NP Adult-Gerontology Acute Care Nurse Practitioner 2

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?

Accepted Answer

Tension pneumothorax

Answer

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?

Accepted Answer

Norepinephrine

Answer

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?

Accepted Answer

Perform RASS and CAM-ICU assessment, then address modifiable causes

Answer

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?

Accepted Answer

Non-invasive positive pressure ventilation (NIPPV)

Answer

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?

Accepted Answer

Ranson criteria

Answer

Ranson criteria uses 11 parameters measured at admission and 48 hours to predict mortality risk in acute pancreatitis; scores ≥3 indicate severe disease.

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP Adult-Gerontology Acute Care Nurse Practitioner 2