NR571 Exam 4 Actual Exam Style V3 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient with septic shock remains hypotensive after receiving 30 mL/kg of
crystalloid. The provider decides to start a vasopressor. Which medication is the first-line
choice for this patient?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for maintaining a mean arterial pressure of at least 65 mmHg. It acts
primarily on alpha-1 receptors to cause vasoconstriction with minimal effect on heart rate.
Using this agent early helps restore perfusion while minimizing the risk of
tachyarrhythmias compared to dopamine.
2. When assessing a patient with suspected ARDS, which of the following findings on a chest
X-ray is characteristic of the condition?
A. Bilateral opacities not fully explained by effusions or collapse
,B. Unilateral lobar consolidation with air bronchograms
C. Cephalization of blood vessels and Kerley B lines
D. Wedge-shaped peripheral opacities
Answer: A
Rationale: The Berlin definition of ARDS requires the presence of bilateral opacities on
imaging that cannot be fully explained by pleural effusions, lung collapse, or nodules. These
findings represent the non-cardiogenic pulmonary edema and diffuse alveolar damage
characteristic of the disease. Distinguishing these from cardiogenic edema is crucial for
appropriate management.
3. A patient in the ICU has the following hemodynamic readings: CVP 2 mmHg, PCWP 4
mmHg, CI 1.8 L/min/m², and SVR 1600 dynes/sec/cm⁻⁵. Which type of shock is most likely
occurring?
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Obstructive shock
Answer: A
Rationale: Hypovolemic shock is characterized by low filling pressures, such as CVP and
PCWP, and a low cardiac index. The body compensates for the low volume by increasing
,systemic vascular resistance (SVR) through vasoconstriction. This hemodynamic profile
differs from cardiogenic shock, where filling pressures would typically be elevated.
4. In the management of Acute Pancreatitis, which intervention is prioritized during the first
24 hours to prevent organ failure?
A. Aggressive intravenous fluid resuscitation
B. Prophylactic antibiotic administration
C. Immediate surgical debridement
D. Strict NPO status for at least 72 hours
Answer: A
Rationale: Aggressive fluid resuscitation is the most critical early intervention for acute
pancreatitis to maintain pancreatic perfusion and prevent necrosis. Research indicates that
isotonic crystalloids are preferred, with Ringer’s lactate often being favored over normal
saline. Inadequate hydration in the early phase is strongly associated with the development
of systemic inflammatory response syndrome and multi-organ failure.
5. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg. Which of the following
is an appropriate first-tier intervention?
A. Inducing therapeutic hypothermia to 32 degrees Celsius
B. Administering hypertonic saline or mannitol
C. Performing an immediate decompressive craniectomy
, D. Starting a high-dose barbiturate infusion
Answer: B
Rationale: Hyperosmolar therapy, such as mannitol or hypertonic saline, is a standard
first-tier intervention to reduce intracranial pressure by drawing fluid out of brain tissue.
Other initial steps include elevating the head of the bed and ensuring adequate sedation.
More invasive measures like craniectomy or barbiturate comas are typically reserved for
refractory ICP that does not respond to these initial treatments.
6. A patient is diagnosed with Heparin-Induced Thrombocytopenia (HIT). Which of the
following is the most appropriate next step in management?
A. Switching to low-molecular-weight heparin (Lovenox)
B. Discontinuing all heparin and starting an alternative anticoagulant like Argatroban
C. Ordering a platelet transfusion to prevent bleeding
D. Waiting for the HIT antibody test results before changing therapy
Answer: B
Rationale: If HIT is clinically suspected, all sources of heparin must be discontinued
immediately, including flushes and coated catheters. A non-heparin anticoagulant, such as a
direct thrombin inhibitor like argatroban, should be started to prevent thrombotic
complications. Low-molecular-weight heparin is contraindicated because it cross-reacts
with HIT antibodies.
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient with septic shock remains hypotensive after receiving 30 mL/kg of
crystalloid. The provider decides to start a vasopressor. Which medication is the first-line
choice for this patient?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for maintaining a mean arterial pressure of at least 65 mmHg. It acts
primarily on alpha-1 receptors to cause vasoconstriction with minimal effect on heart rate.
Using this agent early helps restore perfusion while minimizing the risk of
tachyarrhythmias compared to dopamine.
2. When assessing a patient with suspected ARDS, which of the following findings on a chest
X-ray is characteristic of the condition?
A. Bilateral opacities not fully explained by effusions or collapse
,B. Unilateral lobar consolidation with air bronchograms
C. Cephalization of blood vessels and Kerley B lines
D. Wedge-shaped peripheral opacities
Answer: A
Rationale: The Berlin definition of ARDS requires the presence of bilateral opacities on
imaging that cannot be fully explained by pleural effusions, lung collapse, or nodules. These
findings represent the non-cardiogenic pulmonary edema and diffuse alveolar damage
characteristic of the disease. Distinguishing these from cardiogenic edema is crucial for
appropriate management.
3. A patient in the ICU has the following hemodynamic readings: CVP 2 mmHg, PCWP 4
mmHg, CI 1.8 L/min/m², and SVR 1600 dynes/sec/cm⁻⁵. Which type of shock is most likely
occurring?
A. Hypovolemic shock
B. Distributive shock
C. Cardiogenic shock
D. Obstructive shock
Answer: A
Rationale: Hypovolemic shock is characterized by low filling pressures, such as CVP and
PCWP, and a low cardiac index. The body compensates for the low volume by increasing
,systemic vascular resistance (SVR) through vasoconstriction. This hemodynamic profile
differs from cardiogenic shock, where filling pressures would typically be elevated.
4. In the management of Acute Pancreatitis, which intervention is prioritized during the first
24 hours to prevent organ failure?
A. Aggressive intravenous fluid resuscitation
B. Prophylactic antibiotic administration
C. Immediate surgical debridement
D. Strict NPO status for at least 72 hours
Answer: A
Rationale: Aggressive fluid resuscitation is the most critical early intervention for acute
pancreatitis to maintain pancreatic perfusion and prevent necrosis. Research indicates that
isotonic crystalloids are preferred, with Ringer’s lactate often being favored over normal
saline. Inadequate hydration in the early phase is strongly associated with the development
of systemic inflammatory response syndrome and multi-organ failure.
5. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg. Which of the following
is an appropriate first-tier intervention?
A. Inducing therapeutic hypothermia to 32 degrees Celsius
B. Administering hypertonic saline or mannitol
C. Performing an immediate decompressive craniectomy
, D. Starting a high-dose barbiturate infusion
Answer: B
Rationale: Hyperosmolar therapy, such as mannitol or hypertonic saline, is a standard
first-tier intervention to reduce intracranial pressure by drawing fluid out of brain tissue.
Other initial steps include elevating the head of the bed and ensuring adequate sedation.
More invasive measures like craniectomy or barbiturate comas are typically reserved for
refractory ICP that does not respond to these initial treatments.
6. A patient is diagnosed with Heparin-Induced Thrombocytopenia (HIT). Which of the
following is the most appropriate next step in management?
A. Switching to low-molecular-weight heparin (Lovenox)
B. Discontinuing all heparin and starting an alternative anticoagulant like Argatroban
C. Ordering a platelet transfusion to prevent bleeding
D. Waiting for the HIT antibody test results before changing therapy
Answer: B
Rationale: If HIT is clinically suspected, all sources of heparin must be discontinued
immediately, including flushes and coated catheters. A non-heparin anticoagulant, such as a
direct thrombin inhibitor like argatroban, should be started to prevent thrombotic
complications. Low-molecular-weight heparin is contraindicated because it cross-reacts
with HIT antibodies.
