NUR 265 NUR265 Exam 3– Advanced Concepts of Medical-Surgical Nursing
Galen (Latest 2026 2027 Updates
Section 1: Shock & Hemodynamics (Questions 1–30)
1. A patient with septic shock has a mean arterial pressure (MAP) of 55 mm Hg.
Which intervention should the nurse prioritize?
a. Administer IV antibiotics
b. Start norepinephrine infusion
c. Give 30 mL/kg crystalloid bolus
d. Obtain central venous pressure (CVP)
Answer: c
Rationale: In septic shock, initial resuscitation includes rapid administration of 30
mL/kg crystalloids if hypotension (MAP <65) or lactate ≥4. MAP <65 requires fluid
first, then vasopressors.
2. A patient in cardiogenic shock has a cardiac index (CI) of 1.6 L/min/m². Which
medication is most appropriate?
a. Dopamine
b. Nitroprusside
,c. Dobutamine
d. Norepinephrine
Answer: c
Rationale: Dobutamine increases contractility and cardiac output with
vasodilation, preferred for low CI in cardiogenic shock without severe
hypotension.
3. Which finding indicates adequate tissue perfusion in a shock patient?
a. Urine output 0.3 mL/kg/hr
b. Central venous oxygen saturation (ScvO₂) >70%
c. Serum lactate 4.5 mmol/L
d. Cool, clammy skin
Answer: b
Rationale: ScvO₂ >70% reflects adequate oxygen delivery and tissue extraction, a
key goal in early goal-directed therapy for shock.
4. The nurse recognizes neurogenic shock most commonly results from:
a. Anaphylaxis
,b. Spinal cord injury above T6
c. Myocardial infarction
d. Severe dehydration
Answer: b
Rationale: Neurogenic shock follows loss of sympathetic tone from spinal cord
injury (above T6), causing vasodilation and bradycardia.
5. A patient with distributive shock has a CVP of 2 mm Hg and hypotension. Which
action is appropriate?
a. Start dobutamine
b. Infuse isotonic fluids
c. Administer IV diphenhydramine
d. Prepare for pericardiocentesis
Answer: b
Rationale: Low CVP indicates hypovolemia; fluid resuscitation is first-line for
distributive shock (e.g., sepsis, anaphylaxis).
, 6. Which medication is indicated for anaphylactic shock unresponsive to
epinephrine?
a. Atropine
b. Vasopressin
c. Hydrocortisone
d. Nitroglycerin
Answer: c
Rationale: Hydrocortisone prevents biphasic reactions and reduces inflammation
in anaphylaxis, though epinephrine is first-line.
7. In obstructive shock, the nurse suspects cardiac tamponade. Which finding is
classic?
a. Narrowed pulse pressure
b. Distant heart sounds, jugular vein distention, hypotension
c. Widened pulse pressure
d. Bounding pulses
Answer: b
Galen (Latest 2026 2027 Updates
Section 1: Shock & Hemodynamics (Questions 1–30)
1. A patient with septic shock has a mean arterial pressure (MAP) of 55 mm Hg.
Which intervention should the nurse prioritize?
a. Administer IV antibiotics
b. Start norepinephrine infusion
c. Give 30 mL/kg crystalloid bolus
d. Obtain central venous pressure (CVP)
Answer: c
Rationale: In septic shock, initial resuscitation includes rapid administration of 30
mL/kg crystalloids if hypotension (MAP <65) or lactate ≥4. MAP <65 requires fluid
first, then vasopressors.
2. A patient in cardiogenic shock has a cardiac index (CI) of 1.6 L/min/m². Which
medication is most appropriate?
a. Dopamine
b. Nitroprusside
,c. Dobutamine
d. Norepinephrine
Answer: c
Rationale: Dobutamine increases contractility and cardiac output with
vasodilation, preferred for low CI in cardiogenic shock without severe
hypotension.
3. Which finding indicates adequate tissue perfusion in a shock patient?
a. Urine output 0.3 mL/kg/hr
b. Central venous oxygen saturation (ScvO₂) >70%
c. Serum lactate 4.5 mmol/L
d. Cool, clammy skin
Answer: b
Rationale: ScvO₂ >70% reflects adequate oxygen delivery and tissue extraction, a
key goal in early goal-directed therapy for shock.
4. The nurse recognizes neurogenic shock most commonly results from:
a. Anaphylaxis
,b. Spinal cord injury above T6
c. Myocardial infarction
d. Severe dehydration
Answer: b
Rationale: Neurogenic shock follows loss of sympathetic tone from spinal cord
injury (above T6), causing vasodilation and bradycardia.
5. A patient with distributive shock has a CVP of 2 mm Hg and hypotension. Which
action is appropriate?
a. Start dobutamine
b. Infuse isotonic fluids
c. Administer IV diphenhydramine
d. Prepare for pericardiocentesis
Answer: b
Rationale: Low CVP indicates hypovolemia; fluid resuscitation is first-line for
distributive shock (e.g., sepsis, anaphylaxis).
, 6. Which medication is indicated for anaphylactic shock unresponsive to
epinephrine?
a. Atropine
b. Vasopressin
c. Hydrocortisone
d. Nitroglycerin
Answer: c
Rationale: Hydrocortisone prevents biphasic reactions and reduces inflammation
in anaphylaxis, though epinephrine is first-line.
7. In obstructive shock, the nurse suspects cardiac tamponade. Which finding is
classic?
a. Narrowed pulse pressure
b. Distant heart sounds, jugular vein distention, hypotension
c. Widened pulse pressure
d. Bounding pulses
Answer: b
