NRNP 6566 Week 3 Quiz V3 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 3 Quiz) | Walden University
1. A 65-year-old male with a history of heart failure presents with increased dyspnea and
orthopnea. Physical examination reveals jugular venous distention and bilateral crackles.
Which of the following is the most appropriate initial pharmacological intervention?
A. Intravenous Beta-blockers
B. Oral ACE Inhibitors
C. Intravenous Loop Diuretics
D. Intravenous Calcium Channel Blockers
Answer: C
Rationale: Acute decompensated heart failure with signs of volume overload requires
rapid diuresis to reduce preload and alleviate pulmonary congestion. Loop diuretics such
as Furosemide are the first-line choice in this setting because of their rapid onset of action
when administered intravenously. While ACE inhibitors and beta-blockers are essential for
long-term management, they are not the primary treatment for acute respiratory distress
caused by fluid overload.
,2. A patient in the ICU is being monitored with a pulmonary artery catheter. The readings
show a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg and a Cardiac Index of 1.8
L/min/m2. Which condition does this hemodynamic profile most likely represent?
A. Hypovolemic Shock
B. Septic Shock
C. Cardiogenic Shock
D. Anaphylactic Shock
Answer: C
Rationale: Cardiogenic shock is characterized by an elevated PAWP, indicating left
ventricular end-diastolic pressure elevation, and a decreased cardiac index, indicating
pump failure. In contrast, hypovolemic shock typically presents with a low PAWP and low
cardiac index due to lack of volume. Distributive shocks like sepsis or anaphylaxis usually
present with low or normal PAWP and an initially high or normal cardiac index.
3. When managing a patient with an acute ST-elevation myocardial infarction (STEMI), what
is the recommended ‘door-to-balloon’ time goal for percutaneous coronary intervention
(PCI)?
A. 30 minutes
B. 60 minutes
C. 120 minutes
D. 90 minutes
,Answer: D
Rationale: The American College of Cardiology and American Heart Association guidelines
recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary
PCI. This timeframe is critical for maximizing myocardial salvage and improving long-term
survival outcomes. Delays beyond this window are associated with increased morbidity
and mortality in acute coronary syndrome patients.
4. A 72-year-old female presents with sudden onset of atrial fibrillation with a ventricular rate
of 150 bpm. She is currently hypotensive (BP 82/50) and complaining of chest pain. What is
the next best step in management?
A. Administration of Diltiazem IV
B. Oral administration of Amiodarone
C. Synchronized Cardioversion
D. Carotid sinus massage
Answer: C
Rationale: In patients with symptomatic or unstable tachyarrhythmias, such as those
presenting with hypotension and ischemia, immediate electrical therapy is indicated.
Synchronized cardioversion is used to restore sinus rhythm and stabilize hemodynamic
status quickly. Pharmacological rate control is generally reserved for patients who are
hemodynamically stable.
, 5. A patient with severe COPD presents to the ED with increased sputum production and
worsening dyspnea. The ABG shows a pH of 7.28, PaCO2 of 55 mmHg, and PaO2 of 58 mmHg.
Which treatment is most appropriate for this patient’s respiratory status?
A. High-flow oxygen therapy
B. Immediate Orotracheal Intubation
C. Inhaled Corticosteroids
D. Non-invasive Positive Pressure Ventilation (NiPPV)
Answer: D
Rationale: Non-invasive positive pressure ventilation is the preferred initial treatment for
acute hypercapnic respiratory failure in COPD exacerbations when the patient is not yet in
full cardiac or respiratory arrest. It helps reduce the work of breathing and improves gas
exchange by washing out CO2. If the patient does not improve or shows signs of
deteriorating mental status, invasive mechanical ventilation may then be required.
6. Which physical exam finding is most specifically associated with a diagnosis of Mitral
Stenosis?
