NR571 / NR 571 MIDTERM EXAM ( LATEST UPDATE)
Complex Diagnosis and Management in Acute Care Practicum
Weeks 1 – 4 Covered | Questions and Verified Answers | 100% Correct
Chamberlain University | Graduate Nursing & Advanced Practice Education
Total Questions 120 (multiple choice)
Cognitive Distribution 20% Recall | 50% Application | 30% Analysis
Format 80% scenario-based | 20% direct knowledge
Standards Alignment AACN Essentials (Master's) + AGACNP Competencies (2026/2027)
1. Cardiovascular (20) 2. Respiratory (18) 3. Neurological (18) 4. Renal/GU (15) 5.
Sections
Endocrine (15) 6. GI/Hepatic (12) 7. Heme/Onc (12) 8. Multisystem/Sepsis (10)
Section 1: Complex Cardiovascular Disorders in Acute Care
Q1: A 58-year-old male presents to the ED with crushing substernal chest pain radiating to the left arm,
diaphoresis, and dyspnea that began 45 minutes ago. The 12-lead ECG shows ST-segment elevation in leads
II, III, and aVF with reciprocal depression in I and aVL. The patient is a candidate for PCI, with an estimated
door-to-balloon time of 70 minutes. Which of the following is the MOST appropriate initial pharmacologic
intervention according to current STEMI guidelines?
A. Administer metoprolol 5 mg IV push immediately to reduce myocardial oxygen demand
B. Administer aspirin 325 mg chewed, unfractionated heparin 60 units/kg IV bolus, and ticagrelor 180
mg loading dose *[CORRECT]*
C. Administer nitroglycerin sublingual every 5 minutes for three doses, then morphine 4 mg IV
D. Administer alteplase 15 mg IV bolus followed by infusion since PCI exceeds the 60-minute goal
Correct Answer: B
Rationale: Inferior STEMI requires immediate reperfusion therapy. Per the NR 571 curriculum and ACC/AHA STEMI
guidelines, dual antiplatelet therapy (aspirin + P2Y12 inhibitor such as ticagrelor) plus anticoagulation is the standard
initial pharmacologic regimen when PCI is planned within 90 minutes (Class I). Beta-blockers are contraindicated in
inferior STEMI due to risk of RV involvement and profound bradycardia. Thrombolytics are reserved for facilities without
PCI capability within 120 minutes. Nitroglycerin and morphine are adjunctive, not primary therapy.
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 1
,Q2: A 67-year-old female is admitted with NSTEMI. Troponin I is 0.8 ng/mL (ref <0.04). The GRACE risk
score is 142. Which finding MOST strongly indicates the need for early invasive coronary angiography within
24 hours?
A. Recurrent angina at rest with dynamic ST-segment changes of 1 mm *[CORRECT]*
B. Sustained hemodynamic stability with blood pressure 128/76 mmHg
C. Troponin elevation alone without chest pain recurrence
D. Resolution of ST depression after sublingual nitroglycerin
Correct Answer: A
Rationale: Recurrent angina at rest with dynamic ST changes is a Class I indication for early invasive strategy (within 24
hours) per ACC/AHA NSTEMI guidelines, reflecting ongoing ischemia. The GRACE score of 142 (>139) further stratifies
the patient as high-risk. Hemodynamic stability alone does not justify conservative management in a high-risk NSTEMI.
Isolated troponin elevation without symptoms may represent a lower-risk presentation. ST resolution after nitroglycerin
does not preclude the need for invasive evaluation when other high-risk features are present.
Q3: A 72-year-old male with a history of hypertension and diabetes presents with acute decompensated heart
failure. BP is 88/52 mmHg, HR 118, RR 32, SpO2 88% on room air. Bilateral crackles, JVD, and cool
extremities are noted. Lactate is 4.2 mmol/L. PA catheter reveals: PCWP 28 mmHg, CI 1.8 L/min/m², SVR
1900 dynes·s/cm⁵. Which hemodynamic profile best characterizes this patient's condition, and what is the
priority intervention?
