NR571 FINAL EXAMINATION | 2026-2027 COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
NR571 / NR 571 FINAL EXAM (LATEST UPDATE)
COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
COMPLETE REVIEW | QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT - CHAMBERLAIN
Course NR 571 - Complex Diagnosis and Management in Acute Care Practicum
Institution Chamberlain University | Graduate Nursing and Advanced Practice Education
Framework Alignment Chamberlain NR 571 Course Syllabus; AACN Essentials of Master's Education; AACN
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Competencies, 2026/2027 Edition
Examination Format 150 multiple-choice items (Sections 1-10) | ONE best answer per item (A-D) | Verified answers
and rationales for every question
Cognitive Blueprint 20% recall / 50% application / 30% analysis, including clinical reasoning, prioritization, and
complex critical care decision-making
Item Design 80% scenario-based clinical presentations | 20% direct knowledge | 25 complex clinical reasoning
scenarios | 15 hemodynamic and ventilator management items | 10 pharmacology and medication
management items
Directions: Select the ONE best answer for each item. The verified answer and a rationale referencing NR 571 curriculum content,
AACN standards, and AGACNP certification expectations follow every question.
Section 1: Complex Cardiovascular Disorders in Acute Care
Questions 1 - 20
Q1: Which hemodynamic parameter obtained from a pulmonary artery (PA) catheter most directly reflects left
ventricular end-diastolic preload?
A. Pulmonary artery occlusion pressure (PAOP) [CORRECT]
B. Systemic vascular resistance (SVR)
C. Mean arterial pressure (MAP)
D. Pulmonary vascular resistance (PVR)
Correct Answer: A
Rationale: The PAOP (wedge pressure) approximates left atrial pressure and left ventricular end-diastolic volume, making it the
most direct available index of LV preload in the acute care setting. SVR and MAP reflect afterload and perfusion pressure rather
than preload, and PVR describes resistance within the pulmonary vascular bed. Accurate interpretation of these parameters is a
core NR 571 hemodynamic monitoring competency and an expectation of AGACNP advanced practice preparation under AACN
Essential IX.
1
,NR571 FINAL EXAMINATION | 2026-2027 COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
Q2: Which cardiac biomarker is the most specific indicator of myocardial cell injury?
A. Myoglobin
B. Creatine kinase-MB (CK-MB)
C. High-sensitivity cardiac troponin I [CORRECT]
D. Lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponins I and T are structural regulatory proteins found almost exclusively in cardiac myocytes, giving them
the highest specificity for myocardial injury. CK-MB is less specific because skeletal muscle injury can elevate it, myoglobin rises
earliest but is highly nonspecific, and LDH has been largely abandoned for cardiac diagnosis. This knowledge underpins the NR
571 acute coronary syndrome module and the AGACNP competency for selecting and interpreting diagnostic studies.
Q3: A 58-year-old man presents with an anterior STEMI. He is diaphoretic with HR 112, BP 78/48, bilateral crackles,
and JVD. PA catheter data show PAOP 24 mmHg and cardiac index 1.6 L/min/m2. What is the priority intervention?
A. Administer a 500 mL crystalloid bolus to raise filling pressure
B. Initiate high-dose dopamine infusion for blood pressure support
C. Administer sublingual nitroglycerin to reduce preload
D. Activate the cardiac catheterization laboratory for emergent reperfusion and initiate mechanical circulatory
support [CORRECT]
Correct Answer: D
Rationale: The combination of hypotension, elevated PAOP, and low cardiac index defines cardiogenic shock complicating
STEMI, for which early revascularization is the definitive mortality-reducing intervention, supported by temporary mechanical
circulatory support when needed. A fluid bolus would worsen the already elevated filling pressures, dopamine increases
arrhythmic risk and has fallen out of favor, and nitrates are contraindicated in shock with inadequate coronary perfusion. This
prioritization reflects NR 571 complex management content and the AGACNP competency to direct rapid, evidence-based
stabilization of the critically ill cardiac patient.
Q4: A 66-year-old woman admitted with NSTEMI has ongoing chest discomfort, rising serial troponins, and a
GRACE risk score of 158. What is the most appropriate management strategy?
