Finall Exam:l NRl 571/l NR571l (Latestl
2026/l 2027l Update)l Complexl Diagnosisl &l
Managementl inl Acutel Carel Practicuml
Review|l Q/Al |l Gradel A|l 100%l Correctl
(Verifiedl Answers)l -Chamberlain
Q:l Zezel isl al 52-year-oldl femalel withl metastaticl lungl cancerl tol thel brainl whol isl
admittedl tol thel hospitall withl shortnessl ofl breath.l Al chestl x-rayl demonstratesl al largel
pleurall effusion.l Initially,l shel isl alertl andl conversantl andl isl agreeablel tol thel
recommendedl procedurel ofl al thoracentesisl thatl isl scheduledl forl thel nextl day.l Overnight,l
shel becomesl agitatedl andl requiresl multiplel dosesl ofl benzodiazepines.l Thel followingl
morning,l shel refusesl thoracentesisl andl wantsl tol bel dischargedl froml thel hospitall
immediately.l Whatl isl anl importantl principlel forl thel providerl tol considerl inl responsel tol
thel patient'sl requests?
A.l Competence
B.l Advancedl Directives
C.l Medicall decision-makingl capacity
D.l Hospicel consultation
Answer:
Medicall decision-makingl capacity
Rationale:
Medicall decision-makingl capacityl mayl notl bel presentl inl thisl patientl whol hasl hadl anl
abruptl changel inl mentall statusl asl welll asl anl underlyingl neurologicall conditionl (brainl
metastasis).l Ifl therel isl al concernl thatl thel patientl lacksl thel capacityl forl medicall
decisionl making,l thisl shouldl bel formallyl evaluatedl beforel theyl allowl thel patientl tol
refusel treatment.
Q:l Al 76-year-oldl malel withl al historyl ofl COPDl andl metastaticl lungl cancerl hasl al
DNRCC-l Arrestl orderl inl place.l Hel isl admittedl tol al medical-surgicall unitl withl
,pneumonia.l Hel becomesl progressivelyl dyspneicl andl requiresl increasingl oxygenl
requirementsl perl nasall cannula.l Hisl heartl ratel wasl notedl tol bel atriall fibrillationl withl
rapidl ventricularl ratel inl thel 160sl tol 170s.l Hisl bloodl pressurel isl 96/62.l Whichl ofl thel
followingl interventionsl wouldl notl bel allowedl underl thel DNRCC-l Arrestl order?
A.l Cardioversion
B.l Intubationl withl mechanicall ventilation
C.l IVl amiodarone
D.l Nonel ofl thel above
Answer:
Nonel ofl thel above
Rationale:
Thisl patientl hasl al DNRCC-l Arrestl orderl inl placel andl isl currentlyl hemodynamicallyl
unstablel butl hasl notl experiencedl al cardiacl orl respiratoryl arrestl atl thisl point,l sol fulll
resuscitativel attemptsl arel permittedl forl thisl patientl inl thel currentl clinicall scenario.
Q:l Al 32-year-oldl malel presentsl tol thel EDl withl multiplel gunshotl woundsl tol thel headl
andl chest.l Hisl bloodl pressurel isl undetectablel withl al bloodl pressurel cuffl norl doesl hel
havel al palpablel pulse.l Hel isl foundl tol bel inl PEAl arrest.l Advancedl cardiacl lifel supportl
isl initiated,l andl thel patientl isl eventuallyl stabilizedl andl takenl tol thel Operatingl Room.l
Numerousl peoplel presentl tol thel hospitall requestingl informationl aboutl thel patient'sl
condition.l Accordingl tol HIPAAl privacyl laws,l whol shouldl informationl aboutl thel patientl
bel releasedl to?
A.l Thel police
B.l Thel patient'sl bestl friend
C.l Thel patient'sl mother
D.l Thel policel andl patient'sl mother
Answer:
Thel policel andl patient'sl mother
Rationale:
Accordingl tol HIPAAl emergencyl notificationl principles,l informationl aboutl al patient'sl
conditionl canl bel releasedl withoutl theirl writtenl consentl tol thel patient'sl familyl membersl
orl anyl individuall thel patientl hasl identifiedl asl beingl al partl ofl theirl care.l Inl thisl
situation,l thel patientl didl notl indicatel thatl hisl bestl friendl couldl bel involvedl inl hisl care.l
Additionally,l thel policel mayl bel notifiedl aboutl thel patient'sl condition.
