NRNP 6566 Week 3 Quiz V2 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 3 Quiz) | Walden University
1. A patient presents to the emergency department with a pH of 7.28, PaCO2 of 55 mmHg,
and HCO3 of 26 mEq/L. Which of the following is the most likely diagnosis?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is less than 7.35, indicating acidosis. Since the PaCO2 is elevated above
45 mmHg and the bicarbonate is within the normal range, the primary cause is respiratory.
This profile is consistent with acute respiratory failure where the kidneys have not yet
compensated.
2. When calculating the anion gap for a patient in the ICU, which formula is traditionally used
by clinicians?
A. Na - (Cl - HCO3)
B. Cl + HCO3 - Na
,C. (Na + K) - Cl
D. Na - (Cl + HCO3)
Answer: D
Rationale: The anion gap is calculated by subtracting the sum of chloride and bicarbonate
from the sodium concentration. A normal anion gap is typically between 8 and 12 mEq/L.
This measurement is crucial in differentiating causes of metabolic acidosis, such as
ketoacidosis or lactic acidosis.
3. A patient with a history of heart failure presents with a potassium level of 6.8 mEq/L and
peaked T-waves on the EKG. What is the immediate priority intervention?
A. Administration of intravenous insulin and dextrose
B. Administration of oral sodium polystyrene sulfonate
C. Administration of intravenous calcium gluconate
D. Immediate hemodialysis
Answer: C
Rationale: Intravenous calcium gluconate is administered to stabilize the myocardial cell
membrane and prevent life-threatening arrhythmias. While insulin and dextrose help shift
potassium into cells, they do not provide immediate cardiac protection. Oral resins take
hours to work and are not appropriate for emergent stabilization.
, 4. Which of the following physical exam findings is most specific for a diagnosis of Acute
Heart Failure?
A. Bilateral pitting edema
B. Third heart sound (S3 gallop)
C. Jugular venous distention
D. Bibasilar crackles
Answer: B
Rationale: The S3 gallop is highly specific for volume overload and ventricular dysfunction
in adults. While crackles and edema are common, they can be caused by pulmonary or
renal issues. The presence of an S3 strongly suggests the heart’s inability to manage the
volume load.
5. A patient is suspected of having a Pulmonary Embolism (PE). According to the Wells
Criteria, which of the following scores would indicate a high probability?
A. Score of 2
B. Score of 4
C. Score of 7
D. Score of 0
Answer: C
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 3 Quiz) | Walden University
1. A patient presents to the emergency department with a pH of 7.28, PaCO2 of 55 mmHg,
and HCO3 of 26 mEq/L. Which of the following is the most likely diagnosis?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is less than 7.35, indicating acidosis. Since the PaCO2 is elevated above
45 mmHg and the bicarbonate is within the normal range, the primary cause is respiratory.
This profile is consistent with acute respiratory failure where the kidneys have not yet
compensated.
2. When calculating the anion gap for a patient in the ICU, which formula is traditionally used
by clinicians?
A. Na - (Cl - HCO3)
B. Cl + HCO3 - Na
,C. (Na + K) - Cl
D. Na - (Cl + HCO3)
Answer: D
Rationale: The anion gap is calculated by subtracting the sum of chloride and bicarbonate
from the sodium concentration. A normal anion gap is typically between 8 and 12 mEq/L.
This measurement is crucial in differentiating causes of metabolic acidosis, such as
ketoacidosis or lactic acidosis.
3. A patient with a history of heart failure presents with a potassium level of 6.8 mEq/L and
peaked T-waves on the EKG. What is the immediate priority intervention?
A. Administration of intravenous insulin and dextrose
B. Administration of oral sodium polystyrene sulfonate
C. Administration of intravenous calcium gluconate
D. Immediate hemodialysis
Answer: C
Rationale: Intravenous calcium gluconate is administered to stabilize the myocardial cell
membrane and prevent life-threatening arrhythmias. While insulin and dextrose help shift
potassium into cells, they do not provide immediate cardiac protection. Oral resins take
hours to work and are not appropriate for emergent stabilization.
, 4. Which of the following physical exam findings is most specific for a diagnosis of Acute
Heart Failure?
A. Bilateral pitting edema
B. Third heart sound (S3 gallop)
C. Jugular venous distention
D. Bibasilar crackles
Answer: B
Rationale: The S3 gallop is highly specific for volume overload and ventricular dysfunction
in adults. While crackles and edema are common, they can be caused by pulmonary or
renal issues. The presence of an S3 strongly suggests the heart’s inability to manage the
volume load.
5. A patient is suspected of having a Pulmonary Embolism (PE). According to the Wells
Criteria, which of the following scores would indicate a high probability?
A. Score of 2
B. Score of 4
C. Score of 7
D. Score of 0
Answer: C