A. Discharge home with outpatient stress testing in 72 hours
B. Proceed with an early invasive strategy, with coronary angiography within 24 hours [CORRECT]
C. Continue medical therapy with repeat troponin and catheterization at 48 to 72 hours
D. Administer fibrinolytic therapy immediately
Correct Answer: B
Rationale: Ongoing ischemic symptoms, dynamic troponin elevation, and a high GRACE score identify a very-high-risk
NSTEMI patient who benefits from an early invasive strategy within 24 hours per ACC/AHA guidelines embedded in the NR 571
curriculum. Fibrinolysis is not indicated for NSTEMI because the culprit lesion is typically partially occlusive, and a delayed or
ischemia-guided approach is reserved for lower-risk, stabilized patients. Discharge with outpatient testing would be unsafe given
the active and rising ischemic burden.
2
,NR571 FINAL EXAMINATION | 2026-2027 COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
Q5: A 72-year-old man presents with acute pulmonary edema: BP 198/104, SpO2 86% on 6 L/min nasal cannula,
respiratory rate 34, and diffuse crackles. Which initial management is most appropriate?
A. Immediate endotracheal intubation and mechanical ventilation
B. Intravenous furosemide as the sole initial therapy
C. Intravenous nitroglycerin titrated to blood pressure combined with noninvasive positive-pressure ventilation
[CORRECT]
D. Intravenous hydralazine for rapid afterload reduction
Correct Answer: C
Rationale: Hypertensive acute pulmonary edema is treated first with vasodilator therapy, typically IV nitroglycerin titrated to
afterload and preload, together with CPAP or BiPAP, which reduces work of breathing and redistributes alveolar fluid. Immediate
intubation is reserved for NIV failure, refractory hypoxemia, or hypercapnic obtundation, while diuretics are an adjunct rather
than the sole initial measure because many such patients are not profoundly volume overloaded. Hydralazine produces
unpredictable vasodilation and reflex tachycardia and is a common management misstep. This approach aligns with NR 571 heart
failure exacerbation content and AGACNP ventilatory support competencies.
Q6: A 64-year-old woman with new-onset atrial fibrillation has a ventricular rate of 148, BP 110/70, and mild
dyspnea without chest pain or hypotension. What is the first-line treatment?
A. Intravenous diltiazem with continuous cardiac monitoring [CORRECT]
B. Immediate synchronized electrical cardioversion
C. Intravenous amiodarone loading
D. Adenosine rapid IV push
Correct Answer: A
Rationale: In the hemodynamically stable patient with rapid ventricular response, IV diltiazem or a beta-blocker is first-line for
rate control, per NR 571 dysrhythmia management content. Synchronized cardioversion is reserved for hemodynamic instability or
preexcited AF, amiodarone is a second-line agent typically used when rate control with AV nodal blockers fails, and adenosine
transiently blocks AV nodal conduction and is not effective for sustained rate control in AF.
Q7: A post-MI patient receiving haloperidol develops polymorphic ventricular tachycardia with a prolonged QT
interval. Potassium is 3.1 mEq/L and magnesium is 1.5 mg/dL. What is the most appropriate immediate treatment?
A. Intravenous amiodarone loading
B. Intravenous magnesium sulfate 2 g with correction of potassium and magnesium and discontinuation of
QT-prolonging drugs [CORRECT]
C. Overdrive transvenous pacing at 110 beats/min as first-line therapy
D. Intravenous lidocaine bolus and infusion
Correct Answer: B
Rationale: Polymorphic VT with a long QT interval represents torsades de pointes, which is treated with IV magnesium sulfate,
aggressive correction of potassium and magnesium, and elimination of offending agents. Amiodarone prolongs repolarization and
is contraindicated in torsades, making it a classic critical care medication error, while lidocaine is less reliably effective and
overdrive pacing is reserved for recurrent torsades despite magnesium. This item targets the NR 571 emphasis on distinguishing
polymorphic VT from monomorphic VT before selecting therapy.
3
, NR571 FINAL EXAMINATION | 2026-2027 COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
Q8: A 70-year-old man with complete heart block has a ventricular rate of 32, BP 82/54, and fluctuating confusion.
What is the immediate intervention?
A. Atropine 0.5 mg IV with observation before further measures
B. Transvenous pacemaker placement without temporizing measures
C. Adenosine 6 mg rapid IV push
D. Immediate transcutaneous pacing with sedation and preparation for transvenous pacing [CORRECT]
Correct Answer: D
Rationale: Symptomatic complete heart block requires immediate transcutaneous pacing as a temporizing bridge while
arrangements are made for transvenous pacing. Atropine is frequently ineffective in infranodal (Mobitz II or third-degree) block
and should not delay pacing, a common prioritization error tested in NR 571. Transvenous pacing alone delays treatment of an
unstable patient, and adenosine has no role in complete heart block.
