NR572 Exam 1 Actual Exam Style V2 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient presents with a Mean Arterial Pressure (MAP) of 55 mmHg. What is the priority
intervention for the nurse practitioner to implement first?
A. Administer a 500 mL bolus of isotonic crystalloids.
B. Initiate vasopressor therapy with norepinephrine.
C. Obtain an immediate 12-lead electrocardiogram.
D. Order a STAT serum lactate level.
Answer: A
Rationale: A MAP of less than 65 mmHg indicates inadequate tissue perfusion and
requires immediate intervention. Initial management of hypotension typically begins with
fluid resuscitation to improve preload and cardiac output. Vasopressors are generally
reserved for cases where fluid resuscitation fails to achieve hemodynamic stability.
2. Which clinical finding is most characteristic of early Compensated Shock?
A. Metabolic acidosis and anuria.
B. Hypotension and decreased level of consciousness.
C. Narrowing pulse pressure and tachycardia.
D. Bradycardia and warm, dry skin.
,Answer: C
Rationale: In the compensated stage of shock, the body uses homeostatic mechanisms
such as the sympathetic nervous system to maintain perfusion. Tachycardia and peripheral
vasoconstriction often lead to a narrowing pulse pressure before a drop in systolic blood
pressure occurs. Recognizing these subtle signs is crucial for early intervention in the acute
care setting.
3. A patient’s ABG results are: pH 7.28, PaCO2 55 mmHg, and HCO3 26 mEq/L. How should
the nurse practitioner interpret these results?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Alkalosis
C. Partially Compensated Metabolic Alkalosis
D. Uncompensated Respiratory Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. Since the bicarbonate level is within the normal
range (22-26 mEq/L), the kidneys have not yet begun to compensate for the acidotic state.
Therefore, this is classified as uncompensated respiratory acidosis, often seen in
hypoventilation.
4. What is the primary hemodynamic goal when managing a patient with Cardiogenic Shock?
A. Increase systemic vascular resistance (SVR).
, B. Improve myocardial contractility while reducing afterload.
C. Aggressive fluid resuscitation to increase CVP.
D. Decrease the heart rate to less than 60 beats per minute.
Answer: B
Rationale: Cardiogenic shock results from pump failure, leading to decreased cardiac
output and pulmonary congestion. Management focuses on increasing contractility with
inotropes and reducing the workload of the heart by lowering afterload. Excessive fluids
can worsen pulmonary edema and should be used with extreme caution in these patients.
5. According to the Surviving Sepsis Campaign, what is the recommended initial fluid bolus
for a patient with sepsis-induced hypoperfusion?
A. 10 mL/kg of crystalloid
B. 20 mL/kg of colloid
C. 50 mL/kg of dextrose 5% in water
D. 30 mL/kg of crystalloid
Answer: D
Rationale: The current guidelines recommend an initial fluid resuscitation of at least 30
mL/kg of intravenous crystalloid within the first 3 hours. This volume is intended to
restore intravascular volume and improve organ perfusion in patients suspected of having
572 Advanced Acute Care Management |
Chamberlain
1. A patient presents with a Mean Arterial Pressure (MAP) of 55 mmHg. What is the priority
intervention for the nurse practitioner to implement first?
A. Administer a 500 mL bolus of isotonic crystalloids.
B. Initiate vasopressor therapy with norepinephrine.
C. Obtain an immediate 12-lead electrocardiogram.
D. Order a STAT serum lactate level.
Answer: A
Rationale: A MAP of less than 65 mmHg indicates inadequate tissue perfusion and
requires immediate intervention. Initial management of hypotension typically begins with
fluid resuscitation to improve preload and cardiac output. Vasopressors are generally
reserved for cases where fluid resuscitation fails to achieve hemodynamic stability.
2. Which clinical finding is most characteristic of early Compensated Shock?
A. Metabolic acidosis and anuria.
B. Hypotension and decreased level of consciousness.
C. Narrowing pulse pressure and tachycardia.
D. Bradycardia and warm, dry skin.
,Answer: C
Rationale: In the compensated stage of shock, the body uses homeostatic mechanisms
such as the sympathetic nervous system to maintain perfusion. Tachycardia and peripheral
vasoconstriction often lead to a narrowing pulse pressure before a drop in systolic blood
pressure occurs. Recognizing these subtle signs is crucial for early intervention in the acute
care setting.
3. A patient’s ABG results are: pH 7.28, PaCO2 55 mmHg, and HCO3 26 mEq/L. How should
the nurse practitioner interpret these results?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Alkalosis
C. Partially Compensated Metabolic Alkalosis
D. Uncompensated Respiratory Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. Since the bicarbonate level is within the normal
range (22-26 mEq/L), the kidneys have not yet begun to compensate for the acidotic state.
Therefore, this is classified as uncompensated respiratory acidosis, often seen in
hypoventilation.
4. What is the primary hemodynamic goal when managing a patient with Cardiogenic Shock?
A. Increase systemic vascular resistance (SVR).
, B. Improve myocardial contractility while reducing afterload.
C. Aggressive fluid resuscitation to increase CVP.
D. Decrease the heart rate to less than 60 beats per minute.
Answer: B
Rationale: Cardiogenic shock results from pump failure, leading to decreased cardiac
output and pulmonary congestion. Management focuses on increasing contractility with
inotropes and reducing the workload of the heart by lowering afterload. Excessive fluids
can worsen pulmonary edema and should be used with extreme caution in these patients.
5. According to the Surviving Sepsis Campaign, what is the recommended initial fluid bolus
for a patient with sepsis-induced hypoperfusion?
A. 10 mL/kg of crystalloid
B. 20 mL/kg of colloid
C. 50 mL/kg of dextrose 5% in water
D. 30 mL/kg of crystalloid
Answer: D
Rationale: The current guidelines recommend an initial fluid resuscitation of at least 30
mL/kg of intravenous crystalloid within the first 3 hours. This volume is intended to
restore intravascular volume and improve organ perfusion in patients suspected of having
