ACNP III Final Exam with Complete
Solutions
Means of accidental poisoning Correct Ans-mislabeled cleaning products, broken seals on
medication,
fertilizers and pesticides, doubling up on products
containing acetaminophen, space heater in the garage, fruity or tasty looking
cleaning products (tide pods), mixing of chemicals (bleach and ammonia), over
medicating (misreading or taking too much).
Clinical manifestations Correct Ans-Carbon Monoxide (CO): headache, dizziness, altered
level of responsiveness, weakness, nausea, vomiting, chest pain, and confusion, sleepiness
(people can go to sleep and never wake up). CO binds to hemoglobin resulting in impaired
oxygen transport and utilization because CO has a higher affinity for hemoglobin than oxygen
does.
Acetaminophen (APAP): nausea, vomiting, abdominal pain, jaundice, as toxicity progresses
metabolic acidosis, AKI, coagulopathies, transaminase elevation and progressing to fulminate
hepatic failure. The most common cause of acute liver failure in the United states
Salicylates (ASA): Nausea, vomiting, tinnitus, tachypnea(hyperpnea), tachycardia, diaphoresis,
malaise, metabolic acidosis, seizures, altered LOR,
management of accidental poisoning Correct Ans-• ABC's
• Supportive care: fluids, vasopressors, mechanical ventilation.
• Thorough history(pill bottles, odors at the scene, clues from EMS, bystanders, friends, and
family.
,• Physical exam: Vital signs, mental status, pupillary exam are the most useful elements and
allow classification of the patient into either a state of physiologic excitation or depression
(UpToDate, 2019).
• Poison control 1-800-222-1222
Clinical manifestations of a nicotine addiction Correct Ans-● Cannot quit despite serious but
unsuccessful attempts to stop.
● Withdrawal symptoms during attempts to quit that include strong cravings, anxiety,
irritability, restlessness, difficulty concentrating, depression, anger, insomnia, or
changes in bowel habits.
● The patient cannot quit despite serious health problems.
● Social or recreational activities are avoided because the patient cannot smoke in those
locations or situations.
Test for nicotine dependence Correct Ans-Fagertrom's Test:
1.
Low: no NRT
2.
Low/moderate: treated with single
agent NRT
3.
Moderate: treated with a
combination of NRT (long acting with short acting)
,4.
High: can be treated with a
combination of NRT with oral agent
The US Preventative Services Task Force (USPSTF) for smoking cessation Correct Ans-· 5
A's:
o Ask about tobacco use
o Advise to quit
o Assess for readiness and potential challenges
o Assist with medication, referrals to smoking cessation programs
o Arrange for follow up
·
5 R's:
o Relevance - ask why quitting is relevant/important
o Risks - discuss the risks associated with continued smoking such as lung cancer, COPD, heart
disease, stroke, etc.
o Rewards - these may include improved health, better tasting food, saving money, improved
sense of smell, setting a good example for children, decreased signs of aging, and improved
health.
o Roadblocks - such as fear of failure, weight gain, lack of support, depression, and being around
other tobacco users.
Repetition - explain that many smokers may relapse; repeated attempts to quit may be necessary
before success
, Lung cancer screening recommendations Correct Ans-· Have a history of heavy smoking (30
pack years or more), and
· Smoke now or have quit within the past 15 years, and
· Are between 55 and 80 years old.
stop when the person being screened
· Turns 81 years old, or
· Has not smoked in 15 or more years, or
· Develops a health problem that makes him or her unwilling or unable to have surgery if lung
cancer is found.
toxidromes Correct Ans-any substance that results in dysfunction due to toxic levels in the
body. A
correct diagnosis requires subjective assessment, physical exam and ancillary
testing
Common Toxidromes Correct Ans-Non-benzodiazepine
GABA agonist
Serotonergics
Sedatives/
Hypnotics
Solutions
Means of accidental poisoning Correct Ans-mislabeled cleaning products, broken seals on
medication,
fertilizers and pesticides, doubling up on products
containing acetaminophen, space heater in the garage, fruity or tasty looking
cleaning products (tide pods), mixing of chemicals (bleach and ammonia), over
medicating (misreading or taking too much).
Clinical manifestations Correct Ans-Carbon Monoxide (CO): headache, dizziness, altered
level of responsiveness, weakness, nausea, vomiting, chest pain, and confusion, sleepiness
(people can go to sleep and never wake up). CO binds to hemoglobin resulting in impaired
oxygen transport and utilization because CO has a higher affinity for hemoglobin than oxygen
does.
Acetaminophen (APAP): nausea, vomiting, abdominal pain, jaundice, as toxicity progresses
metabolic acidosis, AKI, coagulopathies, transaminase elevation and progressing to fulminate
hepatic failure. The most common cause of acute liver failure in the United states
Salicylates (ASA): Nausea, vomiting, tinnitus, tachypnea(hyperpnea), tachycardia, diaphoresis,
malaise, metabolic acidosis, seizures, altered LOR,
management of accidental poisoning Correct Ans-• ABC's
• Supportive care: fluids, vasopressors, mechanical ventilation.
• Thorough history(pill bottles, odors at the scene, clues from EMS, bystanders, friends, and
family.
,• Physical exam: Vital signs, mental status, pupillary exam are the most useful elements and
allow classification of the patient into either a state of physiologic excitation or depression
(UpToDate, 2019).
• Poison control 1-800-222-1222
Clinical manifestations of a nicotine addiction Correct Ans-● Cannot quit despite serious but
unsuccessful attempts to stop.
● Withdrawal symptoms during attempts to quit that include strong cravings, anxiety,
irritability, restlessness, difficulty concentrating, depression, anger, insomnia, or
changes in bowel habits.
● The patient cannot quit despite serious health problems.
● Social or recreational activities are avoided because the patient cannot smoke in those
locations or situations.
Test for nicotine dependence Correct Ans-Fagertrom's Test:
1.
Low: no NRT
2.
Low/moderate: treated with single
agent NRT
3.
Moderate: treated with a
combination of NRT (long acting with short acting)
,4.
High: can be treated with a
combination of NRT with oral agent
The US Preventative Services Task Force (USPSTF) for smoking cessation Correct Ans-· 5
A's:
o Ask about tobacco use
o Advise to quit
o Assess for readiness and potential challenges
o Assist with medication, referrals to smoking cessation programs
o Arrange for follow up
·
5 R's:
o Relevance - ask why quitting is relevant/important
o Risks - discuss the risks associated with continued smoking such as lung cancer, COPD, heart
disease, stroke, etc.
o Rewards - these may include improved health, better tasting food, saving money, improved
sense of smell, setting a good example for children, decreased signs of aging, and improved
health.
o Roadblocks - such as fear of failure, weight gain, lack of support, depression, and being around
other tobacco users.
Repetition - explain that many smokers may relapse; repeated attempts to quit may be necessary
before success
, Lung cancer screening recommendations Correct Ans-· Have a history of heavy smoking (30
pack years or more), and
· Smoke now or have quit within the past 15 years, and
· Are between 55 and 80 years old.
stop when the person being screened
· Turns 81 years old, or
· Has not smoked in 15 or more years, or
· Develops a health problem that makes him or her unwilling or unable to have surgery if lung
cancer is found.
toxidromes Correct Ans-any substance that results in dysfunction due to toxic levels in the
body. A
correct diagnosis requires subjective assessment, physical exam and ancillary
testing
Common Toxidromes Correct Ans-Non-benzodiazepine
GABA agonist
Serotonergics
Sedatives/
Hypnotics
