NRNP 6566 Advanced Care of Adults in Acute Settings I Practice Test
Sample Questions and Answers
- Which of the following best describes the primary role of the Acute Care Nurse Practitioner (ACNP) in an interdisciplinary team?
- A) Prescribing medications for chronic conditions
- B) Providing primary care services to patients
- C) Coordinating and managing acute care for critically ill patients
- D) Focusing only on the nursing aspect of care
Answer: C) Coordinating and managing acute care for critically ill patients
Explanation: The ACNP’s role in acute care is focused on the assessment, diagnosis, and management of critically ill patients in collaboration with an interdisciplinary team.
- A 56-year-old male presents with shortness of breath, a dry cough, and pleuritic chest pain. The patient’s vital signs include a heart rate of 110 bpm, respiratory rate of 22, and a temperature of 100.4°F. Which of the following is the most likely cause of his symptoms?
- A) Acute myocardial infarction
- B) Pulmonary embolism
- C) Pneumonia
- D) Chronic obstructive pulmonary disease (COPD)
Answer: B) Pulmonary embolism
Explanation: Pulmonary embolism can present with pleuritic chest pain, shortness of breath, and tachycardia, often with a history of risk factors like prolonged immobility or recent surgery.
- Which of the following lab results would be most consistent with acute kidney injury (AKI) in a patient with an exacerbation of chronic renal disease?
- A) Increased serum creatinine and decreased glomerular filtration rate (GFR)
- B) Decreased serum creatinine and increased GFR
- C) Decreased serum potassium and increased BUN
- D) Increased albumin and decreased BUN
Answer: A) Increased serum creatinine and decreased glomerular filtration rate (GFR)
Explanation: AKI is characterized by an increase in serum creatinine and a decrease in GFR, reflecting impaired kidney function.
- A patient with chronic heart failure is admitted with worsening symptoms. Which of the following is a key component of the nursing management for this patient?
- A) Administering diuretics to reduce fluid overload
- B) Encouraging high sodium intake to maintain blood pressure
- C) Limiting oxygen therapy to prevent hypoxia
- D) Restricting physical activity to reduce stress on the heart
Answer: A) Administering diuretics to reduce fluid overload
Explanation: In heart failure, diuretics help reduce fluid overload, which can decrease symptoms such as shortness of breath and peripheral edema.
- Which of the following cardiac arrhythmias is most likely to occur in patients with acute myocardial infarction (MI)?
- A) Bradycardia
- B) Tachycardia
- C) Atrial fibrillation
- D) Ventricular fibrillation
Answer: D) Ventricular fibrillation
Explanation: Ventricular fibrillation is a life-threatening arrhythmia that can occur following an acute MI and requires immediate intervention.
- A 72-year-old woman presents with confusion, dyspnea, and orthopnea. Physical examination reveals crackles on lung auscultation and pitting edema in the lower extremities. Which of the following is the most appropriate diagnostic test to confirm the suspected diagnosis?
- A) Electrocardiogram (ECG)
- B) Chest X-ray
- C) Urinalysis
- D) Pulmonary function tests
Answer: B) Chest X-ray
Explanation: A chest X-ray is crucial in diagnosing conditions like congestive heart failure, where pulmonary congestion and edema are common findings.
- Which of the following is a common cause of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD)?
- A) Hyperventilation
- B) Viral or bacterial infections
- C) Low blood pressure
- D) Increased fluid intake
Answer: B) Viral or bacterial infections
Explanation: Infections are a common trigger for acute exacerbations in patients with COPD, often leading to increased symptoms such as dyspnea, cough, and sputum production.
- Which of the following medications is commonly used to reduce preload in a patient with acute heart failure?
- A) Lisinopril
- B) Furosemide
- C) Metoprolol
- D) Nitroglycerin
Answer: D) Nitroglycerin
Explanation: Nitroglycerin is a vasodilator that reduces preload and can be useful in managing acute heart failure symptoms.
- A patient presents with an elevated heart rate, low blood pressure, and warm, dry skin. Laboratory tests reveal a blood glucose level of 580 mg/dL. What is the most likely diagnosis?
- A) Diabetic ketoacidosis (DKA)
- B) Hyperosmolar hyperglycemic state (HHS)
- C) Sepsis
- D) Acute pancreatitis
Answer: B) Hyperosmolar hyperglycemic state (HHS)
Explanation: HHS is characterized by extreme hyperglycemia, dehydration, and altered mental status without significant ketoacidosis, which distinguishes it from DKA.
