Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 2 — Questions and Answers
Question 1: A patient in the ICU develops sudden onset hypotension, tachycardia, and distended neck veins after central line insertion. What is the most likely diagnosis?
- Pulmonary embolism
- Tension pneumothorax (Correct answer)
- Cardiac tamponade
- Hypovolemic shock
Correct answer: Tension pneumothorax
Tension pneumothorax after central line insertion presents with hypotension, tachycardia, distended neck veins, and tracheal deviation away from the affected side.
Question 2: Which ventilator setting should be prioritized when managing a patient with ARDS to reduce ventilator-induced lung injury?
- High PEEP with high tidal volumes
- Low tidal volume (6 mL/kg IBW) with permissive hypercapnia (Correct answer)
- High FiO2 with low PEEP
- Pressure control with high respiratory rate
Correct answer: Low tidal volume (6 mL/kg IBW) with permissive hypercapnia
Lung-protective ventilation using low tidal volumes of 6 mL/kg ideal body weight reduces ventilator-induced lung injury in ARDS.
Question 3: A patient presents with confusion, hyponatremia (Na 118 mEq/L), and is found to have SIADH. What is the safest initial treatment?
- Rapid IV bolus of 3% hypertonic saline
- Fluid restriction to 500-1000 mL/day (Correct answer)
- IV normal saline at 200 mL/hr
- Immediate hemodialysis
Correct answer: Fluid restriction to 500-1000 mL/day
Fluid restriction is the first-line treatment for SIADH; sodium correction should not exceed 8-10 mEq/L per 24 hours to prevent osmotic demyelination.
Question 4: A 72-year-old post-operative patient develops fever, leukocytosis, and watery diarrhea 5 days after broad-spectrum antibiotics. What is the next best step?
- Start empiric vancomycin IV
- Send stool for Clostridioides difficile toxin PCR (Correct answer)
- Order abdominal CT scan immediately
- Administer loperamide for symptom relief
Correct answer: Send stool for Clostridioides difficile toxin PCR
C. difficile infection is the most likely diagnosis following antibiotic use, and stool PCR for C. difficile toxin is the appropriate diagnostic test.
Question 5: Which finding best differentiates cardiogenic shock from distributive (septic) shock?
- Systolic BP below 90 mmHg
- Elevated pulmonary capillary wedge pressure (PCWP) with low cardiac output (Correct answer)
- Metabolic acidosis with elevated lactate
- Tachycardia and cool extremities
Correct answer: Elevated pulmonary capillary wedge pressure (PCWP) with low cardiac output
Cardiogenic shock is characterized by elevated PCWP (≥18 mmHg) and low cardiac output, distinguishing it from septic shock which typically shows low SVR and high CO.
Question 6: A patient receiving heparin infusion develops a platelet count drop from 280,000 to 85,000 over 7 days. What is the priority action?
- Increase heparin dose to maintain therapeutic PTT
- Discontinue heparin and start a direct thrombin inhibitor (Correct answer)
- Transfuse platelets immediately
- Switch to low-molecular-weight heparin
Correct answer: Discontinue heparin and start a direct thrombin inhibitor
Heparin-induced thrombocytopenia (HIT) requires immediate discontinuation of all heparin products and initiation of a non-heparin anticoagulant such as argatroban.
Question 7: A patient with chronic liver disease presents with asterixis, confusion, and elevated ammonia. Which dietary intervention is most appropriate?
- High-protein diet to prevent muscle wasting
- Protein restriction to less than 0.5 g/kg/day
- Adequate protein intake (1.2-1.5 g/kg/day) with branched-chain amino acids (Correct answer)
- Total parenteral nutrition with no protein
Correct answer: Adequate protein intake (1.2-1.5 g/kg/day) with branched-chain amino acids
Current guidelines recommend adequate protein intake of 1.2-1.5 g/kg/day in hepatic encephalopathy, as severe protein restriction worsens sarcopenia without improving outcomes.
Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 2
A patient in the ICU develops sudden onset hypotension, tachycardia, and distended neck veins after central line insertion.
What is the most likely diagnosis?