GRADUATE NURSING ACUTE CARE
NUR 5461 EXAM 1 REVIEW | QUESTIONS AND ANSWERS |
2026/2027 UPDATE | WITH COMPLETE SOLUTIONS
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Advanced Assessment and Diagnostic Reasoning in Acute Care
Cardiovascular Pathophysiology and Acute Management
Pulmonary Critical Care and Oxygenation Support
Shock States, Sepsis, and Hemodynamic Instability
Pharmacotherapeutics and Multisystem Supportive Care
STUVIAACTUALEXAM
,SECTION: ADVANCED ASSESSMENT AND DIAGNOSTIC REASONING IN ACUTE CARE
Q1.
A 68-year-old man is admitted from the emergency department with sudden-onset severe epigastric pain radiating to the
back, diaphoresis, and a blood pressure of 88/52 mm Hg. The advanced practice nurse notes a history of poorly
controlled hypertension and a recent cocaine use. While formulating the differential diagnosis, which life-threatening
condition must be prioritized for immediate exclusion?
A. Acute aortic dissection
B. Uncomplicated peptic ulcer disease
C. Biliary colic without obstruction
D. Gastroesophageal reflux with spasm
Correct Answer: A
Rationale:
Sudden severe tearing or radiating pain with hypotension and cocaine use raises high suspicion for acute aortic dissection, which
requires immediate imaging and surgical consultation. Peptic ulcer, biliary colic, and reflux can cause pain but do not typically produce
this degree of hemodynamic instability in the same pattern.
Q2.
An older adult with known heart failure is brought to the ICU with progressive dyspnea, orthopnea, and a new oxygen
requirement. The nurse practitioner auscultates fine crackles bilaterally and notes an S3 gallop. A chest radiograph
shows bilateral interstitial markings. Which pathophysiologic process best explains the current findings?
A. Elevated left ventricular end-diastolic pressure causing pulmonary venous congestion
B. Primary right ventricular failure with isolated systemic venous congestion
C. Acute bacterial pneumonia confined to the left lower lobe
D. Chronic obstructive pulmonary disease exacerbation without cardiac involvement
Correct Answer: A
Rationale:
Left-sided heart failure elevates left ventricular end-diastolic pressure, leading to pulmonary venous hypertension and
interstitial/alveolar edema that produces crackles, S3, and radiographic congestion. Isolated right heart failure produces systemic
congestion; focal pneumonia and pure COPD exacerbation lack the S3 and bilateral interstitial pattern.
Q3.
A 54-year-old woman develops acute altered mental status, fever of 39.1°C, and nuchal rigidity two days after a
neurosurgical procedure. The nurse practitioner orders a lumbar puncture. Which cerebrospinal fluid profile is most
consistent with bacterial meningitis in this postoperative setting?
A. Elevated opening pressure, neutrophilic pleocytosis, low glucose, elevated protein
B. Normal opening pressure, lymphocytic predominance, normal glucose, mildly elevated protein
C. Low opening pressure, acellular fluid, normal glucose and protein
D. Elevated opening pressure, eosinophilic predominance, high glucose
Correct Answer: A
Rationale:
Bacterial meningitis produces high opening pressure, neutrophil-dominant WBC elevation, hypoglycorrhachia, and elevated protein.
Lymphocytic patterns suggest viral or atypical processes; acellular fluid and eosinophilia point to other diagnoses.
, Q4.
A patient with cirrhosis and known esophageal varices presents with hematemesis and a systolic blood pressure of 78
mm Hg. After initial volume resuscitation, the nurse practitioner must rapidly risk-stratify the source. Which finding most
strongly supports an upper gastrointestinal variceal bleed requiring urgent endoscopic therapy?
A. History of cirrhosis with large-volume bright red hematemesis and hemodynamic instability
B. Melena alone without hemodynamic change in a patient on NSAIDs
C. Occult blood-positive stool with stable vital signs and iron-deficiency anemia
D. Coffee-ground emesis in a patient with known peptic ulcer disease on proton-pump inhibitors
Correct Answer: A
Rationale:
Cirrhosis plus large-volume bright red hematemesis and shock is classic for variceal hemorrhage and mandates urgent endoscopy and
vasoactive therapy. Melena or occult blood with stability more often reflects slower or lower-risk sources.
