NR 572 / NR572 FINAL EXAM |ADVANCED ACUTE CARE
MANAGEMENT GUIDE LATEST 2026/2027 UPDATE | CHAMBERLAIN
250 UNIQUE QUESTIONS & VERIFIED ANSWERS WITH COMPLETE
DETAILED SOLUTIONS | GRADED A+ | 100% CORRECT
SECTION 1: CARDIOVASCULAR EMERGENCIES & HEMODYNAMIC MONITORING
(Questions 1–35
Q1. What is the hallmark symptom of Acute Coronary Syndrome (ACS)?
A) Sharp, pleuritic chest pain that worsens with inspiration
B) Substernal chest pressure or pain that may radiate to the jaw, neck, or left arm
C) Epigastric pain that improves with eating
D) Diffuse abdominal pain with nausea and vomiting
Correct Answer: B
Rationale: Acute Coronary Syndrome (ACS) typically presents with substernal
chest pressure or pain that may radiate to the jaw, neck, or left arm. This
pain is often described as crushing, squeezing, or heaviness. It is usually
not pleuritic (worsening with inspiration). Women, diabetics, and the elderly
may present with atypical symptoms such as epigastric pain, nausea, or
fatigue.
Q2. What is the most important initial diagnostic test for a patient with suspected
ACS?
A) Chest X-ray
B) Complete blood count
C) 12-lead electrocardiogram (ECG)
D) Cardiac troponin
Correct Answer: C
Rationale: The 12-lead ECG is the most important initial diagnostic test in
ACS because it can rapidly identify ST-segment elevation myocardial infarction
(STEMI) requiring immediate reperfusion therapy. While troponin is the most
sensitive biomarker for myocardial injury, it can take 2-4 hours to become
elevated, making it less useful in the initial diagnosis.
1
,Q3. What ECG finding is diagnostic of ST-Elevation Myocardial Infarction (STEMI)?
A) ST-segment depression in leads V1-V3
B) New ST-segment elevation at the J point in two contiguous leads
C) T-wave inversion in all leads
D) Q waves in all leads
Correct Answer: B
Rationale: STEMI is diagnosed by new ST-segment elevation at the J point in
two contiguous leads (e.g., V1-V4 for anterior MI, II, III, aVF for inferior
MI). ST-segment depression and T-wave inversion may indicate ischemia or
NSTEMI
but are not diagnostic of STEMI. Q waves indicate old infarction.
Q4. What is the goal time for door-to-balloon (percutaneous coronary
intervention) in STEMI?
A) 30 minutes
B) 60 minutes
C) 90 minutes
D) 120 minutes
Correct Answer: C
Rationale: The guideline-recommended goal for door-to-balloon time in STEMI is
90 minutes or less. This is based on evidence that prompt reperfusion reduces
mortality and improves outcomes. If PCI cannot be performed within 90 minutes,
fibrinolytic therapy should be administered within 30 minutes of arrival.
Q5. What is the treatment for NSTEMI (Non-ST-Elevation Myocardial Infarction)?
A) Immediate PCI
B) Antiplatelet therapy, anticoagulation, and early invasive strategy
C) Fibrinolytic therapy
D) Thrombolytics only
2
,Correct Answer: B
Rationale: NSTEMI is managed with antiplatelet therapy (aspirin, ticagrelor),
anticoagulation (heparin), and an early invasive strategy (coronary angiography
within 24-48 hours) for high-risk patients. Fibrinolytic therapy is not
recommended for NSTEMI, and immediate PCI is only indicated for refractory
ischemia or hemodynamic instability.
Q6. What is the MONA acronym for ACS management?
A) Morphine, Oxygen, Nitroglycerin, Aspirin
B) Morphine, Oxygen, Nitroglycerin, Antiplatelet
C) Morphine, Oxygen, Nitroprusside, Aspirin
D) Metoprolol, Oxygen, Nitroglycerin, Aspirin
Correct Answer: A
Rationale: MONA stands for Morphine (for pain relief), Oxygen (if SpO2 < 90%),
Nitroglycerin (for pain and vasodilation), and Aspirin (antiplatelet). However,
current guidelines recommend judicious use of oxygen only for hypoxia and
morphine only for persistent pain, as both have been associated with increased
mortality in some studies.
