NR571 Final Exam Actual Exam Style V2 |
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient is admitted with suspected sepsis and a serum lactate of 4.5 mmol/L. According
to the Surviving Sepsis Campaign 1-hour bundle, what is the priority action?
A. Administer 30 mL/kg crystalloid for hypotension or lactate >= 4 mmol/L.
B. Wait for blood culture results before starting antibiotics.
C. Initiate vasopressors only if the MAP remains below 60 mmHg after 5 liters of fluid.
D. Administer corticosteroids to reduce the inflammatory response.
Answer: A
Rationale: The Surviving Sepsis Campaign recommends immediate administration of 30
mL/kg of crystalloid for patients with high lactate or hypotension. Early fluid resuscitation
is vital to restore tissue perfusion and oxygen delivery to the organs. Delaying this
intervention can lead to worsening multi-organ failure and increased mortality.
2. Which clinical finding is most characteristic of Acute Respiratory Distress Syndrome
(ARDS)?
A. Pulmonary capillary wedge pressure (PCWP) greater than 18 mmHg.
B. Rapid improvement of oxygenation with low-flow nasal cannula.
,C. Presence of a large pleural effusion on chest X-ray.
D. PaO2/FiO2 ratio less than or equal to 300 mmHg with PEEP >= 5 cmH2O.
Answer: D
Rationale: The Berlin Definition specifies that ARDS is characterized by a P/F ratio of 300
or less with a minimum PEEP of 5. It must also involve bilateral opacities on imaging that
are not fully explained by heart failure or fluid overload. This diagnostic criterion helps
clinicians categorize the severity of lung injury and tailor ventilator settings.
3. A 65-year-old male with a history of heart failure presents with a BNP of 1,200 pg/mL and
bilateral crackles. Which medication is the priority for preload reduction?
A. Metoprolol
B. Lisinopril
C. Furosemide
D. Dopamine
Answer: C
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting
diuresis and decreasing intravascular volume. In acute decompensated heart failure,
removing excess fluid is the primary goal to alleviate pulmonary congestion. This
intervention helps improve the patient’s respiratory status and overall cardiac efficiency.
, 4. When managing a patient with increased intracranial pressure (ICP), which position is most
appropriate?
A. Trendelenburg position
B. Supine with the head turned to the side
C. High Fowler’s position at 90 degrees
D. Head of bed elevated to 30-45 degrees
Answer: D
Rationale: Elevating the head of the bed to 30-45 degrees facilitates venous drainage from
the brain through the jugular veins. This positioning helps reduce intracranial pressure
without compromising mean arterial pressure. It is a standard nursing intervention to
prevent secondary brain injury in patients with neurological trauma.
5. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and peaked T-
waves on EKG. What is the immediate first step in management?
A. Administering Sodium Polystyrene Sulfonate (Kayexalate)
B. Administering IV Calcium Gluconate
C. Starting hemodialysis immediately
D. Giving a dose of IV Furosemide
Answer: B
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient is admitted with suspected sepsis and a serum lactate of 4.5 mmol/L. According
to the Surviving Sepsis Campaign 1-hour bundle, what is the priority action?
A. Administer 30 mL/kg crystalloid for hypotension or lactate >= 4 mmol/L.
B. Wait for blood culture results before starting antibiotics.
C. Initiate vasopressors only if the MAP remains below 60 mmHg after 5 liters of fluid.
D. Administer corticosteroids to reduce the inflammatory response.
Answer: A
Rationale: The Surviving Sepsis Campaign recommends immediate administration of 30
mL/kg of crystalloid for patients with high lactate or hypotension. Early fluid resuscitation
is vital to restore tissue perfusion and oxygen delivery to the organs. Delaying this
intervention can lead to worsening multi-organ failure and increased mortality.
2. Which clinical finding is most characteristic of Acute Respiratory Distress Syndrome
(ARDS)?
A. Pulmonary capillary wedge pressure (PCWP) greater than 18 mmHg.
B. Rapid improvement of oxygenation with low-flow nasal cannula.
,C. Presence of a large pleural effusion on chest X-ray.
D. PaO2/FiO2 ratio less than or equal to 300 mmHg with PEEP >= 5 cmH2O.
Answer: D
Rationale: The Berlin Definition specifies that ARDS is characterized by a P/F ratio of 300
or less with a minimum PEEP of 5. It must also involve bilateral opacities on imaging that
are not fully explained by heart failure or fluid overload. This diagnostic criterion helps
clinicians categorize the severity of lung injury and tailor ventilator settings.
3. A 65-year-old male with a history of heart failure presents with a BNP of 1,200 pg/mL and
bilateral crackles. Which medication is the priority for preload reduction?
A. Metoprolol
B. Lisinopril
C. Furosemide
D. Dopamine
Answer: C
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting
diuresis and decreasing intravascular volume. In acute decompensated heart failure,
removing excess fluid is the primary goal to alleviate pulmonary congestion. This
intervention helps improve the patient’s respiratory status and overall cardiac efficiency.
, 4. When managing a patient with increased intracranial pressure (ICP), which position is most
appropriate?
A. Trendelenburg position
B. Supine with the head turned to the side
C. High Fowler’s position at 90 degrees
D. Head of bed elevated to 30-45 degrees
Answer: D
Rationale: Elevating the head of the bed to 30-45 degrees facilitates venous drainage from
the brain through the jugular veins. This positioning helps reduce intracranial pressure
without compromising mean arterial pressure. It is a standard nursing intervention to
prevent secondary brain injury in patients with neurological trauma.
5. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and peaked T-
waves on EKG. What is the immediate first step in management?
A. Administering Sodium Polystyrene Sulfonate (Kayexalate)
B. Administering IV Calcium Gluconate
C. Starting hemodialysis immediately
D. Giving a dose of IV Furosemide
Answer: B
