1
NRNP 6566 Advanced Care of Adults
in Acute Settings I – Actual Final
Exam 2025 with Verified Questions |
Walden University | Updated &
Graded A
1. A 56-year-old male presents to the ED with chest pain and shortness of breath. ECG
shows atrial fibrillation with rapid ventricular response (RVR) at 160 bpm. BP is
110/70 mmHg. What is the priority intervention?
a) Administer aspirin 325 mg
b) Initiate rate control with diltiazem
c) Start thrombolytic therapy
d) Prepare for immediate cardioversion
Rationale: Atrial fibrillation with RVR requires rate control to stabilize hemodynamics.
Diltiazem, a calcium channel blocker, is effective for rate control in stable patients.
Aspirin is for anticoagulation, not rate control; thrombolytics are for STEMI; and
cardioversion is considered if the patient is unstable (e.g., hypotension).
2. A 63-year-old female with a history of HTN and diabetes presents with dyspnea and
lower extremity edema. Echocardiogram shows an ejection fraction of 35%. What is
the most likely diagnosis?
a) Heart failure with reduced ejection fraction (HFrEF)
b) Pulmonary embolism
c) Chronic obstructive pulmonary disease
d) Pericardial effusion
Rationale: An ejection fraction of 35% indicates systolic dysfunction, characteristic of
HFrEF. Dyspnea and edema are classic heart failure symptoms. Pulmonary embolism
may cause dyspnea but not typically edema. COPD and pericardial effusion do not align
with the echocardiogram findings.
3. A 44-year-old female with a mechanical mitral valve is on warfarin 5 mg daily. She
is scheduled for elective surgery. What is the appropriate management of her
anticoagulation?
a) Continue warfarin unchanged
b) Bridge with heparin after stopping warfarin
c) Stop warfarin and start aspirin
d) Discontinue all anticoagulation
Rationale: Patients with mechanical valves require bridging with heparin when warfarin
is stopped for surgery due to high thromboembolism risk. Continuing warfarin risks
bleeding, aspirin is insufficient, and discontinuing all anticoagulation is unsafe.
4. A 32-year-old male presents with a sore throat, fever of 101.6°F, and white patches
on tonsils. Rapid strep test is positive. What is the first-line treatment?
, 2
a) Azithromycin
b) Penicillin V
c) Ciprofloxacin
d) Doxycycline
Rationale: Penicillin V is the first-line treatment for streptococcal pharyngitis due to its
efficacy against Group A Streptococcus. Azithromycin is an alternative for penicillin-
allergic patients, while ciprofloxacin and doxycycline are not indicated.
5. A 70-year-old female presents with confusion and agitation. She has a history of
dementia. Arterial blood gas (ABG) shows pH 7.30, PaCO2 50 mmHg, HCO3 24
mEq/L. What is the acid-base disorder?
a) Metabolic acidosis
b) Respiratory acidosis
c) Metabolic alkalosis
d) Respiratory alkalosis
Rationale: A pH of 7.30 indicates acidosis. Elevated PaCO2 (50 mmHg) with normal
HCO3 suggests respiratory acidosis, likely due to hypoventilation in the context of
altered mental status.
6. A 56-year-old male in hypovolemic shock has a BP of 80/50 mmHg. What is the
initial intervention?
a) Administer vasopressors
b) Fluid resuscitation with crystalloids
c) Start blood transfusion
d) Insert a central line
Rationale: Fluid resuscitation with crystalloids is the initial treatment for hypovolemic
shock to restore intravascular volume. Vasopressors are used if fluids fail, transfusions
depend on blood loss, and a central line is not the priority.
7. A 65-year-old male with COPD presents with acute respiratory distress. ABG shows
pH 7.28, PaCO2 60 mmHg, PaO2 55 mmHg. What is the most appropriate
intervention?
a) Administer high-flow oxygen
b) Initiate non-invasive ventilation
c) Intubate immediately
d) Administer IV corticosteroids
Rationale: Non-invasive ventilation (e.g., BiPAP) is first-line for COPD exacerbation
with hypercapnic respiratory failure to improve ventilation and reduce PaCO2. High-flow
oxygen may worsen hypercapnia, intubation is reserved for failure of non-invasive
methods, and corticosteroids are adjunctive.
8. A 50-year-old male presents with chest pain radiating to the left arm. ECG shows
ST elevation in leads V1–V4. What is the priority intervention?
a) Administer nitroglycerin
b) Prepare for percutaneous coronary intervention (PCI)
c) Start heparin infusion
d) Administer beta-blockers
Rationale: ST-elevation myocardial infarction (STEMI) in anterior leads (V1–V4)
requires urgent PCI to restore coronary blood flow. Nitroglycerin, heparin, and beta-
blockers are adjunctive therapies but not the priority.
