NR 570 FINAL EXAM 2026/2027
NR570 / NR 570 FINAL EXAM 2026/2027 – COMMON DIAGNOSIS &
MANAGEMENT IN ACUTE CARE PRACTICUM | REAL EXAM QUESTIONS &
VERIFIED ANSWERS | 100% CORRECT | CHAMBERLAIN COLLEGE PACK
Section 1: Cardiovascular Emergencies (Questions 1-25)
1. A 65-year-old male with chronic heart failure presents with worsening dyspnea, orthopnea, and
peripheral edema. Which pathophysiological mechanism is the primary driver of these symptoms?
A. Decreased renin-angiotensin-aldosterone system (RAAS) activity
B. Increased sympathetic nervous system activity
C. Reduced left ventricular afterload
D. Enhanced natriuretic peptide release
Correct Answer: B
Rationale: In heart failure, reduced cardiac output triggers compensatory sympathetic activation,
leading to vasoconstriction, increased preload, and fluid retention, worsening symptoms. RAAS is
increased, not decreased. Afterload is typically increased. Natriuretic peptides are released but
insufficient to overcome these effects .
2. A 67-year-old male with a history of CAD presents with crushing chest pain, diaphoresis, and ST
elevation in leads V2-V4. His BP is 90/60. What is the next step?
A. Start beta blockers immediately
B. Administer IV fluids and prepare for PCI
C. Give thrombolytics only
D. Discharge if pain improves
Correct Answer: B
Rationale: Anterior STEMI with hypotension suggests cardiogenic compromise. Stabilization with
fluids (if no pulmonary edema) and urgent Percutaneous Coronary Intervention (PCI) is the priority.
Beta-blockers are contraindicated in acute heart failure/cardiogenic shock .
3. A patient presents with crushing chest pain and ST elevation in inferior leads (II, III, aVF). Which
artery is most likely affected?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Circumflex
D. Left Main
Correct Answer: B
Rationale: ST elevation in the inferior leads (II, III, aVF) is typically indicative of an occlusion of the
Right Coronary Artery .
, NR 570 FINAL EXAM 2026/2027
4. A 55-year-old with acute decompensated heart failure has crackles to the mid-lungs, S3 gallop,
and oxygen saturation of 90% on room air. BP is 145/90, HR 110. The priority intervention is:
A. IV furosemide 40 mg
B. IV metoprolol 5 mg
C. Oral digoxin loading
D. IV normal saline bolus
Correct Answer: A
Rationale: IV loop diuretic (furosemide) is first-line for acute heart failure with volume overload
(pulmonary congestion). Beta-blockers are not given in acute decompensation .
5. A patient with atrial fibrillation with RVR (HR 150) is hemodynamically stable. Which medication
is most appropriate for rate control?
A. IV amiodarone
B. IV diltiazem or IV metoprolol
C. IV digoxin as monotherapy
D. Direct current cardioversion
Correct Answer: B
Rationale: For hemodynamically stable atrial fibrillation with rapid ventricular response, IV diltiazem
(calcium channel blocker) or IV metoprolol (beta-blocker) are first-line for rate control .
6. A 72-year-old with hypertension presents with sudden onset severe "tearing" chest pain
radiating to the back. BP is 180/100 in the right arm and 130/70 in the left arm. The most likely
diagnosis is:
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Classic presentation of Aortic Dissection includes sudden, severe "tearing" pain and
pulse/blood pressure discrepancies between the upper extremities .
7. A 65-year-old patient presents with acute respiratory distress, crackles in bilateral lung bases,
and an S3 gallop. The BNP is 1200 pg/mL. Which initial medication is most appropriate?
A. Oral Metoprolol
B. Intravenous Furosemide
C. Intravenous Normal Saline
D. Oral Lisinopril
, NR 570 FINAL EXAM 2026/2027
Correct Answer: B
Rationale: Acute decompensated heart failure is characterized by fluid overload and elevated BNP
levels. IV loop diuretics like furosemide are the first-line treatment to reduce preload and alleviate
pulmonary congestion. Initial management focuses on stabilizing hemodynamics and oxygenation .
8. A patient with acute MI develops new systolic murmur and hypotension. The most likely
complication is:
A. Pericarditis
B. Ventricular septal rupture (VSR)
C. Pulmonary embolism
D. Right ventricular infarction
Correct Answer: B
Rationale: Ventricular septal rupture occurs 3-7 days post-MI, presenting with new harsh
holosystolic murmur, thrill, and cardiogenic shock. Immediate surgical repair is often needed .
9. A patient with symptomatic bradycardia (HR 32, BP 80/50, altered mental status) requires
emergent treatment with:
A. IV atropine 0.5 mg
B. Transcutaneous pacing
C. Dopamine infusion
D. IV aminophylline
Correct Answer: B
Rationale: Unstable bradycardia (hypotension, altered mental status, ischemic chest pain) requires
immediate transcutaneous pacing. Atropine is used while preparing for pacing .
10. What is the first-line pharmacologic treatment for symptomatic bradycardia per ACLS?
A. Dopamine
B. Epinephrine
C. Atropine
D. Adenosine
Correct Answer: C
Rationale: Atropine is the first-line medication for symptomatic bradycardia per ACLS guidelines .
