Question 1

What precautions should be followed when administering Phenytoin?

Accepted Answer

When administering Phenytoin, it should NOT be administered with a dextrose solution because it will form precipitation and crystallization of the solution.

Question 2

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?

Accepted Answer

When completing the admission data base and asking about the patient's history the diagnosis that might precipitate Gullian-Barre syndrome is mild fevers, upper respiratory infections or minor viruses. The NP should pay particular attention to any mild infections and fevers the patient has recently had. The primary cause of Guillian-Barre syndrome is not known; however; about 50% of patients with Guillian-Barre have a recent history of infection.

Question 3

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

Accepted Answer

The option that is NOT appropriate for weaning a patient from mechanical ventilation is controlled mandatory ventilation. This method is only used when the patient is unable to take breaths on their own. Controlled mandatory ventilation is not a weaning method.

Question 4

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?

Accepted Answer

A sedentary lifestyle and poor diet are associated with obesity and myocardial infarction; however, the client must be willing and committed to participate in a weight reduction program. Therefore, assessment of interest in reducing weight is the most critical step in prevention of these diseases.

Question 5

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?

Accepted Answer

When working to prevent an infection in a patient with Acute Lymphocytic Leukemia (ALL) with a White Blood Cell count of 6.0, the NP would avoid inserting a Foley Catheter or any other non-critical device that would increase the risk of a patient obtaining an infection. The NP should take vital signs every 2 to 4 hours; check the patient's mouth often to assess for mouth ulceration and give antibiotic therapy quickly.

Question 6

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?

Accepted Answer

The next thing the NP should do with this patient is to give an additional dose of 0.04 mg tablet of Nitroglycerin. Patients can take up to three sublingual Nitroglycerin tablets within 15 minutes. It may take 5 to 10 minutes to relieve chest pain. After administering the Nitroglycerin, the NP can take vital signs and obtain an EKG. However, it is primarily important to relieve the chest pain.

Question 7

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?

Accepted Answer

Upon assessing the symptoms of sluggish and unequal pupils, restlessness and change in level of consciousness, increased weakness and rising blood pressure, the NP would suspect early signs of increased intracranial pressure. Late signs of increased intracranial pressure include fixed pupils, profound weakness, an inability to arouse and an increased systolic pressure with Bradycardia.

Question 8

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

Accepted Answer

The maximum amount of fluid that should be removed during an Abdominal Paracentesis is 1,500 to 2,000 mL. Removing more than 2,000 mL of peritoneal fluid during one Paracentesis may cause an episode of Hypovolemic Shock.

Question 9

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?

Accepted Answer

The underlying cause of respiratory acidosis is that the lungs are not sufficiently ventilating. Acute Respiratory Acidosis is a sudden collapse of the body's ventilation system often resulting from central nervous system disease, drugs or toxins or Chronic Obstructive Pulmonary Disease (COPD).

Question 10

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

Accepted Answer

All of these are early stages of Hypovolemic shock except for hypotension. Patients can lose more than 30% of their intravascular volume before Hypotension occurs.

Question 11

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?

Accepted Answer

The level the Activated Partial Thromboplastin Time (APTT) should be maintained at is 1.5 times to 2 times the normal level. Heparin therapy is usually started with a weight based bolus to reach the therapeutic goal more quickly.

Question 12

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

Accepted Answer

The first step in treating a patient with acute respiratory distress syndrome is to maintain oxygenation. Supplemental oxygenation is first tried. If that does not meet the patient's oxygenation needs, mechanical ventilation following intubation is done.

Question 13

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?

Accepted Answer

A constant positive airway pressure (CPAP) of more than 10 cm H20 pressure could cause an increase in the intrathoracic pressure extensively, negatively affecting the patient's venous return. In turn, this decreases the cardiac output and blood pressure.

Question 14

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:

Accepted Answer

The factor that is not a component of Virchow's triad is Hypertension also known as high blood pressure. Other factors that predispose someone to venous thrombi include atrial fibrillation, immobility, infection and atherosclerosis.

Question 15

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

Accepted Answer

The most likely antibiotics used to treat a Helicobacter pylori infection would be Metronidazole. Other antibiotics used to treat the Helicobacter pylori infection include Tetracyucline and Amoxicillin. Helicobacter pylori is a bacteria that cause stomach inflammation (gastritis) and ulcers in the stomach. This bacteria is the most common cause of ulcers worldwide.

Question 16

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?

Accepted Answer

The signs and symptoms that the patient has progressed from Hypovolemia to shock include a low blood pressure, tachycardia and cold extremities. Changes in mental status including restlessness and confusion may also occur. Shock is a sign of severe illness and the underlying cause should be treated aggressively.

Question 17

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?

Accepted Answer

The first indicator that a patient has a gastrointestinal bleed is the presence of blood in the feces or emesis. Black, tarry stool, also called Melena, is indicative of a upper gastrointestinal disease that cause bleeding.

Question 18

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:

Accepted Answer

The NP would assess for all of the following complications of a gastrointestinal bleed except for myocardial infarction which is not a primary complication of a gastrointestinal bleed. If the patient's gastrointestinal bleed has been extensive, hemorrhagic shock can occur. When the erosion of the gastrointestinal tract occurs, perforation can occur.

Question 19

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?

Accepted Answer

The NP would expect to see the abnormal elevation of the ST segment as a reflection of the ischemic event. The emergence of Q waves would indicate worsening ischemia and necrosis.

Question 20

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?

Accepted Answer

The sign that 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 is a return of the ST interval to normal on the electrocardiogram (EKG). Other signs thrombolytic therapy has been effective include relief of chest pain and improved left ventricular function.

Quiz 1: Collection of Clinical Nurse Practitioner