NUR 2755 Exam 2 | Multidimensional Care IV | Rasmussen University | 2026-2027
Exam 2 - NUR2755 / NUR 2755 (Latest ):
Multidimensional Care IV / MDC 4 - Rasmussen
Grade A Questions and Verified Answers | 100% Correct
Aligned with 2026-2027 Rasmussen University Curriculum Standards
For Educational and Study Purposes Only
SECTION 1: Shock States and Hemodynamic Management (Q1-Q25)
Q1: A 45-year-old patient is admitted to the emergency department with a severe allergic reaction after receiving
penicillin. The patient's blood pressure is 78/50 mmHg, heart rate is 122 bpm, and respirations are 28 breaths/min.
Which type of shock is this patient most likely experiencing?
A. Cardiogenic shock
B. Hypovolemic shock
C. Anaphylactic shock [CORRECT]
D. Neurogenic shock
Correct Answer: C
Rationale: Anaphylactic shock occurs when a massive allergic response triggers widespread vasodilation and increased capillary
permeability, leading to rapid intravascular volume loss. Cardiogenic shock is caused by pump failure, hypovolemic shock by actual
volume loss, and neurogenic shock by loss of sympathetic tone from spinal cord injury. This patient's history of penicillin
administration with acute hemodynamic collapse is classic for anaphylaxis.
Q2: A patient with septic shock has the following vital signs: blood pressure 88/54 mmHg, heart rate 118 bpm. What
is this patient's mean arterial pressure (MAP)?
A. 62 mmHg
B. 65.3 mmHg [CORRECT]
C. 72 mmHg
D. 78 mmHg
Correct Answer: B
Rationale: MAP is calculated as (SBP + 2 x DBP) / 3 = (88 + 2 x 54) / 3 = (88 + 108) / 3 = = 65.3 mmHg. The normal MAP
is 70-100 mmHg, and values below 65 mmHg are associated with inadequate tissue perfusion. The Surviving Sepsis Campaign
recommends maintaining a MAP of at least 65 mmHg in patients with septic shock.
Q3: A 68-year-old patient with a history of heart failure presents with cool, clammy skin; jugular venous distension;
and crackles throughout both lung fields. Blood pressure is 84/60 mmHg. Which type of shock is this patient
experiencing?
A. Hypovolemic shock
B. Cardiogenic shock [CORRECT]
Page 1
, NUR 2755 Exam 2 | Multidimensional Care IV | Rasmussen University | 2026-2027
C. Septic shock
D. Neurogenic shock
Correct Answer: B
Rationale: Cardiogenic shock results from the heart's inability to pump effectively, causing backup of fluid into the pulmonary system
and systemic venous system. The findings of jugular venous distension and pulmonary crackles indicate fluid overload from pump
failure, which distinguishes cardiogenic from other shock types. Hypovolemic shock would present with flat neck veins and absent
lung crackles due to decreased volume.
Q4: A patient in the compensatory stage of shock exhibits tachycardia, cool and pale extremities, and mild anxiety.
Which physiological mechanism is primarily responsible for these findings?
A. Parasympathetic nervous system activation
B. Sympathetic nervous system (SNS) compensation [CORRECT]
C. Decreased aldosterone secretion
D. Increased intracranial pressure
Correct Answer: B
Rationale: During the compensatory stage of shock, the sympathetic nervous system is activated in response to decreased perfusion,
releasing epinephrine and norepinephrine. This causes vasoconstriction (cool, pale skin), tachycardia, and increased cardiac
contractility to maintain perfusion to vital organs. Parasympathetic activation would cause the opposite effects, and aldosterone
increases rather than decreases in shock.
Q5: A 32-year-old patient is brought to the ED after a motor vehicle crash. Assessment reveals blood pressure 74/42
mmHg, heart rate 130 bpm, weak thready pulse, and delayed capillary refill. The abdomen is distended and rigid.
Which intervention should the nurse anticipate first?
A. Administration of a diuretic
B. Initiation of a large-bore IV with rapid fluid resuscitation [CORRECT]
C. Administration of a beta-blocker
D. Placement of a central venous pressure catheter
Correct Answer: B
Rationale: This patient is presenting with hypovolemic shock secondary to suspected intra-abdominal hemorrhage. The first priority is
restoring intravascular volume through large-bore IV access and rapid fluid resuscitation. Diuretics would worsen hypovolemia,
beta-blockers would further decrease blood pressure and cardiac output, and while a CVP catheter may be needed, fluid resuscitation
takes priority over central line placement.
