FREE ANCC Adult-Gerontology Acute Care Nursing Questions and Answers

Question 1

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

Accepted Answer

Microalbuminuria

Answer

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.

Question 2

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:

Accepted Answer

Bed rest and scrotal elevation

Answer

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.

Question 3

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

Accepted Answer

Fluid balance

Answer

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.

Question 4

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:

Accepted Answer

Fluid overload, metabolic acidosis, and hyperkalemia

Answer

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).

Question 5

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:

Accepted Answer

Pneumomediastinum

Answer

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.

ANCC - American Nurses Credentialing Center Practice Test

ANCC - American Nurses Credentialing Center Practice Test

FREE ANCC Adult-Gerontology Acute Care Nursing Questions and Answers