,NR 574 Final Exam – Acute Care Practicum I – Q&A
(2026) | Chamberlain
1. A 68-year-old patient with acute chest pain and ST elevation in leads V1-V4 is
diagnosed with an anterior STEMI. What is the priority intervention?
A) Prepare for immediate percutaneous coronary intervention (PCI)
B) Administer aspirin 325 mg orally
C) Obtain cardiac enzymes
D) Administer sublingual nitroglycerin
Correct Answer: A) Prepare for immediate percutaneous coronary intervention
(PCI)
Rationale: Immediate reperfusion via PCI is the priority to limit myocardial
damage. Aspirin and nitroglycerin are adjunctive but not the priority. Cardiac
enzymes confirm the diagnosis but should not delay reperfusion. Timely PCI
reduces mortality.
2. A 75-year-old patient with heart failure develops acute dyspnea, pink frothy
sputum, and bilateral crackles. The nurse should first:
A) Place the patient in high Fowler's position
B) Administer high-flow supplemental oxygen
C) Obtain a chest x-ray
D) Administer IV furosemide
Correct Answer: B) Administer high-flow supplemental oxygen
,Rationale: Pink frothy sputum indicates acute pulmonary edema. The
immediate priority is oxygenation to correct hypoxemia. Positioning and
diuretics follow after oxygen is initiated. A chest x-ray is diagnostic but not the
first step.
3. A patient with a traumatic brain injury has an ICP of 22 mm Hg and a CPP of
85 mm Hg. The AGACNP interprets this as:
A) ICP normal, CPP elevated
B) ICP elevated, CPP normal
C) ICP elevated, CPP elevated
D) ICP normal, CPP normal
Correct Answer: B) ICP elevated, CPP normal
Rationale: Normal ICP is 5-15 mm Hg; 22 mm Hg is elevated and requires
intervention. CPP = MAP – ICP; a CPP of 85 mm Hg is within the normal range of
60-100 mm Hg. Treatment should focus on reducing ICP while maintaining CPP.
4. Which EKG finding is most indicative of hyperkalemia?
A) Flattened T waves
B) U waves
C) ST depression
D) Peaked T waves
Correct Answer: D) Peaked T waves
, Rationale: Hyperkalemia causes tall, peaked T waves due to altered
repolarization. As potassium rises, the QRS widens and PR interval prolongs. U
waves and flattened T waves are associated with hypokalemia. ST depression
suggests ischemia.
5. A patient with atrial fibrillation is started on warfarin. Which INR range
indicates therapeutic effect?
A) 2.0-3.0
B) 1.5-2.0
C) 2.5-3.5
D) 3.0-4.0
Correct Answer: A) 2.0-3.0
Rationale: For nonvalvular atrial fibrillation, the target INR is 2.0-3.0 to prevent
thromboembolic events while minimizing bleeding risk. A range of 2.5-3.5 is
used for mechanical heart valves. INR below 2.0 is subtherapeutic.
6. A patient with a basilar skull fracture has clear nasal drainage. The AGACNP
should:
A) Pack the nares to stop the leak
B) Place a drip pad under the nose and test the fluid for glucose
C) Suction the nasal passage
D) Insert a nasogastric tube
Correct Answer: B) Place a drip pad under the nose and test the fluid for glucose
(2026) | Chamberlain
1. A 68-year-old patient with acute chest pain and ST elevation in leads V1-V4 is
diagnosed with an anterior STEMI. What is the priority intervention?
A) Prepare for immediate percutaneous coronary intervention (PCI)
B) Administer aspirin 325 mg orally
C) Obtain cardiac enzymes
D) Administer sublingual nitroglycerin
Correct Answer: A) Prepare for immediate percutaneous coronary intervention
(PCI)
Rationale: Immediate reperfusion via PCI is the priority to limit myocardial
damage. Aspirin and nitroglycerin are adjunctive but not the priority. Cardiac
enzymes confirm the diagnosis but should not delay reperfusion. Timely PCI
reduces mortality.
2. A 75-year-old patient with heart failure develops acute dyspnea, pink frothy
sputum, and bilateral crackles. The nurse should first:
A) Place the patient in high Fowler's position
B) Administer high-flow supplemental oxygen
C) Obtain a chest x-ray
D) Administer IV furosemide
Correct Answer: B) Administer high-flow supplemental oxygen
,Rationale: Pink frothy sputum indicates acute pulmonary edema. The
immediate priority is oxygenation to correct hypoxemia. Positioning and
diuretics follow after oxygen is initiated. A chest x-ray is diagnostic but not the
first step.
3. A patient with a traumatic brain injury has an ICP of 22 mm Hg and a CPP of
85 mm Hg. The AGACNP interprets this as:
A) ICP normal, CPP elevated
B) ICP elevated, CPP normal
C) ICP elevated, CPP elevated
D) ICP normal, CPP normal
Correct Answer: B) ICP elevated, CPP normal
Rationale: Normal ICP is 5-15 mm Hg; 22 mm Hg is elevated and requires
intervention. CPP = MAP – ICP; a CPP of 85 mm Hg is within the normal range of
60-100 mm Hg. Treatment should focus on reducing ICP while maintaining CPP.
4. Which EKG finding is most indicative of hyperkalemia?
A) Flattened T waves
B) U waves
C) ST depression
D) Peaked T waves
Correct Answer: D) Peaked T waves
, Rationale: Hyperkalemia causes tall, peaked T waves due to altered
repolarization. As potassium rises, the QRS widens and PR interval prolongs. U
waves and flattened T waves are associated with hypokalemia. ST depression
suggests ischemia.
5. A patient with atrial fibrillation is started on warfarin. Which INR range
indicates therapeutic effect?
A) 2.0-3.0
B) 1.5-2.0
C) 2.5-3.5
D) 3.0-4.0
Correct Answer: A) 2.0-3.0
Rationale: For nonvalvular atrial fibrillation, the target INR is 2.0-3.0 to prevent
thromboembolic events while minimizing bleeding risk. A range of 2.5-3.5 is
used for mechanical heart valves. INR below 2.0 is subtherapeutic.
6. A patient with a basilar skull fracture has clear nasal drainage. The AGACNP
should:
A) Pack the nares to stop the leak
B) Place a drip pad under the nose and test the fluid for glucose
C) Suction the nasal passage
D) Insert a nasogastric tube
Correct Answer: B) Place a drip pad under the nose and test the fluid for glucose
