Acute Care Nurse Practitioner Acute Care Nurse Practitioner 5

Question 1

A critically ill patient is receiving propofol infusion for sedation at 70 mcg/kg/min for 48 hours. The nurse reports increasing lactic acidosis, new ECG changes, and lipemic plasma. The ACNP should suspect:

Accepted Answer

Propofol infusion syndrome

Answer

Propofol infusion syndrome (PRIS) presents with metabolic acidosis, rhabdomyolysis, cardiac dysfunction, and lipemia, especially with doses >4 mg/kg/hr for >48 hours.

Question 2

A patient with severe traumatic brain injury has a Glasgow Coma Scale of 7 and ICP of 28 mmHg. After elevating the head of bed to 30° and ensuring normocapnia, the next intervention is:

Accepted Answer

Administer 23.4% hypertonic saline or mannitol

Answer

Hyperosmolar therapy with hypertonic saline or mannitol is the next step to reduce ICP after basic positioning and ventilation optimization.

Question 3

Which glucose target is recommended by current evidence for critically ill adult patients in the ICU?

Accepted Answer

140-180 mg/dL

Answer

The NICE-SUGAR trial showed that tight glycemic control (80-110) increased mortality; current guidelines target 140-180 mg/dL in most ICU patients.

Question 4

A patient with end-stage renal disease on hemodialysis develops acute chest pain and shortness of breath. ECG shows diffuse ST elevation in all leads with PR depression. The ACNP's initial management should include:

Accepted Answer

NSAIDs and colchicine for pericarditis, with urgent dialysis to remove fluid

Answer

Diffuse ST elevation with PR depression in a dialysis patient indicates uremic pericarditis; NSAIDs, colchicine, and urgent dialysis are first-line treatment.

Question 5

A 45-year-old woman is admitted with thyroid storm (Burch-Wartofsky score 65). Which medication must be given BEFORE radioactive iodine or inorganic iodide?

Accepted Answer

Propylthiouracil (PTU) or methimazole

Answer

Thionamides (PTU or methimazole) must be given before iodine to block new thyroid hormone synthesis and prevent iodine from being used as substrate.

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Acute Care Nurse Practitioner 5