MDC 3 EXAM QUESTIONS AND ANSWERS FULLY SOLVED
• The acute care nurse is providing care for an adult client who is in hypovolemic shock. The
nurse recognizes that antidiuretic hormone (ADH) plays a significant role in this health problem.
What assessment finding will the nurse likely observe related to the role of antidiuretic hormone
during hypovolemic shock?
A. Increased hunger
B. Decreased thirst
C. Decreased urinary output
D. Increased capillary perfusion
Rationale: During hypovolemic shock, a state of hypernatremia occurs. Hypernatremia stimulates
the release of ADH by the pituitary gland. ADH causes the kidneys to further retain water in an
effort to raise blood volume and blood pressure. In a hypovolemic state the body shifts blood away
from anything that is not a vital organ, so hunger is not an issue; thirst is increased as the body
tries to increase fluid volume; and capillary profusion decreases as the body shunts blood away
from the periphery and to the vital organs.
• The nurse is caring for a client whose worsening infection places the client at high risk for
shock. Which assessment finding would the nurse consider a potential sign of shock?
A. Elevated systolic blood pressure
B. Elevated mean arterial pressure (MAP)
C. Shallow, rapid respirations
D. Bradycardia
Rationale: A symptom of shock is shallow, rapid respirations. Systolic blood pressure drops in
shock, and MAP is less than 65 mm Hg. Bradycardia occurs in neurogenic shock; other states of
shock have tachycardia as a symptom. Infection can lead to septic shock.
• The nurse is caring for a client who is receiving large volumes of crystalloid fluid to treat
hypovolemic shock. In light of this intervention, for what sign or symptom should the nurse
monitor?
A. Hypothermia
,MDC 3 EXAM QUESTIONS AND ANSWERS FULLY SOLVED
B. Bradycardia
C. Coffee ground emesis
D. Pain
Rationale: Temperature should be monitored closely to ensure that rapid fluid resuscitation does
not precipitate hypothermia. IV fluids may need to be warmed during the administration of large
volumes. The nurse should monitor the client for cardiovascular overload and pulmonary edema
when large volumes of IV solution are given. Coffee ground emesis is an indication of a GI bleed,
not shock. Pain is related to cardiogenic shock.
• The nurse is caring for a client in intensive care unit whose condition is deteriorating. The
nurse receives orders to initiate an infusion of dopamine. Which assessments and interventions
should the nurse prioritize?
A. Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug
titration
B. Reviewing medications, performing a focused cardiovascular assessment, and providing
client education
C. Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral
edema
D. Routine monitoring of vital signs, monitoring the peripheral intravenous site, and providing
early discharge instructions
Rationale: Dopamine is a sympathomimetic agent that has varying vasoactive effects depending on
the dosage. When vasoactive medications are given, vital signs must be monitored frequently (at
least every 15 minutes until stable, or more often if indicated), not “routinely.” Vasoactive
medications should be given through a central, not peripheral, venous line because infiltration and
extravasation of some vasoactive medications can cause tissue necrosis and sloughing. High doses
can cause vasoconstriction, which increases afterload and thus increases cardiac workload.
Because this effect is undesirable in clients with cardiogenic shock, dopamine doses must be
carefully titrated. Reviewing medications and laboratory findings, monitoring urine output,
assessing for peripheral edema, performing a focused cardiovascular assessment, and providing
client education are important nursing tasks, but they are not specific to the administration of IV
vasoactive drugs.
• The nurse in intensive care unit is admitting a 57-year-old client with a diagnosis of
possible septic shock. The nurse's assessment reveals that the client has a normal blood
pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurse's
analysis of these data should lead to which preliminary conclusion?
,MDC 3 EXAM QUESTIONS AND ANSWERS FULLY SOLVED
A. The client is in the compensatory stage of shock.
B. The client is in the progressive stage of shock.
C. The client will stabilize and be released by tomorrow.
D. The client is in the irreversible stage of shock.
Rationale: In the compensatory stage of shock, the blood pressure remains within normal limits.
Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to
maintaining adequate cardiac output. Clients display the often-described "fight or flight" response.
