NR 574 ACUTE CARE PRACTICUM I
PRACTICE EXAM 2026 – ADVANCED
PRACTICE NURSING | REALISTIC CLINICAL
SCENARIOS & VERIFIED EVIDENCE-BASED
ANSWERS
NR 574 – ACUTE CARE PRACTICUM I PRACTICE EXAM 2026
Advanced Practice Nursing | Realistic Clinical Scenarios & Evidence-Based
Answers
• This 200-question practice exam mirrors real acute care clinical scenarios — use it
by attempting each question independently before revealing the correct answer
and EXPERT RATIONALE beneath it.
• Each question features five options (A–E), a bolded correct answer, and an
evidence-based EXPERT RATIONALE to reinforce clinical reasoning and exam
readiness.
1. A 68-year-old male presents with sudden onset crushing chest pain
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-elevation in
leads II, III, and aVF. Which of the following is the most appropriate
immediate intervention?
A. Administer IV morphine and observe
B. Obtain cardiac enzymes and wait for results
C. Perform urgent echocardiogram
D. Administer oral aspirin and sublingual nitroglycerin only
E. Activate the cardiac catheterization lab for primary PCI
Correct Answer: E. Activate the cardiac catheterization lab for primary PCI
EXPERT RATIONALE: ST-elevation in II, III, and aVF indicates an inferior STEMI.
Primary percutaneous coronary intervention (PCI) is the gold-standard reperfusion
,therapy and should be activated within 90 minutes of first medical contact per
ACC/AHA guidelines.
2. A 55-year-old female with a history of hypertension presents with a blood
pressure of 185/115 mmHg, severe headache, blurred vision, and papilledema.
Which diagnosis is most consistent with these findings?
A. Hypertensive urgency
B. Migraine with aura
C. Ischemic stroke
D. Hypertensive emergency
E. Subarachnoid hemorrhage
Correct Answer: D. Hypertensive emergency
EXPERT RATIONALE: Hypertensive emergency is defined as severely elevated
BP (>180/120 mmHg) with evidence of end-organ damage. Papilledema and
neurological symptoms confirm this diagnosis, requiring immediate IV
antihypertensive therapy in an ICU setting.
3. A 72-year-old male on warfarin presents with an INR of 8.2 and active GI
bleeding. What is the most appropriate immediate management?
A. Hold warfarin and recheck INR in 24 hours
B. Administer vitamin K orally only
C. Transfuse packed red blood cells
D. Administer IV vitamin K and 4-factor PCC (prothrombin complex
concentrate)
E. Administer fresh frozen plasma alone
Correct Answer: D. Administer IV vitamin K and 4-factor PCC (prothrombin
complex concentrate)
, EXPERT RATIONALE: Life-threatening bleeding with supratherapeutic INR
requires rapid reversal. IV vitamin K and 4-factor PCC provide immediate and
sustained reversal of warfarin anticoagulation, superior to FFP alone due to faster
onset and lower volume requirements.
4. A 45-year-old female presents with sudden onset dyspnea, pleuritic chest
pain, and tachycardia. She recently returned from a long-haul flight. CT
pulmonary angiography confirms pulmonary embolism. She is
hemodynamically stable. What is the first-line treatment?
A. Surgical embolectomy
B. IV alteplase thrombolysis
C. Inferior vena cava filter placement
D. Anticoagulation with low molecular weight heparin or rivaroxaban
E. Observation and supplemental oxygen only
Correct Answer: D. Anticoagulation with low molecular weight heparin or
rivaroxaban
EXPERT RATIONALE: Hemodynamically stable PE is managed with
anticoagulation therapy. DOACs such as rivaroxaban or apixaban are first-line per
current guidelines. Thrombolysis is reserved for massive PE with hemodynamic
compromise.
5. A 60-year-old diabetic male presents with fever, flank pain, and
costovertebral angle tenderness. Urinalysis shows pyuria, bacteriuria, and
WBC casts. Which diagnosis is most likely?
A. Cystitis
B. Urolithiasis
C. Pyelonephritis
D. Renal cell carcinoma
, E. Prostatitis
Correct Answer: C. Pyelonephritis
EXPERT RATIONALE: WBC casts in the urine are pathognomonic for
pyelonephritis, indicating upper urinary tract infection involving the renal tubules.
Fever, flank pain, and CVA tenderness support this diagnosis, and empiric
antibiotics should be initiated promptly.
6. A 78-year-old female presents with altered mental status, fever of 39.8°C,
HR 115 bpm, RR 24/min, and WBC of 18,000. Blood cultures are pending. Which
condition best describes her presentation?
A. Systemic inflammatory response syndrome (SIRS)
B. Sepsis
C. Septic shock
D. Bacteremia
E. Severe SIRS without infection
Correct Answer: B. Sepsis
EXPERT RATIONALE: Sepsis is defined as life-threatening organ dysfunction
caused by a dysregulated host response to infection. This patient meets sepsis
criteria with altered mental status (organ dysfunction) and signs of infection per
Sepsis-3 definitions.
7. A 50-year-old male presents with progressive ascending muscle weakness
beginning in the lower extremities following a recent GI illness. Deep tendon
reflexes are absent. CSF analysis shows albuminocytologic dissociation. What
is the most likely diagnosis?
