NR571/NR 571 MIDTERM EXAM (LATEST
2026/2027 UPDATE) COMPLEX DIAGNOSIS
& MANAGEMENT IN ACUTE CARE REVIEW
WITH CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
COMPLEX DIAGNOSIS AND MANAGEMENT
IN ACUTE CARE PRACTICUM
Question 1
An AGACNP is called to evaluate a patient who is preparing for discharge following a carotid
endarterectomy. The patient is acutely altered and reports a new-onset severe headache. Vital signs reveal a
heart rate of 116 beats/min, blood pressure of 170/90 mmHg, and temperature of 99°F (37.2°C). Which
intervention should the AGACNP initiate immediately?
A. Administer acetaminophen 650 mg orally and obtain two sets of blood cultures
B. Administer diltiazem 15 mg IV push followed by infusion titrated to heart rate <90
C. Administer morphine 2 mg IV PRN for pain and acetaminophen 650 mg orally
D. Administer labetalol 20 mg IV push followed by infusion titrated to blood pressure <160 mmHg
Correct Answer: D
Rationale:
This patient’s presentation is consistent with cerebral hyperperfusion syndrome, a serious postoperative
complication following carotid endarterectomy. Rapid blood pressure reduction is the priority to prevent
intracranial hemorrhage or cerebral edema. Labetalol is ideal because it provides controlled reduction in
blood pressure without increasing intracranial pressure. Analgesics alone would mask symptoms without
treating the underlying life-threatening condition.
,Question 2
After achieving return of spontaneous circulation (ROSC) in a patient who experienced cardiac arrest, which
intervention should the AGACNP prioritize during the stabilization phase?
A. Initiate high-quality CPR with minimal interruptions
B. Call for assistance and ensure scene safety
C. Place an endotracheal tube, obtain a 12-lead ECG, and optimize hemodynamics
D. Transfer the patient immediately to a higher level of care and consult cardiology
Correct Answer: C
Rationale:
Once ROSC is achieved, the focus shifts to the stabilization phase, which includes securing the airway,
evaluating cardiac rhythm, and optimizing oxygenation and perfusion. Placement of an endotracheal tube,
ECG monitoring, and hemodynamic optimization are essential to prevent re-arrest. High-quality CPR and
scene safety are priorities before ROSC, not after. Transfer and consultation occur after stabilization is
achieved.
Question 3
A 76-year-old woman presents after a brief loss of consciousness. She reports palpitations and
lightheadedness immediately before the event. Which differential diagnosis is most consistent with this
presentation?
A. Vasovagal syncope
B. Orthostatic hypotension
C. Cardiac arrhythmia
D. Seizure disorder
Correct Answer: C
Rationale:
Syncope preceded by palpitations strongly suggests a cardiac arrhythmia, particularly tachyarrhythmias or
heart block. Vasovagal syncope is typically triggered by emotional stress or pain. Orthostatic hypotension
occurs after position changes, and seizures are often associated with postictal confusion or incontinence.
Cardiac causes of syncope carry a higher mortality risk and require urgent evaluation.
,Question 4
Which therapeutic regimen is most effective in managing symptoms associated with all types of
cardiomyopathy?
A. Diuretics, beta blockers, and calcium channel blockers
B. Aspirin, statins, and beta blockers
C. Nitrates, diuretics, and norepinephrine
D. Aspirin, statins, and implantable cardioverter-defibrillator
Correct Answer: A
Rationale:
Regardless of the underlying type, cardiomyopathy commonly leads to heart failure symptoms and volume
overload. Diuretics reduce preload and congestion, while beta blockers and calcium channel blockers
improve ventricular filling and reduce myocardial oxygen demand. Aspirin and statins do not treat
cardiomyopathy itself. Norepinephrine increases afterload and can worsen heart failure symptoms.
Question 5
An AGACNP evaluates a patient with fever, chills, dyspnea, and recent recovery from COVID-19 infection.
Myocarditis is suspected. Which diagnostic test definitively confirms myocarditis?
