Acute Care AGACNP Test 1
Gastroenteritis
Crampy, at any age. Diarrhea, Nausea, and vomiting Food, fever, occasional relief from
diarrhea or vomiting, and hyperactive peristalsis Gastritis The patient's nature Especially
patients who are alcoholics Gastritis is the source of pain. Epigastrium
S/S appendicitis Vomiting (after pain has started)
Constipation
Fever
appendicitis
Early: epigastrium, later: periumbilicus Cholecystitis, cholelithiasis LOCATION OF PAIN
RUQ
Radiates to inferior angle of right scapula
Associated symptoms of cholecystitis and cholelithiasis Vomiting and vomiting Dark stools
and urine bloating; fatty foods Oral contraceptives and drugs Cholestyramine
Cholecystitis, cholelithiasis
Tenderness when pressed or felt in RUQ Diverticulitis
LLQ, LLQ's palpable mass Pancreatitis: Where the Pain Is epigastric LUQ Radiates to back
Factors that Ameliorate Pancreatitis supine position Moving forward Pancreatitis-PHYSICAL
FINDINGS
Abdominal distention
fewer bowel movements Diffuse rebound
Murphy's warning acute pancreatitis
epigastric LUQ radiates backwards Peptic ulcer with perforation
palpation or percussion of the epigastric region Aortic aneurysm rupture or dissection Chest
or abdomen
May radiate to back and leg
Murmurs
Plan-Do-Study-Act (PDSA) model
ECG with 12 leads ABG
Insufficiency of the vena Patient will have obesity or be pregnant or older
History of prolonged standing, family history of venous insufficiency
reveals leg swelling PE will show skin changes, ulceration, edema, varicose veins
Imaging will show valvular abnormalities
An examination and history are used to make a diagnosis. Most commonly caused by
valvular abnormalities
Leg elevation, compression therapy, ulcer care, and ablation are the treatments. A woman
in her 34s presents with palpitations. Which of the following might you expect to hear on
examination if she has mitral valve prolapse?
Mid-systolic click
Prolapse of the Mitral Valve Patient presents with palpitations, dyspnea, nonexertional CP,
and fatigue
The majority of cases lack symptoms. PE will show midsystolic click and late systolic
murmur
, ↑ preload → ↓ murmur
murmur of preload Marfan syndrome, Ehlers-Danlos
Echo is used to make a diagnosis. A patient in the intensive care unit develops sinus
bradycardia with tall peaked T waves and absent P waves on ECG. Which electrolyte
abnormality is associated with these changes seen on ECG?
Hyperkalemia
Hyperkalemia
Rhabdomyolysis, tumor lysis, kidney failure, and DKA history sluggishness, weakness, and
paralysis Dysrhythmias in the heart, hypotension, and bradycardia will be seen in the PE.
ECG will show peaked T waves, prolonged PR, wide QRS
Treatment is calcium gluconate, insulin, albuterol, bicarbonate
In cardiogenic shock, which of the following hemodynamic parameters decreases?
ventricular output How is cardiac index calculated?
The cardiac output minus the body surface area is the cardiac index. Which of the following
serum tests should be performed frequently on a patient receiving parenteral nutrition to
monitor for intravenous fat emulsion-related complications? Triglycerides
What is the recommended method to treat hyperglycemia associated with parenteral
nutrition?
The preparation for parenteral nutrition should now include regular insulin. Convenience
barrier can be
is a potential obstacle to compliance, which can be influenced by telemedicine, medication
administration methods, access to healthcare, and other factors. Racial disparities in health
care
barriers to compliance are more common among African-American and Hispanic
populations when compared to Caucasians.
Cholecystitis
Colicky, steadily increasing RUQ or epigastric pain after eating fatty foods
PE will show Murphy sign, Boas sign (hyperaesthesia, increased or altered sensitivity,
below the right scapula)
Diagnosis
Initial: US
Gold standard: HIDA
The most common cause is gallstone obstruction. Treatment is cholecystectomy
Cerebral hyperperfusion syndrome
Increased cerebral perfusion following carotid endarterectomy can lead to intracerebral
edema or hemorrhage. Hypertension is a precursor of cerebral hyperperfusion injury so
blood pressure must be carefully controlled postoperatively.
The initial symptom of reperfusion injury is severe headache often in association with
severely elevated blood pressure
What are the consequences of a ruptured ectopic pregnancy? Hemorrhage.
Which kind of study design can be used to find out if an intervention can change how a
disease progresses? Randomized control trial
What other methods are available to the AGACNP to enhance therapeutic communication?
Active listening (Listen more and talk less).
