NU 185 Exam 4 - Med-Surg II (2026)
Actual Questions and Answers - Critical Care Nursing Focus
80 Questions | Comprehensive Rationales | 100% Verified
Section 1: Critical Care Nursing (Shock States, Sepsis, MODS, and ARDS)
Q1. A 42-year-old male arrives in the emergency department after a motor vehicle crash. He is tachycardic (HR 128),
hypotensive (BP 82/50), and has cool, clammy skin. His capillary refill is 5 seconds. Which type of shock is this
patient most likely experiencing?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Septic shock
D. Anaphylactic shock
Correct Answer: B
Rationale: This patient presents with classic signs of hypovolemic shock: tachycardia, hypotension, cool and clammy skin, and delayed
capillary refill secondary to trauma and suspected hemorrhage. Hypovolemic shock results from decreased intravascular volume leading
to inadequate tissue perfusion. Cardiogenic shock typically presents with JVD and pulmonary edema. Septic shock usually presents with
fever and warm skin initially. Anaphylactic shock presents with urticaria and bronchospasm.
Q2. A nurse is caring for a patient in septic shock who has received 30 mL/kg of crystalloid fluids but remains
hypotensive with a MAP of 58 mmHg. Which vasopressor should the nurse expect to be initiated FIRST?
A. Dopamine
B. Epinephrine
C. Norepinephrine [CORRECT]
D. Vasopressin
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock per the Surviving Sepsis Campaign guidelines. It is a potent alpha-1
agonist that causes vasoconstriction to increase MAP, with some beta-1 activity supporting cardiac output. Dopamine is a second-line
agent associated with higher arrhythmia risk. Epinephrine is reserved for refractory shock. Vasopressin may be added as a second agent
but is not first-line.
Q3. A patient with suspected sepsis is being screened using the qSOFA criteria. Which of the following findings
would meet the qSOFA threshold for increased risk of mortality?
A. Temperature of 38.8 degrees C (101.8 degrees F)
B. Respiratory rate of 24 breaths/min [CORRECT]
C. Heart rate of 112 beats/min
D. White blood cell count of 14,000/mm3
Correct Answer: B
Rationale: qSOFA (quick Sequential Organ Failure Assessment) uses three criteria: altered mental status, systolic blood pressure of 100
mmHg or less, and respiratory rate of 22 breaths/min or greater. A respiratory rate of 24 meets the qSOFA threshold. Fever, tachycardia,
and elevated WBC count are part of the SIRS criteria but are not components of qSOFA. A score of 2 or more on qSOFA indicates
increased risk of poor outcomes.
,Q4. A 28-year-old female is brought to the ED with urticaria, angioedema of the face and lips, stridor, and
hypotension (BP 78/50) after receiving IV penicillin. What is the FIRST nursing action?
A. Administer diphenhydramine 50 mg IV push
B. Administer methylprednisolone 125 mg IV
C. Administer epinephrine 0.3-0.5 mg IM in the anterolateral thigh [CORRECT]
D. Establish IV access and begin rapid crystalloid infusion
Correct Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylaxis and must be administered immediately. It causes alpha-1 mediated
vasoconstriction to reverse hypotension and bronchodilation via beta-2 receptors to relieve airway obstruction. The IM route in the
anterolateral thigh provides the most rapid absorption. Antihistamines and corticosteroids are important second-line agents but must not
delay epinephrine administration, which is the only life-saving intervention.
Q5. A patient in cardiogenic shock has a cardiac output of 3.2 L/min, systemic vascular resistance (SVR) of 1800
dynes/sec/cm5, and a pulmonary artery wedge pressure (PAWP) of 22 mmHg. Which pharmacological agent would
the nurse anticipate administering to improve this patient's cardiac output?
A. Norepinephrine
B. Dobutamine [CORRECT]
C. Vasopressin
D. Phenylephrine
Correct Answer: B
Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility and cardiac output, making it the drug of choice for
cardiogenic shock with low cardiac output. This patient has elevated SVR and elevated PAWP, indicating pump failure with increased
afterload. Dobutamine also causes mild vasodilation (beta-2 effect), which can reduce afterload and further improve cardiac output.
Norepinephrine, vasopressin, and phenylephrine are primarily vasoconstrictors that would increase afterload and worsen cardiogenic
shock.
Q6. A patient with septic shock has a lactate level of 6.2 mmol/L. The nurse understands that elevated lactate in sepsis
indicates which of the following?