- In the management of acute respiratory distress syndrome (ARDS), which of the following interventions is most critical in improving oxygenation?
- A) High-flow nasal cannula oxygen
- B) Mechanical ventilation with positive end-expiratory pressure (PEEP)
- C) Chest physiotherapy
- D) Inhaled corticosteroids
Answer: B) Mechanical ventilation with positive end-expiratory pressure (PEEP)
Explanation: PEEP helps prevent alveolar collapse and improve oxygenation in patients with ARDS by maintaining positive pressure in the lungs.
- Which of the following is the most common cause of acute pancreatitis?
- A) Gallstones
- B) Alcohol abuse
- C) Infection
- D) Hypercalcemia
Answer: A) Gallstones
Explanation: Gallstones are the most common cause of acute pancreatitis, as they can block the bile duct, leading to pancreatic inflammation.
- A 45-year-old male is admitted with a suspected pulmonary embolism (PE). Which of the following diagnostic tests would be most appropriate to confirm the diagnosis?
- A) D-dimer assay
- B) Chest X-ray
- C) Ventilation-perfusion (V/Q) scan
- D) Arterial blood gas (ABG)
Answer: C) Ventilation-perfusion (V/Q) scan
Explanation: A V/Q scan is a non-invasive test commonly used to diagnose PE, particularly in patients who cannot undergo CT pulmonary angiography.
- In managing a patient with acute renal failure, which of the following is a key intervention to prevent further kidney damage?
- A) Limiting fluid intake
- B) Administering nephrotoxic medications
- C) Correcting underlying conditions (e.g., sepsis or dehydration)
- D) Restricting protein intake
Answer: C) Correcting underlying conditions (e.g., sepsis or dehydration)
Explanation: Treating the underlying cause of acute renal failure is crucial to preventing further kidney damage and improving renal function.
- A patient presents with severe chest pain radiating to the left arm and diaphoresis. Which of the following is the priority intervention in the management of this patient?
- A) Administer aspirin
- B) Perform an electrocardiogram (ECG)
- C) Start oxygen therapy
- D) Begin intravenous fluids
Answer: A) Administer aspirin
Explanation: Administering aspirin is crucial in the early management of suspected acute myocardial infarction to inhibit platelet aggregation.
- Which of the following diagnostic tests is most appropriate for assessing a patient’s oxygenation status in an acute care setting?
- A) Electrocardiogram (ECG)
- B) Arterial blood gas (ABG)
- C) Complete blood count (CBC)
- D) Urinalysis
Answer: B) Arterial blood gas (ABG)
Explanation: ABG analysis provides detailed information about a patient’s oxygenation, acid-base balance, and ventilation status.
- A patient presents with severe hypotension and tachycardia following a traumatic injury. What is the most appropriate initial management?
- A) Administer intravenous fluids
- B) Administer analgesics
- C) Perform a CT scan of the abdomen
- D) Start vasopressor medications
Answer: A) Administer intravenous fluids
Explanation: In cases of hypotension due to trauma, the first-line intervention is to administer intravenous fluids to restore circulating blood volume.
- Which of the following findings would most likely suggest the need for intubation in a patient with acute respiratory failure?
- A) Oxygen saturation of 92%
- B) Respiratory rate of 28 breaths per minute
- C) Blood pH of 7.30 and PaCO2 of 60 mmHg
- D) Use of accessory muscles for breathing
Answer: C) Blood pH of 7.30 and PaCO2 of 60 mmHg
Explanation: A blood pH of 7.30 and PaCO2 of 60 mmHg suggest respiratory acidosis, which may indicate the need for mechanical ventilation to support breathing.
- Which of the following conditions is most commonly associated with the development of chronic kidney disease (CKD)?
- A) Hypertension
- B) Gastroesophageal reflux disease (GERD)
- C) Asthma
- D) Hyperthyroidism
Answer: A) Hypertension
Explanation: Hypertension is a leading cause of chronic kidney disease due to its effect on the kidneys’ ability to filter blood effectively over time.
- Which of the following interventions is a key component of management for a patient with acute decompensated heart failure?
- A) Restricting fluid intake
- B) Administering vasoconstrictors
- C) Administering positive inotropes
- D) Administering diuretics for fluid removal
Answer: D) Administering diuretics for fluid removal
Explanation: Diuretics help manage fluid overload in acute decompensated heart failure, improving symptoms like shortness of breath and edema.
