NEW PNP - AC (PEDIATRIC NURSE PRACTITIONER - ACUTE CARE) CERTIFICATION EXAM LATEST COMPLETE ACTUAL TEST WITH REAL QUESTIONS AND CORRECT ANSWERS (100 CORRECT VERIFIED SOLUTION) NEWEST UPDATED VERSION

ADULT-
GERONTOLOGYACUTE CARE NURS j j j




E PRACTITIONER CERTIFICATION 20
j j j




24-25 QUESTIONS AND ANSWERS
j j j




Examj1
1. Thejpatientjisjaj27-year-
oldjwomanjwhojpresentsjtojyourjhealthjcarejfacilityjwithjajhistoryjofjdepressedjmoo
djthatjhasjworsenedjduringjthejpastjfewjweeks.jShejgainedj8jkgjinjthejpastj2jmonths;
jshejreportsjthatjshejisjeatingjwhenjshejisjnotjsleeping.jShejisjveryjstressedjandjwor


riedjaboutjherjjob.jShejhasjpassivejthoughtsjofjharmingjherselfjbutjnojdefinitejplan.j
Herjmedicaljhistoryjincludesjanxiety,jandjshejtakesj0.5jmgjofjalprazolamjthreejtimes
jdaily.jWhichjmedicationjisjthejbestjtojtreatjthisjpatient?


1. Paroxetine.
2. Fluoxetine.
3. Imipramine.
4. Mirtazapine.
2. Fluoxetine.
Rationale:jThejpatientjpresentsjwithjsignsjandjsymptomsjofjmajorjdepressivejdisorder.jSele
ctivejserotoninjreceptorjinhibitorsjarejconsideredjajfirst-
linejagentjinjtreatmentjforjthisjpatient.jThejpatientjgainedj8jkgjinjthejpastj2jmonths;jthereforej
paroxetinej(answerj1)jisjnotjrecommendedjforjherjcasejbecausejitjleadsjtojincreasedjappetit
ejandjcausesjsomnolence.jFluoxetinej(answerj2)jisjthejbestjmedicationjforjthisjpatientjbecau
sejitjdoesjnotjaffectjweightjorjappetite.jInjaddition,jfluoxetinejcouldjconcomitantlyjrelievejherj
symptomsjofjanxiety.jImipraminejisjajtricyclicjantidepressantjagentj(TCA)jthatjhasjajwarningj
thatjpatientsjwithjpassivejsuicidaljideasjshouldjnotjreceivejTCAsj(answerj3).
Mirtazapinej(answerj4),jlikejparoxetine,jcouldjincreasejappetitejandjleadjtojweightjgain.
2.jThejpatientjisjaj43-year-
oldjHispanicjmanjwhojisjgettingjreadyjtojbejdischargedjfromjyourjhealthjcarejfacilityj
afterjajmyocardialjinfarction.jHejhasjaj23-
yearjhistoryjofjcigarettejsmokingjandjsmokesj1jpack/day.jHejhasjtriedjtojquitjseveralj
times,jbutjhejwasjunsuccessful.jHejtriedj2-
mgjnicotinejgum,jandjtojsavejmoney,jhejchewedjonlyj6jpiecesjdaily.jHejhasjajhistoryj
ofjdepressionjalongjwithjhisjcardiacjproblems.jWhichjmedicationjisjthejbestjforjthisj
patient?
1. Nicotinej4-mgjgum.
2. Vareniclinej0.5jmgjoncejdaily.

