NUR 4256C HESI RN ADVANCED
PATHOPHYSIOLOGY EXAM PREP
2026/2027 — 160 PRACTICE QUESTIONS
WITH VERIFIED ANSWERS AND
RATIONALES || most recent!!
Questions 1–20: Critical Care, Shock & Sepsis
1. A client develops hypotension, tachycardia, cool clammy
skin, and decreased urine output after major blood loss.
Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Neurogenic
D. Distributive
Answer: B
Rationale: Hemorrhage causes decreased circulating blood
volume, reducing venous return, stroke volume, and cardiac
output.
2. Which finding is most concerning in a client with suspected
septic shock?
A. Temperature of 38.2°C
B. Heart rate of 104/min
C. MAP of 58 mm Hg despite fluid administration
D. WBC count of 14,000/mm³
Answer: C
Rationale: Persistent hypotension despite adequate fluid
,resuscitation indicates severe circulatory failure associated
with septic shock.
3. Which physiologic change occurs first when cardiac output
decreases significantly?
A. Increased tissue perfusion
B. Reduced oxygen delivery to tissues
C. Increased urine production
D. Increased cellular ATP production
Answer: B
Rationale: Reduced cardiac output decreases systemic
oxygen delivery, forcing cells toward anaerobic metabolism.
4. A client in shock has elevated serum lactate. What does this
finding indicate?
A. Improved renal perfusion
B. Increased aerobic metabolism
C. Tissue hypoperfusion and anaerobic metabolism
D. Excessive oxygen delivery
Answer: C
Rationale: Elevated lactate commonly reflects inadequate
tissue oxygen delivery and increased anaerobic metabolism.
5. Which assessment finding is characteristic of early
hypovolemic shock?
A. Bradycardia
B. Tachycardia
C. Bounding pulses
D. Severe hypertension
Answer: B
Rationale: The sympathetic nervous system compensates for
reduced circulating volume by increasing heart rate.
,6. Which hormone promotes sodium and water retention
during hypovolemia?
A. Insulin
B. Aldosterone
C. Calcitonin
D. Thyroxine
Answer: B
Rationale: Aldosterone promotes renal sodium retention,
with water following sodium, helping restore circulating
volume.
7. A client with septic shock develops warm, flushed skin
during the early phase. What explains this finding?
A. Peripheral vasodilation
B. Severe vasoconstriction
C. Increased blood viscosity
D. Reduced inflammatory activity
Answer: A
Rationale: Early distributive shock may involve profound
vasodilation, producing warm skin despite inadequate tissue
perfusion.
8. Which complication is associated with prolonged shock?
A. Improved renal function
B. Multiple-organ dysfunction
C. Increased tissue oxygenation
D. Reduced metabolic demand only
Answer: B
Rationale: Prolonged tissue hypoperfusion can cause kidney,
liver, cardiac, pulmonary, and neurologic dysfunction.
, 9. Which assessment finding suggests worsening tissue
perfusion?
A. Clear mentation
B. Urine output of 10 mL/hr
C. Warm extremities
D. Normal capillary refill
Answer: B
Rationale: Markedly decreased urine output indicates
reduced renal perfusion and potentially worsening shock.
10. Which mediator contributes to vasodilation and increased
vascular permeability during systemic inflammation?
A. Histamine
B. Insulin
C. Erythropoietin
D. Melatonin
Answer: A
Rationale: Histamine increases vascular permeability and
contributes to vasodilation during inflammatory responses.
11. A client with sepsis becomes confused. What is the most
likely explanation?
A. Increased cerebral oxygen delivery
B. Cerebral hypoperfusion
C. Increased glucose uptake by neurons
D. Improved cardiac output
Answer: B
Rationale: Sepsis can impair cerebral perfusion and oxygen
delivery, producing altered mental status.
12. Which finding is consistent with disseminated
intravascular coagulation (DIC)?
PATHOPHYSIOLOGY EXAM PREP
2026/2027 — 160 PRACTICE QUESTIONS
WITH VERIFIED ANSWERS AND
RATIONALES || most recent!!
Questions 1–20: Critical Care, Shock & Sepsis
1. A client develops hypotension, tachycardia, cool clammy
skin, and decreased urine output after major blood loss.
Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Neurogenic
D. Distributive
Answer: B
Rationale: Hemorrhage causes decreased circulating blood
volume, reducing venous return, stroke volume, and cardiac
output.
2. Which finding is most concerning in a client with suspected
septic shock?
A. Temperature of 38.2°C
B. Heart rate of 104/min
C. MAP of 58 mm Hg despite fluid administration
D. WBC count of 14,000/mm³
Answer: C
Rationale: Persistent hypotension despite adequate fluid
,resuscitation indicates severe circulatory failure associated
with septic shock.
3. Which physiologic change occurs first when cardiac output
decreases significantly?
A. Increased tissue perfusion
B. Reduced oxygen delivery to tissues
C. Increased urine production
D. Increased cellular ATP production
Answer: B
Rationale: Reduced cardiac output decreases systemic
oxygen delivery, forcing cells toward anaerobic metabolism.
4. A client in shock has elevated serum lactate. What does this
finding indicate?
A. Improved renal perfusion
B. Increased aerobic metabolism
C. Tissue hypoperfusion and anaerobic metabolism
D. Excessive oxygen delivery
Answer: C
Rationale: Elevated lactate commonly reflects inadequate
tissue oxygen delivery and increased anaerobic metabolism.
5. Which assessment finding is characteristic of early
hypovolemic shock?
A. Bradycardia
B. Tachycardia
C. Bounding pulses
D. Severe hypertension
Answer: B
Rationale: The sympathetic nervous system compensates for
reduced circulating volume by increasing heart rate.
,6. Which hormone promotes sodium and water retention
during hypovolemia?
A. Insulin
B. Aldosterone
C. Calcitonin
D. Thyroxine
Answer: B
Rationale: Aldosterone promotes renal sodium retention,
with water following sodium, helping restore circulating
volume.
7. A client with septic shock develops warm, flushed skin
during the early phase. What explains this finding?
A. Peripheral vasodilation
B. Severe vasoconstriction
C. Increased blood viscosity
D. Reduced inflammatory activity
Answer: A
Rationale: Early distributive shock may involve profound
vasodilation, producing warm skin despite inadequate tissue
perfusion.
8. Which complication is associated with prolonged shock?
A. Improved renal function
B. Multiple-organ dysfunction
C. Increased tissue oxygenation
D. Reduced metabolic demand only
Answer: B
Rationale: Prolonged tissue hypoperfusion can cause kidney,
liver, cardiac, pulmonary, and neurologic dysfunction.
, 9. Which assessment finding suggests worsening tissue
perfusion?
A. Clear mentation
B. Urine output of 10 mL/hr
C. Warm extremities
D. Normal capillary refill
Answer: B
Rationale: Markedly decreased urine output indicates
reduced renal perfusion and potentially worsening shock.
10. Which mediator contributes to vasodilation and increased
vascular permeability during systemic inflammation?
A. Histamine
B. Insulin
C. Erythropoietin
D. Melatonin
Answer: A
Rationale: Histamine increases vascular permeability and
contributes to vasodilation during inflammatory responses.
11. A client with sepsis becomes confused. What is the most
likely explanation?
A. Increased cerebral oxygen delivery
B. Cerebral hypoperfusion
C. Increased glucose uptake by neurons
D. Improved cardiac output
Answer: B
Rationale: Sepsis can impair cerebral perfusion and oxygen
delivery, producing altered mental status.
12. Which finding is consistent with disseminated
intravascular coagulation (DIC)?
