1|Page
**NRNP 6552 FINAL EXAM (VERSION 2) – 100
Q&A (LATEST 2026, WALDEN UNIVERSITY) –
ADVANCED PRACTICE CARE OF ADULTS IN
ACUTE CARE II**
**1.** A 68-year-old male with a history of heart failure with reduced
ejection fraction (HFrEF) is admitted with acute decompensated heart
failure. He is on lisinopril, carvedilol, and furosemide. His blood
pressure is 100/60 mmHg, heart rate 65 bpm, respiratory rate 24, oxygen
saturation 88% on room air. Crackles are heard in bilateral lung bases.
Which intervention should be initiated first?
A) Start IV dobutamine
B) Administer IV furosemide
C) Increase carvedilol dose
D) Initiate non-invasive positive pressure ventilation (NIPPV)
**Correct Answer:** D – Initiate non-invasive positive pressure
ventilation (NIPPV)
**Rationale:** Acute hypoxemic respiratory failure with pulmonary
edema requires immediate respiratory support. NIPPV (e.g., BiPAP)
improves oxygenation, reduces work of breathing, and may prevent
intubation. IV diuretics should be given concurrently, but hypoxemia is
the priority.
,2|Page
**2.** A 72-year-old female with chronic kidney disease stage 4
presents with confusion, nausea, and muscle twitching. Labs: BUN 98
mg/dL, creatinine 6.5 mg/dL, potassium 6.8 mEq/L. ECG shows peaked
T waves. What is the most appropriate immediate intervention?
A) Oral sodium polystyrene sulfonate (Kayexalate)
B) IV calcium gluconate followed by insulin/glucose and albuterol
C) IV furosemide
D) Emergent hemodialysis
**Correct Answer:** B – IV calcium gluconate followed by
insulin/glucose and albuterol
**Rationale:** Severe hyperkalemia (K >6.5) with ECG changes
requires immediate cardiac protection with IV calcium gluconate. Then,
shift potassium intracellularly using insulin/glucose and albuterol.
Definitive removal requires dialysis, but temporizing measures are first.
**3.** A 55-year-old male with cirrhosis presents with hematemesis. He
is hypotensive (BP 85/50 mmHg), tachycardic (HR 120 bpm). What is
the most appropriate immediate pharmacologic therapy?
A) IV pantoprazole
B) IV octreotide
C) IV promethazine
D) IV albumin
,3|Page
**Correct Answer:** B – IV octreotide
**Rationale:** Octreotide (somatostatin analog) reduces splanchnic
blood flow and is first-line pharmacologic therapy for acute variceal
hemorrhage. It should be given before endoscopy. Antibiotics and
vasopressors may also be needed.
**4.** A patient with septic shock is on norepinephrine infusion at 20
mcg/min and remains hypotensive (MAP 55 mmHg). Which vasopressor
should be added next?
A) Phenylephrine
B) Vasopressin
C) Dopamine
D) Dobutamine
**Correct Answer:** B – Vasopressin
**Rationale:** Vasopressin (0.03 units/min) is the second-line
vasopressor in septic shock, often added when norepinephrine doses
exceed 15 mcg/min. It reduces the need for high-dose norepinephrine
and may improve outcomes.
**5.** A 65-year-old male with COPD presents with acute dyspnea,
purulent sputum, and fever. He is confused. ABG on 2 L nasal cannula:
pH 7.28, PaCO2 75 mmHg, PaO2 68 mmHg, HCO3 32 mEq/L. What is
the most appropriate next step?
A) Increase oxygen to 4 L nasal cannula
, 4|Page
B) Initiate non-invasive positive pressure ventilation (NIPPV)
C) Intubate and mechanically ventilate
D) Administer IV solumedrol
**Correct Answer:** B – Initiate non-invasive positive pressure
ventilation (NIPPV)
**Rationale:** Acute hypercapnic respiratory failure in COPD with pH
<7.30 is an indication for NIPPV (BiPAP) unless the patient is
unresponsive or has contraindications. NIPPV reduces intubation and
mortality.
**6.** A 45-year-old male with acute pancreatitis has a Ranson score of
5. Which finding is most likely present?
A) Age >55
B) LDH >350 IU/L
C) Calcium <8 mg/dL
D) PaO2 <60 mmHg
**Correct Answer:** C – Calcium <8 mg/dL
**Rationale:** Ranson criteria (at 48 hours) include calcium <8 mg/dL
(hypocalcemia due to saponification of fat necrosis). Other criteria
include hematocrit drop >10%, BUN rise >5 mg/dL, base deficit >4, and
fluid sequestration >6 L.
