NR572 Exam 2 Actual Exam Style V1 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive after a 30 mL/kg fluid bolus. Which
vasopressor is the first-line choice for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Answer: C
Rationale: Norepinephrine is the recommended first-line vasopressor for septic shock
according to the Surviving Sepsis Campaign. It functions as a potent alpha-1 agonist which
increases systemic vascular resistance to improve blood pressure. Studies have shown it
has a lower risk of arrhythmias compared to dopamine in this patient population.
2. When assessing a patient’s hemodynamics, you note a CVP of 2 mmHg, a PAWP of 4
mmHg, and a Cardiac Index of 1.8 L/min/m2. What type of shock do these findings suggest?
A. Cardiogenic Shock
B. Anaphylactic Shock
C. Septic Shock
,D. Hypovolemic Shock
Answer: D
Rationale: Low Central Venous Pressure (CVP) and low Pulmonary Artery Wedge Pressure
(PAWP) indicate a lack of volume in the vascular space. The low Cardiac Index is a direct
result of inadequate preload failing to support cardiac output. Hypovolemic shock is
characterized specifically by these low filling pressures combined with reduced output.
3. A patient on a mechanical ventilator has the following ABG results: pH 7.28, PaCO2 55
mmHg, HCO3 26 mEq/L, and PaO2 80 mmHg. How would you interpret this acid-base
imbalance?
A. Compensated metabolic acidosis
B. Partially compensated respiratory alkalosis
C. Uncompensated respiratory acidosis
D. Compensated respiratory acidosis
Answer: C
Rationale: The pH is below 7.35, indicating acidosis, while the PaCO2 is elevated above 45
mmHg, which is a respiratory cause. The bicarbonate level is within the normal range,
meaning the kidneys have not yet compensated for the imbalance. Therefore, this is an
uncompensated respiratory acidosis likely due to hypoventilation.
, 4. In the management of ARDS, which ventilation strategy is prioritized to prevent ventilator-
induced lung injury (VILI)?
A. High tidal volumes to maximize recruitment
B. Low PEEP to prevent barotrauma
C. Low tidal volumes (6 mL/kg) and plateau pressure <30 cm H2O
D. High FiO2 regardless of oxygenation targets
Answer: C
Rationale: Lung-protective ventilation using low tidal volumes is the standard of care for
patients with ARDS. This approach prevents volutrauma and barotrauma by limiting the
stretch on alveoli and keeping plateau pressures low. Maintaining a plateau pressure under
30 cm H2O is critical for reducing mortality in these patients.
5. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 550 mg/dL. Before
starting an insulin infusion, which electrolyte must be checked and managed first?
A. Sodium
B. Potassium
C. Magnesium
D. Calcium
Answer: B
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive after a 30 mL/kg fluid bolus. Which
vasopressor is the first-line choice for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Answer: C
Rationale: Norepinephrine is the recommended first-line vasopressor for septic shock
according to the Surviving Sepsis Campaign. It functions as a potent alpha-1 agonist which
increases systemic vascular resistance to improve blood pressure. Studies have shown it
has a lower risk of arrhythmias compared to dopamine in this patient population.
2. When assessing a patient’s hemodynamics, you note a CVP of 2 mmHg, a PAWP of 4
mmHg, and a Cardiac Index of 1.8 L/min/m2. What type of shock do these findings suggest?
A. Cardiogenic Shock
B. Anaphylactic Shock
C. Septic Shock
,D. Hypovolemic Shock
Answer: D
Rationale: Low Central Venous Pressure (CVP) and low Pulmonary Artery Wedge Pressure
(PAWP) indicate a lack of volume in the vascular space. The low Cardiac Index is a direct
result of inadequate preload failing to support cardiac output. Hypovolemic shock is
characterized specifically by these low filling pressures combined with reduced output.
3. A patient on a mechanical ventilator has the following ABG results: pH 7.28, PaCO2 55
mmHg, HCO3 26 mEq/L, and PaO2 80 mmHg. How would you interpret this acid-base
imbalance?
A. Compensated metabolic acidosis
B. Partially compensated respiratory alkalosis
C. Uncompensated respiratory acidosis
D. Compensated respiratory acidosis
Answer: C
Rationale: The pH is below 7.35, indicating acidosis, while the PaCO2 is elevated above 45
mmHg, which is a respiratory cause. The bicarbonate level is within the normal range,
meaning the kidneys have not yet compensated for the imbalance. Therefore, this is an
uncompensated respiratory acidosis likely due to hypoventilation.
, 4. In the management of ARDS, which ventilation strategy is prioritized to prevent ventilator-
induced lung injury (VILI)?
A. High tidal volumes to maximize recruitment
B. Low PEEP to prevent barotrauma
C. Low tidal volumes (6 mL/kg) and plateau pressure <30 cm H2O
D. High FiO2 regardless of oxygenation targets
Answer: C
Rationale: Lung-protective ventilation using low tidal volumes is the standard of care for
patients with ARDS. This approach prevents volutrauma and barotrauma by limiting the
stretch on alveoli and keeping plateau pressures low. Maintaining a plateau pressure under
30 cm H2O is critical for reducing mortality in these patients.
5. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 550 mg/dL. Before
starting an insulin infusion, which electrolyte must be checked and managed first?
A. Sodium
B. Potassium
C. Magnesium
D. Calcium
Answer: B
