NR570 Exam 4 Actual Exam Style V1 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with pneumonia has a blood pressure of 82/44 mmHg after receiving
30 mL/kg of crystalloids. Which of the following is the most appropriate next step in
management?
A. Administer an additional 2L of normal saline bolus.
B. Start a dopamine drip at 10 mcg/kg/min.
C. Initiate norepinephrine infusion to maintain MAP >65 mmHg.
D. Administer broad-spectrum antibiotics and re-evaluate in 4 hours.
Answer: C
Rationale: Septic shock is defined by the need for vasopressors to maintain a MAP of 65
mmHg or greater and a serum lactate level greater than 2 mmol/L despite adequate fluid
resuscitation. Norepinephrine is recommended as the first-choice vasopressor in adult
patients with septic shock. Rapid initiation of vasopressors is essential to ensure adequate
organ perfusion when fluid challenges fail to stabilize hemodynamics.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS) on mechanical
ventilation, which strategy is proven to reduce mortality?
A. High tidal volume (12 mL/kg) to prevent atelectasis.
,B. Low tidal volume (6 mL/kg) ventilation.
C. Maintaining oxygen saturation at 100% at all times.
D. Routine use of high-frequency oscillatory ventilation.
Answer: B
Rationale: The ARDSNet trial demonstrated that low tidal volume ventilation significantly
reduces mortality and increases the number of ventilator-free days. This strategy prevents
ventilator-induced lung injury by limiting alveolar overdistention and cyclic atelectasis.
Targeting 6 mL/kg of predicted body weight is the standard of care for lung-protective
ventilation in ARDS.
3. A patient in the ICU presents with sudden onset of shortness of breath, pleuritic chest pain,
and a heart rate of 120 bpm. What is the most appropriate initial diagnostic test if Pulmonary
Embolism is suspected?
A. CT Pulmonary Angiography (CTPA).
B. D-dimer assay.
C. Chest X-ray.
D. Ventilation-Perfusion (V/Q) scan.
Answer: A
Rationale: CT Pulmonary Angiography is the gold standard and preferred initial imaging
modality for diagnosing pulmonary embolism in most clinical settings. It provides high
, sensitivity and specificity for detecting thrombi in the pulmonary vasculature. While D-
dimer is useful for ruling out PE in low-risk patients, it is often non-specific in the acute
care or ICU setting.
4. Which hemodynamic profile is most characteristic of cardiogenic shock?
A. Low CVP, Low PCWP, High CO.
B. High CVP, High PCWP, Low CO, High SVR.
C. Low CVP, Low PCWP, Low CO, High SVR.
D. High CVP, Low PCWP, High CO, Low SVR.
Answer: B
Rationale: Cardiogenic shock is characterized by pump failure, resulting in a low Cardiac
Output (CO) and elevated filling pressures, such as Pulmonary Capillary Wedge Pressure
(PCWP) and Central Venous Pressure (CVP). Systemic Vascular Resistance (SVR) increases
as a compensatory mechanism to maintain blood pressure. This profile helps differentiate
cardiogenic shock from hypovolemic or distributive shock types.
5. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 240 mg/dL and is
receiving an insulin infusion. What is the next step in fluid management?
A. Switch the IV fluid to D5 with 0.45% NS.
B. Stop the insulin infusion immediately.
C. Increase the insulin infusion rate.
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with pneumonia has a blood pressure of 82/44 mmHg after receiving
30 mL/kg of crystalloids. Which of the following is the most appropriate next step in
management?
A. Administer an additional 2L of normal saline bolus.
B. Start a dopamine drip at 10 mcg/kg/min.
C. Initiate norepinephrine infusion to maintain MAP >65 mmHg.
D. Administer broad-spectrum antibiotics and re-evaluate in 4 hours.
Answer: C
Rationale: Septic shock is defined by the need for vasopressors to maintain a MAP of 65
mmHg or greater and a serum lactate level greater than 2 mmol/L despite adequate fluid
resuscitation. Norepinephrine is recommended as the first-choice vasopressor in adult
patients with septic shock. Rapid initiation of vasopressors is essential to ensure adequate
organ perfusion when fluid challenges fail to stabilize hemodynamics.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS) on mechanical
ventilation, which strategy is proven to reduce mortality?
A. High tidal volume (12 mL/kg) to prevent atelectasis.
,B. Low tidal volume (6 mL/kg) ventilation.
C. Maintaining oxygen saturation at 100% at all times.
D. Routine use of high-frequency oscillatory ventilation.
Answer: B
Rationale: The ARDSNet trial demonstrated that low tidal volume ventilation significantly
reduces mortality and increases the number of ventilator-free days. This strategy prevents
ventilator-induced lung injury by limiting alveolar overdistention and cyclic atelectasis.
Targeting 6 mL/kg of predicted body weight is the standard of care for lung-protective
ventilation in ARDS.
3. A patient in the ICU presents with sudden onset of shortness of breath, pleuritic chest pain,
and a heart rate of 120 bpm. What is the most appropriate initial diagnostic test if Pulmonary
Embolism is suspected?
A. CT Pulmonary Angiography (CTPA).
B. D-dimer assay.
C. Chest X-ray.
D. Ventilation-Perfusion (V/Q) scan.
Answer: A
Rationale: CT Pulmonary Angiography is the gold standard and preferred initial imaging
modality for diagnosing pulmonary embolism in most clinical settings. It provides high
, sensitivity and specificity for detecting thrombi in the pulmonary vasculature. While D-
dimer is useful for ruling out PE in low-risk patients, it is often non-specific in the acute
care or ICU setting.
4. Which hemodynamic profile is most characteristic of cardiogenic shock?
A. Low CVP, Low PCWP, High CO.
B. High CVP, High PCWP, Low CO, High SVR.
C. Low CVP, Low PCWP, Low CO, High SVR.
D. High CVP, Low PCWP, High CO, Low SVR.
Answer: B
Rationale: Cardiogenic shock is characterized by pump failure, resulting in a low Cardiac
Output (CO) and elevated filling pressures, such as Pulmonary Capillary Wedge Pressure
(PCWP) and Central Venous Pressure (CVP). Systemic Vascular Resistance (SVR) increases
as a compensatory mechanism to maintain blood pressure. This profile helps differentiate
cardiogenic shock from hypovolemic or distributive shock types.
5. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 240 mg/dL and is
receiving an insulin infusion. What is the next step in fluid management?
A. Switch the IV fluid to D5 with 0.45% NS.
B. Stop the insulin infusion immediately.
C. Increase the insulin infusion rate.
