ACNP BOARD REVIEW- QUESTIONS &
ANSWERS
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. Correct Ans-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. Correct Ans-
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 Correct Ans-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. Correct Ans-perform a ventriculostomy and
drainage of cerebrospinal fluid.
Usual treatment are:
mannitol and sedatives, surgery
due to acute elevation of ICP, surgery is preferred.
ANSWERS
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. Correct Ans-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. Correct Ans-
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 Correct Ans-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. Correct Ans-perform a ventriculostomy and
drainage of cerebrospinal fluid.
Usual treatment are:
mannitol and sedatives, surgery
due to acute elevation of ICP, surgery is preferred.
