NRNP 6566 WEEK 8 KNOWLEDGE CHECK 2026/2027 |
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Part 1: Gastrointestinal & Hepatic Emergencies (Questions 1-12)
Q1: A 58-year-old male with cirrhosis presents with hematemesis and melena. BP is
88/52, HR 118, Hgb 7.2 g/dL. What is the immediate priority in management?
A. Immediate endoscopy to identify bleeding source
B. IV octreotide 50mcg bolus then 50mcg/hour infusion plus IV ceftriaxone
C. Oral beta-blocker to reduce portal pressure
D. Transjugular intrahepatic portosystemic shunt (TIPS) procedure
Correct Answer: B [CORRECT]
Rationale: Variceal hemorrhage requires immediate pharmacologic therapy with
octreotide (reduces splanchnic blood flow) plus prophylactic antibiotics
(ceftriaxone/ciprofloxacin) to prevent SBP and reduce mortality. Endoscopy (A) should
occur within 12 hours but hemodynamic stabilization and pharmacotherapy come first.
Beta-blockers (C) are for prevention, not acute bleeding. TIPS (D) is rescue therapy if
endoscopic treatment fails.
Q2: A 45-year-old alcoholic presents with severe epigastric pain radiating to the back,
nausea, and vomiting. Lipase is 2,850 U/L. CT shows pancreatic edema without
necrosis. Which Ranson criterion present at admission indicates higher severity?
,A. Age 45 years
B. WBC 16,000/μL
C. Blood glucose 140 mg/dL
D. AST 120 U/L
Correct Answer: B [CORRECT]
Rationale: Ranson criteria at admission: age >55, WBC >16,000, glucose >200, AST
>250, LDH >350. WBC 16,000 meets criterion. Age 45 (A) is under 55. Glucose 140 (C) is
under 200. AST 120 (D) is under 250. Score ≥3 indicates severe disease. This question
requires knowing specific Ranson cutoff values, not just general severity indicators.
Q3: A patient with cirrhosis and ascites develops fever, abdominal pain, and altered
mental status. Paracentesis shows PMN count 450 cells/μL. What is the diagnosis and
appropriate empiric therapy?
A. Culture-negative spontaneous bacterial peritonitis (SBP); start IV cefotaxime 2g q8h
or ceftriaxone 2g daily
B. Secondary peritonitis; urgent surgical consultation required
C. Culture-positive SBP requiring anaerobic coverage with metronidazole
D. Benign ascites; no antibiotics needed
Correct Answer: A [CORRECT]
Rationale: SBP diagnosed when ascitic fluid PMN ≥250 cells/μL with clinical suspicion.
Most common organisms are gram-negative enterics (E. coli, Klebsiella). Empiric
third-generation cephalosporin (cefotaxime, ceftriaxone) covers 95% of
,community-acquired SBP. Add albumin on day 1 and 3 to prevent HRS. Secondary
peritonitis (B) requires surgery but presents differently (multiple organisms, loculations,
free air).
Q4: A 72-year-old on warfarin (INR 3.5) presents with massive hematemesis. Which
blood product administration strategy is most appropriate?
A. FFP 15-20 mL/kg to reverse warfarin plus PRBCs as needed
B. Vitamin K 10mg IV only; takes 6-12 hours to reverse anticoagulation
C. 4-factor prothrombin complex concentrate (PCC) 25-50 units/kg plus vitamin K 10mg
IV for rapid reversal
D. Cryoprecipitate 10 units for fibrinogen replacement
Correct Answer: C [CORRECT]
Rationale: 4-factor PCC contains II, VII, IX, X and rapidly reverses warfarin (minutes) vs.
FFP (hours). PCC plus vitamin K provides immediate and sustained reversal. FFP (A)
requires large volumes and longer time. Vitamin K alone (B) takes too long for active
bleeding. Cryoprecipitate (D) replaces fibrinogen but doesn't reverse warfarin
anticoagulation.
Q5: A patient with hepatic encephalopathy (HE) grade 3 has asterixis and confusion.
Which medication mechanism best explains lactulose's efficacy?
A. Lactulose is absorbed and directly antagonizes ammonia in the brain
B. Lactulose is non-absorbable disaccharide converted to lactic/acetic acid by colonic
bacteria, acidifying gut and trapping ammonia (NH4+) for fecal excretion
, C. Lactulose induces hepatic enzyme production to metabolize ammonia
D. Lactulose is a diuretic that eliminates ammonia through kidneys
Correct Answer: B [CORRECT]
Rationale: Lactulose works through osmotic laxative effect and gut acidification.
Colonic bacteria metabolize lactulose to organic acids, lowering pH and converting
diffusible NH3 to non-diffusible NH4+ which is trapped and excreted. Rifaximin is
add-on therapy to reduce ammonia-producing gut bacteria. Options A, C, and D describe
non-existent mechanisms.
Q6: A 35-year-old with history of heavy alcohol use presents with hematemesis after
forceful retching. Endoscopy shows a 2cm linear mucosal tear at gastroesophageal
junction. What is the diagnosis?
A. Boerhaave syndrome (esophageal rupture)
B. Mallory-Weiss tear
C. Esophageal varix rupture
D. Dieulafoy lesion
Correct Answer: B [CORRECT]
Rationale: Mallory-Weiss tear is mucosal laceration at GE junction caused by forceful
retching/vomiting against closed glottis (alcohol-associated). Usually self-limited; 90%
stop bleeding spontaneously. Boerhaave (A) is transmural rupture with mediastinitis
(severe illness). Varices (C) occur with portal hypertension. Dieulafoy (D) is large
tortuous submucosal vessel without ulcer, usually gastric body.
