NR571 COMPLEX DIAGNOSIS AND
MANAGEMENT IN ACUTE CARE
REVIEW QUESTIONS AND ANSWERS
1. A patient with septic shock is receiving norepinephrine. Despite a MAP of 65 mmHg, the
patient’s serum lactate continues to rise and ScvO2 is 55%. What is the most appropriate next
step in hemodynamic management?
A. Increase the norepinephrine dose to target a MAP of 85 mmHg
B. Initiate a dobutamine infusion to improve oxygen delivery
C. Administer a 2-liter bolus of 0.45% normal saline
D. Start a phenylephrine infusion to decrease heart rate
Answer: B
Conceptual Explanation: In septic shock with adequate MAP but signs of persistent tissue
hypoxia (rising lactate and low ScvO2), dobutamine may be added to increase cardiac
output and improve oxygen delivery.
,2. Which of the following hemodynamic profiles is most consistent with early hypovolemic
shock?
A. Decreased CVP, Decreased SVR, Increased CO
B. Increased CVP, Decreased SVR, Increased CO
C. Decreased CVP, Increased SVR, Decreased CO
D. Increased CVP, Increased SVR, Decreased CO
Answer: C
Conceptual Explanation: Hypovolemic shock is characterized by low preload (decreased
CVP), compensatory vasoconstriction (increased SVR), and a resulting low cardiac output
(CO).
3. A patient with ARDS is being ventilated with low tidal volume (6 mL/kg). The plateau
pressure is 34 cm H2O. What is the priority intervention?
A. Increase the respiratory rate to compensate for hypercapnia
B. Decrease the tidal volume to 4-5 mL/kg to lower plateau pressure
C. Increase PEEP to improve recruitment
D. Perform a recruitment maneuver immediately
Answer: B
, Conceptual Explanation: In lung-protective ventilation for ARDS, the goal is to keep
plateau pressure < 30 cm H2O. If it exceeds this, the tidal volume should be reduced
further, even if it results in permissive hypercapnia.
4. Which laboratory finding is the most sensitive indicator of evolving Disseminated
Intravascular Coagulation (DIC)?
A. Low Fibrinogen levels
B. Low platelet count
C. Prolonged Prothrombin Time (PT)
D. Elevated D-dimer levels
Answer: D
Conceptual Explanation: D-dimer indicates the presence of fibrin degradation and is the
most sensitive marker for the activation of the clotting and fibrinolytic systems seen in DIC.
5. A patient presents with a sudden onset of severe ‘tearing’ chest pain radiating to the back.
Blood pressure is 190/110 mmHg. Which medication should be initiated first?
A. Esmolol
B. Hydralazine
C. Lisinopril
D. Nitroprusside
Answer: A
MANAGEMENT IN ACUTE CARE
REVIEW QUESTIONS AND ANSWERS
1. A patient with septic shock is receiving norepinephrine. Despite a MAP of 65 mmHg, the
patient’s serum lactate continues to rise and ScvO2 is 55%. What is the most appropriate next
step in hemodynamic management?
A. Increase the norepinephrine dose to target a MAP of 85 mmHg
B. Initiate a dobutamine infusion to improve oxygen delivery
C. Administer a 2-liter bolus of 0.45% normal saline
D. Start a phenylephrine infusion to decrease heart rate
Answer: B
Conceptual Explanation: In septic shock with adequate MAP but signs of persistent tissue
hypoxia (rising lactate and low ScvO2), dobutamine may be added to increase cardiac
output and improve oxygen delivery.
,2. Which of the following hemodynamic profiles is most consistent with early hypovolemic
shock?
A. Decreased CVP, Decreased SVR, Increased CO
B. Increased CVP, Decreased SVR, Increased CO
C. Decreased CVP, Increased SVR, Decreased CO
D. Increased CVP, Increased SVR, Decreased CO
Answer: C
Conceptual Explanation: Hypovolemic shock is characterized by low preload (decreased
CVP), compensatory vasoconstriction (increased SVR), and a resulting low cardiac output
(CO).
3. A patient with ARDS is being ventilated with low tidal volume (6 mL/kg). The plateau
pressure is 34 cm H2O. What is the priority intervention?
A. Increase the respiratory rate to compensate for hypercapnia
B. Decrease the tidal volume to 4-5 mL/kg to lower plateau pressure
C. Increase PEEP to improve recruitment
D. Perform a recruitment maneuver immediately
Answer: B
, Conceptual Explanation: In lung-protective ventilation for ARDS, the goal is to keep
plateau pressure < 30 cm H2O. If it exceeds this, the tidal volume should be reduced
further, even if it results in permissive hypercapnia.
4. Which laboratory finding is the most sensitive indicator of evolving Disseminated
Intravascular Coagulation (DIC)?
A. Low Fibrinogen levels
B. Low platelet count
C. Prolonged Prothrombin Time (PT)
D. Elevated D-dimer levels
Answer: D
Conceptual Explanation: D-dimer indicates the presence of fibrin degradation and is the
most sensitive marker for the activation of the clotting and fibrinolytic systems seen in DIC.
5. A patient presents with a sudden onset of severe ‘tearing’ chest pain radiating to the back.
Blood pressure is 190/110 mmHg. Which medication should be initiated first?
A. Esmolol
B. Hydralazine
C. Lisinopril
D. Nitroprusside
Answer: A
