NRNP 6566 Week 9 Knowledge Check (2025/2026)
Real Exam Questions and Verified Answers
Advanced Adult Acute Care I
,Multiple-Choice Questions
Question 1:
A 45-year-old male presents to the ICU with a fever of 102.8°F, chills, and purulent
sputum. Chest X-ray shows a right lower lobe consolidation. Blood cultures are pending,
and the patient has a history of MRSA colonization. What is the most appropriate initial
empiric antibiotic regimen?
Answer Choices:
A. Ceftriaxone and azithromycin
B. Vancomycin and piperacillin-tazobactam
C. Levofloxacin and amoxicillin
D. Meropenem and doxycycline
Correct Answer: B. Vancomycin and piperacillin-tazobactam
Rationale:
Given the patient’s history of MRSA colonization and presentation suggestive of hospital-
acquired pneumonia (HAP), empiric coverage must include anti-MRSA and broad-spectrum
gram-negative agents. Vancomycin targets MRSA, while piperacillin-tazobactam covers
Pseudomonas aeruginosa and other gram-negative pathogens common in HAP. Ceftriax-
one and azithromycin are more suitable for community-acquired pneumonia. Levofloxacin
lacks sufficient MRSA coverage, and meropenem, while broad-spectrum, is typically re-
served for confirmed resistant infections.
Question 2:
A 62-year-old female with COPD is admitted for an acute exacerbation. She is tachypneic
with a respiratory rate of 28 and an oxygen saturation of 88
Answer Choices:
A. Initiate noninvasive positive pressure ventilation (NIPPV)
B. Administer high-flow oxygen therapy
C. Intubate and initiate mechanical ventilation
D. Increase oxygen to 6L nasal cannula
Correct Answer: A. Initiate noninvasive positive pressure ventilation (NIPPV)
Rationale:
The patient has acute hypercapnic respiratory failure due to COPD exacerbation, as
evidenced by ABG showing respiratory acidosis (pH 7.32, pCO2 55 mmHg). NIPPV,
such as BiPAP, is the first-line therapy to improve ventilation, reduce pCO2, and avoid
intubation. High-flow oxygen may worsen hypercapnia in COPD patients. Intubation is
reserved for NIPPV failure or contraindications (e.g., altered mental status). Increasing
oxygen via nasal cannula is insufficient to address hypercapnia.
Question 3:
2
,A 55-year-old male with a history of atrial fibrillation on apixaban presents with acute
chest pain and hypotension (BP 85/50 mmHg). Echocardiogram reveals a pericardial
effusion with tamponade physiology. What is the most urgent intervention?
Answer Choices:
A. Administer IV fluids
B. Perform pericardiocentesis
C. Initiate vasopressors
D. Reverse apixaban with andexanet alfa
Correct Answer: B. Perform pericardiocentesis
Rationale:
Cardiac tamponade is a life-threatening emergency requiring immediate pericardiocente-
sis to relieve pressure on the heart and restore hemodynamic stability. While apixaban
reversal with andexanet alfa is necessary to manage bleeding risk, it is secondary to ad-
dressing the tamponade. IV fluids may provide temporary support, but they do not
address the underlying compression. Vasopressors are not the primary intervention for
tamponade.
Question 4:
A 70-year-old male in the ICU post-myocardial infarction develops ventricular tachycar-
dia with a pulse. He is hemodynamically stable. What is the most appropriate initial
treatment?
Answer Choices:
A. Synchronized cardioversion
B. Amiodarone IV bolus
C. Lidocaine IV bolus
D. Adenosine IV push
Correct Answer: B. Amiodarone IV bolus
Rationale:
For stable ventricular tachycardia, antiarrhythmic therapy with amiodarone (150 mg
IV bolus over 10 minutes) is the first-line treatment per ACLS guidelines. Synchronized
cardioversion is indicated for unstable VT (e.g., hypotension, chest pain). Lidocaine is an
alternative but less preferred due to toxicity risks. Adenosine is used for supraventricular
tachycardias, not VT.
Question 5:
A 38-year-old female with type 1 diabetes presents with nausea, vomiting, and confusion.
