NRNP 6566 ADVANCED CARE OF
ADULTS IN ACUTE SETTINGS I -
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 65-year-old patient presents with acute decompensated heart failure. The hemodynamic
monitoring shows a Pulmonary Capillary Wedge Pressure (PCWP) of 22 mmHg and a Cardiac
Index (CI) of 1.8 L/min/m2. Which hemodynamic subset is this patient in?
A. Warm and Dry
B. Cold and Wet
C. Warm and Wet
D. Cold and Dry
Answer: B
Conceptual Explanation: A CI < 2.2 indicates ‘cold’ (low perfusion) and a PCWP > 18
indicates ‘wet’ (congestion). This patient is in cardiogenic shock/decompensated HF.
,2. Which of the following is the hallmark finding in a patient presenting with Cardiac
Tamponade?
A. Widened pulse pressure and bradycardia
B. Beck’s Triad: Hypotension, JVD, and muffled heart sounds
C. ST-segment elevation in all leads
D. Kussmaul’s sign and pulmonary edema
Answer: B
Conceptual Explanation: Beck’s Triad is the classic clinical presentation of cardiac
tamponade, resulting from fluid accumulation in the pericardial sac impeding diastolic
filling.
3. A patient in the ICU has the following ABG: pH 7.25, PaCO2 55, HCO3 24, PaO2 60. What is
the interpretation?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Compensated Metabolic Alkalosis
Answer: A
Conceptual Explanation: The pH is acidic (<7.35) and the PaCO2 is high (>45), indicating
a respiratory cause for the acidosis with no compensation yet from the bicarbonate.
, 4. Which ventilator setting change is most appropriate for a patient with ARDS who has a low
PaO2 but is already on 100% FiO2?
A. Increase PEEP
B. Decrease PEEP
C. Increase Tidal Volume
D. Increase Respiratory Rate
Answer: A
Conceptual Explanation: Increasing Positive End-Expiratory Pressure (PEEP) helps
recruit collapsed alveoli and improve oxygenation without increasing oxygen toxicity risk
from FiO2.
5. In the management of Acute Pancreatitis, which scoring system is commonly used to
predict severity and mortality within the first 48 hours?
A. CHADS2 Score
B. Ranson’s Criteria
C. Child-Pugh Score
D. CURB-65
Answer: B
Conceptual Explanation: Ranson’s Criteria assesses parameters at admission and at 48
hours to predict the severity of acute pancreatitis.
ADULTS IN ACUTE SETTINGS I -
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 65-year-old patient presents with acute decompensated heart failure. The hemodynamic
monitoring shows a Pulmonary Capillary Wedge Pressure (PCWP) of 22 mmHg and a Cardiac
Index (CI) of 1.8 L/min/m2. Which hemodynamic subset is this patient in?
A. Warm and Dry
B. Cold and Wet
C. Warm and Wet
D. Cold and Dry
Answer: B
Conceptual Explanation: A CI < 2.2 indicates ‘cold’ (low perfusion) and a PCWP > 18
indicates ‘wet’ (congestion). This patient is in cardiogenic shock/decompensated HF.
,2. Which of the following is the hallmark finding in a patient presenting with Cardiac
Tamponade?
A. Widened pulse pressure and bradycardia
B. Beck’s Triad: Hypotension, JVD, and muffled heart sounds
C. ST-segment elevation in all leads
D. Kussmaul’s sign and pulmonary edema
Answer: B
Conceptual Explanation: Beck’s Triad is the classic clinical presentation of cardiac
tamponade, resulting from fluid accumulation in the pericardial sac impeding diastolic
filling.
3. A patient in the ICU has the following ABG: pH 7.25, PaCO2 55, HCO3 24, PaO2 60. What is
the interpretation?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Compensated Metabolic Alkalosis
Answer: A
Conceptual Explanation: The pH is acidic (<7.35) and the PaCO2 is high (>45), indicating
a respiratory cause for the acidosis with no compensation yet from the bicarbonate.
, 4. Which ventilator setting change is most appropriate for a patient with ARDS who has a low
PaO2 but is already on 100% FiO2?
A. Increase PEEP
B. Decrease PEEP
C. Increase Tidal Volume
D. Increase Respiratory Rate
Answer: A
Conceptual Explanation: Increasing Positive End-Expiratory Pressure (PEEP) helps
recruit collapsed alveoli and improve oxygenation without increasing oxygen toxicity risk
from FiO2.
5. In the management of Acute Pancreatitis, which scoring system is commonly used to
predict severity and mortality within the first 48 hours?
A. CHADS2 Score
B. Ranson’s Criteria
C. Child-Pugh Score
D. CURB-65
Answer: B
Conceptual Explanation: Ranson’s Criteria assesses parameters at admission and at 48
hours to predict the severity of acute pancreatitis.
