NR-605 PRIMARY CARE OF ACUTE CONDITIONS EXAM
1,2,3 & FINAL BUDDLE EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant Download
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EXAM COVERAGE
1. Advanced Assessment and Management of Acute Cardiovascular Conditions
2. Acute Respiratory Emergencies and Critical Pulmonary Disorders in Primary Care
3. Urgent Gastrointestinal, Hepatic, and Pancreatic Pathologies
4. Acute Neurological Deficits and Cerebrovascular Emergencies
5. Acute Nephrological, Urological, and Electrolyte Disorders
6. Musculoskeletal Injuries, Acute Orthopedic, and Soft Tissue Trauma
7. Acute Endocrine Emergencies, Toxicological, and Dermatological Crises
1. A 58-year-old male with a history of hypertension and hyperlipidemia presents to the urgent care
clinic complaining of acute, crushing substernal chest pain radiating to his left jaw and
diaphoresis that began 45 minutes ago while shoveling snow. Vital signs reveal BP 150/95
mmHg, HR 102 bpm, RR 22 breaths/min, and SpO2 96% on room air. A 12-lead
electrocardiogram demonstrates 2 mm ST-segment elevation in leads V2 through V6. What is
the most immediate and appropriate clinical action?
A. Administer oral sublingual nitroglycerin and observe for 30 minutes in the clinic
B. Activate emergency medical services (EMS) for immediate transport to a PCI-capable
facility for primary percutaneous coronary intervention
C. Order a high-sensitivity troponin level and await results before considering transfer
D. Administer high-dose outpatient oral metoprolol and schedule a stress test for the following
week
, CORRECT ANSWER : B
Rationale: This patient is presenting with an acute ST-elevation myocardial infarction (STEMI),
which is a time-critical cardiovascular emergency requiring immediate reperfusion therapy.
Primary percutaneous coronary intervention (PCI) is the gold standard and should be performed
within 90 minutes of first medical contact, necessitating immediate emergency transfer.
2. A 67-year-old female with a history of chronic persistent atrial fibrillation and non-compliance
with oral anticoagulation presents with sudden-onset, severe, colicky periumbilical abdominal
pain that is entirely out of proportion to physical examination findings, where her abdomen
remains soft and non-tender on deep palpation. Which of the following is the most likely
diagnosis and diagnostic modality of choice?
A. Acute appendicitis; diagnosed via graded compression abdominal ultrasound
B. Acute mesenteric ischemia; diagnosed via computed tomography angiography (CTA) of
the abdomen and pelvis
C. Acute diverticulitis; diagnosed via abdominal CT scan with oral and IV contrast
D. Perforated peptic ulcer disease; diagnosed via upright chest and abdominal radiography
CORRECT ANSWER : B
Rationale: Severe abdominal pain out of proportion to physical examination findings in a patient
with risk factors like atrial fibrillation is classic for acute mesenteric ischemia due to an embolic
occlusion of the superior mesenteric artery. Computed tomography angiography (CTA) is the
rapid imaging modality of choice to visualize vascular patency.
3. A 45-year-old male presents to the emergency department with acute onset of severe, tearing
interscapular back pain that radiated to his chest as it started. His medical history is significant
for poorly controlled chronic hypertension. Blood pressure is 185/110 mmHg in the right arm
and 140/85 mmHg in the left arm. A chest radiograph demonstrates a widened mediastinum.
What is the definitive initial medication management strategy prior to surgical intervention?
A. Aggressive volume expansion with normal saline and high-dose IV dopamine
B. Intravenous beta-blockade (e.g., esmolol or labetalol) to lower heart rate and blood
pressure, followed by vasodilators if needed
C. Immediate administration of sublingual nifedipine capsules to rapidly drop systolic pressure
D. Initiation of therapeutic-dose intravenous heparin infusion for suspected pulmonary embolism
CORRECT ANSWER : B
, Rationale: Acute aortic dissection requires immediate reduction of both heart rate and blood
pressure to minimize aortic wall shear stress (dP/dt). Intravenous beta-blockers must be initiated
first to prevent reflex tachycardia before adding vasodilator therapy.
