1
NR 570 FINAL EXAM (CHAMBERLAIN) NEWEST 2026
ACTUAL EXAM TEST BANK| NR570 COMMON
DIAGNOSIS & MANAGEMENT IN ACUTE CARE FINAL
EXAM REVIEW WITH 150 REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+
This comprehensive test bank covers the key acute care domains from the NR 570
curriculum. The questions are structured to follow the Next Generation NCLEX
(NGN) Clinical Judgment Measurement Model (Recognize Cues → Analyze Cues
→ Prioritize Hypotheses → Generate Solutions → Take Action → Evaluate
Outcomes). Each question includes the correct answer and a detailed, evidence-
based rationale.
Domain 1: Cardiovascular & Hemodynamic Emergencies (Questions 1–30)
1. A 68-year-old male presents to the ED with acute chest pain that began 2 hours
ago. ECG shows ST-segment elevation of 3 mm in leads V2-V4. Which of the
following is the priority management strategy within the first 90 minutes of
arrival?
A) Administer 325 mg of chewable aspirin and obtain a troponin level.
B) Initiate a heparin drip and prepare for transesophageal echocardiogram.
C) Activate the cardiac catheterization lab for primary percutaneous coronary
intervention (PCI).
D) Administer tenecteplase (TNK) and transfer to a tertiary care center.
: Answer : C
✅ Rationale: For an STEMI patient presenting within 120 minutes of symptom
onset, the goal is primary PCI with a door-to-balloon time of ≤90 minutes. Aspirin
should be given immediately, but the definitive treatment remains mechanical
pg. 1
,2
revascularization at a PCI-capable facility. Fibrinolytics (D) are considered only if
PCI cannot be performed within 120 minutes.
2. A patient with acute decompensated heart failure (HF) presents with dyspnea,
rales in all lung fields, and an oxygen saturation of 84% on room air. What is the
most appropriate first action?
A) Administer IV furosemide 40 mg.
B) Place the patient on non-invasive positive pressure ventilation (NIPPV).
C) Initiate a dobutamine infusion.
D) Obtain a stat echocardiogram.
: Answer : B
✅ Rationale: For severe respiratory distress from pulmonary edema, NIPPV
(BiPAP or CPAP) is indicated to improve oxygenation and ventilation while
reducing preload and afterload, thus avoiding intubation. IV diuretics are
secondary; dobutamine is for low output states; echo is diagnostic but not first.
3. A 75-year-old female with a history of HF with reduced ejection fraction (HFrEF)
is admitted with acute decompensation. BNP is 1,200 pg/mL, creatinine is 1.8
mg/dL, and potassium is 5.6 mEq/L. She is already on lisinopril, carvedilol, and
spironolactone. Which medication should be held pending further evaluation?
A) Lisinopril
B) Carvedilol
C) Spironolactone
D) IV furosemide
: Answer : C
✅ Rationale: Spironolactone is a potassium-sparing diuretic; its use is
contraindicated with hyperkalemia (K⁺ >5.0 mEq/L). Lisinopril (ACE inhibitor) and
carvedilol (beta-blocker) should be continued cautiously. IV furosemide is needed
for volume overload. The potassium level must be addressed before resuming
spironolactone.
pg. 2
,3
4. Which of the following assessment findings is most suggestive of
a right-sided heart failure exacerbation?
A) Crackles in the lung bases
B) Jugular venous distension (JVD) and lower extremity edema
C) Orthopnea and paroxysmal nocturnal dyspnea (PND)
D) S3 gallop and pulsus alternans
: Answer : B
✅ Rationale: Right-sided heart failure presents with systemic congestion: JVD,
peripheral edema, hepatomegaly, and ascites. Crackles, orthopnea, PND, and S3
gallop (A, C, D) are signs of left-sided HF. In acute care, identifying the pattern
helps guide diuretic and afterload reduction therapy.
5. A 54-year-old male with no prior cardiac history presents with substernal chest
pain at rest, with ST-segment depression of 2 mm in leads V3-V5. Troponin is
elevated. What is the most appropriate initial management?
