NR571 Final Exam Actual Exam Style V1 |
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient with septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid.
Which vasopressor is recommended as the first-line agent to achieve a target Mean Arterial
Pressure (MAP) of ≥65 mmHg?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Epinephrine
Answer: B
Rationale: Norepinephrine is the preferred first-line vasopressor for septic shock
according to the Surviving Sepsis Campaign guidelines. It acts primarily on alpha-1
receptors to increase systemic vascular resistance while having minimal effect on heart
rate compared to dopamine. This pharmacological profile makes it effective for maintaining
perfusion pressure without excessively increasing myocardial oxygen demand.
2. Which hemodynamic profile is most consistent with a diagnosis of cardiogenic shock?
A. Decreased CO, Decreased PCWP, Increased SVR
,B. Increased CO, Decreased PCWP, Decreased SVR
C. Decreased CO, Decreased PCWP, Decreased SVR
D. Decreased Cardiac Output (CO), Increased Pulmonary Capillary Wedge Pressure
(PCWP), Increased Systemic Vascular Resistance (SVR)
Answer: D
Rationale: In cardiogenic shock, the primary failure is the heart’s pump function, leading
to a low cardiac output and cardiac index. The body compensates for low output by
increasing systemic vascular resistance through vasoconstriction. Consequently, back-
pressure in the left ventricle leads to an elevated pulmonary capillary wedge pressure.
3. A patient on mechanical ventilation is exhibiting signs of ventilator-induced lung injury
(VILI). Which strategy is most effective in preventing this complication in patients with ARDS?
A. High tidal volume and high PEEP
B. Low tidal volume (6 mL/kg predicted body weight) and limiting plateau pressure
C. Negative end-expiratory pressure
D. Permissive hypercapnia with high peak pressures
Answer: B
Rationale: Low tidal volume ventilation is the cornerstone of lung-protective strategies in
ARDS to prevent overdistension of alveoli, known as volutrauma. By limiting plateau
pressures to less than 30 cm H2O, clinicians reduce the risk of barotrauma and further
, inflammatory damage. This approach has been proven to improve survival rates in
critically ill patients with respiratory failure.
4. Beck’s Triad is a classic clinical indicator of which life-threatening condition?
A. Tension Pneumothorax
B. Pulmonary Embolism
C. Aortic Dissection
D. Cardiac Tamponade
Answer: D
Rationale: Beck’s Triad consists of hypotension, muffled heart sounds, and jugular venous
distension. These signs indicate that fluid in the pericardial sac is compressing the heart
and preventing adequate diastolic filling. Rapid recognition is vital because this condition
requires emergent pericardiocentesis to restore hemodynamics.
5. Which of the following ABG results indicates fully compensated respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 25
B. pH 7.36, PaCO2 55, HCO3 32
C. pH 7.48, PaCO2 30, HCO3 20
D. pH 7.40, PaCO2 40, HCO3 24
Answer: B
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient with septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid.
Which vasopressor is recommended as the first-line agent to achieve a target Mean Arterial
Pressure (MAP) of ≥65 mmHg?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Epinephrine
Answer: B
Rationale: Norepinephrine is the preferred first-line vasopressor for septic shock
according to the Surviving Sepsis Campaign guidelines. It acts primarily on alpha-1
receptors to increase systemic vascular resistance while having minimal effect on heart
rate compared to dopamine. This pharmacological profile makes it effective for maintaining
perfusion pressure without excessively increasing myocardial oxygen demand.
2. Which hemodynamic profile is most consistent with a diagnosis of cardiogenic shock?
A. Decreased CO, Decreased PCWP, Increased SVR
,B. Increased CO, Decreased PCWP, Decreased SVR
C. Decreased CO, Decreased PCWP, Decreased SVR
D. Decreased Cardiac Output (CO), Increased Pulmonary Capillary Wedge Pressure
(PCWP), Increased Systemic Vascular Resistance (SVR)
Answer: D
Rationale: In cardiogenic shock, the primary failure is the heart’s pump function, leading
to a low cardiac output and cardiac index. The body compensates for low output by
increasing systemic vascular resistance through vasoconstriction. Consequently, back-
pressure in the left ventricle leads to an elevated pulmonary capillary wedge pressure.
3. A patient on mechanical ventilation is exhibiting signs of ventilator-induced lung injury
(VILI). Which strategy is most effective in preventing this complication in patients with ARDS?
A. High tidal volume and high PEEP
B. Low tidal volume (6 mL/kg predicted body weight) and limiting plateau pressure
C. Negative end-expiratory pressure
D. Permissive hypercapnia with high peak pressures
Answer: B
Rationale: Low tidal volume ventilation is the cornerstone of lung-protective strategies in
ARDS to prevent overdistension of alveoli, known as volutrauma. By limiting plateau
pressures to less than 30 cm H2O, clinicians reduce the risk of barotrauma and further
, inflammatory damage. This approach has been proven to improve survival rates in
critically ill patients with respiratory failure.
4. Beck’s Triad is a classic clinical indicator of which life-threatening condition?
A. Tension Pneumothorax
B. Pulmonary Embolism
C. Aortic Dissection
D. Cardiac Tamponade
Answer: D
Rationale: Beck’s Triad consists of hypotension, muffled heart sounds, and jugular venous
distension. These signs indicate that fluid in the pericardial sac is compressing the heart
and preventing adequate diastolic filling. Rapid recognition is vital because this condition
requires emergent pericardiocentesis to restore hemodynamics.
5. Which of the following ABG results indicates fully compensated respiratory acidosis?
A. pH 7.32, PaCO2 50, HCO3 25
B. pH 7.36, PaCO2 55, HCO3 32
C. pH 7.48, PaCO2 30, HCO3 20
D. pH 7.40, PaCO2 40, HCO3 24
Answer: B