A. Holosystolic murmur at the apex
B. Crescendo-decrescendo systolic murmur at the base
C. Low-pitched diastolic rumble with an opening snap
D. High-pitched blowing diastolic murmur at the left sternal border
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 3 Quiz) | Walden University
1. A 65-year-old male with a history of heart failure presents with increased dyspnea and
orthopnea. Physical examination reveals jugular venous distention and bilateral crackles.
Which of the following is the most appropriate initial pharmacological intervention?
A. Intravenous Beta-blockers
B. Oral ACE Inhibitors
C. Intravenous Loop Diuretics
D. Intravenous Calcium Channel Blockers
Answer: C
Rationale: Acute decompensated heart failure with signs of volume overload requires
rapid diuresis to reduce preload and alleviate pulmonary congestion. Loop diuretics such
as Furosemide are the first-line choice in this setting because of their rapid onset of action
when administered intravenously. While ACE inhibitors and beta-blockers are essential for
long-term management, they are not the primary treatment for acute respiratory distress
caused by fluid overload.
,2. A patient in the ICU is being monitored with a pulmonary artery catheter. The readings
show a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg and a Cardiac Index of 1.8
L/min/m2. Which condition does this hemodynamic profile most likely represent?
A. Hypovolemic Shock
B. Septic Shock
C. Cardiogenic Shock
D. Anaphylactic Shock
Answer: C
Rationale: Cardiogenic shock is characterized by an elevated PAWP, indicating left
ventricular end-diastolic pressure elevation, and a decreased cardiac index, indicating
pump failure. In contrast, hypovolemic shock typically presents with a low PAWP and low
cardiac index due to lack of volume. Distributive shocks like sepsis or anaphylaxis usually
present with low or normal PAWP and an initially high or normal cardiac index.
3. When managing a patient with an acute ST-elevation myocardial infarction (STEMI), what
is the recommended ‘door-to-balloon’ time goal for percutaneous coronary intervention
(PCI)?
A. 30 minutes
B. 60 minutes
C. 120 minutes
D. 90 minutes
,Answer: D
Rationale: The American College of Cardiology and American Heart Association guidelines
recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary
PCI. This timeframe is critical for maximizing myocardial salvage and improving long-term
survival outcomes. Delays beyond this window are associated with increased morbidity
and mortality in acute coronary syndrome patients.
4. A 72-year-old female presents with sudden onset of atrial fibrillation with a ventricular rate
of 150 bpm. She is currently hypotensive (BP 82/50) and complaining of chest pain. What is
the next best step in management?
A. Administration of Diltiazem IV
B. Oral administration of Amiodarone
C. Synchronized Cardioversion
D. Carotid sinus massage
Answer: C
Rationale: In patients with symptomatic or unstable tachyarrhythmias, such as those
presenting with hypotension and ischemia, immediate electrical therapy is indicated.
Synchronized cardioversion is used to restore sinus rhythm and stabilize hemodynamic
status quickly. Pharmacological rate control is generally reserved for patients who are
hemodynamically stable.
, 5. A patient with severe COPD presents to the ED with increased sputum production and
worsening dyspnea. The ABG shows a pH of 7.28, PaCO2 of 55 mmHg, and PaO2 of 58 mmHg.
Which treatment is most appropriate for this patient’s respiratory status?
A. High-flow oxygen therapy
B. Immediate Orotracheal Intubation
C. Inhaled Corticosteroids
D. Non-invasive Positive Pressure Ventilation (NiPPV)
Answer: D
Rationale: Non-invasive positive pressure ventilation is the preferred initial treatment for
acute hypercapnic respiratory failure in COPD exacerbations when the patient is not yet in
full cardiac or respiratory arrest. It helps reduce the work of breathing and improves gas
exchange by washing out CO2. If the patient does not improve or shows signs of
deteriorating mental status, invasive mechanical ventilation may then be required.
6. Which physical exam finding is most specifically associated with a diagnosis of Mitral
Stenosis?
A. Holosystolic murmur at the apex
B. Crescendo-decrescendo systolic murmur at the base
C. Low-pitched diastolic rumble with an opening snap
D. High-pitched blowing diastolic murmur at the left sternal border
