1
Final Exam: NR 572/ NR572 (New 2025/ 2026 Update)
Advanced Acute Care Management Guide| Questions &
Answers| Grade A| 100% Correct (Verified Solutions)-
Chamberlain
1. A 62-year-old patient with septic shock is on norepinephrine at 0.4
mcg/kg/min. MAP is 58 mmHg, CVP 6 mmHg, ScvO₂ 58%, lactate 5.2 mmol/L.
Which intervention should the nurse practitioner initiate next?
A. Add vasopressin 0.04 units/min
B. Administer a 500 mL crystalloid bolus
C. Start dobutamine at 5 mcg/kg/min
D. Increase norepinephrine to 0.6 mcg/kg/min
: Answer : C
Rationale: ScvO₂ <70% with adequate CVP and persistent hypotension suggests
inadequate cardiac output/oxygen delivery despite fluid resuscitation and
vasopressors. Dobutamine adds inotropic support to improve tissue perfusion.
Vasopressin (A) may further reduce cardiac output. More fluid (B) risks overload
without addressing contractility. Increasing norepinephrine (D) only raises
afterload, potentially worsening low flow state.
2. A 70 kg patient with ARDS is ventilated: mode A/C, Vt 420 mL, rate 16, FiO₂
0.70, PEEP 14. Plateau pressure is 33 cm H₂O, PaO₂ 58 mmHg. What is the
priority action?
A. Increase FiO₂ to 1.0
B. Increase PEEP to 18
C. Decrease tidal volume to 350 mL
D. Switch to APRV
: Answer : C
Rationale: Plateau pressure >30 cm H₂O mandates reducing tidal volume per
ARDSNet protocol to limit volutrauma. Target 6 mL/kg PBW; 420 mL may be too
pg. 1
,2
high for actual PBW. Increasing PEEP (B) might overdistend if Pplat is already high.
FiO₂ (A) is secondary to lung protection. APRV (D) is a rescue mode but not first
step when tidal volume is excessive.
3. A patient post-cardiac arrest remains comatose. Targeted temperature
management (TTM) at 36°C is initiated. Which finding requires immediate
intervention?
A. Potassium 3.4 mEq/L
B. Shivering with BIS 60
C. Urine output 150 mL/hr
D. MAP 70 mmHg
: Answer : B
Rationale: Shivering increases metabolic demand and counteracts TTM benefits;
must be suppressed with sedation/paralytics. Potassium 3.4 (A) is common and
manageable. Urine output 150 mL/hr (C) could be cold diuresis or post-arrest
diuresis, requiring monitoring but not emergent. MAP 70 (D) is acceptable.
4. In managing elevated intracranial pressure (ICP) for a traumatic brain injury
patient, which sequence is correct if ICP is 28 mmHg?
A. Mannitol → hyperventilation → sedation
B. Head elevation → CSF drainage → mannitol
C. Hypertonic saline → head elevation → pentobarbital
D. Hyperventilation → mannitol → decompressive craniectomy
: Answer : B
Rationale: Tiered approach: head elevation, sedation, CSF drainage via EVD, then
osmotherapy (mannitol or hypertonic saline). Hyperventilation (A, D) is temporary
for acute rise, not first-line. Pentobarbital (C) is for refractory ICP.
5. A patient with anterior STEMI undergoes PCI. 2 hours later, BP 80/50, HR 110,
JVD, clear lungs, pulsus paradoxus. Which is most likely?
A. Left ventricular free wall rupture
pg. 2
,3
B. Right ventricular infarction
C. Cardiac tamponade
D. Acute mitral regurgitation
: Answer : B
Rationale: Anterior STEMI plus hypotension, JVD, clear lungs, and pulsus
paradoxus points to RV infarction, often coexisting with inferior MI but can occur
with anterior if RV branch involvement. Tamponade (C) would have muffled
sounds. Free wall rupture (A) causes tamponade physiology. Acute MR (D)
presents with pulmonary edema. Key: clear lungs with shock and JVD suggests RV
failure.
6. A 55-year-old with cirrhosis and ascites presents with fever, abdominal pain,
and paracentesis shows PMN count 350 cells/mm³. What is the best initial
treatment?
A. Ceftriaxone alone
B. Albumin infusion alone
C. Ceftriaxone + albumin
D. Norfloxacin prophylaxis
: Answer : C
Rationale: Spontaneous bacterial peritonitis (SBP) diagnosed with PMN >250.
