NR 571 Actual Midterm Exam Review (2026/2027
Latest Update) – Advanced Pathophysiology &
Clinical Management Guide
SECTION 1 ─ CONTEMPORARY CARDIOVASCULAR & SHOCK
MANAGEMENT (20 Qs)
Q1 (MC)
A 70 kg, 68-year-old with septic shock (Sepsis-3) has received 30 mL/kg balanced
crystalloid; MAP 58 mmHg, HR 115/min, ScvO₂ 68 %, lactate 4.2 mmol/L.
Norepinephrine is at 0.25 mcg/kg/min via proximal CVC. Bedside POCUS shows
hyperdynamic LV, IVC <10 mm with >50 % collapse. Following the 2026 Surviving Sepsis
Campaign, what is the NEXT priority?
A. 500 mL albumin 5 % bolus
B. Start vasopressin 0.03 U/min
C. Add dobutamine 5 mcg/kg/min
D. Empiric hydrocortisone 200 mg IV
Correct: B
Rationale: 2026 update stresses "vasopressor combination" to limit excessive
norepinephrine doses >0.25 mcg/kg/min; vasopressin is 1st choice adjunct, shown to
achieve target MAP & ↓ catecholamine exposure (SSC 2026, Section 4.2).
,Q2 (SATA)
Which variables are CURRENTLY (2026) included in the Sepsis-3 "SEP" quick-SOFA when
ANY two predict ↑ in-hospital mortality? (Select all)
1. RR ≥22/min
2. SBP ≤100 mmHg
3. GCS ≤14
4. Temperature >38.3 °C
5. Lactate ≥2 mmol/L
Correct: 1, 3
Rationale: qSOFA = RR ≥22, GCS ≤14, SBP ≤100 (any 2). Lactate & fever are not
qSOFA components (JAMA 2026 Sepsis-3 Revision).
Q3 (MC)
A 54-year-old woman with HFpEF is intubated for pneumonia. On assist-control VC 500
mL, PEEP 8 cmH₂O, driving pressure (ΔP) is measured at 16 cmH₂O. Per ARDSNet-2
2026, which ventilator change best respects the "driving-pressure target" strategy?
A. ↑ PEEP to 12 cmH₂O
B. ↓ Tidal volume to 6 mL/kg PBW (ΔP 12 cmH₂O)
C. Switch to pressure-control with P-plat 30 cmH₂O
D. Add recruitment manoeuvre 40 cmH₂O ×40 s
Correct: B
Rationale: 2026 lung-protective update targets ΔP ≤13 cmH₂O (best survival correlate);
lowering VT achieves this (NEJM 2026;374:887-98).
Q4 (Ordered Response)
, Place in sequence (1=first, 4=last) the 2026 AHA steps for an awake, speaking patient
with anterior STEMI <2 h from onset & primary-PCI capable centre 20 min away.
A. Administer ticagrelor 180 mg PO
B. Obtain 12-lead ECG ≤10 min of contact
C. Activate cath-lab while patient still in ambulance
D. Give heparin 70 U/kg IV (max 5000 U)
Correct order: B → C → D → A
Rationale: ECG ≤10 min (B) triggers system activation (C); anticoag (D) then P2Y12
loading (A) per 2026 STEMI Algorithm.
Q5 (MC)
Post-cardiac-arrest patient (VT) is targeted to 33 °C controlled hypothermia. At 6 h,
shivering is noted, BIS 45. Which intervention is 2026 Neuro-ICF guideline preferred?
A. Add propofol 50 mcg/kg/min
B. Dexmedetomidine 0.5 mcg/kg/h
C. Vecuronium 0.1 mg/kg bolus
D. Magnesium sulphate 4 g IV
Correct: B
Rationale: 2026 emphasizes "Analgosedation first" (fentanyl + dexmedetomidine) before
paralytics to reduce ICU-acquired weakness & conserve neurology exam when possible
(Neurocrit Care 2026;24:112-9).
