NSG 430 Exam 4: (Latest 2026/2027 Update) Shock States, SIRS/MODS,
Hematologic Disorders, Blood Transfusions, GI Malignancies & Surgery,
Bariatric Surgery | Q&A | Grade A | 100% Correct (Verified Answers) –
Nursing Program
Subject: Critical Care & Advanced Medical-Surgical Nursing – Cardiogenic, Hypovolemic, Distributive (Neurogenic,
Anaphylactic, Septic), Obstructive Shock; SIRS/MODS; Hematology (Leukemia, Lymphoma, DIC, Sickle Cell); Blood
Transfusion Reactions; GI Disorders (Esophageal/Gastric/Colorectal Cancer, Upper GI Bleeding, Appendicitis, Peritonitis);
Bariatric Surgery; Metabolic Syndrome
Source: NSG 430 Exam 4 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
Total Questions: 85+ (All processed – no omissions, no truncation)
1. What is low blood flow cardiogenic shock characterized by?
Correct Answer: Compromised cardiac output with systolic and diastolic dysfunction. Causes include
MI, cardiomyopathy, blunt cardiac injury, severe systemic/pulmonary HTN, cardiac tamponade,
myocardial depression from metabolic problems.
1. Early manifestations: tachycardia, hypotension, narrowed pulse pressure, increased myocardial O2 consumption,
tachypnea, pulmonary congestion, decreased cap refill, anxiety, confusion, decreased UO.
2. Interprofessional care goal: decrease heart workload via angioplasty/stenting, valve replacement, hemodynamic
monitoring, drugs (nitrates, diuretics, vasodilators, beta-blockers).
2. What is hypovolemic shock?
Correct Answer: Absolute hypovolemia: loss of intravascular fluid volume from hemorrhage,
vomiting, diarrhea, fistula drainage, diabetes insipidus, hyperglycemia, diuresis. Fluid moves from
vascular to extravascular space (e.g., burns).
1. Manifestations: anxiety, tachypnea, increased CO and HR, decreased stroke volume, PAWP, urinary output.
2. If loss >30%, blood volume needs replacing. 3:1 rule – 3mL isotonic crystalloid for every 1mL estimated blood loss.
3. What is neurogenic shock?
Correct Answer: Massive vasodilation leading to pooling of blood in vessels, tissue hypoperfusion,
impaired cellular metabolism. Can occur within 30 minutes of spinal cord injury at T5 or above, can
last up to 6 weeks. May be induced by spinal anesthesia.
1. Manifestations: hypotension, bradycardia, inability to regulate body temperature (poikilothermia – taking on temperature
of environment), dry skin.
2. Interprofessional care: spinal stability, atropine for hypotension and bradycardia, monitor for hypothermia.
4. What is anaphylactic shock?
Correct Answer: Acute life-threatening allergic reaction with massive vasodilation, release of
vasoactive mediators, increased capillary permeability. Manifestations: anxiety, confusion, dizziness,
sense of impending doom, chest pain, incontinence, swelling of lips/tongue, flushing, respiratory
distress, circulatory failure.
1. Interprofessional care: epinephrine, diphenhydramine, famotidine; maintain patent airway (bronchodilators, aerosolized
epi, ET tube); fluid replacement.
2. First-line drug is EPINEPHRINE.
, 5. What is septic shock?
Correct Answer: Sepsis with hypotension despite fluid resuscitation, inadequate tissue perfusion
resulting in hypoxia. Increased coagulation and inflammation, decreased fibrinolysis → microthrombi,
obstruction of microvasculature. Hyperdynamic state: increased CO and decreased SVR.
1. Manifestations: tachypnea, hyperventilation → respiratory alkalosis and failure, decreased UO, altered neuro status, GI
dysfunction, paralytic ileus.
2. Interprofessional care: antibiotics within FIRST HOUR! Keep glucose <180, PPIs for stress ulcer prophylaxis (pantoprazole),
DVT prophylaxis (heparin, enoxaparin), vasopressin, IV corticosteroids if BP cannot be maintained with vasopressors.
6. What causes obstructive shock?
Correct Answer: SVC syndrome, abdominal compartment syndrome, cardiac tamponade, tension
pneumothorax, pulmonary embolism. Manifestations: decreased CO, increased afterload. Requires
rapid assessment and treatment.
1. Care includes early recognition, mechanical decompression, thrombolytic therapy, radiation/debulking/removal of mass,
decompressive laparotomy.
2. Tension pneumothorax requires immediate needle decompression.
7. What are the stages of shock?
Correct Answer: 1) INITIAL – not clinically apparent, lactic acid buildup. 2) COMPENSATORY – RAAS
activation, vasoconstriction, impaired GI motility (paralytic ileus risk). 3) PROGRESSIVE –
compensatory fails, ICU transfer, sustained hypoperfusion. 4) REFRACTORY – profound
hypotension/hypoxemia, organ failure, recovery unlikely.
