NR572 Final Exam Actual Exam Style V2 |
NR 572 Advanced Acute Care
Management | Chamberlain
1. A patient with septic shock remains hypotensive despite receiving a 30 mL/kg fluid bolus.
What is the first-line vasopressor recommended for this patient?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor for septic shock that does not
respond to initial fluid resuscitation. It provides potent alpha-1 agonism resulting in
vasoconstriction while having minimal effect on heart rate compared to dopamine. The
goal is to maintain a mean arterial pressure (MAP) of at least 65 mmHg to ensure adequate
tissue perfusion.
2. In a patient with ARDS, which ventilator setting adjustment is most effective for improving
oxygenation while preventing barotrauma?
A. Increasing the Tidal Volume
B. Decreasing the PEEP
,C. Decreasing the Inspiratory Flow
D. Increasing the PEEP
Answer: D
Rationale: Positive End-Expiratory Pressure (PEEP) helps recruit collapsed alveoli and
increases the surface area for gas exchange in ARDS patients. Low tidal volume ventilation
(6 mL/kg) is simultaneously used to prevent ventilator-induced lung injury or barotrauma.
This strategy balances the need for oxygenation with the protection of lung tissue from
overdistension.
3. Which hemodynamic profile is characteristic of cardiogenic shock?
A. Low CVP, Low SVR, High CO
B. High CVP, Low SVR, High CO
C. Low PAOP, High SVR, Low CO
D. High PAOP, High SVR, Low CO
Answer: D
Rationale: Cardiogenic shock is characterized by pump failure, leading to a low Cardiac
Output (CO). The body compensates by increasing Systemic Vascular Resistance (SVR), and
the Pulmonary Artery Occlusion Pressure (PAOP) is high due to blood backing up into the
pulmonary system. Understanding these parameters is crucial for differentiating between
types of shock in the acute care setting.
, 4. A patient presents with a blood glucose of 850 mg/dL, pH of 7.35, and no serum ketones.
What is the most likely diagnosis?
A. Diabetic Ketoacidosis (DKA)
B. Starvation Ketosis
C. Metabolic Acidosis
D. Hyperosmolar Hyperglycemic State (HHS)
Answer: D
Rationale: Hyperosmolar Hyperglycemic State (HHS) typically presents with much higher
glucose levels than DKA and lacks significant ketosis or acidosis. HHS patients have enough
insulin to prevent lipolysis but not enough to control hyperglycemia. Initial management
focuses on aggressive fluid resuscitation to address the severe dehydration common in this
state.
5. Which laboratory value is the most sensitive indicator of Acute Kidney Injury (AKI)
according to the RIFLE criteria?
A. BUN
B. Serum Creatinine
C. Glomerular Filtration Rate (GFR)
D. Urine Output
Answer: B
NR 572 Advanced Acute Care
Management | Chamberlain
1. A patient with septic shock remains hypotensive despite receiving a 30 mL/kg fluid bolus.
What is the first-line vasopressor recommended for this patient?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Answer: D
Rationale: Norepinephrine is the first-line vasopressor for septic shock that does not
respond to initial fluid resuscitation. It provides potent alpha-1 agonism resulting in
vasoconstriction while having minimal effect on heart rate compared to dopamine. The
goal is to maintain a mean arterial pressure (MAP) of at least 65 mmHg to ensure adequate
tissue perfusion.
2. In a patient with ARDS, which ventilator setting adjustment is most effective for improving
oxygenation while preventing barotrauma?
A. Increasing the Tidal Volume
B. Decreasing the PEEP
,C. Decreasing the Inspiratory Flow
D. Increasing the PEEP
Answer: D
Rationale: Positive End-Expiratory Pressure (PEEP) helps recruit collapsed alveoli and
increases the surface area for gas exchange in ARDS patients. Low tidal volume ventilation
(6 mL/kg) is simultaneously used to prevent ventilator-induced lung injury or barotrauma.
This strategy balances the need for oxygenation with the protection of lung tissue from
overdistension.
3. Which hemodynamic profile is characteristic of cardiogenic shock?
A. Low CVP, Low SVR, High CO
B. High CVP, Low SVR, High CO
C. Low PAOP, High SVR, Low CO
D. High PAOP, High SVR, Low CO
Answer: D
Rationale: Cardiogenic shock is characterized by pump failure, leading to a low Cardiac
Output (CO). The body compensates by increasing Systemic Vascular Resistance (SVR), and
the Pulmonary Artery Occlusion Pressure (PAOP) is high due to blood backing up into the
pulmonary system. Understanding these parameters is crucial for differentiating between
types of shock in the acute care setting.
, 4. A patient presents with a blood glucose of 850 mg/dL, pH of 7.35, and no serum ketones.
What is the most likely diagnosis?
A. Diabetic Ketoacidosis (DKA)
B. Starvation Ketosis
C. Metabolic Acidosis
D. Hyperosmolar Hyperglycemic State (HHS)
Answer: D
Rationale: Hyperosmolar Hyperglycemic State (HHS) typically presents with much higher
glucose levels than DKA and lacks significant ketosis or acidosis. HHS patients have enough
insulin to prevent lipolysis but not enough to control hyperglycemia. Initial management
focuses on aggressive fluid resuscitation to address the severe dehydration common in this
state.
5. Which laboratory value is the most sensitive indicator of Acute Kidney Injury (AKI)
according to the RIFLE criteria?
A. BUN
B. Serum Creatinine
C. Glomerular Filtration Rate (GFR)
D. Urine Output
Answer: B
