1
NR 570 MIDTERM EXAM (CHAMBERLAIN) NEWEST 2026
ACTUAL EXAM TEST BANK| NR570 COMMON DIAGNOSIS &
MANAGEMENT IN ACUTE CARE MIDTERM EXAM REVIEW
WITH 75 REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
SECTION 1: CARDIOVASCULAR (Q1–15)
1. A 62-year-old male with a history of hypertension and hyperlipidemia
presents to the emergency department with substernal chest pressure radiating
to the left arm, diaphoresis, and nausea. An ECG shows ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending (LAD)
B) Left circumflex (LCx)
C) Right coronary artery (RCA)
D) Left main coronary artery
: Answer : C
Full Rotation & Rationale:
• A (LAD): Supplies the anterior wall and septum, corresponding to ST
elevation in leads V1–V4. Not consistent with inferior leads.
• B (LCx): Supplies the lateral wall, corresponding to leads I, aVL, V5–V6.
• C (RCA): Correct. Leads II, III, and aVF reflect the inferior wall of the left
ventricle, which is supplied by the right coronary artery in most
right-dominant circulations. Inferior STEMI = RCA occlusion.
• D (Left main): Occlusion would cause widespread anterior and lateral ST
depression or ST elevation in aVR, not isolated inferior changes.
2. The AGACNP is managing a patient in cardiogenic shock after an anterior
STEMI. A pulmonary artery catheter reveals a cardiac index of 1.6 L/min/m²,
pg. 1
,2
pulmonary capillary wedge pressure (PCWP) of 24 mmHg, and systemic vascular
resistance (SVR) of 1,800 dynes/sec/cm⁻⁵. Which intervention is the priority?
A) Administer a 500 mL bolus of normal saline
B) Initiate dobutamine infusion
C) Initiate nitroprusside infusion
D) Administer furosemide IV push
: Answer : B
Full Rotation & Rationale:
• A (Fluid bolus): The PCWP is already elevated at 24 mmHg (normal 4–12
mmHg), indicating pulmonary congestion. Additional fluid would worsen
pulmonary edema.
• B (Dobutamine): Correct. The cardiac index is low and the PCWP is high,
indicating pump failure with elevated filling pressures. Dobutamine, a
beta-1 agonist, increases cardiac contractility and cardiac output without
significantly increasing afterload. It is the inotrope of choice for cardiogenic
shock with elevated filling pressures.
• C (Nitroprusside): While it reduces afterload, it can cause coronary steal
and reflex tachycardia, and it does not directly improve contractility.
• D (Furosemide): Diuretics reduce preload and may help pulmonary
congestion, but they do not address the primary problem of reduced
cardiac output.
3. A 55-year-old female with a history of mitral valve prolapse presents with
fever, splinter hemorrhages, and a new-onset holosystolic murmur at the apex.
Blood cultures are positive for Streptococcus viridans. The AGACNP should
anticipate which of the following as the most appropriate diagnostic test to
evaluate for complications?
A) Chest X-ray
B) Transesophageal echocardiogram (TEE)
C) Cardiac CT angiography
D) 12-lead ECG
pg. 2
,3
: Answer : B
Full Rotation & Rationale:
• A (Chest X-ray): May show signs of heart failure but does not visualize
vegetations or valve dysfunction.
• B (TEE): Correct. The patient meets Duke criteria for infective endocarditis.
TEE is the gold standard for detecting vegetations, perivalvular abscess, and
valve perforation with high sensitivity.
• C (CT angiography): Used for coronary artery assessment, not for
endocarditis.
• D (ECG): May show conduction abnormalities if an abscess extends into the
septum but does not diagnose endocarditis.
4. A patient with a history of atrial fibrillation on warfarin presents with acute
onset of severe flank pain and hematuria. CT shows a wedge-shaped renal
infarct. The INR is 1.3. What is the most likely etiology?
A) Renal artery stenosis
B) Atheroembolic disease
C) Cardioembolic renal infarction
D) Acute pyelonephritis
: Answer : C
Full Rotation & Rationale:
• A (Renal artery stenosis): Causes chronic hypertension and renal
insufficiency, not acute flank pain with a wedge-shaped infarct.