Q9: Which formula correctly calculates systemic vascular resistance (SVR)?
A. SVR = (MAP - CVP) x 80 / cardiac output [CORRECT]
B. SVR = (MAP - CVP) / cardiac output
C. SVR = (PAOP - CVP) x 80 / cardiac index
D. SVR = MAP x cardiac output / 80
Correct Answer: A
Rationale: SVR = 80 x (MAP - CVP) / CO, yielding a normal range of approximately 800 to 1200 dynes-sec/cm5, and this
calculation is a standard NR 571 hemodynamic monitoring expectation. Option B omits the 80 conversion factor to dynes, option
C incorrectly substitutes PAOP and cardiac index, and option D inverts the relationship between pressure gradient and resistance.
Facility with these derived hemodynamic parameters is required for AGACNP interpretation of invasive monitoring data.
Q10: On postoperative day 1 after CABG, a patient has BP 92/58, CI 1.8 L/min/m2, PAOP 6 mmHg, SVR 1750
dynes-sec/cm5, and urine output 20 mL/hr. What is the most appropriate next step?
A. Initiate norepinephrine infusion
B. Administer furosemide 40 mg IV
C. Administer a 250 to 500 mL crystalloid bolus and reassess hemodynamics [CORRECT]
D. Start dobutamine 5 mcg/kg/min
Correct Answer: C
Rationale: Low PAOP, low cardiac index, high SVR, and oliguria indicate hypovolemia as the primary problem, so judicious
volume replacement is the appropriate first intervention. Vasoconstrictors such as norepinephrine would further raise an already
elevated SVR, dobutamine is premature without correcting preload, and furosemide would worsen hypovolemia and renal
perfusion, a classic assessment misinterpretation. This sequence reflects NR 571 post-cardiac surgery management and AGACNP
hemodynamic decision-making standards.
4
NR571 / NR 571 FINAL EXAM (LATEST UPDATE)
COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
COMPLETE REVIEW | QUESTIONS AND VERIFIED ANSWERS | 100% CORRECT - CHAMBERLAIN
Course NR 571 - Complex Diagnosis and Management in Acute Care Practicum
Institution Chamberlain University | Graduate Nursing and Advanced Practice Education
Framework Alignment Chamberlain NR 571 Course Syllabus; AACN Essentials of Master's Education; AACN
Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) Competencies, 2026/2027 Edition
Examination Format 150 multiple-choice items (Sections 1-10) | ONE best answer per item (A-D) | Verified answers
and rationales for every question
Cognitive Blueprint 20% recall / 50% application / 30% analysis, including clinical reasoning, prioritization, and
complex critical care decision-making
Item Design 80% scenario-based clinical presentations | 20% direct knowledge | 25 complex clinical reasoning
scenarios | 15 hemodynamic and ventilator management items | 10 pharmacology and medication
management items
Directions: Select the ONE best answer for each item. The verified answer and a rationale referencing NR 571 curriculum content,
AACN standards, and AGACNP certification expectations follow every question.
Section 1: Complex Cardiovascular Disorders in Acute Care
Questions 1 - 20
Q1: Which hemodynamic parameter obtained from a pulmonary artery (PA) catheter most directly reflects left
ventricular end-diastolic preload?
A. Pulmonary artery occlusion pressure (PAOP) [CORRECT]
B. Systemic vascular resistance (SVR)
C. Mean arterial pressure (MAP)
D. Pulmonary vascular resistance (PVR)
Correct Answer: A
Rationale: The PAOP (wedge pressure) approximates left atrial pressure and left ventricular end-diastolic volume, making it the
most direct available index of LV preload in the acute care setting. SVR and MAP reflect afterload and perfusion pressure rather
than preload, and PVR describes resistance within the pulmonary vascular bed. Accurate interpretation of these parameters is a
core NR 571 hemodynamic monitoring competency and an expectation of AGACNP advanced practice preparation under AACN
Essential IX.
1
,NR571 FINAL EXAMINATION | 2026-2027 COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
Q2: Which cardiac biomarker is the most specific indicator of myocardial cell injury?
