Acute Care Nurse Practitioner Trivia 4 — Questions and Answers
Question 1: Which scoring system is used to assess the severity of organ dysfunction in critically ill patients?
- APACHE II
- SOFA score (Correct answer)
- Glasgow Coma Scale
- CURB-65
Correct answer: SOFA score
The Sequential Organ Failure Assessment (SOFA) score evaluates 6 organ systems and is used to define and monitor sepsis-related organ dysfunction.
Question 2: A patient's ABG shows: pH 7.28, PaCO2 58, HCO3 26. What is the PRIMARY acid-base disturbance?
- Metabolic acidosis
- Respiratory alkalosis
- Respiratory acidosis (Correct answer)
- Mixed metabolic and respiratory acidosis
Correct answer: Respiratory acidosis
Elevated PaCO2 (>45) with low pH indicates respiratory acidosis; the near-normal HCO3 suggests this is acute with limited compensation.
Question 3: Which intervention has the STRONGEST evidence for reducing ventilator-associated pneumonia (VAP)?
- Prophylactic antibiotics
- Elevating the head of bed to 30-45 degrees (Correct answer)
- Daily chest physiotherapy
- Routine bronchoscopy
Correct answer: Elevating the head of bed to 30-45 degrees
Elevating the head of bed to 30-45 degrees is a core VAP bundle element with strong evidence for reducing microaspiration and VAP incidence.
Question 4: A patient develops fever, encephalopathy, and thrombocytopenia after a red blood cell transfusion. Which condition is MOST likely?
- Transfusion-associated circulatory overload (TACO)
- Febrile non-hemolytic transfusion reaction
- Thrombotic thrombocytopenic purpura (TTP) (Correct answer)
- Acute hemolytic transfusion reaction
Correct answer: Thrombotic thrombocytopenic purpura (TTP)
The pentad of TTP includes fever, thrombocytopenia, microangiopathic hemolytic anemia, neurological changes, and renal impairment; it may be triggered by transfusion.
Question 5: Which is the MOST appropriate initial sedation goal for a mechanically ventilated ICU patient per current PADIS guidelines?
- Deep sedation (RASS -3 to -4)
- Light sedation or alert/calm (RASS 0 to -2) (Correct answer)
- Full analgosedation with neuromuscular blockade
- Benzodiazepine-based sedation protocol
Correct answer: Light sedation or alert/calm (RASS 0 to -2)
The 2018 PADIS guidelines recommend targeting light sedation (RASS 0 to -2) to reduce ICU length of stay, ventilator days, and delirium.
Question 6: A patient with known HIT (heparin-induced thrombocytopenia) requires anticoagulation. Which agent should be used?
- Low molecular weight heparin
- Unfractionated heparin
- Argatroban (Correct answer)
- Warfarin alone
Correct answer: Argatroban
Argatroban, a direct thrombin inhibitor, is a first-line anticoagulant for HIT as it does not cross-react with heparin antibodies.
Question 7: Which pulmonary artery catheter reading BEST reflects left ventricular preload?
- Central venous pressure (CVP)
- Pulmonary artery occlusion pressure (PAOP/PCWP) (Correct answer)
- Pulmonary artery systolic pressure
- Mixed venous oxygen saturation (SvO2)
Correct answer: Pulmonary artery occlusion pressure (PAOP/PCWP)
Pulmonary artery occlusion pressure (wedge pressure) reflects left atrial pressure and serves as a surrogate for left ventricular end-diastolic pressure (preload).
Acute Care Nurse Practitioner Trivia 4
Which scoring system is used to assess the severity of organ dysfunction in critically ill patients?