NR571 Final Exam Actual Exam Style V2 |
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 62-year-old patient in the ICU is diagnosed with septic shock. After receiving 30 mL/kg of
crystalloids, the patient’s mean arterial pressure (MAP) remains 58 mmHg. Which of the
following is the first-line vasopressor for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Correct Answer: C
Expert Explanation: Norepinephrine is the first-line vasopressor recommended by the
Surviving Sepsis Campaign for patients who remain hypotensive despite adequate fluid
resuscitation. It acts primarily as an alpha-1 agonist to increase systemic vascular
resistance with minimal impact on heart rate. Clinical studies have shown norepinephrine
to have a lower risk of arrhythmias compared to dopamine in septic shock management.
,2. A patient with ARDS is being ventilated with high levels of PEEP. The nurse practitioner
notes a sudden drop in cardiac output and blood pressure. What is the most likely
physiological explanation?
A. Decreased left ventricular afterload
B. Increased venous return to the right atrium
C. Decreased venous return due to increased intrathoracic pressure
D. Improved alveolar recruitment leading to better oxygenation
Correct Answer: C
Expert Explanation: High levels of positive end-expiratory pressure (PEEP) increase
intrathoracic pressure, which can compress the vena cava. This compression leads to a
decrease in venous return (preload) to the right side of the heart. Consequently, the
reduced preload results in a decrease in stroke volume and overall cardiac output.
3. In a patient with Acute Kidney Injury (AKI), which of the following laboratory findings is
most indicative of a prerenal etiology?
A. Fractional excretion of sodium (FeNa) < 1%
B. Fractional excretion of sodium (FeNa) > 2%
C. BUN to Creatinine ratio of 10:1
D. Presence of muddy brown casts in the urine
Correct Answer: A
,Expert Explanation: A fractional excretion of sodium (FeNa) of less than 1% indicates that
the kidneys are still able to conserve sodium, suggesting that the injury is due to decreased
perfusion rather than intrinsic damage. Prerenal AKI is typically characterized by a high
BUN to Creatinine ratio, often greater than 20:1. In contrast, intrinsic AKI such as acute
tubular necrosis usually presents with an FeNa greater than 2% and cellular casts.
4. A patient presents with a suspected ischemic stroke. The symptoms started 2 hours ago.
Which of the following is the most critical initial step in management?
A. Administering 325 mg of Aspirin
B. Performing a lumbar puncture to rule out hemorrhage
C. Starting an IV heparin drip
D. Obtaining a non-contrast CT scan of the head
Correct Answer: D
Expert Explanation: The most critical initial step in the management of a suspected stroke
is obtaining a non-contrast CT scan of the head to differentiate between ischemic and
hemorrhagic stroke. This distinction is vital because the treatment for ischemic stroke
(fibrinolytics) is contraindicated in hemorrhagic stroke. Rapid imaging is the cornerstone
of the ‘Time is Brain’ philosophy in acute stroke protocols.
5. Which of the following hemodynamic profiles is most consistent with cardiogenic shock?
A. Low CVP, Low PAWP, High CO
B. Low CVP, Low PAWP, Low CO
, C. High CVP, High PAWP, Low CO
D. Normal CVP, Low PAWP, High CO
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by primary pump failure, leading
to a low cardiac output (CO). Because the heart cannot effectively eject blood, pressures
back up into the venous system and lungs, resulting in high central venous pressure (CVP)
and high pulmonary artery wedge pressure (PAWP). This profile distinguishes it from
hypovolemic shock, where all pressures are typically low.
6. A patient with liver cirrhosis presents with altered mental status and asterixis. Which
medication is the primary treatment for reducing ammonia levels in this patient?
A. Spironolactone
B. Furosemide
C. Lactulose
D. Propranolol
Correct Answer: C
Expert Explanation: Lactulose is the gold standard for treating hepatic encephalopathy by
promoting the excretion of ammonia through the stool. It works by acidifying the gut
environment, converting ammonia (NH3) into ammonium (NH4+), which is non-
absorbable. This process effectively lowers systemic ammonia levels and helps clear the
neurological symptoms associated with liver failure.
