Deck 1: Collection of Clinical Nurse Practitioner

Question 1

A patient present with sudden onset shortness of breath and difficult breathing. Her tongue is swollen and she states she is feeling very dizzy. What would the medication most likely given to her?

A)Diphenhydramine
B)Dopamine
C)Aminophylline
D)Epinephrine

Answer 1

Epinephrine

Question 2

A patient recovering from a myocardial infarction is preparing to transfer to a telemetry floor. The acute care NP has begun teaching on the Angiotensin converting enzyme inhibitors he will be taking throughout the hospital stay and after discharge. What statement reflects the patient understanding of the medication?

A)"if I forget to take a dose, I will take the missed dose as soon as I remember."
B)"If I forget to take a dose of medication I will make up for it by taking a double dose the next time it is due."
C)"It's normal to feel light headed with this medication and I will move around as I normally do."
D)"I should increase the amount of potassium I eat in my diet."

Answer 2

"if I forget to take a dose, I will take the missed dose as soon as I remember."

Question 3

The NP is taking care of a patient with Ketoacidosis. She is concerned that the patient is developing further acidosis. The latest ABG's reflect a pH of 7.0. What treatment of acidosis is most likely to correct this imbalance?

A)Fluids and insulin.
B)Oxygenation and insulin.
C)Fluids and potassium replacement.
D)Fluids and arterial blood gases every 6 hours.

Answer 3

Fluids and insulin.

Question 4

The NP has called the doctor about a patient suspected to be experiencing a hypertensive crisis. What medications would the NP anticipate the doctor ordering?

A)Intravenous Nitroprusside
B)Intravenous Metroprolol
C)Sublingual Nitroglycerin
D)Intravenous Furosemide

Question 5

The patient with a hemoglobin level of 4.4 is ordered to receive 5 units packed red blood cells. To avoid circulatory overload, the NP would take all of the following actions except:

A)Administer Furosemide 20 mg intravenously in between each unit.
B)Monitor the patient for signs and symptoms of hypoxia, edema and fever.
C)Transfuse the blood quickly to avoid fatigue.
D)Administer supplemental oxygen to aid the patient's breathing.

Question 6

When preparing to remove an endotracheal tube, the NP should NOT do which of the following:

A)Get the help of another NP to hold the tube while you untape the tube.
B)Deflate the cuff before moving the endotracheal tube.
C)Extubate the endotracheal tube if no air leak is detected around the deflated cuff.
D)Suction during extubation of the endotracheal tube to remove secretions retained at the end of the tube.

Question 7

An experienced intensive care unit NP is teaching a class of new nurses about the neurological system. What is the best way to describe the purpose of Cerebral Spinal Fluid (CSF) to the class?

A)Cerebral spinal fluid cushions the brain and the spinal cord.
B)Cerebral spinal fluid maintains cerebral perfusion pressures.
C)Cerebral spinal fluid transports fluid to the ventricles.
D)Cerebral spinal fluid develops neurotransmitters.

Question 8

What is the leading cause of acute Tubular Necrosis?

A)Sepsis
B)Shock
C)Myocardial infarction
D)Gastro intestinal bleeding

Question 9

What is the most significant complication of intermittent Hemodialysis that the NP needs to asses for?

A)Arrhythmias
B)Hypertension
C)Hypotension
D)Cerebral edema

Question 10

A 77 year old patient with diabetes mellitus has been diagnoses with acute Tubular Necrosis. What would most likely indicate the patient is in the initial phase of acute Tubular Necrosis?

A)Creatinine level of 1.1
B)Urine production of 1200 mL/ day
C)Complaints of nausea and abdominal pain
D)Urine production of less than 400 mL / day

Question 11

Which of the following medications would be most effective in decreasing vagal stimulation, pancreatic secretion and ampullary spasm in a patient with acute Pancreatitis?

A)Opioid analgesics
B)Antiemetics
C)Anticholinergics
D)Antispasmodic

Question 12

A 57 year old man is admitted to the intensive care unit for hepatic failure. All of these previous conditions predispose him to hepatic failure except for:

A)Viral hepatitis
B)Acetaminophen overdose
C)Biliary atresia
D)Pancreatitis

Question 13

In end stage renal disease, what lab value should be monitored in relation to bleeding?

A)Hemoglobin
B)Hematocrit
C)Platelet
D)Prothrombin time

Question 14

A patient in end stage renal disease is due for dialysis today suddenly needs additional help to get out of bed to use the bedside commode. He is short of breath and complains of feeling "extra tired" today. A glance at the telemetry monitor shows a new onset irregular heartbeat. What electrolyte imbalance is the most likely cause of the patient's new symptoms?

A)Hyponatremia
B)Hypercalcemia
C)Hypophosphatemia
D)Hyperkalemia

Question 15

The NP assess that the cause of the patient's acute Tubular Necrosis is a nephrotoxic agent, probably the contrast that was used for the computerized tomography scan of the abdomen. What would be a nursing goal to prevent further damage to the kidneys for this patient?

A)Prevent further exposure to the causative agent
B)Monitor the creatinine and blood, urea, nitrogen levels (BUN)
C)Hold the daily furosemide and diabetic medications
D)Ensure that daily labs are ordered to monitor kidney function

Question 16

What characteristics would the NP most likely assess in a patient with reduced Renal Reserve (early stages of renal disease)?

A)Elevated BUN (blood, urea, nitrogen) lab value.
B)Mild anemia and hypertension
C)Terminal uremia
D)Nocturia

Question 17

The NP is taking care of a Hispanic patient who has a large family. She pulls in extra chairs and lets the patient know what times where multiple family members would be allowed. She gets the patient water without ice. The NP is showing what professional caring quality?

A)Clinical inquiry
B)Systems thinking
C)Caring practice
D)Response to diversity

Question 18

A patient has returned after a lengthy abdominal surgery. The NP enters the room to assess the patient and observes the patient forcefully coughing without using anything to protect her abdomen. The NP would teach the patient to use an abdominal pillow over her abdomen when coughing to avoid the post operative complication of:

A)Atelectasis
B)Dehiscence
C)Tension pneumothorax
D)Paralytic ileus

Question 19

You are working in the emergency room when a 45 year old male comes in with signs and symptoms of acute renal failure. What is the most accurate measure of renal function?

A)glomerular filtration rate
B)urea
C)creatinine
D)urine output

Question 20

The NP is working with a nursing assistant who has recently successfully completed her orientation. What would be an appropriate task to delegate to the nursing assistant?

A)Take the first two sets of vital signs for a patient receiving their first unit of packed red blood cells.
B)Collect information about a new patient.
C)Ambulate a patient who had a lumbar fusion surgery yesterday.
D)Teach a patient with diabetes how to use a Glucometer.

Question 21

The NP is assessing her patient for pressure ulcers. On the patient's right heel, she notices one inch by ½ inch red shallow crater with a small amount of white drainage, surrounded by bright pink skin. She documents this finding as a:

A)Blanchable, stage one pressure ulcer.
B)Stage 2 partial thickness wound.
C)Stage 3 full thickness wound.
D)Non stageable wound.

Question 22

What is the neurotransmitter that is found to be in low levels in patients with Alzheimer's disease?

A)Dopamine
B)Epinephrine
C)Serotonin
D)Acetylcholine

Question 23

A patient has suffered a myocardial infarction due to acute coronary syndrome. The emergency room physician has ordered bivalirudin in preparation for the patient undergoing percutaneous coronary intervention (PCI). What is the most important symptom to watch for when a patient is receiving bivalirudin?

A)bleeding
B)bradycardia
C)hypotension
D)all of the above

Question 24

A 47 year old man is admitted to the ICU for severe injuries as a result of a motor vehicle accident. He has lost a lot of blood and his blood pressure is 70/35. After a few hours he goes into cardiac arrest. The patient has 'DNR' orders in his medical records. But his brother who is present wants doctors to do everything they can to save him. What is the appropriate action at this time of emergency?

A)Do not resuscitate
B)Contact health care proxy
C)Follow brothers wishes
D)Contact hospital ethics committee

Question 25

As a nurse, you must be aware of the visiting policy of the health care center. What would you do if the family of a critically ill patient wishes to spend the night, which is contrary to visiting policy?

A)adhere to the visiting policy.
B)allow the family to stay in the room.
C)obtain a motel room near the hospital where the family may spend the night.
D)allow one or two family members to stay, then evaluate the patient's response.

Question 26

The NP has been called to the desk to take a phone call from a patient's mother. The mother has several questions about the patient's condition and plan of care. What is the nurse's most appropriate response?

A)"I only discuss plan of care when I can see you to verify your identity."
B)"Can you verify the patient's birth date?"
C)"Let me put you through to the patient's room so you can speak to her directly."
D)"I'm sorry; I cannot give you any information about the patient."

Question 27

A NP is assessing a 25 year old admitted for suspected rheumatic fever. What would the NP look for as a confirmation of the diagnosis?

A)A red rash over the trunk and a temperature of 100.8.
B)A productive cough with yellow sputum and a sore throat for 2 weeks.
C)A positive chest x ray with white mass.
D)A positive Antistreptolysin O titer.

Question 28

The patient with a diagnosis of rule out Cerebrovascular accident is scheduled to go to a Magnetic resonance imaging. What would be a contraindication for the patient to undergo the test?

A)Pacemaker
B)History of anxiety
C)History of a heart attack
D)Allergy to contrast

Question 29

The physician orders peak and trough levels for a patient receiving Vancomycin for the treatment of sepsis. If the patient received the last dose of Vancomycin at 12:00 noon, when should the trough be drawn?

A)11:30 am
B)12:30 pm
C)10:00 am
D)2:00 pm

Question 30

Guided exposure therapy is usually used for patients with this time of anxiety disorder:

A)Generalized anxiety disorder
B)Panic disorder
C)Specific Phobias
D)Post traumatic stress disorder

Question 31

A NP is giving instructions to a patient with an iron deficiency anemia. Which meal plan would reflect the patient's understanding of an appropriate diet?

A)Egg salad on wheat bread, carrot sticks, lettuce salad and raising oatmeal cookies
B)Chicken salad sandwich, potato salad and ice cream
C)Pork chop, apple sauce, cornbread and apple pie
D)Hamburger, green salad, green beans and a popsicle

Question 32

The NP is transporting a patient with MRSA to the OR for a shoulder replacement. What precautions regarding infection control should the NP take?

A)Place a sign on the patient's chart to alert the staff in the OR.
B)Wear a mask and gloves when transporting the patient to the OR.
C)Place the patient's chart in a bag before transporting the patient.
D)Place a surgical mask on the patient when outside of the room.

Question 33

A patient undergoing chemotherapy has a platelet count of 20,000 per micro liter. What teaching needs to be done in regard to the low platelet count?

A)Avoid family members with a cold or flu.
B)Take aspirin for headaches and general pain.
C)Avoid activities that could cause injury.
D)Stop working and sleep more.

Question 34

The NP is taking care of a patient who is has been admitted with a diagnosis of "brain dead post traumatic injury." The NP would expect all of the following clinical manifestations except:

A)Absent papillary responses
B)Slight eye movement during the caloric test.
C)No corneal reflex present.
D)Fixed eyes during the doll's eyes test.

Question 35

The importance of evidenced based care is gaining credibility and acknowledgement. Nurses in the critical care setting are often learning new techniques and adapting their care to reflect evidenced based outcomes. Evidence based care would be based on all the following sources except:

A)Formal nursing research
B)Clinical knowledge
C)Scientific knowledge
D)Cultural practice

Question 36

What would not be a nursing intervention for the patient with tonic-clonic seizures?

A)Restraining a patient during a seizure.
B)Clear the area of hard objects.
C)Turn the patient's head or turn him on his side.
D)Assist the patient to a lying position and loosen any tight clothing.

Question 37

A NP is observing her patient after a computerized tomography (CT) scan to assess whether they are having an adverse reaction to the contrast medium. Signs and symptoms of an adverse reaction would include everything but:

A)Facial flushing
B)Urticaria
C)Bradycardia
D)Restlessness

Question 38

What is the most common cause for Cardiogenic shock?

A)Stroke
B)Hypertensive crisis
C)Myocardial infarction
D)Acute pulmonary edema

Question 39

A 49 year old male patient has experienced a myocardial infarction with an approximate 55% damage to his ventricle. What interventions would most likely NOT be performed for this patient to avoid the complication of cardiogenic shock?

A)Intraaortic balloon pump
B)Angioplasty
C)Bypass surgery
D)Chest tube insertion

Question 40

The anticoagulant, Heparin, is appropriate to use in all of the following diagnosis except:

A)Embolism prophylaxis
B)Cerebral thrombosis
C)Ischemic Stroke
D)New onset atrial fibrillation

Question 41

What precautions should be followed when administering Phenytoin?

A)Phenytoin should always be mixed with a dextrose solution when given in an intravenous form.
B)Phenytoin should be given as a pill only.
C)Most people don't react well to Phenytoin so Fosphenytoin is given as an alternate.
D)Phenytoin should not be mixed with a dextrose solution.

Question 42

A patient has been admitted to the intensive care unit with a diagnosis of "rule out" Guillain-Barre syndrome. The NP is completing the admission data base and asking about the patient's history. What diagnosis might precipitate a diagnosis of Guillian-Barre syndrome?

A)Myocardial infarction within the last 6 months
B)Headache, nausea and nuchal rigidity
C)Mild fevers, upper respiratory infection or a minor virus
D)Slurred speech and weakness in one or both sides of the body

Question 43

The NP is preparing to wean a patient from mechanical ventilation. What option is NOT a method of weaning the patient from mechanical ventilation?

A)Pressure support ventilation
B)Controlled mandatory ventilation
C)Using a T-piece, perform spontaneous breathing trials
D)Intermittent mandatory ventilation

Question 44

A 20-year-old male client with a BMI of 33 has been admitted for recurrent chest pains and difficulty breathing. During the assessment, it is found that his father and mother have both suffered from myocardial infarction before the age of 50. Which of the following nursing actions is the first step to prevent the client from developing myocardial infarction?

A)Encourage the client in initiating and maintaining a regular exercise program.
B)Instruct the client to avoid fatty and high-calorie meals.
C)Assess the client's level of interest in weight reduction programs.
D)Educate the client about the risks of obesity and myocardial infarction.

Question 45

The NP is taking care of a 51 year old with Acute Lymphocytic Leukemia (ALL) with a White Blood Cell count of 6.0. What would the NP NOT do when preventing infection from occurring in the patient?

A)Take vital signs every 2 hours.
B)Insert a Foley Catheter.
C)Check the patient's mouth frequently and give saline solution rinses.
D)Give antibiotic therapy immediately when white counts fall.

Question 46

A patient comes to the Cardiovascular Care Unit with a blood pressure of 94/68, a heart rate of 124 and chest pain rated as 8/10. The patient has already taken one 0.04 mg tablet of Nitroglycerin five minutes ago. What should the NP do next?

A)Take the patient's blood pressure and put them on the monitor.
B)Administer a dose of Morphine 2 mg IV and re-assess pain.
C)Obtain a stat EKG.
D)Administer another dose of 0.04 mg tablet of Nitroglycerin.

Question 47

A NP is ending his shift and comes in to re-assess his patient, a seventy six year old woman who was diagnosed with a brain lesion. He notes that the patient appears restless and does not know where she is. Upon further examination, he notes that her pupils are sluggish to react to light and are unequal in size. She is unable to sit up at the side of the bed and her blood pressure has risen to 190/88. What does the NP suspect is occurring?

A)Increased Intracranial Pressure
B)Cerebral aneurysm
C)Stroke
D)Myocardial infarction

Question 48

The NP is assisting the physician during an Abdominal Paracentesis. What is the maximum amount of fluid that should be aspirated?

A)1,000 to 1,500 mL
B)2,000 to 2,500 mL
C)1,500 to 2,000 mL
D)2,500 to 3,000 mL

Question 49

A patient has developed Acute Respiratory Acidosis, with a pH of 7.25 and a PaCO2 of 55. What is the underlying cause of Respiratory Acidosis?

A)The lungs are not sufficiently ventilating.
B)The lungs are working excessively resulting in "over breathing."
C)There is an underlying gastric disorder.
D)There are elevated levels of aldosterone present.

Question 50

All of these signs and symptoms are early stages of Hypovolemic shock except for:

A)Tachycardia
B)Hypotension
C)Tachypnea
D)Decreased urinary output

Question 51

The best treatment for Pulmonary embolism is prevention. Heparin is often used to prevent pulmonary embolisms in at-risk patients. The Activated Partial Thromboplastin Time (APTT) is used to maintain a therapeutic level for heparin therapy. What level should the Activated Partial Thromboplastin Time be maintained at?

A)1.5 to 2 times the normal level
B)2.5 to 3 times the normal level
C)3 to 4 times the normal level
D)5 times the normal level

Question 52

What is the first step in treating a patient with Acute Respiratory Distress Syndrome?

A)Maintain fluid and electrolyte balance
B)Maintain oxygenation
C)Provide adequate nutrition
D)Prevent respiratory and metabolic complications

Question 53

Constant positive airway pressure (CPAP) is a ventilator mode that provides positive pressure when the patient is breathing spontaneously. A NP notices that the constant positive airway pressure is more than 10 cm H20. What problems could this cause?

A)Decreased blood pressure
B)Increased blood pressure
C)Increased risk of respiratory distress
D)Decreased ability to regain lung strength

Question 54

Virchow's triad refers to the factors that predispose a patient to venous thrombi. All of the following factors are a component of Virchow's triad except for:

A)Decreased blood flow
B)Blood clotting problems
C)Hypertension
D)Vessel wall injury

Question 55

What are the most likely antibiotics used to treat Helicobacter pylori infection?

A)Metronidazole
B)Vancomycin
C)Doxycline
D)Levaquin

Question 56

The NP is assessing a newly admitted patient to the intensive care unit. The patient is a 48 year old woman who has been experiencing severe vomiting and diarrhea for 4 days. What signs and symptoms would the present to reflect that her condition has progressed to the complication of shock related to Hypovolemia?

A)Blood pressure of 148/78, heart rate of 116, afebrile
B)Changes in mental status, normal vital signs, acute abdominal pain
C)Blood pressure 98/48, heart rate 120, cold feet and hands
D)Changes in mental status, blood pressure of 130/76, temperature 99.0

Question 57

A 54 year old woman has been admitted with a diagnosis of sepsis. What would be the first signs and symptoms that the patient may have a gastrointestinal bleed?

A)Blood in feces
B)Weakness and fatigue
C)Abdominal pain and discomfort
D)Weight loss and anorexia

Question 58

A NP is taking care of a patient with a gastrointestinal bleed who is receiving intravenous fluids, packed red blood cell transfusion and proton pump inhibitor medication. The NP would assess for all the following complications of a gastrointestinal bleed except for:

A)Hemorrhagic shock
B)Perforation
C)Myocardial infarction
D)Small bowel obstruction

Question 59

The NP is evaluating the 12 lead electrocardiograph of a patient who had a myocardial infarction approximately 2 hours ago. The doctor stated the MI was still "evolving." What abnormalities would the NP expect to see to reflect the ischemic event?

A)ST segment elevation
B)A widening of the QRS interval
C)ST segment depression
D)The emergence of Q waves

Question 60

What signs would be most indicative that Thrombolytic Therapy has been successful in the patient who has had a myocardial infarction and is four hours into Thrombolytic Therapy?

A)A respiratory rate of 22/ minute and an oxygen saturation of 94% on 1 liter of oxygen
B)A heart rate of 102 and a blood pressure of 138/82
C)A return of an elevated ST interval to normal on the electrocardiogram
D)A PR interval less than 0.24 on the electrocardiogram

Question 61

Which patient is at the greatest risk for septic shock?

A)An 84 year old woman with a long term foley catheter, a stage four pressure ulcer on her coccyx and insulin dependent diabetes.
B)A 55 year old woman with pneumonia.
C)A 38 year old woman with asthma and status post day 2 appendectomy.
D)A 63 year old man who had bypass surgery two weeks ago.

Question 62

Which cranial nerve is tested to assess the gag reflex?

A)Trochlear nerve
B)Trigeminal Nerve
C)Vagus Nerve
D)Glossopharyngeal Nerve

Question 63

Mrs) C has been admitted to the hospital for exacerbation of heart failure three times in the last 14 months. What nursing action might decrease the likelihood of being readmitted so quickly?

A)Ask the patient to see their doctor more often
B)Allow the patient to stay in the hospital an extra 36 hours as an inpatient.
C)Increase the diuretic dose on discharge
D)Provide adequate patient education information about the disease and management principles and follow up with the patient within one week

Question 64

Which of the following scenarios reflects the greatest need for mechanical ventilation?

A)A patient with a respiratory rate of 26 and an oxygen saturation of 89% on 1 Liter of oxygen.
B)A patient who is visiting with visitors with an oxygen saturation level of 87%.
C)An alert and oriented patient who is slightly diaphoretic and is having difficulty breathing.
D)A patient who has a history of sleep apnea and continues to wake up because of missed breaths.

Question 65

Which part of the heart usually shows the signs of deterioration in heart failure?

A)Mitral valve
B)Left ventricular function
C)Right ventricular function
D)Aortic valve

Question 66

A patient is admitted to the intensive care unit with a diagnosis of exacerbation of heart failure. Her heart rate is 145/minute and she is breathing rapidly; her oxygen saturation is 90% on 2 L of oxygen. She has been taking beta blockers at home for her heart failure. Which medication would be the drug of choice to increase the contractility of her heart?

A)Primacor
B)Dopamine
C)Digoxin
D)Metroprolol