NS 670
COMPLETE REVIEW
2026–2027 EDITION
COMPLETE STUDY GUIDE WITH VERIFIED QUESTIONS AND
ANSWERS
✓ 2026–2027 Updated Edition
✓ Complete Review
✓ Comprehensive Questions & Answers
✓ Ideal for Exam Preparation
✓ Organized for Quick Revision
This Document Description:
This document contains a comprehensive collection of practice questions with carefully prepared answers for
NS 670 Complete Review (2026–2027 Edition). It is designed to reinforce essential course concepts, support
structured revision, and help learners prepare confidently for quizzes, examinations, and course assessments.
The content provides broad topic coverage in an organized format, making it an effective resource for
academic review and self-study.
, 1. A 68-year-old patient in the intensive care unit is diagnosed with severe sepsis secondary to
a urinary tract infection. The patient is hypotensive, mean arterial pressure (MAP) is 58
mmHg, and serum lactate is 4.2 mmol/L despite 30 mL/kg of crystalloid fluid resuscitation.
Norepinephrine is initiated at 10 mcg/min. Which physiological parameter serves as the
most accurate surrogate marker for measuring the effectiveness of this vasopressor
intervention?
A. Central venous pressure (CVP) between 8 and 12 mmHg.
B. Central venous oxygen saturation (ScvO2) greater than 70%.
C. Mean arterial pressure (MAP) of 65 mmHg or greater.
D. Urine output of 0.5 mL/kg/hr or greater.
Correct Answer: C
Explanation:
In the management of septic shock, the primary endpoint for vasopressor titration is achieving a
mean arterial pressure (MAP) of at least 65 mmHg to ensure adequate perfusion to vital organs.
Norepinephrine, a potent alpha-1 agonist, increases systemic vascular resistance, directly
elevating MAP and restoring perfusion gradients necessary for renal and cerebral viability.
2. A 54-year-old patient with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. The patient's PaO2 is 60 mmHg on an FiO2 of 0.8 and a PEEP of 5 cmH2O. The
critical care team decides to implement a lung-protective ventilation strategy. Which
ventilator setting must be prioritized to prevent further volutrauma and barotrauma?
A. Tidal volume of 6 mL/kg of predicted body weight.
B. Tidal volume of 10 mL/kg of actual body weight.
C. Increasing PEEP to 15 cmH2O without adjusting tidal volume.
D. Increasing the inspiratory flow rate to 100 L/min.
Correct Answer: A
Explanation:
In ARDS, utilizing a low tidal volume ventilation strategy (6 mL/kg of predicted body weight) is
essential to minimize cyclic alveolar overdistension and inflammatory mediator release. Limiting
plateau pressures to less than 30 cmH2O reduces the risk of volutrauma and barotrauma,
significantly decreasing mortality in severe respiratory failure.
, 3. A 72-year-old male presents to the emergency department with an acute ST-elevation
myocardial infarction (STEMI). He has a documented absolute contraindication to aspirin due
to a history of anaphylaxis. The interventional cardiologist is 90 minutes away. Which
antiplatelet regimen must be initiated immediately?
A. Administer aspirin intravenously with concurrent antihistamines.
B. Administer clopidogrel 600 mg orally as a monotherapy loading dose.
C. Administer abciximab intravenously without any oral antiplatelets.
D. Administer low-molecular-weight heparin and wait for PCI.
Correct Answer: B
Explanation:
In a STEMI patient with an absolute aspirin contraindication, a loading dose of a P2Y12 receptor
inhibitor such as clopidogrel or ticagrelor is indicated as monotherapy to achieve acute platelet
inhibition. This prevents further thrombus propagation in the culprit coronary artery while
awaiting definitive percutaneous coronary intervention (PCI).
4. A 31-year-old patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis
(DKA). Initial blood glucose is 650 mg/dL, pH is 7.15, and serum potassium is 5.2 mEq/L.
After two hours of intravenous insulin therapy and fluid resuscitation, the blood glucose
drops to 250 mg/dL. Which intervention is mandated by standard DKA protocols?
A. Discontinue insulin therapy and administer subcutaneous regular insulin.
B. Add 5% dextrose to the intravenous fluids and continue insulin infusion.
C. Administer intravenous sodium bicarbonate to correct the acidosis.
D. Decrease the intravenous fluid rate to prevent cerebral edema.
Correct Answer: B
Explanation:
When blood glucose falls to 200-250 mg/dL during DKA treatment, 5% dextrose must be added
to the intravenous fluids while maintaining the continuous insulin infusion. This prevents
hypoglycemia while allowing the exogenous insulin to continue suppressing ketogenesis and
resolving the anion gap metabolic acidosis.
