AANP Emergency and Urgent Care 5

Question 1

A patient presents 5 hours after an acute acetaminophen overdose. What guides the decision to give N-acetylcysteine?

Accepted Answer

Serum acetaminophen level plotted on the Rumack-Matthew nomogram

Answer

A timed serum level (4 hours or later after ingestion) on the Rumack-Matthew nomogram determines the need for N-acetylcysteine.

Question 2

A healthy adult has an anterior nosebleed. What is the initial management?

Accepted Answer

Pinch the soft part of the nose for 10–15 minutes while leaning forward

Answer

Sustained direct pressure on the cartilaginous nose while leaning forward prevents swallowing blood and controls most anterior bleeds.

Question 3

A patient with diabetic ketoacidosis has glucose 520 mg/dL, pH 7.1, and potassium 3.0 mEq/L. What is the appropriate next step?

Accepted Answer

Give IV fluids and replace potassium before starting insulin

Answer

Insulin drives potassium intracellularly, so insulin is held until potassium is at least 3.3 mEq/L while fluids and potassium are given.

Question 4

A patient meets criteria for septic shock with hypotension and a lactate of 5 mmol/L. Which initial fluid recommendation applies?

Accepted Answer

30 mL/kg of IV crystalloid started promptly

Answer

Surviving Sepsis guidance recommends at least 30 mL/kg IV crystalloid within the first 3 hours for sepsis-induced hypoperfusion.

Question 5

A farmhand has a dirty puncture wound and an unknown tetanus vaccination history. What is the correct prophylaxis?

Accepted Answer

Tdap plus tetanus immune globulin

Answer

With a contaminated wound and unknown or fewer than three prior doses, both a tetanus-toxoid vaccine and TIG are given.

AANP - American Association of Nurse Practitioners Practice Test