NRNP 6566 ADVANCED PRACTICE
CARE OF ADULTS EXAM STUDY GUIDE
QUESTIONS AND ANSWERS
1. A 65-year-old male presents with acute onset crushing chest pain. The EKG shows ST-
segment elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Left Circumflex Artery (LCx)
D. Posterior Descending Artery (PDA)
Answer: A
Conceptual Explanation: Leads V1-V4 correspond to the anterior wall of the left ventricle,
which is primarily supplied by the Left Anterior Descending (LAD) artery.
2. In the management of ARDS, which ventilator strategy is proven to reduce mortality?
A. Low tidal volumes (6 mL/kg PBW) and permissive hypercapnia
B. High tidal volumes to prevent atelectasis
C. Inverse ratio ventilation with peak pressures > 40 cm H2O
,D. Routine use of nitric oxide for all patients
Answer: A
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (6 mL/kg
predicted body weight) is the gold standard for reducing mortality in ARDS by preventing
ventilator-induced lung injury.
3. A patient in the ICU develops sudden hypotension and tachycardia. The pulmonary artery
catheter shows a CVP of 2, a PCWP of 4, and a Cardiac Index of 1.8. What is the most likely
diagnosis?
A. Cardiogenic Shock
B. Hypovolemic Shock
C. Septic Shock
D. Obstructive Shock (PE)
Answer: B
Conceptual Explanation: Low CVP and PCWP combined with a low cardiac index indicate
a volume deficit, characteristic of hypovolemic shock.
4. Which of the following is the most definitive diagnostic test for a suspected pulmonary
embolism?
A. D-dimer assay
B. Ventilation-Perfusion (V/Q) Scan
, C. CT Angiography (CTPA)
D. Chest X-ray
Answer: C
Conceptual Explanation: CT Angiography is the current gold standard and preferred
initial imaging for diagnosing PE in most clinical settings.
5. A patient presents with a sodium level of 118 mEq/L and symptoms of confusion and
seizures. What is the maximum recommended rate of sodium correction in the first 24 hours
to avoid Central Pontine Myelinolysis?
A. 8-10 mEq/L
B. 4-6 mEq/L
C. 15-20 mEq/L
D. 2 mEq/L
Answer: A
Conceptual Explanation: Correction of chronic hyponatremia should generally not exceed
8-10 mEq/L in 24 hours to prevent osmotic demyelination syndrome.
6. Which laboratory finding is most specific for the diagnosis of acute pancreatitis?
A. Elevated Serum Amylase
B. Hypocalcemia
C. Leukocytosis
CARE OF ADULTS EXAM STUDY GUIDE
QUESTIONS AND ANSWERS
1. A 65-year-old male presents with acute onset crushing chest pain. The EKG shows ST-
segment elevation in leads V1 through V4. Which coronary artery is most likely occluded?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Left Circumflex Artery (LCx)
D. Posterior Descending Artery (PDA)
Answer: A
Conceptual Explanation: Leads V1-V4 correspond to the anterior wall of the left ventricle,
which is primarily supplied by the Left Anterior Descending (LAD) artery.
2. In the management of ARDS, which ventilator strategy is proven to reduce mortality?
A. Low tidal volumes (6 mL/kg PBW) and permissive hypercapnia
B. High tidal volumes to prevent atelectasis
C. Inverse ratio ventilation with peak pressures > 40 cm H2O
,D. Routine use of nitric oxide for all patients
Answer: A
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (6 mL/kg
predicted body weight) is the gold standard for reducing mortality in ARDS by preventing
ventilator-induced lung injury.
3. A patient in the ICU develops sudden hypotension and tachycardia. The pulmonary artery
catheter shows a CVP of 2, a PCWP of 4, and a Cardiac Index of 1.8. What is the most likely
diagnosis?
A. Cardiogenic Shock
B. Hypovolemic Shock
C. Septic Shock
D. Obstructive Shock (PE)
Answer: B
Conceptual Explanation: Low CVP and PCWP combined with a low cardiac index indicate
a volume deficit, characteristic of hypovolemic shock.
4. Which of the following is the most definitive diagnostic test for a suspected pulmonary
embolism?
A. D-dimer assay
B. Ventilation-Perfusion (V/Q) Scan
, C. CT Angiography (CTPA)
D. Chest X-ray
Answer: C
Conceptual Explanation: CT Angiography is the current gold standard and preferred
initial imaging for diagnosing PE in most clinical settings.
5. A patient presents with a sodium level of 118 mEq/L and symptoms of confusion and
seizures. What is the maximum recommended rate of sodium correction in the first 24 hours
to avoid Central Pontine Myelinolysis?
A. 8-10 mEq/L
B. 4-6 mEq/L
C. 15-20 mEq/L
D. 2 mEq/L
Answer: A
Conceptual Explanation: Correction of chronic hyponatremia should generally not exceed
8-10 mEq/L in 24 hours to prevent osmotic demyelination syndrome.
6. Which laboratory finding is most specific for the diagnosis of acute pancreatitis?
A. Elevated Serum Amylase
B. Hypocalcemia
C. Leukocytosis