What percentage of the physician's fee are nurse practitioners reimbursed for under
Medicare? 85%
Gastroenteritis
Crampy, at any age. Diarrhea, Nausea, and vomiting Food, fever, occasional relief from
diarrhea or vomiting, and hyperactive peristalsis Gastritis The patient's nature Especially
patients who are alcoholics Gastritis is the source of pain. Epigastrium
S/S appendicitis Vomiting (after pain has started)
Constipation
Fever
appendicitis
Early: epigastrium, later: periumbilicus Cholecystitis, cholelithiasis LOCATION OF PAIN
RUQ
Radiates to inferior angle of right scapula
Associated symptoms of cholecystitis and cholelithiasis Vomiting and vomiting Dark stools
and urine bloating; fatty foods Oral contraceptives and drugs Cholestyramine
Cholecystitis, cholelithiasis
Tenderness when pressed or felt in RUQ Diverticulitis
LLQ, LLQ's palpable mass Pancreatitis: Where the Pain Is epigastric LUQ Radiates to back
Factors that Ameliorate Pancreatitis supine position Moving forward Pancreatitis-PHYSICAL
FINDINGS
Abdominal distention
fewer bowel movements Diffuse rebound
Murphy's warning acute pancreatitis
epigastric LUQ radiates backwards Peptic ulcer with perforation
palpation or percussion of the epigastric region Aortic aneurysm rupture or dissection Chest
or abdomen
May radiate to back and leg
Murmurs
Plan-Do-Study-Act (PDSA) model
ECG with 12 leads ABG
Insufficiency of the vena Patient will have obesity or be pregnant or older
History of prolonged standing, family history of venous insufficiency
reveals leg swelling PE will show skin changes, ulceration, edema, varicose veins
Imaging will show valvular abnormalities
An examination and history are used to make a diagnosis. Most commonly caused by
valvular abnormalities
Leg elevation, compression therapy, ulcer care, and ablation are the treatments. A woman
in her 34s presents with palpitations. Which of the following might you expect to hear on
examination if she has mitral valve prolapse?
Mid-systolic click
Prolapse of the Mitral Valve Patient presents with palpitations, dyspnea, nonexertional CP,
and fatigue
The majority of cases lack symptoms. PE will show midsystolic click and late systolic
murmur
, ↑ preload → ↓ murmur
murmur of preload Marfan syndrome, Ehlers-Danlos
Echo is used to make a diagnosis. A patient in the intensive care unit develops sinus
bradycardia with tall peaked T waves and absent P waves on ECG. Which electrolyte
abnormality is associated with these changes seen on ECG?
Hyperkalemia
Hyperkalemia
Rhabdomyolysis, tumor lysis, kidney failure, and DKA history sluggishness, weakness, and
paralysis Dysrhythmias in the heart, hypotension, and bradycardia will be seen in the PE.
ECG will show peaked T waves, prolonged PR, wide QRS
Treatment is calcium gluconate, insulin, albuterol, bicarbonate
In cardiogenic shock, which of the following hemodynamic parameters decreases?
ventricular output How is cardiac index calculated?
The cardiac output minus the body surface area is the cardiac index. Which of the following
serum tests should be performed frequently on a patient receiving parenteral nutrition to
monitor for intravenous fat emulsion-related complications? Triglycerides
What is the recommended method to treat hyperglycemia associated with parenteral
nutrition?
The preparation for parenteral nutrition should now include regular insulin. Convenience
barrier can be
is a potential obstacle to compliance, which can be influenced by telemedicine, medication
administration methods, access to healthcare, and other factors. Racial disparities in health
care
barriers to compliance are more common among African-American and Hispanic
populations when compared to Caucasians.
Cholecystitis
Colicky, steadily increasing RUQ or epigastric pain after eating fatty foods
PE will show Murphy sign, Boas sign (hyperaesthesia, increased or altered sensitivity,
below the right scapula)
Diagnosis
Initial: US
Gold standard: HIDA
The most common cause is gallstone obstruction. Treatment is cholecystectomy
Cerebral hyperperfusion syndrome
Increased cerebral perfusion following carotid endarterectomy can lead to intracerebral
edema or hemorrhage. Hypertension is a precursor of cerebral hyperperfusion injury so
blood pressure must be carefully controlled postoperatively.
The initial symptom of reperfusion injury is severe headache often in association with
severely elevated blood pressure
What are the consequences of a ruptured ectopic pregnancy? Hemorrhage.
Which kind of study design can be used to find out if an intervention can change how a
disease progresses? Randomized control trial
What other methods are available to the AGACNP to enhance therapeutic communication?
Active listening (Listen more and talk less).
What percentage of the physician's fee are nurse practitioners reimbursed for under
Medicare? 85%
