NR-571 FINAL EXAM REVIEW (LATEST
2026/2027 UPDATE): COMPLEX DIAGNOSIS
AND MANAGEMENT IN ACUTE CARE
PRACTICUM | COMPLETE REVIEW WITH
CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
COMPLEX DIAGNOSIS AND MANAGEMENT
IN ACUTE CARE PRACTICUM
(WEEKS 5–8).
1. A patient has a signed DNR order and an implantable cardiac
device. What is the most appropriate next step?
A. Leave the device active unless cardiac arrest occurs
B. Immediately remove the device surgically
C. Deactivate the implantable cardiac device per patient goals
D. Continue pacing but disable defibrillation only
Correct Answer: C
Rationale:
When a patient has a DNR order or elects withdrawal of life-sustaining treatment (LST), implantable cardiac
devices such as pacemakers, ICDs, or LVADs should be evaluated for deactivation. These devices may
unintentionally prolong dying or cause discomfort, especially ICD shocks. Deactivation is ethically
appropriate and aligns care with patient wishes. Removal is unnecessary and invasive, and continuing device
therapy contradicts DNR intent.
2. Which implantable devices may require deactivation after a DNR
order is signed?
,A. Peripheral IV infusion pumps
B. Permanent pacemakers and AICDs
C. Foley catheters
D. Oxygen delivery systems
Correct Answer: B
Rationale:
Permanent pacemakers (PPM), automatic implantable cardioverter-defibrillators (AICDs), and LVADs
actively sustain cardiac function. In the presence of a DNR or withdrawal of LST, these devices may conflict
with comfort-focused goals. Deactivation prevents unwanted resuscitative interventions. IV pumps,
catheters, and oxygen are comfort-supportive measures, not resuscitative devices.
3. Which statement best describes a DNR Comfort Care-Arrest
(DNRCC-Arrest) order?
A. No treatments are allowed once the order is signed
B. Comfort care only is provided at all times
C. Full treatment until cardiac or respiratory arrest occurs
D. CPR is allowed if the patient requests it
Correct Answer: C
Rationale:
A DNRCC-Arrest allows full medical treatment, including vasopressors, antiarrhythmics, and oxygen, until
cardiac or respiratory arrest occurs. Once arrest happens, only comfort care is provided and no resuscitation
is attempted. This differs from DNR Comfort Care, which limits treatment immediately. CPR is never
allowed once arrest occurs under DNRCC-Arrest.
4. Under a DNRCC-Arrest order, when is the DNR activated?
A. When oxygen saturation drops below 90%
B. When blood pressure becomes unstable
C. At the time of cardiac or respiratory arrest
D. Immediately upon signing the order
Correct Answer: C
Rationale:
The DNR component of a DNRCC-Arrest is triggered only when a cardiac or respiratory arrest occurs. Prior
to arrest, all life-sustaining treatments may be administered. This approach balances aggressive treatment
with patient wishes to avoid CPR. Early activation would misrepresent the intent of this order.
,5. Which finding defines a cardiac arrest?
A. Heart rate less than 40 bpm
B. Asystole on telemetry only
C. No palpable pulse
D. Severe hypotension
Correct Answer: C
Rationale:
Cardiac arrest is clinically defined by the absence of a palpable pulse, regardless of monitor rhythm.
Telemetry alone cannot determine arrest status. Bradycardia and hypotension may be severe but are not
cardiac arrest. Accurate identification ensures appropriate DNR activation.
6. Which intervention is prohibited under a DNR Comfort Care
(DNRCC) order?
A. Pain medication
B. Oxygen for dyspnea
C. Vasopressors
D. Emotional support
Correct Answer: C
Rationale:
DNR Comfort Care prohibits all resuscitative therapies from the time the order is signed. Vasopressors are
considered life-prolonging interventions and are therefore not permitted. Comfort measures such as oxygen,
analgesia, and emotional support remain appropriate. The goal is symptom relief, not prolongation of life.
7. Which intervention is NOT allowed under a DNRCC order?
A. Chest compressions
B. Antiemetics
C. Opioids
D. Anxiolytics
Correct Answer: A
Rationale:
Chest compressions are a resuscitative measure and are strictly prohibited under DNRCC. Medications that
, relieve symptoms such as nausea, pain, and anxiety are core components of comfort care. DNRCC focuses
on dignity and symptom management rather than reversing physiologic decline.
8. A Do Not Intubate (DNI) order specifically prohibits which
intervention?
A. Non-invasive ventilation
B. Placement of an endotracheal tube
C. Oxygen by nasal cannula
D. CPAP
Correct Answer: B
Rationale:
A DNI order prohibits placement of an artificial airway, including endotracheal intubation. Non-invasive
ventilation such as CPAP or BiPAP may still be allowed unless otherwise specified. Oxygen therapy is
always permissible. DNI does not equal DNR.
9. Which statement about DNR reversal during surgery is correct?
A. DNR orders are automatically void in the OR
B. All surgical arrests are considered irreversible
C. DNR status must be addressed before anesthesia
D. DNR orders cannot be reinstated postoperatively
Correct Answer: C
Rationale:
DNR status must be discussed and documented prior to any procedure involving anesthesia. Some arrests
during surgery are potentially reversible, so patients may choose temporary suspension. Automatic voiding
violates patient autonomy. Reinstatement timing must be clearly documented.
10. If a patient chooses NOT to rescind a DNR perioperatively, what
must occur?
