ANCC ADULT GERONTOLOGY ACUTE CARE
CERTIFICATION EXAM NEW LATEST VERSION WITH
ALL 175 MULTIPLE CHOICE QUESTIONS, 100%
CORRECT ANSWERS AND RATIONALE
Acute Renal Insufficiency - CORRECT ANSWERS-Bun increased out of proportion to Cr, ATN,
Obstruction, or contrast media, reversible
Chronic renal insufficiency - CORRECT ANSWERS-Steady increase in BUN:Cr ratio 10:1,
intrinsic but progression can be slowed with tx
Stages of renal failure - CORRECT ANSWERS-Diminished renal reserve :50% loss of nephrons
Renal insufficiency 75% loss
End stage 90% loss
Chronic renal failure treatment - CORRECT ANSWERS-Control htn and DM
Reduce proten to 40g/day
Renal dose meds
CVA infarct - CORRECT ANSWERS-Subtle or sudden neurological deficits, visual alterations,
change sin vital signs, notor weakness, changes in LOC
CVA hemorrhagic - CORRECT ANSWERS-Acute onset of focal neurologic deficits
Sudden increased ICP, hed and vomiting when bleed is extensive
Right (non dominant) side: left hemiparesis right visual field changes spatial disorientation
Left dominant: right hemiparesis aphasia dysrrthria difficulty writing
CVA management - CORRECT ANSWERS-Always head CT first if LP needed, CT first
Thromobitic- fribrinolytic therapy indicated within <3 hours-4.5 hours
Lower systemic BP but not too low MAP at 110-130 to prevent vasospasm
,Nimodipine for vasospasm, maintain CPP and liit increases in CP <20
ICP monitoring indications - CORRECT ANSWERS-Moderate head injury but can't be serially
neuro assessed
GCS <8 +abnormal CT
GCS<8 +normal CT with two of following: >40yo, BP<90, abnormal motor posturing
Simple partial seizure - CORRECT ANSWERS-No loss of consciousness, short, single motor
group and spread to entire side of body
Complex partial seizure - CORRECT ANSWERS-Any simple partial followed by impaired
conciousness
Generalized petit mal/absence - CORRECT ANSWERS-Sudden arrest of motor activity with
blank stare
Tonic-clonic grand mal - CORRECT ANSWERS-May have aura, begins with tonic contraction,
usually 2-5 minutes, may have incontinence and followed by post ictal
Seizure assessment - CORRECT ANSWERS-EEG is most important test in determining type of
seizure
CT for all newonset
Seizure management - CORRECT ANSWERS-Ativan to break seizure 2-4mg IV q
Seizure prevention drugs (recognize them) - CORRECT ANSWERS-Carbamazepine Tegretol,
phenytoin Dilantin, valproic acid depakene
Discontinuance should always be tapered never withdrawn abruptly
Hypovolemic Shock Parameters - CORRECT ANSWERS-Preload CVP decreased, SVR afterload
increased, CI decreased, Oxygen delivery Decreased, Venous Oxygen saturation increased
,Types of hypovolemic shock - CORRECT ANSWERS-Hemorrhage, burns, pancreatitis
Cardiogenic shock parameters - CORRECT ANSWERS-CVP preload increased, SVR afterload
increased, CI decreased, oxygen delivery decreased, SV02 decreased
Types of cardiogenic shock - CORRECT ANSWERS-Post mi, malignant dysrhythmia, acute
myocarditis
Obstructive shock parameters - CORRECT ANSWERS-Preload either, SVR increased, CI
decreased, oxygen delivery decreased, SV02 decreased
Types of obstructive shock - CORRECT ANSWERS-Tension pneumo, cardiac tamponade, PE
Distributive shock parameters - CORRECT ANSWERS-Preload CVP decreased, afterload SVR
decreased, CI increased, SV02 decreased, oxygen delivery increased
Types of distributive shock - CORRECT ANSWERS-Septic shock, anaphylaxis, neurogenic shock
CVP Preload - CORRECT ANSWERS-2-8
Cardiac Output - CORRECT ANSWERS-4-8
MAP - CORRECT ANSWERS-70-90
Fractional Excretion of NA <1% - CORRECT ANSWERS-Prerenal state of kidney dysfunction (i.e.
