NSG 4100 (Adult Health III) Exam 3 Practice
Questions 140 Questions with Multiple
Choice Answers & Explanations in Italics
Nursing / Adult Health Nursing / Medical-
Surgical Nursing
This comprehensive practice exam contains 140 multiple-choice questions for
NSG 4100 Adult Health III Exam 3, covering critical care, complex medical-surgical
conditions, and advanced nursing interventions. Each answer includes a detailed
explanation in italics.
SECTION 1: CRITICAL CARE & SHOCK (Questions 1-20)
Question 1
A client with septic shock has a blood pressure of 78/50 mmHg, heart rate 120
bpm, and respiratory rate 28 breaths/min. The nurse receives an order to start
norepinephrine. What is the primary therapeutic goal of this medication?
A. Increase cardiac contractility
B. Decrease systemic vascular resistance
C. Increase mean arterial pressure (MAP)
D. Decrease pulmonary artery pressure
Correct Answer: C. Increase mean arterial pressure (MAP)
*Norepinephrine is a potent vasopressor that causes vasoconstriction via alpha-1
adrenergic receptors, increasing systemic vascular resistance and MAP. The goal is
to achieve MAP ≥65 mmHg to maintain organ perfusion. While it does have some
beta-1 effects, vasoconstriction is its primary mechanism in septic shock.*
,Question 2
The nurse is caring for a client in cardiogenic shock. Which hemodynamic
parameter is expected?
A. Increased cardiac output
B. Decreased systemic vascular resistance
C. Increased pulmonary artery wedge pressure (PAWP)
D. Decreased central venous pressure (CVP)
Correct Answer: C. Increased pulmonary artery wedge pressure (PAWP)
In cardiogenic shock, the heart fails as a pump, causing fluid backup into the
pulmonary circulation. PAWP (reflecting left atrial pressure) is elevated (>15
mmHg). Cardiac output is decreased, SVR is increased (compensatory
vasoconstriction), and CVP is usually elevated due to right heart failure.
Question 3
A client with septic shock has a lactate level of 6.2 mmol/L. The nurse interprets
this finding as:
A. Normal finding in septic shock
B. Indication of adequate tissue perfusion
C. Evidence of anaerobic metabolism and tissue hypoxia
D. Sign of liver failure
Correct Answer: C. Evidence of anaerobic metabolism and tissue hypoxia
*Lactate is produced during anaerobic metabolism when tissues are hypoxic. In
septic shock, elevated lactate (>2 mmol/L) indicates inadequate tissue perfusion
and is associated with higher mortality. Lactate clearance is used to guide
resuscitation.*
Question 4
The nurse is administering norepinephrine via a central line. The infusion must be
titrated frequently. Which complication is the nurse most concerned about with
extravasation of this medication?
A. Tissue necrosis and sloughing
B. Pulmonary edema
,C. Cardiac arrhythmias
D. Severe hypotension
Correct Answer: A. Tissue necrosis and sloughing
Norepinephrine is a potent vasoconstrictor; if it extravasates into surrounding
tissues, it causes severe local vasoconstriction leading to ischemia, tissue necrosis,
and sloughing. Central line administration is preferred; if a peripheral line is used,
the antecubital fossa is the site of choice, and phentolamine should be available
for infiltration.
Question 5
A client is receiving intravenous fluids for hypovolemic shock. Which finding
indicates adequate fluid resuscitation?
A. Heart rate 110 bpm
B. Urine output 0.5 mL/kg/hour
C. Blood pressure 85/50 mmHg
D. Central venous pressure 4 mmHg
Correct Answer: B. Urine output 0.5 mL/kg/hour
*Adequate fluid resuscitation is indicated by urine output ≥0.5 mL/kg/hour (at
least 30 mL/hour), improving blood pressure (MAP ≥65 mmHg), normalizing heart
rate, and CVP of 8-12 mmHg in septic shock. Urine output is a sensitive indicator
of renal perfusion.*
Question 6
The nurse is caring for a client in distributive shock. Which condition is a cause of
distributive shock?