Labs show glucose 450 mg/dL, pH 7.15, bicarbonate 10 mEq/L, and anion gap 22. What
is the most critical initial treatment?
Answer Choices:
3
, A. Sodium bicarbonate IV
B. Insulin infusion
C. Potassium supplementation
D. IV fluid bolus
Correct Answer: D. IV fluid bolus
Rationale:
The patient has diabetic ketoacidosis (DKA), characterized by hyperglycemia, acidosis,
and elevated anion gap. The initial priority is fluid resuscitation with isotonic saline
(e.g., 1-2L bolus) to correct hypovolemia and improve perfusion, which facilitates glucose
clearance. Insulin infusion is started after fluids to prevent hypokalemia. Sodium bicar-
bonate is rarely indicated unless pH < 6.9. Potassium is supplemented cautiously after
fluid resuscitation and insulin therapy.
Question 6:
A 50-year-old male with cirrhosis is admitted with hematemesis. Esophagogastroduo-
denoscopy (EGD) confirms bleeding esophageal varices. After band ligation, the patient
remains hemodynamically stable. What is the most appropriate pharmacologic therapy
to prevent rebleeding?
Answer Choices:
A. Octreotide IV infusion
B. Propranolol oral
C. Vasopressin IV
D. Pantoprazole IV
Correct Answer: B. Propranolol oral
Rationale:
Non-selective beta-blockers like propranolol are the standard for secondary prevention of
variceal bleeding after endoscopic therapy, as they reduce portal pressure. Octreotide is
used acutely to control active bleeding but is not for long-term prevention. Vasopressin
is less preferred due to side effects. Pantoprazole addresses acid-related issues but does
not prevent variceal rebleeding.
Question 7:
A 65-year-old female presents to the ED with right-sided weakness and slurred speech
for 2 hours. CT head shows no hemorrhage. BP is 190/100 mmHg. What is the most
appropriate next step?
Answer Choices:
A. Administer IV alteplase
B. Start labetalol IV to lower BP
C. Order MRI brain
4
Real Exam Questions and Verified Answers
Advanced Adult Acute Care I
,Multiple-Choice Questions
Question 1:
A 45-year-old male presents to the ICU with a fever of 102.8°F, chills, and purulent
sputum. Chest X-ray shows a right lower lobe consolidation. Blood cultures are pending,
and the patient has a history of MRSA colonization. What is the most appropriate initial
empiric antibiotic regimen?
Answer Choices:
A. Ceftriaxone and azithromycin
B. Vancomycin and piperacillin-tazobactam
C. Levofloxacin and amoxicillin
D. Meropenem and doxycycline
Correct Answer: B. Vancomycin and piperacillin-tazobactam
Rationale:
Given the patient’s history of MRSA colonization and presentation suggestive of hospital-
acquired pneumonia (HAP), empiric coverage must include anti-MRSA and broad-spectrum
gram-negative agents. Vancomycin targets MRSA, while piperacillin-tazobactam covers
Pseudomonas aeruginosa and other gram-negative pathogens common in HAP. Ceftriax-
one and azithromycin are more suitable for community-acquired pneumonia. Levofloxacin
lacks sufficient MRSA coverage, and meropenem, while broad-spectrum, is typically re-
served for confirmed resistant infections.
Question 2:
A 62-year-old female with COPD is admitted for an acute exacerbation. She is tachypneic
with a respiratory rate of 28 and an oxygen saturation of 88
Answer Choices:
A. Initiate noninvasive positive pressure ventilation (NIPPV)
B. Administer high-flow oxygen therapy
C. Intubate and initiate mechanical ventilation
D. Increase oxygen to 6L nasal cannula
Correct Answer: A. Initiate noninvasive positive pressure ventilation (NIPPV)
Rationale:
The patient has acute hypercapnic respiratory failure due to COPD exacerbation, as
evidenced by ABG showing respiratory acidosis (pH 7.32, pCO2 55 mmHg). NIPPV,
such as BiPAP, is the first-line therapy to improve ventilation, reduce pCO2, and avoid
intubation. High-flow oxygen may worsen hypercapnia in COPD patients. Intubation is
reserved for NIPPV failure or contraindications (e.g., altered mental status). Increasing
oxygen via nasal cannula is insufficient to address hypercapnia.
