ADULT-GERONTOLOGY ACUTE CARE NP BARKLEY
PRACTICE EXAM EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Hemodynamic Monitoring and Critical Care Management
2. Acute and Life-Threatening Multi-Organ Pathophysiology
3. Advanced Pharmacotherapy and Toxicology in Acute Care
4. Emergency Procedures and Trauma Management
5. Post-Operative and Complex Surgical Complications
1. A 64-year-old male with a history of anterior ST-elevation myocardial infarction is admitted to
the cardiac intensive care unit. He suddenly becomes acutely dyspneic, tachypneic, and
hypotensive with a blood pressure of 80/50 mmHg. Physical examination reveals a loud
holosystolic murmur best heard at the apex with radiation to the axilla, along with acute
pulmonary edema. What is the most likely mechanical complication?
A. Free wall rupture
B. Acute mitral regurgitation secondary to papillary muscle rupture
C. Ventricular septal rupture
D. Acute aortic dissection type A
CORRECT ANSWER : B
Rationale: Acute papillary muscle rupture following a myocardial infarction leads to sudden,
severe mitral regurgitation, manifesting as a new holosystolic murmur and cardiogenic shock.
Option A results in rapid electromechanical dissociation and cardiac tamponade. Option C
causes a harsh pansystolic murmur at the left sternal border with a palpable thrill. Option D
presents with tearing chest pain and a widened mediastinum.
2. A 58-year-old male is admitted to the intensive care unit with septic shock secondary to
urosepsis. Despite adequate crystalloid resuscitation of 30 mL/kg, his mean arterial pressure
, remains at 55 mmHg, and his central venous pressure is 12 mmHg. Which vasoactive agent
should be initiated as the first-line vasopressor of choice?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
CORRECT ANSWER : B
Rationale: Norepinephrine is recommended as the first-line vasopressor in septic shock due to
its potent alpha-1 and modest beta-1 agonist effects, effectively restoring vascular tone with
lower mortality risks compared to dopamine. Option A carries a higher incidence of
tachyarrhythmias. Option C lacks beta-agonist inotropic support and can severely depress
cardiac output. Option D is used as a second-line adjunctive agent, not as primary monotherapy.
3. A 72-year-old female is admitted following a severe ground-level fall. Initial trauma survey
reveals a Glasgow Coma Scale score of 13, and a non-contrast head CT demonstrates an acute
subdural hematoma with 6 mm of midline shift. Her home medication includes warfarin for atrial
fibrillation, and her initial international normalized ratio (INR) is 3.5. What is the immediate
priority reversal strategy?
A. Fresh frozen plasma alone
B. Four-factor prothrombin complex concentrate (4F-PCC) combined with intravenous
vitamin K
C. High-dose oral vitamin K administration
D. Platelet transfusion and observation
CORRECT ANSWER : B
Rationale: Urgent reversal of vitamin K antagonists in life-threatening intracranial hemorrhage
requires four-factor prothrombin complex concentrate (4F-PCC) for rapid factor replacement,
combined with IV vitamin K to sustain clotting factor synthesis. Option A requires large volume
infusion and takes longer to thaw and administer. Option C has a delayed onset of hours. Option
D fails to replace missing coagulation factors.
4. A 50-year-old male with decompensated alcoholic cirrhosis is admitted with hematemesis and
altered mental status. Endoscopy confirms actively bleeding esophageal varices. Alongside
vasoactive drug therapy (somatostatin analogue) and endoscopic band ligation, which
, pharmacological prophylaxis must be initiated immediately to prevent infection-related
mortality?
A. Short-course broad-spectrum antibiotic prophylaxis (e.g., ceftriaxone)
B. Oral fluconazole therapy
C. Long-term oral vancomycin maintenance
D. Prophylactic antiviral acyclovir therapy
CORRECT ANSWER : A
Rationale: Short-term antibiotic prophylaxis with a third-generation cephalosporin reduces
bacterial infections, prevents rebleeding, and improves survival in cirrhotic patients presenting
with acute variceal hemorrhage. Options B, C, and D are not indicated for primary prophylaxis
of variceal bleeding complications.
5. A 45-year-old male is admitted to the burn unit with full-thickness burns covering 45% of his
total body surface area. Using the Parkland formula (4 mL/kg/%TBSA), calculate the total
volume of lactated Ringer's solution required in the first 8 hours post-injury for an 80 kg patient.
A. 7,200 mL
B. 7,200 mL total in first 8 hours (half of the 14,400 mL 24-hour total)
C. 14,400 mL
D. 3,600 mL
CORRECT ANSWER : B
Rationale: The Parkland formula dictates 4 mL multiplied by weight in kg (80) multiplied by
%TBSA (45), totaling 14,400 mL over 24 hours, with exactly half (7,200 mL) administered in the
first 8 hours post-burn. Option A correctly notes the 8-hour split volume, but option B precisely
defines the mandatory breakdown context. Option C is the total 24-hour volume. Option D is an
under-resuscitation amount.