Treatment: IV antibiotic (e.g., cefotaxime or ceftriaxone) plus albumin (1.5 g/kg
day 1, 1 g/kg day 3) to prevent hepatorenal syndrome. Prophylaxis (D) is for
prevention, not treatment.
7. A patient on mechanical ventilation develops sudden desaturation,
hypotension, and high peak airway pressure. Absent breath sounds on left,
trachea shifted right. Immediate next step?
A. Needle decompression left 2nd ICS
B. Chest tube insertion left
C. Bronchoscopy for mucus plug
D. Increase PEEP
pg. 3
, 4
: Answer : A
Rationale: Tension pneumothorax: tracheal deviation away from affected side,
hyper-resonance, absent breath sounds, shock. Needle decompression
immediately, then chest tube. Chest tube (B) is definitive but not as fast. Mucus
plug (C) would not shift trachea. Increasing PEEP (D) worsens pneumothorax.
8. A patient with DKA: pH 7.0, K 5.8. IV insulin initiated. Which potassium trend
mandates immediate adjustment of therapy?
A. K drops to 4.8 within 2 hours
B. K rises to 6.2 after fluids
C. K remains 5.8 after 1 hour
D. K drops to 3.3 within 3 hours
: Answer : D
Rationale: Severe hypokalemia (<3.5) during insulin therapy is dangerous; must
stop insulin and aggressively replete K until >3.5. Drop to 4.8 (A) is expected and
not dangerous. Rise (B) unlikely if insulin running, would check renal function.
Remaining 5.8 (C) is fine.
9. Which finding is an absolute contraindication to thrombolytic therapy in
acute ischemic stroke?
A. Platelet count 110,000/µL
B. Recent myocardial infarction 3 months ago
C. Blood pressure 185/105 mmHg after labetalol
D. History of intracranial hemorrhage
: Answer : D
Rationale: Prior intracranial hemorrhage is an absolute contraindication. Platelet
<100,000 is contraindication (A is above). BP >185/110 persistent after treatment
(C) is contraindication. Recent MI (B) is relative. D is absolute.
10. A patient post-lobectomy for lung cancer develops new atrial fibrillation, HR
130, BP 100/70. Which treatment is most appropriate?
pg. 4
Final Exam: NR 572/ NR572 (New 2025/ 2026 Update)
Advanced Acute Care Management Guide| Questions &
Answers| Grade A| 100% Correct (Verified Solutions)-
Chamberlain
1. A 62-year-old patient with septic shock is on norepinephrine at 0.4
mcg/kg/min. MAP is 58 mmHg, CVP 6 mmHg, ScvO₂ 58%, lactate 5.2 mmol/L.
Which intervention should the nurse practitioner initiate next?
A. Add vasopressin 0.04 units/min
B. Administer a 500 mL crystalloid bolus
C. Start dobutamine at 5 mcg/kg/min
D. Increase norepinephrine to 0.6 mcg/kg/min
: Answer : C
Rationale: ScvO₂ <70% with adequate CVP and persistent hypotension suggests
inadequate cardiac output/oxygen delivery despite fluid resuscitation and
vasopressors. Dobutamine adds inotropic support to improve tissue perfusion.
Vasopressin (A) may further reduce cardiac output. More fluid (B) risks overload
without addressing contractility. Increasing norepinephrine (D) only raises
afterload, potentially worsening low flow state.
2. A 70 kg patient with ARDS is ventilated: mode A/C, Vt 420 mL, rate 16, FiO₂
0.70, PEEP 14. Plateau pressure is 33 cm H₂O, PaO₂ 58 mmHg. What is the
priority action?
A. Increase FiO₂ to 1.0
B. Increase PEEP to 18
C. Decrease tidal volume to 350 mL
D. Switch to APRV
: Answer : C
Rationale: Plateau pressure >30 cm H₂O mandates reducing tidal volume per
ARDSNet protocol to limit volutrauma. Target 6 mL/kg PBW; 420 mL may be too
pg. 1
,2
high for actual PBW. Increasing PEEP (B) might overdistend if Pplat is already high.
FiO₂ (A) is secondary to lung protection. APRV (D) is a rescue mode but not first
step when tidal volume is excessive.
3. A patient post-cardiac arrest remains comatose. Targeted temperature
management (TTM) at 36°C is initiated. Which finding requires immediate
intervention?
