NR571 Exam 2 Actual Exam Style V1 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with septic shock remains hypotensive despite adequate fluid resuscitation with
30 mL/kg of crystalloids. Which of the following is the first-line vasopressor of choice?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the primary vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after fluid resuscitation. It works by
stimulating alpha-1 receptors to cause vasoconstriction and increase systemic vascular
resistance. This intervention is critical to maintain a Mean Arterial Pressure (MAP) of at
least 65 mmHg.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to minimize lung injury?
A. Low tidal volumes (6 mL/kg) and permissive hypercapnia
B. High tidal volumes to ensure gas exchange
,C. Low PEEP to prevent barotrauma
D. Hyperventilation to reduce intracranial pressure
Answer: A
Rationale: Low tidal volume ventilation is the gold standard for ARDS management to
prevent ventilator-induced lung injury (VILI) and volutrauma. Permissive hypercapnia is
often accepted as long as the pH remains above 7.20. This lung-protective strategy has
been shown to improve survival rates in critically ill patients.
3. A patient presents with a Central Venous Pressure (CVP) of 2 mmHg, a Pulmonary Artery
Occlusion Pressure (PAOP) of 4 mmHg, and a Heart Rate of 120 bpm. Which type of shock is
most likely?
A. Cardiogenic shock
B. Neurogenic shock
C. Hypovolemic shock
D. Anaphylactic shock
Answer: C
Rationale: Hypovolemic shock is characterized by low filling pressures, such as low CVP
and low PAOP, due to decreased intravascular volume. The tachycardia is a compensatory
mechanism to maintain cardiac output in the face of low stroke volume. Management focus
should be on rapid fluid or blood product replacement.
, 4. In a patient with Acute Kidney Injury (AKI) undergoing Continuous Renal Replacement
Therapy (CRRT), which electrolyte imbalance is most commonly a concern during the
treatment?
A. Hypophosphatemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Answer: A
Rationale: Hypophosphatemia is a frequent complication of CRRT because phosphorus is
easily cleared during the filtration process. Monitoring electrolytes frequently is essential
because CRRT runs continuously and can deplete essential minerals. If levels drop
significantly, phosphorus must be replaced via IV or added to the replacement fluids.
5. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse practitioner notes the
potassium level is 3.1 mEq/L. What is the priority action?
A. Initiate insulin infusion at 0.1 units/kg/hr
B. Administer IV bicarbonate for acidosis
C. Administer potassium chloride before starting insulin
D. Start 0.45% normal saline at 500 mL/hr
Answer: C
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with septic shock remains hypotensive despite adequate fluid resuscitation with
30 mL/kg of crystalloids. Which of the following is the first-line vasopressor of choice?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the primary vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after fluid resuscitation. It works by
stimulating alpha-1 receptors to cause vasoconstriction and increase systemic vascular
resistance. This intervention is critical to maintain a Mean Arterial Pressure (MAP) of at
least 65 mmHg.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to minimize lung injury?
A. Low tidal volumes (6 mL/kg) and permissive hypercapnia
B. High tidal volumes to ensure gas exchange
,C. Low PEEP to prevent barotrauma
D. Hyperventilation to reduce intracranial pressure
Answer: A
Rationale: Low tidal volume ventilation is the gold standard for ARDS management to
prevent ventilator-induced lung injury (VILI) and volutrauma. Permissive hypercapnia is
often accepted as long as the pH remains above 7.20. This lung-protective strategy has
been shown to improve survival rates in critically ill patients.
3. A patient presents with a Central Venous Pressure (CVP) of 2 mmHg, a Pulmonary Artery
Occlusion Pressure (PAOP) of 4 mmHg, and a Heart Rate of 120 bpm. Which type of shock is
most likely?
A. Cardiogenic shock
B. Neurogenic shock
C. Hypovolemic shock
D. Anaphylactic shock
Answer: C
Rationale: Hypovolemic shock is characterized by low filling pressures, such as low CVP
and low PAOP, due to decreased intravascular volume. The tachycardia is a compensatory
mechanism to maintain cardiac output in the face of low stroke volume. Management focus
should be on rapid fluid or blood product replacement.
, 4. In a patient with Acute Kidney Injury (AKI) undergoing Continuous Renal Replacement
Therapy (CRRT), which electrolyte imbalance is most commonly a concern during the
treatment?
A. Hypophosphatemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Answer: A
Rationale: Hypophosphatemia is a frequent complication of CRRT because phosphorus is
easily cleared during the filtration process. Monitoring electrolytes frequently is essential
because CRRT runs continuously and can deplete essential minerals. If levels drop
significantly, phosphorus must be replaced via IV or added to the replacement fluids.
5. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse practitioner notes the
potassium level is 3.1 mEq/L. What is the priority action?
A. Initiate insulin infusion at 0.1 units/kg/hr
B. Administer IV bicarbonate for acidosis
C. Administer potassium chloride before starting insulin
D. Start 0.45% normal saline at 500 mL/hr
Answer: C
