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ACNP I Midterm Exam – Questions & Answers (Solved)
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ACNP I Midterm Exam – Questions & Answers (Solved)
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ACNP I Midterm Exam – Questions & Answers (Solved)Immediately Life-Threatening Causes of Altered Mental Status (AMS) Right
Ans - •Arrhythmias
•CO2 narcosis
•Hypoxia
•Loss of airway
•Shock (brain hypoperfusion)
•Cardiogenic
•Distributive (septic, anaphylactic, neurogenic)
•Hypovolemic
•Obstructive
•Stroke
•Ischemic
•Hemorrhagic
Neurologic Causes for AMS Right Ans - •Stroke/TIA
•Structural brain disease
•Tumors: primary or metastatic
•Encephalitis, meningitis, other neurological infections
•Postictal
•Seizures (including partial and subclinical)
•Wernicke's encephalopathy
•Korsakoff syndrome
Metabolic Causes for AMS Right Ans - •Hyper/hypoglycemia
•Hyper/hyponatremia
•Hypercalcemia
•Hyper/hypothyroid
•Encephalopathy
•Hepatic failure, renal failure, drug-induced
•Medications
•Drug or ETOH intoxication or withdrawal
Delirium is a diagnosis of ...... Right Ans - exclusion (always rule out
pathologic causes first)
Immediate Work-Up for AMS Right Ans - •ABG
•Blood glucose
,•CBC with difference
•BMP, Mg
•Lactic acid
•Liver function tests
•Thyroid function tests
•Drug/ETOH screen
•EKG
Other Tests to Consider for AMS Right Ans - •Ammonia (NH3)
•VDRL/RPR
•R/o syphilis
•Vitamin B12
•Folate
•Tests for specific toxic ingestions, if indicated
•Acetaminophen
•Salicylic acid
•And many others
•CT head
•MRI head
•EEG
•Lumbar puncture
Signs and Symptoms Right Ans - •Syndrome that occurs after stopping
heavy and prolonged ETOH use
•Can occur within 12-48 hours after stopping ETOH in any person who is
physically dependent on ETOH
•Agitation
•Anxiety
•Tremors
•Nausea and vomiting
•Weakness
•Diaphoresis
•Hallucinations
•Confusion
•Delirium
•Tachycardia
•HTN
•Fever
•Tonic-clonic seizures
, CIWA-AD (Clinical Institute Withdrawal Assessment for Alcohol) Right Ans
- •Quantifies severity of withdrawal
•Guides patient care
•Benzodiazepines are the mainstay of treatment
•Remember: if giving haloperidol (Haldol), monitor the patient's QT interval;
Haldol can prolong the QT and lead to Torsades
Clinical Opioid Withdrawal Scale (COWS) Right Ans - •Used to help
clinicians determine the stage or severity of opiate withdrawal and assess the
level of physical dependence on opioids
•Caution: opioid withdrawal can have flu-like symptoms; don't give the
patient more than the lowest score in a category, unless they are exhibiting
some signs of withdrawal
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•Score:
•5-12 = mild
•13-24 = moderate
•25-36 = moderately severe
•>36 = severe withdrawal
•Methadone
•Buprenorphine
•Much of the treatment is symptomatic:
•Alpha and beta-blockers: decrease somatic symptoms
•Nausea/vomiting: Odansetron (Zofran)
•Diarrhea: loperamide (Immodium)
•Abdominal cramping: Dicyclomine (Bentyl)
•Myalgias, athralgias: Acetaminophen, Ibuprofen
Delirium: Contributing Factors Right Ans - •Systemic illness
•Fever, infection, metabolic imbalances
•Check for hypoxia, hypercarbia
•Acute renal failure
•Electrolyte imbalances
•Dehydration
•Cardiopulmonary bypass
•Medications
•Drug or alcohol withdrawal
•Sleep deprivation
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