NSG 4100 EXAM 4 FINAL
Comprehensive & Critical Care Concepts — 100-Question Practice
Exam with Answer Key & Rationales
Section A: Shock States
Question 1: A client with severe blood loss from trauma presents with hypotension, tachycardia,
and cool clammy skin. Which type of shock does the nurse suspect?
● A. Cardiogenic shock
● B. Hypovolemic shock
● C. Septic shock
● D. Neurogenic shock
Rationale: Hypovolemic shock results from significant fluid or blood loss, presenting with
hypotension, tachycardia, and poor peripheral perfusion as the body compensates for decreased
circulating volume.
Question 2: A nurse is caring for a client in hypovolemic shock. Which intervention is the
priority?
● A. Administer a vasopressor first
● B. Control the source of fluid loss and administer IV fluids or blood products as
prescribed
● C. Restrict all IV fluids
● D. Position the client in reverse Trendelenburg
Rationale: The priority in hypovolemic shock is restoring circulating volume through fluid or
blood product resuscitation while controlling the underlying cause of loss.
Question 3: A client with a massive myocardial infarction develops hypotension, pulmonary
crackles, and cold extremities. Which type of shock does the nurse suspect?
● A. Hypovolemic shock
● B. Cardiogenic shock
● C. Anaphylactic shock
● D. Septic shock
Rationale: Cardiogenic shock results from the heart's inability to pump effectively, often
following MI, causing hypotension, pulmonary congestion, and poor perfusion despite adequate
volume.
Question 4: A nurse is caring for a client in cardiogenic shock. Which hemodynamic finding is
expected?
● A. Increased cardiac output and decreased systemic vascular resistance
● B. Decreased cardiac output and increased systemic vascular resistance
, ● C. Decreased systemic vascular resistance only
● D. Normal cardiac output with hypertension
Rationale: Cardiogenic shock is characterized by decreased cardiac output due to pump failure,
with compensatory increased systemic vascular resistance from vasoconstriction.
Question 5: A client with septic shock has warm, flushed skin initially. What underlying process
explains this early presentation?
● A. Vasoconstriction from hypovolemia
● B. Widespread vasodilation from the inflammatory response
● C. Cardiac pump failure
● D. Neurogenic vasodilation from spinal injury
Rationale: Septic shock initially causes widespread vasodilation due to inflammatory mediators,
producing warm, flushed skin before progressing to a cold, hypoperfused state as shock worsens.
Question 6: A client with a high spinal cord injury develops sudden hypotension, bradycardia,
and warm dry skin below the level of injury. Which type of shock is this?
● A. Cardiogenic shock
● B. Hypovolemic shock
● C. Neurogenic shock
● D. Septic shock
Rationale: Neurogenic shock results from disruption of sympathetic nervous system outflow
following spinal cord injury, causing vasodilation, bradycardia, and hypotension.
Question 7: A client develops anaphylactic shock after an insect sting. Which finding is
expected?
● A. Bradycardia and hypertension
● B. Hypotension, tachycardia, urticaria, and bronchospasm
● C. Fever and chills only
● D. Normal vital signs
Rationale: Anaphylactic shock is a severe allergic reaction causing widespread vasodilation,
capillary leak, hypotension, tachycardia, and often bronchospasm and urticaria.
Question 8: A client with a tension pneumothorax develops hypotension, distended neck veins,
and absent breath sounds on one side. Which type of shock is occurring?
● A. Obstructive shock
● B. Hypovolemic shock
● C. Septic shock
● D. Neurogenic shock
Rationale: Obstructive shock occurs when a physical obstruction, such as a tension
pneumothorax or cardiac tamponade, impairs cardiac filling or output.
, Question 9: A client with cardiac tamponade presents with muffled heart sounds, jugular vein
distention, and hypotension. What is this classic presentation called?
● A. Cushing's triad
● B. Beck's triad
● C. Virchow's triad
● D. Trousseau's triad
Rationale: Beck's triad, consisting of muffled heart sounds, JVD, and hypotension, is classic for
cardiac tamponade, a form of obstructive shock.
Question 10: A client in shock has a urine output of less than 20 mL/hr for the past 2 hours.
What does this finding indicate?
● A. Adequate renal perfusion
● B. Inadequate organ perfusion requiring intervention
● C. Normal finding requiring no action
● D. Fluid overload
Rationale: Decreased urine output in a client in shock indicates inadequate renal perfusion and
is a key indicator of the need for continued resuscitation and monitoring.
Question 11: A nurse is monitoring a client in shock for early compensatory signs. Which
finding would be expected first?
● A. Severe hypotension
● B. Tachycardia and mild anxiety
● C. Anuria
● D. Coma
Rationale: Early compensatory shock presents with subtle findings such as tachycardia and
anxiety as the body attempts to maintain perfusion before decompensation occurs.
Question 12: A client in septic shock requires fluid resuscitation. Which type of IV fluid is
typically administered first?
● A. 5% dextrose in water
● B. Isotonic crystalloid solution such as normal saline or lactated Ringer's
● C. Hypertonic saline exclusively
● D. 3% saline
Rationale: Isotonic crystalloids are the first-line fluid choice for resuscitation in shock states, as
they expand intravascular volume without causing significant fluid shifts.
Question 13: A client with cardiogenic shock is prescribed dobutamine. What is the expected
therapeutic effect?
