NUR 265 Exam 4 Actual Exam 2026/2027 – Comprehensive
Advanced Med-Surg Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Multisystem Organ Dysfunction & Shock States
Q1: A 68-year-old patient presents following a massive myocardial infarction with a
blood pressure of 72/48 mmHg, heart rate of 118 bpm, cool clammy skin, and a
pulmonary artery occlusion pressure (PAOP) of 22 mmHg. The cardiac output is 3.8
L/min and the systemic vascular resistance (SVR) is 1800 dynes/sec/cm⁻⁵. Which
classification of shock best describes this patient's presentation?
A. Hypovolemic shock characterized by low PAOP and high SVR
B. Distributive shock with low SVR and warm, flushed skin
C. Cardiogenic shock with elevated PAOP and elevated SVR [CORRECT]
D. Obstructive shock caused by tension pneumothorax or cardiac tamponade
Correct Answer: C
Rationale: Cardiogenic shock is characterized by decreased cardiac output, elevated
PAOP (>18 mmHg indicates left ventricular failure/backup), elevated SVR
(compensatory vasoconstriction), and cool clammy skin from sympathetic activation.
Hypovolemic shock would present with low PAOP, distributive shock with low SVR and
warm skin, and obstructive shock with signs of mechanical obstruction.
Q2: A nurse is caring for a patient in the progressive stage of shock. Which clinical
finding indicates the patient is transitioning from the compensatory stage to the
progressive stage?
A. Urine output of 40 mL/hr and alert mental status
B. Tachycardia of 110 bpm with normal blood pressure maintained
C. Metabolic alkalosis with increased urine output
,D. Decreased urine output of 15 mL/hr and altered mental status [CORRECT]
Correct Answer: D
Rationale: The progressive stage of shock is marked by end-organ hypoperfusion
despite compensatory mechanisms, evidenced by oliguria (<0.5 mL/kg/hr), altered
mental status from cerebral hypoxia, and metabolic acidosis (not alkalosis). Options A
and B describe compensatory stage findings where perfusion is still maintained.
Q3: A 54-year-old patient with pneumonia develops sepsis. The nurse obtains the
following vital signs: temperature 38.9°C (102°F), heart rate 112 bpm, respiratory rate
26/min, and blood pressure 88/52 mmHg. The patient is confused and has a creatinine
of 2.1 mg/dL (baseline 0.9 mg/dL). Using the qSOFA criteria, what is the patient's score,
and what does it indicate?
A. qSOFA score of 1, indicating low risk for poor outcome
B. qSOFA score of 2, suggesting the patient should be monitored for sepsis
C. qSOFA score of 3, indicating high risk for poor outcome and probable sepsis
[CORRECT]
D. qSOFA score of 0, indicating no concern for sepsis
Correct Answer: C
Rationale: qSOFA criteria assign 1 point each for: altered mental status (confusion),
respiratory rate ≥22/min (26/min), and systolic BP ≤100 mmHg (88 mmHg). This patient
scores 3/3, indicating high risk for poor outcome and probable sepsis requiring
immediate intervention. The elevated creatinine further supports organ dysfunction
consistent with sepsis.
Q4: A patient with severe sepsis arrives in the ICU. According to the Surviving Sepsis
Campaign 1-hour bundle, which intervention must be completed within the first hour of
recognition?
A. Administering broad-spectrum antibiotics after blood cultures are obtained
B. Measuring serum lactate and beginning fluid resuscitation if hypotensive or lactate
≥4 mmol/L [CORRECT]
, C. Initiating vasopressors to maintain MAP >65 mmHg after 6 hours of fluid
resuscitation
D. Performing source control procedures such as abscess drainage
Correct Answer: B
Rationale: The 1-hour sepsis bundle requires: measuring lactate, obtaining blood
cultures before antibiotics (but not delaying antibiotics >45 min), administering
broad-spectrum antibiotics, and beginning rapid fluid resuscitation (30 mL/kg
crystalloid) for hypotension or lactate ≥4 mmol/L. Antibiotics should be given within 1
hour, but the bundle specifically prioritizes lactate measurement and immediate fluid
resuscitation for shock.
Q5: A patient in septic shock remains hypotensive despite receiving 30 mL/kg of
crystalloid fluid resuscitation. Which vasopressor is the FIRST-LINE agent
recommended by the Surviving Sepsis Campaign to maintain a mean arterial pressure
(MAP) ≥65 mmHg?
A. Vasopressin at 0.03 units/min as monotherapy
B. Dopamine at doses >10 mcg/kg/min
C. Norepinephrine at 0.05-3 mcg/kg/min [CORRECT]
D. Phenylephrine as the initial agent of choice
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock due to its potent
alpha-1 effects (vasoconstriction) with less pronounced beta-1 effects than epinephrine,
improving MAP with less tachycardia and arrhythmia risk than dopamine. Vasopressin
may be added as a second-line agent, and phenylephrine is reserved for specific
situations due to its pure alpha-agonism without inotropic effects.
Q6: A patient develops Multiple Organ Dysfunction Syndrome (MODS) following severe
trauma. Which pathophysiological mechanism is the PRIMARY driver of MODS
progression?