Question 3:
2
,A 55-year-old male with a history of atrial fibrillation on apixaban presents with acute
chest pain and hypotension (BP 85/50 mmHg). Echocardiogram reveals a pericardial
effusion with tamponade physiology. What is the most urgent intervention?
Answer Choices:
A. Administer IV fluids
B. Perform pericardiocentesis
C. Initiate vasopressors
D. Reverse apixaban with andexanet alfa
Correct Answer: B. Perform pericardiocentesis
Rationale:
Cardiac tamponade is a life-threatening emergency requiring immediate pericardiocente-
sis to relieve pressure on the heart and restore hemodynamic stability. While apixaban
reversal with andexanet alfa is necessary to manage bleeding risk, it is secondary to ad-
dressing the tamponade. IV fluids may provide temporary support, but they do not
address the underlying compression. Vasopressors are not the primary intervention for
tamponade.
Question 4:
A 70-year-old male in the ICU post-myocardial infarction develops ventricular tachycar-
dia with a pulse. He is hemodynamically stable. What is the most appropriate initial
treatment?
Answer Choices:
A. Synchronized cardioversion
B. Amiodarone IV bolus
C. Lidocaine IV bolus
D. Adenosine IV push
Correct Answer: B. Amiodarone IV bolus
Rationale:
For stable ventricular tachycardia, antiarrhythmic therapy with amiodarone (150 mg
IV bolus over 10 minutes) is the first-line treatment per ACLS guidelines. Synchronized
cardioversion is indicated for unstable VT (e.g., hypotension, chest pain). Lidocaine is an
alternative but less preferred due to toxicity risks. Adenosine is used for supraventricular
tachycardias, not VT.
Question 5:
A 38-year-old female with type 1 diabetes presents with nausea, vomiting, and confusion.
Labs show glucose 450 mg/dL, pH 7.15, bicarbonate 10 mEq/L, and anion gap 22. What
is the most critical initial treatment?
Answer Choices:
3
, A. Sodium bicarbonate IV
B. Insulin infusion
C. Potassium supplementation
D. IV fluid bolus
Correct Answer: D. IV fluid bolus
Rationale:
The patient has diabetic ketoacidosis (DKA), characterized by hyperglycemia, acidosis,
and elevated anion gap. The initial priority is fluid resuscitation with isotonic saline
(e.g., 1-2L bolus) to correct hypovolemia and improve perfusion, which facilitates glucose
clearance. Insulin infusion is started after fluids to prevent hypokalemia. Sodium bicar-
bonate is rarely indicated unless pH < 6.9. Potassium is supplemented cautiously after
fluid resuscitation and insulin therapy.
Question 6:
A 50-year-old male with cirrhosis is admitted with hematemesis. Esophagogastroduo-
denoscopy (EGD) confirms bleeding esophageal varices. After band ligation, the patient
remains hemodynamically stable. What is the most appropriate pharmacologic therapy
to prevent rebleeding?
Answer Choices:
A. Octreotide IV infusion
B. Propranolol oral
C. Vasopressin IV
D. Pantoprazole IV
Correct Answer: B. Propranolol oral
Rationale:
Non-selective beta-blockers like propranolol are the standard for secondary prevention of
variceal bleeding after endoscopic therapy, as they reduce portal pressure. Octreotide is
used acutely to control active bleeding but is not for long-term prevention. Vasopressin
is less preferred due to side effects. Pantoprazole addresses acid-related issues but does
not prevent variceal rebleeding.
Question 7:
A 65-year-old female presents to the ED with right-sided weakness and slurred speech
for 2 hours. CT head shows no hemorrhage. BP is 190/100 mmHg. What is the most
appropriate next step?
Answer Choices:
A. Administer IV alteplase
B. Start labetalol IV to lower BP
C. Order MRI brain
4
