1|Page
NUR 265: ADVANCED MEDICAL-SURGICAL
NURSING – COMPREHENSIVE EXAM 3 TEST
BANK (2026-2027)
| Section | Topic | Number of Questions |
|---------|-------|---------------------|
| 1 | Shock (Hypovolemic, Cardiogenic, Distributive, Obstructive) | 40 |
| 2 | Acute Respiratory Distress Syndrome (ARDS) | 30 |
| 3 | Multiple Organ Dysfunction Syndrome (MODS) | 25 |
| 4 | Burns (Thermal, Chemical, Electrical, Inhalation) | 35 |
| 5 | Emergency Nursing & Disaster Triage (START, MCI, CBRNE) | 30
|
| 6 | Leadership/Management (Delegation, Prioritization, Ethics, Safety) |
45 |
| **Total** | | **205** |
---
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# SECTION 1: SHOCK (40 questions)
**1. A patient with septic shock has a mean arterial pressure (MAP) of
55 mm Hg and a lactate of 4.5 mmol/L. Which order should the nurse
implement first?**
A) Administer norepinephrine IV
B) Give 30 mL/kg crystalloid bolus
C) Draw blood cultures
D) Start broad-spectrum antibiotics
> **Correct Answer: B** – In septic shock, initial fluid resuscitation (30
mL/kg) is priority before vasopressors. MAP <65 and elevated lactate
indicate hypoperfusion. Cultures and antibiotics should follow quickly
but fluids come first.
**2. Which type of shock is characterized by decreased systemic
vascular resistance (SVR), increased cardiac output (CO), and warm,
flushed skin?**
A) Cardiogenic shock
B) Hypovolemic shock
C) Distributive shock
D) Obstructive shock
> **Correct Answer: C** – Distributive shock (sepsis, anaphylaxis,
neurogenic) causes vasodilation → low SVR, high or normal CO, warm
extremities.
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**3. A patient in cardiogenic shock has an intra-aortic balloon pump
(IABP). Which finding indicates the device is working effectively?**
A) Decreased urine output
B) Narrowed pulse pressure
C) Increased MAP and decreased PCWP
D) Balloon inflates during systole
> **Correct Answer: C** – IABP inflates during diastole to increase
coronary perfusion, deflates in systole to reduce afterload → improved
MAP, decreased preload (PCWP).
**4. A nurse assesses a patient with hypovolemic shock. Which finding
would be expected?**
A) Jugular vein distention
B) Bounding pulses
C) Cool, clammy skin
D) Increased urine output
> **Correct Answer: C** – Hypovolemia causes compensatory
vasoconstriction → cool, clammy skin, tachycardia, decreased urine
output, flat neck veins.
**5. Which laboratory finding is most consistent with early septic
shock?**
A) Decreased white blood cell count
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B) Elevated procalcitonin
C) Metabolic alkalosis
D) Thrombocytosis
> **Correct Answer: B** – Procalcitonin rises rapidly in bacterial
sepsis. Early septic shock may show leukocytosis or leukopenia, lactic
acidosis, and thrombocytopenia.
**6. A patient with neurogenic shock after a C5 spinal cord injury has a
heart rate of 52 bpm and BP 80/50 mm Hg. Which intervention is most
appropriate?**
A) Atropine IV push
B) Norepinephrine infusion
C) Large volume crystalloid bolus
D) Phenylephrine infusion
> **Correct Answer: C** – Neurogenic shock causes loss of
sympathetic tone → bradycardia and hypotension. Initial treatment is
fluid resuscitation, then vasopressors (often phenylephrine or
norepinephrine). Atropine is for symptomatic bradycardia.
**7. In anaphylactic shock, which medication should be administered
first?**
A) Diphenhydramine IV
B) Methylprednisolone IV
C) Epinephrine IM
NUR 265: ADVANCED MEDICAL-SURGICAL
NURSING – COMPREHENSIVE EXAM 3 TEST
BANK (2026-2027)
| Section | Topic | Number of Questions |
|---------|-------|---------------------|
| 1 | Shock (Hypovolemic, Cardiogenic, Distributive, Obstructive) | 40 |
| 2 | Acute Respiratory Distress Syndrome (ARDS) | 30 |
| 3 | Multiple Organ Dysfunction Syndrome (MODS) | 25 |
| 4 | Burns (Thermal, Chemical, Electrical, Inhalation) | 35 |
| 5 | Emergency Nursing & Disaster Triage (START, MCI, CBRNE) | 30
|
| 6 | Leadership/Management (Delegation, Prioritization, Ethics, Safety) |
45 |
| **Total** | | **205** |
---
,2|Page
# SECTION 1: SHOCK (40 questions)
**1. A patient with septic shock has a mean arterial pressure (MAP) of
55 mm Hg and a lactate of 4.5 mmol/L. Which order should the nurse
implement first?**
A) Administer norepinephrine IV
B) Give 30 mL/kg crystalloid bolus
C) Draw blood cultures
D) Start broad-spectrum antibiotics
> **Correct Answer: B** – In septic shock, initial fluid resuscitation (30
mL/kg) is priority before vasopressors. MAP <65 and elevated lactate
indicate hypoperfusion. Cultures and antibiotics should follow quickly
but fluids come first.
**2. Which type of shock is characterized by decreased systemic
vascular resistance (SVR), increased cardiac output (CO), and warm,
flushed skin?**
A) Cardiogenic shock
B) Hypovolemic shock
C) Distributive shock
D) Obstructive shock
> **Correct Answer: C** – Distributive shock (sepsis, anaphylaxis,
neurogenic) causes vasodilation → low SVR, high or normal CO, warm
extremities.
,3|Page
**3. A patient in cardiogenic shock has an intra-aortic balloon pump
(IABP). Which finding indicates the device is working effectively?**
A) Decreased urine output
B) Narrowed pulse pressure
C) Increased MAP and decreased PCWP
D) Balloon inflates during systole
> **Correct Answer: C** – IABP inflates during diastole to increase
coronary perfusion, deflates in systole to reduce afterload → improved
MAP, decreased preload (PCWP).
**4. A nurse assesses a patient with hypovolemic shock. Which finding
would be expected?**
A) Jugular vein distention
B) Bounding pulses
C) Cool, clammy skin
D) Increased urine output
> **Correct Answer: C** – Hypovolemia causes compensatory
vasoconstriction → cool, clammy skin, tachycardia, decreased urine
output, flat neck veins.
**5. Which laboratory finding is most consistent with early septic
shock?**
A) Decreased white blood cell count
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B) Elevated procalcitonin
C) Metabolic alkalosis
D) Thrombocytosis
> **Correct Answer: B** – Procalcitonin rises rapidly in bacterial
sepsis. Early septic shock may show leukocytosis or leukopenia, lactic
acidosis, and thrombocytopenia.
**6. A patient with neurogenic shock after a C5 spinal cord injury has a
heart rate of 52 bpm and BP 80/50 mm Hg. Which intervention is most
appropriate?**
A) Atropine IV push
B) Norepinephrine infusion
C) Large volume crystalloid bolus
D) Phenylephrine infusion
> **Correct Answer: C** – Neurogenic shock causes loss of
sympathetic tone → bradycardia and hypotension. Initial treatment is
fluid resuscitation, then vasopressors (often phenylephrine or
norepinephrine). Atropine is for symptomatic bradycardia.
**7. In anaphylactic shock, which medication should be administered
first?**
A) Diphenhydramine IV
B) Methylprednisolone IV
C) Epinephrine IM
