NR 571 MIDTERM EXAM REVIEW:
COMPLEX DIAGNOSIS &
MANAGEMENT IN ACUTE CARE
1. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid
fluids. What is the first-line vasopressor recommended by the Surviving Sepsis Campaign?
A. Norepinephrine
B. Dopamine
C. Vasopressin
D. Epinephrine
Answer: A
Conceptual Explanation: Norepinephrine is the first-choice vasopressor for septic shock
to achieve a Mean Arterial Pressure (MAP) of 65 mmHg.
2. In a patient with Acute Respiratory Distress Syndrome (ARDS), which ventilator strategy
has been proven to decrease mortality?
A. High tidal volume ventilation
B. Maintenance of SpO2 at 100%
,C. Inverse ratio ventilation
D. Low tidal volume ventilation (6 mL/kg PBW)
A.
Answer: D
Conceptual Explanation: Low tidal volume ventilation (6 mL/kg of predicted body
weight) reduces ventilator-induced lung injury and mortality in ARDS.
3. Which hemodynamic parameter is the most accurate reflection of left ventricular end-
diastolic pressure (LVEDP) in the absence of mitral stenosis?
A. Central Venous Pressure (CVP)
B. Right Ventricular End-Diastolic Pressure
C. Pulmonary Artery Wedge Pressure (PAWP)
D. Systemic Vascular Resistance (SVR)
Answer: C
Conceptual Explanation: PAWP closely approximates LVEDP, providing information
about left-sided heart filling pressures.
4. A patient’s ABG results are: pH 7.22, PaCO2 60 mmHg, HCO3 26 mEq/L. What is the primary
acid-base disturbance?
A. Metabolic Acidosis
B. Metabolic Alkalosis
, C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: The low pH and high PaCO2 indicate a primary respiratory
acidosis with minimal renal compensation.
5. Which electrolyte abnormality is most likely to cause a prolonged QT interval and
potentially lead to Torsades de Pointes?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypomagnesemia
Answer: D
Conceptual Explanation: Hypomagnesemia (and hypokalemia/hypocalcemia) are known
to prolong the QT interval, increasing the risk for ventricular arrhythmias.
6. A patient with a suspected subarachnoid hemorrhage presents with a ‘thunderclap’
headache. What is the gold standard for diagnosing a cerebral aneurysm?
A. Non-contrast CT Head
B. Digital Subtraction Angiography (DSA)
C. Lumbar Puncture
COMPLEX DIAGNOSIS &
MANAGEMENT IN ACUTE CARE
1. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid
fluids. What is the first-line vasopressor recommended by the Surviving Sepsis Campaign?
A. Norepinephrine
B. Dopamine
C. Vasopressin
D. Epinephrine
Answer: A
Conceptual Explanation: Norepinephrine is the first-choice vasopressor for septic shock
to achieve a Mean Arterial Pressure (MAP) of 65 mmHg.
2. In a patient with Acute Respiratory Distress Syndrome (ARDS), which ventilator strategy
has been proven to decrease mortality?
A. High tidal volume ventilation
B. Maintenance of SpO2 at 100%
,C. Inverse ratio ventilation
D. Low tidal volume ventilation (6 mL/kg PBW)
A.
Answer: D
Conceptual Explanation: Low tidal volume ventilation (6 mL/kg of predicted body
weight) reduces ventilator-induced lung injury and mortality in ARDS.
3. Which hemodynamic parameter is the most accurate reflection of left ventricular end-
diastolic pressure (LVEDP) in the absence of mitral stenosis?
A. Central Venous Pressure (CVP)
B. Right Ventricular End-Diastolic Pressure
C. Pulmonary Artery Wedge Pressure (PAWP)
D. Systemic Vascular Resistance (SVR)
Answer: C
Conceptual Explanation: PAWP closely approximates LVEDP, providing information
about left-sided heart filling pressures.
4. A patient’s ABG results are: pH 7.22, PaCO2 60 mmHg, HCO3 26 mEq/L. What is the primary
acid-base disturbance?
A. Metabolic Acidosis
B. Metabolic Alkalosis
, C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: The low pH and high PaCO2 indicate a primary respiratory
acidosis with minimal renal compensation.
5. Which electrolyte abnormality is most likely to cause a prolonged QT interval and
potentially lead to Torsades de Pointes?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypomagnesemia
Answer: D
Conceptual Explanation: Hypomagnesemia (and hypokalemia/hypocalcemia) are known
to prolong the QT interval, increasing the risk for ventricular arrhythmias.
6. A patient with a suspected subarachnoid hemorrhage presents with a ‘thunderclap’
headache. What is the gold standard for diagnosing a cerebral aneurysm?
A. Non-contrast CT Head
B. Digital Subtraction Angiography (DSA)
C. Lumbar Puncture