,Q:l Dorisl isl anl 86-year-oldl (weight:l 48l kg)l withl al seruml creatininel ofl 1.2l mg/dL.l
Herl 21-year-oldl grandsonl isl al competitivel bodybuilderl (weight:l 90l kg)l withl thel samel
seruml creatininel value.l Thel normall rangel ofl seruml creatininel reportedl froml thisl
laboratoryl isl 0.7-1.2l mg/dL.l Dol theyl havel thel samel renall function?
Answer:
Answerl &l Rationale:l No.l Dorisl hasl lessl musclel mass,l asl al resultl ofl thel normall agingl
process.l Seruml creatininel levelsl arel decreasedl inl patientsl withl decreasedl musclel massl
andl thereforel arel underestimatedl byl thel valuel reported.l Thisl underscoresl thel importancel
ofl usingl thel eGFRl equationl asl al morel accuratel measurementl ofl GFRl whichl isl basedl
onl factorsl suchl asl age,l gender,l andl ethnicity.
Q:l Patricel isl al 71-year-oldl admittedl tol thel hospitall froml al skilledl nursingl facilityl
withl alteredl mentall status.l Thel staffl reportsl thatl "shel hasl notl beenl interestedl inl eatingl
orl drinkingl much"l overl thel lastl week.l Physicall examl revealsl orthostaticl hypotension,l
mucousl membranes,l andl poorl skinl turgor.l Labl resultsl arel seruml Crl isl 2.3l mg/dLl (0.7-
1.2l mg/dL)l andl BUNl isl 58l (5-20).l Howl wouldl thel initiall measurementl ofl thel BUN/Crl
ratiol helpl inl determiningl thel causel ofl Patrice'sl acutel kidneyl injuryl (AKI)?
Answer:
Answerl &l Rationale:l Whenl elevationsl inl thel BUNl orl creatininel arel present,l thel
BUN/Crl ratiol canl helpl determinel whetherl azotemial isl duel tol al pre-renal,l intrinsic,l orl
post-renall source.l Inl normall individuals,l thel ratiol rangesl betweenl 12l andl 20.l Inl
prerenall azotemial withl hypoperfusionl ofl thel kidneys,l thel BUN/Crl ratiol wouldl bel
elevatedl (>20).l Usedl inl thel contextl ofl Patrice'sl clinicall history,l alongl withl examl
findingsl consistentl withl dehydration,l thel BUN/Crl ratiol (calculatedl asl 58/2.3=25)l isl
stronglyl suggestivel ofl al pre-renall etiologyl duel tol hypovolemia.
Q:l Rogerl isl anl 82-year-oldl withl cellulitisl tol thel leftl lowerl extremity.l Overl thel lastl
24l hours,l hel hasl developedl hypotension,l fever,l andl metabolicl acidosis.l Whatl dol youl
expectl tol seel onl thel seruml chemistryl panel,l whichl reflectsl Roger'sl kidneyl responsel inl
correctingl thel acid-basel imbalance?
Answer:
Answer:l Totall CO2l contentl shouldl bel decreased
, Rationale:l Seruml CO2l willl bel decreasedl withl metabolicl acidosisl andl representsl thel
kidney'sl bufferl responsel tol al dropl inl thel pH.l (Bonus:l Inl thisl case,l acidosisl isl likelyl al
reflectionl ofl thel accumulationl ofl lacticl acidl inl thel bloodl secondaryl tol hypotensionl andl
decreasedl organl perfusion.
Q:l whatl arel thel 5l waysl tol assessl kidneyl function?
Answer:
Urinel examinationl (urinalysisl andl microscopy)
Seruml chemistryl (electrolytesl andl metabolicl waste)
Acid-basel balancel (seruml chloridel andl carbonl dioxide)
Tubularl functionl (urinel concentrationl andl dilution)
Glomerularl filtrationl (filtrationl ofl functioningl nephrons)
Q:l whatl isl al urinel dipstickl usedl forl inl assessingl kidneyl function?
Answer:
usefull inl differentiatingl urinaryl symptoml etiologyl (dysuria,l polyuria,l hematuria,l etc.)l
whenl usedl inl conjunctionl withl thel physicall examination.l
Urinel microscopy,l specificallyl whenl castsl arel visualized,l isl highlyl suggestivel ofl renall
disease.
Q:l whatl arel thel 3l seruml chemistryl testl usedl tol assessl kidneyl function?
Answer:
Bloodl ureal Nitrogenl (BUN)
Creatininel (Cr)
BUN/Crl Ration
Q:l Whatl isl BUN?
