NR570 Exam 1 Actual Exam Style V3 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid.
What is the next recommended intervention based on surviving sepsis guidelines?
A. Initiate Norepinephrine infusion
B. Administer an additional 2L of normal saline
C. Initiate Dobutamine infusion
D. Administer intravenous hydrocortisone
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended for patients in
septic shock who do not respond to initial fluid resuscitation. The goal is to maintain a
Mean Arterial Pressure (MAP) of at least 65 mmHg to ensure tissue perfusion. Delaying
vasopressor therapy in the setting of persistent hypotension can lead to multi-organ
dysfunction syndrome.
2. Which clinical finding is most characteristic of a patient experiencing the early (exudative)
phase of ARDS?
A. Refractory hypoxemia
B. Increased lung compliance
,C. Decreased pulmonary artery pressure
D. Productive cough with purulent sputum
Answer: A
Rationale: Refractory hypoxemia is a hallmark of ARDS where the PaO2 remains low
despite increasing the fraction of inspired oxygen. During the exudative phase, the alveolar-
capillary membrane is damaged, leading to protein-rich fluid leaking into the alveoli. This
results in significant shunting and impaired gas exchange that does not respond well to
oxygen therapy alone.
3. A patient is admitted with Acute Kidney Injury (AKI). Their urine sodium is 10 mEq/L and
the Fractional Excretion of Sodium (FeNa) is less than 1%. What is the most likely etiology?
A. Acute Tubular Necrosis (ATN)
B. Postrenal obstruction
C. Prerenal azotemia
D. Contrast-induced nephropathy
Answer: C
Rationale: A FeNa less than 1% typically indicates prerenal azotemia, suggesting that the
kidneys are still able to concentrate urine and conserve sodium. This condition is usually
caused by decreased renal perfusion such as dehydration or heart failure. In contrast,
intrarenal causes like ATN usually result in a FeNa greater than 2% due to tubular damage.
, 4. Which ventilator setting is primarily adjusted to improve oxygenation in a patient with
ARDS?
A. Tidal volume
B. Respiratory rate
C. Inspiratory flow rate
D. Positive End-Expiratory Pressure (PEEP)
Answer: D
Rationale: PEEP helps to keep alveoli open at the end of expiration, which increases the
surface area available for gas exchange and prevents atelectasis. Improving oxygenation in
ARDS involves titrating PEEP and FiO2 to achieve adequate arterial oxygen saturation.
Tidal volume and respiratory rate are more closely associated with ventilation and the
clearance of carbon dioxide.
5. An arterial blood gas (ABG) shows: pH 7.25, PaCO2 55 mmHg, HCO3 24 mEq/L. How would
you interpret this result?
A. Compensated Metabolic Acidosis
B. Compensated Respiratory Alkalosis
C. Uncompensated Respiratory Acidosis
D. Uncompensated Metabolic Alkalosis
Answer: C
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid.
What is the next recommended intervention based on surviving sepsis guidelines?
A. Initiate Norepinephrine infusion
B. Administer an additional 2L of normal saline
C. Initiate Dobutamine infusion
D. Administer intravenous hydrocortisone
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended for patients in
septic shock who do not respond to initial fluid resuscitation. The goal is to maintain a
Mean Arterial Pressure (MAP) of at least 65 mmHg to ensure tissue perfusion. Delaying
vasopressor therapy in the setting of persistent hypotension can lead to multi-organ
dysfunction syndrome.
2. Which clinical finding is most characteristic of a patient experiencing the early (exudative)
phase of ARDS?
A. Refractory hypoxemia
B. Increased lung compliance
,C. Decreased pulmonary artery pressure
D. Productive cough with purulent sputum
Answer: A
Rationale: Refractory hypoxemia is a hallmark of ARDS where the PaO2 remains low
despite increasing the fraction of inspired oxygen. During the exudative phase, the alveolar-
capillary membrane is damaged, leading to protein-rich fluid leaking into the alveoli. This
results in significant shunting and impaired gas exchange that does not respond well to
oxygen therapy alone.
3. A patient is admitted with Acute Kidney Injury (AKI). Their urine sodium is 10 mEq/L and
the Fractional Excretion of Sodium (FeNa) is less than 1%. What is the most likely etiology?
A. Acute Tubular Necrosis (ATN)
B. Postrenal obstruction
C. Prerenal azotemia
D. Contrast-induced nephropathy
Answer: C
Rationale: A FeNa less than 1% typically indicates prerenal azotemia, suggesting that the
kidneys are still able to concentrate urine and conserve sodium. This condition is usually
caused by decreased renal perfusion such as dehydration or heart failure. In contrast,
intrarenal causes like ATN usually result in a FeNa greater than 2% due to tubular damage.
, 4. Which ventilator setting is primarily adjusted to improve oxygenation in a patient with
ARDS?
A. Tidal volume
B. Respiratory rate
C. Inspiratory flow rate
D. Positive End-Expiratory Pressure (PEEP)
Answer: D
Rationale: PEEP helps to keep alveoli open at the end of expiration, which increases the
surface area available for gas exchange and prevents atelectasis. Improving oxygenation in
ARDS involves titrating PEEP and FiO2 to achieve adequate arterial oxygen saturation.
Tidal volume and respiratory rate are more closely associated with ventilation and the
clearance of carbon dioxide.
5. An arterial blood gas (ABG) shows: pH 7.25, PaCO2 55 mmHg, HCO3 24 mEq/L. How would
you interpret this result?
A. Compensated Metabolic Acidosis
B. Compensated Respiratory Alkalosis
C. Uncompensated Respiratory Acidosis
D. Uncompensated Metabolic Alkalosis
Answer: C
