Clinical Management of Diabetes, Acute Pancreatitis, and Acute Kidney Injury, Exams of Nursing

Download Clinical Management of Diabetes, Acute Pancreatitis, and Acute Kidney Injury and more Exams Nursing in PDF only on Docsity! NURSING P6566 FINAL NRNP 6566 FINAL EXAM LATEST 2023-2024 (REAL EXAM) ALL QUESTIONS AND CORRECT ANSWERS GRADED A+ Question 1 Which statement is correct about fluoroquinolones? Fluoroquinolones are recommended treatment in uncomplicated skin infections fluoroquinolones are not associated with tendon rupture fluoroquinolones are never indicated in the treatment of pediatric infections Question 2 A 42 year old year old women was admitted to the ICU with a severe asthmatic exacerbation. On rounds today, the patients T is 102.2. Her central IV line site is red, tender, and warm. Your remove the central line and order blood cultures along with IV cefepime. MRSA has been prevalent in this ICU. What additional medication should you order? po vancomycin IV gentamycin IV vancomycin IV pipercillin Question 3 fluoroquinolones are effective treatment for urinary tract infections and pyelonephriti s A 66-year-old male involved in a motor vehicle collision is admitted to the trauma unit with multiplesbone fractions and left hemothorax with chest tube placement. Current vital signs are BP 88/52 HR 120 T 98.4 RR 22. Past medical history is positive for end stage renal disease requiring hemodialysis three times a week. How should the NP manage his renal disease? Hemodialysis Peritoneal dialysis Continuous renal replacement therapy No intervention until his blood pressure stabilizes Question 4 What crucial feature of a penicillin is involved in its mechanism of action? Carboxylic acid β ring Acyl side chain Thiazolidin e ring Question 5 Which drug should the APRN select to treat a patient with an infected post operative surgical wound infected with a positive culture result for MRSA? gentamycin Ampicillin/sulbactam t am vancomycin amphoteracin Question 6 -lactam A 48-year-old female wt 70 kg, is in the ICU with acute pancreatitis. Her vital signs are as follows: BP 92/60 mm Hg; heart rate 116 bpm; She is intubated with current ventilator settings of VT 700 mL, assist control (AC) rate 12 bpm, FiO2 0.85, and positive end expiratory pressure (PEEP) 5.0 cm H2O. Her ABG reveals a pH of 7.31, PaCO2 of 53 mm Hg, and a PaO2 of 62 mm Hg. Her chest radiograph shows diffuse, fluffy infiltrates. Based upon this assessment the ACNP would order a decrease of PEEP to 5.0 an increase of rate to 16 change to SIMV an increase of VT to 900 ml Question 12 A 22 year old patient is transitioning from oral agents to insulin. He will be taking 20 units of lantus at bedtime and regular insulin before meals. What instructions should the NP provide about the timing and dose of regular insulin? Take 5 units of regular insulin immediately after each meal Take 5 units of regular insulin for each 15 grams of carbohydrate consumed immediately after each meal. Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal Take 1 unit of regular insulin for each 5 grams of carbohydrate to be consumed 30 minutes before each meal. Question 13 All of the following statements about Type 2 diabetes mellitus are correct EXCEPT: Higher risk for development Question 18 A 22 year old female patient with type 1 diabetes presents with abdominal pain and T 100.1. Arterial blood gases reveal pH 7.2, pCO2 of 24, HCO3 12. What other finding would you expect on this patient? Decreased anion gap Decreased respirations Decreased urine output Increased serum ketones of CAD, peripheral vascular disease, and acute myocardial infarction Have insulin resistance Have more problems with ketosis than patients with Type 1 diabetes mellitus Obesity is found in the majority of patients Question 14 The NP is managing a male patient with bilateral lower extremity swelling, erythema, and draining blisters. The patient states the blisters have been there about a week but now there is redness around the blisters and moving up the leg. He has been having chills and thinks he has been running a temperature but does not own a thermometer. Vital signs are within normal limits except for an elevated temperature of 101.1 the patient has no known drug allergies. What medication should the NP prescribe? IV Vancomycin IV Cefazolin IV piperacillin IV ciprofloxin Question 15 Amy calls the office and states that her fasting blood sugar has been over 225 for the past three mornings. What adjustments should the AGACNP make? Increase her basal insulin dose at bedtime Decrease her basal insulin dose at bedtime Increase her regular insulin dose before dinner Add a dose of regular insulin before bedtime Question 16 Which statement is correct about macrolide antibiotics? nausea and