NRNP 6566 Week 8 Knowledge Check (2025/2026)
– 100% Correct Answers with Expert Rationales |
Advanced Acute Adult Nursing
Instructions
The following are 80 multiple-choice questions designed for the NRNP 6566 Week 8
Knowledge Check (2025/2026). Each question includes four answer options, one verified
correct answer, and a detailed rationale grounded in advanced acute care of adults. Select
the best answer for each question.
Question 1: A 62-year-old male presents with acute chest pain radiating to the left arm.
ECG shows ST elevation in leads V1–V4. What is the priority interven-
tion?
A. Administer sublingual nitroglycerin
B. Initiate thrombolytic therapy
C. Prepare for percutaneous coronary intervention (PCI)
D. Administer morphine sulfate
Correct Answer: C. Prepare for percutaneous coronary intervention
(PCI)
Rationale: ST-elevation myocardial infarction (STEMI) in anterior leads
(V1–V4) indicates acute coronary occlusion. PCI is the preferred reper-
fusion therapy within 90 minutes of first medical contact, per ACC/AHA
guidelines. Nitroglycerin and morphine are adjunctive, and thrombolytics
are used if PCI is unavailable.
Question 2: A 55-year-old female with septic shock is receiving norepinephrine. Her
MAP is 60 mmHg, and urine output is 15 mL/hr. What is the next step?
A. Increase norepinephrine dose
B. Add vasopressin
C. Administer a fluid bolus
D. Initiate dobutamine
Correct Answer: B. Add vasopressin
Rationale: In septic shock, a MAP <65 mmHg and oliguria indicate in-
adequate perfusion despite norepinephrine. Vasopressin is added to reduce
catecholamine requirements and improve MAP, per Surviving Sepsis Cam-
paign guidelines. Fluid bolus is inappropriate without hypovolemia, and
dobutamine is for cardiac dysfunction.
Question 3: A 70-year-old male with COPD exacerbation has a PaCO2 of 65 mmHg
and pH of 7.28. What is the most appropriate intervention?
A. Increase oxygen to 6 L/min via nasal cannula
B. Initiate non-invasive ventilation (NIV)
C. Administer IV sodium bicarbonate
D. Intubate and initiate mechanical ventilation
Correct Answer: B. Initiate non-invasive ventilation (NIV)
Rationale: Hypercapnic respiratory failure (PaCO2 >50 mmHg, pH <7.35)
in COPD exacerbation is best managed with NIV (e.g., BiPAP) to improve
1
, ventilation and avoid intubation. High-flow oxygen risks worsening hyper-
capnia, bicarbonate is not indicated, and intubation is reserved for NIV
failure.
Question 4: A 45-year-old female presents with acute pancreatitis. Her amylase is 800
U/L, and she reports severe epigastric pain. What is the initial manage-
ment?
A. Administer IV morphine
B. Initiate enteral feeding
C. Start aggressive IV fluid resuscitation
D. Order an immediate CT scan
Correct Answer: C. Start aggressive IV fluid resuscitation
Rationale: Acute pancreatitis requires early aggressive IV fluids (e.g.,
250–500 mL/hr lactated Ringer’s) to prevent hypovolemia and organ fail-
ure, per AGA guidelines. Morphine is used for pain, enteral feeding is
delayed, and CT is not routine initially unless complications are suspected.
Question 5: A 68-year-old male with atrial fibrillation develops sudden hypotension
(BP 80/50 mmHg) and tachycardia (HR 150 bpm). What is the priority
intervention?
A. Administer IV amiodarone
B. Perform synchronized cardioversion
C. Initiate heparin infusion
D. Administer IV metoprolol
Correct Answer: B. Perform synchronized cardioversion
Rationale: Unstable atrial fibrillation with hypotension requires immedi-
ate synchronized cardioversion to restore sinus rhythm, per ACLS guide-
lines. Amiodarone and metoprolol are for stable patients, and heparin is
for thromboembolism prevention, not acute instability.
Question 6: A 50-year-old male with DKA has a blood glucose of 600 mg/dL, pH 7.15,
and potassium 5.8 mEq/L. What is the initial treatment?
A. Administer IV regular insulin
B. Give IV sodium bicarbonate
C. Administer IV potassium chloride
D. Start subcutaneous long-acting insulin
Correct Answer: A. Administer IV regular insulin
Rationale: Diabetic ketoacidosis (DKA) is treated with IV regular insulin
(0.1 U/kg/hr) to correct hyperglycemia and acidosis, per ADA guidelines.
Bicarbonate is rarely used (pH <6.9), potassium is supplemented later,
and long-acting insulin is inappropriate acutely.
Question 7: A 75-year-old female with acute ischemic stroke presents within 2 hours
of symptom onset. Her NIHSS score is 10. What is the most appropriate
treatment?