A. Myoglobin
B. Creatine kinase-MB (CK-MB)
C. High-sensitivity cardiac troponin I [CORRECT]
D. Lactate dehydrogenase (LDH)
Correct Answer: C
Rationale: Cardiac troponins I and T are structural regulatory proteins found almost exclusively in cardiac myocytes, giving them
the highest specificity for myocardial injury. CK-MB is less specific because skeletal muscle injury can elevate it, myoglobin rises
earliest but is highly nonspecific, and LDH has been largely abandoned for cardiac diagnosis. This knowledge underpins the NR
571 acute coronary syndrome module and the AGACNP competency for selecting and interpreting diagnostic studies.
Q3: A 58-year-old man presents with an anterior STEMI. He is diaphoretic with HR 112, BP 78/48, bilateral crackles,
and JVD. PA catheter data show PAOP 24 mmHg and cardiac index 1.6 L/min/m2. What is the priority intervention?
A. Administer a 500 mL crystalloid bolus to raise filling pressure
B. Initiate high-dose dopamine infusion for blood pressure support
C. Administer sublingual nitroglycerin to reduce preload
D. Activate the cardiac catheterization laboratory for emergent reperfusion and initiate mechanical circulatory
support [CORRECT]
Correct Answer: D
Rationale: The combination of hypotension, elevated PAOP, and low cardiac index defines cardiogenic shock complicating
STEMI, for which early revascularization is the definitive mortality-reducing intervention, supported by temporary mechanical
circulatory support when needed. A fluid bolus would worsen the already elevated filling pressures, dopamine increases
arrhythmic risk and has fallen out of favor, and nitrates are contraindicated in shock with inadequate coronary perfusion. This
prioritization reflects NR 571 complex management content and the AGACNP competency to direct rapid, evidence-based
stabilization of the critically ill cardiac patient.
Q4: A 66-year-old woman admitted with NSTEMI has ongoing chest discomfort, rising serial troponins, and a
GRACE risk score of 158. What is the most appropriate management strategy?
A. Discharge home with outpatient stress testing in 72 hours
B. Proceed with an early invasive strategy, with coronary angiography within 24 hours [CORRECT]
C. Continue medical therapy with repeat troponin and catheterization at 48 to 72 hours
D. Administer fibrinolytic therapy immediately
Correct Answer: B
Rationale: Ongoing ischemic symptoms, dynamic troponin elevation, and a high GRACE score identify a very-high-risk
NSTEMI patient who benefits from an early invasive strategy within 24 hours per ACC/AHA guidelines embedded in the NR 571
curriculum. Fibrinolysis is not indicated for NSTEMI because the culprit lesion is typically partially occlusive, and a delayed or
ischemia-guided approach is reserved for lower-risk, stabilized patients. Discharge with outpatient testing would be unsafe given
the active and rising ischemic burden.
2
,NR571 FINAL EXAMINATION | 2026-2027 COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
Q5: A 72-year-old man presents with acute pulmonary edema: BP 198/104, SpO2 86% on 6 L/min nasal cannula,
respiratory rate 34, and diffuse crackles. Which initial management is most appropriate?
A. Immediate endotracheal intubation and mechanical ventilation
B. Intravenous furosemide as the sole initial therapy
C. Intravenous nitroglycerin titrated to blood pressure combined with noninvasive positive-pressure ventilation
[CORRECT]
D. Intravenous hydralazine for rapid afterload reduction
Correct Answer: C
Rationale: Hypertensive acute pulmonary edema is treated first with vasodilator therapy, typically IV nitroglycerin titrated to
afterload and preload, together with CPAP or BiPAP, which reduces work of breathing and redistributes alveolar fluid. Immediate
intubation is reserved for NIV failure, refractory hypoxemia, or hypercapnic obtundation, while diuretics are an adjunct rather
than the sole initial measure because many such patients are not profoundly volume overloaded. Hydralazine produces
unpredictable vasodilation and reflex tachycardia and is a common management misstep. This approach aligns with NR 571 heart
failure exacerbation content and AGACNP ventilatory support competencies.
Q6: A 64-year-old woman with new-onset atrial fibrillation has a ventricular rate of 148, BP 110/70, and mild
dyspnea without chest pain or hypotension. What is the first-line treatment?
