NR572 Exam 3 Actual Exam Style V3 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU presents with a Mean Arterial Pressure (MAP) of 55 mmHg, a Central
Venous Pressure (CVP) of 2 mmHg, and a Systemic Vascular Resistance (SVR) of 1400 dynes.
Which of the following is the most appropriate initial intervention?
A. Initiation of Norepinephrine at 5 mcg/min
B. Administration of a 500 mL Isotonic Crystalloid bolus
C. Administration of Dobutamine to improve cardiac contractility
D. Placement of an Intra-aortic Balloon Pump (IABP)
Correct Answer: B
Expert Explanation: The low CVP and low MAP suggest hypovolemic or distributive shock
requiring volume expansion before vasopressors. According to the Surviving Sepsis
guidelines, initial fluid resuscitation should be prioritized when preload indicators are low.
Providing an isotonic crystalloid bolus helps to restore circulating volume and increase
cardiac output through the Frank-Starling mechanism.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to minimize ventilator-induced lung injury (VILI)?
A. High Tidal Volume (10-12 mL/kg) to maximize alveolar recruitment
B. Inverse Ratio Ventilation with a 1:4 I:E ratio
,C. Low Tidal Volume (6 mL/kg) with plateau pressures below 30 cm H2O
D. Maintaining a low PEEP to prevent barotrauma
Correct Answer: C
Expert Explanation: Low tidal volume ventilation is the gold standard for ARDS
management to prevent volutrauma and atelectrauma. Keeping plateau pressures below 30
cm H2O ensures that the alveoli are not over-distended during the inspiratory phase. This
strategy has been shown to significantly decrease mortality rates in clinical trials such as
the ARDSNet study.
3. A patient with heart failure exhibits a Cardiac Index (CI) of 1.8 L/min/m2 and a Pulmonary
Artery Occlusion Pressure (PAOP) of 22 mmHg. Which medication is most indicated for this
clinical presentation?
A. Dobutamine
B. Norepinephrine
C. Furosemide
D. Vasopressin
Correct Answer: A
Expert Explanation: The low Cardiac Index combined with high PAOP indicates
cardiogenic shock or decompensated heart failure with poor contractility. Dobutamine is
an inotrope that increases myocardial contractility and decreases afterload, making it ideal
,for this scenario. This treatment aims to improve forward flow and reduce the backup of
pressure in the pulmonary vasculature.
4. Which of the following lab findings is most characteristic of Disseminated Intravascular
Coagulation (DIC)?
A. Elevated Platelets and Low Fibrinogen
B. Prolonged PT/PTT and Elevated D-dimer
C. Shortened PT/PTT and Low D-dimer
D. Normal INR and Decreased Schistocytes
Correct Answer: B
Expert Explanation: DIC involves the systemic activation of coagulation, leading to the
consumption of clotting factors and platelets. As a result, PT and PTT are prolonged while
fibrin degradation products like D-dimer are significantly elevated. The simultaneous
occurrence of microvascular thrombosis and profuse bleeding is the hallmark of this
complex disorder.
5. A patient has the following ABG results: pH 7.25, PaCO2 55 mmHg, HCO3 26 mEq/L, and
PaO2 60 mmHg. How should the provider interpret these results?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Partially Compensated Metabolic Alkalosis
, D. Uncompensated Respiratory Alkalosis
Correct Answer: B
Expert Explanation: The pH is low, indicating acidosis, and the PaCO2 is high, which is the
primary cause of the acidic state. Since the bicarbonate level is still within the normal
range, the body has not yet compensated for the respiratory imbalance. This condition
typically requires increasing minute ventilation or addressing the underlying cause of
hypoventilation.
6. During the management of Septic Shock, what is the target Mean Arterial Pressure (MAP)
according to the Surviving Sepsis Campaign guidelines?
A. At least 55 mmHg
B. Between 90 and 100 mmHg
C. Exactly 75 mmHg
D. At least 65 mmHg
Correct Answer: D
Expert Explanation: A MAP of 65 mmHg is considered the minimum pressure necessary
to maintain adequate perfusion to vital organs like the kidneys and brain. Targeting a
higher MAP does not necessarily improve outcomes and may increase the risk of adverse
effects from vasopressors. Monitoring urine output and lactate levels alongside MAP
provides a better picture of global tissue perfusion.