Q7. What is the most common cause of cardiac arrest in adults?
A) Ventricular fibrillation (VF)
B) Pulseless electrical activity (PEA)
C) Asystole
D) Ventricular tachycardia (VT)
Correct Answer: A
Rationale: Ventricular fibrillation (VF) is the most common initial rhythm in
out-of-hospital cardiac arrest and the most shockable rhythm. Prompt
defibrillation is critical for survival. PEA and asystole are non-shockable
rhythms with a poorer prognosis.
3
, Q8. What is the first-line treatment for Ventricular Fibrillation (VF)?
A) Amiodarone
B) Lidocaine
C) Defibrillation
D) Epinephrine
Correct Answer: C
Rationale: Defibrillation is the first-line treatment for VF and pulseless
ventricular tachycardia. It delivers an electrical shock to depolarise the
myocardium, allowing the sinoatrial node to resume normal rhythm. Amiodarone
and lidocaine are antiarrhythmic medications given after defibrillation if the
rhythm persists.
Q9. What is the recommended energy setting for biphasic defibrillation in adults?
A) 100 J
B) 120-200 J
C) 360 J (monophasic)
D) 50 J
Correct Answer: B
Rationale: Biphasic defibrillators are typically set at 120-200 J for initial
shocks. Monophasic defibrillators use 360 J. If the initial shock is
unsuccessful, subsequent shocks may be given at higher energy settings,
up to the maximum for the device.
Q10. What is the first-line medication for pulseless Ventricular Tachycardia (VT)?
A) Amiodarone
B) Lidocaine
C) Defibrillation
D) Epinephrine
Correct Answer: C
Rationale: Defibrillation is the first-line treatment for pulseless VT, as it
4
MANAGEMENT GUIDE LATEST 2026/2027 UPDATE | CHAMBERLAIN
250 UNIQUE QUESTIONS & VERIFIED ANSWERS WITH COMPLETE
DETAILED SOLUTIONS | GRADED A+ | 100% CORRECT
SECTION 1: CARDIOVASCULAR EMERGENCIES & HEMODYNAMIC MONITORING
(Questions 1–35
Q1. What is the hallmark symptom of Acute Coronary Syndrome (ACS)?
A) Sharp, pleuritic chest pain that worsens with inspiration
B) Substernal chest pressure or pain that may radiate to the jaw, neck, or left arm
C) Epigastric pain that improves with eating
D) Diffuse abdominal pain with nausea and vomiting
Correct Answer: B
Rationale: Acute Coronary Syndrome (ACS) typically presents with substernal
chest pressure or pain that may radiate to the jaw, neck, or left arm. This
pain is often described as crushing, squeezing, or heaviness. It is usually
not pleuritic (worsening with inspiration). Women, diabetics, and the elderly
may present with atypical symptoms such as epigastric pain, nausea, or
fatigue.
Q2. What is the most important initial diagnostic test for a patient with suspected
ACS?
A) Chest X-ray
B) Complete blood count
C) 12-lead electrocardiogram (ECG)
D) Cardiac troponin
Correct Answer: C
Rationale: The 12-lead ECG is the most important initial diagnostic test in
ACS because it can rapidly identify ST-segment elevation myocardial infarction
(STEMI) requiring immediate reperfusion therapy. While troponin is the most
sensitive biomarker for myocardial injury, it can take 2-4 hours to become
elevated, making it less useful in the initial diagnosis.
1
,Q3. What ECG finding is diagnostic of ST-Elevation Myocardial Infarction (STEMI)?
