NR 571 PRIMARY CARE OF THE ADULT FINAL EXAM
CHAMBERLAIN UNIVERSITY QUESTIONS AND CORRECT
VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 68-year-old man with severe COPD presents to the emergency department with
worsening dyspnea, productive cough, and increased purulent sputum for 3 days.
His oxygen saturation is 86% on room air, respiratory rate is 28/min, and he is
using accessory muscles to breathe. Which initial treatment plan is most
appropriate?
A. High-dose inhaled corticosteroid alone
B. Short-acting bronchodilator, systemic corticosteroid, and controlled oxygen
therapy
C. Long-acting beta-agonist only
D. Immediate endotracheal intubation without medical therapy
Answer: B
Rationale: An acute COPD exacerbation is characterized by worsening dyspnea,
increased sputum production, and increased sputum purulence. Initial treatment
includes controlled oxygen (target SpO₂ 88–92%), short-acting bronchodilators,
and systemic corticosteroids. Antibiotics should also be considered when sputum
becomes purulent. Immediate intubation is reserved for respiratory failure or
inability to protect the airway.
,Question 2
A mechanically ventilated patient suddenly develops a high-pressure ventilator
alarm. Breath sounds are diminished on the right, oxygen saturation has fallen
from 96% to 84%, and thick secretions are visible in the endotracheal tube. What is
the priority intervention?
A. Increase tidal volume
B. Disconnect the ventilator permanently
C. Suction the endotracheal tube
D. Increase PEEP
Answer: C
Rationale: High-pressure alarms usually indicate increased airway resistance
caused by secretions, mucus plugging, patient coughing, or tube obstruction.
Suctioning is the immediate priority when secretions are suspected.
Question 3
A 62-year-old woman with type 2 diabetes arrives confused. Laboratory findings
include:
Glucose: 840 mg/dL
Serum osmolality: 336 mOsm/kg
pH: 7.39
Bicarbonate: 24 mEq/L
Negative serum ketones
Which diagnosis is most likely?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Lactic acidosis
,D. Starvation ketosis
Answer: B
Rationale: HHS presents with profound hyperglycemia (>600 mg/dL), severe
dehydration, elevated osmolality, minimal or absent ketosis, and little or no
metabolic acidosis.
Question 4
A patient with diabetic ketoacidosis has the following laboratory results:
Glucose 485 mg/dL
pH 7.18
Bicarbonate 11 mEq/L
Positive serum ketones
What is the first priority in management?
A. Intravenous sodium bicarbonate
B. Aggressive isotonic intravenous fluids
C. Long-acting insulin injection
D. Potassium restriction
Answer: B
Rationale: Fluid replacement is the first priority because patients have severe
volume depletion. Insulin therapy follows after potassium assessment.
, Question 5
A patient with ARDS is receiving mechanical ventilation. Which ventilator
strategy has the strongest evidence for reducing ventilator-induced lung injury?
A. Tidal volume of 10 mL/kg
B. Plateau pressure above 35 cm H₂O
C. Low tidal volume ventilation of approximately 6 mL/kg predicted body weight
D. High tidal volume with low PEEP
Answer: C
Rationale: Lung-protective ventilation using tidal volumes of approximately 6
mL/kg predicted body weight and maintaining plateau pressures below 30 cm H₂O
improves survival in ARDS.
Question 6
A critically ill patient is receiving continuous propofol infusion for sedation.
Which laboratory value requires routine monitoring to reduce the risk of propofol-
related complications?
A. Magnesium
B. Triglycerides
C. Calcium
D. Hemoglobin
Answer: B
Rationale: Propofol is lipid based and prolonged infusions can significantly
increase triglyceride levels, increasing the risk for pancreatitis and propofol
infusion syndrome.
CHAMBERLAIN UNIVERSITY QUESTIONS AND CORRECT
VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 68-year-old man with severe COPD presents to the emergency department with
worsening dyspnea, productive cough, and increased purulent sputum for 3 days.
His oxygen saturation is 86% on room air, respiratory rate is 28/min, and he is
using accessory muscles to breathe. Which initial treatment plan is most
appropriate?
A. High-dose inhaled corticosteroid alone
B. Short-acting bronchodilator, systemic corticosteroid, and controlled oxygen
therapy
C. Long-acting beta-agonist only
D. Immediate endotracheal intubation without medical therapy
Answer: B
Rationale: An acute COPD exacerbation is characterized by worsening dyspnea,
increased sputum production, and increased sputum purulence. Initial treatment
includes controlled oxygen (target SpO₂ 88–92%), short-acting bronchodilators,
and systemic corticosteroids. Antibiotics should also be considered when sputum
becomes purulent. Immediate intubation is reserved for respiratory failure or
inability to protect the airway.
,Question 2
A mechanically ventilated patient suddenly develops a high-pressure ventilator
alarm. Breath sounds are diminished on the right, oxygen saturation has fallen
from 96% to 84%, and thick secretions are visible in the endotracheal tube. What is
the priority intervention?
A. Increase tidal volume
B. Disconnect the ventilator permanently
C. Suction the endotracheal tube
D. Increase PEEP
Answer: C
Rationale: High-pressure alarms usually indicate increased airway resistance
caused by secretions, mucus plugging, patient coughing, or tube obstruction.
Suctioning is the immediate priority when secretions are suspected.
Question 3
A 62-year-old woman with type 2 diabetes arrives confused. Laboratory findings
include:
Glucose: 840 mg/dL
Serum osmolality: 336 mOsm/kg
pH: 7.39
Bicarbonate: 24 mEq/L
Negative serum ketones
Which diagnosis is most likely?
A. Diabetic ketoacidosis
B. Hyperosmolar hyperglycemic state
C. Lactic acidosis
,D. Starvation ketosis
Answer: B
Rationale: HHS presents with profound hyperglycemia (>600 mg/dL), severe
dehydration, elevated osmolality, minimal or absent ketosis, and little or no
metabolic acidosis.
Question 4
A patient with diabetic ketoacidosis has the following laboratory results:
Glucose 485 mg/dL
pH 7.18
Bicarbonate 11 mEq/L
Positive serum ketones
What is the first priority in management?
A. Intravenous sodium bicarbonate
B. Aggressive isotonic intravenous fluids
C. Long-acting insulin injection
D. Potassium restriction
Answer: B
Rationale: Fluid replacement is the first priority because patients have severe
volume depletion. Insulin therapy follows after potassium assessment.
, Question 5
A patient with ARDS is receiving mechanical ventilation. Which ventilator
strategy has the strongest evidence for reducing ventilator-induced lung injury?
A. Tidal volume of 10 mL/kg
B. Plateau pressure above 35 cm H₂O
C. Low tidal volume ventilation of approximately 6 mL/kg predicted body weight
D. High tidal volume with low PEEP
Answer: C
Rationale: Lung-protective ventilation using tidal volumes of approximately 6
mL/kg predicted body weight and maintaining plateau pressures below 30 cm H₂O
improves survival in ARDS.
Question 6
A critically ill patient is receiving continuous propofol infusion for sedation.
Which laboratory value requires routine monitoring to reduce the risk of propofol-
related complications?
A. Magnesium
B. Triglycerides
C. Calcium
D. Hemoglobin
Answer: B
Rationale: Propofol is lipid based and prolonged infusions can significantly
increase triglyceride levels, increasing the risk for pancreatitis and propofol
infusion syndrome.
