NR-575: Acute Care Practicum II – Advanced
Management of Critically Ill Patients in High-Acuity
Settings 2025-2026
1. A patient with septic shock remains hypotensive after aggressive
fluid resuscitation. Which vasopressor is first-line according to current
guidelines?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Epinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock
due to its potent α-adrenergic effects and minimal tachycardia.
2. A 64-year-old with COPD exacerbation presents with confusion and
PaCO₂ of 75 mmHg. What is the best next step?
A. Increase oxygen to 10 L/min
B. Initiate noninvasive positive pressure ventilation (BiPAP)
C. Start antibiotics only
D. Intubate immediately
Rationale: BiPAP reduces CO₂ retention and improves ventilation in
COPD exacerbations with hypercapnia.
3. The nurse practitioner notes ST-elevation in leads II, III, and aVF.
Which coronary artery is most likely involved?
A. Left anterior descending
B. Right coronary artery
,C. Circumflex artery
D. Left main coronary artery
Rationale: Inferior wall MI (II, III, aVF) is typically due to right coronary
artery occlusion.
4. In acute pancreatitis, which lab test best correlates with severity of
disease?
A. Serum lipase
B. Amylase
C. Hematocrit
D. Calcium
Rationale: Rising hematocrit indicates third-spacing and
hemoconcentration, markers of severe pancreatitis.
5. Which finding suggests increased intracranial pressure?
A. Hypotension
B. Cushing’s triad (hypertension, bradycardia, irregular respirations)
C. Tachycardia
D. Kussmaul respirations
Rationale: Cushing’s triad reflects increased ICP and impending
brainstem herniation.
6. For acute decompensated heart failure with pulmonary edema,
which medication is first-line?
A. Beta-blocker
B. Intravenous furosemide
C. Spironolactone
,D. Dopamine
Rationale: Loop diuretics rapidly reduce pulmonary congestion by
promoting diuresis.
7. A patient with atrial fibrillation and rapid ventricular rate is
hypotensive and confused. What is the immediate management?
A. Diltiazem IV
B. Synchronized cardioversion
C. Digoxin IV
D. Adenosine
Rationale: Unstable AF with hemodynamic compromise requires
immediate synchronized cardioversion.
8. In ARDS management, which ventilator setting is prioritized to
prevent further lung injury?
A. High tidal volume
B. Low FiO₂
C. Low tidal volume (6 mL/kg)
D. High PEEP only
Rationale: Lung-protective ventilation with low tidal volumes reduces
barotrauma.
9. The nurse practitioner suspects DKA. Which lab finding supports
the diagnosis?
A. pH 7.45
B. Anion gap metabolic acidosis
C. Respiratory alkalosis
, D. Normal bicarbonate
Rationale: DKA presents with metabolic acidosis and an elevated anion
gap due to ketoacids.
10. For an acute ischemic stroke, what is the window for IV alteplase
administration?
A. 1 hour
B. 4.5 hours from symptom onset
C. 6 hours
D. 12 hours
Rationale: IV tPA is effective within 4.5 hours for eligible stroke patients.
11. Which electrolyte abnormality is commonly associated with
digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Rationale: Low potassium increases digoxin binding to Na⁺/K⁺-ATPase,
enhancing toxicity.
12. Which diagnostic tool confirms a pulmonary embolism?
A. Chest X-ray
B. CT pulmonary angiography
C. V/Q scan
D. ECG
Rationale: CTPA is the gold standard for PE diagnosis.
Management of Critically Ill Patients in High-Acuity
Settings 2025-2026
1. A patient with septic shock remains hypotensive after aggressive
fluid resuscitation. Which vasopressor is first-line according to current
guidelines?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Epinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock
due to its potent α-adrenergic effects and minimal tachycardia.
2. A 64-year-old with COPD exacerbation presents with confusion and
PaCO₂ of 75 mmHg. What is the best next step?
A. Increase oxygen to 10 L/min
B. Initiate noninvasive positive pressure ventilation (BiPAP)
C. Start antibiotics only
D. Intubate immediately
Rationale: BiPAP reduces CO₂ retention and improves ventilation in
COPD exacerbations with hypercapnia.
3. The nurse practitioner notes ST-elevation in leads II, III, and aVF.
Which coronary artery is most likely involved?
A. Left anterior descending
B. Right coronary artery
,C. Circumflex artery
D. Left main coronary artery
Rationale: Inferior wall MI (II, III, aVF) is typically due to right coronary
artery occlusion.
4. In acute pancreatitis, which lab test best correlates with severity of
disease?
A. Serum lipase
B. Amylase
C. Hematocrit
D. Calcium
Rationale: Rising hematocrit indicates third-spacing and
hemoconcentration, markers of severe pancreatitis.
5. Which finding suggests increased intracranial pressure?
A. Hypotension
B. Cushing’s triad (hypertension, bradycardia, irregular respirations)
C. Tachycardia
D. Kussmaul respirations
Rationale: Cushing’s triad reflects increased ICP and impending
brainstem herniation.
6. For acute decompensated heart failure with pulmonary edema,
which medication is first-line?
A. Beta-blocker
B. Intravenous furosemide
C. Spironolactone
,D. Dopamine
Rationale: Loop diuretics rapidly reduce pulmonary congestion by
promoting diuresis.
7. A patient with atrial fibrillation and rapid ventricular rate is
hypotensive and confused. What is the immediate management?
A. Diltiazem IV
B. Synchronized cardioversion
C. Digoxin IV
D. Adenosine
Rationale: Unstable AF with hemodynamic compromise requires
immediate synchronized cardioversion.
8. In ARDS management, which ventilator setting is prioritized to
prevent further lung injury?
A. High tidal volume
B. Low FiO₂
C. Low tidal volume (6 mL/kg)
D. High PEEP only
Rationale: Lung-protective ventilation with low tidal volumes reduces
barotrauma.
9. The nurse practitioner suspects DKA. Which lab finding supports
the diagnosis?
A. pH 7.45
B. Anion gap metabolic acidosis
C. Respiratory alkalosis
, D. Normal bicarbonate
Rationale: DKA presents with metabolic acidosis and an elevated anion
gap due to ketoacids.
10. For an acute ischemic stroke, what is the window for IV alteplase
administration?
A. 1 hour
B. 4.5 hours from symptom onset
C. 6 hours
D. 12 hours
Rationale: IV tPA is effective within 4.5 hours for eligible stroke patients.
11. Which electrolyte abnormality is commonly associated with
digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hyponatremia
Rationale: Low potassium increases digoxin binding to Na⁺/K⁺-ATPase,
enhancing toxicity.
12. Which diagnostic tool confirms a pulmonary embolism?
A. Chest X-ray
B. CT pulmonary angiography
C. V/Q scan
D. ECG
Rationale: CTPA is the gold standard for PE diagnosis.
