NR571 Exam 4 Actual Exam Style V3 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with sepsis remains hypotensive after receiving a 30 mL/kg fluid bolus. Which of
the following is the first-choice vasopressor recommended by the Surviving Sepsis Campaign?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Correct Answer: D
Expert Explanation: Norepinephrine is the first-line vasopressor for maintaining a mean
arterial pressure of 65 mmHg in septic shock. It has potent alpha-adrenergic effects which
result in vasoconstriction without excessively increasing heart rate compared to dopamine.
Clinical evidence suggests that norepinephrine is more effective and associated with fewer
adverse events than other vasopressors in this population.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator setting is prioritized to minimize ventilator-induced lung injury?
A. High tidal volumes (12 mL/kg)
B. Low tidal volumes (6 mL/kg)
C. Low Positive End-Expiratory Pressure (PEEP)
,D. High FiO2 (100%) constantly
Correct Answer: B
Expert Explanation: The ARDSNet protocol recommends low tidal volume ventilation to
prevent volutrauma and barotrauma to the alveoli. By limiting tidal volumes to 6 mL/kg of
predicted body weight, clinicians can significantly reduce mortality in ARDS patients. This
strategy focuses on lung protection rather than immediate normalization of blood gases.
3. A patient presents with a GCS of 7 after a traumatic brain injury. What is the immediate
priority for the Advanced Practice Nurse?
A. Securing the airway via endotracheal intubation
B. Ordering a Stat CT of the head
C. Administering 20% Mannitol IV
D. Performing a complete neurological exam
Correct Answer: A
Expert Explanation: In any patient with a Glasgow Coma Scale (GCS) score of 8 or less,
airway protection is the highest priority. These patients are at high risk for aspiration and
inadequate ventilation due to decreased consciousness. Securing the airway ensures
oxygenation and allows for controlled ventilation to manage intracranial pressure if
necessary.
,4. A patient with heart failure is being monitored with a Pulmonary Artery (PA) catheter.
Which hemodynamic finding would be most consistent with cardiogenic shock?
A. PAWP of 6 mmHg and CO of 5.0 L/min
B. PAWP of 22 mmHg and CO of 1.8 L/min
C. PAWP of 10 mmHg and SVR of 800 dynes
D. CVP of 2 mmHg and MAP of 70 mmHg
Correct Answer: B
Expert Explanation: Cardiogenic shock is characterized by pump failure, leading to a low
cardiac output (CO) and elevated filling pressures like Pulmonary Artery Wedge Pressure
(PAWP). A PAWP greater than 15-18 mmHg and a low cardiac index are diagnostic
hallmarks of this condition. These findings indicate that the left ventricle is unable to
effectively eject blood, resulting in back-up into the pulmonary system.
5. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient?
A. CT Pulmonary Angiography (CTPA)
B. Ventilation-Perfusion (V/Q) scan
C. D-dimer assay
D. Chest X-ray
Correct Answer: A
, Expert Explanation: CT Pulmonary Angiography (CTPA) is currently the gold standard
and most common diagnostic tool for identifying a pulmonary embolism. It allows for
direct visualization of the pulmonary vasculature and can identify the specific location of a
thrombus. While a D-dimer is useful for ruling out PE in low-risk patients, it lacks the
specificity needed for a definitive diagnosis.
6. During the resuscitation of a patient with a major burn, the Parkland Formula is used to
calculate fluid requirements. How much of the total calculated volume should be given in the
first 8 hours?
A. 25%
B. 75%
C. 50%
D. 100%
Correct Answer: C
Expert Explanation: The Parkland Formula calculates the total fluid resuscitation needed
for the first 24 hours post-burn (4mL x kg x %TBSA). Exactly half of this total volume is
administered within the first 8 hours following the actual time of the burn injury. The
remaining half is distributed over the subsequent 16 hours to maintain organ perfusion
and prevent hypovolemic shock.
