Chamberlain College of Nursing | NR 571 Complex Diagnosis and Management in Acute
Care Practicum
NR 571 Complex Diagnosis and
Management in Acute Care Practicum
Midterm Examination 2026/2027 |
Verified Questions
Chamberlain College of Nursing | NR 571 Complex Diagnosis and Management in Acute Care Practicum |
University-Level Advanced Practice Nursing Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Chamberlain College of Nursing | NR 571 Complex Diagnosis and Management in Acute Care Practicum
Midterm Comprehensive Examination Actual Exam | Academic Year 2026/2027
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
,Introduction
This examination contains 100 original Verified Questions organized into four core domains that follow
the official blueprint of the Chamberlain College of Nursing NR 571 Complex Diagnosis and Management
in Acute Care Practicum course: Domain 1, Cardiology and Pulmonology in Acute Care, with 25 questions;
Domain 2, Infectious Disease and Sepsis Management, with 25 questions; Domain 3, Neurological and
Gastrointestinal Acute Care, with 25 questions; and Domain 4, Pharmacological Management and
Advanced Diagnostics, with 25 questions. Every question includes four choices, the correct response, and
a rationale that explains the clinical reasoning.
All content in this document is original and has been written to reinforce the official Chamberlain College
of Nursing NR 571 course objectives for the Midterm Comprehensive Examination, supporting actual
exam readiness and clinical proficiency for University-Level advanced nursing students in the 2026/2027
academic year. The questions and rationales follow the foundational acute care textbook methodology of
the NR 571 course materials and standard acute and critical care references, and they align with current
evidence-based acute, critical, and emergency care guidelines. A full answer key and a per-domain score
tracker are provided at the end so that each domain can be checked and used to focus further study.
Actual Questions
Domain 1: Cardiology and Pulmonology in Acute Care
Question 1. Which electrocardiographic finding meets diagnostic criteria for ST-elevation
myocardial infarction in a man with chest pain?
A. ST-segment elevation of at least 1 mm in two contiguous leads, or a newly developed left bundle
branch block with a concerning presentation
B. ST-segment depression of 0.5 mm in two contiguous leads
C. T-wave inversion in leads II, III, and aVF alone
D. A PR interval greater than 200 ms with a normal ST segment
Correct Answer: A
Rationale: Diagnostic ST-elevation myocardial infarction criteria require acute ST elevation of at least 1
mm (0.1 mV) in two or more anatomically contiguous leads, or a newly developed left bundle branch
block with an ischemic presentation, with reciprocal changes supporting the diagnosis. This threshold
and the contiguous lead rule are core content in the NR 571 course materials and standard acute care
ECG criteria. Isolated T-wave inversion or ST depression identifies non-ST-elevation patterns, and PR
prolongation is a conduction finding unrelated to acute infarction.
Question 2. A patient with chest pain has an initial high-sensitivity troponin of 24 ng/L.
Which next step is appropriate?
A. Discharge immediately because the level is confirmatory of myocardial infarction at any value
B. Administer thrombolytic therapy based on this single result
C. Serial troponin measurement and reassessment of symptoms and ECG, with the result
interpreted against the assay's sex-specific 99th percentile
D. Start antibiotics for suspected myopericarditis
Correct Answer: C
Rationale: High-sensitivity troponin assays stratify risk using serial measurements, and results are
interpreted against the assay-specific 99th percentile upper reference limit, with a rise or fall indicating
myocardial injury. A single mildly elevated value is not diagnostic, which is why serial sampling and
symptom and ECG correlation are standard before labeling acute myocardial injury. The NR 571
curriculum emphasizes that elevation also occurs in renal failure, myocarditis, and pulmonary
embolism, so results must be read in context.
Question 3. A patient with an inferior ST-elevation myocardial infarction becomes
profoundly hypotensive after sublingual nitroglycerin. What is the most appropriate
action?
A. Increase the nitroglycerin dose to overcome the tolerance
B. Administer a beta blocker while continuing the nitrate
C. Start an angiotensin-converting enzyme inhibitor immediately
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
, D. Obtain right-sided ECG leads, give intravenous fluids, and avoid further nitrates
Correct Answer: D
Rationale: Hypotension after nitroglycerin in inferior infarction suggests right ventricular involvement,
because preload-dependent right ventricular ischemia worsens with vasodilation. Right-sided leads,
especially V4R, confirm the diagnosis, and treatment is volume expansion while nitrates and diuretics
are avoided. This clinical sequence is a classic acute care pattern in the NR 571 course materials; beta
blockers and ACE inhibitors are also poorly tolerated when right ventricular preload is compromised.
