NURS 6560 FINAL EXAM: WALDEN UNIVERSITY QUESTIONS
WITH
100% CORRECT ANSWERS GRADED A+ 2024
1. Q ANSWER:
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert
the AGACNP for the possibility that the patient is over hydrated, thereby increasing the risk
for increased intracranial pressure?
A. BUN = 10
B. Shift output = 800 ml, shift input =
825 ml Unchanged weight
C. Serum osmolality = 260
2. Q ANSWER:
A patient who has been in the intensive care unit for 17 days develops hyponatremic
hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical
ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and
hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to:
A. reduce serum osmolality by infusing a 5% dextrose in
0.2% sodium chloride solution
B. reduce serum sodium concentration by infusing a 0.45%
sodium chloride solution
C. replenish volume by infusing a 0.9% sodium chloride solution
D. replenish volume by infusing a 5% dextrose in water solution.
Organ rejection diagnosis, treatment - Answer- Diagnosis gold standard: biopsy of graft.
Symptoms mostly failure of the organ (renal failure, liver failure, pulm effusions/ infiltrate, etc. Also, graft
tenderness)
Treatment: high dose corticosteroids, optimizing immunosuppressant regimen, antilymphocytic therapy
immunosuppression: what and general considerations - Answer- Pharmacological manipulation of immune
system to prevent/ suppress rejection.
- Started before or after transplant for up to 2 wks to delay first rejection episode
- maintenance for live of graft
- caution with conversion between generic and brand forms of cyclosporine
- Calcineurin inhibitors metabolized via cytochrome P450 enzyme, so may alter other drig concentrations
- avoid grapefruit juice when on calcineurin inhibitors (may cause increase)
Common medical complications in organ transplantation - Answer- HTN
Calcium channel blockers often used to treat. Usually multiple agents necessary. Avoid hypotension in kidney
recipient.
Posttransplant diabetes mellitus
May be related to corticosteroids. Increases risk for graft loss. Tight glycemic control indicated.
3. Q ANSWER:
A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of
nausea and has had one episode of vomiting, but he denies any diarrhea. His vital signs are as
, follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood
pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/µL. The
AGACNP expects that physical examination will reveal:
A. + Murphy’s sign
B. + Chvostek’s sign
C. + McBurney’s sign
D. + Kernig’s sign
Surgery risk classes - Answer- Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriate
General rules for surgery: testing - Answer- ECG before surgery only if coronary disease, except when low risk
surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Meds before surgery - Answer- - Diabetic agents: Use insulin therapy to maintain glycemic goals(iii) Discontinue
biguanides, alpha glucosidase inhibitors, thiazolidinediones, sulfonylureas, and GLP-1 agonists
- Do not start aspirin before surgery
- Stop Warfarin 5 days before surgery. May be bridged with Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, but may continue
Assessment of surgical risk - Answer- - Unstable cardiac condition (recent MI, active angina, active HF,
uncontrolled HTN, severe valvular disease), concern with CAD, CHF. arrhythmia, CVD
- patient stable or unstable?
- urgency of the procedure (oncology will be time sensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more than 4 METS, more than 10 METs makes low risk)
Low risk surgeries - Answer- catarcts
breast biopsy
,cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
4. Q ANSWER:
Myasthenia gravis is best described as:
A. An imbalance of dopamine and acetylcholine in the
basal ganglia Demyelination of peripheral
ascending nerves
B. Demyelination in the central nervous system
C. An autoimmune disorder characterized by decreased neuromuscular activation
5. Q ANSWER:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate
the patient for persistent and progressive discomfort. Likely causes of her symptoms include
all of the following except:
A. Colic due to return
of peristalsis
B. Leakage from
the duodenal
stump
C. Gastric retention
D. Hemorrhage
6. Q ANSWER:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to
evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms
include all of the following except:
A. Colic due to return
of peristalsis
B. Leakage from
the duodenal
stump
, C. Gastric retention
D. Hemorrhage
WITH
100% CORRECT ANSWERS GRADED A+ 2024
1. Q ANSWER:
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert
the AGACNP for the possibility that the patient is over hydrated, thereby increasing the risk
for increased intracranial pressure?
