NRNP 6645 MIDTERM AND FINAL EXAM
2023 (5 DIFFERENT VERSIONS 500 QS &
ANS) /NRNP6645 PSYCHOTHERAPY
WITH MULTIPLE MODALITIES
QUESTIONS AND ANSWERS
1.rMrs.rWilliamsrisr76ryearsroldrandrcomesrinrtorhaverarwoundrcheckedronrherrrigh
trleg.rSherfellrarmonthragorandrtherwoundrhasrnotrhealed.rSherisrconcernedrthatrs
omethingrisrwrong.rThernurserpractitionerrexaminesrtherwoundrandrseesrthatritrhasr
beenrcleanedrproperlyrandrhasrnorsignsrofrinfection.rTheredgesrarerapproximated,r
butrtherskinraroundrtherwoundrisrredrandrtenderrtortouch.rTherbestrresponserregar
dingrMrs.rWilliams'rconcernris:
1.rWoundrhealingrforrolderrpeoplermayrtakeruprtorfourrtimesrlongerrthanritrdoesrfor
ryoungerrpeople.
2.rLetrusrtalkraboutrwhatryourarereating.
3.rHadryourcomerinrearlier,rIrwouldrhaverorderedrmedicinerthatrwouldrhaverhealedrt
hatrrightrup.
4.rIrwillrorderranrantibioticrtorpreventrinfection.r-rans-1.rAnswer:r1
Page:r96
Feedback
1.
Skinrrenewalrturnoverrtimerincreasesrtorapproximatelyr87rdaysrinrolderradults,rcomp
aredrwithr20rdaysrduringryouth.
2.
Therperceivedrextendedrhealingrtimerisrnotrrelatedrtordiet.
3.
Thisrisrfalserhope,rasrthererisrnormedicationrthatrwillrhealrthisrwoundrquickly.
4.
Prophylacticrantibioticsrarernotrappropriaterwhenrthererarernorsignsrorrsymptomsrofr
infection.
,2.rThernurserpractitionerrisrconductingrpatientrroundsrinrarlong-
termrcarerfacility.rAsrshertalksrwithrMrs.rJones,rshernoticesrthatrherrarmsrandrelbo
wsrarerexcoriatedrandrtherskinrisrshearing.rThernurserpractitionerrexplainsrtortherst
affrthatrMrs.rJonesrneedsrfrequentrassessmentrofrherrskinrandrprotectionrprovidedrt
orpreventrskinrbreakdownrbecause:
1.rHerrlackrofractivityrcausesrtherskinrtortear.
2.rFatrhasrredistributedrtortherabdomenrandrthighs,rleavingrbonyrsurfacesrinrareasr
suchrasrtherface,rhands,randrsacrum.rThisrcanrresultrinrinjury.
3.rSherhasrlostrweightrandrisrinrjeopardyrofrfalling.
4.rSherpicksratrherselfrandrcausesrskinrbreakdown.r-rans-2.rAnswer:r2
Page:r96
Feedback
1.
Lackrofractivityralonerdoesrnotrcauserskinrbreakdown.
2.
Fatrisrredistributedrtortherabdomenrandrthighs,rleavingrbonyrsurfaces,rsuchrasrtherf
ace,rhands,randrsacrum,rexposedrtorpotentialrinjury,respeciallyrskinrtearsrfromrshea
ring,rfrictionrforcesrandrpressurerulcerrdevelopment.
3.
Althoughrlosingrweightrmayrberarriskrfactorrforrfalling,ritrisrnotrdirectlyrrelatedrtorski
nrbreakdown.
4.
Thererisrnorevidencerthatrsherisrpickingratrherself,rasrthererisrnothingrreportedrany
whererelseronrherrarms.
3.rMr.rJamesrisr91ryearsrold.rHisrdaughterrnoticesrthatrherhasrbruisesrandrlaceratio
nsronrhisrarmsrandrreportsrthisrtorthernurserpractitioner,rwhortellsrherrthatrolderrpe
oplerbruisereasilyrduertortheirrfragilerbloodrvessels.rTherskinrlacerationsrhappenrbe
causerherhasrthinrskin.rEvenrso,rthernurserpractitionerrassuresrtherdaughterrthatrsh
erwillrinvestigaterfurtherrtorensurerthatrherisrgettingrproperrcare.rShersaysrthisrbeca
usersherunderstandsrthat:
1.rThesermarkingsronrtherpatient'srskinrarerpartrofragingrskin.
2.rBruisesrandrlacerationsrcanrindicaterinadequatercare.
3.rTherdaughterrneedsrassurancerthatrherrfatherrisrokay.
