ACNP BOARD REVIEW

ACNP BOARD REVIEW To improve the health of a population, an acute care nurse practitioner's intervention is to: -join a professional nursing organization and run for an organizational office. -maintain current certifi ...

ACNP BOARD REVIEW To improve the health of a population, an acute care nurse practitioner's intervention is to: -join a professional nursing organization and run for an organizational office. -maintain current certification as an acute care nurse practitioner. -participate in hospital grand rounds. -report any unusual pattern of infections to the local health department. - ✔✔report any unusual pattern of infections to the local health department. A patient, who is allergic to penicillin, requires antibiotic treatment for community-acquired pneumonia. The patient has a limited income, lacks health insurance, and is about to be discharged from the hospital. An acute care nurse practitioner's intervention is to: -consult social services for assistance. -order an aerosol antibiotic. -transfer the patient to an extended care facility. -write a prescription for an antibiotic. - ✔✔consult social services for assistance. A patient is scheduled for elective orthopedic surgery. During the preadmission physical examination, the acute care nurse practitioner detects an asymptomatic pulsatile mass in the middle upper abdomen. The nurse practitioner's most appropriate action is to: obtain a kidney-urethra-bladder x-ray. obtain a renal arteriogram. obtain an abdominal ultrasound. proceed with the patient's elective surgery. - ✔✔obtain an abdominal ultrasound. Abdominal Aortic aneurysm Which musculoskeletal disease primarily involves the distal joints, hips, knees, and spine, and is characterized by the development of Heberden and Bouchard nodes? Gout Osteoarthritis Osteoporosis Rheumatoid arthritis - ✔✔Osteoarthritis Heberden: distal phalanges Bouchard: proximal phalanges Difference between OA and RA: Heberden and Bouchard nodes are often seen in digits, they are bony round growth near the joints, while rheumatoid nodules are more common with arms and elbows underneath the skin, people with RA later develop curving and bending of fingers. An acute care nurse practitioner is deciding whether to recommend a long-term medication regimen that will help a patient manage disease symptoms but may also introduce problematic side effects. This decision reflects which ethical principle? Autonomy Beneficence Fidelity Justice - ✔✔beneficence A patient, who has been in the intensive care unit for 17 days, develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. An acute care nurse practitioner's initial treatment is to: reduce serum osmolality by infusing a 5% dextrose in 0.2% sodium chloride solution. reduce serum sodium concentration by infusing a 0.45% sodium chloride solution. replenish volume by infusing a 0.9% sodium chloride solution. replenish volume by infusing a 5% dextrose in water solution. - ✔✔replenish volume by infusing a 0.9% sodium chloride solution. priority is to replenish the volume and the fix the osmolality A 78-year-old male patient with heart failure develops a bacterial urinary tract infection secondary to an indwelling Foley catheter. The patient has a known history of allergy to penicillin and sulfonamides. The appropriate choice for antimicrobial therapy is: cephalexin (Keflex). ciprofloxacin (Cipro). doxycycline (Vibramycin). tetracycline (Sumycin). - ✔✔ciprofloxacin (Cipro) Cephalosporin (ceph) are "cousins" with penicillin (cross-allergy). Tetracyclines can cause severe side effects and are not recommended for elderly. An acute care nurse practitioner is evaluating a 78-year-old patient for an aortic valve replacement. Laboratory results indicate a low serum albumin level. The nurse practitioner prescribes a high-protein diet and evaluates the patient's response by: assessing the total serum protein level. calculating the body fat percentage. obtaining a complete blood count. obtaining a serum prealbumin level. - ✔✔obtaining a serum prealbumin level. Albumin is relatively insensitive to change of nutritional status. Our body has a large pool of albumin and it could take up to 14 days for albumin to come back to normal once the pool is depleted. Albumin level could also be affected by one's renal function and hydration state. Prealbumin is one of the earliest indicator for nutritional status now. Normal level 16-35 mg/dL A 42-year-old patient with metastatic lung cancer is admitted with severe intractable pain related to a pathologic fracture of the left femur. The plan is to stabilize the fracture surgically, and begin local radiation therapy to the site. For this patient, the most appropriate analgesic regimen is: -fentanyl (Duragesic) transdermal system applied every 72 hours. -meperidine (Demerol) 50 mg intramuscularly every three hours around the clock. -morphine sulfate (Avinza) IV via a patient-controlled analgesia pump with a basal rate. -oxycodone/acetaminophen (Percocet) orally every six hours around the clock. - ✔✔morphine sulfate (Avinza) IV via a patient-controlled analgesia pump with a basal rate. A female patient is receiving adjuvant chemotherapy for breast cancer and has been given information about her treatment regimen, expected side effects, and symptom management. Which symptom, if occurring two weeks after treatment, warrants a prompt call to the acute care nurse practitioner? Alopecia Fatigue Fever Nausea - ✔✔fever - infection A patient with hydrocephalus secondary to a subarachnoid hemorrhage has developed an intracranial pressure of 25 mm Hg. The acute care nurse practitioner's intervention is to: -hyperventilate to reach a PCO2 of 30 mm Hg. -order dexamethasone (Decadron) 4 mg IV. -perform a ventriculostomy and drainage of cerebrospinal fluid. -prescribe mannitol (Osmitrol) 100 g IV. - ✔✔perform a ventriculostomy and drainage of cerebrospinal fluid. Usual treatment are: mannitol and sedatives, surgery due to acute elevation of ICP, surgery is preferred. Which medication is used with caution in older adults due to the potential for confusion and delirium? Fluoxetine (Prozac) Haloperidol (Haldol) Lorazepam (Ativan) Phenelzine (Nardil) - ✔✔Lorazepam (Ativan) A 45-year-old patient, who is on mechanical ventilatory support in the intensive care unit, is receiving a neuromuscular blockade for respiratory control related to acute respiratory failure. To prevent keratoconjunctivitis sicca, the acute care nurse practitioner