NR-574 NR574: Acute Care Practicum I – Advanced
Clinical Immersion, Critical Patient Assessment,
High-Acuity Intervention, and Evidence-Based Acute
Care Management
1.
A patient with COPD is admitted with acute respiratory distress.
ABG shows pH 7.31, PaCO₂ 55 mmHg, HCO₃⁻ 29 mEq/L. What is
the interpretation?
A. Metabolic acidosis
B. Respiratory acidosis with compensation
C. Metabolic alkalosis
D. Respiratory alkalosis
The elevated PaCO₂ indicates respiratory acidosis; the elevated
HCO₃⁻ shows renal compensation.
2.
Which finding indicates worsening sepsis in a patient receiving
fluids?
A. Urine output 40 mL/hr
B. BP 110/70 mmHg
C. Lactate level 5.2 mmol/L
D. HR 90 bpm
Elevated lactate (>4 mmol/L) suggests tissue hypoperfusion and
worsening sepsis.
,3.
The first-line treatment for supraventricular tachycardia (SVT)
is:
A. Amiodarone IV bolus
B. Vagal maneuvers and adenosine IV
C. Cardioversion at 100 J
D. Lidocaine IV
Vagal maneuvers and adenosine are the initial interventions for
stable SVT.
4.
A postoperative patient suddenly becomes tachypneic,
dyspneic, and has chest pain. Which is the priority action?
A. Start IV fluids
B. Administer nitroglycerin
C. Apply oxygen and assess for pulmonary embolism
D. Obtain ABG
These are hallmark signs of PE; oxygenation takes priority.
5.
Which ECG change is consistent with hypokalemia?
A. Flattened T waves and U waves
B. Peaked T waves
,C. Prolonged PR interval
D. Shortened QT interval
Hypokalemia causes flattened T waves and appearance of U
waves.
6.
A patient on mechanical ventilation shows increasing peak
inspiratory pressures. What should the nurse suspect?
A. Decreased airway resistance
B. Mucus plug or kinked tubing
C. Decreased lung compliance
D. Ventilator malfunction
High pressures often indicate obstruction or decreased
compliance.
7.
Which medication should be given first for a patient with
anaphylaxis?
A. Diphenhydramine
B. Methylprednisolone
C. Epinephrine IM
D. Albuterol
Epinephrine is the first-line, life-saving treatment for
anaphylaxis.
, 8.
A patient with pancreatitis develops hypocalcemia. Which sign
would confirm this?
A. Positive Chvostek’s sign
B. Hypertension
C. Bounding pulse
D. Hypoactive reflexes
Chvostek’s sign (facial twitching) is a hallmark of hypocalcemia.
9.
Which intervention is appropriate for a patient in cardiogenic
shock?
A. Increase IV fluids
B. Administer dobutamine infusion
C. Give beta-blockers
D. Position flat
Dobutamine improves contractility and cardiac output in
cardiogenic shock.
10.
In acute stroke management, the goal for tPA administration is
within:
A. 1 hour of ED arrival
B. 3–4.5 hours from symptom onset
C. 6 hours of admission
Clinical Immersion, Critical Patient Assessment,
High-Acuity Intervention, and Evidence-Based Acute
Care Management
1.
A patient with COPD is admitted with acute respiratory distress.
ABG shows pH 7.31, PaCO₂ 55 mmHg, HCO₃⁻ 29 mEq/L. What is
the interpretation?
A. Metabolic acidosis
B. Respiratory acidosis with compensation
C. Metabolic alkalosis
D. Respiratory alkalosis
The elevated PaCO₂ indicates respiratory acidosis; the elevated
HCO₃⁻ shows renal compensation.
2.
Which finding indicates worsening sepsis in a patient receiving
fluids?
A. Urine output 40 mL/hr
B. BP 110/70 mmHg
C. Lactate level 5.2 mmol/L
D. HR 90 bpm
Elevated lactate (>4 mmol/L) suggests tissue hypoperfusion and
worsening sepsis.
,3.
The first-line treatment for supraventricular tachycardia (SVT)
is:
A. Amiodarone IV bolus
B. Vagal maneuvers and adenosine IV
C. Cardioversion at 100 J
D. Lidocaine IV
Vagal maneuvers and adenosine are the initial interventions for
stable SVT.
4.
A postoperative patient suddenly becomes tachypneic,
dyspneic, and has chest pain. Which is the priority action?
A. Start IV fluids
B. Administer nitroglycerin
C. Apply oxygen and assess for pulmonary embolism
D. Obtain ABG
These are hallmark signs of PE; oxygenation takes priority.
5.
Which ECG change is consistent with hypokalemia?
A. Flattened T waves and U waves
B. Peaked T waves
,C. Prolonged PR interval
D. Shortened QT interval
Hypokalemia causes flattened T waves and appearance of U
waves.
6.
A patient on mechanical ventilation shows increasing peak
inspiratory pressures. What should the nurse suspect?
A. Decreased airway resistance
B. Mucus plug or kinked tubing
C. Decreased lung compliance
D. Ventilator malfunction
High pressures often indicate obstruction or decreased
compliance.
7.
Which medication should be given first for a patient with
anaphylaxis?
A. Diphenhydramine
B. Methylprednisolone
C. Epinephrine IM
D. Albuterol
Epinephrine is the first-line, life-saving treatment for
anaphylaxis.
, 8.
A patient with pancreatitis develops hypocalcemia. Which sign
would confirm this?
A. Positive Chvostek’s sign
B. Hypertension
C. Bounding pulse
D. Hypoactive reflexes
Chvostek’s sign (facial twitching) is a hallmark of hypocalcemia.
9.
Which intervention is appropriate for a patient in cardiogenic
shock?
A. Increase IV fluids
B. Administer dobutamine infusion
C. Give beta-blockers
D. Position flat
Dobutamine improves contractility and cardiac output in
cardiogenic shock.
10.
In acute stroke management, the goal for tPA administration is
within:
A. 1 hour of ED arrival
B. 3–4.5 hours from symptom onset
C. 6 hours of admission
