NUR 265 Exam 1 Versions 1-3 Actual Exam 2026/2027 –
Complete Q&A with Detailed Rationales | 100% Verified |
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Section A: Exam 1 Version 1 - Shock States & Hemodynamic
Monitoring (20 Questions)
Q1: A patient in the progressive stage of shock presents with BP 78/50, HR 128, RR 32,
urine output 15 mL/hr, and cool, clammy skin. Which pathophysiological change is
occurring?
A. Vasodilation and increased perfusion
B. Compensatory mechanisms are maintaining adequate perfusion
C. Cellular hypoxia, anaerobic metabolism, and lactic acidosis [CORRECT]
D. Cellular hypoxia, anaerobic metabolism, and lactic acidosis [CORRECT]
Correct Answer: C
Rationale: The progressive stage of shock is characterized by failure of compensatory
mechanisms, leading to cellular hypoxia, anaerobic metabolism, lactic acidosis, and
organ dysfunction. Option A describes distributive shock, not progressive stage. Option
B describes the compensatory stage.
Q2: A patient with septic shock has a CVP of 4 mmHg, PAOP of 8 mmHg, and CI of 1.8
L/min/m². Which hemodynamic profile is present?
,A. Hypervolemia with high cardiac output
B. Hypovolemia with low cardiac output [CORRECT]
C. Hypovolemia with low cardiac output [CORRECT]
D. Normal volume with high afterload
Correct Answer: C
Rationale: CVP 4 mmHg (low-normal) and CI 1.8 (low) indicate hypovolemia with
decreased cardiac output despite normal PAOP. In early septic shock, vasodilation
causes relative hypovolemia. Option A contradicts the low CI. Option D is inconsistent
with the data.
Q3: Which vasopressor is the first-line agent for septic shock per Surviving Sepsis
Campaign guidelines?
A. Dopamine
B. Epinephrine
C. Norepinephrine [CORRECT]
D. Norepinephrine [CORRECT]
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock due to its potent
vasoconstrictive effects with less tachycardia than dopamine. Dopamine (Option A) is
no longer recommended due to increased arrhythmia risk. Epinephrine (Option B) is
second-line.
,Q4: A patient in cardiogenic shock has a PAOP of 22 mmHg, CI of 1.9 L/min/m², and
SVR of 1500 dynes/sec/cm⁻⁵. Which intervention is most appropriate?
A. Aggressive fluid bolus
B. Diuretics and afterload reduction [CORRECT]
C. Diuretics and afterload reduction [CORRECT]
D. Volume expansion with colloids
Correct Answer: C
Rationale: Elevated PAOP (22 mmHg, normal 6-12) indicates fluid overload/pulmonary
congestion. Low CI (1.9) with high SVR (1500) indicates afterload excess. Diuretics
reduce preload, and afterload reduction (nitroprusside, milrinone) improves cardiac
output. Option A worsens pulmonary edema.
Q5: A patient with anaphylactic shock presents with hypotension, bronchospasm, and
urticaria. Which medication is the priority intervention?
A. Diphenhydramine
B. Epinephrine 1:1000 IM [CORRECT]
C. Epinephrine 1:1000 IM [CORRECT]
D. Methylprednisolone
Correct Answer: C
, Rationale: Epinephrine is the first-line, life-saving treatment for anaphylaxis, reversing
vasodilation, bronchospasm, and edema via alpha-1 and beta-2 agonism.
Antihistamines (Option A) and corticosteroids (Option D) are adjunctive, not priority.
Q6: Which hemodynamic parameter directly reflects left ventricular preload?
A. CVP
B. PAOP (pulmonary artery occlusion pressure) [CORRECT]
C. PAOP (pulmonary artery occlusion pressure) [CORRECT]
D. SVR
Correct Answer: C
Rationale: PAOP (wedge pressure) estimates left atrial pressure and left ventricular
end-diastolic pressure (preload). CVP (Option A) reflects right ventricular preload. SVR
(Option D) reflects afterload.
Q7: A patient with hypovolemic shock receives 2 L of lactated Ringer's. Reassessment
shows CVP increased from 2 to 8 mmHg, but CI remains 1.8 L/min/m². Which action is
most appropriate?
