RNSG 2539 LATEST EXAM Questions and
Verified Answers 2026/2027 Updated
RNSG 2539 – Health Care Concepts IV (2026/2027 Updated)
200 Multiple-Choice Questions | Verified Answers with Explanations
References: ATI RN Content Mastery Series 2026, Lewis’s Medical-Surgical
Nursing (12th Ed), Ignatavicius (11th Ed), Current NCLEX-RN Test Plan
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Topic 1: Hemodynamics & Shock (Questions 1-25)
1. A patient with septic shock has a mean arterial pressure (MAP) of 52 mm Hg.
What is the priority intervention?
A) Administer broad-spectrum antibiotics
B) Start norepinephrine infusion
C) Give 30 mL/kg crystalloid bolus
D) Obtain blood cultures
Answer: C
Explanation: In septic shock, initial management is 30 mL/kg IV crystalloid
within 3 hours to improve MAP (target ≥65 mm Hg). Antibiotics and cultures
follow but fluid resuscitation is first priority.
2. Which type of shock is characterized by decreased systemic vascular
resistance (SVR) and increased cardiac output (CO) in early stages?
A) Cardiogenic shock
B) Hypovolemic shock
C) Distributive shock
D) Obstructive shock
Answer: C
1
,Explanation: Distributive shock (septic, neurogenic, anaphylactic) causes
massive vasodilation → low SVR. Early septic shock may show normal or high
CO due to compensatory mechanisms.
3. A patient with pulmonary artery catheter shows: Cardiac index 1.6 L/min/m²,
PAOP 22 mm Hg, SVR 1800 dynes/sec/cm⁻⁵. Which shock type is this?
A) Hypovolemic
B) Distributive
C) Cardiogenic
D) Obstructive
Answer: C
Explanation: Low cardiac index + high PAOP (fluid overload) + high SVR
(vasoconstriction) is classic cardiogenic shock from pump failure.
4. Norepinephrine is titrated for a patient in distributive shock. What is the
desired therapeutic endpoint?
A) Heart rate < 60 bpm
B) MAP ≥ 65 mm Hg
C) Central venous pressure < 4 mm Hg
D) Urine output > 200 mL/hr
Answer: B
Explanation: Norepinephrine is first-line vasopressor in distributive shock to
achieve MAP ≥65 mm Hg for organ perfusion.
5. A patient in hypovolemic shock has received 2 L of isotonic crystalloid. BP
remains 78/45 mm Hg. What should the nurse anticipate next?
A) Blood transfusion
B) Dopamine infusion
C) Loop diuretic
D) Chest tube insertion
Answer: A
2
,Explanation: If shock persists after 30 mL/kg crystalloid, packed red blood cells
are indicated to restore oxygen-carrying capacity.
6. Which hemodynamic parameter is most specific for evaluating left ventricular
preload?
A) Central venous pressure (CVP)
B) Pulmonary artery occlusion pressure (PAOP)
C) Mixed venous oxygen saturation (SvO2)
D) Cardiac output (CO)
Answer: B
Explanation: PAOP (also called PCWP) reflects left atrial pressure and left
ventricular end-diastolic volume (preload). CVP reflects right heart preload.
7. In obstructive shock from cardiac tamponade, which physical finding is
expected?
A) Widened pulse pressure
B) Pulsus paradoxus > 10 mm Hg
C) Bounding peripheral pulses
D) Decreased jugular venous distension
Answer: B
Explanation: Cardiac tamponade causes pulsus paradoxus (excessive drop in
systolic BP during inspiration), muffled heart sounds, and JVD (Beck's triad).
8. A patient in cardiogenic shock has an order for dobutamine. The nurse
understands this drug primarily:
A) Increases contractility with mild vasodilation
B) Causes pure alpha-mediated vasoconstriction
C) Decreases heart rate significantly
D) Increases SVR drastically
Answer: A
3
, Explanation: Dobutamine is a beta-1 agonist that increases contractility and
cardiac output while causing mild beta-2 mediated vasodilation (reduces
afterload).
9. Mixed venous oxygen saturation (SvO2) drops from 70% to 55% in a shock
patient. This indicates:
A) Increased oxygen delivery
B) Decreased oxygen extraction
C) Increased oxygen extraction or decreased delivery
D) Normal tissue perfusion
Answer: C
Explanation: Low SvO2 means tissues are extracting more oxygen because
delivery is inadequate (low CO, anemia, hypoxemia) or demand is high.
10. A patient with neurogenic shock from a C5 spinal cord injury presents with
bradycardia and hypotension. The nurse should:
A) Administer atropine and phenylephrine
B) Give aggressive fluid bolus only
C) Place in Trendelenburg position
D) Administer nitroglycerin drip
Answer: A
Explanation: Neurogenic shock causes unopposed vagal tone (bradycardia)
and loss of sympathetic tone (vasodilation). Atropine for bradycardia,
vasopressors like phenylephrine.
