NR 574 Acute Care Practicum I Final
Comprehensive Exam 2026/2027 — 150 Latest
Questions & Correct Answers
Section 1: Gastrointestinal & Genitourinary Emergencies (Questions 1–25)
1. A 72-year-old with atrial fibrillation develops sudden severe periumbilical pain that seems
disproportionate to the abdominal examination. Which diagnosis is most concerning?
A. Acute mesenteric ischemia
B. Uncomplicated diverticulitis
C. Viral gastroenteritis
D. Irritable bowel syndrome
Correct Answer: A — Sudden severe pain out of proportion to exam findings in a patient
with AF suggests acute mesenteric ischemia from an embolic occlusion
2. A patient with suspected bowel perforation has rigid guarding, fever, and worsening
tachycardia. What is the priority management approach?
A. Schedule outpatient endoscopy
B. Urgent surgical evaluation with resuscitation and broad-spectrum antibiotics
,C. Give an oral laxative and reassess
D. Delay intervention until stool cultures return
Correct Answer: B — Bowel perforation is a surgical emergency requiring resuscitation
and broad-spectrum antibiotics
3. Which imaging study is generally most useful in a hemodynamically stable adult when
intestinal perforation is suspected?
A. Plain abdominal radiograph only
B. CT of the abdomen and pelvis
C. HIDA scan
D. Barium enema
Correct Answer: B — CT of the abdomen and pelvis is the imaging study of choice for
suspected perforation
4. A patient with small-bowel obstruction has persistent vomiting and dehydration. Which
initial intervention best addresses immediate physiologic risk?
A. High-fiber oral diet
B. Nasogastric decompression and IV fluid resuscitation
C. Immediate surgical resection
D. Oral contrast study
,Correct Answer: B — NG decompression and IV fluids address the immediate risks of
vomiting and dehydration
5. A key characteristic of Type 1 hepatorenal syndrome is:
A. Gradual renal impairment
B. Reversible kidney damage
C. Rapidly progressive renal failure
D. Stable renal function
Correct Answer: C — Type 1 HRS is characterized by rapidly progressive renal
impairment with doubling of serum Cr to >2.5 mg/dL over <2 weeks
6. Patients with advanced liver failure run the risk of developing hepatorenal syndrome,
which can occur secondary to which of the following?
A. Dumping syndrome
B. Decreased vascular perfusion to the kidneys
C. Prolonged clotting time
D. Portal hypertension
Correct Answer: B — HRS occurs due to decreased vascular perfusion to the kidneys
secondary to splanchnic vasodilation
, 7. What is the treatment of choice for both Type 1 and Type 2 hepatorenal syndrome?
A. Hemodialysis
B. Liver transplant
C. Albumin infusion
D. Vasopressors
Correct Answer: B — Liver transplant is the treatment of choice for both types of HRS
8. Which of the following is a risk factor for hepatorenal syndrome?
A. Dilutional hyponatremia
B. Hyperkalemia
C. Metabolic alkalosis
D. Hyperglycemia
Correct Answer: A — Dilutional hyponatremia is a recognized risk factor for HRS
9. A patient with cirrhosis and ascites presents with increased serum Cr >0.3 mg/dL within
48 hours. This meets diagnostic criteria for:
A. Acute kidney injury
B. Hepatorenal syndrome
C. Prerenal azotemia
D. Acute tubular necrosis
Comprehensive Exam 2026/2027 — 150 Latest
Questions & Correct Answers
Section 1: Gastrointestinal & Genitourinary Emergencies (Questions 1–25)
1. A 72-year-old with atrial fibrillation develops sudden severe periumbilical pain that seems
disproportionate to the abdominal examination. Which diagnosis is most concerning?
A. Acute mesenteric ischemia
B. Uncomplicated diverticulitis
C. Viral gastroenteritis
D. Irritable bowel syndrome
Correct Answer: A — Sudden severe pain out of proportion to exam findings in a patient
with AF suggests acute mesenteric ischemia from an embolic occlusion
2. A patient with suspected bowel perforation has rigid guarding, fever, and worsening
tachycardia. What is the priority management approach?
A. Schedule outpatient endoscopy
B. Urgent surgical evaluation with resuscitation and broad-spectrum antibiotics
,C. Give an oral laxative and reassess
D. Delay intervention until stool cultures return
Correct Answer: B — Bowel perforation is a surgical emergency requiring resuscitation
and broad-spectrum antibiotics
3. Which imaging study is generally most useful in a hemodynamically stable adult when
intestinal perforation is suspected?
A. Plain abdominal radiograph only
B. CT of the abdomen and pelvis
C. HIDA scan
D. Barium enema
Correct Answer: B — CT of the abdomen and pelvis is the imaging study of choice for
suspected perforation
4. A patient with small-bowel obstruction has persistent vomiting and dehydration. Which
initial intervention best addresses immediate physiologic risk?
A. High-fiber oral diet
B. Nasogastric decompression and IV fluid resuscitation
C. Immediate surgical resection
D. Oral contrast study
,Correct Answer: B — NG decompression and IV fluids address the immediate risks of
vomiting and dehydration
5. A key characteristic of Type 1 hepatorenal syndrome is:
A. Gradual renal impairment
B. Reversible kidney damage
C. Rapidly progressive renal failure
D. Stable renal function
Correct Answer: C — Type 1 HRS is characterized by rapidly progressive renal
impairment with doubling of serum Cr to >2.5 mg/dL over <2 weeks
6. Patients with advanced liver failure run the risk of developing hepatorenal syndrome,
which can occur secondary to which of the following?
A. Dumping syndrome
B. Decreased vascular perfusion to the kidneys
C. Prolonged clotting time
D. Portal hypertension
Correct Answer: B — HRS occurs due to decreased vascular perfusion to the kidneys
secondary to splanchnic vasodilation
, 7. What is the treatment of choice for both Type 1 and Type 2 hepatorenal syndrome?
A. Hemodialysis
B. Liver transplant
C. Albumin infusion
D. Vasopressors
Correct Answer: B — Liver transplant is the treatment of choice for both types of HRS
8. Which of the following is a risk factor for hepatorenal syndrome?
A. Dilutional hyponatremia
B. Hyperkalemia
C. Metabolic alkalosis
D. Hyperglycemia
Correct Answer: A — Dilutional hyponatremia is a recognized risk factor for HRS
9. A patient with cirrhosis and ascites presents with increased serum Cr >0.3 mg/dL within
48 hours. This meets diagnostic criteria for:
A. Acute kidney injury
B. Hepatorenal syndrome
C. Prerenal azotemia
D. Acute tubular necrosis
