NRNP 6566 ADVANCED CARE OF
ADULTS IN ACUTE SETTINGS I
COMPREHENSIVE KNOWLEDGE
CHECK
1. A patient in the ICU presents with a Pulmonary Capillary Wedge Pressure (PCWP) of 22
mmHg, a Cardiac Index (CI) of 1.8 L/min/m², and an elevated Systemic Vascular Resistance
(SVR). Which type of shock is most likely?
A. Hypovolemic shock
B. Distributive shock
C. Obstructive shock
D. Cardiogenic shock
Answer: D
Conceptual Explanation: Cardiogenic shock is characterized by a high PCWP (indicating
fluid backup in the left heart), a low CI (indicating pump failure), and high SVR
(compensatory vasoconstriction).
,2. In the management of Acute Respiratory Distress Syndrome (ARDS), what is the primary
goal of utilizing low tidal volume ventilation (6 mL/kg)?
A. To prevent volutrauma and barotrauma
B. To maximize carbon dioxide elimination
C. To improve patient-ventilator synchrony
D. To decrease the need for sedation
Answer: A
Conceptual Explanation: Low tidal volume ventilation is a lung-protective strategy
designed to prevent ventilator-induced lung injury (VILI), specifically volutrauma
(overdistension) and barotrauma.
3. A 65-year-old male with a history of HTN presents with sudden, tearing chest pain radiating
to the back. His BP is 190/110 mmHg. What is the priority intervention?
A. Administering high-dose Aspirin
B. Administering Tissue Plasminogen Activator (tPA)
C. Initiating IV Esmolol to reduce heart rate and blood pressure
D. Ordering an immediate V/Q scan
Answer: C
Conceptual Explanation: The presentation is classic for aortic dissection. The immediate
goal is to reduce heart rate and blood pressure to minimize aortic wall stress (dp/dt).
, 4. Which of the following laboratory findings is most indicative of disseminated intravascular
coagulation (DIC)?
A. Elevated Platelets and decreased PT/PTT
B. Elevated D-dimer and decreased Fibrinogen
C. Decreased D-dimer and elevated Fibrinogen
D. Normal Prothrombin Time and normal Platelets
Answer: B
Conceptual Explanation: DIC is characterized by the consumption of clotting factors and
platelets, leading to low fibrinogen/platelets and high D-dimer due to secondary
fibrinolysis.
5. A patient with a Traumatic Brain Injury (TBI) has an Intracranial Pressure (ICP) of 25 mmHg
and a Mean Arterial Pressure (MAP) of 60 mmHg. What is the calculated Cerebral Perfusion
Pressure (CPP)?
A. 35 mmHg
B. 85 mmHg
C. 40 mmHg
D. 70 mmHg
Answer: A
ADULTS IN ACUTE SETTINGS I
COMPREHENSIVE KNOWLEDGE
CHECK
1. A patient in the ICU presents with a Pulmonary Capillary Wedge Pressure (PCWP) of 22
mmHg, a Cardiac Index (CI) of 1.8 L/min/m², and an elevated Systemic Vascular Resistance
(SVR). Which type of shock is most likely?
A. Hypovolemic shock
B. Distributive shock
C. Obstructive shock
D. Cardiogenic shock
Answer: D
Conceptual Explanation: Cardiogenic shock is characterized by a high PCWP (indicating
fluid backup in the left heart), a low CI (indicating pump failure), and high SVR
(compensatory vasoconstriction).
,2. In the management of Acute Respiratory Distress Syndrome (ARDS), what is the primary
goal of utilizing low tidal volume ventilation (6 mL/kg)?
A. To prevent volutrauma and barotrauma
B. To maximize carbon dioxide elimination
C. To improve patient-ventilator synchrony
D. To decrease the need for sedation
Answer: A
Conceptual Explanation: Low tidal volume ventilation is a lung-protective strategy
designed to prevent ventilator-induced lung injury (VILI), specifically volutrauma
(overdistension) and barotrauma.
3. A 65-year-old male with a history of HTN presents with sudden, tearing chest pain radiating
to the back. His BP is 190/110 mmHg. What is the priority intervention?
A. Administering high-dose Aspirin
B. Administering Tissue Plasminogen Activator (tPA)
C. Initiating IV Esmolol to reduce heart rate and blood pressure
D. Ordering an immediate V/Q scan
Answer: C
Conceptual Explanation: The presentation is classic for aortic dissection. The immediate
goal is to reduce heart rate and blood pressure to minimize aortic wall stress (dp/dt).
, 4. Which of the following laboratory findings is most indicative of disseminated intravascular
coagulation (DIC)?
A. Elevated Platelets and decreased PT/PTT
B. Elevated D-dimer and decreased Fibrinogen
C. Decreased D-dimer and elevated Fibrinogen
D. Normal Prothrombin Time and normal Platelets
Answer: B
Conceptual Explanation: DIC is characterized by the consumption of clotting factors and
platelets, leading to low fibrinogen/platelets and high D-dimer due to secondary
fibrinolysis.
5. A patient with a Traumatic Brain Injury (TBI) has an Intracranial Pressure (ICP) of 25 mmHg
and a Mean Arterial Pressure (MAP) of 60 mmHg. What is the calculated Cerebral Perfusion
Pressure (CPP)?
A. 35 mmHg
B. 85 mmHg
C. 40 mmHg
D. 70 mmHg
Answer: A