,3. BupropionjSRj150jmgjtwicejdaily.
4. Nicotinejpatchj21jmg/day.
3. BupropionjSRj150jmgjtwicejdaily.
Rationale:jThejpatient'sjpreviousjattemptjtojquitjsmokingjwithjnicotinejgumjwasjprobablyjun
successfuljbecausejthejgumjstrengthj(2jmg)jandjthejfrequencyjofjusej(fewerjthanj9jpiecesjajd
ay)jwerejtoojlowjtojmanagejhisjnicotinejcraving;jthereforejhisjpreviousjusejofjnicotinejgumjisj
notjajtruejtreatmentjfailure.jVareniclinej(answerj2)jisjnotjcontraindicatedjbecausejofjthejcardi
acjproblems,jbutjitjisjcontraindicatedjbecausejthejpatientjhasjajdepressionjhistory.jBupropio
nj(answerj3)jisjajbetterjfitjbecausejofjitsjappropriatenessjforjdepressivejdisorders.jNicotinejg
umj(answerj1)jorjpatchj(answerj4)jarejappropriatejandjcanjbejaddedjwhenjbupropionjfailsjasj
monotherapyjtojtreatjhisjnicotinejcraving.
3.jThejpatientjisjaj53-year-
oldjAfricanjAmericanjwomanj(weightj95jkg,jheightj73jinches)jwhojcomesjtojyourjclin
icjforjmanagementjofjherjtypej2jdiabetes,jmildjcongestivejheartjdisease,jneuropathy
,jandjrecurrentjmajorjdepression.jHerjmedicationsjarejmetforminj1000jmgjtwicejdail
y,jcarvedilolj12.5jmgjtwicejdaily,jcitalopramj40jmgjdaily,jandjramiprilj10jmgjdaily.jSh
ejstilljhasjdepressivejsymptomsjandjwantsjtojchangejherjmedication.jWhatjisjthejbe
stjactionjforjher?
1. Duloxetine.
2. Desipramine.
3. Sertraline.
4. Bupropion.
1. Duloxetine.
Rationale:jThisjpatientjstilljhasjdepressivejsymptomsjandjdiabeticjneuropathy;j thereforejdu
loxetinej(answerj1)jisjthejbestjchoicejforjthisjpatient.jAlthoughjdesipraminej(answerj2)jcouldj
bejusedjforjtreatingjherjneuropathy,jitjisjnotjajgoodjchoicejbecausejofjherjheartjdisease.jSertr
alinej(answerj3)jwouldjbejajbetterjchoicejforjherjdepression,jbutjitjdoesjnotjhelpjdiabeticjneur
opathy.jHowever,jbupropionjcanjleadjtojweightjloss,jbutjdatajarejnotjstrongjforjtreatmentjofjn
europathyj(answerj4).
4.jThejpatientjisjaj58-year-oldjAsianjmanjwithjaj25-
yearjhistoryjofjalcoholicjdependence.jHejdrinksj1jcupjofjvodkajeveryjday.jHejhasjtrie
djtojquitjseveraljtimesjwithoutjsuccess.jHisjlaboratoryjtestsjrevealjaspartatejaminot
ransferasej135jinternationaljunits/L,jalaninejaminotransferasej75jinternationaljunit
s/L,jalbuminj4jg/dL,jtotaljbilirubinj0.3jmg/dL,jprothrombinjtimej0.8jseconds,jplateletjc
ountj350,000/mm3,jandjcreatininejclearancej35jmL/min.jAfterjdetoxification,jwhichj
maintenancejtreatmentjisjmostjappropriate?
1. Chlordiazepoxide.
2. Disulfiram.
3. Naltrexone.
4. Acamprosate.

,4. Acamprosate.
Rationale:jThisjpatientjhasjalcoholicjhepatitis,jasjindicatedjbyjhisjelevatedjliverjenzymes;jth
usjitjcouldjimprovejwithjabstinence.jHisjliverjfunctionjisjnormal,jasjevidencedjbyjhisjalbumin,j
prothrombinjtime.jandjplateletjcount.jChlordiazepoxidej(answerj1)jhasjanjimportantjrolejinja
cutejalcoholjdetoxification,jbutjtherejarejlimitedjdatajaboutjitsjrolejforjthejmaintenancejtreatm
ent.jDisulfiramj(answerj2)jrequiresjajstrongjrecommendationjfromjthejpatientjtojabstain.jMor
eover,jitjshouldjbejusedjwithjcautionjforjpatientsjwithjactivejliverjdisease.jNaltrexonej(answe
rj3)jshouldjbejusedjwithjcautionjforjpatientsjwithjacutejliverjdisease.jAcamprosatej(answerj4)j
isjthejmostjappropriatejmedicationjforjthisjpatient.jInjaddition,jthejdosejofjAcamprosatejshou
ldjbejreducedjforjpatientsjwithjajcreatininejclearancejbetweenj50jandj30jmL/min.
5. Thejpatientjisjaj35-year-
oldjwhitejwomanjadmittedjtojthejemergencyjdepartmentjwithjagitation,jdiaphoresis
,jandjfeverj(103.5°F).jAlso,jherjeyelidjhasjbeenjtwitchingjforj2jhours.jShejreportsjcol
djsymptomsjforjthejpastj3jdays,jandjshejtookjdextromethorphanjandjpseudoephedr
ine.jHerjmedicaljhistoryjincludesjdepression,jhypertension,jandjosteoarthritis.jShej
currentlyjtakesjsertralinej100jmgjdaily,jglipizidej5jmgjdaily,jdiltiazemjXRj240jmgjdail
y,jcalciumj500jmgjdaily,jandjacetaminophenj650jmgjeveryj6jhours.jWhichjcombinati
onjofjmedicationsjisjmostjlikelyjcontributingjtojherjsymptoms?
1. Dextromethorphanjandjparoxetine.
2. Paroxetinejandjacetaminophen.
3. Paroxetinejandjglipizide.
4. Dextromethorphanjandjpseudoephedrine.
1. Dextromethorphanjandjparoxetine.
Rationale:jThejpatientjpresentsjtojthejemergencyjdepartmentjwithjsignsjandjsymptomsjofjse
rotoninjsyndromej(myoclonus,jagitation,jandjdiaphoresis).jThejmedicationsjmostjlikelyjcont
ributingjtojherjsymptomsjarejdextromethorphanjandjparoxetinejbecausejbothjagentsjhavejs
erotonergicjactivity.jMoreover,jparoxetinejinhibitsjCYP2D6,jwhichjisjresponsiblejforjmetabo
lismjofjdextromethorphan,jsojitjcouldjincreasejthejserotonergicjactivityj(answerj1).jThusjnon
ejofjthejotherjchoicesjleadsjtojserotonergicjactivity,jsojanswersj2,j3,jandj4jarejincorrect.
6. Thejpatientjisjaj23-year-oldjAsianjwomanjwithjaj2-
yearjhistoryjofjheroinjaddiction.jShejhasjsuccessfullyjbeenjmaintainedjonjmethadon
ej40jmgjdailyjforj1jyear.jNow,jshejdoesjnotjwantjtojgojtojajdailyjopioidjtreatmentjprogra
mjtojgetjherjmethadonejdose.jWhichjtreatmentjregimenjcouldjbejchangedjandjisjappr
opriatejforjher?
1. Initiatejnaltrexone.
2. Administerjnaltrexone/buprenorphine.
3. Changejtojbuprenorphinej×j2jdays,jthenjadministerjnaltrexone/buprenorphine.
4. Taperjtojmethadonej30jmg,jthenjchangejtojbuprenorphine.

