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NR 570 EXAM PREP LATEST COMMON DIAGNOSIS & MANAGEMENT IN ACUTE CARE PRACTICUM
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NR 570 EXAM PREP LATEST COMMON DIAGNOSIS & MANAGEMENT IN ACUTE CARE PRACTICUM
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NR 570 EXAM PREPLATEST
Common Diagnosis &
Management in
Acute Care Practicum
ANSWERED
2023/2024
,1. What are the three main types of shock and how are they differentiated? (3 points)
- Hypovolemic shock: caused by a loss of blood or fluid volume, resulting in low blood pressure and
inadequate tissue perfusion.
- Cardiogenic shock: caused by a failure of the heart to pump effectively, resulting in low cardiac
output and inadequate tissue perfusion.
- Distributive shock: caused by a widespread dilation of blood vessels, resulting in low vascular
resistance and inadequate tissue perfusion.
2. What are the signs and symptoms of sepsis and what is the initial management? (4 points)
- Sepsis is a life-threatening condition that occurs when the body's response to an infection causes
systemic inflammation and organ dysfunction. The signs and symptoms of sepsis include fever,
tachycardia, tachypnea, hypotension, altered mental status, oliguria, and increased lactate levels.
- The initial management of sepsis involves rapid identification and treatment of the source of
infection, administration of broad-spectrum antibiotics, fluid resuscitation, vasopressors if needed,
and monitoring of vital signs and organ function.
3. What are the indications and contraindications for endotracheal intubation and what are the steps
involved? (5 points)
- Endotracheal intubation is a procedure that involves inserting a tube through the mouth or nose into
the trachea to establish a secure airway. The indications for endotracheal intubation include
respiratory failure, airway obstruction, protection of the airway from aspiration, facilitation of
mechanical ventilation, and administration of certain medications.
- The contraindications for endotracheal intubation include severe facial trauma, cervical spine injury,
coagulopathy, upper airway infection or inflammation, and lack of equipment or expertise.
- The steps involved in endotracheal intubation are:
- Prepare the equipment and patient
- Preoxygenate the patient with 100% oxygen
- Administer sedation and neuromuscular blockade if indicated
- Position the patient's head in the sniffing position
- Visualize the vocal cords with a laryngoscope
, - Pass the tube through the vocal cords and confirm placement with capnography and auscultation
- Secure the tube and provide ventilation
- Check for complications such as hypoxia, hypotension, arrhythmias, pneumothorax, or esophageal
intubation
4. What are the common causes and complications of acute kidney injury (AKI) and how is it diagnosed
and classified? (4 points)
- AKI is a sudden decline in kidney function that leads to an accumulation of waste products and
electrolytes in the blood. The common causes of AKI are divided into three categories:
- Prerenal: due to decreased blood flow to the kidneys, such as from dehydration, hypovolemia, heart
failure, or sepsis
- Intrinsic: due to damage to the kidney tissue, such as from ischemia, nephrotoxins,
glomerulonephritis, or acute tubular necrosis
- Postrenal: due to obstruction of urine flow from the kidneys, such as from renal stones, benign
prostatic hyperplasia, or tumors
- The complications of AKI include metabolic acidosis, hyperkalemia, hyponatremia, uremia, volume
overload, pulmonary edema, anemia, coagulopathy, and increased risk of infection.
- AKI is diagnosed by measuring serum creatinine and urine output. AKI is classified according to the
KDIGO criteria as follows:
- Stage 1: increase in serum creatinine by ≥0.3 mg/dL within 48 hours or by ≥1.5 times baseline within
7 days or urine output <0.5 mL/kg/h for 6 hours
- Stage 2: increase in serum creatinine by ≥2 times baseline within 7 days or urine output <0.5
mL/kg/h for 12 hours
- Stage 3: increase in serum creatinine by ≥3 times baseline within 7 days or by ≥4 mg/dL or initiation
of renal replacement therapy or urine output <0.3 mL/kg/h for 24 hours or anuria for 12 hours
Which medication below is contraindicated in an asthma patient because it may increase risk of
sudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in combination with an inhaled
steroid. Otherwise, using a long-acting bronchodilator like salmeterol is contraindicated. There is an
increased risk of sudden death with asthma exacerbations when this class is used solo to treat asthma.
The other choices can be used to treat asthma. Choices vary depending on the patient.
A 75-year-old female with emphysema who has been treated with inhaled steroids for many years
should: (should be screened for osteoporosis)
Older females are at higher risk than others for osteoporosis. This female patient, who has used inhaled
steroids and smokes, has multiple risk factors for osteoporosis. Additionally, she probably has
emphysema because she smoked (or still smokes). If she is Asian or Caucasian, she has still another risk
, factor. Screening for osteoporosis should be considered when managing patients with multiple risk
factors.
A patient received the pneumonia immunization at age 60 years. He is 65 years old and presents to
your clinic today. What recommendation should be made about the pneumococcal immunization? (He
should receive another one today)
This patient should receive another one today because he is 65 years old and at least 5 years has elapsed
since his last one. The CDC does not recommend immunizing this patient every 5 years. Two
immunizations are available, PCV13 and PPSV23. He needs both, but PCV13 should be administered
today. PPSV23 should be administered at least 1 year later.
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