NR 574 ACUTE CARE PRACTICUM I FINAL
EXAM 2026 COMPREHENSIVE TEST BANK - 500
QUESTIONS WITH ANSWERS AND RATIONALES
Chamberlain University | 2025-2026 Academic Year |
Most Recent Edition
EXAM OVERVIEW
The NR 574 Acute Care Practicum I final examination assesses the advanced practice
nursing student's ability to synthesize clinical management skills and knowledge for
complex acute care patient populations. This comprehensive test bank covers all major
content areas including cardiovascular emergencies, respiratory failure, neurological
emergencies, gastrointestinal and genitourinary disorders, traumatic injuries, shock
states, infectious diseases, and critical care procedures. Each question is designed to
evaluate clinical reasoning, diagnostic interpretation, and evidence-based intervention
selection aligned with Chamberlain University's AGACNP curriculum and AACN core
competencies. This examination requires integration of advanced pathophysiology,
pharmacology, and physical assessment principles to demonstrate readiness for
independent acute care practice.
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1-50)
1. A patient presents with acute onset of chest pain, hypotension, and jugular venous
distention. Heart sounds are muffled. What is the most likely diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Acute myocardial infarction
D) Aortic dissection
,Answer: B) Cardiac tamponade
Rationale: Beck's triad (hypotension, jugular venous distention, muffled heart sounds)
is the classic presentation of cardiac tamponade caused by fluid accumulation in the
pericardial sac compressing the heart and restricting filling . The acute compression of
the heart by blood or fluid in the pericardial cavity leads to pulsus paradoxus and
electrical alternans on ECG.
2. An unstable patient with atrial fibrillation and rapid ventricular response has
hypotension and chest pain. What is the priority intervention?
A) Administer amiodarone IV
B) Start diltiazem infusion
C) Perform synchronized cardioversion
D) Give metoprolol orally
Answer: C) Perform synchronized cardioversion
Rationale: In unstable atrial fibrillation with hemodynamic compromise (hypotension,
chest pain, altered mental status), immediate synchronized cardioversion is indicated .
Pharmacologic rate control is appropriate only for stable patients. Delaying
cardioversion can lead to further hemodynamic deterioration.
3. Which ventilator strategy is most appropriate for a patient with ARDS?
A) Tidal volume 10-12 mL/kg with low PEEP
B) Tidal volume 6 mL/kg predicted body weight with plateau pressure ≤30 cm H₂O
C) Pressure support ventilation with minimal PEEP
D) High-frequency oscillatory ventilation
Answer: B) Tidal volume 6 mL/kg with plateau pressure ≤30 cm H₂O
,Rationale: Low tidal volume ventilation (6 mL/kg predicted body weight) with plateau
pressure limitation ≤30 cm H₂O reduces ventilator-induced lung injury and mortality in
ARDS . This lung-protective strategy prevents alveolar overdistention and barotrauma.
4. Beck's triad consists of which three findings?
A) Fever, tachycardia, hypotension
B) Hypotension, muffled heart tones, jugular venous distention
C) Chest pain, dyspnea, palpitations
D) Tachycardia, hypertension, tachypnea
Answer: B) Hypotension, muffled heart tones, jugular venous distention
Rationale: Beck's triad is the classic presentation of cardiac tamponade . These findings
result from impaired cardiac filling due to pericardial fluid accumulation, leading to
reduced cardiac output, muffled heart sounds from fluid dampening, and elevated
central venous pressure.
5. A patient with septic shock requires vasopressor support. Which is the first-line
vasopressor per Surviving Sepsis Campaign guidelines?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Vasopressin
Answer: C) Norepinephrine
Rationale: Norepinephrine is the recommended first-line vasopressor for septic shock
due to its potent alpha-adrenergic effects and lower arrhythmia risk compared to
dopamine . It increases mean arterial pressure through vasoconstriction while
maintaining cardiac output.
, 6. Hemodynamic findings showing low cardiac output, elevated PAOP (22 mmHg), and
high SVR are consistent with:
A) Cardiogenic shock
B) Distributive shock
C) Hypovolemic shock
D) Obstructive shock
Answer: A) Cardiogenic shock
Rationale: Low cardiac output, elevated pulmonary artery occlusion pressure indicating
fluid overload, and high systemic vascular resistance are classic findings in cardiogenic
shock due to pump failure . This pattern represents impaired myocardial contractility
with compensatory vasoconstriction.
7. A patient on mechanical ventilation has an acute drop in SpO₂, increased peak airway
pressure, and absent breath sounds on the left. What is the most likely cause?
A) Pneumothorax
B) Mucus plug
C) Endotracheal tube displacement
D) Pulmonary edema
Answer: A) Pneumothorax
Rationale: Acute hypoxia, increased peak airway pressure, and absent breath sounds
unilaterally suggest tension pneumothorax . Immediate needle decompression or chest
tube placement is required. This condition can rapidly progress to hemodynamic
instability.
8. What is the recommended temperature target and duration for targeted temperature
management after cardiac arrest?
