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NR571/ NR 571 Midterm Exam (Latest 2024/ 2025 Update) Complex Diagnosis & Management in Acute Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain

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NR571/ NR 571 Midterm Exam (Latest 2024/ 2025 Update) Complex Diagnosis & Management in Acute Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain Q: The AGACNP is called to see a patient who is ready for discharge after a carotid endarterectomy. The patient is altered and began complaining of new headache this morning. The current vital signs are as follows : heart rate (HR) 116 beats/min, blood pressure (BP) 170/90 mmHg, and temperature 99°F. What orders should the AGACNP give? A. Acetaminophen 650 mg orally now, and blood cultures × 2 obtained stat B. Diltiazem 15 mg intravenous (IV) push followed by continuous infusion at 5 mg/hr; titration to HR 90 beats/min C. Morphine 2 mg IV as needed for pain; acetaminophen 650 mg now D. Labetalol 20 mg IV push followed by continuous infusion titrated to BP 160 mmHg Answer: D. Labetalol 20 mg IV push followed by continuous infusion titrated to BP 160 mmHg The patient is demonstrating symptoms of cerebral hyperperfusion syndrome and requires prompt control of their hypertension. Labetalol IV push followed by a titrat- able infusion will allow correction of the hypertension and titration as needed. While acetaminophen may be given for headache, the patient's pain is part of a larger problem, which is cerebral hyperperfusion. The priority intervention is control of the hyperperfusion. Blood cultures are not indicated. Diltiazem is useful in controlling atrial fibrillation; it will not help address the primary problem for this patient. Beta blockers are a more appropriate choice. Morphine and acetaminophen may be used as secondary agents for this patient's pain; however, they will not address the underlying problem and may only mask the medical emergency that is unfolding. Control of the patient's BP is the priority. Q: When managing a cardiac arrest patient, which interventions should the AGACNP prioritize after achieving return of spontaneous circulation? A. Place endotracheal tube (ETT), obtain EKG, monitor, and optimize respira- tory and hemodynamic parameters B. Transfer to higher level of care, initiate sedation, and consult cardiology C. Administer high-quality cardiopulmonary resuscitation (CPR) with an em- phasis on quality of compressions and minimization of interruptions D. Call for help and assess the scene for safety Answer: A. Place endotracheal tube (ETT), obtain EKG, monitor, and optimize respiratory and hemodynamic para- meters The stabilization phase occurs after return of spontaneous circulation (ROSC) is achieved. During this time, the ETT is placed, the EKG is obtained, and respiratory and hemodynamic parameters are monitored and optimized. Transfer to a higher level of care and obtaining expert consultation occur in the emergent activities phase following the stabilization phase. High-quality CPR is the primary goal in achieving ROSC. This occurs prior to the stabilization phase. Calling for help and securing the scene are the initial steps in performing advanced cardiac life support and occur before ROSC and the stabilization phase. Q: A 76-year-old female patient presents with a report of having "passed out. " The event was preceded by a feeling of lightheadedness and a fluttering in the chest. What differential diagnosis is most consistent with this presentation? A. Vasovagal syncope B. Orthostatic hypotension C. Arrythmia D. Seizure Answer: C. Arrythmia Arrhythmogenic syncope may be preceded by palpitations, chest discomfort, di- aphoresis, and a feeling of lightheadedness. Orthostatic hypotension uncommonly results in syncope and is preceded by a sudden change in position from sitting