NRNP 6566 Week 5 Quiz V2 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 5 Quiz) | Walden University
1. A patient is admitted with suspected compartment syndrome in the lower leg following a
fracture. Which of the following is the most sensitive early clinical indicator for this
condition?
A. Absence of distal pulses
B. Paresthesia in the affected limb
C. Pallor and coolness of the skin
D. Pain out of proportion to the injury or pain with passive stretch
Answer: D
Rationale: Pain out of proportion to clinical findings is the hallmark early sign of
compartment syndrome. While the ‘six Ps’ are classic, pulses and sensation often remain
intact until the condition has progressed to an advanced stage. Early recognition is vital to
prevent permanent tissue necrosis and muscle loss.
,2. An adult male presents with acute onset of a painful, swollen, and erythematous left great
toe. Synovial fluid analysis reveals negatively birefringent needle-shaped crystals. Which
medication is appropriate for acute management?
A. Probenecid
B. Allopurinol
C. Febuxostat
D. Indomethacin
Answer: D
Rationale: NSAIDs like indomethacin are the first-line therapy for acute gouty flares to
reduce inflammation and pain. Allopurinol and febuxostat are xanthine oxidase inhibitors
used for long-term prevention, but starting them during an acute flare can worsen
symptoms. Management focus during the acute phase is solely on symptomatic relief and
inflammation control.
3. In the management of Diabetic Ketoacidosis (DKA), which lab value must be closely
monitored before initiating an insulin drip?
A. Serum sodium level
B. Serum potassium level
C. Serum magnesium level
D. Bicarbonate level
, Answer: B
Rationale: Insulin causes an intracellular shift of potassium, which can lead to life-
threatening hypokalemia in patients who are already depleted. Potassium levels must be
above 3.3 mEq/L before starting insulin to ensure patient safety. Frequent monitoring of
electrolytes is mandatory throughout the resuscitation process in acute care settings.
4. Which of the following diagnostic findings is most characteristic of Hyperosmolar
Hyperglycemic State (HHS) compared to DKA?
A. Positive urine ketones
B. Anion gap greater than 16
C. Serum osmolality greater than 320 mOsm/kg
D. Arterial pH of 7.15
Answer: C
Rationale: HHS is characterized by extreme hyperglycemia and significant
hyperosmolality without significant ketoacidosis. Unlike DKA, these patients typically have
enough insulin to prevent lipolysis but not enough to control blood glucose. This results in
profound dehydration and higher mortality rates in elderly populations.
5. A patient with osteomyelitis of the femur requires long-term antibiotic therapy. What is
the gold standard for identifying the causative organism and guiding treatment?
A. Blood cultures
B. Wound swab of the sinus tract
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 5 Quiz) | Walden University
1. A patient is admitted with suspected compartment syndrome in the lower leg following a
fracture. Which of the following is the most sensitive early clinical indicator for this
condition?
A. Absence of distal pulses
B. Paresthesia in the affected limb
C. Pallor and coolness of the skin
D. Pain out of proportion to the injury or pain with passive stretch
Answer: D
Rationale: Pain out of proportion to clinical findings is the hallmark early sign of
compartment syndrome. While the ‘six Ps’ are classic, pulses and sensation often remain
intact until the condition has progressed to an advanced stage. Early recognition is vital to
prevent permanent tissue necrosis and muscle loss.
,2. An adult male presents with acute onset of a painful, swollen, and erythematous left great
toe. Synovial fluid analysis reveals negatively birefringent needle-shaped crystals. Which
medication is appropriate for acute management?
A. Probenecid
B. Allopurinol
C. Febuxostat
D. Indomethacin
Answer: D
Rationale: NSAIDs like indomethacin are the first-line therapy for acute gouty flares to
reduce inflammation and pain. Allopurinol and febuxostat are xanthine oxidase inhibitors
used for long-term prevention, but starting them during an acute flare can worsen
symptoms. Management focus during the acute phase is solely on symptomatic relief and
inflammation control.
3. In the management of Diabetic Ketoacidosis (DKA), which lab value must be closely
monitored before initiating an insulin drip?
A. Serum sodium level
B. Serum potassium level
C. Serum magnesium level
D. Bicarbonate level
, Answer: B
Rationale: Insulin causes an intracellular shift of potassium, which can lead to life-
threatening hypokalemia in patients who are already depleted. Potassium levels must be
above 3.3 mEq/L before starting insulin to ensure patient safety. Frequent monitoring of
electrolytes is mandatory throughout the resuscitation process in acute care settings.
4. Which of the following diagnostic findings is most characteristic of Hyperosmolar
Hyperglycemic State (HHS) compared to DKA?
A. Positive urine ketones
B. Anion gap greater than 16
C. Serum osmolality greater than 320 mOsm/kg
D. Arterial pH of 7.15
Answer: C
Rationale: HHS is characterized by extreme hyperglycemia and significant
hyperosmolality without significant ketoacidosis. Unlike DKA, these patients typically have
enough insulin to prevent lipolysis but not enough to control blood glucose. This results in
profound dehydration and higher mortality rates in elderly populations.
5. A patient with osteomyelitis of the femur requires long-term antibiotic therapy. What is
the gold standard for identifying the causative organism and guiding treatment?
A. Blood cultures
B. Wound swab of the sinus tract
