NR571 Final Exam Actual Exam Style V1 |
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient in the ICU is diagnosed with septic shock. What is the recommended initial target
for Mean Arterial Pressure (MAP) according to the Surviving Sepsis Guidelines?
A. At least 65 mmHg
B. At least 55 mmHg
C. At least 80 mmHg
D. Exactly 75 mmHg
Correct Answer: A
Expert Explanation: The Surviving Sepsis Campaign recommends targeting a MAP of 65
mmHg in patients with septic shock requiring vasopressors. Maintaining this pressure
ensures adequate tissue perfusion to vital organs during the acute phase. Monitoring this
parameter is essential for evaluating the effectiveness of fluid resuscitation and
pharmacological interventions.
2. Which of the following hemodynamic profiles is most characteristic of cardiogenic shock?
A. Increased Cardiac Index, Decreased PAWP
B. Increased Cardiac Index, Increased PAWP
C. Decreased Cardiac Index, Decreased PAWP
,D. Decreased Cardiac Index, Increased PAWP
Correct Answer: D
Expert Explanation: Cardiogenic shock is characterized by a significant decrease in
cardiac output leading to a low cardiac index. Because the heart fails to pump effectively,
blood backs up into the pulmonary circulation, causing an increase in Pulmonary Artery
Wedge Pressure (PAWP). This distinction helps differentiate cardiogenic shock from
hypovolemic or distributive shock types.
3. A patient with ARDS is being mechanically ventilated. Which lung-protective strategy is
recommended to reduce mortality?
A. High tidal volumes (12 mL/kg)
B. Permissive Hypercapnia is contraindicated
C. Zero PEEP
D. Low tidal volumes (6 mL/kg)
Correct Answer: D
Expert Explanation: Low tidal volume ventilation (6 mL/kg of predicted body weight) is
the standard of care for ARDS to prevent ventilator-induced lung injury (VILI). This
strategy limits plateau pressures and reduces the risk of barotrauma and volutrauma.
Clinicians often allow permissive hypercapnia to occur while maintaining these protective
lung volumes.
, 4. Which electrolyte abnormality is most commonly associated with the administration of
large volumes of normal saline (0.9% NaCl)?
A. Hypochloremia
B. Hyponatremia
C. Hyperchloremic metabolic acidosis
D. Respiratory alkalosis
Correct Answer: C
Expert Explanation: Large volume resuscitation with Normal Saline can lead to
hyperchloremic metabolic acidosis due to the high chloride content. The excess chloride
ions lead to a decrease in the strong ion difference, resulting in an acidic pH. Alternative
balanced crystalloids like Lactated Ringer’s are often preferred to avoid this complication
in complex acute care patients.
5. A patient presents with sudden onset of hypotension, bradycardia, and warm/dry skin
following a spinal cord injury. Which type of shock is suspected?
A. Anaphylactic shock
B. Hypovolemic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: D
NR 571 Complex Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A patient in the ICU is diagnosed with septic shock. What is the recommended initial target
for Mean Arterial Pressure (MAP) according to the Surviving Sepsis Guidelines?
A. At least 65 mmHg
B. At least 55 mmHg
C. At least 80 mmHg
D. Exactly 75 mmHg
Correct Answer: A
Expert Explanation: The Surviving Sepsis Campaign recommends targeting a MAP of 65
mmHg in patients with septic shock requiring vasopressors. Maintaining this pressure
ensures adequate tissue perfusion to vital organs during the acute phase. Monitoring this
parameter is essential for evaluating the effectiveness of fluid resuscitation and
pharmacological interventions.
2. Which of the following hemodynamic profiles is most characteristic of cardiogenic shock?
A. Increased Cardiac Index, Decreased PAWP
B. Increased Cardiac Index, Increased PAWP
C. Decreased Cardiac Index, Decreased PAWP
,D. Decreased Cardiac Index, Increased PAWP
Correct Answer: D
Expert Explanation: Cardiogenic shock is characterized by a significant decrease in
cardiac output leading to a low cardiac index. Because the heart fails to pump effectively,
blood backs up into the pulmonary circulation, causing an increase in Pulmonary Artery
Wedge Pressure (PAWP). This distinction helps differentiate cardiogenic shock from
hypovolemic or distributive shock types.
3. A patient with ARDS is being mechanically ventilated. Which lung-protective strategy is
recommended to reduce mortality?
A. High tidal volumes (12 mL/kg)
B. Permissive Hypercapnia is contraindicated
C. Zero PEEP
D. Low tidal volumes (6 mL/kg)
Correct Answer: D
Expert Explanation: Low tidal volume ventilation (6 mL/kg of predicted body weight) is
the standard of care for ARDS to prevent ventilator-induced lung injury (VILI). This
strategy limits plateau pressures and reduces the risk of barotrauma and volutrauma.
Clinicians often allow permissive hypercapnia to occur while maintaining these protective
lung volumes.
, 4. Which electrolyte abnormality is most commonly associated with the administration of
large volumes of normal saline (0.9% NaCl)?
A. Hypochloremia
B. Hyponatremia
C. Hyperchloremic metabolic acidosis
D. Respiratory alkalosis
Correct Answer: C
Expert Explanation: Large volume resuscitation with Normal Saline can lead to
hyperchloremic metabolic acidosis due to the high chloride content. The excess chloride
ions lead to a decrease in the strong ion difference, resulting in an acidic pH. Alternative
balanced crystalloids like Lactated Ringer’s are often preferred to avoid this complication
in complex acute care patients.
5. A patient presents with sudden onset of hypotension, bradycardia, and warm/dry skin
following a spinal cord injury. Which type of shock is suspected?
A. Anaphylactic shock
B. Hypovolemic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: D
