NR571 Exam 3 Actual Exam Style V3 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient in the ICU is diagnosed with Septic Shock. Following the 1-hour bundle, which of
the following is the priority intervention if the Mean Arterial Pressure (MAP) remains below
65 mmHg despite adequate fluid resuscitation?
A. Initiate Dobutamine infusion
B. Administer 100 mEq of Sodium Bicarbonate
C. Start Norepinephrine as the first-line vasopressor
D. Perform an urgent paracentesis
Answer: C
Rationale: Norepinephrine is recommended as the first-line vasopressor for septic shock
to maintain a MAP of 65 mmHg or higher. Fluid resuscitation should occur first with 30
mL/kg of crystalloids within the first 3 hours. If the patient remains hypotensive,
vasopressor support is critical to maintain end-organ perfusion.
2. A patient with ARDS is being mechanically ventilated. To implement a lung-protective
strategy, which tidal volume setting is most appropriate?
A. 4-8 mL/kg of Ideal Body Weight (IBW)
B. 10-12 mL/kg of Ideal Body Weight (IBW)
,C. 15 mL/kg of Actual Body Weight
D. Tidal volume based on a PEEP of 20 cm H2O
Answer: A
Rationale: Low tidal volume ventilation (4-8 mL/kg of IBW) is the standard of care for
patients with ARDS to prevent ventilator-induced lung injury. This strategy helps reduce
mortality and increases the number of days spent off the ventilator. It specifically targets a
plateau pressure of less than 30 cm H2O to avoid overdistension of the alveoli.
3. Which lab value is the most sensitive indicator of early Acute Kidney Injury (AKI) in the
acute care setting?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Serum Potassium
D. Urine output (oliguria)
Answer: D
Rationale: Urine output decreases often occur before significant elevations in serum
creatinine, making it a sensitive early marker for AKI. According to the RIFLE or KDIGO
criteria, oliguria is defined as less than 0.5 mL/kg/hr for 6 hours. Clinicians must monitor
output hourly in high-risk patients to detect renal insult early.
, 4. A patient presents with Acute Pancreatitis. Which assessment finding would most likely
indicate the development of Cullens sign?
A. Rebound tenderness in the right lower quadrant
B. Bruising on the flanks (Grey Turner’s sign)
C. Elevated serum lipase three times the normal limit
D. Ecchymosis around the umbilicus
Answer: D
Rationale: Cullen’s sign is characterized by superficial edema and bruising in the
subcutaneous fatty tissue around the umbilicus. It is an indicator of retroperitoneal
hemorrhage, often associated with severe acute pancreatitis. This physical finding suggests
a poor prognosis and requires immediate escalation of care.
5. In the management of Hepatic Encephalopathy, what is the primary mechanism of action
for Lactulose?
A. Increases ammonia production in the gut
B. Converts ammonia to ammonium for excretion in stool
C. Enhances the excretion of ammonia via the kidneys
D. Directly inhibits GABA receptors in the brain
Answer: B
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient in the ICU is diagnosed with Septic Shock. Following the 1-hour bundle, which of
the following is the priority intervention if the Mean Arterial Pressure (MAP) remains below
65 mmHg despite adequate fluid resuscitation?
A. Initiate Dobutamine infusion
B. Administer 100 mEq of Sodium Bicarbonate
C. Start Norepinephrine as the first-line vasopressor
D. Perform an urgent paracentesis
Answer: C
Rationale: Norepinephrine is recommended as the first-line vasopressor for septic shock
to maintain a MAP of 65 mmHg or higher. Fluid resuscitation should occur first with 30
mL/kg of crystalloids within the first 3 hours. If the patient remains hypotensive,
vasopressor support is critical to maintain end-organ perfusion.
2. A patient with ARDS is being mechanically ventilated. To implement a lung-protective
strategy, which tidal volume setting is most appropriate?
A. 4-8 mL/kg of Ideal Body Weight (IBW)
B. 10-12 mL/kg of Ideal Body Weight (IBW)
,C. 15 mL/kg of Actual Body Weight
D. Tidal volume based on a PEEP of 20 cm H2O
Answer: A
Rationale: Low tidal volume ventilation (4-8 mL/kg of IBW) is the standard of care for
patients with ARDS to prevent ventilator-induced lung injury. This strategy helps reduce
mortality and increases the number of days spent off the ventilator. It specifically targets a
plateau pressure of less than 30 cm H2O to avoid overdistension of the alveoli.
3. Which lab value is the most sensitive indicator of early Acute Kidney Injury (AKI) in the
acute care setting?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Serum Potassium
D. Urine output (oliguria)
Answer: D
Rationale: Urine output decreases often occur before significant elevations in serum
creatinine, making it a sensitive early marker for AKI. According to the RIFLE or KDIGO
criteria, oliguria is defined as less than 0.5 mL/kg/hr for 6 hours. Clinicians must monitor
output hourly in high-risk patients to detect renal insult early.
, 4. A patient presents with Acute Pancreatitis. Which assessment finding would most likely
indicate the development of Cullens sign?
A. Rebound tenderness in the right lower quadrant
B. Bruising on the flanks (Grey Turner’s sign)
C. Elevated serum lipase three times the normal limit
D. Ecchymosis around the umbilicus
Answer: D
Rationale: Cullen’s sign is characterized by superficial edema and bruising in the
subcutaneous fatty tissue around the umbilicus. It is an indicator of retroperitoneal
hemorrhage, often associated with severe acute pancreatitis. This physical finding suggests
a poor prognosis and requires immediate escalation of care.
5. In the management of Hepatic Encephalopathy, what is the primary mechanism of action
for Lactulose?
A. Increases ammonia production in the gut
B. Converts ammonia to ammonium for excretion in stool
C. Enhances the excretion of ammonia via the kidneys
D. Directly inhibits GABA receptors in the brain
Answer: B
