NR572 Exam 3 Actual Exam Style V3 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient with sepsis has a MAP of 55 mmHg after receiving a 30 mL/kg bolus of crystalloid.
Which of the following is the most appropriate next step in management according to the
Surviving Sepsis guidelines?
A. Initiate Norepinephrine to maintain MAP ≥ 65 mmHg.
B. Administer another 2L of Normal Saline bolus.
C. Start low-dose Vasopressin as monotherapy.
D. Wait 30 minutes to reassess the fluid response.
Answer: A
Rationale: According to the Surviving Sepsis Campaign, if a patient remains hypotensive
after adequate fluid resuscitation, vasopressors should be initiated. Norepinephrine is
recommended as the first-line vasopressor to target a MAP of 65 mmHg. This intervention
is critical to ensure adequate organ perfusion and prevent further tissue hypoxia.
2. A patient presents with a P/F ratio (PaO2/FiO2) of 150 mmHg while on PEEP of 10 cm H2O.
How would this patient’s Acute Respiratory Distress Syndrome (ARDS) be classified based on
the Berlin Definition?
A. Mild ARDS
,B. Severe ARDS
C. Moderate ARDS
D. At risk for ARDS
Answer: C
Rationale: The Berlin criteria categorize ARDS severity based on the P/F ratio. Moderate
ARDS is defined as a P/F ratio between 100 and 200 mmHg. In this scenario, the value of
150 falls squarely within the moderate range, requiring aggressive ventilatory support.
3. Which hemodynamic profile is most characteristic of early (hyperdynamic) septic shock?
A. Low Cardiac Output, High SVR, High CVP
B. High Cardiac Output, Low SVR, Low CVP
C. Low Cardiac Output, Low SVR, Low CVP
D. High Cardiac Output, High SVR, Low CVP
Answer: B
Rationale: Early septic shock is characterized by massive peripheral vasodilation, which
leads to a decreased Systemic Vascular Resistance (SVR). To compensate, the heart
increases its output, resulting in a high Cardiac Output (CO). The CVP is typically low due to
relative hypovolemia from vasodilation and capillary leak.
, 4. A patient in the ICU is suspected of having Disseminated Intravascular Coagulation (DIC).
Which lab finding is most specific for this condition?
A. Elevated Hemoglobin and low Bilirubin
B. Elevated Platelets and decreased PT
C. Decreased PTT and decreased INR
D. Elevated D-dimer and decreased Fibrinogen
Answer: D
Rationale: DIC is characterized by the systemic activation of blood coagulation, which
depletes clotting factors and platelets. An elevated D-dimer indicates fibrinolysis, while a
low fibrinogen level reflects the consumption of clotting precursors. These findings
together are highly suggestive of the consumption coagulopathy seen in DIC.
5. A patient with a T4 spinal cord injury presents with a BP of 82/40 and a HR of 48. What
type of shock is most likely occurring?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Answer: D
572 Advanced Acute Care Management |
Chamberlain
1. A patient with sepsis has a MAP of 55 mmHg after receiving a 30 mL/kg bolus of crystalloid.
Which of the following is the most appropriate next step in management according to the
Surviving Sepsis guidelines?
A. Initiate Norepinephrine to maintain MAP ≥ 65 mmHg.
B. Administer another 2L of Normal Saline bolus.
C. Start low-dose Vasopressin as monotherapy.
D. Wait 30 minutes to reassess the fluid response.
Answer: A
Rationale: According to the Surviving Sepsis Campaign, if a patient remains hypotensive
after adequate fluid resuscitation, vasopressors should be initiated. Norepinephrine is
recommended as the first-line vasopressor to target a MAP of 65 mmHg. This intervention
is critical to ensure adequate organ perfusion and prevent further tissue hypoxia.
2. A patient presents with a P/F ratio (PaO2/FiO2) of 150 mmHg while on PEEP of 10 cm H2O.
How would this patient’s Acute Respiratory Distress Syndrome (ARDS) be classified based on
the Berlin Definition?
A. Mild ARDS
,B. Severe ARDS
C. Moderate ARDS
D. At risk for ARDS
Answer: C
Rationale: The Berlin criteria categorize ARDS severity based on the P/F ratio. Moderate
ARDS is defined as a P/F ratio between 100 and 200 mmHg. In this scenario, the value of
150 falls squarely within the moderate range, requiring aggressive ventilatory support.
3. Which hemodynamic profile is most characteristic of early (hyperdynamic) septic shock?
A. Low Cardiac Output, High SVR, High CVP
B. High Cardiac Output, Low SVR, Low CVP
C. Low Cardiac Output, Low SVR, Low CVP
D. High Cardiac Output, High SVR, Low CVP
Answer: B
Rationale: Early septic shock is characterized by massive peripheral vasodilation, which
leads to a decreased Systemic Vascular Resistance (SVR). To compensate, the heart
increases its output, resulting in a high Cardiac Output (CO). The CVP is typically low due to
relative hypovolemia from vasodilation and capillary leak.
, 4. A patient in the ICU is suspected of having Disseminated Intravascular Coagulation (DIC).
Which lab finding is most specific for this condition?
A. Elevated Hemoglobin and low Bilirubin
B. Elevated Platelets and decreased PT
C. Decreased PTT and decreased INR
D. Elevated D-dimer and decreased Fibrinogen
Answer: D
Rationale: DIC is characterized by the systemic activation of blood coagulation, which
depletes clotting factors and platelets. An elevated D-dimer indicates fibrinolysis, while a
low fibrinogen level reflects the consumption of clotting precursors. These findings
together are highly suggestive of the consumption coagulopathy seen in DIC.
5. A patient with a T4 spinal cord injury presents with a BP of 82/40 and a HR of 48. What
type of shock is most likely occurring?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Answer: D
