NRNP 6566 Advanced Care of Adults in
Acute Settings I Final Exam | Verified
Questions and Answers | Walden
University (2023/2024 New Update)
This 50-question exam assesses advanced practice knowledge in acute adult care, focusing on
sepsis management (Questions 1-13), acute cardiac care (Questions 14-25), pharmacology
(Questions 26-38), and diagnostics (Questions 39-50). Questions emphasize clinical
decision-making, evidence-based guidelines (e.g., Surviving Sepsis Campaign 2021, AHA/ACC
2023 updates), and NP role competencies. Each includes four options (A-D), the correct
answer, and a rationale.
Question 1: A 68-year-old male with pneumonia presents with fever, tachycardia (HR 110 bpm),
and altered mental status. Initial sepsis screening shows qSOFA score of 2. Per Surviving
Sepsis Campaign 2021 guidelines, what is the priority intervention within 1 hour?
A. Administer broad-spectrum antibiotics
B. Order lactate level and blood cultures
C. Start vasopressors
D. Intubate for airway protection
Correct Answer: B
Rationale: Blood cultures and lactate measurement must precede antibiotics in the hour-1
bundle to guide therapy; 2021 SSC guidelines emphasize this for risk stratification, reducing
mortality by 20% through early identification of septic shock.
Question 2: In managing sepsis-induced hypotension (MAP <65 mmHg) unresponsive to fluids,
the first-line vasopressor is:
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
Correct Answer: B
Rationale: Norepinephrine is preferred for its alpha/beta effects, minimizing tachycardia; 2021
SSC meta-analysis shows it reduces arrhythmia risk compared to dopamine, guiding NP titration
for hemodynamic stability.
, Question 3: A patient with urosepsis has a qSOFA score of 3. What diagnostic criterion
confirms septic shock?
A. Lactate <2 mmol/L
B. Lactate >2 mmol/L despite fluid resuscitation
C. WBC <4,000/mm³
D. Temperature <36°C
Correct Answer: B
Rationale: Septic shock requires persistent hypotension or lactate ≥2 mmol/L post-30 mL/kg
fluids; 2021 SSC updates this for organ dysfunction assessment, prompting NP escalation to
ICU.
Question 4: For a septic patient with AKI (creatinine 2.5 mg/dL), fluid choice in the initial bolus
is:
A. 0.45% saline
B. Lactated Ringer's or normal saline
C. 3% saline
D. D5W
Correct Answer: B
Rationale: Balanced crystalloids like LR reduce AKI progression; 2021 SSC/SMART trial
evidence supports this over saline, aiding NP decisions in volume resuscitation.
Question 5: In sepsis, hydrocortisone is indicated for refractory shock when:
A. All patients routinely
B. Vasopressors needed despite fluids and lactate >4 mmol/L
C. Mild hypotension only
D. After antibiotics
Correct Answer: B
Rationale: Low-dose hydrocortisone (200 mg/day) for catecholamine-resistant shock; 2021 SSC
weak recommendation based on ADRENAL trial, balancing infection risk for NPs.
Question 6: A 72-year-old with sepsis has glucose 220 mg/dL. Target blood glucose per
guidelines is:
A. 140-180 mg/dL
B. <110 mg/dL
C. 180-200 mg/dL
D. >250 mg/dL
Correct Answer: A
Rationale: Tight control 140-180 mg/dL reduces mortality without hypoglycemia; 2021 SSC from
Leuven trial, guiding NP insulin protocols in hyperglycemia.
Question 7: Source control in intra-abdominal sepsis prioritizes:
A. Antibiotics alone
Acute Settings I Final Exam | Verified
Questions and Answers | Walden
University (2023/2024 New Update)
This 50-question exam assesses advanced practice knowledge in acute adult care, focusing on
sepsis management (Questions 1-13), acute cardiac care (Questions 14-25), pharmacology
(Questions 26-38), and diagnostics (Questions 39-50). Questions emphasize clinical
decision-making, evidence-based guidelines (e.g., Surviving Sepsis Campaign 2021, AHA/ACC
2023 updates), and NP role competencies. Each includes four options (A-D), the correct
answer, and a rationale.
Question 1: A 68-year-old male with pneumonia presents with fever, tachycardia (HR 110 bpm),
and altered mental status. Initial sepsis screening shows qSOFA score of 2. Per Surviving
Sepsis Campaign 2021 guidelines, what is the priority intervention within 1 hour?
A. Administer broad-spectrum antibiotics
B. Order lactate level and blood cultures
C. Start vasopressors
D. Intubate for airway protection
Correct Answer: B
Rationale: Blood cultures and lactate measurement must precede antibiotics in the hour-1
bundle to guide therapy; 2021 SSC guidelines emphasize this for risk stratification, reducing
mortality by 20% through early identification of septic shock.
Question 2: In managing sepsis-induced hypotension (MAP <65 mmHg) unresponsive to fluids,
the first-line vasopressor is:
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
Correct Answer: B
Rationale: Norepinephrine is preferred for its alpha/beta effects, minimizing tachycardia; 2021
SSC meta-analysis shows it reduces arrhythmia risk compared to dopamine, guiding NP titration
for hemodynamic stability.
, Question 3: A patient with urosepsis has a qSOFA score of 3. What diagnostic criterion
confirms septic shock?
A. Lactate <2 mmol/L
B. Lactate >2 mmol/L despite fluid resuscitation
C. WBC <4,000/mm³
D. Temperature <36°C
Correct Answer: B
Rationale: Septic shock requires persistent hypotension or lactate ≥2 mmol/L post-30 mL/kg
fluids; 2021 SSC updates this for organ dysfunction assessment, prompting NP escalation to
ICU.
Question 4: For a septic patient with AKI (creatinine 2.5 mg/dL), fluid choice in the initial bolus
is:
A. 0.45% saline
B. Lactated Ringer's or normal saline
C. 3% saline
D. D5W
Correct Answer: B
Rationale: Balanced crystalloids like LR reduce AKI progression; 2021 SSC/SMART trial
evidence supports this over saline, aiding NP decisions in volume resuscitation.
Question 5: In sepsis, hydrocortisone is indicated for refractory shock when:
A. All patients routinely
B. Vasopressors needed despite fluids and lactate >4 mmol/L
C. Mild hypotension only
D. After antibiotics
Correct Answer: B
Rationale: Low-dose hydrocortisone (200 mg/day) for catecholamine-resistant shock; 2021 SSC
weak recommendation based on ADRENAL trial, balancing infection risk for NPs.
Question 6: A 72-year-old with sepsis has glucose 220 mg/dL. Target blood glucose per
guidelines is:
A. 140-180 mg/dL
B. <110 mg/dL
C. 180-200 mg/dL
D. >250 mg/dL
Correct Answer: A
Rationale: Tight control 140-180 mg/dL reduces mortality without hypoglycemia; 2021 SSC from
Leuven trial, guiding NP insulin protocols in hyperglycemia.
Question 7: Source control in intra-abdominal sepsis prioritizes:
A. Antibiotics alone