prescribes: artificial tears preparations. IV antibiotic administration. local sulfonamide therapy. topical steroid administration. - ✔✔artificial tears preparations After undergoing a successful autologous bone marrow transplant for multiple myeloma, a 55- year-old male patient comes to the clinic for his followup appointment. The patient reports that a skin lesion has changed in appearance. The acute care nurse practitioner responds by: -consulting dermatology to evaluate the lesion. -inspecting and excising the lesion. -prescribing a topical steroid preparation. -recommending reevaluation in two weeks - ✔✔consulting dermatology to evaluate the lesion. An 83-year-old patient arrives in the emergency department in severe respiratory distress. The patient verbalizes a desire not to be intubated nor to have cardiopulmonary resuscitation performed. The patient states that a neighbor has a copy of the patient's recently signed living will. The acute care nurse practitioner leaves the bedside momentarily and returns to find the physician preparing to intubate. The nurse practitioner's initial action is to: -assist the physician with intubation. -call the patient's neighbor to deliver a copy of the living will. -locate a previous patient record to find a copy of the living will. -notify the physician of the conversation with the patient. - ✔✔notify the physician of the conversation with the patient. let them make the decision A 24-year-old male patient with a closed head injury has been intubated for 12 days. The patient's parents have repeatedly refused consent for a tracheostomy and long-term care placement. On multiple occasions, the surgeon has discussed the risks and benefits of the surgery with them. Addressing the parents, the acute care nurse practitioner states: "I understand you have reservations about the placement of a tracheostomy." "Please know that not many patients die while undergoing a tracheostomy." "Without a tracheostomy, we can't transfer your son to another facility." "You know, your son will die if a tracheostomy is not placed." - ✔✔"I understand you have reservations about the placement of a tracheostomy." Before initiating a new antihypertensive drug therapy, an acute care nurse practitioner uses which evidence-based practice approach? Discussing the medication choices with a collaborating physician Discussing the medication's side effects with a colleague Reviewing the confidence intervals of related research Reviewing the institutional formulary - ✔✔Reviewing the confidence intervals of related research During a clinic appointment, an acute care nurse practitioner sees a 56-year-old male patient with a history of hypertension, metabolic syndrome, and hyperlipidemia. A review of the patient's symptoms reveals nocturia, occasional heartburn, and transient rhinitis. The patient asks about the appropriate interval of certain screening tests for someone his age. The nurse practitioner responds that a: digital prostate examination should be performed monthly. prostate-specific antigen should be performed annually. sigmoidoscopy should be performed every 10 years. testicular examination should be performed every two years. - ✔✔prostate-specific antigen should be performed annually. digital prostate exam: every 4 years sigmoidoscopy: every 5 years testicular exam: every month Which is an accurate statement regarding the formal evaluation of quality of care? -Continuous quality improvement (CQI) programs focus on individual incidents. -Health care regulatory agencies have not identified an effective means to measure quality. -Hospitals do not receive payment for services if quality of care evaluations are not performed. -The Joint Commission mandates that hospitals implement CQI programs. - ✔✔The Joint Commission mandates that hospitals implement CQI programs. While providing a history, a patient requests that an acute care nurse practitioner disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship? Autonomy Beneficence Confidentiality Empathy - ✔✔Confidentiality A 57-year-old male patient arrives at the emergency department with substernal chest pain. An electrocardiogram reveals ST segment depression in leads V3 and V4. Before administering nitrates, an acute care nurse practitioner assesses the patient's use of: angiotensin-converting enzyme inhibitors. aspirin. beta-blockers. phosphodiesterase inhibitors. - ✔✔phosphodiesterase inhibitors PDE 5 is for ED, and it could interact with nitrates to further vasodilate causing severe hypotension and death. For an 84-year-old patient who undergoes surgery, the most accurate predictor of mortality and patient outcome is: a low score on a Mini-Mental State Examination. an impaired functional status. the availability of social support. the patient's chronological age. - ✔✔an impaired functional status. An acute care nurse practitioner performs a cardiac assessment on a patient with a confirmed mitral valve prolapse. During which activity does the nurse practitioner expect the patient's murmur to diminish? Inhaling Sitting Squatting Standing - ✔✔squatting increases peripheral vascular resistance and preload as there are more blood flows through the valve. Squatting decreases the murmur in hypertrophic cardiomyopathy (HCM) and mitral valve prolapse (MVP) A 21-year-old patient is admitted to the intensive care unit with a severe closed head injury. The patient's family is becoming louder and more insistent about seeing the patient. To establish a therapeutic relationship with the family, an acute care nurse practitioner's initial action is to: -acknowledge the family's anxiety. -arrange for a meeting with a social worker. -escort the family to a conference room. -gently direct the family to maintain composure. - ✔✔acknowledge the family's anxiety. An acute care nurse practitioner is called to the medical intensive care unit to evaluate a patient who is intubated for mechanical ventilation. The patient's arterial blood gas results are: pH-7.35; PCO2-44 mm Hg; HCO3-22 mEq/L; and PO2-52 mm Hg. The current ventilator settings are: Assist control; Respiratory rate-14 breaths/min; Tidal volume (TV)-400 mL; Fraction of inspired O2-100%; and positive-end expiratory pressure (PEEP)-5 cm H2O. The nurse practitioner's next action is to increase the: -peak pressure alarm to 40 mm Hg. -PEEP to 10 cm H2O. -respiratory rate to 18 breaths/min. -TV to 500 mL. - ✔✔The right answer was PEEP to 10 cm H2O. Lung is not adequately ventilated leading to hypoxia.