NR570 Exam 1 Actual Exam Style V2 | NR
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents with acute onset chest pain, diaphoresis, and nausea. The EKG
shows ST-segment elevation in leads V1-V4. Which is the most appropriate initial
intervention?
A. Administer 324 mg of non-enteric coated aspirin.
B. Prepare the patient for an immediate stress test.
C. Administer 0.4 mg of sublingual Nitroglycerin before IV access.
D. Start a high-dose heparin drip without an initial bolus.
Answer: A
Rationale: Aspirin is a cornerstone of initial management for suspected acute coronary
syndrome to inhibit platelet aggregation. Non-enteric coated aspirin is preferred for faster
absorption in the acute setting. This intervention significantly reduces mortality in patients
experiencing an acute myocardial infarction.
2. A patient with a history of heart failure presents with increased dyspnea and orthopnea.
Their BNP level is 1,200 pg/mL. Which medication class is the priority for volume
management?
A. Beta-blockers
,B. ACE inhibitors
C. Calcium channel blockers
D. Loop diuretics
Answer: D
Rationale: Loop diuretics such as Furosemide are the first-line treatment for acute
decompensated heart failure with volume overload. They effectively reduce preload by
promoting the excretion of sodium and water. Beta-blockers and ACE inhibitors are used
for long-term management but are not the primary choice for immediate diuresis.
3. In the management of sepsis, which of the following is a requirement of the 3-hour
bundle?
A. Initiating vasopressors to maintain MAP over 65 mmHg.
B. Administration of a 30 mL/kg crystalloid bolus for hypotension.
C. Measurement of central venous pressure.
D. Insertion of an arterial line for continuous monitoring.
Answer: B
Rationale: The Surviving Sepsis Campaign guidelines recommend a 30 mL/kg crystalloid
bolus for patients with hypotension or a lactate level of 4 mmol/L or higher. This fluid
resuscitation should be initiated early to restore tissue perfusion. Completion of this
bundle is critical for reducing morbidity and mortality in septic patients.
, 4. A patient presents with a serum potassium of 6.8 mEq/L and peaked T-waves on EKG.
What is the first priority in management?
A. Administration of Sodium Polystyrene Sulfonate.
B. Intravenous Calcium Gluconate.
C. High-dose Albuterol nebulizers.
D. Intravenous Insulin with D50.
Answer: B
Rationale: Calcium gluconate is administered first to stabilize the cardiac membrane and
prevent life-threatening arrhythmias. While insulin and albuterol shift potassium into cells,
they do not immediately protect the heart from hyperkalemia-induced irritability. This
intervention is a temporary measure that allows time for other potassium-lowering
treatments to work.
5. Which physical exam finding is most suggestive of an acute tension pneumothorax?
A. Hyper-resonance on percussion and tracheal deviation away from the affected side.
B. Tracheal deviation toward the affected side.
C. Dullness to percussion and decreased breath sounds.
D. Increased tactile fremitus over the lung field.
Answer: A
570 Common Diagnosis and Management
in Acute Care Practicum | Chamberlain
1. A 65-year-old male presents with acute onset chest pain, diaphoresis, and nausea. The EKG
shows ST-segment elevation in leads V1-V4. Which is the most appropriate initial
intervention?
A. Administer 324 mg of non-enteric coated aspirin.
B. Prepare the patient for an immediate stress test.
C. Administer 0.4 mg of sublingual Nitroglycerin before IV access.
D. Start a high-dose heparin drip without an initial bolus.
Answer: A
Rationale: Aspirin is a cornerstone of initial management for suspected acute coronary
syndrome to inhibit platelet aggregation. Non-enteric coated aspirin is preferred for faster
absorption in the acute setting. This intervention significantly reduces mortality in patients
experiencing an acute myocardial infarction.
2. A patient with a history of heart failure presents with increased dyspnea and orthopnea.
Their BNP level is 1,200 pg/mL. Which medication class is the priority for volume
management?
A. Beta-blockers
,B. ACE inhibitors
C. Calcium channel blockers
D. Loop diuretics
Answer: D
Rationale: Loop diuretics such as Furosemide are the first-line treatment for acute
decompensated heart failure with volume overload. They effectively reduce preload by
promoting the excretion of sodium and water. Beta-blockers and ACE inhibitors are used
for long-term management but are not the primary choice for immediate diuresis.
3. In the management of sepsis, which of the following is a requirement of the 3-hour
bundle?
A. Initiating vasopressors to maintain MAP over 65 mmHg.
B. Administration of a 30 mL/kg crystalloid bolus for hypotension.
C. Measurement of central venous pressure.
D. Insertion of an arterial line for continuous monitoring.
Answer: B
Rationale: The Surviving Sepsis Campaign guidelines recommend a 30 mL/kg crystalloid
bolus for patients with hypotension or a lactate level of 4 mmol/L or higher. This fluid
resuscitation should be initiated early to restore tissue perfusion. Completion of this
bundle is critical for reducing morbidity and mortality in septic patients.
, 4. A patient presents with a serum potassium of 6.8 mEq/L and peaked T-waves on EKG.
What is the first priority in management?
A. Administration of Sodium Polystyrene Sulfonate.
B. Intravenous Calcium Gluconate.
C. High-dose Albuterol nebulizers.
D. Intravenous Insulin with D50.
Answer: B
Rationale: Calcium gluconate is administered first to stabilize the cardiac membrane and
prevent life-threatening arrhythmias. While insulin and albuterol shift potassium into cells,
they do not immediately protect the heart from hyperkalemia-induced irritability. This
intervention is a temporary measure that allows time for other potassium-lowering
treatments to work.
5. Which physical exam finding is most suggestive of an acute tension pneumothorax?
A. Hyper-resonance on percussion and tracheal deviation away from the affected side.
B. Tracheal deviation toward the affected side.
C. Dullness to percussion and decreased breath sounds.
D. Increased tactile fremitus over the lung field.
Answer: A
