Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 5 — Questions and Answers
Question 1: A mechanically ventilated patient suddenly develops high peak airway pressures with stable plateau pressures. What is the most likely cause?
- Pneumothorax
- Pulmonary edema
- Mucus plugging or bronchospasm (Correct answer)
- ARDS progression
Correct answer: Mucus plugging or bronchospasm
A rise in peak pressure with normal plateau pressure indicates increased airway resistance, most commonly due to mucus plugging, bronchospasm, or ETT kinking — not decreased compliance.
Question 2: A patient is admitted with acute decompensated heart failure and a BNP of 1,800 pg/mL. Which intervention has the strongest evidence for improving dyspnea in the first 24 hours?
- IV beta-blockers to reduce heart rate
- IV loop diuretics for decongestion (Correct answer)
- Immediate BiPAP initiation
- Vasopressin receptor antagonist (tolvaptan)
Correct answer: IV loop diuretics for decongestion
IV loop diuretics (furosemide) remain the cornerstone of acute decompensated heart failure treatment, rapidly reducing preload and relieving pulmonary congestion.
Question 3: A trauma patient arrives with BP 70/40, HR 130, and obvious penetrating abdominal injury. Which resuscitation strategy is most appropriate?
- Aggressive crystalloid resuscitation with 4L normal saline
- Permissive hypotension with 1:1:1 blood product ratio (PRBCs:FFP:platelets) (Correct answer)
- Immediate vasopressor initiation with norepinephrine
- Crystalloid bolus followed by colloid maintenance
Correct answer: Permissive hypotension with 1:1:1 blood product ratio (PRBCs:FFP:platelets)
Damage control resuscitation using permissive hypotension (MAP 50 mmHg) and balanced blood product ratios (1:1:1) until surgical hemorrhage control is the standard of care in hemorrhagic shock.
Question 4: Which electrolyte abnormality is most associated with prolonged QT interval and risk of torsades de pointes in ICU patients?
- Hyperkalemia
- Hypomagnesemia (Correct answer)
- Hypernatremia
- Hypercalcemia
Correct answer: Hypomagnesemia
Hypomagnesemia prolongs ventricular repolarization and QT interval, predisposing ICU patients to torsades de pointes, especially when combined with QT-prolonging medications.
Question 5: A patient with status epilepticus fails to respond after two doses of benzodiazepines. What is the next appropriate pharmacological intervention?
- Repeat benzodiazepine at double the dose
- Levetiracetam, fosphenytoin, or valproate IV (Correct answer)
- Phenobarbital as first choice after benzos
- Immediate propofol infusion
Correct answer: Levetiracetam, fosphenytoin, or valproate IV
Current guidelines recommend second-line agents — levetiracetam, fosphenytoin, or valproate — after benzodiazepine failure in status epilepticus; all three have similar efficacy per the ESETT trial.
Question 6: An ACNP is managing a patient with massive GI bleed and coagulopathy (INR 3.2). The patient requires emergency endoscopy. What is the most appropriate reversal strategy?
- Fresh frozen plasma alone at 4 units IV
- 4-factor prothrombin complex concentrate (PCC) (Correct answer)
- Vitamin K IV push only
- Recombinant factor VIIa as first-line
Correct answer: 4-factor prothrombin complex concentrate (PCC)
4-factor PCC provides rapid reversal of warfarin-associated coagulopathy within minutes and is preferred over FFP for emergent procedures due to faster onset and smaller volume.
Question 7: A patient in the neurological ICU following subarachnoid hemorrhage (SAH) develops delayed cerebral ischemia on day 7. Which intervention has the best evidence for preventing this complication?
- Triple-H therapy (hypertension, hypervolemia, hemodilution)
- Oral nimodipine for 21 days (Correct answer)
- Prophylactic IV magnesium sulfate infusion
- Early surgical clipping within 24 hours
Correct answer: Oral nimodipine for 21 days
Oral nimodipine administered for 21 days after SAH is the only pharmacological intervention proven to reduce delayed cerebral ischemia and improve neurological outcomes.
Acute Care Nurse Practitioner Acute Care Nurse Practitioner MCQ 5
A mechanically ventilated patient suddenly develops high peak airway pressures with stable plateau pressures.
What is the most likely cause?