NR571/ NR 571 Midterm Exam (New 2024/
2025 Update) Complex Diagnosis &
Management in Acute Care Review|
Questions and Verified Answers| 100%
Correct | A Grade – Chamberlain
QUESTION
IAIpatientIisIadmittedIinIcardiogenicIshock,IremainsIhypotensiveIonInorep-
IinephrineIbitartrateIandIepinephrine,IandIhasIanIImpellaIplanted.ITheIAGACNPIshould:
A.IReferItoIextracorporealImembraneIoxygenationI(ECMO)Icenter
B.IStartImilrinoneIinfusion
C.IPrescribeIfurosemideI(Lasix)
D.IAddIaIbetaIblocker
Answer:
IIA.IReferItoIextracorporealImembraneIoxygenation
(ECMO)Icenter
TheIpatientIisIinIrefractoryIcardiogenicIshockIandIshouldIbeIreferredItoIanIECMO
center.IMilrinone,IfurosemideI(Lasix),IandIbetaIblockersIareIcontraindicated.I
I
QUESTION
IAIpatientIisIadmittedIforItheIfourthItimeIthisIyearIwithIanIexacerbationIofIheartIfailureIdespit
eIoptimalItherapyIforItheIpastI3ImonthsIandInowIrequiresIintravenousIdobutamine.IVitalIsignsI
areItemperatureI37°C,IheartIrateI120Ibeats/min,IrespiratoryIrateI22Ibreaths/min,IbloodIpressure
I86/48ImmHg,IandIoxygenIsaturationI95%IonI2ILInasalIcannula.ITheIAGACNPIshould:
A.IReferItoIextracorporealImembraneIoxygenationI(ECMO)IcenterIB.IReferItoIaIventricularIas
sistIdeviceI(VAD)-capableIfacilityIC.IAdministerIaIfluidIbolus
D.IAddIanIepinephrineIinfusion
Answer:
IIB.IReferItoIaIventricularIassistIdevice
(VAD)-capableIfacility
TheIpatientImeetsIcriteriaIforIevaluationIforIaIVAD.IECMOIisInotIindicatedIatIthisItime.IFluid
IbolusIandIepinephrineIareInotIrecommendedItreatmentIoptionsIforIthisIpatient.I
,QUESTION
IWhenIcalculatingItheIprobabilityIthatIaIpatientIhasIaIpulmonaryIembolism
(PE),IwhichIofItheIfollowingItoolsIshouldIbeIused?IA.IPulmonaryIEmbolismISeverityIIndexI(P
ESI)IB.IVirchow'sItriad
C.IModifiedIWells'Icriteria
D.IElectrocardiogramI(EKG)
Answer:
IIC.IModifiedIWells'Icriteria
TheIModifiedIWells'IcriteriaIisIaIscoringItoolIthatIallowsItheIclinicianItoIcalculateItheIprobabil
ityIthatIaIpatientIhasIaIPEIbasedIonItheIpresenceIofIcertainIclinicalIsigns,IpatientIhistory,IandI
currentIpresentation.ITheIPESIIisIaItoolIthatIpredictsItheI30-
dayImortalityIforIpatientsIwithIPE.IItIdoesInotIcalculateItheIprobabilityIofItheIpresenceIofIPE.I
Virchow'sItriadIdescribesItheIthreeIfactorsIrequiredIforIdevelopmentIofIvenousIthromboemboli
sm:Ihypercoagulability,IvenousIstasis,IandIendothelialIinjury.IItIis
notIaIclinicalIpredictionItool.IAnIEKGImayIbeIhelpfulIinItheIdiagnosisIofIPEIifIanIS1T3Q3Iis
Ipresent.IItIisInotIaIclinicalIpredictionItool,Ihowever,IandIdoesInotIcalculateIprobability.I
QUESTION
IPotentiallyIreversibleIcausesIofIpulselessIelectricalIactivityI(PEA)IandIasystoleIincludeIwhich
IofItheIfollowing?
