1
Chamberlain NR569 Actual Exam
Questions and Answers with
Rationales 2026/2027 | Differential
Diagnosis in Acute Care Final Exam |
ACNP Practicum | Pass Guarantee
Q001: A 67-year-old man arrives in the ED with sudden-onset retrosternal chest
pain radiating to both arms, BP 80/50 mmHg, HR 120 bpm, and ST-segment
elevation in leads V2-V5. He is diaphoretic and confused. Which diagnosis is
MOST urgent to rule in or out first?
A. Acute pericarditis
B. Acute myocardial infarction with cardiogenic shock
C. Tension pneumothorax
D. Aortic dissection
ANSWER: B
Q002: A 54-year-old woman with COPD presents with acute dyspnea, HR 135
bpm, RR 32/min, BP 160/90 mmHg, and ABG showing pH 7.29, PaCO₂ 70
mmHg, PaO₂ 48 mmHg on 4 L NC. Which immediate intervention is indicated?
A. Increase nasal cannula to 6 L/min
B. Non-invasive positive-pressure ventilation (NIPPV)
C. Immediate intubation and mechanical ventilation
D. High-flow nasal cannula at 60 L/min FiO₂ 100%
ANSWER: B
Q003: A 29-year-old man is admitted with fever 39.5 °C, HR 125 bpm, BP 88/50
mmHg, lactate 4.8 mmol/L, and WBC 18,000/µL. Blood cultures are pending.
Which is the priority action within the first hour?
A. Obtain CT abdomen/pelvis
, 2
B. Administer 30 mL/kg crystalloid bolus and broad-spectrum antibiotics
C. Start norepinephrine infusion
D. Administer acetaminophen 1 g IV
ANSWER: B
Q004: A 72-year-old woman with AF on warfarin develops acute aphasia and right-
sided weakness; last seen normal 90 minutes ago. INR is 2.3, BP 185/110 mmHg,
glucose 140 mg/dL. CT shows no hemorrhage. Which next step is MOST
appropriate?
A. Administer aspirin 325 mg
B. Give tPA 0.9 mg/kg IV after lowering BP to <185/110 mmHg
C. Start heparin drip immediately
D. Arrange for cerebral angiography only
ANSWER: B
Q005: A 45-year-old man with DM and CKD presents with K⁺ 6.8 mEq/L, peaked
T waves, and pH 7.28. He denies chest pain but feels weak. Which immediate
therapy is indicated?
A. PO sodium polystyrene sulfonate alone
B. 10 mL 10% calcium gluconate IV over 2-3 min + insulin/glucose
C. Emergent hemodialysis only
D. 2 g magnesium sulfate IV push
ANSWER: B
Q006: A 38-year-old woman post-abdominal surgery develops sudden dyspnea,
pleuritic chest pain, and HR 110 bpm. SpO₂ is 89% on RA, lungs are clear. D-
dimer is 2,500 ng/mL. Which test is MOST diagnostic now?
A. Chest X-ray
B. CT pulmonary angiography
C. V/Q scan
D. Lower-extremity duplex ultrasound only
ANSWER: B
Q007: A 60-year-old man with cirrhosis presents with massive hematemesis, BP
70/40 mmHg, HR 130 bpm. Which immediate intervention is MOST critical?
A. Place nasogastric tube and lavage
B. Secure airway, start 2 large-bore IVs, give crystalloid/blood
, 3
C. Administer vitamin K 10 mg IV
D. Perform STAT upper endoscopy in ED
ANSWER: B
Q008: A 55-year-old alcoholic man has severe epigastric pain, serum lipase 1,800
U/L, BP 90/60 mmHg, HR 120 bpm, and urine output 15 mL/hr. CT shows
pancreatic necrosis. Which is the priority management?
A. Immediate surgical debridement
B. Aggressive IV fluid resuscitation and ICU monitoring
C. PO feeding to maintain nutrition
D. ERCP within 6 hours
ANSWER: B
Q009: A 22-year-old woman presents with severe lower abdominal pain, positive
pregnancy test, BP 85/50 mmHg, HR 120 bpm, and free fluid on bedside FAST.
Hgb is 8 g/dL. Which is the MOST urgent intervention?
A. STAT pelvic X-ray
B. Immediate OB-GYN consult and prep for OR
C. Administer methotrexate IM
D. Type and screen only
ANSWER: B
Q010: A 68-year-old man with DM presents with altered mental status, glucose 38
mg/dL, and no IV access. Which immediate action is indicated?
A. Give 1 mg glucagon IM while establishing IV access
B. Start D5W at 125 mL/hr
C. Obtain STAT head CT before treatment
D. Give 50 mL D50W push orally
ANSWER: A
Q011: A 40-year-old woman with asthma presents with acute dyspnea, silent chest,
and peak flow 35% predicted. SpO₂ is 89% on 6 L NC, BP 150/90 mmHg, HR 130
bpm. Which is the priority intervention?