● A. Decrease myocardial contractility
● B. Increase myocardial contractility and cardiac output
● C. Cause peripheral vasoconstriction primarily
Comprehensive & Critical Care Concepts — 100-Question Practice
Exam with Answer Key & Rationales
Section A: Shock States
Question 1: A client with severe blood loss from trauma presents with hypotension, tachycardia,
and cool clammy skin. Which type of shock does the nurse suspect?
● A. Cardiogenic shock
● B. Hypovolemic shock
● C. Septic shock
● D. Neurogenic shock
Rationale: Hypovolemic shock results from significant fluid or blood loss, presenting with
hypotension, tachycardia, and poor peripheral perfusion as the body compensates for decreased
circulating volume.
Question 2: A nurse is caring for a client in hypovolemic shock. Which intervention is the
priority?
● A. Administer a vasopressor first
● B. Control the source of fluid loss and administer IV fluids or blood products as
prescribed
● C. Restrict all IV fluids
● D. Position the client in reverse Trendelenburg
Rationale: The priority in hypovolemic shock is restoring circulating volume through fluid or
blood product resuscitation while controlling the underlying cause of loss.
Question 3: A client with a massive myocardial infarction develops hypotension, pulmonary
crackles, and cold extremities. Which type of shock does the nurse suspect?
● A. Hypovolemic shock
● B. Cardiogenic shock
● C. Anaphylactic shock
● D. Septic shock
Rationale: Cardiogenic shock results from the heart's inability to pump effectively, often
following MI, causing hypotension, pulmonary congestion, and poor perfusion despite adequate
volume.
Question 4: A nurse is caring for a client in cardiogenic shock. Which hemodynamic finding is
expected?
● A. Increased cardiac output and decreased systemic vascular resistance
● B. Decreased cardiac output and increased systemic vascular resistance
, ● C. Decreased systemic vascular resistance only
● D. Normal cardiac output with hypertension
Rationale: Cardiogenic shock is characterized by decreased cardiac output due to pump failure,
with compensatory increased systemic vascular resistance from vasoconstriction.
Question 5: A client with septic shock has warm, flushed skin initially. What underlying process
explains this early presentation?
● A. Vasoconstriction from hypovolemia
● B. Widespread vasodilation from the inflammatory response
● C. Cardiac pump failure
● D. Neurogenic vasodilation from spinal injury
Rationale: Septic shock initially causes widespread vasodilation due to inflammatory mediators,
producing warm, flushed skin before progressing to a cold, hypoperfused state as shock worsens.
Question 6: A client with a high spinal cord injury develops sudden hypotension, bradycardia,
and warm dry skin below the level of injury. Which type of shock is this?
● A. Cardiogenic shock
● B. Hypovolemic shock
● C. Neurogenic shock
● D. Septic shock
Rationale: Neurogenic shock results from disruption of sympathetic nervous system outflow
following spinal cord injury, causing vasodilation, bradycardia, and hypotension.
Question 7: A client develops anaphylactic shock after an insect sting. Which finding is
expected?
● A. Bradycardia and hypertension
● B. Hypotension, tachycardia, urticaria, and bronchospasm
● C. Fever and chills only
● D. Normal vital signs
Rationale: Anaphylactic shock is a severe allergic reaction causing widespread vasodilation,
capillary leak, hypotension, tachycardia, and often bronchospasm and urticaria.
Question 8: A client with a tension pneumothorax develops hypotension, distended neck veins,
and absent breath sounds on one side. Which type of shock is occurring?
● A. Obstructive shock
● B. Hypovolemic shock
● C. Septic shock
● D. Neurogenic shock
Rationale: Obstructive shock occurs when a physical obstruction, such as a tension
pneumothorax or cardiac tamponade, impairs cardiac filling or output.
, Question 9: A client with cardiac tamponade presents with muffled heart sounds, jugular vein
distention, and hypotension. What is this classic presentation called?
● A. Cushing's triad
● B. Beck's triad
● C. Virchow's triad
● D. Trousseau's triad
Rationale: Beck's triad, consisting of muffled heart sounds, JVD, and hypotension, is classic for
cardiac tamponade, a form of obstructive shock.
Question 10: A client in shock has a urine output of less than 20 mL/hr for the past 2 hours.
What does this finding indicate?
● A. Adequate renal perfusion
● B. Inadequate organ perfusion requiring intervention
● C. Normal finding requiring no action
● D. Fluid overload
Rationale: Decreased urine output in a client in shock indicates inadequate renal perfusion and
is a key indicator of the need for continued resuscitation and monitoring.
Question 11: A nurse is monitoring a client in shock for early compensatory signs. Which
finding would be expected first?
● A. Severe hypotension
● B. Tachycardia and mild anxiety
● C. Anuria
● D. Coma
Rationale: Early compensatory shock presents with subtle findings such as tachycardia and
anxiety as the body attempts to maintain perfusion before decompensation occurs.
Question 12: A client in septic shock requires fluid resuscitation. Which type of IV fluid is
typically administered first?
● A. 5% dextrose in water
● B. Isotonic crystalloid solution such as normal saline or lactated Ringer's
● C. Hypertonic saline exclusively
● D. 3% saline
Rationale: Isotonic crystalloids are the first-line fluid choice for resuscitation in shock states, as
they expand intravascular volume without causing significant fluid shifts.
Question 13: A client with cardiogenic shock is prescribed dobutamine. What is the expected
therapeutic effect?
● A. Decrease myocardial contractility
● B. Increase myocardial contractility and cardiac output
● C. Cause peripheral vasoconstriction primarily
