NR572 Exam 3 Actual Exam Style V1 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid
fluids. Which of the following is the first-line vasopressor recommended for this patient?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Correct Answer: D
Expert Explanation: Norepinephrine is the first-choice vasopressor for maintaining a
mean arterial pressure of at least 65 mmHg in septic shock. It works primarily on alpha-1
receptors to increase systemic vascular resistance. Current guidelines prioritize its use
over dopamine due to a lower risk of arrhythmias.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator setting is prioritized to prevent ventilator-associated lung injury?
A. Low tidal volumes (6 mL/kg)
B. High tidal volumes (>10 mL/kg)
C. Low Positive End-Expiratory Pressure (PEEP)
,D. High Fraction of Inspired Oxygen (FiO2) alone
Correct Answer: A
Expert Explanation: The use of low tidal volumes, specifically 6 mL/kg of predicted body
weight, is a cornerstone of lung-protective ventilation in ARDS. This strategy helps reduce
volutrauma and barotrauma by preventing over-distension of the alveoli. It has been
shown to significantly reduce mortality in patients with severe respiratory failure.
3. A patient’s hemodynamic profile shows a Pulmonary Capillary Wedge Pressure (PCWP) of
22 mmHg, a Cardiac Index of 1.8 L/min/m², and high Systemic Vascular Resistance (SVR). This
profile is most consistent with:
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Anaphylactic shock
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by a high PCWP due to fluid
backing up in the left atrium and a low Cardiac Index from pump failure. The body
compensates for the low output by increasing SVR through vasoconstriction. In contrast,
septic shock usually presents with low SVR due to massive vasodilation.
, 4. Which clinical finding is part of the ‘Cushing’s Triad,’ indicating late-stage increased
intracranial pressure (ICP)?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Cheyne-Stokes breathing
C. Bradycardia, hypertension with widened pulse pressure, and irregular respirations
D. Bradycardia, hypotension, and apnea
Correct Answer: C
Expert Explanation: Cushing’s Triad is a physiological response to increased ICP that
signals impending brain herniation. It consists of systemic hypertension (widened pulse
pressure), bradycardia, and irregular respiratory patterns. Immediate intervention is
required when these signs are observed in a neurological patient.
5. In the management of Acute Kidney Injury (AKI), which of the following is the most
sensitive early indicator of declining renal function?
A. Serum Creatinine
B. Urine output monitoring
C. Blood Urea Nitrogen (BUN)
D. Glomerular Filtration Rate (GFR) calculation
Correct Answer: B
572 Advanced Acute Care Management |
Chamberlain
1. A patient with septic shock remains hypotensive despite receiving 30 mL/kg of crystalloid
fluids. Which of the following is the first-line vasopressor recommended for this patient?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Correct Answer: D
Expert Explanation: Norepinephrine is the first-choice vasopressor for maintaining a
mean arterial pressure of at least 65 mmHg in septic shock. It works primarily on alpha-1
receptors to increase systemic vascular resistance. Current guidelines prioritize its use
over dopamine due to a lower risk of arrhythmias.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator setting is prioritized to prevent ventilator-associated lung injury?
A. Low tidal volumes (6 mL/kg)
B. High tidal volumes (>10 mL/kg)
C. Low Positive End-Expiratory Pressure (PEEP)
,D. High Fraction of Inspired Oxygen (FiO2) alone
Correct Answer: A
Expert Explanation: The use of low tidal volumes, specifically 6 mL/kg of predicted body
weight, is a cornerstone of lung-protective ventilation in ARDS. This strategy helps reduce
volutrauma and barotrauma by preventing over-distension of the alveoli. It has been
shown to significantly reduce mortality in patients with severe respiratory failure.
3. A patient’s hemodynamic profile shows a Pulmonary Capillary Wedge Pressure (PCWP) of
22 mmHg, a Cardiac Index of 1.8 L/min/m², and high Systemic Vascular Resistance (SVR). This
profile is most consistent with:
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Anaphylactic shock
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by a high PCWP due to fluid
backing up in the left atrium and a low Cardiac Index from pump failure. The body
compensates for the low output by increasing SVR through vasoconstriction. In contrast,
septic shock usually presents with low SVR due to massive vasodilation.
, 4. Which clinical finding is part of the ‘Cushing’s Triad,’ indicating late-stage increased
intracranial pressure (ICP)?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Cheyne-Stokes breathing
C. Bradycardia, hypertension with widened pulse pressure, and irregular respirations
D. Bradycardia, hypotension, and apnea
Correct Answer: C
Expert Explanation: Cushing’s Triad is a physiological response to increased ICP that
signals impending brain herniation. It consists of systemic hypertension (widened pulse
pressure), bradycardia, and irregular respiratory patterns. Immediate intervention is
required when these signs are observed in a neurological patient.
5. In the management of Acute Kidney Injury (AKI), which of the following is the most
sensitive early indicator of declining renal function?
A. Serum Creatinine
B. Urine output monitoring
C. Blood Urea Nitrogen (BUN)
D. Glomerular Filtration Rate (GFR) calculation
Correct Answer: B
