Acute Care Nurse Practitioner Acute Care Nurse Practitioner 4

Question 1

A patient admitted for septic shock is on norepinephrine 0.3 mcg/kg/min and vasopressin 0.03 units/min. Despite adequate fluid resuscitation (CVP 12, ScvO2 68%), MAP remains 58 mmHg. The next pharmacological intervention should be:

Accepted Answer

Add low-dose corticosteroids (hydrocortisone 200 mg/day)

Answer

Refractory septic shock despite two vasopressors warrants evaluation for relative adrenal insufficiency and empiric corticosteroid therapy per Surviving Sepsis guidelines.

Question 2

A patient with a known history of heparin-induced thrombocytopenia (HIT) requires anticoagulation for a new DVT. The preferred agent is:

Accepted Answer

Argatroban

Answer

Argatroban is a direct thrombin inhibitor that does not cross-react with HIT antibodies and is the preferred anticoagulant for patients with confirmed HIT.

Question 3

A patient with acute liver failure has an INR of 4.2. The ACNP orders fresh frozen plasma (FFP) before a central line placement. What is the primary concern with this approach?

Accepted Answer

FFP does not reliably correct the bleeding risk in acute liver failure and exposes the patient to volume overload

Answer

INR in liver failure reflects both pro- and anti-coagulant factor deficits and does not accurately predict bleeding risk; FFP provides marginal, transient correction with volume and transfusion risks.

Question 4

Which intervention has been shown to reduce 90-day mortality in patients with moderate-to-severe ARDS?

Accepted Answer

Prone positioning for ≥16 hours per day

Answer

The PROSEVA trial demonstrated a 28% absolute reduction in 90-day mortality with prone positioning for ≥16 hours/day in moderate-to-severe ARDS.

Question 5

A patient on warfarin for atrial fibrillation has an INR of 9.2 and active intracranial hemorrhage on CT. The ACNP should immediately administer:

Accepted Answer

4-factor prothrombin complex concentrate (4F-PCC) plus vitamin K

Answer

4F-PCC provides rapid, complete INR reversal for life-threatening warfarin-associated bleeding; vitamin K is added for sustained reversal.

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Acute Care Nurse Practitioner 4