CFRN Shock and Hemodynamic Monitoring 1 — Questions and Answers
Question 1: A flight nurse is transporting a patient with a mean arterial pressure (MAP) of 55 mmHg, heart rate of 128 bpm, and cold clammy skin. Which type of shock is most consistent with these findings?
- Distributive shock
- Hypovolemic shock (Correct answer)
- Neurogenic shock
- Obstructive shock
Correct answer: Hypovolemic shock
Hypovolemic shock presents with tachycardia, hypotension, and cold/clammy skin due to compensatory vasoconstriction from volume loss.
Question 2: Which hemodynamic profile is most characteristic of cardiogenic shock?
- Low SVR, high CO, low PCWP
- High SVR, low CO, high PCWP (Correct answer)
- Low SVR, high CO, high PCWP
- High SVR, high CO, low PCWP
Correct answer: High SVR, low CO, high PCWP
Cardiogenic shock features a failing pump (low CO), compensatory vasoconstriction (high SVR), and fluid backup causing elevated PCWP.
Question 3: A patient's blood pressure is 90/60 mmHg. What is the calculated mean arterial pressure (MAP)?
- 63 mmHg
- 70 mmHg (Correct answer)
- 75 mmHg
- 80 mmHg
Correct answer: 70 mmHg
MAP = DBP + 1/3(PP) = 60 + 1/3(30) = 60 + 10 = 70 mmHg.
Question 4: A shock index greater than 1.0 in an adult trauma patient indicates:
- Mild hemodynamic instability requiring monitoring only
- Significant hemodynamic compromise requiring aggressive intervention (Correct answer)
- Normal compensated response to pain and anxiety
- Isolated neurological injury without hemodynamic significance
Correct answer: Significant hemodynamic compromise requiring aggressive intervention
A shock index (HR/SBP) > 1.0 signals significant compromise and predicts the need for massive transfusion or surgical intervention.
Question 5: During transport of a septic patient, the flight nurse notes a central venous pressure (CVP) of 2 mmHg. This finding is most consistent with:
- Cardiac tamponade
- Pulmonary hypertension
- Hypovolemia requiring fluid resuscitation (Correct answer)
- Right ventricular failure
Correct answer: Hypovolemia requiring fluid resuscitation
A CVP below 5 mmHg indicates low right-sided filling pressure, suggesting hypovolemia and the need for fluid resuscitation.
Question 6: According to the American College of Surgeons, Class III hemorrhagic shock is characterized by blood loss of approximately:
- Up to 750 mL (up to 15% blood volume)
- 750–1500 mL (15–30% blood volume)
- 1500–2000 mL (30–40% blood volume) (Correct answer)
- Greater than 2000 mL (>40% blood volume)
Correct answer: 1500–2000 mL (30–40% blood volume)
Class III hemorrhage (30–40% blood volume loss) manifests with marked tachycardia, tachypnea, altered mental status, and hypotension.
Question 7: Which vasopressor is considered first-line therapy for septic shock according to current Surviving Sepsis Campaign guidelines?
- Epinephrine
- Dopamine
- Norepinephrine (Correct answer)
- Vasopressin
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its potent alpha-adrenergic effect restoring vascular tone with minimal tachycardia.
CFRN Shock and Hemodynamic Monitoring 1
A flight nurse is transporting a patient with a mean arterial pressure (MAP) of 55 mmHg, heart rate of 128 bpm, and cold clammy skin.
Which type of shock is most consistent with these findings?