NRNP 6566 Final Exam / NRNP6566 Final Exam(75 Questions & Answers)(Latest, 2024):Walden, Exams of Nursing

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NRNP 6566 Final Exam

Question 1

Which statement is correct about fluoroquinolones?

fluoroquinolones are effective treatment for urinary tract infections

and pyelonephritis

Fluoroquinolones are recommended treatment in uncomplicated

skin infections

fluoroquinolones are not associated with tendon rupture

fluoroquinolones are never indicated in the treatment of pediatric

infections

Question 2

A 42 year old year old women was admitted to the ICU with a severe asthmatic exacerbation. On rounds today, the patients T is 102.2. Her central IV line site is red, tender, and warm. Your remove the central line and order blood cultures along with IV cefepime. MRSA has been prevalent in this ICU. What additional medication should you order? po vancomycin IV gentamycin IV vancomycin IV pipercillin

Question 3

A 66-year-old male involved in a motor vehicle collision is admitted to the trauma unit with

multiplesbone fractions and left hemothorax with chest tube placement. Current vital signs are

BP 88/52 HR 120 T 98.4 RR 22. Past medical history is positive for end stage renal disease

requiring hemodialysis three times a week. How should the NP manage his renal disease?

Hemodialysis Peritoneal dialysis

Continuous renal replacement therapy No intervention until his blood pressure stabilizes Question 4 What crucial feature of a penicillin is involved in its mechanism of action? Carboxylic acid β -lactam ring Acyl side chain Thiazolidin e ring Question 5 Which drug should the APRN select to treat a patient with an infected post operative surgical wound infected with a positive culture result for MRSA? gentamycin ampicillin/sulbac t am vancomycin amphoteracin Question 6

Mr. D is a 56 year old male with newly diagnosed multiple myeloma who

is admitted through the ER with back pain after falling against a

bookcase at home. Chest x-ray shows a rib fracture. Electrolytes reveal

a serum calcium of 12.7 mg/dl. How would you treat Mr. D?

Normal saline and loop diuretics

Normal saline and thiazide

diuretics Kayexalate enema

Glucose, insulin, and magnesium

Question 7

A 13-year-old thin, female comes to your office with a 6-month history

of nondeliberate weight loss, polyuria and polydypsia. She has no other

significant

.

.

.

illnesses. There are no abnormalities on physical examination except a

random venous blood sugar of 237.

Which of the following statements regarding this case is FALSE?

Type 1 diabetes is confirmed by this test

A glucose tolerance test is not necessary to confirm

diagnosis Obtain a fasting blood glucose

Insulin will probably be required

Question 8

A patient who is allergic to penicillins may also be allergic to

a

Erythromycin

b

Neomycin

c Tetracycline

.

d

Cefazolin

Question 9 Joe is a 46 year old man with normal renal function diagnosed with heparin induced thrombocytopenia (HIT). In addition to stopping all unfractionated heparin products, the next appropriate step in treating this patient would be the addition of? Low molecular weight heparin aspirin Agratroba n Plavix Question 10

A 24-year-old male is a newly diagnosed type 1 diabetic. He weighs 62 kg

and you decide to start him on insulin therapy because his blood glucose

is high and he has ketonuria. His total daily dose of insulin to start with

should be:

31 units

40 units

46 units

56 units

Question 11

A 48-year-old female wt 70 kg, is in the ICU with acute pancreatitis. Her vital signs are as follows: BP 92/60 mm Hg; heart rate 116 bpm; She is intubated with current ventilator settings of VT 700 mL, assist control (AC) rate 12 bpm, FiO2 0.85, and positive end expiratory pressure (PEEP) 5.0 cm H 2 O. Her ABG reveals a pH of 7.31, PaCO2 of 53 mm Hg, and a PaO 2 of 62 mm Hg. Her chest radiograph shows diffuse, fluffy infiltrates. Based upon this assessment the ACNP would order a decrease of PEEP to

an increase of rate to 16 change to SIMV an increase of VT to 900 ml Question 12 A 22 year old patient is transitioning from oral agents to insulin. He will be taking 20 units of lantus at bedtime and regular insulin before meals. What instructions should the NP provide about the timing and dose of regular insulin? Take 5 units of regular insulin immediately after each meal Take 5 units of regular insulin for each 15 grams of carbohydrate consumed immediately after each meal. Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal Take 1 unit of regular insulin for each 5 grams of carbohydrate to be consumed 30 minutes before each meal. Question 13

