NNP EXAM WITH FULL PACK
SOLUTIONS
Which gof gthe gfollowing gwould gprovide gthe gweakest gevidence gfor gpractice?
A.
Case gstudy
B.
Case-control gstudy
C.
Quasi-experimental gstudy g- gcorrect ganswers g-A.
Level gEvidence gtype gI gmeta-analysis gand/or gsystematic greview gof grandomized-
controlled gtrials g(RCT); gII gsingle gRCT; gIII gquasi-experiment g(non-randomized); gIV
gnon-experimental gstudy g(case-control, gcohort, gcorrelational); gV gsystematic greviews
gof gdescriptive gstudies gor gqualitative gstudies; gVI gsingle gqualitative gstudy gor gcross-
,section gstudy g(survey); gVII gexpert gopinion, gcase greports, gcommittee greports g(Polit
g& gBeck, g2018, gpp. g23-34; gThomas, g2015, gp. g840).
An ginitial gsign gof ghyperkalemia gon gan gEKG gis
A.
Peaked gT gwaves
B.
Slurring gof gthe gQRS
C.
Ventricular gfibrillation g- gcorrect ganswers g-A.
EKG gchanges gare goften gthe gfirst gsign gof ghyperkalemia. gEKG gfindings gare
galtered gas gthe gserum gK g+ grises, gpresenting gwith gvarying glevels gof gpeaked gT
gwaves g(secondary gto gincreased grepolarization gof gthe gcardiac gtissue), gflattened gP
gwaves, gand gincreased gPR gintervals g(secondary gto gsuppression gof gatrial
gconductivity). gThese gchanges gare gfollowed gby gwidening gand gslurring gof gthe
gQRS gcomplex g(secondary gto gdelay gin gventricular gconduction gas gwell gas gdelays
gin gmyocardial gconduction) gwith geventual gdevelopment gof gsupraventricular
gtachycardia, gventricular gtachycardia, gbradycardia, gor gventricular gfibrillation
g(Doherty, g2017, gp. g308).
The gHenderson-Hasselebalch gequation gis ga gnegative glogarithm gthat gcalculates
gthe glevel gof
A.
Bicarbonate gions
B.
Dioxide gions
C.
Hydrogen gions g- gcorrect ganswers g-C.
The gHenderson-Hasselebalch gequation gcalculates gplasma gpH. gThe gpH gis ga
gnegative glogarithm gthat gmeasures gthe glevel gof ghydrogen gions g(H+), gwhich
gmeans gthat gthere gis gan ginverse grelationship gbetween gthe gpH gand gH+. gThe gpH
gdecreases gwith ga grise gin gH+ gand gincreases gwith ga gfall gin gH+. gThe gpH gremains
gnormal gwhen gthere gis ga gbalance gin gchanges gof gcarbon gdioxide g(CO2) gand
gbicarbonate g(HCO3) g(Barry, gDeacon, gHernandez, g& gJones, g2016, gp. g145).
The gneonatal gnurse gpractitioner g(NNP) gknows gthat ga gserum gpeak glevel gof ga
gdrug gis ggenerally greflective gof gthe ginfants:
A.
Excretion gof gmetabolites
B.
Digestion gof gthe gdrug
C.
Volume gof gdistribution
ganswer g- gcorrect ganswers g-C.
,Volume gof gdistribution g(Vd) gis ginfluenced gby ggestational gage gdue gto gthe grapid
gchanges gin gtotal gbody gwater gand gfluid gshifts g(Allegaert get gal., g2018, gp. g428;
gWade, g2015, gp. g666).
Infants gwith glarge gextracellular gfluid gvolumes ghave gincreased gVd gfor gwater-
soluble gdrugs gand gmay greduce gpeak gdrug gvalues gand gaffect gdrug gexcretion
g(Blackburn, g2018, gp. g198).
Decreased gbody gfat gin gpreterm gand gintrauterine ggrowth-restricted ginfants
gdecreases gthe gVd gfor glipophilic gdrugs g(Blackburn, g2018, gp. g199).
Pharmacokinetics gis gthe gprocess gof gdrug
A.
Absorption, gdistribution, gbiotransformation, gand gexcretion
B.
Adaptations gmade gto gphysiological gsystems gby gthe gdrugs
C.
Alterations, gmetabolism, gand gexcretion gin gthe gcellular gmatrix g- gcorrect ganswers g-
A.
Pharmacokinetics gare gthe gmathematical grelationships gbetween gdrug gdose gand
gblood glevels gover gtime. gPharmacokinetic gprocesses ginclude gabsorption,
gdistribution, gmetabolism g(biotransformation), gand gexcretion g(Allegaert get gal., g2018,
gpp. g419-421; gBlackburn, g2018; gpp. g180-181; gWade, g2015, gp. g665).
Phase gI gdrug gmetabolism greactions gare gmediated gby
A.
Cytochrome gP450 genzymes
B.
Hepatic goxidation gmetabolites
C.
Enzymatic greduction gmolecules g- gcorrect ganswers g-A.
