NR572 Final Exam Actual Exam Style V3 |
NR 572 Advanced Acute Care Management
| Chamberlain
1. A 65-year-old patient with septic shock remains hypotensive (MAP 58 mmHg) after
receiving a 30 mL/kg fluid bolus. Which vasopressor should be initiated as the first-line agent
according to the Surviving Sepsis Guidelines?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Correct Answer: D
Expert Explanation: Norepinephrine is the first-line vasopressor recommended for septic
shock to achieve a target MAP of at least 65 mmHg. It is preferred over dopamine because it
is more effective at increasing blood pressure and has a lower risk of causing arrhythmias.
Early initiation of norepinephrine is associated with better outcomes in patients who do
not respond to initial fluid resuscitation.
2. A patient with Acute Respiratory Distress Syndrome (ARDS) is being ventilated. Which of
the following ventilator settings is most consistent with the ‘lung protective’ strategy?
A. Tidal volume of 10-12 mL/kg of predicted body weight
B. Low PEEP to prevent barotrauma
,C. Plateau pressure of 40 cm H2O
D. Tidal volume of 4-6 mL/kg of predicted body weight
Correct Answer: D
Expert Explanation: Low tidal volume ventilation of 4 to 6 mL/kg of predicted body
weight is a hallmark of ARDS management to prevent ventilator-induced lung injury. This
strategy aims to maintain plateau pressures below 30 cm H2O to reduce volutrauma and
barotrauma. Higher tidal volumes are associated with increased mortality and systemic
inflammation in ARDS patients.
3. Which hemodynamic profile is most characteristic of Cardiogenic Shock?
A. Low Cardiac Output (CO), Low Systemic Vascular Resistance (SVR), Low Pulmonary
Capillary Wedge Pressure (PCWP)
B. High CO, Low SVR, Low PCWP
C. Low CO, High SVR, High PCWP
D. Low CO, Low SVR, High PCWP
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by a primary failure of the heart
to pump, resulting in low cardiac output and elevated filling pressures like PCWP. The body
attempts to compensate for low perfusion through vasoconstriction, which leads to a high
systemic vascular resistance. This profile distinguishes it from distributive shock, where
SVR is characteristically low.
,4. A patient on a mechanical ventilator has a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 26
mEq/L. Which adjustment is most appropriate?
A. Decrease the respiratory rate
B. Decrease the PEEP
C. Increase the tidal volume or respiratory rate
D. Administer sodium bicarbonate
Correct Answer: C
Expert Explanation: The blood gas indicates respiratory acidosis, characterized by a low
pH and an elevated PaCO2 level. To correct this, the minute ventilation must be increased
by either raising the tidal volume or the respiratory rate to blow off excess CO2. This
intervention aims to normalize the acid-base balance by facilitating CO2 clearance through
the lungs.
5. In the management of Diabetic Ketoacidosis (DKA), when should the clinician transition
from intravenous regular insulin to subcutaneous insulin?
A. As soon as the blood glucose is less than 200 mg/dL
B. When the anion gap has closed and the patient is able to eat
C. Immediately after the first liter of normal saline is infused
D. When the urine ketones are completely negative
Correct Answer: B
, Expert Explanation: Transitioning to subcutaneous insulin in DKA should occur only after
the metabolic acidosis has resolved, indicated by a closed anion gap and a normal pH. The
patient must also be clinically stable and able to tolerate oral intake to ensure safe glucose
management. Overlapping the intravenous insulin with the first dose of subcutaneous
insulin for 1 to 2 hours is essential to prevent rebound hyperglycemia.
6. What is the primary goal of using an Intra-Aortic Balloon Pump (IABP) in a patient with
acute myocardial infarction and cardiogenic shock?
A. To increase preload and decrease afterload
B. To decrease heart rate and increase stroke volume
C. To increase coronary artery perfusion and decrease afterload
D. To provide total circulatory support without the need for vasopressors
Correct Answer: C
Expert Explanation: The IABP works by inflating during diastole to increase diastolic
pressure and coronary artery perfusion. It deflates just before systole, creating a vacuum
effect that reduces afterload and lessens the workload of the left ventricle. This mechanical
assistance helps improve cardiac efficiency while decreasing myocardial oxygen demand in
failing hearts.
7. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 25 mmHg
and a MAP of 75 mmHg. What is the calculated Cerebral Perfusion Pressure (CPP)?
