NRNP 6566 ADVANCED CARE OF ADULTS IN ACUTE
SETTINGS I WEEK 11 KNOWLEDGE CHECK 2026/2027 |
Questions and Verified Answers | Pass Guaranteed - A+
Graded
Hemodynamic Monitoring & Shock States
Q1: A 68-year-old patient with septic shock has MAP 58 mmHg despite 30 mL/kg
crystalloid resuscitation. Heart rate is 118 bpm, CVP 6 mmHg, and lactate 4.2 mmol/L.
Which vasoactive medication is first-line per Surviving Sepsis Campaign guidelines?
A. Phenylephrine for pure vasoconstriction
B. Dobutamine for inotropic support
C. Norepinephrine [CORRECT]
D. Epinephrine for refractory shock
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock, providing potent
alpha-1 adrenergic effects for vascular tone with beta-1 activity for cardiac output.
Phenylephrine lacks inotropic effects and reduces cardiac output; dobutamine is for
cardiogenic shock with low output; epinephrine is reserved for refractory shock or
cardiac arrest.
Q2: A patient with cardiogenic shock following acute MI has cardiac index 1.8
L/min/m², PCWP 24 mmHg, and MAP 62 mmHg. Which hemodynamic profile is
present?
A. Hypovolemic shock
B. Cardiogenic shock with elevated preload and afterload [CORRECT]
C. Distributive shock with low afterload
D. Obstructive shock
Correct Answer: B
,Rationale: Low cardiac index (normal 2.5-4.0), elevated pulmonary capillary wedge
pressure (>18 indicates elevated left ventricular preload/PCWP), and low MAP define
cardiogenic shock with pump failure. The elevated PCWP distinguishes it from
hypovolemic shock; low SVR would suggest distributive shock.
Q3: A patient with hemorrhagic shock from trauma has received 4 units PRBCs and 2
units FFP. MAP remains 58 mmHg, heart rate 128 bpm, and ScvO2 58%. Which next
intervention is priority?
A. Continue crystalloid boluses
B. Initiate norepinephrine and address ongoing hemorrhage with surgery/intervention
[CORRECT]
C. Start dobutamine for low ScvO2
D. Add vasopressin as first-line agent
Correct Answer: B
Rationale: Persistent hypotension with tachycardia and low ScvO2 indicates ongoing
shock despite transfusion. Norepinephrine supports MAP while definitive source control
(surgery, IR embolization) addresses ongoing hemorrhage. Further crystalloid dilutes
clotting factors; dobutamine worsens hypotension in hypovolemia; vasopressin is
adjunct, not first-line.
Q4: A patient with neurogenic shock from spinal cord injury has MAP 54 mmHg, heart
rate 52 bpm, and warm, dry skin. Which vasopressor is most appropriate?
A. Norepinephrine
B. Phenylephrine or norepinephrine [CORRECT]
C. Dobutamine alone
D. Epinephrine at high doses
Correct Answer: B
Rationale: Neurogenic shock involves loss of sympathetic tone with bradycardia and
vasodilation. Phenylephrine (pure alpha-agonist) or norepinephrine (alpha with some
beta) restores vascular tone and MAP. Bradycardia may require atropine or pacing if
symptomatic. Dobutamine worsens vasodilation; high-dose epinephrine is unnecessary.
, Q5: A patient on norepinephrine at 0.5 mcg/kg/min has MAP 62 mmHg. Which
adjunctive therapy is evidence-based for catecholamine-resistant septic shock?
A. Increase norepinephrine to 2 mcg/kg/min
B. Add vasopressin 0.03 units/min [CORRECT]
C. Switch to phenylephrine
D. Add high-dose dopamine
Correct Answer: B
Rationale: Vasopressin deficiency occurs in septic shock; adding vasopressin at 0.03
units/min (fixed dose, not titrated) reduces norepinephrine requirements and may
improve outcomes in catecholamine-resistant shock. High-dose norepinephrine
increases arrhythmias; phenylephrine lacks inotropic support; dopamine increases
arrhythmia risk and is not recommended.
Q6: A pulmonary artery catheter shows CVP 4 mmHg, PAOP 8 mmHg, CI 2.1 L/min/m²,
and SVR 1800 dynes·sec/cm⁵. Which shock state is present?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Septic shock
D. Obstructive shock
Correct Answer: B
Rationale: Low filling pressures (CVP <8, PAOP <12), low cardiac index, and elevated
systemic vascular resistance (SVR >1500) characterize hypovolemic shock. Cardiogenic
shock would show elevated PAOP; septic shock would have low SVR with warm
extremities; obstructive shock would show elevated CVP with low CI.
Q7: A patient with anaphylactic shock has BP 68/42 mmHg after epinephrine 0.3 mg IM.
Which next intervention is appropriate?
