NR570 – Common Diagnosis & Management in Acute
Care Practicum Midterm Exam Review (Weeks 1–4) –
Chamberlain University 2026/2026 Verified Questions
& 100% Correct Answers with Rationales High-Yield
| Graded A | Pass Guarantee
Question 1 A 58-year-old male presents with sudden-onset severe tearing chest pain radiating to
the interscapular area. Blood pressure is 210/110 mmHg in the right arm and 150/90 mmHg in
the left arm. What is the most likely diagnosis?
A. Acute myocardial infarction B. Aortic dissection C. Pulmonary embolism D. Pericarditis
Answer: B
Rationale: Sudden severe tearing pain radiating to the back + unequal blood pressures (pulse
deficit) is classic for acute aortic dissection (Stanford Type A or B). Immediate CT angiography
is required.
Question 2 A 55-year-old female with type 2 diabetes presents with fever, flank pain, dysuria,
and CVA tenderness. Urinalysis shows >50 WBC/hpf and bacteria. Serum creatinine is 2.8
mg/dL (baseline 1.0). What is the most appropriate initial management?
A. Oral ciprofloxacin outpatient B. Hospital admission and IV antibiotics C. Oral cephalexin
outpatient D. Observation only
Answer: B
Rationale: Complicated pyelonephritis with acute kidney injury requires inpatient parenteral
antibiotics (e.g., ceftriaxone or piperacillin-tazobactam) and close monitoring.
Question 3 A 72-year-old male with COPD presents with increasing dyspnea, productive cough,
and fever. ABG: pH 7.29, PaCO₂ 68 mmHg, PaO₂ 52 mmHg, HCO₃⁻ 32 mEq/L. What is the
acid-base disturbance?
A. Acute respiratory acidosis B. Chronic respiratory acidosis with metabolic compensation C.
Metabolic acidosis D. Respiratory alkalosis
, Answer: B
Rationale: Chronic hypercapnia in COPD causes renal compensation (elevated HCO₃⁻).
Expected compensation is ~3–4 mEq/L increase in HCO₃⁻ per 10 mmHg chronic PaCO₂ rise.
Question 4 A 45-year-old male with alcoholic cirrhosis presents with confusion, asterixis, and
elevated ammonia. What is the first-line treatment for acute hepatic encephalopathy?
A. Lactulose B. Rifaximin C. Neomycin D. Zinc supplementation
Answer: A
Rationale: Lactulose acidifies the colon, traps ammonia as ammonium ion, and promotes
excretion. It is first-line for acute hepatic encephalopathy.
Question 5 A 62-year-old female with atrial fibrillation on warfarin presents with melena and
hematemesis. INR is 6.8. What is the most appropriate immediate reversal?
A. Hold warfarin and give vitamin K 5 mg PO B. Hold warfarin, give vitamin K 10 mg IV, and
4-factor PCC C. Give fresh frozen plasma only D. Give recombinant factor VIIa
Answer: B
Rationale: Major bleeding with supratherapeutic INR requires rapid reversal. Vitamin K 10 mg
IV + 4-factor PCC is guideline-recommended for life-threatening hemorrhage.
Question 6 A 38-year-old male with community-acquired pneumonia is treated with
levofloxacin. On day 3 he develops severe watery diarrhea. What is the most likely diagnosis?
A. Viral gastroenteritis B. Clostridioides difficile infection C. Salmonella enteritis D. Norovirus
Answer: B
Rationale: Fluoroquinolones are high-risk antibiotics for C. difficile-associated diarrhea.
Question 7 A 75-year-old female with atrial fibrillation on rivaroxaban presents with acute
subdural hematoma. What is the most appropriate reversal agent?
Care Practicum Midterm Exam Review (Weeks 1–4) –
Chamberlain University 2026/2026 Verified Questions
& 100% Correct Answers with Rationales High-Yield
| Graded A | Pass Guarantee
Question 1 A 58-year-old male presents with sudden-onset severe tearing chest pain radiating to
the interscapular area. Blood pressure is 210/110 mmHg in the right arm and 150/90 mmHg in
the left arm. What is the most likely diagnosis?
A. Acute myocardial infarction B. Aortic dissection C. Pulmonary embolism D. Pericarditis
Answer: B
Rationale: Sudden severe tearing pain radiating to the back + unequal blood pressures (pulse
deficit) is classic for acute aortic dissection (Stanford Type A or B). Immediate CT angiography
is required.
Question 2 A 55-year-old female with type 2 diabetes presents with fever, flank pain, dysuria,
and CVA tenderness. Urinalysis shows >50 WBC/hpf and bacteria. Serum creatinine is 2.8
mg/dL (baseline 1.0). What is the most appropriate initial management?
A. Oral ciprofloxacin outpatient B. Hospital admission and IV antibiotics C. Oral cephalexin
outpatient D. Observation only
Answer: B
Rationale: Complicated pyelonephritis with acute kidney injury requires inpatient parenteral
antibiotics (e.g., ceftriaxone or piperacillin-tazobactam) and close monitoring.
Question 3 A 72-year-old male with COPD presents with increasing dyspnea, productive cough,
and fever. ABG: pH 7.29, PaCO₂ 68 mmHg, PaO₂ 52 mmHg, HCO₃⁻ 32 mEq/L. What is the
acid-base disturbance?
A. Acute respiratory acidosis B. Chronic respiratory acidosis with metabolic compensation C.
Metabolic acidosis D. Respiratory alkalosis
, Answer: B
Rationale: Chronic hypercapnia in COPD causes renal compensation (elevated HCO₃⁻).
Expected compensation is ~3–4 mEq/L increase in HCO₃⁻ per 10 mmHg chronic PaCO₂ rise.
Question 4 A 45-year-old male with alcoholic cirrhosis presents with confusion, asterixis, and
elevated ammonia. What is the first-line treatment for acute hepatic encephalopathy?
A. Lactulose B. Rifaximin C. Neomycin D. Zinc supplementation
Answer: A
Rationale: Lactulose acidifies the colon, traps ammonia as ammonium ion, and promotes
excretion. It is first-line for acute hepatic encephalopathy.
Question 5 A 62-year-old female with atrial fibrillation on warfarin presents with melena and
hematemesis. INR is 6.8. What is the most appropriate immediate reversal?
A. Hold warfarin and give vitamin K 5 mg PO B. Hold warfarin, give vitamin K 10 mg IV, and
4-factor PCC C. Give fresh frozen plasma only D. Give recombinant factor VIIa
Answer: B
Rationale: Major bleeding with supratherapeutic INR requires rapid reversal. Vitamin K 10 mg
IV + 4-factor PCC is guideline-recommended for life-threatening hemorrhage.
Question 6 A 38-year-old male with community-acquired pneumonia is treated with
levofloxacin. On day 3 he develops severe watery diarrhea. What is the most likely diagnosis?
A. Viral gastroenteritis B. Clostridioides difficile infection C. Salmonella enteritis D. Norovirus
Answer: B
Rationale: Fluoroquinolones are high-risk antibiotics for C. difficile-associated diarrhea.
Question 7 A 75-year-old female with atrial fibrillation on rivaroxaban presents with acute
subdural hematoma. What is the most appropriate reversal agent?
