NR570 Exam 3 Actual Exam Style V1 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents with acute onset shortness of breath and pleuritic chest pain.
His D-dimer is elevated, and a CT pulmonary angiogram confirms a pulmonary embolism.
Which of the following is the most appropriate initial management for a hemodynamically
stable patient?
A. Initiation of anticoagulation with low molecular weight heparin
B. Immediate systemic thrombolytic therapy
C. Emergency surgical embolectomy
D. Placement of an inferior vena cava filter
Answer: A
Rationale: In hemodynamically stable patients with pulmonary embolism, anticoagulation
is the primary treatment. Low molecular weight heparin or direct oral anticoagulants are
typically preferred over systemic thrombolytics. Thrombolytic therapy is reserved for
patients who are hemodynamically unstable or showing signs of obstructive shock.
,2. A patient in the ICU with ARDS is being mechanically ventilated. The clinician notes a
decrease in the P/F ratio despite increasing the FiO2 to 80%. What is the most appropriate
next step to improve oxygenation?
A. Increase the Positive End-Expiratory Pressure (PEEP)
B. Decrease the tidal volume to 4 mL/kg
C. Increase the respiratory rate
D. Perform immediate needle decompression
Answer: A
Rationale: Increasing PEEP helps to recruit collapsed alveoli and improve oxygenation in
patients with ARDS. This strategy increases the functional residual capacity and prevents
end-expiratory alveolar collapse. It is a standard maneuver when FiO2 requirements are
high and oxygenation remains suboptimal.
3. Which of the following findings is most characteristic of Diabetic Ketoacidosis (DKA)
compared to Hyperosmolar Hyperglycemic State (HHS)?
A. Blood glucose level greater than 800 mg/dL
B. Occurs primarily in elderly patients with Type 2 Diabetes
C. Severe dehydration and high serum osmolality
D. Presence of significant ketonuria and metabolic acidosis
Answer: D
,Rationale: DKA is characterized by the triad of hyperglycemia, ketosis, and metabolic
acidosis with an increased anion gap. While HHS involves higher glucose levels and greater
osmolality, it lacks the significant ketone production seen in DKA. DKA is most commonly
associated with Type 1 Diabetes but can occur in Type 2 patients under severe stress.
4. A patient presents with a suspected ischemic stroke. What is the maximum time window
from the ‘last known well’ time for the administration of intravenous Alteplase (tPA)
according to current guidelines?
A. 90 minutes
B. 3 hours
C. 4.5 hours
D. 6 hours
Answer: C
Rationale: The standard time window for administering intravenous tPA in eligible
patients is up to 4.5 hours from the time they were last known to be at baseline. Early
administration is critical for salvaging brain tissue and improving functional outcomes.
Clinicians must strictly screen for contraindications, such as recent surgery or active
bleeding, before administration.
, 5. A 72-year-old female is admitted with sepsis. Her blood pressure is 85/50 mmHg after
receiving 30 mL/kg of IV fluids. What is the preferred first-line vasopressor to maintain a
Mean Arterial Pressure (MAP) of 65 mmHg?
A. Epinephrine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
Answer: B
Rationale: Norepinephrine is the first-choice vasopressor for septic shock that is
unresponsive to initial fluid resuscitation. It provides potent alpha-1 and moderate beta-1
adrenergic effects, increasing vascular tone and cardiac output. Other agents like
vasopressin may be added as adjuncts if norepinephrine alone is insufficient.
6. In the management of acute pancreatitis, which of the following is considered the most
important early intervention?
A. Administration of prophylactic antibiotics
B. Aggressive intravenous fluid resuscitation
C. Early endoscopic retrograde cholangiopancreatography (ERCP)
D. Immediate surgical debridement of the pancreas
Answer: B
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents with acute onset shortness of breath and pleuritic chest pain.
His D-dimer is elevated, and a CT pulmonary angiogram confirms a pulmonary embolism.
Which of the following is the most appropriate initial management for a hemodynamically
stable patient?
A. Initiation of anticoagulation with low molecular weight heparin
B. Immediate systemic thrombolytic therapy
C. Emergency surgical embolectomy
D. Placement of an inferior vena cava filter
Answer: A
Rationale: In hemodynamically stable patients with pulmonary embolism, anticoagulation
is the primary treatment. Low molecular weight heparin or direct oral anticoagulants are
typically preferred over systemic thrombolytics. Thrombolytic therapy is reserved for
patients who are hemodynamically unstable or showing signs of obstructive shock.
,2. A patient in the ICU with ARDS is being mechanically ventilated. The clinician notes a
decrease in the P/F ratio despite increasing the FiO2 to 80%. What is the most appropriate
next step to improve oxygenation?
A. Increase the Positive End-Expiratory Pressure (PEEP)
B. Decrease the tidal volume to 4 mL/kg
C. Increase the respiratory rate
D. Perform immediate needle decompression
Answer: A
Rationale: Increasing PEEP helps to recruit collapsed alveoli and improve oxygenation in
patients with ARDS. This strategy increases the functional residual capacity and prevents
end-expiratory alveolar collapse. It is a standard maneuver when FiO2 requirements are
high and oxygenation remains suboptimal.
3. Which of the following findings is most characteristic of Diabetic Ketoacidosis (DKA)
compared to Hyperosmolar Hyperglycemic State (HHS)?
A. Blood glucose level greater than 800 mg/dL
B. Occurs primarily in elderly patients with Type 2 Diabetes
C. Severe dehydration and high serum osmolality
D. Presence of significant ketonuria and metabolic acidosis
Answer: D
,Rationale: DKA is characterized by the triad of hyperglycemia, ketosis, and metabolic
acidosis with an increased anion gap. While HHS involves higher glucose levels and greater
osmolality, it lacks the significant ketone production seen in DKA. DKA is most commonly
associated with Type 1 Diabetes but can occur in Type 2 patients under severe stress.
4. A patient presents with a suspected ischemic stroke. What is the maximum time window
from the ‘last known well’ time for the administration of intravenous Alteplase (tPA)
according to current guidelines?
A. 90 minutes
B. 3 hours
C. 4.5 hours
D. 6 hours
Answer: C
Rationale: The standard time window for administering intravenous tPA in eligible
patients is up to 4.5 hours from the time they were last known to be at baseline. Early
administration is critical for salvaging brain tissue and improving functional outcomes.
Clinicians must strictly screen for contraindications, such as recent surgery or active
bleeding, before administration.
, 5. A 72-year-old female is admitted with sepsis. Her blood pressure is 85/50 mmHg after
receiving 30 mL/kg of IV fluids. What is the preferred first-line vasopressor to maintain a
Mean Arterial Pressure (MAP) of 65 mmHg?
A. Epinephrine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
Answer: B
Rationale: Norepinephrine is the first-choice vasopressor for septic shock that is
unresponsive to initial fluid resuscitation. It provides potent alpha-1 and moderate beta-1
adrenergic effects, increasing vascular tone and cardiac output. Other agents like
vasopressin may be added as adjuncts if norepinephrine alone is insufficient.
6. In the management of acute pancreatitis, which of the following is considered the most
important early intervention?
A. Administration of prophylactic antibiotics
B. Aggressive intravenous fluid resuscitation
C. Early endoscopic retrograde cholangiopancreatography (ERCP)
D. Immediate surgical debridement of the pancreas
Answer: B
