, NR 571 Complex Diagnosis and Management in Acute Care
Practicum – Chamberlain College of Nursing – Academic Year
2026/2027 – Final Comprehensive Examination with 100 Verified
Questions and Correct Answer Rationales .
INTRODUCTION
This comprehensive examination contains 100 verified questions designed to reinforce the
official Chamberlain College of Nursing NR 571 Complex Diagnosis and Management in
Acute Care Practicum Final course objectives for actual exam readiness and clinical
proficiency, aligned to the 2026/2027 academic year. The questions are original and
address four core domains: Hemodynamic Monitoring and Shock States (25
questions) , Respiratory and Pulmonary Disorders (25 questions) , Gastrointestinal and
Hepatic Disorders (25 questions) , and Endocrine and Metabolic Emergencies (25
questions) . Each item requires application of foundational acute care knowledge drawn from
established NR 571 curriculum materials and evidence-based critical care standards.
Successful completion of this examination supports development of the clinical judgment
required for safe and effective management of complex acutely ill clients.
DOMAIN 1: HEMODYNAMIC MONITORING AND SHOCK STATES (25 QUESTIONS)
Question 1
Which parameter most directly reflects left ventricular preload?
A. Systemic vascular resistance
B. Pulmonary artery wedge pressure (PAWP)
C. Mixed venous oxygen saturation only
D. Arterial oxygen content
CorreCt Answer: B ✓
rAtionAle: PAWP estimates left atrial pressure and left ventricular end-diastolic pressure,
serving as the clinical index of left ventricular preload. SVR (A) reflects afterload; mixed venous
oxygen saturation (C) reflects oxygen extraction; arterial oxygen content (D) reflects oxygen-
carrying capacity.
Question 2
A client in septic shock has a cardiac output of 8 L/min, SVR of 500 dynes, and warm
extremities. This hemodynamic profile is most consistent with:
,A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive (hyperdynamic) septic shock
D. Obstructive shock from tamponade
CorreCt Answer: C ✓
rAtionAle: Early hyperdynamic septic shock features high cardiac output, low SVR, and
warm extremities due to profound vasodilation. Hypovolemic (A) and cardiogenic (B) shock
have low cardiac output; obstructive shock (D) has low cardiac output with elevated central
pressures.
Question 3
Which finding indicates that fluid resuscitation in septic shock has been inadequate?
A. Falling lactate and improving mental status
B. Persistent hypotension, rising lactate, and oliguria despite initial fluid boluses
C. Normalizing base deficit
D. Warm, well-perfused extremities
CorreCt Answer: B ✓
rAtionAle: Ongoing hypoperfusion markers (hypotension, rising lactate, oliguria) after
initial fluids indicate the need for additional volume, vasopressors, or both. Falling lactate (A),
normalizing base deficit (C), and warm extremities (D) indicate adequate resuscitation.
Question 4
The primary goal of early goal-directed therapy concepts in septic shock is to:
A. Immediately start high-dose steroids in all clients
B. Restore tissue perfusion by optimizing preload, afterload, and oxygen delivery while
controlling the source of infection
C. Avoid any fluid administration
D. Rely solely on vasopressors without volume assessment
CorreCt Answer: B ✓
rAtionAle: Early resuscitation aims to correct hypovolemia, support perfusion pressure,
and improve oxygen delivery while identifying and treating the infectious source. Steroids (A)
are not routine; fluid administration (C) and vasopressors without volume (D) are not
recommended.
Question 5
A client in cardiogenic shock has a PAWP of 28 mmHg and a cardiac index of 1.6 L/min/m².
Which intervention is most appropriate?
, A. Additional fluid bolus
B. Dobutamine infusion
C. Norepinephrine only
D. High-dose diuretics
CorreCt Answer: B ✓
rAtionAle: In cardiogenic shock with low cardiac index and high PAWP (fluid overload),
the priority is to increase contractility with inotropic support (dobutamine) . Additional fluid (A)
would worsen pulmonary congestion; norepinephrine (C) increases afterload; diuretics (D) may
be used but do not address contractility.
Question 6
A client in shock has a central venous pressure (CVP) of 2 mmHg and a cardiac output of 3.2
L/min. Which type of shock is most likely?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock
D. Obstructive shock
CorreCt Answer: B ✓
rAtionAle: Low CVP (< 4 mmHg) with low cardiac output indicates hypovolemic shock.
Cardiogenic shock (A) typically has elevated CVP; distributive shock (C) has normal or high
cardiac output; obstructive shock (D) has elevated CVP and low cardiac output.
Question 7
Which medication is the first-line vasopressor for septic shock?
A. Epinephrine
B. Dopamine
C. Norepinephrine
D. Phenylephrine
CorreCt Answer: C ✓
rAtionAle: Norepinephrine is the first-line vasopressor for septic shock per Surviving
Sepsis Campaign guidelines. It increases mean arterial pressure through vasoconstriction with
less chronotropic effect than dopamine (B). Vasopressin may be added; epinephrine (A) is
second-line.
Question 8
A client with septic shock is started on norepinephrine. Which of the following is a potential
adverse effect of norepinephrine?