A. 100 mmHg
NR 572 Advanced Acute Care Management
| Chamberlain
1. A 65-year-old patient with septic shock remains hypotensive (MAP 58 mmHg) after
receiving a 30 mL/kg fluid bolus. Which vasopressor should be initiated as the first-line agent
according to the Surviving Sepsis Guidelines?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Correct Answer: D
Expert Explanation: Norepinephrine is the first-line vasopressor recommended for septic
shock to achieve a target MAP of at least 65 mmHg. It is preferred over dopamine because it
is more effective at increasing blood pressure and has a lower risk of causing arrhythmias.
Early initiation of norepinephrine is associated with better outcomes in patients who do
not respond to initial fluid resuscitation.
2. A patient with Acute Respiratory Distress Syndrome (ARDS) is being ventilated. Which of
the following ventilator settings is most consistent with the ‘lung protective’ strategy?
A. Tidal volume of 10-12 mL/kg of predicted body weight
B. Low PEEP to prevent barotrauma
,C. Plateau pressure of 40 cm H2O
D. Tidal volume of 4-6 mL/kg of predicted body weight
Correct Answer: D
Expert Explanation: Low tidal volume ventilation of 4 to 6 mL/kg of predicted body
weight is a hallmark of ARDS management to prevent ventilator-induced lung injury. This
strategy aims to maintain plateau pressures below 30 cm H2O to reduce volutrauma and
barotrauma. Higher tidal volumes are associated with increased mortality and systemic
inflammation in ARDS patients.
3. Which hemodynamic profile is most characteristic of Cardiogenic Shock?
A. Low Cardiac Output (CO), Low Systemic Vascular Resistance (SVR), Low Pulmonary
Capillary Wedge Pressure (PCWP)
B. High CO, Low SVR, Low PCWP
C. Low CO, High SVR, High PCWP
D. Low CO, Low SVR, High PCWP
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by a primary failure of the heart
to pump, resulting in low cardiac output and elevated filling pressures like PCWP. The body
attempts to compensate for low perfusion through vasoconstriction, which leads to a high
systemic vascular resistance. This profile distinguishes it from distributive shock, where
SVR is characteristically low.
,4. A patient on a mechanical ventilator has a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 26
mEq/L. Which adjustment is most appropriate?
A. Decrease the respiratory rate
B. Decrease the PEEP
C. Increase the tidal volume or respiratory rate
D. Administer sodium bicarbonate
Correct Answer: C
Expert Explanation: The blood gas indicates respiratory acidosis, characterized by a low
pH and an elevated PaCO2 level. To correct this, the minute ventilation must be increased
by either raising the tidal volume or the respiratory rate to blow off excess CO2. This
intervention aims to normalize the acid-base balance by facilitating CO2 clearance through
the lungs.
5. In the management of Diabetic Ketoacidosis (DKA), when should the clinician transition
from intravenous regular insulin to subcutaneous insulin?
A. As soon as the blood glucose is less than 200 mg/dL
B. When the anion gap has closed and the patient is able to eat
C. Immediately after the first liter of normal saline is infused
D. When the urine ketones are completely negative
Correct Answer: B
, Expert Explanation: Transitioning to subcutaneous insulin in DKA should occur only after
the metabolic acidosis has resolved, indicated by a closed anion gap and a normal pH. The
patient must also be clinically stable and able to tolerate oral intake to ensure safe glucose
management. Overlapping the intravenous insulin with the first dose of subcutaneous
insulin for 1 to 2 hours is essential to prevent rebound hyperglycemia.
6. What is the primary goal of using an Intra-Aortic Balloon Pump (IABP) in a patient with
acute myocardial infarction and cardiogenic shock?
A. To increase preload and decrease afterload
B. To decrease heart rate and increase stroke volume
C. To increase coronary artery perfusion and decrease afterload
D. To provide total circulatory support without the need for vasopressors
Correct Answer: C
Expert Explanation: The IABP works by inflating during diastole to increase diastolic
pressure and coronary artery perfusion. It deflates just before systole, creating a vacuum
effect that reduces afterload and lessens the workload of the left ventricle. This mechanical
assistance helps improve cardiac efficiency while decreasing myocardial oxygen demand in
failing hearts.
7. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 25 mmHg
and a MAP of 75 mmHg. What is the calculated Cerebral Perfusion Pressure (CPP)?
A. 100 mmHg