A. Potassium 3.4 mEq/L
B. Shivering with BIS 60
C. Urine output 150 mL/hr
D. MAP 70 mmHg
: Answer : B
Rationale: Shivering increases metabolic demand and counteracts TTM benefits;
must be suppressed with sedation/paralytics. Potassium 3.4 (A) is common and
manageable. Urine output 150 mL/hr (C) could be cold diuresis or post-arrest
diuresis, requiring monitoring but not emergent. MAP 70 (D) is acceptable.
4. In managing elevated intracranial pressure (ICP) for a traumatic brain injury
patient, which sequence is correct if ICP is 28 mmHg?
A. Mannitol → hyperventilation → sedation
B. Head elevation → CSF drainage → mannitol
C. Hypertonic saline → head elevation → pentobarbital
D. Hyperventilation → mannitol → decompressive craniectomy
: Answer : B
Rationale: Tiered approach: head elevation, sedation, CSF drainage via EVD, then
osmotherapy (mannitol or hypertonic saline). Hyperventilation (A, D) is temporary
for acute rise, not first-line. Pentobarbital (C) is for refractory ICP.
5. A patient with anterior STEMI undergoes PCI. 2 hours later, BP 80/50, HR 110,
JVD, clear lungs, pulsus paradoxus. Which is most likely?
A. Left ventricular free wall rupture
pg. 2
,3
B. Right ventricular infarction
C. Cardiac tamponade
D. Acute mitral regurgitation
: Answer : B
Rationale: Anterior STEMI plus hypotension, JVD, clear lungs, and pulsus
paradoxus points to RV infarction, often coexisting with inferior MI but can occur
with anterior if RV branch involvement. Tamponade (C) would have muffled
sounds. Free wall rupture (A) causes tamponade physiology. Acute MR (D)
presents with pulmonary edema. Key: clear lungs with shock and JVD suggests RV
failure.
6. A 55-year-old with cirrhosis and ascites presents with fever, abdominal pain,
and paracentesis shows PMN count 350 cells/mm³. What is the best initial
treatment?
A. Ceftriaxone alone
B. Albumin infusion alone
C. Ceftriaxone + albumin
D. Norfloxacin prophylaxis
: Answer : C
Rationale: Spontaneous bacterial peritonitis (SBP) diagnosed with PMN >250.
Treatment: IV antibiotic (e.g., cefotaxime or ceftriaxone) plus albumin (1.5 g/kg
day 1, 1 g/kg day 3) to prevent hepatorenal syndrome. Prophylaxis (D) is for
prevention, not treatment.
7. A patient on mechanical ventilation develops sudden desaturation,
hypotension, and high peak airway pressure. Absent breath sounds on left,
trachea shifted right. Immediate next step?
A. Needle decompression left 2nd ICS
B. Chest tube insertion left
C. Bronchoscopy for mucus plug
D. Increase PEEP
pg. 3
, 4
: Answer : A
Rationale: Tension pneumothorax: tracheal deviation away from affected side,
hyper-resonance, absent breath sounds, shock. Needle decompression
immediately, then chest tube. Chest tube (B) is definitive but not as fast. Mucus
plug (C) would not shift trachea. Increasing PEEP (D) worsens pneumothorax.
8. A patient with DKA: pH 7.0, K 5.8. IV insulin initiated. Which potassium trend
mandates immediate adjustment of therapy?
A. K drops to 4.8 within 2 hours
B. K rises to 6.2 after fluids
C. K remains 5.8 after 1 hour
D. K drops to 3.3 within 3 hours
: Answer : D
Rationale: Severe hypokalemia (<3.5) during insulin therapy is dangerous; must
stop insulin and aggressively replete K until >3.5. Drop to 4.8 (A) is expected and
not dangerous. Rise (B) unlikely if insulin running, would check renal function.
Remaining 5.8 (C) is fine.
9. Which finding is an absolute contraindication to thrombolytic therapy in
acute ischemic stroke?
A. Platelet count 110,000/µL
B. Recent myocardial infarction 3 months ago
C. Blood pressure 185/105 mmHg after labetalol
D. History of intracranial hemorrhage
: Answer : D
Rationale: Prior intracranial hemorrhage is an absolute contraindication. Platelet
<100,000 is contraindication (A is above). BP >185/110 persistent after treatment
(C) is contraindication. Recent MI (B) is relative. D is absolute.
10. A patient post-lobectomy for lung cancer develops new atrial fibrillation, HR
130, BP 100/70. Which treatment is most appropriate?
pg. 4
