NR571 Final Exam Actual Exam Style V3 |
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 65-year-old patient presents with sudden onset of shortness of breath and pleuritic chest
pain. The CT angiography reveals a pulmonary embolism. Which of the following is the most
appropriate initial anticoagulant for a hemodynamically stable patient?
A. Warfarin
B. Low Molecular Weight Heparin
C. Tissue Plasminogen Activator
D. Aspirin
Answer: B
Rationale: Low Molecular Weight Heparin or Unfractionated Heparin is the standard of
care for initial anticoagulation in stable pulmonary embolism. Warfarin requires a bridge
because it takes several days to reach therapeutic levels. TPA is reserved for
hemodynamically unstable patients with massive PE.
2. A patient in the ICU develops acute respiratory distress syndrome (ARDS). According to the
Berlin Definition, which P/F ratio indicates moderate ARDS?
A. P/F ratio > 300
,B. P/F ratio between 200 and 300
C. P/F ratio < 100
D. P/F ratio between 100 and 200
Answer: D
Rationale: Moderate ARDS is defined by a P/F ratio between 100 and 200 mmHg. Mild
ARDS is categorized between 200 and 300, while severe is less than 100. This classification
helps clinicians determine the appropriate level of PEEP and ventilatory support.
3. A patient is admitted with suspected septic shock. According to the Surviving Sepsis
Campaign, what is the target Mean Arterial Pressure (MAP) during initial resuscitation?
A. 55 mmHg
B. 65 mmHg
C. 75 mmHg
D. 85 mmHg
Answer: B
Rationale: The recommended target MAP for patients in septic shock is 65 mmHg to
ensure adequate organ perfusion. Higher targets have not shown improved outcomes and
may increase the risk of arrhythmias. Vasopressors should be initiated if fluid resuscitation
fails to achieve this target.
, 4. Which of the following is a classic clinical finding in a patient presenting with Cardiac
Tamponade?
A. Muffled heart sounds
B. Hypertension
C. Flattened neck veins
D. Bradycardia
Answer: A
Rationale: Beck’s triad for cardiac tamponade includes muffled heart sounds, hypotension,
and jugular venous distention. The fluid in the pericardial sac insulates the heart, leading to
softened sounds on auscultation. Prompt recognition is vital as this condition requires
emergency pericardiocentesis.
5. A patient with Diabetic Ketoacidosis (DKA) has a serum potassium of 3.0 mEq/L. What is
the priority intervention?
A. Administer IV potassium replacement
B. Start insulin infusion at 0.1 units/kg/hr
C. Bolus 1 liter of Normal Saline
D. Administer sodium bicarbonate
Answer: A
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 65-year-old patient presents with sudden onset of shortness of breath and pleuritic chest
pain. The CT angiography reveals a pulmonary embolism. Which of the following is the most
appropriate initial anticoagulant for a hemodynamically stable patient?
A. Warfarin
B. Low Molecular Weight Heparin
C. Tissue Plasminogen Activator
D. Aspirin
Answer: B
Rationale: Low Molecular Weight Heparin or Unfractionated Heparin is the standard of
care for initial anticoagulation in stable pulmonary embolism. Warfarin requires a bridge
because it takes several days to reach therapeutic levels. TPA is reserved for
hemodynamically unstable patients with massive PE.
2. A patient in the ICU develops acute respiratory distress syndrome (ARDS). According to the
Berlin Definition, which P/F ratio indicates moderate ARDS?
A. P/F ratio > 300
,B. P/F ratio between 200 and 300
C. P/F ratio < 100
D. P/F ratio between 100 and 200
Answer: D
Rationale: Moderate ARDS is defined by a P/F ratio between 100 and 200 mmHg. Mild
ARDS is categorized between 200 and 300, while severe is less than 100. This classification
helps clinicians determine the appropriate level of PEEP and ventilatory support.
3. A patient is admitted with suspected septic shock. According to the Surviving Sepsis
Campaign, what is the target Mean Arterial Pressure (MAP) during initial resuscitation?
A. 55 mmHg
B. 65 mmHg
C. 75 mmHg
D. 85 mmHg
Answer: B
Rationale: The recommended target MAP for patients in septic shock is 65 mmHg to
ensure adequate organ perfusion. Higher targets have not shown improved outcomes and
may increase the risk of arrhythmias. Vasopressors should be initiated if fluid resuscitation
fails to achieve this target.
, 4. Which of the following is a classic clinical finding in a patient presenting with Cardiac
Tamponade?
A. Muffled heart sounds
B. Hypertension
C. Flattened neck veins
D. Bradycardia
Answer: A
Rationale: Beck’s triad for cardiac tamponade includes muffled heart sounds, hypotension,
and jugular venous distention. The fluid in the pericardial sac insulates the heart, leading to
softened sounds on auscultation. Prompt recognition is vital as this condition requires
emergency pericardiocentesis.
5. A patient with Diabetic Ketoacidosis (DKA) has a serum potassium of 3.0 mEq/L. What is
the priority intervention?
A. Administer IV potassium replacement
B. Start insulin infusion at 0.1 units/kg/hr
C. Bolus 1 liter of Normal Saline
D. Administer sodium bicarbonate
Answer: A
