NP Adult-Gerontology Acute Care Nurse Practitioner 4

Question 1

A 65-year-old with heart failure presents with acute pulmonary edema. On exam: BP 160/100, HR 110, diffuse crackles, SpO2 84%. Which is the most appropriate initial pharmacological intervention?

Accepted Answer

IV furosemide and IV nitroglycerin

Answer

IV furosemide reduces preload through diuresis and venodilation, while IV nitroglycerin reduces preload and afterload, together providing rapid relief in hypertensive acute pulmonary edema.

Question 2

An AG-ACNP is managing a patient with status epilepticus refractory to benzodiazepines. What is the next recommended pharmacological agent?

Accepted Answer

IV levetiracetam, fosphenytoin, or valproate

Answer

After benzodiazepine failure, second-line agents including IV levetiracetam, fosphenytoin, or valproate are recommended per Neurocritical Care Society guidelines for established status epilepticus.

Question 3

Which clinical finding best differentiates cardiogenic shock from distributive (septic) shock?

Accepted Answer

Cool clammy skin with elevated SVR and low CO

Answer

Cardiogenic shock is characterized by cool, clammy skin with elevated systemic vascular resistance and low cardiac output, unlike septic shock which presents with warm skin and low SVR.

Question 4

A 74-year-old patient on warfarin for atrial fibrillation presents with INR of 9.2 and active GI bleeding. What is the most appropriate reversal strategy?

Accepted Answer

4-factor prothrombin complex concentrate (PCC) plus vitamin K

Answer

4-factor PCC combined with vitamin K provides the fastest, most complete reversal of warfarin in life-threatening bleeding, with PCC acting immediately and vitamin K maintaining reversal.

Question 5

A post-operative 70-year-old develops fever, hypotension, and purulent drainage from a central line site on day 7. Blood cultures are drawn. What is the immediate next action?

Accepted Answer

Remove the central line and start empiric vancomycin

Answer

Suspected CLABSI requires immediate central line removal and initiation of empiric broad-spectrum antibiotics (vancomycin for gram-positives), not waiting for culture results in a hemodynamically unstable patient.

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP Adult-Gerontology Acute Care Nurse Practitioner 4