A. Forrester Class IV (warm/dry) — administer IV fluid bolus to improve preload
B. Forrester Class IV (cold/wet) — initiate inotrope (dobutamine) and consider mechanical circulatory
support *[CORRECT]*
C. Forrester Class II (warm/wet) — administer IV furosemide and vasodilator therapy
D. Forrester Class III (cold/dry) — administer IV fluid challenge to optimize preload
Correct Answer: B
Rationale: The patient presents with cardiogenic shock: hypotension, low cardiac index (<2.2), elevated PCWP (>18),
elevated SVR, and signs of hypoperfusion (lactate 4.2, cool extremities). This is Forrester Class IV (cold/wet). Priority
intervention is inotropic support (dobutamine or milrinone) to improve cardiac output, with consideration of IABP or
Impella if pharmacologic therapy fails. IV fluids would worsen pulmonary edema. Diuresis alone is insufficient given low
cardiac output. Vasodilators are contraindicated with hypotension.
Q4: A 64-year-old post-CABG patient (postoperative day 2) has chest tube drainage that decreased from 250
mL/hr to 30 mL/hr over 4 hours, but now the patient develops tachycardia (HR 128), hypotension (BP 84/50),
elevated CVP (18 mmHg), muffled heart sounds, and pulsus paradoxus of 14 mmHg. Which complication is
MOST likely, and what is the priority action?
A. Acute tamponade — prepare for emergent bedside sternotomy or surgical exploration *[CORRECT]*
B. Acute decompensated heart failure — administer IV furosemide 80 mg
C. Hypovolemic shock from over-diuresis — administer 1 L crystalloid bolus
D. Tension pneumothorax — perform emergent needle decompression at the second ICS midclavicular line
Correct Answer: A
Rationale: Beck's triad (hypotension, elevated CVP, muffled heart sounds) plus pulsus paradoxus >10 mmHg after recent
cardiac surgery strongly indicates cardiac tamponade from mediastinal bleeding/clot. This is a surgical emergency
requiring emergent re-exploration; bedside reopening may be necessary if the patient arrests. Diuretics would worsen
hypotension; fluids are contraindicated given elevated CVP and tamponade physiology. The clinical picture does not fit
pneumothorax (unilateral breath sounds, tracheal deviation absent).
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 2
,Q5: A 59-year-old female with persistent atrial fibrillation for 48 hours (no prior history) presents with HR
152, BP 110/70, mild dyspnea. Which is the MOST appropriate initial management according to the AFFIRM
and RACE trial-derived current practice?
A. Immediate synchronized cardioversion without anticoagulation
B. Anticoagulate with heparin and perform TEE-guided cardioversion within 24 hours, or cardiovert
after 3 weeks of therapeutic anticoagulation *[CORRECT]*
C. Administer adenosine 6 mg IV push to terminate the arrhythmia
D. Administer amiodarone 400 mg PO daily and discharge home with follow-up in 1 week
Correct Answer: B
Rationale: Atrial fibrillation of >48 hours duration (or unknown duration) requires either 3 weeks of therapeutic
anticoagulation prior to cardioversion OR TEE-guided anticoagulation with heparin followed by cardioversion within 24
hours (Class I). Without this, the risk of cardioembolic stroke is 5-7%. Adenosine is ineffective in AF (only terminates SVT).
Immediate cardioversion without anticoagulation is unsafe. Amiodarone alone without anticoagulation/anticoagulation
planning is inappropriate.
Q6: A patient in the ICU develops a wide-complex tachycardia at a rate of 180, with pulse but poor perfusion
(BP 78/40, altered mental status). The patient has a history of structural heart disease with prior MI. Which
intervention is the priority?
A. Administer adenosine 6 mg IV push
B. Administer amiodarone 150 mg IV over 10 minutes
C. Perform immediate synchronized cardioversion at 100 J biphasic *[CORRECT]*
D. Administer lidocaine 1-1.5 mg/kg IV push
Correct Answer: C
Rationale: Stable monomorphic VT with pulse should be treated with antiarrhythmic agents (amiodarone or procainamide).
However, this patient is hemodynamically unstable (hypotension, altered mental status), so synchronized cardioversion is
the priority per ACLS (Class I). Adenosine is only for diagnosed SVT with aberrancy, not VT. Amiodarone is appropriate
only if patient is stable. Lidocaine is second-line for VT, not first-line in unstable presentations.
Q7: A 78-year-old male is admitted with dizziness and syncope. ECG shows a regular rhythm at 42 bpm with
a normal QRS width, more P waves than QRS complexes, and a constant PR interval for conducted beats.
