NRNP 6566 ADVANCED CARE OF
ADULTS IN ACUTE SETTINGS -
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 68-year-old male with a history of HFrEF presents with acute decompensated heart
failure. His BP is 85/50 mmHg, HR 110 bpm, and CI is 1.8 L/min/m2. Which of the following is
the most appropriate initial pharmacological intervention?
A. Intravenous Furosemide 80mg
B. Intravenous Metoprolol 5mg
C. Oral Lisinopril 5mg
D. Intravenous Dobutamine infusion
Answer: D
Conceptual Explanation: The patient is in cardiogenic shock (low CI and hypotension).
Inotropes like Dobutamine are indicated to improve cardiac output and perfusion before
aggressive diuresis or beta-blockade.
,2. Which of the following ABG results is most consistent with a patient in the early stages of
acute pulmonary embolism?
A. pH 7.32, PaCO2 50, PaO2 60
B. pH 7.50, PaCO2 45, HCO3 32
C. pH 7.25, PaCO2 35, HCO3 18
D. pH 7.48, PaCO2 30, PaO2 70
Answer: D
Conceptual Explanation: Early PE typically causes tachypnea and hyperventilation,
leading to respiratory alkalosis (high pH, low PaCO2) and hypoxemia (low PaO2).
3. In the management of ARDS, which ventilator strategy has been shown to improve
mortality?
A. High tidal volume (10-12 mL/kg PBW)
B. Low tidal volume (4-6 mL/kg PBW)
C. Maintenance of peak inspiratory pressure > 40 cm H2O
D. Low PEEP regardless of FiO2
Answer: B
Conceptual Explanation: Low tidal volume ventilation (Lung Protective Strategy)
prevents volutrauma and is proven to reduce mortality in ARDS patients.
, 4. A patient presents with a serum sodium of 118 mEq/L and is symptomatic with a seizure.
What is the recommended rate of sodium correction in the first 24 hours to prevent osmotic
demyelination syndrome?
A. Increase by 4-6 mEq/L in the first 6 hours, not exceeding 8-10 mEq/L total
B. Increase by 8-10 mEq/L
C. Increase by 15-20 mEq/L
D. Increase by 2 mEq/L per hour until sodium reaches 140 mEq/L
Answer: A
Conceptual Explanation: Rapid correction of chronic hyponatremia can lead to osmotic
demyelination syndrome. The goal is small increments for symptom control, usually not
exceeding 8-10 mEq/L in 24 hours.
5. According to the Surviving Sepsis Campaign, what is the target Mean Arterial Pressure
(MAP) for a patient in septic shock requiring vasopressors?
A. 65 mmHg
B. 55 mmHg
C. 75 mmHg
D. 85 mmHg
Answer: A
ADULTS IN ACUTE SETTINGS -
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 68-year-old male with a history of HFrEF presents with acute decompensated heart
failure. His BP is 85/50 mmHg, HR 110 bpm, and CI is 1.8 L/min/m2. Which of the following is
the most appropriate initial pharmacological intervention?
A. Intravenous Furosemide 80mg
B. Intravenous Metoprolol 5mg
C. Oral Lisinopril 5mg
D. Intravenous Dobutamine infusion
Answer: D
Conceptual Explanation: The patient is in cardiogenic shock (low CI and hypotension).
Inotropes like Dobutamine are indicated to improve cardiac output and perfusion before
aggressive diuresis or beta-blockade.
,2. Which of the following ABG results is most consistent with a patient in the early stages of
acute pulmonary embolism?
A. pH 7.32, PaCO2 50, PaO2 60
B. pH 7.50, PaCO2 45, HCO3 32
C. pH 7.25, PaCO2 35, HCO3 18
D. pH 7.48, PaCO2 30, PaO2 70
Answer: D
Conceptual Explanation: Early PE typically causes tachypnea and hyperventilation,
leading to respiratory alkalosis (high pH, low PaCO2) and hypoxemia (low PaO2).
3. In the management of ARDS, which ventilator strategy has been shown to improve
mortality?
A. High tidal volume (10-12 mL/kg PBW)
B. Low tidal volume (4-6 mL/kg PBW)
C. Maintenance of peak inspiratory pressure > 40 cm H2O
D. Low PEEP regardless of FiO2
Answer: B
Conceptual Explanation: Low tidal volume ventilation (Lung Protective Strategy)
prevents volutrauma and is proven to reduce mortality in ARDS patients.
, 4. A patient presents with a serum sodium of 118 mEq/L and is symptomatic with a seizure.
What is the recommended rate of sodium correction in the first 24 hours to prevent osmotic
demyelination syndrome?
A. Increase by 4-6 mEq/L in the first 6 hours, not exceeding 8-10 mEq/L total
B. Increase by 8-10 mEq/L
C. Increase by 15-20 mEq/L
D. Increase by 2 mEq/L per hour until sodium reaches 140 mEq/L
Answer: A
Conceptual Explanation: Rapid correction of chronic hyponatremia can lead to osmotic
demyelination syndrome. The goal is small increments for symptom control, usually not
exceeding 8-10 mEq/L in 24 hours.
5. According to the Surviving Sepsis Campaign, what is the target Mean Arterial Pressure
(MAP) for a patient in septic shock requiring vasopressors?
A. 65 mmHg
B. 55 mmHg
C. 75 mmHg
D. 85 mmHg
Answer: A