vomiting macrolide resistance is not a concern due to infrequent use of this category prolonged QT intervals are an adverse effect associated with macrolides use of macrolides during pregnancy is associated with elevated renal function tests Question 17 Cicely is a known diabetic with COPD who admitted to the hospital for pneumonia and acute COPD exacerbation. What treatment would the ACNP prescribe to manage her blood sugars? Continue her BID day dose of 70/30 insulin Every four hour BS readings with sliding scale insulin administration Administer Lantus at bed time and timed administration of regular insulin before meals first generation macrolides are not associated with GI side effects e.g., Dextrose 50% , insulin and ,sodium bicarbonate Sodium bicarbonate and ipratropium bromide (Atrovent) Calcium gluconate and calcium acetate (PhosLo) Sodium polystyrene (Kayexalate) PO and Kayexalate enema Question 23 The APRN is treating a patient with type 2 diabetes. The patient is on the maximum dose of metformin and glucotrol. Current weight 212 pounds. Labs from this morning indicate a fasting blood sugar of 312 and HbA1C of 9. The APRN wants to start the patient on Lantus 0.2 unit/kg. What dose and instructions should the APRN provide? Give 2 units of Lantus subcutaneously prior to lunch every day Give 19 units of Lantus subcutaneously prior to bedtime. Give 24 units of Lantus subcutaneously prior to dinner Give 42 units of Lantus subcutaneously prior to bedtime. Question 24 When prescribing sildenafil (Viagra) to a patient, the patient should be screened for which of the following? Select all that apply. Use of a statin medication Use of a nitrate medication History of coronary artery disease Use of opiods History of priapism Question 25 The NP is assessing a patient receiving benzodiazepines who is experiencing confusion, dizziness, slurred speech, and difficulty breathing. What medication should the NP order to counter the effects? Ropivacaine Naloxone Bromaze pa m Question 26 The AGACNP orders a renal angiogram for a patient with suspected renal artery stenosis. Which of the following medications would be contraindicated for the patient? a Calcium channel . blockers b Flumazenil . Alpha c blockers. Beta. blockers d ACE inhibitors Question 27 The AGACNP is assessing a patient in the urgent care area. The patient is a 44 year old women in her third round of chemotherapy for breast cancer. She presents today with complains of generalize malaise and fever that has gradually increased over the past 12 hours, BP 110/62 P 96 T 102.6 RR 18 WBC 4.2 ANC 300 The best initial treatment by the AGACNP is: sulfonamides are a good anti-infective choice during pregnancy and in elderly Question 31 Which of the following medications has the best gram negative bacteria coverage? Cefuroxime (Cefzil) Amoxicillin (Amoxil) Clarithromycin (Biaxin) Moxifloxacin (Avelox) Question 32 A 66 year old patient is admitted to the ICU with hospital acquired pneumonia. She has consolidation in the right middle and lower lung lobe. Arterial blood gasses show a pO2 of 55%. Which mechanism likely accounts for this patients hypoxia? Decreased pO2 of inspired air Central hypoventilation Mismatch of ventilation and perfusion Decreased oxygen surface tension Question 33 The NP is managing the care of a patient admitted with hypokalemia. The patient's admission serum potassium was 3.0. The patient has been receiving potassium supplements for 4 days. Today's serum potassium is 3.1. What lab test should the NP order to assess this patient's failure to respond to treatment? Sodium Phosphor u s Calcium Magnesiu m Question 34 A patient with COPD and asthma is intubated and becomes hypotensive. High levels of auto-peep are noted. What changes should be made in the ventilator settings to address the auto peep? Increase tidal volume decrease the tidal volume decrease the respiratory rate Both 2 and 3 Question 35 Mrs. J, age 62, is brought to the hospital by ambulance. She is severely dehydrated, does not respond to verbal stimuli, and withdraws from painful stimuli. BP is 90/60 with a heart rate of 130 bpm. Serum blood glucose level is 1000 mg/dl and there are no ketones in the initial urine analysis. HHS is suspected. Which statement about HHS is INCORRECT? Hyperglycemia occurs because of a total insulin deficiency Cerebral impairment is a factor Ketogenesis does not occur Severe dehydration results from an osmotic diuresis Question 36 A 56-year-old woman comes to the emergency department because she has had increasing swelling of the right ankle over the past two days, since she sustained an injury while playing outdoors with her grandchildren. She says she has been taking over-the- counter ibuprofen 400 to 800 mg every four to six hours to