NR572 Exam 1 Actual Exam Style V3 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive with a MAP of 58 mmHg after receiving a
30 mL/kg crystalloid bolus. Which of the following is the priority pharmacological
intervention?
A. Vasopressin 0.03 units/min
B. Norepinephrine 0.05 mcg/kg/min
C. Dopamine 10 mcg/kg/min
D. Dobutamine 5 mcg/kg/min
Answer: B
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after initial fluid resuscitation. It
works primarily as an alpha-1 agonist to increase systemic vascular resistance and
improve Mean Arterial Pressure. Prompt initiation of vasopressors is critical to ensure
adequate organ perfusion and prevent multi-system organ failure.
,2. During the assessment of a patient with a Swan-Ganz catheter, the nurse notes a
Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. This finding most likely indicates
which condition?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure
D. Pulmonary hypertension
Answer: C
Rationale: The PAWP reflects the left-atrial pressure and is an indirect measure of left-
ventricular end-diastolic pressure. A normal PAWP ranges from 6 to 12 mmHg, so an
elevation to 22 mmHg suggests fluid overload or failure of the left ventricle. This
measurement helps clinicians differentiate between cardiogenic pulmonary edema and
non-cardiogenic causes such as ARDS.
3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The provider
orders a low tidal volume ventilation strategy. What is the primary rationale for this
intervention?
A. To increase the functional residual capacity
B. To prevent ventilator-induced lung injury (VILI)
C. To maximize oxygen delivery to the tissues
D. To decrease the work of breathing
,Answer: B
Rationale: Low tidal volume ventilation (usually 6 mL/kg of predicted body weight) is the
gold standard for ARDS management to avoid overdistension of the alveoli. This strategy
reduces the risk of volutrauma and barotrauma, collectively known as ventilator-induced
lung injury. High tidal volumes in damaged lungs can trigger a pro-inflammatory response
that worsens the underlying condition.
4. A patient’s ABG results are: pH 7.28, PaCO2 55 mmHg, HCO3 26 mEq/L, and PaO2 70
mmHg. How should the nurse interpret these results?
A. Fully compensated metabolic alkalosis
B. Uncompensated respiratory acidosis
C. Partially compensated respiratory acidosis
D. Compensated respiratory alkalosis
Answer: B
Rationale: The pH is low (acidosis) and the PaCO2 is high, indicating the primary cause is
respiratory. Because the HCO3 is within the normal range (22-26 mEq/L), the kidneys have
not yet compensated for the respiratory failure. This represents a state of uncompensated
respiratory acidosis, often seen in acute conditions like COPD exacerbation or sedation.
5. Which of the following clinical indicators is part of the qSOFA (quick Sepsis-related Organ
Failure Assessment) score used in the emergency department?
A. Respiratory rate > 22 breaths/min
, B. Mean Arterial Pressure < 60 mmHg
C. Lactate level > 2.0 mmol/L
D. Urine output < 0.5 mL/kg/hr
Answer: A
Rationale: The qSOFA score utilizes three specific criteria: altered mental status (GCS <
15), systolic blood pressure < 100 mmHg, and respiratory rate > 22 breaths per minute. It
is designed to be a rapid tool to identify patients outside the ICU at high risk for poor
outcomes from sepsis. While lactate is a significant marker for septic shock, it is not part of
the quick bedside assessment tool.
6. A patient with Acute Kidney Injury (AKI) is experiencing hyperkalemia (K+ 6.8 mEq/L). What
is the immediate priority to protect the heart from dysrhythmias?
A. Administering Sodium Polystyrene Sulfonate
B. Administering IV Calcium Gluconate
C. Starting a regular insulin and D50W infusion
D. Initiating emergent hemodialysis
Answer: B
Rationale: Calcium gluconate does not lower potassium levels, but it stabilizes the
myocardial cell membrane to prevent life-threatening arrhythmias. It is the first drug given
in severe hyperkalemia while other treatments like insulin or dialysis work to actually
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive with a MAP of 58 mmHg after receiving a
30 mL/kg crystalloid bolus. Which of the following is the priority pharmacological
intervention?
