NR571 Exam 2 Actual Exam Style V3 NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with acute decompensated heart failure presents with a MAP of 55
mmHg and a Cardiac Index (CI) of 1.6 L/min/m². Which medication should the Nurse
Practitioner prioritize to improve cardiac contractility?
A. Lisinopril
B. Furosemide
C. Metoprolol
D. Dobutamine
Answer: D
Rationale: Dobutamine is a positive inotrope that stimulates beta-1 receptors to increase
myocardial contractility and cardiac output. In cardiogenic shock or severe heart failure
with low CI, inotropes are essential to maintain systemic perfusion. Beta-blockers and ACE
inhibitors are contraindicated in the acute phase of decompensation with hypotension.
2. When managing a patient with ARDS, the Nurse Practitioner targets a plateau pressure
(Pplat) of less than 30 cm H2O. What is the primary reason for this specific goal?
A. To reduce the risk of respiratory alkalosis
B. To maximize oxygenation across the alveolar-capillary membrane
,C. To prevent barotrauma and ventilator-induced lung injury
D. To increase venous return to the right atrium
Answer: C
Rationale: High plateau pressures are directly associated with alveolar overdistention and
barotrauma in patients with stiff lungs. Maintaining Pplat below 30 cm H2O is a core
component of lung-protective ventilation strategies in ARDS. This practice significantly
reduces the risk of ventilator-induced lung injury (VILI) and improves patient outcomes.
3. A patient in the ICU is diagnosed with Septic Shock. Despite adequate fluid resuscitation of
30 mL/kg, the MAP remains 58 mmHg. What is the first-line vasopressor of choice?
A. Vasopressin
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
Answer: B
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after fluid resuscitation. It acts
primarily on alpha-1 receptors to cause vasoconstriction and increase MAP. Other agents
like vasopressin are typically added only if norepinephrine alone is insufficient to reach the
target MAP.
, 4. An elderly patient presents with a serum sodium of 118 mEq/L and signs of confusion.
What is the maximum safe rate of sodium correction in the first 24 hours to prevent osmotic
demyelination?
A. 4-6 mEq/L
B. 8-10 mEq/L
C. 12-14 mEq/L
D. 15-20 mEq/L
Answer: B
Rationale: Correction of severe hyponatremia must be performed cautiously to avoid
central pontine myelinolysis. The general consensus is to limit sodium increase to no more
than 8-10 mEq/L in a 24-hour period. Rapid shifts in osmolarity can cause irreversible
neurological damage and myelin loss in the brainstem.
5. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L with peaked T-
waves on the EKG. Which intervention should be administered first?
A. Sodium Polystyrene Sulfonate
B. Insulin and Dextrose
C. Furosemide
D. Calcium Gluconate
Answer: D
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with acute decompensated heart failure presents with a MAP of 55
mmHg and a Cardiac Index (CI) of 1.6 L/min/m². Which medication should the Nurse
Practitioner prioritize to improve cardiac contractility?
A. Lisinopril
B. Furosemide
C. Metoprolol
D. Dobutamine
Answer: D
Rationale: Dobutamine is a positive inotrope that stimulates beta-1 receptors to increase
myocardial contractility and cardiac output. In cardiogenic shock or severe heart failure
with low CI, inotropes are essential to maintain systemic perfusion. Beta-blockers and ACE
inhibitors are contraindicated in the acute phase of decompensation with hypotension.
2. When managing a patient with ARDS, the Nurse Practitioner targets a plateau pressure
(Pplat) of less than 30 cm H2O. What is the primary reason for this specific goal?
A. To reduce the risk of respiratory alkalosis
B. To maximize oxygenation across the alveolar-capillary membrane
,C. To prevent barotrauma and ventilator-induced lung injury
D. To increase venous return to the right atrium
Answer: C
Rationale: High plateau pressures are directly associated with alveolar overdistention and
barotrauma in patients with stiff lungs. Maintaining Pplat below 30 cm H2O is a core
component of lung-protective ventilation strategies in ARDS. This practice significantly
reduces the risk of ventilator-induced lung injury (VILI) and improves patient outcomes.
3. A patient in the ICU is diagnosed with Septic Shock. Despite adequate fluid resuscitation of
30 mL/kg, the MAP remains 58 mmHg. What is the first-line vasopressor of choice?
A. Vasopressin
B. Norepinephrine
C. Epinephrine
D. Phenylephrine
Answer: B
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after fluid resuscitation. It acts
primarily on alpha-1 receptors to cause vasoconstriction and increase MAP. Other agents
like vasopressin are typically added only if norepinephrine alone is insufficient to reach the
target MAP.
, 4. An elderly patient presents with a serum sodium of 118 mEq/L and signs of confusion.
What is the maximum safe rate of sodium correction in the first 24 hours to prevent osmotic
demyelination?
A. 4-6 mEq/L
B. 8-10 mEq/L
C. 12-14 mEq/L
D. 15-20 mEq/L
Answer: B
Rationale: Correction of severe hyponatremia must be performed cautiously to avoid
central pontine myelinolysis. The general consensus is to limit sodium increase to no more
than 8-10 mEq/L in a 24-hour period. Rapid shifts in osmolarity can cause irreversible
neurological damage and myelin loss in the brainstem.
5. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L with peaked T-
waves on the EKG. Which intervention should be administered first?
A. Sodium Polystyrene Sulfonate
B. Insulin and Dextrose
C. Furosemide
D. Calcium Gluconate
Answer: D
