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ACNP Blueprint Final/Mid Exam: Questions & Answers
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ACNP Blueprint Final/Mid Exam: Questions & Answers
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ACNP Blueprint Final/Mid Exam: Questions & AnswersWhat is the body's metabolic response to injury from a nutrition perspective?
Right Ans - Hypermetabolic
Protein catabolism from muscle breakdown which can in turn increase your
Cr and cause an AKI
Hyperglycemia d/t stress response
Hypoalbunemia because protein synth stops
Elytes get wonky, esp potassium
What is the body's response to critical illness from a nutrition perspective?
Right Ans - Muscle starts breaking down.
Lipolysis - increasing fatty acids and ketones causing an acidotic state.
Glycolysis decreases, but utilization of glucose stores causes hyperglycemic
states
Gluconeogenesis, increased urea and inflammatory proteins.
When should you complete a nutritional screen? Right Ans - W/in 24 hours
of admit
Nutritional risk factors that make you risk for ineffective nutrition Right
Ans - Involuntary loss of 10% in 6 months of 5% in 1 month
BMI not normal
CHronic dz
Increased metabolic requirements
Altered diet/schedules
Inadequate nutrition >7days
,What physical function can correlate to malnutrition Right Ans - decreased
hand grip strength
What does a negative nitrogen balance in the body indicate? When is it
present? Right Ans - malnutrition as it is present in illness, trauma and
stress
How many calories does a critically ill patient need a day? Right Ans - 25-
30 kcal/kg/day
How quick after someone is burned should you start enteral nutritional
support? Right Ans - 4-6 hours
How quick after trauma or critical illness should you start nutrition? Right
Ans - 24-48 hours
What MAP do you need to start feeding someone ideally? Right Ans - >50
Absolute contraindications for enteral nutrition? Right Ans - Mechanical:
obstruction and fistula
Pathological: ischemia (splanchnic), HD instability (gut hypoperfusion)
Relative contraindications to enteral nutrition? Right Ans - Active GI
hemorrhage
Short bowel syndrome
Severe malabsorption (severe V+D)
What you would order for for initial AMS workup? Right Ans - ABG, sugar,
CBC with diff, BMP, Mg, lactate, LFTs, THYROID, drug/etoh screen, EKG
Contributing factors to AMS Right Ans - Systemic illness, bypass,
medications, drug/etoh WD, sleep deprivation
DELIRIUM acronym Right Ans - drug - review meds
electrolyte imbalance
low o2 (hypoxia)
infection
reduced sensory input
,intracranial prob
urinary or fecal retention
myocardial prob
Patient Synergy: Stability Right Ans - ability to maintain steady state
equilibrium
Patient Synergy: Complexity Right Ans - intricate entanglement of two or
more systems (body, family, etc.)
Patient Synergy: Vulnerability Right Ans - Susceptibility to actual or
potential stressors that may adversely affect outcomes.
Patient Synergy: Resiliency Right Ans - ability for patient to return to
restorative level of functioning by compensatory mechanisms
Patient synergy: Predictability Right Ans - allows one to expect a certain
course of illness
Patient synergy: Resource availability Right Ans - extent of resources that
patient/family bring to situation (person, financial, social etc)
Patient synergy: Participation in care and decision making Right Ans - how
much they can/do participate
Nurse synergy: Clinical judgement Right Ans - clinical reasoning (decision
making, critical thinking, grasp) mixed with clinical skills acquired through
knowledge and EBP to treat patients
Nurse synergy: Advocacy Right Ans - representing concerns for patient,
family and community; serving as a moral agent
Nurse synergy: Collaboration Right Ans - working with others to meet
goals for the situation/patient for best outcomes
Nurse synergy: Systems thinking Right Ans - body of knowledge/tools that
allows the nurse to manage not only the patient but everything
interally/externally
, Nurse synergy: Clinical inquiry Right Ans - ongoing questioning and
evaluating practice
Nurse synergy: facilitator of learning Right Ans - help dem peeps learn
things
nurse synergy: response to diversity Right Ans - appreciate, recognize and
incorporate differences into the provision of care
nurse synergy: caring practices Right Ans - the constellation of nursing
activities that are responsible to the uniqueness of patient/fam/situation that
create a compassionate and therapeutic environment with the aim of
promoting comfort and preventing suffering
When would you give FFP Right Ans - massive hemorrhage, INR > 2
When would you give cryo Right Ans - Bleeding issues, low fibrinogen,
hemophilia, factor 7 deficiency
How much does 1 U PRBC increase H&H Right Ans - 1g/3%
When should you treat with blood if stable? Right Ans - Hgb <7
When should you treat with blood if surgical or have CV hx Right Ans - Hgb
<8
How much does one unit of plt increase the count? Right Ans - 5-10K
How much does apheresis increase plt count? Right Ans - 30-60K
When would you use apheresis? Right Ans - In TTP with plt count <10K
When do you give plt prophylactically? Right Ans - Lumbar procedures and
central line placement with counts <50K
What is dosing for FFP to raise factors what percent? Right Ans - 10-
15ml/kg -- 25%
How many units of FFP to reverse INR for anti-coag? Right Ans - 4 units
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