NR572 Exam 3 Actual Exam Style V1 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A 65-year-old male presents with acute decompensated heart failure and a blood pressure
of 82/50 mmHg. Which intravenous medication is the most appropriate first-line choice for
inotropic support in this patient?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Dobutamine
Answer: D
Rationale: Dobutamine is a positive inotope that increases myocardial contractility and
cardiac output in cardiogenic shock or decompensated heart failure. It acts primarily on
beta-1 receptors to improve stroke volume and systemic perfusion. In the setting of
hypotension, inotropic support is prioritized over vasodilators or beta-blockers.
2. Which clinical finding is most indicative of the transition from the compensatory stage to
the progressive stage of shock?
A. Slightly increased heart rate
B. Metabolic acidosis and increased lactate levels
,C. Narrowing pulse pressure
D. Cool and clammy skin
Answer: B
Rationale: During the progressive stage of shock, compensatory mechanisms begin to fail,
leading to cellular hypoxia and anaerobic metabolism. The buildup of lactic acid results in
metabolic acidosis, which is a hallmark sign of worsening tissue perfusion. Monitoring
serum lactate is essential for identifying the severity of organ dysfunction.
3. An ICU patient on mechanical ventilation for ARDS has a PaO2 of 58 mmHg despite an FiO2
of 80% and PEEP of 12 cmH2O. What is the next most appropriate intervention to improve
oxygenation?
A. Decreasing the PEEP to 5 cmH2O
B. Prone positioning
C. Switching to a non-rebreather mask
D. Increasing tidal volume to 12 mL/kg
Answer: B
Rationale: Prone positioning is recommended for patients with severe ARDS and a
PaO2/FiO2 ratio less than 150. It helps redistribute pulmonary blood flow and improves
ventilation-perfusion matching in the dorsal lung regions. This technique is often used
when conventional ventilator adjustments fail to maintain adequate oxygenation.
, 4. A patient with suspected sepsis has a MAP of 55 mmHg after receiving a 30 mL/kg fluid
bolus. Which vasopressor is the first-line recommendation according to the Surviving Sepsis
Guidelines?
A. Norepinephrine
B. Epinephrine
C. Vasopressin
D. Phenylephrine
Answer: A
Rationale: Norepinephrine is the first-line vasopressor for septic shock because it
effectively increases blood pressure through alpha-1 stimulation with minimal
chronotropic effects. It is preferred over other agents due to its superior safety profile and
efficacy in maintaining MAP. If the target MAP of 65 mmHg is not met, vasopressin may be
added as a second agent.
5. In a patient with Acute Kidney Injury (AKI), which electrolyte abnormality is considered a
medical emergency requiring immediate stabilization of the cardiac membrane?
A. Hypocalcemia
B. Hypernatremia
C. Hypomagnesemia
D. Hyperkalemia
572 Advanced Acute Care Management |
Chamberlain
1. A 65-year-old male presents with acute decompensated heart failure and a blood pressure
of 82/50 mmHg. Which intravenous medication is the most appropriate first-line choice for
inotropic support in this patient?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Dobutamine
Answer: D
Rationale: Dobutamine is a positive inotope that increases myocardial contractility and
cardiac output in cardiogenic shock or decompensated heart failure. It acts primarily on
beta-1 receptors to improve stroke volume and systemic perfusion. In the setting of
hypotension, inotropic support is prioritized over vasodilators or beta-blockers.
2. Which clinical finding is most indicative of the transition from the compensatory stage to
the progressive stage of shock?
A. Slightly increased heart rate
B. Metabolic acidosis and increased lactate levels
,C. Narrowing pulse pressure
D. Cool and clammy skin
Answer: B
Rationale: During the progressive stage of shock, compensatory mechanisms begin to fail,
leading to cellular hypoxia and anaerobic metabolism. The buildup of lactic acid results in
metabolic acidosis, which is a hallmark sign of worsening tissue perfusion. Monitoring
serum lactate is essential for identifying the severity of organ dysfunction.
3. An ICU patient on mechanical ventilation for ARDS has a PaO2 of 58 mmHg despite an FiO2
of 80% and PEEP of 12 cmH2O. What is the next most appropriate intervention to improve
oxygenation?
A. Decreasing the PEEP to 5 cmH2O
B. Prone positioning
C. Switching to a non-rebreather mask
D. Increasing tidal volume to 12 mL/kg
Answer: B
Rationale: Prone positioning is recommended for patients with severe ARDS and a
PaO2/FiO2 ratio less than 150. It helps redistribute pulmonary blood flow and improves
ventilation-perfusion matching in the dorsal lung regions. This technique is often used
when conventional ventilator adjustments fail to maintain adequate oxygenation.
, 4. A patient with suspected sepsis has a MAP of 55 mmHg after receiving a 30 mL/kg fluid
bolus. Which vasopressor is the first-line recommendation according to the Surviving Sepsis
Guidelines?
A. Norepinephrine
B. Epinephrine
C. Vasopressin
D. Phenylephrine
Answer: A
Rationale: Norepinephrine is the first-line vasopressor for septic shock because it
effectively increases blood pressure through alpha-1 stimulation with minimal
chronotropic effects. It is preferred over other agents due to its superior safety profile and
efficacy in maintaining MAP. If the target MAP of 65 mmHg is not met, vasopressin may be
added as a second agent.
5. In a patient with Acute Kidney Injury (AKI), which electrolyte abnormality is considered a
medical emergency requiring immediate stabilization of the cardiac membrane?
A. Hypocalcemia
B. Hypernatremia
C. Hypomagnesemia
D. Hyperkalemia
