NR570 Exam 4 Actual Exam Style V2 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient presents to the ICU with suspected sepsis. According to the Surviving Sepsis
Campaign, what is the recommended initial fluid bolus volume for patients with sepsis-
induced hypotension or a lactate level greater than or equal to 4 mmol/L?
A. 10 mL/kg of crystalloid
B. 30 mL/kg of crystalloid
C. 20 mL/kg of colloid
D. 50 mL/kg of crystalloid
Answer: B
Rationale: The Surviving Sepsis Campaign guidelines recommend an initial fluid
resuscitation of at least 30 mL/kg of intravenous crystalloid fluid. This fluid challenge
should be completed within the first 3 hours of recognition of sepsis-induced
hypoperfusion. Crystalloids are preferred over colloids for initial volume replacement in
these patients.
2. Which hemodynamic parameter is most indicative of cardiogenic shock in a patient
following an acute myocardial infarction?
A. Decreased Central Venous Pressure (CVP)
,B. Increased Cardiac Index (CI)
C. Decreased Systemic Vascular Resistance (SVR)
D. Increased Pulmonary Capillary Wedge Pressure (PCWP)
Answer: D
Rationale: Cardiogenic shock is characterized by a low cardiac output despite adequate
filling pressures, leading to an increased PCWP. The systemic vascular resistance is
typically elevated as a compensatory mechanism to maintain blood pressure. A decreased
cardiac index is the hallmark of heart failure-related shock.
3. A 65-year-old male with a history of COPD presents with worsening dyspnea and
productive cough. His ABG shows pH 7.25, PaCO2 60 mmHg, and PaO2 55 mmHg. What is the
most appropriate first-line respiratory intervention?
A. Non-invasive positive pressure ventilation (NIPPV)
B. High-flow nasal cannula at 60L/min
C. Immediate endotracheal intubation
D. Simple face mask at 6L/min
Answer: A
Rationale: NIPPV is the gold standard for acute exacerbations of COPD with respiratory
acidosis. It helps reduce the work of breathing and improves gas exchange without the
, risks associated with intubation. Intubation is reserved for patients who fail NIPPV or have
contraindications such as altered mental status.
4. In the management of Acute Respiratory Distress Syndrome (ARDS), what is the primary
goal of utilizing higher Positive End-Expiratory Pressure (PEEP)?
A. To prevent alveolar collapse and improve oxygenation
B. To increase tidal volume
C. To decrease the risk of barotrauma
D. To increase the fraction of inspired oxygen (FiO2)
Answer: A
Rationale: PEEP is used in ARDS to recruit collapsed alveoli and keep them open
throughout the respiratory cycle. This improves the surface area for gas exchange and
reduces intrapulmonary shunting. Managing PEEP effectively allows for a reduction in FiO2
to non-toxic levels.
5. Which of the following is a classic laboratory finding in a patient with prerenal Acute
Kidney Injury (AKI)?
A. Fractional Excretion of Sodium (FeNa) > 2%
B. BUN to Creatinine ratio of 10:1
C. Fractional Excretion of Sodium (FeNa) < 1%
D. Low urine osmolality (< 300 mOsm/kg)
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient presents to the ICU with suspected sepsis. According to the Surviving Sepsis
Campaign, what is the recommended initial fluid bolus volume for patients with sepsis-
induced hypotension or a lactate level greater than or equal to 4 mmol/L?
A. 10 mL/kg of crystalloid
B. 30 mL/kg of crystalloid
C. 20 mL/kg of colloid
D. 50 mL/kg of crystalloid
Answer: B
Rationale: The Surviving Sepsis Campaign guidelines recommend an initial fluid
resuscitation of at least 30 mL/kg of intravenous crystalloid fluid. This fluid challenge
should be completed within the first 3 hours of recognition of sepsis-induced
hypoperfusion. Crystalloids are preferred over colloids for initial volume replacement in
these patients.
2. Which hemodynamic parameter is most indicative of cardiogenic shock in a patient
following an acute myocardial infarction?
A. Decreased Central Venous Pressure (CVP)
,B. Increased Cardiac Index (CI)
C. Decreased Systemic Vascular Resistance (SVR)
D. Increased Pulmonary Capillary Wedge Pressure (PCWP)
Answer: D
Rationale: Cardiogenic shock is characterized by a low cardiac output despite adequate
filling pressures, leading to an increased PCWP. The systemic vascular resistance is
typically elevated as a compensatory mechanism to maintain blood pressure. A decreased
cardiac index is the hallmark of heart failure-related shock.
3. A 65-year-old male with a history of COPD presents with worsening dyspnea and
productive cough. His ABG shows pH 7.25, PaCO2 60 mmHg, and PaO2 55 mmHg. What is the
most appropriate first-line respiratory intervention?
A. Non-invasive positive pressure ventilation (NIPPV)
B. High-flow nasal cannula at 60L/min
C. Immediate endotracheal intubation
D. Simple face mask at 6L/min
Answer: A
Rationale: NIPPV is the gold standard for acute exacerbations of COPD with respiratory
acidosis. It helps reduce the work of breathing and improves gas exchange without the
, risks associated with intubation. Intubation is reserved for patients who fail NIPPV or have
contraindications such as altered mental status.
4. In the management of Acute Respiratory Distress Syndrome (ARDS), what is the primary
goal of utilizing higher Positive End-Expiratory Pressure (PEEP)?
A. To prevent alveolar collapse and improve oxygenation
B. To increase tidal volume
C. To decrease the risk of barotrauma
D. To increase the fraction of inspired oxygen (FiO2)
Answer: A
Rationale: PEEP is used in ARDS to recruit collapsed alveoli and keep them open
throughout the respiratory cycle. This improves the surface area for gas exchange and
reduces intrapulmonary shunting. Managing PEEP effectively allows for a reduction in FiO2
to non-toxic levels.
5. Which of the following is a classic laboratory finding in a patient with prerenal Acute
Kidney Injury (AKI)?
A. Fractional Excretion of Sodium (FeNa) > 2%
B. BUN to Creatinine ratio of 10:1
C. Fractional Excretion of Sodium (FeNa) < 1%
D. Low urine osmolality (< 300 mOsm/kg)