or lying to standing. Syncope that is preceded by an aura and that includes fecal or urinary incontinence is highly suspicious for a seizure. Vasovagal syncope is associated with noxious stimuli including fear, anxiety, or pain. Q: Which choice of therapeutics is most likely to be efficacious in treatment of symptoms associated with all types of cardiomyopathy? A. Diuretics, beta blockers, and calcium channel blockers B. Aspirin, statins, and beta blockers C. Nitrates, diuretics, and norepinephrine D. Aspirin, statins, and implantable defibrillator Answer: A. Diuretics, beta block- ers, and calcium channel blockers Patients presenting with cardiomyopathy often present with heart failure (HF) symptoms and volume overload regardless of the type of cardiomyopathy. These symptoms are best treated with HF recommended medications, including diuretics to decrease volume overload and beta blockers and calcium channel blockers to decrease heart rate and increase time for ventricular filling. Aspirin and statins are not recommended to treat cardiomyopathy. While nitrates and diuretics may be useful in the treatment of volume overload in patients with cardiomyopathy, norepinephrine is an afterload-increasing agent and would likely worsen symptoms of HF in these patients. An implantable defibrillator may be indicated for some patients with cardiomyopathy who are at risk of sudden cardiac death, but it is not appropriate for all patients. Additionally, aspirin and statins are not indicated. Q: The AGACNP admits a patient who presents with fever, chills, and dyspnea. The patient notes that they recently recovered from COVID-19 viral infection. The AGACNP suspects myocarditis and knows the definitive diagnosis is made by: A. Transthoracic echocardiogram B. Myocardial biopsy C. Transesophageal echocardiogram D. Cardiac magnetic resonance imaging (MRI) Answer: B. Myocardial biopsy Myocardial biopsy confirms the diagnosis of myocarditis. The classic histological findings include lymphocytic infiltrates with myocyte necrosis, as described by the Dallas criteria. While myocardial biopsy is rarely done, it is the gold standard for diagnosis. Echocardiogram and cardiac MRI can contribute information to suggest myocarditis but cannot confirm the diagnosis. Q: The AGACNP admits a patient who presents with acute chest pain that is relieved by leaning forward. On physical exam, the patient is tachycardic and has a pericardial friction rub and normal lung sounds. The AGACNP suspects that the primary diagnosis is: A. Myocarditis B. Endocarditis C. Pericarditis D. Hypertrophic cardiomyopathy Answer: C. Pericarditis Classic findings suggestive of pericarditis include chest pain relieved by leaning forward and presence of a pericardial friction rub. Myocarditis and endocarditis do not have classic presentations of relief of symptoms when leaning forward and a pericardial friction rub. A diagnosis of hypertrophic cardiomyopathy cannot be made based on the patient's presentation

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NR57 1/ NR 57 1 Midterm Exam (Latest 2024/ 2025 Update) Complex Diagnosis & Management in Acute Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain Q:ITheIAGACNPIisIcalledItoIseeIaIpatientIwhoIisIreadyIforIdischargeIafterIaIcarotidIendarte
rectomy.ITheIpatientIisIalteredIandIbeganIcomplaining IofInewIheadacheIthisImorning.ITheIcur
rentIvitalIsignsIareIasIfollowsI:IheartIrateI(HR) 116Ibeats/min,IbloodIpressureI(BP)I170/90ImmHg,IandItemperature I99°F.IWhatIordersIshouldI
theIAGACNPIgive? A.IAcetaminophen I650ImgIorallyInow,IandIbloodIculturesI×I2IobtainedIstat I B.IDiltiazemI15ImgIintravenous I(IV)IpushIfollowedIbyIcontinuous IinfusionIatI5Img/hr;Ititratio
nItoIHRI<90Ibeats/min C.IMorphineI2ImgIIVIasIneededIforIpain;Iacetaminophen I650ImgInowID.ILabetalolI20ImgIIV