A. Surgery must be canceled
B. Ethics committee approval is required
C. Decision must be documented in surgical consent
D. CPR must still be attempted
2026/2027 UPDATE): COMPLEX DIAGNOSIS
AND MANAGEMENT IN ACUTE CARE
PRACTICUM | COMPLETE REVIEW WITH
CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
COMPLEX DIAGNOSIS AND MANAGEMENT
IN ACUTE CARE PRACTICUM
(WEEKS 5–8).
1. A patient has a signed DNR order and an implantable cardiac
device. What is the most appropriate next step?
A. Leave the device active unless cardiac arrest occurs
B. Immediately remove the device surgically
C. Deactivate the implantable cardiac device per patient goals
D. Continue pacing but disable defibrillation only
Correct Answer: C
Rationale:
When a patient has a DNR order or elects withdrawal of life-sustaining treatment (LST), implantable cardiac
devices such as pacemakers, ICDs, or LVADs should be evaluated for deactivation. These devices may
unintentionally prolong dying or cause discomfort, especially ICD shocks. Deactivation is ethically
appropriate and aligns care with patient wishes. Removal is unnecessary and invasive, and continuing device
therapy contradicts DNR intent.
2. Which implantable devices may require deactivation after a DNR
order is signed?
,A. Peripheral IV infusion pumps
B. Permanent pacemakers and AICDs
C. Foley catheters
D. Oxygen delivery systems
Correct Answer: B
Rationale:
Permanent pacemakers (PPM), automatic implantable cardioverter-defibrillators (AICDs), and LVADs
actively sustain cardiac function. In the presence of a DNR or withdrawal of LST, these devices may conflict
with comfort-focused goals. Deactivation prevents unwanted resuscitative interventions. IV pumps,
catheters, and oxygen are comfort-supportive measures, not resuscitative devices.
3. Which statement best describes a DNR Comfort Care-Arrest
(DNRCC-Arrest) order?
A. No treatments are allowed once the order is signed
B. Comfort care only is provided at all times
C. Full treatment until cardiac or respiratory arrest occurs
D. CPR is allowed if the patient requests it
Correct Answer: C
Rationale:
A DNRCC-Arrest allows full medical treatment, including vasopressors, antiarrhythmics, and oxygen, until
cardiac or respiratory arrest occurs. Once arrest happens, only comfort care is provided and no resuscitation
is attempted. This differs from DNR Comfort Care, which limits treatment immediately. CPR is never
allowed once arrest occurs under DNRCC-Arrest.
4. Under a DNRCC-Arrest order, when is the DNR activated?
A. When oxygen saturation drops below 90%
B. When blood pressure becomes unstable
C. At the time of cardiac or respiratory arrest
D. Immediately upon signing the order
Correct Answer: C
Rationale:
The DNR component of a DNRCC-Arrest is triggered only when a cardiac or respiratory arrest occurs. Prior
to arrest, all life-sustaining treatments may be administered. This approach balances aggressive treatment
with patient wishes to avoid CPR. Early activation would misrepresent the intent of this order.
,5. Which finding defines a cardiac arrest?
A. Heart rate less than 40 bpm
B. Asystole on telemetry only
C. No palpable pulse
D. Severe hypotension
Correct Answer: C
Rationale:
Cardiac arrest is clinically defined by the absence of a palpable pulse, regardless of monitor rhythm.
Telemetry alone cannot determine arrest status. Bradycardia and hypotension may be severe but are not
cardiac arrest. Accurate identification ensures appropriate DNR activation.
6. Which intervention is prohibited under a DNR Comfort Care
(DNRCC) order?
A. Pain medication
B. Oxygen for dyspnea
C. Vasopressors
D. Emotional support
Correct Answer: C
Rationale:
DNR Comfort Care prohibits all resuscitative therapies from the time the order is signed. Vasopressors are
considered life-prolonging interventions and are therefore not permitted. Comfort measures such as oxygen,
analgesia, and emotional support remain appropriate. The goal is symptom relief, not prolongation of life.
7. Which intervention is NOT allowed under a DNRCC order?
A. Chest compressions
B. Antiemetics
C. Opioids
D. Anxiolytics
Correct Answer: A
Rationale:
Chest compressions are a resuscitative measure and are strictly prohibited under DNRCC. Medications that
, relieve symptoms such as nausea, pain, and anxiety are core components of comfort care. DNRCC focuses
on dignity and symptom management rather than reversing physiologic decline.
8. A Do Not Intubate (DNI) order specifically prohibits which
intervention?
A. Non-invasive ventilation
B. Placement of an endotracheal tube
C. Oxygen by nasal cannula
D. CPAP
Correct Answer: B
Rationale:
A DNI order prohibits placement of an artificial airway, including endotracheal intubation. Non-invasive
ventilation such as CPAP or BiPAP may still be allowed unless otherwise specified. Oxygen therapy is
always permissible. DNI does not equal DNR.
9. Which statement about DNR reversal during surgery is correct?
A. DNR orders are automatically void in the OR
B. All surgical arrests are considered irreversible
C. DNR status must be addressed before anesthesia
D. DNR orders cannot be reinstated postoperatively
Correct Answer: C
Rationale:
DNR status must be discussed and documented prior to any procedure involving anesthesia. Some arrests
during surgery are potentially reversible, so patients may choose temporary suspension. Automatic voiding
violates patient autonomy. Reinstatement timing must be clearly documented.
10. If a patient chooses NOT to rescind a DNR perioperatively, what
must occur?
A. Surgery must be canceled
B. Ethics committee approval is required
C. Decision must be documented in surgical consent
D. CPR must still be attempted