4. A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with acute worsening of dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and
bilateral lower extremity edema up to his knees. Vital signs show BP 168/98 mmHg, HR 115
bpm irregularly irregular, RR 26 breaths/min, and SpO2 88% on room air. Auscultation reveals
diffuse crackles lung bases and an S3 gallop. What is the initial pharmacological intervention?
A. Intravenous fluid bolus to maintain renal perfusion and oral metoprolol
B. Intravenous loop diuretics (e.g., furosemide) combined with immediate supplemental
oxygen and non-invasive positive pressure ventilation if indicated
C. Initiation of high-dose long-acting oral opioids for dyspnea palliation
D. Immediate administration of oral amiodarone for rate control alone
CORRECT ANSWER : B
Rationale: Acute decompensated heart failure with volume overload requires rapid decongestion
using intravenous loop diuretics, alongside oxygenation and afterload reduction to manage
acute respiratory distress.
5. A 50-year-old female presents with sudden onset of right-sided weakness, facial droop, and
expressive aphasia that started exactly 90 minutes ago. Non-contrast head CT demonstrates no
acute intracranial hemorrhage. Her blood pressure is 172/98 mmHg. What is the primary
guideline-directed management?
A. Administer sublingual labetalol until blood pressure drops below 120/80 mmHg, then observe
B. Assess eligibility for intravenous recombinant tissue plasminogen activator (IV
alteplase) or tenecteplase administration
C. Discharge home with dual antiplatelet therapy and a referral for outpatient physical therapy
D. Perform immediate carotid endarterectomy within the emergency setting
CORRECT ANSWER : B
Rationale: Patients presenting within the 4.5-hour window for acute ischemic stroke without
hemorrhage on CT should be evaluated for systemic thrombolysis with IV alteplase or
tenecteplase to restore cerebral blood flow.
, 6. A 64-year-old male presents with acute onset of severe right eye pain, blurred vision, headache,
and nausea with vomiting. Examination reveals a cloudy cornea, a mid-dilated fixed pupil, and a
rock-hard eye on palpation. Intraocular pressure measured by tonometry is 48 mmHg. What is
the immediate pharmacological management?
A. Topical mydriatic eye drops to dilate the pupil and open the angle
B. Topical beta-blockers, alpha-agonists, and systemic carbonic anhydrase inhibitors to
lower intraocular pressure
C. High-dose oral systemic corticosteroid taper
D. Topical antibiotic ointment for infectious uveitis
CORRECT ANSWER : B
Rationale: Acute angle-closure glaucoma is an ophthalmological emergency characterized by
sudden pressure elevation. Treatment focuses on immediate medical reduction of intraocular
pressure using topical and systemic agents before definitive laser peripheral iridotomy.
7. A 29-year-old female presents with acute right lower quadrant abdominal pain, low-grade fever,
and nausea over the past 18 hours. Pain started periumbilically before localizing. Examination
reveals localized tenderness at McBurney's point, positive obturator and psoas signs. What is the
diagnostic imaging modality of choice for confirmation in this non-pregnant adult?
A. Plain abdominal radiograph in upright and supine positions
B. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast
C. Graded compression abdominal ultrasound
D. Magnetic resonance cholangiopancreatography (MRCP)
CORRECT ANSWER : B
Rationale: Acute appendicitis presentation is classic here, and abdominal CT with IV contrast is
the gold standard diagnostic imaging modality in non-pregnant adults to confirm inflammation
and rule out mimics.
8. A 35-year-old male presents to the urgent care clinic following a motor vehicle collision where
his right knee struck the dashboard. Examination reveals posterior displacement of the tibia
relative to the femur when a posterior force is applied to the proximal tibia with the knee flexed
at 90 degrees (positive posterior drawer test). What ligamentous structure is injured?