Q5.
A 72-year-old man with chronic kidney disease stage 4 is admitted with progressive weakness and peaked T waves on
ECG. Serum potassium is 6.8 mEq/L. The nurse practitioner initiates calcium gluconate. What is the primary physiologic
rationale for this immediate intervention?
A. Calcium antagonizes the membrane effects of hyperkalemia and stabilizes cardiac myocyte excitability
B. Calcium directly lowers the serum potassium concentration within minutes
C. Calcium shifts potassium intracellularly via activation of the sodium-potassium ATPase
D. Calcium binds potassium in the vascular space and promotes renal excretion
Correct Answer: A
Rationale:
Intravenous calcium does not lower serum potassium; it stabilizes the myocardial membrane against the arrhythmogenic effects of
hyperkalemia. Insulin, beta-agonists, and dialysis address the potassium level itself.
Q6.
A previously healthy 45-year-old woman develops acute right-sided pleuritic chest pain and dyspnea two weeks after a
long-haul flight. Oxygen saturation is 91% on room air. The nurse practitioner orders a CT pulmonary angiogram. Which
pretest clinical feature most increases the post-test probability of pulmonary embolism?
A. Recent prolonged immobility combined with pleuritic pain and hypoxemia
B. History of seasonal allergies and mild intermittent wheezing
C. Chronic gastroesophageal reflux with occasional nonexertional chest discomfort
D. Stable hypertension controlled on a single agent without recent medication change
Correct Answer: A
Rationale:
Prolonged immobility is a major risk factor; when combined with pleuritic pain and hypoxemia it substantially raises the pretest
probability of PE. Allergies, reflux, and controlled hypertension do not meaningfully increase PE likelihood.
NUR 5461 EXAM 1 REVIEW | QUESTIONS AND ANSWERS | 2026/2... STUVIAACTUALEXAM
NUR 5461 EXAM 1 REVIEW | QUESTIONS AND ANSWERS |
2026/2027 UPDATE | WITH COMPLETE SOLUTIONS
A+
Complete Blueprint Coverage
A+ 5 100%
QUESTIONS VERIFIED EXAM DOMAINS COVERED RATIONALES INCLUDED
CATEGORIES
Advanced Assessment and Diagnostic Reasoning in Acute Care
Cardiovascular Pathophysiology and Acute Management
Pulmonary Critical Care and Oxygenation Support
Shock States, Sepsis, and Hemodynamic Instability
Pharmacotherapeutics and Multisystem Supportive Care
STUVIAACTUALEXAM
,SECTION: ADVANCED ASSESSMENT AND DIAGNOSTIC REASONING IN ACUTE CARE
Q1.
A 68-year-old man is admitted from the emergency department with sudden-onset severe epigastric pain radiating to the
back, diaphoresis, and a blood pressure of 88/52 mm Hg. The advanced practice nurse notes a history of poorly
controlled hypertension and a recent cocaine use. While formulating the differential diagnosis, which life-threatening
condition must be prioritized for immediate exclusion?
A. Acute aortic dissection
B. Uncomplicated peptic ulcer disease
C. Biliary colic without obstruction
D. Gastroesophageal reflux with spasm
Correct Answer: A
Rationale:
Sudden severe tearing or radiating pain with hypotension and cocaine use raises high suspicion for acute aortic dissection, which
requires immediate imaging and surgical consultation. Peptic ulcer, biliary colic, and reflux can cause pain but do not typically produce
this degree of hemodynamic instability in the same pattern.
Q2.
An older adult with known heart failure is brought to the ICU with progressive dyspnea, orthopnea, and a new oxygen
requirement. The nurse practitioner auscultates fine crackles bilaterally and notes an S3 gallop. A chest radiograph
shows bilateral interstitial markings. Which pathophysiologic process best explains the current findings?
