NP Adult-Gerontology Acute Care Nurse Practitioner 2 — Questions and Answers
Question 1: A 72-year-old patient on mechanical ventilation develops sudden hypotension, tachycardia, and decreased breath sounds on the left. What is the most likely diagnosis?
- Pneumonia
- Tension pneumothorax (Correct answer)
- Pulmonary embolism
- Hemothorax
Correct answer: Tension pneumothorax
Tension pneumothorax presents with hypotension, tachycardia, tracheal deviation, and absent breath sounds on the affected side — a life-threatening emergency requiring immediate needle decompression.
Question 2: Which vasopressor is first-line for distributive shock in septic patients when mean arterial pressure (MAP) cannot be maintained above 65 mmHg with fluids?
- Epinephrine
- Vasopressin
- Norepinephrine (Correct answer)
- Dopamine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines due to its potent alpha-adrenergic activity and minimal chronotropic effects.
Question 3: An 80-year-old post-surgical patient develops acute confusion, agitation, and visual hallucinations on hospital day 2. Which intervention is most appropriate?
- Immediately administer haloperidol IV
- Perform RASS and CAM-ICU assessment, then address modifiable causes (Correct answer)
- Order CT head immediately
- Restrain the patient and administer lorazepam
Correct answer: Perform RASS and CAM-ICU assessment, then address modifiable causes
Delirium management begins with systematic assessment using validated tools (CAM-ICU) and addressing reversible causes like pain, sleep disruption, and medications before pharmacological intervention.
Question 4: A 68-year-old with COPD exacerbation has a pH of 7.26, PaCO2 of 68 mmHg, and PaO2 of 52 mmHg. Which intervention should be initiated first?
- High-flow oxygen at 100%
- Immediate intubation
- Non-invasive positive pressure ventilation (NIPPV) (Correct answer)
- IV methylprednisolone only
Correct answer: Non-invasive positive pressure ventilation (NIPPV)
Non-invasive positive pressure ventilation (BiPAP) is the first-line intervention for acute hypercapnic respiratory failure in COPD, reducing mortality and intubation rates.
Question 5: Which scoring system is used to assess the severity of acute pancreatitis within the first 48 hours of admission?
- Child-Pugh score
- Ranson criteria (Correct answer)
- APACHE II score only
- Alvarado score
Correct answer: Ranson criteria
Ranson criteria uses 11 parameters measured at admission and 48 hours to predict mortality risk in acute pancreatitis; scores ≥3 indicate severe disease.
Question 6: A 75-year-old presents with sudden-onset severe tearing chest pain radiating to the back. BP is 200/110 in the right arm and 160/90 in the left arm. What is the priority action?
- Administer thrombolytics immediately
- Obtain urgent CTA of the chest (Correct answer)
- Start heparin infusion
- Perform emergent coronary angiography
Correct answer: Obtain urgent CTA of the chest
CTA of the chest is the diagnostic study of choice for suspected aortic dissection, and BP differential between arms is a classic finding; thrombolytics are contraindicated.
Question 7: When managing acute ischemic stroke, what is the maximum time window for IV alteplase administration from symptom onset in eligible patients?
- 1.5 hours
- 3 hours
- 4.5 hours (Correct answer)
- 6 hours
Correct answer: 4.5 hours
IV alteplase can be administered up to 4.5 hours from symptom onset in carefully selected patients per AHA/ASA guidelines, though benefit is greatest when given earlier.
NP Adult-Gerontology Acute Care Nurse Practitioner 2
A 72-year-old patient on mechanical ventilation develops sudden hypotension, tachycardia, and decreased breath sounds on the left.
What is the most likely diagnosis?