NRNP 6566 Advanced Care of Adults in Acute
Settings I | Week 11 Knowledge Check Study
Guide | 2026 Update
Instructions: Select the single best answer unless the stem asks for multiple selections.
Assume full ACNP scope of practice including authority to order/perform the
interventions listed.
Q1
A 67-year-old man is admitted to the MICU with septic shock secondary to
community-acquired pneumonia. His BP is 78/40 mm Hg, HR 118 bpm, RR 28/min, T
38.9 °C, SpO₂ 88 % on 15 L non-rebreather. ABG: pH 7.28, PaCO₂ 32 mm Hg, PaO₂ 58
mm Hg, lactate 5.2 mmol/L. He has received 3 L crystalloid. What is the NEXT most
appropriate action?
A) Start norepinephrine 0.1 mcg/kg/min via peripheral IV while preparing central line
B) Administer 1 L 5 % dextrose water for additional volume
C) Initiate high-flow nasal cannula at 60 L/min FiO₂ 100 %
D) Order emergent ECHO to rule out cardiogenic shock
Correct Answer: A
Rationale: Septic shock with persistent hypotension despite 30 mL/kg crystalloid
requires immediate vasopressor therapy to restore MAP ≥ 65 mm Hg. Norepinephrine is
, first-line and can be started peripherally for ≤1 h while obtaining central access.
Dextrose water (B) is hypotonic and provides no oncotic pressure. High-flow (C) may
help oxygenation but does not address perfusion. ECHO (D) is useful but should not
delay vasopressor initiation in obvious septic shock.
Q2
A 54-year-old woman post-MI develops acute pulmonary edema and hypoxemic
respiratory failure. She is agitated, diaphoretic, and using accessory muscles. BP
190/110 mm Hg, HR 120 bpm, SpO₂ 85 % on NRB. Lung US shows bilateral B-lines.
Which immediate pharmacologic intervention is most appropriate?
A) IV furosemide 80 mg push
B) IV nitroglycerin 50 mcg/min after 400 mcg bolus
C) IV dopamine 10 mcg/kg/min
D) IV morphine 4 mg
Correct Answer: B
Rationale: Hypertensive flash pulmonary edema is a vasoconstrictive crisis; afterload
reduction with nitroglycerin (venous + arterial) rapidly lowers filling pressures and
improves forward flow. High-dose loop diuretics (A) are secondary and may cause
vasoconstriction. Dopamine (C) increases afterload and heart rate. Morphine (D) offers
no mortality benefit and may depress respiration.
Q3
Settings I | Week 11 Knowledge Check Study
Guide | 2026 Update
Instructions: Select the single best answer unless the stem asks for multiple selections.
Assume full ACNP scope of practice including authority to order/perform the
interventions listed.
Q1
A 67-year-old man is admitted to the MICU with septic shock secondary to
community-acquired pneumonia. His BP is 78/40 mm Hg, HR 118 bpm, RR 28/min, T
38.9 °C, SpO₂ 88 % on 15 L non-rebreather. ABG: pH 7.28, PaCO₂ 32 mm Hg, PaO₂ 58
mm Hg, lactate 5.2 mmol/L. He has received 3 L crystalloid. What is the NEXT most
appropriate action?
A) Start norepinephrine 0.1 mcg/kg/min via peripheral IV while preparing central line
B) Administer 1 L 5 % dextrose water for additional volume
C) Initiate high-flow nasal cannula at 60 L/min FiO₂ 100 %
D) Order emergent ECHO to rule out cardiogenic shock
Correct Answer: A
Rationale: Septic shock with persistent hypotension despite 30 mL/kg crystalloid
requires immediate vasopressor therapy to restore MAP ≥ 65 mm Hg. Norepinephrine is
, first-line and can be started peripherally for ≤1 h while obtaining central access.
Dextrose water (B) is hypotonic and provides no oncotic pressure. High-flow (C) may
help oxygenation but does not address perfusion. ECHO (D) is useful but should not
delay vasopressor initiation in obvious septic shock.
Q2
A 54-year-old woman post-MI develops acute pulmonary edema and hypoxemic
respiratory failure. She is agitated, diaphoretic, and using accessory muscles. BP
190/110 mm Hg, HR 120 bpm, SpO₂ 85 % on NRB. Lung US shows bilateral B-lines.
Which immediate pharmacologic intervention is most appropriate?
A) IV furosemide 80 mg push
B) IV nitroglycerin 50 mcg/min after 400 mcg bolus
C) IV dopamine 10 mcg/kg/min
D) IV morphine 4 mg
Correct Answer: B
Rationale: Hypertensive flash pulmonary edema is a vasoconstrictive crisis; afterload
reduction with nitroglycerin (venous + arterial) rapidly lowers filling pressures and
improves forward flow. High-dose loop diuretics (A) are secondary and may cause
vasoconstriction. Dopamine (C) increases afterload and heart rate. Morphine (D) offers
no mortality benefit and may depress respiration.
Q3
