NUR2502 Multidimensional Care III Exam 1 Review
- Advanced Acuity Synthesis 2026 | Complex
Patient Management & Critical Thinking
50 High-Acuity Case-Based Questions | 15 Cases | 4 Questions/Case
CASE 1: Acute Coronary Syndrome with Cardiogenic Shock
ED/ICU Transfer Report
Patient: 58 y/o M, PMH: HTN, HLD, 40 pk-yr smoking.
Presenting to: ICU from Cardiac Cath Lab.
Brief History: 45 min crushing substernal CP, STEMI on ECG. Emergent PCI → LAD
stent.
Current Status: Anxious, diaphoretic. BP 88/52, HR 118 (sinus tach), RR 28, SpO₂ 92% on
100% NRB. Crackles bilaterally to mid-scapulae. UOP 15 mL last hour.
Key Diagnostics: Troponin I 15 ng/mL (peak), BNP 850 pg/mL, CXR: pulmonary vascular
congestion.
Current Interventions: Dopamine 8 mcg/kg/min, furosemide 40 mg IV given, dual
antiplatelets administered.
Primary Medical Problem: Anterior STEMI s/p PCI, complicated by cardiogenic shock
and pulmonary edema.
,1. Which pathophysiological process is primarily responsible for the patient's
hypotension and pulmonary crackles?
A. Systemic vasodilation causing distributive shock.
B. Pump failure (reduced cardiac output) leading to cardiogenic shock and backward
failure.
C. Hypovolemia from diuretic therapy.
D. Cardiac tamponade post-procedure.
Answer: B
C.A.R.E.: MI → LV necrosis → ↓ contractility → ↓ CO (hypotension) & ↑ LVEDP →
pulmonary edema (crackles).
A: ABCs – airway/oxygenation first.
R: Dopamine β1 effect → ↑ contractility.
E: Watch for ↑ lactate, ↓ UOP, worsening SpO₂.
2. Upon receiving this report, the nurse's immediate priority action is to:
A. Obtain a stat 12-lead ECG.
B. Assess airway patency and work of breathing, prepare for possible intubation.
C. Titrate dopamine downward to reduce myocardial oxygen demand.
D. Administer another 40 mg dose of furosemide IV.
Answer: B
, C.A.R.E.: ABCs – respiratory failure imminent (tachypnea, low SpO₂, crackles).
A: ABCDE framework – airway first.
R: Intubation reduces work of breathing & myocardial O₂ demand.
E: Monitor ABG, CXR, listen for diminishing breath sounds.
3. The nurse is managing the dopamine drip. The primary therapeutic goal of this
infusion in cardiogenic shock is to:
A. Promote renal arterial dilation and increase urine output.
B. Increase myocardial contractility and cardiac output.
C. Cause peripheral vasoconstriction to increase venous return.
D. Reduce systemic vascular resistance (afterload).
Answer: B
C.A.R.E.: Dopamine 5-10 mcg/kg/min → β1 agonism → ↑ contractility & HR.
A: Inotrope first – ↑ CO.
R: Improves BP, perfusion, UOP.
E: Monitor for tachyarrhythmias, chest pain.
4. Two hours later, which assessment finding would indicate the patient is deteriorating
despite interventions?
A. Heart rate decreases from 118 to 100 bpm.
B. Crackles are now audible only at the lung bases.
- Advanced Acuity Synthesis 2026 | Complex
Patient Management & Critical Thinking
50 High-Acuity Case-Based Questions | 15 Cases | 4 Questions/Case
CASE 1: Acute Coronary Syndrome with Cardiogenic Shock
ED/ICU Transfer Report
Patient: 58 y/o M, PMH: HTN, HLD, 40 pk-yr smoking.
Presenting to: ICU from Cardiac Cath Lab.
Brief History: 45 min crushing substernal CP, STEMI on ECG. Emergent PCI → LAD
stent.
Current Status: Anxious, diaphoretic. BP 88/52, HR 118 (sinus tach), RR 28, SpO₂ 92% on
100% NRB. Crackles bilaterally to mid-scapulae. UOP 15 mL last hour.
Key Diagnostics: Troponin I 15 ng/mL (peak), BNP 850 pg/mL, CXR: pulmonary vascular
congestion.
Current Interventions: Dopamine 8 mcg/kg/min, furosemide 40 mg IV given, dual
antiplatelets administered.
Primary Medical Problem: Anterior STEMI s/p PCI, complicated by cardiogenic shock
and pulmonary edema.
,1. Which pathophysiological process is primarily responsible for the patient's
hypotension and pulmonary crackles?
A. Systemic vasodilation causing distributive shock.
B. Pump failure (reduced cardiac output) leading to cardiogenic shock and backward
failure.
C. Hypovolemia from diuretic therapy.
D. Cardiac tamponade post-procedure.
Answer: B
C.A.R.E.: MI → LV necrosis → ↓ contractility → ↓ CO (hypotension) & ↑ LVEDP →
pulmonary edema (crackles).
A: ABCs – airway/oxygenation first.
R: Dopamine β1 effect → ↑ contractility.
E: Watch for ↑ lactate, ↓ UOP, worsening SpO₂.
2. Upon receiving this report, the nurse's immediate priority action is to:
A. Obtain a stat 12-lead ECG.
B. Assess airway patency and work of breathing, prepare for possible intubation.
C. Titrate dopamine downward to reduce myocardial oxygen demand.
D. Administer another 40 mg dose of furosemide IV.
Answer: B
, C.A.R.E.: ABCs – respiratory failure imminent (tachypnea, low SpO₂, crackles).
A: ABCDE framework – airway first.
R: Intubation reduces work of breathing & myocardial O₂ demand.
E: Monitor ABG, CXR, listen for diminishing breath sounds.
3. The nurse is managing the dopamine drip. The primary therapeutic goal of this
infusion in cardiogenic shock is to:
A. Promote renal arterial dilation and increase urine output.
B. Increase myocardial contractility and cardiac output.
C. Cause peripheral vasoconstriction to increase venous return.
D. Reduce systemic vascular resistance (afterload).
Answer: B
C.A.R.E.: Dopamine 5-10 mcg/kg/min → β1 agonism → ↑ contractility & HR.
A: Inotrope first – ↑ CO.
R: Improves BP, perfusion, UOP.
E: Monitor for tachyarrhythmias, chest pain.
4. Two hours later, which assessment finding would indicate the patient is deteriorating
despite interventions?
A. Heart rate decreases from 118 to 100 bpm.
B. Crackles are now audible only at the lung bases.