11. Which laboratory finding is consistent with early stages of septic shock?
A) Severe metabolic alkalosis
B) Elevated lactate and elevated glucose
C) Profound hypoglycemia
D) Normal white blood cell count without bands
Answer: B
4
Verified Answers 2026/2027 Updated
RNSG 2539 – Health Care Concepts IV (2026/2027 Updated)
200 Multiple-Choice Questions | Verified Answers with Explanations
References: ATI RN Content Mastery Series 2026, Lewis’s Medical-Surgical
Nursing (12th Ed), Ignatavicius (11th Ed), Current NCLEX-RN Test Plan
---
Topic 1: Hemodynamics & Shock (Questions 1-25)
1. A patient with septic shock has a mean arterial pressure (MAP) of 52 mm Hg.
What is the priority intervention?
A) Administer broad-spectrum antibiotics
B) Start norepinephrine infusion
C) Give 30 mL/kg crystalloid bolus
D) Obtain blood cultures
Answer: C
Explanation: In septic shock, initial management is 30 mL/kg IV crystalloid
within 3 hours to improve MAP (target ≥65 mm Hg). Antibiotics and cultures
follow but fluid resuscitation is first priority.
2. Which type of shock is characterized by decreased systemic vascular
resistance (SVR) and increased cardiac output (CO) in early stages?
A) Cardiogenic shock
B) Hypovolemic shock
C) Distributive shock
D) Obstructive shock
Answer: C
1
,Explanation: Distributive shock (septic, neurogenic, anaphylactic) causes
massive vasodilation → low SVR. Early septic shock may show normal or high
CO due to compensatory mechanisms.
3. A patient with pulmonary artery catheter shows: Cardiac index 1.6 L/min/m²,
PAOP 22 mm Hg, SVR 1800 dynes/sec/cm⁻⁵. Which shock type is this?
A) Hypovolemic
B) Distributive
C) Cardiogenic
D) Obstructive
Answer: C
Explanation: Low cardiac index + high PAOP (fluid overload) + high SVR
(vasoconstriction) is classic cardiogenic shock from pump failure.
4. Norepinephrine is titrated for a patient in distributive shock. What is the
desired therapeutic endpoint?
A) Heart rate < 60 bpm
B) MAP ≥ 65 mm Hg
C) Central venous pressure < 4 mm Hg
D) Urine output > 200 mL/hr
Answer: B
Explanation: Norepinephrine is first-line vasopressor in distributive shock to
achieve MAP ≥65 mm Hg for organ perfusion.
5. A patient in hypovolemic shock has received 2 L of isotonic crystalloid. BP
remains 78/45 mm Hg. What should the nurse anticipate next?
A) Blood transfusion
B) Dopamine infusion
C) Loop diuretic
D) Chest tube insertion
Answer: A
2
,Explanation: If shock persists after 30 mL/kg crystalloid, packed red blood cells
are indicated to restore oxygen-carrying capacity.
6. Which hemodynamic parameter is most specific for evaluating left ventricular
preload?
A) Central venous pressure (CVP)
B) Pulmonary artery occlusion pressure (PAOP)
C) Mixed venous oxygen saturation (SvO2)
D) Cardiac output (CO)
Answer: B
Explanation: PAOP (also called PCWP) reflects left atrial pressure and left
ventricular end-diastolic volume (preload). CVP reflects right heart preload.
7. In obstructive shock from cardiac tamponade, which physical finding is
expected?
A) Widened pulse pressure
B) Pulsus paradoxus > 10 mm Hg
C) Bounding peripheral pulses
D) Decreased jugular venous distension
Answer: B
Explanation: Cardiac tamponade causes pulsus paradoxus (excessive drop in
systolic BP during inspiration), muffled heart sounds, and JVD (Beck's triad).
8. A patient in cardiogenic shock has an order for dobutamine. The nurse
understands this drug primarily:
A) Increases contractility with mild vasodilation
B) Causes pure alpha-mediated vasoconstriction
C) Decreases heart rate significantly
D) Increases SVR drastically
Answer: A
3
, Explanation: Dobutamine is a beta-1 agonist that increases contractility and
cardiac output while causing mild beta-2 mediated vasodilation (reduces
afterload).
9. Mixed venous oxygen saturation (SvO2) drops from 70% to 55% in a shock
patient. This indicates:
A) Increased oxygen delivery
B) Decreased oxygen extraction
C) Increased oxygen extraction or decreased delivery
D) Normal tissue perfusion
Answer: C
Explanation: Low SvO2 means tissues are extracting more oxygen because
delivery is inadequate (low CO, anemia, hypoxemia) or demand is high.
10. A patient with neurogenic shock from a C5 spinal cord injury presents with
bradycardia and hypotension. The nurse should:
A) Administer atropine and phenylephrine
B) Give aggressive fluid bolus only
C) Place in Trendelenburg position
D) Administer nitroglycerin drip
Answer: A
Explanation: Neurogenic shock causes unopposed vagal tone (bradycardia)
and loss of sympathetic tone (vasodilation). Atropine for bradycardia,
vasopressors like phenylephrine.
11. Which laboratory finding is consistent with early stages of septic shock?
A) Severe metabolic alkalosis
B) Elevated lactate and elevated glucose
C) Profound hypoglycemia
D) Normal white blood cell count without bands
Answer: B
4
