NR571 Final Exam Actual Exam Style V3 |
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient in the ICU presents with a Mean Arterial Pressure (MAP) of 50 mmHg, a Central
Venous Pressure (CVP) of 2 mmHg, and a Systemic Vascular Resistance (SVR) of 1400
dynes/sec/cm^-5. Which of the following is the most appropriate initial intervention?
A. Initiate a Norepinephrine infusion at 0.05 mcg/kg/min.
B. Administer Furosemide 40 mg IV push to reduce afterload.
C. Start a Dobutamine infusion to improve cardiac output.
D. Administer a 500 mL to 1000 mL bolus of isotonic crystalloid.
Correct Answer: D
Expert Explanation: The hemodynamic profile of low MAP, low CVP, and elevated SVR is
characteristic of hypovolemic shock. Initial management requires fluid resuscitation to
restore intravascular volume and improve preload. Systemic vascular resistance is high as
a compensatory mechanism, so vasopressors are not the first-line treatment until volume is
restored.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to prevent ventilator-associated lung injury (VALI)?
A. High tidal volumes of 10-12 mL/kg to ensure adequate CO2 clearance.
,B. Low tidal volumes of 6 mL/kg predicted body weight and plateau pressure < 30 cm H2O.
C. Inverse ratio ventilation with a fixed PEEP of 5 cm H2O.
D. Maintaining a PaO2 of 100 mmHg regardless of FiO2 levels.
Correct Answer: B
Expert Explanation: The ARDSNet protocol emphasizes lung-protective ventilation using
low tidal volumes to prevent volutrauma. Maintaining a plateau pressure below 30 cm H2O
helps prevent barotrauma and reduces the risk of alveolar overdistension. This approach
has been proven to decrease mortality in patients with severe respiratory failure.
3. A patient with septic shock remains hypotensive after 30 mL/kg of crystalloid resuscitation.
The nurse practitioner decides to initiate a first-line vasopressor. Which medication is the
gold standard?
A. Norepinephrine
B. Vasopressin
C. Phenylephrine
D. Epinephrine
Correct Answer: A
Expert Explanation: Norepinephrine is the first-line vasopressor recommended by the
Surviving Sepsis Campaign for septic shock. It provides potent alpha-1 agonist effects to
,increase SVR while having limited beta-1 effects on heart rate. Other agents like
Vasopressin are typically added if Norepinephrine fails to reach MAP targets.
4. During the management of Diabetic Ketoacidosis (DKA), at what point should the
intravenous fluid be changed to include 5% Dextrose?
A. When the patient’s blood glucose reaches 300 mg/dL.
B. When the blood glucose drops below 200-250 mg/dL.
C. When the serum potassium level is above 5.0 mEq/L.
D. Only after the anion gap has completely closed.
Correct Answer: B
Expert Explanation: Adding dextrose to intravenous fluids when glucose falls below 250
mg/dL prevents hypoglycemia during the ongoing insulin infusion. The insulin infusion
must continue until the anion gap closes and metabolic acidosis is resolved. This strategy
allows for the continued suppression of ketogenesis while maintaining safe plasma glucose
levels.
5. A patient with a traumatic brain injury (TBI) has an Intracranial Pressure (ICP) of 25 mmHg
and a MAP of 70 mmHg. What is the calculated Cerebral Perfusion Pressure (CPP), and is it
adequate?
A. CPP is 95 mmHg; this is excessively high.
B. CPP is 70 mmHg; this is the optimal target.
C. CPP is 45 mmHg; this is inadequate.
, D. CPP is 50 mmHg; this is within the normal range.
Correct Answer: C
Expert Explanation: Cerebral Perfusion Pressure (CPP) is calculated as MAP minus ICP
(70 - 25 = 45). The target CPP for patients with TBI is generally 60 to 70 mmHg to ensure
adequate brain oxygenation. A CPP of 45 mmHg puts the patient at significant risk for
secondary ischemic brain injury.
6. A patient with Acute Kidney Injury (AKI) is being evaluated for Continuous Renal
Replacement Therapy (CRRT). Which of the following is an absolute indication for starting
CRRT?
A. Serum creatinine of 2.1 mg/dL.
B. Mild peripheral edema responsive to diuretics.
C. Refractory hyperkalemia with EKG changes.
D. A urine output of 0.5 mL/kg/hr for 6 hours.
Correct Answer: C
Expert Explanation: Absolute indications for renal replacement therapy include the
‘AEIOU’ mnemonics: Acidosis, Electrolyte imbalances (specifically hyperkalemia),
Ingestions, Overload (fluid), and Uremia. Refractory hyperkalemia with EKG changes is a
life-threatening emergency requiring immediate clearance. Mild AKI stages or diuretic-
responsive edema do not necessitate emergent CRRT.