A. Repeat IM epinephrine every 15 minutes only
B. Establish IV access and start epinephrine infusion 0.05-0.1 mcg/kg/min [CORRECT]
C. Start norepinephrine instead of epinephrine
D. Administer diphenhydramine and observe
Correct Answer: B
SETTINGS I WEEK 11 KNOWLEDGE CHECK 2026/2027 |
Questions and Verified Answers | Pass Guaranteed - A+
Graded
Hemodynamic Monitoring & Shock States
Q1: A 68-year-old patient with septic shock has MAP 58 mmHg despite 30 mL/kg
crystalloid resuscitation. Heart rate is 118 bpm, CVP 6 mmHg, and lactate 4.2 mmol/L.
Which vasoactive medication is first-line per Surviving Sepsis Campaign guidelines?
A. Phenylephrine for pure vasoconstriction
B. Dobutamine for inotropic support
C. Norepinephrine [CORRECT]
D. Epinephrine for refractory shock
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock, providing potent
alpha-1 adrenergic effects for vascular tone with beta-1 activity for cardiac output.
Phenylephrine lacks inotropic effects and reduces cardiac output; dobutamine is for
cardiogenic shock with low output; epinephrine is reserved for refractory shock or
cardiac arrest.
Q2: A patient with cardiogenic shock following acute MI has cardiac index 1.8
L/min/m², PCWP 24 mmHg, and MAP 62 mmHg. Which hemodynamic profile is
present?
A. Hypovolemic shock
B. Cardiogenic shock with elevated preload and afterload [CORRECT]
C. Distributive shock with low afterload
D. Obstructive shock
Correct Answer: B
,Rationale: Low cardiac index (normal 2.5-4.0), elevated pulmonary capillary wedge
pressure (>18 indicates elevated left ventricular preload/PCWP), and low MAP define
cardiogenic shock with pump failure. The elevated PCWP distinguishes it from
hypovolemic shock; low SVR would suggest distributive shock.
Q3: A patient with hemorrhagic shock from trauma has received 4 units PRBCs and 2
units FFP. MAP remains 58 mmHg, heart rate 128 bpm, and ScvO2 58%. Which next
intervention is priority?
A. Continue crystalloid boluses
B. Initiate norepinephrine and address ongoing hemorrhage with surgery/intervention
[CORRECT]
C. Start dobutamine for low ScvO2
D. Add vasopressin as first-line agent
Correct Answer: B
Rationale: Persistent hypotension with tachycardia and low ScvO2 indicates ongoing
shock despite transfusion. Norepinephrine supports MAP while definitive source control
(surgery, IR embolization) addresses ongoing hemorrhage. Further crystalloid dilutes
clotting factors; dobutamine worsens hypotension in hypovolemia; vasopressin is
adjunct, not first-line.
Q4: A patient with neurogenic shock from spinal cord injury has MAP 54 mmHg, heart
rate 52 bpm, and warm, dry skin. Which vasopressor is most appropriate?
A. Norepinephrine
B. Phenylephrine or norepinephrine [CORRECT]
C. Dobutamine alone
D. Epinephrine at high doses
Correct Answer: B
Rationale: Neurogenic shock involves loss of sympathetic tone with bradycardia and
vasodilation. Phenylephrine (pure alpha-agonist) or norepinephrine (alpha with some
beta) restores vascular tone and MAP. Bradycardia may require atropine or pacing if
symptomatic. Dobutamine worsens vasodilation; high-dose epinephrine is unnecessary.
, Q5: A patient on norepinephrine at 0.5 mcg/kg/min has MAP 62 mmHg. Which
adjunctive therapy is evidence-based for catecholamine-resistant septic shock?
A. Increase norepinephrine to 2 mcg/kg/min
B. Add vasopressin 0.03 units/min [CORRECT]
C. Switch to phenylephrine
D. Add high-dose dopamine
Correct Answer: B
Rationale: Vasopressin deficiency occurs in septic shock; adding vasopressin at 0.03
units/min (fixed dose, not titrated) reduces norepinephrine requirements and may
improve outcomes in catecholamine-resistant shock. High-dose norepinephrine
increases arrhythmias; phenylephrine lacks inotropic support; dopamine increases
arrhythmia risk and is not recommended.
Q6: A pulmonary artery catheter shows CVP 4 mmHg, PAOP 8 mmHg, CI 2.1 L/min/m²,
and SVR 1800 dynes·sec/cm⁵. Which shock state is present?
A. Cardiogenic shock
B. Hypovolemic shock [CORRECT]
C. Septic shock
D. Obstructive shock
Correct Answer: B
Rationale: Low filling pressures (CVP <8, PAOP <12), low cardiac index, and elevated
systemic vascular resistance (SVR >1500) characterize hypovolemic shock. Cardiogenic
shock would show elevated PAOP; septic shock would have low SVR with warm
extremities; obstructive shock would show elevated CVP with low CI.
Q7: A patient with anaphylactic shock has BP 68/42 mmHg after epinephrine 0.3 mg IM.
Which next intervention is appropriate?
A. Repeat IM epinephrine every 15 minutes only
B. Establish IV access and start epinephrine infusion 0.05-0.1 mcg/kg/min [CORRECT]
C. Start norepinephrine instead of epinephrine
D. Administer diphenhydramine and observe
Correct Answer: B
