NR571 COMPLEX DIAGNOSIS &
MANAGEMENT IN ACUTE CARE
REVIEW
1. A patient in the ICU presents with a MAP of 55 mmHg, CVP of 2 mmHg, and a Cardiac Index
of 1.8 L/min/m2. The Systemic Vascular Resistance Index (SVRI) is 2800 dynes.sec/cm5/m2.
Which type of shock is most likely?
A. Hypovolemic Shock
B. Septic Shock
C. Cardiogenic Shock
D. Neurogenic Shock
Answer: A
Conceptual Explanation: The low CVP and low Cardiac Index combined with a high SVRI
(compensatory vasoconstriction) indicate Hypovolemic Shock. Cardiogenic shock would
typically have a high CVP/PCWP.
,2. In the management of ARDS, which ventilator setting is evidence-based to improve
mortality?
A. High Tidal Volume (10-12 mL/kg)
B. Low Tidal Volume (4-6 mL/kg)
C. Inverse Ratio Ventilation
D. High FiO2 with low PEEP
Answer: B
Conceptual Explanation: The ARDSNet trial demonstrated that low tidal volume
ventilation (4-6 mL/kg of predicted body weight) significantly reduces mortality by
preventing ventilator-induced lung injury (VILI).
3. A patient with a traumatic brain injury has an ICP of 22 mmHg and a MAP of 65 mmHg.
What is the calculated Cerebral Perfusion Pressure (CPP) and the appropriate intervention?
A. CPP 43; Increase MAP to reach goal CPP >60
B. CPP 87; Decrease IV fluids
C. CPP 43; Administer sedation to lower MAP
D. CPP 87; Administer Mannitol
Answer: A
, Conceptual Explanation: CPP = MAP - ICP. 65 - 22 = 43 mmHg. A CPP below 60 mmHg is
inadequate for cerebral perfusion; thus, interventions should aim to increase MAP or
decrease ICP.
4. Which hemodynamic profile is most characteristic of early Septic Shock?
A. Low Cardiac Output, High SVR, High CVP
B. Low Cardiac Output, Low SVR, High PCWP
C. High Cardiac Output, Low SVR, Low PCWP
D. High Cardiac Output, High SVR, Low CVP
Answer: C
Conceptual Explanation: Septic shock is a distributive shock characterized by massive
vasodilation (low SVR) and often a compensatory increase in Cardiac Output in the early
‘hyperdynamic’ phase.
5. A patient presents with the following ABG: pH 7.25, PaCO2 55, HCO3 26. How would you
interpret this?
A. Uncompensated Respiratory Acidosis
B. Compensated Metabolic Acidosis
C. Partially Compensated Respiratory Alkalosis
D. Uncompensated Metabolic Alkalosis
Answer: A
MANAGEMENT IN ACUTE CARE
REVIEW
1. A patient in the ICU presents with a MAP of 55 mmHg, CVP of 2 mmHg, and a Cardiac Index
of 1.8 L/min/m2. The Systemic Vascular Resistance Index (SVRI) is 2800 dynes.sec/cm5/m2.
Which type of shock is most likely?
A. Hypovolemic Shock
B. Septic Shock
C. Cardiogenic Shock
D. Neurogenic Shock
Answer: A
Conceptual Explanation: The low CVP and low Cardiac Index combined with a high SVRI
(compensatory vasoconstriction) indicate Hypovolemic Shock. Cardiogenic shock would
typically have a high CVP/PCWP.
,2. In the management of ARDS, which ventilator setting is evidence-based to improve
mortality?
A. High Tidal Volume (10-12 mL/kg)
B. Low Tidal Volume (4-6 mL/kg)
C. Inverse Ratio Ventilation
D. High FiO2 with low PEEP
Answer: B
Conceptual Explanation: The ARDSNet trial demonstrated that low tidal volume
ventilation (4-6 mL/kg of predicted body weight) significantly reduces mortality by
preventing ventilator-induced lung injury (VILI).
3. A patient with a traumatic brain injury has an ICP of 22 mmHg and a MAP of 65 mmHg.
What is the calculated Cerebral Perfusion Pressure (CPP) and the appropriate intervention?
A. CPP 43; Increase MAP to reach goal CPP >60
B. CPP 87; Decrease IV fluids
C. CPP 43; Administer sedation to lower MAP
D. CPP 87; Administer Mannitol
Answer: A
, Conceptual Explanation: CPP = MAP - ICP. 65 - 22 = 43 mmHg. A CPP below 60 mmHg is
inadequate for cerebral perfusion; thus, interventions should aim to increase MAP or
decrease ICP.
4. Which hemodynamic profile is most characteristic of early Septic Shock?
A. Low Cardiac Output, High SVR, High CVP
B. Low Cardiac Output, Low SVR, High PCWP
C. High Cardiac Output, Low SVR, Low PCWP
D. High Cardiac Output, High SVR, Low CVP
Answer: C
Conceptual Explanation: Septic shock is a distributive shock characterized by massive
vasodilation (low SVR) and often a compensatory increase in Cardiac Output in the early
‘hyperdynamic’ phase.
5. A patient presents with the following ABG: pH 7.25, PaCO2 55, HCO3 26. How would you
interpret this?
A. Uncompensated Respiratory Acidosis
B. Compensated Metabolic Acidosis
C. Partially Compensated Respiratory Alkalosis
D. Uncompensated Metabolic Alkalosis
Answer: A
