NR 574 FINAL EXAM
ACUTE CARE PRACTICUM I
2026 Aligned Practice Bank
Part I - Questions
GI Emergencies
1. A 72-year-old with atrial fibrillation develops sudden severe periumbilical pain that seems
disproportionate to the abdominal examination. Which diagnosis is most concerning?
A. Acute mesenteric ischemia
B. Uncomplicated diverticulitis
C. Viral gastroenteritis
D. Irritable bowel syndrome
2. A patient with suspected bowel perforation has rigid guarding, fever, and worsening tachycardia.
What is the priority management approach?
A. Schedule outpatient endoscopy
B. Urgent surgical evaluation with resuscitation and broad-spectrum antibiotics
C. Give an oral laxative and reassess
D. Delay intervention until stool cultures return
3. Which imaging study is generally most useful in a hemodynamically stable adult when intestinal
perforation is suspected?
A. Plain abdominal radiograph only
B. CT of the abdomen and pelvis
C. HIDA scan
D. Barium enema
4. A patient with small-bowel obstruction has persistent vomiting and dehydration. Which initial
intervention best addresses immediate physiologic risk?
A. High-fiber oral diet
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
, B. IV isotonic fluid resuscitation and electrolyte correction
C. Routine antidiarrheal therapy
D. Immediate oral contrast administration
5. Which finding in a patient with intestinal obstruction most strongly suggests strangulation or
ischemia?
A. Intermittent mild cramping only
B. Passage of flatus
C. Continuous severe pain with peritoneal signs and metabolic acidosis
D. Hyperactive bowel sounds without tenderness
6. A patient with suspected acute mesenteric ischemia is stable enough for definitive imaging. Which test
is preferred?
A. CT angiography
B. Noncontrast head CT
C. Upper GI series
D. Abdominal ultrasound alone
7. A patient with large-bowel obstruction develops fever, rebound tenderness, and hypotension. What
complication should be presumed until proven otherwise?
A. Simple constipation
B. Perforation with peritonitis and sepsis
C. Functional dyspepsia
D. Chronic pancreatitis
8. Which laboratory trend can support concern for worsening intestinal ischemia but cannot by itself
exclude it when normal?
A. TSH
B. Serum lactate
C. HbA1c
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
, D. Amylase only
9. A patient with adhesive small-bowel obstruction has no peritoneal signs and is hemodynamically
stable. Which conservative measure is commonly appropriate while closely monitoring?
A. Immediate high-residue diet
B. Bowel rest, nasogastric decompression when indicated, and IV fluids
C. Daily stimulant laxatives
D. Routine colonoscopy
10. Which physical finding is most consistent with generalized peritonitis from a perforated viscus?
A. Painless pulsatile mass
B. Board-like abdominal rigidity
C. Isolated costovertebral angle tenderness
D. Positive Tinel sign
Hepatic & Renal Complications
11. Acute liver failure is most characteristically associated with which combination in a patient without
preexisting cirrhosis?
A. Chronic ascites for years
B. Coagulopathy and hepatic encephalopathy developing acutely
C. Isolated alkaline phosphatase elevation
D. Nephrotic-range proteinuria
12. In suspected acetaminophen-related acute liver failure, which therapy should be started promptly
when indicated, even if the exact ingestion time is uncertain?
A. Lactulose only
B. N-acetylcysteine
C. Warfarin
D. Metformin
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
, 13. A patient with acute liver failure becomes increasingly confused. Which complication requires
especially close neurologic monitoring?
A. Carpal tunnel syndrome
B. Cerebral edema and intracranial hypertension
C. Otitis externa
D. Nephrolithiasis
14. Which finding is most consistent with hepatorenal syndrome-AKI rather than intrinsic
glomerulonephritis?
A. Heavy hematuria with red-cell casts
B. Rising creatinine in advanced liver disease with a relatively bland urine sediment
C. Marked eosinophiluria after antibiotics
D. Massive proteinuria with lipid casts
15. For a hospitalized patient with cirrhosis and suspected HRS-AKI, which initial step is important while
evaluating reversible causes?
A. Start an NSAID
B. Stop nephrotoxins and assess volume status, often with albumin-based volume expansion when
appropriate
C. Restrict all IV fluids regardless of status
D. Begin iodinated contrast studies immediately
16. Which vasoconstrictor strategy may be used with albumin for HRS-AKI depending on setting and
availability?
A. Nitroprusside
B. Terlipressin or norepinephrine
C. Amlodipine
D. Hydralazine monotherapy
17. A patient with acute liver failure has INR 3.0 but no active bleeding and no procedure planned. What
is the best general approach to plasma transfusion?
