NR572 Final Exam Actual Exam Style V1 |
NR 572 Advanced Acute Care
Management | Chamberlain
1. A patient presents to the ICU with suspected sepsis. According to the Surviving Sepsis
Campaign guidelines, what is the initial recommended volume for intravenous fluid
resuscitation in sepsis-induced hypotension?
A. 10 mL/kg of crystalloid
B. 30 mL/kg of crystalloid
C. 20 mL/kg of crystalloid
D. 50 mL/kg of crystalloid
Answer: B
Rationale: Current guidelines recommend an initial fluid bolus of at least 30 mL/kg of
intravenous crystalloid. This should be administered within the first 3 hours of
presentation for patients with sepsis-induced hypotension or a lactate level greater than 4
mmol/L. Early fluid resuscitation is critical to improve tissue perfusion and stabilize the
patient’s hemodynamic status.
2. In the management of Acute Respiratory Distress Syndrome (ARDS), which ventilator
setting is most strongly associated with improved survival outcomes?
A. High tidal volume ventilation (12 mL/kg)
,B. Inverse ratio ventilation
C. Low tidal volume ventilation (6 mL/kg)
D. Maintaining a PEEP of 0 cm H2O
Answer: C
Rationale: Low tidal volume ventilation, typically targeted at 6 mL/kg of predicted body
weight, is the standard of care for ARDS. This strategy, often called lung-protective
ventilation, helps prevent ventilator-induced lung injury caused by overdistension of the
alveoli. Clinical trials have demonstrated that this approach significantly reduces mortality
compared to higher tidal volumes.
3. A patient with heart failure is being monitored via a pulmonary artery catheter. Which of
the following hemodynamic profiles most likely indicates cardiogenic shock?
A. High Cardiac Index, Low PCWP, Low SVR
B. Low Cardiac Index, High PCWP, High SVR
C. Low Cardiac Index, Low PCWP, Low SVR
D. High Cardiac Index, High PCWP, High SVR
Answer: B
Rationale: Cardiogenic shock is characterized by primary pump failure, resulting in a low
Cardiac Index. The backup of blood into the lungs leads to an elevated Pulmonary Capillary
Wedge Pressure (PCWP). To compensate for low cardiac output, the body increases
, Systemic Vascular Resistance (SVR) through vasoconstriction, which completes the classic
hemodynamic profile of this condition.
4. Which medication is considered the first-line vasopressor for the management of septic
shock after adequate fluid resuscitation has failed?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is the first-choice vasopressor recommended for septic shock
management. It acts primarily on alpha-1 receptors to cause vasoconstriction and increase
mean arterial pressure. While other agents like vasopressin can be added, norepinephrine
remains the standard initial agent due to its efficacy and lower risk of arrhythmias
compared to dopamine.
5. A patient is admitted with a suspected ischemic stroke. What is the maximum time
window from the ‘last known well’ time for the administration of intravenous Alteplase (tPA)
in eligible patients?
A. 2 hours
B. 3 to 4.5 hours
C. 6 hours
NR 572 Advanced Acute Care
Management | Chamberlain
1. A patient presents to the ICU with suspected sepsis. According to the Surviving Sepsis
Campaign guidelines, what is the initial recommended volume for intravenous fluid
resuscitation in sepsis-induced hypotension?
A. 10 mL/kg of crystalloid
B. 30 mL/kg of crystalloid
C. 20 mL/kg of crystalloid
D. 50 mL/kg of crystalloid
Answer: B
Rationale: Current guidelines recommend an initial fluid bolus of at least 30 mL/kg of
intravenous crystalloid. This should be administered within the first 3 hours of
presentation for patients with sepsis-induced hypotension or a lactate level greater than 4
mmol/L. Early fluid resuscitation is critical to improve tissue perfusion and stabilize the
patient’s hemodynamic status.
2. In the management of Acute Respiratory Distress Syndrome (ARDS), which ventilator
setting is most strongly associated with improved survival outcomes?
A. High tidal volume ventilation (12 mL/kg)
,B. Inverse ratio ventilation
C. Low tidal volume ventilation (6 mL/kg)
D. Maintaining a PEEP of 0 cm H2O
Answer: C
Rationale: Low tidal volume ventilation, typically targeted at 6 mL/kg of predicted body
weight, is the standard of care for ARDS. This strategy, often called lung-protective
ventilation, helps prevent ventilator-induced lung injury caused by overdistension of the
alveoli. Clinical trials have demonstrated that this approach significantly reduces mortality
compared to higher tidal volumes.
3. A patient with heart failure is being monitored via a pulmonary artery catheter. Which of
the following hemodynamic profiles most likely indicates cardiogenic shock?
A. High Cardiac Index, Low PCWP, Low SVR
B. Low Cardiac Index, High PCWP, High SVR
C. Low Cardiac Index, Low PCWP, Low SVR
D. High Cardiac Index, High PCWP, High SVR
Answer: B
Rationale: Cardiogenic shock is characterized by primary pump failure, resulting in a low
Cardiac Index. The backup of blood into the lungs leads to an elevated Pulmonary Capillary
Wedge Pressure (PCWP). To compensate for low cardiac output, the body increases
, Systemic Vascular Resistance (SVR) through vasoconstriction, which completes the classic
hemodynamic profile of this condition.
4. Which medication is considered the first-line vasopressor for the management of septic
shock after adequate fluid resuscitation has failed?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Vasopressin
Answer: A
Rationale: Norepinephrine is the first-choice vasopressor recommended for septic shock
management. It acts primarily on alpha-1 receptors to cause vasoconstriction and increase
mean arterial pressure. While other agents like vasopressin can be added, norepinephrine
remains the standard initial agent due to its efficacy and lower risk of arrhythmias
compared to dopamine.
5. A patient is admitted with a suspected ischemic stroke. What is the maximum time
window from the ‘last known well’ time for the administration of intravenous Alteplase (tPA)
in eligible patients?
A. 2 hours
B. 3 to 4.5 hours
C. 6 hours