IpushIfollowedIbyIcontinuous IinfusionItitratedItoIBPI<160ImmHg Answer: IID.ILabetalolI20ImgIIVIpushIfollowedIbyIcontinuous IinfusionItitratedItoIBPI<160ImmHg TheIpatientIisIdemonstrating IsymptomsIofIcerebralIhyperperfusion IsyndromeIandIrequiresIpro
mptIcontrolIofItheirIhypertension .ILabetalolIIVIpushIfollowedIbyIaItitrat-
IableIinfusionIwillIallowIcorrectionIofItheIhypertension IandItitrationIasIneeded.IWhileIacetami
nophenImayIbeIgivenIforIheadache,ItheIpatient'sIpainIisIpartIofIaIlargerIproblem,IwhichIisIcer
ebralIhyperperfusion .ITheIpriorityIintervention IisIcontrolIofItheIhyperperfusion .IBloodIcultures
IareInotIindicated.IDiltiazemIisIusefulIinIcontrolling IatrialIfibrillation; IitIwillInotIhelpIaddressIt
heIprimaryIproblemIforIthisIpatient.IBetaIblockersIareIaImoreIappropriate Ichoice.IMorphineIan
dIacetaminophen ImayIbeIusedIasIsecondaryIagentsIforIthisIpatient'sIpain;Ihowever,ItheyIwillIn
otIaddressItheIunderlying IproblemIandImayIonlyImaskItheImedicalIemergency IthatIisIunfoldin
g.IControlIofItheIpatient'sIBPIisItheIpriority.I Q:IWhenImanagingIaIcardiacIarrestIpatient,IwhichIinterventions IshouldItheIAGACNPIprioriti
zeIafterIachievingIreturnIofIspontaneous Icirculation? IA.IPlaceIendotracheal ItubeI(ETT),Iobtain
IEKG,Imonitor,IandIoptimizeIrespira-ItoryIandIhemodynamic Iparameters B.ITransferItoIhigherIlevelIofIcare,IinitiateIsedation,IandIconsultIcardiology IC.IAdminister Ihig
h-qualityIcardiopulmonary Iresuscitation I(CPR)IwithIanIem-
IphasisIonIqualityIofIcompressions IandIminimization IofIinterruptions D.ICallIforIhelpIandIassessItheIsceneIforIsafety Answer: IIA.IPlaceIendotracheal ItubeI(ETT),IobtainIEKG,Imonitor,IandIoptimizeIrespiratory IandIhemod
ynamicIpara-Imeters TheIstabilization IphaseIoccursIafterIreturnIofIspontaneous Icirculation I(ROSC)IisIachieved.IDur
ingIthisItime,ItheIETTIisIplaced,ItheIEKGIisIobtained,IandIrespiratory IandIhemodynamic Ipara
metersIareImonitoredIandIoptimized.ITransferItoIaIhigherIlevelIofIcareIandIobtainingIexpertIco
nsultationIoccurIinItheIemergentIactivitiesIphaseIfollowingItheIstabilization Iphase.IHigh-
qualityICPRIisItheIprimaryIgoalIinIachievingIROSC.IThisIoccursIpriorItoItheIstabilization Ipha
se.ICallingIforIhelpIandIsecuringItheIsceneIareItheIinitialIstepsIinIperforming IadvancedIcardiac
IlifeIsupportIandIoccurIbeforeIROSCIandItheIstabilization Iphase.I Q:IAI76-year-
oldIfemaleIpatientIpresentsIwithIaIreportIofIhavingI"passedIout.I"ITheIeventIwasIprecededIbyI
aIfeelingIofIlightheadedness IandIaIflutteringIinItheIchest.IWhatIdifferential IdiagnosisIisImostIc
onsistentIwithIthisIpresentation? IA.IVasovagalIsyncope I B.IOrthostatic Ihypotension C.IArrythmia D.ISeizure Answer: IIC.IArrythmia Arrhythmogenic IsyncopeImayIbeIprecededIbyIpalpitations, IchestIdiscomfort, Idi-
Iaphoresis,IandIaIfeelingIofIlightheadedness .IOrthostatic Ihypotension Iuncommonly IresultsIinIs
yncopeIandIisIprecededIbyIaIsuddenIchangeIinIpositionIfromIsitting orIlyingItoIstanding.ISyncopeIthatIisIprecededIbyIanIauraIandIthatIincludesIfecalIorIurinaryIin
continence IisIhighlyIsuspiciousIforIaIseizure.IVasovagalIsyncopeIisIassociatedIwithInoxiousIsti
muliIincludingIfear,Ianxiety,IorIpain.I Q:IWhichIchoiceIofItherapeutics IisImostIlikelyItoIbeIefficacious IinItreatmentIofIsymptomsIas
sociatedIwithIallItypesIofIcardiomyopathy? A.IDiuretics,IbetaIblockers,IandIcalciumIchannelIblockers B.IAspirin,Istatins,IandIbetaIblockers C.INitrates,Idiuretics,IandInorepinephrine D.IAspirin,Istatins,IandIimplantable Idefibrillator Answer: IIA.IDiuretics,IbetaIblock-Iers,IandIcalciumIchannelIblockers PatientsIpresentingIwithIcardiomyopathy IoftenIpresentIwithIheartIfailureI(HF)IsymptomsIandIv
olumeIoverloadIregardlessIofItheItypeIofIcardiomyopathy .ITheseIsymptomsIareIbestItreatedIwi
thIHFIrecommended Imedications, IincludingIdiureticsItoIdecreaseIvolumeIoverloadIandIbetaIbl
ockersIandIcalciumIchannelIblockersItoIdecreaseIheartIrateIandIincreaseItimeIforIventricular Ifil
