NURS231 PATHOPHYSIOLOGY MODULE 3
CERTIFICATION TEST 2026 COMPREHENSIVE
STUDY GUIDE
◉ How does the nurse recognize that a positive outcome has
occurred with IV fluid resuscitation for pt with shock?
a) MAP of 70
b) Albumin 3.5
c) Hemoglobin 7.6
d) Urine output 20 to 30 mL/hr for the last 4 hours. Answer: a) MAP
of 70
*Goal when treating shock is to maintain MAP greater than 65 and
urine output needs to be 0.5 mL/kg/hr, or greater than 30 mL/hr.
*Albumin levels reflect nutritional status, which may be poor in
shock states due to an increased need for calories.
◉ What typical sign/symptom indicates the early stage of sepsis?
a) Tachypnea and tachycardia
b) Pallor and cool skin
c) Respiratory acidosis
d) Blood pressure 84/50. Answer: a) Tachypnea and tachycardia
,*Early signs/symptoms of systemic inflammatory response
syndrome include tachypnea, leukocytosis, and tachycardia.
Respiratory alkalosis occurs early in shock because of an increased
respiratory rate. In the early stage of septic shock, the client is
usually warm and febrile. Hypotension does not develop until later
in severe sepsis due to compensatory mechanisms.
◉ A postoperative client is admitted to the intensive care unit (ICU)
with hypovolemic shock. Which nursing action does the nurse
delegate to an experienced unlicensed assistive personnel (UAP)?
a) Measure hourly urine output.
b) Assess level of alertness.
c) Obtain vital signs every 15 minutes.
d) Check oxygen saturation.. Answer: a) Measure hourly urine
output.
*Monitoring hourly urine output is included in nursing assistant
education and does not require special clinical judgment. The nurse
will evaluate the results. Obtaining vital signs, monitoring oxygen
saturation, and assessing mental status in critically ill clients
requires the clinical judgment of the critical care nurse because
immediate intervention may be needed.
,◉ When caring for an obtunded client admitted with shock of
unknown origin, which action does the nurse take first?
a) Obtain IV access and hang prescribed fluid infusions.
b) Assess level of consciousness and pupil reaction to light.
c) Apply the automatic blood pressure cuff.
d) Check the airway and respiratory status.. Answer: d) Check the
airway and respiratory status.
*When caring for any client, determining airway and respiratory
status is the priority. The airway takes priority over obtaining IV
access, applying the blood pressure cuff, and assessing for changes
in the client's mental status.
◉ The nurse reviews the medical record of a client with
hemorrhagic shock, which contains the following information:
Pulse 140 and thready, ABG respiratory acidosis, BP 60/40, Lactate
level 63, Respirations 40 and shallow. Which does the nurse carry
out first?
a) Give Plasmanate 1 unit now.
b) Type and crossmatch for 4 units of packed red blood cells
(PRBCs).
c) Give normal saline solution 250 mL/hr.
d) Notify anesthesia for endotracheal intubation.. Answer: d) Notify
anesthesia for endotracheal intubation.
, *Establishing an airway is the priority in all emergency situations.
Although administering Plasmanate and normal saline, and typing
and cross matching for 4 units of PRBCs are important actions,
airway always takes priority.
◉ Which clinical symptoms in a postoperative client indicate early
sepsis with an excellent recovery rate if treated?
a) Low-grade fever and mild hypotension
b) Low oxygen saturation rate and decreased cognition
c) Localized erythema and edema
d) Reduced urinary output and increased respiratory rate. Answer:
a) Low-grade fever and mild hypotension
*With treatment, the probability of recovery is high. Localized
erythema and edema indicate local infection. A low oxygen
saturation rate and decreased cognition indicate severe sepsis.
Reduced urinary output and increased respiratory rate indicate
active (not early) sepsis.
