NR570 Final Exam Actual Exam Style V3 |
NR 570 Common Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 65-year-old male presents with sudden onset of shortness of breath, bibasilar crackles,
and an S3 gallop. Which initial medication is most appropriate for this patient?
A. Oral Metoprolol
B. Intravenous Furosemide
C. Intravenous Fluids
D. Oral Lisinopril
Answer: B
Rationale: The patient is presenting with signs of acute decompensated heart failure and
pulmonary edema. Intravenous loop diuretics such as Furosemide are the first-line
treatment to reduce preload and alleviate respiratory distress. Monitoring urine output
and renal function is critical during the initial phase of therapy.
2. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient?
A. CT Pulmonary Angiography (CTPA)
B. Chest X-ray
,C. D-dimer assay
D. Ventilation-Perfusion (V/Q) Scan
Answer: A
Rationale: CT Pulmonary Angiography is considered the gold standard for diagnosing
pulmonary embolism due to its high sensitivity and specificity. While V/Q scans are used,
they are typically reserved for patients with contraindications to CT contrast. The D-dimer
is a screening tool with high negative predictive value but lacks specificity for diagnosis.
3. An arterial blood gas (ABG) shows pH 7.28, PaCO2 58 mmHg, and HCO3 26 mEq/L. How
should this be interpreted?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. The bicarbonate level is within the normal range,
suggesting no compensation has occurred yet. This pattern is commonly seen in patients
with acute respiratory failure or hypoventilation.
, 4. Which electrolyte abnormality is most commonly associated with the use of ACE
inhibitors?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Answer: A
Rationale: ACE inhibitors decrease the production of aldosterone, which can lead to the
retention of potassium. Patients should have their serum potassium and creatinine
monitored within one to two weeks of starting therapy. This risk is increased in patients
with underlying chronic kidney disease or those taking potassium supplements.
5. According to the Surviving Sepsis Campaign, what is the recommended initial fluid bolus
for a patient in septic shock?
A. 30 mL/kg of crystalloid
B. 10 mL/kg of crystalloid
C. 500 mL of normal saline
D. 2 Liters of Lactated Ringer’s
Answer: A
NR 570 Common Diagnosis and
Management in Acute Care Practicum |
Chamberlain
1. A 65-year-old male presents with sudden onset of shortness of breath, bibasilar crackles,
and an S3 gallop. Which initial medication is most appropriate for this patient?
A. Oral Metoprolol
B. Intravenous Furosemide
C. Intravenous Fluids
D. Oral Lisinopril
Answer: B
Rationale: The patient is presenting with signs of acute decompensated heart failure and
pulmonary edema. Intravenous loop diuretics such as Furosemide are the first-line
treatment to reduce preload and alleviate respiratory distress. Monitoring urine output
and renal function is critical during the initial phase of therapy.
2. Which of the following is the gold standard for diagnosing a pulmonary embolism in a
stable patient?
A. CT Pulmonary Angiography (CTPA)
B. Chest X-ray
,C. D-dimer assay
D. Ventilation-Perfusion (V/Q) Scan
Answer: A
Rationale: CT Pulmonary Angiography is considered the gold standard for diagnosing
pulmonary embolism due to its high sensitivity and specificity. While V/Q scans are used,
they are typically reserved for patients with contraindications to CT contrast. The D-dimer
is a screening tool with high negative predictive value but lacks specificity for diagnosis.
3. An arterial blood gas (ABG) shows pH 7.28, PaCO2 58 mmHg, and HCO3 26 mEq/L. How
should this be interpreted?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, indicating a respiratory cause. The bicarbonate level is within the normal range,
suggesting no compensation has occurred yet. This pattern is commonly seen in patients
with acute respiratory failure or hypoventilation.
, 4. Which electrolyte abnormality is most commonly associated with the use of ACE
inhibitors?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypercalcemia
Answer: A
Rationale: ACE inhibitors decrease the production of aldosterone, which can lead to the
retention of potassium. Patients should have their serum potassium and creatinine
monitored within one to two weeks of starting therapy. This risk is increased in patients
with underlying chronic kidney disease or those taking potassium supplements.
5. According to the Surviving Sepsis Campaign, what is the recommended initial fluid bolus
for a patient in septic shock?
A. 30 mL/kg of crystalloid
B. 10 mL/kg of crystalloid
C. 500 mL of normal saline
D. 2 Liters of Lactated Ringer’s
Answer: A
