NR-571 ADULT-GERONTOLOGY ACUTE CARE III EXAM
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026/2027 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Complex Cardiovascular Disorders in Acute Care
Complex Respiratory Disorders in Acute Care
Neurological and Neurosurgical Critical Care
Renal and Genitourinary Critical Care
Endocrine and Metabolic Critical Care
Gastrointestinal and Hepatic Critical Care
Hematological and Oncological Critical Care
Multisystem and Sepsis Critical Care
Ethics, Legal, and Professional Practice in Acute Care
Hemodynamic Monitoring and Mechanical Circulatory Support
Introduction
The NR-571 Adult-Gerontology Acute Care III examination
assesses the advanced practice nursing student's competency in
the complex diagnosis and management of critically ill adults and
older adults. This comprehensive evaluation emphasizes the
application of evidence-based practice to hemodynamic
monitoring, shock states, acute coronary syndromes, respiratory
failure, and multisystem critical illness. The multiple-choice and
scenario-based structure requires candidates to demonstrate
mastery of diagnostic reasoning, pharmacologic and mechanical
interventions, and the professional standards of the Adult-
Gerontology Acute Care Nurse Practitioner role. The examination
reflects the clinical judgment necessary for safe, effective acute
care practice in high-acuity settings.
,Section One: Questions 1–100
Question 1
A 58-year-old male presents to the emergency department with
crushing substernal chest pain, diaphoresis, and nausea. ECG
shows 2 mm ST-segment elevation in leads II, III, and aVF. Which
intervention is the highest priority?
A. Administer sublingual nitroglycerin
B. Initiate IV access and administer aspirin 325 mg
C. Activate the cardiac catheterization lab for primary PCI
D. Administer morphine 4 mg IV
🟢 Correct answer: C
🔴 RATIONALE: The patient presents with an inferior STEMI. Per
ACC/AHA guidelines, immediate reperfusion via primary PCI
within 90 minutes of first medical contact is the standard of care.
Time-to-reperfusion is the strongest predictor of mortality benefit.
Nitroglycerin is relatively contraindicated in inferior wall MI due to
risk of right ventricular infarct and profound hypotension.
Question 2
A 72-year-old female with a history of hypertension and diabetes
is admitted with NSTEMI. Her GRACE score is 155, and high-
sensitivity troponin has risen from 80 to 760 ng/L over 3 hours.
Per ACC/AHA pathways, the preferred risk stratification approach
is:
A. Conservative management with medication titration and stress
testing prior to discharge
B. An early invasive strategy with coronary angiography within 24
hours
C. Discharge on optimal medical therapy with outpatient
cardiology follow-up
,D. Thrombolytic therapy with tenecteplase within 30 minutes of
arrival
🟢 Correct answer: B
🔴 RATIONALE: A GRACE score >140 plus a rising troponin profile
classifies this patient as high-risk NSTEMI, mandating an early
invasive strategy with angiography within 24 hours per ACC/AHA
and ESC guidelines. Conservative management is reserved for
low-risk patients. Thrombolytics are contraindicated in NSTEMI.
Question 3
A 64-year-old male is admitted with acute decompensated heart
failure (HFrEF, EF 25%). BP 88/52, HR 122, RR 32, SpO2 88% on
room air. Bilateral crackles, JVD to the jaw, cool extremities, and
lactate 4.8 mmol/L. The AGACNP suspects cardiogenic shock.
Which hemodynamic profile on a pulmonary artery catheter
would MOST strongly support this diagnosis?
A. Cardiac index 2.4 L/min/m2, PCWP 12 mmHg, SVR 800
dynes/s/cm5
B. Cardiac index 1.6 L/min/m2, PCWP 28 mmHg, SVR 1900
dynes/s/cm5
C. Cardiac index 3.2 L/min/m2, PCWP 6 mmHg, SVR 600
dynes/s/cm5
D. Cardiac index 2.0 L/min/m2, PCWP 8 mmHg, SVR 1500
dynes/s/cm5
🟢 Correct answer: B
🔴 RATIONALE: Cardiogenic shock classically demonstrates a low
cardiac index (<2.2 L/min/m2), elevated PCWP (>18 mmHg)
reflecting pulmonary congestion, and a compensatorily elevated
SVR from sympathetic activation. Option A is normal; option C is
distributive shock; option D is hypovolemic shock.
, Question 4
A patient with an intra-aortic balloon pump (IABP) displays a
waveform with balloon inflation occurring during systole (after the
aortic valve opens) and deflation during diastole. The AGACNP
correctly identifies this as:
A. Optimal timing; no intervention required
B. Early inflation, which can increase afterload and worsen LV
workload
C. Late deflation, which increases coronary perfusion pressure
D. Late inflation, which improves diastolic augmentation
🟢 Correct answer: B
🔴 RATIONALE: Early inflation (during systole) increases afterload
and worsens left ventricular workload, potentially causing harm.
Optimal IABP timing requires inflation during diastole and
deflation just before systole to augment coronary perfusion and
reduce afterload.
Question 5
Which hemodynamic parameter obtained from a pulmonary
artery catheter most directly reflects left ventricular end-diastolic
preload?
A. Pulmonary artery occlusion pressure (PAOP)
B. Systemic vascular resistance (SVR)
C. Mean arterial pressure (MAP)
D. Pulmonary vascular resistance (PVR)
🟢 Correct answer: A
🔴 RATIONALE: The PAOP (wedge pressure) approximates left
atrial pressure and left ventricular end-diastolic volume, making it
the most direct available index of LV preload in the acute care
setting. SVR and MAP reflect afterload and perfusion pressure
rather than preload.
