Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 4 — Questions and Answers
Question 1: A patient with diabetic ketoacidosis has a serum potassium of 3.2 mEq/L on presentation. What is the appropriate initial management?
- Start insulin immediately and give potassium simultaneously
- Hold insulin and replace potassium until K+ is above 3.5 mEq/L (Correct answer)
- Begin bicarbonate infusion before insulin
- Give insulin and monitor potassium every 4 hours
Correct answer: Hold insulin and replace potassium until K+ is above 3.5 mEq/L
Insulin should be withheld until serum potassium is ≥3.5 mEq/L, as insulin drives potassium intracellularly and can cause life-threatening hypokalemia.
Question 2: Which criterion is NOT part of the SOFA score used to define organ dysfunction in sepsis?
- PaO2/FiO2 ratio
- Glasgow Coma Scale
- Serum creatinine
- Serum albumin (Correct answer)
Correct answer: Serum albumin
The SOFA score assesses six organ systems using PaO2/FiO2, GCS, creatinine, bilirubin, MAP/vasopressors, and platelets — albumin is not included.
Question 3: A patient with acute respiratory failure is being transitioned from assist-control ventilation to a spontaneous breathing trial. Which parameter is most predictive of successful extubation?
- FiO2 requirement below 0.5
- Rapid Shallow Breathing Index (RSBI) less than 105 (Correct answer)
- Negative inspiratory force greater than -20 cmH2O
- PEEP of 10 cmH2O or less
Correct answer: Rapid Shallow Breathing Index (RSBI) less than 105
An RSBI (respiratory rate/tidal volume in liters) of less than 105 breaths/min/L is the most validated predictor of successful extubation.
Question 4: A 65-year-old patient develops oliguria, elevated creatinine, and muddy brown casts on urinalysis 48 hours after a CT with contrast. What best describes this condition?
- Pre-renal azotemia from dehydration
- Contrast-induced nephropathy (acute tubular necrosis) (Correct answer)
- Acute interstitial nephritis
- Post-renal obstruction
Correct answer: Contrast-induced nephropathy (acute tubular necrosis)
Contrast-induced nephropathy presents as acute tubular necrosis 24-72 hours after contrast exposure, evidenced by muddy brown granular casts and rising creatinine.
Question 5: An ICU patient on continuous renal replacement therapy (CRRT) develops bleeding from IV sites and has prolonged PT/PTT. What is the most likely cause related to CRRT?
- Heparin overdose from anticoagulation circuit
- Dilutional coagulopathy from large volume replacement fluid
- Citrate accumulation causing hypocalcemia and coagulopathy (Correct answer)
- Filter clotting causing thrombocytopenia
Correct answer: Citrate accumulation causing hypocalcemia and coagulopathy
In citrate-anticoagulated CRRT, citrate accumulation (citrate lock syndrome) causes systemic hypocalcemia that impairs coagulation and can lead to bleeding.
Question 6: Which finding on a 12-lead ECG is most specific for right ventricular strain in the setting of acute pulmonary embolism?
- ST elevation in V1-V4
- S1Q3T3 pattern
- New right bundle branch block
- T-wave inversions in V1-V4 (Correct answer)
Correct answer: T-wave inversions in V1-V4
T-wave inversions in the right precordial leads (V1-V4) are the most common and specific ECG finding of RV strain due to massive pulmonary embolism.
Question 7: A patient with severe pancreatitis has a Ranson's criteria score of 5 on admission. What does this predict?
- Mild pancreatitis requiring outpatient management
- High mortality risk requiring ICU-level care (Correct answer)
- Need for immediate surgical intervention
- Likelihood of gallstone etiology
Correct answer: High mortality risk requiring ICU-level care
A Ranson's score ≥3 indicates severe pancreatitis; a score of 5 is associated with approximately 40% mortality risk and necessitates ICU-level monitoring.
Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 4
A patient with diabetic ketoacidosis has a serum potassium of 3.2 mEq/L on presentation.
What is the appropriate initial management?