NR571 Exam 1 Actual Exam Style V2 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents with a MAP of 55 mmHg, heart rate of 120 bpm, and a CVP
of 2 mmHg. Which is the most appropriate initial intervention?
A. Administer Furosemide 40 mg IV push.
B. Start a Norepinephrine drip at 5 mcg/min.
C. Administer a 500 mL bolus of isotonic crystalloids.
D. Initiate Dobutamine to improve cardiac output.
Answer: C
Rationale: The patient’s low MAP and low CVP indicate hypovolemia as the primary issue.
Isotonic crystalloids are the first-line treatment to restore intravascular volume and
improve preload. This approach aligns with the Surviving Sepsis guidelines for initial fluid
resuscitation.
2. Which of the following hemodynamic profiles is most consistent with Cardiogenic Shock?
A. Low CO, Low PAWP, Low SVR
B. High CO, Low PAWP, Low SVR
C. Low CO, High PAWP, High SVR
D. High CO, High PAWP, Low SVR
,Answer: C
Rationale: Cardiogenic shock is characterized by pump failure, resulting in a low Cardiac
Output (CO). The body compensates by increasing Systemic Vascular Resistance (SVR) to
maintain pressure, while backflow into the lungs increases Pulmonary Artery Wedge
Pressure (PAWP). Recognizing this pattern is critical for differentiating shock types in
acute care settings.
3. A patient with ARDS has a PaO2/FiO2 ratio of 150 mmHg. According to the Berlin
Definition, how is the severity classified?
A. Mild ARDS
B. Severe ARDS
C. Moderate ARDS
D. Acute Lung Injury (ALI)
Answer: C
Rationale: The Berlin Definition categorizes ARDS severity based on the P/F ratio while on
at least 5 cmH2O of PEEP. Moderate ARDS is defined by a P/F ratio between 100 and 200
mmHg. Severe ARDS is indicated by a ratio less than 100 mmHg, while mild is between 200
and 300 mmHg.
4. What is the primary mechanism of action of Norepinephrine when used in the
management of Septic Shock?
A. Pure Beta-1 stimulation to increase heart rate.
, B. Alpha-1 agonist effect causing peripheral vasoconstriction.
C. Phosphodiesterase inhibition to increase contractility.
D. Dopaminergic stimulation to increase renal blood flow.
Answer: B
Rationale: Norepinephrine is the first-line vasopressor for septic shock because it
primarily targets Alpha-1 receptors to cause vasoconstriction. It also has some Beta-1
effects which help maintain cardiac output. This dual action helps increase Mean Arterial
Pressure (MAP) effectively in distributive shock states.
5. An intubated patient is fighting the ventilator and has a high peak airway pressure. The
plateau pressure is normal. What is the most likely cause?
A. Pneumothorax
B. Worsening Pulmonary Edema
C. Increased airway resistance, such as secretions or biting the tube.
D. Decreased lung compliance.
Answer: C
Rationale: When peak pressure is elevated but plateau pressure remains normal, the
problem is related to airway resistance. Plateau pressure reflects lung compliance, whereas
peak pressure reflects both resistance and compliance. Issues like bronchospasm or tube
kinks primarily affect resistance, thus raising peak pressure only.
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents with a MAP of 55 mmHg, heart rate of 120 bpm, and a CVP
of 2 mmHg. Which is the most appropriate initial intervention?
A. Administer Furosemide 40 mg IV push.
B. Start a Norepinephrine drip at 5 mcg/min.
C. Administer a 500 mL bolus of isotonic crystalloids.
D. Initiate Dobutamine to improve cardiac output.
Answer: C
Rationale: The patient’s low MAP and low CVP indicate hypovolemia as the primary issue.
Isotonic crystalloids are the first-line treatment to restore intravascular volume and
improve preload. This approach aligns with the Surviving Sepsis guidelines for initial fluid
resuscitation.
2. Which of the following hemodynamic profiles is most consistent with Cardiogenic Shock?
A. Low CO, Low PAWP, Low SVR
B. High CO, Low PAWP, Low SVR
C. Low CO, High PAWP, High SVR
D. High CO, High PAWP, Low SVR
,Answer: C
Rationale: Cardiogenic shock is characterized by pump failure, resulting in a low Cardiac
Output (CO). The body compensates by increasing Systemic Vascular Resistance (SVR) to
maintain pressure, while backflow into the lungs increases Pulmonary Artery Wedge
Pressure (PAWP). Recognizing this pattern is critical for differentiating shock types in
acute care settings.
3. A patient with ARDS has a PaO2/FiO2 ratio of 150 mmHg. According to the Berlin
Definition, how is the severity classified?
A. Mild ARDS
B. Severe ARDS
C. Moderate ARDS
D. Acute Lung Injury (ALI)
Answer: C
Rationale: The Berlin Definition categorizes ARDS severity based on the P/F ratio while on
at least 5 cmH2O of PEEP. Moderate ARDS is defined by a P/F ratio between 100 and 200
mmHg. Severe ARDS is indicated by a ratio less than 100 mmHg, while mild is between 200
and 300 mmHg.
4. What is the primary mechanism of action of Norepinephrine when used in the
management of Septic Shock?
A. Pure Beta-1 stimulation to increase heart rate.
, B. Alpha-1 agonist effect causing peripheral vasoconstriction.
C. Phosphodiesterase inhibition to increase contractility.
D. Dopaminergic stimulation to increase renal blood flow.
Answer: B
Rationale: Norepinephrine is the first-line vasopressor for septic shock because it
primarily targets Alpha-1 receptors to cause vasoconstriction. It also has some Beta-1
effects which help maintain cardiac output. This dual action helps increase Mean Arterial
Pressure (MAP) effectively in distributive shock states.
5. An intubated patient is fighting the ventilator and has a high peak airway pressure. The
plateau pressure is normal. What is the most likely cause?
A. Pneumothorax
B. Worsening Pulmonary Edema
C. Increased airway resistance, such as secretions or biting the tube.
D. Decreased lung compliance.
Answer: C
Rationale: When peak pressure is elevated but plateau pressure remains normal, the
problem is related to airway resistance. Plateau pressure reflects lung compliance, whereas
peak pressure reflects both resistance and compliance. Issues like bronchospasm or tube
kinks primarily affect resistance, thus raising peak pressure only.
