NUNP 6560 Advanced Practice Care of
Adults in Acute care settings II
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, Case: A 60-year-old male with a history of pneumonia presents with
hypotension (SBP 85 mmHg), tachycardia, and signs of end-organ
hypoperfusion. You suspect septic shock.
Question: According to current guidelines, what is the recommended
initial fluid resuscitation strategy for septic shock in this patient?
a) 10 mL/kg of crystalloid
b) 20 mL/kg of crystalloid
c) 30 mL/kg of intravenous crystalloids
d) 40 mL/kg of crystalloid
Correct ANS: c) 30 mL/kg of intravenous crystalloids
Rationale: The Surviving Sepsis Campaign recommends an initial fluid
challenge of 30 mL/kg of crystalloid as soon as possible in patients with
septic shock. This approach is aimed at restoring intravascular volume
and improving tissue perfusion.
---
2. Fill-in-the-Blank
Case: An ICU patient with multiple organ dysfunction is being assessed
to estimate the risk of mortality based on organ function.
Question: The __________ score is used to quantify the severity of
organ dysfunction by evaluating respiratory, cardiovascular, hepatic,
coagulation, renal, and neurologic systems.
Correct ANS: Sequential Organ Failure Assessment (SOFA)
Rationale: The SOFA score is widely employed in the ICU to assess the
extent of organ failure in septic and critically ill patients, making it a
valuable prognostic tool.
---
©2025
, 3. True/False
Case: A 70-year-old female with acute respiratory distress syndrome
(ARDS) is managed with mechanical ventilation.
Statement: True or False: A lung-protective strategy employing a tidal
volume of 6 mL/kg of predicted body weight is recommended in patients
with ARDS.
Correct ANS: True
Rationale: Lung-protective ventilation is a cornerstone of ARDS
management. Using low tidal volumes (approximately 6 mL/kg) helps
minimize ventilator-induced lung injury and improves outcomes.
---
4. Multiple Response
Case: A 55-year-old patient develops cardiogenic shock following an
acute myocardial infarction and is admitted to the ICU.
Question: Which of the following interventions should be included as
part of the initial management? (Select all that apply.)
a) Inotropic support with agents like dobutamine
b) Early consideration for mechanical circulatory support when indicated
c) Aggressive fluid administration to maximize preload
d) Continuous hemodynamic monitoring using a pulmonary artery
catheter
Correct ANSs: a), b), and d)
Rationale: In cardiogenic shock, optimizing cardiac output with
inotropic agents (a) and supporting circulatory status with advanced
monitoring devices and potential mechanical support (b, d) is critical.
Overzealous fluid administration (c) can worsen pulmonary edema and
further impair cardiac function.
©2025
Adults in Acute care settings II
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, Case: A 60-year-old male with a history of pneumonia presents with
hypotension (SBP 85 mmHg), tachycardia, and signs of end-organ
hypoperfusion. You suspect septic shock.
Question: According to current guidelines, what is the recommended
initial fluid resuscitation strategy for septic shock in this patient?
a) 10 mL/kg of crystalloid
b) 20 mL/kg of crystalloid
c) 30 mL/kg of intravenous crystalloids
d) 40 mL/kg of crystalloid
Correct ANS: c) 30 mL/kg of intravenous crystalloids
Rationale: The Surviving Sepsis Campaign recommends an initial fluid
challenge of 30 mL/kg of crystalloid as soon as possible in patients with
septic shock. This approach is aimed at restoring intravascular volume
and improving tissue perfusion.
---
2. Fill-in-the-Blank
Case: An ICU patient with multiple organ dysfunction is being assessed
to estimate the risk of mortality based on organ function.
Question: The __________ score is used to quantify the severity of
organ dysfunction by evaluating respiratory, cardiovascular, hepatic,
coagulation, renal, and neurologic systems.
Correct ANS: Sequential Organ Failure Assessment (SOFA)
Rationale: The SOFA score is widely employed in the ICU to assess the
extent of organ failure in septic and critically ill patients, making it a
valuable prognostic tool.
---
©2025
, 3. True/False
Case: A 70-year-old female with acute respiratory distress syndrome
(ARDS) is managed with mechanical ventilation.
Statement: True or False: A lung-protective strategy employing a tidal
volume of 6 mL/kg of predicted body weight is recommended in patients
with ARDS.
Correct ANS: True
Rationale: Lung-protective ventilation is a cornerstone of ARDS
management. Using low tidal volumes (approximately 6 mL/kg) helps
minimize ventilator-induced lung injury and improves outcomes.
---
4. Multiple Response
Case: A 55-year-old patient develops cardiogenic shock following an
acute myocardial infarction and is admitted to the ICU.
Question: Which of the following interventions should be included as
part of the initial management? (Select all that apply.)
a) Inotropic support with agents like dobutamine
b) Early consideration for mechanical circulatory support when indicated
c) Aggressive fluid administration to maximize preload
d) Continuous hemodynamic monitoring using a pulmonary artery
catheter
Correct ANSs: a), b), and d)
Rationale: In cardiogenic shock, optimizing cardiac output with
inotropic agents (a) and supporting circulatory status with advanced
monitoring devices and potential mechanical support (b, d) is critical.
Overzealous fluid administration (c) can worsen pulmonary edema and
further impair cardiac function.
©2025
