NR570 Common Diagnosis Management
Acute Care Practicum Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & RESPIRATORY ACUTE DIAGNOSES
Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man arrives in the emergency department with crushing substernal chest pain
radiating to his left jaw and arm. His blood pressure is 88/52 mmHg, heart rate is 110 bpm,
and he appears diaphoretic. The 12-lead ECG shows ST elevation in leads V1 through V4. His
oxygen saturation is 94% on room air. Which intervention should be initiated first?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes
B. Start a nitroprusside infusion to reduce afterload
C. Give aspirin 325 mg chewable and activate the cath lab ✓ CORRECT
D. Insert a nasogastric tube for gastric decompression
Correct Answer: C
Rationale: Aspirin reduces mortality in acute ST-elevation MI and should be given
immediately, while activating the cath lab is the definitive management for this STEMI
presentation. Nitroglycerin is contraindicated with hypotension (SBP < 90 mmHg) and could
worsen his hemodynamics. In practice, the door-to-balloon time goal is 90 minutes, so every
second of early activation matters.
Question 2 of 50
A 54-year-old woman with a history of hypertension presents with sudden onset of dyspnea at
rest, orthopnea, and pink frothy sputum. Her vital signs show BP 180/110 mmHg, HR 128
bpm, RR 32/min, and SpO2 86% on room air. Bilateral crackles are heard on auscultation, and
a chest X-ray reveals pulmonary edema with cephalization. What is the most appropriate
immediate management?
,A. Administer IV furosemide 40 mg and initiate noninvasive positive pressure ventilation ✓
CORRECT
B. Give a loading dose of oral metoprolol 25 mg
C. Start a continuous albuterol nebulizer treatment
D. Administer IV morphine 4 mg as the sole initial intervention
Correct Answer: A
Rationale: Acute cardiogenic pulmonary edema requires both afterload reduction with
diuresis and respiratory support with BiPAP or CPAP to reduce work of breathing and improve
oxygenation. Oral beta-blockers are inappropriate in acute decompensated heart failure and
can worsen the situation. Noninvasive ventilation reduces the need for intubation and should
be started early when SpO2 remains low despite supplemental oxygen.
Question 3 of 50
A 72-year-old man with atrial fibrillation on warfarin presents after a fall with altered mental
status. His Glasgow Coma Scale score is 10, and a non-contrast head CT reveals a large
right-sided subdural hematoma with 8 mm midline shift. His INR is 3.8. What is the priority
intervention before neurosurgical evacuation?
A. Administer vitamin K 10 mg IV and 4-factor prothrombin complex concentrate ✓ CORRECT
B. Give fresh frozen plasma 2 units immediately
C. Start a heparin infusion for bridge anticoagulation
D. Transfuse 2 units of packed red blood cells
Correct Answer: A
Rationale: Rapid reversal of warfarin anticoagulation in life-threatening intracranial
hemorrhage requires 4-factor PCC with vitamin K, as PCC restores clotting factors within
minutes compared to hours for FFP. Heparin would worsen bleeding and is absolutely
contraindicated. Vitamin K alone takes 6–12 hours to work, so it must be paired with PCC for
immediate effect in this time-critical scenario.
Question 4 of 50
A 45-year-old man with no significant medical history presents with pleuritic chest pain,
dyspnea, and tachycardia after a 14-hour car ride. His vital signs are BP 118/76 mmHg, HR
118 bpm, RR 24/min, and SpO2 91% on room air. A CT pulmonary angiogram confirms a large
saddle pulmonary embolism with right ventricular strain on echocardiogram. What is the
most appropriate definitive therapy?
A. Initiate therapeutic enoxaparin and transition to oral warfarin
B. Administer systemic thrombolytics with alteplase ✓ CORRECT
C. Place an inferior vena cava filter and observe
D. Start fondaparinux alone without additional intervention
, Correct Answer: B
Rationale: Massive PE with hemodynamic compromise and right ventricular strain is an
indication for systemic thrombolysis to rapidly reduce clot burden and restore pulmonary
perfusion. Anticoagulation alone is insufficient for massive PE, and IVC filters are reserved
for patients with contraindications to anticoagulation. The mortality benefit of thrombolysis
in massive PE outweighs the bleeding risk in appropriately selected patients.