Q6: A patient with septic shock is receiving norepinephrine (Levophed) via continuous IV infusion. Which finding
indicates the medication is achieving its therapeutic effect?
A. Heart rate decreased from 110 to 90 bpm
B. Blood pressure increased from 78/50 to 100/65 mmHg [CORRECT]
C. Urine output decreased from 40 to 20 mL/hr
D. Temperature decreased from 39.2C to 37.8C
Correct Answer: B
Rationale: Norepinephrine is a potent alpha-adrenergic agonist that causes vasoconstriction, thereby increasing blood pressure. An
increase in MAP is the primary therapeutic goal. While a decreased heart rate may occur, the main purpose is blood pressure support.
Decreased urine output would indicate worsening perfusion, and temperature reduction is not the intended effect of norepinephrine.
Q7: A 25-year-old patient arrives at the ED after a diving accident with a suspected spinal cord injury at C6. Vital
signs show blood pressure 80/50 mmHg, heart rate 52 bpm, and warm, dry skin. Which type of shock is this patient
most likely experiencing?
Page 2
, NUR 2755 Exam 2 | Multidimensional Care IV | Rasmussen University | 2026-2027
A. Hypovolemic shock
B. Cardiogenic shock
C. Neurogenic shock [CORRECT]
D. Anaphylactic shock
Correct Answer: C
Rationale: Neurogenic shock results from loss of sympathetic tone below the level of spinal cord injury, causing vasodilation and
unopposed parasympathetic activity. The hallmark findings of neurogenic shock are hypotension with bradycardia and warm, dry
skin (due to loss of vasoconstriction). Hypovolemic and cardiogenic shock typically present with tachycardia and cool, clammy skin.
Q8: A patient in the progressive stage of shock has the following laboratory results: lactate 6.2 mmol/L, base deficit
-8 mEq/L, and fibrinogen 120 mg/dL. Which complication should the nurse monitor for most closely?
A. Chronic obstructive pulmonary disease
B. Disseminated intravascular coagulation (DIC) [CORRECT]
C. Type 2 diabetes mellitus
D. Chronic kidney disease
Correct Answer: B
Rationale: The elevated lactate, negative base deficit, and decreased fibrinogen indicate tissue hypoperfusion, metabolic acidosis, and
coagulation factor consumption, which are hallmark findings of DIC. DIC is a serious complication of progressive shock in which the
coagulation cascade is abnormally activated, consuming clotting factors and platelets while simultaneously causing microthrombi
formation and bleeding.
Q9: According to the Surviving Sepsis Campaign guidelines, within how many hours should broad-spectrum
antibiotics be administered after recognizing sepsis?
A. Within 1 hour [CORRECT]
B. Within 3 hours
C. Within 6 hours
D. Within 12 hours
Correct Answer: A
Rationale: The Surviving Sepsis Campaign recommends administering broad-spectrum antibiotics within 1 hour of recognition of
sepsis or septic shock. Early antibiotic administration is strongly associated with reduced mortality. Waiting 3 hours or longer
significantly increases the risk of death, as the infection continues to trigger an uncontrolled inflammatory response.
Q10: A patient in septic shock has not responded adequately to norepinephrine at the maximum dose. Which
vasopressor does the Surviving Sepsis Campaign recommend adding as a second-line agent?
A. Dopamine
B. Epinephrine
C. Vasopressin [CORRECT]
D. Dobutamine
Correct Answer: C
Rationale: The Surviving Sepsis Campaign guidelines recommend adding vasopressin at a fixed dose of 0.03 units/min as a
second-line vasopressor when norepinephrine alone is insufficient to maintain adequate MAP. Vasopressin acts on V1 receptors to
cause vasoconstriction and can reduce the required dose of norepinephrine. Dopamine is no longer recommended as a first-line agent
due to increased arrhythmia risk.
Q11: A 55-year-old patient with a massive pulmonary embolism suddenly develops severe hypotension, distended
jugular veins, and muffled heart sounds. Which type of shock is occurring?
