NR 571 – Complex Diagnosis and Management
in Acute Care (Chamberlain College of
Nursing) | Final Exam Review 2025/2026 –
Verified Questions and Answers | 100%
Correct | Grade A
Comprehensive Assessment
⸻
Student ID: _________________ Date: _________________
Instructor: [Instructor Name] Course Mentor: [Mentor Name]
Time Limit: 120 minutes Total Points: 100 points
Question 1
A 65-year-old male presents to the ED with acute onset of chest pain radiating to
the left arm, diaphoresis, and nausea. ECG shows ST-segment elevation in leads II,
III, and aVF. What is the most likely diagnosis?
A. Unstable angina
B. Acute pericarditis
C. Inferior wall myocardial infarction
D. Aortic dissection
E. Pulmonary embolism
Correct Answer: C
Expert Rationale: ST-elevation in inferior leads (II, III, aVF) indicates acute
inferior STEMI, requiring emergent reperfusion. Clinical reasoning prioritizes
ABCs and rapid cath lab activation per AHA/ACC guidelines. Differential
,excludes angina (no elevation), pericarditis (diffuse changes), dissection (tearing
pain), and PE (right-sided leads V1-V4).
Question 2
In managing the patient from Question 1, what is the priority pharmacologic
intervention?
A. Nitroglycerin sublingual
B. Aspirin 325 mg chewed
C. Heparin bolus
D. Metoprolol IV
E. Morphine IV
Correct Answer: B
Expert Rationale: Aspirin inhibits platelet aggregation, reducing mortality in
STEMI by 23% (ISIS-2 trial). Administer immediately upon suspicion. MONA
(morphine, oxygen, nitro, aspirin) is outdated; aspirin precedes others to avoid
delaying reperfusion. Evidence-based per AHA: chewed for rapid absorption.
Question 3
A 72-year-old female with COPD exacerbation develops respiratory failure. ABG:
pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg, HCO3 28 mEq/L. What acid-base
disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
E. Mixed metabolic-respiratory acidosis
Correct Answer: B
Expert Rationale: Acute hypercapnia (elevated PaCO2) with low pH indicates
respiratory acidosis from CO2 retention in COPD. Compensation (HCO3 rise) is
partial. Diagnostic reasoning uses Winter's formula; management includes NIPPV
to avoid intubation (GOLD guidelines).
,Question 4
For the COPD patient, what is the first-line non-invasive ventilation?
A. High-flow nasal cannula
B. BiPAP
C. CPAP
D. Mechanical ventilation
E. Incentive spirometry
Correct Answer: B
Expert Rationale: BiPAP reduces work of breathing and improves gas exchange
in hypercapnic respiratory failure, decreasing intubation risk by 50% (RCT
evidence). Titrate to IPAP 10-20 cmH2O, EPAP 5-10 cmH2O. Interprofessional:
involve RT for setup.
Question 5 (Case-Based: Scenario 1)
A 55-year-old male with sepsis from pneumonia is admitted to ICU. VS: BP 85/50,
HR 120, RR 28, Temp 39°C. Lactate 4.5 mmol/L. Initial fluid bolus 30 mL/kg
completed. What is the next diagnostic step?
A. Repeat lactate
B. Echocardiogram
C. Central line placement
D. Broad-spectrum antibiotics
E. Chest X-ray
Correct Answer: A
Expert Rationale: Surviving Sepsis Campaign mandates lactate repeat within 2-4
hours post-resuscitation to guide vasopressors if >2 mmol/L. Diagnostic reasoning:
lactate trends predict mortality (qSOFA/SOFA scores).
Question 6 (Case-Based: Scenario 1 continued)
If lactate remains elevated, what vasopressor is first-line?
A. Vasopressin
B. Epinephrine
, C. Norepinephrine
D. Phenylephrine
E. Dopamine
Correct Answer: C
Expert Rationale: Norepinephrine is first-line for septic shock (vasodilation),
improving MAP >65 mmHg with least arrhythmias (SOAP II trial). Start 0.01-0.5
mcg/kg/min; titrate via arterial line. Evidence: reduces mortality vs. dopamine.
Question 7
A patient with acute pancreatitis presents with epigastric pain, nausea, and elevated
lipase 800 U/L. What is the most common etiology?
A. Alcohol abuse
B. Gallstones
C. Hypertriglyceridemia
D. Medications
E. Trauma
Correct Answer: B
Expert Rationale: Gallstones cause 40-50% of cases via bile duct obstruction
(Atlanta criteria). Diagnostic: ultrasound for stones; management: NPO, fluids,
pain control. Reasoning: rule out biliary vs. alcoholic (history).
Question 8
In acute pancreatitis, what is the target fluid resuscitation rate?