Question 5 of 50
A 61-year-old woman with COPD presents with worsening dyspnea over 3 days, increased
sputum production, and fever to 38.9°C. She is using accessory muscles to breathe, and her
ABG on 2 L nasal cannula shows pH 7.28, PaCO2 68 mmHg, and PaO2 58 mmHg. What is the
most appropriate next step in management?
A. Increase the nasal cannula to 6 L/min and administer IV methylprednisolone
B. Initiate noninvasive positive pressure ventilation and broad-spectrum antibiotics ✓
CORRECT
C. Perform immediate endotracheal intubation and mechanical ventilation
D. Administer high-flow nasal cannula at 40 L/min with 100% FiO2
Correct Answer: B
Rationale: This patient has acute-on-chronic hypercapnic respiratory failure due to COPD
exacerbation, and NIV is the first-line intervention to reduce work of breathing, improve
ventilation, and avoid intubation. Immediate intubation is unnecessary given her alert mental
status and the reversible nature of the exacerbation. Antibiotics are indicated for infectious
exacerbations with increased sputum and fever, as bacterial infection drives most severe
COPD flares.
Question 6 of 50
A 58-year-old man with a history of heart failure with reduced ejection fraction (35%) presents
with progressive dyspnea, orthopnea, and bilateral lower extremity edema. His weight has
increased by 6 kg over 2 weeks. Vital signs show BP 96/62 mmHg, HR 92 bpm, and JVD to
the angle of the jaw. His creatinine is 2.1 mg/dL, up from a baseline of 1.2 mg/dL. What is the
most appropriate management?
A. Administer a high-dose IV furosemide bolus of 200 mg
B. Start an IV dobutamine infusion and consider ultrafiltration ✓ CORRECT
C. Give IV hydralazine 20 mg to reduce afterload
D. Initiate aggressive oral diuresis with metolazone and furosemide
Correct Answer: B
Rationale: Cardiorenal syndrome with hypotension and acute kidney injury in decompensated
heart failure requires inotropic support rather than aggressive diuresis, which could worsen
Acute Care Practicum Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR & RESPIRATORY ACUTE DIAGNOSES
Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old man arrives in the emergency department with crushing substernal chest pain
radiating to his left jaw and arm. His blood pressure is 88/52 mmHg, heart rate is 110 bpm,
and he appears diaphoretic. The 12-lead ECG shows ST elevation in leads V1 through V4. His
oxygen saturation is 94% on room air. Which intervention should be initiated first?
A. Administer sublingual nitroglycerin 0.4 mg every 5 minutes
B. Start a nitroprusside infusion to reduce afterload
C. Give aspirin 325 mg chewable and activate the cath lab ✓ CORRECT
D. Insert a nasogastric tube for gastric decompression
Correct Answer: C
Rationale: Aspirin reduces mortality in acute ST-elevation MI and should be given
immediately, while activating the cath lab is the definitive management for this STEMI
presentation. Nitroglycerin is contraindicated with hypotension (SBP < 90 mmHg) and could
worsen his hemodynamics. In practice, the door-to-balloon time goal is 90 minutes, so every
second of early activation matters.
Question 2 of 50
A 54-year-old woman with a history of hypertension presents with sudden onset of dyspnea at
rest, orthopnea, and pink frothy sputum. Her vital signs show BP 180/110 mmHg, HR 128
bpm, RR 32/min, and SpO2 86% on room air. Bilateral crackles are heard on auscultation, and
a chest X-ray reveals pulmonary edema with cephalization. What is the most appropriate
immediate management?
,A. Administer IV furosemide 40 mg and initiate noninvasive positive pressure ventilation ✓
CORRECT
B. Give a loading dose of oral metoprolol 25 mg
C. Start a continuous albuterol nebulizer treatment
D. Administer IV morphine 4 mg as the sole initial intervention
Correct Answer: A
Rationale: Acute cardiogenic pulmonary edema requires both afterload reduction with
diuresis and respiratory support with BiPAP or CPAP to reduce work of breathing and improve
oxygenation. Oral beta-blockers are inappropriate in acute decompensated heart failure and
can worsen the situation. Noninvasive ventilation reduces the need for intubation and should
be started early when SpO2 remains low despite supplemental oxygen.