A. Intravenous diltiazem with continuous cardiac monitoring [CORRECT]
B. Immediate synchronized electrical cardioversion
C. Intravenous amiodarone loading
D. Adenosine rapid IV push
Correct Answer: A
Rationale: In the hemodynamically stable patient with rapid ventricular response, IV diltiazem or a beta-blocker is first-line for
rate control, per NR 571 dysrhythmia management content. Synchronized cardioversion is reserved for hemodynamic instability or
preexcited AF, amiodarone is a second-line agent typically used when rate control with AV nodal blockers fails, and adenosine
transiently blocks AV nodal conduction and is not effective for sustained rate control in AF.
Q7: A post-MI patient receiving haloperidol develops polymorphic ventricular tachycardia with a prolonged QT
interval. Potassium is 3.1 mEq/L and magnesium is 1.5 mg/dL. What is the most appropriate immediate treatment?
A. Intravenous amiodarone loading
B. Intravenous magnesium sulfate 2 g with correction of potassium and magnesium and discontinuation of
QT-prolonging drugs [CORRECT]
C. Overdrive transvenous pacing at 110 beats/min as first-line therapy
D. Intravenous lidocaine bolus and infusion
Correct Answer: B
Rationale: Polymorphic VT with a long QT interval represents torsades de pointes, which is treated with IV magnesium sulfate,
aggressive correction of potassium and magnesium, and elimination of offending agents. Amiodarone prolongs repolarization and
is contraindicated in torsades, making it a classic critical care medication error, while lidocaine is less reliably effective and
overdrive pacing is reserved for recurrent torsades despite magnesium. This item targets the NR 571 emphasis on distinguishing
polymorphic VT from monomorphic VT before selecting therapy.
3
, NR571 FINAL EXAMINATION | 2026-2027 COMPLEX DIAGNOSIS AND MANAGEMENT IN ACUTE CARE PRACTICUM
Q8: A 70-year-old man with complete heart block has a ventricular rate of 32, BP 82/54, and fluctuating confusion.
What is the immediate intervention?
A. Atropine 0.5 mg IV with observation before further measures
B. Transvenous pacemaker placement without temporizing measures
C. Adenosine 6 mg rapid IV push
D. Immediate transcutaneous pacing with sedation and preparation for transvenous pacing [CORRECT]
Correct Answer: D
Rationale: Symptomatic complete heart block requires immediate transcutaneous pacing as a temporizing bridge while
arrangements are made for transvenous pacing. Atropine is frequently ineffective in infranodal (Mobitz II or third-degree) block
and should not delay pacing, a common prioritization error tested in NR 571. Transvenous pacing alone delays treatment of an
unstable patient, and adenosine has no role in complete heart block.
Q9: Which formula correctly calculates systemic vascular resistance (SVR)?
A. SVR = (MAP - CVP) x 80 / cardiac output [CORRECT]
B. SVR = (MAP - CVP) / cardiac output
C. SVR = (PAOP - CVP) x 80 / cardiac index
D. SVR = MAP x cardiac output / 80
Correct Answer: A
Rationale: SVR = 80 x (MAP - CVP) / CO, yielding a normal range of approximately 800 to 1200 dynes-sec/cm5, and this
calculation is a standard NR 571 hemodynamic monitoring expectation. Option B omits the 80 conversion factor to dynes, option
C incorrectly substitutes PAOP and cardiac index, and option D inverts the relationship between pressure gradient and resistance.
Facility with these derived hemodynamic parameters is required for AGACNP interpretation of invasive monitoring data.
Q10: On postoperative day 1 after CABG, a patient has BP 92/58, CI 1.8 L/min/m2, PAOP 6 mmHg, SVR 1750
dynes-sec/cm5, and urine output 20 mL/hr. What is the most appropriate next step?
A. Initiate norepinephrine infusion
B. Administer furosemide 40 mg IV
C. Administer a 250 to 500 mL crystalloid bolus and reassess hemodynamics [CORRECT]
D. Start dobutamine 5 mcg/kg/min
Correct Answer: C
Rationale: Low PAOP, low cardiac index, high SVR, and oliguria indicate hypovolemia as the primary problem, so judicious
volume replacement is the appropriate first intervention. Vasoconstrictors such as norepinephrine would further raise an already
elevated SVR, dobutamine is premature without correcting preload, and furosemide would worsen hypovolemia and renal
perfusion, a classic assessment misinterpretation. This sequence reflects NR 571 post-cardiac surgery management and AGACNP
hemodynamic decision-making standards.
4