A. Localized bacterial infection confined to the primary injury site
Advanced Med-Surg Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Multisystem Organ Dysfunction & Shock States
Q1: A 68-year-old patient presents following a massive myocardial infarction with a
blood pressure of 72/48 mmHg, heart rate of 118 bpm, cool clammy skin, and a
pulmonary artery occlusion pressure (PAOP) of 22 mmHg. The cardiac output is 3.8
L/min and the systemic vascular resistance (SVR) is 1800 dynes/sec/cm⁻⁵. Which
classification of shock best describes this patient's presentation?
A. Hypovolemic shock characterized by low PAOP and high SVR
B. Distributive shock with low SVR and warm, flushed skin
C. Cardiogenic shock with elevated PAOP and elevated SVR [CORRECT]
D. Obstructive shock caused by tension pneumothorax or cardiac tamponade
Correct Answer: C
Rationale: Cardiogenic shock is characterized by decreased cardiac output, elevated
PAOP (>18 mmHg indicates left ventricular failure/backup), elevated SVR
(compensatory vasoconstriction), and cool clammy skin from sympathetic activation.
Hypovolemic shock would present with low PAOP, distributive shock with low SVR and
warm skin, and obstructive shock with signs of mechanical obstruction.
Q2: A nurse is caring for a patient in the progressive stage of shock. Which clinical
finding indicates the patient is transitioning from the compensatory stage to the
progressive stage?
A. Urine output of 40 mL/hr and alert mental status
B. Tachycardia of 110 bpm with normal blood pressure maintained
C. Metabolic alkalosis with increased urine output
,D. Decreased urine output of 15 mL/hr and altered mental status [CORRECT]
Correct Answer: D
Rationale: The progressive stage of shock is marked by end-organ hypoperfusion
despite compensatory mechanisms, evidenced by oliguria (<0.5 mL/kg/hr), altered
mental status from cerebral hypoxia, and metabolic acidosis (not alkalosis). Options A
and B describe compensatory stage findings where perfusion is still maintained.
Q3: A 54-year-old patient with pneumonia develops sepsis. The nurse obtains the
following vital signs: temperature 38.9°C (102°F), heart rate 112 bpm, respiratory rate
26/min, and blood pressure 88/52 mmHg. The patient is confused and has a creatinine
of 2.1 mg/dL (baseline 0.9 mg/dL). Using the qSOFA criteria, what is the patient's score,
and what does it indicate?
A. qSOFA score of 1, indicating low risk for poor outcome
B. qSOFA score of 2, suggesting the patient should be monitored for sepsis
C. qSOFA score of 3, indicating high risk for poor outcome and probable sepsis
[CORRECT]
D. qSOFA score of 0, indicating no concern for sepsis
Correct Answer: C
Rationale: qSOFA criteria assign 1 point each for: altered mental status (confusion),
respiratory rate ≥22/min (26/min), and systolic BP ≤100 mmHg (88 mmHg). This patient
scores 3/3, indicating high risk for poor outcome and probable sepsis requiring
immediate intervention. The elevated creatinine further supports organ dysfunction
consistent with sepsis.
Q4: A patient with severe sepsis arrives in the ICU. According to the Surviving Sepsis
Campaign 1-hour bundle, which intervention must be completed within the first hour of
recognition?
A. Administering broad-spectrum antibiotics after blood cultures are obtained
B. Measuring serum lactate and beginning fluid resuscitation if hypotensive or lactate
≥4 mmol/L [CORRECT]
, C. Initiating vasopressors to maintain MAP >65 mmHg after 6 hours of fluid
resuscitation
D. Performing source control procedures such as abscess drainage
Correct Answer: B
Rationale: The 1-hour sepsis bundle requires: measuring lactate, obtaining blood
cultures before antibiotics (but not delaying antibiotics >45 min), administering
broad-spectrum antibiotics, and beginning rapid fluid resuscitation (30 mL/kg
crystalloid) for hypotension or lactate ≥4 mmol/L. Antibiotics should be given within 1
hour, but the bundle specifically prioritizes lactate measurement and immediate fluid
resuscitation for shock.
Q5: A patient in septic shock remains hypotensive despite receiving 30 mL/kg of
crystalloid fluid resuscitation. Which vasopressor is the FIRST-LINE agent
recommended by the Surviving Sepsis Campaign to maintain a mean arterial pressure
(MAP) ≥65 mmHg?
A. Vasopressin at 0.03 units/min as monotherapy
B. Dopamine at doses >10 mcg/kg/min
C. Norepinephrine at 0.05-3 mcg/kg/min [CORRECT]
D. Phenylephrine as the initial agent of choice
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock due to its potent
alpha-1 effects (vasoconstriction) with less pronounced beta-1 effects than epinephrine,
improving MAP with less tachycardia and arrhythmia risk than dopamine. Vasopressin
may be added as a second-line agent, and phenylephrine is reserved for specific
situations due to its pure alpha-agonism without inotropic effects.
Q6: A patient develops Multiple Organ Dysfunction Syndrome (MODS) following severe
trauma. Which pathophysiological mechanism is the PRIMARY driver of MODS
progression?
A. Localized bacterial infection confined to the primary injury site
