NR571 Midterm Exam: Complex Diagnosis &
Management in Acute Care - 100 Q&A
1. What is the primary goal of the "Sepsis Six" bundle of care, to be delivered within the first
hour of recognition?
A) Administer broad-spectrum antibiotics
B) Perform source control surgery
C) Achieve a mix of hemodynamic, microbiological, and supportive interventions
D) Transfer the patient to the intensive care unit
2. A patient with a history of heart failure presents with acute dyspnea, bibasilar crackles,
JVD, and peripheral edema. Chest X-ray shows pulmonary edema and cardiomegaly. What is
the most likely diagnosis?
A) Pneumonia
B) Acute Exacerbation of COPD
C) Acute Decompensated Heart Failure (ADHF)
D) Pulmonary Embolism
3. Which of the following is the most sensitive initial laboratory test for diagnosing acute
myocardial infarction?
A) Creatine Kinase-MB (CK-MB)
B) Myoglobin
C) High-Sensitivity Troponin I or T
D) Lactate Dehydrogenase (LDH)
4. In the management of acute ischemic stroke, what is the critical time window for the
administration of intravenous alteplase (tPA)?
A) Within 3 hours of symptom onset
B) Within 4.5 hours of symptom onset
C) Within 6 hours of symptom onset
D) Within 12 hours of symptom onset
5. A patient presents with sudden-onset "tearing" or "ripping" chest pain radiating to the
back. BP is 180/100 in the right arm and 140/80 in the left arm. What is the most critical initial
diagnostic test?
A) Echocardiogram
B) ECG
C) Chest X-ray
D) CT Angiography of the Chest
,6. Which finding on an arterial blood gas (ABG) is most consistent with a primary metabolic
acidosis?
A) Low pH, Low PaCO2
B) Low pH, High PaCO2
C) Low pH, Low HCO3
D) High pH, High HCO3
7. For a patient in rapid atrial fibrillation with a heart rate of 160 bpm and a BP of 80/50
mmHg, the immediate priority is:
A) Administer IV Metoprolol
B) Administer IV Diltiazem
C) Perform synchronized cardioversion
D) Start a heparin infusion
8. The RIFLE criteria for Acute Kidney Injury (AKI) are based primarily on changes in:
A) Urine Output and Serum Creatinine
B) Blood Urea Nitrogen (BUN) and Glomerular Filtration Rate (GFR)
C) Urine Sediment and Potassium Levels
D) Fluid Status and Blood Pressure
9. A patient with diabetic ketoacidosis (DKA) is being treated. After initial fluid resuscitation,
the most important step to correct their acidosis is:
A) Sodium Bicarbonate administration
B) Intravenous Insulin infusion
C) Potassium replacement
D) Broad-spectrum antibiotics
10. Which of the following is a classic sign of cardiac tamponade?
A) Pulsus Paradoxus
B) Kussmaul's Sign
C) Homan's Sign
D) Grey Turner's Sign
11. The initial antibiotic choice for a patient with suspected hospital-acquired pneumonia
(HAP) should cover for:
A) Only gram-positive organisms
B) Only gram-negative organisms
C) Multidrug-resistant (MDR) organisms
D) Atypical organisms only
,12. In a patient with a suspected pulmonary embolism, a Wells' Score is used to:
A) Determine the need for thrombolytics
B) Assess the clinical probability of PE to guide diagnostic testing
C) Calculate the required heparin dose
D) Decide on the need for an IVC filter
13. The management of hyperkalemia with ECG changes (peaked T-waves) includes all
EXCEPT:
A) IV Calcium Gluconate
B) IV Insulin with Glucose
C) Sodium Polystyrene Sulfonate (Kayexalate)
D) Albuterol Nebulizers
(Rationale: While Kayexalate is used to remove potassium, it acts too slowly for the immediate
stabilization of the myocardium required when ECG changes are present. The other options act
within minutes.)
14. Which type of shock is characterized by high cardiac output and low systemic vascular
resistance?
A) Cardiogenic Shock
B) Hypovolemic Shock
C) Obstructive Shock
D) Distributive Shock
15. The most common cause of Upper Gastrointestinal (GI) Bleeding is:
A) Esophageal Varices
B) Mallory-Weiss Tear
C) Peptic Ulcer Disease
D) Gastric Cancer
16. For a patient with altered mental status, the "DON'T" mnemonic helps to identify
reversible causes. What does the 'T' stand for?
