NR570 Exam 2 Actual Exam Style V3 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents with a MAP of 55 mmHg, heart rate of 120 bpm, and a
serum lactate of 4.2 mmol/L after receiving 3L of IV fluids. What is the most likely diagnosis?
A. Sepsis
B. Septic Shock
C. Hypovolemic Shock
D. Systemic Inflammatory Response Syndrome (SIRS)
Answer: B
Rationale: The patient meets the criteria for septic shock because they remain hypotensive
(MAP < 65 mmHg) despite adequate fluid resuscitation and have an elevated lactate. This
condition requires vasopressor therapy to maintain perfusion to vital organs. Early
identification is crucial for improving patient outcomes in the acute care setting.
2. In the management of Acute Kidney Injury (AKI), which Fractional Excretion of Sodium
(FENa) result most strongly suggests a prerenal etiology?
A. FENa > 2%
B. FENa = 3%
C. FENa < 1%
,D. FENa < 5% but > 2%
Answer: C
Rationale: A FENa of less than 1% indicates that the kidneys are still able to concentrate
urine and conserve sodium, pointing to reduced renal perfusion rather than intrinsic
damage. This is a hallmark of prerenal AKI, often caused by dehydration or heart failure.
Clinical management focuses on restoring volume or cardiac output to improve renal blood
flow.
3. A patient with a history of COPD presents with increased dyspnea and productive cough.
Arterial blood gas (ABG) shows pH 7.32, PaCO2 55, and HCO3 28. What is the first-line non-
pharmacological intervention?
A. Immediate Intubation
B. Non-invasive Positive Pressure Ventilation (BiPAP)
C. Incentive Spirometry
D. High-flow Nasal Cannula at 60L/min
Answer: B
Rationale: BiPAP is the preferred initial intervention for patients with acute respiratory
acidosis due to COPD exacerbations. It helps reduce the work of breathing and improves
gas exchange, potentially avoiding the need for invasive mechanical ventilation. Clinicians
must monitor the patient closely for improvement in pH and mental status.
, 4. Which of the following is the most appropriate initial fluid choice for a patient in Diabetic
Ketoacidosis (DKA) with a blood glucose of 550 mg/dL and signs of dehydration?
A. 0.9% Normal Saline
B. D5 1/2 Normal Saline
C. D5W at 150 mL/hr
D. Lactated Ringer’s with 20 mEq KCl
Answer: A
Rationale: Initial management of DKA requires aggressive volume expansion with isotonic
saline to restore circulatory volume. Once the blood glucose drops below 200-250 mg/dL,
the fluid is usually switched to a dextrose-containing solution. This sequential approach
prevents cerebral edema and manages the metabolic derangements effectively.
5. During an assessment of a patient with suspected Heart Failure, you note a third heart
sound (S3). What does this finding primarily indicate?
A. Left ventricular hypertrophy
B. Stiff, non-compliant ventricle
C. Ventricular overfilling or volume overload
D. Aortic valve stenosis
Answer: C
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents with a MAP of 55 mmHg, heart rate of 120 bpm, and a
serum lactate of 4.2 mmol/L after receiving 3L of IV fluids. What is the most likely diagnosis?
A. Sepsis
B. Septic Shock
C. Hypovolemic Shock
D. Systemic Inflammatory Response Syndrome (SIRS)
Answer: B
Rationale: The patient meets the criteria for septic shock because they remain hypotensive
(MAP < 65 mmHg) despite adequate fluid resuscitation and have an elevated lactate. This
condition requires vasopressor therapy to maintain perfusion to vital organs. Early
identification is crucial for improving patient outcomes in the acute care setting.
2. In the management of Acute Kidney Injury (AKI), which Fractional Excretion of Sodium
(FENa) result most strongly suggests a prerenal etiology?
A. FENa > 2%
B. FENa = 3%
C. FENa < 1%
,D. FENa < 5% but > 2%
Answer: C
Rationale: A FENa of less than 1% indicates that the kidneys are still able to concentrate
urine and conserve sodium, pointing to reduced renal perfusion rather than intrinsic
damage. This is a hallmark of prerenal AKI, often caused by dehydration or heart failure.
Clinical management focuses on restoring volume or cardiac output to improve renal blood
flow.
3. A patient with a history of COPD presents with increased dyspnea and productive cough.
Arterial blood gas (ABG) shows pH 7.32, PaCO2 55, and HCO3 28. What is the first-line non-
pharmacological intervention?
A. Immediate Intubation
B. Non-invasive Positive Pressure Ventilation (BiPAP)
C. Incentive Spirometry
D. High-flow Nasal Cannula at 60L/min
Answer: B
Rationale: BiPAP is the preferred initial intervention for patients with acute respiratory
acidosis due to COPD exacerbations. It helps reduce the work of breathing and improves
gas exchange, potentially avoiding the need for invasive mechanical ventilation. Clinicians
must monitor the patient closely for improvement in pH and mental status.
, 4. Which of the following is the most appropriate initial fluid choice for a patient in Diabetic
Ketoacidosis (DKA) with a blood glucose of 550 mg/dL and signs of dehydration?
A. 0.9% Normal Saline
B. D5 1/2 Normal Saline
C. D5W at 150 mL/hr
D. Lactated Ringer’s with 20 mEq KCl
Answer: A
Rationale: Initial management of DKA requires aggressive volume expansion with isotonic
saline to restore circulatory volume. Once the blood glucose drops below 200-250 mg/dL,
the fluid is usually switched to a dextrose-containing solution. This sequential approach
prevents cerebral edema and manages the metabolic derangements effectively.
5. During an assessment of a patient with suspected Heart Failure, you note a third heart
sound (S3). What does this finding primarily indicate?
A. Left ventricular hypertrophy
B. Stiff, non-compliant ventricle
C. Ventricular overfilling or volume overload
D. Aortic valve stenosis
Answer: C