The body shunts blood from organs such as the skin, kidneys, and gastrointestinal tract to the
brain and heart to ensure adequate blood supply to these vital organs. As a result, the skin is cool
and clammy, and bowel sounds are hypoactive. In progressive shock, the blood pressure drops. In
septic shock, the client's chance of survival is low and he will certainly not be released within 24
hours. If the client were in the irreversible stage of shock, his blood pressure would be very low
and his organs would be failing.
• The nurse in a rural nursing facility will be receiving a client in hypovolemic shock due to a
massive postpartum hemorrhage after giving birth at home. Which principle should guide the
nurse's administration of intravenous fluid?
A. 5% albumin is preferred because it is inexpensive and is always readily available.
B. Dextran should be given because it increases intravascular volume and counteracts
coagulopathy.
C. Whatever fluid is most readily available in the clinic should be given, due to the nature of the
emergency.
D. Lactated Ringer solution is ideal because it increases volume, buffers acidosis, and is the
best choice for clients with liver failure.
Rationale: The best fluid to treat shock remains controversial. In emergencies, the "best" fluid is
often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to
maximize intravascular volume. Both crystalloids and colloids can be administered to restore
intravascular volume. There is no consensus regarding whether crystalloids or colloids, such as
dextran and albumin, should be used; however, with crystalloids, more fluid is necessary to restore
intravascular volume. Albumin is very expensive and is a blood product so it is not always readily
available for use. Dextran does increase intravascular volume, but it increases the risk for
coagulopathy. Lactated Ringer is a good solution choice because it increases volume and buffers
acidosis, but it should not be used in clients with liver failure because the liver is unable to convert
lactate to bicarbonate. This client does not have liver disease.
• The nurse in the intensive care unit is caring for a 47-year-old, obese client who is in shock
following a motor vehicle accident. What would be the main challenge in meeting this client's
elevated energy requirements during prolonged rehabilitation?
, MDC 3 EXAM QUESTIONS AND ANSWERS FULLY SOLVED
A. Loss of adipose tissue
B. Loss of skeletal muscle
C. Inability to convert adipose tissue to energy
D. Inability to maintain normal body mass
Rationale: Nutritional energy requirements are met by breaking down lean body mass. In this
catabolic process, skeletal muscle mass is broken down even when the client has large stores of fat
or adipose tissue. Loss of skeletal muscle greatly prolongs the client's recovery time. Loss of
adipose tissue, the inability to convert adipose tissue to energy, and the inability to maintain
normal body mass are not main concerns in meeting nutritional energy requirements for this
client.
• The nurse in the emergency department is caring for a client recently admitted with a likely
myocardial infarction (MI). The nurse understands that the client's heart is pumping an
inadequate supply of oxygen to the tissues. The nurse knows the client is at an increased risk for
MI due to which factor?
A. Arrhythmias
B. Elevated B-natriuretic peptide (BNP)
C. Use of thrombolytics
D. Dehydration
Rationale: Cardiogenic shock occurs when the heart's ability to pump blood is impaired and the
supply of oxygen is inadequate for the heart and tissues. An elevated BNP is noted after an MI has
occurred and does not increase risk. Use of thrombolytics decreases risk of developing blood clots.
Dehydration does not lead to MI.
• The nurse is caring for a client admitted with cardiogenic shock. The client is experiencing
chest pain and there is an order for the administration of morphine. In addition to pain control,
what is the main rationale for administering morphine to this client?
A. It promotes coping and slows catecholamine release. B. It stimulates the client so he or she is
more alert.
C. It decreases gastric secretions.
D. It dilates the blood vessels.
Rationale: For clients experiencing chest pain, morphine is the drug of choice because it dilates the
blood vessels and controls the client's anxiety. Morphine would not be prescribed to promote
coping or to stimulate the client. The rationale behind using morphine would not be to decrease
gastric secretions.
• The nurse is providing care for a client who is in shock after massive blood loss from a
workplace injury. The nurse recognizes that many of the findings from the most recent
assessment are due to compensatory mechanisms. What
• The acute care nurse is providing care for an adult client who is in hypovolemic shock. The
nurse recognizes that antidiuretic hormone (ADH) plays a significant role in this health problem.