Latest Update) – Advanced Pathophysiology &
Clinical Management Guide
SECTION 1 ─ CONTEMPORARY CARDIOVASCULAR & SHOCK
MANAGEMENT (20 Qs)
Q1 (MC)
A 70 kg, 68-year-old with septic shock (Sepsis-3) has received 30 mL/kg balanced
crystalloid; MAP 58 mmHg, HR 115/min, ScvO₂ 68 %, lactate 4.2 mmol/L.
Norepinephrine is at 0.25 mcg/kg/min via proximal CVC. Bedside POCUS shows
hyperdynamic LV, IVC <10 mm with >50 % collapse. Following the 2026 Surviving Sepsis
Campaign, what is the NEXT priority?
A. 500 mL albumin 5 % bolus
B. Start vasopressin 0.03 U/min
C. Add dobutamine 5 mcg/kg/min
D. Empiric hydrocortisone 200 mg IV
Correct: B
Rationale: 2026 update stresses "vasopressor combination" to limit excessive
norepinephrine doses >0.25 mcg/kg/min; vasopressin is 1st choice adjunct, shown to
achieve target MAP & ↓ catecholamine exposure (SSC 2026, Section 4.2).
,Q2 (SATA)
Which variables are CURRENTLY (2026) included in the Sepsis-3 "SEP" quick-SOFA when
ANY two predict ↑ in-hospital mortality? (Select all)
1. RR ≥22/min
2. SBP ≤100 mmHg
3. GCS ≤14
4. Temperature >38.3 °C
5. Lactate ≥2 mmol/L
Correct: 1, 3
Rationale: qSOFA = RR ≥22, GCS ≤14, SBP ≤100 (any 2). Lactate & fever are not
qSOFA components (JAMA 2026 Sepsis-3 Revision).
Q3 (MC)
A 54-year-old woman with HFpEF is intubated for pneumonia. On assist-control VC 500
mL, PEEP 8 cmH₂O, driving pressure (ΔP) is measured at 16 cmH₂O. Per ARDSNet-2
2026, which ventilator change best respects the "driving-pressure target" strategy?
A. ↑ PEEP to 12 cmH₂O
B. ↓ Tidal volume to 6 mL/kg PBW (ΔP 12 cmH₂O)
C. Switch to pressure-control with P-plat 30 cmH₂O
D. Add recruitment manoeuvre 40 cmH₂O ×40 s
Correct: B
Rationale: 2026 lung-protective update targets ΔP ≤13 cmH₂O (best survival correlate);
lowering VT achieves this (NEJM 2026;374:887-98).
Q4 (Ordered Response)
, Place in sequence (1=first, 4=last) the 2026 AHA steps for an awake, speaking patient
with anterior STEMI <2 h from onset & primary-PCI capable centre 20 min away.
A. Administer ticagrelor 180 mg PO
B. Obtain 12-lead ECG ≤10 min of contact
C. Activate cath-lab while patient still in ambulance
D. Give heparin 70 U/kg IV (max 5000 U)
Correct order: B → C → D → A
Rationale: ECG ≤10 min (B) triggers system activation (C); anticoag (D) then P2Y12
loading (A) per 2026 STEMI Algorithm.
Q5 (MC)
Post-cardiac-arrest patient (VT) is targeted to 33 °C controlled hypothermia. At 6 h,
shivering is noted, BIS 45. Which intervention is 2026 Neuro-ICF guideline preferred?
A. Add propofol 50 mcg/kg/min
B. Dexmedetomidine 0.5 mcg/kg/h
C. Vecuronium 0.1 mg/kg bolus
D. Magnesium sulphate 4 g IV
Correct: B
Rationale: 2026 emphasizes "Analgosedation first" (fentanyl + dexmedetomidine) before
paralytics to reduce ICU-acquired weakness & conserve neurology exam when possible
(Neurocrit Care 2026;24:112-9).
