NR572 Exam 2 Actual Exam Style V2 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient in septic shock has failed to respond to a 30 mL/kg fluid bolus. What is the first-
line vasopressor of choice according to the Surviving Sepsis Campaign?
A. Epinephrine
B. Dopamine
C. Norepinephrine
D. Vasopressin
Answer: C
Rationale: Norepinephrine is the recommended first-line vasopressor for maintaining a
mean arterial pressure (MAP) of 65 mmHg in septic shock. It provides potent alpha-1 and
mild beta-1 stimulation to increase systemic vascular resistance without excessively
increasing heart rate. Using dopamine or epinephrine as first-line agents is associated with
higher rates of arrhythmias and metabolic side effects.
2. Which hemodynamic profile is most consistent with cardiogenic shock?
A. Low CVP, High CO, Low SVR
B. High CVP, High CO, Low SVR
C. Low PCWP, Low CO, Low SVR
,D. High PCWP, Low CO, High SVR
Answer: D
Rationale: Cardiogenic shock is characterized by a high Pulmonary Capillary Wedge
Pressure (PCWP) due to left ventricular failure and fluid backup. The Cardiac Output (CO)
is low because the heart cannot pump effectively, leading to a compensatory increase in
Systemic Vascular Resistance (SVR) to maintain pressure. Distributive shock states would
typically show a low SVR, while hypovolemic shock would show low filling pressures.
3. A patient with ARDS is being ventilated with a low tidal volume strategy. What is the
primary goal of using 6 mL/kg of predicted body weight?
A. To prevent lung-protective hypercapnia
B. To reduce the need for PEEP
C. To maximize alveolar recruitment
D. To minimize ventilator-induced lung injury (VILI)
Answer: D
Rationale: Low tidal volume ventilation is the standard of care for ARDS to prevent
volutrauma and barotrauma, collectively known as ventilator-induced lung injury. This
strategy has been shown to reduce mortality and increase the number of ventilator-free
days. It often results in permissive hypercapnia, which is acceptable as long as the pH does
not drop below critical levels.
, 4. A patient’s ABG shows: pH 7.28, PaCO2 55, HCO3 26. Which of the following describes this
acid-base imbalance?
A. Compensated metabolic acidosis
B. Uncompensated respiratory acidosis
C. Partially compensated metabolic alkalosis
D. Uncompensated respiratory alkalosis
Answer: B
Rationale: The pH is low (acidosis) and the PaCO2 is high, indicating that the primary
cause is respiratory. Since the bicarbonate (HCO3) is within the normal range, the kidneys
have not yet compensated for the respiratory failure. This clinical picture is common in
acute respiratory failure or sedation overdose.
5. In the early phase of sepsis, a patient exhibits ‘warm shock.’ What is the underlying
physiological reason for this presentation?
A. Massive vasodilation leading to decreased SVR
B. Increased myocardial contractility from sympathetic surge
C. Hypovolemia causing peripheral vasoconstriction
D. High cardiac output due to fluid overload
Answer: A
572 Advanced Acute Care Management |
Chamberlain
1. A patient in septic shock has failed to respond to a 30 mL/kg fluid bolus. What is the first-
line vasopressor of choice according to the Surviving Sepsis Campaign?
A. Epinephrine
B. Dopamine
C. Norepinephrine
D. Vasopressin
Answer: C
Rationale: Norepinephrine is the recommended first-line vasopressor for maintaining a
mean arterial pressure (MAP) of 65 mmHg in septic shock. It provides potent alpha-1 and
mild beta-1 stimulation to increase systemic vascular resistance without excessively
increasing heart rate. Using dopamine or epinephrine as first-line agents is associated with
higher rates of arrhythmias and metabolic side effects.
2. Which hemodynamic profile is most consistent with cardiogenic shock?
A. Low CVP, High CO, Low SVR
B. High CVP, High CO, Low SVR
C. Low PCWP, Low CO, Low SVR
,D. High PCWP, Low CO, High SVR
Answer: D
Rationale: Cardiogenic shock is characterized by a high Pulmonary Capillary Wedge
Pressure (PCWP) due to left ventricular failure and fluid backup. The Cardiac Output (CO)
is low because the heart cannot pump effectively, leading to a compensatory increase in
Systemic Vascular Resistance (SVR) to maintain pressure. Distributive shock states would
typically show a low SVR, while hypovolemic shock would show low filling pressures.
3. A patient with ARDS is being ventilated with a low tidal volume strategy. What is the
primary goal of using 6 mL/kg of predicted body weight?
A. To prevent lung-protective hypercapnia
B. To reduce the need for PEEP
C. To maximize alveolar recruitment
D. To minimize ventilator-induced lung injury (VILI)
Answer: D
Rationale: Low tidal volume ventilation is the standard of care for ARDS to prevent
volutrauma and barotrauma, collectively known as ventilator-induced lung injury. This
strategy has been shown to reduce mortality and increase the number of ventilator-free
days. It often results in permissive hypercapnia, which is acceptable as long as the pH does
not drop below critical levels.
, 4. A patient’s ABG shows: pH 7.28, PaCO2 55, HCO3 26. Which of the following describes this
acid-base imbalance?
A. Compensated metabolic acidosis
B. Uncompensated respiratory acidosis
C. Partially compensated metabolic alkalosis
D. Uncompensated respiratory alkalosis
Answer: B
Rationale: The pH is low (acidosis) and the PaCO2 is high, indicating that the primary
cause is respiratory. Since the bicarbonate (HCO3) is within the normal range, the kidneys
have not yet compensated for the respiratory failure. This clinical picture is common in
acute respiratory failure or sedation overdose.
5. In the early phase of sepsis, a patient exhibits ‘warm shock.’ What is the underlying
physiological reason for this presentation?
A. Massive vasodilation leading to decreased SVR
B. Increased myocardial contractility from sympathetic surge
C. Hypovolemia causing peripheral vasoconstriction
D. High cardiac output due to fluid overload
Answer: A
