NR571 Acute Care Nurse Practitioner Midterm: (Latest
2026/2027 Update) Cardiology, Pulmonology, Infectious
Disease | Q&A | Grade A | 100% Correct Verified Answers
Subject: Acute Care – Cardiac Enzymes (Troponin, CK-MB, BNP); Acute Coronary Syndrome (Angina
Types, STEMI/NSTEMI, ECG Lead Localization, Early Management, DAPT, Statins); Arrhythmias
(Atrial Fibrillation, PAT/SVT, BBB, Adenosine Administration); Valvular Heart Disease (Aortic Stenosis –
Parvus et Tardus, Gallavardin; Mitral Regurgitation – P mitrale); Infective Endocarditis (Modified Duke
Criteria, Empiric Antibiotics, Surgical Indications); Venous Thromboembolism (DVT/PE – Wells Criteria,
DOACs, LMWH, Warfarin, Reversal Agents, HIT); Takotsubo Cardiomyopathy; Lymphedema;
Peripheral Artery Disease (PAD) & Chronic Venous Disease; Pulmonary (Asthma Exacerbation, COPD
Exacerbation – GOLD Guidelines, Steroid Administration, PFT Interpretation); Pneumonia (CAP, HAP,
VAP Prevention); Osteomyelitis (Diagnosis, Antibiotics, Surgical Debridement); Necrotizing Fasciitis;
Pressure Ulcer Staging (Braden Scale).
Source: NR571 Midterm Blueprint 2026, ACC/AHA, GOLD, IDSA, ATS, CDC.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
Cardiac Enzymes & Laboratory Interpretation
Troponin interpretation in cardiac injury
Correct Answer: Troponin is a protein in heart muscle cells that regulates contraction. When heart
muscle is damaged (MI), troponin releases into bloodstream. Levels elevate 3-4 hours after MI,
remain elevated up to 14 days. Highly specific indicator of heart damage.
1. High sensitivity troponin (hs-cTn) detects micro-infarctions. Serial troponins every 8 hours to assess
rise/fall pattern; dynamic change (20-50% variation) indicates acute MI vs chronic elevation.
2. Causes of elevated troponin: MI, myocarditis, takotsubo, PE, sepsis, renal failure, CHF,
tachyarrhythmias, severe hypertension, strenuous exercise.
3. CK-MB rises within hours, peaks 24 hours, less specific (muscle injury, inflammation, exercise). BNP
>100 pg/mL suggests heart failure (useful to differentiate dyspnea from cardiac vs pulmonary).
Additional laboratory tests in ACS workup
Correct Answer: Troponin q8h; BNP; CBC (H/H, platelets baseline); PTT, PT/INR (coagulation
baseline); BMP (renal function, electrolytes); TSH, magnesium, phosphorus (imbalances cause
dysrhythmias); echocardiogram (ejection fraction, valve patency); coronary angiography.
1. Echocardiogram also evaluates wall motion abnormalities. Coronary angiography is gold standard for
identifying coronary artery stenosis.
Acute Coronary Syndrome – Differentials, Management, ECG Localization
, Differentials for angina
Correct Answer: Unstable angina (pain without exertion, normal enzymes, ST depression/T
inversion). NSTEMI (elevated enzymes ± ECG changes). STEMI (ST elevations, elevated enzymes).
Stable angina (exertional, relieved by rest). Variant/Prinzmetal (arterial spasm, not CAD, more
common in women).
1. Unstable angina and NSTEMI are classified as non-ST elevation ACS; STEMI requires emergent
reperfusion.
Risk factors for cardiac ischemia
Correct Answer: Age >55 years, family history of CAD, tobacco use, diabetes, HTN, hyperlipidemia,
vascular atherosclerosis, obesity, unhealthy diet, inactivity, COVID-19.
EKG interpretation in ACS/MI – lead localization
Correct Answer: Inferior wall: II, III, aVF (RCA, LCx). Intraventricular septum: V1-V2 (LAD). Anterior
wall: V3-V4 (LAD, LCA). Lateral wall: I, aVL, V5, V6 (LCx). Right atrium: aVR (RCA).
1. LAD occlusion (anterior MI) – highest mortality. RCA occlusion (inferior MI) – often associated with RV
infarct, avoid nitroglycerin (hypotension).
