NR571 Exam 1 Actual Exam Style V1 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient in the ICU is diagnosed with cardiogenic shock. Which hemodynamic profile is
most consistent with this diagnosis?
A. Low CVP, High CO
B. Low PCWP, Low CO, Low SVR
C. High PCWP, Low CO, High SVR
D. Normal PCWP, High CO, Low SVR
Answer: C
Rationale: Cardiogenic shock is characterized by a failure of the pump, leading to
decreased cardiac output and an increase in wedge pressure due to fluid backup. Systemic
vascular resistance increases as a compensatory mechanism to maintain blood pressure.
Understanding these parameters is essential for identifying the underlying cause of shock
in acute care settings.
2. Which of the following is the first-line vasopressor for a patient in septic shock who
remains hypotensive despite adequate fluid resuscitation?
A. Norepinephrine
B. Epinephrine
,C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is recommended as the first-choice vasopressor for septic
shock management. It primarily targets alpha-1 receptors to cause vasoconstriction while
having minimal effect on heart rate compared to dopamine. Current guidelines emphasize
its use to achieve a mean arterial pressure of at least 65 mmHg.
3. In the management of ARDS, which ventilator strategy has been shown to improve
survival?
A. High tidal volume ventilation
B. Inspiratory-to-expiratory ratio of 1:1
C. Low tidal volume ventilation (6 mL/kg)
D. Routine use of high-frequency oscillation
Answer: C
Rationale: Low tidal volume ventilation is the standard of care for patients with ARDS to
prevent ventilator-induced lung injury. This strategy minimizes volutrauma and
barotrauma to the remaining functional alveoli. Large-scale studies have demonstrated that
this lung-protective strategy significantly reduces mortality.
, 4. A patient presents with a prolonged PT/PTT, decreased fibrinogen, and elevated D-dimer.
These findings are most indicative of:
A. Immune Thrombocytopenic Purpura (ITP)
B. Disseminated Intravascular Coagulation (DIC)
C. Heparin-Induced Thrombocytopenia (HIT)
D. Vitamin K deficiency
Answer: B
Rationale: DIC is characterized by widespread activation of the clotting cascade leading to
both microthrombi and bleeding. Laboratory markers typically show prolonged PT/PTT,
decreased fibrinogen, and elevated D-dimer. These findings reflect the simultaneous
consumption of clotting factors and the breakdown of clots.
5. During a hypertensive emergency, the primary goal of initial treatment is to:
A. Reduce MAP by 25% within the first hour
B. Lower blood pressure to 120/80 immediately
C. Maintain a systolic blood pressure above 180 mmHg
D. Administer oral beta-blockers immediately
Answer: A
Rationale: In hypertensive emergencies, the goal is to reduce the mean arterial pressure
by no more than 25% within the first hour. Rapid over-correction can lead to cerebral or
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient in the ICU is diagnosed with cardiogenic shock. Which hemodynamic profile is
most consistent with this diagnosis?
A. Low CVP, High CO
B. Low PCWP, Low CO, Low SVR
C. High PCWP, Low CO, High SVR
D. Normal PCWP, High CO, Low SVR
Answer: C
Rationale: Cardiogenic shock is characterized by a failure of the pump, leading to
decreased cardiac output and an increase in wedge pressure due to fluid backup. Systemic
vascular resistance increases as a compensatory mechanism to maintain blood pressure.
Understanding these parameters is essential for identifying the underlying cause of shock
in acute care settings.
2. Which of the following is the first-line vasopressor for a patient in septic shock who
remains hypotensive despite adequate fluid resuscitation?
A. Norepinephrine
B. Epinephrine
,C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is recommended as the first-choice vasopressor for septic
shock management. It primarily targets alpha-1 receptors to cause vasoconstriction while
having minimal effect on heart rate compared to dopamine. Current guidelines emphasize
its use to achieve a mean arterial pressure of at least 65 mmHg.
3. In the management of ARDS, which ventilator strategy has been shown to improve
survival?
A. High tidal volume ventilation
B. Inspiratory-to-expiratory ratio of 1:1
C. Low tidal volume ventilation (6 mL/kg)
D. Routine use of high-frequency oscillation
Answer: C
Rationale: Low tidal volume ventilation is the standard of care for patients with ARDS to
prevent ventilator-induced lung injury. This strategy minimizes volutrauma and
barotrauma to the remaining functional alveoli. Large-scale studies have demonstrated that
this lung-protective strategy significantly reduces mortality.
, 4. A patient presents with a prolonged PT/PTT, decreased fibrinogen, and elevated D-dimer.
These findings are most indicative of:
A. Immune Thrombocytopenic Purpura (ITP)
B. Disseminated Intravascular Coagulation (DIC)
C. Heparin-Induced Thrombocytopenia (HIT)
D. Vitamin K deficiency
Answer: B
Rationale: DIC is characterized by widespread activation of the clotting cascade leading to
both microthrombi and bleeding. Laboratory markers typically show prolonged PT/PTT,
decreased fibrinogen, and elevated D-dimer. These findings reflect the simultaneous
consumption of clotting factors and the breakdown of clots.
5. During a hypertensive emergency, the primary goal of initial treatment is to:
A. Reduce MAP by 25% within the first hour
B. Lower blood pressure to 120/80 immediately
C. Maintain a systolic blood pressure above 180 mmHg
D. Administer oral beta-blockers immediately
Answer: A
Rationale: In hypertensive emergencies, the goal is to reduce the mean arterial pressure
by no more than 25% within the first hour. Rapid over-correction can lead to cerebral or