Question 3 of 50
A 72-year-old man with atrial fibrillation on warfarin presents after a fall with altered mental
status. His Glasgow Coma Scale score is 10, and a non-contrast head CT reveals a large
right-sided subdural hematoma with 8 mm midline shift. His INR is 3.8. What is the priority
intervention before neurosurgical evacuation?
A. Administer vitamin K 10 mg IV and 4-factor prothrombin complex concentrate ✓ CORRECT
B. Give fresh frozen plasma 2 units immediately
C. Start a heparin infusion for bridge anticoagulation
D. Transfuse 2 units of packed red blood cells
Correct Answer: A
Rationale: Rapid reversal of warfarin anticoagulation in life-threatening intracranial
hemorrhage requires 4-factor PCC with vitamin K, as PCC restores clotting factors within
minutes compared to hours for FFP. Heparin would worsen bleeding and is absolutely
contraindicated. Vitamin K alone takes 6–12 hours to work, so it must be paired with PCC for
immediate effect in this time-critical scenario.
Question 4 of 50
A 45-year-old man with no significant medical history presents with pleuritic chest pain,
dyspnea, and tachycardia after a 14-hour car ride. His vital signs are BP 118/76 mmHg, HR
118 bpm, RR 24/min, and SpO2 91% on room air. A CT pulmonary angiogram confirms a large
saddle pulmonary embolism with right ventricular strain on echocardiogram. What is the
most appropriate definitive therapy?
A. Initiate therapeutic enoxaparin and transition to oral warfarin
B. Administer systemic thrombolytics with alteplase ✓ CORRECT
C. Place an inferior vena cava filter and observe
D. Start fondaparinux alone without additional intervention
, Correct Answer: B
Rationale: Massive PE with hemodynamic compromise and right ventricular strain is an
indication for systemic thrombolysis to rapidly reduce clot burden and restore pulmonary
perfusion. Anticoagulation alone is insufficient for massive PE, and IVC filters are reserved
for patients with contraindications to anticoagulation. The mortality benefit of thrombolysis
in massive PE outweighs the bleeding risk in appropriately selected patients.
Question 5 of 50
A 61-year-old woman with COPD presents with worsening dyspnea over 3 days, increased
sputum production, and fever to 38.9°C. She is using accessory muscles to breathe, and her
ABG on 2 L nasal cannula shows pH 7.28, PaCO2 68 mmHg, and PaO2 58 mmHg. What is the
most appropriate next step in management?
A. Increase the nasal cannula to 6 L/min and administer IV methylprednisolone
B. Initiate noninvasive positive pressure ventilation and broad-spectrum antibiotics ✓
CORRECT
C. Perform immediate endotracheal intubation and mechanical ventilation
D. Administer high-flow nasal cannula at 40 L/min with 100% FiO2
Correct Answer: B
Rationale: This patient has acute-on-chronic hypercapnic respiratory failure due to COPD
exacerbation, and NIV is the first-line intervention to reduce work of breathing, improve
ventilation, and avoid intubation. Immediate intubation is unnecessary given her alert mental
status and the reversible nature of the exacerbation. Antibiotics are indicated for infectious
exacerbations with increased sputum and fever, as bacterial infection drives most severe
COPD flares.
Question 6 of 50
A 58-year-old man with a history of heart failure with reduced ejection fraction (35%) presents
with progressive dyspnea, orthopnea, and bilateral lower extremity edema. His weight has
increased by 6 kg over 2 weeks. Vital signs show BP 96/62 mmHg, HR 92 bpm, and JVD to
the angle of the jaw. His creatinine is 2.1 mg/dL, up from a baseline of 1.2 mg/dL. What is the
most appropriate management?
A. Administer a high-dose IV furosemide bolus of 200 mg
B. Start an IV dobutamine infusion and consider ultrafiltration ✓ CORRECT
C. Give IV hydralazine 20 mg to reduce afterload
D. Initiate aggressive oral diuresis with metolazone and furosemide
Correct Answer: B
Rationale: Cardiorenal syndrome with hypotension and acute kidney injury in decompensated
heart failure requires inotropic support rather than aggressive diuresis, which could worsen