A. Start continuous albuterol nebulizer and IV steroids
B. Apply BiPAP immediately
C. Intubate without delay
Chamberlain NR569 Actual Exam
Questions and Answers with
Rationales 2026/2027 | Differential
Diagnosis in Acute Care Final Exam |
ACNP Practicum | Pass Guarantee
Q001: A 67-year-old man arrives in the ED with sudden-onset retrosternal chest
pain radiating to both arms, BP 80/50 mmHg, HR 120 bpm, and ST-segment
elevation in leads V2-V5. He is diaphoretic and confused. Which diagnosis is
MOST urgent to rule in or out first?
A. Acute pericarditis
B. Acute myocardial infarction with cardiogenic shock
C. Tension pneumothorax
D. Aortic dissection
ANSWER: B
Q002: A 54-year-old woman with COPD presents with acute dyspnea, HR 135
bpm, RR 32/min, BP 160/90 mmHg, and ABG showing pH 7.29, PaCO₂ 70
mmHg, PaO₂ 48 mmHg on 4 L NC. Which immediate intervention is indicated?
A. Increase nasal cannula to 6 L/min
B. Non-invasive positive-pressure ventilation (NIPPV)
C. Immediate intubation and mechanical ventilation
D. High-flow nasal cannula at 60 L/min FiO₂ 100%
ANSWER: B
Q003: A 29-year-old man is admitted with fever 39.5 °C, HR 125 bpm, BP 88/50
mmHg, lactate 4.8 mmol/L, and WBC 18,000/µL. Blood cultures are pending.
Which is the priority action within the first hour?
A. Obtain CT abdomen/pelvis
, 2
B. Administer 30 mL/kg crystalloid bolus and broad-spectrum antibiotics
C. Start norepinephrine infusion
D. Administer acetaminophen 1 g IV
ANSWER: B
Q004: A 72-year-old woman with AF on warfarin develops acute aphasia and right-
sided weakness; last seen normal 90 minutes ago. INR is 2.3, BP 185/110 mmHg,
glucose 140 mg/dL. CT shows no hemorrhage. Which next step is MOST
appropriate?
A. Administer aspirin 325 mg
B. Give tPA 0.9 mg/kg IV after lowering BP to <185/110 mmHg
C. Start heparin drip immediately
D. Arrange for cerebral angiography only
ANSWER: B
Q005: A 45-year-old man with DM and CKD presents with K⁺ 6.8 mEq/L, peaked
T waves, and pH 7.28. He denies chest pain but feels weak. Which immediate
therapy is indicated?
A. PO sodium polystyrene sulfonate alone
B. 10 mL 10% calcium gluconate IV over 2-3 min + insulin/glucose
C. Emergent hemodialysis only
D. 2 g magnesium sulfate IV push
ANSWER: B
Q006: A 38-year-old woman post-abdominal surgery develops sudden dyspnea,
pleuritic chest pain, and HR 110 bpm. SpO₂ is 89% on RA, lungs are clear. D-
dimer is 2,500 ng/mL. Which test is MOST diagnostic now?
A. Chest X-ray
B. CT pulmonary angiography
C. V/Q scan
D. Lower-extremity duplex ultrasound only
ANSWER: B
Q007: A 60-year-old man with cirrhosis presents with massive hematemesis, BP
70/40 mmHg, HR 130 bpm. Which immediate intervention is MOST critical?
A. Place nasogastric tube and lavage
B. Secure airway, start 2 large-bore IVs, give crystalloid/blood
, 3
C. Administer vitamin K 10 mg IV
D. Perform STAT upper endoscopy in ED
ANSWER: B
Q008: A 55-year-old alcoholic man has severe epigastric pain, serum lipase 1,800
U/L, BP 90/60 mmHg, HR 120 bpm, and urine output 15 mL/hr. CT shows
pancreatic necrosis. Which is the priority management?
A. Immediate surgical debridement
B. Aggressive IV fluid resuscitation and ICU monitoring
C. PO feeding to maintain nutrition
D. ERCP within 6 hours
ANSWER: B
Q009: A 22-year-old woman presents with severe lower abdominal pain, positive
pregnancy test, BP 85/50 mmHg, HR 120 bpm, and free fluid on bedside FAST.
Hgb is 8 g/dL. Which is the MOST urgent intervention?
A. STAT pelvic X-ray
B. Immediate OB-GYN consult and prep for OR
C. Administer methotrexate IM
D. Type and screen only
ANSWER: B
Q010: A 68-year-old man with DM presents with altered mental status, glucose 38
mg/dL, and no IV access. Which immediate action is indicated?
A. Give 1 mg glucagon IM while establishing IV access
B. Start D5W at 125 mL/hr
C. Obtain STAT head CT before treatment
D. Give 50 mL D50W push orally
ANSWER: A
Q011: A 40-year-old woman with asthma presents with acute dyspnea, silent chest,
and peak flow 35% predicted. SpO₂ is 89% on 6 L NC, BP 150/90 mmHg, HR 130
bpm. Which is the priority intervention?
A. Start continuous albuterol nebulizer and IV steroids
B. Apply BiPAP immediately
C. Intubate without delay
