NRNP 6566 Week 5 Knowledge Check (2025/2026)
100% Accurate Questions and Verified Answer Key |
Adult Acute Care Nursing
Question 1: A 55-year-old male presents with acute chest pain radiating to the left arm,
nausea, and diaphoresis. The ECG shows ST elevation in leads V1V4.
What is the most likely diagnosis?
A. Inferior wall myocardial infarction
B. Anterior wall myocardial infarction
C. Pericarditis
D. Aortic dissection
Correct Answer: B. Anterior wall myocardial infarction
Clinical Rationale: ST elevation in leads V1V4 indicates an anterior
wall myocardial infarction, typically due to occlusion of the left anterior
descending artery. This artery supplies the anterior wall of the left ven-
tricle, and acute occlusion leads to ischemia, presenting with chest pain,
nausea, and diaphoresis, common in adult acute care settings.
Question 2: A 62-year-old female with a pulmonary embolism is on heparin. Her aPTT
is 45 seconds (therapeutic range 6080 seconds). What is the next step?
A. Discontinue heparin
B. Increase heparin dose
C. Maintain current dose
D. Switch to warfarin
Correct Answer: B. Increase heparin dose
Clinical Rationale: In acute care, heparin is titrated to achieve a thera-
peutic aPTT (6080 seconds) for pulmonary embolism treatment. An aPTT
of 45 seconds is subtherapeutic, requiring an increase in the heparin dose
to prevent thrombus progression.
Question 3: A 70-year-old male with atrial fibrillation develops acute dyspnea and hy-
poxia. A CT scan confirms a pulmonary embolism. Which anticoagulant is
contraindicated if he has a history of heparin-induced thrombocytopenia?
A. Heparin
B. Warfarin
1
, C. Rivaroxaban
D. Apixaban
Correct Answer: A. Heparin
Clinical Rationale: Heparin is contraindicated in patients with heparin-
induced thrombocytopenia due to the risk of worsening thrombocytopenia
and thrombosis. Direct oral anticoagulants like rivaroxaban or apixaban
are preferred in acute care for such patients.
Question 4: A 58-year-old male post-myocardial infarction is prescribed metoprolol.
What is the primary reason for this medication in this context?
A. To reduce blood pressure
B. To prevent ventricular arrhythmias
C. To improve left ventricular function
D. To reduce myocardial oxygen demand
Correct Answer: D. To reduce myocardial oxygen demand
Clinical Rationale: Beta-blockers like metoprolol reduce heart rate and
contractility, decreasing myocardial oxygen demand in post-myocardial in-
farction patients, which is critical in acute care to prevent further ischemic
damage.
Question 5: A 45-year-old female presents with severe abdominal pain and hypotension.
A CT scan reveals a ruptured abdominal aortic aneurysm. What is the
immediate priority?
A. Administer IV antibiotics
B. Initiate fluid resuscitation
C. Order a stat echocardiogram
D. Prepare for endovascular repair
Correct Answer: B. Initiate fluid resuscitation
Clinical Rationale: In a ruptured abdominal aortic aneurysm, hypoten-
sion indicates significant blood loss. Immediate fluid resuscitation is critical
in acute care to stabilize hemodynamics before surgical intervention.
Question 6: A 67-year-old male with COPD presents with acute respiratory distress.
His arterial blood gas shows pH 7.28, PaCO2 60 mmHg, PaO2 55 mmHg.
What is the most appropriate initial intervention?
2
, A. Intubate and mechanically ventilate
B. Administer high-flow oxygen
C. Initiate non-invasive ventilation
D. Administer IV corticosteroids
Correct Answer: C. Initiate non-invasive ventilation
Clinical Rationale: In acute COPD exacerbation with respiratory aci-
dosis (pH 7.28, elevated PaCO2), non-invasive ventilation (e.g., BiPAP)
is the first-line treatment in acute care to improve ventilation and avoid
intubation.
Question 7: A 50-year-old female with septic shock is started on norepinephrine. Her
mean arterial pressure (MAP) remains 60 mmHg despite maximum dosing.
What is the next step?
A. Add vasopressin
B. Increase fluid bolus
C. Discontinue norepinephrine
D. Administer dobutamine
Correct Answer: A. Add vasopressin
Clinical Rationale: In septic shock, if MAP remains below 65 mmHg
despite norepinephrine, vasopressin is added as a second-line vasopressor
to maintain perfusion in critical care settings.
Question 8: A 60-year-old male with acute pancreatitis develops severe abdominal pain
and fever. A CT scan shows pancreatic necrosis. What is the most appro-
priate next step?
A. Start broad-spectrum antibiotics
B. Perform urgent surgical debridement
C. Administer IV fluids aggressively
D. Initiate total parenteral nutrition
Correct Answer: A. Start broad-spectrum antibiotics
Clinical Rationale: Pancreatic necrosis with fever suggests infection, a
common complication in acute pancreatitis. Broad-spectrum antibiotics
are initiated in acute care to address potential sepsis.
