NUR201 | NUR201 Medical Surgical Exam 2
Version 3 | Questions with Correct Answers and
Expert Explanation for Each Question | Saint Paul’s
School of Nursing
1. A patient is admitted with suspected hypovolemic shock due to severe dehydration.
Which intravenous fluid should the nurse prepare to administer initially?
A. 0.45% Normal Saline
B. 5% Dextrose in Water
C. 0.9% Normal Saline
D. 3% Sodium Chloride
Correct Answer: C
Expert Explanation: Isotonic solutions like 0.9% Normal Saline are the preferred
initial fluids for volume resuscitation in hypovolemic shock. These fluids expand the
intravascular space without causing significant shifts in cellular fluid. This
intervention is critical for maintaining blood pressure and ensuring vital organ
perfusion. The nurse must monitor for signs of fluid overload during rapid
administration. Successful stabilization is indicated by improved urine output and
stabilized heart rate.
,2. When assessing a patient for early signs of hypoxia, which clinical manifestation
should the nurse prioritize?
A. Restlessness and agitation
B. Cyanosis of the lips
C. Bradypnea
D. Decreased heart rate
Correct Answer: A
Expert Explanation: Restlessness and agitation are often the earliest signs of
hypoxia as the brain is sensitive to oxygen deprivation. These symptoms occur
before more visible signs like cyanosis appear. Identifying these changes early
allows for prompt intervention to prevent respiratory failure. Cyanosis is typically a
late sign indicating severe desaturation. Monitoring mental status is a key nursing
responsibility in respiratory assessment.
3. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation. What is
the nurse’s next priority action?
A. Administer another 2L bolus of Lactated Ringers
B. Initiate vasopressor therapy with norepinephrine
C. Begin a dopamine infusion at a renal dose
,D. Check the patient’s temperature
Correct Answer: B
Expert Explanation: When fluid resuscitation fails to maintain a MAP above 65
mmHg in septic shock, vasopressors are required. Norepinephrine is the first-line
vasopressor used to restore vascular tone and improve perfusion. Continued fluid
boluses without response can lead to pulmonary edema and other complications.
The goal is to ensure adequate pressure for organ autoregulation. The nurse must
monitor the infusion site closely for extravasation.
4. Which hemodynamic finding is most characteristic of a patient in cardiogenic shock?
A. Decreased Pulmonary Capillary Wedge Pressure (PCWP)
B. Increased Cardiac Output
C. Decreased Systemic Vascular Resistance (SVR)
D. Increased Pulmonary Capillary Wedge Pressure (PCWP)
Correct Answer: D
Expert Explanation: In cardiogenic shock, the heart fails to pump effectively,
leading to backflow into the pulmonary circulation. This results in an elevated
Pulmonary Capillary Wedge Pressure (PCWP) as the left ventricle fails. Systemic
vascular resistance usually increases as a compensatory mechanism to maintain
, blood pressure. Cardiac output is significantly decreased because the pump is
ineffective. Monitoring these values helps guide the use of inotropes and diuretics.
5. A patient with a spinal cord injury at T3 is experiencing neurogenic shock. Which
vital sign should the nurse expect to find?
A. Tachycardia and hypertension
B. Bradycardia and hypertension
C. Tachycardia and hypotension
D. Bradycardia and hypotension
Correct Answer: D
Expert Explanation: Neurogenic shock is characterized by a loss of sympathetic
tone, leading to massive vasodilation and bradycardia. Unlike other types of shock
where the heart rate increases to compensate, neurogenic shock prevents this
response. This leads to a dangerous drop in blood pressure and organ perfusion.
Atropine may be required if the heart rate becomes dangerously low. Managing both
the hemodynamic instability and the spinal injury is crucial for recovery.
6. An emergency department nurse is caring for a patient with an anaphylactic
reaction to a bee sting. Which medication is the priority?