5. A 60-year-old patient is brought to the emergency department with acute onset of right-
sided hemiplegia and global aphasia. The symptoms began 45 minutes prior to arrival, and a
non-contrast CT scan of the head shows no evidence of hemorrhage. The patient had a
, lumbar puncture performed three days ago for suspected viral meningitis. What is the most
appropriate clinical action regarding thrombolytic therapy?
A. Administer intravenous alteplase immediately at a dose of 0.9 mg/kg.
B. Withhold alteplase and consult neurosurgery for mechanical thrombectomy.
C. Administer tenecteplase due to its shorter infusion time than alteplase.
D. Withhold thrombolytics and initiate high-dose aspirin therapy.
Correct Answer: B
Explanation:
A recent lumbar puncture within the past 7 days is an absolute contraindication to intravenous
thrombolytic therapy due to the elevated risk of devastating intraspinal or intracranial
hemorrhage. In this scenario, mechanical thrombectomy must be pursued if the patient meets
criteria for large vessel occlusion, bypassing systemic fibrinolysis.
6. A 59-year-old patient with a history of chronic heart failure presents to the emergency
department with severe dyspnea, bilateral crackles, and a productive cough of pink, frothy
sputum. Blood pressure is 210/115 mmHg, heart rate is 125 bpm, and respiratory rate is 35.
Which pharmacological intervention must be prioritized to rapidly reduce preload and
afterload?
A. Initiating an intravenous esmolol infusion.
B. Administering intravenous enalaprilat.
C. Initiating an intravenous nitroglycerin infusion.
D. Administering intravenous metoprolol.
Correct Answer: C
Explanation:
In acute decompensated heart failure with severe pulmonary edema and hypertensive crisis,
intravenous nitroglycerin provides rapid venodilation to decrease preload and arterial
vasodilation to decrease afterload. This immediately reduces myocardial oxygen demand and
improves cardiac output while pulmonary congestion is concurrently managed with high-dose
loop diuretics.
7. A 45-year-old trauma patient arrives via EMS following a high-speed motor vehicle collision.
The patient is hypotensive, tachycardic, and lacks breath sounds on the left side. Jugular
venous distension is present, and the trachea is deviated to the right. Which immediate
COMPLETE REVIEW
2026–2027 EDITION
COMPLETE STUDY GUIDE WITH VERIFIED QUESTIONS AND
ANSWERS
✓ 2026–2027 Updated Edition
✓ Complete Review
✓ Comprehensive Questions & Answers
✓ Ideal for Exam Preparation
✓ Organized for Quick Revision
This Document Description:
This document contains a comprehensive collection of practice questions with carefully prepared answers for
NS 670 Complete Review (2026–2027 Edition). It is designed to reinforce essential course concepts, support
structured revision, and help learners prepare confidently for quizzes, examinations, and course assessments.
The content provides broad topic coverage in an organized format, making it an effective resource for
academic review and self-study.
, 1. A 68-year-old patient in the intensive care unit is diagnosed with severe sepsis secondary to
a urinary tract infection. The patient is hypotensive, mean arterial pressure (MAP) is 58
mmHg, and serum lactate is 4.2 mmol/L despite 30 mL/kg of crystalloid fluid resuscitation.
Norepinephrine is initiated at 10 mcg/min. Which physiological parameter serves as the
most accurate surrogate marker for measuring the effectiveness of this vasopressor
intervention?
A. Central venous pressure (CVP) between 8 and 12 mmHg.
B. Central venous oxygen saturation (ScvO2) greater than 70%.
C. Mean arterial pressure (MAP) of 65 mmHg or greater.
D. Urine output of 0.5 mL/kg/hr or greater.
Correct Answer: C
Explanation:
In the management of septic shock, the primary endpoint for vasopressor titration is achieving a
mean arterial pressure (MAP) of at least 65 mmHg to ensure adequate perfusion to vital organs.
Norepinephrine, a potent alpha-1 agonist, increases systemic vascular resistance, directly
elevating MAP and restoring perfusion gradients necessary for renal and cerebral viability.
2. A 54-year-old patient with acute respiratory distress syndrome (ARDS) is mechanically
ventilated. The patient's PaO2 is 60 mmHg on an FiO2 of 0.8 and a PEEP of 5 cmH2O. The
critical care team decides to implement a lung-protective ventilation strategy. Which
ventilator setting must be prioritized to prevent further volutrauma and barotrauma?