A. Administer IV alteplase
B. Initiate aspirin 325 mg orally
C. Start IV heparin infusion
D. Order a STAT MRI brain
Correct Answer: A. Administer IV alteplase
2
, Rationale: IV alteplase is indicated for acute ischemic stroke within 4.5
hours if no contraindications exist, per AHA guidelines. NIHSS 10 indicates
moderate stroke. Aspirin is secondary, heparin is not routine, and MRI
delays thrombolysis.
Question 8: A 60-year-old male with ARDS has a PaO2/FiO2 ratio of 150 and requires
mechanical ventilation. What is the best ventilator setting?
A. High tidal volume (10 mL/kg)
B. Low tidal volume (6 mL/kg)
C. Zero PEEP
D. FiO2 of 100%
Correct Answer: B. Low tidal volume (6 mL/kg)
Rationale: ARDS is managed with low tidal volume ventilation (6 mL/kg
ideal body weight) to prevent volutrauma, per ARDSNet protocol. High
tidal volumes worsen injury, PEEP is essential, and FiO2 is titrated to
maintain PaO2 >55 mmHg.
Question 9: A 48-year-old female with acute liver failure develops confusion and aster-
ixis. What is the most likely diagnosis?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Stroke
D. Sepsis
Correct Answer: B. Hepatic encephalopathy
Rationale: Confusion and asterixis in acute liver failure indicate hepatic
encephalopathy due to ammonia accumulation. Hypoglycemia, stroke, or
sepsis may cause confusion but lack asterixis as a hallmark sign.
Question 10: A 65-year-old male with pneumonia develops a pleural effusion. Thoracen-
tesis reveals pH 7.15 and glucose 40 mg/dL. What is the diagnosis?
A. Transudative effusion
B. Malignant effusion
C. Empyema
D. Hemothorax
Correct Answer: C. Empyema
Rationale: Pleural fluid with pH <7.2 and low glucose (<60 mg/dL) indi-
cates empyema, an infected pleural space, often complicating pneumonia.
Transudative effusions have normal pH/glucose, malignant effusions vary,
and hemothorax shows blood.
Question 11: A 72-year-old female with acute heart failure has a BP of 90/60 mmHg
and pulmonary edema. What is the initial treatment?
A. Administer IV furosemide
B. Start norepinephrine infusion
C. Initiate non-invasive positive pressure ventilation (NIPPV)
D. Administer IV digoxin
Correct Answer: C. Initiate non-invasive positive pressure ventilation
(NIPPV)
Rationale: NIPPV (e.g., CPAP/BiPAP) reduces preload and improves
oxygenation in acute heart failure with pulmonary edema. Furosemide is
3
– 100% Correct Answers with Expert Rationales |
Advanced Acute Adult Nursing
Instructions
The following are 80 multiple-choice questions designed for the NRNP 6566 Week 8
Knowledge Check (2025/2026). Each question includes four answer options, one verified
correct answer, and a detailed rationale grounded in advanced acute care of adults. Select
the best answer for each question.
Question 1: A 62-year-old male presents with acute chest pain radiating to the left arm.
ECG shows ST elevation in leads V1–V4. What is the priority interven-
tion?
A. Administer sublingual nitroglycerin
B. Initiate thrombolytic therapy
C. Prepare for percutaneous coronary intervention (PCI)
D. Administer morphine sulfate
Correct Answer: C. Prepare for percutaneous coronary intervention
(PCI)
Rationale: ST-elevation myocardial infarction (STEMI) in anterior leads
(V1–V4) indicates acute coronary occlusion. PCI is the preferred reper-
fusion therapy within 90 minutes of first medical contact, per ACC/AHA
guidelines. Nitroglycerin and morphine are adjunctive, and thrombolytics
are used if PCI is unavailable.
Question 2: A 55-year-old female with septic shock is receiving norepinephrine. Her
MAP is 60 mmHg, and urine output is 15 mL/hr. What is the next step?
A. Increase norepinephrine dose
B. Add vasopressin
C. Administer a fluid bolus
D. Initiate dobutamine
Correct Answer: B. Add vasopressin
Rationale: In septic shock, a MAP <65 mmHg and oliguria indicate in-
adequate perfusion despite norepinephrine. Vasopressin is added to reduce
catecholamine requirements and improve MAP, per Surviving Sepsis Cam-
paign guidelines. Fluid bolus is inappropriate without hypovolemia, and
dobutamine is for cardiac dysfunction.
Question 3: A 70-year-old male with COPD exacerbation has a PaCO2 of 65 mmHg
and pH of 7.28. What is the most appropriate intervention?
A. Increase oxygen to 6 L/min via nasal cannula
B. Initiate non-invasive ventilation (NIV)
C. Administer IV sodium bicarbonate
D. Intubate and initiate mechanical ventilation
Correct Answer: B. Initiate non-invasive ventilation (NIV)
Rationale: Hypercapnic respiratory failure (PaCO2 >50 mmHg, pH <7.35)
in COPD exacerbation is best managed with NIV (e.g., BiPAP) to improve
1
, ventilation and avoid intubation. High-flow oxygen risks worsening hyper-
capnia, bicarbonate is not indicated, and intubation is reserved for NIV
failure.
