FINAL EXAM: NR 574 / NR574 (LATEST UPDATE) ACUTE CARE PRACTICUM I – CHAMBERLAIN
UNIVERSITY TEST BANK QUESTIONS AND CORRECT SOLUTIONS JUST RELEASED THIS YEAR………...
Core Domains:
1. Advanced Hemodynamic Monitoring and Shock States
2. Acute Respiratory Failure and Mechanical Ventilation
3. Neurological Emergencies and Neurocritical Care
4. Acute Kidney Injury and Renal Replacement Therapies
5. Endocrine Emergencies (DKA, Thyroid Storm, Adrenal Crisis)
6. Infectious Disease and Sepsis Management
7. Cardiovascular Emergencies (ACS, Arrhythmias, Heart Failure)
8. Gastrointestinal Emergencies and Nutritional Support
9. Ethical and Legal Issues in Acute Care
10. Procedures and Point-of-Care Ultrasound (POCUS)
Introduction:
This comprehensive examination is designed to rigorously assess the competencies required for successful
completion of the Acute Care Practicum I course at Chamberlain University. It evaluates a candidate's foundational
knowledge of advanced pathophysiology, applied clinical skills in acute care settings, and critical decision-making
abilities in complex patient scenarios. The assessment is structured using multiple-choice questions and scenario-
based inquiries to gauge not only theoretical understanding but also the practical application of evidence-based
protocols, ethical frameworks, and clinical best practices. Success in this exam demonstrates a candidate's
readiness to navigate the multifaceted challenges of acute care nursing practice, prioritizing patient safety, clinical
excellence, and interprofessional collaboration.
,SECTION ONE: QUESTIONS 1 – 100
1. A 68-year-old male is admitted to the ICU with septic shock. His blood pressure is 82/46 mmHg, heart rate
118 bpm, and lactate 4.2 mmol/L. Which of the following is the FIRST-line vasopressor recommended in the
Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
🟢 B. Norepinephrine
🔴 RATIONALE: The Surviving Sepsis Campaign guidelines recommend norepinephrine as the first-line
vasopressor for septic shock. It has potent alpha-adrenergic effects causing vasoconstriction with less
chronotropic effect than dopamine, making it preferred for increasing mean arterial pressure (MAP).
2. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with a tidal volume
of 6 mL/kg of predicted body weight. The plateau pressure is 32 cm H2O. What is the MOST appropriate
next action?
A. Increase the tidal volume to 8 mL/kg
B. Decrease the PEEP level
C. Maintain current settings; plateau pressure is acceptable
D. Reduce the tidal volume to 4 mL/kg
🟢 C. Maintain current settings; plateau pressure is acceptable
,🔴 RATIONALE: Lung-protective ventilation in ARDS aims to maintain plateau pressures < 30 cm H2O to
prevent ventilator-induced lung injury. A plateau pressure of 32 cm H2O is borderline but acceptable with
careful monitoring, especially when using a tidal volume of 6 mL/kg.
3. A 72-year-old female presents with sudden onset of severe headache, nausea, and photophobia. A non-
contrast head CT shows subarachnoid hemorrhage. What is the MOST critical initial nursing intervention?
A. Administer oral acetaminophen for headache
B. Place the patient in Trendelenburg position
C. Maintain strict bed rest and minimize stimulation
D. Prepare for immediate lumbar puncture
🟢 C. Maintain strict bed rest and minimize stimulation
🔴 RATIONALE: Patients with subarachnoid hemorrhage are at high risk for re-bleeding and increased
intracranial pressure. Strict bed rest, minimizing stimulation (quiet, dark environment), and avoiding valsalva
maneuvers are critical to reduce the risk of re-bleeding and lower ICP.
4. A patient with diabetic ketoacidosis (DKA) has an initial serum potassium of 5.6 mEq/L. Which of the
following is the MOST appropriate action?
A. Begin potassium replacement immediately
B. Hold potassium replacement until urine output is established
C. Begin insulin infusion and monitor potassium closely
D. Administer sodium polystyrene sulfonate (Kayexalate)
🟢 C. Begin insulin infusion and monitor potassium closely
, 🔴 RATIONALE: In DKA, elevated serum potassium is often due to acidosis causing shifts out of cells. As insulin
is administered and acidosis improves, potassium will shift back into cells, potentially causing hypokalemia.
Close monitoring is essential, and replacement is typically started once the serum potassium drops below 5.0
mEq/L.
5. A patient in the ICU is receiving continuous renal replacement therapy (CRRT). The nurse notices that the
venous pressure alarm is high. What is the MOST likely cause?
A. Catheter kinking or malposition
B. Decreased blood flow rate
C. Filter clotting
D. Access pressure issues
🟢 A. Catheter kinking or malposition
🔴 RATIONALE: High venous pressure alarms during CRRT typically indicate an obstruction or kink in the
venous return line or catheter malposition. It suggests resistance to blood returning to the patient. Access
pressure issues (D) affect the arterial (inflow) side, not the venous side.
6. A patient is admitted with acute pancreatitis. Which of the following lab values is MOST specific for this
diagnosis?
