NR 572 / NR572 Advanced Acute Care Management
Midterm Exam Actual 2024/2025 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: ADVANCED CARDIOVASCULAR CARE (14 Questions)
Q1: A patient with acute coronary syndrome (ACS) presents with ST-segment
elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Left circumflex artery
B. Right coronary artery
C. Left anterior descending artery
D. Posterior descending artery
Correct Answer: C
Rationale: ST-segment elevation in leads V1 through V4 indicates an anterior wall
myocardial infarction, which is most commonly caused by occlusion of the left
anterior descending artery.
Q2: A patient with acute heart failure develops acute pulmonary edema with a blood
pressure of 210/120 mmHg. Which medication is the priority for reducing afterload
and improving cardiac output?
A. Dobutamine
B. Nitroprusside or nicardipine
,D. Atropine
Correct Answer: C
Rationale: Vasodilators such as nitroprusside or nicardipine reduce afterload and
preload in hypertensive emergency with pulmonary edema, rapidly decreasing
myocardial oxygen demand and improving forward flow.
Q3: A patient with suspected aortic dissection presents with tearing chest pain
radiating to the back and a blood pressure difference of 30 mmHg between the right
and left arms. Which diagnostic study is the gold standard?
A. 12-lead ECG
B. Chest X-ray
C. CT angiography of the chest, abdomen, and pelvis
D. Echocardiography
Correct Answer: C
Rationale: CT angiography is the gold standard for diagnosing aortic dissection,
providing detailed visualization of the intimal flap, true and false lumens, and branch
vessel involvement.
Q4: A patient develops cardiac tamponade following cardiac surgery. Which classic
physical finding triad (Beck's triad) is most specific for this condition?
A. Hypertension, bounding pulses, and jugular venous distension
B. Hypotension, muffled heart sounds, and jugular venous distension
C. Tachycardia, hypertension, and clear lung fields
D. Bradycardia, loud S3 gallop, and peripheral edema
,Correct Answer: B
Rationale: Beck's triad consists of hypotension, muffled or distant heart sounds, and
jugular venous distension, representing the classic presentation of cardiac
tamponade with impaired ventricular filling.
Q5: A patient in the ICU develops polymorphic ventricular tachycardia (torsades de
pointes) with a QTc interval of 560 ms. Which electrolyte abnormality is most likely
contributing?
A. Hypercalcemia
B. Hypomagnesemia
C. Hypernatremia
D. Hyperkalemia
Correct Answer: B
Rationale: Hypomagnesemia prolongs the QT interval and predisposes to torsades
de pointes; intravenous magnesium sulfate is the first-line treatment for this
dysrhythmia.
Q6: A patient with acute decompensated heart failure has a serum BNP of 1,200
pg/mL. Which clinical interpretation is most accurate?
A. The BNP level is within normal limits and rules out heart failure
B. The elevated BNP supports a diagnosis of heart failure and correlates with
severity of ventricular wall stress
C. The BNP level indicates acute kidney injury
D. The BNP level is falsely elevated due to obesity
Correct Answer: B
, Rationale: BNP is released from ventricular myocardium in response to wall stress;
levels above 400 pg/mL strongly support heart failure diagnosis and correlate with
disease severity and prognosis.
Q7: A patient with atrial fibrillation and rapid ventricular response presents with
hypotension and altered mental status. Which intervention is the priority?
A. Initiate oral metoprolol
B. Perform synchronized cardioversion
C. Administer intravenous digoxin
D. Start therapeutic anticoagulation with warfarin
Correct Answer: B
Rationale: Unstable atrial fibrillation with rapid ventricular response causing
hypotension and altered mental status requires immediate synchronized
cardioversion to restore perfusion and hemodynamic stability.
Q8: A patient receiving tissue plasminogen activator (tPA) for acute ischemic stroke
develops orolingual angioedema. Which action should the nurse take first?
A. Discontinue the tPA infusion immediately
B. Administer intravenous diphenhydramine and methylprednisolone
C. Prepare for intubation
D. Continue the infusion and monitor closely
Correct Answer: B
Rationale: Orolingual angioedema is a known complication of tPA; antihistamines
and corticosteroids are first-line treatment, with airway management reserved for
progressive airway compromise.