- Which of the following is a common sign of acute respiratory failure in an adult patient?
- A) Low blood pressure and bradycardia
- B) Cyanosis and confusion
- C) Tachycardia and hypotension
- D) Fever and dry cough
Answer: B) Cyanosis and confusion
Explanation: Cyanosis (blue discoloration of the skin) and confusion are common signs of inadequate oxygenation, indicating acute respiratory failure.
- Which of the following is the primary goal when managing a patient with acute myocardial infarction (MI)?
- A) To restore myocardial oxygen supply and reduce myocardial workload
- B) To increase heart rate and improve myocardial contractility
- C) To promote tissue necrosis in the infarcted area
- D) To prevent the formation of thrombus in the coronary arteries
Answer: A) To restore myocardial oxygen supply and reduce myocardial workload
Explanation: The main goals in managing MI are to restore oxygen supply to the myocardium, reduce the heart’s workload, and prevent further ischemia.
- In a patient with acute respiratory distress syndrome (ARDS), what is the most appropriate mode of mechanical ventilation?
- A) Continuous positive airway pressure (CPAP)
- B) Bilevel positive airway pressure (BiPAP)
- C) Positive end-expiratory pressure (PEEP) with low tidal volumes
- D) High-frequency oscillatory ventilation (HFOV)
Answer: C) Positive end-expiratory pressure (PEEP) with low tidal volumes
Explanation: PEEP helps to prevent alveolar collapse and improve oxygenation in ARDS, and low tidal volumes help reduce ventilator-induced lung injury.
- A patient with a history of chronic obstructive pulmonary disease (COPD) presents with increased dyspnea and wheezing. What is the first line of management?
- A) Inhaled corticosteroids
- B) Oral antibiotics
- C) Short-acting beta-agonists (SABA)
- D) Oxygen therapy
Answer: C) Short-acting beta-agonists (SABA)
Explanation: SABAs are the first line of treatment for acute exacerbations of COPD, as they help relieve bronchospasm.
- Which of the following lab findings would most likely indicate the presence of acute liver failure?
- A) Elevated serum creatinine and blood urea nitrogen (BUN)
- B) Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
- C) Elevated hemoglobin and hematocrit
- D) Low platelet count and elevated prothrombin time (PT)
Answer: B) Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
Explanation: ALT and AST are liver enzymes, and their elevated levels indicate liver injury or dysfunction, as seen in acute liver failure.
- Which of the following diagnostic tests is most useful for assessing the severity of a patient’s heart failure?
- A) Electrocardiogram (ECG)
- B) Chest X-ray
- C) Brain natriuretic peptide (BNP) level
- D) Complete blood count (CBC)
Answer: C) Brain natriuretic peptide (BNP) level
Explanation: BNP levels correlate with the severity of heart failure, and elevated levels indicate worsening heart failure.
- A patient presents with a blood pressure of 170/110 mmHg, headache, and visual disturbances. Which of the following is the most appropriate immediate management?
- A) Administer a diuretic
- B) Initiate antihypertensive medication
- C) Perform a lumbar puncture
- D) Administer morphine for pain relief
Answer: B) Initiate antihypertensive medication
Explanation: The patient likely has a hypertensive crisis, and prompt reduction of blood pressure is necessary to prevent complications like stroke or organ damage.
- Which of the following is a common complication of acute pancreatitis?
- A) Acute respiratory distress syndrome (ARDS)
- B) Renal failure
- C) Sepsis
- D) All of the above
Answer: D) All of the above
Explanation: Acute pancreatitis can lead to multiple complications, including ARDS, renal failure, and sepsis, all of which require urgent management.
- Which of the following conditions is most associated with an increased risk of pulmonary embolism (PE)?
- A) Chronic obstructive pulmonary disease (COPD)
- B) Atrial fibrillation
- C) Deep vein thrombosis (DVT)
- D) Asthma
Answer: C) Deep vein thrombosis (DVT)
Explanation: DVT is the most common source of emboli that lead to pulmonary embolism, especially if a thrombus dislodges from the lower extremities.
- A 60-year-old patient with diabetes and hypertension presents with sudden onset of severe abdominal pain, nausea, and vomiting. A physical exam reveals a rigid abdomen. Which of the following is the most likely diagnosis?
- A) Acute cholecystitis
- B) Acute pancreatitis
- C) Bowel perforation
- D) Acute myocardial infarction
Answer: C) Bowel perforation
Explanation: The rigid abdomen is a hallmark of peritonitis, which is most often caused by bowel perforation. This is a surgical emergency.