Answer:
2026/l 2027l Update)l Complexl Diagnosisl &l
Managementl inl Acutel Carel Practicuml
Review|l Q/Al |l Gradel A|l 100%l Correctl
(Verifiedl Answers)l -Chamberlain
Q:l Zezel isl al 52-year-oldl femalel withl metastaticl lungl cancerl tol thel brainl whol isl
admittedl tol thel hospitall withl shortnessl ofl breath.l Al chestl x-rayl demonstratesl al largel
pleurall effusion.l Initially,l shel isl alertl andl conversantl andl isl agreeablel tol thel
recommendedl procedurel ofl al thoracentesisl thatl isl scheduledl forl thel nextl day.l Overnight,l
shel becomesl agitatedl andl requiresl multiplel dosesl ofl benzodiazepines.l Thel followingl
morning,l shel refusesl thoracentesisl andl wantsl tol bel dischargedl froml thel hospitall
immediately.l Whatl isl anl importantl principlel forl thel providerl tol considerl inl responsel tol
thel patient'sl requests?
A.l Competence
B.l Advancedl Directives
C.l Medicall decision-makingl capacity
D.l Hospicel consultation
Answer:
Medicall decision-makingl capacity
Rationale:
Medicall decision-makingl capacityl mayl notl bel presentl inl thisl patientl whol hasl hadl anl
abruptl changel inl mentall statusl asl welll asl anl underlyingl neurologicall conditionl (brainl
metastasis).l Ifl therel isl al concernl thatl thel patientl lacksl thel capacityl forl medicall
decisionl making,l thisl shouldl bel formallyl evaluatedl beforel theyl allowl thel patientl tol
refusel treatment.
Q:l Al 76-year-oldl malel withl al historyl ofl COPDl andl metastaticl lungl cancerl hasl al
DNRCC-l Arrestl orderl inl place.l Hel isl admittedl tol al medical-surgicall unitl withl
,pneumonia.l Hel becomesl progressivelyl dyspneicl andl requiresl increasingl oxygenl
requirementsl perl nasall cannula.l Hisl heartl ratel wasl notedl tol bel atriall fibrillationl withl
rapidl ventricularl ratel inl thel 160sl tol 170s.l Hisl bloodl pressurel isl 96/62.l Whichl ofl thel
followingl interventionsl wouldl notl bel allowedl underl thel DNRCC-l Arrestl order?
A.l Cardioversion
B.l Intubationl withl mechanicall ventilation
C.l IVl amiodarone
D.l Nonel ofl thel above
Answer:
Nonel ofl thel above
Rationale:
Thisl patientl hasl al DNRCC-l Arrestl orderl inl placel andl isl currentlyl hemodynamicallyl
unstablel butl hasl notl experiencedl al cardiacl orl respiratoryl arrestl atl thisl point,l sol fulll
resuscitativel attemptsl arel permittedl forl thisl patientl inl thel currentl clinicall scenario.
Q:l Al 32-year-oldl malel presentsl tol thel EDl withl multiplel gunshotl woundsl tol thel headl
andl chest.l Hisl bloodl pressurel isl undetectablel withl al bloodl pressurel cuffl norl doesl hel
havel al palpablel pulse.l Hel isl foundl tol bel inl PEAl arrest.l Advancedl cardiacl lifel supportl
isl initiated,l andl thel patientl isl eventuallyl stabilizedl andl takenl tol thel Operatingl Room.l
Numerousl peoplel presentl tol thel hospitall requestingl informationl aboutl thel patient'sl
condition.l Accordingl tol HIPAAl privacyl laws,l whol shouldl informationl aboutl thel patientl
bel releasedl to?
A.l Thel police
B.l Thel patient'sl bestl friend
C.l Thel patient'sl mother
D.l Thel policel andl patient'sl mother
Answer:
Thel policel andl patient'sl mother
Rationale:
Accordingl tol HIPAAl emergencyl notificationl principles,l informationl aboutl al patient'sl
conditionl canl bel releasedl withoutl theirl writtenl consentl tol thel patient'sl familyl membersl
orl anyl individuall thel patientl hasl identifiedl asl beingl al partl ofl theirl care.l Inl thisl
situation,l thel patientl didl notl indicatel thatl hisl bestl friendl couldl bel involvedl inl hisl care.l
Additionally,l thel policel mayl bel notifiedl aboutl thel patient'sl condition.
