NR 571 / NR571 FINAL EXAM |COMPLEX DIAGNOSIS &
MANAGEMENT IN ACUTE CARE PRACTICUM LATEST 2026/2027
UPDATE | 200 QUESTIONS & ANSWERS | GRADE A+ 100% CORRECT
(VERIFIED ANSWERS) – CHAMBERLAIN UNIVERSITY
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–25)
QUESTION 1
A 68-year-old male presents with substernal chest pain radiating to the left
jaw, diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4.
Which diagnosis is most likely?
A. Unstable angina
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. ST-elevation myocardial infarction (STEMI)
D. Aortic dissection
ANSWER: C
DETAILED RATIONALE: ST-segment elevation in contiguous precordial leads (V1–
V4) with typical ischemic symptoms indicates an anterior STEMI, which is caused
by acute occlusion of the left anterior descending artery. This requires emergent
reperfusion therapy (percutaneous coronary intervention [PCI] within 90 minutes
or fibrinolysis if PCI unavailable). Unstable angina and NSTEMI typically
present with ST-segment depression or T-wave inversion, not elevation. Aortic
dissection classically causes tearing chest pain radiating to the back, with
pulse deficits, not ST elevation.
QUESTION 2
A 72-year-old female with hypertension presents with acute onset of severe,
tearing chest pain radiating to the back. BP is 180/100 in the right arm and
140/80 in the left arm. Which diagnostic test is most appropriate?
A. 12-lead ECG
B. Cardiac troponin
C. CT angiography of the chest
D. Transthoracic echocardiogram
ANSWER: C
1
,DETAILED RATIONALE: Tearing chest pain radiating to the back with a blood
pressure differential between arms is classic for aortic dissection. CT
angiography of the chest is the definitive diagnostic test because it rapidly
identifies the intimal flap and extent of dissection. ECG and troponin are
useful to rule out MI but are not definitive for dissection. Echocardiography
(TTE) may show an aortic root abnormality but has lower sensitivity than
CT angiography for the entire thoracic aorta.
QUESTION 3
A patient with septic shock remains hypotensive (MAP 55 mmHg) despite
receiving 30 mL/kg of crystalloid. Which vasopressor is recommended as first-line
therapy to achieve a target MAP ≥65 mmHg?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Epinephrine
ANSWER: B
DETAILED RATIONALE: According to the Surviving Sepsis Campaign guidelines,
norepinephrine is the first-line vasopressor for septic shock due to its
potent alpha-adrenergic vasoconstrictor effects with less beta-1-mediated
tachycardia compared to dopamine or epinephrine. Dopamine is associated with
higher rates of arrhythmias and mortality in certain populations. Vasopressin
is an adjunctive second-line agent, typically added when norepinephrine doses
exceed 0.25 mcg/kg/min.
QUESTION 4
A 65-year-old with acute decompensated heart failure has crackles in all lung
fields, JVD, and an S3 gallop. Which initial intervention is most appropriate?
A. IV furosemide 40 mg
B. IV metoprolol 5 mg
C. IV dopamine infusion
D. Oral digoxin 0.25 mg
ANSWER: A
DETAILED RATIONALE: Acute decompensated heart failure with volume overload
2
,(pulmonary crackles, JVD, S3) requires rapid diuresis with IV loop diuretics
(furosemide) to reduce preload and pulmonary congestion. Beta-blockers
(metoprolol) are initiated in stable chronic HF but are contraindicated in
acute decompensated failure due to negative inotropic effects. Dopamine may
be used in cardiogenic shock but is not first-line for fluid overload.
Digoxin has a narrow therapeutic window and is not urgent in acute
decompensation.
QUESTION 5
A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m² and a
pulmonary artery occlusion pressure (PAOP) of 22 mmHg. Which therapy is most
likely to improve outcomes?
A. Dobutamine infusion
B. Intra-aortic balloon pump (IABP)
C. Norepinephrine infusion
D. IV nitroglycerin
ANSWER: B
DETAILED RATIONALE: In cardiogenic shock with low cardiac index (<2.2) and
elevated filling pressures, mechanical circulatory support such as an intra-
aortic balloon pump (IABP) can improve coronary perfusion and reduce afterload,
bridging to definitive therapy (PCI, CABG, or LVAD). Dobutamine provides
inotropic support but may increase myocardial oxygen demand. Norepinephrine
is for vasodilation, not pump failure. Nitroglycerin reduces preload but does
not improve cardiac output in profound shock.