ling.IAspirinIandIstatins areInotIrecommended ItoItreatIcardiomyopathy .IWhileInitratesIandIdiureticsImayIbeIusefulIinIt
heItreatmentIofIvolumeIoverloadIinIpatientsIwithIcardiomyopathy, Inorepinephrine IisIanIafterlo
ad-
increasingIagentIandIwouldIlikelyIworsenIsymptomsIofIHFIinItheseIpatients.IAnIimplantable Id
efibrillator ImayIbeIindicatedIforIsomeIpatientsIwithIcardiomyopathy IwhoIareIatIriskIofIsudden
IcardiacIdeath,IbutIitIisInotIappropriate IforIallIpatients.IAdditionally, IaspirinIandIstatinsIareInot
Iindicated.I Q:ITheIAGACNPIadmitsIaIpatientIwhoIpresentsIwithIfever,Ichills,IandIdyspnea.ITheIpatientI
notesIthatItheyIrecentlyIrecoveredIfromICOVID-
19IviralIinfection.ITheIAGACNPIsuspectsImyocarditis IandIknowsItheIdefinitiveIdiagnosisIisI
madeIby: A.ITransthoracic Iechocardiogram IB.IMyocardial IbiopsyIC.ITransesophageal Iechocardiogram D.ICardiacImagneticIresonanceIimagingI(MRI) Answer: IIB.IMyocardial IbiopsyIMyocardial IbiopsyIconfirmsItheIdiagnosisIofImyocarditis .ITheIclassicI
histological IfindingsIincludeIlymphocytic IinfiltratesIwithImyocyteInecrosis,IasIdescribedIbyIth
eIDallasIcriteria.IWhileImyocardial IbiopsyIisIrarelyIdone,IitIisItheIgoldIstandardIfor I diagnosis.IEchocardiogram IandIcardiacIMRIIcanIcontributeIinformation ItoIsuggestImyocarditis
IbutIcannotIconfirmItheIdiagnosis.I Q:ITheIAGACNPIadmitsIaIpatientIwhoIpresentsIwithIacuteIchestIpainIthatIisIrelievedIbyIlea
ningIforward.IOnIphysicalIexam,ItheIpatientIisItachycardic IandIhasIaIpericardial IfrictionIrubIa
ndInormalIlungIsounds.ITheIAGACNPIsuspectsIthatItheIprimaryIdiagnosisIis: A.IMyocarditis IB.IEndocarditis IC.IPericarditis D.IHypertrophic Icardiomyopathy Answer: IIC.IPericarditis ClassicIfindingsIsuggestiveIofIpericarditis IincludeIchestIpainIrelievedIbyIleaningIforwardIandI
presenceIofIaIpericardial IfrictionIrub.IMyocarditis IandIendocarditis IdoInotIhaveIclassicIpresent
ationsIofIreliefIofIsymptomsIwhenIleaningIforwardIandIaIpericardial IfrictionIrub.IAIdiagnosisI
ofIhypertrophic Icardiomyopathy IcannotIbeImadeIbasedIonItheIpatient'sIpresentation .I Q:ITheIAGACNPIisIcalledItoItheIroomIofIaIpatientIwithIcardiacIarrest.ITheIreportedIinitialIr
hythmIisIpulselessIelectricalIactivityI(PEA).IAtItheIfirstIpulseIcheck,ItheImonitorIrevealsIventr
icularIfibrillation .ITheIAGACNP's InextIorderIisIto: A.IPreparation IforIsynchronized Icardioversion IB.IAdministration IofIintravenous I(IV)Iamiodaro
neIC.IAdministration IofIIVImagnesium D.IShockI(200IJIbiphasicIdevice) Answer: IID.IShockI(200IJIbiphasicIdevice) TheIfirstIactionIwhenImanagingIaIpatientIwithIcardiacIarrestIandIshockableIrhythmI(ventricula
rIfibrillation, IportalIveinIthrombosis) IisItoIshock.ISynchronized Icardiover-
IsionIisInotIindicatedIforIventricular Ifibrillation IorIportalIveinIthrombosis .IIVIamio-
IdaroneIcanIbeIconsidered, IbutIshockIshouldIbeItheIfirstIaction.I Q:ITheIAGACNPIisIcaringIforIaIpatientIadmittedIwithIcellulitis.ITheIpatientIhasIaIpastImedi
calIhistoryIofIsymptomatic Ibradycardia IandIhasIaIpacemaker IinIplace.ITheIpacemaker IisIsetIu
pIasIVVI.ITheIAGACNPIknowsIthisImeansItheIpacemaker Iwill: A.IPaceItheIatria,IsenseItheIatria,IinhibitIB.IPaceItheIatria,IpaceItheIatria,IinhibitIC.ISenseItheI
ventricle,IpaceItheIatria,Iinhibit D.IPaceItheIventricle,IsenseItheIventricle,Iinhibit Answer: IID.IPaceItheIventricle,IsenseItheIventricle,Iinhibit StandardInomenclature IforIpacemakers IincludesIfirstIletterI=IchamberIpaced,Isec-
IondIletterI=IchamberIsensed,IandIthirdIletterI=IresponseItoIsensing.I I Q:ITheIAGACNPIisIcaringIforIaIpatientIadmittedItoItheIICUIpostIcoronaryIarteryIbypassIgra
ftI(CABG).ITheIpatientIhasIanIintra-
aorticIballoonIpumpI(IABP).ITheIAGACNPIexplainsItoItheIpatient'sIfamilyIthatItheIIABPIwill
:IA.IIncreaseIrateIandIcontractility IofItheIheart
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