NR571 FINAL EXAM PREP: COMPLEX
DIAGNOSIS & MANAGEMENT IN
ACUTE CARE QUESTIONS AND
ANSWERS
1. A patient with septic shock remains hypotensive despite adequate fluid resuscitation and
norepinephrine at 0.2 mcg/kg/min. The provider adds vasopressin. Which physiological effect
is the primary rationale for this addition?
A. To increase cardiac output via beta-1 stimulation.
B. To decrease the production of nitric oxide in the liver.
C. To induce peripheral vasodilation to improve renal perfusion.
D. To sensitize vascular smooth muscle to catecholamines.
Answer: D
Conceptual Explanation: In septic shock, vasopressin levels are often depleted. Adding
vasopressin helps restore vascular tone and increases the sensitivity of receptors to
catecholamines like norepinephrine.
,2. When managing a patient with ARDS, the provider employs a lung-protective ventilation
strategy. What is the target tidal volume and plateau pressure?
A. 10 mL/kg PBW; Plateau pressure < 40 cm H2O.
B. 8 mL/kg PBW; Plateau pressure < 35 cm H2O.
C. 6 mL/kg PBW; Plateau pressure < 30 cm H2O.
D. 4 mL/kg PBW; Plateau pressure < 25 cm H2O.
Answer: C
Conceptual Explanation: Evidence-based ARDS management recommends a low tidal
volume (6 mL/kg predicted body weight) and keeping plateau pressures below 30 cm H2O
to prevent ventilator-induced lung injury (VILI).
3. A patient presents with a MAP of 55 mmHg, CVP 18 mmHg, CI 1.8 L/min/m2, and PAOP 22
mmHg. Which type of shock is most likely occurring?
A. Hypovolemic shock
B. Distributive shock
C. Obstructive shock
D. Cardiogenic shock
Answer: D
, Conceptual Explanation: Cardiogenic shock is characterized by low cardiac index (CI),
high central venous pressure (CVP), and high pulmonary artery occlusion pressure (PAOP)
due to pump failure.
4. In the management of Diabetic Ketoacidosis (DKA), at what point should Dextrose be
added to the intravenous fluids?
A. When the blood glucose reaches 300 mg/dL.
B. As soon as the insulin drip is started.
C. When the blood glucose reaches 200 mg/dL.
D. Only after the anion gap has closed.
Answer: C
Conceptual Explanation: Dextrose (usually 5% Dextrose) is added to IV fluids when
glucose drops to 200 mg/dL to prevent hypoglycemia while the insulin infusion continues
to resolve the ketosis.
5. A patient with acute liver failure develops Grade III hepatic encephalopathy. Which
medication is the first-line treatment to lower ammonia levels?
A. Lactulose
B. Neomycin
C. Rifaximin
D. Metronidazole
DIAGNOSIS & MANAGEMENT IN
ACUTE CARE QUESTIONS AND
ANSWERS
1. A patient with septic shock remains hypotensive despite adequate fluid resuscitation and
norepinephrine at 0.2 mcg/kg/min. The provider adds vasopressin. Which physiological effect
is the primary rationale for this addition?
A. To increase cardiac output via beta-1 stimulation.
B. To decrease the production of nitric oxide in the liver.
C. To induce peripheral vasodilation to improve renal perfusion.
D. To sensitize vascular smooth muscle to catecholamines.
Answer: D
Conceptual Explanation: In septic shock, vasopressin levels are often depleted. Adding
vasopressin helps restore vascular tone and increases the sensitivity of receptors to
catecholamines like norepinephrine.
,2. When managing a patient with ARDS, the provider employs a lung-protective ventilation
strategy. What is the target tidal volume and plateau pressure?
A. 10 mL/kg PBW; Plateau pressure < 40 cm H2O.
B. 8 mL/kg PBW; Plateau pressure < 35 cm H2O.
C. 6 mL/kg PBW; Plateau pressure < 30 cm H2O.
D. 4 mL/kg PBW; Plateau pressure < 25 cm H2O.
Answer: C
Conceptual Explanation: Evidence-based ARDS management recommends a low tidal
volume (6 mL/kg predicted body weight) and keeping plateau pressures below 30 cm H2O
to prevent ventilator-induced lung injury (VILI).
3. A patient presents with a MAP of 55 mmHg, CVP 18 mmHg, CI 1.8 L/min/m2, and PAOP 22
mmHg. Which type of shock is most likely occurring?
A. Hypovolemic shock
B. Distributive shock
C. Obstructive shock
D. Cardiogenic shock
Answer: D
, Conceptual Explanation: Cardiogenic shock is characterized by low cardiac index (CI),
high central venous pressure (CVP), and high pulmonary artery occlusion pressure (PAOP)
due to pump failure.
4. In the management of Diabetic Ketoacidosis (DKA), at what point should Dextrose be
added to the intravenous fluids?
A. When the blood glucose reaches 300 mg/dL.
B. As soon as the insulin drip is started.
C. When the blood glucose reaches 200 mg/dL.
D. Only after the anion gap has closed.
Answer: C
Conceptual Explanation: Dextrose (usually 5% Dextrose) is added to IV fluids when
glucose drops to 200 mg/dL to prevent hypoglycemia while the insulin infusion continues
to resolve the ketosis.
5. A patient with acute liver failure develops Grade III hepatic encephalopathy. Which
medication is the first-line treatment to lower ammonia levels?
A. Lactulose
B. Neomycin
C. Rifaximin
D. Metronidazole
