Walden University NRNP 6550 Final Exam (pdf) | 2026/2027 | Adv
Practice Care | Adult-Gerontology Acute Care
**1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A
Foley catheter was inserted intraoperatively and remains in place. His urine
output has declined markedly despite continued IV fluid infusion. Today his
morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A
leading differential includes:**
A) Foley lodged in the urethra causing post-renal failure
B) Decreased renal perfusion causing prerenal failure
C) Age-related decreased eGFR causing prerenal failure
D) Post-surgical rhabdomyolysis causing intrarenal failure
**Correct Answer: A**
**Rationale:** The patient has a Foley catheter that remains in place. A
lodged Foley catheter can cause post-renal obstruction and acute kidney
injury. The BUN-to-creatinine ratio (19/2 = 9.5) is low, which is more
consistent with post-renal or intrarenal causes rather than prerenal causes
(which typically have a BUN:Cr ratio >20:1). Post-surgical rhabdomyolysis
would typically present with elevated creatine kinase and myoglobinuria.
---
**2. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m.
and she is weak, diaphoretic, and anxious. Physical examination reveals a
5'4" 107 lb black female who is awake, alert, and oriented, anxious, with
moist skin and racing pulse. Her blood pressure is 140/100 mm Hg.
Temperature and respiratory rate are within normal limits. The patient admits
to having a "thyroid condition" but she never followed up on it when she was
advised to see an endocrinologist. The AGACNP anticipates a diagnosis of:**
,A) Hashimoto's thyroiditis
B) Cushing's syndrome
C) Grave's disease
D) Addison's disease
**Correct Answer: C**
**Rationale:** The patient presents with classic signs of hyperthyroidism:
tachycardia, diaphoresis, anxiety, and hypertension. Graves' disease is the
most common cause of hyperthyroidism. Hashimoto's thyroiditis typically
causes hypothyroidism. Cushing's syndrome presents with weight gain,
moon facies, and buffalo hump. Addison's disease presents with hypotension,
hyperpigmentation, and fatigue.
---
**3. Systemic lupus erythematosus (SLE) is a multiorgan system
autoimmune disorder that can present with a wide variety of manifestations.
Which clinical triad should prompt an evaluation for SLE?**
A) Fever, normal white count, elevated sedimentation rate
B) Hyperkalemia, hyponatremia, low blood pressure
C) Leukocytosis, hyperglycemia, hypokalemia
D) Joint pain, rash, fever
**Correct Answer: D**
**Rationale:** The classic triad of SLE includes joint pain (arthritis/arthralgia),
rash (particularly malar rash), and fever. SLE is a multisystem autoimmune
,disorder that can affect the skin, joints, kidneys, nervous system, and
hematologic system. The other options do not represent a classic SLE triad.
---
**4. A patient presents with profound vertigo of acute onset yesterday. She
can barely turn her head without becoming very vertiginous; she is nauseous
and just doesn't want to move. This morning when she tried to get out of bed
she felt like she was pushed back down. The vertigo is reproducible with
cervical rotation. The patient denies any hearing loss or tinnitus, she has no
fever or other symptoms. The AGACNP knows that the most helpful
intervention will probably be:**
A) Meclizine
B) Diazepam
C) Bed rest
D) Epley's maneuvers
**Correct Answer: D**
**Rationale:** The presentation is consistent with benign paroxysmal
positional vertigo (BPPV). The vertigo is reproducible with cervical rotation,
and there is no hearing loss or tinnitus. Epley's maneuvers (canalith
repositioning procedures) are the most effective treatment for BPPV.
Meclizine and diazepam are symptomatic treatments for vertigo but do not
address the underlying cause. Bed rest is not the most helpful intervention.
---
**5. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of
acute mental status change from the long term care facility. She is normally
, ambulatory and participates in lots of facility activities. Today a nursing
assistant found her in her room, appearing confused and disconnected from
her environment. When she tried to get up she fell down. Her vital signs are
stable excepting a blood pressure of 100/60 mm Hg. What is the most likely
diagnosis?**
A) Dementia
B) Delirium
C) Depression
D) Stroke
**Correct Answer: B**
**Rationale:** The acute onset of confusion and disconnection from the
environment in an elderly patient is most consistent with delirium. Delirium
is an acute, fluctuating disturbance in attention and awareness that develops
over a short period. Dementia is chronic and progressive. The acute
presentation and fall suggest delirium, which may be caused by infection,
dehydration, or medication effects.
