Latest 2026/2027 NURS 6560: Advanced Practice Care of Adults in
Acute Care exam with correct answers and rationales A+ Graded
1. A patient with acute respiratory distress has a PaO₂ of 55 mmHg despite supplemental
oxygen. Which condition should the acute care nurse practitioner suspect?
A. Mild hypoxemia
B. Severe oxygenation impairment
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: B
Rationale: A PaO₂ of 55 mmHg indicates significant hypoxemia requiring prompt assessment
and intervention.
2. Which finding is most concerning in a patient with acute respiratory distress?
A. Mild tachycardia
B. Ability to speak in full sentences
C. Altered mental status
D. Respiratory rate of 18/min
Correct Answer: C
Rationale: Altered mental status may indicate severe hypoxemia, hypercapnia, or impending
respiratory failure.
3. A patient with COPD exacerbation has increasing somnolence and a PaCO₂ of 75
mmHg. What is the most likely cause?
A. Hypocapnic respiratory failure
B. Hypercapnic respiratory failure
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: B
Rationale: Markedly elevated PaCO₂ indicates carbon dioxide retention and hypercapnic
respiratory failure.
4. Which ABG pattern is consistent with acute respiratory acidosis?
A. Low pH and high PaCO₂
B. High pH and low PaCO₂
C. Low pH and low PaCO₂
D. High pH and high PaCO₂
Correct Answer: A
Rationale: Acute respiratory acidosis occurs when inadequate ventilation causes CO₂ retention
and a decrease in pH.
,5. A patient with severe asthma develops a sudden decrease in wheezing and worsening
respiratory distress. What does this finding suggest?
A. Clinical improvement
B. Improved airflow
C. Severe airflow obstruction with minimal air movement
D. Resolution of bronchospasm
Correct Answer: C
Rationale: A “silent chest” may indicate critically reduced airflow and impending respiratory
failure.
6. Which medication is commonly used as an initial bronchodilator in acute
bronchospasm?
A. Albuterol
B. Warfarin
C. Furosemide
D. Digoxin
Correct Answer: A
Rationale: Short-acting beta₂-agonists such as albuterol rapidly relieve bronchospasm.
7. A patient with acute pulmonary edema has severe dyspnea and pink frothy sputum.
Which intervention is appropriate?
A. Place the patient flat
B. Provide oxygen and support ventilation as needed
C. Administer large amounts of oral fluids
D. Encourage vigorous ambulation
Correct Answer: B
Rationale: Pulmonary edema causes severe oxygenation impairment and requires respiratory
support and treatment of the underlying cause.
8. Which finding is most consistent with tension pneumothorax?
A. Bilateral equal breath sounds
B. Hypotension, severe respiratory distress, and tracheal deviation
C. Bradycardia with hypertension only
D. Mild cough
Correct Answer: B
Rationale: Tension pneumothorax causes obstructive shock and may produce severe respiratory
distress, hypotension, and mediastinal shift.
9. What is the immediate treatment for a clinically unstable tension pneumothorax?
A. Observation only
B. Immediate decompression
, C. Oral antibiotics
D. Fluid restriction
Correct Answer: B
Rationale: A tension pneumothorax is a life-threatening emergency requiring immediate
decompression followed by definitive management.
10. Which patient is most likely to develop acute respiratory distress syndrome (ARDS)?
A. Patient with mild seasonal allergies
B. Patient with severe sepsis and bilateral pulmonary infiltrates
C. Patient with uncomplicated hypertension
D. Patient with a minor ankle sprain
Correct Answer: B
Rationale: Sepsis is a major risk factor for ARDS, which involves severe inflammatory lung
injury and impaired oxygenation.
11. In a patient with ARDS receiving mechanical ventilation, which strategy is generally
used to reduce ventilator-induced lung injury?
A. High tidal volumes
B. Low tidal volume ventilation
C. No PEEP
D. Prolonged hyperoxia in all cases
Correct Answer: B
Rationale: Lung-protective ventilation uses low tidal volumes to reduce volutrauma.
12. What is the primary purpose of PEEP?
A. Prevent alveolar collapse at end expiration
B. Decrease oxygenation
C. Eliminate all carbon dioxide
D. Stop cardiac output
Correct Answer: A
Rationale: Positive end-expiratory pressure helps maintain alveolar recruitment and improve
oxygenation.
13. A patient suddenly develops crushing substernal chest pain radiating to the left arm.
What is the priority diagnostic test?
A. Routine urinalysis
B. 12-lead ECG
C. Colonoscopy
D. Pulmonary function testing
Correct Answer: B
Rationale: A 12-lead ECG should be obtained rapidly in suspected acute coronary syndrome.
