NR 574 ACUTE-CARE PRACTICUM I EXAM
2026 | NGN-STYLE COMPREHENSIVE
PRACTICE QUESTIONS, VERIFIED ANSWERS
& DETAILED RATIONALES | ADVANCED
PRACTICE NURSING | JUST RELEASED PDF
NR 574 ACUTE-CARE PRACTICUM I EXAM 2026
NGN-STYLE COMPREHENSIVE PRACTICE QUESTIONS
DOCUMENT OVERVIEW
• 200 NGN-formatted questions covering acute-care nursing scenarios, clinical
decision-making, and advanced practice interventions with verified answers
• Study by reviewing each question's rationale to deepen understanding of
evidence-based practice; focus on questions you miss to identify knowledge gaps
QUESTION 1
A 68-year-old male presents to the ED with acute onset chest pain radiating to
the left arm, diaphoresis, and dyspnea. His 12-lead ECG shows ST elevation in
leads II, III, and aVF. Blood pressure is 92/58 mmHg, heart rate 108 bpm. What
is the priority nursing intervention?
A) Administer aspirin 325 mg and nitrates
B) Establish large-bore IV access and initiate continuous cardiac monitoring
C) Obtain chest X-ray to rule out pneumonia
D) Place patient in reverse Trendelenburg position
E) Administer oxygen and prepare for immediate cardiac catheterization
✓ CORRECT ANSWER: E) Establish large-bore IV access and initiate continuous
cardiac monitoring while preparing for immediate cardiac catheterization
,RATIONALE: This patient is experiencing an acute STEMI (ST-elevation myocardial
infarction) of the inferior wall. The priority is to stabilize the patient
hemodynamically (IV access, monitoring) and prepare for reperfusion therapy
(cardiac catheterization), which is the gold standard for STEMI management. While
aspirin and oxygen are important, the priority action is establishing vascular access
and continuous monitoring while expediting catheterization. Nitrates may worsen
hypotension in this hypotensive patient. Chest X-ray delays critical care.
QUESTION 2
A 54-year-old female with acute decompensated heart failure presents with
orthopnea, paroxysmal nocturnal dyspnea, and bilateral peripheral edema.
BNP is 450 pg/mL. Which pharmacological intervention should be initiated
first?
A) Initiate dobutamine infusion
B) Administer IV furosemide
C) Start beta-blocker therapy
D) Initiate ACE inhibitor
E) Administer milrinone
✓ CORRECT ANSWER: B) Administer IV furosemide
RATIONALE: In acute decompensated heart failure with pulmonary congestion
symptoms (orthopnea, PND), diuretics are the first-line therapy to reduce fluid
overload and improve breathing. Furosemide acts rapidly to promote diuresis.
While beta-blockers and ACE inhibitors are essential long-term therapies, they are
not acute interventions. Dobutamine and milrinone are inotropes reserved for
cardiogenic shock or severe hypotension, which this patient does not have.
QUESTION 3
,A 45-year-old male with sepsis secondary to pneumonia presents with fever
39.8°C, HR 118 bpm, RR 28/min, BP 88/52 mmHg, and lactate 3.2 mmol/L. What
is the first critical intervention per sepsis protocols?
A) Administer broad-spectrum antibiotics
B) Draw blood cultures and administer broad-spectrum antibiotics
C) Initiate vasopressor support immediately
D) Administer 500 mL normal saline bolus
E) Place central venous catheter
✓ CORRECT ANSWER: B) Draw blood cultures and administer broad-spectrum
antibiotics
RATIONALE: According to surviving sepsis campaign guidelines, blood cultures must
be drawn BEFORE antibiotics but both should occur within the first hour. Broad-
spectrum antibiotics are critical within 1 hour of sepsis diagnosis. While IV fluids
and vasopressors are also important, antibiotics take priority along with cultures to
identify the organism. Central lines are supportive but not the first intervention.
