NR571 FINAL EXAM STUDY GUIDE:
COMPLEX DIAGNOSIS &
MANAGEMENT IN ACUTE CARE
QUESTIONS AND ANSWERS
1. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid.
The provider initiates norepinephrine. What is the primary physiological rationale for
selecting norepinephrine as the first-line vasopressor?
A. It causes profound peripheral vasodilation to improve organ perfusion.
B. It primarily targets beta-2 receptors to increase cardiac output via chronotropy.
C. It increases mean arterial pressure via alpha-1 adrenergic receptor stimulation with
minimal increase in heart rate.
D. It acts as a pure venous constrictor to increase preload without affecting systemic
vascular resistance.
Answer: C
Conceptual Explanation: Norepinephrine is the first-line vasopressor in septic shock
because it is a potent alpha-1 agonist that increases SVR and MAP, while its beta-1 effects
provide moderate inotropic support with less tachycardia than dopamine.
,2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is essential for reducing ventilator-induced lung injury (VILI)?
A. High tidal volumes (10-12 mL/kg) to maximize alveolar recruitment.
B. Low tidal volumes (4-6 mL/kg) and maintaining plateau pressures below 30 cm H2O.
C. Maintenance of high FiO2 levels to ensure oxygen saturation remains at 100%.
D. Decreasing PEEP to zero to prevent barotrauma in stiff lungs.
Answer: B
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (4-6 mL/kg
predicted body weight) and limiting plateau pressure to less than 30 cm H2O is the
standard of care to prevent volutrauma and barotrauma in ARDS.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg and a
mean arterial pressure (MAP) of 75 mmHg. What is the calculated Cerebral Perfusion
Pressure (CPP), and is it adequate?
A. CPP is 97 mmHg; it is higher than the recommended range.
B. CPP is 53 mmHg; it is inadequate and below the target of 60-70 mmHg.
C. CPP is 65 mmHg; it is within the optimal target range.
D. CPP is 48 mmHg; it is dangerously low and requires immediate decompression.
Answer: B
, Conceptual Explanation: CPP is calculated as MAP minus ICP (75 - 22 = 53). For TBI
patients, the target CPP is generally 60-70 mmHg; 53 mmHg is inadequate and places the
patient at risk for secondary ischemic injury.
4. In the management of Diabetic Ketoacidosis (DKA), which laboratory parameter must be
resolved before transitioning from intravenous insulin to subcutaneous insulin?
A. Serum glucose must be less than 100 mg/dL.
B. Serum potassium must be greater than 5.5 mEq/L.
C. The anion gap must be closed (typically <12 mEq/L) and the patient must be able to eat.
D. Urine ketones must be completely absent for at least 24 hours.
Answer: C
Conceptual Explanation: Transitioning to subcutaneous insulin in DKA requires the
resolution of ketoacidosis, signaled by a closed anion gap and a normal serum bicarbonate,
alongside the patient’s ability to tolerate oral intake.
5. A patient with Acute Kidney Injury (AKI) is initiated on Continuous Renal Replacement
Therapy (CRRT). The nurse notes the ‘filtration fraction’ is exceeding 25%. What is the most
appropriate action to prevent filter clotting?
A. Decrease the blood flow rate (BFR).
B. Increase the blood flow rate or decrease the replacement/effluent rate.
C. Increase the ultrafiltration rate.
COMPLEX DIAGNOSIS &
MANAGEMENT IN ACUTE CARE
QUESTIONS AND ANSWERS
1. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid.
The provider initiates norepinephrine. What is the primary physiological rationale for
selecting norepinephrine as the first-line vasopressor?
A. It causes profound peripheral vasodilation to improve organ perfusion.
B. It primarily targets beta-2 receptors to increase cardiac output via chronotropy.
C. It increases mean arterial pressure via alpha-1 adrenergic receptor stimulation with
minimal increase in heart rate.
D. It acts as a pure venous constrictor to increase preload without affecting systemic
vascular resistance.
Answer: C
Conceptual Explanation: Norepinephrine is the first-line vasopressor in septic shock
because it is a potent alpha-1 agonist that increases SVR and MAP, while its beta-1 effects
provide moderate inotropic support with less tachycardia than dopamine.
,2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is essential for reducing ventilator-induced lung injury (VILI)?
A. High tidal volumes (10-12 mL/kg) to maximize alveolar recruitment.
B. Low tidal volumes (4-6 mL/kg) and maintaining plateau pressures below 30 cm H2O.
C. Maintenance of high FiO2 levels to ensure oxygen saturation remains at 100%.
D. Decreasing PEEP to zero to prevent barotrauma in stiff lungs.
Answer: B
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (4-6 mL/kg
predicted body weight) and limiting plateau pressure to less than 30 cm H2O is the
standard of care to prevent volutrauma and barotrauma in ARDS.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg and a
mean arterial pressure (MAP) of 75 mmHg. What is the calculated Cerebral Perfusion
Pressure (CPP), and is it adequate?
A. CPP is 97 mmHg; it is higher than the recommended range.
B. CPP is 53 mmHg; it is inadequate and below the target of 60-70 mmHg.
C. CPP is 65 mmHg; it is within the optimal target range.
D. CPP is 48 mmHg; it is dangerously low and requires immediate decompression.
Answer: B
, Conceptual Explanation: CPP is calculated as MAP minus ICP (75 - 22 = 53). For TBI
patients, the target CPP is generally 60-70 mmHg; 53 mmHg is inadequate and places the
patient at risk for secondary ischemic injury.
4. In the management of Diabetic Ketoacidosis (DKA), which laboratory parameter must be
resolved before transitioning from intravenous insulin to subcutaneous insulin?
A. Serum glucose must be less than 100 mg/dL.
B. Serum potassium must be greater than 5.5 mEq/L.
C. The anion gap must be closed (typically <12 mEq/L) and the patient must be able to eat.
D. Urine ketones must be completely absent for at least 24 hours.
Answer: C
Conceptual Explanation: Transitioning to subcutaneous insulin in DKA requires the
resolution of ketoacidosis, signaled by a closed anion gap and a normal serum bicarbonate,
alongside the patient’s ability to tolerate oral intake.
5. A patient with Acute Kidney Injury (AKI) is initiated on Continuous Renal Replacement
Therapy (CRRT). The nurse notes the ‘filtration fraction’ is exceeding 25%. What is the most
appropriate action to prevent filter clotting?
A. Decrease the blood flow rate (BFR).
B. Increase the blood flow rate or decrease the replacement/effluent rate.
C. Increase the ultrafiltration rate.
