NRNP 6566 Week 8 Quiz V3 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 8 Quiz) | Walden University
1. A 62-year-old patient with non-Hodgkin lymphoma presents with confusion, muscle
weakness, and an ECG showing peaked T-waves after starting chemotherapy. Which
laboratory finding is most characteristic of Tumor Lysis Syndrome (TLS)?
A. Hypokalemia
B. Hypophosphatemia
C. Hyperuricemia
D. Hypercalcemia
Answer: C
Rationale: Tumor Lysis Syndrome is an oncologic emergency characterized by the rapid
release of intracellular contents into the bloodstream. Hyperuricemia occurs due to the
catabolism of nucleic acids released from destroyed malignant cells. This condition also
typically involves hyperkalemia and hyperphosphatemia, while hypocalcemia results from
phosphate binding to calcium.
2. In a patient suspected of having Disseminated Intravascular Coagulation (DIC), which of the
following laboratory profiles most strongly supports the diagnosis?
A. Elevated platelets, low D-dimer, and prolonged PTT
,B. Shortened PT/PTT, elevated fibrinogen, and low D-dimer
C. Normal PT/PTT, low platelets, and normal fibrinogen
D. Prolonged PT/PTT, decreased fibrinogen, and elevated D-dimer
Answer: D
Rationale: DIC involves the systemic activation of coagulation, leading to the consumption
of clotting factors and platelets. As clotting factors are depleted, the PT and PTT become
prolonged and fibrinogen levels drop significantly. The concurrent fibrinolysis leads to the
production of fibrin degradation products, specifically reflected in an elevated D-dimer.
3. A patient on a heparin drip for five days experiences a 60% drop in platelet count. What is
the immediate priority intervention for suspected Heparin-Induced Thrombocytopenia (HIT)?
A. Administer a platelet transfusion
B. Discontinue all heparin products and initiate a direct thrombin inhibitor
C. Switch the patient to Low Molecular Weight Heparin (LMWH)
D. Wait for the HIT antibody test results before changing therapy
Answer: B
Rationale: HIT is a life-threatening prothrombotic condition caused by antibodies against
heparin-platelet factor 4 complexes. The first step in management is the immediate
cessation of all heparin, including flushes, to prevent further thrombotic events. A non-
,heparin anticoagulant, such as argatroban or bivalirudin, must be started while awaiting
confirmatory testing.
4. Which clinical manifestation is considered a classic indicator of Vitamin B12 deficiency but
is NOT present in Folate deficiency?
A. Glossitis
B. Neurological symptoms like paresthesia and ataxia
C. Macrocytic anemia
D. Increased homocysteine levels
Answer: B
Rationale: While both B12 and folate deficiencies cause megaloblastic anemia and
glossitis, B12 deficiency uniquely leads to subacute combined degeneration of the spinal
cord. This results in neurological deficits such as loss of vibratory sense and paresthesia
due to impaired myelin synthesis. Folate deficiency does not present with these specific
neurological findings.
5. An adult patient with an Absolute Neutrophil Count (ANC) of 450/mm3 presents with a
temperature of 101.5°F. What is the most appropriate initial action?
A. Administer broad-spectrum intravenous antibiotics immediately after cultures
B. Wait for blood culture results before starting therapy
C. Give oral acetaminophen and reassess in four hours
, D. Discharge the patient with a prescription for oral ciprofloxacin
Answer: A
Rationale: Neutropenic fever is a medical emergency in the acute care setting because the
patient lacks the immune response to fight infection. Empiric broad-spectrum antibiotic
therapy, such as cefepime or piperacillin-tazobactam, must be initiated within one hour of
presentation. Delaying treatment while waiting for cultures significantly increases the risk
of septic shock and mortality.
6. A patient presents with a painful Sickle Cell Crisis. Which of the following is the highest
priority in the acute management phase?
A. Routine blood transfusion to reach a hemoglobin of 14 g/dL
B. Ice packs applied to the painful joints
C. Aggressive intravenous hydration and parenteral opioid analgesia
D. Administration of hydroxyurea to stop the current crisis
Answer: C
Rationale: The management of an acute sickle cell vaso-occlusive crisis focuses on
reversing the triggers of sickling and managing excruciating pain. Intravenous fluids help
reduce blood viscosity and improve perfusion to ischemic tissues. Adequate pain control
with opioids is essential, as the pain is often severe and requires scheduled dosing rather
than PRN.