, 3
9. A 72-year-old female presents with acute abdominal pain and vomiting. Imaging
shows air-fluid levels and dilated loops of bowel. What is the most likely diagnosis?
a) Appendicitis
b) Small bowel obstruction
c) Pancreatitis
d) Cholecystitis
Rationale: Air-fluid levels and dilated bowel loops on imaging are classic for small
bowel obstruction. Appendicitis, pancreatitis, and cholecystitis present differently and
lack these specific findings.
10. A 60-year-old male with septic shock due to a urinary tract infection has a BP of
85/55 mmHg after fluid resuscitation. Which medication should be initiated?
a) Norepinephrine
b) Dopamine
c) Epinephrine
d) Vasopressin
Rationale: Norepinephrine is the first-line vasopressor for septic shock to restore blood
pressure after adequate fluid resuscitation, per sepsis guidelines. Dopamine, epinephrine,
and vasopressin are secondary options.
11. A 45-year-old female presents with dyspnea and chest pain. D-dimer is elevated, and
CT pulmonary angiography confirms pulmonary embolism. What is the initial
treatment?
a) Warfarin
b) Heparin
c) Thrombolytics
d) Aspirin
Rationale: Heparin (unfractionated or low-molecular-weight) is the initial treatment for
acute pulmonary embolism to prevent clot propagation. Warfarin is for long-term
management, thrombolytics are for massive PE, and aspirin is not indicated.
12. A 68-year-old male presents with altered mental status. Serum sodium is 125
mEq/L, and plasma osmolality is 260 mOsm/kg. What is the most likely diagnosis?
a) Syndrome of inappropriate antidiuretic hormone (SIADH)
b) Diabetes insipidus
c) Hypernatremia
d) Dehydration
Rationale: Low serum sodium (125 mEq/L) with low plasma osmolality (260 mOsm/kg)
indicates hypotonic hyponatremia, commonly caused by SIADH, which leads to water
retention.
13. A 55-year-old male with a history of alcoholism presents with epigastric pain and
vomiting. Serum amylase and lipase are elevated. What is the most likely diagnosis?
a) Acute pancreatitis
b) Peptic ulcer disease
c) Cholecystitis
d) Gastritis
Rationale: Elevated amylase and lipase with epigastric pain in a patient with alcoholism
strongly suggest acute pancreatitis. Other conditions may cause similar symptoms but
lack these specific lab findings.
NRNP 6566 Advanced Care of Adults
in Acute Settings I – Actual Final
Exam 2025 with Verified Questions |
Walden University | Updated &
Graded A
1. A 56-year-old male presents to the ED with chest pain and shortness of breath. ECG
shows atrial fibrillation with rapid ventricular response (RVR) at 160 bpm. BP is
110/70 mmHg. What is the priority intervention?
a) Administer aspirin 325 mg
b) Initiate rate control with diltiazem
c) Start thrombolytic therapy
d) Prepare for immediate cardioversion
Rationale: Atrial fibrillation with RVR requires rate control to stabilize hemodynamics.
Diltiazem, a calcium channel blocker, is effective for rate control in stable patients.
Aspirin is for anticoagulation, not rate control; thrombolytics are for STEMI; and
cardioversion is considered if the patient is unstable (e.g., hypotension).
2. A 63-year-old female with a history of HTN and diabetes presents with dyspnea and
lower extremity edema. Echocardiogram shows an ejection fraction of 35%. What is
the most likely diagnosis?
a) Heart failure with reduced ejection fraction (HFrEF)
b) Pulmonary embolism
c) Chronic obstructive pulmonary disease
d) Pericardial effusion
Rationale: An ejection fraction of 35% indicates systolic dysfunction, characteristic of
HFrEF. Dyspnea and edema are classic heart failure symptoms. Pulmonary embolism
may cause dyspnea but not typically edema. COPD and pericardial effusion do not align
with the echocardiogram findings.
3. A 44-year-old female with a mechanical mitral valve is on warfarin 5 mg daily. She
is scheduled for elective surgery. What is the appropriate management of her
anticoagulation?
a) Continue warfarin unchanged
b) Bridge with heparin after stopping warfarin
c) Stop warfarin and start aspirin
d) Discontinue all anticoagulation
Rationale: Patients with mechanical valves require bridging with heparin when warfarin
is stopped for surgery due to high thromboembolism risk. Continuing warfarin risks
bleeding, aspirin is insufficient, and discontinuing all anticoagulation is unsafe.
4. A 32-year-old male presents with a sore throat, fever of 101.6°F, and white patches
on tonsils. Rapid strep test is positive. What is the first-line treatment?