A. Elevated left ventricular end-diastolic pressure causing pulmonary venous congestion
B. Primary right ventricular failure with isolated systemic venous congestion
C. Acute bacterial pneumonia confined to the left lower lobe
D. Chronic obstructive pulmonary disease exacerbation without cardiac involvement
Correct Answer: A
Rationale:
Left-sided heart failure elevates left ventricular end-diastolic pressure, leading to pulmonary venous hypertension and
interstitial/alveolar edema that produces crackles, S3, and radiographic congestion. Isolated right heart failure produces systemic
congestion; focal pneumonia and pure COPD exacerbation lack the S3 and bilateral interstitial pattern.
Q3.
A 54-year-old woman develops acute altered mental status, fever of 39.1°C, and nuchal rigidity two days after a
neurosurgical procedure. The nurse practitioner orders a lumbar puncture. Which cerebrospinal fluid profile is most
consistent with bacterial meningitis in this postoperative setting?
A. Elevated opening pressure, neutrophilic pleocytosis, low glucose, elevated protein
B. Normal opening pressure, lymphocytic predominance, normal glucose, mildly elevated protein
C. Low opening pressure, acellular fluid, normal glucose and protein
D. Elevated opening pressure, eosinophilic predominance, high glucose
Correct Answer: A
Rationale:
Bacterial meningitis produces high opening pressure, neutrophil-dominant WBC elevation, hypoglycorrhachia, and elevated protein.
Lymphocytic patterns suggest viral or atypical processes; acellular fluid and eosinophilia point to other diagnoses.
, Q4.
A patient with cirrhosis and known esophageal varices presents with hematemesis and a systolic blood pressure of 78
mm Hg. After initial volume resuscitation, the nurse practitioner must rapidly risk-stratify the source. Which finding most
strongly supports an upper gastrointestinal variceal bleed requiring urgent endoscopic therapy?
A. History of cirrhosis with large-volume bright red hematemesis and hemodynamic instability
B. Melena alone without hemodynamic change in a patient on NSAIDs
C. Occult blood-positive stool with stable vital signs and iron-deficiency anemia
D. Coffee-ground emesis in a patient with known peptic ulcer disease on proton-pump inhibitors
Correct Answer: A
Rationale:
Cirrhosis plus large-volume bright red hematemesis and shock is classic for variceal hemorrhage and mandates urgent endoscopy and
vasoactive therapy. Melena or occult blood with stability more often reflects slower or lower-risk sources.
Q5.
A 72-year-old man with chronic kidney disease stage 4 is admitted with progressive weakness and peaked T waves on
ECG. Serum potassium is 6.8 mEq/L. The nurse practitioner initiates calcium gluconate. What is the primary physiologic
rationale for this immediate intervention?
A. Calcium antagonizes the membrane effects of hyperkalemia and stabilizes cardiac myocyte excitability
B. Calcium directly lowers the serum potassium concentration within minutes
C. Calcium shifts potassium intracellularly via activation of the sodium-potassium ATPase
D. Calcium binds potassium in the vascular space and promotes renal excretion
Correct Answer: A
Rationale:
Intravenous calcium does not lower serum potassium; it stabilizes the myocardial membrane against the arrhythmogenic effects of
hyperkalemia. Insulin, beta-agonists, and dialysis address the potassium level itself.
Q6.
A previously healthy 45-year-old woman develops acute right-sided pleuritic chest pain and dyspnea two weeks after a
long-haul flight. Oxygen saturation is 91% on room air. The nurse practitioner orders a CT pulmonary angiogram. Which
pretest clinical feature most increases the post-test probability of pulmonary embolism?
A. Recent prolonged immobility combined with pleuritic pain and hypoxemia
B. History of seasonal allergies and mild intermittent wheezing
C. Chronic gastroesophageal reflux with occasional nonexertional chest discomfort
D. Stable hypertension controlled on a single agent without recent medication change
Correct Answer: A
Rationale:
Prolonged immobility is a major risk factor; when combined with pleuritic pain and hypoxemia it substantially raises the pretest
probability of PE. Allergies, reflux, and controlled hypertension do not meaningfully increase PE likelihood.
NUR 5461 EXAM 1 REVIEW | QUESTIONS AND ANSWERS | 2026/2... STUVIAACTUALEXAM