Which conduction abnormality is present, and what is the recommended management?
A. Second-degree AV block Type I (Wenckebach) — observe and monitor
B. Second-degree AV block Type II (Mobitz II) — permanent pacemaker insertion indicated
*[CORRECT]*
C. Third-degree AV block (complete heart block) — emergent temporary pacemaker
D. First-degree AV block — no intervention required
Correct Answer: B
Rationale: Mobitz II second-degree AV block is characterized by constant PR intervals with sudden non-conducted P waves
and a wide QRS often due to infranodal block. Mobitz II has a high progression rate to complete heart block and is an
indication for permanent pacemaker (Class I) regardless of symptoms. Mobitz I (Wenckebach) shows progressive PR
prolongation and is usually benign. First-degree AV block requires no treatment. Third-degree AV block shows complete AV
dissociation, requiring emergent pacing.
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 3
, Q8: A patient with a pulmonary artery catheter has the following readings: RA pressure 14 mmHg, PA
pressure 65/28 mmHg, PCWP 12 mmHg, CO 4.2 L/min, calculated PVR 480 dynes·s/cm⁵. These
hemodynamics are MOST consistent with which diagnosis?
A. Left ventricular failure (elevated PCWP)
B. Pulmonary arterial hypertension with right heart involvement *[CORRECT]*
C. Hypovolemia (low RA pressure)
D. Constrictive pericarditis (equalization of pressures)
Correct Answer: B
Rationale: The elevated PA pressure (mean >25 mmHg at rest, here = (65+2*28)/3 = 40.3) with normal PCWP (<15) and
elevated PVR (>240, here 480) is the diagnostic hemodynamic profile of pre-capillary pulmonary hypertension (Group 1
PAH or appropriate groups). LV failure would show elevated PCWP. Hypovolemia would show low RA. Constrictive
pericarditis shows equalization of RA, PA diastolic, and PCWP. The elevated RA (14) indicates right heart dysfunction from
chronic pressure overload.
Q9: A patient on a heparin infusion for acute coronary syndrome develops heparin-induced
thrombocytopenia (HIT) confirmed by ELISA (optical density 1.8) and serotonin release assay positive.
Platelet count dropped from 280,000 to 95,000. Which anticoagulant is MOST appropriate for transition
therapy?
A. Continue heparin and add aspirin
B. Discontinue all anticoagulation and observe platelet recovery
C. Initiate argatroban or bivalirudin (direct thrombin inhibitor) *[CORRECT]*
D. Switch to warfarin immediately for long-term anticoagulation
Correct Answer: C
Rationale: HIT requires immediate discontinuation of ALL heparin products (including LMWH, heparin flushes) and
initiation of a non-heparin anticoagulant such as argatroban or bivalirudin (direct thrombin inhibitors) or fondaparinux.
Warfarin should NOT be started alone in acute HIT due to risk of venous limb gangrene and skin necrosis; warfarin can be
initiated only after platelet recovery (>150,000) and overlapped with a DTI. Continuing heparin would worsen HIT.
Stopping all anticoagulation is dangerous given the prothrombotic state of HIT.
Q10: A post-MI patient develops acute severe mitral regurgitation from papillary muscle rupture. Bedside
echocardiogram shows flail mitral leaflet with severe regurgitation. The patient is in cardiogenic shock (BP
80/50, CI 1.7, PCWP 30). Which intervention provides the BEST bridge to definitive surgical repair?
A. IV furosemide 80 mg bolus
B. Intra-aortic balloon pump (IABP) insertion *[CORRECT]*
C. Increasing norepinephrine infusion to maximize SVR
D. Emergent pericardiocentesis
Correct Answer: B
Rationale: Acute severe MR from papillary muscle rupture causes sudden volume overload of the left atrium and pulmonary
edema, with decreased forward cardiac output. IABP reduces afterload, decreases regurgitant fraction, and improves
forward flow while augmenting coronary perfusion, providing hemodynamic bridge to surgical mitral valve
repair/replacement. Diuretics alone are insufficient in shock. Pure alpha-agonists would increase afterload and worsen
regurgitation. Pericardiocentesis is not indicated (no tamponade).