relieve the pain. Medical history includes mild hypertension, which is currently controlled with lisinopril. Results of laboratory studies show elevated levels of serum creatinine and blood urea nitrogen. Acute renal failure induced by use of nonsteroidal anti-inflammatory drugs is suspected. If this suspected diagnosis is correct, which of the following additional abnormal laboratory results would the AGACNP expect to see ? a Decreased serum chloride level oxide Decrease tidal volume Increase bronchodilators Question 41 The NP is assessing a patient with a serum potassium level of 2.9 What EKG finding would you expect to see based on this lab? Uwaves AbsentPwa ves ElevatedT waves ElevatedS Tsegment Question 42 The NP is managing the care of a patient admitted with a serum sodium level of 115. The patient has been receiving 3% normal saline 50 ml/hour for the past 16 hours. On rounds this morning, the patient complains of shortness of breath and fatigue. What is the priority intervention? Stop the infusion Check a serum sodium level tomorrow morning Assess for signs of fluid overload Increase the 3% saline infusion to 60 cc / hour Question 43 The NP is consulting on a patient in the postanesthsia care unit that is immediate post op from a total knee replacement. The patient is increasing somnolent and has been treated with multiple doses of fentanyl for severe pain. Arterial blood gas results show pH 7.28 pO2 68 HCO3 24 oxygen saturation 92% . The next step for the NP to order is: Intubate immediately Give naloxone (Narcan) Place on BIPAP Given flumazenil (Romazicon) Question 44 The NP is caring for a patient with prerenal acute kidney injury (AKI). Which of the following would cause this? Acute glomerulonephritis Ureter obstruction Acute pyelonephritis Hypovolemia due to hemorrhage Question 45 Miss Smith arrives in the ER with a blood glucose of 420 and + ketones in her urine. She is a type 1 diabetic weighing 70 kg. She is diagnosed with Diabetic Ketoacidosis. The initial bolus dose of insulin is: 10 units of NPH IV 10 units of Regular Insulin IV 20 units of regular insulin IV 0.1 units of regular insulin/hr via continuous infusion Question 46 An insulin-dependent diabetic patient is seen today with the following blood sugar readings from home 250-280 mg/dL in the morning before breakfast 120-140 before lunch 120-130 before dinner 100-110 at bedtime. 160-180 at 3 am Her current insulin dose is 30 units of NPH insulin and 4 units of Regular insulin and before dinner she takes 18 units of NPH and 4 units of Regular. What is your next plan of action? Switch her over to Lantus insulin by multiplying her evening NPH dose by 1.20 and tell her to give that amount of Lantus at bedtime and call you in a week with the readings. Increase the evening regular insulin dosage by 2 more units and have her call you with the readings in a week. Order a fasting blood glucose test and glycosylated hemoglobin. Increase her evening NPH insulin dosage by 2 units Question 47 A 78-year-old male patient with heart failure develops a bacterial urinary tract infection secondary to an indwelling Foley catheter. The patient has a known history of allergy to penicillin and sulfonamides. The appropriate choice for antimicrobial therapy is: a . Cephalexin (Keflex) b Ciprofloxacin (Cipro) . Doxycycline c . (Vibramycin) d T etracycline . (Sumycin). Question 48 The NP is managing care for a patient with hypoparathyroidism. He complains of numbness and tingling in his fingers and around him mouth. What electrolyte imbalance would you expect? Hyponatrem Absent pate l reflex Diarrhea Pre ma t urea en trice s In dare s urea AR contra c tin cream s edible Question 55 The NP is caring for a patient on BIPAP. His latest arterial blood gases indicate that an increase in tidal volume is needed. What changes in the BIPAP settings would you make to accomplish this? Increase the FIO2 Increase the expiratory pressure (EPAP) while maintaining the inspiratory pressure (IPAP) Decrease the expiratory pressure (EPAP) while maintaining the inspiratory pressure (IPAP) Increase the inspiratory pressure (IPAP) while maintaining the expiratory pressure (EPAP) Question 56 The NP is initiating procedural sedation for insertion of a central venous line. Which of the following is NOT a goal of procedural (moderate) sedation? Guard the patient’s safety and welfare Maintain adequate sedation with minimal risk Allay patient fear and anxiety Produce an unconscious patient Question 57 Your patient has a post-operative incision infection. He has a low grade temperature and is allergic to sulfa. What oral antibiotic would provide empiric coverage for MRSA? TMP / SMX DS Doxycycline ne Augmentin n 3rd generation cephlosporin Question 58 The ACNP suspects her patient