,NRNP 6550 Advanced Practice Care of
Adults in Acute Care Settings II Exam
Prep — Comprehensive Review +
Practice MCQs — Walden University
2025/2026
1. The AGACNP is caring for a patient with a large right-sided pleural effusion. Thoracentesis fluid analysis
reveals a transudate. The AGACNP understands that the least worrisome type of pleural fluid is:
A. Exudate
B. Transudate
C. Chyliform effusion
D. Hemorrhagic effusion
Correct Answer: B. Transudate
Rationale: Transudate fluid results from systemic factors affecting hydrostatic and oncotic pressures (e.g., CHF,
hypoalbuminemia) and is generally less concerning than exudate, which indicates local inflammation,
malignancy, or infection. Chyliform effusion (triglycerides) and hemorrhagic effusion (blood) both indicate
significant underlying pathology.
2. A patient presents with acute onset of unilateral facial paralysis, inability to close the left eye, and no other
neurologic deficits. The AGACNP suspects:
A. Trigeminal neuralgia
B. Stroke
,C. Bell’s palsy
D. TMJ disorder
Correct Answer: C. Bell’s palsy
Rationale: Bell’s palsy is an acute peripheral facial nerve (CN VII) palsy presenting with unilateral facial
weakness involving both upper and lower face. Stroke typically spares the forehead (upper motor neuron
pattern) and may present with other focal deficits. Trigeminal neuralgia causes pain without motor weakness.
3. A patient reports “dizziness.” To differentiate vertigo from near-syncope and ataxia, the AGACNP asks the
patient to describe the primary symptom. The patient states, “The room is spinning.” This finding is most
consistent with:
A. Near-syncope
B. Ataxia
C. Vertigo
D. Orthostatic hypotension
Correct Answer: C. Vertigo
Rationale: Vertigo is characterized by a sensation of spinning or rotation, typically due to inner ear pathology
(vestibular system). Ataxia presents as imbalance or unsteadiness (neurologic). Near-syncope presents as
lightheadedness or feelings of impending loss of consciousness.
4. The primary risk factor for pulmonary embolism is:
A. Atrial fibrillation
, B. Deep vein thrombosis (DVT)
C. Hyperlipidemia
D. Smoking
Correct Answer: B. Deep vein thrombosis (DVT)
Rationale: The majority of pulmonary emboli originate from DVTs in the lower extremities. Risk factors for DVT
include stasis (immobility, surgery), endothelial injury, and hypercoagulability (malignancy, inherited
thrombophilias).
5. A patient with suspected ascending aortic aneurysm should undergo which diagnostic test for confirmation?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT scan with contrast
D. MRI without contrast
Correct Answer: C. CT scan with contrast
Rationale: CT angiography with contrast is the gold standard for diagnosing and characterizing aortic
aneurysms and dissections. It provides detailed information about aneurysm size, extent, and involvement of
branch vessels.
6. A patient on an unfractionated heparin infusion requires monitoring for which potentially fatal
complication?
A. Hyperkalemia
Adults in Acute Care Settings II Exam
Prep — Comprehensive Review +
Practice MCQs — Walden University
2025/2026
1. The AGACNP is caring for a patient with a large right-sided pleural effusion. Thoracentesis fluid analysis
reveals a transudate. The AGACNP understands that the least worrisome type of pleural fluid is:
A. Exudate
B. Transudate
C. Chyliform effusion
D. Hemorrhagic effusion
Correct Answer: B. Transudate
Rationale: Transudate fluid results from systemic factors affecting hydrostatic and oncotic pressures (e.g., CHF,
hypoalbuminemia) and is generally less concerning than exudate, which indicates local inflammation,
malignancy, or infection. Chyliform effusion (triglycerides) and hemorrhagic effusion (blood) both indicate
significant underlying pathology.
2. A patient presents with acute onset of unilateral facial paralysis, inability to close the left eye, and no other
neurologic deficits. The AGACNP suspects:
A. Trigeminal neuralgia
B. Stroke
,C. Bell’s palsy
D. TMJ disorder
Correct Answer: C. Bell’s palsy
Rationale: Bell’s palsy is an acute peripheral facial nerve (CN VII) palsy presenting with unilateral facial
weakness involving both upper and lower face. Stroke typically spares the forehead (upper motor neuron
pattern) and may present with other focal deficits. Trigeminal neuralgia causes pain without motor weakness.
3. A patient reports “dizziness.” To differentiate vertigo from near-syncope and ataxia, the AGACNP asks the
patient to describe the primary symptom. The patient states, “The room is spinning.” This finding is most
consistent with:
A. Near-syncope
B. Ataxia
C. Vertigo
D. Orthostatic hypotension
Correct Answer: C. Vertigo
Rationale: Vertigo is characterized by a sensation of spinning or rotation, typically due to inner ear pathology
(vestibular system). Ataxia presents as imbalance or unsteadiness (neurologic). Near-syncope presents as
lightheadedness or feelings of impending loss of consciousness.
4. The primary risk factor for pulmonary embolism is:
A. Atrial fibrillation
, B. Deep vein thrombosis (DVT)
C. Hyperlipidemia
D. Smoking
Correct Answer: B. Deep vein thrombosis (DVT)
Rationale: The majority of pulmonary emboli originate from DVTs in the lower extremities. Risk factors for DVT
include stasis (immobility, surgery), endothelial injury, and hypercoagulability (malignancy, inherited
thrombophilias).
5. A patient with suspected ascending aortic aneurysm should undergo which diagnostic test for confirmation?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT scan with contrast
D. MRI without contrast
Correct Answer: C. CT scan with contrast
Rationale: CT angiography with contrast is the gold standard for diagnosing and characterizing aortic
aneurysms and dissections. It provides detailed information about aneurysm size, extent, and involvement of
branch vessels.
6. A patient on an unfractionated heparin infusion requires monitoring for which potentially fatal
complication?
A. Hyperkalemia
