NR 571 | Complex Diagnosis and Management in Acute Care | 2026/2027
OBJECTIVE ASSESSMENT - EXAM
NR 571 - Complex Diagnosis and
Management
in Acute Care
Midterm Exam Questions & Answers
Chamberlain University | 2026/2027 Edition
A+ Verified Passing Score Graduate Level
2026/2027 Official Edition 80% AGACNP Acute Care
COVER PAGE - 1
, NR 571 - Complex Diagnosis and Management in Acute Care | 2026/2027 Edition
SECTIONS COVERED
Section 1: Cardiovascular Emergencies in Acute Care
Section 2: Respiratory Failure and Critical Pulmonary Conditions
Section 3: Neurological and Multisystem Trauma and Emergencies
Section 4: Shock, Sepsis, and Multiorgan Dysfunction
Section 5: Endocrine, Metabolic, Renal, and Infectious Complex Diagnoses
EXAM INFORMATION
This midterm examination assesses advanced clinical reasoning in the diagnosis and management
of complex acute care conditions for the Adult-Gerontology Acute Care Nurse Practitioner.
Each question requires analysis of a realistic patient scenario and selection of the most
appropriate diagnostic or management action. Passing score is 80 percent (40 correct answers).
All questions are at the analysis and evaluation levels of Bloom's taxonomy.
Section 1: Cardiovascular Emergencies in Acute Care
Q1 A 68-year-old male with a history of hypertension and coronary artery disease is admitted to the ICU after presenting with
sudden severe chest pain radiating to the back, described as tearing in nature. Blood pressure is 188/110 mmHg in the right arm
and 142/88 mmHg in the left arm. CT angiography confirms a Stanford type A aortic dissection. Which immediate management
priority is most appropriate while awaiting surgical consultation?
A. Initiate intravenous labetalol to achieve a systolic blood pressure of 100-120 mmHg and heart rate less than 60 bpm
B. Administer high-dose intravenous nitroglycerin for afterload reduction alone
C. Start dual antiplatelet therapy and prepare for emergent cardiac catheterization
D. Give intravenous fluids aggressively to expand intravascular volume before beta blockade
Correct Answer: A
Rationale: Beta-blockade first reduces shear stress and dP/dt, then vasodilators lower blood pressure. Labetalol provides both effects. Isolated
afterload reduction without heart rate control can worsen dissection. Antiplatelet therapy and fluid loading are contraindicated in type A dissection.
Q2 A 72-year-old woman develops acute pulmonary edema and cardiogenic shock two days after an anterior STEMI treated with
primary PCI. Swan-Ganz catheter reveals a cardiac index of 1.8 L/min/m2, PCWP of 28 mmHg, and SVR of 1800 dynes.
Echocardiogram shows an ejection fraction of 25% with no mechanical complication. Which pharmacologic strategy is indicated
next?
A. Initiate dobutamine infusion to improve contractility while carefully monitoring for arrhythmias
B. Start high-dose norepinephrine as the sole vasopressor without inotropic support
C. Administer large-volume crystalloid boluses to optimize preload further
D. Begin pure vasodilator therapy with nitroprusside alone without inotropic support
Correct Answer: A
Rationale: In cardiogenic shock with low cardiac index and elevated filling pressures, an inotrope such as dobutamine improves contractility. Pure
vasopressors alone may increase afterload. Further volume loading or isolated vasodilators without inotropic support are inappropriate given the
hemodynamics.
Q3 A 55-year-old man with known non-ischemic cardiomyopathy presents with progressive dyspnea, orthopnea, and a new third
heart sound. BNP is 1850 pg/mL. He is currently on carvedilol, lisinopril, and spironolactone. Which evidence-based adjustment
optimizes guideline-directed medical therapy for acute decompensated heart failure with reduced ejection fraction once
euvolemia is achieved?
A. Add a sodium-glucose cotransporter-2 inhibitor such as dapagliflozin if renal function permits
B. Discontinue the beta-blocker indefinitely to avoid negative inotropy
C. Replace lisinopril with a calcium-channel blocker for better blood pressure control
D. Increase spironolactone to 100 mg daily regardless of potassium level
Correct Answer: A
Rationale: SGLT2 inhibitors reduce heart failure hospitalizations and mortality and are recommended in HFrEF. Beta-blockers should be
continued or restarted once euvolemic. Calcium-channel blockers are not indicated, and high-dose spironolactone risks hyperkalemia.
