NR-573: Advanced Acute Care Management Lab –
Comprehensive Simulation and Clinical Skills for Critical
Patient Care, Rapid Assessment, and Evidence-Based
Intervention in High-Acuity Settings 2025-2026
1. A patient presents with acute shortness of breath, frothy
sputum, and crackles bilaterally. The most likely diagnosis is:
A. COPD exacerbation
B. Acute pulmonary edema
C. Asthma attack
D. Pneumothorax
Rationale: Frothy sputum and bilateral crackles are hallmark
signs of fluid overload in the lungs, consistent with pulmonary
edema.
2. The first-line treatment for acute pulmonary edema
includes:
A. Furosemide IV
B. Morphine sulfate
C. Nitroglycerin patch
D. Dopamine infusion
Rationale: IV loop diuretics rapidly reduce pulmonary
congestion by decreasing preload.
3. Which ABG finding is consistent with metabolic acidosis?
,A. pH 7.48, PaCO₂ 32
B. pH 7.36, PaCO₂ 45
C. pH 7.28, HCO₃⁻ 17
D. pH 7.52, HCO₃⁻ 30
Rationale: Low pH and low bicarbonate indicate metabolic
acidosis.
4. The most accurate method for assessing cardiac output in
critically ill patients is:
A. Central venous pressure
B. Pulmonary artery catheter (Swan-Ganz)
C. Arterial line pressure
D. Echocardiogram
Rationale: The Swan-Ganz catheter directly measures cardiac
output and hemodynamic parameters.
5. In managing septic shock, the initial fluid resuscitation goal
is:
A. 10 mL/kg NS
B. 15 mL/kg LR
C. 30 mL/kg crystalloid within first 3 hours
D. 1 L colloid solution
Rationale: Guidelines recommend early aggressive fluid
resuscitation of 30 mL/kg in sepsis management.
,6. The target mean arterial pressure (MAP) for a patient in
septic shock is:
A. 55 mmHg
B. 60 mmHg
C. ≥65 mmHg
D. ≥75 mmHg
Rationale: Maintaining MAP ≥65 mmHg ensures adequate
organ perfusion.
7. Which vasopressor is first-line for septic shock if fluids are
inadequate?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Dobutamine
Rationale: Norepinephrine is preferred for restoring vascular
tone and perfusion.
8. The most reliable indicator of adequate tissue perfusion in a
critically ill patient is:
A. Skin color
B. Lactate level
C. Heart rate
D. Blood pressure
, Rationale: Elevated lactate reflects anaerobic metabolism and
poor tissue perfusion.
9. A patient with COPD develops respiratory acidosis. Which
ABG result is expected?
A. pH 7.32, PaCO₂ 58
B. pH 7.48, PaCO₂ 32
C. pH 7.45, HCO₃⁻ 22
D. pH 7.40, PaCO₂ 40
Rationale: Elevated PaCO₂ with decreased pH indicates
respiratory acidosis.
10. A post-op patient suddenly develops hypotension and a
distended abdomen. You suspect:
A. Ileus
B. PE
C. Internal hemorrhage
D. Fluid overload
Rationale: Rapid drop in BP and abdominal distention
postoperatively suggest internal bleeding.
11. Which ECG change indicates hyperkalemia?
A. Peaked T waves
B. ST depression
Comprehensive Simulation and Clinical Skills for Critical
Patient Care, Rapid Assessment, and Evidence-Based
Intervention in High-Acuity Settings 2025-2026
1. A patient presents with acute shortness of breath, frothy
sputum, and crackles bilaterally. The most likely diagnosis is:
A. COPD exacerbation
B. Acute pulmonary edema
C. Asthma attack
D. Pneumothorax
Rationale: Frothy sputum and bilateral crackles are hallmark
signs of fluid overload in the lungs, consistent with pulmonary
edema.
2. The first-line treatment for acute pulmonary edema
includes:
A. Furosemide IV
B. Morphine sulfate
C. Nitroglycerin patch
D. Dopamine infusion
Rationale: IV loop diuretics rapidly reduce pulmonary
congestion by decreasing preload.
3. Which ABG finding is consistent with metabolic acidosis?
,A. pH 7.48, PaCO₂ 32
B. pH 7.36, PaCO₂ 45
C. pH 7.28, HCO₃⁻ 17
D. pH 7.52, HCO₃⁻ 30
Rationale: Low pH and low bicarbonate indicate metabolic
acidosis.
4. The most accurate method for assessing cardiac output in
critically ill patients is:
A. Central venous pressure
B. Pulmonary artery catheter (Swan-Ganz)
C. Arterial line pressure
D. Echocardiogram
Rationale: The Swan-Ganz catheter directly measures cardiac
output and hemodynamic parameters.
5. In managing septic shock, the initial fluid resuscitation goal
is:
A. 10 mL/kg NS
B. 15 mL/kg LR
C. 30 mL/kg crystalloid within first 3 hours
D. 1 L colloid solution
Rationale: Guidelines recommend early aggressive fluid
resuscitation of 30 mL/kg in sepsis management.
,6. The target mean arterial pressure (MAP) for a patient in
septic shock is:
A. 55 mmHg
B. 60 mmHg
C. ≥65 mmHg
D. ≥75 mmHg
Rationale: Maintaining MAP ≥65 mmHg ensures adequate
organ perfusion.
7. Which vasopressor is first-line for septic shock if fluids are
inadequate?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Dobutamine
Rationale: Norepinephrine is preferred for restoring vascular
tone and perfusion.
8. The most reliable indicator of adequate tissue perfusion in a
critically ill patient is:
A. Skin color
B. Lactate level
C. Heart rate
D. Blood pressure
, Rationale: Elevated lactate reflects anaerobic metabolism and
poor tissue perfusion.
9. A patient with COPD develops respiratory acidosis. Which
ABG result is expected?
A. pH 7.32, PaCO₂ 58
B. pH 7.48, PaCO₂ 32
C. pH 7.45, HCO₃⁻ 22
D. pH 7.40, PaCO₂ 40
Rationale: Elevated PaCO₂ with decreased pH indicates
respiratory acidosis.
10. A post-op patient suddenly develops hypotension and a
distended abdomen. You suspect:
A. Ileus
B. PE
C. Internal hemorrhage
D. Fluid overload
Rationale: Rapid drop in BP and abdominal distention
postoperatively suggest internal bleeding.
11. Which ECG change indicates hyperkalemia?
A. Peaked T waves
B. ST depression
