NR571 Exam 4 Actual Exam Style V2 | NR
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient in the ICU is being monitored for hypovolemic shock. Which hemodynamic
finding would the nurse practitioner expect to observe?
A. Increased Central Venous Pressure (CVP)
B. Decreased Pulmonary Artery Wedge Pressure (PAWP)
C. Decreased Systemic Vascular Resistance (SVR)
D. Increased Cardiac Output (CO)
Correct Answer: B
Expert Explanation: In hypovolemic shock, there is a significant loss of intravascular
volume, which leads to decreased preload as reflected by a low PAWP and CVP. The body
attempts to compensate by increasing SVR through vasoconstriction, while the CO typically
falls due to low stroke volume. Understanding these trends helps clinicians differentiate
hypovolemia from other shock states like cardiogenic or distributive shock.
2. The nurse practitioner is managing a patient with Acute Respiratory Distress Syndrome
(ARDS). According to the Berlin definition, which PaO2/FiO2 ratio indicates severe ARDS?
A. PaO2/FiO2 ratio > 300 mmHg
B. PaO2/FiO2 ratio 200-300 mmHg
C. PaO2/FiO2 ratio 100-200 mmHg
,D. PaO2/FiO2 ratio < 100 mmHg
Correct Answer: D
Expert Explanation: The Berlin definition categorizes ARDS severity based on the
PaO2/FiO2 ratio with a PEEP of at least 5 cm H2O. Severe ARDS is defined as a ratio of less
than 100 mmHg, whereas moderate is 100-200 and mild is 200-300. Early identification of
severity is essential for determining if advanced therapies like prone positioning or ECMO
are warranted.
3. Which assessment finding is part of Beck’s Triad, indicating cardiac tamponade?
A. Distended neck veins
B. Widened pulse pressure
C. Hypertension
D. Tachycardia with a loud S1
Correct Answer: A
Expert Explanation: Beck’s Triad consists of muffled heart sounds, distended neck veins
(JVD), and hypotension. These signs occur because fluid accumulation in the pericardial sac
restricts ventricular filling and reduces cardiac output. Rapid recognition of these
symptoms is a medical emergency that usually requires immediate pericardiocentesis.
4. A patient on a ventilator has an Arterial Blood Gas (ABG) showing: pH 7.28, PaCO2 56
mmHg, PaO2 70 mmHg, and HCO3 26 mEq/L. How should this be interpreted?
A. Metabolic Acidosis
,B. Uncompensated Respiratory Acidosis
C. Compensated Respiratory Alkalosis
D. Uncompensated Metabolic Alkalosis
Correct Answer: B
Expert Explanation: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated
above 45 mmHg, which points to a respiratory cause. Since the bicarbonate (HCO3) level is
within the normal range (22-26), the body has not yet compensated for the imbalance. This
pattern suggests hypoventilation, and the ventilator settings may need to be adjusted to
increase minute ventilation.
5. Which medication is considered the first-line vasopressor for the management of septic
shock after adequate fluid resuscitation?
A. Norepinephrine
B. Vasopressin
C. Dobutamine
D. Epinephrine
Correct Answer: A
Expert Explanation: Norepinephrine (Levophed) is the primary vasopressor
recommended by the Surviving Sepsis Campaign because it effectively increases MAP with
less tachycardia than dopamine. It works primarily on alpha-1 receptors to cause
, vasoconstriction, thereby improving perfusion to vital organs. Vasopressin is often added
as a second agent, but it is not typically the initial choice.
6. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and EKG
changes showing peaked T waves. What is the immediate priority intervention?
A. Administering IV Calcium Gluconate
B. Administering oral Kayexalate
C. Initiating a low-potassium diet
D. Administering a bolus of Normal Saline
Correct Answer: A
Expert Explanation: IV Calcium Gluconate is the priority because it stabilizes the
myocardial cell membrane to prevent lethal arrhythmias caused by hyperkalemia. While it
does not lower the potassium level itself, it provides a window of safety while other
treatments like insulin/dextrose or dialysis are prepared. Following calcium, medications
to shift potassium into the cells or remove it from the body must be administered.
7. Which of the following is a classic sign of Neurogenic Shock following a high spinal cord
injury?