4.rTherpatientrisrbeingrabused.r-rans-3.rAnswer:r2
Page:r97
Feedback
1.
Markingsronrtherskinrmayrbersignsrofraging,rardisease,rorrmaltreatment.
,2.
Poorlyrhealingrwoundsrorrchronicrpressurerulcersrmayrsignalrarproblemrnotronlyrwit
hrtherpatientrbutrwithrthercaregiver'srabilityrtorprovideradequatercare.rWelts,rlacerati
ons,rburns,randrdistinctivermarkingsrmayrindicaterarneedrforrintervention.
3.
Thisrisrarresultrofrthernurserpractitionerraddressingritrfurtherrratherrthanrtherreasonr
forraddressingrit.
4.
Arprofessionalrcannotrassumerabuserwithoutrgoodrreason.
4.rThernurserpractitionerrassessesrarpatient'srskinrandrfindsranrinfectiousrlesionronr
therlowerrleg.rTherlesionrisrconsideredrarsecondaryrlesion.rThernurserpractitionerre
xplainsrthatrarsecondaryrlesionrisronerthat:
1.rArisesrfromrchangesrtorarprimaryrlesion.
2.rIsrarcomplicationrofranrunderlyingrdisease.
3.rIsrdifficultrtortreat.
4.rIsrarnormalrsignrofraging.r-rans-4.rAnswer:r1
Page:r97
Feedback
1.
Secondaryrlesionsr(infections)rariserfromrchangesrtortherprimaryrlesion.
2.
Secondaryrlesionsrarernotrnecessarilyrtherresultrofranrunderlyingrdisease.
3.
Secondaryrlesionsrcanrbertreatedrwithrmedicationsrorrsurgery.
4.
Secondaryrlesionsrariserasrarconditionrnotrnormalrtoraging.
5.rMs.rRose,r88ryearsrold,rcomesrtorthernurserpractitionerrwithrarcomplaintraboutra
rgrowthronrherrhand.rSherwantsrtorhaverarbiopsyrdone.rThernurserpractitionerrasks
rtherfollowingrquestion:
1.rHaveryourinjuredryourrhandrrecently?
2.rAreryourusingrardifferentrdetergent?
3.rHasrthisrgrowthrchanged,rbled,rorrisritrpainful?
4.rHasrthisrgrowthrmaderitrdifficultrtorputronryourrrings?r-rans-5.rAnswer:r3
Page:r97
Feedback
1.
Anrinjuryrwouldrnotrstimulatergrowth.
2.
, Arreactionrtorardetergentrwouldrmorerlikelyrberarrash.
3.
Lesionsrthatrwarrantrbiopsyrarerthoserthatrhaverchanged,rbleed,rorrarerpainful.
4.
Therabilityrtorputronrherrringrisrnotrtherproblem.
6.rAr60-year-
oldrmalerentersrtherburnrcenterrforrtriagerandrtreatmentrduertorarburnrherreceivedr
atrarcampfire.rHisrleftrarmrhasranrarearthatrisrerythematousrandrpainful,randranothe
rrarearhasrarblister.rWhatrdoesrthernurserpractitionerrrecordrasrtherdegreerofrburn?
1.rFirstrdegree
2.rSecondrdegree
3.rFirstrandrsecondrdegree
4.rSecondrandrthirdrdegreer-rans-6.rAnswer:r3
Page:r98
Feedback
1.
First-
degreerburnsrinvolvingrtherepidermisrarererythematousrandrpainfulrbutrdornotrblister
.
2.
Second-degreerburnsrinvolvertherdermisrandrarercharacterizedrbyrblisters.
3.
Therpatientrpresentsrwithrerythematousrskin,rpainfulrwithrblisters,rwhichrindicatesrbo
thrfirst-randrsecond-degreerburnrareas.
4.
Inrthird-degreerburnsrthererisrnorsensationrwhenrtherwoundrisrpinpricked.
7.rThernurserpractitionerrisrconcernedrwithrprimaryrpreventionrstrategies.rHowrcanrt
hernurserpractitionerrimplementrprimaryrpreventionrstrategiesrforranr80-year-
oldrmalerpatientrwhorsmokes?
1.rReviewrhomerfirersafetyrprotocols,rincludingrtherproperruserofrsmokeralarms,rand
rdiscussrsmokingrcessation.
2.rInformrhimrthatrifrherdoesrnotrstoprsmoking,rthernurserpractitionerrcannotrseerhi
mragain.
3.rHaverarconferencerwithrhisrfamilyraboutrhisrsmoking.
4.rPlanrarfamilyrmeetingrwithrtherpatientrtordiscussrbenefitsrofrhisrsmokingrcessatio
n.r-rans-7.rAnswer:r1
Page:r115,r116
Feedback
1.
