, NRNP 6566 Advanced Care of Adults in Acute Settings I –
Walden University – Academic Year 2026/2027 – Final
Comprehensive Examination with 100 Verified Questions and
Correct Answer Rationales | | verified by experts .
INTRODUCTION
Welcome to the NRNP 6566 Advanced Care of Adults in Acute Settings I comprehensive
exam study guide. This resource is specifically designed for Walden University Adult-
Gerontology Acute Care Nurse Practitioner (AGACNP) students preparing for the midterm and
final examinations for the 2026/2027 academic year.
Course Overview:
• Course Code: NRNP 6566 / NRNP6566
• Title: Advanced Care of Adults in Acute Settings I
• Institution: Walden University
• Credits: 3 credits didactic + practicum component
• Prerequisites: NURS 6521 Advanced Pharmacology
• Academic Year: 2026/2027
DOMAIN 1: ACUTE CARDIOPULMONARY & SHOCK MANAGEMENT
Question 1
A 68-year-old male with a history of hypertension presents with substernal chest pressure
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment elevation in leads
V1–V4. Which of the following is the priority intervention?
A. Administer sublingual nitroglycerin
B. Obtain a chest X-ray
C. Initiate immediate reperfusion therapy (PCI or fibrinolysis)
D. Administer morphine sulfate for pain
CorreCt Answer: C ✓
rAtionAle: ST-segment elevation in leads V1–V4 indicates an anterior ST-elevation
myocardial infarction (STEMI) . The priority is immediate reperfusion therapy via
percutaneous coronary intervention (PCI) or fibrinolysis. "Time is muscle" – the goal is door-to-
balloon time < 90 minutes.
,Question 2
Which of the following ECG findings is most characteristic of acute pericarditis?
A. ST-segment depression in leads V1–V3
B. Diffuse ST-segment elevation with PR-segment depression
C. Pathologic Q waves in leads II, III, aVF
D. Tall, peaked T waves
CorreCt Answer: B ✓
rAtionAle: Acute pericarditis is characterized by diffuse ST-segment elevation (concave
upward) with PR-segment depression. This is due to inflammation of the pericardium. Tall,
peaked T waves are associated with hyperkalemia; pathologic Q waves indicate prior MI.
Question 3
A 72-year-old female with heart failure presents with dyspnea, orthopnea, and bilateral crackles
on auscultation. Her ejection fraction is 35%. Which medication class has been shown to reduce
mortality in heart failure with reduced ejection fraction (HFrEF)?
A. Calcium channel blockers
B. Beta-blockers (e.g., carvedilol, metoprolol succinate)
C. Thiazide diuretics
D. Direct vasodilators alone
CorreCt Answer: B ✓
rAtionAle: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) have been shown
to reduce mortality in HFrEF by decreasing sympathetic activation and preventing adverse
remodeling. They are a cornerstone of guideline-directed medical therapy (GDMT).
Question 4
Which of the following is a contraindication to the use of fibrinolytic therapy in acute ST-
elevation myocardial infarction (STEMI)?
A. Age > 75 years
B. Prior intracranial hemorrhage at any time
C. Systolic blood pressure > 180 mmHg
D. History of diabetes mellitus
CorreCt Answer: B ✓
rAtionAle: Absolute contraindications to fibrinolysis include prior intracranial
hemorrhage at any time, known structural cerebral vascular lesion, ischemic stroke within 3
months, suspected aortic dissection, and active bleeding. Age >75 is a relative, not absolute,
contraindication.
, Question 5
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the
most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Aspirin plus clopidogrel
C. Oral anticoagulant (warfarin or direct oral anticoagulant)
D. No anticoagulation needed
CorreCt Answer: C ✓
rAtionAle: A CHA₂DS₂-VASc score ≥ 2 in males or ≥ 3 in females indicates high stroke
risk and warrants oral anticoagulation (warfarin or a DOAC). Aspirin alone is insufficient for
stroke prevention in atrial fibrillation.
Question 6
In a patient with unstable angina, which of the following findings on cardiac troponin would be
expected?
A. Elevated troponin above the 99th percentile upper reference limit
B. Normal troponin levels
C. Troponin elevation with a rising and falling pattern
D. Troponin elevation without a rise or fall
CorreCt Answer: B ✓
rAtionAle: By definition, unstable angina is characterized by normal troponin levels.
Elevated troponin indicates myocardial necrosis (NSTEMI) with a rising and falling pattern.
Unstable angina is diagnosed based on clinical presentation and ECG changes without
biomarker elevation.
Question 7
A 68-year-old man with a history of COPD presents to the ED with increasing dyspnea,
tachypnea, and accessory muscle use. ABG on 6 L NC: pH 7.28, PaCO₂ 72 mmHg, PaO₂ 58
mmHg, HCO₃⁻ 34 mEq/L. Which acid-base disorder is present?
A. Acute respiratory acidosis
B. Acute metabolic acidosis
C. Chronic respiratory acidosis with acute-on-chronic exacerbation
D. Chronic metabolic alkalosis
CorreCt Answer: C ✓
rAtionAle: pH is acidemic (< 7.35), PaCO₂ is markedly elevated (consistent with respiratory
acidosis), and HCO₃⁻ is elevated (renal compensation). The degree of HCO₃⁻ elevation (> 30
Walden University – Academic Year 2026/2027 – Final
Comprehensive Examination with 100 Verified Questions and
Correct Answer Rationales | | verified by experts .
