FREE ANCC Adult-Gerontology Acute Care Nursing Questions and Answers

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Fifteen hours after a patient was involved in an accident that resulted in a comminuted fracture of the femur, the patient exhibits increasing dyspnea and tachypnea as well as confusion, difficulty speaking, and a petechial rash in the mouth and upper body. The most likely cause of this triad of symptoms is:

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Explanation:
The most likely cause of this triad of symptoms is fat embolism syndrome. Fat emboli enter the bloodstream and lodge in the lungs where platelets, red blood cells, and fibrin adhere to them, leading to respiratory distress syndrome. They can migrate to the skin (causing petechiae) and to the brain (causing central nervous system [CNS] problems).

A patient with burns is placed on an air-fluidized bed to relieve pressure. It is especially important to carefully monitor this patient for:

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Explanation:
When a patient, such as a burn patient, is placed on an air-fluidized bed, it is especially important to monitor fluid balance because he or she can easily become dehydrated. Air-fluidized beds contain a mass of fine ceramic microspheres through which warm air flows. The patient is placed on a special polyester filter sheet that allows air to pass through it. The warmth causes perspiration, which is quickly absorbed, so diaphoresis may not be evident.

If a patient reports that injuries resulted from domestic violence, when documenting the abuse in the patient's health record, the NP should:

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Explanation:
If a patient reports that injuries resulted from domestic violence, the NP should use direct quotations to document the patient's statements. The NP should make notes that are as detailed and accurate as possible, including descriptions of all injuries (size, location, extent) and any interventions because the health record may become part of a criminal proceeding.

For patients with diabetes mellitus, the first indication of diabetic nephropathy is usually:

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Explanation:
For patients with diabetes mellitus, the first indication of diabetic nephropathy, the most common cause of end-stage renal disease, is usually microalbuminuria. Microalbuminuria is usually detectable before a decrease in the glomerular filtration rate (GFR) and occurs 10-15 years after the onset of diabetes. With the onset of microalbuminuria, the patient should be maintained on strict glycemic control and treatment of hypertension to slow the progression. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin I| receptor blockers (ARBs) have been shown to slow progression by reducing pressure within the glomeruli.

Because combining monoamine oxidase inhibitors (MAOls) with some foods may cause adverse reactions (hypertension, headache, diaphoresis, cardiac abnormalities, intracerebral hemorrhage), patients taking MAOls should be advised to avoid which of the following foods/beverages?

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Explanation:
Monoamine oxidase inhibitors (MAOls) should not be taken with alcohol and nonalcoholic substitutes for beer or wine, foods high in tyramine (organ meats, cured meats, caviar, cheese products, avocados, bananas, raisins, soy, and fava beans), and products containing caffeine (tea, cola, chocolate, and coffee). MAOls are older antidepressant medications that are used less frequently now that others are available because they have significant side effects and interactions with other medications, such as decongestants, opioids, and antidepressants.

Which of the following antidysrhythmic drugs is most likely to result in bradycardia, hypotension, heart failure, PR prolongation, and/or constipation?

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Explanation:
Common adverse effects of calcium channel blockers, such as diltiazem or verapamil, include bradycardia, hypotension, heart failure, PR prolongation, and/or constipation. Bradycardia results from decreased sinoatrial (SA) nodal output and PR prolongations from delays in atrioventricular (AV) conduction. These drugs may cause marked hypotension and worsening of existing heart failure. Calcium channel blockers, used to treat tachycardia, block the influx of calcium ions across membranes of cardiac and arterial muscle cells, slowing the AV node conduction of impulses into the ventricles, thereby slowing the ventricular rate.

A 36-year-old male patient has acute sexually transmitted epididymitis. In addition to antibiotics during the acute phase of the disease, the treatment regimen should include:

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Explanation:
If a 36-year-old male patient has acute sexually transmitted epididymitis, in addition to antibiotics during the acute phase of the disease, the treatment regimen should include bed rest and scrotal elevation, which may help to alleviate some of the pain. Treatment usually continues for 10-21 days. Sexually transmitted epididymitis is most common in males younger than age 40. Laboratory findings include elevated white blood cell (WBC) count and left shift. Gram stain may be done to isolate the pathogen for sexually transmitted disease.

Mike Brown has completed gender reassignment surgery (male-to-female) and is now legally Mikaela Brown. Mikaela states that she is still attracted to females and not males. Her sexual orientation should be most appropriately classified as:

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Explanation:
Once a person completes gender reassignment surgery and legally changes genders, that person is then considered the reassigned gender; thus, Mikaela is considered female, so her attraction to other females would result in her sexual orientation as lesbian. If she were attracted to both males and females, she would be considered bisexual. Mikaela would be questioning if she was still exploring her sexual orientation. Those who are non-binary do not consider themselves exclusively male or female.

In conducting evidence-based research, which of the following types of studies represents one in which those with a condition (such as infection) are compared to those without the condition?

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Explanation:
Case-control studies compare those with a condition (cases) to a group without (controls) to determine if the affected group has characteristics that are different. Prospective cohort studies choose a group of patients without the disease, assess risk factors, and then follow the group over time to determine (prospect for) which ones develop the disease. Retrospective cohort studies are initiated after a condition develops and data are collected retrospectively from medical records to evaluate whether members of the cohort selected had exposure and developed disease. Cross-sectional studies assess disease and exposure at the same time in a target population, evaluating the presence of disease at a point in time.

A 68-year-old patient has been treated for renal disease but has exhibited a sudden change in her condition. The primary indications for renal replacement therapy (RRT) for acute renal failure are:

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Explanation:
The primary indications for renal replacement therapy (RRT) include fluid overload, metabolic acidosis, and hyperkalemia. Other indications include increased confusion, pericarditis, or gastrointestinal (Gl) bleeding. Increasing oliguria and increasing serum creatinine require further evaluation and may trigger RRT to prevent further kidney damage. Intermittent hemodialysis (administered over 3-4 hours about three times weekly) and continuous venovenous hemofiltration are commonly used after cardiac surgery for patients requiring RRT. Continuous venovenous systems include slow continuous ultrafiltration (SCUF), continuous venovenous hemofiltration (CVVH), and continuous venovenous hemodiafiltration (CVVHD).

After removal of a chest tube, a 48-year-old patient complains of retrosternal and neck pain, is dyspneic, and has slight neck edema. Hamman's sign is positive (precordial systolic crepitus). The probable diagnosis is:

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Explanation:
Retrosternal and neck pain, dyspnea, and slight neck edema indicate pneumomediastinum. Hamman's sign —a precordial rasping sound heard on auscultation during heartbeat as the heart moves against tissues filled with air-is an indication of both pneumomediastinum and pneumopericardium but is not generally present with pneumothorax or cardiac tamponade. However, neck edema can occur with pneumomediastinum. Air leaks can occur from damage to the pleura during surgery or (less commonly) from obstructed chest tubes. Air leaks usually resolve within a few days but may require the reinsertion of a chest tube.

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