NR571 / NR 571 FINAL EXAM – COMPLEX
DIAGNOSIS AND MANAGEMENT IN ACUTE CARE
PRACTICUM Chamberlain University | 2025/2026
Edition | Questions & Verified Answers | Grade A+
Question 1
A 68-year-old male presents to the emergency department with substernal
chest pain radiating to the left jaw, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V1 through V4. Which of the following is the most
likely diagnosis?
A) Unstable angina
B) Non-ST-elevation myocardial infarction (NSTEMI)
C) ST-elevation myocardial infarction (STEMI)
D) Aortic dissection
Answer: C
Rationale: ST-segment elevation in contiguous precordial leads (V1-V4) with
typical ischemic symptoms indicates an anterior STEMI. This requires
emergent reperfusion therapy (PCI or fibrinolysis) within 90 minutes of
presentation. Unstable angina and NSTEMI do not present with ST-segment
elevation. Aortic dissection typically presents with tearing chest pain
radiating to the back with pulse deficits.
Question 2
A patient with acute decompensated heart failure presents with dyspnea,
orthopnea, and bilateral crackles. Which of the following is the most
appropriate initial intervention?
A) Aggressive intravenous fluid resuscitation
B) Intravenous loop diuretics and noninvasive ventilation
C) Immediate endotracheal intubation
D) High-dose beta-blocker therapy
,Answer: B
Rationale: Acute pulmonary edema requires immediate IV loop diuretics and
noninvasive positive pressure ventilation (CPAP or BiPAP). Aggressive IV
fluids would worsen pulmonary edema and should be avoided. Intubation
is reserved for patients who fail noninvasive ventilation or are unable to
protect their airway. Beta-blockers are not first-line in acute decompensation.
Question 3
A patient with septic shock requires vasopressor support. Which of the
following is the first-line vasopressor recommended for septic shock?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Vasopressin
Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock due
to its potent alpha-1 vasoconstrictor effects with less chronotropic effects
than dopamine. Dopamine is associated with more arrhythmias. Epinephrine
may be used as a second-line agent. Vasopressin is typically added as a second
agent in refractory shock.
Question 4
A 72-year-old patient with atrial fibrillation is on warfarin therapy. Which of
the following laboratory values should be monitored to assess the therapeutic
effectiveness of warfarin?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
,C) Platelet count
D) D-dimer
Answer: B
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR), with a therapeutic target of 2.0-3.0 for atrial fibrillation. aPTT is
used to monitor heparin therapy. Platelet count monitors for heparin-induced
thrombocytopenia. D-dimer is a diagnostic test for thromboembolism, not a
monitoring parameter.
Question 5
A patient with a wide-complex tachycardia and a history of structural heart
disease is being evaluated. Which of the following is the most appropriate
initial management?
A) Treat as ventricular tachycardia unless proven otherwise
B) Administer adenosine for rhythm diagnosis
C) Perform synchronized cardioversion at 50 J
D) Obtain a 12-lead ECG and await cardiology consult
Answer: A
Rationale: Wide complex tachycardia in a patient with structural heart
disease should be treated as ventricular tachycardia (VT) until proven
otherwise. Adenosine should be avoided as it can precipitate degeneration to
ventricular fibrillation in VT. Immediate synchronized cardioversion is
indicated if the patient is unstable, but stable patients may first receive
antiarrhythmic therapy.
Question 6
, A patient presents with chest pain that worsens when supine and improves
when leaning forward. ECG shows diffuse ST-segment elevations and PR-
segment depression. Which of the following is the most likely diagnosis?
A) Acute myocardial infarction
B) Pericarditis
C) Aortic dissection
D) Pulmonary embolism
Answer: B
Rationale: Pericarditis is characterized by chest pain that is worse when
supine and improves with leaning forward, along with a pericardial friction
rub, diffuse ST-segment elevations, and PR-segment depressions. These
findings distinguish pericarditis from acute MI (which has localized ST
elevations with reciprocal changes).
Question 7
A patient has an intra-aortic balloon pump (IABP) in place. Which of the
following describes the physiologic benefits of IABP therapy?
A) Increased coronary perfusion during systole and increased afterload
B) Increased coronary perfusion during diastole and reduced afterload during
systole
C) Decreased coronary perfusion during diastole and increased afterload
D) No effect on coronary perfusion or afterload
Answer: B
Rationale: IABP therapy provides increased coronary perfusion during
diastole (augmented diastolic pressure) and reduced afterload during
systole (balloon deflation reduces systolic pressure). This improves
myocardial oxygen supply while decreasing demand.
