NR571 MIDTERM EXAM: COMPLEX
DIAGNOSIS & MANAGEMENT IN
ACUTE CARE QUESTIONS AND
ANSWERS
1. A 65-year-old patient in the ICU develops sudden hypotension, tachycardia, and increased
central venous pressure (CVP) following a central line insertion. Physical exam reveals
muffled heart sounds. What is the most likely diagnosis?
A. Cardiac tamponade
B. Tension pneumothorax
C. Pulmonary embolism
D. Hypovolemic shock
Answer: A
Conceptual Explanation: Cardiac tamponade is characterized by Beck’s Triad:
hypotension, muffled heart sounds, and elevated CVP (jugular venous distension). Tension
pneumothorax would show absent breath sounds and tracheal deviation.
,2. In the management of Acute Respiratory Distress Syndrome (ARDS), which ventilator
strategy has been shown to improve survival?
A. High tidal volume to ensure CO2 clearance
B. Low tidal volume (6 mL/kg predicted body weight)
C. Routine use of high-frequency oscillatory ventilation
D. Maintenance of peak inspiratory pressures > 40 cm H2O
Answer: B
Conceptual Explanation: Low tidal volume ventilation (lung-protective ventilation)
reduces ventilator-induced lung injury (VILI) and has a proven mortality benefit in ARDS
patients.
3. Which of the following is the primary hemodynamic goal in the initial treatment of Septic
Shock?
A. Mean Arterial Pressure (MAP) > 65 mmHg
B. Central Venous Pressure (CVP) > 15 mmHg
C. Heart rate < 60 bpm
D. Systemic Vascular Resistance (SVR) > 1500 dynes/sec/cm5
Answer: A
Conceptual Explanation: The Surviving Sepsis Campaign guidelines recommend targeting
a MAP of at least 65 mmHg to ensure adequate organ perfusion.
, 4. A patient with a history of alcohol use disorder presents with hematemesis. Octreotide
infusion is started. What is the primary mechanism of action for Octreotide in this setting?
A. Directly neutralizes gastric acid
B. Promotes platelet aggregation
C. Causes splanchnic vasoconstriction to reduce portal inflow
D. Induces systemic hypertension to offset blood loss
Answer: C
Conceptual Explanation: Octreotide, a somatostatin analog, reduces portal venous
pressure by causing splanchnic vasoconstriction, which is effective in managing variceal
bleeding.
5. Which electrolyte abnormality is most likely to cause prolonged QT interval and Torsades
de Pointes?
A. Hyperkalemia
B. Hypomagnesemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
DIAGNOSIS & MANAGEMENT IN
ACUTE CARE QUESTIONS AND
ANSWERS
1. A 65-year-old patient in the ICU develops sudden hypotension, tachycardia, and increased
central venous pressure (CVP) following a central line insertion. Physical exam reveals
muffled heart sounds. What is the most likely diagnosis?
A. Cardiac tamponade
B. Tension pneumothorax
C. Pulmonary embolism
D. Hypovolemic shock
Answer: A
Conceptual Explanation: Cardiac tamponade is characterized by Beck’s Triad:
hypotension, muffled heart sounds, and elevated CVP (jugular venous distension). Tension
pneumothorax would show absent breath sounds and tracheal deviation.
,2. In the management of Acute Respiratory Distress Syndrome (ARDS), which ventilator
strategy has been shown to improve survival?
A. High tidal volume to ensure CO2 clearance
B. Low tidal volume (6 mL/kg predicted body weight)
C. Routine use of high-frequency oscillatory ventilation
D. Maintenance of peak inspiratory pressures > 40 cm H2O
Answer: B
Conceptual Explanation: Low tidal volume ventilation (lung-protective ventilation)
reduces ventilator-induced lung injury (VILI) and has a proven mortality benefit in ARDS
patients.
3. Which of the following is the primary hemodynamic goal in the initial treatment of Septic
Shock?
A. Mean Arterial Pressure (MAP) > 65 mmHg
B. Central Venous Pressure (CVP) > 15 mmHg
C. Heart rate < 60 bpm
D. Systemic Vascular Resistance (SVR) > 1500 dynes/sec/cm5
Answer: A
Conceptual Explanation: The Surviving Sepsis Campaign guidelines recommend targeting
a MAP of at least 65 mmHg to ensure adequate organ perfusion.
, 4. A patient with a history of alcohol use disorder presents with hematemesis. Octreotide
infusion is started. What is the primary mechanism of action for Octreotide in this setting?
A. Directly neutralizes gastric acid
B. Promotes platelet aggregation
C. Causes splanchnic vasoconstriction to reduce portal inflow
D. Induces systemic hypertension to offset blood loss
Answer: C
Conceptual Explanation: Octreotide, a somatostatin analog, reduces portal venous
pressure by causing splanchnic vasoconstriction, which is effective in managing variceal
bleeding.
5. Which electrolyte abnormality is most likely to cause prolonged QT interval and Torsades
de Pointes?
A. Hyperkalemia
B. Hypomagnesemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