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 8 Quiz) | Walden University
1. A 62-year-old patient with non-Hodgkin lymphoma presents with confusion, muscle
weakness, and an ECG showing peaked T-waves after starting chemotherapy. Which
laboratory finding is most characteristic of Tumor Lysis Syndrome (TLS)?
A. Hypokalemia
B. Hypophosphatemia
C. Hyperuricemia
D. Hypercalcemia
Answer: C
Rationale: Tumor Lysis Syndrome is an oncologic emergency characterized by the rapid
release of intracellular contents into the bloodstream. Hyperuricemia occurs due to the
catabolism of nucleic acids released from destroyed malignant cells. This condition also
typically involves hyperkalemia and hyperphosphatemia, while hypocalcemia results from
phosphate binding to calcium.
2. In a patient suspected of having Disseminated Intravascular Coagulation (DIC), which of the
following laboratory profiles most strongly supports the diagnosis?
A. Elevated platelets, low D-dimer, and prolonged PTT
,B. Shortened PT/PTT, elevated fibrinogen, and low D-dimer
C. Normal PT/PTT, low platelets, and normal fibrinogen
D. Prolonged PT/PTT, decreased fibrinogen, and elevated D-dimer
Answer: D
Rationale: DIC involves the systemic activation of coagulation, leading to the consumption
of clotting factors and platelets. As clotting factors are depleted, the PT and PTT become
prolonged and fibrinogen levels drop significantly. The concurrent fibrinolysis leads to the
production of fibrin degradation products, specifically reflected in an elevated D-dimer.
3. A patient on a heparin drip for five days experiences a 60% drop in platelet count. What is
the immediate priority intervention for suspected Heparin-Induced Thrombocytopenia (HIT)?
A. Administer a platelet transfusion
B. Discontinue all heparin products and initiate a direct thrombin inhibitor
C. Switch the patient to Low Molecular Weight Heparin (LMWH)
D. Wait for the HIT antibody test results before changing therapy
Answer: B
Rationale: HIT is a life-threatening prothrombotic condition caused by antibodies against
heparin-platelet factor 4 complexes. The first step in management is the immediate
cessation of all heparin, including flushes, to prevent further thrombotic events. A non-
,heparin anticoagulant, such as argatroban or bivalirudin, must be started while awaiting
confirmatory testing.
4. Which clinical manifestation is considered a classic indicator of Vitamin B12 deficiency but
is NOT present in Folate deficiency?
A. Glossitis
B. Neurological symptoms like paresthesia and ataxia
C. Macrocytic anemia
D. Increased homocysteine levels
Answer: B
Rationale: While both B12 and folate deficiencies cause megaloblastic anemia and
glossitis, B12 deficiency uniquely leads to subacute combined degeneration of the spinal
cord. This results in neurological deficits such as loss of vibratory sense and paresthesia
due to impaired myelin synthesis. Folate deficiency does not present with these specific
neurological findings.
5. An adult patient with an Absolute Neutrophil Count (ANC) of 450/mm3 presents with a
temperature of 101.5°F. What is the most appropriate initial action?
A. Administer broad-spectrum intravenous antibiotics immediately after cultures
B. Wait for blood culture results before starting therapy
C. Give oral acetaminophen and reassess in four hours
, D. Discharge the patient with a prescription for oral ciprofloxacin
Answer: A
Rationale: Neutropenic fever is a medical emergency in the acute care setting because the
patient lacks the immune response to fight infection. Empiric broad-spectrum antibiotic
therapy, such as cefepime or piperacillin-tazobactam, must be initiated within one hour of
presentation. Delaying treatment while waiting for cultures significantly increases the risk
of septic shock and mortality.
6. A patient presents with a painful Sickle Cell Crisis. Which of the following is the highest
priority in the acute management phase?
A. Routine blood transfusion to reach a hemoglobin of 14 g/dL
B. Ice packs applied to the painful joints
C. Aggressive intravenous hydration and parenteral opioid analgesia
D. Administration of hydroxyurea to stop the current crisis
Answer: C
Rationale: The management of an acute sickle cell vaso-occlusive crisis focuses on
reversing the triggers of sickling and managing excruciating pain. Intravenous fluids help
reduce blood viscosity and improve perfusion to ischemic tissues. Adequate pain control
with opioids is essential, as the pain is often severe and requires scheduled dosing rather
than PRN.