A. BUN = 10
B. Shift output = 800 ml, shift input =
825 ml Unchanged weight
C. Serum osmolality = 260
2. Q ANSWER:
A patient who has been in the intensive care unit for 17 days develops hyponatremic
hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical
ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and
hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to:
A. reduce serum osmolality by infusing a 5% dextrose in
0.2% sodium chloride solution
B. reduce serum sodium concentration by infusing a 0.45%
sodium chloride solution
C. replenish volume by infusing a 0.9% sodium chloride solution
D. replenish volume by infusing a 5% dextrose in water solution.
Organ rejection diagnosis, treatment - Answer- Diagnosis gold standard: biopsy of graft.
Symptoms mostly failure of the organ (renal failure, liver failure, pulm effusions/ infiltrate, etc. Also, graft
tenderness)
Treatment: high dose corticosteroids, optimizing immunosuppressant regimen, antilymphocytic therapy
immunosuppression: what and general considerations - Answer- Pharmacological manipulation of immune
system to prevent/ suppress rejection.
- Started before or after transplant for up to 2 wks to delay first rejection episode
- maintenance for live of graft
- caution with conversion between generic and brand forms of cyclosporine
- Calcineurin inhibitors metabolized via cytochrome P450 enzyme, so may alter other drig concentrations
- avoid grapefruit juice when on calcineurin inhibitors (may cause increase)
Common medical complications in organ transplantation - Answer- HTN
Calcium channel blockers often used to treat. Usually multiple agents necessary. Avoid hypotension in kidney
recipient.
Posttransplant diabetes mellitus
May be related to corticosteroids. Increases risk for graft loss. Tight glycemic control indicated.
3. Q ANSWER:
A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of
nausea and has had one episode of vomiting, but he denies any diarrhea. His vital signs are as
, follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood
pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/µL. The
AGACNP expects that physical examination will reveal:
A. + Murphy’s sign
B. + Chvostek’s sign
C. + McBurney’s sign
D. + Kernig’s sign
Surgery risk classes - Answer- Class 1: benefits outweigh risk, should be done
Class 2a: reasonable to perform
Class 2b: should be considered
Class 3: rarely appropriate
General rules for surgery: testing - Answer- ECG before surgery only if coronary disease, except when low risk
surgery
Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Meds before surgery - Answer- - Diabetic agents: Use insulin therapy to maintain glycemic goals(iii) Discontinue
biguanides, alpha glucosidase inhibitors, thiazolidinediones, sulfonylureas, and GLP-1 agonists
- Do not start aspirin before surgery
- Stop Warfarin 5 days before surgery. May be bridged with Lovenox.
- Do not stop statin before surgery
- Do not start beta-blocker on day of surgery, but may continue
Assessment of surgical risk - Answer- - Unstable cardiac condition (recent MI, active angina, active HF,
uncontrolled HTN, severe valvular disease), concern with CAD, CHF. arrhythmia, CVD
- patient stable or unstable?
- urgency of the procedure (oncology will be time sensitive)
- risk of procedure
- nutritional status
- immune competence
- determine functional capacity (need to be more than 4 METS, more than 10 METs makes low risk)
Low risk surgeries - Answer- catarcts
breast biopsy
,cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
4. Q ANSWER:
Myasthenia gravis is best described as:
A. An imbalance of dopamine and acetylcholine in the
basal ganglia Demyelination of peripheral
ascending nerves
B. Demyelination in the central nervous system
C. An autoimmune disorder characterized by decreased neuromuscular activation
5. Q ANSWER:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate
the patient for persistent and progressive discomfort. Likely causes of her symptoms include
all of the following except:
A. Colic due to return
of peristalsis
B. Leakage from
the duodenal
stump
C. Gastric retention
D. Hemorrhage
6. Q ANSWER:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to
evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms
include all of the following except:
A. Colic due to return
of peristalsis
B. Leakage from
the duodenal
stump
, C. Gastric retention
D. Hemorrhage
