NR571 Exam 3 Actual Exam Style V1 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with a history of heart failure presents with a blood pressure of
80/50 mmHg, a heart rate of 110 bpm, and cold, clammy extremities. Which of the following
is the most likely diagnosis?
A. Septic Shock
B. Hypovolemic Shock
C. Cardiogenic Shock
D. Anaphylactic Shock
Answer: C
Rationale: The patient’s history of heart failure combined with hypotension, tachycardia,
and signs of poor peripheral perfusion suggests cardiogenic shock. This condition occurs
when the heart cannot pump enough blood to meet the body’s metabolic demands.
Management typically involves inotropic support and addressing the underlying cardiac
cause.
2. When managing a patient with ARDS on mechanical ventilation, which of the following
tidal volume settings is recommended to prevent ventilator-induced lung injury?
A. 10-12 mL/kg of ideal body weight
,B. 4-8 mL/kg of ideal body weight
C. 15 mL/kg of ideal body weight
D. 8-10 mL/kg of actual body weight
Answer: B
Rationale: Low tidal volume ventilation is the standard of care for patients with ARDS to
minimize barotrauma and volutrauma. Research indicates that 4 to 8 mL/kg of ideal body
weight helps reduce mortality rates. This lung-protective strategy focuses on preventing
alveolar overdistention during inspiration.
3. A patient in the ICU has the following ABG results: pH 7.28, PaCO2 55 mmHg, HCO3 26
mEq/L. How should the Nurse Practitioner interpret these results?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: A
Rationale: The pH is below the normal range of 7.35 to 7.45, indicating acidosis. The
PaCO2 is elevated above 45 mmHg, which points toward a respiratory cause for the low pH.
The bicarbonate level is within normal limits, suggesting that compensation has not yet
occurred.
, 4. In the management of Septic Shock, what is the initial recommended fluid resuscitation
volume?
A. 30 mL/kg of crystalloid
B. 10 mL/kg of crystalloid
C. 50 mL/kg of colloid
D. 20 mL/kg of albumin
Answer: A
Rationale: Surviving Sepsis Campaign guidelines recommend an initial fluid bolus of at
least 30 mL/kg of intravenous crystalloids. This should be completed within the first 3
hours of recognizing sepsis-induced hypoperfusion. Monitoring for fluid responsiveness is
essential to avoid fluid overload during the resuscitation phase.
5. Which medication is considered the first-line vasopressor for a patient with Septic Shock
that is refractory to fluid resuscitation?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Answer: B
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 68-year-old patient with a history of heart failure presents with a blood pressure of
80/50 mmHg, a heart rate of 110 bpm, and cold, clammy extremities. Which of the following
is the most likely diagnosis?
A. Septic Shock
B. Hypovolemic Shock
C. Cardiogenic Shock
D. Anaphylactic Shock
Answer: C
Rationale: The patient’s history of heart failure combined with hypotension, tachycardia,
and signs of poor peripheral perfusion suggests cardiogenic shock. This condition occurs
when the heart cannot pump enough blood to meet the body’s metabolic demands.
Management typically involves inotropic support and addressing the underlying cardiac
cause.
2. When managing a patient with ARDS on mechanical ventilation, which of the following
tidal volume settings is recommended to prevent ventilator-induced lung injury?
A. 10-12 mL/kg of ideal body weight
,B. 4-8 mL/kg of ideal body weight
C. 15 mL/kg of ideal body weight
D. 8-10 mL/kg of actual body weight
Answer: B
Rationale: Low tidal volume ventilation is the standard of care for patients with ARDS to
minimize barotrauma and volutrauma. Research indicates that 4 to 8 mL/kg of ideal body
weight helps reduce mortality rates. This lung-protective strategy focuses on preventing
alveolar overdistention during inspiration.
3. A patient in the ICU has the following ABG results: pH 7.28, PaCO2 55 mmHg, HCO3 26
mEq/L. How should the Nurse Practitioner interpret these results?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: A
Rationale: The pH is below the normal range of 7.35 to 7.45, indicating acidosis. The
PaCO2 is elevated above 45 mmHg, which points toward a respiratory cause for the low pH.
The bicarbonate level is within normal limits, suggesting that compensation has not yet
occurred.
, 4. In the management of Septic Shock, what is the initial recommended fluid resuscitation
volume?
A. 30 mL/kg of crystalloid
B. 10 mL/kg of crystalloid
C. 50 mL/kg of colloid
D. 20 mL/kg of albumin
Answer: A
Rationale: Surviving Sepsis Campaign guidelines recommend an initial fluid bolus of at
least 30 mL/kg of intravenous crystalloids. This should be completed within the first 3
hours of recognizing sepsis-induced hypoperfusion. Monitoring for fluid responsiveness is
essential to avoid fluid overload during the resuscitation phase.
5. Which medication is considered the first-line vasopressor for a patient with Septic Shock
that is refractory to fluid resuscitation?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Answer: B