3
100% Accurate Questions and Verified Answer Key |
Adult Acute Care Nursing
Question 1: A 55-year-old male presents with acute chest pain radiating to the left arm,
nausea, and diaphoresis. The ECG shows ST elevation in leads V1V4.
What is the most likely diagnosis?
A. Inferior wall myocardial infarction
B. Anterior wall myocardial infarction
C. Pericarditis
D. Aortic dissection
Correct Answer: B. Anterior wall myocardial infarction
Clinical Rationale: ST elevation in leads V1V4 indicates an anterior
wall myocardial infarction, typically due to occlusion of the left anterior
descending artery. This artery supplies the anterior wall of the left ven-
tricle, and acute occlusion leads to ischemia, presenting with chest pain,
nausea, and diaphoresis, common in adult acute care settings.
Question 2: A 62-year-old female with a pulmonary embolism is on heparin. Her aPTT
is 45 seconds (therapeutic range 6080 seconds). What is the next step?
A. Discontinue heparin
B. Increase heparin dose
C. Maintain current dose
D. Switch to warfarin
Correct Answer: B. Increase heparin dose
Clinical Rationale: In acute care, heparin is titrated to achieve a thera-
peutic aPTT (6080 seconds) for pulmonary embolism treatment. An aPTT
of 45 seconds is subtherapeutic, requiring an increase in the heparin dose
to prevent thrombus progression.
Question 3: A 70-year-old male with atrial fibrillation develops acute dyspnea and hy-
poxia. A CT scan confirms a pulmonary embolism. Which anticoagulant is
contraindicated if he has a history of heparin-induced thrombocytopenia?
A. Heparin
B. Warfarin
1
, C. Rivaroxaban
D. Apixaban
Correct Answer: A. Heparin
Clinical Rationale: Heparin is contraindicated in patients with heparin-
induced thrombocytopenia due to the risk of worsening thrombocytopenia
and thrombosis. Direct oral anticoagulants like rivaroxaban or apixaban
are preferred in acute care for such patients.
Question 4: A 58-year-old male post-myocardial infarction is prescribed metoprolol.
What is the primary reason for this medication in this context?
A. To reduce blood pressure
B. To prevent ventricular arrhythmias
C. To improve left ventricular function
D. To reduce myocardial oxygen demand
Correct Answer: D. To reduce myocardial oxygen demand
Clinical Rationale: Beta-blockers like metoprolol reduce heart rate and
contractility, decreasing myocardial oxygen demand in post-myocardial in-
farction patients, which is critical in acute care to prevent further ischemic
damage.
Question 5: A 45-year-old female presents with severe abdominal pain and hypotension.
A CT scan reveals a ruptured abdominal aortic aneurysm. What is the
immediate priority?
A. Administer IV antibiotics
B. Initiate fluid resuscitation
C. Order a stat echocardiogram
D. Prepare for endovascular repair
Correct Answer: B. Initiate fluid resuscitation
Clinical Rationale: In a ruptured abdominal aortic aneurysm, hypoten-
sion indicates significant blood loss. Immediate fluid resuscitation is critical
in acute care to stabilize hemodynamics before surgical intervention.
Question 6: A 67-year-old male with COPD presents with acute respiratory distress.
His arterial blood gas shows pH 7.28, PaCO2 60 mmHg, PaO2 55 mmHg.
What is the most appropriate initial intervention?
2
, A. Intubate and mechanically ventilate
B. Administer high-flow oxygen
C. Initiate non-invasive ventilation
D. Administer IV corticosteroids
Correct Answer: C. Initiate non-invasive ventilation
Clinical Rationale: In acute COPD exacerbation with respiratory aci-
dosis (pH 7.28, elevated PaCO2), non-invasive ventilation (e.g., BiPAP)
is the first-line treatment in acute care to improve ventilation and avoid
intubation.
Question 7: A 50-year-old female with septic shock is started on norepinephrine. Her
mean arterial pressure (MAP) remains 60 mmHg despite maximum dosing.
What is the next step?
A. Add vasopressin
B. Increase fluid bolus
C. Discontinue norepinephrine
D. Administer dobutamine
Correct Answer: A. Add vasopressin
Clinical Rationale: In septic shock, if MAP remains below 65 mmHg
despite norepinephrine, vasopressin is added as a second-line vasopressor
to maintain perfusion in critical care settings.
Question 8: A 60-year-old male with acute pancreatitis develops severe abdominal pain
and fever. A CT scan shows pancreatic necrosis. What is the most appro-
priate next step?
A. Start broad-spectrum antibiotics
B. Perform urgent surgical debridement
C. Administer IV fluids aggressively
D. Initiate total parenteral nutrition
Correct Answer: A. Start broad-spectrum antibiotics
Clinical Rationale: Pancreatic necrosis with fever suggests infection, a
common complication in acute pancreatitis. Broad-spectrum antibiotics
are initiated in acute care to address potential sepsis.
3
