NR570 Exam 2 Actual Exam Style V1 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents to the emergency department with acute onset of shortness of
breath, orthopnea, and bilateral 3+ pitting edema. Physical exam reveals an S3 gallop and
crackles halfway up the lung fields. Which of the following is the most appropriate initial
medication to manage this patient’s symptoms?
A. Lisinopril
B. Atorvastatin
C. Metoprolol
D. Furosemide
Answer: D
Rationale: The patient is presenting with signs of acute decompensated heart failure and
pulmonary congestion. Loop diuretics like furosemide are the first-line treatment to reduce
preload and alleviate pulmonary edema. Diuresis should be monitored by tracking urine
output and assessing for resolution of crackles and edema.
2. Which of the following findings is most consistent with a diagnosis of prerenal acute kidney
injury (AKI)?
A. BUN to Creatinine ratio of greater than 20:1
,B. BUN to Creatinine ratio of 10:1
C. Presence of muddy brown casts in urine sediment
D. Fractional Excretion of Sodium (FeNa) greater than 2%
Answer: A
Rationale: A BUN to Creatinine ratio greater than 20:1 typically indicates prerenal
azotemia where the kidneys are structurally sound but under-perfused. In contrast,
intrarenal AKI usually presents with a ratio closer to 10:1 to 15:1. Prerenal AKI is also
characterized by a low FeNa (less than 1%) as the kidneys attempt to conserve sodium and
water.
3. A patient is admitted with suspected sepsis. According to the Surviving Sepsis Campaign
guidelines, which of the following should be completed within the first hour of presentation?
A. Administration of broad-spectrum antibiotics
B. Insertion of a central venous catheter
C. Initiation of enteral nutrition
D. Repeat lactate level in 12 hours
Answer: A
Rationale: The 1-hour bundle for sepsis management emphasizes early recognition and
rapid intervention. This includes measuring lactate levels, obtaining blood cultures, and
, administering broad-spectrum antibiotics. Prompt antibiotic therapy is critical for reducing
mortality in patients with sepsis and septic shock.
4. An arterial blood gas (ABG) reveals the following: pH 7.28, PaCO2 55 mmHg, HCO3 26
mEq/L. How would you interpret this result?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated above 45
mmHg, which points to a respiratory cause for the acidemia. Since the bicarbonate (HCO3)
is within the normal range, this is an uncompensated respiratory acidosis.
5. Which clinical finding is part of the ‘Beck’s Triad’ associated with cardiac tamponade?
A. Hypertension
B. Jugular Venous Distension
C. Tachycardia
D. Bounding peripheral pulses
Answer: B
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents to the emergency department with acute onset of shortness of
breath, orthopnea, and bilateral 3+ pitting edema. Physical exam reveals an S3 gallop and
crackles halfway up the lung fields. Which of the following is the most appropriate initial
medication to manage this patient’s symptoms?
A. Lisinopril
B. Atorvastatin
C. Metoprolol
D. Furosemide
Answer: D
Rationale: The patient is presenting with signs of acute decompensated heart failure and
pulmonary congestion. Loop diuretics like furosemide are the first-line treatment to reduce
preload and alleviate pulmonary edema. Diuresis should be monitored by tracking urine
output and assessing for resolution of crackles and edema.
2. Which of the following findings is most consistent with a diagnosis of prerenal acute kidney
injury (AKI)?
A. BUN to Creatinine ratio of greater than 20:1
,B. BUN to Creatinine ratio of 10:1
C. Presence of muddy brown casts in urine sediment
D. Fractional Excretion of Sodium (FeNa) greater than 2%
Answer: A
Rationale: A BUN to Creatinine ratio greater than 20:1 typically indicates prerenal
azotemia where the kidneys are structurally sound but under-perfused. In contrast,
intrarenal AKI usually presents with a ratio closer to 10:1 to 15:1. Prerenal AKI is also
characterized by a low FeNa (less than 1%) as the kidneys attempt to conserve sodium and
water.
3. A patient is admitted with suspected sepsis. According to the Surviving Sepsis Campaign
guidelines, which of the following should be completed within the first hour of presentation?
A. Administration of broad-spectrum antibiotics
B. Insertion of a central venous catheter
C. Initiation of enteral nutrition
D. Repeat lactate level in 12 hours
Answer: A
Rationale: The 1-hour bundle for sepsis management emphasizes early recognition and
rapid intervention. This includes measuring lactate levels, obtaining blood cultures, and
, administering broad-spectrum antibiotics. Prompt antibiotic therapy is critical for reducing
mortality in patients with sepsis and septic shock.
4. An arterial blood gas (ABG) reveals the following: pH 7.28, PaCO2 55 mmHg, HCO3 26
mEq/L. How would you interpret this result?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated above 45
mmHg, which points to a respiratory cause for the acidemia. Since the bicarbonate (HCO3)
is within the normal range, this is an uncompensated respiratory acidosis.
5. Which clinical finding is part of the ‘Beck’s Triad’ associated with cardiac tamponade?
A. Hypertension
B. Jugular Venous Distension
C. Tachycardia
D. Bounding peripheral pulses
Answer: B