dehydration)
Fractional Excretion of NA >2% - CORRECT ANSWERS-ATN (acute tubular necrosis)
, CPP equation - CORRECT ANSWERS-MAP-ICP
SIADH Hyposmolar hyponatremia "inappropriate water retention" - CORRECT ANSWERS-
serum sodium low, serum osmo low <280, urine osmo high >100, no dehydration, tx restrict fluids
if neuro symptoms give 3%NS
DI Hyperosmolar hypernatremia dry - CORRECT ANSWERS-Serum sodium high, serum osmo
high >290, urine osmo low <100, urine spec grave 1.005 (urine is like water), urine sodium >20,
dehydration, if serum Na >150 give D5W to replace ½ volume deficit in 12-24 hours, avoid rapid lowering
of Na, DDAVP for acute situations
Serum Osmo - CORRECT ANSWERS-280
Urine Osmo - CORRECT ANSWERS-300-800
Sodium - CORRECT ANSWERS-~140
Total cholesterol - CORRECT ANSWERS-<200
Triglycerides - CORRECT ANSWERS-<150
HDL - CORRECT ANSWERS->40
LDL - CORRECT ANSWERS-<100
Management of pulm edema - CORRECT ANSWERS-02, sitting up, morphine 2-4mg, Lasix 40,
another Lasix 40 if needed
Left heart failure - CORRECT ANSWERS-LUNGS, dyspnea at rest, rales, wheezing, generally
healthy except acute event, S3, murmur of mitral regurg
CERTIFICATION EXAM NEW LATEST VERSION WITH
ALL 175 MULTIPLE CHOICE QUESTIONS, 100%
CORRECT ANSWERS AND RATIONALE
Acute Renal Insufficiency - CORRECT ANSWERS-Bun increased out of proportion to Cr, ATN,
Obstruction, or contrast media, reversible
Chronic renal insufficiency - CORRECT ANSWERS-Steady increase in BUN:Cr ratio 10:1,
intrinsic but progression can be slowed with tx
Stages of renal failure - CORRECT ANSWERS-Diminished renal reserve :50% loss of nephrons
Renal insufficiency 75% loss
End stage 90% loss
Chronic renal failure treatment - CORRECT ANSWERS-Control htn and DM
Reduce proten to 40g/day
Renal dose meds
CVA infarct - CORRECT ANSWERS-Subtle or sudden neurological deficits, visual alterations,
change sin vital signs, notor weakness, changes in LOC
CVA hemorrhagic - CORRECT ANSWERS-Acute onset of focal neurologic deficits
Sudden increased ICP, hed and vomiting when bleed is extensive
Right (non dominant) side: left hemiparesis right visual field changes spatial disorientation
Left dominant: right hemiparesis aphasia dysrrthria difficulty writing
CVA management - CORRECT ANSWERS-Always head CT first if LP needed, CT first
Thromobitic- fribrinolytic therapy indicated within <3 hours-4.5 hours
Lower systemic BP but not too low MAP at 110-130 to prevent vasospasm
,Nimodipine for vasospasm, maintain CPP and liit increases in CP <20
ICP monitoring indications - CORRECT ANSWERS-Moderate head injury but can't be serially
neuro assessed
GCS <8 +abnormal CT
GCS<8 +normal CT with two of following: >40yo, BP<90, abnormal motor posturing
Simple partial seizure - CORRECT ANSWERS-No loss of consciousness, short, single motor
group and spread to entire side of body
Complex partial seizure - CORRECT ANSWERS-Any simple partial followed by impaired
conciousness
Generalized petit mal/absence - CORRECT ANSWERS-Sudden arrest of motor activity with
blank stare
Tonic-clonic grand mal - CORRECT ANSWERS-May have aura, begins with tonic contraction,
usually 2-5 minutes, may have incontinence and followed by post ictal
Seizure assessment - CORRECT ANSWERS-EEG is most important test in determining type of
seizure
CT for all newonset
Seizure management - CORRECT ANSWERS-Ativan to break seizure 2-4mg IV q
Seizure prevention drugs (recognize them) - CORRECT ANSWERS-Carbamazepine Tegretol,
phenytoin Dilantin, valproic acid depakene
Discontinuance should always be tapered never withdrawn abruptly
Hypovolemic Shock Parameters - CORRECT ANSWERS-Preload CVP decreased, SVR afterload
increased, CI decreased, Oxygen delivery Decreased, Venous Oxygen saturation increased
,Types of hypovolemic shock - CORRECT ANSWERS-Hemorrhage, burns, pancreatitis
Cardiogenic shock parameters - CORRECT ANSWERS-CVP preload increased, SVR afterload
increased, CI decreased, oxygen delivery decreased, SV02 decreased
Types of cardiogenic shock - CORRECT ANSWERS-Post mi, malignant dysrhythmia, acute
myocarditis
Obstructive shock parameters - CORRECT ANSWERS-Preload either, SVR increased, CI
decreased, oxygen delivery decreased, SV02 decreased
Types of obstructive shock - CORRECT ANSWERS-Tension pneumo, cardiac tamponade, PE
Distributive shock parameters - CORRECT ANSWERS-Preload CVP decreased, afterload SVR
decreased, CI increased, SV02 decreased, oxygen delivery increased
Types of distributive shock - CORRECT ANSWERS-Septic shock, anaphylaxis, neurogenic shock
CVP Preload - CORRECT ANSWERS-2-8
Cardiac Output - CORRECT ANSWERS-4-8
MAP - CORRECT ANSWERS-70-90
Fractional Excretion of NA <1% - CORRECT ANSWERS-Prerenal state of kidney dysfunction (i.e.
dehydration)
Fractional Excretion of NA >2% - CORRECT ANSWERS-ATN (acute tubular necrosis)
, CPP equation - CORRECT ANSWERS-MAP-ICP
SIADH Hyposmolar hyponatremia "inappropriate water retention" - CORRECT ANSWERS-
serum sodium low, serum osmo low <280, urine osmo high >100, no dehydration, tx restrict fluids
if neuro symptoms give 3%NS
DI Hyperosmolar hypernatremia dry - CORRECT ANSWERS-Serum sodium high, serum osmo
high >290, urine osmo low <100, urine spec grave 1.005 (urine is like water), urine sodium >20,
dehydration, if serum Na >150 give D5W to replace ½ volume deficit in 12-24 hours, avoid rapid lowering
of Na, DDAVP for acute situations
Serum Osmo - CORRECT ANSWERS-280
Urine Osmo - CORRECT ANSWERS-300-800
Sodium - CORRECT ANSWERS-~140
Total cholesterol - CORRECT ANSWERS-<200
Triglycerides - CORRECT ANSWERS-<150
HDL - CORRECT ANSWERS->40
LDL - CORRECT ANSWERS-<100
Management of pulm edema - CORRECT ANSWERS-02, sitting up, morphine 2-4mg, Lasix 40,
another Lasix 40 if needed
Left heart failure - CORRECT ANSWERS-LUNGS, dyspnea at rest, rales, wheezing, generally
healthy except acute event, S3, murmur of mitral regurg