A) Dual antiplatelet therapy (aspirin + clopidogrel) and anticoagulation
B) Immediate fibrinolytic therapy
C) Stress test to risk stratify
D) Discharge with oral nitrates and follow-up
: Answer : A
✅ Rationale: This is an NSTEMI. Initial management includes dual antiplatelet
therapy (DAPT) with aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor, or
prasugrel) plus anticoagulation (e.g., unfractionated heparin). Fibrinolysis is
contraindicated in NSTEMI. Invasive risk stratification follows within 24 hours.
6. What is the target oxygen saturation for a patient with acute decompensated
heart failure who has a history of COPD and chronic hypercapnia?
A) 100%
B) 94-98%
C) 88-92%
D) 92-96%
pg. 3
, 4
: Answer : C
✅ Rationale: In patients with COPD and chronic CO₂ retention, the target is
88-92% to avoid oxygen-induced hypercapnia that can suppress the hypoxic drive.
If this patient also has acute HF, careful oxygen titration is required, with
ventilatory support if needed.
7. A patient with septic shock is receiving norepinephrine (Levophed) at 15
mcg/min and remains hypotensive (MAP 55 mm Hg). What should be the next
intervention?
A) Increase norepinephrine to 30 mcg/min.
B) Add a second vasopressor, such as vasopressin.
C) Administer a fluid bolus of 1,000 mL of normal saline.
D) Start an epinephrine drip.
: Answer : B
✅ Rationale: When high-dose norepinephrine fails to achieve MAP ≥65 mm Hg,
adding vasopressin is guideline-supported. Vasopressin is a non-catecholamine
vasopressor that is effective even in catecholamine-resistant shock. Fluid status
should have been optimized first.
8. A 68-year-old male is admitted with bradycardia (HR 38 bpm), hypotension (BP
82/50 mm Hg), and altered mental status. The ECG shows complete heart block.
What is the priority intervention?
A) Administer atropine 0.5 mg IV push.
B) Start a dopamine infusion.
C) Prepare for transcutaneous pacing.
D) Administer IV fluids.
: Answer : C
✅ Rationale: In symptomatic bradycardia (hypotension, altered mental status),
transcutaneous pacing (TCP) is the definitive treatment when the patient is
unstable. Atropine (A) may be attempted while preparing TCP, but it is often
ineffective in complete heart block.
pg. 4
NR 570 FINAL EXAM (CHAMBERLAIN) NEWEST 2026
ACTUAL EXAM TEST BANK| NR570 COMMON
DIAGNOSIS & MANAGEMENT IN ACUTE CARE FINAL
EXAM REVIEW WITH 150 REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+
This comprehensive test bank covers the key acute care domains from the NR 570
curriculum. The questions are structured to follow the Next Generation NCLEX
(NGN) Clinical Judgment Measurement Model (Recognize Cues → Analyze Cues
→ Prioritize Hypotheses → Generate Solutions → Take Action → Evaluate
Outcomes). Each question includes the correct answer and a detailed, evidence-
based rationale.
Domain 1: Cardiovascular & Hemodynamic Emergencies (Questions 1–30)
1. A 68-year-old male presents to the ED with acute chest pain that began 2 hours
ago. ECG shows ST-segment elevation of 3 mm in leads V2-V4. Which of the
following is the priority management strategy within the first 90 minutes of
arrival?
A) Administer 325 mg of chewable aspirin and obtain a troponin level.
B) Initiate a heparin drip and prepare for transesophageal echocardiogram.
C) Activate the cardiac catheterization lab for primary percutaneous coronary
intervention (PCI).
D) Administer tenecteplase (TNK) and transfer to a tertiary care center.
: Answer : C
✅ Rationale: For an STEMI patient presenting within 120 minutes of symptom
onset, the goal is primary PCI with a door-to-balloon time of ≤90 minutes. Aspirin
should be given immediately, but the definitive treatment remains mechanical
pg. 1
,2
revascularization at a PCI-capable facility. Fibrinolytics (D) are considered only if
PCI cannot be performed within 120 minutes.
2. A patient with acute decompensated heart failure (HF) presents with dyspnea,
rales in all lung fields, and an oxygen saturation of 84% on room air. What is the
most appropriate first action?
A) Administer IV furosemide 40 mg.
B) Place the patient on non-invasive positive pressure ventilation (NIPPV).
C) Initiate a dobutamine infusion.
D) Obtain a stat echocardiogram.
