NR570 Exam 2 Actual Exam Style V2 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents with a suspected UTI, BP 85/50, and a lactate of 4.5.
Following the Surviving Sepsis Campaign, what is the priority intervention?
A. Start norepinephrine infusion immediately
B. Order a stat CT scan of the abdomen
C. Administer 30 mL/kg of IV crystalloids
D. Perform a lumbar puncture to rule out meningitis
Answer: C
Rationale: The initial management for sepsis-induced hypotension or lactate ≥ 4 mmol/L
is rapid fluid resuscitation with 30 mL/kg of crystalloids. This should be initiated within
the first 3 hours of presentation to improve organ perfusion. Early fluid administration is
crucial before escalating to vasopressors if the patient remains hypotensive.
2. Which criteria are included in the CURB-65 score to evaluate the severity of community-
acquired pneumonia?
A. Creatinine, Urine output, RR, BP, Gender
B. COPD history, Urea, RR, Bilirubin, Age ≥ 65
C. Confusion, Urea, RR, BP, Age ≥ 65
,D. Confusion, Uric acid, RR, BP, Age ≥ 70
Answer: C
Rationale: The CURB-65 score is a validated clinical prediction rule for mortality in
community-acquired pneumonia. It stands for Confusion, Urea > 7 mmol/L, Respiratory
rate ≥ 30, Blood pressure < 90/60, and Age ≥ 65. Each criterion is worth one point and
helps guide the decision for inpatient versus outpatient management.
3. A patient with Acute Coronary Syndrome (ACS) is receiving MONA therapy. What is the
primary mechanism of action of Nitroglycerin in this setting?
A. Decreases preload through peripheral vasodilation
B. Inhibits platelet aggregation
C. Increases myocardial contractility
D. Blocks beta-1 adrenergic receptors
Answer: A
Rationale: Nitroglycerin acts as a potent vasodilator, primarily affecting the venous system
to decrease preload. This reduction in preload lowers the workload of the heart and
decreases myocardial oxygen demand. It also provides some coronary artery dilation to
improve blood flow to ischemic areas.
4. What is the first-line diagnostic test for a patient suspected of having a pulmonary
embolism (PE) who is hemodynamically stable?
A. D-dimer assay
, B. Chest X-ray
C. CT Angiography of the Chest
D. Ventilation-Perfusion (V/Q) Scan
Answer: C
Rationale: CT Angiography of the chest is considered the gold standard for diagnosing
pulmonary embolism in stable patients. It provides high sensitivity and specificity for
visualizing thrombi within the pulmonary vasculature. If CT is contraindicated, such as in
severe renal failure, a V/Q scan may be performed instead.
5. In the management of Diabetic Ketoacidosis (DKA), why is it critical to check the potassium
level before starting an insulin drip?
A. Insulin causes potassium to move from the ICF to the ECF
B. High potassium levels prevent insulin from binding to receptors
C. Insulin can cause severe hypokalemia by shifting potassium into cells
D. DKA is always associated with hyperkalemia initially
Answer: C
Rationale: Insulin promotes the shift of potassium into the intracellular compartment,
which can lead to a dangerous drop in serum potassium levels. If a patient is already
hypokalemic (K+ < 3.3 mEq/L), starting insulin can trigger fatal arrhythmias. Therefore,
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents with a suspected UTI, BP 85/50, and a lactate of 4.5.
Following the Surviving Sepsis Campaign, what is the priority intervention?
A. Start norepinephrine infusion immediately
B. Order a stat CT scan of the abdomen
C. Administer 30 mL/kg of IV crystalloids
D. Perform a lumbar puncture to rule out meningitis
Answer: C
Rationale: The initial management for sepsis-induced hypotension or lactate ≥ 4 mmol/L
is rapid fluid resuscitation with 30 mL/kg of crystalloids. This should be initiated within
the first 3 hours of presentation to improve organ perfusion. Early fluid administration is
crucial before escalating to vasopressors if the patient remains hypotensive.
2. Which criteria are included in the CURB-65 score to evaluate the severity of community-
acquired pneumonia?
A. Creatinine, Urine output, RR, BP, Gender
B. COPD history, Urea, RR, Bilirubin, Age ≥ 65
C. Confusion, Urea, RR, BP, Age ≥ 65
,D. Confusion, Uric acid, RR, BP, Age ≥ 70
Answer: C
Rationale: The CURB-65 score is a validated clinical prediction rule for mortality in
community-acquired pneumonia. It stands for Confusion, Urea > 7 mmol/L, Respiratory
rate ≥ 30, Blood pressure < 90/60, and Age ≥ 65. Each criterion is worth one point and
helps guide the decision for inpatient versus outpatient management.
3. A patient with Acute Coronary Syndrome (ACS) is receiving MONA therapy. What is the
primary mechanism of action of Nitroglycerin in this setting?
A. Decreases preload through peripheral vasodilation
B. Inhibits platelet aggregation
C. Increases myocardial contractility
D. Blocks beta-1 adrenergic receptors
Answer: A
Rationale: Nitroglycerin acts as a potent vasodilator, primarily affecting the venous system
to decrease preload. This reduction in preload lowers the workload of the heart and
decreases myocardial oxygen demand. It also provides some coronary artery dilation to
improve blood flow to ischemic areas.
4. What is the first-line diagnostic test for a patient suspected of having a pulmonary
embolism (PE) who is hemodynamically stable?
A. D-dimer assay
, B. Chest X-ray
C. CT Angiography of the Chest
D. Ventilation-Perfusion (V/Q) Scan
Answer: C
Rationale: CT Angiography of the chest is considered the gold standard for diagnosing
pulmonary embolism in stable patients. It provides high sensitivity and specificity for
visualizing thrombi within the pulmonary vasculature. If CT is contraindicated, such as in
severe renal failure, a V/Q scan may be performed instead.
5. In the management of Diabetic Ketoacidosis (DKA), why is it critical to check the potassium
level before starting an insulin drip?
A. Insulin causes potassium to move from the ICF to the ECF
B. High potassium levels prevent insulin from binding to receptors
C. Insulin can cause severe hypokalemia by shifting potassium into cells
D. DKA is always associated with hyperkalemia initially
Answer: C
Rationale: Insulin promotes the shift of potassium into the intracellular compartment,
which can lead to a dangerous drop in serum potassium levels. If a patient is already
hypokalemic (K+ < 3.3 mEq/L), starting insulin can trigger fatal arrhythmias. Therefore,