---
**6. A Foley lodged in the urethra causing post-renal failure is characterized
by which of the following laboratory findings?**
A) Elevated BUN with normal creatinine
B) Elevated BUN and creatinine with BUN:Cr ratio >20:1
C) Elevated BUN and creatinine with BUN:Cr ratio <15:1
D) Normal BUN with elevated creatinine
Practice Care | Adult-Gerontology Acute Care
**1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A
Foley catheter was inserted intraoperatively and remains in place. His urine
output has declined markedly despite continued IV fluid infusion. Today his
morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A
leading differential includes:**
A) Foley lodged in the urethra causing post-renal failure
B) Decreased renal perfusion causing prerenal failure
C) Age-related decreased eGFR causing prerenal failure
D) Post-surgical rhabdomyolysis causing intrarenal failure
**Correct Answer: A**
**Rationale:** The patient has a Foley catheter that remains in place. A
lodged Foley catheter can cause post-renal obstruction and acute kidney
injury. The BUN-to-creatinine ratio (19/2 = 9.5) is low, which is more
consistent with post-renal or intrarenal causes rather than prerenal causes
(which typically have a BUN:Cr ratio >20:1). Post-surgical rhabdomyolysis
would typically present with elevated creatine kinase and myoglobinuria.
---
**2. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m.
and she is weak, diaphoretic, and anxious. Physical examination reveals a
5'4" 107 lb black female who is awake, alert, and oriented, anxious, with
moist skin and racing pulse. Her blood pressure is 140/100 mm Hg.
Temperature and respiratory rate are within normal limits. The patient admits
to having a "thyroid condition" but she never followed up on it when she was
advised to see an endocrinologist. The AGACNP anticipates a diagnosis of:**
,A) Hashimoto's thyroiditis
B) Cushing's syndrome
C) Grave's disease
D) Addison's disease
**Correct Answer: C**
**Rationale:** The patient presents with classic signs of hyperthyroidism:
tachycardia, diaphoresis, anxiety, and hypertension. Graves' disease is the
most common cause of hyperthyroidism. Hashimoto's thyroiditis typically
causes hypothyroidism. Cushing's syndrome presents with weight gain,
moon facies, and buffalo hump. Addison's disease presents with hypotension,
hyperpigmentation, and fatigue.
---
**3. Systemic lupus erythematosus (SLE) is a multiorgan system
autoimmune disorder that can present with a wide variety of manifestations.
Which clinical triad should prompt an evaluation for SLE?**
A) Fever, normal white count, elevated sedimentation rate
B) Hyperkalemia, hyponatremia, low blood pressure
C) Leukocytosis, hyperglycemia, hypokalemia
D) Joint pain, rash, fever
**Correct Answer: D**
**Rationale:** The classic triad of SLE includes joint pain (arthritis/arthralgia),
rash (particularly malar rash), and fever. SLE is a multisystem autoimmune
,disorder that can affect the skin, joints, kidneys, nervous system, and
hematologic system. The other options do not represent a classic SLE triad.
---
**4. A patient presents with profound vertigo of acute onset yesterday. She
can barely turn her head without becoming very vertiginous; she is nauseous
and just doesn't want to move. This morning when she tried to get out of bed
she felt like she was pushed back down. The vertigo is reproducible with
cervical rotation. The patient denies any hearing loss or tinnitus, she has no
fever or other symptoms. The AGACNP knows that the most helpful
intervention will probably be:**
A) Meclizine
B) Diazepam
C) Bed rest
D) Epley's maneuvers
**Correct Answer: D**
**Rationale:** The presentation is consistent with benign paroxysmal
positional vertigo (BPPV). The vertigo is reproducible with cervical rotation,
and there is no hearing loss or tinnitus. Epley's maneuvers (canalith
repositioning procedures) are the most effective treatment for BPPV.
Meclizine and diazepam are symptomatic treatments for vertigo but do not
address the underlying cause. Bed rest is not the most helpful intervention.
---
**5. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of
acute mental status change from the long term care facility. She is normally
, ambulatory and participates in lots of facility activities. Today a nursing
assistant found her in her room, appearing confused and disconnected from
her environment. When she tried to get up she fell down. Her vital signs are
stable excepting a blood pressure of 100/60 mm Hg. What is the most likely
diagnosis?**
A) Dementia
B) Delirium
C) Depression
D) Stroke
**Correct Answer: B**
**Rationale:** The acute onset of confusion and disconnection from the
environment in an elderly patient is most consistent with delirium. Delirium
is an acute, fluctuating disturbance in attention and awareness that develops
over a short period. Dementia is chronic and progressive. The acute
presentation and fall suggest delirium, which may be caused by infection,
dehydration, or medication effects.
---
**6. A Foley lodged in the urethra causing post-renal failure is characterized
by which of the following laboratory findings?**
A) Elevated BUN with normal creatinine
B) Elevated BUN and creatinine with BUN:Cr ratio >20:1
C) Elevated BUN and creatinine with BUN:Cr ratio <15:1
D) Normal BUN with elevated creatinine