A. Transthoracic echocardiogram
B. Myocardial biopsy
C. Transesophageal echocardiogram
D. Cardiac magnetic resonance imaging
Correct Answer: B
Rationale:
Endomyocardial biopsy is the gold standard for diagnosing myocarditis, allowing histologic confirmation
of inflammatory infiltrates and myocyte necrosis. While echocardiography and cardiac MRI may suggest
myocarditis, they cannot definitively confirm the diagnosis. Biopsy findings are defined by the Dallas
criteria. Although invasive, biopsy provides diagnostic certainty when required.
, Question 6
A patient presents with acute chest pain that improves when leaning forward. Physical examination reveals
tachycardia and a pericardial friction rub with clear lung sounds. What is the most likely diagnosis?
A. Myocarditis
B. Endocarditis
C. Pericarditis
D. Hypertrophic cardiomyopathy
Correct Answer: C
Rationale:
Classic findings of acute pericarditis include sharp chest pain relieved by leaning forward and the presence
of a pericardial friction rub. Lung sounds are typically normal unless complications occur. Myocarditis does
not cause positional chest pain, and endocarditis presents with systemic infection signs. Hypertrophic
cardiomyopathy requires imaging and does not present with friction rubs.
Question 7
During cardiac arrest management, a patient initially presents in pulseless electrical activity (PEA). At the
next rhythm check, ventricular fibrillation is noted. What is the AGACNP’s next action?
A. Prepare for synchronized cardioversion
B. Administer IV amiodarone
C. Administer IV magnesium sulfate
D. Deliver a defibrillation shock at 200 J biphasic
Correct Answer: D
Rationale:
Ventricular fibrillation is a shockable rhythm, and immediate defibrillation is the priority intervention.
Delays in defibrillation significantly reduce survival. Antiarrhythmic medications may be considered after
shock delivery if the rhythm persists. Synchronized cardioversion is inappropriate for pulseless rhythms.
2026/2027 UPDATE) COMPLEX DIAGNOSIS
& MANAGEMENT IN ACUTE CARE REVIEW
WITH CORRECT/ACCURATE ANSWERS
AT CHAMBERLAIN COLLEGE OF NURSING
COMPLEX DIAGNOSIS AND MANAGEMENT
IN ACUTE CARE PRACTICUM
Question 1
An AGACNP is called to evaluate a patient who is preparing for discharge following a carotid
endarterectomy. The patient is acutely altered and reports a new-onset severe headache. Vital signs reveal a
heart rate of 116 beats/min, blood pressure of 170/90 mmHg, and temperature of 99°F (37.2°C). Which
intervention should the AGACNP initiate immediately?
A. Administer acetaminophen 650 mg orally and obtain two sets of blood cultures
B. Administer diltiazem 15 mg IV push followed by infusion titrated to heart rate <90
C. Administer morphine 2 mg IV PRN for pain and acetaminophen 650 mg orally
D. Administer labetalol 20 mg IV push followed by infusion titrated to blood pressure <160 mmHg
Correct Answer: D
Rationale:
This patient’s presentation is consistent with cerebral hyperperfusion syndrome, a serious postoperative
complication following carotid endarterectomy. Rapid blood pressure reduction is the priority to prevent
intracranial hemorrhage or cerebral edema. Labetalol is ideal because it provides controlled reduction in
blood pressure without increasing intracranial pressure. Analgesics alone would mask symptoms without
treating the underlying life-threatening condition.
,Question 2
After achieving return of spontaneous circulation (ROSC) in a patient who experienced cardiac arrest, which
intervention should the AGACNP prioritize during the stabilization phase?