has pneumonia. The diagnostic tests that might be most helpful in supporting diagnosis of pneumonia would include: CBC, chest x-ray, and lumbar puncture Chest x-ray, sedimentation rate CBC and chest x ray CBC, electrolytes A 56-year-old female Type 2 diabetic who presents to the ER complaining of abdominal pain, nausea, and vomiting for three days. She takes Metformin 1000 mg. BID and has good control of her blood glucose on this regimen. She has an abdominal CT with contrast, is diagnosed with irritable bowel syndrome, and admitted. As the ACNP you would do all the following EXCEPT: Start IV fluids for rehydration Order quid blood sugar monitoring and sliding scale insulin Restart the metformin Check electrolytes , BUN, and Cart before resuming Metformin Question 63 Which one of the following statements about acute respiratory distress syndrome (ARDS) is FALSE? A chest radiograph can show bilateral opacification of both lung fields Causes of this acute lung injury can include severe sepsis, trauma, and blood transfusions. Many patients with ARDS will experience multi-organ dysfunction syndrome (MODS). Treatment includes using high tidal volumes to maintain oxygenation Question 64 A 72 year old ICU patient was intubated for increasing hypoxia due to pneumonia 2 days ago. The patient has been stable on the ventilator. Medication orders include antibiotics, propofol, and midazolam. Current ventilator settings include FIO2 40%, tidal volume 600 cc rate 12 PEEP 5 cm Suddenly the patient becomes very agitated and fighting the vent. His oxygen saturation drops from 92 % to 87%. What is the best INITIAL step in your evaluation of this patient? Increase maintenance of propofol and give additional dose of midazolam Send patient for a chest CT Increase PEEP Remove the patient from the ventilator and hand bag with ambo Question 65 A 30 year old patient with a history of type 2 diabetes is brought to the ER in a near comatose state. His heart rate is 124 bpm and the B/P is 90/50 mm hg. Initial laboratory evaluation reveals a blood glucose of 625 g/dl, . Urine glucose is 4+ and ketones are present in the urine. Serum potassium is 4.0 mEq/ld. and serum osmolality is 32 mOsm/L. Which feature distinguishes DKA from HHS coma in this patient? Hyperglycemia IA Elevated serum osmolality Normal serum potassium Positive urine ketones Question 66 A 78 year old man is admitted from an extended care facility with confusion and shortness of breath. He had been admitted there following a stroke. He has an indwelling urethral catheter. His T is 102 pulse 112 RR 22 BP 86/62 oxygen saturation 94%. Chest x-ray is clear. Urinalysis shows 40 WBC, positive nitrites, positive leukocyte esterase. Pending the culture results, what antibiotics should be started now? Bactrim NItrofurantoi n Amoxicillin Vancomycin and cefepime uestion 67 The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of hypoglycemia hyperglycemia insulin resistence insulin sensitivity Question 68 The NP responds to a rapid response team page regarding a 56 year old female with vomiting and diarrhea. The patient reported feeling very dizzy and had to be assisted to bed. VItal signs are BP 58/32 P 140. What IV fluid should the NP order? 3 6 4 2 Question 72 A 32 year old women presents to the ER after being found clumped over the wheel unconscious in an automobile. Analyze the following ABG results: ph. 7.28, PaO2 60, PaCO2 70, HCO 33, BE +5 Partially compensated metabolic acidosis Partially compensated respiratory acidosis Fully compensated respiratory acidosis Fully compensated metabolic acidosis Question 73 The NP is managing the care of a patient with diabetic ketoacidosis. The patients anion gap is now normal, hydration status appears normal, and serum blood sugar was 182. Normal saline IV fluids have been decreased to 50 cc/ hour and insulin drip was stopped. 6 hours ago. The NP is notified that the serum blood sugar prior to dinner was 332. How would you explain this rise in blood sugar? Rebound hyperglycemia is expected after an episode of DKA The previous insulin dosing schedule for this patient should be resumed now with dosing prior to the dinner meal Patient should have received a subcutaneous dose of basal insulin prior to stopping the insulin drip This must be an error - order a repeat of the blood sugar Question 74 The NP is planning to repair multiple leg lacerations on a 13 year old girl in the ED. What is the maximum number of ml of lidocaine in this 60 kg patient can receive? 6 4 5 0 2 4 4 2 Question 75 The primary concern in the management of a patient with acute onset of DKA is: Potentiation of insulin utilization Normalization of glucose levels Correction of Potassium and Chloride levels Replacement of fluid and electrolytes. Score 60/75.