NR571 MIDTERM EXAM: COMPLEX
DIAGNOSIS & MANAGEMENT IN
ACUTE CARE REVIEW
1. A patient in the ICU with ARDS is being ventilated with low tidal volume (6 mL/kg). Despite
a PEEP of 12 cmH2O and FiO2 of 0.80, the PaO2 remains 55 mmHg. What is the next most
appropriate evidence-based intervention?
A. Increase tidal volume to 10 mL/kg to improve minute ventilation
B. Decrease PEEP to 5 cmH2O to reduce intrathoracic pressure
C. Administer high-dose corticosteroids immediately
D. Initiate prone positioning for at least 16 hours per day
Answer: D
Conceptual Explanation: According to the PROSEVA trial, prone positioning for patients
with severe ARDS (PaO2/FiO2 < 150) significantly reduces mortality when performed for
prolonged periods.
,2. In a patient with Septic Shock, which hemodynamic parameter is the primary target for
initial fluid resuscitation according to the Surviving Sepsis Campaign guidelines?
A. Heart rate < 100 beats per minute
B. Central Venous Pressure (CVP) of 15-20 mmHg
C. Mean Arterial Pressure (MAP) ≥ 65 mmHg
D. Pulmonary Capillary Wedge Pressure (PCWP) of 18 mmHg
Answer: C
Conceptual Explanation: The current Surviving Sepsis guidelines recommend targeting a
MAP of at least 65 mmHg to ensure adequate tissue perfusion during the initial
resuscitation phase.
3. A patient presents with the following ABG: pH 7.28, PaCO2 55 mmHg, HCO3 28 mEq/L. How
would you classify this acid-base imbalance?
A. Partially Compensated Respiratory Acidosis
B. Compensated Metabolic Acidosis
C. Uncompensated Metabolic Alkalosis
D. Fully Compensated Respiratory Alkalosis
Answer: A
, Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (indicating
respiratory origin), and the HCO3 is elevated above normal (indicating the kidneys are
attempting to compensate), but the pH is not yet back to normal range.
4. Which of the following is a classic clinical manifestation of Beck’s Triad, indicating Cardiac
Tamponade?
A. Hypertension, bradycardia, and irregular respirations
B. Tachycardia, narrow pulse pressure, and clear breath sounds
C. Hypotension, muffled heart sounds, and jugular venous distention
D. Pulsus paradoxus, ST-segment elevation, and fever
Answer: C
Conceptual Explanation: Beck’s Triad consists of hypotension (low stroke volume),
muffled heart sounds (fluid in the pericardial sac), and JVD (impaired venous return to the
right heart).
5. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 25 mmHg.
The blood pressure is 110/70 mmHg. What is the calculated Cerebral Perfusion Pressure
(CPP), and is it adequate?
A. 58 mmHg; Inadequate
B. 85 mmHg; Adequate
C. 65 mmHg; Adequate
DIAGNOSIS & MANAGEMENT IN
ACUTE CARE REVIEW
1. A patient in the ICU with ARDS is being ventilated with low tidal volume (6 mL/kg). Despite
a PEEP of 12 cmH2O and FiO2 of 0.80, the PaO2 remains 55 mmHg. What is the next most
appropriate evidence-based intervention?
A. Increase tidal volume to 10 mL/kg to improve minute ventilation
B. Decrease PEEP to 5 cmH2O to reduce intrathoracic pressure
C. Administer high-dose corticosteroids immediately
D. Initiate prone positioning for at least 16 hours per day
Answer: D
Conceptual Explanation: According to the PROSEVA trial, prone positioning for patients
with severe ARDS (PaO2/FiO2 < 150) significantly reduces mortality when performed for
prolonged periods.
,2. In a patient with Septic Shock, which hemodynamic parameter is the primary target for
initial fluid resuscitation according to the Surviving Sepsis Campaign guidelines?
A. Heart rate < 100 beats per minute
B. Central Venous Pressure (CVP) of 15-20 mmHg
C. Mean Arterial Pressure (MAP) ≥ 65 mmHg
D. Pulmonary Capillary Wedge Pressure (PCWP) of 18 mmHg
Answer: C
Conceptual Explanation: The current Surviving Sepsis guidelines recommend targeting a
MAP of at least 65 mmHg to ensure adequate tissue perfusion during the initial
resuscitation phase.
3. A patient presents with the following ABG: pH 7.28, PaCO2 55 mmHg, HCO3 28 mEq/L. How
would you classify this acid-base imbalance?
A. Partially Compensated Respiratory Acidosis
B. Compensated Metabolic Acidosis
C. Uncompensated Metabolic Alkalosis
D. Fully Compensated Respiratory Alkalosis
Answer: A
, Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (indicating
respiratory origin), and the HCO3 is elevated above normal (indicating the kidneys are
attempting to compensate), but the pH is not yet back to normal range.
4. Which of the following is a classic clinical manifestation of Beck’s Triad, indicating Cardiac
Tamponade?
A. Hypertension, bradycardia, and irregular respirations
B. Tachycardia, narrow pulse pressure, and clear breath sounds
C. Hypotension, muffled heart sounds, and jugular venous distention
D. Pulsus paradoxus, ST-segment elevation, and fever
Answer: C
Conceptual Explanation: Beck’s Triad consists of hypotension (low stroke volume),
muffled heart sounds (fluid in the pericardial sac), and JVD (impaired venous return to the
right heart).
5. A patient with traumatic brain injury (TBI) has an intracranial pressure (ICP) of 25 mmHg.
The blood pressure is 110/70 mmHg. What is the calculated Cerebral Perfusion Pressure
(CPP), and is it adequate?
A. 58 mmHg; Inadequate
B. 85 mmHg; Adequate
C. 65 mmHg; Adequate
