Page 1 of 17
“ ADULT-GERONTOLOGY ACUTE CARE
NURSE”LATEST EXAM SOLVED QUESTIONS &
ANSWERS VERIFIED 100% GRADED A+ (LATEST
VERSION) WELL REVISED 100% GUARANTEE
PASS
Adult-Gerontology Acute Care Nurse Practitioner Certification ENDOCRINE
1. A 25-year-old male patient is admitted to the intensive care unit after a motor
vehicle collision resulting in an isolated severe traumatic brain injury causing
elevated intracranial pressure. He is on a ventilator and minimally responsive.
On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. To address this problem, the
nurse practitioner would:
1. Order a fluid restriction.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of the head.
Answer:2. Order serum sodium, urine-specific gravity.
Rationale: This scenario suggests a diagnosis of diabetes insipidus, for which serum
sodium and urine specific gravity will aid in the diagnosis.
, Page 2 of 17
2. A 25-year-old male patient is admitted to the intensive care unit after a motor
vehicle collision resulting in an isolated severe traumatic brain injury causing
elevated intracranial pressure. He is on a ventilator and minimally responsive.
On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. His serum sodium increased
from 146 to 155 in the last 6 hours and urine specific gravity (SG) is 1.001. To
address this problem, the nurse practitioner would:
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
2. Increase maintenance fluids from 75 to 150 mL/hr and repeat sodium and SG
in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water via nasogastric tube.
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
Rationale: This patient has central diabetes insipidus from pituitary compression.
Treatment involves urgent administration of desmopressin and fluids to attenuate the
hypernatremia.
3. A 68-year-old 70-kg male patient with a history of tobacco abuse was
admitted with dyspnea. A chest x-ray revealed a pulmonary mass, flattened
bilateral diaphragm, and no pulmonary edema. He is alert and breathing
comfortably after being started on 4 L of oxygen via nasal cannula. His initial
sodium is 128 mEq/L. Based on the nurse practitioner's knowledge of the
probable diagnosis, how would the nurse practitioner correct his sodium?
1. Start 3% saline at 75 mL/hr.
2. Start 0.9% saline at 1000 mL/hr.
3. Institute a fluid restriction.
4. Order 40 mg furosemide and repeat sodium in 8 hours.
3. Institute a fluid restriction.
Rationale: The syndrome of inappropriate antidiuretic hormone is commonly caused
by pulmonary disease and malignancy. First-line treatment is a fluid restriction in the
absence of symptoms such as seizure, mental status change, and falls.
4. A 55-year-old female patient with a history of type 2 diabetes and
diverticulitis is admitted to the intensive care unit following laparotomy for
colectomy. She remains intubated and requires norepinephrine at 0.06
mcg/kg/min to maintain a mean arterial pressure greater than 65 mmHg
, Page 3 of 17
despite adequate intraoperative fluid resuscitation. Her blood glucose is 220
mg/dL. The nurse practitioner's initial glucose management strategy will entail
starting:
1. Insulin(R) infusion with target glucose less than 120 mg/dL.
2. Insulin(R) subcutaneous (SQ) sliding scale with target glucose 140 to 180
mg/dL.
3. Insulin(R) SQ sliding scale with target glucose less than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
Rationale: Preferred insulin route in the intensive care unit setting is intravenous
infusion with a target of 140 to 180 mg/dL to avoid hypoglycemic complications.
Vasoconstriction and edema of subcutaneous tissue can alter absorption.
5. A 55-year-old female patient with a history of type 2 diabetes and
diverticulitis was admitted to the intensive care unit after laparotomy for
colectomy. She was briefly intubated and on vasopressors. She is now
weaned off norepinephrine and transferred to a med/surg floor. She is
tolerating oral nutrition with a carbohydrate-controlled diet and is still on
insulin infusion at 0.5 units/hr with a 24-hour glucose range of 150 to 180
mg/dL. Her home regimen involves metformin 1000 mg twice a day (BID) by
mouth and a carbohydrate-controlled diet. Hemoglobin A1c is 7.8%. The most
appropriate next step in the management of this patient's diabetes is:
1. Restart home metformin and monitor blood glucose Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcutaneous sliding scale.
1. Restart home metformin and monitor blood glucose Q achs.
Rationale: This patient had adequate glucose control and can be safely transitioned
back to her home regimen in the absence of other contraindications.
6. An 85-year-old female patient is admitted to a med/surg floor with a urinary
tract infection and confusion. She is tolerating a regular diet and has no
history of diabetes. The glucose on her initial chemistry panel is 230 mg/dL
and hemoglobin A1c is 10%. The most appropriate management of this
patient's glucose is:
1. Start insulin infusion and follow glucose once every hour.
“ ADULT-GERONTOLOGY ACUTE CARE
NURSE”LATEST EXAM SOLVED QUESTIONS &
ANSWERS VERIFIED 100% GRADED A+ (LATEST
VERSION) WELL REVISED 100% GUARANTEE
PASS
Adult-Gerontology Acute Care Nurse Practitioner Certification ENDOCRINE
1. A 25-year-old male patient is admitted to the intensive care unit after a motor
vehicle collision resulting in an isolated severe traumatic brain injury causing
elevated intracranial pressure. He is on a ventilator and minimally responsive.
