NUR 265 Exam 2 Medical-Surgical Nursing
(2026/2027) PDF | Nursing | Galen College
1. A patient with septic shock has a CVP of 2 mm Hg and
a MAP of 55 mm Hg. Which order should the nurse
implement first?
A. Administer norepinephrine IV push.
B. Start a second large-bore IV with lactated Ringer's.
C. Draw serum lactate level.
D. Send blood cultures.
Correct Answer: B
Rationale: Low CVP (normal 2-8) indicates hypovolemia.
In septic shock, fluid resuscitation (30 mL/kg) is the
priority before vasopressors. MAP <65 requires volume
first unless cardiogenic shock is suspected.
2. In hypovolemic shock, which hemodynamic change
occurs initially?
A. Increased cardiac output
B. Increased systemic vascular resistance (SVR)
1
,C. Decreased heart rate
D. Decreased pulmonary artery wedge pressure (PAWP)
Correct Answer: D
Rationale: PAWP reflects left ventricular preload. In
hypovolemia, reduced circulating volume decreases
PAWP. SVR rises later as compensation (vasoconstriction).
3. The nurse notes pulsus paradoxus of 18 mm Hg in a
patient with obstructive shock. Which condition is most
likely?
A. Tension pneumothorax
B. Massive PE
C. Cardiac tamponade
D. Anaphylaxis
Correct Answer: C
Rationale: Pulsus paradoxus >10 mm Hg is classic for
cardiac tamponade due to restricted ventricular filling.
Tension pneumothorax also causes it but is more
2
,associated with absent breath sounds and tracheal
deviation.
4. A patient in distributive shock has a heart rate of 120
bpm, BP 80/50 mm Hg, and warm, flushed skin. Which
type of shock is this?
A. Hypovolemic
B. Cardiogenic
C. Septic
D. Neurogenic
Correct Answer: C
Rationale: Warm, flushed skin in distributive shock
indicates hyperdynamic septic shock (early phase) due to
peripheral vasodilation. Neurogenic shock causes warm
skin but with bradycardia, not tachycardia.
5. The nurse is caring for a patient with cardiogenic shock.
Which finding indicates worsening cardiac output?
A. Urine output 35 mL/hr
B. Cool, clammy extremities
3
, C. Crackles in lung bases only
D. Strong peripheral pulses
Correct Answer: B
Rationale: Cool, clammy extremities indicate
compensatory vasoconstriction due to decreased cardiac
output. Urine output >30 mL/hr is adequate. Worsening
shock would show increasing crackles and weak pulses.
6. Which medication is the first-line vasopressor for septic
shock?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Correct Answer: C
Rationale: Norepinephrine is recommended as first-line
vasopressor in septic shock (Surviving Sepsis Campaign)
due to its potent alpha-adrenergic effects with less
tachycardia than dopamine.
4
(2026/2027) PDF | Nursing | Galen College
1. A patient with septic shock has a CVP of 2 mm Hg and
a MAP of 55 mm Hg. Which order should the nurse
implement first?
A. Administer norepinephrine IV push.
B. Start a second large-bore IV with lactated Ringer's.
C. Draw serum lactate level.
D. Send blood cultures.
Correct Answer: B
Rationale: Low CVP (normal 2-8) indicates hypovolemia.
In septic shock, fluid resuscitation (30 mL/kg) is the
priority before vasopressors. MAP <65 requires volume
first unless cardiogenic shock is suspected.
2. In hypovolemic shock, which hemodynamic change
occurs initially?
A. Increased cardiac output
B. Increased systemic vascular resistance (SVR)
1
,C. Decreased heart rate
D. Decreased pulmonary artery wedge pressure (PAWP)
Correct Answer: D
Rationale: PAWP reflects left ventricular preload. In
hypovolemia, reduced circulating volume decreases
PAWP. SVR rises later as compensation (vasoconstriction).
3. The nurse notes pulsus paradoxus of 18 mm Hg in a
patient with obstructive shock. Which condition is most
likely?
A. Tension pneumothorax
B. Massive PE
C. Cardiac tamponade
D. Anaphylaxis
Correct Answer: C
Rationale: Pulsus paradoxus >10 mm Hg is classic for
cardiac tamponade due to restricted ventricular filling.
Tension pneumothorax also causes it but is more
2
,associated with absent breath sounds and tracheal
deviation.
4. A patient in distributive shock has a heart rate of 120
bpm, BP 80/50 mm Hg, and warm, flushed skin. Which
type of shock is this?
A. Hypovolemic
B. Cardiogenic
C. Septic
D. Neurogenic
Correct Answer: C
Rationale: Warm, flushed skin in distributive shock
indicates hyperdynamic septic shock (early phase) due to
peripheral vasodilation. Neurogenic shock causes warm
skin but with bradycardia, not tachycardia.
5. The nurse is caring for a patient with cardiogenic shock.
Which finding indicates worsening cardiac output?
A. Urine output 35 mL/hr
B. Cool, clammy extremities
3
, C. Crackles in lung bases only
D. Strong peripheral pulses
Correct Answer: B
Rationale: Cool, clammy extremities indicate
compensatory vasoconstriction due to decreased cardiac
output. Urine output >30 mL/hr is adequate. Worsening
shock would show increasing crackles and weak pulses.
6. Which medication is the first-line vasopressor for septic
shock?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Correct Answer: C
Rationale: Norepinephrine is recommended as first-line
vasopressor in septic shock (Surviving Sepsis Campaign)
due to its potent alpha-adrenergic effects with less
tachycardia than dopamine.
4