- A 75-year-old patient presents with fever, cough, and dyspnea. Chest X-ray reveals bilateral infiltrates. What is the most appropriate first step in management?
- A) Administer oxygen
- B) Begin broad-spectrum antibiotics
- C) Perform a bronchoscopy
- D) Start antiviral therapy
Answer: B) Begin broad-spectrum antibiotics
Explanation: The patient’s presentation suggests community-acquired pneumonia (CAP), and broad-spectrum antibiotics are indicated as the initial treatment.
- What is the first line of treatment for an anaphylactic reaction in a critically ill patient?
- A) Intravenous fluids
- B) Antihistamines
- C) Epinephrine
- D) Corticosteroids
Answer: C) Epinephrine
Explanation: Epinephrine is the first-line treatment for anaphylaxis, as it reverses airway constriction, reduces swelling, and improves circulation.
- A patient with heart failure presents with orthopnea and paroxysmal nocturnal dyspnea. Which of the following is most likely contributing to the patient’s symptoms?
- A) Fluid accumulation in the lungs
- B) Hyperventilation
- C) Cardiac arrhythmia
- D) Pulmonary embolism
Answer: A) Fluid accumulation in the lungs
Explanation: Fluid accumulation in the lungs due to heart failure leads to symptoms like orthopnea and paroxysmal nocturnal dyspnea.
- A patient with acute kidney injury (AKI) presents with elevated serum creatinine and oliguria. Which of the following is most important in the initial management of this patient?
- A) Administer intravenous fluids
- B) Restrict protein intake
- C) Perform hemodialysis immediately
- D) Begin corticosteroids
Answer: A) Administer intravenous fluids
Explanation: Adequate hydration is crucial in the initial management of AKI, especially in cases related to prerenal causes (e.g., dehydration, blood loss).
- Which of the following is the most common cause of septic shock in the adult population?
- A) Gram-negative bacteria
- B) Gram-positive bacteria
- C) Fungal infections
- D) Viral infections
Answer: A) Gram-negative bacteria
Explanation: Gram-negative bacteria, especially Escherichia coli, are the most common pathogens causing septic shock in adults.
- Which of the following is the most appropriate management for a patient with suspected tension pneumothorax?
- A) Chest tube insertion
- B) Thoracotomy
- C) Needle thoracostomy
- D) High-flow oxygen therapy
Answer: C) Needle thoracostomy
Explanation: Needle thoracostomy is the first intervention for tension pneumothorax to relieve pressure before further interventions.
- A patient with chronic kidney disease presents with pruritus, muscle cramps, and bone pain. Which of the following is the most likely cause of these symptoms?
- A) Hyperphosphatemia
- B) Hyperkalemia
- C) Hypokalemia
- D) Hypocalcemia
Answer: A) Hyperphosphatemia
Explanation: Hyperphosphatemia commonly occurs in chronic kidney disease and can lead to pruritus, bone pain, and muscle cramps.
- Which of the following is the first line of treatment for acute gout in a patient with renal insufficiency?
- A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
- B) Colchicine
- C) Corticosteroids
- D) Allopurinol
Answer: C) Corticosteroids
Explanation: Corticosteroids are the first-line treatment for acute gout in patients with renal insufficiency, as NSAIDs and colchicine may be contraindicated due to renal impairment.
- Which of the following conditions is a risk factor for developing deep vein thrombosis (DVT)?
- A) Immobility
- B) Hypotension
- C) Anemia
- D) Hyperthyroidism
Answer: A) Immobility
Explanation: Immobility is a major risk factor for DVT, as it leads to venous stasis, which can promote thrombus formation.
- A patient with a history of coronary artery disease presents with sudden severe chest pain. What is the first diagnostic test you should order?
- A) Chest X-ray
- B) Electrocardiogram (ECG)
- C) Echocardiogram
- D) Coronary angiography
Answer: B) Electrocardiogram (ECG)
Explanation: An ECG is the first test to assess for signs of acute myocardial infarction or ischemia.
- A patient is diagnosed with acute ischemic stroke. What is the primary goal in the first 24 hours of management?
- A) Achieve thrombolysis
- B) Prevent the formation of a clot
- C) Control blood pressure
- D) Provide neuroprotective medications
Answer: C) Control blood pressure
Explanation: In acute ischemic stroke, blood pressure control is essential to avoid further brain injury and complications.