Question 4. A hemodynamically stable patient with recent-onset atrial fibrillation has a
ventricular rate of 146. Which initial intervention is appropriate?
A. Immediate synchronized cardioversion
B. Rate control with a beta blocker or nondihydropyridine calcium channel blocker
C. Digoxin loading as the sole first-line therapy
D. Unsynced defibrillation at 200 joules
Correct Answer: B
Rationale: In stable recent-onset atrial fibrillation, rate control with a beta blocker such as metoprolol
or a nondihydropyridine calcium channel blocker such as diltiazem is first-line; synchronized
cardioversion is reserved for hemodynamic instability or refractory symptomatic tachydysrhythmia.
Digoxin is a second-line rate agent, especially with concurrent heart failure, and unsynchronized
defibrillation is for pulseless ventricular rhythms. Anticoagulation decisions follow stroke risk scoring, a
key distinction taught in the NR 571 course materials.
Question 5. A patient with a prolonged QT interval develops polymorphic ventricular
tachycardia with a pulse. Which medication is indicated?
A. Intravenous amiodarone as the sole initial agent
B. Intravenous procainamide
C. Intravenous magnesium sulfate
D. Atropine 1 mg every 3 minutes
Correct Answer: C
Rationale: Torsades de pointes is treated with intravenous magnesium sulfate even when the serum
magnesium is normal, followed by correction of potassium and magnesium deficits and discontinuation
of QT-prolonging drugs. Amiodarone and procainamide may worsen or perpetuate polymorphic
tachycardia in this setting and are not first-line, and atropine is for bradycardia. These treatment
priorities are emphasized in the NR 571 course materials and standard advanced cardiac life support
algorithms.
Question 6. A stable patient with a narrow-complex regular tachycardia at 190 bpm
receives adenosine 6 mg intravenously with no effect. What is the next step?
A. Adenosine 12 mg, then synchronized cardioversion if the rhythm persists
B. Immediate unsynchronized defibrillation
C. Amiodarone 300 mg rapid push without further adenosine
D. Verapamil 20 mg intravenously over 1 minute
Correct Answer: A
Rationale: Supraventricular tachycardia is managed with rapid intravenous adenosine beginning at 6
mg via a large-bore proximal site followed by a saline flush, escalating to 12 mg if the first dose fails;
synchronized cardioversion follows if the rhythm persists or instability develops. Verapamil is used for
narrow-complex rhythms in selected patients but at lower doses and with caution, and defibrillation is
reserved for unstable or pulseless rhythms. This stepwise algorithm is core to the NR 571 curriculum
and advanced cardiac life support standards.
Question 7. A patient presents with syncope and a heart rate of 32 with third-degree heart
block. Which intervention is required?
A. Atropine only, repeated indefinitely
B. Transcutaneous pacing with preparation for transvenous pacemaker placement
C. Initiation of a beta blocker to reduce the ventricular rate
D. Observation with telemetry alone
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
, Correct Answer: B
Rationale: Third-degree heart block with symptomatic bradycardia requires immediate pacing;
transcutaneous pacing provides temporary support while transvenous pacing is arranged, with
atropine used only as a bridge when true atrioventricular nodal block is the cause. Beta blockers would
worsen the block and are contraindicated, and observation alone is unsafe in an unstable patient.
Recognition of the requirement for pacing is a key competency in the NR 571 course materials and
advanced cardiac life support algorithms.
Question 8. Which cluster of findings is most characteristic of cardiac tamponade?
A. Fever, a newly apparent murmur, and splinter hemorrhages
B. A widened pulse pressure with bounding pulses
C. Unilateral leg swelling with pleuritic chest pain
D. Hypotension, muffled heart sounds, jugular venous distention, and pulsus paradoxus
Correct Answer: D
Rationale: Cardiac tamponade presents with Beck's triad of hypotension, muffled heart sounds, and
jugular venous distention, along with pulsus paradoxus and electrical alternans, from impaired
diastolic filling of the compressed heart. Immediate management is pericardial drainage guided by
bedside ultrasound. Fever with a murmur and embolic signs suggests endocarditis, a widened pulse
pressure suggests aortic regurgitation or high-output states, and unilateral leg swelling with pleuritic
pain suggests thromboembolism, each a distinct diagnostic pathway.