Question 4: A 45-year-old female presents with acute pancreatitis. Her amylase is 800
U/L, and she reports severe epigastric pain. What is the initial manage-
ment?
A. Administer IV morphine
B. Initiate enteral feeding
C. Start aggressive IV fluid resuscitation
D. Order an immediate CT scan
Correct Answer: C. Start aggressive IV fluid resuscitation
Rationale: Acute pancreatitis requires early aggressive IV fluids (e.g.,
250–500 mL/hr lactated Ringer’s) to prevent hypovolemia and organ fail-
ure, per AGA guidelines. Morphine is used for pain, enteral feeding is
delayed, and CT is not routine initially unless complications are suspected.
Question 5: A 68-year-old male with atrial fibrillation develops sudden hypotension
(BP 80/50 mmHg) and tachycardia (HR 150 bpm). What is the priority
intervention?
A. Administer IV amiodarone
B. Perform synchronized cardioversion
C. Initiate heparin infusion
D. Administer IV metoprolol
Correct Answer: B. Perform synchronized cardioversion
Rationale: Unstable atrial fibrillation with hypotension requires immedi-
ate synchronized cardioversion to restore sinus rhythm, per ACLS guide-
lines. Amiodarone and metoprolol are for stable patients, and heparin is
for thromboembolism prevention, not acute instability.
Question 6: A 50-year-old male with DKA has a blood glucose of 600 mg/dL, pH 7.15,
and potassium 5.8 mEq/L. What is the initial treatment?
A. Administer IV regular insulin
B. Give IV sodium bicarbonate
C. Administer IV potassium chloride
D. Start subcutaneous long-acting insulin
Correct Answer: A. Administer IV regular insulin
Rationale: Diabetic ketoacidosis (DKA) is treated with IV regular insulin
(0.1 U/kg/hr) to correct hyperglycemia and acidosis, per ADA guidelines.
Bicarbonate is rarely used (pH <6.9), potassium is supplemented later,
and long-acting insulin is inappropriate acutely.
Question 7: A 75-year-old female with acute ischemic stroke presents within 2 hours
of symptom onset. Her NIHSS score is 10. What is the most appropriate
treatment?
A. Administer IV alteplase
B. Initiate aspirin 325 mg orally
C. Start IV heparin infusion
D. Order a STAT MRI brain
Correct Answer: A. Administer IV alteplase
2
, Rationale: IV alteplase is indicated for acute ischemic stroke within 4.5
hours if no contraindications exist, per AHA guidelines. NIHSS 10 indicates
moderate stroke. Aspirin is secondary, heparin is not routine, and MRI
delays thrombolysis.
Question 8: A 60-year-old male with ARDS has a PaO2/FiO2 ratio of 150 and requires
mechanical ventilation. What is the best ventilator setting?
A. High tidal volume (10 mL/kg)
B. Low tidal volume (6 mL/kg)
C. Zero PEEP
D. FiO2 of 100%
Correct Answer: B. Low tidal volume (6 mL/kg)
Rationale: ARDS is managed with low tidal volume ventilation (6 mL/kg
ideal body weight) to prevent volutrauma, per ARDSNet protocol. High
tidal volumes worsen injury, PEEP is essential, and FiO2 is titrated to
maintain PaO2 >55 mmHg.
Question 9: A 48-year-old female with acute liver failure develops confusion and aster-
ixis. What is the most likely diagnosis?
A. Hypoglycemia
B. Hepatic encephalopathy
C. Stroke
D. Sepsis
Correct Answer: B. Hepatic encephalopathy
Rationale: Confusion and asterixis in acute liver failure indicate hepatic
encephalopathy due to ammonia accumulation. Hypoglycemia, stroke, or
sepsis may cause confusion but lack asterixis as a hallmark sign.
Question 10: A 65-year-old male with pneumonia develops a pleural effusion. Thoracen-
tesis reveals pH 7.15 and glucose 40 mg/dL. What is the diagnosis?
A. Transudative effusion
B. Malignant effusion
C. Empyema
D. Hemothorax
Correct Answer: C. Empyema
Rationale: Pleural fluid with pH <7.2 and low glucose (<60 mg/dL) indi-
cates empyema, an infected pleural space, often complicating pneumonia.
Transudative effusions have normal pH/glucose, malignant effusions vary,
and hemothorax shows blood.
Question 11: A 72-year-old female with acute heart failure has a BP of 90/60 mmHg
and pulmonary edema. What is the initial treatment?
A. Administer IV furosemide
B. Start norepinephrine infusion
C. Initiate non-invasive positive pressure ventilation (NIPPV)
D. Administer IV digoxin
Correct Answer: C. Initiate non-invasive positive pressure ventilation
(NIPPV)
Rationale: NIPPV (e.g., CPAP/BiPAP) reduces preload and improves
oxygenation in acute heart failure with pulmonary edema. Furosemide is
3