• B (Atheroembolic disease): Typically occurs after vascular manipulation,
causing small, multiple emboli, not a single large wedge-shaped infarct.
• C (Cardioembolic renal infarction): Correct. Subtherapeutic INR in a patient
with atrial fibrillation predisposes to left atrial thrombus formation, which
can embolize to the renal artery, causing an acute wedge-shaped infarction.
• D (Acute pyelonephritis): Presents with fever, flank pain, and pyuria, not a
wedge-shaped infarct.
pg. 3
, 4
5. A 70-year-old with severe aortic stenosis develops acute pulmonary edema.
Blood pressure is 90/60 mmHg, heart rate 120 bpm. Which medication is
contraindicated?
A) Furosemide
B) Dobutamine
C) Nitroglycerin
D) Phenylephrine
: Answer : C
Full Rotation & Rationale:
• A (Furosemide): May be used cautiously to reduce preload, but may drop
BP further. Not absolutely contraindicated.
• B (Dobutamine): May improve cardiac output in cardiogenic shock, even
with AS, by increasing contractility.
• C (Nitroglycerin): Correct. Nitrates reduce preload and afterload. In severe
aortic stenosis, reducing preload can cause a critical drop in cardiac output
because the ventricle requires adequate filling to overcome the stenotic
valve. Nitrates can precipitate profound hypotension.
• D (Phenylephrine): A vasopressor that increases afterload; while not ideal
in cardiogenic shock, it is not absolutely contraindicated in AS.
6. The AGACNP is interpreting a Swan-Ganz catheter reading. The pulmonary
artery diastolic pressure (PAD) is 20 mmHg, and the PCWP is 10 mmHg. The
difference between PAD and PCWP indicates:
A) Normal physiology
B) Mitral stenosis
C) Pulmonary hypertension
D) Cardiac tamponade
: Answer : C
Full Rotation & Rationale:
pg. 4
NR 570 MIDTERM EXAM (CHAMBERLAIN) NEWEST 2026
ACTUAL EXAM TEST BANK| NR570 COMMON DIAGNOSIS &
MANAGEMENT IN ACUTE CARE MIDTERM EXAM REVIEW
WITH 75 REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
SECTION 1: CARDIOVASCULAR (Q1–15)
1. A 62-year-old male with a history of hypertension and hyperlipidemia
presents to the emergency department with substernal chest pressure radiating
to the left arm, diaphoresis, and nausea. An ECG shows ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending (LAD)
B) Left circumflex (LCx)
C) Right coronary artery (RCA)
D) Left main coronary artery
: Answer : C
Full Rotation & Rationale:
• A (LAD): Supplies the anterior wall and septum, corresponding to ST
elevation in leads V1–V4. Not consistent with inferior leads.
• B (LCx): Supplies the lateral wall, corresponding to leads I, aVL, V5–V6.
• C (RCA): Correct. Leads II, III, and aVF reflect the inferior wall of the left
ventricle, which is supplied by the right coronary artery in most
right-dominant circulations. Inferior STEMI = RCA occlusion.
• D (Left main): Occlusion would cause widespread anterior and lateral ST
depression or ST elevation in aVR, not isolated inferior changes.
2. The AGACNP is managing a patient in cardiogenic shock after an anterior
STEMI. A pulmonary artery catheter reveals a cardiac index of 1.6 L/min/m²,
pg. 1
,2
pulmonary capillary wedge pressure (PCWP) of 24 mmHg, and systemic vascular
resistance (SVR) of 1,800 dynes/sec/cm⁻⁵. Which intervention is the priority?
A) Administer a 500 mL bolus of normal saline
B) Initiate dobutamine infusion
C) Initiate nitroprusside infusion
D) Administer furosemide IV push
: Answer : B
Full Rotation & Rationale:
• A (Fluid bolus): The PCWP is already elevated at 24 mmHg (normal 4–12
mmHg), indicating pulmonary congestion. Additional fluid would worsen
pulmonary edema.