A) Toxins
B) Thrombosis
C) Tumor
D) Trauma
17. A patient with liver cirrhosis presents with confusion and asterixis. What is the most
appropriate initial treatment for this hepatic encephalopathy?
A) Oral Neomycin
B) Intravenous Steroids
, C) Lactulose
D) High-protein diet
18. In the management of status asthmaticus that is not responding to bronchodilators, what
is the next critical step?
A) IV Magnesium Sulfate
B) Non-invasive Positive Pressure Ventilation (NIPPV)
C) Systemic Corticosteroids
D) Intubation and Mechanical Ventilation
19. The diagnosis of acute pancreatitis requires at least two of the following three criteria
EXCEPT:
A) Abdominal pain consistent with pancreatitis
B) Serum lipase (or amylase) > 3 times the upper limit of normal
C) Characteristic findings on abdominal ultrasonography
D) Leukocytosis > 12,000/mm³
(Rationale: Leukocytosis is a common finding but is not one of the three diagnostic criteria from
the Revised Atlanta Classification.)
20. What is the primary mechanism of action of Naloxone (Narcan) in an opioid overdose?
A) It is a GABA agonist
B) It is a competitive opioid receptor antagonist
C) It enhances renal excretion of opioids
D) It reverses metabolic acidosis
21. Which of the following is a late sign of increased intracranial pressure (ICP)?
A) Headache
B) Cushing's Triad (Hypertension, Bradycardia, Irregular Respirations)
C) Nausea and Vomiting
D) Papilledema
22. The initial fluid of choice for the resuscitation of a patient with septic shock is:
A) 5% Dextrose in Water (D5W)
B) 0.9% Normal Saline (or a balanced crystalloid like Lactated Ringer's)
C) Hypertonic Saline
D) Packed Red Blood Cells
23. A patient with myasthenia gravis presents with acute respiratory failure. This is known as:
A) Serotonin Syndrome
B) Cholinergic Crisis
Management in Acute Care - 100 Q&A
1. What is the primary goal of the "Sepsis Six" bundle of care, to be delivered within the first
hour of recognition?
A) Administer broad-spectrum antibiotics
B) Perform source control surgery
C) Achieve a mix of hemodynamic, microbiological, and supportive interventions
D) Transfer the patient to the intensive care unit
2. A patient with a history of heart failure presents with acute dyspnea, bibasilar crackles,
JVD, and peripheral edema. Chest X-ray shows pulmonary edema and cardiomegaly. What is
the most likely diagnosis?
A) Pneumonia
B) Acute Exacerbation of COPD
C) Acute Decompensated Heart Failure (ADHF)
D) Pulmonary Embolism
3. Which of the following is the most sensitive initial laboratory test for diagnosing acute
myocardial infarction?
A) Creatine Kinase-MB (CK-MB)
B) Myoglobin
C) High-Sensitivity Troponin I or T
D) Lactate Dehydrogenase (LDH)
4. In the management of acute ischemic stroke, what is the critical time window for the
administration of intravenous alteplase (tPA)?
A) Within 3 hours of symptom onset
B) Within 4.5 hours of symptom onset
C) Within 6 hours of symptom onset
D) Within 12 hours of symptom onset
5. A patient presents with sudden-onset "tearing" or "ripping" chest pain radiating to the
back. BP is 180/100 in the right arm and 140/80 in the left arm. What is the most critical initial
diagnostic test?
A) Echocardiogram
B) ECG
C) Chest X-ray
D) CT Angiography of the Chest
,6. Which finding on an arterial blood gas (ABG) is most consistent with a primary metabolic
acidosis?