Management of chest pain in CAD – 7 early treatment measures in ACS
Correct Answer: 1. Oxygen, 2. Nitroglycerin, 3. Morphine, 4. Beta-blocker, 5. Aspirin, 6. Clopidogrel
(or ticagrelor), 7. Anticoagulation (heparin or enoxaparin).
1. MONA-B: Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker.
2. Nitroglycerin contraindicated in RV infarct (hypotension). Morphine reserved for severe pain (may
increase mortality).
Outpatient medication management s/p STEMI
Correct Answer: Chewable ASA 325mg, high-dose atorvastatin or rosuvastatin (high-intensity
statin), beta-blocker (avoid in cocaine-induced STEMI), morphine (severe pain only), oxygen for
SaO2 <90%, sublingual NTG x3 then NTG drip if pain not resolved (contraindicated with RV infarct).
1. DAPT (dual antiplatelet therapy) for at least 1 year after ACS. Beta-blocker reduces mortality post-MI.
2. Cardiac rehabilitation should be offered to all ACS patients. Smoking cessation education and
treatment documented.
Arrhythmias & Electrophysiology
Differentials for atrial fibrillation
Correct Answer: Cardiomyopathy, CHF, heart disease, hyperthyroidism, acute alcohol intoxication,
MI, PE, pericarditis, cardiac surgery, obesity, hypertension, DM, sleep disordered breathing (OSA).
1. Treatment: rate control (beta-blocker, diltiazem, digoxin) or rhythm control (amiodarone, sotalol,
dofetilide). Anticoagulation (CHA₂DS₂-VASc score).
2. Atrial fib with RVR (rapid ventricular response) has loss of atrial kick, treat with diltiazem or metoprolol.
Adenosine administration for SVT/PAT
Correct Answer: Paroxysmal atrial tachycardia (PAT) / AVNRT (supraventricular tachycardia) –
narrow QRS. Vagal maneuvers first. Adenosine: 6mg rapid IV bolus over 1-3 seconds, followed by
20 mL NS flush; then 12mg dose. Cardioversion if hemodynamically unstable refractory to meds.
1. Adenosine slows cardiac conduction through AV node, interrupts reentry pathways.
2. Contraindications: asthma, sick sinus syndrome, second/third degree AV block.
2026/2027 Update) Cardiology, Pulmonology, Infectious
Disease | Q&A | Grade A | 100% Correct Verified Answers
Subject: Acute Care – Cardiac Enzymes (Troponin, CK-MB, BNP); Acute Coronary Syndrome (Angina
Types, STEMI/NSTEMI, ECG Lead Localization, Early Management, DAPT, Statins); Arrhythmias
(Atrial Fibrillation, PAT/SVT, BBB, Adenosine Administration); Valvular Heart Disease (Aortic Stenosis –
Parvus et Tardus, Gallavardin; Mitral Regurgitation – P mitrale); Infective Endocarditis (Modified Duke
Criteria, Empiric Antibiotics, Surgical Indications); Venous Thromboembolism (DVT/PE – Wells Criteria,
DOACs, LMWH, Warfarin, Reversal Agents, HIT); Takotsubo Cardiomyopathy; Lymphedema;
Peripheral Artery Disease (PAD) & Chronic Venous Disease; Pulmonary (Asthma Exacerbation, COPD
Exacerbation – GOLD Guidelines, Steroid Administration, PFT Interpretation); Pneumonia (CAP, HAP,
VAP Prevention); Osteomyelitis (Diagnosis, Antibiotics, Surgical Debridement); Necrotizing Fasciitis;
Pressure Ulcer Staging (Braden Scale).
Source: NR571 Midterm Blueprint 2026, ACC/AHA, GOLD, IDSA, ATS, CDC.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
Cardiac Enzymes & Laboratory Interpretation
Troponin interpretation in cardiac injury
Correct Answer: Troponin is a protein in heart muscle cells that regulates contraction. When heart
muscle is damaged (MI), troponin releases into bloodstream. Levels elevate 3-4 hours after MI,
remain elevated up to 14 days. Highly specific indicator of heart damage.
1. High sensitivity troponin (hs-cTn) detects micro-infarctions. Serial troponins every 8 hours to assess
rise/fall pattern; dynamic change (20-50% variation) indicates acute MI vs chronic elevation.
