NR572 Exam 4 Actual Exam Style V2 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU with ARDS is placed on mechanical ventilation with a high PEEP setting.
Which hemodynamic change should the nurse most closely monitor for?
A. Increased systemic vascular resistance
B. Increased left ventricular end-diastolic volume
C. Decreased cardiac output
D. Decreased pulmonary vascular resistance
Correct Answer: C
Expert Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which can impede venous return to the right heart. This reduction
in preload leads to a decrease in stroke volume and overall cardiac output. Monitoring
blood pressure and perfusion is essential to ensure that the respiratory benefits of PEEP do
not compromise systemic circulation.
2. Which clinical finding is most indicative of the ‘Cold Phase’ in a patient progressing through
septic shock?
A. Hyperdynamic cardiac output
B. Flushed, warm skin
C. Bounding peripheral pulses
,D. Narrow pulse pressure and cool extremities
Correct Answer: D
Expert Explanation: The late or ‘cold’ phase of septic shock is characterized by profound
hypovolemia and myocardial depression. Clinically, patients present with cool, clammy
skin and a narrow pulse pressure as the body attempts to compensate via vasoconstriction.
This stage indicates a failure of compensatory mechanisms and necessitates aggressive
vasopressor support.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which intervention is the priority according to evidence-based guidelines?
A. Place the patient in a Trendelenburg position
B. Encourage family members to engage the patient in stimulating conversation
C. Provide vigorous tracheal suctioning every hour
D. Administer a bolus of 3% Hypertonic Saline as ordered
Correct Answer: D
Expert Explanation: An ICP greater than 20 mmHg is considered hypertensive and
requires immediate intervention to prevent herniation. Hypertonic saline or mannitol acts
to create an osmotic gradient that draws fluid out of the cerebral tissue into the
intravascular space. These interventions help reduce cerebral edema and maintain
adequate cerebral perfusion pressure.
, 4. In managing a patient with Acute Kidney Injury (AKI), which electrolyte abnormality is
considered the most life-threatening?
A. Hypocalcemia
B. Hyperkalemia
C. Hyponatremia
D. Hypermagnesemia
Correct Answer: B
Expert Explanation: Hyperkalemia is the most dangerous electrolyte imbalance in AKI
because it can lead to lethal cardiac arrhythmias or asystole. Because the kidneys are
unable to excrete potassium, levels can rise rapidly to critical points. Immediate treatment
often includes calcium gluconate for cardiac stabilization followed by insulin and glucose to
shift potassium intracellularly.
5. A nurse is reviewing the Arterial Blood Gas (ABG) results for a patient on a ventilator: pH
7.28, PaCO2 55 mmHg, HCO3 26 mEq/L. How should this be interpreted?
A. Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Compensated Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: B
572 Advanced Acute Care Management |
Chamberlain
1. A patient in the ICU with ARDS is placed on mechanical ventilation with a high PEEP setting.
Which hemodynamic change should the nurse most closely monitor for?
A. Increased systemic vascular resistance
B. Increased left ventricular end-diastolic volume
C. Decreased cardiac output
D. Decreased pulmonary vascular resistance
Correct Answer: C
Expert Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which can impede venous return to the right heart. This reduction
in preload leads to a decrease in stroke volume and overall cardiac output. Monitoring
blood pressure and perfusion is essential to ensure that the respiratory benefits of PEEP do
not compromise systemic circulation.
2. Which clinical finding is most indicative of the ‘Cold Phase’ in a patient progressing through
septic shock?
A. Hyperdynamic cardiac output
B. Flushed, warm skin
C. Bounding peripheral pulses
,D. Narrow pulse pressure and cool extremities
Correct Answer: D
Expert Explanation: The late or ‘cold’ phase of septic shock is characterized by profound
hypovolemia and myocardial depression. Clinically, patients present with cool, clammy
skin and a narrow pulse pressure as the body attempts to compensate via vasoconstriction.
This stage indicates a failure of compensatory mechanisms and necessitates aggressive
vasopressor support.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which intervention is the priority according to evidence-based guidelines?
A. Place the patient in a Trendelenburg position
B. Encourage family members to engage the patient in stimulating conversation
C. Provide vigorous tracheal suctioning every hour
D. Administer a bolus of 3% Hypertonic Saline as ordered
Correct Answer: D
Expert Explanation: An ICP greater than 20 mmHg is considered hypertensive and
requires immediate intervention to prevent herniation. Hypertonic saline or mannitol acts
to create an osmotic gradient that draws fluid out of the cerebral tissue into the
intravascular space. These interventions help reduce cerebral edema and maintain
adequate cerebral perfusion pressure.
, 4. In managing a patient with Acute Kidney Injury (AKI), which electrolyte abnormality is
considered the most life-threatening?
A. Hypocalcemia
B. Hyperkalemia
C. Hyponatremia
D. Hypermagnesemia
Correct Answer: B
Expert Explanation: Hyperkalemia is the most dangerous electrolyte imbalance in AKI
because it can lead to lethal cardiac arrhythmias or asystole. Because the kidneys are
unable to excrete potassium, levels can rise rapidly to critical points. Immediate treatment
often includes calcium gluconate for cardiac stabilization followed by insulin and glucose to
shift potassium intracellularly.
5. A nurse is reviewing the Arterial Blood Gas (ABG) results for a patient on a ventilator: pH
7.28, PaCO2 55 mmHg, HCO3 26 mEq/L. How should this be interpreted?
A. Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Compensated Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: B
