NR 574 ACUTE CARE PRACTICUM I | CHAMBERLAIN
COLLEGE OF NURSING | ACADEMIC YEAR 2026/2027 |
FINAL
• CORE DOMAINS *
• Cardiovascular and Pulmonary Acute Care *
• Neurological and Endocrine Acute Care *
• Gastrointestinal, Renal, and Hematologic Acute Care*
• Trauma, Sepsis, and Multisystem Organ Failure *
• INTRODUCTION *
• The NR 574 Acute Care Practicum I Final Examination is the comprehensive
capstone assessment for graduate nursing students at Chamberlain College
of Nursing. This examination evaluates the student's ability to synthesize
clinical management skills and knowledge essential for advanced practice in
complex acute care settings. Through multiple-choice and scenario-based
questions, candidates must demonstrate critical thinking, prioritization, and
evidence-based decision-making across cardiovascular, pulmonary,
neurological, endocrine, gastrointestinal, renal, hematologic, and
multisystem conditions. The examination emphasizes hemodynamic
management, acute assessment, and critical intervention strategies drawn
from foundational acute and critical care nursing methodology. Mastery of
these competencies ensures readiness for independent practice as an
Adult-Gerontology Acute Care Nurse Practitioner. *
SECTION ONE: QUESTIONS 1–150
1. A 68-year-old patient with acute chest pain and ST elevation in leads V1-V4 is
diagnosed with an anterior STEMI. What is the priority intervention?
A. Administer aspirin 325 mg orally
B. Obtain cardiac enzymes
, C. Prepare for immediate percutaneous coronary intervention (PCI)
D. Administer sublingual nitroglycerin
RATIONALE: Immediate reperfusion via PCI is the priority to limit myocardial
damage. Aspirin and nitroglycerin are adjunctive but not the priority. Cardiac
enzymes confirm the diagnosis but should not delay reperfusion.
2. A 75-year-old patient with heart failure develops acute dyspnea, pink frothy
sputum, and bilateral crackles. The nurse practitioner should first:
A. Place the patient in high Fowler's position
B. Administer IV furosemide
C. Administer high-flow supplemental oxygen
D. Obtain a chest x-ray
RATIONALE: Pink frothy sputum indicates acute pulmonary edema. The
immediate priority is oxygenation to correct hypoxemia. Positioning and diuretics
follow after oxygen is initiated.
3. A patient in the ICU has a central venous pressure (CVP) of 2 mm Hg and is
hypotensive. What does this finding most likely indicate?
A. Fluid overload
B. Left ventricular failure
C. Hypovolemia or decreased venous return
D. Increased afterload only
RATIONALE: A low CVP reflects reduced right-sided preload and is consistent
with hypovolemia or decreased venous return. Volume resuscitation is typically
indicated after confirming the clinical context.
4. Which hemodynamic profile is most consistent with cardiogenic shock?
A. High cardiac output, low systemic vascular resistance
B. High cardiac output, high systemic vascular resistance
C. Low cardiac output, high systemic vascular resistance, elevated pulmonary
artery wedge pressure
D. Normal cardiac output with low wedge pressure
RATIONALE: Cardiogenic shock is characterized by pump failure: reduced
,cardiac output, compensatory vasoconstriction (high SVR), and elevated left-sided
filling pressures (high PAWP).
5. A patient with acute decompensated heart failure is receiving nitroprusside.
What is the primary therapeutic goal of this medication?
A. Increase preload
B. Increase myocardial contractility directly
C. Reduce afterload through arterial vasodilation
D. Provide rate control
RATIONALE: Nitroprusside is a potent arterial vasodilator used to reduce
afterload, thereby improving forward stroke volume in selected patients with
acute heart failure and elevated systemic vascular resistance.
6. Which ventilator mode delivers a set tidal volume with each mandatory
breath and allows spontaneous breathing between mandatory breaths?
A. Pressure support ventilation only
B. Continuous positive airway pressure (CPAP) alone
C. Synchronized intermittent mandatory ventilation (SIMV)
D. High-frequency oscillatory ventilation
RATIONALE: SIMV delivers a clinician-set number of mandatory volume- or
pressure-controlled breaths synchronized with patient effort and permits
spontaneous breathing between those breaths.