1. In compensatory stage, except septic patient who is warm and flushed (others are cool, clammy).
2. Progressive stage: cardiac dysrhythmias, pulmonary edema (anasarca), AKI with metabolic acidosis, liver dysfunction/DIC
risk.
8. What is the #1 intervention for shock?
Correct Answer: Volume expansion. One or two large-bore IV catheters, isotonic crystalloids (NS, LR,
albumin). Complications: hypothermia, coagulopathy. May add dopamine, norepinephrine, or
dobutamine (vasopressors).
1. Goal: correct low tissue perfusion. Vasopressors achieve MAP >60-65. Vasodilators (nitroglycerin, nitroprusside) may be
used.
2. Nutrition: start enteral nutrition within first 24 hours (trophic feeding).
3. Do NOT treat hypotension with Trendelenburg position.
9. What is SIRS (Systemic Inflammatory Response Syndrome)?
Correct Answer: Generalized inflammation in organs remote from initial insult. Triggers: mechanical
tissue trauma (burns, crash injuries, surgery), abscess formation, ischemic/necrotic tissue (pancreatitis,
MI), microbial invasion (gram-negative bacteria), global perfusion deficits (post-cardiac resuscitation,
shock states).
1. Consequences: release of mediators, direct endothelial damage, hypermetabolism, increased vascular permeability,
coagulation cascade activation.
2. Leads to organ dysfunction: hypotension, decreased perfusion, microemboli formation, blood shunting.
10. What is MODS (Multiple Organ Dysfunction Syndrome)?
Correct Answer: Failure of two or more organ systems resulting from SIRS. Poor prognosis.
Respiratory: alveolar edema, decreased surfactant, V/Q mismatch → ARDS. Cardiovascular:
myocardial depression, massive vasodilation → decreased SVR/BP. Neuro: mental status changes
(early sign). Renal: AKI. GI: abdominal distension, paralytic ileus, ulceration/bleeding risk.
1. Hypermetabolic state: hyper/hypoglycemia, insulin resistance, lactic acidosis, liver dysfunction.
2. Hematologic: DIC (clotting and bleeding from depletion of clotting factors).
3. Care focus: prevent/treat infection (strict asepsis), maintain tissue oxygenation, enteral nutrition, glycemic control, support
failing organs (CRRT/dialysis, blood products, aggressive O2 therapy).
Hematologic Disorders, Blood Transfusions, GI Malignancies & Surgery,
Bariatric Surgery | Q&A | Grade A | 100% Correct (Verified Answers) –
Nursing Program
Subject: Critical Care & Advanced Medical-Surgical Nursing – Cardiogenic, Hypovolemic, Distributive (Neurogenic,
Anaphylactic, Septic), Obstructive Shock; SIRS/MODS; Hematology (Leukemia, Lymphoma, DIC, Sickle Cell); Blood
Transfusion Reactions; GI Disorders (Esophageal/Gastric/Colorectal Cancer, Upper GI Bleeding, Appendicitis, Peritonitis);
Bariatric Surgery; Metabolic Syndrome
Source: NSG 430 Exam 4 Bank – Latest 2026/2027 Curriculum
Format: Q&A Guide with Clinical Rationale
Total Questions: 85+ (All processed – no omissions, no truncation)
1. What is low blood flow cardiogenic shock characterized by?
Correct Answer: Compromised cardiac output with systolic and diastolic dysfunction. Causes include
MI, cardiomyopathy, blunt cardiac injury, severe systemic/pulmonary HTN, cardiac tamponade,
myocardial depression from metabolic problems.
1. Early manifestations: tachycardia, hypotension, narrowed pulse pressure, increased myocardial O2 consumption,
tachypnea, pulmonary congestion, decreased cap refill, anxiety, confusion, decreased UO.
2. Interprofessional care goal: decrease heart workload via angioplasty/stenting, valve replacement, hemodynamic
monitoring, drugs (nitrates, diuretics, vasodilators, beta-blockers).
2. What is hypovolemic shock?
Correct Answer: Absolute hypovolemia: loss of intravascular fluid volume from hemorrhage,
vomiting, diarrhea, fistula drainage, diabetes insipidus, hyperglycemia, diuresis. Fluid moves from
vascular to extravascular space (e.g., burns).
1. Manifestations: anxiety, tachypnea, increased CO and HR, decreased stroke volume, PAWP, urinary output.
2. If loss >30%, blood volume needs replacing. 3:1 rule – 3mL isotonic crystalloid for every 1mL estimated blood loss.
3. What is neurogenic shock?
Correct Answer: Massive vasodilation leading to pooling of blood in vessels, tissue hypoperfusion,
impaired cellular metabolism. Can occur within 30 minutes of spinal cord injury at T5 or above, can
last up to 6 weeks. May be induced by spinal anesthesia.