EXAM 2026 COMPREHENSIVE TEST BANK - 500
QUESTIONS WITH ANSWERS AND RATIONALES
Chamberlain University | 2025-2026 Academic Year |
Most Recent Edition
EXAM OVERVIEW
The NR 574 Acute Care Practicum I final examination assesses the advanced practice
nursing student's ability to synthesize clinical management skills and knowledge for
complex acute care patient populations. This comprehensive test bank covers all major
content areas including cardiovascular emergencies, respiratory failure, neurological
emergencies, gastrointestinal and genitourinary disorders, traumatic injuries, shock
states, infectious diseases, and critical care procedures. Each question is designed to
evaluate clinical reasoning, diagnostic interpretation, and evidence-based intervention
selection aligned with Chamberlain University's AGACNP curriculum and AACN core
competencies. This examination requires integration of advanced pathophysiology,
pharmacology, and physical assessment principles to demonstrate readiness for
independent acute care practice.
SECTION 1: CARDIOVASCULAR EMERGENCIES (Questions 1-50)
1. A patient presents with acute onset of chest pain, hypotension, and jugular venous
distention. Heart sounds are muffled. What is the most likely diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Acute myocardial infarction
D) Aortic dissection
,Answer: B) Cardiac tamponade
Rationale: Beck's triad (hypotension, jugular venous distention, muffled heart sounds)
is the classic presentation of cardiac tamponade caused by fluid accumulation in the
pericardial sac compressing the heart and restricting filling . The acute compression of
the heart by blood or fluid in the pericardial cavity leads to pulsus paradoxus and
electrical alternans on ECG.
2. An unstable patient with atrial fibrillation and rapid ventricular response has
hypotension and chest pain. What is the priority intervention?
A) Administer amiodarone IV
B) Start diltiazem infusion
C) Perform synchronized cardioversion
D) Give metoprolol orally
Answer: C) Perform synchronized cardioversion
Rationale: In unstable atrial fibrillation with hemodynamic compromise (hypotension,
chest pain, altered mental status), immediate synchronized cardioversion is indicated .
Pharmacologic rate control is appropriate only for stable patients. Delaying
cardioversion can lead to further hemodynamic deterioration.
3. Which ventilator strategy is most appropriate for a patient with ARDS?
A) Tidal volume 10-12 mL/kg with low PEEP
B) Tidal volume 6 mL/kg predicted body weight with plateau pressure ≤30 cm H₂O
C) Pressure support ventilation with minimal PEEP
D) High-frequency oscillatory ventilation
Answer: B) Tidal volume 6 mL/kg with plateau pressure ≤30 cm H₂O
,Rationale: Low tidal volume ventilation (6 mL/kg predicted body weight) with plateau
pressure limitation ≤30 cm H₂O reduces ventilator-induced lung injury and mortality in
ARDS . This lung-protective strategy prevents alveolar overdistention and barotrauma.
4. Beck's triad consists of which three findings?
A) Fever, tachycardia, hypotension
B) Hypotension, muffled heart tones, jugular venous distention
C) Chest pain, dyspnea, palpitations
D) Tachycardia, hypertension, tachypnea
Answer: B) Hypotension, muffled heart tones, jugular venous distention
Rationale: Beck's triad is the classic presentation of cardiac tamponade . These findings
result from impaired cardiac filling due to pericardial fluid accumulation, leading to
reduced cardiac output, muffled heart sounds from fluid dampening, and elevated
central venous pressure.
5. A patient with septic shock requires vasopressor support. Which is the first-line
vasopressor per Surviving Sepsis Campaign guidelines?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Vasopressin
Answer: C) Norepinephrine
Rationale: Norepinephrine is the recommended first-line vasopressor for septic shock
due to its potent alpha-adrenergic effects and lower arrhythmia risk compared to
dopamine . It increases mean arterial pressure through vasoconstriction while
maintaining cardiac output.
, 6. Hemodynamic findings showing low cardiac output, elevated PAOP (22 mmHg), and
high SVR are consistent with:
A) Cardiogenic shock
B) Distributive shock
C) Hypovolemic shock
D) Obstructive shock
Answer: A) Cardiogenic shock
Rationale: Low cardiac output, elevated pulmonary artery occlusion pressure indicating
fluid overload, and high systemic vascular resistance are classic findings in cardiogenic
shock due to pump failure . This pattern represents impaired myocardial contractility
with compensatory vasoconstriction.
7. A patient on mechanical ventilation has an acute drop in SpO₂, increased peak airway
pressure, and absent breath sounds on the left. What is the most likely cause?
A) Pneumothorax
B) Mucus plug
C) Endotracheal tube displacement
D) Pulmonary edema
Answer: A) Pneumothorax
Rationale: Acute hypoxia, increased peak airway pressure, and absent breath sounds
unilaterally suggest tension pneumothorax . Immediate needle decompression or chest
tube placement is required. This condition can rapidly progress to hemodynamic
instability.
8. What is the recommended temperature target and duration for targeted temperature
management after cardiac arrest?