**NRNP 6552 FINAL EXAM (VERSION 2) – 100
Q&A (LATEST 2026, WALDEN UNIVERSITY) –
ADVANCED PRACTICE CARE OF ADULTS IN
ACUTE CARE II**
**1.** A 68-year-old male with a history of heart failure with reduced
ejection fraction (HFrEF) is admitted with acute decompensated heart
failure. He is on lisinopril, carvedilol, and furosemide. His blood
pressure is 100/60 mmHg, heart rate 65 bpm, respiratory rate 24, oxygen
saturation 88% on room air. Crackles are heard in bilateral lung bases.
Which intervention should be initiated first?
A) Start IV dobutamine
B) Administer IV furosemide
C) Increase carvedilol dose
D) Initiate non-invasive positive pressure ventilation (NIPPV)
**Correct Answer:** D – Initiate non-invasive positive pressure
ventilation (NIPPV)
**Rationale:** Acute hypoxemic respiratory failure with pulmonary
edema requires immediate respiratory support. NIPPV (e.g., BiPAP)
improves oxygenation, reduces work of breathing, and may prevent
intubation. IV diuretics should be given concurrently, but hypoxemia is
the priority.
,2|Page
**2.** A 72-year-old female with chronic kidney disease stage 4
presents with confusion, nausea, and muscle twitching. Labs: BUN 98
mg/dL, creatinine 6.5 mg/dL, potassium 6.8 mEq/L. ECG shows peaked
T waves. What is the most appropriate immediate intervention?
A) Oral sodium polystyrene sulfonate (Kayexalate)
B) IV calcium gluconate followed by insulin/glucose and albuterol
C) IV furosemide
D) Emergent hemodialysis
**Correct Answer:** B – IV calcium gluconate followed by
insulin/glucose and albuterol
**Rationale:** Severe hyperkalemia (K >6.5) with ECG changes
requires immediate cardiac protection with IV calcium gluconate. Then,
shift potassium intracellularly using insulin/glucose and albuterol.
Definitive removal requires dialysis, but temporizing measures are first.
**3.** A 55-year-old male with cirrhosis presents with hematemesis. He
is hypotensive (BP 85/50 mmHg), tachycardic (HR 120 bpm). What is
the most appropriate immediate pharmacologic therapy?
A) IV pantoprazole
B) IV octreotide
C) IV promethazine
D) IV albumin
,3|Page
**Correct Answer:** B – IV octreotide
**Rationale:** Octreotide (somatostatin analog) reduces splanchnic
blood flow and is first-line pharmacologic therapy for acute variceal
hemorrhage. It should be given before endoscopy. Antibiotics and
vasopressors may also be needed.
**4.** A patient with septic shock is on norepinephrine infusion at 20
mcg/min and remains hypotensive (MAP 55 mmHg). Which vasopressor
should be added next?
A) Phenylephrine
B) Vasopressin
C) Dopamine
D) Dobutamine
**Correct Answer:** B – Vasopressin
**Rationale:** Vasopressin (0.03 units/min) is the second-line
vasopressor in septic shock, often added when norepinephrine doses
exceed 15 mcg/min. It reduces the need for high-dose norepinephrine
and may improve outcomes.
**5.** A 65-year-old male with COPD presents with acute dyspnea,
purulent sputum, and fever. He is confused. ABG on 2 L nasal cannula:
pH 7.28, PaCO2 75 mmHg, PaO2 68 mmHg, HCO3 32 mEq/L. What is
the most appropriate next step?
A) Increase oxygen to 4 L nasal cannula
, 4|Page
B) Initiate non-invasive positive pressure ventilation (NIPPV)
C) Intubate and mechanically ventilate
D) Administer IV solumedrol
**Correct Answer:** B – Initiate non-invasive positive pressure
ventilation (NIPPV)
**Rationale:** Acute hypercapnic respiratory failure in COPD with pH
<7.30 is an indication for NIPPV (BiPAP) unless the patient is
unresponsive or has contraindications. NIPPV reduces intubation and
mortality.
**6.** A 45-year-old male with acute pancreatitis has a Ranson score of
5. Which finding is most likely present?
A) Age >55
B) LDH >350 IU/L
C) Calcium <8 mg/dL
D) PaO2 <60 mmHg
**Correct Answer:** C – Calcium <8 mg/dL
**Rationale:** Ranson criteria (at 48 hours) include calcium <8 mg/dL
(hypocalcemia due to saponification of fat necrosis). Other criteria
include hematocrit drop >10%, BUN rise >5 mg/dL, base deficit >4, and
fluid sequestration >6 L.