Cytochrome gP450 g(CYP450) genzymes gmediate gPhase gI gmetabolism gand gare
gpresent gin gmany gtissues, gbut gthey gare gmost ghighly gconcentrated gin ghepatic
gtissues g(Allegaert get gal., g2018, gpp. g655-657; gMcClary, g2015b, gpp. g420-421).
The gtranslocation gof ga gdrug gfrom gthe gsite gof gadministration ginto gthe gsystemic
gcirculation gis gcalled
A.
Absorption
B.
Distribution
C.
Drug gdelivery
ganswer g- gcorrect ganswers g-A.
, Absorption gis gthe gprocess gof gdrug gmovement gfrom gthe gadministration gsite
g(gastrointestinal, gintravenous, gintramuscular, gintrapulmonary/inhaled, gand
gsubcutaneous) gacross gmembranes gand ginto gthe gsystemic gcirculation g(Allegaert
get gal., g2018, gp. g419; gDomonoske, g2015, gpp. g220-221; gWade, g2015, gp. g665).
8.
The grecommendation gfor glength gof gtime gto gdelay gumbilical gcord gclamping gafter
gdelivery gof ga gwell gnewborn gis
A.
0 gto g20 gseconds
B.
30 gto g60 gseconds
C.
90 gto g120 gseconds g- gcorrect ganswers g-B.
Delayed gumbilical gcord gclamping gis gdefined gas ga g30- gto g60-second gpause
gbefore gclamping gthe gcord gin gorder gto gallow gfor gplacental gtransfusion gof gblood
gto gthe ginfant g(Katheria g& gFiner, g2018, gpp. g277-279).
9.
A gnewborn ginfant's goxygen gsaturation gat g10 gminutes gafter gbirth gshould gbe ga
gminimum gof
A.
80%
B.
85%
C.
90% g- gcorrect ganswers g-B.
Preductal goxygen glevels ggenerally gshould gbe gabove g85% gto g95% gafter g10
gminutes g(Pappas g& gRobey, g2015, gp. g86).
10.
The gmost gappropriate gvalue gto guse gas gan gindicator gof gfetal gand guteroplacental
gstates gis gthe
A.
Arterial gcord gblood
B.
Placental gcord gvolume
C.
Venous gcord gblood gflow g- gcorrect ganswers g-A.
The gumbilical gcord garterial gblood ggas gis gmore gvaluable gthan gthe gumbilical gcord
gvenous gblood ggas gfor gdetermining gneonatal gacid-base gstatus gbecause git
grepresents gboth gthe gfetal gand guteroplacental gstates g(Lyndon, gO'Brien-Abel, g&
gRice gSimpson, g2014, gp. g481).
11.
SOLUTIONS
Which gof gthe gfollowing gwould gprovide gthe gweakest gevidence gfor gpractice?
A.
Case gstudy
B.
Case-control gstudy
C.
Quasi-experimental gstudy g- gcorrect ganswers g-A.
Level gEvidence gtype gI gmeta-analysis gand/or gsystematic greview gof grandomized-
controlled gtrials g(RCT); gII gsingle gRCT; gIII gquasi-experiment g(non-randomized); gIV
gnon-experimental gstudy g(case-control, gcohort, gcorrelational); gV gsystematic greviews
gof gdescriptive gstudies gor gqualitative gstudies; gVI gsingle gqualitative gstudy gor gcross-
,section gstudy g(survey); gVII gexpert gopinion, gcase greports, gcommittee greports g(Polit
g& gBeck, g2018, gpp. g23-34; gThomas, g2015, gp. g840).
An ginitial gsign gof ghyperkalemia gon gan gEKG gis
A.
Peaked gT gwaves
B.
Slurring gof gthe gQRS
C.
Ventricular gfibrillation g- gcorrect ganswers g-A.
EKG gchanges gare goften gthe gfirst gsign gof ghyperkalemia. gEKG gfindings gare
galtered gas gthe gserum gK g+ grises, gpresenting gwith gvarying glevels gof gpeaked gT
gwaves g(secondary gto gincreased grepolarization gof gthe gcardiac gtissue), gflattened gP
gwaves, gand gincreased gPR gintervals g(secondary gto gsuppression gof gatrial
gconductivity). gThese gchanges gare gfollowed gby gwidening gand gslurring gof gthe
gQRS gcomplex g(secondary gto gdelay gin gventricular gconduction gas gwell gas gdelays
gin gmyocardial gconduction) gwith geventual gdevelopment gof gsupraventricular
gtachycardia, gventricular gtachycardia, gbradycardia, gor gventricular gfibrillation
g(Doherty, g2017, gp. g308).
The gHenderson-Hasselebalch gequation gis ga gnegative glogarithm gthat gcalculates
gthe glevel gof
A.
Bicarbonate gions
B.
Dioxide gions
C.
Hydrogen gions g- gcorrect ganswers g-C.
