NUR 445 Exam 2: Acute & Chronic Health Disruptions In
Adults III V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient in the early stages of septic shock exhibits a high cardiac output and low systemic vascular
resistance. Which phase of shock is the patient experiencing?
A. Hyperdynamic (Warm) phase
B. Compensatory stage
C. Hypodynamic (Cold) phase
D. Refractory stage
Ans: A
Explanation: The hyperdynamic phase of septic shock is characterized by high cardiac output due to
vasodilation. Patients often appear warm and flushed because of the decreased systemic vascular
resistance. This is a unique characteristic of early sepsis compared to other types of shock. The nurse
must recognize these signs to initiate aggressive fluid resuscitation and antibiotic therapy. Monitoring for
progression to the hypodynamic phase is vital for patient survival.
2. Which clinical finding is most indicative of the ‘Cold’ phase of septic shock?
A. Increased urinary output
B. Bounding peripheral pulses
C. Cool, clammy skin and mottled extremities
D. Decreased heart rate
Ans: C
,Explanation: The hypodynamic or cold phase of septic shock occurs as the body’s compensatory
mechanisms fail. Vasoconstriction occurs as a late attempt to maintain blood pressure, leading to cool
and clammy skin. Cardiac output drops significantly during this stage, worsening tissue perfusion. This
phase is often associated with multi-organ dysfunction and a poorer prognosis. Nurses should anticipate
the need for vasopressors and advanced hemodynamic monitoring.
3. A patient with a massive pulmonary embolism is at highest risk for which type of shock?
A. Distributive shock
B. Obstructive shock
C. Hypovolemic shock
D. Anaphylactic shock
Ans: B
Explanation: Obstructive shock occurs when a physical obstruction prevents the heart from pumping
enough blood. A large pulmonary embolism blocks blood flow from the right ventricle to the lungs,
causing an acute drop in cardiac output. This condition leads to rapid hemodynamic collapse if the
obstruction is not relieved. Management focuses on thrombolytics or surgical embolectomy to restore
blood flow. The nurse should monitor for signs of right-sided heart failure and severe hypoxia.
4. In a patient with cardiogenic shock, which medication is primarily used to increase myocardial
contractility?
A. Nitroglycerin
B. Dobutamine
C. Furosemide
D. Amiodarone
, Ans: B
Explanation: Dobutamine is a positive inotrope that increases the strength of myocardial contraction.
This helps improve cardiac output in patients whose heart muscle is failing. While it improves
contractility, it can also increase myocardial oxygen demand, which requires careful monitoring. It is
commonly used in the intensive care unit for cardiogenic shock management. The nurse must assess for
arrhythmias and changes in blood pressure during infusion.
5. A nurse is caring for a patient with a spinal cord injury at T3. The patient’s blood pressure is 84/40 mmHg
and the heart rate is 50 bpm. Which condition is most likely?
A. Hypovolemic shock
B. Septic shock
C. Autonomic dysreflexia
D. Neurogenic shock
Ans: D
Explanation: Neurogenic shock is characterized by a loss of sympathetic tone resulting in vasodilation
and bradycardia. This typically occurs with spinal cord injuries at or above the T6 level. Unlike other
forms of shock, the heart rate does not increase to compensate for low blood pressure. Treatment focuses
on fluid resuscitation and vasopressors to maintain mean arterial pressure. Preventing further spinal
cord injury and maintaining stability are primary nursing goals.
6. When calculating fluid resuscitation using the Parkland formula for a burn patient, what is the total
volume required in the first 8 hours?
A. One-fourth of the total calculated volume
B. The entire calculated volume
Adults III V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient in the early stages of septic shock exhibits a high cardiac output and low systemic vascular
resistance. Which phase of shock is the patient experiencing?
A. Hyperdynamic (Warm) phase
B. Compensatory stage
C. Hypodynamic (Cold) phase
D. Refractory stage
Ans: A
Explanation: The hyperdynamic phase of septic shock is characterized by high cardiac output due to
vasodilation. Patients often appear warm and flushed because of the decreased systemic vascular
resistance. This is a unique characteristic of early sepsis compared to other types of shock. The nurse
must recognize these signs to initiate aggressive fluid resuscitation and antibiotic therapy. Monitoring for
progression to the hypodynamic phase is vital for patient survival.
2. Which clinical finding is most indicative of the ‘Cold’ phase of septic shock?
A. Increased urinary output
B. Bounding peripheral pulses
C. Cool, clammy skin and mottled extremities
D. Decreased heart rate
Ans: C
,Explanation: The hypodynamic or cold phase of septic shock occurs as the body’s compensatory
mechanisms fail. Vasoconstriction occurs as a late attempt to maintain blood pressure, leading to cool
and clammy skin. Cardiac output drops significantly during this stage, worsening tissue perfusion. This
phase is often associated with multi-organ dysfunction and a poorer prognosis. Nurses should anticipate
the need for vasopressors and advanced hemodynamic monitoring.
3. A patient with a massive pulmonary embolism is at highest risk for which type of shock?
A. Distributive shock
B. Obstructive shock
C. Hypovolemic shock
D. Anaphylactic shock
Ans: B
Explanation: Obstructive shock occurs when a physical obstruction prevents the heart from pumping
enough blood. A large pulmonary embolism blocks blood flow from the right ventricle to the lungs,
causing an acute drop in cardiac output. This condition leads to rapid hemodynamic collapse if the
obstruction is not relieved. Management focuses on thrombolytics or surgical embolectomy to restore
blood flow. The nurse should monitor for signs of right-sided heart failure and severe hypoxia.
4. In a patient with cardiogenic shock, which medication is primarily used to increase myocardial
contractility?
A. Nitroglycerin
B. Dobutamine
C. Furosemide
D. Amiodarone
, Ans: B
Explanation: Dobutamine is a positive inotrope that increases the strength of myocardial contraction.
This helps improve cardiac output in patients whose heart muscle is failing. While it improves
contractility, it can also increase myocardial oxygen demand, which requires careful monitoring. It is
commonly used in the intensive care unit for cardiogenic shock management. The nurse must assess for
arrhythmias and changes in blood pressure during infusion.
5. A nurse is caring for a patient with a spinal cord injury at T3. The patient’s blood pressure is 84/40 mmHg
and the heart rate is 50 bpm. Which condition is most likely?
A. Hypovolemic shock
B. Septic shock
C. Autonomic dysreflexia
D. Neurogenic shock
Ans: D
Explanation: Neurogenic shock is characterized by a loss of sympathetic tone resulting in vasodilation
and bradycardia. This typically occurs with spinal cord injuries at or above the T6 level. Unlike other
forms of shock, the heart rate does not increase to compensate for low blood pressure. Treatment focuses
on fluid resuscitation and vasopressors to maintain mean arterial pressure. Preventing further spinal
cord injury and maintaining stability are primary nursing goals.
6. When calculating fluid resuscitation using the Parkland formula for a burn patient, what is the total
volume required in the first 8 hours?
A. One-fourth of the total calculated volume
B. The entire calculated volume
