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?

Accepted Answer

The medication that would most likely to be given to a patient presenting with a sudden onset of shortness of breath, difficulty breathing, a swollen tongue and dizziness would be Epinephrine. The patient is presenting signs and symptoms of anaphylactic shock.

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?

Accepted Answer

The statement that best reflects the patient understands how to take his medication is the first statement, "If I forget to take a dose, I will take a missed dose as soon as I remember." The other answers reflect incorrect understandings. Doses should never be doubled. The patient should make an effort to move slower if he is experiencing lightheadedness. Potassium should not be increased as it interacts poorly with Angiotensin converting enzyme inhibitors.

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?

Accepted Answer

For the patient with Diabetes Ketoacidosis, the treatment most likely to turn around the additional complication of acidosis is fluids and insulin. Potassium is used to treat Hypokalemia. Drawing the arterial blood gases would be considered a diagnostic tool, not a treatment.

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?

Accepted Answer

The medications the NP would anticipate the doctor ordering would be Intravenous Nitroprusside for blood pressure management. Other medications that would be appropriate include Intravenous Nitroglycerin or Hydralazine.

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:

Accepted Answer

To avoid circulatory overload, the NP would administer Furosemide in between units, administer supplemental oxygen and monitor the patient for signs of hypoxia, edema, and fever. However, the NP would not transfuse the blood quickly because that would contribute to possible circulatory overload.

Question 6

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

Accepted Answer

When preparing to remove an endotracheal tube, the NP should NOT proceed with extubation if there is no air leak detected around the deflated cuff. The absence of an air leak can indicate marked tracheal edema which can cause total airway obstruction if the endotracheal tube is removed.

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?

Accepted Answer

The best way to describe the purpose of cerebral spinal fluid is that "cerebral spinal fluid cushions the brain and the spinal cord." It works to absorb shock and protects the brain from injury.

Question 8

What is the leading cause of acute Tubular Necrosis?

Accepted Answer

The leading cause of acute Tubular Necrosis is Sepsis. It is usually precipitated by a Hypotensive event. Tubular Necrosis is a severe form of acute renal failure that develops in people with severe illnesses.

Question 9

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

Accepted Answer

The most significant complication of intermittent Hemodialysis that the NP needs to asses for is Hypotension. In the critically ill patient in the intensive care unit setting, Hemodialysis can cause severe Hemodynamic instability that is most quickly seen in the blood pressure.

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?

Accepted Answer

The most likely indicator that the patient is in the initial phase of acute tubular necrosis is a urine output less than 400 mL/ day. A creatinine level of 1.1 would be a sign that the patient is in the recovery phase of acute tubular necrosis.

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?

Accepted Answer

The group of medications that would be most effective in decreasing vagal stimulation, pancreatic secretion and ampullary spasm in the patient with acute pancreatitis are Anticholinergics such as Atropine and Propantheline.

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:

Accepted Answer

The previous condition of Pancreatitis would not predispose the patient to hepatic failure. Viral hepatitis, overdose of Acetaminophen and Biliary atresia are all conditions that can prelude failure of the liver.

Question 13

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

Accepted Answer

The lab value that should be monitored in relation to bleeding is the level of platelets in the patient's blood. The patient with end stage renal disease is at risk for platelet dysfunction, putting them at risk for bleeding.

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?

Accepted Answer

The electrolyte imbalance most likely for the patient's symptoms of weakness, fatigue, irregular heartbeat and shortness of breath is a high potassium level. The most common electrolyte imbalance most common in patients with end stage renal disease is a Hyperkalemia which refers to elevated blood potassium.

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?

Accepted Answer

A nursing goal that would protect the patient from future damage to the kidneys would be to prevent further exposure to the causative agent. This could be done through documentation and alerts put in the medical record of the patient. Changing medications and ordering laboratory studies needs to be done under the direction of the doctor.

Question 16

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

Accepted Answer

In the beginning stages of renal disease, known as reduced renal reserve, the characteristics that the NP would assess is a Glomerular Filtration Rate that is reduced to 50% of what it normally is. The BUN (blood, urea, nitrogen lab value) will be slightly elevated- but there will be minimal, if any, clinical symptoms.

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?

Accepted Answer

When the NP shows respect for the patient's family, pulls in more chairs for family members, works with the family to accommodate larger groups and is sensitive to culture traditions, they are showing a response to diversity. This response is sensitive to recognize, appreciate and incorporate differences into the plan of care.

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:

Accepted Answer

After an abdominal surgery, the NP would teach the patient to use an abdominal pillow over the incision while coughing to avoid the post operative complication of dehiscence. Wound dehiscence occurs when the wound edges separate and can lead to evisceration.

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?

Accepted Answer

The most accurate measure of renal function is the Glomerular Filtration Rate (GFR). The GFR is the flow rate of filtration through the kidneys and provides the most accurate state of kidney function and physiology.

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?

Accepted Answer

An appropriate task to delegate to the nursing assistant would be able to ambulate a patient. Assessing and teaching are not within the nursing assistant's scope of practice.

Quiz 1: Collection of Clinical Nurse Practitioner