NR571 Exam 4 Actual Exam Style V1 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents to the ICU with a diagnosis of Septic Shock. Following initial
fluid resuscitation of 30 mL/kg, his Mean Arterial Pressure (MAP) remains at 58 mmHg. Which
is the preferred first-line vasopressor for this patient?
A. Epinephrine
B. Vasopressin
C. Dopamine
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation. It
provides potent alpha-1 agonism resulting in vasoconstriction and moderate beta-1
stimulation to support cardiac output. This agent is preferred over dopamine due to a
lower risk of arrhythmias and better overall outcomes in septic shock.
2. A patient with ARDS is being managed with mechanical ventilation. To prevent ventilator-
induced lung injury (VILI), the nurse practitioner should ensure the patient is receiving:
A. High tidal volume of 10-12 mL/kg
,B. Zero Positive End-Expiratory Pressure (PEEP)
C. Maintenance of Plateau pressure above 35 cm H2O
D. Low tidal volume of 4-8 mL/kg of predicted body weight
Answer: D
Rationale: Lung-protective ventilation strategies in ARDS utilize low tidal volumes
between 4 and 8 mL/kg of predicted body weight. This approach reduces the risk of
barotrauma and volutrauma associated with alveolar overdistention. Additionally,
maintaining a plateau pressure below 30 cm H2O is critical for improving survival in these
critically ill patients.
3. A 72-year-old female is admitted with suspected Acute Ischemic Stroke. Her last known
well time was 2 hours ago. Which of the following is an absolute contraindication for the
administration of Alteplase (tPA)?
A. Blood pressure of 160/90 mmHg
B. Platelet count of 150,000/mm3
C. Patient age over 70 years
D. History of intracranial hemorrhage
Answer: D
Rationale: A history of intracranial hemorrhage is a permanent absolute contraindication
for the administration of fibrinolytic therapy like tPA. Administering tPA in such cases
,poses a significant risk of catastrophic secondary bleeding within the brain. Other
contraindications include active internal bleeding, recent intracranial surgery, or severe
uncontrolled hypertension above 185/110 mmHg.
4. A patient in the ICU is being monitored for increased Intracranial Pressure (ICP) following a
traumatic brain injury. Which intervention is most appropriate to maintain a Cerebral
Perfusion Pressure (CPP) between 60-70 mmHg?
A. Administering Mannitol as an osmotic diuretic
B. Keeping the head of the bed flat at 0 degrees
C. Aggressively inducing hypocapnia with hyperventilation
D. Restricting all IV fluids to induce dehydration
Answer: A
Rationale: Mannitol is an osmotic diuretic that helps reduce cerebral edema by drawing
fluid from the brain tissue into the vascular space. By lowering intracranial pressure, it
effectively increases the Cerebral Perfusion Pressure (CPP) to ensure adequate oxygen
delivery to neural tissues. The nurse practitioner must monitor serum osmolality and
electrolytes closely during its administration to avoid acute kidney injury.
5. In the management of Diabetic Ketoacidosis (DKA), which criteria must be met before
transitioning the patient from intravenous (IV) insulin to subcutaneous (SQ) insulin?
A. Blood glucose level below 150 mg/dL and a normal anion gap
B. Blood glucose level below 250 mg/dL, pH > 7.30, and bicarbonate > 18 mEq/L
, C. Complete resolution of polyuria and polydipsia
D. Negative urine ketones regardless of serum pH
Answer: B
Rationale: The transition from IV to SQ insulin in DKA requires the resolution of
ketoacidosis, which is defined by a pH greater than 7.30 and a serum bicarbonate level
greater than 15-18 mEq/L. The patient must also be able to tolerate oral intake to maintain
glucose stability without continuous IV support. It is essential to overlap the first SQ dose
with the IV infusion for 1-2 hours to prevent a rebound of hyperglycemia.
6. A patient presents with sudden onset of crushing chest pain and ST-segment elevation in
leads II, III, and aVF. Which area of the heart is most likely affected?
A. Anterior wall
B. Inferior wall
C. Lateral wall
D. Septal wall
Answer: B
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which typically involves the right coronary artery. Management
must be cautious with nitrates and diuretics because these patients are often preload-
dependent due to right ventricular involvement. Ensuring adequate volume resuscitation is
vital if hypotension occurs in this specific clinical scenario.