DIAGNOSIS AND MANAGEMENT IN ACUTE CARE
PRACTICUM Chamberlain University | 2025/2026
Edition | Questions & Verified Answers | Grade A+
Question 1
A 68-year-old male presents to the emergency department with substernal
chest pain radiating to the left jaw, diaphoresis, and nausea. ECG shows ST-
segment elevation in leads V1 through V4. Which of the following is the most
likely diagnosis?
A) Unstable angina
B) Non-ST-elevation myocardial infarction (NSTEMI)
C) ST-elevation myocardial infarction (STEMI)
D) Aortic dissection
Answer: C
Rationale: ST-segment elevation in contiguous precordial leads (V1-V4) with
typical ischemic symptoms indicates an anterior STEMI. This requires
emergent reperfusion therapy (PCI or fibrinolysis) within 90 minutes of
presentation. Unstable angina and NSTEMI do not present with ST-segment
elevation. Aortic dissection typically presents with tearing chest pain
radiating to the back with pulse deficits.
Question 2
A patient with acute decompensated heart failure presents with dyspnea,
orthopnea, and bilateral crackles. Which of the following is the most
appropriate initial intervention?
A) Aggressive intravenous fluid resuscitation
B) Intravenous loop diuretics and noninvasive ventilation
C) Immediate endotracheal intubation
D) High-dose beta-blocker therapy
,Answer: B
Rationale: Acute pulmonary edema requires immediate IV loop diuretics and
noninvasive positive pressure ventilation (CPAP or BiPAP). Aggressive IV
fluids would worsen pulmonary edema and should be avoided. Intubation
is reserved for patients who fail noninvasive ventilation or are unable to
protect their airway. Beta-blockers are not first-line in acute decompensation.
Question 3
A patient with septic shock requires vasopressor support. Which of the
following is the first-line vasopressor recommended for septic shock?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Vasopressin
Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock due
to its potent alpha-1 vasoconstrictor effects with less chronotropic effects
than dopamine. Dopamine is associated with more arrhythmias. Epinephrine
may be used as a second-line agent. Vasopressin is typically added as a second
agent in refractory shock.
Question 4
A 72-year-old patient with atrial fibrillation is on warfarin therapy. Which of
the following laboratory values should be monitored to assess the therapeutic
effectiveness of warfarin?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
,C) Platelet count
D) D-dimer
Answer: B
Rationale: Warfarin therapy is monitored using the International Normalized
Ratio (INR), with a therapeutic target of 2.0-3.0 for atrial fibrillation. aPTT is
used to monitor heparin therapy. Platelet count monitors for heparin-induced
thrombocytopenia. D-dimer is a diagnostic test for thromboembolism, not a
monitoring parameter.
Question 5
A patient with a wide-complex tachycardia and a history of structural heart
disease is being evaluated. Which of the following is the most appropriate
initial management?
A) Treat as ventricular tachycardia unless proven otherwise
B) Administer adenosine for rhythm diagnosis
C) Perform synchronized cardioversion at 50 J
D) Obtain a 12-lead ECG and await cardiology consult
Answer: A
Rationale: Wide complex tachycardia in a patient with structural heart
disease should be treated as ventricular tachycardia (VT) until proven
otherwise. Adenosine should be avoided as it can precipitate degeneration to
ventricular fibrillation in VT. Immediate synchronized cardioversion is
indicated if the patient is unstable, but stable patients may first receive
antiarrhythmic therapy.
Question 6
, A patient presents with chest pain that worsens when supine and improves
when leaning forward. ECG shows diffuse ST-segment elevations and PR-
segment depression. Which of the following is the most likely diagnosis?
A) Acute myocardial infarction
B) Pericarditis
C) Aortic dissection
D) Pulmonary embolism
Answer: B
Rationale: Pericarditis is characterized by chest pain that is worse when
supine and improves with leaning forward, along with a pericardial friction
rub, diffuse ST-segment elevations, and PR-segment depressions. These
findings distinguish pericarditis from acute MI (which has localized ST
elevations with reciprocal changes).
Question 7
A patient has an intra-aortic balloon pump (IABP) in place. Which of the
following describes the physiologic benefits of IABP therapy?
A) Increased coronary perfusion during systole and increased afterload
B) Increased coronary perfusion during diastole and reduced afterload during
systole
C) Decreased coronary perfusion during diastole and increased afterload
D) No effect on coronary perfusion or afterload
Answer: B
Rationale: IABP therapy provides increased coronary perfusion during
diastole (augmented diastolic pressure) and reduced afterload during
systole (balloon deflation reduces systolic pressure). This improves
myocardial oxygen supply while decreasing demand.
