NR570 Exam 1 Actual Exam Style V1 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents to the emergency department with acute shortness of
breath, bibasilar crackles, and an S3 gallop. Which diagnostic laboratory test is most specific
for confirming the diagnosis of acute decompensated heart failure?
A. Troponin I
B. D-dimer
C. Creatine Kinase-MB
D. Brain Natriuretic Peptide (BNP)
Answer: D
Rationale: Brain Natriuretic Peptide (BNP) is released by the ventricles in response to
increased wall tension and volume overload. A high BNP level is highly sensitive and
specific for heart failure in patients presenting with dyspnea. It helps differentiate cardiac
causes of respiratory distress from pulmonary causes like COPD or pneumonia.
2. According to the Surviving Sepsis Campaign guidelines, what is the recommended initial
fluid bolus for a patient with sepsis-induced hypotension or a lactate level of 4 mmol/L or
greater?
A. 10 mL/kg of crystalloid
,B. 20 mL/kg of colloid
C. 500 mL of normal saline over 1 hour
D. 30 mL/kg of crystalloid
Answer: D
Rationale: The current standard of care for initial resuscitation in septic shock is 30 mL/kg
of intravenous crystalloid solution. This volume should be administered within the first 3
hours of recognition to improve tissue perfusion. Monitoring clinical response via blood
pressure and urine output is essential after the bolus is completed.
3. A patient is admitted with a suspected ST-elevation myocardial infarction (STEMI). What is
the national standard goal for ‘door-to-balloon’ time for patients undergoing primary
percutaneous coronary intervention (PCI)?
A. 30 minutes
B. 60 minutes
C. 120 minutes
D. 90 minutes
Answer: D
Rationale: The American College of Cardiology and American Heart Association
recommend a door-to-balloon time of 90 minutes or less for patients with STEMI. Faster
reperfusion is directly correlated with better myocardial salvage and lower mortality rates.
, If PCI is not available at the presenting facility, the goal for fibrinolytic therapy is a door-to-
needle time of 30 minutes.
4. Which of the following ABG results is most consistent with a patient experiencing an acute
exacerbation of COPD with respiratory failure?
A. pH 7.25, PaCO2 35, HCO3 15
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 58, HCO3 28
D. pH 7.52, PaCO2 48, HCO3 34
Answer: C
Rationale: Acute COPD exacerbation typically causes respiratory acidosis due to CO2
retention. The pH is acidic (below 7.35), the PaCO2 is elevated (above 45), and the
bicarbonate may be slightly elevated as a compensatory mechanism. This pattern reflects
the patient’s inability to ventilate effectively, leading to hypercapnia.
5. A patient with Type 1 Diabetes presents with nausea, vomiting, and abdominal pain.
Laboratory results show a glucose of 450 mg/dL, pH of 7.15, and positive serum ketones.
What is the most critical first step in management?
A. Aggressive fluid resuscitation with isotonic saline
B. Subcutaneous long-acting insulin
C. Intravenous insulin bolus
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old patient presents to the emergency department with acute shortness of
breath, bibasilar crackles, and an S3 gallop. Which diagnostic laboratory test is most specific
for confirming the diagnosis of acute decompensated heart failure?
A. Troponin I
B. D-dimer
C. Creatine Kinase-MB
D. Brain Natriuretic Peptide (BNP)
Answer: D
Rationale: Brain Natriuretic Peptide (BNP) is released by the ventricles in response to
increased wall tension and volume overload. A high BNP level is highly sensitive and
specific for heart failure in patients presenting with dyspnea. It helps differentiate cardiac
causes of respiratory distress from pulmonary causes like COPD or pneumonia.
2. According to the Surviving Sepsis Campaign guidelines, what is the recommended initial
fluid bolus for a patient with sepsis-induced hypotension or a lactate level of 4 mmol/L or
greater?
A. 10 mL/kg of crystalloid
,B. 20 mL/kg of colloid
C. 500 mL of normal saline over 1 hour
D. 30 mL/kg of crystalloid
Answer: D
Rationale: The current standard of care for initial resuscitation in septic shock is 30 mL/kg
of intravenous crystalloid solution. This volume should be administered within the first 3
hours of recognition to improve tissue perfusion. Monitoring clinical response via blood
pressure and urine output is essential after the bolus is completed.
3. A patient is admitted with a suspected ST-elevation myocardial infarction (STEMI). What is
the national standard goal for ‘door-to-balloon’ time for patients undergoing primary
percutaneous coronary intervention (PCI)?
A. 30 minutes
B. 60 minutes
C. 120 minutes
D. 90 minutes
Answer: D
Rationale: The American College of Cardiology and American Heart Association
recommend a door-to-balloon time of 90 minutes or less for patients with STEMI. Faster
reperfusion is directly correlated with better myocardial salvage and lower mortality rates.
, If PCI is not available at the presenting facility, the goal for fibrinolytic therapy is a door-to-
needle time of 30 minutes.
4. Which of the following ABG results is most consistent with a patient experiencing an acute
exacerbation of COPD with respiratory failure?
A. pH 7.25, PaCO2 35, HCO3 15
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 58, HCO3 28
D. pH 7.52, PaCO2 48, HCO3 34
Answer: C
Rationale: Acute COPD exacerbation typically causes respiratory acidosis due to CO2
retention. The pH is acidic (below 7.35), the PaCO2 is elevated (above 45), and the
bicarbonate may be slightly elevated as a compensatory mechanism. This pattern reflects
the patient’s inability to ventilate effectively, leading to hypercapnia.
5. A patient with Type 1 Diabetes presents with nausea, vomiting, and abdominal pain.
Laboratory results show a glucose of 450 mg/dL, pH of 7.15, and positive serum ketones.
What is the most critical first step in management?
A. Aggressive fluid resuscitation with isotonic saline
B. Subcutaneous long-acting insulin
C. Intravenous insulin bolus
