NRNP 6566 ADVANCED CARE OF
ADULTS IN ACUTE SETTINGS I
KNOWLEDGE CHECK 2026/2027
1. A 65-year-old male with a history of HFrEF presents with acute shortness of breath and
orthopnea. His BP is 160/95, HR 110, and O2 saturation 88% on room air. What is the priority
initial pharmacological intervention?
A. Intravenous Beta-blockers
B. Oral Lisinopril
C. Intravenous Furosemide
D. Intravenous Digoxin
Answer: C
Conceptual Explanation: In acute decompensated heart failure with volume overload,
loop diuretics like intravenous furosemide are the first-line treatment to reduce preload
and improve respiratory status. Beta-blockers should be avoided in the acute phase of
decompensation.
,2. A patient in the ICU develops sudden onset of tachypnea and tachycardia. The ABG shows
pH 7.32, PaCO2 50, and PaO2 55. The patient is diagnosed with ARDS. Which ventilator
strategy is most appropriate?
A. High tidal volume (10-12 mL/kg) and low PEEP
B. Pressure support ventilation with zero PEEP
C. High tidal volume and high FiO2
D. Low tidal volume (4-6 mL/kg) and high PEEP
Answer: D
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (4-6 mL/kg
of predicted body weight) and higher PEEP is the standard of care for ARDS to prevent
ventilator-induced lung injury (VILI) and atelectrauma.
3. Which electrolyte abnormality is most commonly associated with the administration of
large volumes of IV insulin in a patient with Diabetic Ketoacidosis (DKA)?
A. Hypercalcemia
B. Hypernatremia
C. Hypomagnesemia
D. Hypokalemia
Answer: D
, Conceptual Explanation: Insulin causes an intracellular shift of potassium. In DKA, while
total body potassium is depleted, serum levels may appear normal or high; once insulin
starts, levels can drop rapidly, leading to life-threatening hypokalemia.
4. A 72-year-old female is admitted with suspected sepsis. Her MAP is 58 mmHg despite a 30
mL/kg fluid bolus. Which vasopressor is the first-line choice for septic shock?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Epinephrine
Answer: B
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock that
is non-responsive to fluid resuscitation, as it effectively increases MAP with fewer
tachyarrhythmias than dopamine.
5. In a patient presenting with an acute ischemic stroke, what is the maximum time window
for the administration of intravenous Alteplase (tPA) from the time the patient was last
known well?
A. 4.5 hours
B. 3 hours
C. 90 minutes
ADULTS IN ACUTE SETTINGS I
KNOWLEDGE CHECK 2026/2027
1. A 65-year-old male with a history of HFrEF presents with acute shortness of breath and
orthopnea. His BP is 160/95, HR 110, and O2 saturation 88% on room air. What is the priority
initial pharmacological intervention?
A. Intravenous Beta-blockers
B. Oral Lisinopril
C. Intravenous Furosemide
D. Intravenous Digoxin
Answer: C
Conceptual Explanation: In acute decompensated heart failure with volume overload,
loop diuretics like intravenous furosemide are the first-line treatment to reduce preload
and improve respiratory status. Beta-blockers should be avoided in the acute phase of
decompensation.
,2. A patient in the ICU develops sudden onset of tachypnea and tachycardia. The ABG shows
pH 7.32, PaCO2 50, and PaO2 55. The patient is diagnosed with ARDS. Which ventilator
strategy is most appropriate?
A. High tidal volume (10-12 mL/kg) and low PEEP
B. Pressure support ventilation with zero PEEP
C. High tidal volume and high FiO2
D. Low tidal volume (4-6 mL/kg) and high PEEP
Answer: D
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (4-6 mL/kg
of predicted body weight) and higher PEEP is the standard of care for ARDS to prevent
ventilator-induced lung injury (VILI) and atelectrauma.
3. Which electrolyte abnormality is most commonly associated with the administration of
large volumes of IV insulin in a patient with Diabetic Ketoacidosis (DKA)?
A. Hypercalcemia
B. Hypernatremia
C. Hypomagnesemia
D. Hypokalemia
Answer: D
, Conceptual Explanation: Insulin causes an intracellular shift of potassium. In DKA, while
total body potassium is depleted, serum levels may appear normal or high; once insulin
starts, levels can drop rapidly, leading to life-threatening hypokalemia.
4. A 72-year-old female is admitted with suspected sepsis. Her MAP is 58 mmHg despite a 30
mL/kg fluid bolus. Which vasopressor is the first-line choice for septic shock?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Epinephrine
Answer: B
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock that
is non-responsive to fluid resuscitation, as it effectively increases MAP with fewer
tachyarrhythmias than dopamine.
5. In a patient presenting with an acute ischemic stroke, what is the maximum time window
for the administration of intravenous Alteplase (tPA) from the time the patient was last
known well?
A. 4.5 hours
B. 3 hours
C. 90 minutes
