NR 574 Acute Care Practicum
Midterm Review 2026/2027 –
Questions & Answers with
Detailed Rationales
Question 1. A patient with acute dyspnea has an oxygen
saturation of 84% on room air. What is the nurse’s priority
action?
A. Obtain a detailed medical history
B. Place the patient in a supine position
C. Administer supplemental oxygen as prescribed
D. Encourage oral fluid intake
Answer: C. Administer supplemental oxygen as prescribed
Rationale: An oxygen saturation of 84% indicates significant
hypoxemia. Supporting oxygenation is the immediate priority
while the underlying cause is evaluated.
Question 2. Which assessment finding is most concerning in a
patient with suspected sepsis?
A. Temperature of 37.4°C
B. Respiratory rate of 28/min
C. Heart rate of 78/min
D. Blood pressure of 138/82 mmHg
Answer: B. Respiratory rate of 28/min
,Rationale: Tachypnea can be an early sign of systemic infection
and tissue hypoperfusion. In an acutely ill patient, an elevated
respiratory rate warrants prompt evaluation.
Question 3. A patient reports crushing substernal chest pain
radiating to the left arm. Which diagnostic test should be
obtained promptly?
A. Colonoscopy
B. 12-lead electrocardiogram
C. Abdominal ultrasound
D. Pulmonary function test
Answer: B. 12-lead electrocardiogram
Rationale: A 12-lead ECG is a priority in suspected acute
coronary syndrome because it can rapidly identify ischemic
changes and guide treatment.
Question 4. Which finding is most consistent with hypovolemic
shock?
A. Warm flushed skin and bounding pulses
B. Bradycardia and hypertension
C. Tachycardia, hypotension, and cool skin
D. Hypertension and pulmonary edema
Answer: C. Tachycardia, hypotension, and cool skin
Rationale: Hypovolemia reduces circulating volume and tissue
perfusion. Compensatory tachycardia occurs, while hypotension
and peripheral vasoconstriction can produce cool, pale skin.
,Question 5. A patient suddenly develops facial drooping and
difficulty speaking. What is the priority action?
A. Give the patient oral fluids
B. Determine the time symptoms began
C. Allow the patient to sleep
D. Administer a sedative
Answer: B. Determine the time symptoms began
Rationale: Establishing the exact or last-known-well time is
essential when acute stroke is suspected because eligibility for
time-sensitive interventions depends on symptom onset.
Question 6. Which laboratory value is most important to
monitor in a patient receiving unfractionated heparin?
A. INR only
B. aPTT or institution-specific anti-Xa monitoring
C. Hemoglobin A1c
D. Serum amylase
Answer: B. aPTT or institution-specific anti-Xa monitoring
Rationale: Unfractionated heparin requires laboratory
monitoring to evaluate anticoagulant effect and reduce the risk
of excessive anticoagulation.
Question 7. Which assessment finding suggests worsening
respiratory distress?
A. Respiratory rate of 16/min
B. Ability to speak in complete sentences
, C. Use of accessory muscles
D. Oxygen saturation of 98%
Answer: C. Use of accessory muscles
Rationale: Accessory muscle use indicates increased work of
breathing and may signal progression of respiratory
compromise.
Question 8. A patient with heart failure develops severe
dyspnea and pink, frothy sputum. Which condition should the
nurse suspect?
A. Pulmonary edema
B. Appendicitis
C. Hypoglycemia
D. Dehydration
Answer: A. Pulmonary edema
Rationale: Acute pulmonary edema can occur with severe left-
sided heart failure and is characterized by respiratory distress,
crackles, and potentially pink, frothy sputum.
Question 9. Which finding is most suggestive of acute kidney
injury?
A. Increasing serum creatinine
B. Decreasing blood glucose
C. Increased hemoglobin
D. Reduced serum sodium caused by exercise
Answer: A. Increasing serum creatinine
Midterm Review 2026/2027 –
Questions & Answers with
Detailed Rationales
Question 1. A patient with acute dyspnea has an oxygen
saturation of 84% on room air. What is the nurse’s priority
action?
A. Obtain a detailed medical history
B. Place the patient in a supine position
C. Administer supplemental oxygen as prescribed
D. Encourage oral fluid intake
Answer: C. Administer supplemental oxygen as prescribed
Rationale: An oxygen saturation of 84% indicates significant
hypoxemia. Supporting oxygenation is the immediate priority
while the underlying cause is evaluated.
Question 2. Which assessment finding is most concerning in a
patient with suspected sepsis?
A. Temperature of 37.4°C
B. Respiratory rate of 28/min
C. Heart rate of 78/min
D. Blood pressure of 138/82 mmHg
Answer: B. Respiratory rate of 28/min
,Rationale: Tachypnea can be an early sign of systemic infection
and tissue hypoperfusion. In an acutely ill patient, an elevated
respiratory rate warrants prompt evaluation.
Question 3. A patient reports crushing substernal chest pain
radiating to the left arm. Which diagnostic test should be
obtained promptly?
A. Colonoscopy
B. 12-lead electrocardiogram
C. Abdominal ultrasound
D. Pulmonary function test
Answer: B. 12-lead electrocardiogram
Rationale: A 12-lead ECG is a priority in suspected acute
coronary syndrome because it can rapidly identify ischemic
changes and guide treatment.
Question 4. Which finding is most consistent with hypovolemic
shock?
A. Warm flushed skin and bounding pulses
B. Bradycardia and hypertension
C. Tachycardia, hypotension, and cool skin
D. Hypertension and pulmonary edema
Answer: C. Tachycardia, hypotension, and cool skin
Rationale: Hypovolemia reduces circulating volume and tissue
perfusion. Compensatory tachycardia occurs, while hypotension
and peripheral vasoconstriction can produce cool, pale skin.
,Question 5. A patient suddenly develops facial drooping and
difficulty speaking. What is the priority action?
A. Give the patient oral fluids
B. Determine the time symptoms began
C. Allow the patient to sleep
D. Administer a sedative
Answer: B. Determine the time symptoms began
Rationale: Establishing the exact or last-known-well time is
essential when acute stroke is suspected because eligibility for
time-sensitive interventions depends on symptom onset.
Question 6. Which laboratory value is most important to
monitor in a patient receiving unfractionated heparin?
A. INR only
B. aPTT or institution-specific anti-Xa monitoring
C. Hemoglobin A1c
D. Serum amylase
Answer: B. aPTT or institution-specific anti-Xa monitoring
Rationale: Unfractionated heparin requires laboratory
monitoring to evaluate anticoagulant effect and reduce the risk
of excessive anticoagulation.
Question 7. Which assessment finding suggests worsening
respiratory distress?
A. Respiratory rate of 16/min
B. Ability to speak in complete sentences
, C. Use of accessory muscles
D. Oxygen saturation of 98%
Answer: C. Use of accessory muscles
Rationale: Accessory muscle use indicates increased work of
breathing and may signal progression of respiratory
compromise.
Question 8. A patient with heart failure develops severe
dyspnea and pink, frothy sputum. Which condition should the
nurse suspect?
A. Pulmonary edema
B. Appendicitis
C. Hypoglycemia
D. Dehydration
Answer: A. Pulmonary edema
Rationale: Acute pulmonary edema can occur with severe left-
sided heart failure and is characterized by respiratory distress,
crackles, and potentially pink, frothy sputum.
Question 9. Which finding is most suggestive of acute kidney
injury?
A. Increasing serum creatinine
B. Decreasing blood glucose
C. Increased hemoglobin
D. Reduced serum sodium caused by exercise
Answer: A. Increasing serum creatinine
