LATEST UPDATED NUR 265 EXAM 1 - MED
SURG 2 FOUNDATION | COMPLETE EXAM WITH
CORRECT ANSWERS AND RATIONALES. A+
GUARANTEED SUCCESS
1. A nurse is caring for a client in hypovolemic
shock. Which finding is most consistent with
this diagnosis?
A) Jugular vein distension
B) Bounding peripheral pulses
C) Decreased central venous pressure (CVP)
D) Crackles in the lung bases
Correct answer: C
Rationale: Hypovolemic shock causes
decreased preload, leading to decreased CVP.
Jugular vein distension, bounding pulses, and
crackles are signs of fluid overload
(hypervolemia or cardiogenic shock).
2. A nurse is assessing a client with sepsis.
Which finding indicates the client is developing
septic shock?
A) Temperature of 38.5 degrees Celsius
,B) Heart rate of 110 beats per minute
C) Blood pressure of 85/45 mm Hg after fluid
resuscitation
D) White blood cell count of 15,000 per mm3
Correct answer: C
Rationale: Septic shock is defined as sepsis
with persistent hypotension requiring
vasopressors despite adequate fluid
resuscitation. Fever, tachycardia, and
leukocytosis are signs of sepsis but not shock.
3. A nurse is caring for a client with
cardiogenic shock. Which medication does the
nurse anticipate administering to improve
cardiac contractility?
A) Dobutamine
B) Norepinephrine
C) Furosemide
D) Nitroglycerin
Correct answer: A
Rationale: Dobutamine is a positive inotrope
that increases cardiac contractility and output.
Norepinephrine is a vasopressor. Furosemide
is a diuretic. Nitroglycerin is a vasodilator.
,4. A nurse is assessing a client who is
receiving a norepinephrine infusion for septic
shock. The nurse notes that the client's fingers
are pale and cool. What is the priority action?
A) Decrease the norepinephrine infusion rate
B) Stop the norepinephrine infusion
C) Assess the blood pressure and notify the
provider
D) Apply warm compresses to the fingers
Correct answer: C
Rationale: Norepinephrine is a potent
vasopressor that can cause peripheral
ischemia. The nurse should assess blood
pressure (to ensure perfusion is maintained)
and notify the provider. Stopping the infusion
abruptly could cause severe hypotension.
5. A nurse is reviewing hemodynamic values
for a client in shock. Which finding indicates
decreased cardiac output?
A) Cardiac index of 2.0 L per minute per m2
B) Cardiac index of 3.2 L per minute per m2
C) Central venous pressure (CVP) of 8 mm Hg
, D) Pulmonary artery wedge pressure (PAWP)
of 12 mm Hg
Correct answer: A
Rationale: Normal cardiac index is 2.5 to 4.0 L
per minute per m2. A cardiac index of 2.0
indicates decreased cardiac output. CVP and
PAWP are preload measures.
6. A nurse is assessing a client with
anaphylactic shock. Which finding is most
characteristic?
A) Wheezing and urticaria
B) Bradycardia and hypotension
C) Jugular vein distension
D) Fever and chills
Correct answer: A
Rationale: Anaphylactic shock causes
bronchospasm (wheezing) and urticaria (hives)
due to histamine release. Tachycardia (not
bradycardia) occurs. JVD suggests
cardiogenic shock. Fever suggests septic
shock.
SURG 2 FOUNDATION | COMPLETE EXAM WITH
CORRECT ANSWERS AND RATIONALES. A+
GUARANTEED SUCCESS
1. A nurse is caring for a client in hypovolemic
shock. Which finding is most consistent with
this diagnosis?
A) Jugular vein distension
B) Bounding peripheral pulses
C) Decreased central venous pressure (CVP)
D) Crackles in the lung bases
Correct answer: C
Rationale: Hypovolemic shock causes
decreased preload, leading to decreased CVP.
Jugular vein distension, bounding pulses, and
crackles are signs of fluid overload
(hypervolemia or cardiogenic shock).
2. A nurse is assessing a client with sepsis.
Which finding indicates the client is developing
septic shock?
A) Temperature of 38.5 degrees Celsius
,B) Heart rate of 110 beats per minute
C) Blood pressure of 85/45 mm Hg after fluid
resuscitation
D) White blood cell count of 15,000 per mm3
Correct answer: C
Rationale: Septic shock is defined as sepsis
with persistent hypotension requiring
vasopressors despite adequate fluid
resuscitation. Fever, tachycardia, and
leukocytosis are signs of sepsis but not shock.
3. A nurse is caring for a client with
cardiogenic shock. Which medication does the
nurse anticipate administering to improve
cardiac contractility?
A) Dobutamine
B) Norepinephrine
C) Furosemide
D) Nitroglycerin
Correct answer: A
Rationale: Dobutamine is a positive inotrope
that increases cardiac contractility and output.
Norepinephrine is a vasopressor. Furosemide
is a diuretic. Nitroglycerin is a vasodilator.
,4. A nurse is assessing a client who is
receiving a norepinephrine infusion for septic
shock. The nurse notes that the client's fingers
are pale and cool. What is the priority action?
A) Decrease the norepinephrine infusion rate
B) Stop the norepinephrine infusion
C) Assess the blood pressure and notify the
provider
D) Apply warm compresses to the fingers
Correct answer: C
Rationale: Norepinephrine is a potent
vasopressor that can cause peripheral
ischemia. The nurse should assess blood
pressure (to ensure perfusion is maintained)
and notify the provider. Stopping the infusion
abruptly could cause severe hypotension.
5. A nurse is reviewing hemodynamic values
for a client in shock. Which finding indicates
decreased cardiac output?
A) Cardiac index of 2.0 L per minute per m2
B) Cardiac index of 3.2 L per minute per m2
C) Central venous pressure (CVP) of 8 mm Hg
, D) Pulmonary artery wedge pressure (PAWP)
of 12 mm Hg
Correct answer: A
Rationale: Normal cardiac index is 2.5 to 4.0 L
per minute per m2. A cardiac index of 2.0
indicates decreased cardiac output. CVP and
PAWP are preload measures.
6. A nurse is assessing a client with
anaphylactic shock. Which finding is most
characteristic?
A) Wheezing and urticaria
B) Bradycardia and hypotension
C) Jugular vein distension
D) Fever and chills
Correct answer: A
Rationale: Anaphylactic shock causes
bronchospasm (wheezing) and urticaria (hives)
due to histamine release. Tachycardia (not
bradycardia) occurs. JVD suggests
cardiogenic shock. Fever suggests septic
shock.