A. Multiple sclerosis
B. Myasthenia gravis
PRACTICE EXAM 2026 – ADVANCED
PRACTICE NURSING | REALISTIC CLINICAL
SCENARIOS & VERIFIED EVIDENCE-BASED
ANSWERS
NR 574 – ACUTE CARE PRACTICUM I PRACTICE EXAM 2026
Advanced Practice Nursing | Realistic Clinical Scenarios & Evidence-Based
Answers
• This 200-question practice exam mirrors real acute care clinical scenarios — use it
by attempting each question independently before revealing the correct answer
and EXPERT RATIONALE beneath it.
• Each question features five options (A–E), a bolded correct answer, and an
evidence-based EXPERT RATIONALE to reinforce clinical reasoning and exam
readiness.
1. A 68-year-old male presents with sudden onset crushing chest pain
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-elevation in
leads II, III, and aVF. Which of the following is the most appropriate
immediate intervention?
A. Administer IV morphine and observe
B. Obtain cardiac enzymes and wait for results
C. Perform urgent echocardiogram
D. Administer oral aspirin and sublingual nitroglycerin only
E. Activate the cardiac catheterization lab for primary PCI
Correct Answer: E. Activate the cardiac catheterization lab for primary PCI
EXPERT RATIONALE: ST-elevation in II, III, and aVF indicates an inferior STEMI.
Primary percutaneous coronary intervention (PCI) is the gold-standard reperfusion
,therapy and should be activated within 90 minutes of first medical contact per
ACC/AHA guidelines.
2. A 55-year-old female with a history of hypertension presents with a blood
pressure of 185/115 mmHg, severe headache, blurred vision, and papilledema.
Which diagnosis is most consistent with these findings?
A. Hypertensive urgency
B. Migraine with aura
C. Ischemic stroke
D. Hypertensive emergency
E. Subarachnoid hemorrhage
Correct Answer: D. Hypertensive emergency
EXPERT RATIONALE: Hypertensive emergency is defined as severely elevated
BP (>180/120 mmHg) with evidence of end-organ damage. Papilledema and
neurological symptoms confirm this diagnosis, requiring immediate IV
antihypertensive therapy in an ICU setting.
3. A 72-year-old male on warfarin presents with an INR of 8.2 and active GI
bleeding. What is the most appropriate immediate management?
A. Hold warfarin and recheck INR in 24 hours
B. Administer vitamin K orally only
C. Transfuse packed red blood cells
D. Administer IV vitamin K and 4-factor PCC (prothrombin complex
concentrate)
E. Administer fresh frozen plasma alone
Correct Answer: D. Administer IV vitamin K and 4-factor PCC (prothrombin
complex concentrate)
, EXPERT RATIONALE: Life-threatening bleeding with supratherapeutic INR
requires rapid reversal. IV vitamin K and 4-factor PCC provide immediate and
sustained reversal of warfarin anticoagulation, superior to FFP alone due to faster
onset and lower volume requirements.
4. A 45-year-old female presents with sudden onset dyspnea, pleuritic chest
pain, and tachycardia. She recently returned from a long-haul flight. CT
pulmonary angiography confirms pulmonary embolism. She is
hemodynamically stable. What is the first-line treatment?
A. Surgical embolectomy
B. IV alteplase thrombolysis
C. Inferior vena cava filter placement
D. Anticoagulation with low molecular weight heparin or rivaroxaban
E. Observation and supplemental oxygen only
Correct Answer: D. Anticoagulation with low molecular weight heparin or
rivaroxaban
EXPERT RATIONALE: Hemodynamically stable PE is managed with
anticoagulation therapy. DOACs such as rivaroxaban or apixaban are first-line per
current guidelines. Thrombolysis is reserved for massive PE with hemodynamic
compromise.
5. A 60-year-old diabetic male presents with fever, flank pain, and
costovertebral angle tenderness. Urinalysis shows pyuria, bacteriuria, and
WBC casts. Which diagnosis is most likely?
A. Cystitis
B. Urolithiasis
C. Pyelonephritis
D. Renal cell carcinoma
, E. Prostatitis
Correct Answer: C. Pyelonephritis
EXPERT RATIONALE: WBC casts in the urine are pathognomonic for
pyelonephritis, indicating upper urinary tract infection involving the renal tubules.
Fever, flank pain, and CVA tenderness support this diagnosis, and empiric
antibiotics should be initiated promptly.
6. A 78-year-old female presents with altered mental status, fever of 39.8°C,
HR 115 bpm, RR 24/min, and WBC of 18,000. Blood cultures are pending. Which
condition best describes her presentation?
A. Systemic inflammatory response syndrome (SIRS)
B. Sepsis
C. Septic shock
D. Bacteremia
E. Severe SIRS without infection
Correct Answer: B. Sepsis
EXPERT RATIONALE: Sepsis is defined as life-threatening organ dysfunction
caused by a dysregulated host response to infection. This patient meets sepsis
criteria with altered mental status (organ dysfunction) and signs of infection per
Sepsis-3 definitions.
7. A 50-year-old male presents with progressive ascending muscle weakness
beginning in the lower extremities following a recent GI illness. Deep tendon
reflexes are absent. CSF analysis shows albuminocytologic dissociation. What
is the most likely diagnosis?
A. Multiple sclerosis
B. Myasthenia gravis
