NSG 5714 Adult-Gerontology Acute Care
Residency Practice Exam 2 Questions
And Correct Answers (Verified Answers)
Plus Rationales 2026|2027 Q&A |
Instant Download Pdf| South College
Q1. A 68-year-old patient with COPD is admitted with acute hypercapnic
respiratory failure. Which intervention is most appropriate as first-line
ventilatory support?
A. Immediate endotracheal intubation and mechanical ventilation
B. High-flow nasal cannula at 60 L/min
C. Noninvasive positive pressure ventilation (NIPPV) such as BiPAP
D. Supplemental oxygen via simple face mask at 10 L/min
Rationale: NIPPV (e.g., BiPAP) is first-line for acute hypercapnic respiratory
failure in COPD when the patient is cooperative and airway protective
reflexes are intact; it improves ventilation and may avoid intubation.
,Q2. Which arterial blood gas pattern is most consistent with acute
respiratory acidosis with metabolic compensation?
A. pH 7.55, PaCO2 20 mmHg, HCO3- 18 mEq/L
B. pH 7.25, PaCO2 65 mmHg, HCO3- 28 mEq/L
C. pH 7.35, PaCO2 45 mmHg, HCO3- 24 mEq/L
D. pH 7.15, PaCO2 35 mmHg, HCO3- 10 mEq/L
Rationale: Acute respiratory acidosis shows low pH with elevated PaCO2;
partial metabolic compensation (renal retention of HCO3-) raises HCO3-
above normal, e.g., ~28.
Q3. In a patient with suspected pulmonary embolism and hemodynamic
instability, which diagnostic/therapeutic step is most appropriate?
A. D-dimer test to rule out PE
B. Ventilation-perfusion scan before anticoagulation
C. Empiric systemic thrombolysis if PE is strongly suspected and patient is
unstable
D. CT pulmonary angiography only after stabilizing hemodynamics
Rationale: In massive PE with hemodynamic compromise, immediate
reperfusion therapy (systemic thrombolysis) is indicated; diagnostic
imaging should not delay life-saving therapy.
Q4. A patient on continuous infusion of norepinephrine develops
extravasation at the IV site. The best immediate action is:
A. Elevate the limb and apply warm compresses only
B. Stop the infusion, aspirate the drug from the catheter, leave catheter in
,place, and infiltrate with phentolamine if available
C. Remove the catheter and apply cold compresses only
D. Continue infusion through same IV if the pain is mild
Rationale: For vasopressor extravasation, stop infusion, attempt
aspiration, leave catheter for possible antidote infiltration (phentolamine),
and provide limb support; removing catheter before aspiration may
worsen tissue exposure.
Q5. Which finding most reliably differentiates cardiogenic shock from
hypovolemic shock?
A. Low urine output
B. Elevated pulmonary capillary wedge pressure (PCWP)
C. Tachycardia
D. Cold, clammy skin
Rationale: Elevated PCWP is characteristic of cardiogenic shock due to left
ventricular failure; hypovolemic shock usually has low PCWP.
Q6. For a patient with acute coronary syndrome presenting within 6 hours
of chest pain onset, which therapy has strongest mortality benefit when ST-
elevation myocardial infarction (STEMI) is confirmed and PCI is available?
A. High-dose intravenous beta blocker immediately
B. Thrombolytic therapy instead of PCI
C. Primary percutaneous coronary intervention (PCI) as soon as possible
D. Intravenous nitroglycerin only
Rationale: Primary PCI is the preferred reperfusion strategy for STEMI
, when it can be performed promptly; it reduces mortality and complications
compared to fibrinolysis when available.
Q7. A patient develops new-onset peaked T waves on ECG after receiving
several liters of IV fluids. The most urgent next step is:
A. Repeat the ECG in 30 minutes
B. Obtain a stat serum potassium level and treat for hyperkalemia if
elevated
C. Administer IV magnesium
D. Start loop diuretic therapy empirically
Rationale: Peaked T waves suggest hyperkalemia; check serum potassium
urgently and treat emergently if elevated because arrhythmia risk is high.
Q8. Which antibiotic choice is most appropriate empiric coverage for
suspected hospital-acquired MRSA pneumonia in a critically ill adult?
A. Ceftriaxone alone
B. Piperacillin-tazobactam alone
C. Vancomycin or linezolid (add MRSA-active agent)
D. Azithromycin monotherapy
Rationale: MRSA-active agents (vancomycin or linezolid) are required for
empiric coverage of suspected MRSA pneumonia; broad-spectrum gram-
negative coverage may also be needed depending on risk factors.
Q9. In ARDS, which ventilator strategy is associated with improved
mortality?