A. Tachycardia and Hypertension
B. Bradycardia and Hypotension
C. Tachycardia and Hypotension
571 Complex Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A patient in the ICU is being monitored for hypovolemic shock. Which hemodynamic
finding would the nurse practitioner expect to observe?
A. Increased Central Venous Pressure (CVP)
B. Decreased Pulmonary Artery Wedge Pressure (PAWP)
C. Decreased Systemic Vascular Resistance (SVR)
D. Increased Cardiac Output (CO)
Correct Answer: B
Expert Explanation: In hypovolemic shock, there is a significant loss of intravascular
volume, which leads to decreased preload as reflected by a low PAWP and CVP. The body
attempts to compensate by increasing SVR through vasoconstriction, while the CO typically
falls due to low stroke volume. Understanding these trends helps clinicians differentiate
hypovolemia from other shock states like cardiogenic or distributive shock.
2. The nurse practitioner is managing a patient with Acute Respiratory Distress Syndrome
(ARDS). According to the Berlin definition, which PaO2/FiO2 ratio indicates severe ARDS?
A. PaO2/FiO2 ratio > 300 mmHg
B. PaO2/FiO2 ratio 200-300 mmHg
C. PaO2/FiO2 ratio 100-200 mmHg
,D. PaO2/FiO2 ratio < 100 mmHg
Correct Answer: D
Expert Explanation: The Berlin definition categorizes ARDS severity based on the
PaO2/FiO2 ratio with a PEEP of at least 5 cm H2O. Severe ARDS is defined as a ratio of less
than 100 mmHg, whereas moderate is 100-200 and mild is 200-300. Early identification of
severity is essential for determining if advanced therapies like prone positioning or ECMO
are warranted.
3. Which assessment finding is part of Beck’s Triad, indicating cardiac tamponade?
A. Distended neck veins
B. Widened pulse pressure
C. Hypertension
D. Tachycardia with a loud S1
Correct Answer: A
Expert Explanation: Beck’s Triad consists of muffled heart sounds, distended neck veins
(JVD), and hypotension. These signs occur because fluid accumulation in the pericardial sac
restricts ventricular filling and reduces cardiac output. Rapid recognition of these
symptoms is a medical emergency that usually requires immediate pericardiocentesis.
4. A patient on a ventilator has an Arterial Blood Gas (ABG) showing: pH 7.28, PaCO2 56
mmHg, PaO2 70 mmHg, and HCO3 26 mEq/L. How should this be interpreted?
A. Metabolic Acidosis
,B. Uncompensated Respiratory Acidosis
C. Compensated Respiratory Alkalosis
D. Uncompensated Metabolic Alkalosis
Correct Answer: B
Expert Explanation: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated
above 45 mmHg, which points to a respiratory cause. Since the bicarbonate (HCO3) level is
within the normal range (22-26), the body has not yet compensated for the imbalance. This
pattern suggests hypoventilation, and the ventilator settings may need to be adjusted to
increase minute ventilation.
5. Which medication is considered the first-line vasopressor for the management of septic
shock after adequate fluid resuscitation?
A. Norepinephrine
B. Vasopressin
C. Dobutamine
D. Epinephrine
Correct Answer: A
Expert Explanation: Norepinephrine (Levophed) is the primary vasopressor
recommended by the Surviving Sepsis Campaign because it effectively increases MAP with
less tachycardia than dopamine. It works primarily on alpha-1 receptors to cause
, vasoconstriction, thereby improving perfusion to vital organs. Vasopressin is often added
as a second agent, but it is not typically the initial choice.
6. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and EKG
changes showing peaked T waves. What is the immediate priority intervention?
A. Administering IV Calcium Gluconate
B. Administering oral Kayexalate
C. Initiating a low-potassium diet
D. Administering a bolus of Normal Saline
Correct Answer: A
Expert Explanation: IV Calcium Gluconate is the priority because it stabilizes the
myocardial cell membrane to prevent lethal arrhythmias caused by hyperkalemia. While it
does not lower the potassium level itself, it provides a window of safety while other
treatments like insulin/dextrose or dialysis are prepared. Following calcium, medications
to shift potassium into the cells or remove it from the body must be administered.
7. Which of the following is a classic sign of Neurogenic Shock following a high spinal cord
injury?
A. Tachycardia and Hypertension
B. Bradycardia and Hypotension
C. Tachycardia and Hypotension