A. Myocardial infarction
B. Pulmonary embolism
C. Severe allergic reaction (anaphylaxis)
D. Hemorrhage
Correct Answer: C. Severe allergic reaction (anaphylaxis)
Distributive shock includes septic shock, anaphylactic shock, and neurogenic
shock. It is characterized by widespread vasodilation and increased capillary
, permeability. Myocardial infarction causes cardiogenic shock, pulmonary
embolism can cause obstructive shock, and hemorrhage causes hypovolemic
shock.
Question 7
A client in septic shock has a central venous oxygen saturation (ScvO2) of 52%.
The nurse should anticipate which intervention?
A. Discontinue vasopressors
B. Transfuse packed red blood cells
C. Administer additional IV fluids
D. Decrease oxygen delivery
Correct Answer: B. Transfuse packed red blood cells
*Normal ScvO2 is 65-70%. A low ScvO2 (<65%) indicates inadequate oxygen
delivery relative to demand. If ScvO2 remains low after fluid resuscitation and
vasopressors, the Surviving Sepsis Campaign guidelines recommend transfusion of
PRBCs to increase oxygen-carrying capacity when hemoglobin is <7 g/dL.*
Question 8
The nurse is assessing a client with neurogenic shock after a C5 spinal cord injury.
Which finding is characteristic of neurogenic shock?
A. Hypertension and tachycardia
B. Bradycardia and hypotension
C. Fever and vasodilation
D. Tachypnea and wheezing
Correct Answer: B. Bradycardia and hypotension
Neurogenic shock results from loss of sympathetic tone below the level of injury,
causing unopposed vagal tone. This leads to hypotension (vasodilation) and
bradycardia (unopposed parasympathetic). Warm, dry extremities are also typical
(unlike hypovolemic shock with cool, clammy skin).
Question 9
A client with cardiogenic shock has a pulmonary artery catheter in place. The
nurse notes a cardiac index of 1.6 L/min/m². What is the correct interpretation?
Questions 140 Questions with Multiple
Choice Answers & Explanations in Italics
Nursing / Adult Health Nursing / Medical-
Surgical Nursing
This comprehensive practice exam contains 140 multiple-choice questions for
NSG 4100 Adult Health III Exam 3, covering critical care, complex medical-surgical
conditions, and advanced nursing interventions. Each answer includes a detailed
explanation in italics.
SECTION 1: CRITICAL CARE & SHOCK (Questions 1-20)
Question 1
A client with septic shock has a blood pressure of 78/50 mmHg, heart rate 120
bpm, and respiratory rate 28 breaths/min. The nurse receives an order to start
norepinephrine. What is the primary therapeutic goal of this medication?
A. Increase cardiac contractility
B. Decrease systemic vascular resistance
C. Increase mean arterial pressure (MAP)
D. Decrease pulmonary artery pressure
Correct Answer: C. Increase mean arterial pressure (MAP)
*Norepinephrine is a potent vasopressor that causes vasoconstriction via alpha-1
adrenergic receptors, increasing systemic vascular resistance and MAP. The goal is
to achieve MAP ≥65 mmHg to maintain organ perfusion. While it does have some
beta-1 effects, vasoconstriction is its primary mechanism in septic shock.*
,Question 2
The nurse is caring for a client in cardiogenic shock. Which hemodynamic
parameter is expected?
A. Increased cardiac output
B. Decreased systemic vascular resistance
C. Increased pulmonary artery wedge pressure (PAWP)
D. Decreased central venous pressure (CVP)
Correct Answer: C. Increased pulmonary artery wedge pressure (PAWP)
In cardiogenic shock, the heart fails as a pump, causing fluid backup into the
pulmonary circulation. PAWP (reflecting left atrial pressure) is elevated (>15
mmHg). Cardiac output is decreased, SVR is increased (compensatory
vasoconstriction), and CVP is usually elevated due to right heart failure.
