, TESTBANK FOR Textbook for the Adult-
Gerontology Acute Care Nurse Practitioner Fuller
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Textbook for the Adult-Gerontology Acute Care Nurse
Practitioner: Evidence-Based Standards of Practice
Valerie J. Fuller, PhD, DNP, AGACNP-BC, FNP-BC,
FNAP, FAANP
Paula S. McCauley, DNP, ACNP-BC, CMC, CSC,
FAANP
Editors and Authors
Copyright © Springer Publishing Company
,Copyright © 2024 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
www.springerpub.com
Test Bank ISBN: 978-0-8261-5234-3
Textbook ISBN: 978-0-8261-5232-9
The author and the publisher of this work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
The publisher and authors wish to thank the following individuals and organizations for allowing
reuse of images and data:
Questions 6.13 and 10.9: James Heilman, MD; Question 14.7, Jay2Base; Question 14.8,
Burntfingers; Question 14.10, Kewal Arunkumar Mistry, Radiopaedia.org; Question 14.14, Lu
Ann Reed, RN, Medscape; Question 14.15, Textbook of Primary Care Dermatology, Springer;
Question 20.12, Savvas Radevic; Question 23.2, table data from Core Curriculum for Transplant
Nurses (2nd ed.), Wolters Kluwer and World Journal of Surgery, Wiley.
Copyright © Springer Publishing Company
,Contents
Chapter 1: Role of the Acute Care Nurse Practitioner............................................................................4
Chapter 2: Head, Eyes, Ears, Nose, and Throat Disorders.....................................................................7
Chapter 3: Cardiovascular Disorders ..................................................................................................... 11
Chapter 4: Cardiovascular Surgery........................................................................................................16
Chapter 5: Thoracic Surgery ................................................................................................................... 20
Chapter 6: Vascular Disorders ................................................................................................................ 24
Chapter 7: Pulmonary Disorders.............................................................................................................29
Chapter 8: Endocrine Disorders..............................................................................................................34
Chapter 9: Hematologic and Oncologic Disorders.................................................................................38
Chapter 10: Gastrointestinal Disorders..................................................................................................43
Chapter 11: Nutritional Considerations in Acute Care.........................................................................48
Chapter 12: Kidney Disorders ................................................................................................................. 52
Chapter 13: Genitourinary and Gynecologic Disorders........................................................................56
Chapter 14: Integumentary Disorders....................................................................................................61
Chapter 15: Musculoskeletal Disorders..................................................................................................69
Chapter 16: Neurologic Disorders...........................................................................................................73
Chapter 17: Psychosocial, Behavioral, and Cognitive Health Disorders.............................................78
Chapter 18: Infection Diseases.................................................................................................................82
Chapter 19: Management of Traumatic Injury in Adults and Older Adults......................................87
Chapter 20: Fluids, Electrolytes, and Acid-Base Disorders..................................................................91
Chapter 21: Shock.....................................................................................................................................96
Chapter 22: Poisoning and Drug Toxicity............................................................................................101
Chapter 23: Solid Organ Transplantation ........................................................................................... 105
Chapter 24: Gerontological Principles of Aging..................................................................................110
Chapter 25: Palliative and End-of-Life Care.......................................................................................113
Copyright © Springer Publishing Company
,Chapter 26: Pain and Management ...................................................................................................... 116
Copyright © Springer Publishing Company
,Chapter 1: Role of the Acute Care Nurse Practitioner
1. According to the American Association of Critical-Care Nurses’ (AACN) Scope and Standards for
acute care nurse practitioner (ACNP) practice, the training and education of an ACNP qualifies them
to practice independently in which of the following?
a. Surgical interventions
*b. Perform comprehensive health assessment
c. Prescribing medical marijuana
d. Specialty interventions
Rationale: The specialized education and training for ACNPs qualifies them to independently
perform comprehensive health assessments; order and interpret diagnostic tests and
procedures; use differential diagnoses to reach a medical diagnosis; and order, provide, and
evaluate the outcomes of interventions. The AACN Scope and Standards for ACNP practice
does not currently speak to medical marijuana, surgery, or specialty interventions.
2. The Consensus Model for APRN Regulation was published in 2008 in response to the proliferation
of nurse practitioner specialties. Which of the following is the purpose of the Consensus Model?