A. Vasopressin 0.03 units/min
B. Norepinephrine 0.05 mcg/kg/min
C. Dopamine 10 mcg/kg/min
D. Dobutamine 5 mcg/kg/min
Answer: B
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after initial fluid resuscitation. It
works primarily as an alpha-1 agonist to increase systemic vascular resistance and
improve Mean Arterial Pressure. Prompt initiation of vasopressors is critical to ensure
adequate organ perfusion and prevent multi-system organ failure.
,2. During the assessment of a patient with a Swan-Ganz catheter, the nurse notes a
Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. This finding most likely indicates
which condition?
A. Hypovolemic shock
B. Right-sided heart failure
C. Left-sided heart failure
D. Pulmonary hypertension
Answer: C
Rationale: The PAWP reflects the left-atrial pressure and is an indirect measure of left-
ventricular end-diastolic pressure. A normal PAWP ranges from 6 to 12 mmHg, so an
elevation to 22 mmHg suggests fluid overload or failure of the left ventricle. This
measurement helps clinicians differentiate between cardiogenic pulmonary edema and
non-cardiogenic causes such as ARDS.
3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The provider
orders a low tidal volume ventilation strategy. What is the primary rationale for this
intervention?
A. To increase the functional residual capacity
B. To prevent ventilator-induced lung injury (VILI)
C. To maximize oxygen delivery to the tissues
D. To decrease the work of breathing
,Answer: B
Rationale: Low tidal volume ventilation (usually 6 mL/kg of predicted body weight) is the
gold standard for ARDS management to avoid overdistension of the alveoli. This strategy
reduces the risk of volutrauma and barotrauma, collectively known as ventilator-induced
lung injury. High tidal volumes in damaged lungs can trigger a pro-inflammatory response
that worsens the underlying condition.
4. A patient’s ABG results are: pH 7.28, PaCO2 55 mmHg, HCO3 26 mEq/L, and PaO2 70
mmHg. How should the nurse interpret these results?
A. Fully compensated metabolic alkalosis
B. Uncompensated respiratory acidosis
C. Partially compensated respiratory acidosis
D. Compensated respiratory alkalosis
Answer: B
Rationale: The pH is low (acidosis) and the PaCO2 is high, indicating the primary cause is
respiratory. Because the HCO3 is within the normal range (22-26 mEq/L), the kidneys have
not yet compensated for the respiratory failure. This represents a state of uncompensated
respiratory acidosis, often seen in acute conditions like COPD exacerbation or sedation.
5. Which of the following clinical indicators is part of the qSOFA (quick Sepsis-related Organ
Failure Assessment) score used in the emergency department?
A. Respiratory rate > 22 breaths/min
, B. Mean Arterial Pressure < 60 mmHg
C. Lactate level > 2.0 mmol/L
D. Urine output < 0.5 mL/kg/hr
Answer: A
Rationale: The qSOFA score utilizes three specific criteria: altered mental status (GCS <
15), systolic blood pressure < 100 mmHg, and respiratory rate > 22 breaths per minute. It
is designed to be a rapid tool to identify patients outside the ICU at high risk for poor
outcomes from sepsis. While lactate is a significant marker for septic shock, it is not part of
the quick bedside assessment tool.
6. A patient with Acute Kidney Injury (AKI) is experiencing hyperkalemia (K+ 6.8 mEq/L). What
is the immediate priority to protect the heart from dysrhythmias?
A. Administering Sodium Polystyrene Sulfonate
B. Administering IV Calcium Gluconate
C. Starting a regular insulin and D50W infusion
D. Initiating emergent hemodialysis
Answer: B
Rationale: Calcium gluconate does not lower potassium levels, but it stabilizes the
myocardial cell membrane to prevent life-threatening arrhythmias. It is the first drug given
in severe hyperkalemia while other treatments like insulin or dialysis work to actually