Question 9. A patient with sudden tearing chest pain has a widened mediastinum on chest
radiograph. Which action is contraindicated?
A. Thrombolytic therapy
B. Beta blocker therapy to reduce aortic wall stress
C. Intravenous antihypertensive therapy to lower blood pressure
D. Immediate cross-sectional aortic imaging
Correct Answer: A
Rationale: Suspected aortic dissection demands rapid imaging with CT angiography and control of
heart rate and blood pressure with beta blockers and vasodilators to reduce aortic wall stress.
Thrombolytics are strictly contraindicated because they exacerbate hemorrhage into the dissection and
worsen mortality, a distinction from acute myocardial infarction that the NR 571 course materials
stress. The management priority is blood pressure and heart rate control, not fibrinolysis.
Question 10. Which blood pressure target is appropriate for a patient with hypertensive
emergency and acute ischemic stroke who is not receiving thrombolytic therapy?
A. Reduce systolic blood pressure below 120 mm Hg within the first hour
B. Lower the mean arterial pressure to 65 mm Hg immediately
C. Withhold all antihypertensive therapy for the first 72 hours
D. Reduce blood pressure by about 15 percent over the first 24 hours
Correct Answer: D
Rationale: In hypertensive emergency with acute ischemic stroke not treated with reperfusion therapy,
blood pressure is lowered cautiously, by about 15 percent in the first 24 hours, because rapid reduction
can extend the ischemic penumbra. Patients treated with thrombolysis require tighter control below
185/110 mm Hg before and 180/105 mm Hg after therapy. These differentiated targets are foundational
in the NR 571 course materials, and the treatment approaches for stroke differ from routine
hypertensive emergency guidelines.
Question 11. A patient has positional chest pain that improves when sitting forward, with
diffuse ST elevation and PR depression on ECG. Which diagnosis is most likely?
A. Acute myocardial infarction
B. Acute pericarditis
C. Aortic dissection
D. Pulmonary embolism
Correct Answer: B
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
Care Practicum
NR 571 Complex Diagnosis and
Management in Acute Care Practicum
Midterm Examination 2026/2027 |
Verified Questions
Chamberlain College of Nursing | NR 571 Complex Diagnosis and Management in Acute Care Practicum |
University-Level Advanced Practice Nursing Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Chamberlain College of Nursing | NR 571 Complex Diagnosis and Management in Acute Care Practicum
Midterm Comprehensive Examination Actual Exam | Academic Year 2026/2027
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
,Introduction
This examination contains 100 original Verified Questions organized into four core domains that follow
the official blueprint of the Chamberlain College of Nursing NR 571 Complex Diagnosis and Management
in Acute Care Practicum course: Domain 1, Cardiology and Pulmonology in Acute Care, with 25 questions;
Domain 2, Infectious Disease and Sepsis Management, with 25 questions; Domain 3, Neurological and
Gastrointestinal Acute Care, with 25 questions; and Domain 4, Pharmacological Management and
Advanced Diagnostics, with 25 questions. Every question includes four choices, the correct response, and
a rationale that explains the clinical reasoning.
All content in this document is original and has been written to reinforce the official Chamberlain College
of Nursing NR 571 course objectives for the Midterm Comprehensive Examination, supporting actual
exam readiness and clinical proficiency for University-Level advanced nursing students in the 2026/2027
academic year. The questions and rationales follow the foundational acute care textbook methodology of
the NR 571 course materials and standard acute and critical care references, and they align with current
evidence-based acute, critical, and emergency care guidelines. A full answer key and a per-domain score
tracker are provided at the end so that each domain can be checked and used to focus further study.
Actual Questions
Domain 1: Cardiology and Pulmonology in Acute Care
Question 1. Which electrocardiographic finding meets diagnostic criteria for ST-elevation
myocardial infarction in a man with chest pain?
