NR570 Final Exam Actual Exam Style V1 |
NR 570 Common Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 65-year-old patient presents with acute onset of shortness of breath and pleuritic chest
pain. The CT pulmonary angiogram confirms a pulmonary embolism (PE). What is the most
appropriate initial treatment for a hemodynamically stable patient?
A. Systemic Thrombolytic Therapy
B. Low Molecular Weight Heparin (LMWH)
C. Immediate Surgical Embolectomy
D. Inferior Vena Cava (IVC) Filter Placement
Answer: B
Rationale: In hemodynamically stable patients with pulmonary embolism, anticoagulation
is the primary treatment. Low molecular weight heparin is often preferred over
unfractionated heparin in the absence of severe renal failure. This therapy prevents the
extension of the current clot while the body’s natural fibrinolytic system works to dissolve
it.
2. A patient in the ICU develops sudden hypotension, muffled heart sounds, and jugular
venous distension. These findings are most indicative of which condition?
A. Tension Pneumothorax
,B. Acute Myocardial Infarction
C. Pulmonary Embolism
D. Cardiac Tamponade
Answer: D
Rationale: The clinical triad of hypotension, muffled heart sounds, and jugular venous
distension is known as Beck’s triad. This combination is a classic indicator of cardiac
tamponade, which requires urgent pericardiocentesis. Failure to treat this condition
promptly can lead to obstructive shock and cardiac arrest.
3. According to the Surviving Sepsis Campaign guidelines, what is the target mean arterial
pressure (MAP) for a patient being treated for septic shock?
A. 55 mmHg
B. 65 mmHg
C. 75 mmHg
D. 85 mmHg
Answer: B
Rationale: The recommended initial target mean arterial pressure (MAP) for patients in
septic shock is at least 65 mmHg. Maintaining this pressure ensures adequate tissue
perfusion to vital organs such as the kidneys and brain. Vasopressors, such as
,norepinephrine, are frequently utilized to achieve this hemodynamic goal when fluid
resuscitation alone is insufficient.
4. A 45-year-old male with a history of alcohol abuse presents with severe epigastric pain
radiating to the back and an elevated serum lipase. What is the most common electrolyte
abnormality associated with severe acute pancreatitis?
A. Hypocalcemia
B. Hypercalcemia
C. Hypernatremia
D. Hyponatremia
Answer: A
Rationale: Hypocalcemia is a frequent finding in severe acute pancreatitis due to the
saponification of calcium in the retroperitoneum. Low calcium levels can indicate a more
severe disease course and are included in various prognostic scoring systems. Management
involves monitoring levels closely and replacing calcium intravenously if the patient
becomes symptomatic.
5. Which of the following is the most appropriate initial diagnostic test for a patient
suspected of having an acute ischemic stroke within 3 hours of symptom onset?
A. Magnetic Resonance Imaging (MRI)
B. Carotid Ultrasound
C. Non-contrast Computed Tomography (CT) of the Head
, D. Lumbar Puncture
Answer: C
Rationale: A non-contrast CT scan of the head is the gold standard for initial evaluation in
suspected acute stroke. Its primary purpose is to rule out intracranial hemorrhage before
administering thrombolytic therapy. Although it may not show ischemic changes
immediately, it is fast and widely available in emergency settings.
6. A patient with Acute Respiratory Distress Syndrome (ARDS) is being mechanically
ventilated. Which ventilation strategy has been shown to improve survival?
A. Low Tidal Volume Ventilation (6 mL/kg)
B. High Tidal Volume Ventilation (12 mL/kg)
C. Inverse Ratio Ventilation
D. Low Positive End-Expiratory Pressure (PEEP)
E.
Answer: A
Rationale: Low tidal volume ventilation, typically around 6 mL/kg of predicted body
weight, is the cornerstone of ARDS management. This strategy, known as lung-protective
ventilation, reduces the risk of ventilator-induced lung injury (VILI). It has been proven in
clinical trials to significantly decrease mortality compared to traditional high-volume
settings.
