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ACNPC-AG Actual Questions


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Nursing


ACNPC-AG


AACN Acute Care Nurse Practitioner (Adult-Gerontology)


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Question: 1


A 55-year-old patient presents with right upper quadrant abdominal pain, fever, and jaundice. Laboratory tests reveal elevated liver enzymes and a total bilirubin level of 3.5 mg/dL. Imaging shows gallstones within the gallbladder. Which of the following conditions is the most likely diagnosis?



holedocholithiasis holecystitis

iver abscess


wer: C


anation: The clinical presentation, laboratory findings, and imaging ngs are consistent with acute cholecystitis. This condition is commonl ed by gallstones obstructing the cystic duct, leading to inflammation a tion of the gallbladder. Treatment options include pain management, iotics, and surgical removal of the gallbladder (cholecystectomy).


stion: 2


-year-old patient presents with sudden onset of bright red blood per

m. Hemodynamic stability is maintained. Which of the following is t appropriate initial management for this patient?

  1. Acute pancreatitis

  2. C

  3. C

  4. L


Ans Expl

findi y

caus nd

infec antib


Que


A 60

rectu he

most


  1. Upper endoscopy

  2. Colonoscopy

  3. Angiography

  4. Exploratory laparotomy

Answer: B



stion: 3


-year-old patient presents with severe abdominal pain, nausea, and ting. Physical examination reveals abdominal distention and absent b ds. Imaging shows dilated loops of small bowel with air-fluid levels. ch of the following conditions is the most likely diagnosis?


owel infarction owel perforation owel obstruction ancreatitis


wer: C


anation: The clinical presentation, physical examination findings, and ing findings are consistent with bowel obstruction. This can occur du

Explanation: The presentation of bright red blood per rectum suggests a lower gastrointestinal (GI) bleed. The most appropriate initial management is colonoscopy, which can help identify the source of bleeding and potentially provide interventions such as hemostasis or sclerotherapy. Upper endoscopy is indicated for an upper GI bleed, while angiography and exploratory laparotomy are reserved for cases of severe bleeding or hemodynamic instability.


Que


A 72

vomi owel

soun Whi


  1. B

  2. B

  3. B

  4. P


Ans Expl

imag e to

various causes such as adhesions, hernias, tumors, or volvulus. Treatment options include bowel decompression, fluid resuscitation, and surgical intervention if necessary.


Question: 4

recurrent episodes of abdominal pain, bloating, and early satiety. Medical management with prokinetic agentssuch as metoclopramide and dietary modifications have been ineffective. Which of the following surgical procedures is the most appropriate treatment option for this patient?


  1. Gastric pacemaker placement

  2. Gastric sleeve surgery

    astrectomy


    wer: A


    anation: In patients with refractory gastroparesis, gastric pacemaker ement (also known as gastric electrical stimulation) can be considered. edure involves the placement of a device that delivers electrical stimul

    stomach, promoting gastric motility. Surgical options such as gastric ss or gastrectomy are typically reserved for patients with severe plications or those who have failed other treatments.


    stion: 5


    -year-old patient presents to the emergency department with severe minal pain, distention, and tenderness. Imaging reveals free air under hragm. Which of the following conditions is the most likely cause?

  3. Gastric bypass surgery

  4. G


Ans Expl

plac This

proc ation

to the bypa com


Que


A 65

abdo the

diap


  1. Abdominal aortic aneurysm

  2. Acute appendicitis

  3. Bowel perforation

  4. Pancreatic pseudocyst

Explanation: The presence of free air under the diaphragm on imaging is highly suggestive of bowel perforation. This can occur due to various causes such as trauma, inflammatory bowel disease, or perforated diverticulitis. Prompt surgical intervention is necessary to repair the perforation and prevent further complications.



-year-old patient with a history of chronic hepatitis C infection presen aundice, ascites, and hepatic encephalopathy. Laboratory tests reveal rely elevated liver enzymes and prolonged prothrombin time. Imaging ws evidence of cirrhosis. Which of the following conditions is the most

diagnosis?


cute liver failure lcoholic hepatitis epatocellular carcinoma ecompensated cirrhosis


wer: D


anation: The clinical presentation, laboratory findings, and imaging ngs are consistent with decompensated cirrhosis. Decompensated cirr

to the advanced stage of liver disease characterized by the developm gnificant complications such as ascites, hepatic encephalopathy, and

Question: 6


A 40 ts

with j seve sho likely


  1. A

  2. A

  3. H

  4. D

Ans Expl

findi hosis

refers ent

of si

jaundice. Treatment options include lifestyle modifications, medical management, and, in some cases, liver transplantation.


Question: 7


A 60-year-old patient with decompensated cirrhosis develops progressive renal impairment, characterized by elevated serum creatinine, decreased urine output,

and sodium retention. Which of the following conditions is the most likely diagnosis?


  1. Renal calculi

  2. Acute kidney injury

  3. Urinary tract infection

    wer: D


    anation: The clinical presentation and laboratory findings are consiste epatorenal syndrome. This condition is a functional renal impairmen rs as a complication of advanced liver disease, particularly cirrhosis. I acterized by renal vasoconstriction and decreased renal blood flow. Pr gnition and treatment are important to prevent further renal deteriorati


    stion: 8


    -year-old patient with a history of chronic constipation presents with minal distention, pain, and absence of bowel movements for the past t Physical examination reveals a tympanic abdomen and high-pitched

    el sounds. Imaging shows dilated loops of small bowel without eviden uction. Which of the following conditions is the most likely diagnosis


    echanical bowel obstruction aralytic ileus

  4. Hepatorenal syndrome Ans

Expl nt

with h t that

occu t is

char ompt

reco on.


Que


A 75

abdo hree

days.

bow ce of

obstr ?


  1. M

  2. P

  3. Diverticulitis

  4. Intestinal pseudo-obstruction Answer: D

Explanation: The clinical presentation, physical examination findings, and imaging findings are consistent with intestinal pseudo-obstruction (also known

as Ogilvie's syndrome). This condition is characterized by non-mechanical dilation of the large bowel without evidence of mechanical obstruction. It is typically associated with underlying medical conditions, such as neurologic disorders or medication use. Treatment options include bowel decompression, correction of underlying causes, and supportive care.


Question: 9


-year-old patient presents with watery diarrhea, abdominal cramping, grade fever. Stool studies reveal the presence of Clostridium difficile

s. Which of the following medications is the most appropriate treatm his patient?


iprofloxacin ancomycin zithromycin etronidazole


wer: B


anation: Clostridium difficile infection is a common cause of infectio hea, especially in healthcare settings. The most appropriate treatment nfection is oral vancomycin or fidaxomicin. Metronidazole can be us ternative, but it is less effective in severe cases. Ciprofloxacin and romycin are not effective against Clostridium difficile.

A 30 and

low-

toxin ent

for t


  1. C

  2. V

  3. A

  4. M


Ans


Expl us

diarr for

this i ed as

an al azith