A) Low pH, Low PaCO2
B) Low pH, High PaCO2
C) Low pH, Low HCO3
D) High pH, High HCO3
7. For a patient in rapid atrial fibrillation with a heart rate of 160 bpm and a BP of 80/50
mmHg, the immediate priority is:
A) Administer IV Metoprolol
B) Administer IV Diltiazem
C) Perform synchronized cardioversion
D) Start a heparin infusion
8. The RIFLE criteria for Acute Kidney Injury (AKI) are based primarily on changes in:
A) Urine Output and Serum Creatinine
B) Blood Urea Nitrogen (BUN) and Glomerular Filtration Rate (GFR)
C) Urine Sediment and Potassium Levels
D) Fluid Status and Blood Pressure
9. A patient with diabetic ketoacidosis (DKA) is being treated. After initial fluid resuscitation,
the most important step to correct their acidosis is:
A) Sodium Bicarbonate administration
B) Intravenous Insulin infusion
C) Potassium replacement
D) Broad-spectrum antibiotics
10. Which of the following is a classic sign of cardiac tamponade?
A) Pulsus Paradoxus
B) Kussmaul's Sign
C) Homan's Sign
D) Grey Turner's Sign
11. The initial antibiotic choice for a patient with suspected hospital-acquired pneumonia
(HAP) should cover for:
A) Only gram-positive organisms
B) Only gram-negative organisms
C) Multidrug-resistant (MDR) organisms
D) Atypical organisms only
,12. In a patient with a suspected pulmonary embolism, a Wells' Score is used to:
A) Determine the need for thrombolytics
B) Assess the clinical probability of PE to guide diagnostic testing
C) Calculate the required heparin dose
D) Decide on the need for an IVC filter
13. The management of hyperkalemia with ECG changes (peaked T-waves) includes all
EXCEPT:
A) IV Calcium Gluconate
B) IV Insulin with Glucose
C) Sodium Polystyrene Sulfonate (Kayexalate)
D) Albuterol Nebulizers
(Rationale: While Kayexalate is used to remove potassium, it acts too slowly for the immediate
stabilization of the myocardium required when ECG changes are present. The other options act
within minutes.)
14. Which type of shock is characterized by high cardiac output and low systemic vascular
resistance?
A) Cardiogenic Shock
B) Hypovolemic Shock
C) Obstructive Shock
D) Distributive Shock
15. The most common cause of Upper Gastrointestinal (GI) Bleeding is:
A) Esophageal Varices
B) Mallory-Weiss Tear
C) Peptic Ulcer Disease
D) Gastric Cancer
16. For a patient with altered mental status, the "DON'T" mnemonic helps to identify
reversible causes. What does the 'T' stand for?
A) Toxins
B) Thrombosis
C) Tumor
D) Trauma
17. A patient with liver cirrhosis presents with confusion and asterixis. What is the most
appropriate initial treatment for this hepatic encephalopathy?
A) Oral Neomycin
B) Intravenous Steroids
, C) Lactulose
D) High-protein diet
18. In the management of status asthmaticus that is not responding to bronchodilators, what
is the next critical step?
A) IV Magnesium Sulfate
B) Non-invasive Positive Pressure Ventilation (NIPPV)
C) Systemic Corticosteroids
D) Intubation and Mechanical Ventilation
19. The diagnosis of acute pancreatitis requires at least two of the following three criteria
EXCEPT:
A) Abdominal pain consistent with pancreatitis
B) Serum lipase (or amylase) > 3 times the upper limit of normal
C) Characteristic findings on abdominal ultrasonography
D) Leukocytosis > 12,000/mm³
(Rationale: Leukocytosis is a common finding but is not one of the three diagnostic criteria from
the Revised Atlanta Classification.)
20. What is the primary mechanism of action of Naloxone (Narcan) in an opioid overdose?
A) It is a GABA agonist
B) It is a competitive opioid receptor antagonist
C) It enhances renal excretion of opioids
D) It reverses metabolic acidosis
21. Which of the following is a late sign of increased intracranial pressure (ICP)?
A) Headache
B) Cushing's Triad (Hypertension, Bradycardia, Irregular Respirations)
C) Nausea and Vomiting
D) Papilledema
22. The initial fluid of choice for the resuscitation of a patient with septic shock is:
A) 5% Dextrose in Water (D5W)
B) 0.9% Normal Saline (or a balanced crystalloid like Lactated Ringer's)
C) Hypertonic Saline
D) Packed Red Blood Cells
23. A patient with myasthenia gravis presents with acute respiratory failure. This is known as:
A) Serotonin Syndrome
B) Cholinergic Crisis