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Part 1: Gastrointestinal & Hepatic Emergencies (Questions 1-12)
Q1: A 58-year-old male with cirrhosis presents with hematemesis and melena. BP is
88/52, HR 118, Hgb 7.2 g/dL. What is the immediate priority in management?
A. Immediate endoscopy to identify bleeding source
B. IV octreotide 50mcg bolus then 50mcg/hour infusion plus IV ceftriaxone
C. Oral beta-blocker to reduce portal pressure
D. Transjugular intrahepatic portosystemic shunt (TIPS) procedure
Correct Answer: B [CORRECT]
Rationale: Variceal hemorrhage requires immediate pharmacologic therapy with
octreotide (reduces splanchnic blood flow) plus prophylactic antibiotics
(ceftriaxone/ciprofloxacin) to prevent SBP and reduce mortality. Endoscopy (A) should
occur within 12 hours but hemodynamic stabilization and pharmacotherapy come first.
Beta-blockers (C) are for prevention, not acute bleeding. TIPS (D) is rescue therapy if
endoscopic treatment fails.
Q2: A 45-year-old alcoholic presents with severe epigastric pain radiating to the back,
nausea, and vomiting. Lipase is 2,850 U/L. CT shows pancreatic edema without
necrosis. Which Ranson criterion present at admission indicates higher severity?
,A. Age 45 years
B. WBC 16,000/μL
C. Blood glucose 140 mg/dL
D. AST 120 U/L
Correct Answer: B [CORRECT]
Rationale: Ranson criteria at admission: age >55, WBC >16,000, glucose >200, AST
>250, LDH >350. WBC 16,000 meets criterion. Age 45 (A) is under 55. Glucose 140 (C) is
under 200. AST 120 (D) is under 250. Score ≥3 indicates severe disease. This question
requires knowing specific Ranson cutoff values, not just general severity indicators.
Q3: A patient with cirrhosis and ascites develops fever, abdominal pain, and altered
mental status. Paracentesis shows PMN count 450 cells/μL. What is the diagnosis and
appropriate empiric therapy?
A. Culture-negative spontaneous bacterial peritonitis (SBP); start IV cefotaxime 2g q8h
or ceftriaxone 2g daily
B. Secondary peritonitis; urgent surgical consultation required
C. Culture-positive SBP requiring anaerobic coverage with metronidazole
D. Benign ascites; no antibiotics needed
Correct Answer: A [CORRECT]
Rationale: SBP diagnosed when ascitic fluid PMN ≥250 cells/μL with clinical suspicion.
Most common organisms are gram-negative enterics (E. coli, Klebsiella). Empiric
third-generation cephalosporin (cefotaxime, ceftriaxone) covers 95% of
,community-acquired SBP. Add albumin on day 1 and 3 to prevent HRS. Secondary
peritonitis (B) requires surgery but presents differently (multiple organisms, loculations,
free air).
Q4: A 72-year-old on warfarin (INR 3.5) presents with massive hematemesis. Which
blood product administration strategy is most appropriate?
A. FFP 15-20 mL/kg to reverse warfarin plus PRBCs as needed
B. Vitamin K 10mg IV only; takes 6-12 hours to reverse anticoagulation
C. 4-factor prothrombin complex concentrate (PCC) 25-50 units/kg plus vitamin K 10mg
IV for rapid reversal
D. Cryoprecipitate 10 units for fibrinogen replacement
Correct Answer: C [CORRECT]
Rationale: 4-factor PCC contains II, VII, IX, X and rapidly reverses warfarin (minutes) vs.
FFP (hours). PCC plus vitamin K provides immediate and sustained reversal. FFP (A)
requires large volumes and longer time. Vitamin K alone (B) takes too long for active
bleeding. Cryoprecipitate (D) replaces fibrinogen but doesn't reverse warfarin
anticoagulation.
Q5: A patient with hepatic encephalopathy (HE) grade 3 has asterixis and confusion.
Which medication mechanism best explains lactulose's efficacy?
A. Lactulose is absorbed and directly antagonizes ammonia in the brain
B. Lactulose is non-absorbable disaccharide converted to lactic/acetic acid by colonic
bacteria, acidifying gut and trapping ammonia (NH4+) for fecal excretion
, C. Lactulose induces hepatic enzyme production to metabolize ammonia
D. Lactulose is a diuretic that eliminates ammonia through kidneys
Correct Answer: B [CORRECT]
Rationale: Lactulose works through osmotic laxative effect and gut acidification.
Colonic bacteria metabolize lactulose to organic acids, lowering pH and converting
diffusible NH3 to non-diffusible NH4+ which is trapped and excreted. Rifaximin is
add-on therapy to reduce ammonia-producing gut bacteria. Options A, C, and D describe
non-existent mechanisms.
Q6: A 35-year-old with history of heavy alcohol use presents with hematemesis after
forceful retching. Endoscopy shows a 2cm linear mucosal tear at gastroesophageal
junction. What is the diagnosis?
A. Boerhaave syndrome (esophageal rupture)
B. Mallory-Weiss tear
C. Esophageal varix rupture
D. Dieulafoy lesion
Correct Answer: B [CORRECT]
Rationale: Mallory-Weiss tear is mucosal laceration at GE junction caused by forceful
retching/vomiting against closed glottis (alcohol-associated). Usually self-limited; 90%
stop bleeding spontaneously. Boerhaave (A) is transmural rupture with mediastinitis
(severe illness). Varices (C) occur with portal hypertension. Dieulafoy (D) is large
tortuous submucosal vessel without ulcer, usually gastric body.
