NP Adult-Gerontology Acute Care Nurse Practitioner 5 — Questions and Answers
Question 1: A 77-year-old develops acute tubular necrosis (ATN) after contrast administration. Which urinalysis finding is most characteristic of ATN?
- RBC casts and proteinuria
- Muddy brown granular casts (Correct answer)
- WBC casts and pyuria
- Hyaline casts with minimal proteinuria
Correct answer: Muddy brown granular casts
Muddy brown granular casts are pathognomonic of acute tubular necrosis, representing sloughed tubular epithelial cells and debris from ischemic or nephrotoxic injury.
Question 2: A geriatric ICU patient is on low-tidal-volume ventilation. PaO2/FiO2 ratio is 120 mmHg, bilateral infiltrates are present, and PAOP is normal. What ARDS severity category does this represent?
- Mild ARDS (PF ratio 200-300)
- Moderate ARDS (PF ratio 100-200) (Correct answer)
- Severe ARDS (PF ratio <100)
- Not ARDS — PAOP is normal
Correct answer: Moderate ARDS (PF ratio 100-200)
Per the Berlin Definition, a PaO2/FiO2 ratio of 100-200 mmHg with bilateral opacities and non-cardiogenic etiology constitutes moderate ARDS.
Question 3: Which pain assessment tool is most appropriate for a non-verbal, mechanically ventilated adult patient in the ICU?
- Numeric Rating Scale (NRS)
- Visual Analog Scale (VAS)
- Critical Care Pain Observation Tool (CPOT) (Correct answer)
- Wong-Baker FACES scale
Correct answer: Critical Care Pain Observation Tool (CPOT)
CPOT uses behavioral indicators (facial expression, body movements, muscle tension, ventilator compliance) to assess pain in non-verbal ICU patients and is endorsed by SCCM guidelines.
Question 4: A 72-year-old post-cardiac arrest patient achieves return of spontaneous circulation (ROSC) but remains comatose. Which intervention has the strongest evidence for improving neurological outcomes?
- Immediate therapeutic hypothermia to 28°C
- Targeted temperature management (TTM) at 33-36°C for 24 hours (Correct answer)
- Permissive hyperthermia to maximize cerebral blood flow
- Early barbiturate coma induction
Correct answer: Targeted temperature management (TTM) at 33-36°C for 24 hours
Targeted temperature management between 33-36°C for 24 hours post-ROSC is recommended to prevent secondary neurological injury by reducing cerebral metabolic demand.
Question 5: An older adult with acute STEMI is referred for primary PCI. What is the recommended door-to-balloon time?
- 30 minutes
- 60 minutes
- 90 minutes (Correct answer)
- 120 minutes
Correct answer: 90 minutes
ACC/AHA guidelines recommend a door-to-balloon time of ≤90 minutes for primary PCI in STEMI, as every 30-minute delay increases 1-year mortality by approximately 7.5%.
Question 6: When managing a patient with acute adrenal crisis (Addisonian crisis), which of the following is the correct immediate treatment?
- Oral prednisone and IV fluids
- IM dexamethasone only
- IV hydrocortisone 100 mg bolus plus aggressive IV fluid resuscitation (Correct answer)
- IV fludrocortisone and potassium replacement
Correct answer: IV hydrocortisone 100 mg bolus plus aggressive IV fluid resuscitation
Adrenal crisis is treated with immediate IV hydrocortisone 100 mg bolus (or 200-400 mg/day continuous infusion) plus aggressive normal saline resuscitation to correct volume depletion and hypotension.
Question 7: Which drug class is contraindicated in the management of acute decompensated heart failure with cardiogenic shock?
- Loop diuretics
- Nitrates
- Beta-blockers (Correct answer)
- Inotropes
Correct answer: Beta-blockers
Beta-blockers are contraindicated in acute cardiogenic shock because they reduce cardiac contractility and heart rate, further compromising already critically low cardiac output.
NP Adult-Gerontology Acute Care Nurse Practitioner 5
A 77-year-old develops acute tubular necrosis (ATN) after contrast administration.
Which urinalysis finding is most characteristic of ATN?