 1) Parameters to Monitor (Select 2)
□ Administer 30 mL/kg IV crystalloid bolus ○ Cardiogenic shock □ Blood pressure
□ Start norepinephrine infusion ○ Hypovolemic shock □ Serum lactate
pg. 3
, 4
Actions to Take (Select 2) Condition (Select 1) Parameters to Monitor (Select 2)
□ Administer furosemide IV ○ Septic shock □ Urine output
□ Prepare for immediate cardioversion ○ Anaphylactic shock □ Pupil size
Answer:
• Actions: Administer IV crystalloid bolus (30 mL/kg), Start norepinephrine.
• Condition: Septic shock.
• Parameters: Blood pressure, Serum lactate.
11. A client with a history of heart failure is admitted with fluid overload. The nurse notes a CVP of 14
mmHg. What action is appropriate?
A. Start a fluid bolus
B. Administer furosemide as prescribed
C. Place the client flat
D. Increase IV fluids
Answer: B. Administer furosemide as prescribed.
Rationale: CVP >8–12 indicates elevated right ventricular preload, consistent with fluid volume excess.
Diuresis is needed to reduce preload and improve symptoms.
12. A client is receiving vasopressin for septic shock. The nurse understands this drug is used as an
adjunct to norepinephrine because it:
A. Causes vasodilation
B. Increases heart rate
C. Constricts blood vessels and may reduce catecholamine requirements
D. Promotes diuresis
Answer: C. Constricts blood vessels and may reduce catecholamine requirements.
Rationale: Vasopressin is a potent vasoconstrictor used in septic shock when norepinephrine alone is
insufficient. It also has a synergistic effect with norepinephrine. It does not significantly increase heart
rate.
Section 2: Acute Respiratory Failure & ARDS (13–24)
13. A client with ARDS is being ventilated. The nurse understands that low tidal volume ventilation (6
mL/kg ideal body weight) is used to:
A. Increase cardiac output
pg. 4
