NR572 Final Exam Actual Exam Style V2
1. A patient diagnosed with sepsis remains hypotensive despite receiving a 30 mL/kg fluid
bolus. Which vasopressor is the first-line choice for management?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
Correct Answer: B
Expert Explanation: Norepinephrine is recommended as the first-line vasopressor in
patients with septic shock to maintain a mean arterial pressure of at least 65 mmHg. It
primarily acts on alpha-1 adrenergic receptors to cause vasoconstriction with minimal
effect on heart rate. If blood pressure remains low, vasopressin is often added as a second-
line agent.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which tidal
volume setting is recommended to prevent lung injury?
A. 10 mL/kg of ideal body weight
B. 6 mL/kg of ideal body weight
C. 4 mL/kg of ideal body weight
D. 12 mL/kg of ideal body weight
,Correct Answer: B
Expert Explanation: Lung-protective ventilation using a low tidal volume of 6 mL/kg is
the standard of care for ARDS patients. This strategy aims to reduce volutrauma and
barotrauma by preventing over-distension of the alveoli. Maintaining plateau pressures
below 30 cm H2O is also a key component of this management protocol.
3. A patient with heart failure has a Pulmonary Capillary Wedge Pressure (PCWP) of 22 mmHg
and a Cardiac Index (CI) of 1.8 L/min/m2. Which type of shock does this profile suggest?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Neurogenic shock
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by a low cardiac index and
elevated filling pressures such as the PCWP. In this state, the heart is unable to pump
effectively, leading to pulmonary congestion and systemic hypoperfusion. Management
often involves inotropes to increase contractility and diuretics to reduce volume overload.
4. What is the goal for door-to-balloon time for a patient presenting with an Acute ST-
Segment Elevation Myocardial Infarction (STEMI)?
A. 60 minutes
B. 30 minutes
, C. 120 minutes
D. 90 minutes
Correct Answer: D
Expert Explanation: The American Heart Association recommends a door-to-balloon time
of 90 minutes or less for patients undergoing primary percutaneous coronary intervention.
Rapid reperfusion is critical to salvaging myocardium and improving long-term survival
rates. Delays in treatment are associated with increased morbidity and higher risk of heart
failure.
5. Which of the following findings is part of Cushing’s Triad, indicating increased intracranial
pressure?
A. Tachycardia
B. Hypotension
C. Widening pulse pressure
D. Increased respiratory rate
Correct Answer: C
Expert Explanation: Cushing’s Triad consists of bradycardia, irregular respirations, and a
widening pulse pressure with hypertension. These signs represent a late-stage response to
significantly elevated intracranial pressure and impending brain herniation. Immediate
intervention is required to reduce pressure and stabilize the patient’s neurological status.
1. A patient diagnosed with sepsis remains hypotensive despite receiving a 30 mL/kg fluid
bolus. Which vasopressor is the first-line choice for management?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
Correct Answer: B
Expert Explanation: Norepinephrine is recommended as the first-line vasopressor in
patients with septic shock to maintain a mean arterial pressure of at least 65 mmHg. It
primarily acts on alpha-1 adrenergic receptors to cause vasoconstriction with minimal
effect on heart rate. If blood pressure remains low, vasopressin is often added as a second-
line agent.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which tidal
volume setting is recommended to prevent lung injury?
A. 10 mL/kg of ideal body weight
B. 6 mL/kg of ideal body weight
C. 4 mL/kg of ideal body weight
D. 12 mL/kg of ideal body weight
,Correct Answer: B
Expert Explanation: Lung-protective ventilation using a low tidal volume of 6 mL/kg is
the standard of care for ARDS patients. This strategy aims to reduce volutrauma and
barotrauma by preventing over-distension of the alveoli. Maintaining plateau pressures
below 30 cm H2O is also a key component of this management protocol.
3. A patient with heart failure has a Pulmonary Capillary Wedge Pressure (PCWP) of 22 mmHg
and a Cardiac Index (CI) of 1.8 L/min/m2. Which type of shock does this profile suggest?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Neurogenic shock
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by a low cardiac index and
elevated filling pressures such as the PCWP. In this state, the heart is unable to pump
effectively, leading to pulmonary congestion and systemic hypoperfusion. Management
often involves inotropes to increase contractility and diuretics to reduce volume overload.
4. What is the goal for door-to-balloon time for a patient presenting with an Acute ST-
Segment Elevation Myocardial Infarction (STEMI)?
A. 60 minutes
B. 30 minutes
, C. 120 minutes
D. 90 minutes
Correct Answer: D
Expert Explanation: The American Heart Association recommends a door-to-balloon time
of 90 minutes or less for patients undergoing primary percutaneous coronary intervention.
Rapid reperfusion is critical to salvaging myocardium and improving long-term survival
rates. Delays in treatment are associated with increased morbidity and higher risk of heart
failure.
5. Which of the following findings is part of Cushing’s Triad, indicating increased intracranial
pressure?
A. Tachycardia
B. Hypotension
C. Widening pulse pressure
D. Increased respiratory rate
Correct Answer: C
Expert Explanation: Cushing’s Triad consists of bradycardia, irregular respirations, and a
widening pulse pressure with hypertension. These signs represent a late-stage response to
significantly elevated intracranial pressure and impending brain herniation. Immediate
intervention is required to reduce pressure and stabilize the patient’s neurological status.