2. Causes of elevated troponin: MI, myocarditis, takotsubo, PE, sepsis, renal failure, CHF,
tachyarrhythmias, severe hypertension, strenuous exercise.
3. CK-MB rises within hours, peaks 24 hours, less specific (muscle injury, inflammation, exercise). BNP
>100 pg/mL suggests heart failure (useful to differentiate dyspnea from cardiac vs pulmonary).
Additional laboratory tests in ACS workup
Correct Answer: Troponin q8h; BNP; CBC (H/H, platelets baseline); PTT, PT/INR (coagulation
baseline); BMP (renal function, electrolytes); TSH, magnesium, phosphorus (imbalances cause
dysrhythmias); echocardiogram (ejection fraction, valve patency); coronary angiography.
1. Echocardiogram also evaluates wall motion abnormalities. Coronary angiography is gold standard for
identifying coronary artery stenosis.
Acute Coronary Syndrome – Differentials, Management, ECG Localization
, Differentials for angina
Correct Answer: Unstable angina (pain without exertion, normal enzymes, ST depression/T
inversion). NSTEMI (elevated enzymes ± ECG changes). STEMI (ST elevations, elevated enzymes).
Stable angina (exertional, relieved by rest). Variant/Prinzmetal (arterial spasm, not CAD, more
common in women).
1. Unstable angina and NSTEMI are classified as non-ST elevation ACS; STEMI requires emergent
reperfusion.
Risk factors for cardiac ischemia
Correct Answer: Age >55 years, family history of CAD, tobacco use, diabetes, HTN, hyperlipidemia,
vascular atherosclerosis, obesity, unhealthy diet, inactivity, COVID-19.
EKG interpretation in ACS/MI – lead localization
Correct Answer: Inferior wall: II, III, aVF (RCA, LCx). Intraventricular septum: V1-V2 (LAD). Anterior
wall: V3-V4 (LAD, LCA). Lateral wall: I, aVL, V5, V6 (LCx). Right atrium: aVR (RCA).
1. LAD occlusion (anterior MI) – highest mortality. RCA occlusion (inferior MI) – often associated with RV
infarct, avoid nitroglycerin (hypotension).
Management of chest pain in CAD – 7 early treatment measures in ACS
Correct Answer: 1. Oxygen, 2. Nitroglycerin, 3. Morphine, 4. Beta-blocker, 5. Aspirin, 6. Clopidogrel
(or ticagrelor), 7. Anticoagulation (heparin or enoxaparin).
1. MONA-B: Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker.
2. Nitroglycerin contraindicated in RV infarct (hypotension). Morphine reserved for severe pain (may
increase mortality).
Outpatient medication management s/p STEMI
Correct Answer: Chewable ASA 325mg, high-dose atorvastatin or rosuvastatin (high-intensity
statin), beta-blocker (avoid in cocaine-induced STEMI), morphine (severe pain only), oxygen for
SaO2 <90%, sublingual NTG x3 then NTG drip if pain not resolved (contraindicated with RV infarct).
1. DAPT (dual antiplatelet therapy) for at least 1 year after ACS. Beta-blocker reduces mortality post-MI.
2. Cardiac rehabilitation should be offered to all ACS patients. Smoking cessation education and
treatment documented.
Arrhythmias & Electrophysiology
Differentials for atrial fibrillation
Correct Answer: Cardiomyopathy, CHF, heart disease, hyperthyroidism, acute alcohol intoxication,
MI, PE, pericarditis, cardiac surgery, obesity, hypertension, DM, sleep disordered breathing (OSA).
1. Treatment: rate control (beta-blocker, diltiazem, digoxin) or rhythm control (amiodarone, sotalol,
dofetilide). Anticoagulation (CHA₂DS₂-VASc score).
2. Atrial fib with RVR (rapid ventricular response) has loss of atrial kick, treat with diltiazem or metoprolol.
Adenosine administration for SVT/PAT
Correct Answer: Paroxysmal atrial tachycardia (PAT) / AVNRT (supraventricular tachycardia) –
narrow QRS. Vagal maneuvers first. Adenosine: 6mg rapid IV bolus over 1-3 seconds, followed by
20 mL NS flush; then 12mg dose. Cardioversion if hemodynamically unstable refractory to meds.
1. Adenosine slows cardiac conduction through AV node, interrupts reentry pathways.
2. Contraindications: asthma, sick sinus syndrome, second/third degree AV block.
