NRNP 6550 Final Exam – Walden
University 2025/2026 – Verified
Questions & Correct Clinical Answers
40 Highest-Yield Questions & Correct Answers + Rationales
1 Large right pleural effusion. Least worrisome fluid type? A) Transudate Rationale: Low
protein/LDH (Light’s criteria); caused by pressure imbalances (CHF, cirrhosis) → treat
underlying condition.
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2 72 yo acute dyspnea, bilateral infiltrates, BNP 2,100 pg/mL. Diagnosis? C) Cardiogenic
pulmonary edema Rationale: BNP >500 + bilateral infiltrates = cardiogenic. Treat with
furosemide, nitroglycerin, BiPAP.
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3 Moderate-severe COPD exacerbation – first-first line includes all EXCEPT: D) Target SpO₂
94–98% (correct target 88–92%) Rationale: High-flow O₂ risks CO₂ narcosis in chronic
retainers (GOLD guidelines).
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4 Subcutaneous emphysema post-thoracentesis. Priority? C) Monitor for tension
pneumothorax Rationale: Air leak → can progress to tension physiology → needle
decompression if unstable.
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5 CAP sputum: gram-positive diplococci. Organism? B) Streptococcus pneumoniae Rationale:
Classic finding. Inpatient regimen: ceftriaxone + azithromycin.
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6 Massive PE + SBP 78 mmHg. Next step? B) Systemic thrombolytics (alteplase 100 mg IV)
Rationale: AHA/ESC definition of massive PE → thrombolyse if no absolute contraindication.
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, 7 Pleural fluid pH 7.05. Implication? B) Complicated parapneumonic effusion/empyema →
chest tube Rationale: pH <7.2 requires drainage.
────────────────────────────
8 Most common VAP pathogen? B) Pseudomonas aeruginosa Rationale: Anti-pseudomonal
beta-lactam + vancomycin is standard empiric coverage.
────────────────────────────
9 Inferior STEMI – reperfusion of choice? B) PCI within 90 minutes Rationale: ACC/AHA
Class I recommendation.
────────────────────────────
10 Tearing chest pain, unequal arm BPs. Confirmatory test? C) CT angiography Rationale:
Gold standard for aortic dissection.
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11 New A-fib RVR, HR 155, BP stable. First-line rate control? B) Diltiazem IV 0.25 mg/kg
Rationale: Fastest onset (2–5 min) in stable patients.
────────────────────────────
12 HFrEF (EF 30%) on lisinopril & carvedilol. Next GDMT additions? D) Spironolactone +
SGLT2i (e.g., dapagliflozin) Rationale: 2022 ACC/AHA four-pillar therapy.
────────────────────────────
13 Post-inferior MI hypotension, clear lungs, elevated JVP. Diagnosis? B) Right ventricular
infarct Rationale: Preload dependent → give fluids, avoid nitrates.
────────────────────────────
14 Bacterial meningitis CSF profile? A) Low glucose, high protein, PMN predominant
Rationale: Empiric ceftriaxone 2 g q12h + vancomycin + dexamethasone.
────────────────────────────
15 Worst headache of life, CT negative, LP xanthochromia? B) Subarachnoid hemorrhage
Rationale: LP required if CT negative within 6 hr.
────────────────────────────
University 2025/2026 – Verified
Questions & Correct Clinical Answers
40 Highest-Yield Questions & Correct Answers + Rationales
1 Large right pleural effusion. Least worrisome fluid type? A) Transudate Rationale: Low
protein/LDH (Light’s criteria); caused by pressure imbalances (CHF, cirrhosis) → treat
underlying condition.
────────────────────────────
2 72 yo acute dyspnea, bilateral infiltrates, BNP 2,100 pg/mL. Diagnosis? C) Cardiogenic
pulmonary edema Rationale: BNP >500 + bilateral infiltrates = cardiogenic. Treat with
furosemide, nitroglycerin, BiPAP.
────────────────────────────
3 Moderate-severe COPD exacerbation – first-first line includes all EXCEPT: D) Target SpO₂
94–98% (correct target 88–92%) Rationale: High-flow O₂ risks CO₂ narcosis in chronic
retainers (GOLD guidelines).
────────────────────────────
4 Subcutaneous emphysema post-thoracentesis. Priority? C) Monitor for tension
pneumothorax Rationale: Air leak → can progress to tension physiology → needle
decompression if unstable.
────────────────────────────
5 CAP sputum: gram-positive diplococci. Organism? B) Streptococcus pneumoniae Rationale:
Classic finding. Inpatient regimen: ceftriaxone + azithromycin.
────────────────────────────
6 Massive PE + SBP 78 mmHg. Next step? B) Systemic thrombolytics (alteplase 100 mg IV)
Rationale: AHA/ESC definition of massive PE → thrombolyse if no absolute contraindication.
────────────────────────────
, 7 Pleural fluid pH 7.05. Implication? B) Complicated parapneumonic effusion/empyema →
chest tube Rationale: pH <7.2 requires drainage.
────────────────────────────
8 Most common VAP pathogen? B) Pseudomonas aeruginosa Rationale: Anti-pseudomonal
beta-lactam + vancomycin is standard empiric coverage.
────────────────────────────
9 Inferior STEMI – reperfusion of choice? B) PCI within 90 minutes Rationale: ACC/AHA
Class I recommendation.
────────────────────────────
10 Tearing chest pain, unequal arm BPs. Confirmatory test? C) CT angiography Rationale:
Gold standard for aortic dissection.
────────────────────────────
11 New A-fib RVR, HR 155, BP stable. First-line rate control? B) Diltiazem IV 0.25 mg/kg
Rationale: Fastest onset (2–5 min) in stable patients.
────────────────────────────
12 HFrEF (EF 30%) on lisinopril & carvedilol. Next GDMT additions? D) Spironolactone +
SGLT2i (e.g., dapagliflozin) Rationale: 2022 ACC/AHA four-pillar therapy.
────────────────────────────
13 Post-inferior MI hypotension, clear lungs, elevated JVP. Diagnosis? B) Right ventricular
infarct Rationale: Preload dependent → give fluids, avoid nitrates.
────────────────────────────
14 Bacterial meningitis CSF profile? A) Low glucose, high protein, PMN predominant
Rationale: Empiric ceftriaxone 2 g q12h + vancomycin + dexamethasone.
────────────────────────────
15 Worst headache of life, CT negative, LP xanthochromia? B) Subarachnoid hemorrhage
Rationale: LP required if CT negative within 6 hr.
────────────────────────────