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient with sepsis remains hypotensive after receiving a 30 mL/kg fluid bolus. Which of
the following is the first-choice vasopressor recommended by the Surviving Sepsis Campaign?
A. Dopamine
B. Epinephrine
C. Vasopressin
D. Norepinephrine
Correct Answer: D
Expert Explanation: Norepinephrine is the first-line vasopressor for maintaining a mean
arterial pressure of 65 mmHg in septic shock. It has potent alpha-adrenergic effects which
result in vasoconstriction without excessively increasing heart rate compared to dopamine.
Clinical evidence suggests that norepinephrine is more effective and associated with fewer
adverse events than other vasopressors in this population.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator setting is prioritized to minimize ventilator-induced lung injury?
A. High tidal volumes (12 mL/kg)
B. Low tidal volumes (6 mL/kg)
C. Low Positive End-Expiratory Pressure (PEEP)
,D. High FiO2 (100%) constantly
Correct Answer: B
Expert Explanation: The ARDSNet protocol recommends low tidal volume ventilation to
prevent volutrauma and barotrauma to the alveoli. By limiting tidal volumes to 6 mL/kg of
predicted body weight, clinicians can significantly reduce mortality in ARDS patients. This
strategy focuses on lung protection rather than immediate normalization of blood gases.
3. A patient presents with a GCS of 7 after a traumatic brain injury. What is the immediate
priority for the Advanced Practice Nurse?
A. Securing the airway via endotracheal intubation
B. Ordering a Stat CT of the head
C. Administering 20% Mannitol IV
D. Performing a complete neurological exam
Correct Answer: A
Expert Explanation: In any patient with a Glasgow Coma Scale (GCS) score of 8 or less,
airway protection is the highest priority. These patients are at high risk for aspiration and
inadequate ventilation due to decreased consciousness. Securing the airway ensures
oxygenation and allows for controlled ventilation to manage intracranial pressure if
necessary.
,4. A patient with heart failure is being monitored with a Pulmonary Artery (PA) catheter.
Which hemodynamic finding would be most consistent with cardiogenic shock?
A. PAWP of 6 mmHg and CO of 5.0 L/min
B. PAWP of 22 mmHg and CO of 1.8 L/min
C. PAWP of 10 mmHg and SVR of 800 dynes
D. CVP of 2 mmHg and MAP of 70 mmHg
Correct Answer: B
Expert Explanation: Cardiogenic shock is characterized by pump failure, leading to a low
cardiac output (CO) and elevated filling pressures like Pulmonary Artery Wedge Pressure
(PAWP). A PAWP greater than 15-18 mmHg and a low cardiac index are diagnostic
hallmarks of this condition. These findings indicate that the left ventricle is unable to
effectively eject blood, resulting in back-up into the pulmonary system.
5. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient?
A. CT Pulmonary Angiography (CTPA)
B. Ventilation-Perfusion (V/Q) scan
C. D-dimer assay
D. Chest X-ray
Correct Answer: A
, Expert Explanation: CT Pulmonary Angiography (CTPA) is currently the gold standard
and most common diagnostic tool for identifying a pulmonary embolism. It allows for
direct visualization of the pulmonary vasculature and can identify the specific location of a
thrombus. While a D-dimer is useful for ruling out PE in low-risk patients, it lacks the
specificity needed for a definitive diagnosis.
6. During the resuscitation of a patient with a major burn, the Parkland Formula is used to
calculate fluid requirements. How much of the total calculated volume should be given in the
first 8 hours?
A. 25%
B. 75%
C. 50%
D. 100%
Correct Answer: C
Expert Explanation: The Parkland Formula calculates the total fluid resuscitation needed
for the first 24 hours post-burn (4mL x kg x %TBSA). Exactly half of this total volume is
administered within the first 8 hours following the actual time of the burn injury. The
remaining half is distributed over the subsequent 16 hours to maintain organ perfusion
and prevent hypovolemic shock.