: Answer : B
✅ Rationale: For severe respiratory distress from pulmonary edema, NIPPV
(BiPAP or CPAP) is indicated to improve oxygenation and ventilation while
reducing preload and afterload, thus avoiding intubation. IV diuretics are
secondary; dobutamine is for low output states; echo is diagnostic but not first.
3. A 75-year-old female with a history of HF with reduced ejection fraction (HFrEF)
is admitted with acute decompensation. BNP is 1,200 pg/mL, creatinine is 1.8
mg/dL, and potassium is 5.6 mEq/L. She is already on lisinopril, carvedilol, and
spironolactone. Which medication should be held pending further evaluation?
A) Lisinopril
B) Carvedilol
C) Spironolactone
D) IV furosemide
: Answer : C
✅ Rationale: Spironolactone is a potassium-sparing diuretic; its use is
contraindicated with hyperkalemia (K⁺ >5.0 mEq/L). Lisinopril (ACE inhibitor) and
carvedilol (beta-blocker) should be continued cautiously. IV furosemide is needed
for volume overload. The potassium level must be addressed before resuming
spironolactone.
pg. 2
,3
4. Which of the following assessment findings is most suggestive of
a right-sided heart failure exacerbation?
A) Crackles in the lung bases
B) Jugular venous distension (JVD) and lower extremity edema
C) Orthopnea and paroxysmal nocturnal dyspnea (PND)
D) S3 gallop and pulsus alternans
: Answer : B
✅ Rationale: Right-sided heart failure presents with systemic congestion: JVD,
peripheral edema, hepatomegaly, and ascites. Crackles, orthopnea, PND, and S3
gallop (A, C, D) are signs of left-sided HF. In acute care, identifying the pattern
helps guide diuretic and afterload reduction therapy.
5. A 54-year-old male with no prior cardiac history presents with substernal chest
pain at rest, with ST-segment depression of 2 mm in leads V3-V5. Troponin is
elevated. What is the most appropriate initial management?
A) Dual antiplatelet therapy (aspirin + clopidogrel) and anticoagulation
B) Immediate fibrinolytic therapy
C) Stress test to risk stratify
D) Discharge with oral nitrates and follow-up
: Answer : A
✅ Rationale: This is an NSTEMI. Initial management includes dual antiplatelet
therapy (DAPT) with aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor, or
prasugrel) plus anticoagulation (e.g., unfractionated heparin). Fibrinolysis is
contraindicated in NSTEMI. Invasive risk stratification follows within 24 hours.
6. What is the target oxygen saturation for a patient with acute decompensated
heart failure who has a history of COPD and chronic hypercapnia?
A) 100%
B) 94-98%
C) 88-92%
D) 92-96%
pg. 3
, 4
: Answer : C
✅ Rationale: In patients with COPD and chronic CO₂ retention, the target is
88-92% to avoid oxygen-induced hypercapnia that can suppress the hypoxic drive.
If this patient also has acute HF, careful oxygen titration is required, with
ventilatory support if needed.
7. A patient with septic shock is receiving norepinephrine (Levophed) at 15
mcg/min and remains hypotensive (MAP 55 mm Hg). What should be the next
intervention?
A) Increase norepinephrine to 30 mcg/min.
B) Add a second vasopressor, such as vasopressin.
C) Administer a fluid bolus of 1,000 mL of normal saline.
D) Start an epinephrine drip.
: Answer : B
✅ Rationale: When high-dose norepinephrine fails to achieve MAP ≥65 mm Hg,
adding vasopressin is guideline-supported. Vasopressin is a non-catecholamine
vasopressor that is effective even in catecholamine-resistant shock. Fluid status
should have been optimized first.
8. A 68-year-old male is admitted with bradycardia (HR 38 bpm), hypotension (BP
82/50 mm Hg), and altered mental status. The ECG shows complete heart block.
What is the priority intervention?
A) Administer atropine 0.5 mg IV push.
B) Start a dopamine infusion.
C) Prepare for transcutaneous pacing.
D) Administer IV fluids.
: Answer : C
✅ Rationale: In symptomatic bradycardia (hypotension, altered mental status),
transcutaneous pacing (TCP) is the definitive treatment when the patient is
unstable. Atropine (A) may be attempted while preparing TCP, but it is often
ineffective in complete heart block.
pg. 4