NR 570 Common Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 65-year-old patient presents with acute onset of shortness of breath and pleuritic chest
pain. The CT pulmonary angiogram confirms a pulmonary embolism (PE). What is the most
appropriate initial treatment for a hemodynamically stable patient?
A. Systemic Thrombolytic Therapy
B. Low Molecular Weight Heparin (LMWH)
C. Immediate Surgical Embolectomy
D. Inferior Vena Cava (IVC) Filter Placement
Answer: B
Rationale: In hemodynamically stable patients with pulmonary embolism, anticoagulation
is the primary treatment. Low molecular weight heparin is often preferred over
unfractionated heparin in the absence of severe renal failure. This therapy prevents the
extension of the current clot while the body’s natural fibrinolytic system works to dissolve
it.
2. A patient in the ICU develops sudden hypotension, muffled heart sounds, and jugular
venous distension. These findings are most indicative of which condition?
A. Tension Pneumothorax
,B. Acute Myocardial Infarction
C. Pulmonary Embolism
D. Cardiac Tamponade
Answer: D
Rationale: The clinical triad of hypotension, muffled heart sounds, and jugular venous
distension is known as Beck’s triad. This combination is a classic indicator of cardiac
tamponade, which requires urgent pericardiocentesis. Failure to treat this condition
promptly can lead to obstructive shock and cardiac arrest.
3. According to the Surviving Sepsis Campaign guidelines, what is the target mean arterial
pressure (MAP) for a patient being treated for septic shock?
A. 55 mmHg
B. 65 mmHg
C. 75 mmHg
D. 85 mmHg
Answer: B
Rationale: The recommended initial target mean arterial pressure (MAP) for patients in
septic shock is at least 65 mmHg. Maintaining this pressure ensures adequate tissue
perfusion to vital organs such as the kidneys and brain. Vasopressors, such as
,norepinephrine, are frequently utilized to achieve this hemodynamic goal when fluid
resuscitation alone is insufficient.
4. A 45-year-old male with a history of alcohol abuse presents with severe epigastric pain
radiating to the back and an elevated serum lipase. What is the most common electrolyte
abnormality associated with severe acute pancreatitis?
A. Hypocalcemia
B. Hypercalcemia
C. Hypernatremia
D. Hyponatremia
Answer: A
Rationale: Hypocalcemia is a frequent finding in severe acute pancreatitis due to the
saponification of calcium in the retroperitoneum. Low calcium levels can indicate a more
severe disease course and are included in various prognostic scoring systems. Management
involves monitoring levels closely and replacing calcium intravenously if the patient
becomes symptomatic.
5. Which of the following is the most appropriate initial diagnostic test for a patient
suspected of having an acute ischemic stroke within 3 hours of symptom onset?
A. Magnetic Resonance Imaging (MRI)
B. Carotid Ultrasound
C. Non-contrast Computed Tomography (CT) of the Head
, D. Lumbar Puncture
Answer: C
Rationale: A non-contrast CT scan of the head is the gold standard for initial evaluation in
suspected acute stroke. Its primary purpose is to rule out intracranial hemorrhage before
administering thrombolytic therapy. Although it may not show ischemic changes
immediately, it is fast and widely available in emergency settings.
6. A patient with Acute Respiratory Distress Syndrome (ARDS) is being mechanically
ventilated. Which ventilation strategy has been shown to improve survival?
A. Low Tidal Volume Ventilation (6 mL/kg)
B. High Tidal Volume Ventilation (12 mL/kg)
C. Inverse Ratio Ventilation
D. Low Positive End-Expiratory Pressure (PEEP)
E.
Answer: A
Rationale: Low tidal volume ventilation, typically around 6 mL/kg of predicted body
weight, is the cornerstone of ARDS management. This strategy, known as lung-protective
ventilation, reduces the risk of ventilator-induced lung injury (VILI). It has been proven in
clinical trials to significantly decrease mortality compared to traditional high-volume
settings.