A. Elevated amylase
B. Elevated lipase
C. Elevated liver function tests
D. Elevated white blood cell count
🟢 B. Elevated lipase
UNIVERSITY TEST BANK QUESTIONS AND CORRECT SOLUTIONS JUST RELEASED THIS YEAR………...
Core Domains:
1. Advanced Hemodynamic Monitoring and Shock States
2. Acute Respiratory Failure and Mechanical Ventilation
3. Neurological Emergencies and Neurocritical Care
4. Acute Kidney Injury and Renal Replacement Therapies
5. Endocrine Emergencies (DKA, Thyroid Storm, Adrenal Crisis)
6. Infectious Disease and Sepsis Management
7. Cardiovascular Emergencies (ACS, Arrhythmias, Heart Failure)
8. Gastrointestinal Emergencies and Nutritional Support
9. Ethical and Legal Issues in Acute Care
10. Procedures and Point-of-Care Ultrasound (POCUS)
Introduction:
This comprehensive examination is designed to rigorously assess the competencies required for successful
completion of the Acute Care Practicum I course at Chamberlain University. It evaluates a candidate's foundational
knowledge of advanced pathophysiology, applied clinical skills in acute care settings, and critical decision-making
abilities in complex patient scenarios. The assessment is structured using multiple-choice questions and scenario-
based inquiries to gauge not only theoretical understanding but also the practical application of evidence-based
protocols, ethical frameworks, and clinical best practices. Success in this exam demonstrates a candidate's
readiness to navigate the multifaceted challenges of acute care nursing practice, prioritizing patient safety, clinical
excellence, and interprofessional collaboration.
,SECTION ONE: QUESTIONS 1 – 100
1. A 68-year-old male is admitted to the ICU with septic shock. His blood pressure is 82/46 mmHg, heart rate
118 bpm, and lactate 4.2 mmol/L. Which of the following is the FIRST-line vasopressor recommended in the
Surviving Sepsis Campaign guidelines?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
🟢 B. Norepinephrine
🔴 RATIONALE: The Surviving Sepsis Campaign guidelines recommend norepinephrine as the first-line
vasopressor for septic shock. It has potent alpha-adrenergic effects causing vasoconstriction with less
chronotropic effect than dopamine, making it preferred for increasing mean arterial pressure (MAP).
2. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with a tidal volume
of 6 mL/kg of predicted body weight. The plateau pressure is 32 cm H2O. What is the MOST appropriate
next action?
A. Increase the tidal volume to 8 mL/kg
B. Decrease the PEEP level
C. Maintain current settings; plateau pressure is acceptable
D. Reduce the tidal volume to 4 mL/kg
🟢 C. Maintain current settings; plateau pressure is acceptable
,🔴 RATIONALE: Lung-protective ventilation in ARDS aims to maintain plateau pressures < 30 cm H2O to
prevent ventilator-induced lung injury. A plateau pressure of 32 cm H2O is borderline but acceptable with
careful monitoring, especially when using a tidal volume of 6 mL/kg.
3. A 72-year-old female presents with sudden onset of severe headache, nausea, and photophobia. A non-
contrast head CT shows subarachnoid hemorrhage. What is the MOST critical initial nursing intervention?
A. Administer oral acetaminophen for headache
B. Place the patient in Trendelenburg position
C. Maintain strict bed rest and minimize stimulation
D. Prepare for immediate lumbar puncture
🟢 C. Maintain strict bed rest and minimize stimulation
🔴 RATIONALE: Patients with subarachnoid hemorrhage are at high risk for re-bleeding and increased
intracranial pressure. Strict bed rest, minimizing stimulation (quiet, dark environment), and avoiding valsalva
maneuvers are critical to reduce the risk of re-bleeding and lower ICP.
4. A patient with diabetic ketoacidosis (DKA) has an initial serum potassium of 5.6 mEq/L. Which of the
following is the MOST appropriate action?
A. Begin potassium replacement immediately
B. Hold potassium replacement until urine output is established
C. Begin insulin infusion and monitor potassium closely
D. Administer sodium polystyrene sulfonate (Kayexalate)
🟢 C. Begin insulin infusion and monitor potassium closely
, 🔴 RATIONALE: In DKA, elevated serum potassium is often due to acidosis causing shifts out of cells. As insulin
is administered and acidosis improves, potassium will shift back into cells, potentially causing hypokalemia.
Close monitoring is essential, and replacement is typically started once the serum potassium drops below 5.0
mEq/L.
5. A patient in the ICU is receiving continuous renal replacement therapy (CRRT). The nurse notices that the
venous pressure alarm is high. What is the MOST likely cause?
A. Catheter kinking or malposition
B. Decreased blood flow rate
C. Filter clotting
D. Access pressure issues
🟢 A. Catheter kinking or malposition
🔴 RATIONALE: High venous pressure alarms during CRRT typically indicate an obstruction or kink in the
venous return line or catheter malposition. It suggests resistance to blood returning to the patient. Access
pressure issues (D) affect the arterial (inflow) side, not the venous side.
6. A patient is admitted with acute pancreatitis. Which of the following lab values is MOST specific for this
diagnosis?
A. Elevated amylase
B. Elevated lipase
C. Elevated liver function tests
D. Elevated white blood cell count
🟢 B. Elevated lipase
