NR57 1/ NR 57 1 Midterm Exam (Latest 2024/ 2025 Update) Complex Diagnosis & Management in Acute Care Review| Questions and Verified Answers| 100% Correct |Grade A – Chamberlain Q:ITheIAGACNPIisIcalledItoIseeIaIpatientIwhoIisIreadyIforIdischargeIafterIaIcarotidIendarte
rectomy.ITheIpatientIisIalteredIandIbeganIcomplaining IofInewIheadacheIthisImorning.ITheIcur
rentIvitalIsignsIareIasIfollowsI:IheartIrateI(HR) 116Ibeats/min,IbloodIpressureI(BP)I170/90ImmHg,IandItemperature I99°F.IWhatIordersIshouldI
theIAGACNPIgive? A.IAcetaminophen I650ImgIorallyInow,IandIbloodIculturesI×I2IobtainedIstat I B.IDiltiazemI15ImgIintravenous I(IV)IpushIfollowedIbyIcontinuous IinfusionIatI5Img/hr;Ititratio
nItoIHRI<90Ibeats/min C.IMorphineI2ImgIIVIasIneededIforIpain;Iacetaminophen I650ImgInowID.ILabetalolI20ImgIIV
IpushIfollowedIbyIcontinuous IinfusionItitratedItoIBPI<160ImmHg Answer: IID.ILabetalolI20ImgIIVIpushIfollowedIbyIcontinuous IinfusionItitratedItoIBPI<160ImmHg TheIpatientIisIdemonstrating IsymptomsIofIcerebralIhyperperfusion IsyndromeIandIrequiresIpro
mptIcontrolIofItheirIhypertension .ILabetalolIIVIpushIfollowedIbyIaItitrat-
IableIinfusionIwillIallowIcorrectionIofItheIhypertension IandItitrationIasIneeded.IWhileIacetami
nophenImayIbeIgivenIforIheadache,ItheIpatient'sIpainIisIpartIofIaIlargerIproblem,IwhichIisIcer
ebralIhyperperfusion .ITheIpriorityIintervention IisIcontrolIofItheIhyperperfusion .IBloodIcultures
IareInotIindicated.IDiltiazemIisIusefulIinIcontrolling IatrialIfibrillation; IitIwillInotIhelpIaddressIt
heIprimaryIproblemIforIthisIpatient.IBetaIblockersIareIaImoreIappropriate Ichoice.IMorphineIan
dIacetaminophen ImayIbeIusedIasIsecondaryIagentsIforIthisIpatient'sIpain;Ihowever,ItheyIwillIn
otIaddressItheIunderlying IproblemIandImayIonlyImaskItheImedicalIemergency IthatIisIunfoldin
g.IControlIofItheIpatient'sIBPIisItheIpriority.I Q:IWhenImanagingIaIcardiacIarrestIpatient,IwhichIinterventions IshouldItheIAGACNPIprioriti
zeIafterIachievingIreturnIofIspontaneous Icirculation? IA.IPlaceIendotracheal ItubeI(ETT),Iobtain
IEKG,Imonitor,IandIoptimizeIrespira-ItoryIandIhemodynamic Iparameters B.ITransferItoIhigherIlevelIofIcare,IinitiateIsedation,IandIconsultIcardiology IC.IAdminister Ihig
h-qualityIcardiopulmonary Iresuscitation I(CPR)IwithIanIem-
IphasisIonIqualityIofIcompressions IandIminimization IofIinterruptions D.ICallIforIhelpIandIassessItheIsceneIforIsafety Answer: IIA.IPlaceIendotracheal ItubeI(ETT),IobtainIEKG,Imonitor,IandIoptimizeIrespiratory IandIhemod
ynamicIpara-Imeters TheIstabilization IphaseIoccursIafterIreturnIofIspontaneous Icirculation I(ROSC)IisIachieved.IDur
ingIthisItime,ItheIETTIisIplaced,ItheIEKGIisIobtained,IandIrespiratory IandIhemodynamic Ipara
metersIareImonitoredIandIoptimized.ITransferItoIaIhigherIlevelIofIcareIandIobtainingIexpertIco
