NR572 Exam 3 Actual Exam Style V2 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU has a Mean Arterial Pressure (MAP) of 55 mmHg despite adequate
fluid resuscitation. Which of the following is the first-line vasopressor for septic shock?
A. Dopamine
B. Vasopressin
C. Norepinephrine
D. Epinephrine
Answer: C
Rationale: Norepinephrine is the first-choice vasopressor recommended by the Surviving
Sepsis Campaign guidelines. It provides a potent alpha-1 adrenergic effect to increase
systemic vascular resistance. Compared to dopamine, it is associated with a lower
incidence of arrhythmias.
2. When managing a patient with ARDS, which ventilatory strategy is most effective at
reducing mortality?
A. High tidal volumes to maximize recruitment
B. Low tidal volume ventilation (6 mL/kg PBW)
C. Inverse ratio ventilation
,D. Maintaining plateau pressures above 40 cm H2O
Answer: B
Rationale: Low tidal volume ventilation is the cornerstone of lung-protective strategies in
ARDS management. This approach helps prevent ventilator-induced lung injury (VILI) by
reducing overdistention of the alveoli. Clinical trials have demonstrated a significant
reduction in mortality when tidal volumes are limited to approximately 6 mL per kilogram
of predicted body weight.
3. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg and a MAP of 85
mmHg. What is the calculated Cerebral Perfusion Pressure (CPP)?
A. 63 mmHg
B. 107 mmHg
C. 45 mmHg
D. 70 mmHg
Answer: A
Rationale: The formula for calculating Cerebral Perfusion Pressure (CPP) is MAP minus
ICP. In this scenario, 85 mmHg minus 22 mmHg equals 63 mmHg. A target CPP of 60 to 70
mmHg is generally recommended to ensure adequate brain tissue oxygenation in TBI
patients.
4. Which hemodynamic profile is most consistent with early septic shock (distributive shock)?
A. Low Cardiac Output, High SVR, High PCWP
, B. High Cardiac Output, Low SVR, Low CVP
C. Low Cardiac Output, Low SVR, High CVP
D. Normal Cardiac Output, Normal SVR, Low PCWP
Answer: B
Rationale: Early septic shock is characterized by a hyperdynamic state with increased
cardiac output. The underlying pathophysiology involves massive vasodilation leading to a
decrease in systemic vascular resistance (SVR). Additionally, relative hypovolemia from
capillary leak often results in low central venous pressure (CVP) and pulmonary capillary
wedge pressure (PCWP).
5. A patient presents with acute onset of severe chest pain and back pain. An echocardiogram
reveals a flap in the ascending aorta. What is the priority management step?
A. Administration of high-dose Aspirin
B. Aggressive blood pressure and heart rate control
C. Initiation of a Heparin drip
D. Immediate thrombolytic therapy
Answer: B
Rationale: For an aortic dissection, the primary goal is to reduce the shear stress on the
aortic wall. This is achieved by lowering the heart rate and blood pressure, typically using
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU has a Mean Arterial Pressure (MAP) of 55 mmHg despite adequate
fluid resuscitation. Which of the following is the first-line vasopressor for septic shock?
A. Dopamine
B. Vasopressin
C. Norepinephrine
D. Epinephrine
Answer: C
Rationale: Norepinephrine is the first-choice vasopressor recommended by the Surviving
Sepsis Campaign guidelines. It provides a potent alpha-1 adrenergic effect to increase
systemic vascular resistance. Compared to dopamine, it is associated with a lower
incidence of arrhythmias.
2. When managing a patient with ARDS, which ventilatory strategy is most effective at
reducing mortality?
A. High tidal volumes to maximize recruitment
B. Low tidal volume ventilation (6 mL/kg PBW)
C. Inverse ratio ventilation
,D. Maintaining plateau pressures above 40 cm H2O
Answer: B
Rationale: Low tidal volume ventilation is the cornerstone of lung-protective strategies in
ARDS management. This approach helps prevent ventilator-induced lung injury (VILI) by
reducing overdistention of the alveoli. Clinical trials have demonstrated a significant
reduction in mortality when tidal volumes are limited to approximately 6 mL per kilogram
of predicted body weight.
3. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg and a MAP of 85
mmHg. What is the calculated Cerebral Perfusion Pressure (CPP)?
A. 63 mmHg
B. 107 mmHg
C. 45 mmHg
D. 70 mmHg
Answer: A
Rationale: The formula for calculating Cerebral Perfusion Pressure (CPP) is MAP minus
ICP. In this scenario, 85 mmHg minus 22 mmHg equals 63 mmHg. A target CPP of 60 to 70
mmHg is generally recommended to ensure adequate brain tissue oxygenation in TBI
patients.
4. Which hemodynamic profile is most consistent with early septic shock (distributive shock)?
A. Low Cardiac Output, High SVR, High PCWP
, B. High Cardiac Output, Low SVR, Low CVP
C. Low Cardiac Output, Low SVR, High CVP
D. Normal Cardiac Output, Normal SVR, Low PCWP
Answer: B
Rationale: Early septic shock is characterized by a hyperdynamic state with increased
cardiac output. The underlying pathophysiology involves massive vasodilation leading to a
decrease in systemic vascular resistance (SVR). Additionally, relative hypovolemia from
capillary leak often results in low central venous pressure (CVP) and pulmonary capillary
wedge pressure (PCWP).
5. A patient presents with acute onset of severe chest pain and back pain. An echocardiogram
reveals a flap in the ascending aorta. What is the priority management step?
A. Administration of high-dose Aspirin
B. Aggressive blood pressure and heart rate control
C. Initiation of a Heparin drip
D. Immediate thrombolytic therapy
Answer: B
Rationale: For an aortic dissection, the primary goal is to reduce the shear stress on the
aortic wall. This is achieved by lowering the heart rate and blood pressure, typically using