, 4.jTaperjtojmethadonej30jmg,jthenjchangejtojbuprenorphine.
Rationale:jInitiationjofjnaltrexonejasjmonotherapyjisjinappropriatejbecausejitjcouldjprecipit
atejwithdrawaljsymptomsjofjmethadonej(answerj1).jPatientsjwhojtakejlong-
jactingjopioidsjsuchjasjmethadonejshouldjbejchangedjtojbuprenorphinejfirstjbeforejbeingjad


vancedjtojbuprenorphine/naltrexonej(answerj2).jInitiationjofjbuprenorphinejwithjajhigherjdo
sejofjmethadonejcouldjprecipitatejthejwithdrawaljsymptomsjbecausejofjhigherjbindingjaffinit
yjofjbuprenorphinejforjthejmujreceptorjwithjlessjactivityjandjthejaddedjantagonismjatjthejkap
pajreceptorj(answerj3).jThereforejpatientsjwhojtakejlong-
jactingjopioidjshouldjbejtapered,jtojavoidjwithdrawaljsymptoms,jbeforejchangingjtojbupreno


rphinej(answerj4).
7. Aj29-year-
oldjwomanjpresentsjtojthejpsychiatricjclinicjcomplainingjofjlosingjinterestjinjherjjo
bjandjshejwantsjtojbejalone.jShejhasjaj6-
yearjhistoryjofjtypejIjbipolarjdisorderjandjtakesjlithiumj300jmgjtwicejdaily.jShejstate
sjthatjshejtakesjherjmedicinejeveryjdayjjustjasjprescribed.jHerjlithiumjleveljtodayjisj
1.0jmEq/L.jShejhasjbeenjwithoutjmanicjdisordersjforjthejpastj5jyears.jWhichjmedica
tionjisjthejbestjforjherjacutejdepressionjsymptoms?
1. Venlafaxine.
2. Quetiapine.
3. Aripiprazole.
4. Lamotrigine.
2. Quetiapine.
Rationale:jThisjpatientjhasjajhistoryjofjtypejIjbipolarjdisorder.jShejhasjbeenjonjlithiumjforj6jye
ars,jwithjanjacceptablejtherapeuticjrange,jwhichjisjlongjenoughjtojderivejanyjantidepressan
tjeffects.jVenlafaxinej(answerj1)jisjajserotoninjandjnorepinephrinejreuptakejinhibitorjthatjco
uldjleadjtojmania.jMoreover,jthejeffectjofjantidepressantsjforjtreatmentjofjdepressionjdisord
ersjassociatedjwithjbipolarjdisordersjisjstilljquestionable.jQuetiapinej(answerj2)jhasjajFoodj
andjDrugjAdministrationjindicationjforjthejtreatmentjofjdepressionjsymptomsjassociatedjwit
hjbipolarjdisordersjbecausejofjitsjrapidjonsetjofjaction.jAripiprazolej(answerj3)jisjinappropria
tejforjtreatmentjofjdepressionjsymptomsjassociatedjwithjbipolarjdisordersjbecausejitjisjnotje
ffectivejandjtherejisjnotjenoughjdatajtojsupportjitsjeffectiveness.jLamotriginej(answerj4)jisja
ppropriatejforjmaintenancejtreatmentjbecausejofjitsjslowjonsetjandjitjrequiresjajslowjtitratio
njtojreachjtherapeuticjdoses.
8. Aj29-year-
oldjwomanjpresentsjtojthejpsychiatricjclinicjcomplainingjofjlosingjinterestjinjherjjobj
andjwantsjtojbejalonejalljthejtime.jShejhasjaj6-
yearjofjhistoryjofjtypejIjbipolarjdisorderjandjtakesjlithiumj300jmgjtwicejdaily.jShejstate
sjthatjshejtakesjherjmedicinejeveryjdayjjustjasjprescribed.jHerjlithiumjleveljtodayjisj1.
0jmEq/L.jShejhasjbeenjwithoutjmanicjdisordersjforjthejpastj5jyears.jWhichjtherapyjwo
uldjbejthejbestjforjthejmaintenancejdepressionjsymptoms?
1. Venlafaxine.