A.IHypoxia,Ihypovolemia,Ihypothermia,Itetany
B.ITensionIpneumothorax,Ithrombosis,Itoxins,IhypernatremiaIC.IHypothermia,Ihypervolemia,Ic
ardiacItamponade,ItensionIpneumothoraxID.IHypokalemia,Ihypothermia,IhydrogenIionIacidosis
,IcardiacItamponade
Answer:
IAn-
Iswer:ID.IHypokalemia,Ihypothermia,IhydrogenIionIacidosis,IcardiacItamponadeIPotentiallyIre
versibleIcausesIofIPEAIandIasystoleIareIknownIasItheI"HsIandITs.I"ITheseIincludeIhypokalem
ia,Ihyperkalemia,Ihypovolemia,Ihypothermia,IhydrogenIionIacidosis,Ihypoxia,ItensionIpneumot
horax,Itoxins,IcardiacItamponade,IandIthrombo-
Isis.ITetanyIisImuscularIspasmIassociatedIwithIhypocalcemiaIandIisInotIoneIofIthe
I
potentiallyIreversibleIHsIandITs.IHypernatremiaIisIassociatedIwithIconfusionIandImuscularIcon
tractions.IItIisInotIoneIofItheIHsIandITs.IHypovolemiaIisIaIpotentiallyIreversibleIcauseIofIPEA
IandIasystole,IbutIhypervolemiaIisInot.I
,QUESTION
IWhichIofItheIfollowingIclassicIfindingsIonIphysicalIexamIareIassociatedIwithIaIdiagnosisIofI
infectiveIendocarditisI(IE)?
A.IFever,IhistoryIofIIE,IRothIspots,IOslerInodes
B.IFeverI>38°C,IJanewayIlesions,IOslerInodes,ItrackImarksIonIarmsIC.IJanewayIlesions,IOsler
Inodes,IRothIspots,IsplinterIhemorrhagesID.IChills,Ifatigue,IsplinterIhemorrhages,IOslerInodes
Answer:
IIC.IJanewayIle-Isions,IOslerInodes,IRothIspots,IsplinterIhemorrhages
JanewayIlesions,IOslerInodes,IRothIspots,IandIsplinterIhemorrhagesIareIallIfindingsIonItheIphy
sicalIexamIthatIareIconsistentIwithIaIdiagnosisIofIIE.IJanewayIlesionsIareIsmall,InontenderIery
thematousImaculesIlocatedIonItheIsolesIofItheIfeetIorItheIpalms.IOslerInodes,IinIcontrast,IareI
oftenIpainful,IraisedIlesionsIthatIareIreddenedIandIareIpresentIonIhandsIandIfeet.IRothIspotsIar
eIroundIretinalIhemorrhagesIseenIinIthoseIwithIbacterialIendocarditis.ISplinterIhemorrhagesIar
eIseenIbeneathItheInailIbedsIandIhaveIanIelongated,IlinearIpattern.IHistoryIofIIEIisIaIriskIfacto
rIforIdevelopmentIofIrecurrentIIE,IbutIthisIisIpartIofItheIpatient'sIhistoryIandIisInotIaIphysicalI
examIfinding.IJanewayIlesionsIandIOslerInodesIareIconsistentIwithIaIdiagnosisIofIIE;Ihowever
,ItrackImarksImadeIbyIintravenousIdrugIuseImayIbeIanIindicationIofIanIIEIriskIfactorIbutIareI
notIconsideredIaIclassicIfinding.ISplinterIhemorrhagesIandIOslerInodesIareIconsistentIwithIaId
iagnosisIofIIE;Ihowever,IchillIandIfatigueIareIsubjectiveIsymptomsIandInotIaspectsIofItheIphys
icalIexam.I
QUESTION
IWhichIclassIofImedicationsImustIbeIusedIwithIextremeIcautionIinIpatientsIwithIhypertrophicI
cardiomyopathyI(HCM)?
