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ACNP III Midterm Exam: Questions With A+ Solutions
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ACNP III Midterm Exam: Questions With A+ Solutions
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ACNP III Midterm Exam: Questions With A+ SolutionsA 76-year-old male has been in the ICU of 10 days recovering from
Community Acquired Pneumonia. The night nurse calls the AG-ACNP to report
the patient has been awake all night and is now agitated and will not take his
medications. Upon Exam, the patient is noticeably confused and does not
remember why he is in the hospital. He is yelling and combative with the staff
as the struggle to keep him from hurting himself. Which of the following is
appropriate step in managing this patient?
A. Move the patient down the hall to a quieter room
B. Call the patient's family and ask if someone can speak to him to help him to
reorient
C. Prescribe lorazepam (Ativan 0.5) IV every 2 hours as needed for agitation
D. Check a corrected QT(QTc) and prescribe haloperidol (Haldol) 2.5 mg IV x1
now for agitation Right Ans - D
A 35 year old female patient is admitted with community acquired
pneumonia(CAP). While being interviewed, the patient confides that she
drinks 6-7 alcoholic beverages almost every day. Her last drink was earlier
this morning. What should the AG-ACNP order for this patient?
A. CIWA
B. Disulfiram (Antabuse) on discharge
C. Periodic Opioid therapy to prevent withdrawal
D. Phenytoin to be given in case the patient seizes Right Ans - A
A confused older adult patient in a skilled nursing facility was asleep when
unlicensed assistive personnel (UAP) entered the room quietly and touched
the bed to see if it was wet. The patient awakened and hit the UAP in the face.
Which statement best explains the patient's action?
a. older adult patients often demonstrate exaggerations of behaviors used
earlier in life.
b. Crowding in skilled nursing facilities increases an individual's tendency
toward violence.
c. The patient learned violent behavior by watching other patients act out.
d. The patient interpreted the UAP's behavior as potentially harmful. Right
Ans - D
,Two main classes of drugs for pharm management in an agitated pt Right
Ans - Benzos, anticholingerics
5 Strategies for providers dealing with agitated patient/family dynamics
Right Ans - Strategy 1, checking your emotional posture, encourages nurses to
become mindful of any emotional vigilance during an interaction with a family
Strategy 2, becoming an ally to the family, emphasizes the benefits of
acknowledging the multiple perspectives in a family
Strategy 3, frame choices, describes ways to address discrepant perspectives
between the family and healthcare worker, enabling the nurse to maintain
collaboration and support to the family
Strategy 4, respond empathically, involves acknowledging, validating, and
normalizing sources of distress and/or mistakes made.
Strategy 5, block escalation if inevitable, recognizes those occasions when the
nurse or the family becomes too distressed to maintain constructive
discussion, at which point facilitating a transition to a "timeout" with a clear
plan to return is an encouraged solution.
Which of the following patients is most likely to be subjected to intimate
personal violence?
49 year old female, married, mother of 3 young adults, who works in
hospitality
26 year old male, married, currently in graduate school
74 year old male, widowed, living in an assisted living facility
21 year old female, unmarried & cohabitating, unemployed, pregnant with
second child (toddler from a previous relationship) Right Ans - 21 year old
female, unmarried & cohabitating, unemployed, pregnant with second child
(toddler from a previous relationship)
Which of the following statements is characteristic of intimate personal
violence?
Only heterosexual women are victims.
Intimate personal violence only encompasses physical assaults.
Women are at highest risk of intimate personal violence during childbearing
ages.
,Intimate personal violence only impacts the lower socioeconomic
demographic segments of society. Right Ans - Women are at highest risk of
intimate personal violence during childbearing ages.
Who is at highest risk for IPV? Right Ans - Women of childbearing ages are
at the highest risk for intimate personal violence, which is why ACOG, AAP,
AMA, ANA, JCAHO, and DHHS all recommend regular IPV screening at well-
women exams, during initial pregnancy contacts, during each trimester, and at
the post-partum medical checks.
Hallmark sign/dynamic of IPV Right Ans - The most common underlying
dynamic noted within IPV is the use of violence or force by which the abuser
exerts control over the victim.
Who should be screened for IPV Right Ans - • All women of childbearing
age, at annual well-women exams and subsequent obstetric appointments
(emphasis on initial, each trimester, and postpartum exams)
• All women with chronic headaches, abdominal pain, or frequent STI's
• Any unplanned encounters for injuries that require medical attention (ER,
urgent care, etc).
• All geriatric patients with potential neglect occurring • Any patient with
frequent benign complaints, or those accompanied by counterparts
inappropriately involved
Mild symptoms of ETOH WD Right Ans - Elevated blood pressure
Insomnia
Tremors
Hyperreflexia
Anxiety
Gastrointestinal upset
Headache
Palpitations
Moderate symptoms of ETOH WD Right Ans - Generally, occur 12-24 hours
after cessation
Hallucinations
Seizures
Approx 50% of individuals who seize develop severe symptoms
, Severe symptoms of ETOH WD Right Ans - Delirium tremens (DTs)
Autonomic dysfunction causes hallucinations, tachycardia, hyperthermia,
diaphoresis, and agitation
Can last up to 7 days after cessation
1st line treatment for ETOH WD Right Ans - benzos as they act similarly to
GABA receptors as ETOH does
Which two meds are best for rebound ETOH WD symptoms Right Ans -
Diazepam and chlordiazepoxide
What is the percentage of individuals that will move on to DTs if they have a
withdrawal seizure?
25%
50%
60%
40% Right Ans - 50%
Your patient reports to you they have suffered a recent loss of a family
member one month ago. They have been experiencing periods of insomnia,
weight loss, and feeling sad about their current life situation stating,
"Everything's changed so quickly. I'm up and then down and I can't seem to
stable. I think I'm depressed; can you help me?" They also report an intact
self-esteem and feel good about their own value, talents, and abilities. What is
your response to your patient?
a. You agree with your patient that they may be depressed and prescribe
Citalopram 20mg QD.
b. You agree with your patient that they may be depressed and advise lifestyle
modifications along with a grief support counselor.
c. You advise a grief support counselor along with a short-term sleep aid,
telling your patient they are less likely to be depressed as their self-esteem is
intact and their labile feelings are expected during bereavement proc Right
Ans - B-depression differs from bereavement in that bereavement often
accompanies swings of positive and negative emotions with an intact self-
esteem unlike depression.
Your patient has had ongoing depression for over 2 years. They are on a
current regimen of anti-depressants, as well as seeing a cognitive behavioral
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