Midterm Exam Actual 2024/2025 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: ADVANCED CARDIOVASCULAR CARE (14 Questions)
Q1: A patient with acute coronary syndrome (ACS) presents with ST-segment
elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Left circumflex artery
B. Right coronary artery
C. Left anterior descending artery
D. Posterior descending artery
Correct Answer: C
Rationale: ST-segment elevation in leads V1 through V4 indicates an anterior wall
myocardial infarction, which is most commonly caused by occlusion of the left
anterior descending artery.
Q2: A patient with acute heart failure develops acute pulmonary edema with a blood
pressure of 210/120 mmHg. Which medication is the priority for reducing afterload
and improving cardiac output?
A. Dobutamine
B. Nitroprusside or nicardipine
,D. Atropine
Correct Answer: C
Rationale: Vasodilators such as nitroprusside or nicardipine reduce afterload and
preload in hypertensive emergency with pulmonary edema, rapidly decreasing
myocardial oxygen demand and improving forward flow.
Q3: A patient with suspected aortic dissection presents with tearing chest pain
radiating to the back and a blood pressure difference of 30 mmHg between the right
and left arms. Which diagnostic study is the gold standard?
A. 12-lead ECG
B. Chest X-ray
C. CT angiography of the chest, abdomen, and pelvis
D. Echocardiography
Correct Answer: C
Rationale: CT angiography is the gold standard for diagnosing aortic dissection,
providing detailed visualization of the intimal flap, true and false lumens, and branch
vessel involvement.
Q4: A patient develops cardiac tamponade following cardiac surgery. Which classic
physical finding triad (Beck's triad) is most specific for this condition?
A. Hypertension, bounding pulses, and jugular venous distension
B. Hypotension, muffled heart sounds, and jugular venous distension
C. Tachycardia, hypertension, and clear lung fields
D. Bradycardia, loud S3 gallop, and peripheral edema
,Correct Answer: B
Rationale: Beck's triad consists of hypotension, muffled or distant heart sounds, and
jugular venous distension, representing the classic presentation of cardiac
tamponade with impaired ventricular filling.
Q5: A patient in the ICU develops polymorphic ventricular tachycardia (torsades de
pointes) with a QTc interval of 560 ms. Which electrolyte abnormality is most likely
contributing?
A. Hypercalcemia
B. Hypomagnesemia
C. Hypernatremia
D. Hyperkalemia
Correct Answer: B
Rationale: Hypomagnesemia prolongs the QT interval and predisposes to torsades
de pointes; intravenous magnesium sulfate is the first-line treatment for this
dysrhythmia.
Q6: A patient with acute decompensated heart failure has a serum BNP of 1,200
pg/mL. Which clinical interpretation is most accurate?
A. The BNP level is within normal limits and rules out heart failure
B. The elevated BNP supports a diagnosis of heart failure and correlates with
severity of ventricular wall stress
C. The BNP level indicates acute kidney injury
D. The BNP level is falsely elevated due to obesity
Correct Answer: B
, Rationale: BNP is released from ventricular myocardium in response to wall stress;
levels above 400 pg/mL strongly support heart failure diagnosis and correlate with
disease severity and prognosis.
Q7: A patient with atrial fibrillation and rapid ventricular response presents with
hypotension and altered mental status. Which intervention is the priority?
A. Initiate oral metoprolol
B. Perform synchronized cardioversion
C. Administer intravenous digoxin
D. Start therapeutic anticoagulation with warfarin
Correct Answer: B
Rationale: Unstable atrial fibrillation with rapid ventricular response causing
hypotension and altered mental status requires immediate synchronized
cardioversion to restore perfusion and hemodynamic stability.
Q8: A patient receiving tissue plasminogen activator (tPA) for acute ischemic stroke
develops orolingual angioedema. Which action should the nurse take first?
A. Discontinue the tPA infusion immediately
B. Administer intravenous diphenhydramine and methylprednisolone
C. Prepare for intubation
D. Continue the infusion and monitor closely
Correct Answer: B
Rationale: Orolingual angioedema is a known complication of tPA; antihistamines
and corticosteroids are first-line treatment, with airway management reserved for
progressive airway compromise.