The gHenderson-Hasselebalch gequation gcalculates gplasma gpH. gThe gpH gis ga
gnegative glogarithm gthat gmeasures gthe glevel gof ghydrogen gions g(H+), gwhich
gmeans gthat gthere gis gan ginverse grelationship gbetween gthe gpH gand gH+. gThe gpH
gdecreases gwith ga grise gin gH+ gand gincreases gwith ga gfall gin gH+. gThe gpH gremains
gnormal gwhen gthere gis ga gbalance gin gchanges gof gcarbon gdioxide g(CO2) gand
gbicarbonate g(HCO3) g(Barry, gDeacon, gHernandez, g& gJones, g2016, gp. g145).
The gneonatal gnurse gpractitioner g(NNP) gknows gthat ga gserum gpeak glevel gof ga
gdrug gis ggenerally greflective gof gthe ginfants:
A.
Excretion gof gmetabolites
B.
Digestion gof gthe gdrug
C.
Volume gof gdistribution
ganswer g- gcorrect ganswers g-C.
,Volume gof gdistribution g(Vd) gis ginfluenced gby ggestational gage gdue gto gthe grapid
gchanges gin gtotal gbody gwater gand gfluid gshifts g(Allegaert get gal., g2018, gp. g428;
gWade, g2015, gp. g666).
Infants gwith glarge gextracellular gfluid gvolumes ghave gincreased gVd gfor gwater-
soluble gdrugs gand gmay greduce gpeak gdrug gvalues gand gaffect gdrug gexcretion
g(Blackburn, g2018, gp. g198).
Decreased gbody gfat gin gpreterm gand gintrauterine ggrowth-restricted ginfants
gdecreases gthe gVd gfor glipophilic gdrugs g(Blackburn, g2018, gp. g199).
Pharmacokinetics gis gthe gprocess gof gdrug
A.
Absorption, gdistribution, gbiotransformation, gand gexcretion
B.
Adaptations gmade gto gphysiological gsystems gby gthe gdrugs
C.
Alterations, gmetabolism, gand gexcretion gin gthe gcellular gmatrix g- gcorrect ganswers g-
A.
Pharmacokinetics gare gthe gmathematical grelationships gbetween gdrug gdose gand
gblood glevels gover gtime. gPharmacokinetic gprocesses ginclude gabsorption,
gdistribution, gmetabolism g(biotransformation), gand gexcretion g(Allegaert get gal., g2018,
gpp. g419-421; gBlackburn, g2018; gpp. g180-181; gWade, g2015, gp. g665).
Phase gI gdrug gmetabolism greactions gare gmediated gby
A.
Cytochrome gP450 genzymes
B.
Hepatic goxidation gmetabolites
C.
Enzymatic greduction gmolecules g- gcorrect ganswers g-A.
Cytochrome gP450 g(CYP450) genzymes gmediate gPhase gI gmetabolism gand gare
gpresent gin gmany gtissues, gbut gthey gare gmost ghighly gconcentrated gin ghepatic
gtissues g(Allegaert get gal., g2018, gpp. g655-657; gMcClary, g2015b, gpp. g420-421).
The gtranslocation gof ga gdrug gfrom gthe gsite gof gadministration ginto gthe gsystemic
gcirculation gis gcalled
A.
Absorption
B.
Distribution
C.
Drug gdelivery
ganswer g- gcorrect ganswers g-A.
, Absorption gis gthe gprocess gof gdrug gmovement gfrom gthe gadministration gsite
g(gastrointestinal, gintravenous, gintramuscular, gintrapulmonary/inhaled, gand
gsubcutaneous) gacross gmembranes gand ginto gthe gsystemic gcirculation g(Allegaert
get gal., g2018, gp. g419; gDomonoske, g2015, gpp. g220-221; gWade, g2015, gp. g665).
8.
The grecommendation gfor glength gof gtime gto gdelay gumbilical gcord gclamping gafter
gdelivery gof ga gwell gnewborn gis
A.
0 gto g20 gseconds
B.
30 gto g60 gseconds
C.
90 gto g120 gseconds g- gcorrect ganswers g-B.
Delayed gumbilical gcord gclamping gis gdefined gas ga g30- gto g60-second gpause
gbefore gclamping gthe gcord gin gorder gto gallow gfor gplacental gtransfusion gof gblood
gto gthe ginfant g(Katheria g& gFiner, g2018, gpp. g277-279).
9.
A gnewborn ginfant's goxygen gsaturation gat g10 gminutes gafter gbirth gshould gbe ga
gminimum gof
A.
80%
B.
85%
C.
90% g- gcorrect ganswers g-B.
Preductal goxygen glevels ggenerally gshould gbe gabove g85% gto g95% gafter g10
gminutes g(Pappas g& gRobey, g2015, gp. g86).
10.
The gmost gappropriate gvalue gto guse gas gan gindicator gof gfetal gand guteroplacental
gstates gis gthe
A.
Arterial gcord gblood
B.
Placental gcord gvolume
C.
Venous gcord gblood gflow g- gcorrect ganswers g-A.
The gumbilical gcord garterial gblood ggas gis gmore gvaluable gthan gthe gumbilical gcord
gvenous gblood ggas gfor gdetermining gneonatal gacid-base gstatus gbecause git
grepresents gboth gthe gfetal gand guteroplacental gstates g(Lyndon, gO'Brien-Abel, g&
gRice gSimpson, g2014, gp. g481).
11.