• B (Dobutamine): Correct. The cardiac index is low and the PCWP is high,
indicating pump failure with elevated filling pressures. Dobutamine, a
beta-1 agonist, increases cardiac contractility and cardiac output without
significantly increasing afterload. It is the inotrope of choice for cardiogenic
shock with elevated filling pressures.
• C (Nitroprusside): While it reduces afterload, it can cause coronary steal
and reflex tachycardia, and it does not directly improve contractility.
• D (Furosemide): Diuretics reduce preload and may help pulmonary
congestion, but they do not address the primary problem of reduced
cardiac output.
3. A 55-year-old female with a history of mitral valve prolapse presents with
fever, splinter hemorrhages, and a new-onset holosystolic murmur at the apex.
Blood cultures are positive for Streptococcus viridans. The AGACNP should
anticipate which of the following as the most appropriate diagnostic test to
evaluate for complications?
A) Chest X-ray
B) Transesophageal echocardiogram (TEE)
C) Cardiac CT angiography
D) 12-lead ECG
pg. 2
,3
: Answer : B
Full Rotation & Rationale:
• A (Chest X-ray): May show signs of heart failure but does not visualize
vegetations or valve dysfunction.
• B (TEE): Correct. The patient meets Duke criteria for infective endocarditis.
TEE is the gold standard for detecting vegetations, perivalvular abscess, and
valve perforation with high sensitivity.
• C (CT angiography): Used for coronary artery assessment, not for
endocarditis.
• D (ECG): May show conduction abnormalities if an abscess extends into the
septum but does not diagnose endocarditis.
4. A patient with a history of atrial fibrillation on warfarin presents with acute
onset of severe flank pain and hematuria. CT shows a wedge-shaped renal
infarct. The INR is 1.3. What is the most likely etiology?
A) Renal artery stenosis
B) Atheroembolic disease
C) Cardioembolic renal infarction
D) Acute pyelonephritis
: Answer : C
Full Rotation & Rationale:
• A (Renal artery stenosis): Causes chronic hypertension and renal
insufficiency, not acute flank pain with a wedge-shaped infarct.
• B (Atheroembolic disease): Typically occurs after vascular manipulation,
causing small, multiple emboli, not a single large wedge-shaped infarct.
• C (Cardioembolic renal infarction): Correct. Subtherapeutic INR in a patient
with atrial fibrillation predisposes to left atrial thrombus formation, which
can embolize to the renal artery, causing an acute wedge-shaped infarction.
• D (Acute pyelonephritis): Presents with fever, flank pain, and pyuria, not a
wedge-shaped infarct.
pg. 3
, 4
5. A 70-year-old with severe aortic stenosis develops acute pulmonary edema.
Blood pressure is 90/60 mmHg, heart rate 120 bpm. Which medication is
contraindicated?
A) Furosemide
B) Dobutamine
C) Nitroglycerin
D) Phenylephrine
: Answer : C
Full Rotation & Rationale:
• A (Furosemide): May be used cautiously to reduce preload, but may drop
BP further. Not absolutely contraindicated.
• B (Dobutamine): May improve cardiac output in cardiogenic shock, even
with AS, by increasing contractility.
• C (Nitroglycerin): Correct. Nitrates reduce preload and afterload. In severe
aortic stenosis, reducing preload can cause a critical drop in cardiac output
because the ventricle requires adequate filling to overcome the stenotic
valve. Nitrates can precipitate profound hypotension.
• D (Phenylephrine): A vasopressor that increases afterload; while not ideal
in cardiogenic shock, it is not absolutely contraindicated in AS.
6. The AGACNP is interpreting a Swan-Ganz catheter reading. The pulmonary
artery diastolic pressure (PAD) is 20 mmHg, and the PCWP is 10 mmHg. The
difference between PAD and PCWP indicates:
A) Normal physiology
B) Mitral stenosis
C) Pulmonary hypertension
D) Cardiac tamponade
: Answer : C
Full Rotation & Rationale:
pg. 4