A. Anterior cruciate ligament (ACL)
1,2,3 & FINAL BUDDLE EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant Download
EXAM COVERAGE
1. Advanced Assessment and Management of Acute Cardiovascular Conditions
2. Acute Respiratory Emergencies and Critical Pulmonary Disorders in Primary Care
3. Urgent Gastrointestinal, Hepatic, and Pancreatic Pathologies
4. Acute Neurological Deficits and Cerebrovascular Emergencies
5. Acute Nephrological, Urological, and Electrolyte Disorders
6. Musculoskeletal Injuries, Acute Orthopedic, and Soft Tissue Trauma
7. Acute Endocrine Emergencies, Toxicological, and Dermatological Crises
1. A 58-year-old male with a history of hypertension and hyperlipidemia presents to the urgent care
clinic complaining of acute, crushing substernal chest pain radiating to his left jaw and
diaphoresis that began 45 minutes ago while shoveling snow. Vital signs reveal BP 150/95
mmHg, HR 102 bpm, RR 22 breaths/min, and SpO2 96% on room air. A 12-lead
electrocardiogram demonstrates 2 mm ST-segment elevation in leads V2 through V6. What is
the most immediate and appropriate clinical action?
A. Administer oral sublingual nitroglycerin and observe for 30 minutes in the clinic
B. Activate emergency medical services (EMS) for immediate transport to a PCI-capable
facility for primary percutaneous coronary intervention
C. Order a high-sensitivity troponin level and await results before considering transfer
D. Administer high-dose outpatient oral metoprolol and schedule a stress test for the following
week
, CORRECT ANSWER : B
Rationale: This patient is presenting with an acute ST-elevation myocardial infarction (STEMI),
which is a time-critical cardiovascular emergency requiring immediate reperfusion therapy.
Primary percutaneous coronary intervention (PCI) is the gold standard and should be performed
within 90 minutes of first medical contact, necessitating immediate emergency transfer.
2. A 67-year-old female with a history of chronic persistent atrial fibrillation and non-compliance
with oral anticoagulation presents with sudden-onset, severe, colicky periumbilical abdominal
pain that is entirely out of proportion to physical examination findings, where her abdomen
remains soft and non-tender on deep palpation. Which of the following is the most likely
diagnosis and diagnostic modality of choice?
A. Acute appendicitis; diagnosed via graded compression abdominal ultrasound
B. Acute mesenteric ischemia; diagnosed via computed tomography angiography (CTA) of
the abdomen and pelvis
C. Acute diverticulitis; diagnosed via abdominal CT scan with oral and IV contrast
D. Perforated peptic ulcer disease; diagnosed via upright chest and abdominal radiography
CORRECT ANSWER : B
Rationale: Severe abdominal pain out of proportion to physical examination findings in a patient
with risk factors like atrial fibrillation is classic for acute mesenteric ischemia due to an embolic
occlusion of the superior mesenteric artery. Computed tomography angiography (CTA) is the
rapid imaging modality of choice to visualize vascular patency.
3. A 45-year-old male presents to the emergency department with acute onset of severe, tearing
interscapular back pain that radiated to his chest as it started. His medical history is significant
for poorly controlled chronic hypertension. Blood pressure is 185/110 mmHg in the right arm
and 140/85 mmHg in the left arm. A chest radiograph demonstrates a widened mediastinum.
What is the definitive initial medication management strategy prior to surgical intervention?
A. Aggressive volume expansion with normal saline and high-dose IV dopamine
B. Intravenous beta-blockade (e.g., esmolol or labetalol) to lower heart rate and blood
pressure, followed by vasodilators if needed
C. Immediate administration of sublingual nifedipine capsules to rapidly drop systolic pressure
D. Initiation of therapeutic-dose intravenous heparin infusion for suspected pulmonary embolism
CORRECT ANSWER : B
, Rationale: Acute aortic dissection requires immediate reduction of both heart rate and blood
pressure to minimize aortic wall shear stress (dP/dt). Intravenous beta-blockers must be initiated
first to prevent reflex tachycardia before adding vasodilator therapy.