QUESTION 6
A patient is in atrial fibrillation with a ventricular rate of 150 bpm and is
hemodynamically stable. Which drug is first-line for rate control?
A. Amiodarone
B. Diltiazem
C. Digoxin
D. Lidocaine
ANSWER: B
DETAILED RATIONALE: In stable atrial fibrillation with rapid ventricular
3
, response, rate control is achieved with either a nondihydropyridine calcium
channel blocker (diltiazem or verapamil) or a beta-blocker (metoprolol).
Diltiazem is often preferred due to rapid onset and titratability. Amiodarone
is used for rhythm control, not rate control in stable patients. Digoxin has a
slow onset and is less effective for high adrenergic states. Lidocaine is for
ventricular arrhythmias.
QUESTION 7
Which ECG finding is most characteristic of pericarditis?
A. Diffuse ST-segment elevation
B. ST-segment depression in leads V1–V3
C. Pathologic Q waves
D. Peaked T waves
ANSWER: A
DETAILED RATIONALE: Acute pericarditis classically presents with diffuse
concave-upward ST-segment elevation in multiple leads (usually all leads
except aVR and V1) and PR-segment depression. This reflects epicardial
inflammation. Focal ST elevation indicates MI. Pathologic Q waves suggest
infarction. Peaked T waves are seen in hyperkalemia.
QUESTION 8
A patient with a history of heart failure and ejection fraction of 25%
presents with dyspnea, fatigue, and peripheral edema. Which medication is
most likely to reduce mortality in this patient?
A. Lisinopril
B. Losartan
C. Carvedilol
D. All of the above
ANSWER: D
DETAILED RATIONALE: Guideline-directed medical therapy for heart failure with
reduced ejection fraction (HFrEF) includes an ACE inhibitor (lisinopril), an
ARB (losartan) if ACE-intolerant, and a beta-blocker (carvedilol, metoprolol
succinate, or bisoprolol). These agents have all been shown to reduce mortality
and hospitalizations. The combination of these classes is synergistic.
4
MANAGEMENT IN ACUTE CARE PRACTICUM LATEST 2026/2027
UPDATE | 200 QUESTIONS & ANSWERS | GRADE A+ 100% CORRECT
(VERIFIED ANSWERS) – CHAMBERLAIN UNIVERSITY
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–25)
QUESTION 1
A 68-year-old male presents with substernal chest pain radiating to the left
jaw, diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4.
Which diagnosis is most likely?
A. Unstable angina
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. ST-elevation myocardial infarction (STEMI)
D. Aortic dissection
ANSWER: C
DETAILED RATIONALE: ST-segment elevation in contiguous precordial leads (V1–
V4) with typical ischemic symptoms indicates an anterior STEMI, which is caused
by acute occlusion of the left anterior descending artery. This requires emergent
reperfusion therapy (percutaneous coronary intervention [PCI] within 90 minutes
or fibrinolysis if PCI unavailable). Unstable angina and NSTEMI typically
present with ST-segment depression or T-wave inversion, not elevation. Aortic
dissection classically causes tearing chest pain radiating to the back, with
pulse deficits, not ST elevation.
QUESTION 2
A 72-year-old female with hypertension presents with acute onset of severe,
tearing chest pain radiating to the back. BP is 180/100 in the right arm and
140/80 in the left arm. Which diagnostic test is most appropriate?
A. 12-lead ECG
B. Cardiac troponin
C. CT angiography of the chest
D. Transthoracic echocardiogram
ANSWER: C
1
,DETAILED RATIONALE: Tearing chest pain radiating to the back with a blood
pressure differential between arms is classic for aortic dissection. CT
angiography of the chest is the definitive diagnostic test because it rapidly
identifies the intimal flap and extent of dissection. ECG and troponin are
useful to rule out MI but are not definitive for dissection. Echocardiography
(TTE) may show an aortic root abnormality but has lower sensitivity than
CT angiography for the entire thoracic aorta.