A. ST-segment elevation of at least 1 mm in two contiguous leads, or a newly developed left bundle
branch block with a concerning presentation
B. ST-segment depression of 0.5 mm in two contiguous leads
C. T-wave inversion in leads II, III, and aVF alone
D. A PR interval greater than 200 ms with a normal ST segment
Correct Answer: A
Rationale: Diagnostic ST-elevation myocardial infarction criteria require acute ST elevation of at least 1
mm (0.1 mV) in two or more anatomically contiguous leads, or a newly developed left bundle branch
block with an ischemic presentation, with reciprocal changes supporting the diagnosis. This threshold
and the contiguous lead rule are core content in the NR 571 course materials and standard acute care
ECG criteria. Isolated T-wave inversion or ST depression identifies non-ST-elevation patterns, and PR
prolongation is a conduction finding unrelated to acute infarction.
Question 2. A patient with chest pain has an initial high-sensitivity troponin of 24 ng/L.
Which next step is appropriate?
A. Discharge immediately because the level is confirmatory of myocardial infarction at any value
B. Administer thrombolytic therapy based on this single result
C. Serial troponin measurement and reassessment of symptoms and ECG, with the result
interpreted against the assay's sex-specific 99th percentile
D. Start antibiotics for suspected myopericarditis
Correct Answer: C
Rationale: High-sensitivity troponin assays stratify risk using serial measurements, and results are
interpreted against the assay-specific 99th percentile upper reference limit, with a rise or fall indicating
myocardial injury. A single mildly elevated value is not diagnostic, which is why serial sampling and
symptom and ECG correlation are standard before labeling acute myocardial injury. The NR 571
curriculum emphasizes that elevation also occurs in renal failure, myocarditis, and pulmonary
embolism, so results must be read in context.
Question 3. A patient with an inferior ST-elevation myocardial infarction becomes
profoundly hypotensive after sublingual nitroglycerin. What is the most appropriate
action?
A. Increase the nitroglycerin dose to overcome the tolerance
B. Administer a beta blocker while continuing the nitrate
C. Start an angiotensin-converting enzyme inhibitor immediately
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
, D. Obtain right-sided ECG leads, give intravenous fluids, and avoid further nitrates
Correct Answer: D
Rationale: Hypotension after nitroglycerin in inferior infarction suggests right ventricular involvement,
because preload-dependent right ventricular ischemia worsens with vasodilation. Right-sided leads,
especially V4R, confirm the diagnosis, and treatment is volume expansion while nitrates and diuretics
are avoided. This clinical sequence is a classic acute care pattern in the NR 571 course materials; beta
blockers and ACE inhibitors are also poorly tolerated when right ventricular preload is compromised.
Question 4. A hemodynamically stable patient with recent-onset atrial fibrillation has a
ventricular rate of 146. Which initial intervention is appropriate?
A. Immediate synchronized cardioversion
B. Rate control with a beta blocker or nondihydropyridine calcium channel blocker
C. Digoxin loading as the sole first-line therapy
D. Unsynced defibrillation at 200 joules
Correct Answer: B
Rationale: In stable recent-onset atrial fibrillation, rate control with a beta blocker such as metoprolol
or a nondihydropyridine calcium channel blocker such as diltiazem is first-line; synchronized
cardioversion is reserved for hemodynamic instability or refractory symptomatic tachydysrhythmia.
Digoxin is a second-line rate agent, especially with concurrent heart failure, and unsynchronized
defibrillation is for pulseless ventricular rhythms. Anticoagulation decisions follow stroke risk scoring, a
key distinction taught in the NR 571 course materials.
Question 5. A patient with a prolonged QT interval develops polymorphic ventricular
tachycardia with a pulse. Which medication is indicated?
A. Intravenous amiodarone as the sole initial agent
B. Intravenous procainamide
C. Intravenous magnesium sulfate
D. Atropine 1 mg every 3 minutes
Correct Answer: C
Rationale: Torsades de pointes is treated with intravenous magnesium sulfate even when the serum
magnesium is normal, followed by correction of potassium and magnesium deficits and discontinuation
of QT-prolonging drugs. Amiodarone and procainamide may worsen or perpetuate polymorphic
tachycardia in this setting and are not first-line, and atropine is for bradycardia. These treatment
priorities are emphasized in the NR 571 course materials and standard advanced cardiac life support
algorithms.
Question 6. A stable patient with a narrow-complex regular tachycardia at 190 bpm
receives adenosine 6 mg intravenously with no effect. What is the next step?
