NRNP 6566 ADVANCED CARE OF
ADULTS IN ACUTE SETTINGS I -
KNOWLEDGE CHECK QUESTIONS AND
ANSWERS
1. A patient presents 3 days post-myocardial infarction with sudden onset of a new
holosystolic murmur at the apex, pulmonary edema, and hypotension. Which complication is
most likely?
A. Ventricular septal rupture
B. Left ventricular aneurysm
C. Pericarditis
D. Papillary muscle rupture
Answer: D
Conceptual Explanation: Papillary muscle rupture typically occurs 2-7 days post-MI,
causing acute mitral regurgitation, a holosystolic murmur at the apex, and rapid
hemodynamic collapse.
,2. In the management of ARDS, which ventilator strategy has been shown to improve
survival?
A. High tidal volume (10-12 mL/kg)
B. Low PEEP levels
C. Permissive hyperoxia
D. Low tidal volume (6 mL/kg)
Answer: D
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (6 mL/kg of
predicted body weight) reduces volutrauma and is proven to decrease mortality in ARDS.
3. Which of the following is the most effective intervention to prevent contrast-induced
nephropathy (CIN) in a high-risk patient undergoing coronary angiography?
A. Oral N-acetylcysteine alone
B. High-dose loop diuretics
C. Intravenous hydration with isotonic saline
D. Mannitol infusion
Answer: C
Conceptual Explanation: Isotonic saline hydration is the most evidence-based method to
prevent CIN; diuretics can actually worsen the risk by causing volume depletion.
, 4. A patient with acute pancreatitis has a Ranson’s score of 5. What does this indicate
regarding their predicted mortality?
A. 0-3% mortality
B. 10-15% mortality
C. 40-50% mortality
D. Nearly 100% mortality
Answer: C
Conceptual Explanation: A Ranson’s score of 5-6 indicates severe pancreatitis with a
predicted mortality rate of approximately 40%.
5. Which laboratory finding differentiates Hyperosmolar Hyperglycemic State (HHS) from
Diabetic Ketoacidosis (DKA)?
A. Blood glucose > 600 mg/dL
B. Presence of significant ketonuria
C. Arterial pH < 7.30
D. Serum bicarbonate < 18 mEq/L
Answer: A
Conceptual Explanation: HHS is characterized by extreme hyperglycemia (often >600
mg/dL) and high serum osmolality without significant ketoacidosis, whereas DKA involves
lower glucose levels and acidosis.
ADULTS IN ACUTE SETTINGS I -
KNOWLEDGE CHECK QUESTIONS AND
ANSWERS
1. A patient presents 3 days post-myocardial infarction with sudden onset of a new
holosystolic murmur at the apex, pulmonary edema, and hypotension. Which complication is
most likely?
A. Ventricular septal rupture
B. Left ventricular aneurysm
C. Pericarditis
D. Papillary muscle rupture
Answer: D
Conceptual Explanation: Papillary muscle rupture typically occurs 2-7 days post-MI,
causing acute mitral regurgitation, a holosystolic murmur at the apex, and rapid
hemodynamic collapse.
,2. In the management of ARDS, which ventilator strategy has been shown to improve
survival?
A. High tidal volume (10-12 mL/kg)
B. Low PEEP levels
C. Permissive hyperoxia
D. Low tidal volume (6 mL/kg)
Answer: D
Conceptual Explanation: Lung-protective ventilation using low tidal volumes (6 mL/kg of
predicted body weight) reduces volutrauma and is proven to decrease mortality in ARDS.
3. Which of the following is the most effective intervention to prevent contrast-induced
nephropathy (CIN) in a high-risk patient undergoing coronary angiography?
A. Oral N-acetylcysteine alone
B. High-dose loop diuretics
C. Intravenous hydration with isotonic saline
D. Mannitol infusion
Answer: C
Conceptual Explanation: Isotonic saline hydration is the most evidence-based method to
prevent CIN; diuretics can actually worsen the risk by causing volume depletion.
, 4. A patient with acute pancreatitis has a Ranson’s score of 5. What does this indicate
regarding their predicted mortality?
A. 0-3% mortality
B. 10-15% mortality
C. 40-50% mortality
D. Nearly 100% mortality
Answer: C
Conceptual Explanation: A Ranson’s score of 5-6 indicates severe pancreatitis with a
predicted mortality rate of approximately 40%.
5. Which laboratory finding differentiates Hyperosmolar Hyperglycemic State (HHS) from
Diabetic Ketoacidosis (DKA)?
A. Blood glucose > 600 mg/dL
B. Presence of significant ketonuria
C. Arterial pH < 7.30
D. Serum bicarbonate < 18 mEq/L
Answer: A
Conceptual Explanation: HHS is characterized by extreme hyperglycemia (often >600
mg/dL) and high serum osmolality without significant ketoacidosis, whereas DKA involves
lower glucose levels and acidosis.
