NR572 Exam 2 Actual Exam Style V3 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient with ARDS is being mechanically ventilated. Which of the following is the primary
goal of using low tidal volume ventilation (6 mL/kg PBW)?
A. To normalize the PaCO2 level to 40 mmHg
B. To maximize oxygenation through alveolar recruitment
C. To prevent volutrauma and barotrauma
D. To increase the functional residual capacity
Answer: C
Rationale: Low tidal volume ventilation is a cornerstone of the ARDSnet protocol to
prevent ventilator-induced lung injury. By limiting the volume of air delivered, the risk of
overdistending the alveoli (volutrauma) is significantly reduced. This protective strategy
has been shown to improve survival rates in patients with severe acute respiratory failure.
2. When assessing a patient’s hemodynamic status, the nurse notes a Pulmonary Artery
Wedge Pressure (PAWP) of 22 mmHg. Which condition is most likely indicated by this
finding?
A. Hypovolemia
B. Left ventricular failure
,C. Right ventricular failure
D. Pulmonary embolism
Answer: B
Rationale: A normal PAWP ranges from 6 to 12 mmHg. An elevation to 22 mmHg indicates
an increase in left-sided cardiac pressures, which is common in left ventricular failure or
mitral stenosis. This elevated pressure often leads to pulmonary congestion and edema as
fluid is pushed back into the lungs.
3. A patient is admitted with septic shock. According to the Surviving Sepsis Campaign, what
is the recommended initial intravenous fluid bolus for resuscitation?
A. 10 mL/kg of crystalloids
B. 500 mL of 5% Albumin
C. 30 mL/kg of crystalloids
D. 2 liters of 0.45% Saline
Answer: C
Rationale: The standard of care for initial resuscitation in septic shock is 30 mL/kg of
isotonic crystalloids. This volume should be administered within the first 3 hours of
recognizing sepsis-induced hypoperfusion. This rapid volume expansion is critical to
maintaining mean arterial pressure and improving tissue perfusion.
, 4. Which of the following ABG results indicates partially compensated respiratory acidosis?
A. pH 7.32, PaCO2 55, HCO3 28
B. pH 7.45, PaCO2 30, HCO3 20
C. pH 7.35, PaCO2 45, HCO3 24
D. pH 7.28, PaCO2 35, HCO3 18
Answer: A
Rationale: In this scenario, the pH is acidic (below 7.35) and the PaCO2 is high, identifying
the primary problem as respiratory acidosis. The HCO3 is elevated (above 26), which
indicates the kidneys are attempting to compensate by retaining base. Because the pH has
not yet returned to the normal range, the compensation is described as partial.
5. A patient is receiving mechanical ventilation on AC/VC mode. The high-pressure alarm
sounds. Which action should the nurse take first?
A. Check for a cuff leak
B. Suction the patient’s airway
C. Increase the oxygen concentration to 100%
D. Administer a sedative medication
Answer: B
Rationale: A high-pressure alarm indicates that the ventilator is meeting resistance when
trying to deliver the set tidal volume. Common causes include secretions in the airway,
572 Advanced Acute Care Management |
Chamberlain
1. A patient with ARDS is being mechanically ventilated. Which of the following is the primary
goal of using low tidal volume ventilation (6 mL/kg PBW)?
A. To normalize the PaCO2 level to 40 mmHg
B. To maximize oxygenation through alveolar recruitment
C. To prevent volutrauma and barotrauma
D. To increase the functional residual capacity
Answer: C
Rationale: Low tidal volume ventilation is a cornerstone of the ARDSnet protocol to
prevent ventilator-induced lung injury. By limiting the volume of air delivered, the risk of
overdistending the alveoli (volutrauma) is significantly reduced. This protective strategy
has been shown to improve survival rates in patients with severe acute respiratory failure.
2. When assessing a patient’s hemodynamic status, the nurse notes a Pulmonary Artery
Wedge Pressure (PAWP) of 22 mmHg. Which condition is most likely indicated by this
finding?
A. Hypovolemia
B. Left ventricular failure
,C. Right ventricular failure
D. Pulmonary embolism
Answer: B
Rationale: A normal PAWP ranges from 6 to 12 mmHg. An elevation to 22 mmHg indicates
an increase in left-sided cardiac pressures, which is common in left ventricular failure or
mitral stenosis. This elevated pressure often leads to pulmonary congestion and edema as
fluid is pushed back into the lungs.
3. A patient is admitted with septic shock. According to the Surviving Sepsis Campaign, what
is the recommended initial intravenous fluid bolus for resuscitation?
A. 10 mL/kg of crystalloids
B. 500 mL of 5% Albumin
C. 30 mL/kg of crystalloids
D. 2 liters of 0.45% Saline
Answer: C
Rationale: The standard of care for initial resuscitation in septic shock is 30 mL/kg of
isotonic crystalloids. This volume should be administered within the first 3 hours of
recognizing sepsis-induced hypoperfusion. This rapid volume expansion is critical to
maintaining mean arterial pressure and improving tissue perfusion.
, 4. Which of the following ABG results indicates partially compensated respiratory acidosis?
A. pH 7.32, PaCO2 55, HCO3 28
B. pH 7.45, PaCO2 30, HCO3 20
C. pH 7.35, PaCO2 45, HCO3 24
D. pH 7.28, PaCO2 35, HCO3 18
Answer: A
Rationale: In this scenario, the pH is acidic (below 7.35) and the PaCO2 is high, identifying
the primary problem as respiratory acidosis. The HCO3 is elevated (above 26), which
indicates the kidneys are attempting to compensate by retaining base. Because the pH has
not yet returned to the normal range, the compensation is described as partial.
5. A patient is receiving mechanical ventilation on AC/VC mode. The high-pressure alarm
sounds. Which action should the nurse take first?
A. Check for a cuff leak
B. Suction the patient’s airway
C. Increase the oxygen concentration to 100%
D. Administer a sedative medication
Answer: B
Rationale: A high-pressure alarm indicates that the ventilator is meeting resistance when
trying to deliver the set tidal volume. Common causes include secretions in the airway,