A. The liver is unable to metabolize lactate due to hepatic dysfunction
B. Tissue hypoperfusion and anaerobic metabolism are occurring [CORRECT]
C. The patient has developed metabolic alkalosis from bicarbonate loss
D. The infection has entered the bloodstream and is causing hemolysis
Correct Answer: B
Rationale: Elevated lactate in sepsis indicates tissue hypoperfusion and a shift to anaerobic metabolism. When oxygen delivery to tissues is
inadequate, cells convert from aerobic to anaerobic metabolism, producing lactic acid as a byproduct. A lactate level of 6.2 mmol/L is
significantly elevated (normal is less than 2.0) and suggests severe sepsis with inadequate tissue perfusion. Serial lactate measurements are
used to guide resuscitation, with the goal of lactate clearance of at least 10% per hour.
Q7. The nurse is caring for a patient who developed disseminated intravascular coagulation (DIC) secondary to severe
sepsis. Which laboratory findings are most consistent with DIC?
A. Elevated platelet count, prolonged PT, elevated fibrinogen
B. Decreased platelet count, prolonged PT, and decreased fibrinogen [CORRECT]
C. Decreased platelet count, shortened PT, and elevated D-dimer only
D. Normal platelet count, normal PT, elevated fibrin degradation products
Correct Answer: B
, Rationale: DIC is characterized by widespread activation of the coagulation cascade, consuming clotting factors and platelets. This results
in decreased platelet count (thrombocytopenia), prolonged PT and aPTT (factor consumption), decreased fibrinogen (consumption), and
elevated D-dimer and fibrin degradation products (evidence of fibrinolysis). DIC causes both thrombotic and hemorrhagic complications
simultaneously. Treatment focuses on addressing the underlying cause, replacing blood products, and managing bleeding.
Q8. A 65-year-old patient with septic shock is receiving norepinephrine at 0.3 mcg/kg/min. The nurse notes the
patient's blood pressure is now 110/70 mmHg with a MAP of 83 mmHg. The nurse should recognize that which of the
following is the target MAP for septic shock resuscitation?
A. 60 mmHg
B. 65 mmHg [CORRECT]
C. 70 mmHg
D. 75 mmHg
Correct Answer: B
Rationale: The Surviving Sepsis Campaign recommends a target MAP of 65 mmHg or greater during initial resuscitation of septic shock.
This target ensures adequate organ perfusion pressure. A MAP of 83 mmHg exceeds the target, and the nurse should monitor for potential
adverse effects of excessive vasopressor use such as digital ischemia, arrhythmias, and mesenteric ischemia. Some clinicians target higher
MAP (75-85 mmHg) in patients with chronic hypertension, but the standard initial target remains 65 mmHg.
Q9. A patient with hypovolemic shock has received 2 liters of lactated Ringer's solution over 30 minutes. The nurse
reassesses and finds the blood pressure has improved slightly but the patient remains tachycardic. Which intervention
should the nurse anticipate NEXT?
A. Initiating a vasopressor infusion
B. Administering a diuretic to prevent fluid overload
C. Preparing to administer blood products [CORRECT]
D. Decreasing the IV fluid rate to maintenance
Correct Answer: C
Rationale: When crystalloid fluid resuscitation fails to fully restore hemodynamic stability in hypovolemic shock, blood product
administration should be anticipated. This is especially true in trauma patients where hemorrhage is the likely cause. Packed red blood
cells restore oxygen-carrying capacity, and fresh frozen plasma and platelets may be needed for coagulopathy. Vasopressors are not
indicated in hypovolemic shock until volume is adequately restored. Diuretics would worsen hypovolemia.
Q10. A patient with multisystem organ dysfunction syndrome (MODS) has developed acute respiratory distress
syndrome (ARDS). The nurse understands that MODS is best described by which of the following statements?
A. It is a single organ failure that progresses predictably to death
B. It involves sequential failure of two or more organ systems resulting from an uncontrolled inflammatory response
[CORRECT]
C. It only occurs in patients with preexisting chronic organ disease
D. It is easily reversed with aggressive antibiotic therapy alone
Correct Answer: B
Rationale: MODS is defined as the progressive, sequential failure of two or more organ systems that occurs as a result of an uncontrolled
systemic inflammatory response, most commonly triggered by sepsis, severe trauma, or major surgery. It is not a single organ failure, does
not only occur in patients with preexisting disease, and is not simply reversed by antibiotics. MODS carries a high mortality rate (40-80%)
and management is primarily supportive while treating the underlying cause.