A. 5 mL/kg/hr
B. 250-500 mL/hr lactated Ringer's
C. 1 L bolus then maintenance
D. 10% dextrose at 100 mL/hr
E. Normal saline at KVO
Correct Answer: B
in Acute Care (Chamberlain College of
Nursing) | Final Exam Review 2025/2026 –
Verified Questions and Answers | 100%
Correct | Grade A
Comprehensive Assessment
⸻
Student ID: _________________ Date: _________________
Instructor: [Instructor Name] Course Mentor: [Mentor Name]
Time Limit: 120 minutes Total Points: 100 points
Question 1
A 65-year-old male presents to the ED with acute onset of chest pain radiating to
the left arm, diaphoresis, and nausea. ECG shows ST-segment elevation in leads II,
III, and aVF. What is the most likely diagnosis?
A. Unstable angina
B. Acute pericarditis
C. Inferior wall myocardial infarction
D. Aortic dissection
E. Pulmonary embolism
Correct Answer: C
Expert Rationale: ST-elevation in inferior leads (II, III, aVF) indicates acute
inferior STEMI, requiring emergent reperfusion. Clinical reasoning prioritizes
ABCs and rapid cath lab activation per AHA/ACC guidelines. Differential
,excludes angina (no elevation), pericarditis (diffuse changes), dissection (tearing
pain), and PE (right-sided leads V1-V4).
Question 2
In managing the patient from Question 1, what is the priority pharmacologic
intervention?
A. Nitroglycerin sublingual
B. Aspirin 325 mg chewed
C. Heparin bolus
D. Metoprolol IV
E. Morphine IV
Correct Answer: B
Expert Rationale: Aspirin inhibits platelet aggregation, reducing mortality in
STEMI by 23% (ISIS-2 trial). Administer immediately upon suspicion. MONA
(morphine, oxygen, nitro, aspirin) is outdated; aspirin precedes others to avoid
delaying reperfusion. Evidence-based per AHA: chewed for rapid absorption.
Question 3
A 72-year-old female with COPD exacerbation develops respiratory failure. ABG:
pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg, HCO3 28 mEq/L. What acid-base
disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
E. Mixed metabolic-respiratory acidosis
Correct Answer: B
Expert Rationale: Acute hypercapnia (elevated PaCO2) with low pH indicates
respiratory acidosis from CO2 retention in COPD. Compensation (HCO3 rise) is
partial. Diagnostic reasoning uses Winter's formula; management includes NIPPV
to avoid intubation (GOLD guidelines).
,Question 4
For the COPD patient, what is the first-line non-invasive ventilation?
A. High-flow nasal cannula
B. BiPAP
C. CPAP
D. Mechanical ventilation
E. Incentive spirometry
Correct Answer: B
Expert Rationale: BiPAP reduces work of breathing and improves gas exchange
in hypercapnic respiratory failure, decreasing intubation risk by 50% (RCT
evidence). Titrate to IPAP 10-20 cmH2O, EPAP 5-10 cmH2O. Interprofessional:
involve RT for setup.
Question 5 (Case-Based: Scenario 1)
A 55-year-old male with sepsis from pneumonia is admitted to ICU. VS: BP 85/50,
HR 120, RR 28, Temp 39°C. Lactate 4.5 mmol/L. Initial fluid bolus 30 mL/kg
completed. What is the next diagnostic step?
A. Repeat lactate
B. Echocardiogram
C. Central line placement
D. Broad-spectrum antibiotics
E. Chest X-ray
Correct Answer: A
Expert Rationale: Surviving Sepsis Campaign mandates lactate repeat within 2-4
hours post-resuscitation to guide vasopressors if >2 mmol/L. Diagnostic reasoning:
lactate trends predict mortality (qSOFA/SOFA scores).
Question 6 (Case-Based: Scenario 1 continued)
If lactate remains elevated, what vasopressor is first-line?
A. Vasopressin
B. Epinephrine
, C. Norepinephrine
D. Phenylephrine
E. Dopamine
Correct Answer: C
Expert Rationale: Norepinephrine is first-line for septic shock (vasodilation),
improving MAP >65 mmHg with least arrhythmias (SOAP II trial). Start 0.01-0.5
mcg/kg/min; titrate via arterial line. Evidence: reduces mortality vs. dopamine.
Question 7
A patient with acute pancreatitis presents with epigastric pain, nausea, and elevated
lipase 800 U/L. What is the most common etiology?
A. Alcohol abuse
B. Gallstones
C. Hypertriglyceridemia
D. Medications
E. Trauma
Correct Answer: B
Expert Rationale: Gallstones cause 40-50% of cases via bile duct obstruction
(Atlanta criteria). Diagnostic: ultrasound for stones; management: NPO, fluids,
pain control. Reasoning: rule out biliary vs. alcoholic (history).
Question 8
In acute pancreatitis, what is the target fluid resuscitation rate?
A. 5 mL/kg/hr
B. 250-500 mL/hr lactated Ringer's
C. 1 L bolus then maintenance
D. 10% dextrose at 100 mL/hr
E. Normal saline at KVO
Correct Answer: B