, 2
a) Azithromycin
b) Penicillin V
c) Ciprofloxacin
d) Doxycycline
Rationale: Penicillin V is the first-line treatment for streptococcal pharyngitis due to its
efficacy against Group A Streptococcus. Azithromycin is an alternative for penicillin-
allergic patients, while ciprofloxacin and doxycycline are not indicated.
5. A 70-year-old female presents with confusion and agitation. She has a history of
dementia. Arterial blood gas (ABG) shows pH 7.30, PaCO2 50 mmHg, HCO3 24
mEq/L. What is the acid-base disorder?
a) Metabolic acidosis
b) Respiratory acidosis
c) Metabolic alkalosis
d) Respiratory alkalosis
Rationale: A pH of 7.30 indicates acidosis. Elevated PaCO2 (50 mmHg) with normal
HCO3 suggests respiratory acidosis, likely due to hypoventilation in the context of
altered mental status.
6. A 56-year-old male in hypovolemic shock has a BP of 80/50 mmHg. What is the
initial intervention?
a) Administer vasopressors
b) Fluid resuscitation with crystalloids
c) Start blood transfusion
d) Insert a central line
Rationale: Fluid resuscitation with crystalloids is the initial treatment for hypovolemic
shock to restore intravascular volume. Vasopressors are used if fluids fail, transfusions
depend on blood loss, and a central line is not the priority.
7. A 65-year-old male with COPD presents with acute respiratory distress. ABG shows
pH 7.28, PaCO2 60 mmHg, PaO2 55 mmHg. What is the most appropriate
intervention?
a) Administer high-flow oxygen
b) Initiate non-invasive ventilation
c) Intubate immediately
d) Administer IV corticosteroids
Rationale: Non-invasive ventilation (e.g., BiPAP) is first-line for COPD exacerbation
with hypercapnic respiratory failure to improve ventilation and reduce PaCO2. High-flow
oxygen may worsen hypercapnia, intubation is reserved for failure of non-invasive
methods, and corticosteroids are adjunctive.
8. A 50-year-old male presents with chest pain radiating to the left arm. ECG shows
ST elevation in leads V1–V4. What is the priority intervention?
a) Administer nitroglycerin
b) Prepare for percutaneous coronary intervention (PCI)
c) Start heparin infusion
d) Administer beta-blockers
Rationale: ST-elevation myocardial infarction (STEMI) in anterior leads (V1–V4)
requires urgent PCI to restore coronary blood flow. Nitroglycerin, heparin, and beta-
blockers are adjunctive therapies but not the priority.
, 3
9. A 72-year-old female presents with acute abdominal pain and vomiting. Imaging
shows air-fluid levels and dilated loops of bowel. What is the most likely diagnosis?
a) Appendicitis
b) Small bowel obstruction
c) Pancreatitis
d) Cholecystitis
Rationale: Air-fluid levels and dilated bowel loops on imaging are classic for small
bowel obstruction. Appendicitis, pancreatitis, and cholecystitis present differently and
lack these specific findings.
10. A 60-year-old male with septic shock due to a urinary tract infection has a BP of
85/55 mmHg after fluid resuscitation. Which medication should be initiated?
a) Norepinephrine
b) Dopamine
c) Epinephrine
d) Vasopressin
Rationale: Norepinephrine is the first-line vasopressor for septic shock to restore blood
pressure after adequate fluid resuscitation, per sepsis guidelines. Dopamine, epinephrine,
and vasopressin are secondary options.
11. A 45-year-old female presents with dyspnea and chest pain. D-dimer is elevated, and
CT pulmonary angiography confirms pulmonary embolism. What is the initial
treatment?
a) Warfarin
b) Heparin
c) Thrombolytics
d) Aspirin
Rationale: Heparin (unfractionated or low-molecular-weight) is the initial treatment for
acute pulmonary embolism to prevent clot propagation. Warfarin is for long-term
management, thrombolytics are for massive PE, and aspirin is not indicated.
12. A 68-year-old male presents with altered mental status. Serum sodium is 125
mEq/L, and plasma osmolality is 260 mOsm/kg. What is the most likely diagnosis?
a) Syndrome of inappropriate antidiuretic hormone (SIADH)
b) Diabetes insipidus
c) Hypernatremia
d) Dehydration
Rationale: Low serum sodium (125 mEq/L) with low plasma osmolality (260 mOsm/kg)
indicates hypotonic hyponatremia, commonly caused by SIADH, which leads to water
retention.
13. A 55-year-old male with a history of alcoholism presents with epigastric pain and
vomiting. Serum amylase and lipase are elevated. What is the most likely diagnosis?
a) Acute pancreatitis
b) Peptic ulcer disease
c) Cholecystitis
d) Gastritis
Rationale: Elevated amylase and lipase with epigastric pain in a patient with alcoholism
strongly suggest acute pancreatitis. Other conditions may cause similar symptoms but
lack these specific lab findings.