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 4
Complex Diagnosis and Management in Acute Care Practicum
Weeks 1 – 4 Covered | Questions and Verified Answers | 100% Correct
Chamberlain University | Graduate Nursing & Advanced Practice Education
Total Questions 120 (multiple choice)
Cognitive Distribution 20% Recall | 50% Application | 30% Analysis
Format 80% scenario-based | 20% direct knowledge
Standards Alignment AACN Essentials (Master's) + AGACNP Competencies (2026/2027)
1. Cardiovascular (20) 2. Respiratory (18) 3. Neurological (18) 4. Renal/GU (15) 5.
Sections
Endocrine (15) 6. GI/Hepatic (12) 7. Heme/Onc (12) 8. Multisystem/Sepsis (10)
Section 1: Complex Cardiovascular Disorders in Acute Care
Q1: A 58-year-old male presents to the ED with crushing substernal chest pain radiating to the left arm,
diaphoresis, and dyspnea that began 45 minutes ago. The 12-lead ECG shows ST-segment elevation in leads
II, III, and aVF with reciprocal depression in I and aVL. The patient is a candidate for PCI, with an estimated
door-to-balloon time of 70 minutes. Which of the following is the MOST appropriate initial pharmacologic
intervention according to current STEMI guidelines?
A. Administer metoprolol 5 mg IV push immediately to reduce myocardial oxygen demand
B. Administer aspirin 325 mg chewed, unfractionated heparin 60 units/kg IV bolus, and ticagrelor 180
mg loading dose *[CORRECT]*
C. Administer nitroglycerin sublingual every 5 minutes for three doses, then morphine 4 mg IV
D. Administer alteplase 15 mg IV bolus followed by infusion since PCI exceeds the 60-minute goal
Correct Answer: B
Rationale: Inferior STEMI requires immediate reperfusion therapy. Per the NR 571 curriculum and ACC/AHA STEMI
guidelines, dual antiplatelet therapy (aspirin + P2Y12 inhibitor such as ticagrelor) plus anticoagulation is the standard
initial pharmacologic regimen when PCI is planned within 90 minutes (Class I). Beta-blockers are contraindicated in
inferior STEMI due to risk of RV involvement and profound bradycardia. Thrombolytics are reserved for facilities without
PCI capability within 120 minutes. Nitroglycerin and morphine are adjunctive, not primary therapy.
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 1
,Q2: A 67-year-old female is admitted with NSTEMI. Troponin I is 0.8 ng/mL (ref <0.04). The GRACE risk
score is 142. Which finding MOST strongly indicates the need for early invasive coronary angiography within
24 hours?
A. Recurrent angina at rest with dynamic ST-segment changes of 1 mm *[CORRECT]*
B. Sustained hemodynamic stability with blood pressure 128/76 mmHg
C. Troponin elevation alone without chest pain recurrence
D. Resolution of ST depression after sublingual nitroglycerin
Correct Answer: A
Rationale: Recurrent angina at rest with dynamic ST changes is a Class I indication for early invasive strategy (within 24
hours) per ACC/AHA NSTEMI guidelines, reflecting ongoing ischemia. The GRACE score of 142 (>139) further stratifies
the patient as high-risk. Hemodynamic stability alone does not justify conservative management in a high-risk NSTEMI.
Isolated troponin elevation without symptoms may represent a lower-risk presentation. ST resolution after nitroglycerin
does not preclude the need for invasive evaluation when other high-risk features are present.
Q3: A 72-year-old male with a history of hypertension and diabetes presents with acute decompensated heart
failure. BP is 88/52 mmHg, HR 118, RR 32, SpO2 88% on room air. Bilateral crackles, JVD, and cool
extremities are noted. Lactate is 4.2 mmol/L. PA catheter reveals: PCWP 28 mmHg, CI 1.8 L/min/m², SVR
1900 dynes·s/cm⁵. Which hemodynamic profile best characterizes this patient's condition, and what is the
priority intervention?
