NR571 Exam 1 Actual Exam Style V3 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient with acute respiratory distress syndrome (ARDS) has a PaO2/FiO2
ratio of 145. According to the Berlin Definition, how is the severity of this patient’s ARDS
classified?
A. Mild
B. Severe
C. Moderate
D. Life-threatening
Answer: C
Rationale: The Berlin criteria classify ARDS severity based on the P/F ratio while on a
PEEP of at least 5. Moderate ARDS is defined as a P/F ratio between 100 and 200. This
classification helps clinicians determine appropriate ventilatory strategies and prognostic
outcomes for the patient.
2. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of isotonic
crystalloids. Which vasopressor is recommended as the first-line agent according to the
Surviving Sepsis Campaign?
A. Vasopressin
,B. Dopamine
C. Epinephrine
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor for septic shock because it
effectively increases mean arterial pressure with fewer tachyarrhythmias compared to
dopamine. It primarily acts on alpha-1 receptors to cause vasoconstriction. If target MAP is
not met, vasopressin or epinephrine may be added as adjunctive therapy.
3. An arterial blood gas (ABG) shows pH 7.28, PaCO2 58 mmHg, and HCO3 26 mEq/L. Which
acid-base imbalance does this represent?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Partially Compensated Metabolic Alkalosis
D. Uncompensated Respiratory Alkalosis
Answer: B
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. Since the bicarbonate (HCO3) is within the normal
range of 22-26, no compensation has occurred yet. This pattern is consistent with acute
respiratory failure resulting in uncompensated respiratory acidosis.
, 4. During hemodynamic monitoring, a patient is found to have a Central Venous Pressure
(CVP) of 2 mmHg and a Pulmonary Artery Occlusion Pressure (PAOP) of 4 mmHg. What is the
most appropriate initial intervention?
A. Administer a loop diuretic
B. Start a dobutamine infusion
C. Initiate vasopressor therapy
D. Administer a fluid bolus
Answer: D
Rationale: Low CVP and PAOP values suggest low preload and intravascular volume
depletion. Fluid resuscitation is the priority to restore stroke volume and cardiac output in
hypovolemic states. Once filling pressures are optimized, the clinician can reassess the
need for further hemodynamic support.
5. A patient with a suspected myocardial infarction has an EKG showing ST-segment elevation
in leads II, III, and aVF. Which area of the heart is affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall
D. Septal wall
Answer: A
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient with acute respiratory distress syndrome (ARDS) has a PaO2/FiO2
ratio of 145. According to the Berlin Definition, how is the severity of this patient’s ARDS
classified?
A. Mild
B. Severe
C. Moderate
D. Life-threatening
Answer: C
Rationale: The Berlin criteria classify ARDS severity based on the P/F ratio while on a
PEEP of at least 5. Moderate ARDS is defined as a P/F ratio between 100 and 200. This
classification helps clinicians determine appropriate ventilatory strategies and prognostic
outcomes for the patient.
2. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of isotonic
crystalloids. Which vasopressor is recommended as the first-line agent according to the
Surviving Sepsis Campaign?
A. Vasopressin
,B. Dopamine
C. Epinephrine
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor for septic shock because it
effectively increases mean arterial pressure with fewer tachyarrhythmias compared to
dopamine. It primarily acts on alpha-1 receptors to cause vasoconstriction. If target MAP is
not met, vasopressin or epinephrine may be added as adjunctive therapy.
3. An arterial blood gas (ABG) shows pH 7.28, PaCO2 58 mmHg, and HCO3 26 mEq/L. Which
acid-base imbalance does this represent?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Partially Compensated Metabolic Alkalosis
D. Uncompensated Respiratory Alkalosis
Answer: B
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. Since the bicarbonate (HCO3) is within the normal
range of 22-26, no compensation has occurred yet. This pattern is consistent with acute
respiratory failure resulting in uncompensated respiratory acidosis.
, 4. During hemodynamic monitoring, a patient is found to have a Central Venous Pressure
(CVP) of 2 mmHg and a Pulmonary Artery Occlusion Pressure (PAOP) of 4 mmHg. What is the
most appropriate initial intervention?
A. Administer a loop diuretic
B. Start a dobutamine infusion
C. Initiate vasopressor therapy
D. Administer a fluid bolus
Answer: D
Rationale: Low CVP and PAOP values suggest low preload and intravascular volume
depletion. Fluid resuscitation is the priority to restore stroke volume and cardiac output in
hypovolemic states. Once filling pressures are optimized, the clinician can reassess the
need for further hemodynamic support.
5. A patient with a suspected myocardial infarction has an EKG showing ST-segment elevation
in leads II, III, and aVF. Which area of the heart is affected?
A. Inferior wall
B. Lateral wall
C. Anterior wall
D. Septal wall
Answer: A