Page 3
Exam 2 - NUR2755 / NUR 2755 (Latest ):
Multidimensional Care IV / MDC 4 - Rasmussen
Grade A Questions and Verified Answers | 100% Correct
Aligned with 2026-2027 Rasmussen University Curriculum Standards
For Educational and Study Purposes Only
SECTION 1: Shock States and Hemodynamic Management (Q1-Q25)
Q1: A 45-year-old patient is admitted to the emergency department with a severe allergic reaction after receiving
penicillin. The patient's blood pressure is 78/50 mmHg, heart rate is 122 bpm, and respirations are 28 breaths/min.
Which type of shock is this patient most likely experiencing?
A. Cardiogenic shock
B. Hypovolemic shock
C. Anaphylactic shock [CORRECT]
D. Neurogenic shock
Correct Answer: C
Rationale: Anaphylactic shock occurs when a massive allergic response triggers widespread vasodilation and increased capillary
permeability, leading to rapid intravascular volume loss. Cardiogenic shock is caused by pump failure, hypovolemic shock by actual
volume loss, and neurogenic shock by loss of sympathetic tone from spinal cord injury. This patient's history of penicillin
administration with acute hemodynamic collapse is classic for anaphylaxis.
Q2: A patient with septic shock has the following vital signs: blood pressure 88/54 mmHg, heart rate 118 bpm. What
is this patient's mean arterial pressure (MAP)?
A. 62 mmHg
B. 65.3 mmHg [CORRECT]
C. 72 mmHg
D. 78 mmHg
Correct Answer: B
Rationale: MAP is calculated as (SBP + 2 x DBP) / 3 = (88 + 2 x 54) / 3 = (88 + 108) / 3 = = 65.3 mmHg. The normal MAP
is 70-100 mmHg, and values below 65 mmHg are associated with inadequate tissue perfusion. The Surviving Sepsis Campaign
recommends maintaining a MAP of at least 65 mmHg in patients with septic shock.
Q3: A 68-year-old patient with a history of heart failure presents with cool, clammy skin; jugular venous distension;
and crackles throughout both lung fields. Blood pressure is 84/60 mmHg. Which type of shock is this patient
experiencing?
A. Hypovolemic shock
B. Cardiogenic shock [CORRECT]
Page 1
, NUR 2755 Exam 2 | Multidimensional Care IV | Rasmussen University | 2026-2027
C. Septic shock
D. Neurogenic shock
Correct Answer: B
Rationale: Cardiogenic shock results from the heart's inability to pump effectively, causing backup of fluid into the pulmonary system
and systemic venous system. The findings of jugular venous distension and pulmonary crackles indicate fluid overload from pump
failure, which distinguishes cardiogenic from other shock types. Hypovolemic shock would present with flat neck veins and absent
lung crackles due to decreased volume.
Q4: A patient in the compensatory stage of shock exhibits tachycardia, cool and pale extremities, and mild anxiety.
Which physiological mechanism is primarily responsible for these findings?
A. Parasympathetic nervous system activation
B. Sympathetic nervous system (SNS) compensation [CORRECT]
C. Decreased aldosterone secretion
D. Increased intracranial pressure
Correct Answer: B
Rationale: During the compensatory stage of shock, the sympathetic nervous system is activated in response to decreased perfusion,
releasing epinephrine and norepinephrine. This causes vasoconstriction (cool, pale skin), tachycardia, and increased cardiac
contractility to maintain perfusion to vital organs. Parasympathetic activation would cause the opposite effects, and aldosterone
increases rather than decreases in shock.
Q5: A 32-year-old patient is brought to the ED after a motor vehicle crash. Assessment reveals blood pressure 74/42
mmHg, heart rate 130 bpm, weak thready pulse, and delayed capillary refill. The abdomen is distended and rigid.
Which intervention should the nurse anticipate first?
A. Administration of a diuretic
B. Initiation of a large-bore IV with rapid fluid resuscitation [CORRECT]
C. Administration of a beta-blocker
D. Placement of a central venous pressure catheter
Correct Answer: B
Rationale: This patient is presenting with hypovolemic shock secondary to suspected intra-abdominal hemorrhage. The first priority is
restoring intravascular volume through large-bore IV access and rapid fluid resuscitation. Diuretics would worsen hypovolemia,
beta-blockers would further decrease blood pressure and cardiac output, and while a CVP catheter may be needed, fluid resuscitation
takes priority over central line placement.