On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. To address this problem, the
nurse practitioner would:
1. Order a fluid restriction.
2. Order serum sodium, urine-specific gravity.
3. Order 24-hour urine protein and creatinine.
4. Order a stat noncontrast computed tomography of the head.
Answer:2. Order serum sodium, urine-specific gravity.
Rationale: This scenario suggests a diagnosis of diabetes insipidus, for which serum
sodium and urine specific gravity will aid in the diagnosis.
, Page 2 of 17
2. A 25-year-old male patient is admitted to the intensive care unit after a motor
vehicle collision resulting in an isolated severe traumatic brain injury causing
elevated intracranial pressure. He is on a ventilator and minimally responsive.
On the second day of hospitalization, he has increasing vasopressor
requirements and hourly urine output of 400 mL. His serum sodium increased
from 146 to 155 in the last 6 hours and urine specific gravity (SG) is 1.001. To
address this problem, the nurse practitioner would:
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
2. Increase maintenance fluids from 75 to 150 mL/hr and repeat sodium and SG
in 6 hours.
3. Order 2 mcg DDAVP IV and fluid restriction.
4. Calculate the free water deficit and order free water via nasogastric tube.
1. Order 2 mcg desmopressin (DDAVP) intravenously (IV) and 1 L 0.9% saline.
Rationale: This patient has central diabetes insipidus from pituitary compression.
Treatment involves urgent administration of desmopressin and fluids to attenuate the
hypernatremia.
3. A 68-year-old 70-kg male patient with a history of tobacco abuse was
admitted with dyspnea. A chest x-ray revealed a pulmonary mass, flattened
bilateral diaphragm, and no pulmonary edema. He is alert and breathing
comfortably after being started on 4 L of oxygen via nasal cannula. His initial
sodium is 128 mEq/L. Based on the nurse practitioner's knowledge of the
probable diagnosis, how would the nurse practitioner correct his sodium?
1. Start 3% saline at 75 mL/hr.
2. Start 0.9% saline at 1000 mL/hr.
3. Institute a fluid restriction.
4. Order 40 mg furosemide and repeat sodium in 8 hours.
3. Institute a fluid restriction.
Rationale: The syndrome of inappropriate antidiuretic hormone is commonly caused
by pulmonary disease and malignancy. First-line treatment is a fluid restriction in the
absence of symptoms such as seizure, mental status change, and falls.
4. A 55-year-old female patient with a history of type 2 diabetes and
diverticulitis is admitted to the intensive care unit following laparotomy for
colectomy. She remains intubated and requires norepinephrine at 0.06
mcg/kg/min to maintain a mean arterial pressure greater than 65 mmHg
, Page 3 of 17
despite adequate intraoperative fluid resuscitation. Her blood glucose is 220
mg/dL. The nurse practitioner's initial glucose management strategy will entail
starting:
1. Insulin(R) infusion with target glucose less than 120 mg/dL.
2. Insulin(R) subcutaneous (SQ) sliding scale with target glucose 140 to 180
mg/dL.
3. Insulin(R) SQ sliding scale with target glucose less than 120 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
4. Insulin(R) infusion with target glucose 140 to 180 mg/dL.
Rationale: Preferred insulin route in the intensive care unit setting is intravenous
infusion with a target of 140 to 180 mg/dL to avoid hypoglycemic complications.
Vasoconstriction and edema of subcutaneous tissue can alter absorption.
5. A 55-year-old female patient with a history of type 2 diabetes and
diverticulitis was admitted to the intensive care unit after laparotomy for
colectomy. She was briefly intubated and on vasopressors. She is now
weaned off norepinephrine and transferred to a med/surg floor. She is
tolerating oral nutrition with a carbohydrate-controlled diet and is still on
insulin infusion at 0.5 units/hr with a 24-hour glucose range of 150 to 180
mg/dL. Her home regimen involves metformin 1000 mg twice a day (BID) by
mouth and a carbohydrate-controlled diet. Hemoglobin A1c is 7.8%. The most
appropriate next step in the management of this patient's diabetes is:
1. Restart home metformin and monitor blood glucose Q achs.
2. Continue the insulin infusion for 24 more hours.
3. Restart and increase metformin to 2000 mg BID.
4. Start insulin glargine 12 units daily and a subcutaneous sliding scale.
1. Restart home metformin and monitor blood glucose Q achs.
Rationale: This patient had adequate glucose control and can be safely transitioned
back to her home regimen in the absence of other contraindications.
6. An 85-year-old female patient is admitted to a med/surg floor with a urinary
tract infection and confusion. She is tolerating a regular diet and has no
history of diabetes. The glucose on her initial chemistry panel is 230 mg/dL
and hemoglobin A1c is 10%. The most appropriate management of this
patient's glucose is:
1. Start insulin infusion and follow glucose once every hour.
