Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 3 — Questions and Answers
Question 1: A patient presents with acute MI and develops new holosystolic murmur with hemodynamic compromise 3 days post-infarction. What complication is most likely?
- Acute mitral stenosis
- Ventricular septal rupture (Correct answer)
- Aortic regurgitation
- Pericardial effusion
Correct answer: Ventricular septal rupture
Ventricular septal rupture typically occurs 3-5 days after MI (especially inferior MI), presenting with a new harsh holosystolic murmur and rapid hemodynamic deterioration.
Question 2: Which parameter most accurately reflects tissue oxygen delivery and is used to guide resuscitation in septic shock?
- Central venous pressure (CVP)
- Serum lactate clearance (Correct answer)
- Urine output alone
- Heart rate normalization
Correct answer: Serum lactate clearance
Serum lactate clearance of ≥10% over 2 hours is a validated endpoint for resuscitation in septic shock, reflecting improved tissue oxygenation.
Question 3: A patient with known COPD is intubated and placed on mechanical ventilation. ABG shows pH 7.22, PaCO2 88, PaO2 78. What adjustment addresses auto-PEEP?
- Increase respiratory rate to 20 breaths/min
- Increase tidal volume to 10 mL/kg
- Decrease respiratory rate and increase expiratory time (Correct answer)
- Increase PEEP to 10 cmH2O
Correct answer: Decrease respiratory rate and increase expiratory time
In COPD patients, auto-PEEP results from air trapping; decreasing the respiratory rate and prolonging expiratory time allows complete exhalation and reduces dynamic hyperinflation.
Question 4: A post-cardiac surgery patient has a MAP of 55 mmHg, CVP of 18 mmHg, and mixed venous O2 saturation of 45%. Which diagnosis is most consistent?
- Distributive shock
- Hypovolemic shock
- Cardiogenic shock (Correct answer)
- Obstructive shock
Correct answer: Cardiogenic shock
Cardiogenic shock presents with low MAP, elevated CVP (high filling pressure), and low mixed venous O2 saturation due to increased oxygen extraction from poor cardiac output.
Question 5: Which intervention is most effective in preventing stress ulcers in mechanically ventilated ICU patients?
- Sucralfate oral suspension
- Proton pump inhibitors (PPIs)
- H2 receptor antagonists
- Early enteral nutrition (Correct answer)
Correct answer: Early enteral nutrition
Early enteral nutrition is the most effective intervention for stress ulcer prophylaxis as it maintains mucosal integrity and reduces gastric pH through physiological mechanisms.
Question 6: A patient on vasopressors develops cold, mottled extremities with a rising creatinine. Which medication should be considered to improve renal perfusion?
- Phenylephrine at high doses
- Low-dose vasopressin as an adjunct (Correct answer)
- High-dose epinephrine
- Dobutamine as the primary vasopressor
Correct answer: Low-dose vasopressin as an adjunct
Low-dose vasopressin (0.03-0.04 units/min) as an adjunct to norepinephrine may reduce catecholamine requirements and has favorable renal effects in vasodilatory shock.
Question 7: A patient develops sudden dyspnea, pleuritic chest pain, and right heart strain on ECG after prolonged immobilization. D-dimer is elevated. What is the next diagnostic step?
- Start therapeutic heparin immediately without imaging
- CT pulmonary angiography (CTPA) (Correct answer)
- Ventilation-perfusion (V/Q) scan first
- Echocardiogram only
Correct answer: CT pulmonary angiography (CTPA)
CT pulmonary angiography is the gold standard diagnostic test for pulmonary embolism when clinical suspicion is high and renal function allows contrast use.
Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 3
A patient presents with acute MI and develops new holosystolic murmur with hemodynamic compromise 3 days post-infarction.
What complication is most likely?