All of the following statements about Type 2 diabetes mellitus are correct

EXCEPT:

Higher risk for development Question 18 A 22 year old female patient with type 1 diabetes presents with abdominal pain and T 100.1. Arterial blood gases reveal pH 7.2, pCO2 of 24, HCO3 12. What other finding would you expect on this patient? Decreased anion gap Decreased respirations Decreased urine output

Increased serum ketones

of CAD, peripheral vascular disease, and acute myocardial

infarction Have insulin resistance

Have more problems with ketosis than patients with Type 1 diabetes

mellitus Obesity is found in the majority of patients

Question 14 The NP is managing a male patient with bilateral lower extremity swelling, erythema, and draining blisters. The patient states the blisters have been there about a week but now there is redness around the blisters and moving up the leg. He has been having chills and thinks he has been running a temperature but does not own a thermometer. Vital signs are within normal limits except for an elevated temperature of 101.1 The patient has no known drug allergies. What medication should the NP prescribe?

IV Vancomycin

IV Cefazolin

IV piperacillin IV ciprofloxin Question 15 Amy calls the office and states that her fasting blood sugar has been over 225 for the past three mornings. What adjustments should the AGACNP make? Increase her basal insulin dose at bedtime Decrease her basal insulin dose at bedtime Increase her regular insulin dose before dinner Add a dose of regular insulin before bedtime Question 16

Which statement is correct about macrolide antibiotics?

first generation macrolides are not associated with GI side effects e.g.,

nausea

and vomiting

macrolide resistance is not a concern due to infrequent use of this

category

prolonged QT intervals are an adverse effect associated with

macrolides

use of macrolides during pregnancy is associated with elevated renal

function tests

Question 17 Cicely is a known diabetic with COPD who admitted to the hospital for pneumonia and acute COPD exacerbation. What treatment would the ACNP prescribe to manage her blood sugars? Continue her BID day dose of 70/30 insulin Every four hour BS readings with sliding scale insulin administration Administer Lantus at bed time and timed administration of regular insulin before meals Continue her 70/30 coverage but increase the dose by 10% to account for the stress of the illness Question 18 A 22 year old female patient with type 1 diabetes presents with abdominal pain and T 100.1. Arterial blood gases reveal pH 7.2, pCO2 of 24, HCO3 12. What other finding would you expect on this patient? Decreased anion gap Decreased respirations Decreased urine output Increased serum ketones Question 19 A patient with end stage renal disease misses three dialysis appointments. Which of the following arterial blood gases would indicate the patient is in metabolic acidosis?

PHof 7. 43 ,PCO 2 of 3

6 ,HCO 3 of 26

PHof 7. 41 ,PCO 2 of 4

9 ,HCO 3 of 30

PHof 7. 33 ,PCO 2 of 35

,HCO 3 of 17

PHof 7. 25 ,PCO 2 of 5

6 ,HCO 3 of 28

Question 20

The most common cause of low serum sodium and high serum osmolality is:

a

Hyperglycemia

.

b

Hypothyroidism

.

c Adrenal insufficiency

.

d

K+ sparing diuretic

.

Question 21 Which antibiotics would NOT be appropriate to empirically treat an E. Coli infection? Penicillin VK (Pen VK) Cephalexin (Keflex) Nitrofurantoin (Macrobid) Trimethoprim-Sulfamethoxazole (Bactri m DS) Question 22

The NP is managing a 66 year old female admitted to the ICU with a serum potassium level of

8.9 mEg/L. Hemodialysis will be started as soon as the on-call staff can arrive. What

intervention should the NP order now?

Dextrose 50% , insulin and ,sodium bicarbonate

Sodium bicarbonate and ipratropium bromide (Atrovent)

Calcium gluconate and calcium acetate (PhosLo)

Sodium polystyrene (Kayexalate) PO and Kayexalate enema

Question 23 The APRN is treating a patient with type 2 diabetes. The patient is on the maximum dose of metformin and glucotrol. Current weight 212 pounds. Labs from this morning indicate a fasting blood sugar of 312 and HbA1C of 9. The APRN wants to start the patient on Lantus 0.2 unit/kg. What dose and instructions should the APRN provide? Give 2 units of Lantus subcutaneously prior to lunch every day

Give 19 units of Lantus subcutaneously prior to

.

.

.

bedtime. Give 24 units of Lantus subcutaneously prior to dinner Give 42 units of Lantus subcutaneously prior to bedtime. Question 24

When prescribing sildenafil (Viagra) to a patient, the patient should be

screened for which of the following? Select all that apply.

Use of a statin

medication Use of a

nitrate medication

History of coronary artery

disease Use of opiods

History of priapism

Question 25 The NP is assessing a patient receiving benzodiazepines who is experiencing confusion, dizziness, slurred speech, and difficulty breathing. What medication should the NP order to counter the effects? Ropivacaine Naloxone Bromaze pa m Flumazenil Question 26 The AGACNP orders a renal angiogram for a patient with suspected renal artery stenosis. Which of the following medications would be contraindicated for the patient? a Calcium channel

. (^) blockers

b

Alpha blockers

c

Beta blockers

d

ACE inhibitors Question 27 The AGACNP is assessing a patient in the urgent care area. The patient is a 44 year old women in her third round of chemotherapy for breast cancer. She presents today with complains of generalize malaise and fever that has gradually increased over the past 12 hours, BP 110/62 P 96 T 102.6 RR 18

WBC 4.2 ANC 300 The best initial treatment by the AGACNP is:

Begin oral cephlosporin until causative organism is identified Monitor in the observation area for 12 hours to see if temperature is sustained before starting treatment Broad spectrum empiric antibiotic coverage Culture blood, sputum, and urine. Treat with tylenol until culture and sensitivity results are available Question 28 Mrs. J, age 62, is brought to the hospital by ambulance. She is severely dehydrated, does not respond to verbal stimuli, and withdraws from painful stimuli. BP is 90/ with a heart rate of 130 bpm. Serum blood glucose level is 1000 mg/dl and there are no ketones in the initial urine analysis. HHS is suspected. Mrs. J's lab values would include which finding? Serum sodium of 120 mEq/l Serum osmolality of 380 mOsm/l Urine sodium of 50 mEq/l Bicarbonate of 15 mEq/l Question 29

The NP is caring for a patient with intra renal acute kidney injury (AKI). Which of the

following would cause this?

Acute glomerulonephritis

Ureter obstruction Acute pyelonephritis

Hypovolemia due to hemorrhage

uestion 30

What should be considered prior to prescribing a sulfonamide?

sulfonamide allergy is mild and uncommon

sulfonamides are effective against gram positive organisms only

sulfonamides are effective treatment for wound infections

sulfonamides are a good anti-infective choice during pregnancy and in

elderly

Question 31

Which of the following medications has the best gram negative bacteria

coverage?

Cefuroxime (Cefzil)

Amoxicillin (Amoxil)

Clarithromycin

(Biaxin)

Moxifloxacin

(Avelox)

Question 32 A 66 year old patient is admitted to the ICU with hospital acquired pneumonia. She has consolidation in the right middle and lower lung lobe. Arterial blood gasses show a pO2 of 55%. Which mechanism likely accounts for this patients hypoxia? Decreased pO2 of inspired air Central hypoventilation Mismatch of ventilation and perfusion Decreased oxygen surface tension Question 33 The NP is managing the care of a patient admitted with hypokalemia. The patient's admission serum potassium was 3.0. The patient has been receiving potassium supplements for 4 days. Today's serum potassium is 3.1. What lab test should the NP order to assess this patient's failure to respond to treatment? Sodium Phosphor u s Calcium Magnesiu m

Question 34 A patient with COPD and asthma is intubated and becomes hypotensive. High levels of auto-peep are noted. What changes should be made in the ventilator settings to address the auto peep?

Increase tidal volume decrease the tidal volume decrease the respiratory rate Both 2 and 3 Question 35 Mrs. J, age 62, is brought to the hospital by ambulance. She is severely dehydrated, does not respond to verbal stimuli, and withdraws from painful stimuli. BP is 90/ with a heart rate of 130 bpm. Serum blood glucose level is 1000 mg/dl and there are no ketones in the initial urine analysis. HHS is suspected.

Which statement about HHS is INCORRECT?

Hyperglycemia occurs because of a total insulin

deficiency Cerebral impairment is a factor

Ketogenesis does not occur

Severe dehydration results from an osmotic diuresis

Question 36

A 56-year-old woman comes to the emergency department because she has

had increasing swelling of the right ankle over the past two days, since she

sustained an injury while playing outdoors with her grandchildren. She says

she has been taking over-the- counter ibuprofen 400 to 800 mg every four

to six hours to relieve the pain. Medical history includes mild hypertension,

which is currently controlled with lisinopril. Results of laboratory studies

show elevated levels of serum creatinine and blood urea nitrogen. Acute

renal failure induced by use of nonsteroidal anti-inflammatory drugs is

suspected. If this suspected diagnosis is correct, which of the following

additional abnormal laboratory results would the AGACNP expect to see?

a Decreased^ serum^ chloride^ level

.

b Decreased

. serum potassium level

c

Elevated serum potassium level

.

d

Elevated serum sodium level

.

Question 37

The NP is treating a patient in septic shock. The patient remains hypotensive despite initial fluid resuscitation. Based on the surviving sepsis guidelines, which of the following is true? Fluid resuscitation requires 20 ml/kg of crystalloids Vasopressors should be used next to target a MAP^ of^50 The first line vasopressor to use is norepinephrine Vasopressin is contraindicated to use with norepinephrine Question 38 The NP is planning a rapid sequence intubation (RSI) on a 44 year old male. He weighs 88 kg. What medications should be administered prior to the RSI? Etomidate 26 mg IV and Succinylcholine 132 mg IV Etomidate 264 mg IV and Succinylcholine 312 mg IV Etomidate 88 mg IV and Succinylcholine 88 mg IV Etomidate 2 mg IV and Succinylcholine 11 mg IV Question 39 The NP is managing the care of a patient in metabolic acidosis. Which exam finding would indicate that the acidosis is getting worse?

Dee

ptendonreflexesdecreasingf

rom + 2 to+ 1

Bicarbonaterisingfrom

20 mEq/Lto 22 mEq/L UrinepHless

than 6 Serum

potassium decreasingfrom

6. 0 mEq/Lto 4. 5 mEq/L

Question 40 A 44 year old female is in acute respiratory distress syndrome. She is intubated and mechanically ventilated. Her ideal body weight is 60 Kg. Current ventilator settings include FIO2 100% Tidal volume 450 RR 22 PEEP 10 Current arterial blood gas results are pH 7.45 pCO2 34 pO 75 Chest xray shows bilateral infiltrates. Which of the following interventions will increase her chance of survival? Decrease PEEP Add inhaled

nitric

oxide Decrease tidal volume Increase bronchodilators Question 41 The NP is assessing a patient with a serum potassium level of 2.9 What EKG finding would you expect to see based on this lab?

Uwaves

AbsentPwa

ves

ElevatedT

waves

ElevatedS

Tsegment

Question 42 The NP is managing the care of a patient admitted with a serum sodium level of

115. The patient has been receiving 3% normal saline 50 ml/hour for the past 16 hours. On rounds this morning, the patient complains of shortness of breath and fatigue. What is the priority intervention? Stop the infusion Check a serum sodium level tomorrow morning Assess for signs of fluid overload Increase the 3% saline infusion to 60 cc / hour Question 43 The NP is consulting on a patient in the postanesthsia care unit that is immediate post op from a total knee replacement. The patient is increasing somnolent and has been treated with multiple doses of fentanyl for severe pain. Arterial blood gas results show pH 7.28 pO2 68 HCO3 24 oxygen saturation 92%. The next step for the NP to order is: Intubate immediately

Give naloxone (Narcan)

Place on BIPAP

Given flumazenil (Romazicon)

Question 44

The NP is caring for a patient with prerenal acute kidney injury (AKI). Which of the following

would cause this?

Acute glomerulonephritis

Ureter obstruction Acute pyelonephritis

Hypovolemia due to hemorrhage

Question 45

Miss Smith arrives in the ER with a blood glucose of 420 and + ketones

in her urine. She is a type 1 diabetic weighing 70 kg. She is diagnosed

with Diabetic Ketoacidosis. The initial bolus dose of insulin is:

10 units of NPH IV

10 units of Regular

Insulin IV 20 units of

regular insulin IV

0.1 units of regular insulin/hr via continuous infusion

Question 46 An insulin-dependent diabetic patient is seen today with the following blood sugar readings from home 250-280 mg/dL in the morning before breakfast 120-140 before lunch 120-130 before dinner 100-110 at bedtime. 160-180 at 3 am Her current insulin dose is 30 units of NPH insulin and 4 units of Regular insulin and before dinner she takes 18 units of NPH and 4 units of Regular. What is your next plan of action? Switch her over to Lantus insulin by multiplying her evening NPH dose by 1. and tell her to give that amount of Lantus at bedtime and call you in a week with the readings. Increase the evening regular insulin dosage by 2 more units and have her call you with the readings in a week. Order a fasting blood glucose test and glycosylated hemoglobin. Increase her evening NPH insulin dosage by 2 units

.

.

Question 47 A 78-year-old male patient with heart failure develops a bacterial urinary tract infection secondary to an indwelling Foley catheter. The patient has a known history of allergy to penicillin and sulfonamides. The appropriate choice for antimicrobial therapy is:

a

Cephalexin (Keflex) b Ciprofloxacin^ (Cipro)

.

Doxycycline

c

(Vibramycin) d T etracycline

. (^) (Sumycin). Question 48 The NP is managing care for a patient with hypoparathyroidism. He complains of numbness and tingling in his fingers and around him mouth. What electrolyte imbalance would you expect? Hyponatrem ia Hypocalcemi a Hyperkalemi a Hypermagne se mia Question 49

Which of the following blood gas values illustrates respiratory

acidosis? pH 7.28 PaCO2 22 HCO3 -16

pH 7.38 PaCO2 62 HCO3 -36

pH 7.48 PaCO2 31 HCO3 -24

pH 7.22 PaCO2 62 HCO3 -25

Question 50 The NP is discharging a patient newly diagnosed with end stage renal disease that has been started on hemodialysis. The patient states he has frequent constipation at home. What over the counter product should the NP instruct the patient to AVOID?

Bisacodyl

(Dulcolax

) supp

ository

Fibersupp

lements

Docusate

sodium

Milkofmagnesia

Question 51 A 42 year old homeless man is found unresponsive. Upon arrival at the ER, his arterial blood gasses show: pH 7.10 pCO2 28 pO2 94 HCO3 9 Which of the following is true regarding this patient? metabolic acidosis with respiratory compensation metabolic acidosis with inadequate respiratory compensation respiratory alkalosis with metabolic compensation respiratory alkolosis with inadequate compensation Question 52

The NP is caring for a patient with post renal acute kidney injury (AKI). Which of the

following would cause this?

Acute glomerulonephritis

Ureter obstruction Acute pyelonephritis

Hypovolemia due to hemorrhage

Question 53

Which of the following initial diagnostic studies would not reflect DKA?

Decreased arterial pCO2, decreased arterial pH, and decreased

HCO3 Elevated serum potassium and decreased HCO3-

Elevated urine specific gravity and BUN

Decreased serum potassium and decreased hematocrit

Question 54 The NP has ordered an IV magnesium infusion for a patient with a serum magnesium level of 1.2 Which of the following symptoms would indicate the need to stop the infusion?

Absentpate

l arreflex

Diarrhea

Prematureventricul

arcontractions

Increaseinbloo

dpressure

Question 55 The NP is caring for a patient on BIPAP. His latest arterial blood gases indicate that an increase in tidal volume is needed. What changes in the BIPAP settings would you make to accomplish this? Increase the FIO2 Increase the expiratory pressure (EPAP) while maintaining the inspiratory pressure (IPAP) Decrease the expiratory pressure (EPAP) while maintaining the inspiratory pressure (IPAP) Increase the inspiratory pressure (IPAP) while maintaining the expiratory pressure (EPAP) Question 56 The NP is initiating procedural sedation for insertion of a central venous line. Which of the following is NOT a goal of procedural (moderate) sedation? Guard the patient’s safety and welfare Maintain adequate sedation with minimal risk Allay patient fear and anxiety Produce an unconscious patient Question 57 Your patient has a post operative incision infecion. He has a low grade temperature and is allergic to sulfa. What oral antibiotic would provide empiric coverage for MRSA? TMP / SMX DS Doxycycli ne Augmenti n 3rd generation cephlosporin Question 58

The ACNP suspects her patient has pneumonia. The diagnostic tests that

might be most helpful in supporting diagnosis of pneumonia would

include:

CBC, chest x-ray, and lumbar