NR572 Exam 4 Actual Exam Style V1 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A 65-year-old patient with septic shock remains hypotensive despite receiving 30 mL/kg of
isotonic crystalloids. What is the first-line vasopressor recommended by the Surviving Sepsis
Campaign?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor of choice for the management of
septic shock to achieve a mean arterial pressure of at least 65 mmHg. It is preferred over
dopamine because it is more effective at reversing hypotension and has a lower incidence
of arrhythmias. Once fluid resuscitation is adequate, initiating norepinephrine helps
improve vascular tone and systemic perfusion.
2. A patient with ARDS is being mechanically ventilated. The clinician notes a PaO2/FiO2 ratio
of 150 mmHg. This indicates which severity level of ARDS according to the Berlin Definition?
A. Mild
,B. Moderate
C. Severe
D. Acute Lung Injury
Answer: B
Rationale: The Berlin Definition classifies ARDS based on the P/F ratio when the patient is
on a PEEP of at least 5 cmH2O. Moderate ARDS is defined as a P/F ratio between 100 and
200 mmHg. Severe ARDS is less than 100 mmHg, while mild ARDS is between 200 and 300
mmHg.
3. Which hemodynamic profile is most consistent with cardiogenic shock?
A. High CVP, Low PCWP, High CO
B. Low CVP, Low PCWP, Low CO
C. Low CVP, Low PCWP, High CO
D. High CVP, High PCWP, Low CO
Answer: D
Rationale: Cardiogenic shock is characterized by pump failure, leading to a low Cardiac
Output (CO). This results in a backup of fluid, which increases the Pulmonary Capillary
Wedge Pressure (PCWP) and Central Venous Pressure (CVP). In contrast, hypovolemic
shock would show low pressures and low output.
, 4. A patient is admitted with Acute Kidney Injury (AKI) and has a potassium level of 6.8 mEq/L
with peaked T-waves on EKG. What is the priority intervention?
A. Oral Sodium Polystyrene Sulfonate
B. Albuterol nebulizer treatment
C. Intravenous Furosemide
D. Intravenous Calcium Gluconate
Answer: D
Rationale: IV Calcium Gluconate is the priority treatment to stabilize the myocardial cell
membrane in the presence of hyperkalemia with EKG changes. While it does not lower the
potassium level itself, it prevents life-threatening arrhythmias. Subsequent treatments such
as insulin with glucose or dialysis are needed to actually remove or shift the potassium.
5. In the management of a patient with an intracranial pressure (ICP) of 25 mmHg, which
position is most appropriate?
A. Trendelenburg position
B. Head of bed elevated 30-45 degrees
C. Supine with head of bed at 0 degrees
D. Prone position
Answer: B
572 Advanced Acute Care Management |
Chamberlain
1. A 65-year-old patient with septic shock remains hypotensive despite receiving 30 mL/kg of
isotonic crystalloids. What is the first-line vasopressor recommended by the Surviving Sepsis
Campaign?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor of choice for the management of
septic shock to achieve a mean arterial pressure of at least 65 mmHg. It is preferred over
dopamine because it is more effective at reversing hypotension and has a lower incidence
of arrhythmias. Once fluid resuscitation is adequate, initiating norepinephrine helps
improve vascular tone and systemic perfusion.
2. A patient with ARDS is being mechanically ventilated. The clinician notes a PaO2/FiO2 ratio
of 150 mmHg. This indicates which severity level of ARDS according to the Berlin Definition?
A. Mild
,B. Moderate
C. Severe
D. Acute Lung Injury
Answer: B
Rationale: The Berlin Definition classifies ARDS based on the P/F ratio when the patient is
on a PEEP of at least 5 cmH2O. Moderate ARDS is defined as a P/F ratio between 100 and
200 mmHg. Severe ARDS is less than 100 mmHg, while mild ARDS is between 200 and 300
mmHg.
3. Which hemodynamic profile is most consistent with cardiogenic shock?
A. High CVP, Low PCWP, High CO
B. Low CVP, Low PCWP, Low CO
C. Low CVP, Low PCWP, High CO
D. High CVP, High PCWP, Low CO
Answer: D
Rationale: Cardiogenic shock is characterized by pump failure, leading to a low Cardiac
Output (CO). This results in a backup of fluid, which increases the Pulmonary Capillary
Wedge Pressure (PCWP) and Central Venous Pressure (CVP). In contrast, hypovolemic
shock would show low pressures and low output.
, 4. A patient is admitted with Acute Kidney Injury (AKI) and has a potassium level of 6.8 mEq/L
with peaked T-waves on EKG. What is the priority intervention?
A. Oral Sodium Polystyrene Sulfonate
B. Albuterol nebulizer treatment
C. Intravenous Furosemide
D. Intravenous Calcium Gluconate
Answer: D
Rationale: IV Calcium Gluconate is the priority treatment to stabilize the myocardial cell
membrane in the presence of hyperkalemia with EKG changes. While it does not lower the
potassium level itself, it prevents life-threatening arrhythmias. Subsequent treatments such
as insulin with glucose or dialysis are needed to actually remove or shift the potassium.
5. In the management of a patient with an intracranial pressure (ICP) of 25 mmHg, which
position is most appropriate?
A. Trendelenburg position
B. Head of bed elevated 30-45 degrees
C. Supine with head of bed at 0 degrees
D. Prone position
Answer: B
