NR574 Acute Care Practicum Final Exam
Review | Weeks 5-8 Comprehensive
Synthesis | 2026-2027
SECTION 1: COMPLEX CRITICAL-CARE MANAGEMENT
Q1. A 68-yr-old intubated for pneumonia is on norepinephrine 0.1 mcg/kg/min (MAP
67). Lactate 4.5 mmol/L, ScvO₂ 58%. Next step?
A) Add vasopressin 0.03 U/min
B) Start dobutamine 2.5 mcg/kg/min
C) Raise MAP target to >75 mmHg
D) Begin milrinone
Correct: B
Rationale: Persistent hypoperfusion (↑ lactate, ScvO₂ < 70) despite adequate MAP →
add inotrope to ↑ cardiac output. Vasopressin (A) is vaso-pressor sparing; milrinone (D)
vasodilates and may drop MAP.
Q2. SATA. A COVID ARDS patient on VC-AC (TV 6 mL/kg, PEEP 14, FiO₂ 80%) has P-plat
32 cmH₂O and PaO₂ 58 mmHg. Which actions comply with current guidelines? (Select
all.)
,A) Increase PEEP to 18 cmH₂O
B) Prone ventilation 16 h daily
C) Maintain P-plat ≤ 30 cmH₂O
D) Give cisatracurium 48 h if pH < 7.20
E) Consider ECMO if PaO₂/FiO₂ < 80 on FiO₂ 100%
Correct: A, B, C, E
Rationale: Cisatracurium (D) is recommended for PaO₂/FiO₂ < 150 with pH < 7.20, not <
7.20 alone.
Q3. A post-ROSC patient (VT arrest) is being cooled. Core temp 33 °C, K⁺ 2.8 mEq/L, HR
45 with junctional escape. Priority?
A) Start norepinephrine
B) Give amiodarone 150 mg
C) Infuse KCl 20 mEq over 1 h
D) Pace at 60 bpm
Correct: C
Rationale: Hypothermia causes K⁺ shift; level < 3 predisposes to VT/VF. Replace before
considering pacing or anti-arrhythmics.
Q4. A cirrhotic patient presents with hematochezia and BP 70/40, HR 140. Which blood
product is transfused first?
, A) 6 units platelets
B) 4-factor PCC + 1:1:1 RBC:FFP:plt
C) Massive-transfusion protocol RBC
D) Cryoprecipitate 10 units
Correct: C
Rationale: Hemodynamic instability → immediate type-O or typed RBC via
massive-transfusion protocol. Factor concentrates (B) follow plasma.
Q5. A patient with TBI (GCS 6) has ICP 28 mmHg, CPP 52 mmHg on norepinephrine.
Which intervention is performed first?
A) Mannitol 1 g/kg IV
B) Elevate head 30°, midline
C) Start propofol 50 mcg/kg/min
D) Hyperventilate to PaCO₂ 30 mmHg
Correct: B
Rationale: Basic positioning optimizes venous drainage and is done before osmotic
agents, sedation, or hyperventilation.
Q6. SATA. Which criteria support continuing norepinephrine through a femoral central
line while awaiting subclavian placement? (Select all.)
A) Line tip at cavo-atrial junction on CXR
Review | Weeks 5-8 Comprehensive
Synthesis | 2026-2027
SECTION 1: COMPLEX CRITICAL-CARE MANAGEMENT
Q1. A 68-yr-old intubated for pneumonia is on norepinephrine 0.1 mcg/kg/min (MAP
67). Lactate 4.5 mmol/L, ScvO₂ 58%. Next step?
A) Add vasopressin 0.03 U/min
B) Start dobutamine 2.5 mcg/kg/min
C) Raise MAP target to >75 mmHg
D) Begin milrinone
Correct: B
Rationale: Persistent hypoperfusion (↑ lactate, ScvO₂ < 70) despite adequate MAP →
add inotrope to ↑ cardiac output. Vasopressin (A) is vaso-pressor sparing; milrinone (D)
vasodilates and may drop MAP.
Q2. SATA. A COVID ARDS patient on VC-AC (TV 6 mL/kg, PEEP 14, FiO₂ 80%) has P-plat
32 cmH₂O and PaO₂ 58 mmHg. Which actions comply with current guidelines? (Select
all.)
,A) Increase PEEP to 18 cmH₂O
B) Prone ventilation 16 h daily
C) Maintain P-plat ≤ 30 cmH₂O
D) Give cisatracurium 48 h if pH < 7.20
E) Consider ECMO if PaO₂/FiO₂ < 80 on FiO₂ 100%
Correct: A, B, C, E
Rationale: Cisatracurium (D) is recommended for PaO₂/FiO₂ < 150 with pH < 7.20, not <
7.20 alone.
Q3. A post-ROSC patient (VT arrest) is being cooled. Core temp 33 °C, K⁺ 2.8 mEq/L, HR
45 with junctional escape. Priority?
A) Start norepinephrine
B) Give amiodarone 150 mg
C) Infuse KCl 20 mEq over 1 h
D) Pace at 60 bpm
Correct: C
Rationale: Hypothermia causes K⁺ shift; level < 3 predisposes to VT/VF. Replace before
considering pacing or anti-arrhythmics.
Q4. A cirrhotic patient presents with hematochezia and BP 70/40, HR 140. Which blood
product is transfused first?
, A) 6 units platelets
B) 4-factor PCC + 1:1:1 RBC:FFP:plt
C) Massive-transfusion protocol RBC
D) Cryoprecipitate 10 units
Correct: C
Rationale: Hemodynamic instability → immediate type-O or typed RBC via
massive-transfusion protocol. Factor concentrates (B) follow plasma.
Q5. A patient with TBI (GCS 6) has ICP 28 mmHg, CPP 52 mmHg on norepinephrine.
Which intervention is performed first?
A) Mannitol 1 g/kg IV
B) Elevate head 30°, midline
C) Start propofol 50 mcg/kg/min
D) Hyperventilate to PaCO₂ 30 mmHg
Correct: B
Rationale: Basic positioning optimizes venous drainage and is done before osmotic
agents, sedation, or hyperventilation.
Q6. SATA. Which criteria support continuing norepinephrine through a femoral central
line while awaiting subclavian placement? (Select all.)
A) Line tip at cavo-atrial junction on CXR
