NR571 COMPLEX DIAGNOSIS &
MANAGEMENT IN ACUTE CARE
COMPREHENSIVE EXAM REVIEW
1. A patient in the ICU post-MI develops sudden hypotension, tachycardia, and a new
holosystolic murmur at the apex. The PA catheter shows a significant oxygen saturation
increase between the right atrium and the right ventricle. Which condition is most likely?
A. Acute Mitral Regurgitation
B. Ventricular Septal Rupture
C. Cardiac Tamponade
D. Right Ventricular Infarction
Answer: B
Conceptual Explanation: A step-up in oxygen saturation from the right atrium to the right
ventricle is pathognomonic for a ventricular septal rupture (VSR). Mitral regurgitation
would cause large V-waves on the PAOP tracing but not a right-sided oxygen step-up.
,2. When managing a patient with ARDS, which ventilatory strategy has been shown to
improve survival outcomes?
A. High tidal volumes to prevent atelectasis
B. Rapid weaning of PEEP to minimize barotrauma
C. Maintaining a pH >7.45 through hyperventilation
D. Low tidal volume (6 mL/kg PBW) and plateau pressure <30 cm H2O
Answer: D
Conceptual Explanation: The ARDSNet trial demonstrated that lung-protective
ventilation using low tidal volumes (6 mL/kg of predicted body weight) and limiting
plateau pressures reduces mortality.
3. A patient with a history of alcohol use disorder presents with confusion, ataxia, and
ophthalmoplegia. What is the priority pharmacological intervention?
A. Intravenous Dextrose 50% bolus
B. High-dose Intravenous Thiamine
C. Haloperidol for agitation
D. Normal Saline fluid resuscitation
Answer: B
, Conceptual Explanation: The triad of confusion, ataxia, and ophthalmoplegia suggests
Wernicke’s Encephalopathy. Thiamine must be given before dextrose to prevent worsening
of the condition.
4. In the management of Septic Shock, which is the preferred first-line vasopressor to
maintain a Mean Arterial Pressure (MAP) of ≥65 mmHg?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Answer: C
Conceptual Explanation: According to the Surviving Sepsis Campaign, Norepinephrine is
the first-line vasopressor of choice for septic shock due to its potent alpha-1 and mild beta-
1 effects.
5. A patient presents with a Serum Sodium of 118 mEq/L and is symptomatic with seizures.
What is the recommended rate of correction for the first 24 hours to avoid Central Pontine
Myelinolysis?
A. Increase sodium by 15-20 mEq/L
B. Decrease sodium by 5 mEq/L per hour
C. Immediate normalization to 140 mEq/L
MANAGEMENT IN ACUTE CARE
COMPREHENSIVE EXAM REVIEW
1. A patient in the ICU post-MI develops sudden hypotension, tachycardia, and a new
holosystolic murmur at the apex. The PA catheter shows a significant oxygen saturation
increase between the right atrium and the right ventricle. Which condition is most likely?
A. Acute Mitral Regurgitation
B. Ventricular Septal Rupture
C. Cardiac Tamponade
D. Right Ventricular Infarction
Answer: B
Conceptual Explanation: A step-up in oxygen saturation from the right atrium to the right
ventricle is pathognomonic for a ventricular septal rupture (VSR). Mitral regurgitation
would cause large V-waves on the PAOP tracing but not a right-sided oxygen step-up.
,2. When managing a patient with ARDS, which ventilatory strategy has been shown to
improve survival outcomes?
A. High tidal volumes to prevent atelectasis
B. Rapid weaning of PEEP to minimize barotrauma
C. Maintaining a pH >7.45 through hyperventilation
D. Low tidal volume (6 mL/kg PBW) and plateau pressure <30 cm H2O
Answer: D
Conceptual Explanation: The ARDSNet trial demonstrated that lung-protective
ventilation using low tidal volumes (6 mL/kg of predicted body weight) and limiting
plateau pressures reduces mortality.
3. A patient with a history of alcohol use disorder presents with confusion, ataxia, and
ophthalmoplegia. What is the priority pharmacological intervention?
A. Intravenous Dextrose 50% bolus
B. High-dose Intravenous Thiamine
C. Haloperidol for agitation
D. Normal Saline fluid resuscitation
Answer: B
, Conceptual Explanation: The triad of confusion, ataxia, and ophthalmoplegia suggests
Wernicke’s Encephalopathy. Thiamine must be given before dextrose to prevent worsening
of the condition.
4. In the management of Septic Shock, which is the preferred first-line vasopressor to
maintain a Mean Arterial Pressure (MAP) of ≥65 mmHg?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Phenylephrine
Answer: C
Conceptual Explanation: According to the Surviving Sepsis Campaign, Norepinephrine is
the first-line vasopressor of choice for septic shock due to its potent alpha-1 and mild beta-
1 effects.
5. A patient presents with a Serum Sodium of 118 mEq/L and is symptomatic with seizures.
What is the recommended rate of correction for the first 24 hours to avoid Central Pontine
Myelinolysis?
A. Increase sodium by 15-20 mEq/L
B. Decrease sodium by 5 mEq/L per hour
C. Immediate normalization to 140 mEq/L