2023 (5 DIFFERENT VERSIONS 500 QS &
ANS) /NRNP6645 PSYCHOTHERAPY
WITH MULTIPLE MODALITIES
QUESTIONS AND ANSWERS
1.rMrs.rWilliamsrisr76ryearsroldrandrcomesrinrtorhaverarwoundrcheckedronrherrrigh
trleg.rSherfellrarmonthragorandrtherwoundrhasrnotrhealed.rSherisrconcernedrthatrs
omethingrisrwrong.rThernurserpractitionerrexaminesrtherwoundrandrseesrthatritrhasr
beenrcleanedrproperlyrandrhasrnorsignsrofrinfection.rTheredgesrarerapproximated,r
butrtherskinraroundrtherwoundrisrredrandrtenderrtortouch.rTherbestrresponserregar
dingrMrs.rWilliams'rconcernris:
1.rWoundrhealingrforrolderrpeoplermayrtakeruprtorfourrtimesrlongerrthanritrdoesrfor
ryoungerrpeople.
2.rLetrusrtalkraboutrwhatryourarereating.
3.rHadryourcomerinrearlier,rIrwouldrhaverorderedrmedicinerthatrwouldrhaverhealedrt
hatrrightrup.
4.rIrwillrorderranrantibioticrtorpreventrinfection.r-rans-1.rAnswer:r1
Page:r96
Feedback
1.
Skinrrenewalrturnoverrtimerincreasesrtorapproximatelyr87rdaysrinrolderradults,rcomp
aredrwithr20rdaysrduringryouth.
2.
Therperceivedrextendedrhealingrtimerisrnotrrelatedrtordiet.
3.
Thisrisrfalserhope,rasrthererisrnormedicationrthatrwillrhealrthisrwoundrquickly.
4.
Prophylacticrantibioticsrarernotrappropriaterwhenrthererarernorsignsrorrsymptomsrofr
infection.
,2.rThernurserpractitionerrisrconductingrpatientrroundsrinrarlong-
termrcarerfacility.rAsrshertalksrwithrMrs.rJones,rshernoticesrthatrherrarmsrandrelbo
wsrarerexcoriatedrandrtherskinrisrshearing.rThernurserpractitionerrexplainsrtortherst
affrthatrMrs.rJonesrneedsrfrequentrassessmentrofrherrskinrandrprotectionrprovidedrt
orpreventrskinrbreakdownrbecause:
1.rHerrlackrofractivityrcausesrtherskinrtortear.
2.rFatrhasrredistributedrtortherabdomenrandrthighs,rleavingrbonyrsurfacesrinrareasr
suchrasrtherface,rhands,randrsacrum.rThisrcanrresultrinrinjury.
3.rSherhasrlostrweightrandrisrinrjeopardyrofrfalling.
4.rSherpicksratrherselfrandrcausesrskinrbreakdown.r-rans-2.rAnswer:r2
Page:r96
Feedback
1.
Lackrofractivityralonerdoesrnotrcauserskinrbreakdown.
2.
Fatrisrredistributedrtortherabdomenrandrthighs,rleavingrbonyrsurfaces,rsuchrasrtherf
ace,rhands,randrsacrum,rexposedrtorpotentialrinjury,respeciallyrskinrtearsrfromrshea
ring,rfrictionrforcesrandrpressurerulcerrdevelopment.
3.
Althoughrlosingrweightrmayrberarriskrfactorrforrfalling,ritrisrnotrdirectlyrrelatedrtorski
nrbreakdown.
4.
Thererisrnorevidencerthatrsherisrpickingratrherself,rasrthererisrnothingrreportedrany
whererelseronrherrarms.
3.rMr.rJamesrisr91ryearsrold.rHisrdaughterrnoticesrthatrherhasrbruisesrandrlaceratio
nsronrhisrarmsrandrreportsrthisrtorthernurserpractitioner,rwhortellsrherrthatrolderrpe
oplerbruisereasilyrduertortheirrfragilerbloodrvessels.rTherskinrlacerationsrhappenrbe
causerherhasrthinrskin.rEvenrso,rthernurserpractitionerrassuresrtherdaughterrthatrsh
erwillrinvestigaterfurtherrtorensurerthatrherisrgettingrproperrcare.rShersaysrthisrbeca
usersherunderstandsrthat:
1.rThesermarkingsronrtherpatient'srskinrarerpartrofragingrskin.
2.rBruisesrandrlacerationsrcanrindicaterinadequatercare.
3.rTherdaughterrneedsrassurancerthatrherrfatherrisrokay.
4.rTherpatientrisrbeingrabused.r-rans-3.rAnswer:r2
Page:r97
Feedback
1.