A. Diphenhydramine IV
B. Methylprednisolone IV
Version 3 | Questions with Correct Answers and
Expert Explanation for Each Question | Saint Paul’s
School of Nursing
1. A patient is admitted with suspected hypovolemic shock due to severe dehydration.
Which intravenous fluid should the nurse prepare to administer initially?
A. 0.45% Normal Saline
B. 5% Dextrose in Water
C. 0.9% Normal Saline
D. 3% Sodium Chloride
Correct Answer: C
Expert Explanation: Isotonic solutions like 0.9% Normal Saline are the preferred
initial fluids for volume resuscitation in hypovolemic shock. These fluids expand the
intravascular space without causing significant shifts in cellular fluid. This
intervention is critical for maintaining blood pressure and ensuring vital organ
perfusion. The nurse must monitor for signs of fluid overload during rapid
administration. Successful stabilization is indicated by improved urine output and
stabilized heart rate.
,2. When assessing a patient for early signs of hypoxia, which clinical manifestation
should the nurse prioritize?
A. Restlessness and agitation
B. Cyanosis of the lips
C. Bradypnea
D. Decreased heart rate
Correct Answer: A
Expert Explanation: Restlessness and agitation are often the earliest signs of
hypoxia as the brain is sensitive to oxygen deprivation. These symptoms occur
before more visible signs like cyanosis appear. Identifying these changes early
allows for prompt intervention to prevent respiratory failure. Cyanosis is typically a
late sign indicating severe desaturation. Monitoring mental status is a key nursing
responsibility in respiratory assessment.
3. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation. What is
the nurse’s next priority action?
A. Administer another 2L bolus of Lactated Ringers
B. Initiate vasopressor therapy with norepinephrine
C. Begin a dopamine infusion at a renal dose
,D. Check the patient’s temperature
Correct Answer: B
Expert Explanation: When fluid resuscitation fails to maintain a MAP above 65
mmHg in septic shock, vasopressors are required. Norepinephrine is the first-line
vasopressor used to restore vascular tone and improve perfusion. Continued fluid
boluses without response can lead to pulmonary edema and other complications.
The goal is to ensure adequate pressure for organ autoregulation. The nurse must
monitor the infusion site closely for extravasation.
4. Which hemodynamic finding is most characteristic of a patient in cardiogenic shock?
A. Decreased Pulmonary Capillary Wedge Pressure (PCWP)
B. Increased Cardiac Output
C. Decreased Systemic Vascular Resistance (SVR)
D. Increased Pulmonary Capillary Wedge Pressure (PCWP)
Correct Answer: D
Expert Explanation: In cardiogenic shock, the heart fails to pump effectively,
leading to backflow into the pulmonary circulation. This results in an elevated
Pulmonary Capillary Wedge Pressure (PCWP) as the left ventricle fails. Systemic
vascular resistance usually increases as a compensatory mechanism to maintain
, blood pressure. Cardiac output is significantly decreased because the pump is
ineffective. Monitoring these values helps guide the use of inotropes and diuretics.
5. A patient with a spinal cord injury at T3 is experiencing neurogenic shock. Which
vital sign should the nurse expect to find?
A. Tachycardia and hypertension
B. Bradycardia and hypertension
C. Tachycardia and hypotension
D. Bradycardia and hypotension
Correct Answer: D
Expert Explanation: Neurogenic shock is characterized by a loss of sympathetic
tone, leading to massive vasodilation and bradycardia. Unlike other types of shock
where the heart rate increases to compensate, neurogenic shock prevents this
response. This leads to a dangerous drop in blood pressure and organ perfusion.
Atropine may be required if the heart rate becomes dangerously low. Managing both
the hemodynamic instability and the spinal injury is crucial for recovery.
6. An emergency department nurse is caring for a patient with an anaphylactic
reaction to a bee sting. Which medication is the priority?
A. Diphenhydramine IV
B. Methylprednisolone IV
