NR570 Final Exam Actual Exam Style V2 |
NR 570 Common Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 68-year-old male with a history of heart failure presents with increased dyspnea and an
S3 gallop. Which of the following is the most appropriate initial pharmacological
intervention?
A. Oral Digoxin
B. Oral Lisinopril
C. Intravenous Metoprolol
D. Intravenous Furosemide
Answer: D
Rationale: Intravenous loop diuretics like furosemide are the first-line treatment for acute
decompensated heart failure to reduce volume overload. The presence of an S3 gallop and
dyspnea indicates significant pulmonary congestion. Rapid diuresis is necessary to improve
respiratory status and reduce preload on the heart.
2. A patient is admitted with suspected sepsis. According to the Surviving Sepsis Campaign,
what is the recommended initial fluid bolus for hypotension or a lactate ≥4 mmol/L?
A. 30 mL/kg of crystalloids
,B. 20 mL/kg of colloids
C. 10 mL/kg of crystalloids
D. 500 mL of normal saline
Answer: A
Rationale: Current guidelines recommend an initial fluid resuscitation of at least 30 mL/kg
of intravenous crystalloid fluid. This should be completed within the first 3 hours of
presentation to restore intravascular volume. Crystalloids are preferred over colloids for
the initial management of sepsis and septic shock.
3. Which of the following ECG findings is most characteristic of Hyperkalemia?
A. Prominent U waves
B. ST-segment depression
C. Peaked T waves
D. Shortened PR interval
Answer: C
Rationale: Peaked T waves are the earliest ECG manifestation of hyperkalemia. As
potassium levels continue to rise, the PR interval lengthens and the QRS complex widens.
Failure to recognize these changes can lead to lethal arrhythmias like ventricular
fibrillation or asystole.
, 4. A 55-year-old female presents with sudden onset of ‘the worst headache of my life.’ What
is the primary diagnostic test to order first?
A. Non-contrast CT scan of the Head
B. Lumbar Puncture
C. MRI of the Brain
D. Cerebral Angiography
Answer: A
Rationale: A non-contrast CT scan is the initial gold standard for diagnosing a
subarachnoid hemorrhage. It is highly sensitive for detecting acute blood in the
subarachnoid space. If the CT is negative but clinical suspicion remains high, a lumbar
puncture should be performed next.
5. In the management of Diabetic Ketoacidosis (DKA), when should the provider switch from
0.9% Normal Saline to D5 1/2 Normal Saline?
A. When the anion gap is closed
B. When blood glucose levels drop below 200-250 mg/dL
C. When the serum bicarbonate reaches 18 mEq/L
D. Immediately after the first liter of fluid
Answer: B
NR 570 Common Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 68-year-old male with a history of heart failure presents with increased dyspnea and an
S3 gallop. Which of the following is the most appropriate initial pharmacological
intervention?
A. Oral Digoxin
B. Oral Lisinopril
C. Intravenous Metoprolol
D. Intravenous Furosemide
Answer: D
Rationale: Intravenous loop diuretics like furosemide are the first-line treatment for acute
decompensated heart failure to reduce volume overload. The presence of an S3 gallop and
dyspnea indicates significant pulmonary congestion. Rapid diuresis is necessary to improve
respiratory status and reduce preload on the heart.
2. A patient is admitted with suspected sepsis. According to the Surviving Sepsis Campaign,
what is the recommended initial fluid bolus for hypotension or a lactate ≥4 mmol/L?
A. 30 mL/kg of crystalloids
,B. 20 mL/kg of colloids
C. 10 mL/kg of crystalloids
D. 500 mL of normal saline
Answer: A
Rationale: Current guidelines recommend an initial fluid resuscitation of at least 30 mL/kg
of intravenous crystalloid fluid. This should be completed within the first 3 hours of
presentation to restore intravascular volume. Crystalloids are preferred over colloids for
the initial management of sepsis and septic shock.
3. Which of the following ECG findings is most characteristic of Hyperkalemia?
A. Prominent U waves
B. ST-segment depression
C. Peaked T waves
D. Shortened PR interval
Answer: C
Rationale: Peaked T waves are the earliest ECG manifestation of hyperkalemia. As
potassium levels continue to rise, the PR interval lengthens and the QRS complex widens.
Failure to recognize these changes can lead to lethal arrhythmias like ventricular
fibrillation or asystole.
, 4. A 55-year-old female presents with sudden onset of ‘the worst headache of my life.’ What
is the primary diagnostic test to order first?
A. Non-contrast CT scan of the Head
B. Lumbar Puncture
C. MRI of the Brain
D. Cerebral Angiography
Answer: A
Rationale: A non-contrast CT scan is the initial gold standard for diagnosing a
subarachnoid hemorrhage. It is highly sensitive for detecting acute blood in the
subarachnoid space. If the CT is negative but clinical suspicion remains high, a lumbar
puncture should be performed next.
5. In the management of Diabetic Ketoacidosis (DKA), when should the provider switch from
0.9% Normal Saline to D5 1/2 Normal Saline?
A. When the anion gap is closed
B. When blood glucose levels drop below 200-250 mg/dL
C. When the serum bicarbonate reaches 18 mEq/L
D. Immediately after the first liter of fluid
Answer: B