◉ The client in the cardiac care unit has had a large myocardial
infarction. How does the nurse recognize onset of left ventricular
failure?
a) Expectoration of yellow sputum
b) Pedal edema
CERTIFICATION TEST 2026 COMPREHENSIVE
STUDY GUIDE
◉ How does the nurse recognize that a positive outcome has
occurred with IV fluid resuscitation for pt with shock?
a) MAP of 70
b) Albumin 3.5
c) Hemoglobin 7.6
d) Urine output 20 to 30 mL/hr for the last 4 hours. Answer: a) MAP
of 70
*Goal when treating shock is to maintain MAP greater than 65 and
urine output needs to be 0.5 mL/kg/hr, or greater than 30 mL/hr.
*Albumin levels reflect nutritional status, which may be poor in
shock states due to an increased need for calories.
◉ What typical sign/symptom indicates the early stage of sepsis?
a) Tachypnea and tachycardia
b) Pallor and cool skin
c) Respiratory acidosis
d) Blood pressure 84/50. Answer: a) Tachypnea and tachycardia
,*Early signs/symptoms of systemic inflammatory response
syndrome include tachypnea, leukocytosis, and tachycardia.
Respiratory alkalosis occurs early in shock because of an increased
respiratory rate. In the early stage of septic shock, the client is
usually warm and febrile. Hypotension does not develop until later
in severe sepsis due to compensatory mechanisms.
◉ A postoperative client is admitted to the intensive care unit (ICU)
with hypovolemic shock. Which nursing action does the nurse
delegate to an experienced unlicensed assistive personnel (UAP)?
a) Measure hourly urine output.
b) Assess level of alertness.
c) Obtain vital signs every 15 minutes.
d) Check oxygen saturation.. Answer: a) Measure hourly urine
output.
*Monitoring hourly urine output is included in nursing assistant
education and does not require special clinical judgment. The nurse
will evaluate the results. Obtaining vital signs, monitoring oxygen
saturation, and assessing mental status in critically ill clients
requires the clinical judgment of the critical care nurse because
immediate intervention may be needed.
,◉ When caring for an obtunded client admitted with shock of
unknown origin, which action does the nurse take first?
a) Obtain IV access and hang prescribed fluid infusions.
b) Assess level of consciousness and pupil reaction to light.
c) Apply the automatic blood pressure cuff.
d) Check the airway and respiratory status.. Answer: d) Check the
airway and respiratory status.
*When caring for any client, determining airway and respiratory
status is the priority. The airway takes priority over obtaining IV
access, applying the blood pressure cuff, and assessing for changes
in the client's mental status.
◉ The nurse reviews the medical record of a client with
hemorrhagic shock, which contains the following information:
Pulse 140 and thready, ABG respiratory acidosis, BP 60/40, Lactate
level 63, Respirations 40 and shallow. Which does the nurse carry
out first?
a) Give Plasmanate 1 unit now.
b) Type and crossmatch for 4 units of packed red blood cells
(PRBCs).
c) Give normal saline solution 250 mL/hr.
d) Notify anesthesia for endotracheal intubation.. Answer: d) Notify
anesthesia for endotracheal intubation.
, *Establishing an airway is the priority in all emergency situations.
Although administering Plasmanate and normal saline, and typing
and cross matching for 4 units of PRBCs are important actions,
airway always takes priority.
◉ Which clinical symptoms in a postoperative client indicate early
sepsis with an excellent recovery rate if treated?
a) Low-grade fever and mild hypotension
b) Low oxygen saturation rate and decreased cognition
c) Localized erythema and edema
d) Reduced urinary output and increased respiratory rate. Answer:
a) Low-grade fever and mild hypotension
*With treatment, the probability of recovery is high. Localized
erythema and edema indicate local infection. A low oxygen
saturation rate and decreased cognition indicate severe sepsis.
Reduced urinary output and increased respiratory rate indicate
active (not early) sepsis.
◉ The client in the cardiac care unit has had a large myocardial
infarction. How does the nurse recognize onset of left ventricular
failure?
a) Expectoration of yellow sputum
b) Pedal edema
