NRNP 6566 ADVANCED CARE OF ADULTS
IN ACUTE SETTINGS I - KNOWLEDGE
CHECK 2027
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with increased dyspnea. His BP is 110/70, HR 88, and K+ 4.2. Which medication class
is now recommended as first-line to replace ACE inhibitors or ARBs in stable patients to
further reduce mortality?
A. Angiotensin Receptor-Neprilysin Inhibitors (ARNI)
B. Beta-blockers
C. Mineralocorticoid Receptor Antagonists
D. Loop Diuretics
Answer: A
Conceptual Explanation: ARNIs (e.g., Sacubitril/Valsartan) are now recommended as
first-line therapy to replace ACEIs or ARBs in HFrEF patients to further decrease morbidity
and mortality.
,2. When managing a patient with an acute ST-elevation myocardial infarction (STEMI), what
is the target ‘door-to-balloon’ time for primary percutaneous coronary intervention (PCI)?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
Answer: C
Conceptual Explanation: The clinical standard for door-to-balloon time in a PCI-capable
facility for patients with STEMI is 90 minutes or less.
3. A patient presents with sudden onset of ‘tearing’ chest pain radiating to the back. Blood
pressure is 190/110 mmHg. Which is the most appropriate initial pharmacological goal?
A. Rapid fluid bolus to maintain perfusion
B. Administration of thrombolytics
C. Immediate anticoagulation with Heparin
D. Reduce heart rate to <60 bpm and SBP to 100-120 mmHg
Answer: D
Conceptual Explanation: In aortic dissection, the goal is to reduce shearing forces by
lowering both the heart rate (usually with beta-blockers) and the blood pressure.
, 4. In the management of Atrial Fibrillation, which scoring system is used to determine the
necessity of long-term anticoagulation based on stroke risk?
A. CURB-65
B. CHADS2-VASc score
C. Ranson’s Criteria
D. NYHA Classification
Answer: B
Conceptual Explanation: The CHA2DS2-VASc score is used to assess stroke risk in
patients with non-valvular atrial fibrillation to guide anticoagulation therapy.
5. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). What is the
primary ventilatory strategy to reduce mortality?
A. High tidal volume to ensure CO2 clearance
B. Low tidal volume (6 mL/kg of predicted body weight)
C. Maintaining a Plateau Pressure > 40 cm H2O
D. Liberal fluid management
Answer: B
Conceptual Explanation: Low tidal volume ventilation (lung-protective strategy) is
proven to reduce mortality in ARDS by preventing ventilator-induced lung injury (VILI).
IN ACUTE SETTINGS I - KNOWLEDGE
CHECK 2027
1. A 68-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents with increased dyspnea. His BP is 110/70, HR 88, and K+ 4.2. Which medication class
is now recommended as first-line to replace ACE inhibitors or ARBs in stable patients to
further reduce mortality?
A. Angiotensin Receptor-Neprilysin Inhibitors (ARNI)
B. Beta-blockers
C. Mineralocorticoid Receptor Antagonists
D. Loop Diuretics
Answer: A
Conceptual Explanation: ARNIs (e.g., Sacubitril/Valsartan) are now recommended as
first-line therapy to replace ACEIs or ARBs in HFrEF patients to further decrease morbidity
and mortality.
,2. When managing a patient with an acute ST-elevation myocardial infarction (STEMI), what
is the target ‘door-to-balloon’ time for primary percutaneous coronary intervention (PCI)?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
Answer: C
Conceptual Explanation: The clinical standard for door-to-balloon time in a PCI-capable
facility for patients with STEMI is 90 minutes or less.
3. A patient presents with sudden onset of ‘tearing’ chest pain radiating to the back. Blood
pressure is 190/110 mmHg. Which is the most appropriate initial pharmacological goal?
A. Rapid fluid bolus to maintain perfusion
B. Administration of thrombolytics
C. Immediate anticoagulation with Heparin
D. Reduce heart rate to <60 bpm and SBP to 100-120 mmHg
Answer: D
Conceptual Explanation: In aortic dissection, the goal is to reduce shearing forces by
lowering both the heart rate (usually with beta-blockers) and the blood pressure.
, 4. In the management of Atrial Fibrillation, which scoring system is used to determine the
necessity of long-term anticoagulation based on stroke risk?
A. CURB-65
B. CHADS2-VASc score
C. Ranson’s Criteria
D. NYHA Classification
Answer: B
Conceptual Explanation: The CHA2DS2-VASc score is used to assess stroke risk in
patients with non-valvular atrial fibrillation to guide anticoagulation therapy.
5. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). What is the
primary ventilatory strategy to reduce mortality?
A. High tidal volume to ensure CO2 clearance
B. Low tidal volume (6 mL/kg of predicted body weight)
C. Maintaining a Plateau Pressure > 40 cm H2O
D. Liberal fluid management
Answer: B
Conceptual Explanation: Low tidal volume ventilation (lung-protective strategy) is
proven to reduce mortality in ARDS by preventing ventilator-induced lung injury (VILI).
