ACCNS-AG Adult-Gerontology Acute Care Clinical Nurse Specialist Certification

Question 1

A 70-year-old patient on warfarin for atrial fibrillation is admitted for pneumonia. The patient develops QTc prolongation (QTc 520 ms) on the cardiac monitor. Which antibiotic should the CNS recognize as most likely contributing to QT prolongation?

Amoxicillin-clavulanate Azithromycin Cephalexin Trimethoprim-sulfamethoxazole

Correct Answer:

Azithromycin

Question 2

A patient with severe sepsis requires vasopressor support. Norepinephrine has been initiated. The intensivist is considering adding vasopressin. What is the primary pharmacological rationale for vasopressin use in septic shock?

Vasopressin is a more potent alpha-1 agonist than norepinephrine at equivalent doses Vasopressin acts on V1 receptors independently of adrenergic receptors, compensating for relative vasopressin deficiency in septic shock Vasopressin has positive inotropic effects that improve cardiac output in septic shock Vasopressin is preferred in septic shock because it does not increase myocardial oxygen demand

Correct Answer:

Vasopressin acts on V1 receptors independently of adrenergic receptors, compensating for relative vasopressin deficiency in septic shock

Question 3

A 65-year-old patient with CKD stage 4 (GFR 22 mL/min) requires pain management after total knee replacement. Which opioid selection and dosing consideration is most appropriate?

Morphine is preferred because it has no active metabolites in renal failure Hydromorphone at reduced doses with extended dosing intervals is safer than morphine in significant renal impairment Codeine is appropriate for moderate pain because it requires renal dose adjustment only above 75 years Meperidine is preferred for post-operative pain because it avoids the constipation of other opioids

Correct Answer:

Hydromorphone at reduced doses with extended dosing intervals is safer than morphine in significant renal impairment

Question 4

A patient on chronic prednisone 20 mg daily for rheumatoid arthritis requires emergency appendectomy. What is the critical perioperative pharmacological concern?

Risk of postoperative bleeding due to prednisone's antiplatelet effects Hypothalamic-pituitary-adrenal (HPA) axis suppression requiring stress-dose steroids Increased risk of prednisone toxicity due to surgical anesthesia interactions Need to discontinue prednisone 48 hours preoperatively to prevent wound dehiscence

Correct Answer:

Hypothalamic-pituitary-adrenal (HPA) axis suppression requiring stress-dose steroids

Question 5

A CNS reviewing a patient's medication list notes the patient takes simvastatin 80 mg and has been newly prescribed clarithromycin for H. pylori. What is the critical drug interaction concern?

Clarithromycin reduces simvastatin efficacy by inducing CYP3A4 metabolism Clarithromycin inhibits CYP3A4, dramatically increasing simvastatin levels and risk of rhabdomyolysis The combination increases clarithromycin levels, requiring dose reduction of the antibiotic There is no clinically significant interaction between these two medications

Correct Answer:

Clarithromycin inhibits CYP3A4, dramatically increasing simvastatin levels and risk of rhabdomyolysis

Question 1

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About this Exam

Prepare with the ACCNS-AG Adult-Gerontology Acute Care Clinical Nurse Specialist Certification practice quiz. This question bank includes 174 questions covering patient, nurse, clinical, specialist, and develops. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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ACCNS-AG Adult-Gerontology Acute Care Clinical Nurse Specialist Certification

This practice set contains 174 questions from the matching question bank and focuses on patient, nurse, clinical, specialist, and develops. Work through each question carefully, review the provided solutions, and revisit topics that need more study before your next attempt.

This is an independent study resource intended for practice and review; it is not an official examination or an endorsement by any organization named in the title.

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ACCNS-AG Adult-Gerontology Acute Care Clinical Nurse Specialist Certification

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