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient in the ICU presents with a Mean Arterial Pressure (MAP) of 50 mmHg, a Central
Venous Pressure (CVP) of 2 mmHg, and a Systemic Vascular Resistance (SVR) of 1400
dynes/sec/cm^-5. Which of the following is the most appropriate initial intervention?
A. Initiate a Norepinephrine infusion at 0.05 mcg/kg/min.
B. Administer Furosemide 40 mg IV push to reduce afterload.
C. Start a Dobutamine infusion to improve cardiac output.
D. Administer a 500 mL to 1000 mL bolus of isotonic crystalloid.
Correct Answer: D
Expert Explanation: The hemodynamic profile of low MAP, low CVP, and elevated SVR is
characteristic of hypovolemic shock. Initial management requires fluid resuscitation to
restore intravascular volume and improve preload. Systemic vascular resistance is high as
a compensatory mechanism, so vasopressors are not the first-line treatment until volume is
restored.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to prevent ventilator-associated lung injury (VALI)?
A. High tidal volumes of 10-12 mL/kg to ensure adequate CO2 clearance.
,B. Low tidal volumes of 6 mL/kg predicted body weight and plateau pressure < 30 cm H2O.
C. Inverse ratio ventilation with a fixed PEEP of 5 cm H2O.
D. Maintaining a PaO2 of 100 mmHg regardless of FiO2 levels.
Correct Answer: B
Expert Explanation: The ARDSNet protocol emphasizes lung-protective ventilation using
low tidal volumes to prevent volutrauma. Maintaining a plateau pressure below 30 cm H2O
helps prevent barotrauma and reduces the risk of alveolar overdistension. This approach
has been proven to decrease mortality in patients with severe respiratory failure.
3. A patient with septic shock remains hypotensive after 30 mL/kg of crystalloid resuscitation.
The nurse practitioner decides to initiate a first-line vasopressor. Which medication is the
gold standard?
A. Norepinephrine
B. Vasopressin
C. Phenylephrine
D. Epinephrine
Correct Answer: A
Expert Explanation: Norepinephrine is the first-line vasopressor recommended by the
Surviving Sepsis Campaign for septic shock. It provides potent alpha-1 agonist effects to
,increase SVR while having limited beta-1 effects on heart rate. Other agents like
Vasopressin are typically added if Norepinephrine fails to reach MAP targets.
4. During the management of Diabetic Ketoacidosis (DKA), at what point should the
intravenous fluid be changed to include 5% Dextrose?
A. When the patient’s blood glucose reaches 300 mg/dL.
B. When the blood glucose drops below 200-250 mg/dL.
C. When the serum potassium level is above 5.0 mEq/L.
D. Only after the anion gap has completely closed.
Correct Answer: B
Expert Explanation: Adding dextrose to intravenous fluids when glucose falls below 250
mg/dL prevents hypoglycemia during the ongoing insulin infusion. The insulin infusion
must continue until the anion gap closes and metabolic acidosis is resolved. This strategy
allows for the continued suppression of ketogenesis while maintaining safe plasma glucose
levels.
5. A patient with a traumatic brain injury (TBI) has an Intracranial Pressure (ICP) of 25 mmHg
and a MAP of 70 mmHg. What is the calculated Cerebral Perfusion Pressure (CPP), and is it
adequate?
A. CPP is 95 mmHg; this is excessively high.
B. CPP is 70 mmHg; this is the optimal target.
C. CPP is 45 mmHg; this is inadequate.
, D. CPP is 50 mmHg; this is within the normal range.
Correct Answer: C
Expert Explanation: Cerebral Perfusion Pressure (CPP) is calculated as MAP minus ICP
(70 - 25 = 45). The target CPP for patients with TBI is generally 60 to 70 mmHg to ensure
adequate brain oxygenation. A CPP of 45 mmHg puts the patient at significant risk for
secondary ischemic brain injury.
6. A patient with Acute Kidney Injury (AKI) is being evaluated for Continuous Renal
Replacement Therapy (CRRT). Which of the following is an absolute indication for starting
CRRT?
A. Serum creatinine of 2.1 mg/dL.
B. Mild peripheral edema responsive to diuretics.
C. Refractory hyperkalemia with EKG changes.
D. A urine output of 0.5 mL/kg/hr for 6 hours.
Correct Answer: C
Expert Explanation: Absolute indications for renal replacement therapy include the
‘AEIOU’ mnemonics: Acidosis, Electrolyte imbalances (specifically hyperkalemia),
Ingestions, Overload (fluid), and Uremia. Refractory hyperkalemia with EKG changes is a
life-threatening emergency requiring immediate clearance. Mild AKI stages or diuretic-
responsive edema do not necessitate emergent CRRT.