nsultationIoccurIinItheIemergentIactivitiesIphaseIfollowingItheIstabilization Iphase.IHigh-
qualityICPRIisItheIprimaryIgoalIinIachievingIROSC.IThisIoccursIpriorItoItheIstabilization Ipha
se.ICallingIforIhelpIandIsecuringItheIsceneIareItheIinitialIstepsIinIperforming IadvancedIcardiac
IlifeIsupportIandIoccurIbeforeIROSCIandItheIstabilization Iphase.I Q:IAI76-year-
oldIfemaleIpatientIpresentsIwithIaIreportIofIhavingI"passedIout.I"ITheIeventIwasIprecededIbyI
aIfeelingIofIlightheadedness IandIaIflutteringIinItheIchest.IWhatIdifferential IdiagnosisIisImostIc
onsistentIwithIthisIpresentation? IA.IVasovagalIsyncope I B.IOrthostatic Ihypotension C.IArrythmia D.ISeizure Answer: IIC.IArrythmia Arrhythmogenic IsyncopeImayIbeIprecededIbyIpalpitations, IchestIdiscomfort, Idi-
Iaphoresis,IandIaIfeelingIofIlightheadedness .IOrthostatic Ihypotension Iuncommonly IresultsIinIs
yncopeIandIisIprecededIbyIaIsuddenIchangeIinIpositionIfromIsitting orIlyingItoIstanding.ISyncopeIthatIisIprecededIbyIanIauraIandIthatIincludesIfecalIorIurinaryIin
continence IisIhighlyIsuspiciousIforIaIseizure.IVasovagalIsyncopeIisIassociatedIwithInoxiousIsti
muliIincludingIfear,Ianxiety,IorIpain.I Q:IWhichIchoiceIofItherapeutics IisImostIlikelyItoIbeIefficacious IinItreatmentIofIsymptomsIas
sociatedIwithIallItypesIofIcardiomyopathy? A.IDiuretics,IbetaIblockers,IandIcalciumIchannelIblockers B.IAspirin,Istatins,IandIbetaIblockers C.INitrates,Idiuretics,IandInorepinephrine D.IAspirin,Istatins,IandIimplantable Idefibrillator Answer: IIA.IDiuretics,IbetaIblock-Iers,IandIcalciumIchannelIblockers PatientsIpresentingIwithIcardiomyopathy IoftenIpresentIwithIheartIfailureI(HF)IsymptomsIandIv
olumeIoverloadIregardlessIofItheItypeIofIcardiomyopathy .ITheseIsymptomsIareIbestItreatedIwi
thIHFIrecommended Imedications, IincludingIdiureticsItoIdecreaseIvolumeIoverloadIandIbetaIbl
ockersIandIcalciumIchannelIblockersItoIdecreaseIheartIrateIandIincreaseItimeIforIventricular Ifil
ling.IAspirinIandIstatins areInotIrecommended ItoItreatIcardiomyopathy .IWhileInitratesIandIdiureticsImayIbeIusefulIinIt
heItreatmentIofIvolumeIoverloadIinIpatientsIwithIcardiomyopathy, Inorepinephrine IisIanIafterlo
ad-
increasingIagentIandIwouldIlikelyIworsenIsymptomsIofIHFIinItheseIpatients.IAnIimplantable Id
efibrillator ImayIbeIindicatedIforIsomeIpatientsIwithIcardiomyopathy IwhoIareIatIriskIofIsudden
IcardiacIdeath,IbutIitIisInotIappropriate IforIallIpatients.IAdditionally, IaspirinIandIstatinsIareInot
Iindicated.I Q:ITheIAGACNPIadmitsIaIpatientIwhoIpresentsIwithIfever,Ichills,IandIdyspnea.ITheIpatientI
notesIthatItheyIrecentlyIrecoveredIfromICOVID-
19IviralIinfection.ITheIAGACNPIsuspectsImyocarditis IandIknowsItheIdefinitiveIdiagnosisIisI
madeIby: A.ITransthoracic Iechocardiogram IB.IMyocardial IbiopsyIC.ITransesophageal Iechocardiogram D.ICardiacImagneticIresonanceIimagingI(MRI) Answer: IIB.IMyocardial IbiopsyIMyocardial IbiopsyIconfirmsItheIdiagnosisIofImyocarditis .ITheIclassicI
