NR570 Exam 4 Actual Exam Style V3 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with a history of heart failure presents with increased dyspnea,
orthopnea, and crackles in all lung fields. Which of the following is the most appropriate
initial pharmacological intervention for acute decompensated heart failure?
A. Intravenous beta-blockers
B. Intravenous loop diuretics
C. Oral ACE inhibitors
D. Intravenous calcium channel blockers
Answer: B
Rationale: The standard of care for acute pulmonary edema in the setting of heart failure is
intravenous loop diuretics to reduce preload. Beta-blockers are generally avoided or
reduced during an acute exacerbation until the patient is stabilized. Loop diuretics provide
rapid symptomatic relief by increasing urinary output and reducing circulating volume.
2. According to the Surviving Sepsis Campaign, what is the target mean arterial pressure
(MAP) for a patient in septic shock after initial fluid resuscitation?
A. 65 mmHg
B. 60 mmHg
,C. 55 mmHg
D. 80 mmHg
Answer: A
Rationale: Guidelines recommend maintaining a MAP of at least 65 mmHg to ensure
adequate tissue perfusion. Maintaining a MAP below this level can lead to organ
dysfunction due to ischemia. Vasopressors, such as norepinephrine, are often required if
fluid resuscitation alone does not achieve this target.
3. A patient with Diabetic Ketoacidosis (DKA) has a serum potassium of 3.1 mEq/L. What is
the most critical next step before starting insulin therapy?
A. Begin intravenous insulin bolus
B. Start potassium replacement
C. Administer sodium bicarbonate
D. Monitor hourly glucose levels
Answer: B
Rationale: Insulin should be held if the serum potassium is below 3.3 mEq/L because
insulin causes potassium to shift into the cells, potentially worsening hypokalemia. Severe
hypokalemia can lead to life-threatening cardiac arrhythmias or respiratory muscle
weakness. Potassium replacement must be initiated first to stabilize the patient before
insulin is safely administered.
, 4. In the management of Acute Respiratory Distress Syndrome (ARDS), which ventilator
setting is recommended to minimize ventilator-induced lung injury?
A. High tidal volume (10-12 mL/kg)
B. Negative pressure ventilation
C. Low tidal volume (4-6 mL/kg)
D. Low Positive End-Expiratory Pressure (PEEP)
Answer: C
Rationale: Lung-protective ventilation strategies utilizing low tidal volumes have been
shown to improve survival in ARDS patients. This strategy prevents volutrauma and
barotrauma to the remaining functional alveoli. High tidal volumes can overdistend the
lungs and trigger an inflammatory cascade that worsens lung injury.
5. A patient is suspected of having a Pulmonary Embolism (PE). Which diagnostic tool is
considered the gold standard for definitive diagnosis in the acute care setting?
A. CT Angiography (CTPA)
B. D-dimer assay
C. Chest X-ray
D. Venous Doppler of the lower extremities
Answer: A
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with a history of heart failure presents with increased dyspnea,
orthopnea, and crackles in all lung fields. Which of the following is the most appropriate
initial pharmacological intervention for acute decompensated heart failure?
A. Intravenous beta-blockers
B. Intravenous loop diuretics
C. Oral ACE inhibitors
D. Intravenous calcium channel blockers
Answer: B
Rationale: The standard of care for acute pulmonary edema in the setting of heart failure is
intravenous loop diuretics to reduce preload. Beta-blockers are generally avoided or
reduced during an acute exacerbation until the patient is stabilized. Loop diuretics provide
rapid symptomatic relief by increasing urinary output and reducing circulating volume.
2. According to the Surviving Sepsis Campaign, what is the target mean arterial pressure
(MAP) for a patient in septic shock after initial fluid resuscitation?
A. 65 mmHg
B. 60 mmHg
,C. 55 mmHg
D. 80 mmHg
Answer: A
Rationale: Guidelines recommend maintaining a MAP of at least 65 mmHg to ensure
adequate tissue perfusion. Maintaining a MAP below this level can lead to organ
dysfunction due to ischemia. Vasopressors, such as norepinephrine, are often required if
fluid resuscitation alone does not achieve this target.
3. A patient with Diabetic Ketoacidosis (DKA) has a serum potassium of 3.1 mEq/L. What is
the most critical next step before starting insulin therapy?
A. Begin intravenous insulin bolus
B. Start potassium replacement
C. Administer sodium bicarbonate
D. Monitor hourly glucose levels
Answer: B
Rationale: Insulin should be held if the serum potassium is below 3.3 mEq/L because
insulin causes potassium to shift into the cells, potentially worsening hypokalemia. Severe
hypokalemia can lead to life-threatening cardiac arrhythmias or respiratory muscle
weakness. Potassium replacement must be initiated first to stabilize the patient before
insulin is safely administered.
, 4. In the management of Acute Respiratory Distress Syndrome (ARDS), which ventilator
setting is recommended to minimize ventilator-induced lung injury?
A. High tidal volume (10-12 mL/kg)
B. Negative pressure ventilation
C. Low tidal volume (4-6 mL/kg)
D. Low Positive End-Expiratory Pressure (PEEP)
Answer: C
Rationale: Lung-protective ventilation strategies utilizing low tidal volumes have been
shown to improve survival in ARDS patients. This strategy prevents volutrauma and
barotrauma to the remaining functional alveoli. High tidal volumes can overdistend the
lungs and trigger an inflammatory cascade that worsens lung injury.
5. A patient is suspected of having a Pulmonary Embolism (PE). Which diagnostic tool is
considered the gold standard for definitive diagnosis in the acute care setting?
A. CT Angiography (CTPA)
B. D-dimer assay
C. Chest X-ray
D. Venous Doppler of the lower extremities
Answer: A