A. Initiate high-quality CPR with minimal interruptions
B. Call for assistance and ensure scene safety
C. Place an endotracheal tube, obtain a 12-lead ECG, and optimize hemodynamics
D. Transfer the patient immediately to a higher level of care and consult cardiology
Correct Answer: C
Rationale:
Once ROSC is achieved, the focus shifts to the stabilization phase, which includes securing the airway,
evaluating cardiac rhythm, and optimizing oxygenation and perfusion. Placement of an endotracheal tube,
ECG monitoring, and hemodynamic optimization are essential to prevent re-arrest. High-quality CPR and
scene safety are priorities before ROSC, not after. Transfer and consultation occur after stabilization is
achieved.
Question 3
A 76-year-old woman presents after a brief loss of consciousness. She reports palpitations and
lightheadedness immediately before the event. Which differential diagnosis is most consistent with this
presentation?
A. Vasovagal syncope
B. Orthostatic hypotension
C. Cardiac arrhythmia
D. Seizure disorder
Correct Answer: C
Rationale:
Syncope preceded by palpitations strongly suggests a cardiac arrhythmia, particularly tachyarrhythmias or
heart block. Vasovagal syncope is typically triggered by emotional stress or pain. Orthostatic hypotension
occurs after position changes, and seizures are often associated with postictal confusion or incontinence.
Cardiac causes of syncope carry a higher mortality risk and require urgent evaluation.
,Question 4
Which therapeutic regimen is most effective in managing symptoms associated with all types of
cardiomyopathy?
A. Diuretics, beta blockers, and calcium channel blockers
B. Aspirin, statins, and beta blockers
C. Nitrates, diuretics, and norepinephrine
D. Aspirin, statins, and implantable cardioverter-defibrillator
Correct Answer: A
Rationale:
Regardless of the underlying type, cardiomyopathy commonly leads to heart failure symptoms and volume
overload. Diuretics reduce preload and congestion, while beta blockers and calcium channel blockers
improve ventricular filling and reduce myocardial oxygen demand. Aspirin and statins do not treat
cardiomyopathy itself. Norepinephrine increases afterload and can worsen heart failure symptoms.
Question 5
An AGACNP evaluates a patient with fever, chills, dyspnea, and recent recovery from COVID-19 infection.
Myocarditis is suspected. Which diagnostic test definitively confirms myocarditis?
A. Transthoracic echocardiogram
B. Myocardial biopsy
C. Transesophageal echocardiogram
D. Cardiac magnetic resonance imaging
Correct Answer: B
Rationale:
Endomyocardial biopsy is the gold standard for diagnosing myocarditis, allowing histologic confirmation
of inflammatory infiltrates and myocyte necrosis. While echocardiography and cardiac MRI may suggest
myocarditis, they cannot definitively confirm the diagnosis. Biopsy findings are defined by the Dallas
criteria. Although invasive, biopsy provides diagnostic certainty when required.
, Question 6
A patient presents with acute chest pain that improves when leaning forward. Physical examination reveals
tachycardia and a pericardial friction rub with clear lung sounds. What is the most likely diagnosis?
A. Myocarditis
B. Endocarditis
C. Pericarditis
D. Hypertrophic cardiomyopathy
Correct Answer: C
Rationale:
Classic findings of acute pericarditis include sharp chest pain relieved by leaning forward and the presence
of a pericardial friction rub. Lung sounds are typically normal unless complications occur. Myocarditis does
not cause positional chest pain, and endocarditis presents with systemic infection signs. Hypertrophic
cardiomyopathy requires imaging and does not present with friction rubs.
Question 7
During cardiac arrest management, a patient initially presents in pulseless electrical activity (PEA). At the
next rhythm check, ventricular fibrillation is noted. What is the AGACNP’s next action?
A. Prepare for synchronized cardioversion
B. Administer IV amiodarone
C. Administer IV magnesium sulfate
D. Deliver a defibrillation shock at 200 J biphasic
Correct Answer: D
Rationale:
Ventricular fibrillation is a shockable rhythm, and immediate defibrillation is the priority intervention.
Delays in defibrillation significantly reduce survival. Antiarrhythmic medications may be considered after
shock delivery if the rhythm persists. Synchronized cardioversion is inappropriate for pulseless rhythms.