A. Tidal volume of 6 mL/kg of predicted body weight.
B. Tidal volume of 10 mL/kg of actual body weight.
C. Increasing PEEP to 15 cmH2O without adjusting tidal volume.
D. Increasing the inspiratory flow rate to 100 L/min.
Correct Answer: A
Explanation:
In ARDS, utilizing a low tidal volume ventilation strategy (6 mL/kg of predicted body weight) is
essential to minimize cyclic alveolar overdistension and inflammatory mediator release. Limiting
plateau pressures to less than 30 cmH2O reduces the risk of volutrauma and barotrauma,
significantly decreasing mortality in severe respiratory failure.
, 3. A 72-year-old male presents to the emergency department with an acute ST-elevation
myocardial infarction (STEMI). He has a documented absolute contraindication to aspirin due
to a history of anaphylaxis. The interventional cardiologist is 90 minutes away. Which
antiplatelet regimen must be initiated immediately?
A. Administer aspirin intravenously with concurrent antihistamines.
B. Administer clopidogrel 600 mg orally as a monotherapy loading dose.
C. Administer abciximab intravenously without any oral antiplatelets.
D. Administer low-molecular-weight heparin and wait for PCI.
Correct Answer: B
Explanation:
In a STEMI patient with an absolute aspirin contraindication, a loading dose of a P2Y12 receptor
inhibitor such as clopidogrel or ticagrelor is indicated as monotherapy to achieve acute platelet
inhibition. This prevents further thrombus propagation in the culprit coronary artery while
awaiting definitive percutaneous coronary intervention (PCI).
4. A 31-year-old patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis
(DKA). Initial blood glucose is 650 mg/dL, pH is 7.15, and serum potassium is 5.2 mEq/L.
After two hours of intravenous insulin therapy and fluid resuscitation, the blood glucose
drops to 250 mg/dL. Which intervention is mandated by standard DKA protocols?
A. Discontinue insulin therapy and administer subcutaneous regular insulin.
B. Add 5% dextrose to the intravenous fluids and continue insulin infusion.
C. Administer intravenous sodium bicarbonate to correct the acidosis.
D. Decrease the intravenous fluid rate to prevent cerebral edema.
Correct Answer: B
Explanation:
When blood glucose falls to 200-250 mg/dL during DKA treatment, 5% dextrose must be added
to the intravenous fluids while maintaining the continuous insulin infusion. This prevents
hypoglycemia while allowing the exogenous insulin to continue suppressing ketogenesis and
resolving the anion gap metabolic acidosis.
5. A 60-year-old patient is brought to the emergency department with acute onset of right-
sided hemiplegia and global aphasia. The symptoms began 45 minutes prior to arrival, and a
non-contrast CT scan of the head shows no evidence of hemorrhage. The patient had a
, lumbar puncture performed three days ago for suspected viral meningitis. What is the most
appropriate clinical action regarding thrombolytic therapy?
A. Administer intravenous alteplase immediately at a dose of 0.9 mg/kg.
B. Withhold alteplase and consult neurosurgery for mechanical thrombectomy.
C. Administer tenecteplase due to its shorter infusion time than alteplase.
D. Withhold thrombolytics and initiate high-dose aspirin therapy.
Correct Answer: B
Explanation:
A recent lumbar puncture within the past 7 days is an absolute contraindication to intravenous
thrombolytic therapy due to the elevated risk of devastating intraspinal or intracranial
hemorrhage. In this scenario, mechanical thrombectomy must be pursued if the patient meets
criteria for large vessel occlusion, bypassing systemic fibrinolysis.
6. A 59-year-old patient with a history of chronic heart failure presents to the emergency
department with severe dyspnea, bilateral crackles, and a productive cough of pink, frothy
sputum. Blood pressure is 210/115 mmHg, heart rate is 125 bpm, and respiratory rate is 35.
Which pharmacological intervention must be prioritized to rapidly reduce preload and
afterload?
A. Initiating an intravenous esmolol infusion.
B. Administering intravenous enalaprilat.
C. Initiating an intravenous nitroglycerin infusion.
D. Administering intravenous metoprolol.
Correct Answer: C
Explanation:
In acute decompensated heart failure with severe pulmonary edema and hypertensive crisis,
intravenous nitroglycerin provides rapid venodilation to decrease preload and arterial
vasodilation to decrease afterload. This immediately reduces myocardial oxygen demand and
improves cardiac output while pulmonary congestion is concurrently managed with high-dose
loop diuretics.
7. A 45-year-old trauma patient arrives via EMS following a high-speed motor vehicle collision.
The patient is hypotensive, tachycardic, and lacks breath sounds on the left side. Jugular
venous distension is present, and the trachea is deviated to the right. Which immediate