*a. To promote uniformity and standardization of APRN roles
b. In response to too few APRN licensure specialties
c. To limit APRN licensure
d. To remove regulation for APRN specialties
Rationale: The Consensus Model for APRN Regulation was published in response to a
proliferation of nurse practitioner specialties along with a lack of standardization around
advanced practice registered nurse (APRN) licensure, accreditation, certification, education,
and regulation.
3. Advanced practice registered nurse (APRN) specialties for practice beyond the original APRN role
are divided into six population foci. Which is one of those foci?
a. Cardiology
b. Emergency
c. Surgical
*d. Women’s health
Rationale: The six population foci for specialty practice are family/life span, adult-
gerontology, women’s health/gender-related, neonatal, pediatrics, and psychiatric/mental
health. Both adult-gerontology and pediatrics are also subdivided into acute and primary care.
Cardiology, emergency, and surgical are not currently a population focus for specialty
practice.
4. There are seven elements in the Consensus Model. Which requirement is included in the Consensus
Model?
a. Either an RN or APRN license
*b. National certification
c. Use of the RN title
d. Prescribing under an MD
Copyright © Springer Publishing Company
, Rationale: In addition to formal education in one of six population foci, the Consensus Model
requires a graduate or postgraduate degree from an accredited institution, national
certification, use of the advanced practice registered nurse (APRN) title, independent
prescribing, independent practice, and both RN and APRN licensure.
5. An advanced practice registered nurse (APRN) student asks about where to find details regarding
APRN scope and standards of practice. Where is the most appropriate place for the APRN to direct
the student?
*a. The state Nurse Practice Act
b. The Consensus Model
c. The state Board of Medicine
d. The licensure regulations
Rationale: The scope and standards of practice for APRNs are outlined in each state’s Nurse
Practice Act. Nurse practitioners are licensed and regulated by the Board of Nursing in all
states. In some states with restricted practice environments, they may also be jointly regulated
by the state Board of Medicine.
6. Which of the following describes the purpose of national certification for the AGACNP?
*a. To ensure minimal competency for safe entry into practice
b. To provide eligibility for state licensure
c. To validate an APRN license
d. To validate required faculty-supervised clinical hours
Rationale: The purpose of national certification is to ensure the nurse practitioner (NP) meets
the minimal competency levels for safe entry into practice. National certification does not
provide state licensure but does make the NP eligible for state licensure. The national
certification applicant must hold a current RN license and complete the required faculty-
supervised clinical hours in the AGACNP role and population.
7. AGANCPs must have an understanding of billing policies and guidelines. Which statement
regarding AGACNP billing is true?
a. If care is provided in the inpatient setting, it must be billed as direct.
b. For care in a clinic, only the complexity of the visit impacts billing.
c. NP billing is about 75% of the physician rate.
*d. Billing is dependent upon the NP’s salary listing in the facility’s Medicare cost report.
Rationale: The nurse practitioner (NP) billing is 85% of the physician’s rate, which may
result in lower healthcare costs. AGACNPs who provide inpatient care may bill direct or
shared. If care is provided in the clinic or office setting, the AGACNP will bill for the type of
visit, level of encounter, new or follow-up, and complexity of the visit.
8. Documentation is key to reimbursement and must be sufficient to support the billed service. Which
of the following four categories of history-taking is recognized when designating the level of care?
a. Straightforward
*b. Detailed
c. Low complexity
d. Severity
Copyright © Springer Publishing Company
, Rationale: Four categories of history-taking are involved in designating the level of care.
These include problem-focused, expanded problem-focused, detailed, and comprehensive.
The four levels of decision-making are straightforward, low complexity, moderate
complexity, and high complexity. Severity is one of the variables to be included in the
statement of the chief complaint.
9. During the COVID-19 pandemic, waivers authorized nurse practitioners (NPs) in critical access
hospitals to practice to the full extent of their license by authorizing Medicare patients to be under the
care of an NP. These waivers have since expired, but the Centers for Medicare & Medicaid Services
(CMS) is currently proposing which permanent authorization that allow NPs to practice to their full
extent?
a. Authorization to perform mandatory telehealth visits
*b. Direct supervision of cardiac rehabilitation patients
c. Authorization to perform assessments in skilled nursing facilities
d. Removal of the physical physician presence requirement
Rationale: Waivers authorized NPs to practice more fully by removing the physical physician
presence requirement and authorizing Medicare hospital patients to be under the care of an
NP. CMS is proposing a permanent authorization for NPs to order and directly supervise
cardiac and pulmonary rehabilitation. Waivers were issued by CMS to reduce barriers to care,
such as authorizing NPs to perform all mandatory visits in skilled nursing facilities,
telehealth, and home healthcare.