A. Adenosine 12 mg, then synchronized cardioversion if the rhythm persists
B. Immediate unsynchronized defibrillation
C. Amiodarone 300 mg rapid push without further adenosine
D. Verapamil 20 mg intravenously over 1 minute
Correct Answer: A
Rationale: Supraventricular tachycardia is managed with rapid intravenous adenosine beginning at 6
mg via a large-bore proximal site followed by a saline flush, escalating to 12 mg if the first dose fails;
synchronized cardioversion follows if the rhythm persists or instability develops. Verapamil is used for
narrow-complex rhythms in selected patients but at lower doses and with caution, and defibrillation is
reserved for unstable or pulseless rhythms. This stepwise algorithm is core to the NR 571 curriculum
and advanced cardiac life support standards.
Question 7. A patient presents with syncope and a heart rate of 32 with third-degree heart
block. Which intervention is required?
A. Atropine only, repeated indefinitely
B. Transcutaneous pacing with preparation for transvenous pacemaker placement
C. Initiation of a beta blocker to reduce the ventricular rate
D. Observation with telemetry alone
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
, Correct Answer: B
Rationale: Third-degree heart block with symptomatic bradycardia requires immediate pacing;
transcutaneous pacing provides temporary support while transvenous pacing is arranged, with
atropine used only as a bridge when true atrioventricular nodal block is the cause. Beta blockers would
worsen the block and are contraindicated, and observation alone is unsafe in an unstable patient.
Recognition of the requirement for pacing is a key competency in the NR 571 course materials and
advanced cardiac life support algorithms.
Question 8. Which cluster of findings is most characteristic of cardiac tamponade?
A. Fever, a newly apparent murmur, and splinter hemorrhages
B. A widened pulse pressure with bounding pulses
C. Unilateral leg swelling with pleuritic chest pain
D. Hypotension, muffled heart sounds, jugular venous distention, and pulsus paradoxus
Correct Answer: D
Rationale: Cardiac tamponade presents with Beck's triad of hypotension, muffled heart sounds, and
jugular venous distention, along with pulsus paradoxus and electrical alternans, from impaired
diastolic filling of the compressed heart. Immediate management is pericardial drainage guided by
bedside ultrasound. Fever with a murmur and embolic signs suggests endocarditis, a widened pulse
pressure suggests aortic regurgitation or high-output states, and unilateral leg swelling with pleuritic
pain suggests thromboembolism, each a distinct diagnostic pathway.
Question 9. A patient with sudden tearing chest pain has a widened mediastinum on chest
radiograph. Which action is contraindicated?
A. Thrombolytic therapy
B. Beta blocker therapy to reduce aortic wall stress
C. Intravenous antihypertensive therapy to lower blood pressure
D. Immediate cross-sectional aortic imaging
Correct Answer: A
Rationale: Suspected aortic dissection demands rapid imaging with CT angiography and control of
heart rate and blood pressure with beta blockers and vasodilators to reduce aortic wall stress.
Thrombolytics are strictly contraindicated because they exacerbate hemorrhage into the dissection and
worsen mortality, a distinction from acute myocardial infarction that the NR 571 course materials
stress. The management priority is blood pressure and heart rate control, not fibrinolysis.
Question 10. Which blood pressure target is appropriate for a patient with hypertensive
emergency and acute ischemic stroke who is not receiving thrombolytic therapy?
A. Reduce systolic blood pressure below 120 mm Hg within the first hour
B. Lower the mean arterial pressure to 65 mm Hg immediately
C. Withhold all antihypertensive therapy for the first 72 hours
D. Reduce blood pressure by about 15 percent over the first 24 hours
Correct Answer: D
Rationale: In hypertensive emergency with acute ischemic stroke not treated with reperfusion therapy,
blood pressure is lowered cautiously, by about 15 percent in the first 24 hours, because rapid reduction
can extend the ischemic penumbra. Patients treated with thrombolysis require tighter control below
185/110 mm Hg before and 180/105 mm Hg after therapy. These differentiated targets are foundational
in the NR 571 course materials, and the treatment approaches for stroke differ from routine
hypertensive emergency guidelines.
Question 11. A patient has positional chest pain that improves when sitting forward, with
diffuse ST elevation and PR depression on ECG. Which diagnosis is most likely?
A. Acute myocardial infarction
B. Acute pericarditis
C. Aortic dissection
D. Pulmonary embolism
Correct Answer: B
NR 571 Complex Diagnosis and Management in Acute Care Practicum Midterm Examination 2026/2027 | Verified
Questions
