NR571/ NR 571 Midterm Exam (Latest 2024/ 2025
Update) Complex Diagnosis & Management in Acute
Care Review| Questions and Verified Answers| 100%
Correct |Grade A + Chamberlain
Complications from post cardiac arrest cooling - ANS-Tachy, then brady
w/ prolonged PR and QT. Potential for cerebral vasoconstriction, so keep
MAP higher than usual.
Hyperglycemia- cooling causes increased insulin resistance and
decreased insulin secretion. Monitor BG q 1 hr.
Hypokalemia d/t cooling driving potassium into cells
Infection d/t suppression of cellular and antibody immunity. Do
surveillance cultures, broad spectrum ABX
Rewarming has risks of: HTN, hyperkalemia, hypoglycemia
HTN Urgency Definition - ANS-DBP > 120 without acute end-organ
damage
In hemorrhagic shock it is important to:
,a. maintain a MAP of 65 or greater in order to perfuse vital organs.
b. give fresh frozen plasma and platelets to stop the bleeding.
c. allow for lower blood pressure until bleeding stops.
d. a. and b.
e. b. and c.
f. a. and c. - ANS-e. b. and c. ICU 209, 210
Aggressive volume replacement can exacerbate bleeding before the
hemorrhage is controlled. This leads to permitting lower BP's (sys BP=90
and mean BP=50) in trauma pts with hemorrhagic shock until bleeding
is controlled. This leads to reduced rescucitation volumes and increased
survival rates. This is allowed if evidence of adequate organ perfusion
(ie pt is awake and follows commands).
The preferred delivery system for rapid fluid resuscitation is:
a. central venous catheter, because it is in the largest vein.
b. short, large bore peripheral catheters, because flow is 4 times
greater through these.
c. intraosseous access, because fluid flows more rapidly in marrow
space.
d. PO or via an NG tube, because it's always better to use the gut when
possible. - ANS-b. short, large bore peripheral catheters, because flow is
4 times greater through these.
,T or F
SIRS, or Systemic Inflammatory Response Syndrome, is always due to an
infection. - ANS-FALSE
T or F
In critically ill patients with poor tissue perfusion, up to 85% of glucose
metabolism is diverted to lactate production, causing significant
elevation of serum lactate. - ANS-TRUE
reaching a diagnosis and decisions about treatment - ANS-Use
Diagnostic reasoning: Work Backwards from the symptom to the
disease in order to diagnose.
Inductive reasoning: Based on observation. Specific to general. Used to
form hypotheses and theories.
Deductive reasoning: Based on theory. Starts with a general statement
or hypothesis. Works general to specific. Used to apply theories to
specific situations, predicting what the observations will be if the theory
is correct.
Abductive reasoning: Based on observation and theory. Starts with
incomplete set of observations abd proceeds to the likeliest
explanation. Based on making and testing the best hypothesis from the
info available. Often an educated guess after observing a phenomenon
, where theire is no clear explanation. Used to form hypotheses to be
tested.
Clinical decision making: Diagnostic and therapeutic decision making
causes of severe sepsis and septic shock - ANS-Infection (bacteria, fungi,
parasites, viruses); blood born infection; pancreatitis; burns; trauma,
other....??
Common Causes of Septic Shock:
gram negative or gram positive bacteremia
pneumonia
pancreatitis
necrotizing fasciitis
meningitis
UTI, pyelonephritis
indwelling catheters
SBP
how to rapidly assess whether a patient with suspected infection is at
risk for poor outcomes - ANS-qSOFA - quick Sequential [Sepsis-related]
Organ Failure Assessment
Update) Complex Diagnosis & Management in Acute
Care Review| Questions and Verified Answers| 100%
Correct |Grade A + Chamberlain
Complications from post cardiac arrest cooling - ANS-Tachy, then brady
w/ prolonged PR and QT. Potential for cerebral vasoconstriction, so keep
MAP higher than usual.
Hyperglycemia- cooling causes increased insulin resistance and
decreased insulin secretion. Monitor BG q 1 hr.
Hypokalemia d/t cooling driving potassium into cells
Infection d/t suppression of cellular and antibody immunity. Do
surveillance cultures, broad spectrum ABX
Rewarming has risks of: HTN, hyperkalemia, hypoglycemia
HTN Urgency Definition - ANS-DBP > 120 without acute end-organ
damage
In hemorrhagic shock it is important to:
,a. maintain a MAP of 65 or greater in order to perfuse vital organs.
b. give fresh frozen plasma and platelets to stop the bleeding.
c. allow for lower blood pressure until bleeding stops.
d. a. and b.
e. b. and c.
f. a. and c. - ANS-e. b. and c. ICU 209, 210
Aggressive volume replacement can exacerbate bleeding before the
hemorrhage is controlled. This leads to permitting lower BP's (sys BP=90
and mean BP=50) in trauma pts with hemorrhagic shock until bleeding
is controlled. This leads to reduced rescucitation volumes and increased
survival rates. This is allowed if evidence of adequate organ perfusion
(ie pt is awake and follows commands).
The preferred delivery system for rapid fluid resuscitation is:
a. central venous catheter, because it is in the largest vein.
b. short, large bore peripheral catheters, because flow is 4 times
greater through these.
c. intraosseous access, because fluid flows more rapidly in marrow
space.
d. PO or via an NG tube, because it's always better to use the gut when
possible. - ANS-b. short, large bore peripheral catheters, because flow is
4 times greater through these.
,T or F
SIRS, or Systemic Inflammatory Response Syndrome, is always due to an
infection. - ANS-FALSE
T or F
In critically ill patients with poor tissue perfusion, up to 85% of glucose
metabolism is diverted to lactate production, causing significant
elevation of serum lactate. - ANS-TRUE
reaching a diagnosis and decisions about treatment - ANS-Use
Diagnostic reasoning: Work Backwards from the symptom to the
disease in order to diagnose.
Inductive reasoning: Based on observation. Specific to general. Used to
form hypotheses and theories.
Deductive reasoning: Based on theory. Starts with a general statement
or hypothesis. Works general to specific. Used to apply theories to
specific situations, predicting what the observations will be if the theory
is correct.
Abductive reasoning: Based on observation and theory. Starts with
incomplete set of observations abd proceeds to the likeliest
explanation. Based on making and testing the best hypothesis from the
info available. Often an educated guess after observing a phenomenon
, where theire is no clear explanation. Used to form hypotheses to be
tested.
Clinical decision making: Diagnostic and therapeutic decision making
causes of severe sepsis and septic shock - ANS-Infection (bacteria, fungi,
parasites, viruses); blood born infection; pancreatitis; burns; trauma,
other....??
Common Causes of Septic Shock:
gram negative or gram positive bacteremia
pneumonia
pancreatitis
necrotizing fasciitis
meningitis
UTI, pyelonephritis
indwelling catheters
SBP
how to rapidly assess whether a patient with suspected infection is at
risk for poor outcomes - ANS-qSOFA - quick Sequential [Sepsis-related]
Organ Failure Assessment
