NR572 Exam 2 Actual Exam Style V3 | NR
572 Advanced Acute Care Management |
Chamberlain
1. A patient in septic shock remains hypotensive after receiving 30 mL/kg of isotonic
crystalloids. The provider orders Norepinephrine. Which hemodynamic parameter is the
primary target for this medication?
A. Increase Systemic Vascular Resistance (SVR)
B. Decrease Heart Rate
C. Decrease Pulmonary Artery Wedge Pressure (PAWP)
D. Increase Stroke Volume Variation (SVV)
Correct Answer: A
Expert Explanation: Norepinephrine acts primarily as an alpha-1 agonist to cause
vasoconstriction, thereby increasing systemic vascular resistance. This intervention is
crucial in distributive shock where vasodilation is the primary pathophysiology. Proper
titration is required to maintain a Mean Arterial Pressure (MAP) of at least 65 mmHg.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), the nurse
practitioner implements a lung-protective ventilation strategy. Which setting is most critical
for this strategy?
A. Low tidal volumes (4-6 mL/kg)
B. High tidal volumes (10-12 mL/kg)
,C. Inverse ratio ventilation 4:1
D. Zero Positive End-Expiratory Pressure (PEEP)
Correct Answer: A
Expert Explanation: Low tidal volume ventilation is essential to prevent ventilator-
induced lung injury such as volutrauma and barotrauma. By limiting the volume of air
delivered, the pressure on the alveoli is reduced, which has been shown to improve
mortality in ARDS patients. This strategy often requires allowing for permissive
hypercapnia as long as the pH remains within a safe range.
3. A patient with a suspected intracranial hemorrhage has an Intracranial Pressure (ICP) of 25
mmHg. Which of the following is the most appropriate initial pharmacological intervention?
A. Nitroprusside infusion
B. Hypotonic saline (0.45% NaCl)
C. High-dose Heparin bolus
D. Mannitol 20% intravenously
Correct Answer: D
Expert Explanation: Mannitol is an osmotic diuretic that creates an osmotic gradient to
pull fluid from the brain tissue into the vascular space. This helps reduce cerebral edema
and lower intracranial pressure effectively. It is vital to monitor serum osmolality and renal
function during administration to avoid complications.
, 4. In a patient with Acute Kidney Injury (AKI), the nurse practitioner notes a serum potassium
level of 6.8 mEq/L and EKG changes (peaked T-waves). What is the priority intervention?
A. Administer intravenous Calcium Gluconate
B. Administer Sodium Polystyrene Sulfonate (Kayexalate) orally
C. Start a 24-hour urine collection
D. Order a stat Renal Ultrasound
Correct Answer: A
Expert Explanation: Intravenous calcium gluconate is administered to stabilize the
myocardial cell membrane and prevent life-threatening arrhythmias associated with
hyperkalemia. While it does not lower the potassium level itself, it provides immediate
cardioprotection. This intervention must be followed by therapies that shift potassium into
the cells or remove it from the body.
5. A patient with Acute Pancreatitis develops sudden shortness of breath and a PaO2/FiO2
ratio of 150. What complication should the nurse practitioner suspect?
A. Pulmonary Embolism
B. Acute Respiratory Distress Syndrome (ARDS)
C. Congestive Heart Failure
D. Aspiration Pneumonia
Correct Answer: B
572 Advanced Acute Care Management |
Chamberlain
1. A patient in septic shock remains hypotensive after receiving 30 mL/kg of isotonic
crystalloids. The provider orders Norepinephrine. Which hemodynamic parameter is the
primary target for this medication?
A. Increase Systemic Vascular Resistance (SVR)
B. Decrease Heart Rate
C. Decrease Pulmonary Artery Wedge Pressure (PAWP)
D. Increase Stroke Volume Variation (SVV)
Correct Answer: A
Expert Explanation: Norepinephrine acts primarily as an alpha-1 agonist to cause
vasoconstriction, thereby increasing systemic vascular resistance. This intervention is
crucial in distributive shock where vasodilation is the primary pathophysiology. Proper
titration is required to maintain a Mean Arterial Pressure (MAP) of at least 65 mmHg.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), the nurse
practitioner implements a lung-protective ventilation strategy. Which setting is most critical
for this strategy?
A. Low tidal volumes (4-6 mL/kg)
B. High tidal volumes (10-12 mL/kg)
,C. Inverse ratio ventilation 4:1
D. Zero Positive End-Expiratory Pressure (PEEP)
Correct Answer: A
Expert Explanation: Low tidal volume ventilation is essential to prevent ventilator-
induced lung injury such as volutrauma and barotrauma. By limiting the volume of air
delivered, the pressure on the alveoli is reduced, which has been shown to improve
mortality in ARDS patients. This strategy often requires allowing for permissive
hypercapnia as long as the pH remains within a safe range.
3. A patient with a suspected intracranial hemorrhage has an Intracranial Pressure (ICP) of 25
mmHg. Which of the following is the most appropriate initial pharmacological intervention?
A. Nitroprusside infusion
B. Hypotonic saline (0.45% NaCl)
C. High-dose Heparin bolus
D. Mannitol 20% intravenously
Correct Answer: D
Expert Explanation: Mannitol is an osmotic diuretic that creates an osmotic gradient to
pull fluid from the brain tissue into the vascular space. This helps reduce cerebral edema
and lower intracranial pressure effectively. It is vital to monitor serum osmolality and renal
function during administration to avoid complications.
, 4. In a patient with Acute Kidney Injury (AKI), the nurse practitioner notes a serum potassium
level of 6.8 mEq/L and EKG changes (peaked T-waves). What is the priority intervention?
A. Administer intravenous Calcium Gluconate
B. Administer Sodium Polystyrene Sulfonate (Kayexalate) orally
C. Start a 24-hour urine collection
D. Order a stat Renal Ultrasound
Correct Answer: A
Expert Explanation: Intravenous calcium gluconate is administered to stabilize the
myocardial cell membrane and prevent life-threatening arrhythmias associated with
hyperkalemia. While it does not lower the potassium level itself, it provides immediate
cardioprotection. This intervention must be followed by therapies that shift potassium into
the cells or remove it from the body.
5. A patient with Acute Pancreatitis develops sudden shortness of breath and a PaO2/FiO2
ratio of 150. What complication should the nurse practitioner suspect?
A. Pulmonary Embolism
B. Acute Respiratory Distress Syndrome (ARDS)
C. Congestive Heart Failure
D. Aspiration Pneumonia
Correct Answer: B
