NRNP 6550 Final Exam 200 Multiple Choice
Questions with Verified Correct Answers and
Detailed Clinical Rationales for Advanced
Practice Adult Acute Care Success100% pass
graded A+
1. A 68-year-old patient with pneumonia develops BP 82/48 mmHg, HR 124/min, RR 30/min,
and altered mental status despite receiving IV fluids. Which intervention is the priority?
A. Administer a loop diuretic
B. Initiate vasopressor support
C. Restrict fluids
D. Administer oral antihypertensive therapy
Answer: B. Initiate vasopressor support
Rationale: Persistent hypotension despite adequate fluid resuscitation suggests septic shock.
Norepinephrine is generally the preferred first-line vasopressor to restore adequate perfusion.
2. Which finding most strongly suggests acute respiratory distress syndrome (ARDS)?
A. Unilateral pleural effusion
B. Bilateral pulmonary infiltrates with refractory hypoxemia
C. Mild wheezing responsive to bronchodilators
D. Isolated hypercapnia without hypoxemia
Answer: B. Bilateral pulmonary infiltrates with refractory hypoxemia
Rationale: ARDS is characterized by acute hypoxemic respiratory failure with bilateral
pulmonary opacities not fully explained by cardiogenic pulmonary edema or fluid overload.
3. A mechanically ventilated patient suddenly develops hypotension, tachycardia, and absent
breath sounds on the right. What is the most likely diagnosis?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
,Answer: B. Tension pneumothorax
Rationale: Sudden hemodynamic instability with unilateral absent breath sounds in a ventilated
patient is highly concerning for tension pneumothorax and requires immediate intervention.
4. Which ventilator strategy is most appropriate for a patient with ARDS?
A. High tidal volumes
B. Low tidal volume based on predicted body weight
C. Zero PEEP
D. Routine hyperventilation
Answer: B. Low tidal volume based on predicted body weight
Rationale: Lung-protective ventilation using low tidal volumes reduces ventilator-induced lung
injury.
5. A patient with COPD exacerbation has pH 7.28 and PaCO₂ 68 mmHg. Which acid-base
disorder is present?
A. Metabolic alkalosis
B. Acute respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Answer: B. Acute respiratory acidosis
Rationale: Elevated PaCO₂ with acidemia indicates respiratory acidosis. In acute COPD
exacerbation, this commonly reflects hypoventilation and CO₂ retention.
6. Which intervention is generally appropriate for acute COPD exacerbation with
bronchospasm?
A. Short-acting bronchodilators
B. Immediate beta-blocker escalation
C. Fluid restriction in every patient
D. High-dose sedatives
Answer: A. Short-acting bronchodilators
Rationale: Inhaled short-acting beta₂-agonists, often combined with an anticholinergic
bronchodilator, are key treatments for acute COPD exacerbations.
,7. A patient with severe asthma becomes increasingly somnolent and develops a normalizing
PaCO₂ after previously having low PaCO₂. What does this suggest?
A. Clinical improvement
B. Respiratory muscle fatigue
C. Metabolic alkalosis
D. Resolution of bronchospasm
Answer: B. Respiratory muscle fatigue
Rationale: A rising or "normalizing" PaCO₂ in a severely obstructed patient can indicate
worsening ventilation and impending respiratory failure.
8. Which finding is most concerning for impending respiratory failure in status asthmaticus?
A. Mild expiratory wheezing
B. Increasing ability to speak
C. Silent chest and altered mental status
D. Mild tachycardia
Answer: C. Silent chest and altered mental status
Rationale: A silent chest indicates severely reduced airflow. Altered mental status suggests
inadequate oxygenation or ventilation and is an emergency.
9. A patient with pulmonary embolism becomes hypotensive and develops signs of right
ventricular failure. How should this PE be classified?
A. Low-risk PE
B. Massive/high-risk PE
C. Incidental PE
D. Chronic stable PE
Answer: B. Massive/high-risk PE
Rationale: Hemodynamic instability in acute PE indicates high-risk disease and may require
systemic thrombolysis or another reperfusion strategy when appropriate.
10. Which ECG finding is most characteristic of acute pericarditis?
A. Diffuse ST-segment elevation
B. ST elevation isolated to V1
C. Deep Q waves in all leads
D. Complete heart block in every case
, Answer: A. Diffuse ST-segment elevation
Rationale: Acute pericarditis classically causes diffuse, often concave ST elevation with PR-
segment depression.
11. A patient with chest pain has ST elevation in leads II, III, and aVF. Which myocardial
territory is most likely affected?
A. Anterior
B. Inferior
C. Lateral
D. Septal
Answer: B. Inferior
Rationale: Leads II, III, and aVF represent the inferior wall of the heart, commonly supplied by
the right coronary artery.
12. A patient with an inferior STEMI develops hypotension, clear lungs, and elevated jugular
venous pressure. What complication should be suspected?
A. Left ventricular failure
B. Right ventricular infarction
C. Pulmonary edema
D. Aortic dissection
Answer: B. Right ventricular infarction
Rationale: Right ventricular infarction can cause hypotension, elevated JVP, and clear lungs.
These patients may be preload dependent.
13. Which biomarker is most specific for myocardial injury?
A. CK-MB
B. Troponin
C. Myoglobin
D. LDH
Answer: B. Troponin
Rationale: Cardiac troponins are highly sensitive and specific markers of myocardial injury.