QUESTION 3
A patient with septic shock remains hypotensive (MAP 55 mmHg) despite
receiving 30 mL/kg of crystalloid. Which vasopressor is recommended as first-line
therapy to achieve a target MAP ≥65 mmHg?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Epinephrine
ANSWER: B
DETAILED RATIONALE: According to the Surviving Sepsis Campaign guidelines,
norepinephrine is the first-line vasopressor for septic shock due to its
potent alpha-adrenergic vasoconstrictor effects with less beta-1-mediated
tachycardia compared to dopamine or epinephrine. Dopamine is associated with
higher rates of arrhythmias and mortality in certain populations. Vasopressin
is an adjunctive second-line agent, typically added when norepinephrine doses
exceed 0.25 mcg/kg/min.
QUESTION 4
A 65-year-old with acute decompensated heart failure has crackles in all lung
fields, JVD, and an S3 gallop. Which initial intervention is most appropriate?
A. IV furosemide 40 mg
B. IV metoprolol 5 mg
C. IV dopamine infusion
D. Oral digoxin 0.25 mg
ANSWER: A
DETAILED RATIONALE: Acute decompensated heart failure with volume overload
2
,(pulmonary crackles, JVD, S3) requires rapid diuresis with IV loop diuretics
(furosemide) to reduce preload and pulmonary congestion. Beta-blockers
(metoprolol) are initiated in stable chronic HF but are contraindicated in
acute decompensated failure due to negative inotropic effects. Dopamine may
be used in cardiogenic shock but is not first-line for fluid overload.
Digoxin has a narrow therapeutic window and is not urgent in acute
decompensation.
QUESTION 5
A patient with cardiogenic shock has a cardiac index of 1.8 L/min/m² and a
pulmonary artery occlusion pressure (PAOP) of 22 mmHg. Which therapy is most
likely to improve outcomes?
A. Dobutamine infusion
B. Intra-aortic balloon pump (IABP)
C. Norepinephrine infusion
D. IV nitroglycerin
ANSWER: B
DETAILED RATIONALE: In cardiogenic shock with low cardiac index (<2.2) and
elevated filling pressures, mechanical circulatory support such as an intra-
aortic balloon pump (IABP) can improve coronary perfusion and reduce afterload,
bridging to definitive therapy (PCI, CABG, or LVAD). Dobutamine provides
inotropic support but may increase myocardial oxygen demand. Norepinephrine
is for vasodilation, not pump failure. Nitroglycerin reduces preload but does
not improve cardiac output in profound shock.
QUESTION 6
A patient is in atrial fibrillation with a ventricular rate of 150 bpm and is
hemodynamically stable. Which drug is first-line for rate control?
A. Amiodarone
B. Diltiazem
C. Digoxin
D. Lidocaine
ANSWER: B
DETAILED RATIONALE: In stable atrial fibrillation with rapid ventricular
3
, response, rate control is achieved with either a nondihydropyridine calcium
channel blocker (diltiazem or verapamil) or a beta-blocker (metoprolol).
Diltiazem is often preferred due to rapid onset and titratability. Amiodarone
is used for rhythm control, not rate control in stable patients. Digoxin has a
slow onset and is less effective for high adrenergic states. Lidocaine is for
ventricular arrhythmias.
QUESTION 7
Which ECG finding is most characteristic of pericarditis?
A. Diffuse ST-segment elevation
B. ST-segment depression in leads V1–V3
C. Pathologic Q waves
D. Peaked T waves
ANSWER: A
DETAILED RATIONALE: Acute pericarditis classically presents with diffuse
concave-upward ST-segment elevation in multiple leads (usually all leads
except aVR and V1) and PR-segment depression. This reflects epicardial
inflammation. Focal ST elevation indicates MI. Pathologic Q waves suggest
infarction. Peaked T waves are seen in hyperkalemia.
QUESTION 8
A patient with a history of heart failure and ejection fraction of 25%
presents with dyspnea, fatigue, and peripheral edema. Which medication is
most likely to reduce mortality in this patient?
A. Lisinopril
B. Losartan
C. Carvedilol
D. All of the above
ANSWER: D
DETAILED RATIONALE: Guideline-directed medical therapy for heart failure with
reduced ejection fraction (HFrEF) includes an ACE inhibitor (lisinopril), an
ARB (losartan) if ACE-intolerant, and a beta-blocker (carvedilol, metoprolol
succinate, or bisoprolol). These agents have all been shown to reduce mortality
and hospitalizations. The combination of these classes is synergistic.
4
