PCCN PCCN Multisystem Conditions and Shock 1 — Questions and Answers
Question 1: A patient in septic shock has a MAP of 58 mmHg despite 2 liters of IV fluid. Which vasopressor is the first-line agent per Surviving Sepsis guidelines?
- Epinephrine
- Phenylephrine
- Norepinephrine (Correct answer)
- Vasopressin
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines due to its alpha-adrenergic effects.
Question 2: Which hemodynamic profile is characteristic of early distributive (septic) shock?
- High SVR, low CO, high PCWP
- Low SVR, high CO, low PCWP (Correct answer)
- High SVR, high CO, normal PCWP
- Low SVR, low CO, high PCWP
Correct answer: Low SVR, high CO, low PCWP
Septic shock causes vasodilation (low SVR), compensatory high cardiac output, and low filling pressures (low PCWP) in early stages.
Question 3: A trauma patient develops hypotension, distended neck veins, and absent breath sounds on the left. The nurse should prepare for:
- Immediate blood transfusion
- Needle decompression of the left chest (Correct answer)
- Pericardiocentesis
- Endotracheal intubation
Correct answer: Needle decompression of the left chest
Absent breath sounds with hypotension and JVD after trauma indicates tension pneumothorax requiring emergency needle decompression.
Question 4: Which finding best differentiates cardiogenic shock from hypovolemic shock?
- Tachycardia
- Hypotension
- Elevated PCWP and reduced cardiac output (Correct answer)
- Cool, clammy skin
Correct answer: Elevated PCWP and reduced cardiac output
Cardiogenic shock is characterized by elevated PCWP (fluid backing up) and reduced cardiac output, unlike hypovolemic shock which has low PCWP.
Question 5: A patient with anaphylactic shock after contrast dye administration. Which medication is administered first?
- Methylprednisolone IV
- Diphenhydramine IV
- Epinephrine 1:1000 IM (Correct answer)
- Ranitidine IV
Correct answer: Epinephrine 1:1000 IM
Epinephrine IM is the first-line and life-saving treatment for anaphylaxis, reversing bronchospasm and vasodilation immediately.
Question 6: What is the most important early goal in managing hemorrhagic shock following trauma?
- Achieve a MAP > 90 mmHg with crystalloid
- Control the source of bleeding (Correct answer)
- Administer high-dose corticosteroids
- Insert a pulmonary artery catheter
Correct answer: Control the source of bleeding
Definitive hemorrhage control is the primary goal because ongoing blood loss cannot be corrected by fluid resuscitation alone.
PCCN PCCN Multisystem Conditions and Shock 1
A patient in septic shock has a MAP of 58 mmHg despite 2 liters of IV fluid.
Which vasopressor is the first-line agent per Surviving Sepsis guidelines?