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 62-year-old patient in the ICU is diagnosed with septic shock. After receiving 30 mL/kg of
crystalloids, the patient’s mean arterial pressure (MAP) remains 58 mmHg. Which of the
following is the first-line vasopressor for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Correct Answer: C
Expert Explanation: Norepinephrine is the first-line vasopressor recommended by the
Surviving Sepsis Campaign for patients who remain hypotensive despite adequate fluid
resuscitation. It acts primarily as an alpha-1 agonist to increase systemic vascular
resistance with minimal impact on heart rate. Clinical studies have shown norepinephrine
to have a lower risk of arrhythmias compared to dopamine in septic shock management.
,2. A patient with ARDS is being ventilated with high levels of PEEP. The nurse practitioner
notes a sudden drop in cardiac output and blood pressure. What is the most likely
physiological explanation?
A. Decreased left ventricular afterload
B. Increased venous return to the right atrium
C. Decreased venous return due to increased intrathoracic pressure
D. Improved alveolar recruitment leading to better oxygenation
Correct Answer: C
Expert Explanation: High levels of positive end-expiratory pressure (PEEP) increase
intrathoracic pressure, which can compress the vena cava. This compression leads to a
decrease in venous return (preload) to the right side of the heart. Consequently, the
reduced preload results in a decrease in stroke volume and overall cardiac output.
3. In a patient with Acute Kidney Injury (AKI), which of the following laboratory findings is
most indicative of a prerenal etiology?
A. Fractional excretion of sodium (FeNa) < 1%
B. Fractional excretion of sodium (FeNa) > 2%
C. BUN to Creatinine ratio of 10:1
D. Presence of muddy brown casts in the urine
Correct Answer: A
,Expert Explanation: A fractional excretion of sodium (FeNa) of less than 1% indicates that
the kidneys are still able to conserve sodium, suggesting that the injury is due to decreased
perfusion rather than intrinsic damage. Prerenal AKI is typically characterized by a high
BUN to Creatinine ratio, often greater than 20:1. In contrast, intrinsic AKI such as acute
tubular necrosis usually presents with an FeNa greater than 2% and cellular casts.
4. A patient presents with a suspected ischemic stroke. The symptoms started 2 hours ago.
Which of the following is the most critical initial step in management?
A. Administering 325 mg of Aspirin
B. Performing a lumbar puncture to rule out hemorrhage
C. Starting an IV heparin drip
D. Obtaining a non-contrast CT scan of the head
Correct Answer: D
Expert Explanation: The most critical initial step in the management of a suspected stroke
is obtaining a non-contrast CT scan of the head to differentiate between ischemic and
hemorrhagic stroke. This distinction is vital because the treatment for ischemic stroke
(fibrinolytics) is contraindicated in hemorrhagic stroke. Rapid imaging is the cornerstone
of the ‘Time is Brain’ philosophy in acute stroke protocols.
5. Which of the following hemodynamic profiles is most consistent with cardiogenic shock?
A. Low CVP, Low PAWP, High CO
B. Low CVP, Low PAWP, Low CO
, C. High CVP, High PAWP, Low CO
D. Normal CVP, Low PAWP, High CO
Correct Answer: C
Expert Explanation: Cardiogenic shock is characterized by primary pump failure, leading
to a low cardiac output (CO). Because the heart cannot effectively eject blood, pressures
back up into the venous system and lungs, resulting in high central venous pressure (CVP)
and high pulmonary artery wedge pressure (PAWP). This profile distinguishes it from
hypovolemic shock, where all pressures are typically low.
6. A patient with liver cirrhosis presents with altered mental status and asterixis. Which
medication is the primary treatment for reducing ammonia levels in this patient?
A. Spironolactone
B. Furosemide
C. Lactulose
D. Propranolol
Correct Answer: C
Expert Explanation: Lactulose is the gold standard for treating hepatic encephalopathy by
promoting the excretion of ammonia through the stool. It works by acidifying the gut
environment, converting ammonia (NH3) into ammonium (NH4+), which is non-
absorbable. This process effectively lowers systemic ammonia levels and helps clear the
neurological symptoms associated with liver failure.