Q11. A nurse is reviewing the chart of a patient admitted with septic shock. The order reads: "Administer
broad-spectrum antibiotics within 1 hour of sepsis recognition." The nurse understands that the rationale for early
Actual Questions and Answers - Critical Care Nursing Focus
80 Questions | Comprehensive Rationales | 100% Verified
Section 1: Critical Care Nursing (Shock States, Sepsis, MODS, and ARDS)
Q1. A 42-year-old male arrives in the emergency department after a motor vehicle crash. He is tachycardic (HR 128),
hypotensive (BP 82/50), and has cool, clammy skin. His capillary refill is 5 seconds. Which type of shock is this
patient most likely experiencing?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Septic shock
D. Anaphylactic shock
Correct Answer: B
Rationale: This patient presents with classic signs of hypovolemic shock: tachycardia, hypotension, cool and clammy skin, and delayed
capillary refill secondary to trauma and suspected hemorrhage. Hypovolemic shock results from decreased intravascular volume leading
to inadequate tissue perfusion. Cardiogenic shock typically presents with JVD and pulmonary edema. Septic shock usually presents with
fever and warm skin initially. Anaphylactic shock presents with urticaria and bronchospasm.
Q2. A nurse is caring for a patient in septic shock who has received 30 mL/kg of crystalloid fluids but remains
hypotensive with a MAP of 58 mmHg. Which vasopressor should the nurse expect to be initiated FIRST?
A. Dopamine
B. Epinephrine
C. Norepinephrine [CORRECT]
D. Vasopressin
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock per the Surviving Sepsis Campaign guidelines. It is a potent alpha-1
agonist that causes vasoconstriction to increase MAP, with some beta-1 activity supporting cardiac output. Dopamine is a second-line
agent associated with higher arrhythmia risk. Epinephrine is reserved for refractory shock. Vasopressin may be added as a second agent
but is not first-line.
Q3. A patient with suspected sepsis is being screened using the qSOFA criteria. Which of the following findings
would meet the qSOFA threshold for increased risk of mortality?
A. Temperature of 38.8 degrees C (101.8 degrees F)
B. Respiratory rate of 24 breaths/min [CORRECT]
C. Heart rate of 112 beats/min
D. White blood cell count of 14,000/mm3
Correct Answer: B
Rationale: qSOFA (quick Sequential Organ Failure Assessment) uses three criteria: altered mental status, systolic blood pressure of 100
mmHg or less, and respiratory rate of 22 breaths/min or greater. A respiratory rate of 24 meets the qSOFA threshold. Fever, tachycardia,
and elevated WBC count are part of the SIRS criteria but are not components of qSOFA. A score of 2 or more on qSOFA indicates
increased risk of poor outcomes.
,Q4. A 28-year-old female is brought to the ED with urticaria, angioedema of the face and lips, stridor, and
hypotension (BP 78/50) after receiving IV penicillin. What is the FIRST nursing action?
A. Administer diphenhydramine 50 mg IV push
B. Administer methylprednisolone 125 mg IV
C. Administer epinephrine 0.3-0.5 mg IM in the anterolateral thigh [CORRECT]
D. Establish IV access and begin rapid crystalloid infusion
Correct Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylaxis and must be administered immediately. It causes alpha-1 mediated
vasoconstriction to reverse hypotension and bronchodilation via beta-2 receptors to relieve airway obstruction. The IM route in the
anterolateral thigh provides the most rapid absorption. Antihistamines and corticosteroids are important second-line agents but must not
delay epinephrine administration, which is the only life-saving intervention.
Q5. A patient in cardiogenic shock has a cardiac output of 3.2 L/min, systemic vascular resistance (SVR) of 1800
dynes/sec/cm5, and a pulmonary artery wedge pressure (PAWP) of 22 mmHg. Which pharmacological agent would
the nurse anticipate administering to improve this patient's cardiac output?
A. Norepinephrine
B. Dobutamine [CORRECT]
C. Vasopressin
D. Phenylephrine
Correct Answer: B
Rationale: Dobutamine is a beta-1 agonist that increases cardiac contractility and cardiac output, making it the drug of choice for
cardiogenic shock with low cardiac output. This patient has elevated SVR and elevated PAWP, indicating pump failure with increased
afterload. Dobutamine also causes mild vasodilation (beta-2 effect), which can reduce afterload and further improve cardiac output.
Norepinephrine, vasopressin, and phenylephrine are primarily vasoconstrictors that would increase afterload and worsen cardiogenic
shock.
Q6. A patient with septic shock has a lactate level of 6.2 mmol/L. The nurse understands that elevated lactate in sepsis
indicates which of the following?
A. The liver is unable to metabolize lactate due to hepatic dysfunction
B. Tissue hypoperfusion and anaerobic metabolism are occurring [CORRECT]
C. The patient has developed metabolic alkalosis from bicarbonate loss
D. The infection has entered the bloodstream and is causing hemolysis
Correct Answer: B
Rationale: Elevated lactate in sepsis indicates tissue hypoperfusion and a shift to anaerobic metabolism. When oxygen delivery to tissues is
inadequate, cells convert from aerobic to anaerobic metabolism, producing lactic acid as a byproduct. A lactate level of 6.2 mmol/L is
significantly elevated (normal is less than 2.0) and suggests severe sepsis with inadequate tissue perfusion. Serial lactate measurements are
used to guide resuscitation, with the goal of lactate clearance of at least 10% per hour.
Q7. The nurse is caring for a patient who developed disseminated intravascular coagulation (DIC) secondary to severe
sepsis. Which laboratory findings are most consistent with DIC?
A. Elevated platelet count, prolonged PT, elevated fibrinogen
B. Decreased platelet count, prolonged PT, and decreased fibrinogen [CORRECT]
C. Decreased platelet count, shortened PT, and elevated D-dimer only
D. Normal platelet count, normal PT, elevated fibrin degradation products
Correct Answer: B
, Rationale: DIC is characterized by widespread activation of the coagulation cascade, consuming clotting factors and platelets. This results
in decreased platelet count (thrombocytopenia), prolonged PT and aPTT (factor consumption), decreased fibrinogen (consumption), and
elevated D-dimer and fibrin degradation products (evidence of fibrinolysis). DIC causes both thrombotic and hemorrhagic complications
simultaneously. Treatment focuses on addressing the underlying cause, replacing blood products, and managing bleeding.
Q8. A 65-year-old patient with septic shock is receiving norepinephrine at 0.3 mcg/kg/min. The nurse notes the
patient's blood pressure is now 110/70 mmHg with a MAP of 83 mmHg. The nurse should recognize that which of the
following is the target MAP for septic shock resuscitation?
A. 60 mmHg
B. 65 mmHg [CORRECT]
C. 70 mmHg
D. 75 mmHg
Correct Answer: B
Rationale: The Surviving Sepsis Campaign recommends a target MAP of 65 mmHg or greater during initial resuscitation of septic shock.
This target ensures adequate organ perfusion pressure. A MAP of 83 mmHg exceeds the target, and the nurse should monitor for potential
adverse effects of excessive vasopressor use such as digital ischemia, arrhythmias, and mesenteric ischemia. Some clinicians target higher
MAP (75-85 mmHg) in patients with chronic hypertension, but the standard initial target remains 65 mmHg.
Q9. A patient with hypovolemic shock has received 2 liters of lactated Ringer's solution over 30 minutes. The nurse
reassesses and finds the blood pressure has improved slightly but the patient remains tachycardic. Which intervention
should the nurse anticipate NEXT?
A. Initiating a vasopressor infusion
B. Administering a diuretic to prevent fluid overload
C. Preparing to administer blood products [CORRECT]
D. Decreasing the IV fluid rate to maintenance
Correct Answer: C
Rationale: When crystalloid fluid resuscitation fails to fully restore hemodynamic stability in hypovolemic shock, blood product
administration should be anticipated. This is especially true in trauma patients where hemorrhage is the likely cause. Packed red blood
cells restore oxygen-carrying capacity, and fresh frozen plasma and platelets may be needed for coagulopathy. Vasopressors are not
indicated in hypovolemic shock until volume is adequately restored. Diuretics would worsen hypovolemia.
Q10. A patient with multisystem organ dysfunction syndrome (MODS) has developed acute respiratory distress
syndrome (ARDS). The nurse understands that MODS is best described by which of the following statements?
A. It is a single organ failure that progresses predictably to death
B. It involves sequential failure of two or more organ systems resulting from an uncontrolled inflammatory response
[CORRECT]
C. It only occurs in patients with preexisting chronic organ disease
D. It is easily reversed with aggressive antibiotic therapy alone
Correct Answer: B
Rationale: MODS is defined as the progressive, sequential failure of two or more organ systems that occurs as a result of an uncontrolled
systemic inflammatory response, most commonly triggered by sepsis, severe trauma, or major surgery. It is not a single organ failure, does
not only occur in patients with preexisting disease, and is not simply reversed by antibiotics. MODS carries a high mortality rate (40-80%)
and management is primarily supportive while treating the underlying cause.
Q11. A nurse is reviewing the chart of a patient admitted with septic shock. The order reads: "Administer
broad-spectrum antibiotics within 1 hour of sepsis recognition." The nurse understands that the rationale for early