histological IfindingsIincludeIlymphocytic IinfiltratesIwithImyocyteInecrosis,IasIdescribedIbyIth
eIDallasIcriteria.IWhileImyocardial IbiopsyIisIrarelyIdone,IitIisItheIgoldIstandardIfor I diagnosis.IEchocardiogram IandIcardiacIMRIIcanIcontributeIinformation ItoIsuggestImyocarditis
IbutIcannotIconfirmItheIdiagnosis.I Q:ITheIAGACNPIadmitsIaIpatientIwhoIpresentsIwithIacuteIchestIpainIthatIisIrelievedIbyIlea
ningIforward.IOnIphysicalIexam,ItheIpatientIisItachycardic IandIhasIaIpericardial IfrictionIrubIa
ndInormalIlungIsounds.ITheIAGACNPIsuspectsIthatItheIprimaryIdiagnosisIis: A.IMyocarditis IB.IEndocarditis IC.IPericarditis D.IHypertrophic Icardiomyopathy Answer: IIC.IPericarditis ClassicIfindingsIsuggestiveIofIpericarditis IincludeIchestIpainIrelievedIbyIleaningIforwardIandI
presenceIofIaIpericardial IfrictionIrub.IMyocarditis IandIendocarditis IdoInotIhaveIclassicIpresent
ationsIofIreliefIofIsymptomsIwhenIleaningIforwardIandIaIpericardial IfrictionIrub.IAIdiagnosisI
ofIhypertrophic Icardiomyopathy IcannotIbeImadeIbasedIonItheIpatient'sIpresentation .I Q:ITheIAGACNPIisIcalledItoItheIroomIofIaIpatientIwithIcardiacIarrest.ITheIreportedIinitialIr
hythmIisIpulselessIelectricalIactivityI(PEA).IAtItheIfirstIpulseIcheck,ItheImonitorIrevealsIventr
icularIfibrillation .ITheIAGACNP's InextIorderIisIto: A.IPreparation IforIsynchronized Icardioversion IB.IAdministration IofIintravenous I(IV)Iamiodaro
neIC.IAdministration IofIIVImagnesium D.IShockI(200IJIbiphasicIdevice) Answer: IID.IShockI(200IJIbiphasicIdevice) TheIfirstIactionIwhenImanagingIaIpatientIwithIcardiacIarrestIandIshockableIrhythmI(ventricula
rIfibrillation, IportalIveinIthrombosis) IisItoIshock.ISynchronized Icardiover-
IsionIisInotIindicatedIforIventricular Ifibrillation IorIportalIveinIthrombosis .IIVIamio-
IdaroneIcanIbeIconsidered, IbutIshockIshouldIbeItheIfirstIaction.I Q:ITheIAGACNPIisIcaringIforIaIpatientIadmittedIwithIcellulitis.ITheIpatientIhasIaIpastImedi
calIhistoryIofIsymptomatic Ibradycardia IandIhasIaIpacemaker IinIplace.ITheIpacemaker IisIsetIu
pIasIVVI.ITheIAGACNPIknowsIthisImeansItheIpacemaker Iwill: A.IPaceItheIatria,IsenseItheIatria,IinhibitIB.IPaceItheIatria,IpaceItheIatria,IinhibitIC.ISenseItheI
ventricle,IpaceItheIatria,Iinhibit D.IPaceItheIventricle,IsenseItheIventricle,Iinhibit Answer: IID.IPaceItheIventricle,IsenseItheIventricle,Iinhibit StandardInomenclature IforIpacemakers IincludesIfirstIletterI=IchamberIpaced,Isec-
IondIletterI=IchamberIsensed,IandIthirdIletterI=IresponseItoIsensing.I I Q:ITheIAGACNPIisIcaringIforIaIpatientIadmittedItoItheIICUIpostIcoronaryIarteryIbypassIgra
ftI(CABG).ITheIpatientIhasIanIintra-
aorticIballoonIpumpI(IABP).ITheIAGACNPIexplainsItoItheIpatient'sIfamilyIthatItheIIABPIwill
:IA.IIncreaseIrateIandIcontractility IofItheIheart