10. The COVID-19 pandemic rapidly moved telehealth to the forefront as a necessary option for
access to healthcare. Which statement correctly identifies the role of telehealth in advanced practice
registered nurse (APRN) practice?
a. AGACNP follow-up for wound management must be in-person.
b. AGACNPs may not assess stored information via telehealth visits.
*c. Telehealth has been integrated into AGACNP education.
d. Telehealth simulations have not yet been included in AGACNP education.
Rationale: Telehealth has been integrated into nurse practitioner (NP) education in order to
equip them with the skills and knowledge necessary to meet direct clinical needs and
innovative opportunities to address healthcare needs. Telehealth includes live and
asynchronous types of technology, such as remote monitoring and various types of stored
information. AGACNPs may utilize telehealth for postacute follow-up visits, in specialty
clinics for routine visits and follow-ups, for monitoring of special populations such as heart
failure or diabetes, wound management, as well as patient and family education programs.
NP students may find telehealth included in both simulations and actual precepted visits.
Copyright © Springer Publishing Company
, Chapter 2: Head, Eyes, Ears, Nose, and Throat Disorders
1. John is a 40-year-old male who presents to the ED with acute onset of facial asymmetry and the
inability to close his right eyelid. Which of the following findings is a crucial discriminator for the
diagnosis of Bell’s palsy?
a. Nasal congestion
*b. Paresis of the forehead
c. Diplopia
d. Dysarthria
Rationale: Dysarthria and nasal congestion may be seen in Bell’s palsy, but the critical
physical exam finding is paresis/paralysis of the forehead.
2. An 83-year-old male presents with complaints of severe right eye pain, blurred vision, and
vomiting that began 1 hour ago. Ocular exam reveals a very shallow anterior chamber and corneal
edema. Which is the best course of action by the AGACNP?
a. Administer timolol maleate 0.5% ophthalmic drops to the affected eye four times daily.
*b. Arrange for an emergency ophthalmology consult.
c. Prescribe ciprofloxacin ophthalmic solution 0.3% twice daily for 7 days.
d. Recommend artificial tears and cool compresses four times daily.
Rationale: This patient is presenting with signs and symptoms of acute angle-closure
glaucoma. If not treated promptly, intraocular pressure from acute angle-closure glaucoma
can result in blindness. Emergency ophthalmology consult is necessary for possible laser
iridotomy.
3. James is an 18-year-old male with an unremarkable past medical history who presents to the walk-
in side of the ED with complaints of severe right ear pain, fever, and headache for 3 days. He reports
having upper respiratory symptoms 2 weeks ago consisting of nasal congestion, ear fullness, and
cough. Vital signs demonstrate the following: temperature 38.8°C, pulse 98, respiratory rate 20, and
blood pressure 108/62. On physical exam, he is a well-appearing young male in mild distress
secondary to right ear discomfort. There is significant postauricular erythema, edema, warmth, and
tenderness. Otoscopic exam demonstrates swelling of the auditory canal, with bulging and purulence
noted behind the tympanic membrane (TM). Which of the following interventions would not be
recommended?
a. CT imaging of the head
b. Emergent consultation with ENT
c. Hospital admission for IV vancomycin and ceftriaxone
*d. Initiation of amoxicillin-clavulanate 875/125 orally twice daily for the next 10 days with
close follow-up with his primary care provider in 24 to 48 hours
Rationale: This individual is presenting with acute mastoiditis: postauricular edema,
erythema, tenderness, and fever, likely as a result of acute otitis media. The appropriate
course of action is to obtain a CT; an emergent ENT consult; and admission to the hospital
for broad-spectrum IV antibiotic therapy.
4. Which of the following would not be a common topical medication for the treatment of epistaxis?
*a. Vasopressin
Copyright © Springer Publishing Company
Gerontology Acute Care Nurse Practitioner Fuller
Notes
1- The file is chapter after chapter.
2- We have shown you few pages sample.
3- The file contains all Appendix and Excel sheet
if it exists.
4- We have all what you need, we make update
at every time. There are many new editions
waiting you.
5- If you think you purchased the wrong file You
can contact us at every time, we can replace it
with true one.