4. A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with acute worsening of dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and
bilateral lower extremity edema up to his knees. Vital signs show BP 168/98 mmHg, HR 115
bpm irregularly irregular, RR 26 breaths/min, and SpO2 88% on room air. Auscultation reveals
diffuse crackles lung bases and an S3 gallop. What is the initial pharmacological intervention?
A. Intravenous fluid bolus to maintain renal perfusion and oral metoprolol
B. Intravenous loop diuretics (e.g., furosemide) combined with immediate supplemental
oxygen and non-invasive positive pressure ventilation if indicated
C. Initiation of high-dose long-acting oral opioids for dyspnea palliation
D. Immediate administration of oral amiodarone for rate control alone
CORRECT ANSWER : B
Rationale: Acute decompensated heart failure with volume overload requires rapid decongestion
using intravenous loop diuretics, alongside oxygenation and afterload reduction to manage
acute respiratory distress.
5. A 50-year-old female presents with sudden onset of right-sided weakness, facial droop, and
expressive aphasia that started exactly 90 minutes ago. Non-contrast head CT demonstrates no
acute intracranial hemorrhage. Her blood pressure is 172/98 mmHg. What is the primary
guideline-directed management?
A. Administer sublingual labetalol until blood pressure drops below 120/80 mmHg, then observe
B. Assess eligibility for intravenous recombinant tissue plasminogen activator (IV
alteplase) or tenecteplase administration
C. Discharge home with dual antiplatelet therapy and a referral for outpatient physical therapy
D. Perform immediate carotid endarterectomy within the emergency setting
CORRECT ANSWER : B
Rationale: Patients presenting within the 4.5-hour window for acute ischemic stroke without
hemorrhage on CT should be evaluated for systemic thrombolysis with IV alteplase or
tenecteplase to restore cerebral blood flow.
, 6. A 64-year-old male presents with acute onset of severe right eye pain, blurred vision, headache,
and nausea with vomiting. Examination reveals a cloudy cornea, a mid-dilated fixed pupil, and a
rock-hard eye on palpation. Intraocular pressure measured by tonometry is 48 mmHg. What is
the immediate pharmacological management?
A. Topical mydriatic eye drops to dilate the pupil and open the angle
B. Topical beta-blockers, alpha-agonists, and systemic carbonic anhydrase inhibitors to
lower intraocular pressure
C. High-dose oral systemic corticosteroid taper
D. Topical antibiotic ointment for infectious uveitis
CORRECT ANSWER : B
Rationale: Acute angle-closure glaucoma is an ophthalmological emergency characterized by
sudden pressure elevation. Treatment focuses on immediate medical reduction of intraocular
pressure using topical and systemic agents before definitive laser peripheral iridotomy.
7. A 29-year-old female presents with acute right lower quadrant abdominal pain, low-grade fever,
and nausea over the past 18 hours. Pain started periumbilically before localizing. Examination
reveals localized tenderness at McBurney's point, positive obturator and psoas signs. What is the
diagnostic imaging modality of choice for confirmation in this non-pregnant adult?
A. Plain abdominal radiograph in upright and supine positions
B. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast
C. Graded compression abdominal ultrasound
D. Magnetic resonance cholangiopancreatography (MRCP)
CORRECT ANSWER : B
Rationale: Acute appendicitis presentation is classic here, and abdominal CT with IV contrast is
the gold standard diagnostic imaging modality in non-pregnant adults to confirm inflammation
and rule out mimics.
8. A 35-year-old male presents to the urgent care clinic following a motor vehicle collision where
his right knee struck the dashboard. Examination reveals posterior displacement of the tibia
relative to the femur when a posterior force is applied to the proximal tibia with the knee flexed
at 90 degrees (positive posterior drawer test). What ligamentous structure is injured?
A. Anterior cruciate ligament (ACL)
