NP Adult-Gerontology Acute Care Nurse Practitioner 3 — Questions and Answers
Question 1: An elderly patient in the ICU has serum sodium of 118 mEq/L with altered mental status. What is the maximum rate of correction to prevent osmotic demyelination syndrome?
- 20 mEq/L in 24 hours
- 8-10 mEq/L in 24 hours (Correct answer)
- 15 mEq/L in 12 hours
- 12 mEq/L in 6 hours
Correct answer: 8-10 mEq/L in 24 hours
Sodium should be corrected no faster than 8-10 mEq/L per 24 hours to avoid osmotic demyelination syndrome (central pontine myelinolysis), which is irreversible.
Question 2: A 70-year-old with acute kidney injury has a potassium of 6.8 mEq/L with peaked T-waves on EKG. What is the FIRST intervention?
- Sodium polystyrene sulfonate (Kayexalate)
- IV calcium gluconate (Correct answer)
- IV insulin with dextrose
- Emergent hemodialysis
Correct answer: IV calcium gluconate
IV calcium gluconate is administered first to stabilize the cardiac membrane, even though it does not lower potassium levels — this buys time for definitive treatment.
Question 3: Which ventilator strategy has been shown to reduce mortality in ARDS patients?
- High tidal volume (10-12 mL/kg IBW) with high PEEP
- Low tidal volume (6 mL/kg IBW) with plateau pressure ≤30 cmH2O (Correct answer)
- Pressure control with high FiO2 and low PEEP
- Volume control with normal tidal volumes and prone positioning only
Correct answer: Low tidal volume (6 mL/kg IBW) with plateau pressure ≤30 cmH2O
The ARDSNet protocol using low tidal volumes of 6 mL/kg IBW and limiting plateau pressures to ≤30 cmH2O has demonstrated a 22% reduction in mortality in ARDS.
Question 4: A geriatric patient post-hip replacement develops sudden dyspnea, pleuritic chest pain, and oxygen saturation of 88%. Wells score is high. What is the next best step?
- Start empiric anticoagulation and skip imaging
- CT pulmonary angiography (CTPA) (Correct answer)
- V/Q scan only
- Duplex ultrasound of lower extremities only
Correct answer: CT pulmonary angiography (CTPA)
CT pulmonary angiography is the gold-standard diagnostic test for pulmonary embolism, offering high sensitivity and specificity in hemodynamically stable patients.
Question 5: Which laboratory finding is most consistent with disseminated intravascular coagulation (DIC)?
- Elevated fibrinogen, low D-dimer, normal PT
- Low fibrinogen, elevated D-dimer, prolonged PT and aPTT (Correct answer)
- Normal fibrinogen, elevated platelets, low D-dimer
- Elevated fibrinogen, normal D-dimer, shortened PT
Correct answer: Low fibrinogen, elevated D-dimer, prolonged PT and aPTT
DIC is characterized by consumptive coagulopathy: low fibrinogen, elevated D-dimer (fibrin degradation products), prolonged PT/aPTT, and thrombocytopenia.
Question 6: A 78-year-old patient in the ICU is assessed using the ABCDEF bundle. What does the 'A' component represent?
- Analgesia-first approach
- Assess, prevent, and manage pain (Correct answer)
- Agitation management with sedatives
- Antibiotic stewardship
Correct answer: Assess, prevent, and manage pain
In the ABCDEF ICU Liberation Bundle, 'A' stands for 'Assess, Prevent, and Manage Pain,' emphasizing that pain should be addressed before sedation.
Question 7: Which condition is the most common cause of acute liver failure in the United States?
- Hepatitis B infection
- Ischemic hepatitis
- Acetaminophen toxicity (Correct answer)
- Wilson's disease
Correct answer: Acetaminophen toxicity
Acetaminophen (Tylenol) overdose — both intentional and unintentional — accounts for approximately 50% of all acute liver failure cases in the United States.
NP Adult-Gerontology Acute Care Nurse Practitioner 3
An elderly patient in the ICU has serum sodium of 118 mEq/L with altered mental status.
What is the maximum rate of correction to prevent osmotic demyelination syndrome?