NUR 692 EXAM 3 QUESTIONS
AND CORRECT ANSWERS
(VERIFIED ANSWERS) A GRADE
__________________is the best diagnostic test to
determine splenic injury. - correct answer- CT
scan with contrast
______________is the emergent treatment for tension
pneumothorax. - correct answer- needle
decompression
A 29-year-old male is brought to the trauma center by
helicopter status post gunshot wound to the abdomen.
Paramedics estimate that he has lost two liters of blood.
His pulse is weak at 140 bpm and his blood pressure is
palpable at 50 mmHg. Skin is cool and extremities are
cyanotic. Neck veins are completely flat. His chest is clear
and his heart sounds are weak. To prevent irreversible
shock related to complications while preparing him for
the operating room, which intervention is most important
at this time?
,Infuse isotonic crystalloids through a short, large bore IV
Broad spectrum antibiotics to prevent sepsis
Sodium bicarbonate to prevent metabolic acidosis
Infuse normal saline at a rate of 3-4 times the volume
deficit - correct answer- Infuse isotonic
crystalloids through a short, large bore IV
A 33 y/o male with PMH of morbid obesity and HLD
presents witha five day history of sharp abdominal pain
that radiates to his back. On exam, there is cool and
clammy skin with mottling and vitals notable for BP of
75/40, ST 128, and temp of 103F. As the ACNP caring for
this patient, you understand that the most reliable
diagnostic and prognostic indicator in shock states is:
heart rate >90
serum lactate of >2mmol/L
Creatinine of 1.2
temp of 103F - correct answer- serum lactate
of >2mmol/L
,A 36 year old female presents to the ED for complaints of
headache, vomiting, neck rigidity, and visual disturbances.
The patient's VS are: BP 126/67, HR 95, Temp 98.9, RR 14,
O2 sat is 100% on room air. The patient denies fever or
body aches. The patients states that this has happened
before in the past several times but was only treated with
medicine without any other workup. The patient also
states that she is concerned because her father was
diagnosed with meningioma in his 60's. The nurse
practitioner knows that if the patient continues to exhibit
these symptoms after medications have been
administered:
the patient will need labs drawn and a lumbar puncture.
the patient will need to follow up with her PCP for
treatment and workup as this is a chronic issue.
the patient will need labs drawn and a CT head without
contrast. If the CT is negative, she may need a lumbar
puncture.
the patient will need to have the hea - correct
answer- the patient will need labs drawn and a CT
head without contrast. If the CT is negative, she may need
a lumbar puncture.
, A 38 y/o female with PMH of hypothyroidism and SLE with
chronic immunosuppression on Plaquenil and Prednisone
presents with a four day history of pyrexia, n/v, dyspnea,
and chills. Upon admission to the ED, found to be hypoxic
with sats of 80% on RA and hypotensive with BP of 68/34
and lactic acidosis of 8. Placed on oxygen therapy and
given 4L of LR with no improvement in hypotension and
LA only improved to 7. Labs concerning for UTI. Pan
cultures obtained, started on Levo, and given broad
spectrum abx therapy of Vanc, Zosyn, and Micafungin,
and transferred to the ICU for further critical care
management. After two days in the ICU, remains
hypotensive with rising pressor requirements, despite
adequate treatment of Klebsiella UTI, bedside u/s
revealing of full IVC, TTE with normal EF's, and resolution
of LA. TSH was checked and within normal range. As the
advanced provider caring for this patient, you recognize
that - correct answer- Start Hydrocortisone
50mg IV q6h with a now dose of 100mg IV.
A 44 y/o male with PMH of DM, ESRD s/p transpslant in
2021 now on chronic immunosuppression with
Cyclosporin/Prednisone/Cellcept with a recent
hospitalization for 10 days for UTI and AKI, discharged
AND CORRECT ANSWERS
(VERIFIED ANSWERS) A GRADE
__________________is the best diagnostic test to
determine splenic injury. - correct answer- CT
scan with contrast
______________is the emergent treatment for tension
pneumothorax. - correct answer- needle
decompression
A 29-year-old male is brought to the trauma center by
helicopter status post gunshot wound to the abdomen.
Paramedics estimate that he has lost two liters of blood.
His pulse is weak at 140 bpm and his blood pressure is
palpable at 50 mmHg. Skin is cool and extremities are
cyanotic. Neck veins are completely flat. His chest is clear
and his heart sounds are weak. To prevent irreversible
shock related to complications while preparing him for
the operating room, which intervention is most important
at this time?
,Infuse isotonic crystalloids through a short, large bore IV
Broad spectrum antibiotics to prevent sepsis
Sodium bicarbonate to prevent metabolic acidosis
Infuse normal saline at a rate of 3-4 times the volume
deficit - correct answer- Infuse isotonic
crystalloids through a short, large bore IV
A 33 y/o male with PMH of morbid obesity and HLD
presents witha five day history of sharp abdominal pain
that radiates to his back. On exam, there is cool and
clammy skin with mottling and vitals notable for BP of
75/40, ST 128, and temp of 103F. As the ACNP caring for
this patient, you understand that the most reliable
diagnostic and prognostic indicator in shock states is:
heart rate >90
serum lactate of >2mmol/L
Creatinine of 1.2
temp of 103F - correct answer- serum lactate
of >2mmol/L
,A 36 year old female presents to the ED for complaints of
headache, vomiting, neck rigidity, and visual disturbances.
The patient's VS are: BP 126/67, HR 95, Temp 98.9, RR 14,
O2 sat is 100% on room air. The patient denies fever or
body aches. The patients states that this has happened
before in the past several times but was only treated with
medicine without any other workup. The patient also
states that she is concerned because her father was
diagnosed with meningioma in his 60's. The nurse
practitioner knows that if the patient continues to exhibit
these symptoms after medications have been
administered:
the patient will need labs drawn and a lumbar puncture.
the patient will need to follow up with her PCP for
treatment and workup as this is a chronic issue.
the patient will need labs drawn and a CT head without
contrast. If the CT is negative, she may need a lumbar
puncture.
the patient will need to have the hea - correct
answer- the patient will need labs drawn and a CT
head without contrast. If the CT is negative, she may need
a lumbar puncture.
, A 38 y/o female with PMH of hypothyroidism and SLE with
chronic immunosuppression on Plaquenil and Prednisone
presents with a four day history of pyrexia, n/v, dyspnea,
and chills. Upon admission to the ED, found to be hypoxic
with sats of 80% on RA and hypotensive with BP of 68/34
and lactic acidosis of 8. Placed on oxygen therapy and
given 4L of LR with no improvement in hypotension and
LA only improved to 7. Labs concerning for UTI. Pan
cultures obtained, started on Levo, and given broad
spectrum abx therapy of Vanc, Zosyn, and Micafungin,
and transferred to the ICU for further critical care
management. After two days in the ICU, remains
hypotensive with rising pressor requirements, despite
adequate treatment of Klebsiella UTI, bedside u/s
revealing of full IVC, TTE with normal EF's, and resolution
of LA. TSH was checked and within normal range. As the
advanced provider caring for this patient, you recognize
that - correct answer- Start Hydrocortisone
50mg IV q6h with a now dose of 100mg IV.
A 44 y/o male with PMH of DM, ESRD s/p transpslant in
2021 now on chronic immunosuppression with
Cyclosporin/Prednisone/Cellcept with a recent
hospitalization for 10 days for UTI and AKI, discharged
