NR571 Exam 2 Actual Exam Style V2 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with septic shock remains hypotensive despite receiving a 30 mL/kg fluid bolus of
crystalloids. Which of the following is the first-line vasopressor recommended to achieve a
Mean Arterial Pressure (MAP) of at least 65 mmHg?
A. Vasopressin
B. Norepinephrine
C. Dopamine
D. Epinephrine
Answer: B
Rationale: According to the Surviving Sepsis Campaign guidelines, Norepinephrine is the
first-choice vasopressor for septic shock. It works primarily as an alpha-1 agonist to
increase systemic vascular resistance through vasoconstriction. Other agents like
Vasopressin are typically added only if Norepinephrine is insufficient to reach target MAP.
2. Which hemodynamic profile is most consistent with a patient experiencing Cardiogenic
Shock?
A. High CI, High PAWP, Low SVR
B. High CI, Low PAWP, Low SVR
,C. Low CI, Low PAWP, High SVR
D. Low Cardiac Index (CI), High Pulmonary Artery Wedge Pressure (PAWP), High Systemic
Vascular Resistance (SVR)
Answer: D
Rationale: In cardiogenic shock, the primary failure is the pump, leading to a decreased
Cardiac Index. The backup of blood into the lungs results in an elevated Pulmonary Artery
Wedge Pressure. The body compensates for low output by increasing Systemic Vascular
Resistance via vasoconstriction to maintain perfusion.
3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). What is the
primary rationale for using low tidal volume ventilation (6 mL/kg of predicted body weight) in
this patient?
A. To increase the functional residual capacity
B. To decrease the work of breathing for the patient
C. To prevent ventilator-induced lung injury (VILI) from volutrauma
D. To normalize the arterial pH as quickly as possible
Answer: C
Rationale: Low tidal volume ventilation is the cornerstone of ARDS management to
minimize alveolar over-distension. This strategy reduces the risk of barotrauma and
volutrauma, which can worsen inflammation and lung injury. It has been proven to
improve survival outcomes in clinical trials compared to traditional high tidal volumes.
, 4. A 65-year-old male with chronic heart failure presents with increased dyspnea and
peripheral edema. His BNP level is 1,200 pg/mL. Which medication class is essential for long-
term mortality reduction and should be optimized once the patient is stable?
A. Loop Diuretics
B. Calcium Channel Blockers
C. Beta-Blockers
D. Short-acting Nitrates
Answer: C
Rationale: Beta-blockers are a foundational therapy for Heart Failure with Reduced
Ejection Fraction (HFrEF) because they decrease sympathetic nervous system activation.
They have been consistently shown to improve survival and reduce hospitalizations over
the long term. While loop diuretics manage symptoms and fluid volume, they do not
provide the same mortality benefit as Beta-blockers or ACE inhibitors.
5. Which laboratory finding is most characteristic of Disseminated Intravascular Coagulation
(DIC)?
A. Increased Fibrinogen and Decreased D-dimer
B. Decreased Platelets, Increased PT/INR, and Increased D-dimer
C. Increased Platelet count and Increased PT
D. Decreased PTT and Normal Fibrinogen
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with septic shock remains hypotensive despite receiving a 30 mL/kg fluid bolus of
crystalloids. Which of the following is the first-line vasopressor recommended to achieve a
Mean Arterial Pressure (MAP) of at least 65 mmHg?
A. Vasopressin
B. Norepinephrine
C. Dopamine
D. Epinephrine
Answer: B
Rationale: According to the Surviving Sepsis Campaign guidelines, Norepinephrine is the
first-choice vasopressor for septic shock. It works primarily as an alpha-1 agonist to
increase systemic vascular resistance through vasoconstriction. Other agents like
Vasopressin are typically added only if Norepinephrine is insufficient to reach target MAP.
2. Which hemodynamic profile is most consistent with a patient experiencing Cardiogenic
Shock?
A. High CI, High PAWP, Low SVR
B. High CI, Low PAWP, Low SVR
,C. Low CI, Low PAWP, High SVR
D. Low Cardiac Index (CI), High Pulmonary Artery Wedge Pressure (PAWP), High Systemic
Vascular Resistance (SVR)
Answer: D
Rationale: In cardiogenic shock, the primary failure is the pump, leading to a decreased
Cardiac Index. The backup of blood into the lungs results in an elevated Pulmonary Artery
Wedge Pressure. The body compensates for low output by increasing Systemic Vascular
Resistance via vasoconstriction to maintain perfusion.
3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). What is the
primary rationale for using low tidal volume ventilation (6 mL/kg of predicted body weight) in
this patient?
A. To increase the functional residual capacity
B. To decrease the work of breathing for the patient
C. To prevent ventilator-induced lung injury (VILI) from volutrauma
D. To normalize the arterial pH as quickly as possible
Answer: C
Rationale: Low tidal volume ventilation is the cornerstone of ARDS management to
minimize alveolar over-distension. This strategy reduces the risk of barotrauma and
volutrauma, which can worsen inflammation and lung injury. It has been proven to
improve survival outcomes in clinical trials compared to traditional high tidal volumes.
, 4. A 65-year-old male with chronic heart failure presents with increased dyspnea and
peripheral edema. His BNP level is 1,200 pg/mL. Which medication class is essential for long-
term mortality reduction and should be optimized once the patient is stable?
A. Loop Diuretics
B. Calcium Channel Blockers
C. Beta-Blockers
D. Short-acting Nitrates
Answer: C
Rationale: Beta-blockers are a foundational therapy for Heart Failure with Reduced
Ejection Fraction (HFrEF) because they decrease sympathetic nervous system activation.
They have been consistently shown to improve survival and reduce hospitalizations over
the long term. While loop diuretics manage symptoms and fluid volume, they do not
provide the same mortality benefit as Beta-blockers or ACE inhibitors.
5. Which laboratory finding is most characteristic of Disseminated Intravascular Coagulation
(DIC)?
A. Increased Fibrinogen and Decreased D-dimer
B. Decreased Platelets, Increased PT/INR, and Increased D-dimer
C. Increased Platelet count and Increased PT
D. Decreased PTT and Normal Fibrinogen
