Acute Care Nurse Practitioner Trivia 5 — Questions and Answers
Question 1: A post-operative patient is oliguric with urine Na of 8 mEq/L and FENa <1%. What is the MOST likely cause?
- Acute tubular necrosis
- Pre-renal azotemia (Correct answer)
- Obstructive uropathy
- Contrast nephropathy
Correct answer: Pre-renal azotemia
FENa <1% with low urine sodium indicates avid tubular sodium reabsorption, consistent with pre-renal azotemia from decreased effective circulating volume.
Question 2: Which finding is MOST consistent with ARDS on a chest X-ray?
- Unilateral pleural effusion
- Bilateral fluffy infiltrates in a non-cardiogenic pattern (Correct answer)
- Lobar consolidation with air bronchograms
- Perihilar bat-wing pattern
Correct answer: Bilateral fluffy infiltrates in a non-cardiogenic pattern
ARDS produces bilateral, diffuse alveolar infiltrates without cardiomegaly or vascular redistribution, reflecting non-cardiogenic pulmonary edema.
Question 3: What is the purpose of the CAM-ICU tool in the acute care setting?
- Assess pain in non-verbal patients
- Screen for delirium in ICU patients (Correct answer)
- Grade level of consciousness after sedation
- Predict ICU mortality
Correct answer: Screen for delirium in ICU patients
The Confusion Assessment Method for the ICU (CAM-ICU) is a validated tool for detecting delirium in mechanically ventilated and non-verbal ICU patients.
Question 4: A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m² and PCWP of 24 mmHg. Which hemodynamic profile does this represent?
- Hypovolemic shock
- Distributive shock
- Cold and wet cardiogenic shock (Correct answer)
- Obstructive shock
Correct answer: Cold and wet cardiogenic shock
Low cardiac index (<2.2) with elevated PCWP (>18) indicates cold and wet cardiogenic shock — poor forward flow with volume overload.
Question 5: Which electrolyte abnormality is a common COMPLICATION of massive blood transfusion?
- Hypernatremia
- Hypocalcemia
- Hyperkalemia from stored RBCs combined with metabolic alkalosis from citrate (Correct answer)
- Hypomagnesemia
Correct answer: Hyperkalemia from stored RBCs combined with metabolic alkalosis from citrate
Massive transfusion causes hypocalcemia (citrate chelates calcium) and initially hyperkalemia from stored RBCs, though citrate metabolism later produces alkalosis.
Question 6: A patient with status epilepticus fails lorazepam and fosphenytoin. What is the NEXT step in management?
- Repeat lorazepam dose
- Administer levetiracetam IV
- Initiate propofol or midazolam infusion for refractory status (Correct answer)
- Perform emergent EEG
Correct answer: Initiate propofol or midazolam infusion for refractory status
Refractory status epilepticus (failing two adequate medications) requires continuous IV anesthetic infusion (propofol, midazolam, or pentobarbital) with EEG monitoring.
Question 7: Which acid-base disorder is MOST commonly associated with prolonged nasogastric suctioning?
- Metabolic acidosis with normal anion gap
- Respiratory alkalosis
- Metabolic alkalosis (Correct answer)
- Respiratory acidosis
Correct answer: Metabolic alkalosis
Nasogastric suctioning removes hydrochloric acid (H+ and Cl-), leading to metabolic alkalosis and hypochloremia.
Acute Care Nurse Practitioner Trivia 5
A post-operative patient is oliguric with urine Na of 8 mEq/L and FENa <1%.
What is the MOST likely cause?