Practicum – Chamberlain College of Nursing – Academic Year
2026/2027 – Final Comprehensive Examination with 100 Verified
Questions and Correct Answer Rationales .
INTRODUCTION
This comprehensive examination contains 100 verified questions designed to reinforce the
official Chamberlain College of Nursing NR 571 Complex Diagnosis and Management in
Acute Care Practicum Final course objectives for actual exam readiness and clinical
proficiency, aligned to the 2026/2027 academic year. The questions are original and
address four core domains: Hemodynamic Monitoring and Shock States (25
questions) , Respiratory and Pulmonary Disorders (25 questions) , Gastrointestinal and
Hepatic Disorders (25 questions) , and Endocrine and Metabolic Emergencies (25
questions) . Each item requires application of foundational acute care knowledge drawn from
established NR 571 curriculum materials and evidence-based critical care standards.
Successful completion of this examination supports development of the clinical judgment
required for safe and effective management of complex acutely ill clients.
DOMAIN 1: HEMODYNAMIC MONITORING AND SHOCK STATES (25 QUESTIONS)
Question 1
Which parameter most directly reflects left ventricular preload?
A. Systemic vascular resistance
B. Pulmonary artery wedge pressure (PAWP)
C. Mixed venous oxygen saturation only
D. Arterial oxygen content
CorreCt Answer: B ✓
rAtionAle: PAWP estimates left atrial pressure and left ventricular end-diastolic pressure,
serving as the clinical index of left ventricular preload. SVR (A) reflects afterload; mixed venous
oxygen saturation (C) reflects oxygen extraction; arterial oxygen content (D) reflects oxygen-
carrying capacity.
Question 2
A client in septic shock has a cardiac output of 8 L/min, SVR of 500 dynes, and warm
extremities. This hemodynamic profile is most consistent with:
,A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive (hyperdynamic) septic shock
D. Obstructive shock from tamponade
CorreCt Answer: C ✓
rAtionAle: Early hyperdynamic septic shock features high cardiac output, low SVR, and
warm extremities due to profound vasodilation. Hypovolemic (A) and cardiogenic (B) shock
have low cardiac output; obstructive shock (D) has low cardiac output with elevated central
pressures.
Question 3
Which finding indicates that fluid resuscitation in septic shock has been inadequate?
A. Falling lactate and improving mental status
B. Persistent hypotension, rising lactate, and oliguria despite initial fluid boluses
C. Normalizing base deficit
D. Warm, well-perfused extremities
CorreCt Answer: B ✓
rAtionAle: Ongoing hypoperfusion markers (hypotension, rising lactate, oliguria) after
initial fluids indicate the need for additional volume, vasopressors, or both. Falling lactate (A),
normalizing base deficit (C), and warm extremities (D) indicate adequate resuscitation.
Question 4
The primary goal of early goal-directed therapy concepts in septic shock is to:
A. Immediately start high-dose steroids in all clients
B. Restore tissue perfusion by optimizing preload, afterload, and oxygen delivery while
controlling the source of infection
C. Avoid any fluid administration
D. Rely solely on vasopressors without volume assessment
CorreCt Answer: B ✓
rAtionAle: Early resuscitation aims to correct hypovolemia, support perfusion pressure,
and improve oxygen delivery while identifying and treating the infectious source. Steroids (A)
are not routine; fluid administration (C) and vasopressors without volume (D) are not
recommended.
Question 5
A client in cardiogenic shock has a PAWP of 28 mmHg and a cardiac index of 1.6 L/min/m².
Which intervention is most appropriate?
, A. Additional fluid bolus
B. Dobutamine infusion
C. Norepinephrine only
D. High-dose diuretics
CorreCt Answer: B ✓
rAtionAle: In cardiogenic shock with low cardiac index and high PAWP (fluid overload),
the priority is to increase contractility with inotropic support (dobutamine) . Additional fluid (A)
would worsen pulmonary congestion; norepinephrine (C) increases afterload; diuretics (D) may
be used but do not address contractility.
Question 6
A client in shock has a central venous pressure (CVP) of 2 mmHg and a cardiac output of 3.2
L/min. Which type of shock is most likely?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock
D. Obstructive shock
CorreCt Answer: B ✓
rAtionAle: Low CVP (< 4 mmHg) with low cardiac output indicates hypovolemic shock.
Cardiogenic shock (A) typically has elevated CVP; distributive shock (C) has normal or high
cardiac output; obstructive shock (D) has elevated CVP and low cardiac output.
Question 7
Which medication is the first-line vasopressor for septic shock?
A. Epinephrine
B. Dopamine
C. Norepinephrine
D. Phenylephrine
CorreCt Answer: C ✓
rAtionAle: Norepinephrine is the first-line vasopressor for septic shock per Surviving
Sepsis Campaign guidelines. It increases mean arterial pressure through vasoconstriction with
less chronotropic effect than dopamine (B). Vasopressin may be added; epinephrine (A) is
second-line.
Question 8
A client with septic shock is started on norepinephrine. Which of the following is a potential
adverse effect of norepinephrine?