What assessment finding will the nurse likely observe related to the role of antidiuretic hormone
during hypovolemic shock?
A. Increased hunger
B. Decreased thirst
C. Decreased urinary output
D. Increased capillary perfusion
Rationale: During hypovolemic shock, a state of hypernatremia occurs. Hypernatremia stimulates
the release of ADH by the pituitary gland. ADH causes the kidneys to further retain water in an
effort to raise blood volume and blood pressure. In a hypovolemic state the body shifts blood away
from anything that is not a vital organ, so hunger is not an issue; thirst is increased as the body
tries to increase fluid volume; and capillary profusion decreases as the body shunts blood away
from the periphery and to the vital organs.
• The nurse is caring for a client whose worsening infection places the client at high risk for
shock. Which assessment finding would the nurse consider a potential sign of shock?
A. Elevated systolic blood pressure
B. Elevated mean arterial pressure (MAP)
C. Shallow, rapid respirations
D. Bradycardia
Rationale: A symptom of shock is shallow, rapid respirations. Systolic blood pressure drops in
shock, and MAP is less than 65 mm Hg. Bradycardia occurs in neurogenic shock; other states of
shock have tachycardia as a symptom. Infection can lead to septic shock.
• The nurse is caring for a client who is receiving large volumes of crystalloid fluid to treat
hypovolemic shock. In light of this intervention, for what sign or symptom should the nurse
monitor?
A. Hypothermia
,MDC 3 EXAM QUESTIONS AND ANSWERS FULLY SOLVED
B. Bradycardia
C. Coffee ground emesis
D. Pain
Rationale: Temperature should be monitored closely to ensure that rapid fluid resuscitation does
not precipitate hypothermia. IV fluids may need to be warmed during the administration of large
volumes. The nurse should monitor the client for cardiovascular overload and pulmonary edema
when large volumes of IV solution are given. Coffee ground emesis is an indication of a GI bleed,
not shock. Pain is related to cardiogenic shock.
• The nurse is caring for a client in intensive care unit whose condition is deteriorating. The
nurse receives orders to initiate an infusion of dopamine. Which assessments and interventions
should the nurse prioritize?
A. Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug
titration
B. Reviewing medications, performing a focused cardiovascular assessment, and providing
client education
C. Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral
edema
D. Routine monitoring of vital signs, monitoring the peripheral intravenous site, and providing
early discharge instructions
Rationale: Dopamine is a sympathomimetic agent that has varying vasoactive effects depending on
the dosage. When vasoactive medications are given, vital signs must be monitored frequently (at
least every 15 minutes until stable, or more often if indicated), not “routinely.” Vasoactive
medications should be given through a central, not peripheral, venous line because infiltration and
extravasation of some vasoactive medications can cause tissue necrosis and sloughing. High doses
can cause vasoconstriction, which increases afterload and thus increases cardiac workload.
Because this effect is undesirable in clients with cardiogenic shock, dopamine doses must be
carefully titrated. Reviewing medications and laboratory findings, monitoring urine output,
assessing for peripheral edema, performing a focused cardiovascular assessment, and providing
client education are important nursing tasks, but they are not specific to the administration of IV
vasoactive drugs.
• The nurse in intensive care unit is admitting a 57-year-old client with a diagnosis of
possible septic shock. The nurse's assessment reveals that the client has a normal blood
pressure, increased heart rate, decreased bowel sounds, and cold, clammy skin. The nurse's
analysis of these data should lead to which preliminary conclusion?
,MDC 3 EXAM QUESTIONS AND ANSWERS FULLY SOLVED
A. The client is in the compensatory stage of shock.
B. The client is in the progressive stage of shock.
C. The client will stabilize and be released by tomorrow.
D. The client is in the irreversible stage of shock.
Rationale: In the compensatory stage of shock, the blood pressure remains within normal limits.
Vasoconstriction, increased heart rate, and increased contractility of the heart contribute to
maintaining adequate cardiac output. Clients display the often-described "fight or flight" response.