1. Manifestations: hypotension, bradycardia, inability to regulate body temperature (poikilothermia – taking on temperature
of environment), dry skin.
2. Interprofessional care: spinal stability, atropine for hypotension and bradycardia, monitor for hypothermia.
4. What is anaphylactic shock?
Correct Answer: Acute life-threatening allergic reaction with massive vasodilation, release of
vasoactive mediators, increased capillary permeability. Manifestations: anxiety, confusion, dizziness,
sense of impending doom, chest pain, incontinence, swelling of lips/tongue, flushing, respiratory
distress, circulatory failure.
1. Interprofessional care: epinephrine, diphenhydramine, famotidine; maintain patent airway (bronchodilators, aerosolized
epi, ET tube); fluid replacement.
2. First-line drug is EPINEPHRINE.
, 5. What is septic shock?
Correct Answer: Sepsis with hypotension despite fluid resuscitation, inadequate tissue perfusion
resulting in hypoxia. Increased coagulation and inflammation, decreased fibrinolysis → microthrombi,
obstruction of microvasculature. Hyperdynamic state: increased CO and decreased SVR.
1. Manifestations: tachypnea, hyperventilation → respiratory alkalosis and failure, decreased UO, altered neuro status, GI
dysfunction, paralytic ileus.
2. Interprofessional care: antibiotics within FIRST HOUR! Keep glucose <180, PPIs for stress ulcer prophylaxis (pantoprazole),
DVT prophylaxis (heparin, enoxaparin), vasopressin, IV corticosteroids if BP cannot be maintained with vasopressors.
6. What causes obstructive shock?
Correct Answer: SVC syndrome, abdominal compartment syndrome, cardiac tamponade, tension
pneumothorax, pulmonary embolism. Manifestations: decreased CO, increased afterload. Requires
rapid assessment and treatment.
1. Care includes early recognition, mechanical decompression, thrombolytic therapy, radiation/debulking/removal of mass,
decompressive laparotomy.
2. Tension pneumothorax requires immediate needle decompression.
7. What are the stages of shock?
Correct Answer: 1) INITIAL – not clinically apparent, lactic acid buildup. 2) COMPENSATORY – RAAS
activation, vasoconstriction, impaired GI motility (paralytic ileus risk). 3) PROGRESSIVE –
compensatory fails, ICU transfer, sustained hypoperfusion. 4) REFRACTORY – profound
hypotension/hypoxemia, organ failure, recovery unlikely.
1. In compensatory stage, except septic patient who is warm and flushed (others are cool, clammy).
2. Progressive stage: cardiac dysrhythmias, pulmonary edema (anasarca), AKI with metabolic acidosis, liver dysfunction/DIC
risk.
8. What is the #1 intervention for shock?
Correct Answer: Volume expansion. One or two large-bore IV catheters, isotonic crystalloids (NS, LR,
albumin). Complications: hypothermia, coagulopathy. May add dopamine, norepinephrine, or
dobutamine (vasopressors).
1. Goal: correct low tissue perfusion. Vasopressors achieve MAP >60-65. Vasodilators (nitroglycerin, nitroprusside) may be
used.
2. Nutrition: start enteral nutrition within first 24 hours (trophic feeding).
3. Do NOT treat hypotension with Trendelenburg position.
9. What is SIRS (Systemic Inflammatory Response Syndrome)?
Correct Answer: Generalized inflammation in organs remote from initial insult. Triggers: mechanical
tissue trauma (burns, crash injuries, surgery), abscess formation, ischemic/necrotic tissue (pancreatitis,
MI), microbial invasion (gram-negative bacteria), global perfusion deficits (post-cardiac resuscitation,
shock states).
1. Consequences: release of mediators, direct endothelial damage, hypermetabolism, increased vascular permeability,
coagulation cascade activation.
2. Leads to organ dysfunction: hypotension, decreased perfusion, microemboli formation, blood shunting.
10. What is MODS (Multiple Organ Dysfunction Syndrome)?
Correct Answer: Failure of two or more organ systems resulting from SIRS. Poor prognosis.
Respiratory: alveolar edema, decreased surfactant, V/Q mismatch → ARDS. Cardiovascular:
myocardial depression, massive vasodilation → decreased SVR/BP. Neuro: mental status changes
(early sign). Renal: AKI. GI: abdominal distension, paralytic ileus, ulceration/bleeding risk.
1. Hypermetabolic state: hyper/hypoglycemia, insulin resistance, lactic acidosis, liver dysfunction.
2. Hematologic: DIC (clotting and bleeding from depletion of clotting factors).
3. Care focus: prevent/treat infection (strict asepsis), maintain tissue oxygenation, enteral nutrition, glycemic control, support
failing organs (CRRT/dialysis, blood products, aggressive O2 therapy).