,Q:l Dorisl isl anl 86-year-oldl (weight:l 48l kg)l withl al seruml creatininel ofl 1.2l mg/dL.l
Herl 21-year-oldl grandsonl isl al competitivel bodybuilderl (weight:l 90l kg)l withl thel samel
seruml creatininel value.l Thel normall rangel ofl seruml creatininel reportedl froml thisl
laboratoryl isl 0.7-1.2l mg/dL.l Dol theyl havel thel samel renall function?
Answer:
Answerl &l Rationale:l No.l Dorisl hasl lessl musclel mass,l asl al resultl ofl thel normall agingl
process.l Seruml creatininel levelsl arel decreasedl inl patientsl withl decreasedl musclel massl
andl thereforel arel underestimatedl byl thel valuel reported.l Thisl underscoresl thel importancel
ofl usingl thel eGFRl equationl asl al morel accuratel measurementl ofl GFRl whichl isl basedl
onl factorsl suchl asl age,l gender,l andl ethnicity.
Q:l Patricel isl al 71-year-oldl admittedl tol thel hospitall froml al skilledl nursingl facilityl
withl alteredl mentall status.l Thel staffl reportsl thatl "shel hasl notl beenl interestedl inl eatingl
orl drinkingl much"l overl thel lastl week.l Physicall examl revealsl orthostaticl hypotension,l
mucousl membranes,l andl poorl skinl turgor.l Labl resultsl arel seruml Crl isl 2.3l mg/dLl (0.7-
1.2l mg/dL)l andl BUNl isl 58l (5-20).l Howl wouldl thel initiall measurementl ofl thel BUN/Crl
ratiol helpl inl determiningl thel causel ofl Patrice'sl acutel kidneyl injuryl (AKI)?
Answer:
Answerl &l Rationale:l Whenl elevationsl inl thel BUNl orl creatininel arel present,l thel
BUN/Crl ratiol canl helpl determinel whetherl azotemial isl duel tol al pre-renal,l intrinsic,l orl
post-renall source.l Inl normall individuals,l thel ratiol rangesl betweenl 12l andl 20.l Inl
prerenall azotemial withl hypoperfusionl ofl thel kidneys,l thel BUN/Crl ratiol wouldl bel
elevatedl (>20).l Usedl inl thel contextl ofl Patrice'sl clinicall history,l alongl withl examl
findingsl consistentl withl dehydration,l thel BUN/Crl ratiol (calculatedl asl 58/2.3=25)l isl
stronglyl suggestivel ofl al pre-renall etiologyl duel tol hypovolemia.
Q:l Rogerl isl anl 82-year-oldl withl cellulitisl tol thel leftl lowerl extremity.l Overl thel lastl
24l hours,l hel hasl developedl hypotension,l fever,l andl metabolicl acidosis.l Whatl dol youl
expectl tol seel onl thel seruml chemistryl panel,l whichl reflectsl Roger'sl kidneyl responsel inl
correctingl thel acid-basel imbalance?
Answer:
Answer:l Totall CO2l contentl shouldl bel decreased
, Rationale:l Seruml CO2l willl bel decreasedl withl metabolicl acidosisl andl representsl thel
kidney'sl bufferl responsel tol al dropl inl thel pH.l (Bonus:l Inl thisl case,l acidosisl isl likelyl al
reflectionl ofl thel accumulationl ofl lacticl acidl inl thel bloodl secondaryl tol hypotensionl andl
decreasedl organl perfusion.
Q:l whatl arel thel 5l waysl tol assessl kidneyl function?
Answer:
Urinel examinationl (urinalysisl andl microscopy)
Seruml chemistryl (electrolytesl andl metabolicl waste)
Acid-basel balancel (seruml chloridel andl carbonl dioxide)
Tubularl functionl (urinel concentrationl andl dilution)
Glomerularl filtrationl (filtrationl ofl functioningl nephrons)
Q:l whatl isl al urinel dipstickl usedl forl inl assessingl kidneyl function?
Answer:
usefull inl differentiatingl urinaryl symptoml etiologyl (dysuria,l polyuria,l hematuria,l etc.)l
whenl usedl inl conjunctionl withl thel physicall examination.l
Urinel microscopy,l specificallyl whenl castsl arel visualized,l isl highlyl suggestivel ofl renall
disease.
Q:l whatl arel thel 3l seruml chemistryl testl usedl tol assessl kidneyl function?
Answer:
Bloodl ureal Nitrogenl (BUN)
Creatininel (Cr)
BUN/Crl Ration
Q:l Whatl isl BUN?
Answer:
