NRNP 6560 Final Exam-with 100% verified solutions- Graded A+
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Course
NRNP 6560
Institution
NRNP 6560
A patient who has been in the intensive care unit for 17 days develops hyponatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-g...
NRNP 6560 Final Exam-with 100% verified solutions-2024-2025
Graded A+
1. Q ANSWER:
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert
the AGACNP for the possibility that the patient is over hydrated, thereby increasing the risk for
increased intracranial pressure?
A. BUN = 10
B. Shift output = 800 ml, shift input =
825 ml Unchanged weight
C. Serum osmolality = 260
2. Q ANSWER:
A patient who has been in the intensive care unit for 17 days develops hyponatremic
hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical
ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and
hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to:
A. reduce serum osmolality by infusing a 5% dextrose in 0.2%
sodium chloride solution
B. reduce serum sodium concentration by infusing a 0.45% sodium
chloride solution
C. replenish volume by infusing a 0.9% sodium chloride solution
D. replenish volume by infusing a 5% dextrose in water solution.
Surgery risk classes - Answer- Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriate
General rules for surgery: testing - Answer- ECG before surgery only if coronary disease, except when low risk
surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Meds before surgery - Answer- - Diabetic agents: Use insulin therapy to maintain glycemic goals(iii) Discontinue
biguanides, alpha glucosidase inhibitors, thiazolidinediones, sulfonylureas, and GLP-1 agonists
- Do not start aspirin before surgery
- Stop Warfarin 5 days before surgery. May be bridged with Lovenox.
,- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, but may continue
Assessment of surgical risk - Answer- - Unstable cardiac condition (recent MI, active angina, active HF,
uncontrolled HTN, severe valvular disease), concern with CAD, CHF. arrhythmia, CVD
- patient stable or unstable?
- urgency of the procedure (oncology will be time sensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more than 4 METS, more than 10 METs makes low risk)
3. Q ANSWER:
A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of
nausea and has had one episode of vomiting, but he denies any diarrhea. His vital signs are as
follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood
pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/µL. The
AGACNP expects that physical examination will reveal:
A. + Murphy’s sign
B. + Chvostek’s sign
C. + McBurney’s sign
D. + Kernig’s sign
4. Q ANSWER:
Myasthenia gravis is best described as:
A. An imbalance of dopamine and acetylcholine in the
basal ganglia Demyelination of peripheral ascending
nerves
B. Demyelination in the central nervous system
C. An autoimmune disorder characterized by decreased neuromuscular activation
Low risk surgeries - Answer- catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries - Answer- Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
, 5. Q ANSWER:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate
the patient for persistent and progressive discomfort. Likely causes of her symptoms include all
of the following except:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
6. Q ANSWER:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to
evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms
include all of the following except:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
7. Q ANSWER:
When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke
most likely resulted from a subarachnoid hemorrhage when the patient’s family reports that
the patient:
A. Has a history of atrial fibrillation
B. Was unable to be aroused in the morning
C. Had been complaining of a headache before losing consciousness
D. Has had several brief episodes of mental confusion and right arm and leg weakness
8. Q ANSWER:
You are asked to see a 29 year old female complaining of abdominal pain. She states she is
experiencing constant RUQ pain that radiates to her back. The pain is not relieved by bowel
movements, over the counter antacids or food. Review of initial labs shows elevated amylase
and lipase and you diagnose her with acute pancreatitis. Which test will you order next to
determine the underlying cause of her pancreatitis?
serum cholesterol
level blood
toxicology
, right upper quadrant
ultrasound endoscopy
High risk surgeries - Answer- aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk index - Answer- 6 points:
High risk surgery = 1
CAD = 1
CHF = 1
Cerebrovascular disease = 1
DM 1 on insulin = 1
Creat greater than 2 = 1
1 = low risk
2 = moderate risk
3 = high risk
SCIP pre-operative infection measures - Answer- - Prophylactic antibiotics should be received within 1 h prior to
surgical incision
- be selected for activity against the most probable antimicrobial contaminants
- be discontinued within 24 h after the surgery end-time
9. Q ANSWER:
Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ
resection following a catastrophic motor vehicle accident. Due to the nature of his injuries, a
large portion of his jejunum had to be resected. In planning for his recovery and nutritional
needs, the AGACNP considers that:
He will probably be able to transition to oral nutrition but will have lifetime
issues with diarrhea His procedure has put him at significant risk for B12
absorption problems
Most jejunum absorption functions will be assumed by the ileum
Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation
10.Q ANSWER:
A 32-year-old man comes to the clinic because he has had pain in the back for the past 24
hours. The patient says he first noticed the pain when he awoke in the morning and had
difficulty getting out of bed. He had been playing flag football the day before the pain began
but did not sustain any injuries during the game. Acetaminophen has provided only minimal
relief of the patient's pain. On physical examination, pain is elicited on palpation of the back on
the left, lateral to the region of L2-L5. Full range of motion is noted in vertebral flexion,
extension, lateral rotation, and lateral bending, with some hesitancy because of pain on the left
side. Which of the following is the most appropriate initial step?
Anti-inflammatory and muscle relaxant
therapy Epidural injection of a
corticosteroid
MRI of the lumbar spine
Strict bed rest and application of moist heat to the lower back
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