6. A 65-year-old male develops sudden-onset, severe shortness of breath and pleuritic chest pain on
postoperative day three following a total knee arthroplasty. Bedside echocardiogram reveals
acute right ventricular dilation and McConnell's sign. What is the most appropriate initial
management for this massive pulmonary embolism if he is hemodynamically unstable with a
systolic blood pressure of 75 mmHg?
A. Therapeutic subcutaneous low-molecular-weight heparin
, B. Systemic thrombolytic therapy (e.g., alteplase)
C. Placement of an inferior vena cava filter alone
D. Immediate surgical embolectomy without thrombolytics
CORRECT ANSWER : B
Rationale: Massive pulmonary embolism presenting with hemodynamic instability (hypotension)
is an absolute indication for systemic fibrinolytic therapy to rapidly lyse clot burden and relieve
right ventricular failure. Option A is reserved for hemodynamically stable patients. Option C
prevents recurrent emboli but does not treat acute obstruction. Option D is secondary when
thrombolysis is contraindicated.
7. A 60-year-old male with septic shock has a central venous catheter in place. Hemodynamic
measurements reveal: CVP 4 mmHg, Mean Arterial Pressure (MAP) 58 mmHg, ScvO2 55%,
and Cardiac Index 2.0 L/min/m². According to early goal-directed resuscitation principles, what
is the most appropriate next therapeutic intervention?
A. Initiate maintenance diuretic therapy
B. Administer a fluid bolus of balanced crystalloids
C. Titrate norepinephrine to higher blood pressure goals
D. Initiate beta-blocker infusion therapy
CORRECT ANSWER : B
Rationale: A low CVP (<8 mmHg) combined with low ScvO2 (<70%) and reduced cardiac index
in septic shock indicates inadequate preload, requiring immediate fluid resuscitation with
balanced crystalloids. Options A and D would worsen hemodynamic collapse. Option C
addresses vascular tone but fails to correct underlying intravascular volume depletion.
8. A 32-year-old male is admitted following a high-speed motor vehicle collision. He exhibits a
widened mediastinum on chest radiography, and a CT angiogram reveals a traumatic aortic
injury at the isthmus. What is the immediate primary medical stabilization goal prior to surgical
or endovascular repair?
A. Strict heart rate and blood pressure control (SBP 100-120 mmHg, HR <60 bpm)
B. Immediate volume loading with uncrossed packed red blood cells
C. Administration of rapid-acting systemic vasodilators without beta-blockers
D. Maintenance of a mean arterial pressure above 110 mmHg
PRACTICE EXAM EXAM with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Hemodynamic Monitoring and Critical Care Management
2. Acute and Life-Threatening Multi-Organ Pathophysiology
3. Advanced Pharmacotherapy and Toxicology in Acute Care
4. Emergency Procedures and Trauma Management
5. Post-Operative and Complex Surgical Complications
1. A 64-year-old male with a history of anterior ST-elevation myocardial infarction is admitted to
the cardiac intensive care unit. He suddenly becomes acutely dyspneic, tachypneic, and
hypotensive with a blood pressure of 80/50 mmHg. Physical examination reveals a loud
holosystolic murmur best heard at the apex with radiation to the axilla, along with acute
pulmonary edema. What is the most likely mechanical complication?
A. Free wall rupture
B. Acute mitral regurgitation secondary to papillary muscle rupture
C. Ventricular septal rupture
D. Acute aortic dissection type A
CORRECT ANSWER : B
Rationale: Acute papillary muscle rupture following a myocardial infarction leads to sudden,
severe mitral regurgitation, manifesting as a new holosystolic murmur and cardiogenic shock.
Option A results in rapid electromechanical dissociation and cardiac tamponade. Option C
causes a harsh pansystolic murmur at the left sternal border with a palpable thrill. Option D
presents with tearing chest pain and a widened mediastinum.
2. A 58-year-old male is admitted to the intensive care unit with septic shock secondary to
urosepsis. Despite adequate crystalloid resuscitation of 30 mL/kg, his mean arterial pressure
, remains at 55 mmHg, and his central venous pressure is 12 mmHg. Which vasoactive agent
should be initiated as the first-line vasopressor of choice?
A. Dopamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
CORRECT ANSWER : B
Rationale: Norepinephrine is recommended as the first-line vasopressor in septic shock due to
its potent alpha-1 and modest beta-1 agonist effects, effectively restoring vascular tone with
lower mortality risks compared to dopamine. Option A carries a higher incidence of
tachyarrhythmias. Option C lacks beta-agonist inotropic support and can severely depress
cardiac output. Option D is used as a second-line adjunctive agent, not as primary monotherapy.
3. A 72-year-old female is admitted following a severe ground-level fall. Initial trauma survey
reveals a Glasgow Coma Scale score of 13, and a non-contrast head CT demonstrates an acute
subdural hematoma with 6 mm of midline shift. Her home medication includes warfarin for atrial
fibrillation, and her initial international normalized ratio (INR) is 3.5. What is the immediate
priority reversal strategy?