Acute Care exam with correct answers and rationales A+ Graded
1. A patient with acute respiratory distress has a PaO₂ of 55 mmHg despite supplemental
oxygen. Which condition should the acute care nurse practitioner suspect?
A. Mild hypoxemia
B. Severe oxygenation impairment
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: B
Rationale: A PaO₂ of 55 mmHg indicates significant hypoxemia requiring prompt assessment
and intervention.
2. Which finding is most concerning in a patient with acute respiratory distress?
A. Mild tachycardia
B. Ability to speak in full sentences
C. Altered mental status
D. Respiratory rate of 18/min
Correct Answer: C
Rationale: Altered mental status may indicate severe hypoxemia, hypercapnia, or impending
respiratory failure.
3. A patient with COPD exacerbation has increasing somnolence and a PaCO₂ of 75
mmHg. What is the most likely cause?
A. Hypocapnic respiratory failure
B. Hypercapnic respiratory failure
C. Metabolic acidosis
D. Respiratory alkalosis
Correct Answer: B
Rationale: Markedly elevated PaCO₂ indicates carbon dioxide retention and hypercapnic
respiratory failure.
4. Which ABG pattern is consistent with acute respiratory acidosis?
A. Low pH and high PaCO₂
B. High pH and low PaCO₂
C. Low pH and low PaCO₂
D. High pH and high PaCO₂
Correct Answer: A
Rationale: Acute respiratory acidosis occurs when inadequate ventilation causes CO₂ retention
and a decrease in pH.
,5. A patient with severe asthma develops a sudden decrease in wheezing and worsening
respiratory distress. What does this finding suggest?
A. Clinical improvement
B. Improved airflow
C. Severe airflow obstruction with minimal air movement
D. Resolution of bronchospasm
Correct Answer: C
Rationale: A “silent chest” may indicate critically reduced airflow and impending respiratory
failure.
6. Which medication is commonly used as an initial bronchodilator in acute
bronchospasm?
A. Albuterol
B. Warfarin
C. Furosemide
D. Digoxin
Correct Answer: A
Rationale: Short-acting beta₂-agonists such as albuterol rapidly relieve bronchospasm.
7. A patient with acute pulmonary edema has severe dyspnea and pink frothy sputum.
Which intervention is appropriate?
A. Place the patient flat
B. Provide oxygen and support ventilation as needed
C. Administer large amounts of oral fluids
D. Encourage vigorous ambulation
Correct Answer: B
Rationale: Pulmonary edema causes severe oxygenation impairment and requires respiratory
support and treatment of the underlying cause.
8. Which finding is most consistent with tension pneumothorax?
A. Bilateral equal breath sounds
B. Hypotension, severe respiratory distress, and tracheal deviation
C. Bradycardia with hypertension only
D. Mild cough
Correct Answer: B
Rationale: Tension pneumothorax causes obstructive shock and may produce severe respiratory
distress, hypotension, and mediastinal shift.
9. What is the immediate treatment for a clinically unstable tension pneumothorax?
A. Observation only
B. Immediate decompression
, C. Oral antibiotics
D. Fluid restriction
Correct Answer: B
Rationale: A tension pneumothorax is a life-threatening emergency requiring immediate
decompression followed by definitive management.
10. Which patient is most likely to develop acute respiratory distress syndrome (ARDS)?
A. Patient with mild seasonal allergies
B. Patient with severe sepsis and bilateral pulmonary infiltrates
C. Patient with uncomplicated hypertension
D. Patient with a minor ankle sprain
Correct Answer: B
Rationale: Sepsis is a major risk factor for ARDS, which involves severe inflammatory lung
injury and impaired oxygenation.
11. In a patient with ARDS receiving mechanical ventilation, which strategy is generally
used to reduce ventilator-induced lung injury?
A. High tidal volumes
B. Low tidal volume ventilation
C. No PEEP
D. Prolonged hyperoxia in all cases
Correct Answer: B
Rationale: Lung-protective ventilation uses low tidal volumes to reduce volutrauma.
12. What is the primary purpose of PEEP?
A. Prevent alveolar collapse at end expiration
B. Decrease oxygenation
C. Eliminate all carbon dioxide
D. Stop cardiac output
Correct Answer: A
Rationale: Positive end-expiratory pressure helps maintain alveolar recruitment and improve
oxygenation.
13. A patient suddenly develops crushing substernal chest pain radiating to the left arm.
What is the priority diagnostic test?
A. Routine urinalysis
B. 12-lead ECG
C. Colonoscopy
D. Pulmonary function testing
Correct Answer: B
Rationale: A 12-lead ECG should be obtained rapidly in suspected acute coronary syndrome.
