NP Adult-Gerontology Acute Care Nurse Practitioner 5

Question 1

A 77-year-old develops acute tubular necrosis (ATN) after contrast administration. Which urinalysis finding is most characteristic of ATN?

Accepted Answer

Muddy brown granular casts

Answer

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?

Accepted Answer

Moderate ARDS (PF ratio 100-200)

Answer

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?

Accepted Answer

Critical Care Pain Observation Tool (CPOT)

Answer

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?

Accepted Answer

Targeted temperature management (TTM) at 33-36°C for 24 hours

Answer

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?

Accepted Answer

90 minutes

Answer

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%.

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP Adult-Gerontology Acute Care Nurse Practitioner 5