11. A patient with acute heart failure and severe hypertension (BP 190/110) is best treated with:
A. IV furosemide alone
B. IV nitroglycerin or IV nitroprusside (vasodilators)
NR570 / NR 570 FINAL EXAM 2026/2027 – COMMON DIAGNOSIS &
MANAGEMENT IN ACUTE CARE PRACTICUM | REAL EXAM QUESTIONS &
VERIFIED ANSWERS | 100% CORRECT | CHAMBERLAIN COLLEGE PACK
Section 1: Cardiovascular Emergencies (Questions 1-25)
1. A 65-year-old male with chronic heart failure presents with worsening dyspnea, orthopnea, and
peripheral edema. Which pathophysiological mechanism is the primary driver of these symptoms?
A. Decreased renin-angiotensin-aldosterone system (RAAS) activity
B. Increased sympathetic nervous system activity
C. Reduced left ventricular afterload
D. Enhanced natriuretic peptide release
Correct Answer: B
Rationale: In heart failure, reduced cardiac output triggers compensatory sympathetic activation,
leading to vasoconstriction, increased preload, and fluid retention, worsening symptoms. RAAS is
increased, not decreased. Afterload is typically increased. Natriuretic peptides are released but
insufficient to overcome these effects .
2. A 67-year-old male with a history of CAD presents with crushing chest pain, diaphoresis, and ST
elevation in leads V2-V4. His BP is 90/60. What is the next step?
A. Start beta blockers immediately
B. Administer IV fluids and prepare for PCI
C. Give thrombolytics only
D. Discharge if pain improves
Correct Answer: B
Rationale: Anterior STEMI with hypotension suggests cardiogenic compromise. Stabilization with
fluids (if no pulmonary edema) and urgent Percutaneous Coronary Intervention (PCI) is the priority.
Beta-blockers are contraindicated in acute heart failure/cardiogenic shock .
3. A patient presents with crushing chest pain and ST elevation in inferior leads (II, III, aVF). Which
artery is most likely affected?
A. Left Anterior Descending (LAD)
B. Right Coronary Artery (RCA)
C. Circumflex
D. Left Main
Correct Answer: B
Rationale: ST elevation in the inferior leads (II, III, aVF) is typically indicative of an occlusion of the
Right Coronary Artery .
, NR 570 FINAL EXAM 2026/2027
4. A 55-year-old with acute decompensated heart failure has crackles to the mid-lungs, S3 gallop,
and oxygen saturation of 90% on room air. BP is 145/90, HR 110. The priority intervention is:
A. IV furosemide 40 mg
B. IV metoprolol 5 mg
C. Oral digoxin loading
D. IV normal saline bolus
Correct Answer: A
Rationale: IV loop diuretic (furosemide) is first-line for acute heart failure with volume overload
(pulmonary congestion). Beta-blockers are not given in acute decompensation .
5. A patient with atrial fibrillation with RVR (HR 150) is hemodynamically stable. Which medication
is most appropriate for rate control?
A. IV amiodarone
B. IV diltiazem or IV metoprolol
C. IV digoxin as monotherapy
D. Direct current cardioversion
Correct Answer: B
Rationale: For hemodynamically stable atrial fibrillation with rapid ventricular response, IV diltiazem
(calcium channel blocker) or IV metoprolol (beta-blocker) are first-line for rate control .
6. A 72-year-old with hypertension presents with sudden onset severe "tearing" chest pain
radiating to the back. BP is 180/100 in the right arm and 130/70 in the left arm. The most likely
diagnosis is:
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Classic presentation of Aortic Dissection includes sudden, severe "tearing" pain and
pulse/blood pressure discrepancies between the upper extremities .
7. A 65-year-old patient presents with acute respiratory distress, crackles in bilateral lung bases,
and an S3 gallop. The BNP is 1200 pg/mL. Which initial medication is most appropriate?
A. Oral Metoprolol
B. Intravenous Furosemide
C. Intravenous Normal Saline
D. Oral Lisinopril
, NR 570 FINAL EXAM 2026/2027
Correct Answer: B
Rationale: Acute decompensated heart failure is characterized by fluid overload and elevated BNP
levels. IV loop diuretics like furosemide are the first-line treatment to reduce preload and alleviate
pulmonary congestion. Initial management focuses on stabilizing hemodynamics and oxygenation .
8. A patient with acute MI develops new systolic murmur and hypotension. The most likely
complication is:
A. Pericarditis
B. Ventricular septal rupture (VSR)
C. Pulmonary embolism
D. Right ventricular infarction
Correct Answer: B
Rationale: Ventricular septal rupture occurs 3-7 days post-MI, presenting with new harsh
holosystolic murmur, thrill, and cardiogenic shock. Immediate surgical repair is often needed .
9. A patient with symptomatic bradycardia (HR 32, BP 80/50, altered mental status) requires
emergent treatment with:
A. IV atropine 0.5 mg
B. Transcutaneous pacing
C. Dopamine infusion
D. IV aminophylline
Correct Answer: B
Rationale: Unstable bradycardia (hypotension, altered mental status, ischemic chest pain) requires
immediate transcutaneous pacing. Atropine is used while preparing for pacing .
10. What is the first-line pharmacologic treatment for symptomatic bradycardia per ACLS?
A. Dopamine
B. Epinephrine
C. Atropine
D. Adenosine
Correct Answer: C
Rationale: Atropine is the first-line medication for symptomatic bradycardia per ACLS guidelines .
11. A patient with acute heart failure and severe hypertension (BP 190/110) is best treated with:
A. IV furosemide alone
B. IV nitroglycerin or IV nitroprusside (vasodilators)
