NR572 Exam 4 Actual Exam Style V3 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive after receiving 30 mL/kg of crystalloid.
The nurse practitioner should initiate which first-line vasopressor?
A. Dopamine
B. Vasopressin
C. Norepinephrine
D. Epinephrine
Answer: C
Rationale: Norepinephrine is the first-choice vasopressor for septic shock to achieve a
Mean Arterial Pressure (MAP) of 65 mmHg. It is preferred due to its potent alpha-
adrenergic effects which increase vascular resistance without the excessive tachycardia
seen with dopamine. This intervention follows the Surviving Sepsis Campaign guidelines
for fluid-refractory hypotension.
2. Which hemodynamic profile is most characteristic of cardiogenic shock?
A. Low CVP, High CI, Low SVR
B. High PAWP, Low CI, High SVR
C. High CVP, Low CI, Low SVR
,D. Low PAWP, Low CI, Low SVR
Answer: B
Rationale: Cardiogenic shock is characterized by a failure of the pump, leading to a low
Cardiac Index (CI). Elevated Pulmonary Artery Wedge Pressure (PAWP) reflects fluid
backing up into the lungs due to left ventricular dysfunction. Systemic Vascular Resistance
(SVR) increases as a compensatory mechanism to maintain blood pressure.
3. An ARDS patient has a PaO2/FiO2 ratio of 150 mmHg while on PEEP of 10 cmH2O. This
indicates which severity of ARDS?
A. Moderate
B. Mild
C. Severe
D. Acute Lung Injury
Answer: A
Rationale: According to the Berlin Definition, moderate ARDS is defined by a P/F ratio
between 100 and 200 mmHg. Mild ARDS is between 200 and 300, while severe is less than
100 mmHg. This classification helps clinicians determine the necessity for more aggressive
interventions like prone positioning or neuromuscular blockade.
4. A patient with a Traumatic Brain Injury (TBI) has an ICP of 22 mmHg and a MAP of 85
mmHg. What is the calculated Cerebral Perfusion Pressure (CPP)?
A. 63 mmHg
, B. 107 mmHg
C. 70 mmHg
D. 55 mmHg
Answer: A
Rationale: Cerebral Perfusion Pressure (CPP) is calculated by subtracting Intra-Cranial
Pressure (ICP) from the Mean Arterial Pressure (MAP), so 85 minus 22 equals 63. A CPP
target of 60-70 mmHg is generally maintained to ensure adequate cerebral oxygenation.
Values below 50-60 mmHg are associated with worse neurological outcomes.
5. In the management of Acute Renal Failure, which electrolyte abnormality is considered a
life-threatening emergency requiring immediate intervention?
A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypophosphatemia
Answer: A
Rationale: Hyperkalemia is the most dangerous electrolyte imbalance in acute renal failure
because it can lead to fatal cardiac arrhythmias. Management includes membrane
stabilization with calcium gluconate and shifting potassium into cells with insulin and
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive after receiving 30 mL/kg of crystalloid.
The nurse practitioner should initiate which first-line vasopressor?
A. Dopamine
B. Vasopressin
C. Norepinephrine
D. Epinephrine
Answer: C
Rationale: Norepinephrine is the first-choice vasopressor for septic shock to achieve a
Mean Arterial Pressure (MAP) of 65 mmHg. It is preferred due to its potent alpha-
adrenergic effects which increase vascular resistance without the excessive tachycardia
seen with dopamine. This intervention follows the Surviving Sepsis Campaign guidelines
for fluid-refractory hypotension.
2. Which hemodynamic profile is most characteristic of cardiogenic shock?
A. Low CVP, High CI, Low SVR
B. High PAWP, Low CI, High SVR
C. High CVP, Low CI, Low SVR
,D. Low PAWP, Low CI, Low SVR
Answer: B
Rationale: Cardiogenic shock is characterized by a failure of the pump, leading to a low
Cardiac Index (CI). Elevated Pulmonary Artery Wedge Pressure (PAWP) reflects fluid
backing up into the lungs due to left ventricular dysfunction. Systemic Vascular Resistance
(SVR) increases as a compensatory mechanism to maintain blood pressure.
3. An ARDS patient has a PaO2/FiO2 ratio of 150 mmHg while on PEEP of 10 cmH2O. This
indicates which severity of ARDS?
A. Moderate
B. Mild
C. Severe
D. Acute Lung Injury
Answer: A
Rationale: According to the Berlin Definition, moderate ARDS is defined by a P/F ratio
between 100 and 200 mmHg. Mild ARDS is between 200 and 300, while severe is less than
100 mmHg. This classification helps clinicians determine the necessity for more aggressive
interventions like prone positioning or neuromuscular blockade.
4. A patient with a Traumatic Brain Injury (TBI) has an ICP of 22 mmHg and a MAP of 85
mmHg. What is the calculated Cerebral Perfusion Pressure (CPP)?
A. 63 mmHg
, B. 107 mmHg
C. 70 mmHg
D. 55 mmHg
Answer: A
Rationale: Cerebral Perfusion Pressure (CPP) is calculated by subtracting Intra-Cranial
Pressure (ICP) from the Mean Arterial Pressure (MAP), so 85 minus 22 equals 63. A CPP
target of 60-70 mmHg is generally maintained to ensure adequate cerebral oxygenation.
Values below 50-60 mmHg are associated with worse neurological outcomes.
5. In the management of Acute Renal Failure, which electrolyte abnormality is considered a
life-threatening emergency requiring immediate intervention?
A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypophosphatemia
Answer: A
Rationale: Hyperkalemia is the most dangerous electrolyte imbalance in acute renal failure
because it can lead to fatal cardiac arrhythmias. Management includes membrane
stabilization with calcium gluconate and shifting potassium into cells with insulin and