Our email:
,Textbook for the Adult-Gerontology Acute Care Nurse
Practitioner: Evidence-Based Standards of Practice
Valerie J. Fuller, PhD, DNP, AGACNP-BC, FNP-BC,
FNAP, FAANP
Paula S. McCauley, DNP, ACNP-BC, CMC, CSC,
FAANP
Editors and Authors
Copyright © Springer Publishing Company
,Copyright © 2024 Springer Publishing Company, LLC
All rights reserved.
This work is protected by U.S. copyright laws and is provided solely for the use of instructors in
teaching their courses and as an aid for student learning. No part of this publication may be
sold, reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of
Springer Publishing Company, LLC.
Springer Publishing Company, LLC
www.springerpub.com
Test Bank ISBN: 978-0-8261-5234-3
Textbook ISBN: 978-0-8261-5232-9
The author and the publisher of this work have made every effort to use sources believed to be
reliable to provide information that is accurate and compatible with the standards generally
accepted at the time of publication. The author and publisher shall not be liable for any special,
consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or
reliance on, the information contained in this book. The publisher has no responsibility for the
persistence or accuracy of URLs for external or third-party Internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
The publisher and authors wish to thank the following individuals and organizations for allowing
reuse of images and data:
Questions 6.13 and 10.9: James Heilman, MD; Question 14.7, Jay2Base; Question 14.8,
Burntfingers; Question 14.10, Kewal Arunkumar Mistry, Radiopaedia.org; Question 14.14, Lu
Ann Reed, RN, Medscape; Question 14.15, Textbook of Primary Care Dermatology, Springer;
Question 20.12, Savvas Radevic; Question 23.2, table data from Core Curriculum for Transplant
Nurses (2nd ed.), Wolters Kluwer and World Journal of Surgery, Wiley.
Copyright © Springer Publishing Company
,Contents
Chapter 1: Role of the Acute Care Nurse Practitioner............................................................................4
Chapter 2: Head, Eyes, Ears, Nose, and Throat Disorders.....................................................................7
Chapter 3: Cardiovascular Disorders ..................................................................................................... 11
Chapter 4: Cardiovascular Surgery........................................................................................................16
Chapter 5: Thoracic Surgery ................................................................................................................... 20
Chapter 6: Vascular Disorders ................................................................................................................ 24
Chapter 7: Pulmonary Disorders.............................................................................................................29
Chapter 8: Endocrine Disorders..............................................................................................................34
Chapter 9: Hematologic and Oncologic Disorders.................................................................................38
Chapter 10: Gastrointestinal Disorders..................................................................................................43
Chapter 11: Nutritional Considerations in Acute Care.........................................................................48
Chapter 12: Kidney Disorders ................................................................................................................. 52
Chapter 13: Genitourinary and Gynecologic Disorders........................................................................56
Chapter 14: Integumentary Disorders....................................................................................................61
Chapter 15: Musculoskeletal Disorders..................................................................................................69
Chapter 16: Neurologic Disorders...........................................................................................................73
Chapter 17: Psychosocial, Behavioral, and Cognitive Health Disorders.............................................78
Chapter 18: Infection Diseases.................................................................................................................82
Chapter 19: Management of Traumatic Injury in Adults and Older Adults......................................87
Chapter 20: Fluids, Electrolytes, and Acid-Base Disorders..................................................................91
Chapter 21: Shock.....................................................................................................................................96
Chapter 22: Poisoning and Drug Toxicity............................................................................................101
Chapter 23: Solid Organ Transplantation ........................................................................................... 105
Chapter 24: Gerontological Principles of Aging..................................................................................110
Chapter 25: Palliative and End-of-Life Care.......................................................................................113
Copyright © Springer Publishing Company
,Chapter 26: Pain and Management ...................................................................................................... 116
Copyright © Springer Publishing Company
,Chapter 1: Role of the Acute Care Nurse Practitioner
1. According to the American Association of Critical-Care Nurses’ (AACN) Scope and Standards for
acute care nurse practitioner (ACNP) practice, the training and education of an ACNP qualifies them
to practice independently in which of the following?
a. Surgical interventions
*b. Perform comprehensive health assessment
c. Prescribing medical marijuana
d. Specialty interventions
Rationale: The specialized education and training for ACNPs qualifies them to independently
perform comprehensive health assessments; order and interpret diagnostic tests and
procedures; use differential diagnoses to reach a medical diagnosis; and order, provide, and
evaluate the outcomes of interventions. The AACN Scope and Standards for ACNP practice
does not currently speak to medical marijuana, surgery, or specialty interventions.
2. The Consensus Model for APRN Regulation was published in 2008 in response to the proliferation
of nurse practitioner specialties. Which of the following is the purpose of the Consensus Model?
*a. To promote uniformity and standardization of APRN roles
b. In response to too few APRN licensure specialties
c. To limit APRN licensure
d. To remove regulation for APRN specialties
Rationale: The Consensus Model for APRN Regulation was published in response to a
proliferation of nurse practitioner specialties along with a lack of standardization around
advanced practice registered nurse (APRN) licensure, accreditation, certification, education,
and regulation.
3. Advanced practice registered nurse (APRN) specialties for practice beyond the original APRN role
are divided into six population foci. Which is one of those foci?
a. Cardiology
b. Emergency
c. Surgical
*d. Women’s health
Rationale: The six population foci for specialty practice are family/life span, adult-
gerontology, women’s health/gender-related, neonatal, pediatrics, and psychiatric/mental
health. Both adult-gerontology and pediatrics are also subdivided into acute and primary care.
Cardiology, emergency, and surgical are not currently a population focus for specialty
practice.
4. There are seven elements in the Consensus Model. Which requirement is included in the Consensus
Model?
a. Either an RN or APRN license
*b. National certification
c. Use of the RN title
d. Prescribing under an MD
Copyright © Springer Publishing Company
, Rationale: In addition to formal education in one of six population foci, the Consensus Model
requires a graduate or postgraduate degree from an accredited institution, national
certification, use of the advanced practice registered nurse (APRN) title, independent
prescribing, independent practice, and both RN and APRN licensure.
5. An advanced practice registered nurse (APRN) student asks about where to find details regarding
APRN scope and standards of practice. Where is the most appropriate place for the APRN to direct
the student?
*a. The state Nurse Practice Act
b. The Consensus Model
c. The state Board of Medicine
d. The licensure regulations
Rationale: The scope and standards of practice for APRNs are outlined in each state’s Nurse
Practice Act. Nurse practitioners are licensed and regulated by the Board of Nursing in all
states. In some states with restricted practice environments, they may also be jointly regulated
by the state Board of Medicine.
6. Which of the following describes the purpose of national certification for the AGACNP?
*a. To ensure minimal competency for safe entry into practice
b. To provide eligibility for state licensure
c. To validate an APRN license
d. To validate required faculty-supervised clinical hours
Rationale: The purpose of national certification is to ensure the nurse practitioner (NP) meets
the minimal competency levels for safe entry into practice. National certification does not
provide state licensure but does make the NP eligible for state licensure. The national
certification applicant must hold a current RN license and complete the required faculty-
supervised clinical hours in the AGACNP role and population.
7. AGANCPs must have an understanding of billing policies and guidelines. Which statement
regarding AGACNP billing is true?
a. If care is provided in the inpatient setting, it must be billed as direct.
b. For care in a clinic, only the complexity of the visit impacts billing.
c. NP billing is about 75% of the physician rate.
*d. Billing is dependent upon the NP’s salary listing in the facility’s Medicare cost report.
Rationale: The nurse practitioner (NP) billing is 85% of the physician’s rate, which may
result in lower healthcare costs. AGACNPs who provide inpatient care may bill direct or
shared. If care is provided in the clinic or office setting, the AGACNP will bill for the type of
visit, level of encounter, new or follow-up, and complexity of the visit.
8. Documentation is key to reimbursement and must be sufficient to support the billed service. Which
of the following four categories of history-taking is recognized when designating the level of care?
a. Straightforward
*b. Detailed
c. Low complexity
d. Severity
Copyright © Springer Publishing Company
, Rationale: Four categories of history-taking are involved in designating the level of care.
These include problem-focused, expanded problem-focused, detailed, and comprehensive.
The four levels of decision-making are straightforward, low complexity, moderate
complexity, and high complexity. Severity is one of the variables to be included in the
statement of the chief complaint.
