Question 1

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:

Accepted Answer

The NP would document the pressure ulcer on the heel as a stage 2 partial thickness pressure ulcer. It involves two layers of the skin- the epidermis and the dermis with a shallow crater that breaks through the first layer of skin.

Question 2

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

Accepted Answer

The neurotransmitter that is found to be in low levels in patients with Alzheimer's disease is Acetylcholine. Alzheimer's disease changes the brain in many ways. One of the changes results in a decrease in the levels of acetylcholine, a chemical messenger that's believed to be important for alertness, memory, thought and judgment. Cholinesterase inhibitors are a type of drug that improves the effectiveness of acetylcholine either by increasing the amount of it in the brain or by enhancing nerve cells' response to it.

Question 3

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?

Accepted Answer

The most important symptom to watch for when a patient is receiving bivalirudin is bleeding, bradycardia and hypotension. Bivalirudin is a direct thrombin inhibitor (DTI) and does not have many of the complications of heparin such as heparin induced thrombocytopenia (HIT) and is indicated for use an as anticoagulant in patients having suffered a non ST-elevation myocardial infarction (NSTEMI) and an ST-elevation myocardial infarction (STEMI).

Question 4

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?

Accepted Answer

An appropriate action when a patient is admitted to the ICU for severe injuries and has lost lot of blood would be to NOT to resuscitate. A "Do Not Resuscitate" or DNR order is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest.

Question 5

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?

Accepted Answer

If the family of a critically ill patient wishes to spend the night, which is contrary to visiting policy, the nurse's best action would be to allow one or two family members to stay, then evaluate the patient's response.

Question 6

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?

Accepted Answer

Being a NP called to the desk to take a phone call from a patient's mother about the patient's condition and plan of care; the most appropriate response which reflects HIPPA law states that no patient information be given out without the patient's consent.

Question 7

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?

Accepted Answer

The test which confirms the diagnosis is the positive Antistreptolysin O titer. A rash over the trunk, fever and sore throat are all symptoms of rheumatic fever.

Question 8

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?

Accepted Answer

A condition that would contraindicate the patient from undergoing a magnetic resonance imaging test would be the presence of a pacemaker. Other contraindications include artificial joints, metal fragments and the inability to lie still.

Question 9

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?

Accepted Answer

The trough should be drawn at 11:30 am if the last dose of the Vancomycin was at 12:00 noon. The goal of the trough is to draw the blood at the lowest level before the administration of the next dose.

Question 10

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

Accepted Answer

Guided exposure therapy is usually used for patients with specific phobias. Guided exposure therapy includes teaching relaxation and imagery techniques and educating the patient about their problem, treatment and signs and symptoms.

Question 11

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?

Accepted Answer

The diet that would reflect the patient's understanding of a iron-rich diet would be the diet that has eggs, wheat bread, carrots, raisins and green leafy vegetables.

Question 12

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

Accepted Answer

Appropriate precautions regarding infection control include placing a surgical mask on the patient when he or she is outside the room. Centers for disease control state that when patients with an infection requiring isolation must wear a surgical mask when outside of their room.

Question 13

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?

Accepted Answer

The teaching that needs to be done is to educate the patient about the risk of bleeding and decreasing activities that could put the patient at an increased risk for bleeding. Aspirin can increase bleeding and should be avoided.

Question 14

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:

Accepted Answer

The NP would expect to see no eye movement during the caloric test in a patient with a diagnosis of "brain dead." During the caloric test, cold water is instilled into the ears. Normally, the eyes would move toward the ear where the water is instilled.

Question 15

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:

Accepted Answer

Evidence based care is based on formal nursing research, clinical knowledge and scientific knowledge. Cultural practices are not a basis for evidence based care. The acute care NP has the opportunity to educate and inform the patients and their families about the best care for them based on research and knowledge.

Question 16

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

Accepted Answer

Restraining a patient during a tonic-clonic seizure, would NOT be a nursing intervention. A tonic-clonic seizure is the classic type of seizure consisting of two phases; during the clonic phase the entire body becomes rigid and in the tonic phase, there is uncontrollable jerking. Clearing the area of hard objects, turning the patient to the side and helping them to a lying position (if standing) are all appropriate nursing actions to prevent injury and maintain a patent airway during a seizure.

Question 17

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:

Accepted Answer

Signs and symptoms of an adverse reaction to contrast medium include everything except Bradycardia, which is characterized as a regular but unusually slow heart beat (60 beats/minute or less at rest). A patient experiencing an adverse reaction to contrast medium would experience Tachycardia.

Question 18

What is the most common cause for Cardiogenic shock?

Accepted Answer

The most common cause for Cardiogenic shock is a Myocardial infarction where more than 40% of the ventricle of the heart has been damaged. Shock occurs when, because of the decreased function of the heart, there is a decreased flow of oxygen rich blood the tissues.

Question 19

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?

Accepted Answer

The interventions that would most likely NOT be performed for this patient is insertion of a chest tube. All treatments are aimed with the goal of restoring blood flow and oxygenation early and quickly to avoid organ damage.

Question 20

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

Accepted Answer

Heparin, an anticoagulant is appropriate for all of the diagnosis except hemorrhagic stroke. In a hemorrhagic stroke, Heparin may increase the bleeding into the brain more severely.

Quiz 1: Collection of Clinical Nurse Practitioner