ANCC ADULT GERONTOLOGY ACUTE CARE
NURSE PRACTITIONER ACTUAL QUESTIONS
WITH VERIFIED SOLUTIONS
◉ DI Hyperosmolar hypernatremia dry.
Answer: Serum sodium high, serum osmo high >290, urine osmo
low <100, urine spec grave 1.005 (urine is like water), urine sodium
>20, dehydration, if serum Na >150 give D5W to replace ½ volume
deficit in 12-24 hours, avoid rapid lowering of Na, DDAVP for acute
situations
◉ Serum Osmo.
Answer: 280
◉ Urine Osmo.
Answer: 300-800
◉ Sodium.
Answer: ~140
◉ Total cholesterol.
Answer: <200
,◉ Triglycerides.
Answer: <150
◉ HDL.
Answer: >40
◉ LDL.
Answer: <100
◉ Management of pulm edema.
Answer: 02, sitting up, morphine 2-4mg, Lasix 40, another Lasix 40
if needed
◉ Left heart failure.
Answer: LUNGS, dyspnea at rest, rales, wheezing, generally healthy
except acute event, S3, murmur of mitral regurg
◉ Right heart failure.
Answer: JVD, hepatomegaly, peripheral edema
◉ MR ASS.
,Answer: Mitral regurg, aortic stenosis, systolic murmurs
◉ MS ARD.
Answer: Mitral Stenosis, aortic regurg, diastolic
◉ Mitral murmur locations.
Answer: 5th ICS, apex
◉ Aortic murmur locations.
Answer: 2nd or 3rd ICS, base
◉ S1.
Answer: AV valves closed, SL open
◉ S2.
Answer: SL closed, AV open
◉ Cardiac blood flow.
Answer: SVC,RA, tricuspid, RV, pulmonic valve, pulmonary artery,
lungs, pulmonary veins, LA, mitral, LV, Aortic valve, aorta, body
◉ Cushing's.
, Answer: Moon face, buffalo hump, hypertension, HYPERglycemia,
HYPERnatremia, HYPOkalemia, tx depends on cause (stop meds,
tumor)
◉ Addison's ADRENOcorticoid deficiency.
Answer: Remember: SEX, SALT, and SUGAR
Deficient cortisol, androgens, and aldosterone, hyperpigmentation in
buccal mucosa, tanning, HYPOtension, scant hair, HYPOglycemia,
HYPOnatremia, HYPERkalemia, cosyntropin is the rule out for
addison's, manage: referral, glucorticoid, hydrocortisone,
fludrocortisone inpatient: hydrocortisone and fluids
◉ HYPERthyroidism/Grave's.
Answer: TSH LOW, T3 High, Grave's Disease, bulgy eyes, weight loss,
fine thin hair, smooth skin, a fib
Specialist referral, propranolol, methimazole, PTU, lugol's
◉ Thyroid crisis.
Answer: PTU or Methimazole with adjunct within 1 hour Lugol's
propranolol, hydrocortisone
No ASA
◉ Hypothyroidism.
Answer: (TSH assay most sensitive test) TSH ELEVATED, T4 LOW
NURSE PRACTITIONER ACTUAL QUESTIONS
WITH VERIFIED SOLUTIONS
◉ DI Hyperosmolar hypernatremia dry.
Answer: Serum sodium high, serum osmo high >290, urine osmo
low <100, urine spec grave 1.005 (urine is like water), urine sodium
>20, dehydration, if serum Na >150 give D5W to replace ½ volume
deficit in 12-24 hours, avoid rapid lowering of Na, DDAVP for acute
situations
◉ Serum Osmo.
Answer: 280
◉ Urine Osmo.
Answer: 300-800
◉ Sodium.
Answer: ~140
◉ Total cholesterol.
Answer: <200
,◉ Triglycerides.
Answer: <150
◉ HDL.
Answer: >40
◉ LDL.
Answer: <100
◉ Management of pulm edema.
Answer: 02, sitting up, morphine 2-4mg, Lasix 40, another Lasix 40
if needed
◉ Left heart failure.
Answer: LUNGS, dyspnea at rest, rales, wheezing, generally healthy
except acute event, S3, murmur of mitral regurg
◉ Right heart failure.
Answer: JVD, hepatomegaly, peripheral edema
◉ MR ASS.
,Answer: Mitral regurg, aortic stenosis, systolic murmurs
◉ MS ARD.
Answer: Mitral Stenosis, aortic regurg, diastolic
◉ Mitral murmur locations.
Answer: 5th ICS, apex
◉ Aortic murmur locations.
Answer: 2nd or 3rd ICS, base
◉ S1.
Answer: AV valves closed, SL open
◉ S2.
Answer: SL closed, AV open
◉ Cardiac blood flow.
Answer: SVC,RA, tricuspid, RV, pulmonic valve, pulmonary artery,
lungs, pulmonary veins, LA, mitral, LV, Aortic valve, aorta, body
◉ Cushing's.
, Answer: Moon face, buffalo hump, hypertension, HYPERglycemia,
HYPERnatremia, HYPOkalemia, tx depends on cause (stop meds,
tumor)
◉ Addison's ADRENOcorticoid deficiency.
Answer: Remember: SEX, SALT, and SUGAR
Deficient cortisol, androgens, and aldosterone, hyperpigmentation in
buccal mucosa, tanning, HYPOtension, scant hair, HYPOglycemia,
HYPOnatremia, HYPERkalemia, cosyntropin is the rule out for
addison's, manage: referral, glucorticoid, hydrocortisone,
fludrocortisone inpatient: hydrocortisone and fluids
◉ HYPERthyroidism/Grave's.
Answer: TSH LOW, T3 High, Grave's Disease, bulgy eyes, weight loss,
fine thin hair, smooth skin, a fib
Specialist referral, propranolol, methimazole, PTU, lugol's
◉ Thyroid crisis.
Answer: PTU or Methimazole with adjunct within 1 hour Lugol's
propranolol, hydrocortisone
No ASA
◉ Hypothyroidism.
Answer: (TSH assay most sensitive test) TSH ELEVATED, T4 LOW