9. During the COVID-19 pandemic, waivers authorized nurse practitioners (NPs) in critical access
hospitals to practice to the full extent of their license by authorizing Medicare patients to be under the
care of an NP. These waivers have since expired, but the Centers for Medicare & Medicaid Services
(CMS) is currently proposing which permanent authorization that allow NPs to practice to their full
extent?
a. Authorization to perform mandatory telehealth visits
*b. Direct supervision of cardiac rehabilitation patients
c. Authorization to perform assessments in skilled nursing facilities
d. Removal of the physical physician presence requirement
Rationale: Waivers authorized NPs to practice more fully by removing the physical physician
presence requirement and authorizing Medicare hospital patients to be under the care of an
NP. CMS is proposing a permanent authorization for NPs to order and directly supervise
cardiac and pulmonary rehabilitation. Waivers were issued by CMS to reduce barriers to care,
such as authorizing NPs to perform all mandatory visits in skilled nursing facilities,
telehealth, and home healthcare.
10. The COVID-19 pandemic rapidly moved telehealth to the forefront as a necessary option for
access to healthcare. Which statement correctly identifies the role of telehealth in advanced practice
registered nurse (APRN) practice?
a. AGACNP follow-up for wound management must be in-person.
b. AGACNPs may not assess stored information via telehealth visits.
*c. Telehealth has been integrated into AGACNP education.
d. Telehealth simulations have not yet been included in AGACNP education.
Rationale: Telehealth has been integrated into nurse practitioner (NP) education in order to
equip them with the skills and knowledge necessary to meet direct clinical needs and
innovative opportunities to address healthcare needs. Telehealth includes live and
asynchronous types of technology, such as remote monitoring and various types of stored
information. AGACNPs may utilize telehealth for postacute follow-up visits, in specialty
clinics for routine visits and follow-ups, for monitoring of special populations such as heart
failure or diabetes, wound management, as well as patient and family education programs.
NP students may find telehealth included in both simulations and actual precepted visits.
Copyright © Springer Publishing Company
, Chapter 2: Head, Eyes, Ears, Nose, and Throat Disorders
1. John is a 40-year-old male who presents to the ED with acute onset of facial asymmetry and the
inability to close his right eyelid. Which of the following findings is a crucial discriminator for the
diagnosis of Bell’s palsy?
a. Nasal congestion
*b. Paresis of the forehead
c. Diplopia
d. Dysarthria
Rationale: Dysarthria and nasal congestion may be seen in Bell’s palsy, but the critical
physical exam finding is paresis/paralysis of the forehead.
2. An 83-year-old male presents with complaints of severe right eye pain, blurred vision, and
vomiting that began 1 hour ago. Ocular exam reveals a very shallow anterior chamber and corneal
edema. Which is the best course of action by the AGACNP?
a. Administer timolol maleate 0.5% ophthalmic drops to the affected eye four times daily.
*b. Arrange for an emergency ophthalmology consult.
c. Prescribe ciprofloxacin ophthalmic solution 0.3% twice daily for 7 days.
d. Recommend artificial tears and cool compresses four times daily.
Rationale: This patient is presenting with signs and symptoms of acute angle-closure
glaucoma. If not treated promptly, intraocular pressure from acute angle-closure glaucoma
can result in blindness. Emergency ophthalmology consult is necessary for possible laser
iridotomy.
3. James is an 18-year-old male with an unremarkable past medical history who presents to the walk-
in side of the ED with complaints of severe right ear pain, fever, and headache for 3 days. He reports
having upper respiratory symptoms 2 weeks ago consisting of nasal congestion, ear fullness, and
cough. Vital signs demonstrate the following: temperature 38.8°C, pulse 98, respiratory rate 20, and
blood pressure 108/62. On physical exam, he is a well-appearing young male in mild distress
secondary to right ear discomfort. There is significant postauricular erythema, edema, warmth, and
tenderness. Otoscopic exam demonstrates swelling of the auditory canal, with bulging and purulence
noted behind the tympanic membrane (TM). Which of the following interventions would not be
recommended?
a. CT imaging of the head
b. Emergent consultation with ENT
c. Hospital admission for IV vancomycin and ceftriaxone
*d. Initiation of amoxicillin-clavulanate 875/125 orally twice daily for the next 10 days with
close follow-up with his primary care provider in 24 to 48 hours
Rationale: This individual is presenting with acute mastoiditis: postauricular edema,
erythema, tenderness, and fever, likely as a result of acute otitis media. The appropriate
course of action is to obtain a CT; an emergent ENT consult; and admission to the hospital
for broad-spectrum IV antibiotic therapy.
4. Which of the following would not be a common topical medication for the treatment of epistaxis?
*a. Vasopressin
Copyright © Springer Publishing Company