QUESTION 4
A 62-year-old male experiencing acute ischemic stroke within 3 hours of
symptom onset presents to the ED. CT head shows no hemorrhage. What is
the next immediate action?
A) Administer aspirin 325 mg
B) Prepare patient for thrombolytic therapy with alteplase (tPA)
C) Initiate anticoagulation with heparin
D) Obtain MRI brain
E) Start physical therapy
✓ CORRECT ANSWER: B) Prepare patient for thrombolytic therapy with
alteplase (tPA)
, RATIONALE: A patient within the 3-4.5 hour window (ideal within 4.5 hours for most
patients) with acute ischemic stroke and ruled-out hemorrhage is a candidate for
thrombolytic therapy with IV tPA. This is the gold standard for acute ischemic stroke
management in this timeframe. Aspirin and anticoagulation come after
thrombolytics or in cases where thrombolytics are contraindicated. MRI, while
useful, delays treatment.
QUESTION 5
A 71-year-old female with COPD presents with acute exacerbation: increased
sputum production, dyspnea, and wheezing. ABG shows pH 7.32, PCO2 58
mmHg, HCO3 28 mEq/L, PO2 62 mmHg. Which intervention is most
appropriate?
A) Intubation and mechanical ventilation
B) Oxygen to maintain SaO2 88-92%, bronchodilators, and corticosteroids
C) High-flow oxygen (non-rebreather mask)
D) Sedation and paralysis
E) Immediate transfer to ICU without interventions
✓ CORRECT ANSWER: B) Oxygen to maintain SaO2 88-92%, bronchodilators,
and corticosteroids
RATIONALE: This patient has acute exacerbation of COPD with compensatory
respiratory acidosis (pH 7.32, elevated PCO2 and HCO3). The goal is gentle
oxygenation (88-92% target) to avoid suppressing respiratory drive, combined with
bronchodilators and corticosteroids. High-flow oxygen risks CO2 retention.
Intubation is reserved for respiratory failure, not as first-line. This patient is
compensating adequately with mild acidosis, allowing time for medical
management.
QUESTION 6
2026 | NGN-STYLE COMPREHENSIVE
PRACTICE QUESTIONS, VERIFIED ANSWERS
& DETAILED RATIONALES | ADVANCED
PRACTICE NURSING | JUST RELEASED PDF
NR 574 ACUTE-CARE PRACTICUM I EXAM 2026
NGN-STYLE COMPREHENSIVE PRACTICE QUESTIONS
DOCUMENT OVERVIEW
• 200 NGN-formatted questions covering acute-care nursing scenarios, clinical
decision-making, and advanced practice interventions with verified answers
• Study by reviewing each question's rationale to deepen understanding of
evidence-based practice; focus on questions you miss to identify knowledge gaps
QUESTION 1
A 68-year-old male presents to the ED with acute onset chest pain radiating to
the left arm, diaphoresis, and dyspnea. His 12-lead ECG shows ST elevation in
leads II, III, and aVF. Blood pressure is 92/58 mmHg, heart rate 108 bpm. What
is the priority nursing intervention?
A) Administer aspirin 325 mg and nitrates
B) Establish large-bore IV access and initiate continuous cardiac monitoring
C) Obtain chest X-ray to rule out pneumonia
D) Place patient in reverse Trendelenburg position
E) Administer oxygen and prepare for immediate cardiac catheterization
✓ CORRECT ANSWER: E) Establish large-bore IV access and initiate continuous
cardiac monitoring while preparing for immediate cardiac catheterization
,RATIONALE: This patient is experiencing an acute STEMI (ST-elevation myocardial
infarction) of the inferior wall. The priority is to stabilize the patient
hemodynamically (IV access, monitoring) and prepare for reperfusion therapy
(cardiac catheterization), which is the gold standard for STEMI management. While
aspirin and oxygen are important, the priority action is establishing vascular access
and continuous monitoring while expediting catheterization. Nitrates may worsen
hypotension in this hypotensive patient. Chest X-ray delays critical care.