A. Continue fluid bolus
B. Add an inotrope (dobutamine) [CORRECT]
C. Add an inotrope (dobutamine) [CORRECT]
D. Administer a vasopressor
Complete Q&A with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
Section A: Exam 1 Version 1 - Shock States & Hemodynamic
Monitoring (20 Questions)
Q1: A patient in the progressive stage of shock presents with BP 78/50, HR 128, RR 32,
urine output 15 mL/hr, and cool, clammy skin. Which pathophysiological change is
occurring?
A. Vasodilation and increased perfusion
B. Compensatory mechanisms are maintaining adequate perfusion
C. Cellular hypoxia, anaerobic metabolism, and lactic acidosis [CORRECT]
D. Cellular hypoxia, anaerobic metabolism, and lactic acidosis [CORRECT]
Correct Answer: C
Rationale: The progressive stage of shock is characterized by failure of compensatory
mechanisms, leading to cellular hypoxia, anaerobic metabolism, lactic acidosis, and
organ dysfunction. Option A describes distributive shock, not progressive stage. Option
B describes the compensatory stage.
Q2: A patient with septic shock has a CVP of 4 mmHg, PAOP of 8 mmHg, and CI of 1.8
L/min/m². Which hemodynamic profile is present?
,A. Hypervolemia with high cardiac output
B. Hypovolemia with low cardiac output [CORRECT]
C. Hypovolemia with low cardiac output [CORRECT]
D. Normal volume with high afterload
Correct Answer: C
Rationale: CVP 4 mmHg (low-normal) and CI 1.8 (low) indicate hypovolemia with
decreased cardiac output despite normal PAOP. In early septic shock, vasodilation
causes relative hypovolemia. Option A contradicts the low CI. Option D is inconsistent
with the data.
Q3: Which vasopressor is the first-line agent for septic shock per Surviving Sepsis
Campaign guidelines?
A. Dopamine
B. Epinephrine
C. Norepinephrine [CORRECT]
D. Norepinephrine [CORRECT]
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock due to its potent
vasoconstrictive effects with less tachycardia than dopamine. Dopamine (Option A) is
no longer recommended due to increased arrhythmia risk. Epinephrine (Option B) is
second-line.
,Q4: A patient in cardiogenic shock has a PAOP of 22 mmHg, CI of 1.9 L/min/m², and
SVR of 1500 dynes/sec/cm⁻⁵. Which intervention is most appropriate?
A. Aggressive fluid bolus
B. Diuretics and afterload reduction [CORRECT]
C. Diuretics and afterload reduction [CORRECT]
D. Volume expansion with colloids
Correct Answer: C
Rationale: Elevated PAOP (22 mmHg, normal 6-12) indicates fluid overload/pulmonary
congestion. Low CI (1.9) with high SVR (1500) indicates afterload excess. Diuretics
reduce preload, and afterload reduction (nitroprusside, milrinone) improves cardiac
output. Option A worsens pulmonary edema.
Q5: A patient with anaphylactic shock presents with hypotension, bronchospasm, and
urticaria. Which medication is the priority intervention?
A. Diphenhydramine
B. Epinephrine 1:1000 IM [CORRECT]
C. Epinephrine 1:1000 IM [CORRECT]
D. Methylprednisolone
Correct Answer: C
, Rationale: Epinephrine is the first-line, life-saving treatment for anaphylaxis, reversing
vasodilation, bronchospasm, and edema via alpha-1 and beta-2 agonism.
Antihistamines (Option A) and corticosteroids (Option D) are adjunctive, not priority.
Q6: Which hemodynamic parameter directly reflects left ventricular preload?
A. CVP
B. PAOP (pulmonary artery occlusion pressure) [CORRECT]
C. PAOP (pulmonary artery occlusion pressure) [CORRECT]
D. SVR
Correct Answer: C
Rationale: PAOP (wedge pressure) estimates left atrial pressure and left ventricular
end-diastolic pressure (preload). CVP (Option A) reflects right ventricular preload. SVR
(Option D) reflects afterload.
Q7: A patient with hypovolemic shock receives 2 L of lactated Ringer's. Reassessment
shows CVP increased from 2 to 8 mmHg, but CI remains 1.8 L/min/m². Which action is
most appropriate?
A. Continue fluid bolus
B. Add an inotrope (dobutamine) [CORRECT]
C. Add an inotrope (dobutamine) [CORRECT]
D. Administer a vasopressor
