NR574 Acute Care Practicum Midterm
Exam Review | Weeks 1-4 Foundational
Synthesis | 2026/2027
Format: 48 items – 42 single-best-answer MCQs, 4 SATA, 2 ordered-response.
Scope: First-month acute-care immersion – common ED/ICU/step-down presentations,
initial stabilization, basic procedures, SBAR/hand-offs, early consult decisions.
SECTION 1 – CLINICAL ASSESSMENT & DIAGNOSTIC REASONING (Q1-10)
Q1 55-year-old ICU pneumonia now RR 32, SpO₂ 88% on 6 L NC, ↓ breath sounds right
side. FIRST test you order as the student ACNP?
A) Stat CT-PE
B) Bedside CXR
C) ABG on room air
D) Call anesthesia for emergent intubation
Correct: B
Rationale: Localized exam change → quickest actionable data is bedside CXR
(pneumothorax, effusion, consolidation). CT-PE (A) is downstream after basic image.
,Q2 ABG: pH 7.18, PaCO₂ 70, PaO₂ 55 on 6 L NC. You change to HFNC 40 L @ 100%.
Next ABG should be obtained:
A) 15 min
B) 30 min
C) 1 h
D) 4 h
Correct: C
Rationale: HFNC equilibrates by 60 min; earlier draws (A,B) may not reflect new steady
state, later (D) delays escalation if failing.
Q3 [SATA] 30-year-old chest pain, diaphoretic. ECG shows ST ↑ I, aVL, V2-4. Which
actions are student ACNP priorities within 10 min?
A) Insert 18 g IV × 2
B) Give PO metoprolol 25 mg
C) Send high-sensitivity troponin
D) Activate cath lab
E) Give SL nitro if SBP >100
F) Obtain portable CXR
Correct: A,C,D,E
, Rationale: STEMI bundle: access (A), troponin (C), activate (D), SL nitro if no
hypotension (E). PO BB (B) is later; CXR (F) delays if hemodynamically stable.
Q4 70-year-old acute confusion, Na 118 mEq/L. Which additional finding best confirms
hypervolemic hyponatremia?
A) BUN 45 mg/dL, Cr 1.5 mg/dL
B) Peripheral edema + ascites
C) UO <500 mL/24 h
D) Uric acid 12 mg/dL
Correct: B
Rationale: Edema/ascites (B) indicates total body sodium excess (HF, cirrhosis). High
BUN/Cr (A) suggests prerenal azotemia ≠ hypervolemic.
Q5 You are asked to consent a patient for thoracentesis. Which lab value must you
check first?
A) PT/INR
B) Platelet count
C) Creatinine
D) WBC
Correct: B
Exam Review | Weeks 1-4 Foundational
Synthesis | 2026/2027
Format: 48 items – 42 single-best-answer MCQs, 4 SATA, 2 ordered-response.
Scope: First-month acute-care immersion – common ED/ICU/step-down presentations,
initial stabilization, basic procedures, SBAR/hand-offs, early consult decisions.
SECTION 1 – CLINICAL ASSESSMENT & DIAGNOSTIC REASONING (Q1-10)
Q1 55-year-old ICU pneumonia now RR 32, SpO₂ 88% on 6 L NC, ↓ breath sounds right
side. FIRST test you order as the student ACNP?
A) Stat CT-PE
B) Bedside CXR
C) ABG on room air
D) Call anesthesia for emergent intubation
Correct: B
Rationale: Localized exam change → quickest actionable data is bedside CXR
(pneumothorax, effusion, consolidation). CT-PE (A) is downstream after basic image.
,Q2 ABG: pH 7.18, PaCO₂ 70, PaO₂ 55 on 6 L NC. You change to HFNC 40 L @ 100%.
Next ABG should be obtained:
A) 15 min
B) 30 min
C) 1 h
D) 4 h
Correct: C
Rationale: HFNC equilibrates by 60 min; earlier draws (A,B) may not reflect new steady
state, later (D) delays escalation if failing.
Q3 [SATA] 30-year-old chest pain, diaphoretic. ECG shows ST ↑ I, aVL, V2-4. Which
actions are student ACNP priorities within 10 min?
A) Insert 18 g IV × 2
B) Give PO metoprolol 25 mg
C) Send high-sensitivity troponin
D) Activate cath lab
E) Give SL nitro if SBP >100
F) Obtain portable CXR
Correct: A,C,D,E
, Rationale: STEMI bundle: access (A), troponin (C), activate (D), SL nitro if no
hypotension (E). PO BB (B) is later; CXR (F) delays if hemodynamically stable.
Q4 70-year-old acute confusion, Na 118 mEq/L. Which additional finding best confirms
hypervolemic hyponatremia?
A) BUN 45 mg/dL, Cr 1.5 mg/dL
B) Peripheral edema + ascites
C) UO <500 mL/24 h
D) Uric acid 12 mg/dL
Correct: B
Rationale: Edema/ascites (B) indicates total body sodium excess (HF, cirrhosis). High
BUN/Cr (A) suggests prerenal azotemia ≠ hypervolemic.
Q5 You are asked to consent a patient for thoracentesis. Which lab value must you
check first?
A) PT/INR
B) Platelet count
C) Creatinine
D) WBC
Correct: B