7. A patient develops acute respiratory distress syndrome (ARDS). Which
ventilation strategy is evidence-based?
A. High tidal volumes of 12–15 mL/kg predicted body weight
B. Zero positive end-expiratory pressure
C. Low tidal volume ventilation (approximately 6 mL/kg predicted body
weight) with plateau pressure limitation
D. Permissive hypercapnia with high tidal volumes
RATIONALE: The ARDSNet protocol recommends low tidal volume ventilation
(6 mL/kg predicted body weight) with plateau pressure ≤30 cm H₂O to reduce
ventilator-induced lung injury and mortality.
, 8. A patient with a traumatic brain injury has an ICP of 22 mm Hg and a CPP of
85 mm Hg. The AGACNP interprets this as:
A. ICP normal, CPP elevated
B. ICP normal, CPP normal
C. ICP elevated, CPP normal
D. ICP elevated, CPP elevated
RATIONALE: Normal ICP is 5–15 mm Hg; 22 mm Hg is elevated and requires
intervention. CPP = MAP − ICP; a CPP of 85 mm Hg is within the normal range of
60–100 mm Hg.
9. Which EKG finding is most indicative of hyperkalemia?
A. Flattened T waves
B. U waves
C. ST depression
D. Peaked T waves
RATIONALE: Hyperkalemia causes tall, peaked T waves due to altered
repolarization. As potassium rises, the QRS widens and PR interval prolongs.
10. A patient with atrial fibrillation is started on warfarin. Which INR range
indicates therapeutic effect?
A. 1.5–2.0
B. 2.5–3.5
C. 2.0–3.0
D. 3.0–4.0
RATIONALE: For nonvalvular atrial fibrillation, the target INR is 2.0–3.0 to
prevent thromboembolic events while minimizing bleeding risk.
11. A patient with a pulmonary embolism is hemodynamically stable. What is
the first-line diagnostic test?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography (CTPA)
D. Ventilation-perfusion (V/Q) scan
COLLEGE OF NURSING | ACADEMIC YEAR 2026/2027 |
FINAL
• CORE DOMAINS *
• Cardiovascular and Pulmonary Acute Care *
• Neurological and Endocrine Acute Care *
• Gastrointestinal, Renal, and Hematologic Acute Care*
• Trauma, Sepsis, and Multisystem Organ Failure *
• INTRODUCTION *
• The NR 574 Acute Care Practicum I Final Examination is the comprehensive
capstone assessment for graduate nursing students at Chamberlain College
of Nursing. This examination evaluates the student's ability to synthesize
clinical management skills and knowledge essential for advanced practice in
complex acute care settings. Through multiple-choice and scenario-based
questions, candidates must demonstrate critical thinking, prioritization, and
evidence-based decision-making across cardiovascular, pulmonary,
neurological, endocrine, gastrointestinal, renal, hematologic, and
multisystem conditions. The examination emphasizes hemodynamic
management, acute assessment, and critical intervention strategies drawn
from foundational acute and critical care nursing methodology. Mastery of
these competencies ensures readiness for independent practice as an
Adult-Gerontology Acute Care Nurse Practitioner. *
SECTION ONE: QUESTIONS 1–150
1. A 68-year-old patient with acute chest pain and ST elevation in leads V1-V4 is
diagnosed with an anterior STEMI. What is the priority intervention?
A. Administer aspirin 325 mg orally
B. Obtain cardiac enzymes
, C. Prepare for immediate percutaneous coronary intervention (PCI)
D. Administer sublingual nitroglycerin
RATIONALE: Immediate reperfusion via PCI is the priority to limit myocardial
damage. Aspirin and nitroglycerin are adjunctive but not the priority. Cardiac
enzymes confirm the diagnosis but should not delay reperfusion.
2. A 75-year-old patient with heart failure develops acute dyspnea, pink frothy
sputum, and bilateral crackles. The nurse practitioner should first:
A. Place the patient in high Fowler's position
B. Administer IV furosemide
C. Administer high-flow supplemental oxygen
D. Obtain a chest x-ray
RATIONALE: Pink frothy sputum indicates acute pulmonary edema. The
immediate priority is oxygenation to correct hypoxemia. Positioning and diuretics
follow after oxygen is initiated.