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU presents with a Mean Arterial Pressure (MAP) of 55 mmHg, a Central
Venous Pressure (CVP) of 2 mmHg, and a Systemic Vascular Resistance (SVR) of 1400 dynes.
Which of the following is the most appropriate initial intervention?
A. Initiation of Norepinephrine at 5 mcg/min
B. Administration of a 500 mL Isotonic Crystalloid bolus
C. Administration of Dobutamine to improve cardiac contractility
D. Placement of an Intra-aortic Balloon Pump (IABP)
Correct Answer: B
Expert Explanation: The low CVP and low MAP suggest hypovolemic or distributive shock
requiring volume expansion before vasopressors. According to the Surviving Sepsis
guidelines, initial fluid resuscitation should be prioritized when preload indicators are low.
Providing an isotonic crystalloid bolus helps to restore circulating volume and increase
cardiac output through the Frank-Starling mechanism.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to minimize ventilator-induced lung injury (VILI)?
A. High Tidal Volume (10-12 mL/kg) to maximize alveolar recruitment
B. Inverse Ratio Ventilation with a 1:4 I:E ratio
,C. Low Tidal Volume (6 mL/kg) with plateau pressures below 30 cm H2O
D. Maintaining a low PEEP to prevent barotrauma
Correct Answer: C
Expert Explanation: Low tidal volume ventilation is the gold standard for ARDS
management to prevent volutrauma and atelectrauma. Keeping plateau pressures below 30
cm H2O ensures that the alveoli are not over-distended during the inspiratory phase. This
strategy has been shown to significantly decrease mortality rates in clinical trials such as
the ARDSNet study.
3. A patient with heart failure exhibits a Cardiac Index (CI) of 1.8 L/min/m2 and a Pulmonary
Artery Occlusion Pressure (PAOP) of 22 mmHg. Which medication is most indicated for this
clinical presentation?
A. Dobutamine
B. Norepinephrine
C. Furosemide
D. Vasopressin
Correct Answer: A
Expert Explanation: The low Cardiac Index combined with high PAOP indicates
cardiogenic shock or decompensated heart failure with poor contractility. Dobutamine is
an inotrope that increases myocardial contractility and decreases afterload, making it ideal
,for this scenario. This treatment aims to improve forward flow and reduce the backup of
pressure in the pulmonary vasculature.
4. Which of the following lab findings is most characteristic of Disseminated Intravascular
Coagulation (DIC)?
A. Elevated Platelets and Low Fibrinogen
B. Prolonged PT/PTT and Elevated D-dimer
C. Shortened PT/PTT and Low D-dimer
D. Normal INR and Decreased Schistocytes
Correct Answer: B
Expert Explanation: DIC involves the systemic activation of coagulation, leading to the
consumption of clotting factors and platelets. As a result, PT and PTT are prolonged while
fibrin degradation products like D-dimer are significantly elevated. The simultaneous
occurrence of microvascular thrombosis and profuse bleeding is the hallmark of this
complex disorder.
5. A patient has the following ABG results: pH 7.25, PaCO2 55 mmHg, HCO3 26 mEq/L, and
PaO2 60 mmHg. How should the provider interpret these results?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Partially Compensated Metabolic Alkalosis
, D. Uncompensated Respiratory Alkalosis
Correct Answer: B
Expert Explanation: The pH is low, indicating acidosis, and the PaCO2 is high, which is the
primary cause of the acidic state. Since the bicarbonate level is still within the normal
range, the body has not yet compensated for the respiratory imbalance. This condition
typically requires increasing minute ventilation or addressing the underlying cause of
hypoventilation.
6. During the management of Septic Shock, what is the target Mean Arterial Pressure (MAP)
according to the Surviving Sepsis Campaign guidelines?
A. At least 55 mmHg
B. Between 90 and 100 mmHg
C. Exactly 75 mmHg
D. At least 65 mmHg
Correct Answer: D
Expert Explanation: A MAP of 65 mmHg is considered the minimum pressure necessary
to maintain adequate perfusion to vital organs like the kidneys and brain. Targeting a
higher MAP does not necessarily improve outcomes and may increase the risk of adverse
effects from vasopressors. Monitoring urine output and lactate levels alongside MAP
provides a better picture of global tissue perfusion.