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026/2027 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Complex Cardiovascular Disorders in Acute Care
Complex Respiratory Disorders in Acute Care
Neurological and Neurosurgical Critical Care
Renal and Genitourinary Critical Care
Endocrine and Metabolic Critical Care
Gastrointestinal and Hepatic Critical Care
Hematological and Oncological Critical Care
Multisystem and Sepsis Critical Care
Ethics, Legal, and Professional Practice in Acute Care
Hemodynamic Monitoring and Mechanical Circulatory Support
Introduction
The NR-571 Adult-Gerontology Acute Care III examination
assesses the advanced practice nursing student's competency in
the complex diagnosis and management of critically ill adults and
older adults. This comprehensive evaluation emphasizes the
application of evidence-based practice to hemodynamic
monitoring, shock states, acute coronary syndromes, respiratory
failure, and multisystem critical illness. The multiple-choice and
scenario-based structure requires candidates to demonstrate
mastery of diagnostic reasoning, pharmacologic and mechanical
interventions, and the professional standards of the Adult-
Gerontology Acute Care Nurse Practitioner role. The examination
reflects the clinical judgment necessary for safe, effective acute
care practice in high-acuity settings.
,Section One: Questions 1–100
Question 1
A 58-year-old male presents to the emergency department with
crushing substernal chest pain, diaphoresis, and nausea. ECG
shows 2 mm ST-segment elevation in leads II, III, and aVF. Which
intervention is the highest priority?
A. Administer sublingual nitroglycerin
B. Initiate IV access and administer aspirin 325 mg
C. Activate the cardiac catheterization lab for primary PCI
D. Administer morphine 4 mg IV
🟢 Correct answer: C
🔴 RATIONALE: The patient presents with an inferior STEMI. Per
ACC/AHA guidelines, immediate reperfusion via primary PCI
within 90 minutes of first medical contact is the standard of care.
Time-to-reperfusion is the strongest predictor of mortality benefit.
Nitroglycerin is relatively contraindicated in inferior wall MI due to
risk of right ventricular infarct and profound hypotension.
Question 2
A 72-year-old female with a history of hypertension and diabetes
is admitted with NSTEMI. Her GRACE score is 155, and high-
sensitivity troponin has risen from 80 to 760 ng/L over 3 hours.
Per ACC/AHA pathways, the preferred risk stratification approach
is:
A. Conservative management with medication titration and stress
testing prior to discharge
B. An early invasive strategy with coronary angiography within 24
hours
C. Discharge on optimal medical therapy with outpatient
cardiology follow-up
,D. Thrombolytic therapy with tenecteplase within 30 minutes of
arrival
🟢 Correct answer: B
🔴 RATIONALE: A GRACE score >140 plus a rising troponin profile
classifies this patient as high-risk NSTEMI, mandating an early
invasive strategy with angiography within 24 hours per ACC/AHA
and ESC guidelines. Conservative management is reserved for
low-risk patients. Thrombolytics are contraindicated in NSTEMI.
Question 3
A 64-year-old male is admitted with acute decompensated heart
failure (HFrEF, EF 25%). BP 88/52, HR 122, RR 32, SpO2 88% on
room air. Bilateral crackles, JVD to the jaw, cool extremities, and
lactate 4.8 mmol/L. The AGACNP suspects cardiogenic shock.
Which hemodynamic profile on a pulmonary artery catheter
would MOST strongly support this diagnosis?
A. Cardiac index 2.4 L/min/m2, PCWP 12 mmHg, SVR 800
dynes/s/cm5
B. Cardiac index 1.6 L/min/m2, PCWP 28 mmHg, SVR 1900
dynes/s/cm5
C. Cardiac index 3.2 L/min/m2, PCWP 6 mmHg, SVR 600
dynes/s/cm5
D. Cardiac index 2.0 L/min/m2, PCWP 8 mmHg, SVR 1500
dynes/s/cm5
🟢 Correct answer: B
🔴 RATIONALE: Cardiogenic shock classically demonstrates a low
cardiac index (<2.2 L/min/m2), elevated PCWP (>18 mmHg)
reflecting pulmonary congestion, and a compensatorily elevated
SVR from sympathetic activation. Option A is normal; option C is
distributive shock; option D is hypovolemic shock.
, Question 4
A patient with an intra-aortic balloon pump (IABP) displays a
waveform with balloon inflation occurring during systole (after the
aortic valve opens) and deflation during diastole. The AGACNP
correctly identifies this as:
A. Optimal timing; no intervention required
B. Early inflation, which can increase afterload and worsen LV
workload
C. Late deflation, which increases coronary perfusion pressure
D. Late inflation, which improves diastolic augmentation
🟢 Correct answer: B
🔴 RATIONALE: Early inflation (during systole) increases afterload
and worsens left ventricular workload, potentially causing harm.
Optimal IABP timing requires inflation during diastole and
deflation just before systole to augment coronary perfusion and
reduce afterload.
Question 5
Which hemodynamic parameter obtained from a pulmonary
artery catheter most directly reflects left ventricular end-diastolic
preload?
A. Pulmonary artery occlusion pressure (PAOP)
B. Systemic vascular resistance (SVR)
C. Mean arterial pressure (MAP)
D. Pulmonary vascular resistance (PVR)
🟢 Correct answer: A
🔴 RATIONALE: The PAOP (wedge pressure) approximates left
atrial pressure and left ventricular end-diastolic volume, making it
the most direct available index of LV preload in the acute care
setting. SVR and MAP reflect afterload and perfusion pressure
rather than preload.
