NR572 Exam 4 Actual Exam Style V3 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU is being treated for septic shock. Despite receiving a 30 mL/kg fluid
bolus of crystalloids, the mean arterial pressure (MAP) remains 54 mmHg. What is the most
appropriate first-line pharmacologic intervention?
A. Dopamine infusion at 10 mcg/kg/min
B. Norepinephrine infusion titrated to MAP ≥ 65 mmHg
C. Vasopressin at 0.03 units/min as a standalone agent
D. Epinephrine infusion at 0.1 mcg/kg/min
Correct Answer: B
Expert Explanation: Norepinephrine is recommended as the first-line vasopressor for
patients in septic shock who remain hypotensive after adequate fluid resuscitation. It
primarily acts on alpha-1 receptors to increase systemic vascular resistance and improve
perfusion pressure. Early administration of norepinephrine has been shown to reduce
mortality and prevent prolonged periods of hypoperfusion.
2. A patient with ARDS is on mechanical ventilation with a plateau pressure (Pplat) of 34 cm
H2O. Which adjustment to the ventilator settings is most appropriate to reduce the risk of
ventilator-induced lung injury (VILI)?
A. Decrease the tidal volume by 1 mL/kg of predicted body weight
,B. Increase the respiratory rate to 35 breaths per minute
C. Decrease the PEEP to 5 cm H2O
D. Switch from Pressure Control to Volume Control ventilation
Correct Answer: A
Expert Explanation: The target plateau pressure for patients with ARDS should be less
than or equal to 30 cm H2O to prevent barotrauma. Reducing the tidal volume is the
primary method to lower the plateau pressure while maintaining lung-protective
ventilation strategies. This approach minimizes the risk of alveolar overdistension and
subsequent lung injury in critically ill patients.
3. During the assessment of a patient with suspected disseminated intravascular coagulation
(DIC), which laboratory profile is most consistent with this diagnosis?
A. Elevated platelets, shortened PT, and decreased D-dimer
B. Normal INR, elevated platelets, and low FDPs
C. Decreased fibrinogen, elevated D-dimer, and prolonged aPTT
D. Decreased PT, decreased aPTT, and elevated fibrinogen
Correct Answer: C
Expert Explanation: DIC is characterized by the systemic activation of coagulation, leading
to the consumption of clotting factors and platelets. Therefore, findings typically include
low fibrinogen levels and a prolonged aPTT or PT due to factor consumption. The presence
,of elevated D-dimer and fibrin degradation products (FDPs) confirms the secondary
activation of the fibrinolytic system.
4. A patient admitted with acute pancreatitis develops sudden respiratory distress and
hypoxemia that does not improve with 100% oxygen via non-rebreather mask. The chest X-
ray shows bilateral fluffy infiltrates without cardiomegaly. What is the most likely diagnosis?
A. Acute Heart Failure
B. Acute Respiratory Distress Syndrome (ARDS)
C. Pulmonary Embolism
D. Bacterial Pneumonia
Correct Answer: B
Expert Explanation: ARDS is a common complication of severe acute pancreatitis due to
the systemic inflammatory response and enzyme release. The criteria for diagnosis include
sudden onset, severe hypoxemia (P/F ratio < 300), and bilateral infiltrates on imaging that
are not explained by cardiac failure. Pancreatitis-induced ARDS carries a high morbidity
rate and requires immediate lung-protective mechanical ventilation.
5. A patient is receiving Continuous Venous-Venous Hemofiltration (CVVH) for Acute Kidney
Injury (AKI). The nurse notes the ‘Filter Pressure’ is rising rapidly and the ‘Effluent Flow’ is
decreasing. What is the most likely cause?
A. The patient’s blood pressure has dropped significantly
B. The replacement fluid bag is empty
, C. The venous access catheter is kinked
D. The filter is clotting due to inadequate anticoagulation
Correct Answer: D
Expert Explanation: Rising filter pressures and falling effluent flow are classic indicators
of filter clotting or ‘clogging’ in CRRT circuits. This often occurs when the anticoagulation
strategy (such as heparin or citrate) is insufficient for the patient’s pro-coagulant state.
Regular monitoring of transmembrane pressure (TMP) and filter pressures is essential to
maintain the patency of the CRRT circuit.
6. In the management of a patient with a traumatic brain injury (TBI), which of the following
is the target range for cerebral perfusion pressure (CPP)?
A. 40 - 50 mmHg
B. 60 - 70 mmHg
C. 80 - 90 mmHg
D. Above 100 mmHg
Correct Answer: B
Expert Explanation: Cerebral Perfusion Pressure (CPP) is calculated as Mean Arterial
Pressure (MAP) minus Intracranial Pressure (ICP). For patients with TBI, maintaining a
CPP between 60 and 70 mmHg is recommended to ensure adequate oxygen delivery to the
brain tissue. Values below 60 mmHg are associated with cerebral ischemia, while values
over 70 mmHg may increase the risk of ARDS due to aggressive fluid or pressor use.
