NRNP 6566 Final Quiz V1 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Final Quiz) | Walden University
1. A 65-year-old patient presents with a lactate level of 4.2 mmol/L and hypotension
requiring vasopressors to maintain a MAP > 65 mmHg despite adequate fluid resuscitation.
Which of the following is the most likely diagnosis?
A. Sepsis
B. Systemic Inflammatory Response Syndrome
C. Septic Shock
D. Multiple Organ Dysfunction Syndrome
Answer: C
Rationale: Septic shock is defined as a subset of sepsis in which particularly profound
circulatory, cellular, and metabolic abnormalities are associated with a greater risk of
mortality. Clinical criteria include the need for vasopressors to maintain MAP and a serum
lactate level > 2 mmol/L. Prompt recognition is essential for initiating the surviving sepsis
bundle.
2. When managing a patient with Diabetic Ketoacidosis (DKA), what is the first priority in the
treatment plan?
A. Fluid resuscitation
,B. Insulin bolus
C. Bicarbonate administration
D. Potassium replacement
Answer: A
Rationale: The initial management of DKA focuses on restoring circulatory volume and
improving tissue perfusion. Isotonic saline is typically the first fluid administered to
address the significant volume deficit. Insulin should be initiated only after fluid
resuscitation has begun and potassium levels are verified to be above 3.3 mEq/L.
3. A patient is suspected of having a Pulmonary Embolism (PE). Which diagnostic test is
considered the gold standard for definitive diagnosis in the acute setting?
A. Computed Tomography Pulmonary Angiography (CTPA)
B. Ventilation/Perfusion (V/Q) Scan
C. D-dimer
D. Chest X-ray
Answer: A
Rationale: CTPA is currently the preferred imaging modality for diagnosing PE due to its
high sensitivity and specificity. It allows for direct visualization of the embolus within the
pulmonary vasculature. In cases where CTPA is contraindicated, such as severe renal
failure, a V/Q scan may be performed.
, 4. An EKG shows peaked T-waves and a widened QRS complex in a patient with acute kidney
injury. Which electrolyte abnormality is most likely?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypomagnesemia
Answer: C
Rationale: Hyperkalemia is a life-threatening condition often seen in patients with renal
failure. Peaked T-waves are the earliest EKG manifestation, followed by QRS widening and
potentially a sine wave pattern. Treatment must be aggressive, including calcium gluconate
for cardiac stabilization followed by measures to shift or remove potassium.
5. A patient presents with a blood pressure of 210/130 mmHg and evidence of acute
pulmonary edema. Which classification best describes this condition?
A. Hypertensive Urgency
B. Secondary Hypertension
C. Malignant Hypertension
D. Hypertensive Emergency
Answer: D
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Final Quiz) | Walden University
1. A 65-year-old patient presents with a lactate level of 4.2 mmol/L and hypotension
requiring vasopressors to maintain a MAP > 65 mmHg despite adequate fluid resuscitation.
Which of the following is the most likely diagnosis?
A. Sepsis
B. Systemic Inflammatory Response Syndrome
C. Septic Shock
D. Multiple Organ Dysfunction Syndrome
Answer: C
Rationale: Septic shock is defined as a subset of sepsis in which particularly profound
circulatory, cellular, and metabolic abnormalities are associated with a greater risk of
mortality. Clinical criteria include the need for vasopressors to maintain MAP and a serum
lactate level > 2 mmol/L. Prompt recognition is essential for initiating the surviving sepsis
bundle.
2. When managing a patient with Diabetic Ketoacidosis (DKA), what is the first priority in the
treatment plan?
A. Fluid resuscitation
,B. Insulin bolus
C. Bicarbonate administration
D. Potassium replacement
Answer: A
Rationale: The initial management of DKA focuses on restoring circulatory volume and
improving tissue perfusion. Isotonic saline is typically the first fluid administered to
address the significant volume deficit. Insulin should be initiated only after fluid
resuscitation has begun and potassium levels are verified to be above 3.3 mEq/L.
3. A patient is suspected of having a Pulmonary Embolism (PE). Which diagnostic test is
considered the gold standard for definitive diagnosis in the acute setting?
A. Computed Tomography Pulmonary Angiography (CTPA)
B. Ventilation/Perfusion (V/Q) Scan
C. D-dimer
D. Chest X-ray
Answer: A
Rationale: CTPA is currently the preferred imaging modality for diagnosing PE due to its
high sensitivity and specificity. It allows for direct visualization of the embolus within the
pulmonary vasculature. In cases where CTPA is contraindicated, such as severe renal
failure, a V/Q scan may be performed.
, 4. An EKG shows peaked T-waves and a widened QRS complex in a patient with acute kidney
injury. Which electrolyte abnormality is most likely?
A. Hypernatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypomagnesemia
Answer: C
Rationale: Hyperkalemia is a life-threatening condition often seen in patients with renal
failure. Peaked T-waves are the earliest EKG manifestation, followed by QRS widening and
potentially a sine wave pattern. Treatment must be aggressive, including calcium gluconate
for cardiac stabilization followed by measures to shift or remove potassium.
5. A patient presents with a blood pressure of 210/130 mmHg and evidence of acute
pulmonary edema. Which classification best describes this condition?
A. Hypertensive Urgency
B. Secondary Hypertension
C. Malignant Hypertension
D. Hypertensive Emergency
Answer: D