Q6: A patient with septic shock is receiving norepinephrine (Levophed) via continuous IV infusion. Which finding
indicates the medication is achieving its therapeutic effect?
A. Heart rate decreased from 110 to 90 bpm
B. Blood pressure increased from 78/50 to 100/65 mmHg [CORRECT]
C. Urine output decreased from 40 to 20 mL/hr
D. Temperature decreased from 39.2C to 37.8C
Correct Answer: B
Rationale: Norepinephrine is a potent alpha-adrenergic agonist that causes vasoconstriction, thereby increasing blood pressure. An
increase in MAP is the primary therapeutic goal. While a decreased heart rate may occur, the main purpose is blood pressure support.
Decreased urine output would indicate worsening perfusion, and temperature reduction is not the intended effect of norepinephrine.
Q7: A 25-year-old patient arrives at the ED after a diving accident with a suspected spinal cord injury at C6. Vital
signs show blood pressure 80/50 mmHg, heart rate 52 bpm, and warm, dry skin. Which type of shock is this patient
most likely experiencing?
Page 2
, NUR 2755 Exam 2 | Multidimensional Care IV | Rasmussen University | 2026-2027
A. Hypovolemic shock
B. Cardiogenic shock
C. Neurogenic shock [CORRECT]
D. Anaphylactic shock
Correct Answer: C
Rationale: Neurogenic shock results from loss of sympathetic tone below the level of spinal cord injury, causing vasodilation and
unopposed parasympathetic activity. The hallmark findings of neurogenic shock are hypotension with bradycardia and warm, dry
skin (due to loss of vasoconstriction). Hypovolemic and cardiogenic shock typically present with tachycardia and cool, clammy skin.
Q8: A patient in the progressive stage of shock has the following laboratory results: lactate 6.2 mmol/L, base deficit
-8 mEq/L, and fibrinogen 120 mg/dL. Which complication should the nurse monitor for most closely?
A. Chronic obstructive pulmonary disease
B. Disseminated intravascular coagulation (DIC) [CORRECT]
C. Type 2 diabetes mellitus
D. Chronic kidney disease
Correct Answer: B
Rationale: The elevated lactate, negative base deficit, and decreased fibrinogen indicate tissue hypoperfusion, metabolic acidosis, and
coagulation factor consumption, which are hallmark findings of DIC. DIC is a serious complication of progressive shock in which the
coagulation cascade is abnormally activated, consuming clotting factors and platelets while simultaneously causing microthrombi
formation and bleeding.
Q9: According to the Surviving Sepsis Campaign guidelines, within how many hours should broad-spectrum
antibiotics be administered after recognizing sepsis?
A. Within 1 hour [CORRECT]
B. Within 3 hours
C. Within 6 hours
D. Within 12 hours
Correct Answer: A
Rationale: The Surviving Sepsis Campaign recommends administering broad-spectrum antibiotics within 1 hour of recognition of
sepsis or septic shock. Early antibiotic administration is strongly associated with reduced mortality. Waiting 3 hours or longer
significantly increases the risk of death, as the infection continues to trigger an uncontrolled inflammatory response.
Q10: A patient in septic shock has not responded adequately to norepinephrine at the maximum dose. Which
vasopressor does the Surviving Sepsis Campaign recommend adding as a second-line agent?
A. Dopamine
B. Epinephrine
C. Vasopressin [CORRECT]
D. Dobutamine
Correct Answer: C
Rationale: The Surviving Sepsis Campaign guidelines recommend adding vasopressin at a fixed dose of 0.03 units/min as a
second-line vasopressor when norepinephrine alone is insufficient to maintain adequate MAP. Vasopressin acts on V1 receptors to
cause vasoconstriction and can reduce the required dose of norepinephrine. Dopamine is no longer recommended as a first-line agent
due to increased arrhythmia risk.
Q11: A 55-year-old patient with a massive pulmonary embolism suddenly develops severe hypotension, distended
jugular veins, and muffled heart sounds. Which type of shock is occurring?
Page 3