A. Forrester Class IV (warm/dry) — administer IV fluid bolus to improve preload
B. Forrester Class IV (cold/wet) — initiate inotrope (dobutamine) and consider mechanical circulatory
support *[CORRECT]*
C. Forrester Class II (warm/wet) — administer IV furosemide and vasodilator therapy
D. Forrester Class III (cold/dry) — administer IV fluid challenge to optimize preload
Correct Answer: B
Rationale: The patient presents with cardiogenic shock: hypotension, low cardiac index (<2.2), elevated PCWP (>18),
elevated SVR, and signs of hypoperfusion (lactate 4.2, cool extremities). This is Forrester Class IV (cold/wet). Priority
intervention is inotropic support (dobutamine or milrinone) to improve cardiac output, with consideration of IABP or
Impella if pharmacologic therapy fails. IV fluids would worsen pulmonary edema. Diuresis alone is insufficient given low
cardiac output. Vasodilators are contraindicated with hypotension.
Q4: A 64-year-old post-CABG patient (postoperative day 2) has chest tube drainage that decreased from 250
mL/hr to 30 mL/hr over 4 hours, but now the patient develops tachycardia (HR 128), hypotension (BP 84/50),
elevated CVP (18 mmHg), muffled heart sounds, and pulsus paradoxus of 14 mmHg. Which complication is
MOST likely, and what is the priority action?
A. Acute tamponade — prepare for emergent bedside sternotomy or surgical exploration *[CORRECT]*
B. Acute decompensated heart failure — administer IV furosemide 80 mg
C. Hypovolemic shock from over-diuresis — administer 1 L crystalloid bolus
D. Tension pneumothorax — perform emergent needle decompression at the second ICS midclavicular line
Correct Answer: A
Rationale: Beck's triad (hypotension, elevated CVP, muffled heart sounds) plus pulsus paradoxus >10 mmHg after recent
cardiac surgery strongly indicates cardiac tamponade from mediastinal bleeding/clot. This is a surgical emergency
requiring emergent re-exploration; bedside reopening may be necessary if the patient arrests. Diuretics would worsen
hypotension; fluids are contraindicated given elevated CVP and tamponade physiology. The clinical picture does not fit
pneumothorax (unilateral breath sounds, tracheal deviation absent).
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 2
,Q5: A 59-year-old female with persistent atrial fibrillation for 48 hours (no prior history) presents with HR
152, BP 110/70, mild dyspnea. Which is the MOST appropriate initial management according to the AFFIRM
and RACE trial-derived current practice?
A. Immediate synchronized cardioversion without anticoagulation
B. Anticoagulate with heparin and perform TEE-guided cardioversion within 24 hours, or cardiovert
after 3 weeks of therapeutic anticoagulation *[CORRECT]*
C. Administer adenosine 6 mg IV push to terminate the arrhythmia
D. Administer amiodarone 400 mg PO daily and discharge home with follow-up in 1 week
Correct Answer: B
Rationale: Atrial fibrillation of >48 hours duration (or unknown duration) requires either 3 weeks of therapeutic
anticoagulation prior to cardioversion OR TEE-guided anticoagulation with heparin followed by cardioversion within 24
hours (Class I). Without this, the risk of cardioembolic stroke is 5-7%. Adenosine is ineffective in AF (only terminates SVT).
Immediate cardioversion without anticoagulation is unsafe. Amiodarone alone without anticoagulation/anticoagulation
planning is inappropriate.
Q6: A patient in the ICU develops a wide-complex tachycardia at a rate of 180, with pulse but poor perfusion
(BP 78/40, altered mental status). The patient has a history of structural heart disease with prior MI. Which
intervention is the priority?
A. Administer adenosine 6 mg IV push
B. Administer amiodarone 150 mg IV over 10 minutes
C. Perform immediate synchronized cardioversion at 100 J biphasic *[CORRECT]*
D. Administer lidocaine 1-1.5 mg/kg IV push
Correct Answer: C
Rationale: Stable monomorphic VT with pulse should be treated with antiarrhythmic agents (amiodarone or procainamide).
However, this patient is hemodynamically unstable (hypotension, altered mental status), so synchronized cardioversion is
the priority per ACLS (Class I). Adenosine is only for diagnosed SVT with aberrancy, not VT. Amiodarone is appropriate
only if patient is stable. Lidocaine is second-line for VT, not first-line in unstable presentations.
Q7: A 78-year-old male is admitted with dizziness and syncope. ECG shows a regular rhythm at 42 bpm with
a normal QRS width, more P waves than QRS complexes, and a constant PR interval for conducted beats.
