NR572 | NR 572 Midterm Week 1- 4
Exam | Advanced Acute Care
Management Exam | 100% Correctly
Answered & Rated A+ | Chamberlain
You are called to the bedside of a 60-year-old woman who was
hospitalized for pneumonia. She has become acutely agitated and
confused. Her vital signs are as follows: Temperature is 39.0 °C (102.2
°F), blood pressure is 90/60 mm Hg, pulse rate is 100/min, and
respiration rate is 24/min. SpO2 has improved from 80% to 92% with 4 L
NC. You suspect sepsis and decide to initiate intravenous fluid
resuscitation. Which of the following resuscitation therapies is
contraindicated in this patient?
a. Albumin
b.Hetastarch
c. Isotonic crystalloids
d. Lactated Ringer solution
- Correct Answer - b. Hetastarch
Rationale: Isotonic crystalloids (which include LR) and albumin are
appropriate fluids for volume resuscitation in the initial treatment of
sepsis. Hetastarch (Hespan) should be avoided due to an increased risk
for AKI.
,SOFA is a bedside tool to identify high-risk patients for adverse
outcomes due to sepsis. The tool is based on which three parameters?
a. Hypotension, tachycardia, and tachypnea
b. Altered mental status, tachycardia, and oliguria
c. Hypotension, hypoxia, and hypoalbuminemia
d. Hypotension, altered mental status, and tachypnea
- Correct Answer - d. Hypotension, altered mental status, and tachypnea.
Rationale: SOFA is based on 3 parameters that can easily be
remembered by the acronym "HAT": hypotension, altered mental status,
and tachypnea.
what type of sepsis patient would benefit from the use of antifungals?
- Correct Answer - pt at risk for fungal infections (TPN admin, recent abd
surgery, chronic steroid use.) Empirical antifungal therapy should be
administered only to septic patients at high risk for invasive candidiasis
what is the first line vasopressor for severe sepsis or septic shock?
- Correct Answer - norep- inephrine (0.01-3.00 mcg/kg/min)
how does cardiac tamponade occur?
- Correct Answer - when a large effusion occurs rapidly, the pericardium
cannot stretch enough to accommodate the sudden volume of fluid
without negatively impacting cardiac output.
When the volume of fluid exceeds the ability of the heart to maintain
,adequate cardiac output, symptoms of obstructive shock occur. -is a life-
threatening situation that requires rapid intervention.
risk factors of cardiac tamponade
- Correct Answer - idiopathic - in most cases, patients with pericardial
disease do not have an identifiable etiology (presumed to be
autoimmune or viral)
infection - most often occurs due to a viral source but can also be
caused by fungus, bacteria, or parasite autoimmune -associated with
numerous autoimmune conditions including rheumatoid arthritis, lupus,
scleroderma, Sjogren's, inflammatory bowel disease
iatrogenic - resulting from cardiothoracic surgery, CPR, pacemaker
perforation, or catheter perforation
malignancy - can occur with metastatic disease from Hodgkin's disease,
breast or lung cancer. Can also occur with rhabdomyosarcoma, fibroma,
angioma, or teratoma as well as with paraneoplastic syndrome.
drugs - certain drugs such as isoniazid, procainamide, or hydralazine are
associated with cardiac tamponade cardiac trauma radiation dissecting
aortic aneurysm hypothyroidism uremia
What is Beck's triad?
- Correct Answer - Hypotension, Muffled Heart Sounds, JVD
*Caracteristic for Cardiac Tamponade*
objective findings in cardiac tamponade
, - Correct Answer –
-tachycardia
-hypotension
-pericardial rub
-becks triad
-JVD
-pulsus paradoxus (Significant decrease in systolic blood pressure, (>10
mmHg) that occurs with inspiration)
what is the gold standard dx tool for cardiac tamponade
- Correct Answer - If there is hemodynamic compromise, a pericardio-
centesis is necessary to relieve fluid accumulation.
A 70-year-old female with a history of coronary artery disease, hyper-
tension, arthritis, and breast cancer presents with dyspnea on exertion
and dizziness slowly progressing over the past 2 weeks. Today she
reports acute worsening of these symptoms and new onset chest pain.
Vital signs are as follows: BP is 92/50, HR 118, RR 24, and SpO2 88%
on room air. Physical exam reveals muffled heart sounds, JVD, and
peripheral edema. Breath sounds are equal, and trachea is midline. Her
carotid pulse disappears during inspiration. Laboratory studies are
normal. Which of the following is the best initial man- agement of this
patient?
