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ACUTE CARE MELNIC - AC PNP PEDIATRIC NURSE PRACTITIONER QUESTIONS AND ANSWERS 2024
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ACUTE CARE MELNIC - AC PNP PEDIATRIC NURSE PRACTITIONER QUESTIONS AND ANSWERS 2024
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ACUTE CARE MELNIC - AC PNP PEDIATRICNURSE PRACTITIONER
You are the NP in the ED and are admitting a patient who has been a passenger
involved in a MVC. Per EMS he has presumed head injury as there is a large scalp
laceration noted. Which of the following drugs would you order on stand by for
possible intubation in this patient?
A. Ketamine
B.Thiopental
C. Propofol
D. Vecuronium - ANSWERS-Explanation: Answer B. Intubation drugs which can be
used safely in a patient with presumed increased ICP include Thiopental.
Answer A. Ketamine - increases ICP but also has bronchodilator effects. It may be
used for induction in asthmatics requiring intubation due to its bronchodilation
effects.
Answer C. Propofol - decreases BP and cannot use in patients with egg allergies
Answer D. Vecuronium - is a paralytic, not sedation medication
In a patient < 2 months of age diagnosed with bacterial meningitis caused by E.
coli, what antibiotics would you start?
A. Cefotaxime
,B. Ceftriaxone
C. Vancomycin
D. Ampicillin with or without Gentamicin - ANSWERS-Explanation: In a patient < 2
months of age with bacterial meningitis caused by E. coli, your antibiotic of choice
is: Cefotaxime, Ceftizoxime, or Cefepime. You also need CNS penetration.
In a patient < 2 months of age with bacterial meningitis caused by Group B Strep,
the antibiotic of choice is: Penicillin G or Ampicillin
In a patient < 2 months of age with bacterial meningitis caused by Listeria, the
antibiotic of choice is Ampicillin with or without Gentamicin
Treatment for Neisseria Meningitis includes?
A. Penicillin G or if allergic Chloramphenicol
B. Rifampin
C. Gentamicin
D. Meningiococcal Vaccine - ANSWERS-Explanation: Neisseria meningitidis or
meningococcemia is a gram-negative encapsulated organism. It can carry up to
100 times the endotoxin load. The level off endotoxin load correlates with the
severity of the disease. In these answer choices the best choice is Penicillin.
However if there had been a 3rd generation cephalosporin such as ceftriaxone or
cefotaxime, this answer would have been correct. Chloramphenicol can be used if
the patient has a penicillin allergy
,Answer B. Rifampin is prophylaxis to those exposed including close contacts and
health care workers
Answer C. Gentamicin does not enter the CSF
Answer D. Meningococcal vaccine is given to prevent the disease
You are rounding on a 4 year old patient who has been on an aggressive diuretic
therapy with fluid restriction as a postoperative cardiac therapy for pleural
effusion. His labwork this morning shows a Sodium value of 126 meq/L. On exam,
he is awake and watching tv. What is your next course of action?
A. Encourage foods high in sodium
B. Restrict free water intake
C. Call the code team to the bedside
D. Order a dose of 3% Sodium chloride, Lasix and allow fluid intake. - ANSWERS-
Explanation: Answer D. In a patient with asymptomatic hyponatremia, you may
allow fluid intake after they receive 3% NaCL and Lasix because you do not want
too rapid of a fluid shift
Answer A. This can be ordered but is not your immediate course of action
Answer B. This too can be ordered but is not priority
Answer C. This patient is stable at this time, so this is not warranted
, Which of the following antibiotics are the best option for coverage of
Pseudomonas aeruginosa positive pneumonia?
A. Penicillin G
B. Vancomycin
C. Ampicillin
D. Ceftazidime - ANSWERS-Explanation: Answer D. Ceftazidime is a third
generation Cephalosporin which is active against pseudomonas, a Gram negative
bacilli. Its use is indicated for the treatment of patients with infections caused by
susceptible strains of Pseudomonas aeruginosa in the lower respiratory tract. It is
a broad spectrum beta lactam antibiotic and administered IV. In patients with
Cystic Fibrosis, pseudomonas can cause chronic lung infections and shorten their
lifespan.
Answer A. Penicillin is effective on Gram + organisms. Pseudomonas is normally
resistant to Pencillin
Answer B. Vancomycin in combination with a quinolone can be tried but not
vancomycin alone
Answer C. Ampicillin is a pencillin so not effective against Pseudomonas
You are the PNP on duty tonight and are given the following ABG values on a
patient who has recently been reintubated. pH: 7.35, PaO2 300, PCO2 35. What
do you want to do next?
A. Decrease the Rate
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