Which conduction abnormality is present, and what is the recommended management?
A. Second-degree AV block Type I (Wenckebach) — observe and monitor
B. Second-degree AV block Type II (Mobitz II) — permanent pacemaker insertion indicated
*[CORRECT]*
C. Third-degree AV block (complete heart block) — emergent temporary pacemaker
D. First-degree AV block — no intervention required
Correct Answer: B
Rationale: Mobitz II second-degree AV block is characterized by constant PR intervals with sudden non-conducted P waves
and a wide QRS often due to infranodal block. Mobitz II has a high progression rate to complete heart block and is an
indication for permanent pacemaker (Class I) regardless of symptoms. Mobitz I (Wenckebach) shows progressive PR
prolongation and is usually benign. First-degree AV block requires no treatment. Third-degree AV block shows complete AV
dissociation, requiring emergent pacing.
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 3
, Q8: A patient with a pulmonary artery catheter has the following readings: RA pressure 14 mmHg, PA
pressure 65/28 mmHg, PCWP 12 mmHg, CO 4.2 L/min, calculated PVR 480 dynes·s/cm⁵. These
hemodynamics are MOST consistent with which diagnosis?
A. Left ventricular failure (elevated PCWP)
B. Pulmonary arterial hypertension with right heart involvement *[CORRECT]*
C. Hypovolemia (low RA pressure)
D. Constrictive pericarditis (equalization of pressures)
Correct Answer: B
Rationale: The elevated PA pressure (mean >25 mmHg at rest, here = (65+2*28)/3 = 40.3) with normal PCWP (<15) and
elevated PVR (>240, here 480) is the diagnostic hemodynamic profile of pre-capillary pulmonary hypertension (Group 1
PAH or appropriate groups). LV failure would show elevated PCWP. Hypovolemia would show low RA. Constrictive
pericarditis shows equalization of RA, PA diastolic, and PCWP. The elevated RA (14) indicates right heart dysfunction from
chronic pressure overload.
Q9: A patient on a heparin infusion for acute coronary syndrome develops heparin-induced
thrombocytopenia (HIT) confirmed by ELISA (optical density 1.8) and serotonin release assay positive.
Platelet count dropped from 280,000 to 95,000. Which anticoagulant is MOST appropriate for transition
therapy?
A. Continue heparin and add aspirin
B. Discontinue all anticoagulation and observe platelet recovery
C. Initiate argatroban or bivalirudin (direct thrombin inhibitor) *[CORRECT]*
D. Switch to warfarin immediately for long-term anticoagulation
Correct Answer: C
Rationale: HIT requires immediate discontinuation of ALL heparin products (including LMWH, heparin flushes) and
initiation of a non-heparin anticoagulant such as argatroban or bivalirudin (direct thrombin inhibitors) or fondaparinux.
Warfarin should NOT be started alone in acute HIT due to risk of venous limb gangrene and skin necrosis; warfarin can be
initiated only after platelet recovery (>150,000) and overlapped with a DTI. Continuing heparin would worsen HIT.
Stopping all anticoagulation is dangerous given the prothrombotic state of HIT.
Q10: A post-MI patient develops acute severe mitral regurgitation from papillary muscle rupture. Bedside
echocardiogram shows flail mitral leaflet with severe regurgitation. The patient is in cardiogenic shock (BP
80/50, CI 1.7, PCWP 30). Which intervention provides the BEST bridge to definitive surgical repair?
A. IV furosemide 80 mg bolus
B. Intra-aortic balloon pump (IABP) insertion *[CORRECT]*
C. Increasing norepinephrine infusion to maximize SVR
D. Emergent pericardiocentesis
Correct Answer: B
Rationale: Acute severe MR from papillary muscle rupture causes sudden volume overload of the left atrium and pulmonary
edema, with decreased forward cardiac output. IABP reduces afterload, decreases regurgitant fraction, and improves
forward flow while augmenting coronary perfusion, providing hemodynamic bridge to surgical mitral valve
repair/replacement. Diuretics alone are insufficient in shock. Pure alpha-agonists would increase afterload and worsen
regurgitation. Pericardiocentesis is not indicated (no tamponade).
NR571 Midterm Exam (2026/2027) | Complex Diagnosis & Management in Acute Care Practicum | Page 4