BetaIblockersIAntibioticsIDiuretics
CalciumIchannelIblockers
Answer:
IIC.IDiuretics
DiureticsImustIbeIusedIwithIextremeIcautionIinIpeopleIwithIHCMIasItheyImayIresultIinIhypov
olemiaIandIreducedIstrokeIvolume,IwhichIwillIfurtherIexacerbateIaIleftIventricularIoutflowIobs
tructionIandImayIresultIinIhypotension.IBetaIblockersIareInotIcontraindicatedIinIHCMIandIma
yIbeIpartIofItheItreatmentIplan.IAntibioticsIareInotIindicatedIinItheItreatmentIofIHCM.ICalciu
mIchannelIblockersImayIbeIusedItoItreatIHCMIandIdoInotIcarryIanyIspecialIprecautionsIwithIt
heirIuseIforIthisIillness.I
, QUESTION
ITheImechanismIbyIwhichIvasovagalIsyncopeIisIthoughtItoIoccurIcanIbeIexplainedIbyIwhat?
A.IAbnormalIelectricalIactivityIoccurringIinItheIbrainIandIleadingItoIseizureIandIsyncope
I
B.ISuddenIactivationIofItheIsympatheticInervousIsystemIresultingIinIincreasedItoneIandIchang
esIinIcardiacIoutput
C.IDevelopmentIofIaItransitoryIarrhythmiaIthatIresultsIinIdecreasedIcerebralIperfusion
D.IReductionIinIsympatheticIandIparasympatheticIactivityIinIresponseItoInox-
IiousIstimuliIresultingIinIvasodilationIandIbradycardia
Answer:
IID.IReductionIinIsympatheticIandIparasympatheticIactivityIinIresponseItoInoxiousIstimuliIres
ultingIinIvasodilationIandIbradycardia
VasovagalIsyncopeIoccursIinIresponseItoIaInoxiousIstimulusI(fear,Ipain,Istress)IthatIdepressesIt
heIsympatheticIandIparasympatheticInervousIsystems.IThisIresultsIinIpoolingIofIbloodIviaIvas
odilationIandIbradycardiaIthatIdecreasesIcerebralIperfusion,IcausingIfainting.IAbnormalIelectri
calIactivityIinItheIbrainIisIaIcharacteristicIofIseizure.IAlthoughIaIpersonImayIloseIconsciousne
ssIduringIseizure,IitIisIaIdifferentIentityIthanIsyncope.IWhileItheIsympatheticInervousIsystemIi
sIimplicatedIinIvasovagalIsyncope,IitIisIdepression,InotIactivation,IofIitsIfunctionIthatIresultsIi
nIdecreasedIsympatheticItone.IArrythmiaIisIanIimportantIcauseIofIsyncope;Ihowever,IitIisInotIt
heIcauseIofIvasovagalIsyncope.I
QUESTION
IWhatIcharacteristicIfindingsIonIelectrocardiogramI(EKG)IareIexpectedIforItheIpatientIdiagnos
edIwithIacuteIpericarditis?
A.ISTIdepressions
B.IGlobalIconcaveIshapedISTIelevations
C.IT-waveIinversions
D.IAnIS1Q3T3Ipattern
Answer:
IB.IGlobalIconcaveIshapedISTIelevations
GlobalIconcaveIshapedISTIelevationsIandIPRIdepressionsImayIbeIseenIonIEKGIinIpatientsIwit
hIpericarditis.ISTIdepressionsIareIindicativeIofImyocardialIischemiaIandIareInotItypicalIinIacut
eIpericarditis.IT-
waveIinversionsImayIindicateIischemiaIbutIareInotIpresentIinIacuteIpericarditis.IAnIS1Q3T3Ip
atternImayIbeIseenIinItheIpresenceIofIpulmonaryIembolism.IItIisInotIassociatedIwithIpericardit
is.I
