NR 571 MIDTERM EXAM LATEST 2026 ACTUAL EXAM|
COMPLEX DIAGNOSIS & MANAGEMENT IN ACUTE
CARE MIDTERM EXAM REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (BRAND NEW!!)
1. A 72-year-old male presents with substernal chest pressure
radiating to the jaw, diaphoresis, and nausea. ECG shows 2mm
ST elevation in leads V2–V4. What is the most time-sensitive
initial management step?
A) Administer sublingual nitroglycerin
B) Obtain cardiac biomarkers
C) Activate the STEMI protocol for emergent PCI
D) Start a heparin drip
Correct Answer: C
Rationale: For STEMI, time to reperfusion is critical. Emergent PCI
(within 90 minutes of presentation) is the gold standard.
Fibrinolytics may be used if PCI >120 minutes away.
2. A 55-year-old with acute-onset dyspnea, hypoxia, and
hypotension has a distended neck vein, clear lungs, and muffled
1
,heart sounds. What is the most likely diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive pulmonary embolism
D) Acute myocardial infarction
Correct Answer: B
Rationale: Beck’s triad (hypotension, distended neck veins,
muffled heart sounds) is classic for cardiac tamponade.
Immediate pericardiocentesis may be life-saving.
3. A patient with new-onset atrial fibrillation has a heart rate of
150 bpm, BP 110/70, and no signs of heart failure. Which
medication is first-line for rate control?
A) Amiodarone
B) Digoxin
C) Metoprolol
D) Diltiazem
Answer: C (or D – beta-blocker or nondihydropyridine CCB)
Rationale: For acute rate control in stable AF, beta-blockers
(metoprolol, esmolol) or diltiazem are first-line. Amiodarone is
not first-line for rate control. Digoxin is second-line.
2
,4. An 80-year-old with severe aortic stenosis presents with
syncope on exertion. The murmur is best described as:
A) Hologystolic at the apex radiating to axilla
B) Crescendo-decrescendo systolic at the right upper sternal
border radiating to carotids
C) Diastolic decrescendo at left sternal border
D) Continuous machine-like murmur
Correct Answer: B
Rationale: Aortic stenosis causes a harsh, crescendo-decrescendo
systolic ejection murmur at the 2nd right intercostal space (aortic
area) radiating to the carotids.
5. A patient presents with acute chest pain and ECG shows
diffuse ST elevations, PR depressions, and elevated troponin. This
is most consistent with:
A) STEMI
B) Pericarditis
C) Early repolarization
D) Left ventricular aneurysm
3
, Correct Answer: B
Rationale: Diffuse ST elevation with PR depression is classic for
acute pericarditis. STEMI typically has regional, not diffuse,
changes.
Domain 2: Respiratory Disorders (25 questions)
6. A 45-year-old with asthma presents with respiratory rate 32,
oxygen saturation 88% on room air, and unable to speak full
sentences. What is the most appropriate immediate intervention?
A) Intubate immediately
B) Albuterol nebulizer every 20 minutes and systemic
corticosteroids
C) Chest x-ray
D) Levalbuterol MDI two puffs
Correct Answer: B
Rationale: Severe asthma exacerbation requires high-dose
inhaled beta-agonists (continuous or frequent), systemic
corticosteroids, and close monitoring. Intubation is last resort.
4
COMPLEX DIAGNOSIS & MANAGEMENT IN ACUTE
CARE MIDTERM EXAM REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (BRAND NEW!!)
1. A 72-year-old male presents with substernal chest pressure
radiating to the jaw, diaphoresis, and nausea. ECG shows 2mm
ST elevation in leads V2–V4. What is the most time-sensitive
initial management step?
A) Administer sublingual nitroglycerin
B) Obtain cardiac biomarkers
C) Activate the STEMI protocol for emergent PCI
D) Start a heparin drip
Correct Answer: C
Rationale: For STEMI, time to reperfusion is critical. Emergent PCI
(within 90 minutes of presentation) is the gold standard.
Fibrinolytics may be used if PCI >120 minutes away.
2. A 55-year-old with acute-onset dyspnea, hypoxia, and
hypotension has a distended neck vein, clear lungs, and muffled
1
,heart sounds. What is the most likely diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive pulmonary embolism
D) Acute myocardial infarction
Correct Answer: B
Rationale: Beck’s triad (hypotension, distended neck veins,
muffled heart sounds) is classic for cardiac tamponade.
Immediate pericardiocentesis may be life-saving.
3. A patient with new-onset atrial fibrillation has a heart rate of
150 bpm, BP 110/70, and no signs of heart failure. Which
medication is first-line for rate control?
A) Amiodarone
B) Digoxin
C) Metoprolol
D) Diltiazem
Answer: C (or D – beta-blocker or nondihydropyridine CCB)
Rationale: For acute rate control in stable AF, beta-blockers
(metoprolol, esmolol) or diltiazem are first-line. Amiodarone is
not first-line for rate control. Digoxin is second-line.
2
,4. An 80-year-old with severe aortic stenosis presents with
syncope on exertion. The murmur is best described as:
A) Hologystolic at the apex radiating to axilla
B) Crescendo-decrescendo systolic at the right upper sternal
border radiating to carotids
C) Diastolic decrescendo at left sternal border
D) Continuous machine-like murmur
Correct Answer: B
Rationale: Aortic stenosis causes a harsh, crescendo-decrescendo
systolic ejection murmur at the 2nd right intercostal space (aortic
area) radiating to the carotids.
5. A patient presents with acute chest pain and ECG shows
diffuse ST elevations, PR depressions, and elevated troponin. This
is most consistent with:
A) STEMI
B) Pericarditis
C) Early repolarization
D) Left ventricular aneurysm
3
, Correct Answer: B
Rationale: Diffuse ST elevation with PR depression is classic for
acute pericarditis. STEMI typically has regional, not diffuse,
changes.
Domain 2: Respiratory Disorders (25 questions)
6. A 45-year-old with asthma presents with respiratory rate 32,
oxygen saturation 88% on room air, and unable to speak full
sentences. What is the most appropriate immediate intervention?
A) Intubate immediately
B) Albuterol nebulizer every 20 minutes and systemic
corticosteroids
C) Chest x-ray
D) Levalbuterol MDI two puffs
Correct Answer: B
Rationale: Severe asthma exacerbation requires high-dose
inhaled beta-agonists (continuous or frequent), systemic
corticosteroids, and close monitoring. Intubation is last resort.
4