Markingsronrtherskinrmayrbersignsrofraging,rardisease,rorrmaltreatment.
,2.
Poorlyrhealingrwoundsrorrchronicrpressurerulcersrmayrsignalrarproblemrnotronlyrwit
hrtherpatientrbutrwithrthercaregiver'srabilityrtorprovideradequatercare.rWelts,rlacerati
ons,rburns,randrdistinctivermarkingsrmayrindicaterarneedrforrintervention.
3.
Thisrisrarresultrofrthernurserpractitionerraddressingritrfurtherrratherrthanrtherreasonr
forraddressingrit.
4.
Arprofessionalrcannotrassumerabuserwithoutrgoodrreason.
4.rThernurserpractitionerrassessesrarpatient'srskinrandrfindsranrinfectiousrlesionronr
therlowerrleg.rTherlesionrisrconsideredrarsecondaryrlesion.rThernurserpractitionerre
xplainsrthatrarsecondaryrlesionrisronerthat:
1.rArisesrfromrchangesrtorarprimaryrlesion.
2.rIsrarcomplicationrofranrunderlyingrdisease.
3.rIsrdifficultrtortreat.
4.rIsrarnormalrsignrofraging.r-rans-4.rAnswer:r1
Page:r97
Feedback
1.
Secondaryrlesionsr(infections)rariserfromrchangesrtortherprimaryrlesion.
2.
Secondaryrlesionsrarernotrnecessarilyrtherresultrofranrunderlyingrdisease.
3.
Secondaryrlesionsrcanrbertreatedrwithrmedicationsrorrsurgery.
4.
Secondaryrlesionsrariserasrarconditionrnotrnormalrtoraging.
5.rMs.rRose,r88ryearsrold,rcomesrtorthernurserpractitionerrwithrarcomplaintraboutra
rgrowthronrherrhand.rSherwantsrtorhaverarbiopsyrdone.rThernurserpractitionerrasks
rtherfollowingrquestion:
1.rHaveryourinjuredryourrhandrrecently?
2.rAreryourusingrardifferentrdetergent?
3.rHasrthisrgrowthrchanged,rbled,rorrisritrpainful?
4.rHasrthisrgrowthrmaderitrdifficultrtorputronryourrrings?r-rans-5.rAnswer:r3
Page:r97
Feedback
1.
Anrinjuryrwouldrnotrstimulatergrowth.
2.
, Arreactionrtorardetergentrwouldrmorerlikelyrberarrash.
3.
Lesionsrthatrwarrantrbiopsyrarerthoserthatrhaverchanged,rbleed,rorrarerpainful.
4.
Therabilityrtorputronrherrringrisrnotrtherproblem.
6.rAr60-year-
oldrmalerentersrtherburnrcenterrforrtriagerandrtreatmentrduertorarburnrherreceivedr
atrarcampfire.rHisrleftrarmrhasranrarearthatrisrerythematousrandrpainful,randranothe
rrarearhasrarblister.rWhatrdoesrthernurserpractitionerrrecordrasrtherdegreerofrburn?
1.rFirstrdegree
2.rSecondrdegree
3.rFirstrandrsecondrdegree
4.rSecondrandrthirdrdegreer-rans-6.rAnswer:r3
Page:r98
Feedback
1.
First-
degreerburnsrinvolvingrtherepidermisrarererythematousrandrpainfulrbutrdornotrblister
.
2.
Second-degreerburnsrinvolvertherdermisrandrarercharacterizedrbyrblisters.
3.
Therpatientrpresentsrwithrerythematousrskin,rpainfulrwithrblisters,rwhichrindicatesrbo
thrfirst-randrsecond-degreerburnrareas.
4.
Inrthird-degreerburnsrthererisrnorsensationrwhenrtherwoundrisrpinpricked.
7.rThernurserpractitionerrisrconcernedrwithrprimaryrpreventionrstrategies.rHowrcanrt
hernurserpractitionerrimplementrprimaryrpreventionrstrategiesrforranr80-year-
oldrmalerpatientrwhorsmokes?
1.rReviewrhomerfirersafetyrprotocols,rincludingrtherproperruserofrsmokeralarms,rand
rdiscussrsmokingrcessation.
2.rInformrhimrthatrifrherdoesrnotrstoprsmoking,rthernurserpractitionerrcannotrseerhi
mragain.
3.rHaverarconferencerwithrhisrfamilyraboutrhisrsmoking.
4.rPlanrarfamilyrmeetingrwithrtherpatientrtordiscussrbenefitsrofrhisrsmokingrcessatio
n.r-rans-7.rAnswer:r1
Page:r115,r116
Feedback
1.
