NUNP 6550 Advanced Practice Care of
Adults in Acute Care Settings
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, 1. Multiple Choice
Case: A 68-year-old male with a history of chronic obstructive
pulmonary disease (COPD) and heart failure is admitted with bacterial
pneumonia. Over a few hours, he develops tachycardia, hypotension, and
tachypnea, suggesting the onset of septic shock.
Question: Which initial intervention is most critical in the management
of this patient’s septic shock?
- a) Immediate initiation of broad-spectrum antibiotics
- b) Aggressive fluid resuscitation with intravenous crystalloids
- c) Early start of high-dose vasopressor therapy
- d) Endotracheal intubation and mechanical ventilation
Correct ANS: b) Aggressive fluid resuscitation with intravenous
crystalloids
Rationale: Early goal-directed therapy in septic shock emphasizes the
importance of rapid fluid resuscitation (typically around 30 mL/kg of IV
crystalloids) to restore intravascular volume and improve tissue perfusion
before the use of vasopressors or advanced airway interventions are
considered .
---
2. Fill-in-the-Blank
Case: An advanced practice nurse is assessing a critically ill patient with
suspected sepsis. Rapid determination of organ dysfunction is crucial.
Question: The _______ score is routinely calculated to quantify the
severity of organ failure and predict mortality in septic patients.
Correct ANS: Sequential Organ Failure Assessment (SOFA)
©2025
, Rationale: The SOFA score evaluates several organ systems
(respiratory, coagulation, liver, cardiovascular, central nervous, and
renal) to quantify the extent of dysfunction and provides prognostic
information in patients with sepsis .
---
3. True/False
Case: A patient with acute respiratory distress syndrome (ARDS)
secondary to pneumonia is being managed on mechanical ventilation.
Statement: Initiating high positive end-expiratory pressure (PEEP)
immediately, regardless of the patient’s hemodynamic status, is the best
strategy to improve oxygenation in ARDS.
Correct ANS: False
Rationale: While PEEP is essential to improve oxygenation in ARDS,
excessively high levels can compromise venous return and worsen
hypotension. PEEP must be titrated to balance oxygenation with
hemodynamic stability .
---
4. Multiple Response
Case: A 55-year-old female is admitted with an acute myocardial
infarction complicated by cardiogenic shock. Prompt advanced practice
management is essential.
Question: Which of the following interventions should be
implemented? (Select all that apply.)
- a) Inotropic support with dobutamine
- b) Immediate coronary angiography for reperfusion
- c) Strict fluid restriction to avoid volume overload
©2025
Adults in Acute Care Settings
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, 1. Multiple Choice
Case: A 68-year-old male with a history of chronic obstructive
pulmonary disease (COPD) and heart failure is admitted with bacterial
pneumonia. Over a few hours, he develops tachycardia, hypotension, and
tachypnea, suggesting the onset of septic shock.
Question: Which initial intervention is most critical in the management
of this patient’s septic shock?
- a) Immediate initiation of broad-spectrum antibiotics
- b) Aggressive fluid resuscitation with intravenous crystalloids
- c) Early start of high-dose vasopressor therapy
- d) Endotracheal intubation and mechanical ventilation
Correct ANS: b) Aggressive fluid resuscitation with intravenous
crystalloids
Rationale: Early goal-directed therapy in septic shock emphasizes the
importance of rapid fluid resuscitation (typically around 30 mL/kg of IV
crystalloids) to restore intravascular volume and improve tissue perfusion
before the use of vasopressors or advanced airway interventions are
considered .
---
2. Fill-in-the-Blank
Case: An advanced practice nurse is assessing a critically ill patient with
suspected sepsis. Rapid determination of organ dysfunction is crucial.
Question: The _______ score is routinely calculated to quantify the
severity of organ failure and predict mortality in septic patients.
Correct ANS: Sequential Organ Failure Assessment (SOFA)
©2025
, Rationale: The SOFA score evaluates several organ systems
(respiratory, coagulation, liver, cardiovascular, central nervous, and
renal) to quantify the extent of dysfunction and provides prognostic
information in patients with sepsis .
---
3. True/False
Case: A patient with acute respiratory distress syndrome (ARDS)
secondary to pneumonia is being managed on mechanical ventilation.
Statement: Initiating high positive end-expiratory pressure (PEEP)
immediately, regardless of the patient’s hemodynamic status, is the best
strategy to improve oxygenation in ARDS.
Correct ANS: False
Rationale: While PEEP is essential to improve oxygenation in ARDS,
excessively high levels can compromise venous return and worsen
hypotension. PEEP must be titrated to balance oxygenation with
hemodynamic stability .
---
4. Multiple Response
Case: A 55-year-old female is admitted with an acute myocardial
infarction complicated by cardiogenic shock. Prompt advanced practice
management is essential.
Question: Which of the following interventions should be
implemented? (Select all that apply.)
- a) Inotropic support with dobutamine
- b) Immediate coronary angiography for reperfusion
- c) Strict fluid restriction to avoid volume overload
©2025