The body shunts blood from organs such as the skin, kidneys, and gastrointestinal tract to the
brain and heart to ensure adequate blood supply to these vital organs. As a result, the skin is cool
and clammy, and bowel sounds are hypoactive. In progressive shock, the blood pressure drops. In
septic shock, the client's chance of survival is low and he will certainly not be released within 24
hours. If the client were in the irreversible stage of shock, his blood pressure would be very low
and his organs would be failing.
• The nurse in a rural nursing facility will be receiving a client in hypovolemic shock due to a
massive postpartum hemorrhage after giving birth at home. Which principle should guide the
nurse's administration of intravenous fluid?
A. 5% albumin is preferred because it is inexpensive and is always readily available.
B. Dextran should be given because it increases intravascular volume and counteracts
coagulopathy.
C. Whatever fluid is most readily available in the clinic should be given, due to the nature of the
emergency.
D. Lactated Ringer solution is ideal because it increases volume, buffers acidosis, and is the
best choice for clients with liver failure.
Rationale: The best fluid to treat shock remains controversial. In emergencies, the "best" fluid is
often the fluid that is readily available. Fluid resuscitation should be initiated early in shock to
maximize intravascular volume. Both crystalloids and colloids can be administered to restore
intravascular volume. There is no consensus regarding whether crystalloids or colloids, such as
dextran and albumin, should be used; however, with crystalloids, more fluid is necessary to restore
intravascular volume. Albumin is very expensive and is a blood product so it is not always readily
available for use. Dextran does increase intravascular volume, but it increases the risk for
coagulopathy. Lactated Ringer is a good solution choice because it increases volume and buffers
acidosis, but it should not be used in clients with liver failure because the liver is unable to convert
lactate to bicarbonate. This client does not have liver disease.
• The nurse in the intensive care unit is caring for a 47-year-old, obese client who is in shock
following a motor vehicle accident. What would be the main challenge in meeting this client's
elevated energy requirements during prolonged rehabilitation?
, MDC 3 EXAM QUESTIONS AND ANSWERS FULLY SOLVED
A. Loss of adipose tissue
B. Loss of skeletal muscle
C. Inability to convert adipose tissue to energy
D. Inability to maintain normal body mass
Rationale: Nutritional energy requirements are met by breaking down lean body mass. In this
catabolic process, skeletal muscle mass is broken down even when the client has large stores of fat
or adipose tissue. Loss of skeletal muscle greatly prolongs the client's recovery time. Loss of
adipose tissue, the inability to convert adipose tissue to energy, and the inability to maintain
normal body mass are not main concerns in meeting nutritional energy requirements for this
client.
• The nurse in the emergency department is caring for a client recently admitted with a likely
myocardial infarction (MI). The nurse understands that the client's heart is pumping an
inadequate supply of oxygen to the tissues. The nurse knows the client is at an increased risk for
MI due to which factor?
A. Arrhythmias
B. Elevated B-natriuretic peptide (BNP)
C. Use of thrombolytics
D. Dehydration
Rationale: Cardiogenic shock occurs when the heart's ability to pump blood is impaired and the
supply of oxygen is inadequate for the heart and tissues. An elevated BNP is noted after an MI has
occurred and does not increase risk. Use of thrombolytics decreases risk of developing blood clots.
Dehydration does not lead to MI.
• The nurse is caring for a client admitted with cardiogenic shock. The client is experiencing
chest pain and there is an order for the administration of morphine. In addition to pain control,
what is the main rationale for administering morphine to this client?
A. It promotes coping and slows catecholamine release. B. It stimulates the client so he or she is
more alert.
C. It decreases gastric secretions.
D. It dilates the blood vessels.
Rationale: For clients experiencing chest pain, morphine is the drug of choice because it dilates the
blood vessels and controls the client's anxiety. Morphine would not be prescribed to promote
coping or to stimulate the client. The rationale behind using morphine would not be to decrease
gastric secretions.
• The nurse is providing care for a client who is in shock after massive blood loss from a
workplace injury. The nurse recognizes that many of the findings from the most recent
assessment are due to compensatory mechanisms. What