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU is being treated for septic shock. Despite receiving a 30 mL/kg fluid
bolus of crystalloids, the mean arterial pressure (MAP) remains 54 mmHg. What is the most
appropriate first-line pharmacologic intervention?
A. Dopamine infusion at 10 mcg/kg/min
B. Norepinephrine infusion titrated to MAP ≥ 65 mmHg
C. Vasopressin at 0.03 units/min as a standalone agent
D. Epinephrine infusion at 0.1 mcg/kg/min
Correct Answer: B
Expert Explanation: Norepinephrine is recommended as the first-line vasopressor for
patients in septic shock who remain hypotensive after adequate fluid resuscitation. It
primarily acts on alpha-1 receptors to increase systemic vascular resistance and improve
perfusion pressure. Early administration of norepinephrine has been shown to reduce
mortality and prevent prolonged periods of hypoperfusion.
2. A patient with ARDS is on mechanical ventilation with a plateau pressure (Pplat) of 34 cm
H2O. Which adjustment to the ventilator settings is most appropriate to reduce the risk of
ventilator-induced lung injury (VILI)?
A. Decrease the tidal volume by 1 mL/kg of predicted body weight
,B. Increase the respiratory rate to 35 breaths per minute
C. Decrease the PEEP to 5 cm H2O
D. Switch from Pressure Control to Volume Control ventilation
Correct Answer: A
Expert Explanation: The target plateau pressure for patients with ARDS should be less
than or equal to 30 cm H2O to prevent barotrauma. Reducing the tidal volume is the
primary method to lower the plateau pressure while maintaining lung-protective
ventilation strategies. This approach minimizes the risk of alveolar overdistension and
subsequent lung injury in critically ill patients.
3. During the assessment of a patient with suspected disseminated intravascular coagulation
(DIC), which laboratory profile is most consistent with this diagnosis?
A. Elevated platelets, shortened PT, and decreased D-dimer
B. Normal INR, elevated platelets, and low FDPs
C. Decreased fibrinogen, elevated D-dimer, and prolonged aPTT
D. Decreased PT, decreased aPTT, and elevated fibrinogen
Correct Answer: C
Expert Explanation: DIC is characterized by the systemic activation of coagulation, leading
to the consumption of clotting factors and platelets. Therefore, findings typically include
low fibrinogen levels and a prolonged aPTT or PT due to factor consumption. The presence
,of elevated D-dimer and fibrin degradation products (FDPs) confirms the secondary
activation of the fibrinolytic system.
4. A patient admitted with acute pancreatitis develops sudden respiratory distress and
hypoxemia that does not improve with 100% oxygen via non-rebreather mask. The chest X-
ray shows bilateral fluffy infiltrates without cardiomegaly. What is the most likely diagnosis?
A. Acute Heart Failure
B. Acute Respiratory Distress Syndrome (ARDS)
C. Pulmonary Embolism
D. Bacterial Pneumonia
Correct Answer: B
Expert Explanation: ARDS is a common complication of severe acute pancreatitis due to
the systemic inflammatory response and enzyme release. The criteria for diagnosis include
sudden onset, severe hypoxemia (P/F ratio < 300), and bilateral infiltrates on imaging that
are not explained by cardiac failure. Pancreatitis-induced ARDS carries a high morbidity
rate and requires immediate lung-protective mechanical ventilation.
5. A patient is receiving Continuous Venous-Venous Hemofiltration (CVVH) for Acute Kidney
Injury (AKI). The nurse notes the ‘Filter Pressure’ is rising rapidly and the ‘Effluent Flow’ is
decreasing. What is the most likely cause?
A. The patient’s blood pressure has dropped significantly
B. The replacement fluid bag is empty
, C. The venous access catheter is kinked
D. The filter is clotting due to inadequate anticoagulation
Correct Answer: D
Expert Explanation: Rising filter pressures and falling effluent flow are classic indicators
of filter clotting or ‘clogging’ in CRRT circuits. This often occurs when the anticoagulation
strategy (such as heparin or citrate) is insufficient for the patient’s pro-coagulant state.
Regular monitoring of transmembrane pressure (TMP) and filter pressures is essential to
maintain the patency of the CRRT circuit.
6. In the management of a patient with a traumatic brain injury (TBI), which of the following
is the target range for cerebral perfusion pressure (CPP)?
A. 40 - 50 mmHg
B. 60 - 70 mmHg
C. 80 - 90 mmHg
D. Above 100 mmHg
Correct Answer: B
Expert Explanation: Cerebral Perfusion Pressure (CPP) is calculated as Mean Arterial
Pressure (MAP) minus Intracranial Pressure (ICP). For patients with TBI, maintaining a
CPP between 60 and 70 mmHg is recommended to ensure adequate oxygen delivery to the
brain tissue. Values below 60 mmHg are associated with cerebral ischemia, while values
over 70 mmHg may increase the risk of ARDS due to aggressive fluid or pressor use.