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
ACUTE CARE PRACTICUM I
2026 Aligned Practice Bank
Part I - Questions
GI Emergencies
1. A 72-year-old with atrial fibrillation develops sudden severe periumbilical pain that seems
disproportionate to the abdominal examination. Which diagnosis is most concerning?
A. Acute mesenteric ischemia
B. Uncomplicated diverticulitis
C. Viral gastroenteritis
D. Irritable bowel syndrome
2. A patient with suspected bowel perforation has rigid guarding, fever, and worsening tachycardia.
What is the priority management approach?
A. Schedule outpatient endoscopy
B. Urgent surgical evaluation with resuscitation and broad-spectrum antibiotics
C. Give an oral laxative and reassess
D. Delay intervention until stool cultures return
3. Which imaging study is generally most useful in a hemodynamically stable adult when intestinal
perforation is suspected?
A. Plain abdominal radiograph only
B. CT of the abdomen and pelvis
C. HIDA scan
D. Barium enema
4. A patient with small-bowel obstruction has persistent vomiting and dehydration. Which initial
intervention best addresses immediate physiologic risk?
A. High-fiber oral diet
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
, B. IV isotonic fluid resuscitation and electrolyte correction
C. Routine antidiarrheal therapy
D. Immediate oral contrast administration
5. Which finding in a patient with intestinal obstruction most strongly suggests strangulation or
ischemia?
A. Intermittent mild cramping only
B. Passage of flatus
C. Continuous severe pain with peritoneal signs and metabolic acidosis
D. Hyperactive bowel sounds without tenderness
6. A patient with suspected acute mesenteric ischemia is stable enough for definitive imaging. Which test
is preferred?
A. CT angiography
B. Noncontrast head CT
C. Upper GI series
D. Abdominal ultrasound alone
7. A patient with large-bowel obstruction develops fever, rebound tenderness, and hypotension. What
complication should be presumed until proven otherwise?
A. Simple constipation
B. Perforation with peritonitis and sepsis
C. Functional dyspepsia
D. Chronic pancreatitis
8. Which laboratory trend can support concern for worsening intestinal ischemia but cannot by itself
exclude it when normal?
A. TSH
B. Serum lactate
C. HbA1c
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
, D. Amylase only
9. A patient with adhesive small-bowel obstruction has no peritoneal signs and is hemodynamically
stable. Which conservative measure is commonly appropriate while closely monitoring?
A. Immediate high-residue diet
B. Bowel rest, nasogastric decompression when indicated, and IV fluids
C. Daily stimulant laxatives
D. Routine colonoscopy
10. Which physical finding is most consistent with generalized peritonitis from a perforated viscus?
A. Painless pulsatile mass
B. Board-like abdominal rigidity
C. Isolated costovertebral angle tenderness
D. Positive Tinel sign
Hepatic & Renal Complications
11. Acute liver failure is most characteristically associated with which combination in a patient without
preexisting cirrhosis?
A. Chronic ascites for years
B. Coagulopathy and hepatic encephalopathy developing acutely
C. Isolated alkaline phosphatase elevation
D. Nephrotic-range proteinuria
12. In suspected acetaminophen-related acute liver failure, which therapy should be started promptly
when indicated, even if the exact ingestion time is uncertain?
A. Lactulose only
B. N-acetylcysteine
C. Warfarin
D. Metformin
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
, 13. A patient with acute liver failure becomes increasingly confused. Which complication requires
especially close neurologic monitoring?
A. Carpal tunnel syndrome
B. Cerebral edema and intracranial hypertension
C. Otitis externa
D. Nephrolithiasis
14. Which finding is most consistent with hepatorenal syndrome-AKI rather than intrinsic
glomerulonephritis?
A. Heavy hematuria with red-cell casts
B. Rising creatinine in advanced liver disease with a relatively bland urine sediment
C. Marked eosinophiluria after antibiotics
D. Massive proteinuria with lipid casts
15. For a hospitalized patient with cirrhosis and suspected HRS-AKI, which initial step is important while
evaluating reversible causes?
A. Start an NSAID
B. Stop nephrotoxins and assess volume status, often with albumin-based volume expansion when
appropriate
C. Restrict all IV fluids regardless of status
D. Begin iodinated contrast studies immediately
16. Which vasoconstrictor strategy may be used with albumin for HRS-AKI depending on setting and
availability?
A. Nitroprusside
B. Terlipressin or norepinephrine
C. Amlodipine
D. Hydralazine monotherapy
17. A patient with acute liver failure has INR 3.0 but no active bleeding and no procedure planned. What
is the best general approach to plasma transfusion?
NR 574 Acute Care Practicum I - Original 2026 Practice Bank | Educational use