Page 2
OBJECTIVE ASSESSMENT - EXAM
NR 571 - Complex Diagnosis and
Management
in Acute Care
Midterm Exam Questions & Answers
Chamberlain University | 2026/2027 Edition
A+ Verified Passing Score Graduate Level
2026/2027 Official Edition 80% AGACNP Acute Care
COVER PAGE - 1
, NR 571 - Complex Diagnosis and Management in Acute Care | 2026/2027 Edition
SECTIONS COVERED
Section 1: Cardiovascular Emergencies in Acute Care
Section 2: Respiratory Failure and Critical Pulmonary Conditions
Section 3: Neurological and Multisystem Trauma and Emergencies
Section 4: Shock, Sepsis, and Multiorgan Dysfunction
Section 5: Endocrine, Metabolic, Renal, and Infectious Complex Diagnoses
EXAM INFORMATION
This midterm examination assesses advanced clinical reasoning in the diagnosis and management
of complex acute care conditions for the Adult-Gerontology Acute Care Nurse Practitioner.
Each question requires analysis of a realistic patient scenario and selection of the most
appropriate diagnostic or management action. Passing score is 80 percent (40 correct answers).
All questions are at the analysis and evaluation levels of Bloom's taxonomy.
Section 1: Cardiovascular Emergencies in Acute Care
Q1 A 68-year-old male with a history of hypertension and coronary artery disease is admitted to the ICU after presenting with
sudden severe chest pain radiating to the back, described as tearing in nature. Blood pressure is 188/110 mmHg in the right arm
and 142/88 mmHg in the left arm. CT angiography confirms a Stanford type A aortic dissection. Which immediate management
priority is most appropriate while awaiting surgical consultation?
A. Initiate intravenous labetalol to achieve a systolic blood pressure of 100-120 mmHg and heart rate less than 60 bpm
B. Administer high-dose intravenous nitroglycerin for afterload reduction alone
C. Start dual antiplatelet therapy and prepare for emergent cardiac catheterization
D. Give intravenous fluids aggressively to expand intravascular volume before beta blockade
Correct Answer: A
Rationale: Beta-blockade first reduces shear stress and dP/dt, then vasodilators lower blood pressure. Labetalol provides both effects. Isolated
afterload reduction without heart rate control can worsen dissection. Antiplatelet therapy and fluid loading are contraindicated in type A dissection.
Q2 A 72-year-old woman develops acute pulmonary edema and cardiogenic shock two days after an anterior STEMI treated with
primary PCI. Swan-Ganz catheter reveals a cardiac index of 1.8 L/min/m2, PCWP of 28 mmHg, and SVR of 1800 dynes.
Echocardiogram shows an ejection fraction of 25% with no mechanical complication. Which pharmacologic strategy is indicated
next?
A. Initiate dobutamine infusion to improve contractility while carefully monitoring for arrhythmias
B. Start high-dose norepinephrine as the sole vasopressor without inotropic support
C. Administer large-volume crystalloid boluses to optimize preload further
D. Begin pure vasodilator therapy with nitroprusside alone without inotropic support
Correct Answer: A
Rationale: In cardiogenic shock with low cardiac index and elevated filling pressures, an inotrope such as dobutamine improves contractility. Pure
vasopressors alone may increase afterload. Further volume loading or isolated vasodilators without inotropic support are inappropriate given the
hemodynamics.
Q3 A 55-year-old man with known non-ischemic cardiomyopathy presents with progressive dyspnea, orthopnea, and a new third
heart sound. BNP is 1850 pg/mL. He is currently on carvedilol, lisinopril, and spironolactone. Which evidence-based adjustment
optimizes guideline-directed medical therapy for acute decompensated heart failure with reduced ejection fraction once
euvolemia is achieved?
A. Add a sodium-glucose cotransporter-2 inhibitor such as dapagliflozin if renal function permits
B. Discontinue the beta-blocker indefinitely to avoid negative inotropy
C. Replace lisinopril with a calcium-channel blocker for better blood pressure control
D. Increase spironolactone to 100 mg daily regardless of potassium level
Correct Answer: A
Rationale: SGLT2 inhibitors reduce heart failure hospitalizations and mortality and are recommended in HFrEF. Beta-blockers should be
continued or restarted once euvolemic. Calcium-channel blockers are not indicated, and high-dose spironolactone risks hyperkalemia.
Page 2