Question 3
A client with septic shock has a lactate level of 6.2 mmol/L. The nurse interprets
this finding as:
A. Normal finding in septic shock
B. Indication of adequate tissue perfusion
C. Evidence of anaerobic metabolism and tissue hypoxia
D. Sign of liver failure
Correct Answer: C. Evidence of anaerobic metabolism and tissue hypoxia
*Lactate is produced during anaerobic metabolism when tissues are hypoxic. In
septic shock, elevated lactate (>2 mmol/L) indicates inadequate tissue perfusion
and is associated with higher mortality. Lactate clearance is used to guide
resuscitation.*
Question 4
The nurse is administering norepinephrine via a central line. The infusion must be
titrated frequently. Which complication is the nurse most concerned about with
extravasation of this medication?
A. Tissue necrosis and sloughing
B. Pulmonary edema
,C. Cardiac arrhythmias
D. Severe hypotension
Correct Answer: A. Tissue necrosis and sloughing
Norepinephrine is a potent vasoconstrictor; if it extravasates into surrounding
tissues, it causes severe local vasoconstriction leading to ischemia, tissue necrosis,
and sloughing. Central line administration is preferred; if a peripheral line is used,
the antecubital fossa is the site of choice, and phentolamine should be available
for infiltration.
Question 5
A client is receiving intravenous fluids for hypovolemic shock. Which finding
indicates adequate fluid resuscitation?
A. Heart rate 110 bpm
B. Urine output 0.5 mL/kg/hour
C. Blood pressure 85/50 mmHg
D. Central venous pressure 4 mmHg
Correct Answer: B. Urine output 0.5 mL/kg/hour
*Adequate fluid resuscitation is indicated by urine output ≥0.5 mL/kg/hour (at
least 30 mL/hour), improving blood pressure (MAP ≥65 mmHg), normalizing heart
rate, and CVP of 8-12 mmHg in septic shock. Urine output is a sensitive indicator
of renal perfusion.*
Question 6
The nurse is caring for a client in distributive shock. Which condition is a cause of
distributive shock?
A. Myocardial infarction
B. Pulmonary embolism
C. Severe allergic reaction (anaphylaxis)
D. Hemorrhage
Correct Answer: C. Severe allergic reaction (anaphylaxis)
Distributive shock includes septic shock, anaphylactic shock, and neurogenic
shock. It is characterized by widespread vasodilation and increased capillary
, permeability. Myocardial infarction causes cardiogenic shock, pulmonary
embolism can cause obstructive shock, and hemorrhage causes hypovolemic
shock.
Question 7
A client in septic shock has a central venous oxygen saturation (ScvO2) of 52%.
The nurse should anticipate which intervention?
A. Discontinue vasopressors
B. Transfuse packed red blood cells
C. Administer additional IV fluids
D. Decrease oxygen delivery
Correct Answer: B. Transfuse packed red blood cells
*Normal ScvO2 is 65-70%. A low ScvO2 (<65%) indicates inadequate oxygen
delivery relative to demand. If ScvO2 remains low after fluid resuscitation and
vasopressors, the Surviving Sepsis Campaign guidelines recommend transfusion of
PRBCs to increase oxygen-carrying capacity when hemoglobin is <7 g/dL.*
Question 8
The nurse is assessing a client with neurogenic shock after a C5 spinal cord injury.
Which finding is characteristic of neurogenic shock?
A. Hypertension and tachycardia
B. Bradycardia and hypotension
C. Fever and vasodilation
D. Tachypnea and wheezing
Correct Answer: B. Bradycardia and hypotension
Neurogenic shock results from loss of sympathetic tone below the level of injury,
causing unopposed vagal tone. This leads to hypotension (vasodilation) and
bradycardia (unopposed parasympathetic). Warm, dry extremities are also typical
(unlike hypovolemic shock with cool, clammy skin).
Question 9
A client with cardiogenic shock has a pulmonary artery catheter in place. The
nurse notes a cardiac index of 1.6 L/min/m². What is the correct interpretation?