A) ST-segment depression in leads V1-V3
B) New ST-segment elevation at the J point in two contiguous leads
C) T-wave inversion in all leads
D) Q waves in all leads
Correct Answer: B
Rationale: STEMI is diagnosed by new ST-segment elevation at the J point in
two contiguous leads (e.g., V1-V4 for anterior MI, II, III, aVF for inferior
MI). ST-segment depression and T-wave inversion may indicate ischemia or
NSTEMI
but are not diagnostic of STEMI. Q waves indicate old infarction.
Q4. What is the goal time for door-to-balloon (percutaneous coronary
intervention) in STEMI?
A) 30 minutes
B) 60 minutes
C) 90 minutes
D) 120 minutes
Correct Answer: C
Rationale: The guideline-recommended goal for door-to-balloon time in STEMI is
90 minutes or less. This is based on evidence that prompt reperfusion reduces
mortality and improves outcomes. If PCI cannot be performed within 90 minutes,
fibrinolytic therapy should be administered within 30 minutes of arrival.
Q5. What is the treatment for NSTEMI (Non-ST-Elevation Myocardial Infarction)?
A) Immediate PCI
B) Antiplatelet therapy, anticoagulation, and early invasive strategy
C) Fibrinolytic therapy
D) Thrombolytics only
2
,Correct Answer: B
Rationale: NSTEMI is managed with antiplatelet therapy (aspirin, ticagrelor),
anticoagulation (heparin), and an early invasive strategy (coronary angiography
within 24-48 hours) for high-risk patients. Fibrinolytic therapy is not
recommended for NSTEMI, and immediate PCI is only indicated for refractory
ischemia or hemodynamic instability.
Q6. What is the MONA acronym for ACS management?
A) Morphine, Oxygen, Nitroglycerin, Aspirin
B) Morphine, Oxygen, Nitroglycerin, Antiplatelet
C) Morphine, Oxygen, Nitroprusside, Aspirin
D) Metoprolol, Oxygen, Nitroglycerin, Aspirin
Correct Answer: A
Rationale: MONA stands for Morphine (for pain relief), Oxygen (if SpO2 < 90%),
Nitroglycerin (for pain and vasodilation), and Aspirin (antiplatelet). However,
current guidelines recommend judicious use of oxygen only for hypoxia and
morphine only for persistent pain, as both have been associated with increased
mortality in some studies.
Q7. What is the most common cause of cardiac arrest in adults?
A) Ventricular fibrillation (VF)
B) Pulseless electrical activity (PEA)
C) Asystole
D) Ventricular tachycardia (VT)
Correct Answer: A
Rationale: Ventricular fibrillation (VF) is the most common initial rhythm in
out-of-hospital cardiac arrest and the most shockable rhythm. Prompt
defibrillation is critical for survival. PEA and asystole are non-shockable
rhythms with a poorer prognosis.
3
, Q8. What is the first-line treatment for Ventricular Fibrillation (VF)?
A) Amiodarone
B) Lidocaine
C) Defibrillation
D) Epinephrine
Correct Answer: C
Rationale: Defibrillation is the first-line treatment for VF and pulseless
ventricular tachycardia. It delivers an electrical shock to depolarise the
myocardium, allowing the sinoatrial node to resume normal rhythm. Amiodarone
and lidocaine are antiarrhythmic medications given after defibrillation if the
rhythm persists.
Q9. What is the recommended energy setting for biphasic defibrillation in adults?
A) 100 J
B) 120-200 J
C) 360 J (monophasic)
D) 50 J
Correct Answer: B
Rationale: Biphasic defibrillators are typically set at 120-200 J for initial
shocks. Monophasic defibrillators use 360 J. If the initial shock is
unsuccessful, subsequent shocks may be given at higher energy settings,
up to the maximum for the device.
Q10. What is the first-line medication for pulseless Ventricular Tachycardia (VT)?
A) Amiodarone
B) Lidocaine
C) Defibrillation
D) Epinephrine
Correct Answer: C
Rationale: Defibrillation is the first-line treatment for pulseless VT, as it
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