A. Tidal volume 12 mL/kg predicted body weight
Residency Practice Exam 2 Questions
And Correct Answers (Verified Answers)
Plus Rationales 2026|2027 Q&A |
Instant Download Pdf| South College
Q1. A 68-year-old patient with COPD is admitted with acute hypercapnic
respiratory failure. Which intervention is most appropriate as first-line
ventilatory support?
A. Immediate endotracheal intubation and mechanical ventilation
B. High-flow nasal cannula at 60 L/min
C. Noninvasive positive pressure ventilation (NIPPV) such as BiPAP
D. Supplemental oxygen via simple face mask at 10 L/min
Rationale: NIPPV (e.g., BiPAP) is first-line for acute hypercapnic respiratory
failure in COPD when the patient is cooperative and airway protective
reflexes are intact; it improves ventilation and may avoid intubation.
,Q2. Which arterial blood gas pattern is most consistent with acute
respiratory acidosis with metabolic compensation?
A. pH 7.55, PaCO2 20 mmHg, HCO3- 18 mEq/L
B. pH 7.25, PaCO2 65 mmHg, HCO3- 28 mEq/L
C. pH 7.35, PaCO2 45 mmHg, HCO3- 24 mEq/L
D. pH 7.15, PaCO2 35 mmHg, HCO3- 10 mEq/L
Rationale: Acute respiratory acidosis shows low pH with elevated PaCO2;
partial metabolic compensation (renal retention of HCO3-) raises HCO3-
above normal, e.g., ~28.
Q3. In a patient with suspected pulmonary embolism and hemodynamic
instability, which diagnostic/therapeutic step is most appropriate?
A. D-dimer test to rule out PE
B. Ventilation-perfusion scan before anticoagulation
C. Empiric systemic thrombolysis if PE is strongly suspected and patient is
unstable
D. CT pulmonary angiography only after stabilizing hemodynamics
Rationale: In massive PE with hemodynamic compromise, immediate
reperfusion therapy (systemic thrombolysis) is indicated; diagnostic
imaging should not delay life-saving therapy.
Q4. A patient on continuous infusion of norepinephrine develops
extravasation at the IV site. The best immediate action is:
A. Elevate the limb and apply warm compresses only
B. Stop the infusion, aspirate the drug from the catheter, leave catheter in
,place, and infiltrate with phentolamine if available
C. Remove the catheter and apply cold compresses only
D. Continue infusion through same IV if the pain is mild
Rationale: For vasopressor extravasation, stop infusion, attempt
aspiration, leave catheter for possible antidote infiltration (phentolamine),
and provide limb support; removing catheter before aspiration may
worsen tissue exposure.
Q5. Which finding most reliably differentiates cardiogenic shock from
hypovolemic shock?
A. Low urine output
B. Elevated pulmonary capillary wedge pressure (PCWP)
C. Tachycardia
D. Cold, clammy skin
Rationale: Elevated PCWP is characteristic of cardiogenic shock due to left
ventricular failure; hypovolemic shock usually has low PCWP.
Q6. For a patient with acute coronary syndrome presenting within 6 hours
of chest pain onset, which therapy has strongest mortality benefit when ST-
elevation myocardial infarction (STEMI) is confirmed and PCI is available?
A. High-dose intravenous beta blocker immediately
B. Thrombolytic therapy instead of PCI
C. Primary percutaneous coronary intervention (PCI) as soon as possible
D. Intravenous nitroglycerin only
Rationale: Primary PCI is the preferred reperfusion strategy for STEMI
, when it can be performed promptly; it reduces mortality and complications
compared to fibrinolysis when available.
Q7. A patient develops new-onset peaked T waves on ECG after receiving
several liters of IV fluids. The most urgent next step is:
A. Repeat the ECG in 30 minutes
B. Obtain a stat serum potassium level and treat for hyperkalemia if
elevated
C. Administer IV magnesium
D. Start loop diuretic therapy empirically
Rationale: Peaked T waves suggest hyperkalemia; check serum potassium
urgently and treat emergently if elevated because arrhythmia risk is high.
Q8. Which antibiotic choice is most appropriate empiric coverage for
suspected hospital-acquired MRSA pneumonia in a critically ill adult?
A. Ceftriaxone alone
B. Piperacillin-tazobactam alone
C. Vancomycin or linezolid (add MRSA-active agent)
D. Azithromycin monotherapy
Rationale: MRSA-active agents (vancomycin or linezolid) are required for
empiric coverage of suspected MRSA pneumonia; broad-spectrum gram-
negative coverage may also be needed depending on risk factors.
Q9. In ARDS, which ventilator strategy is associated with improved
mortality?
A. Tidal volume 12 mL/kg predicted body weight
