NRSG 2500 Test 3 - QUESTIONS WITH
VERIFIED & REVISED ANSWERS (NEW) 2026.
Perfusion
Mechanisms that facilitate or impair circulation of blood through tissue
What is shock
Shock can best be defined as a clinical syndrome that results from inadequate tissue perfusion,
creating an imbalance between the delivery of oxygen and nutrients needed to support cellular
function
Regardless of the initial cause of shock, certain physiologic responses are common to all types of
shock. These physiologic responses include hypoperfusion of tissues, hypermetabolism, and
activation of the inflammatory response.
Cellular Effects of Shock
when the cells are not getting blood/oxygen like they need. It leads to cellular edema (swelling of
the cell) (sodium goes into the cell), increased membrane permeability (outer layer of the cell is
malfunctioning), effluent of K+ (leave the cell), influx of NA+ and H2O, lysosomal membrane
rupture, mitochondrial damage
3 stages of shock
Compensatory (stage 1)
Progressive (stage 2)
Irreversible or refractory (stage 3)
,Early recognition and treatment are key!!
Compensatory stage
"Fight or flight"
BP normal, HR increased (body senses BP dropping and the HR goes up to try to compensate)
Shunting of blood to vital organs (prioritizing) (brain, heart, lungs are what they think is
important) (not kidneys, stomach, liver, etc)
Cool and pale extremities (in most categories of shock) because of vasoconstriction
Prolonged capillary refill
Weak peripheral pulses compared to central pulses
Can lead to metabolic acidosis, RR can increase
Monitor for progression into next stage
Pulse pressure
Pulse pressure correlates well with stroke volume (the amount of blood ejected). It is calculated
by subtracting diastolic from the systolic measurement.
A narrowing pulse pressure is an earlier sign of deterioration than a drop in systolic pressure <
90.
Normal pulse pressure is 30-40 mm hg
if you go lower than 30 than that means the internal organs are not getting the perfusion they
need to function, HF
, Elevation of the diastolic BP releases catecholamines and attempts to increase venous return
through vasoconstriction.
Progressive Stage
Mechanisms that regulate BP can no longer compensate. MAP falls below normal limits (<65)
Hypotension (Systolic BP <100 or decrease in systolic BP of 40 mmHg from baseline)
Declining mental status, increased restlessness
Acute lung injury: (if they are no longer able to keep up, it leads to increase CO2 which leads to
ARDS (acute respiratory distress syndrome))
- Respirations rapid and shallow (intubation may be necessary), crackles, pulmonary edema
- Increased CO2
- If progresses to fibrosis and inflammation, ARDS will result
Arrhythmias, chest pain, weak central pulses, mottling
Impaired kidney, liver, and GI function, hypoxemia
Assess for declining status and progression
monitoring for worsening symptoms (MODS) (multiple organ dysfunction syndrome)
Irreversible stage (MODS)
Patient no longer able to survive
Blood pressure remains low
Organ dysfunction and failure
VERIFIED & REVISED ANSWERS (NEW) 2026.
Perfusion
Mechanisms that facilitate or impair circulation of blood through tissue
What is shock
Shock can best be defined as a clinical syndrome that results from inadequate tissue perfusion,
creating an imbalance between the delivery of oxygen and nutrients needed to support cellular
function
Regardless of the initial cause of shock, certain physiologic responses are common to all types of
shock. These physiologic responses include hypoperfusion of tissues, hypermetabolism, and
activation of the inflammatory response.
Cellular Effects of Shock
when the cells are not getting blood/oxygen like they need. It leads to cellular edema (swelling of
the cell) (sodium goes into the cell), increased membrane permeability (outer layer of the cell is
malfunctioning), effluent of K+ (leave the cell), influx of NA+ and H2O, lysosomal membrane
rupture, mitochondrial damage
3 stages of shock
Compensatory (stage 1)
Progressive (stage 2)
Irreversible or refractory (stage 3)
,Early recognition and treatment are key!!
Compensatory stage
"Fight or flight"
BP normal, HR increased (body senses BP dropping and the HR goes up to try to compensate)
Shunting of blood to vital organs (prioritizing) (brain, heart, lungs are what they think is
important) (not kidneys, stomach, liver, etc)
Cool and pale extremities (in most categories of shock) because of vasoconstriction
Prolonged capillary refill
Weak peripheral pulses compared to central pulses
Can lead to metabolic acidosis, RR can increase
Monitor for progression into next stage
Pulse pressure
Pulse pressure correlates well with stroke volume (the amount of blood ejected). It is calculated
by subtracting diastolic from the systolic measurement.
A narrowing pulse pressure is an earlier sign of deterioration than a drop in systolic pressure <
90.
Normal pulse pressure is 30-40 mm hg
if you go lower than 30 than that means the internal organs are not getting the perfusion they
need to function, HF
, Elevation of the diastolic BP releases catecholamines and attempts to increase venous return
through vasoconstriction.
Progressive Stage
Mechanisms that regulate BP can no longer compensate. MAP falls below normal limits (<65)
Hypotension (Systolic BP <100 or decrease in systolic BP of 40 mmHg from baseline)
Declining mental status, increased restlessness
Acute lung injury: (if they are no longer able to keep up, it leads to increase CO2 which leads to
ARDS (acute respiratory distress syndrome))
- Respirations rapid and shallow (intubation may be necessary), crackles, pulmonary edema
- Increased CO2
- If progresses to fibrosis and inflammation, ARDS will result
Arrhythmias, chest pain, weak central pulses, mottling
Impaired kidney, liver, and GI function, hypoxemia
Assess for declining status and progression
monitoring for worsening symptoms (MODS) (multiple organ dysfunction syndrome)
Irreversible stage (MODS)
Patient no longer able to survive
Blood pressure remains low
Organ dysfunction and failure