3. A patient in the ICU has a central venous pressure (CVP) of 2 mm Hg and is
hypotensive. What does this finding most likely indicate?
A. Fluid overload
B. Left ventricular failure
C. Hypovolemia or decreased venous return
D. Increased afterload only
RATIONALE: A low CVP reflects reduced right-sided preload and is consistent
with hypovolemia or decreased venous return. Volume resuscitation is typically
indicated after confirming the clinical context.
4. Which hemodynamic profile is most consistent with cardiogenic shock?
A. High cardiac output, low systemic vascular resistance
B. High cardiac output, high systemic vascular resistance
C. Low cardiac output, high systemic vascular resistance, elevated pulmonary
artery wedge pressure
D. Normal cardiac output with low wedge pressure
RATIONALE: Cardiogenic shock is characterized by pump failure: reduced
,cardiac output, compensatory vasoconstriction (high SVR), and elevated left-sided
filling pressures (high PAWP).
5. A patient with acute decompensated heart failure is receiving nitroprusside.
What is the primary therapeutic goal of this medication?
A. Increase preload
B. Increase myocardial contractility directly
C. Reduce afterload through arterial vasodilation
D. Provide rate control
RATIONALE: Nitroprusside is a potent arterial vasodilator used to reduce
afterload, thereby improving forward stroke volume in selected patients with
acute heart failure and elevated systemic vascular resistance.
6. Which ventilator mode delivers a set tidal volume with each mandatory
breath and allows spontaneous breathing between mandatory breaths?
A. Pressure support ventilation only
B. Continuous positive airway pressure (CPAP) alone
C. Synchronized intermittent mandatory ventilation (SIMV)
D. High-frequency oscillatory ventilation
RATIONALE: SIMV delivers a clinician-set number of mandatory volume- or
pressure-controlled breaths synchronized with patient effort and permits
spontaneous breathing between those breaths.
7. A patient develops acute respiratory distress syndrome (ARDS). Which
ventilation strategy is evidence-based?
A. High tidal volumes of 12–15 mL/kg predicted body weight
B. Zero positive end-expiratory pressure
C. Low tidal volume ventilation (approximately 6 mL/kg predicted body
weight) with plateau pressure limitation
D. Permissive hypercapnia with high tidal volumes
RATIONALE: The ARDSNet protocol recommends low tidal volume ventilation
(6 mL/kg predicted body weight) with plateau pressure ≤30 cm H₂O to reduce
ventilator-induced lung injury and mortality.
, 8. A patient with a traumatic brain injury has an ICP of 22 mm Hg and a CPP of
85 mm Hg. The AGACNP interprets this as:
A. ICP normal, CPP elevated
B. ICP normal, CPP normal
C. ICP elevated, CPP normal
D. ICP elevated, CPP elevated
RATIONALE: Normal ICP is 5–15 mm Hg; 22 mm Hg is elevated and requires
intervention. CPP = MAP − ICP; a CPP of 85 mm Hg is within the normal range of
60–100 mm Hg.
9. Which EKG finding is most indicative of hyperkalemia?
A. Flattened T waves
B. U waves
C. ST depression
D. Peaked T waves
RATIONALE: Hyperkalemia causes tall, peaked T waves due to altered
repolarization. As potassium rises, the QRS widens and PR interval prolongs.
10. A patient with atrial fibrillation is started on warfarin. Which INR range
indicates therapeutic effect?
A. 1.5–2.0
B. 2.5–3.5
C. 2.0–3.0
D. 3.0–4.0
RATIONALE: For nonvalvular atrial fibrillation, the target INR is 2.0–3.0 to
prevent thromboembolic events while minimizing bleeding risk.
11. A patient with a pulmonary embolism is hemodynamically stable. What is
the first-line diagnostic test?
A. Chest X-ray
B. D-dimer
C. CT pulmonary angiography (CTPA)
D. Ventilation-perfusion (V/Q) scan