QUESTION 2
A 54-year-old female with acute decompensated heart failure presents with
orthopnea, paroxysmal nocturnal dyspnea, and bilateral peripheral edema.
BNP is 450 pg/mL. Which pharmacological intervention should be initiated
first?
A) Initiate dobutamine infusion
B) Administer IV furosemide
C) Start beta-blocker therapy
D) Initiate ACE inhibitor
E) Administer milrinone
✓ CORRECT ANSWER: B) Administer IV furosemide
RATIONALE: In acute decompensated heart failure with pulmonary congestion
symptoms (orthopnea, PND), diuretics are the first-line therapy to reduce fluid
overload and improve breathing. Furosemide acts rapidly to promote diuresis.
While beta-blockers and ACE inhibitors are essential long-term therapies, they are
not acute interventions. Dobutamine and milrinone are inotropes reserved for
cardiogenic shock or severe hypotension, which this patient does not have.
QUESTION 3
,A 45-year-old male with sepsis secondary to pneumonia presents with fever
39.8°C, HR 118 bpm, RR 28/min, BP 88/52 mmHg, and lactate 3.2 mmol/L. What
is the first critical intervention per sepsis protocols?
A) Administer broad-spectrum antibiotics
B) Draw blood cultures and administer broad-spectrum antibiotics
C) Initiate vasopressor support immediately
D) Administer 500 mL normal saline bolus
E) Place central venous catheter
✓ CORRECT ANSWER: B) Draw blood cultures and administer broad-spectrum
antibiotics
RATIONALE: According to surviving sepsis campaign guidelines, blood cultures must
be drawn BEFORE antibiotics but both should occur within the first hour. Broad-
spectrum antibiotics are critical within 1 hour of sepsis diagnosis. While IV fluids
and vasopressors are also important, antibiotics take priority along with cultures to
identify the organism. Central lines are supportive but not the first intervention.
QUESTION 4
A 62-year-old male experiencing acute ischemic stroke within 3 hours of
symptom onset presents to the ED. CT head shows no hemorrhage. What is
the next immediate action?
A) Administer aspirin 325 mg
B) Prepare patient for thrombolytic therapy with alteplase (tPA)
C) Initiate anticoagulation with heparin
D) Obtain MRI brain
E) Start physical therapy
✓ CORRECT ANSWER: B) Prepare patient for thrombolytic therapy with
alteplase (tPA)
, RATIONALE: A patient within the 3-4.5 hour window (ideal within 4.5 hours for most
patients) with acute ischemic stroke and ruled-out hemorrhage is a candidate for
thrombolytic therapy with IV tPA. This is the gold standard for acute ischemic stroke
management in this timeframe. Aspirin and anticoagulation come after
thrombolytics or in cases where thrombolytics are contraindicated. MRI, while
useful, delays treatment.
QUESTION 5
A 71-year-old female with COPD presents with acute exacerbation: increased
sputum production, dyspnea, and wheezing. ABG shows pH 7.32, PCO2 58
mmHg, HCO3 28 mEq/L, PO2 62 mmHg. Which intervention is most
appropriate?
A) Intubation and mechanical ventilation
B) Oxygen to maintain SaO2 88-92%, bronchodilators, and corticosteroids
C) High-flow oxygen (non-rebreather mask)
D) Sedation and paralysis
E) Immediate transfer to ICU without interventions
✓ CORRECT ANSWER: B) Oxygen to maintain SaO2 88-92%, bronchodilators,
and corticosteroids
RATIONALE: This patient has acute exacerbation of COPD with compensatory
respiratory acidosis (pH 7.32, elevated PCO2 and HCO3). The goal is gentle
oxygenation (88-92% target) to avoid suppressing respiratory drive, combined with
bronchodilators and corticosteroids. High-flow oxygen risks CO2 retention.
Intubation is reserved for respiratory failure, not as first-line. This patient is
compensating adequately with mild acidosis, allowing time for medical
management.
QUESTION 6
