Acute Care Nurse Practitioner Trivia 2 — Questions and Answers
Question 1: Which lab value is the MOST sensitive early marker of acute kidney injury (AKI)?
- Serum creatinine
- Blood urea nitrogen (BUN)
- Serum cystatin C (Correct answer)
- Urine specific gravity
Correct answer: Serum cystatin C
Cystatin C rises earlier than creatinine in AKI because it is freely filtered and not affected by muscle mass.
Question 2: A patient on mechanical ventilation has a plateau pressure of 34 cmH2O. What is the BEST next step?
- Increase PEEP
- Decrease tidal volume to 6 mL/kg IBW (Correct answer)
- Administer bronchodilator
- Increase FiO2
Correct answer: Decrease tidal volume to 6 mL/kg IBW
Plateau pressures >30 cmH2O indicate over-distension; reducing tidal volume to 6 mL/kg IBW per ARDSNet protocol is the priority.
Question 3: Which rhythm is a contraindication to synchronized cardioversion?
- Atrial flutter
- Ventricular tachycardia with pulse
- Atrial fibrillation
- Ventricular fibrillation (Correct answer)
Correct answer: Ventricular fibrillation
Ventricular fibrillation has no organized QRS complex to synchronize to, requiring unsynchronized defibrillation instead.
Question 4: What is the primary mechanism of injury in transfusion-related acute lung injury (TRALI)?
- Volume overload
- Donor antibodies activating recipient neutrophils (Correct answer)
- Hemolytic reaction
- Cytokine storm from stored blood
Correct answer: Donor antibodies activating recipient neutrophils
TRALI is most commonly caused by donor HLA or HNA antibodies that activate recipient neutrophils, leading to pulmonary capillary leak.
Question 5: A patient with septic shock receives adequate fluid resuscitation but MAP remains <65 mmHg. Which vasopressor is the FIRST-LINE agent?
- Epinephrine
- Vasopressin
- Norepinephrine (Correct answer)
- Dopamine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor recommended by Surviving Sepsis Campaign guidelines for septic shock.
Question 6: Which finding on a 12-lead ECG is MOST consistent with right ventricular strain from a massive pulmonary embolism?
- ST elevation in V1-V4
- S1Q3T3 pattern (Correct answer)
- Left bundle branch block
- Diffuse ST depression with PR elevation
Correct answer: S1Q3T3 pattern
The S1Q3T3 pattern (S wave in lead I, Q wave and T wave inversion in lead III) is the classic ECG finding in acute massive PE.
Question 7: In DKA management, insulin infusion should NOT be started until which lab value is corrected?
- Sodium <135 mEq/L
- Potassium ≥3.5 mEq/L (Correct answer)
- Bicarbonate <15 mEq/L
- Glucose >350 mg/dL
Correct answer: Potassium ≥3.5 mEq/L
Insulin drives potassium intracellularly; starting insulin with hypokalemia risks life-threatening arrhythmias from further potassium drop.
Acute Care Nurse Practitioner Trivia 2
Which lab value is the MOST sensitive early marker of acute kidney injury (AKI)?