NR571 Exam 3 Actual Exam Style V2 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 45-year-old patient presents with a blood glucose of 850 mg/dL, serum osmolality of 340
mOsm/kg, and absence of ketones in the urine. Which condition is most likely?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Diabetes Insipidus
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: B
Rationale: HHS is characterized by extreme hyperglycemia and high serum osmolality
without significant ketosis. Patients with HHS typically have enough insulin to prevent
lipolysis but not enough to control blood sugar. Treatment focuses on aggressive fluid
resuscitation and gradual insulin administration to lower glucose levels safely.
2. When managing a patient with ARDS, which ventilator strategy is prioritized to prevent
ventilator-induced lung injury?
A. Low tidal volume (6 mL/kg)
B. High tidal volume (12 mL/kg)
C. Zero PEEP setting
,D. FiO2 of 1.0 for the first 48 hours
Answer: A
Rationale: Low tidal volume ventilation is the standard of care for ARDS to prevent
volutrauma and barotrauma. This protective lung strategy aims to keep plateau pressures
below 30 cm H2O. Clinicians must balance the resulting permissive hypercapnia with the
patient’s acid-base status.
3. A patient in the ICU has a MAP of 80 mmHg and an ICP of 20 mmHg. What is the calculated
Cerebral Perfusion Pressure (CPP)?
A. 100 mmHg
B. 40 mmHg
C. 60 mmHg
D. 120 mmHg
Answer: C
Rationale: The formula for CPP is Mean Arterial Pressure (MAP) minus Intracranial
Pressure (ICP). In this case, 80 minus 20 equals 60 mmHg. Maintaining a CPP between 60-
70 mmHg is essential for providing adequate oxygen and nutrients to brain tissue.
4. Which lab finding is most indicative of the ‘I’ (Injury) stage in the RIFLE criteria for Acute
Kidney Injury?
A. Serum creatinine increased by 1.5 times
, B. Serum creatinine increased by 3.0 times
C. Serum creatinine increased by 2.0 times
D. Total loss of kidney function for 4 weeks
Answer: C
Rationale: The RIFLE criteria categorize AKI into Risk, Injury, Failure, Loss, and End-stage.
The Injury stage is defined by a doubling of serum creatinine or a decrease in GFR of more
than 50%. Identifying this stage early is vital for initiating interventions that prevent
progression to permanent renal failure.
5. A patient presents with tachycardia, fever, agitation, and psychosis. The family reports the
patient has a history of hyperthyroidism. What is the priority intervention?
A. Administering IV Levothyroxine
B. Administering Beta-blockers and PTU
C. Performing an immediate CT of the head
D. Fluid restriction to 1 liter per day
Answer: B
Rationale: These symptoms are characteristic of a thyroid storm, which is a life-
threatening medical emergency. Management involves blocking the peripheral effects of
thyroid hormones with beta-blockers and inhibiting new hormone synthesis with PTU or
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 45-year-old patient presents with a blood glucose of 850 mg/dL, serum osmolality of 340
mOsm/kg, and absence of ketones in the urine. Which condition is most likely?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Diabetes Insipidus
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: B
Rationale: HHS is characterized by extreme hyperglycemia and high serum osmolality
without significant ketosis. Patients with HHS typically have enough insulin to prevent
lipolysis but not enough to control blood sugar. Treatment focuses on aggressive fluid
resuscitation and gradual insulin administration to lower glucose levels safely.
2. When managing a patient with ARDS, which ventilator strategy is prioritized to prevent
ventilator-induced lung injury?
A. Low tidal volume (6 mL/kg)
B. High tidal volume (12 mL/kg)
C. Zero PEEP setting
,D. FiO2 of 1.0 for the first 48 hours
Answer: A
Rationale: Low tidal volume ventilation is the standard of care for ARDS to prevent
volutrauma and barotrauma. This protective lung strategy aims to keep plateau pressures
below 30 cm H2O. Clinicians must balance the resulting permissive hypercapnia with the
patient’s acid-base status.
3. A patient in the ICU has a MAP of 80 mmHg and an ICP of 20 mmHg. What is the calculated
Cerebral Perfusion Pressure (CPP)?
A. 100 mmHg
B. 40 mmHg
C. 60 mmHg
D. 120 mmHg
Answer: C
Rationale: The formula for CPP is Mean Arterial Pressure (MAP) minus Intracranial
Pressure (ICP). In this case, 80 minus 20 equals 60 mmHg. Maintaining a CPP between 60-
70 mmHg is essential for providing adequate oxygen and nutrients to brain tissue.
4. Which lab finding is most indicative of the ‘I’ (Injury) stage in the RIFLE criteria for Acute
Kidney Injury?
A. Serum creatinine increased by 1.5 times
, B. Serum creatinine increased by 3.0 times
C. Serum creatinine increased by 2.0 times
D. Total loss of kidney function for 4 weeks
Answer: C
Rationale: The RIFLE criteria categorize AKI into Risk, Injury, Failure, Loss, and End-stage.
The Injury stage is defined by a doubling of serum creatinine or a decrease in GFR of more
than 50%. Identifying this stage early is vital for initiating interventions that prevent
progression to permanent renal failure.
5. A patient presents with tachycardia, fever, agitation, and psychosis. The family reports the
patient has a history of hyperthyroidism. What is the priority intervention?
A. Administering IV Levothyroxine
B. Administering Beta-blockers and PTU
C. Performing an immediate CT of the head
D. Fluid restriction to 1 liter per day
Answer: B
Rationale: These symptoms are characteristic of a thyroid storm, which is a life-
threatening medical emergency. Management involves blocking the peripheral effects of
thyroid hormones with beta-blockers and inhibiting new hormone synthesis with PTU or