- Correct Answer - ECG findings in pericarditis
diffuse ST elevation and PR depression
Exam | Advanced Acute Care
Management Exam | 100% Correctly
Answered & Rated A+ | Chamberlain
You are called to the bedside of a 60-year-old woman who was
hospitalized for pneumonia. She has become acutely agitated and
confused. Her vital signs are as follows: Temperature is 39.0 °C (102.2
°F), blood pressure is 90/60 mm Hg, pulse rate is 100/min, and
respiration rate is 24/min. SpO2 has improved from 80% to 92% with 4 L
NC. You suspect sepsis and decide to initiate intravenous fluid
resuscitation. Which of the following resuscitation therapies is
contraindicated in this patient?
a. Albumin
b.Hetastarch
c. Isotonic crystalloids
d. Lactated Ringer solution
- Correct Answer - b. Hetastarch
Rationale: Isotonic crystalloids (which include LR) and albumin are
appropriate fluids for volume resuscitation in the initial treatment of
sepsis. Hetastarch (Hespan) should be avoided due to an increased risk
for AKI.
,SOFA is a bedside tool to identify high-risk patients for adverse
outcomes due to sepsis. The tool is based on which three parameters?
a. Hypotension, tachycardia, and tachypnea
b. Altered mental status, tachycardia, and oliguria
c. Hypotension, hypoxia, and hypoalbuminemia
d. Hypotension, altered mental status, and tachypnea
- Correct Answer - d. Hypotension, altered mental status, and tachypnea.
Rationale: SOFA is based on 3 parameters that can easily be
remembered by the acronym "HAT": hypotension, altered mental status,
and tachypnea.
what type of sepsis patient would benefit from the use of antifungals?
- Correct Answer - pt at risk for fungal infections (TPN admin, recent abd
surgery, chronic steroid use.) Empirical antifungal therapy should be
administered only to septic patients at high risk for invasive candidiasis
what is the first line vasopressor for severe sepsis or septic shock?
- Correct Answer - norep- inephrine (0.01-3.00 mcg/kg/min)
how does cardiac tamponade occur?
- Correct Answer - when a large effusion occurs rapidly, the pericardium
cannot stretch enough to accommodate the sudden volume of fluid
without negatively impacting cardiac output.
When the volume of fluid exceeds the ability of the heart to maintain
,adequate cardiac output, symptoms of obstructive shock occur. -is a life-
threatening situation that requires rapid intervention.
risk factors of cardiac tamponade
- Correct Answer - idiopathic - in most cases, patients with pericardial
disease do not have an identifiable etiology (presumed to be
autoimmune or viral)
infection - most often occurs due to a viral source but can also be
caused by fungus, bacteria, or parasite autoimmune -associated with
numerous autoimmune conditions including rheumatoid arthritis, lupus,
scleroderma, Sjogren's, inflammatory bowel disease
iatrogenic - resulting from cardiothoracic surgery, CPR, pacemaker
perforation, or catheter perforation
malignancy - can occur with metastatic disease from Hodgkin's disease,
breast or lung cancer. Can also occur with rhabdomyosarcoma, fibroma,
angioma, or teratoma as well as with paraneoplastic syndrome.
drugs - certain drugs such as isoniazid, procainamide, or hydralazine are
associated with cardiac tamponade cardiac trauma radiation dissecting
aortic aneurysm hypothyroidism uremia
What is Beck's triad?
- Correct Answer - Hypotension, Muffled Heart Sounds, JVD
*Caracteristic for Cardiac Tamponade*
objective findings in cardiac tamponade
, - Correct Answer –
-tachycardia
-hypotension
-pericardial rub
-becks triad
-JVD
-pulsus paradoxus (Significant decrease in systolic blood pressure, (>10
mmHg) that occurs with inspiration)
what is the gold standard dx tool for cardiac tamponade
- Correct Answer - If there is hemodynamic compromise, a pericardio-
centesis is necessary to relieve fluid accumulation.
A 70-year-old female with a history of coronary artery disease, hyper-
tension, arthritis, and breast cancer presents with dyspnea on exertion
and dizziness slowly progressing over the past 2 weeks. Today she
reports acute worsening of these symptoms and new onset chest pain.
Vital signs are as follows: BP is 92/50, HR 118, RR 24, and SpO2 88%
on room air. Physical exam reveals muffled heart sounds, JVD, and
peripheral edema. Breath sounds are equal, and trachea is midline. Her
carotid pulse disappears during inspiration. Laboratory studies are
normal. Which of the following is the best initial man- agement of this
patient?
- Correct Answer - ECG findings in pericarditis
diffuse ST elevation and PR depression