Questions with Verified Correct Answers and
Detailed Clinical Rationales for Advanced
Practice Adult Acute Care Success100% pass
graded A+
1. A 68-year-old patient with pneumonia develops BP 82/48 mmHg, HR 124/min, RR 30/min,
and altered mental status despite receiving IV fluids. Which intervention is the priority?
A. Administer a loop diuretic
B. Initiate vasopressor support
C. Restrict fluids
D. Administer oral antihypertensive therapy
Answer: B. Initiate vasopressor support
Rationale: Persistent hypotension despite adequate fluid resuscitation suggests septic shock.
Norepinephrine is generally the preferred first-line vasopressor to restore adequate perfusion.
2. Which finding most strongly suggests acute respiratory distress syndrome (ARDS)?
A. Unilateral pleural effusion
B. Bilateral pulmonary infiltrates with refractory hypoxemia
C. Mild wheezing responsive to bronchodilators
D. Isolated hypercapnia without hypoxemia
Answer: B. Bilateral pulmonary infiltrates with refractory hypoxemia
Rationale: ARDS is characterized by acute hypoxemic respiratory failure with bilateral
pulmonary opacities not fully explained by cardiogenic pulmonary edema or fluid overload.
3. A mechanically ventilated patient suddenly develops hypotension, tachycardia, and absent
breath sounds on the right. What is the most likely diagnosis?
A. Pulmonary edema
B. Tension pneumothorax
C. Atelectasis
D. Pleural effusion
,Answer: B. Tension pneumothorax
Rationale: Sudden hemodynamic instability with unilateral absent breath sounds in a ventilated
patient is highly concerning for tension pneumothorax and requires immediate intervention.
4. Which ventilator strategy is most appropriate for a patient with ARDS?
A. High tidal volumes
B. Low tidal volume based on predicted body weight
C. Zero PEEP
D. Routine hyperventilation
Answer: B. Low tidal volume based on predicted body weight
Rationale: Lung-protective ventilation using low tidal volumes reduces ventilator-induced lung
injury.
5. A patient with COPD exacerbation has pH 7.28 and PaCO₂ 68 mmHg. Which acid-base
disorder is present?
A. Metabolic alkalosis
B. Acute respiratory acidosis
C. Metabolic acidosis
D. Respiratory alkalosis
Answer: B. Acute respiratory acidosis
Rationale: Elevated PaCO₂ with acidemia indicates respiratory acidosis. In acute COPD
exacerbation, this commonly reflects hypoventilation and CO₂ retention.
6. Which intervention is generally appropriate for acute COPD exacerbation with
bronchospasm?
A. Short-acting bronchodilators
B. Immediate beta-blocker escalation
C. Fluid restriction in every patient
D. High-dose sedatives
Answer: A. Short-acting bronchodilators
Rationale: Inhaled short-acting beta₂-agonists, often combined with an anticholinergic
bronchodilator, are key treatments for acute COPD exacerbations.
,7. A patient with severe asthma becomes increasingly somnolent and develops a normalizing
PaCO₂ after previously having low PaCO₂. What does this suggest?
A. Clinical improvement
B. Respiratory muscle fatigue
C. Metabolic alkalosis
D. Resolution of bronchospasm
Answer: B. Respiratory muscle fatigue
Rationale: A rising or "normalizing" PaCO₂ in a severely obstructed patient can indicate
worsening ventilation and impending respiratory failure.
8. Which finding is most concerning for impending respiratory failure in status asthmaticus?
A. Mild expiratory wheezing
B. Increasing ability to speak
C. Silent chest and altered mental status
D. Mild tachycardia
Answer: C. Silent chest and altered mental status
Rationale: A silent chest indicates severely reduced airflow. Altered mental status suggests
inadequate oxygenation or ventilation and is an emergency.
9. A patient with pulmonary embolism becomes hypotensive and develops signs of right
ventricular failure. How should this PE be classified?
A. Low-risk PE
B. Massive/high-risk PE
C. Incidental PE
D. Chronic stable PE
Answer: B. Massive/high-risk PE
Rationale: Hemodynamic instability in acute PE indicates high-risk disease and may require
systemic thrombolysis or another reperfusion strategy when appropriate.
10. Which ECG finding is most characteristic of acute pericarditis?
A. Diffuse ST-segment elevation
B. ST elevation isolated to V1
C. Deep Q waves in all leads
D. Complete heart block in every case
, Answer: A. Diffuse ST-segment elevation
Rationale: Acute pericarditis classically causes diffuse, often concave ST elevation with PR-
segment depression.
11. A patient with chest pain has ST elevation in leads II, III, and aVF. Which myocardial
territory is most likely affected?
A. Anterior
B. Inferior
C. Lateral
D. Septal
Answer: B. Inferior
Rationale: Leads II, III, and aVF represent the inferior wall of the heart, commonly supplied by
the right coronary artery.
12. A patient with an inferior STEMI develops hypotension, clear lungs, and elevated jugular
venous pressure. What complication should be suspected?
A. Left ventricular failure
B. Right ventricular infarction
C. Pulmonary edema
D. Aortic dissection
Answer: B. Right ventricular infarction
Rationale: Right ventricular infarction can cause hypotension, elevated JVP, and clear lungs.
These patients may be preload dependent.
13. Which biomarker is most specific for myocardial injury?
A. CK-MB
B. Troponin
C. Myoglobin
D. LDH
Answer: B. Troponin
Rationale: Cardiac troponins are highly sensitive and specific markers of myocardial injury.
