Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 3

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?

Accepted Answer

Ventricular septal rupture

Answer

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?

Accepted Answer

Serum lactate clearance

Answer

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?

Accepted Answer

Decrease respiratory rate and increase expiratory time

Answer

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?

Accepted Answer

Cardiogenic shock

Answer

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?

Accepted Answer

Early enteral nutrition

Answer

Early enteral nutrition is the most effective intervention for stress ulcer prophylaxis as it maintains mucosal integrity and reduces gastric pH through physiological mechanisms.

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Practice Test

Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 3