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents to the ICU with a diagnosis of Septic Shock. Following initial
fluid resuscitation of 30 mL/kg, his Mean Arterial Pressure (MAP) remains at 58 mmHg. Which
is the preferred first-line vasopressor for this patient?
A. Epinephrine
B. Vasopressin
C. Dopamine
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation. It
provides potent alpha-1 agonism resulting in vasoconstriction and moderate beta-1
stimulation to support cardiac output. This agent is preferred over dopamine due to a
lower risk of arrhythmias and better overall outcomes in septic shock.
2. A patient with ARDS is being managed with mechanical ventilation. To prevent ventilator-
induced lung injury (VILI), the nurse practitioner should ensure the patient is receiving:
A. High tidal volume of 10-12 mL/kg
,B. Zero Positive End-Expiratory Pressure (PEEP)
C. Maintenance of Plateau pressure above 35 cm H2O
D. Low tidal volume of 4-8 mL/kg of predicted body weight
Answer: D
Rationale: Lung-protective ventilation strategies in ARDS utilize low tidal volumes
between 4 and 8 mL/kg of predicted body weight. This approach reduces the risk of
barotrauma and volutrauma associated with alveolar overdistention. Additionally,
maintaining a plateau pressure below 30 cm H2O is critical for improving survival in these
critically ill patients.
3. A 72-year-old female is admitted with suspected Acute Ischemic Stroke. Her last known
well time was 2 hours ago. Which of the following is an absolute contraindication for the
administration of Alteplase (tPA)?
A. Blood pressure of 160/90 mmHg
B. Platelet count of 150,000/mm3
C. Patient age over 70 years
D. History of intracranial hemorrhage
Answer: D
Rationale: A history of intracranial hemorrhage is a permanent absolute contraindication
for the administration of fibrinolytic therapy like tPA. Administering tPA in such cases
,poses a significant risk of catastrophic secondary bleeding within the brain. Other
contraindications include active internal bleeding, recent intracranial surgery, or severe
uncontrolled hypertension above 185/110 mmHg.
4. A patient in the ICU is being monitored for increased Intracranial Pressure (ICP) following a
traumatic brain injury. Which intervention is most appropriate to maintain a Cerebral
Perfusion Pressure (CPP) between 60-70 mmHg?
A. Administering Mannitol as an osmotic diuretic
B. Keeping the head of the bed flat at 0 degrees
C. Aggressively inducing hypocapnia with hyperventilation
D. Restricting all IV fluids to induce dehydration
Answer: A
Rationale: Mannitol is an osmotic diuretic that helps reduce cerebral edema by drawing
fluid from the brain tissue into the vascular space. By lowering intracranial pressure, it
effectively increases the Cerebral Perfusion Pressure (CPP) to ensure adequate oxygen
delivery to neural tissues. The nurse practitioner must monitor serum osmolality and
electrolytes closely during its administration to avoid acute kidney injury.
5. In the management of Diabetic Ketoacidosis (DKA), which criteria must be met before
transitioning the patient from intravenous (IV) insulin to subcutaneous (SQ) insulin?
A. Blood glucose level below 150 mg/dL and a normal anion gap
B. Blood glucose level below 250 mg/dL, pH > 7.30, and bicarbonate > 18 mEq/L
, C. Complete resolution of polyuria and polydipsia
D. Negative urine ketones regardless of serum pH
Answer: B
Rationale: The transition from IV to SQ insulin in DKA requires the resolution of
ketoacidosis, which is defined by a pH greater than 7.30 and a serum bicarbonate level
greater than 15-18 mEq/L. The patient must also be able to tolerate oral intake to maintain
glucose stability without continuous IV support. It is essential to overlap the first SQ dose
with the IV infusion for 1-2 hours to prevent a rebound of hyperglycemia.
6. A patient presents with sudden onset of crushing chest pain and ST-segment elevation in
leads II, III, and aVF. Which area of the heart is most likely affected?
A. Anterior wall
B. Inferior wall
C. Lateral wall
D. Septal wall
Answer: B
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which typically involves the right coronary artery. Management
must be cautious with nitrates and diuretics because these patients are often preload-
dependent due to right ventricular involvement. Ensuring adequate volume resuscitation is
vital if hypotension occurs in this specific clinical scenario.
