Vasopressor Quiz: Hemodynamic Support & Shock Management

1. A patient receiving high-dose vasopressor therapy develops severe headache and confusion. What adverse effect should you suspect?

Hypertensive emergency

Sepsis progression

Medication allergy

Intracranial hemorrhage

2. When transitioning a patient off vasopressor therapy, the appropriate approach is to:

Abruptly discontinue to prevent dependence

Gradually taper while monitoring hemodynamics and reassessing underlying cause

Switch to oral blood pressure medications immediately

Maintain maximum dose for 24 hours then stop

3. A patient receiving vasopressor therapy has cold, mottled extremities despite adequate MAP. What does this suggest?

Successful vasoconstriction

Peripheral hypoperfusion and possible tissue ischemia

Normal response to vasopressors

Improved cardiac output

4. Epinephrine is the vasopressor of choice in which emergency situation?

Routine septic shock

Cardiac arrest and anaphylaxis

Mild hypotension in stable patients

Chronic hypertension management

5. A patient on norepinephrine develops atrial fibrillation. What is the appropriate nursing response?

Immediately discontinue the vasopressor

Notify the provider; assess for underlying causes and continue monitoring

Increase the norepinephrine dose

Administer amiodarone without provider order

6. Continuous monitoring during vasopressor infusion should include which parameters?

Blood pressure and heart rate only

BP, HR, urine output, lactate, tissue perfusion, and organ function

Only central venous pressure

Electrocardiogram and troponin

7. A patient requires vasopressor therapy. Which assessment finding would indicate adequate response to treatment?

Increased heart rate to 110 bpm

MAP >65 mmHg, improved urine output, normal mentation

Decreased respiratory rate

Increased glucose level

8. A patient in septic shock has a lactate of 4 mmol/L despite vasopressor support and fluid resuscitation. What does this indicate?

Adequate tissue perfusion

Persistent tissue hypoperfusion and hypoxia

Successful vasopressor therapy

Kidney injury from vasopressors

9. Which statement about vasopressor infusion site is correct?

Peripheral IV is acceptable for short-term use

Peripheral IV is preferred to reduce infection risk

Central line is required for all vasopressors

IO access is contraindicated

10. Which vasopressor is the first-line agent for septic shock according to current guidelines?

Norepinephrine

Dopamine

Phenylephrine

Epinephrine

11. Vasopressin is an ADH analog used as an adjunctive vasopressor. In which shock state is it considered most beneficial?

Distributive shock refractory to catecholamines

Hypovolemic shock

Anaphylactic shock

Hemorrhagic shock

12. A patient in hypovolemic shock is receiving vasopressors but remains hypotensive. What is the critical missing component of treatment?

Increasing the vasopressor dose

Fluid resuscitation

Adding a second vasopressor

Administering antibiotics

13. What is the target mean arterial pressure (MAP) for most patients receiving vasopressor support?

>50 mmHg

>65 mmHg

>80 mmHg

>100 mmHg

14. A patient on vasopressor therapy develops a cool, pale extremity on the infusion arm. What complication is suspected?

Vasopressor allergy

Extravasation

Central line infection

Acute MI

15. Which vasopressor has the strongest beta-adrenergic effects and is preferred in anaphylactic shock?

Phenylephrine

Vasopressin

Epinephrine

Methoxamine

16. Norepinephrine acts primarily on which adrenergic receptors?

Alpha-1 and beta-1

Beta-1 and beta-2

Alpha-2 and dopamine

Only alpha-1

17. A patient in cardiogenic shock has a systolic BP of 85 mmHg and poor peripheral perfusion. What is the primary goal of vasopressor therapy?

Increase urine output to >200 mL/hr

Restore adequate tissue perfusion and organ function

Decrease heart rate to

Reduce pulmonary capillary wedge pressure

18. A patient receiving dopamine at 10 mcg/kg/min develops severe vasoconstriction and decreased urine output. What is the most appropriate nursing action?

Increase the infusion rate further

Notify the provider to consider switching to norepinephrine

Decrease the infusion rate to 2 mcg/kg/min

Administer a bolus of normal saline

19. Dopamine at low doses (2-5 mcg/kg/min) preferentially stimulates which receptors?

Alpha-1 receptors

Dopamine and beta-1 receptors

Beta-2 receptors

Only dopamine receptors

20. Phenylephrine is primarily used in which clinical scenario?

Septic shock with low cardiac output

Pure distributive shock requiring vasoconstriction

Anaphylaxis with airway compromise

Cardiogenic shock with pulmonary edema

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