INTRODUCTION
Welcome to the NRNP 6566 Advanced Care of Adults in Acute Settings I comprehensive
exam study guide. This resource is specifically designed for Walden University Adult-
Gerontology Acute Care Nurse Practitioner (AGACNP) students preparing for the midterm and
final examinations for the 2026/2027 academic year.
Course Overview:
• Course Code: NRNP 6566 / NRNP6566
• Title: Advanced Care of Adults in Acute Settings I
• Institution: Walden University
• Credits: 3 credits didactic + practicum component
• Prerequisites: NURS 6521 Advanced Pharmacology
• Academic Year: 2026/2027
DOMAIN 1: ACUTE CARDIOPULMONARY & SHOCK MANAGEMENT
Question 1
A 68-year-old male with a history of hypertension presents with substernal chest pressure
radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment elevation in leads
V1–V4. Which of the following is the priority intervention?
A. Administer sublingual nitroglycerin
B. Obtain a chest X-ray
C. Initiate immediate reperfusion therapy (PCI or fibrinolysis)
D. Administer morphine sulfate for pain
CorreCt Answer: C ✓
rAtionAle: ST-segment elevation in leads V1–V4 indicates an anterior ST-elevation
myocardial infarction (STEMI) . The priority is immediate reperfusion therapy via
percutaneous coronary intervention (PCI) or fibrinolysis. "Time is muscle" – the goal is door-to-
balloon time < 90 minutes.
,Question 2
Which of the following ECG findings is most characteristic of acute pericarditis?
A. ST-segment depression in leads V1–V3
B. Diffuse ST-segment elevation with PR-segment depression
C. Pathologic Q waves in leads II, III, aVF
D. Tall, peaked T waves
CorreCt Answer: B ✓
rAtionAle: Acute pericarditis is characterized by diffuse ST-segment elevation (concave
upward) with PR-segment depression. This is due to inflammation of the pericardium. Tall,
peaked T waves are associated with hyperkalemia; pathologic Q waves indicate prior MI.
Question 3
A 72-year-old female with heart failure presents with dyspnea, orthopnea, and bilateral crackles
on auscultation. Her ejection fraction is 35%. Which medication class has been shown to reduce
mortality in heart failure with reduced ejection fraction (HFrEF)?
A. Calcium channel blockers
B. Beta-blockers (e.g., carvedilol, metoprolol succinate)
C. Thiazide diuretics
D. Direct vasodilators alone
CorreCt Answer: B ✓
rAtionAle: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) have been shown
to reduce mortality in HFrEF by decreasing sympathetic activation and preventing adverse
remodeling. They are a cornerstone of guideline-directed medical therapy (GDMT).
Question 4
Which of the following is a contraindication to the use of fibrinolytic therapy in acute ST-
elevation myocardial infarction (STEMI)?
A. Age > 75 years
B. Prior intracranial hemorrhage at any time
C. Systolic blood pressure > 180 mmHg
D. History of diabetes mellitus
CorreCt Answer: B ✓
rAtionAle: Absolute contraindications to fibrinolysis include prior intracranial
hemorrhage at any time, known structural cerebral vascular lesion, ischemic stroke within 3
months, suspected aortic dissection, and active bleeding. Age >75 is a relative, not absolute,
contraindication.
, Question 5
A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the
most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Aspirin plus clopidogrel
C. Oral anticoagulant (warfarin or direct oral anticoagulant)
D. No anticoagulation needed
CorreCt Answer: C ✓
rAtionAle: A CHA₂DS₂-VASc score ≥ 2 in males or ≥ 3 in females indicates high stroke
risk and warrants oral anticoagulation (warfarin or a DOAC). Aspirin alone is insufficient for
stroke prevention in atrial fibrillation.
Question 6
In a patient with unstable angina, which of the following findings on cardiac troponin would be
expected?
A. Elevated troponin above the 99th percentile upper reference limit
B. Normal troponin levels
C. Troponin elevation with a rising and falling pattern
D. Troponin elevation without a rise or fall
CorreCt Answer: B ✓
rAtionAle: By definition, unstable angina is characterized by normal troponin levels.
Elevated troponin indicates myocardial necrosis (NSTEMI) with a rising and falling pattern.
Unstable angina is diagnosed based on clinical presentation and ECG changes without
biomarker elevation.
Question 7
A 68-year-old man with a history of COPD presents to the ED with increasing dyspnea,
tachypnea, and accessory muscle use. ABG on 6 L NC: pH 7.28, PaCO₂ 72 mmHg, PaO₂ 58
mmHg, HCO₃⁻ 34 mEq/L. Which acid-base disorder is present?
A. Acute respiratory acidosis
B. Acute metabolic acidosis
C. Chronic respiratory acidosis with acute-on-chronic exacerbation
D. Chronic metabolic alkalosis
CorreCt Answer: C ✓
rAtionAle: pH is acidemic (< 7.35), PaCO₂ is markedly elevated (consistent with respiratory
acidosis), and HCO₃⁻ is elevated (renal compensation). The degree of HCO₃⁻ elevation (> 30