A. Fresh frozen plasma alone
B. Four-factor prothrombin complex concentrate (4F-PCC) combined with intravenous
vitamin K
C. High-dose oral vitamin K administration
D. Platelet transfusion and observation
CORRECT ANSWER : B
Rationale: Urgent reversal of vitamin K antagonists in life-threatening intracranial hemorrhage
requires four-factor prothrombin complex concentrate (4F-PCC) for rapid factor replacement,
combined with IV vitamin K to sustain clotting factor synthesis. Option A requires large volume
infusion and takes longer to thaw and administer. Option C has a delayed onset of hours. Option
D fails to replace missing coagulation factors.
4. A 50-year-old male with decompensated alcoholic cirrhosis is admitted with hematemesis and
altered mental status. Endoscopy confirms actively bleeding esophageal varices. Alongside
vasoactive drug therapy (somatostatin analogue) and endoscopic band ligation, which
, pharmacological prophylaxis must be initiated immediately to prevent infection-related
mortality?
A. Short-course broad-spectrum antibiotic prophylaxis (e.g., ceftriaxone)
B. Oral fluconazole therapy
C. Long-term oral vancomycin maintenance
D. Prophylactic antiviral acyclovir therapy
CORRECT ANSWER : A
Rationale: Short-term antibiotic prophylaxis with a third-generation cephalosporin reduces
bacterial infections, prevents rebleeding, and improves survival in cirrhotic patients presenting
with acute variceal hemorrhage. Options B, C, and D are not indicated for primary prophylaxis
of variceal bleeding complications.
5. A 45-year-old male is admitted to the burn unit with full-thickness burns covering 45% of his
total body surface area. Using the Parkland formula (4 mL/kg/%TBSA), calculate the total
volume of lactated Ringer's solution required in the first 8 hours post-injury for an 80 kg patient.
A. 7,200 mL
B. 7,200 mL total in first 8 hours (half of the 14,400 mL 24-hour total)
C. 14,400 mL
D. 3,600 mL
CORRECT ANSWER : B
Rationale: The Parkland formula dictates 4 mL multiplied by weight in kg (80) multiplied by
%TBSA (45), totaling 14,400 mL over 24 hours, with exactly half (7,200 mL) administered in the
first 8 hours post-burn. Option A correctly notes the 8-hour split volume, but option B precisely
defines the mandatory breakdown context. Option C is the total 24-hour volume. Option D is an
under-resuscitation amount.
6. A 65-year-old male develops sudden-onset, severe shortness of breath and pleuritic chest pain on
postoperative day three following a total knee arthroplasty. Bedside echocardiogram reveals
acute right ventricular dilation and McConnell's sign. What is the most appropriate initial
management for this massive pulmonary embolism if he is hemodynamically unstable with a
systolic blood pressure of 75 mmHg?
A. Therapeutic subcutaneous low-molecular-weight heparin
, B. Systemic thrombolytic therapy (e.g., alteplase)
C. Placement of an inferior vena cava filter alone
D. Immediate surgical embolectomy without thrombolytics
CORRECT ANSWER : B
Rationale: Massive pulmonary embolism presenting with hemodynamic instability (hypotension)
is an absolute indication for systemic fibrinolytic therapy to rapidly lyse clot burden and relieve
right ventricular failure. Option A is reserved for hemodynamically stable patients. Option C
prevents recurrent emboli but does not treat acute obstruction. Option D is secondary when
thrombolysis is contraindicated.
7. A 60-year-old male with septic shock has a central venous catheter in place. Hemodynamic
measurements reveal: CVP 4 mmHg, Mean Arterial Pressure (MAP) 58 mmHg, ScvO2 55%,
and Cardiac Index 2.0 L/min/m². According to early goal-directed resuscitation principles, what
is the most appropriate next therapeutic intervention?
A. Initiate maintenance diuretic therapy
B. Administer a fluid bolus of balanced crystalloids
C. Titrate norepinephrine to higher blood pressure goals
D. Initiate beta-blocker infusion therapy
CORRECT ANSWER : B
Rationale: A low CVP (<8 mmHg) combined with low ScvO2 (<70%) and reduced cardiac index
in septic shock indicates inadequate preload, requiring immediate fluid resuscitation with
balanced crystalloids. Options A and D would worsen hemodynamic collapse. Option C
addresses vascular tone but fails to correct underlying intravascular volume depletion.
8. A 32-year-old male is admitted following a high-speed motor vehicle collision. He exhibits a
widened mediastinum on chest radiography, and a CT angiogram reveals a traumatic aortic
injury at the isthmus. What is the immediate primary medical stabilization goal prior to surgical
or endovascular repair?
A. Strict heart rate and blood pressure control (SBP 100-120 mmHg, HR <60 bpm)
B. Immediate volume loading with uncrossed packed red blood cells
C. Administration of rapid-acting systemic vasodilators without beta-blockers
D. Maintenance of a mean arterial pressure above 110 mmHg
