Acute Care Nurse Practitioner Acute Care Nurse Practitioner 2 — Questions and Answers
Question 1: A patient on mechanical ventilation develops sudden hypoxia, decreased breath sounds on the left, and tracheal deviation to the right. The ACNP's immediate action should be:
- Obtain a STAT chest X-ray
- Perform needle decompression at the second intercostal space, midclavicular line (Correct answer)
- Increase FiO2 to 100%
- Administer IV epinephrine
Correct answer: Perform needle decompression at the second intercostal space, midclavicular line
Tension pneumothorax requires immediate needle decompression; delaying for imaging is life-threatening.
Question 2: Which hemodynamic pattern is most consistent with cardiogenic shock?
- Low CVP, low PCWP, high CO, low SVR
- High CVP, high PCWP, low CO, high SVR (Correct answer)
- Low CVP, low PCWP, low CO, high SVR
- High CVP, low PCWP, high CO, low SVR
Correct answer: High CVP, high PCWP, low CO, high SVR
Cardiogenic shock presents with elevated filling pressures, reduced cardiac output, and compensatory increased systemic vascular resistance.
Question 3: A patient with chronic kidney disease stage 4 has a potassium of 6.8 mEq/L with peaked T-waves on ECG. The first intervention should be:
- Sodium polystyrene sulfonate (Kayexalate)
- IV calcium gluconate (Correct answer)
- IV insulin with dextrose
- Emergent hemodialysis
Correct answer: IV calcium gluconate
IV calcium gluconate stabilizes the cardiac membrane immediately, which is the priority when ECG changes are present.
Question 4: When interpreting a bronchoalveolar lavage (BAL) result showing >15% hemosiderin-laden macrophages, the ACNP should suspect:
- Ventilator-associated pneumonia
- Diffuse alveolar hemorrhage (Correct answer)
- Aspiration pneumonitis
- Pulmonary embolism
Correct answer: Diffuse alveolar hemorrhage
Hemosiderin-laden macrophages in BAL indicate prior alveolar bleeding, consistent with diffuse alveolar hemorrhage.
Question 5: A post-operative patient develops fever (38.8°C), tachycardia, and confusion on day 2. Blood cultures are pending. The ACNP should initiate empiric antibiotics targeting:
- Anaerobic organisms only
- Gram-positive cocci only
- Broad-spectrum coverage including gram-negative organisms (Correct answer)
- Fungal organisms only
Correct answer: Broad-spectrum coverage including gram-negative organisms
Early post-operative sepsis requires broad-spectrum coverage until culture sensitivities narrow treatment.
Question 6: The ACNP is managing a patient with acute respiratory distress syndrome (ARDS). The lung-protective ventilation strategy includes:
- Tidal volume 10-12 mL/kg ideal body weight, PEEP 5 cmH2O
- Tidal volume 6 mL/kg ideal body weight, plateau pressure <30 cmH2O (Correct answer)
- High-frequency oscillatory ventilation for all patients
- FiO2 100% with minimal PEEP
Correct answer: Tidal volume 6 mL/kg ideal body weight, plateau pressure <30 cmH2O
ARDSNet protocol specifies low tidal volume (6 mL/kg IBW) with plateau pressure kept below 30 cmH2O to prevent ventilator-induced lung injury.
Question 7: A 58-year-old patient presents with sudden-onset severe headache described as 'the worst headache of my life.' The ACNP's priority diagnostic step is:
- Lumbar puncture immediately
- Non-contrast CT of the head (Correct answer)
- MRI brain with contrast
- CBC and coagulation studies
Correct answer: Non-contrast CT of the head
Non-contrast CT of the head is the first-line imaging to rule out subarachnoid hemorrhage in thunderclap headache.
Acute Care Nurse Practitioner Acute Care Nurse Practitioner 2
A patient on mechanical ventilation develops sudden hypoxia, decreased breath sounds on the left, and tracheal deviation to the right.
The ACNP's immediate action should be: