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1. Question: Which statement is correct about fluoroquinolones?
2. Question: A 42 year old year old women was admitted to the ICU with a severe asthmatic exacerbation. On rounds today, the patients T is 102.2. Her central IV line site is red, tender, and warm. Your remove the central line and order blood cultures along with IV cefepime. MRSA has been prevalent in this ICU. What additional medication should you order?
3. Question: A 66-year-old male involved in a motor vehicle collision is admitted to the trauma unit with multiples bone fractions and left hemothorax with chest tube placement. Current vital signs are BP 88/52 HR 120 T 98.4 RR 22. Past medical history is positive for end stage renal disease requiring hemodialysis three times a week. How should the NP manage his renal disease?
4. Question: What crucial feature of a penicillin is involved in its mechanism of action?
5. Question: Which drug should the APRN select to treat a patient with an infected post operative surgical wound infected with a positive culture result for MRSA?
6. Question: Mr. D is a 56 year old male with newly diagnosed multiple myeloma who is admitted through the ER with back pain after falling against a bookcase at home. Chest x-ray shows a rib fracture. Electrolytes reveal a serum calcium of 12.7 mg/dl. How would you treat Mr. D?
7. Question: A 13-year-old thin, female comes to your office with a 6-month history of nondeliberate weight loss, polyuria and polydypsia. She has no other significant illnesses. There are no abnormalities on physical examination except a random venous blood sugar of 237. Which of the following statements regarding this case is FALSE?
8. Question: A patient who is allergic to penicillins may also be allergic to
9. Question: Joe is a 46 year old man with normal renal function diagnosed with heparin induced thrombocytopenia (HIT). In addition to stopping all unfractionated heparin products, the next appropriate step in treating this patient would be the addition of?
10. Question: A 24-year-old male is a newly diagnosed type 1 diabetic. He weighs 62 kg and you decide to start him on insulin therapy because his blood glucose is high and he has ketonuria. His total daily dose of insulin to start with should be:
11. Question: A 48-year-old female wt 70 kg, is in the ICU with acute pancreatitis. Her vital signs are as follows: BP 92/60 mm Hg; heart rate 116 bpm; She is intubated with current ventilator settings of VT 700 mL, assist control (AC) rate 12 bpm, FiO2 0.85, and positive end expiratory pressure (PEEP) 5.0 cm H2O. Her ABG reveals a pH of 7.31, PaCO2 of 53 mm Hg, and a PaO2 of 62 mm Hg. Her chest radiograph shows diffuse, fluffy infiltrates.
12. Question: A 22 year old patient is transitioning from oral agents to insulin. He will be taking 20 units of lantus at bedtime and regular insulin before meals. What instructions should the NP provide about the timing and dose of regular insulin?
13. Question: All of the following statements about Type 2 diabetes mellitus are correct EXCEPT:
14. Question: The NP is managing a male patient with bilateral lower extremity swelling, erythema, and draining blisters. The patient states the blisters have been there about a week but now there is redness around the blisters and moving up the leg. He has been having chills and thinks he has been running a temperature but does not own a thermometer. Vital signs are within normal limits except for an elevated temperature of 101.1  The patient has no known drug allergies. What medication should the NP prescribe?
15. Question: Amy calls the office and states that her fasting blood sugar has been over 225 for the past three mornings. What adjustments should the AGACNP make?
16. Question: Which statement is correct about macrolide antibiotics?
17. Question: Cicely is a known diabetic with COPD who admitted to the hospital for pneumonia and acute COPD exacerbation. What treatment would the ACNP prescribe to manage her blood sugars?
18. Question: A 22 year old female patient with type 1 diabetes presents with abdominal pain and T
19. Question: A patient with end stage renal disease misses three dialysis appointments. Which of the following arterial blood gases would indicate the patient is in metabolic acidosis?
20. Question: The most common cause of low serum sodium and high serum osmolality is:
21. Question: Which antibiotics would NOT be appropriate to empirically treat an E. Coli infection?
22. Question: The NP is managing a 66 year old female admitted to the ICU with a serum potassium level of 8.9 mEg/L. Hemodialysis will be started as soon as the on-call staff can arrive. What intervention should the NP order now?
23. Question: The APRN is treating a patient with type 2 diabetes. The patient is on the maximum dose of metformin and glucotrol. Current weight 212 pounds. Labs from this morning indicate a fasting blood sugar of 312 and HbA1C of 9.  The APRN wants to start the patient on Lantus 0.2 unit/kg. What dose and instructions should the APRN provide?
24. Question: When prescribing sildenafil (Viagra) to a patient, the patient should be screened for which of the following? Select all that apply.
25. Question: The NP is assessing a patient receiving benzodiazepines who is experiencing confusion, dizziness, slurred speech, and difficulty breathing. What medication should the NP order to counter the effects?
26. Question: The AGACNP orders a renal angiogram for a patient with suspected renal artery stenosis. Which of the following medications would be contraindicated for the patient?
27. Question: The AGACNP is assessing a patient in the urgent care area. The patient is a 44 year old women in her third round of chemotherapy for breast cancer. She presents today with complains of generalize malaise and fever that has gradually increased over the past 12 hours, BP 110/62 P 96 T 102.6 RR 18 WBC 4.2 ANC 300 The best initial treatment by the AGACNP is:
28. Question: Mrs. J, age 62, is brought to the hospital by ambulance. She is severely dehydrated, does not respond to verbal stimuli, and withdraws from painful stimuli. BP is 90/60 with a heart rate of 130 bpm. Serum blood glucose level is 1000 mg/dl and there are no ketones in the initial urine analysis. HHS is suspected.
29. Question: The NP is caring for a patient with intra renal acute kidney injury (AKI). Which of the following would cause this?
30. Question: What should be considered prior to prescribing a sulfonamide?
31. Question: Which of the following medications has the best gram negative bacteria coverage? Cefuroxime (Cefzil)
32. Question: A 66 year old patient is admitted to the ICU with hospital acquired pneumonia. She has consolidation in the right middle and lower lung lobe. Arterial blood gasses show a pO2 of 55%. Which mechanism likely accounts for this patients hypoxia?
33. Question: The NP is managing the care of a patient admitted with hypokalemia. The patient’s admission serum potassium was 3.0. The patient has been receiving potassium supplements for 4 days. Today’s serum potassium is 3.1.    What lab test should the NP order to assess this patient’s failure to respond to treatment?
34. Question: A patient with COPD and asthma is intubated and becomes hypotensive. High levels of auto-peep are noted. What changes should be made in the ventilator settings to address the auto peep?
35. Question: Mrs. J, age 62, is brought to the hospital by ambulance. She is severely dehydrated, does not respond to verbal stimuli, and withdraws from painful stimuli. BP is 90/60 with a heart rate of 130 bpm. Serum blood glucose level is 1000 mg/dl and there are no ketones in the initial urine analysis. HHS is suspected. Which statement about HHS is INCORRECT?
36. Question: A 56-year-old woman comes to the emergency department because she has had increasing swelling of the right ankle over the past two days, since she sustained an injury while playing outdoors with her grandchildren. She says she has been taking over-the- counter ibuprofen 400 to 800 mg every four to six hours to relieve the pain. Medical history includes mild hypertension, which is currently controlled with lisinopril. Results of laboratory studies show elevated levels of serum creatinine and blood urea nitrogen. Acute renal failure induced by use of nonsteroidal anti-inflammatory drugs is suspected. If this suspected diagnosis is correct, which of the following additional abnormal laboratory results would the AGACNP expect to see ?
37. Question: The NP is treating a patient in septic shock. The patient remains hypotensive despite initial fluid resuscitation. Based on the surviving sepsis guidelines, which of the following is true?
38. Question: The NP is planning a rapid sequence intubation (RSI) on a 44 year old male. He weighs 88 kg. What medications should be administered prior to the RSI?
39. Question: The NP is managing the care of a patient in metabolic acidosis. Which exam finding would indicate that the acidosis is getting worse?
40. Question: A 44 year old female is in acute respiratory distress syndrome. She is intubated and mechanically ventilated. Her ideal body weight is 60 Kg . Current ventilator settings include FIO2 100% Tidal volume 450 RR 22 PEEP 10 Current arterial blood gas results are pH 7.45 pCO2 34 pO2 75 Chest xray shows bilateral infiltrates. Which of the following interventions will increase her chance of survival?
41. Question: The NP is assessing a patient with a serum potassium level of 2.9 What EKG finding would you expect to see based on this lab?
42. Question: The NP is managing the care of a patient admitted with a serum sodium level of 115. The patient has been receiving 3% normal saline 50 ml/hour for the past 16 hours. On rounds this morning, the patient complains of shortness of breath and fatigue. What is the priority intervention?
43. Question: The NP is consulting on a patient in the postanesthsia care unit that is immediate post op from a total knee replacement. The patient is increasing somnolent and has been treated with multiple doses of fentanyl for severe pain. Arterial blood gas results show pH 7.28 pO2 68 HCO3 24 oxygen saturation 92% . The next step for the NP to order is:
44. Question: The NP is caring for a patient with prerenal acute kidney injury (AKI). Which of the following would cause this?
45. Question: Miss Smith arrives in the ER with a blood glucose of 420 and + ketones in her urine. She is a type 1 diabetic weighing 70 kg. She is diagnosed with Diabetic Ketoacidosis. The initial bolus dose of insulin is:
46. Question: An insulin-dependent diabetic patient is seen today with the following blood sugar readings from home
47. Question: 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:
48. Question: The NP is managing care for a patient with hypoparathyroidism. He complains of numbness and tingling in his fingers and around him mouth. What electrolyte imbalance would you expect?
49. Question: Which of the following blood gas values illustrates respiratory acidosis?
50. Question: The NP is discharging a patient newly diagnosed with end stage renal disease that has been started on hemodialysis. The patient states he has frequent constipation at home. What over the counter product should the NP instruct the patient to AVOID?
51. Question: A 42 year old homeless man is found unresponsive. Upon arrival at the ER, his arterial blood gasses show:
52. Question: The NP is caring for a patient with post renal acute kidney injury (AKI). Which of the following would cause this?
53. Question: Which of the following initial diagnostic studies would not reflect DKA?
54. Question: The NP has ordered an IV magnesium infusion for a patient with a serum magnesium level of
55. Question: The NP is caring for a patient on BIPAP. His latest arterial blood gases indicate that an increase in tidal volume is needed. What changes in the BIPAP settings would you make to accomplish this?
56. Question: The NP is initiating procedural sedation for insertion of a central venous line. Which of the following is NOT a goal of procedural (moderate) sedation?
57. Question: Your patient has a post operative incision infecion. He has a low grade temperature and is allergic to sulfa. What oral antibiotic would provide empiric coverage for MRSA?
58. Question: The ACNP suspects her patient has pneumonia. The diagnostic tests that might be most helpful in supporting diagnosis of pneumonia would include:
59. Question: The NP is caring for a patient in the ICU with 45% body burns. He is intubated and ventilated due to inhalation injury.
60. Question: The NP is managing a patient with chronic renal failure. The patient reports that he has not been eating very much, has had a 10 pound weight loss in 3 months, and has not been able to take his calcium supplements? His serum calcium today is 6.9 What would be the next best action for the NP to take?
61. Question: The NP is admitting a patient from an extended care facility. The patients hematocrit is 55% and serums sodium is 155. Which of the following would be a cause of these findings
62. Question: A 56-year-old female Type 2 diabetic who presents to the ER complaining of abdominal pain, nausea, and vomiting for three days. She takes Metformin 1000 mg. BID and has good control of her blood glucose on this regimen. She has an abdominal CT with contrast, is diagnosed with iritable bowel syndrome, and admitted. As the ACNP you would do all the following EXCEPT:
63. Question: Which one of the following statements about acute respiratory distress syndrome (ARDS) is FALSE?
64. Question: A 72 year old ICU patient was intubated for increasing hypoxia due to pneumonia 2 days ago. The patient has been stable on the ventilator. Medication orders include antibiotics, propofol, and midazolam.
65. Question: A 30 year old patient with a history of type 2 diabetes is brought to the ER in a near comatose state. His heart rate is 124 bpm and the B/P is 90/50 mm hg. Initial laboratory evaluation reveals a blood glucose of 625 g/dl, . Urine glucose is 4+ and ketones are present in the urine. Serum potassium is 4.0 mEq/dL and serum osmolality is 32 mOsm/L. Which feature distinguishes DKA from HHS coma in this patient?
66. Question: A 78 year old man is admitted from an extended care facility with confusion and shortness of breath. He had been admitted there following a stroke. He has an indwelling urethral catheter.      His T is 102 pulse 112 RR 22  BP 86/62  oxygen saturation 94%. Chest x-ray is clear. Urinalysis shows 40 WBC, positive nitrites, positive leukocyte esterase. Pending the culture results, what antibiotics should be started now?
67. Question: The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of
68. Question: The NP responds to a rapid response team page regarding a 56 year old female with vomiting and diarrhea. The patient reported feeling very dizzy and had to be assisted to bed. VItal signs are BP 58/32 P 140. What IV fluid should the NP order?
69. Question: When evaluating the arterial blood gases (ABGs) of a patient with a 20 year history of chronic bronchitis, which of these would the healthcare provider expect?
70. Question: A 26 year old female arrives at the ED via EMS. She was found unarousable in her apartment by her roommate. T 101.2 RR 32 HR 110 BP 138/88 Pupils are equal, round, and reactive. There is no sign of trauma. Labs: NA 140 K 4.0 CL 102 BUN 16 CR 0.8 Arterial blood gas pH 7.20 pCO2 24 pO2 96% Which of the following are true?
71. Question: The NP is planning to repair multiple arm and leg lacerations on a multiple trauma patient in the ICU. What is the maximum number of ml of lidocaine with epinephrine this 92 kg patient can receive?
72. Question: A 32 year old women presents to the ER after being found clumped over the wheel unconcious in an automobile. Analyze the following ABG results:
73. Question: The NP is managing the care of a patient with diabetic ketoacidosis. The patients anion gap is now normal, hydration status appears normal, and serum blood sugar was 182. Normal saline IV fluids have been decreased to 50 cc/ hour and insulin drip was stopped. 6 hours ago. The NP is notified that the serum blood sugar prior to dinner was 332. How would you explain this rise in blood sugar?
74. Question: The NP is planning to repair multiple leg lacerations on a 13 year old girl in the ED. What is the maximum number of ml of lidocaine in this 60 kg patient can receive?
75. Question: The primary concern in the management of a patient with acute onset of DKA is: