NRNP6566 FINAL NRNP 6566 FINAL EXAM LATEST 2023-2024 (REAL EXAM) ALL QUESTIONS AND CORRECT, Exams of Nursing

Download NRNP6566 FINAL NRNP 6566 FINAL EXAM LATEST 2023-2024 (REAL EXAM) ALL QUESTIONS AND CORRECT and more Exams Nursing in PDF only on Docsity! NRNP6566 FINAL NRNP 6566 FINAL EXAM LATEST 2023-2024 (REAL EXAM) ALL QUESTIONS AND CORRECT ANSWERS| GRADED A+ Question 1 Which statement is correct about fluoroquinolones? 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? fluoroquinolones are effective treatment for urinary tract infections and pyelonephriti s Carboxylic acid β 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 -lactam 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? nausea and vomiting macrolide resistance is not a concern due to infrequent use of this category first generation macrolides are not associated with GI side effects e.g., 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? PHof7.43,PCO2of3 6,HCO3of26 PHof7.41,PCO2of4 9,HCO3of30 PHof7.3 PCO2of35,HCO3of1 7 PHof7.25,PCO2of5 6,HCO3of28 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? 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 90/60 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 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? sulfonamides are effective against gram positive organisms only sulfonamides are effective treatment for wound infections sulfonamide allergy is mild and uncommon Serum osmolality 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? PEEP 10 Current arterial blood gas results are pH 7.45 pCO2 34 pO2 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 1.20 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 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 areflex Diarrhea Pre m a t urev en tricul s In arcontra c tion crea s einblo dpre s ure 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 puncture Chest x-ray, sedimentation rate CBC and chest x ray CBC, electrolytes A 56-year-old female Type 2 diabetic who presents to the ER complaining of abdominal pain, nausea, and vomiting for three days. She takes Metformin 1000 mg. BID and has good control of her blood glucose on this regimen. She has an abdominal CT with contrast, is diagnosed with iritable bowel syndrome, and admitted. As the ACNP you would do all the following EXCEPT: Start IV fluids for rehydration Order qid blood sugar monitoring and sliding scale insulin Restart the metformin Check electrolytes , BUN, and Crt before resuming Metformin Question 63 Which one of the following statements about acute respiratory distress syndrome (ARDS) is FALSE? A chest radiograph can show bilateral opacification of both lung fields Causes of this acute lung injury can include severe sepsis, trauma, and blood transfusions. Many patients with ARDS will experience multi-organ dysfunction syndrome (MODS). Treatment includes using high tidal volumes to maintain oxygenation Question 64 A 72 year old ICU patient was intubated for increasing hypoxia due to pneumonia 2 days ago. The patient has been stable on the ventilator. Medication orders include antibiotics, propofol, and midazolam. Current ventilator settings include FIO2 40%, tidal volume 600 cc rate 12 PEEP 5 cm Suddenly the patient becomes very agitated and fighting the vent. His oxygen saturation drops from 92 % to 87%. What is the best INITIAL step in your evaluation of this patient? Increase maintenance of propofol and give additional dose of midazolam Send patient for a chest CT Increase PEEP Remove the patient from the ventilator and hand bag with ambu Question 65 A 30 year old patient with a history of type 2 diabetes is brought to the ER in a near comatose state. His heart rate is 124 bpm and the B/P is 90/50 mm hg. Initial laboratory evaluation reveals a blood glucose of 625 g/dl, . Urine glucose is 4+ and ketones are present in the urine. Serum potassium is 4.0 mEq/dL and serum osmolality is 32 mOsm/L. Which feature distinguishes DKA from HHS coma in this patient? Hyperglycem ia Elevated serum osmolality Normal serum potassium Positive urine ketones Question 66 A 78 year old man is admitted from an extended care facility with confusion and shortness of breath. He had been admitted there following a stroke. He has an indwelling urethral catheter. His T is 102 pulse 112 RR 22 BP 86/62 oxygen saturation 94%. Chest x-ray is clear. Urinalysis shows 40 WBC, positive nitrites, positive leukocyte esterase. Pending the culture results, what antibiotics should be started now? Bactrim NItrofurantoi n Amoxicillin Vancomycin and cefepime uestion 67 The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of hypoglycemia hyperglycemia insulin resistence insulin sensitivity Question 68 The NP responds to a rapid response team page regarding a 56 year old female with vomiting and diarrhea. The patient reported feeling very dizzy and had to be assisted to bed. VItal signs are BP 58/32 P 140. What IV fluid should the NP order? D5.45NSat5 0ml / h 0.9NSatano penrate D5W at125ml / h r 0.45NSatop enrate Question 69 When evaluating the arterial blood gases (ABGs) of a patient with a bronchitis, which of these would the healthcare provider expect? 20 year history of chronic Metabolic acidosis, uncompensated Respiratory acidosis, compensated Respiratory alkalosis, uncompensated Metabolic alkalosis, compensated Question 70 A 26 year old female arrives at the ED via EMS. She was found unarousable in her apartment by her roommate. T 101.2 RR 32 HR 110 BP 138/88 Pupils are equal, round, and reactive. There is no sign of trauma. Labs: NA 140 K 4.0 CL 102 BUN 16 CR 0.8 Arterial blood gas pH 7.20 pCO2 24 pO2 96% Which of the following are true? Compensated metabolic alkalosis