NR572 Exam 1 Actual Exam Style V1 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient with sepsis has a blood pressure of 82/46 mmHg after receiving 30 mL/kg of
intravenous crystalloids. What is the next priority intervention in the management of this
patient?
A. Administer a second fluid bolus of 20 mL/kg.
B. Start broad-spectrum antibiotics immediately.
C. Initiate norepinephrine to maintain MAP ≥ 65 mmHg.
D. Order an urgent echocardiogram to assess cardiac output.
Answer: C
Rationale: Septic shock is characterized by persistent hypotension despite adequate fluid
resuscitation. According to the Surviving Sepsis Campaign, norepinephrine is the first-line
vasopressor for maintaining mean arterial pressure. Delaying vasopressors in fluid-
refractory shock increases the risk of organ hypoperfusion and mortality.
2. Which hemodynamic profile is most consistent with a patient experiencing cardiogenic
shock?
A. Low CVP, Low PCWP, High CO
B. Low CVP, High PCWP, High CO
,C. High CVP, High PCWP, Low CO
D. High CVP, Low PCWP, High CO
Answer: C
Rationale: Cardiogenic shock involves the failure of the heart to pump effectively, leading
to a decrease in cardiac output. This failure causes blood to back up into the venous system
and lungs, resulting in elevated central venous pressure (CVP) and pulmonary capillary
wedge pressure (PCWP). Treatment focuses on increasing contractility and reducing
afterload to improve flow.
3. An arterial blood gas (ABG) shows: pH 7.28, PaCO2 56, HCO3 25. How should the provider
interpret these results?
A. Compensated Metabolic Acidosis
B. Uncompensated Metabolic Acidosis
C. Uncompensated Respiratory Acidosis
D. Compensated Respiratory Alkalosis
Answer: C
Rationale: The pH of 7.28 indicates acidosis as it is below the normal range of 7.35-7.45.
The PaCO2 is elevated at 56, which explains the acidotic state, while the bicarbonate
remains within a normal range. Because the bicarbonate has not moved to counteract the
pH change, the condition is considered uncompensated.
, 4. A patient on mechanical ventilation has an abrupt increase in Peak Inspiratory Pressure
(PIP) while the Plateau Pressure remains stable. Which condition is the most likely cause?
A. Acute Respiratory Distress Syndrome (ARDS)
B. Development of a Tension Pneumothorax
C. Increased secretions in the endotracheal tube
D. Pulmonary Edema
Answer: C
Rationale: An increase in PIP without an increase in plateau pressure suggests an increase
in airway resistance rather than a change in lung compliance. Common causes of resistance
include secretions, bronchospasms, or a kinked tube. Conditions that affect the lung tissue
itself, like ARDS or pneumothorax, would cause both PIP and plateau pressures to rise.
5. What is the primary physiological goal of applying Positive End-Expiratory Pressure (PEEP)
in a patient with ARDS?
A. To recruit collapsed alveoli and improve oxygenation.
B. To increase the fraction of inspired oxygen (FiO2).
C. To decrease the risk of barotrauma.
D. To reduce the patient’s respiratory drive.
Answer: A
572 Advanced Acute Care Management |
Chamberlain
1. A patient with sepsis has a blood pressure of 82/46 mmHg after receiving 30 mL/kg of
intravenous crystalloids. What is the next priority intervention in the management of this
patient?
A. Administer a second fluid bolus of 20 mL/kg.
B. Start broad-spectrum antibiotics immediately.
C. Initiate norepinephrine to maintain MAP ≥ 65 mmHg.
D. Order an urgent echocardiogram to assess cardiac output.
Answer: C
Rationale: Septic shock is characterized by persistent hypotension despite adequate fluid
resuscitation. According to the Surviving Sepsis Campaign, norepinephrine is the first-line
vasopressor for maintaining mean arterial pressure. Delaying vasopressors in fluid-
refractory shock increases the risk of organ hypoperfusion and mortality.
2. Which hemodynamic profile is most consistent with a patient experiencing cardiogenic
shock?
A. Low CVP, Low PCWP, High CO
B. Low CVP, High PCWP, High CO
,C. High CVP, High PCWP, Low CO
D. High CVP, Low PCWP, High CO
Answer: C
Rationale: Cardiogenic shock involves the failure of the heart to pump effectively, leading
to a decrease in cardiac output. This failure causes blood to back up into the venous system
and lungs, resulting in elevated central venous pressure (CVP) and pulmonary capillary
wedge pressure (PCWP). Treatment focuses on increasing contractility and reducing
afterload to improve flow.
3. An arterial blood gas (ABG) shows: pH 7.28, PaCO2 56, HCO3 25. How should the provider
interpret these results?
A. Compensated Metabolic Acidosis
B. Uncompensated Metabolic Acidosis
C. Uncompensated Respiratory Acidosis
D. Compensated Respiratory Alkalosis
Answer: C
Rationale: The pH of 7.28 indicates acidosis as it is below the normal range of 7.35-7.45.
The PaCO2 is elevated at 56, which explains the acidotic state, while the bicarbonate
remains within a normal range. Because the bicarbonate has not moved to counteract the
pH change, the condition is considered uncompensated.
, 4. A patient on mechanical ventilation has an abrupt increase in Peak Inspiratory Pressure
(PIP) while the Plateau Pressure remains stable. Which condition is the most likely cause?
A. Acute Respiratory Distress Syndrome (ARDS)
B. Development of a Tension Pneumothorax
C. Increased secretions in the endotracheal tube
D. Pulmonary Edema
Answer: C
Rationale: An increase in PIP without an increase in plateau pressure suggests an increase
in airway resistance rather than a change in lung compliance. Common causes of resistance
include secretions, bronchospasms, or a kinked tube. Conditions that affect the lung tissue
itself, like ARDS or pneumothorax, would cause both PIP and plateau pressures to rise.
5. What is the primary physiological goal of applying Positive End-Expiratory Pressure (PEEP)
in a patient with ARDS?
A. To recruit collapsed alveoli and improve oxygenation.
B. To increase the fraction of inspired oxygen (FiO2).
C. To decrease the risk of barotrauma.
D. To reduce the patient’s respiratory drive.
Answer: A
