NRNP 6566 Week 5 Quiz V3 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 5 Quiz) | Walden University
1. Which of the following laboratory findings is most specific for a diagnosis of acute
pancreatitis in the emergency department setting?
A. Elevated serum amylase
B. Decreased serum calcium
C. Elevated white blood cell count
D. Elevated serum lipase
Answer: D
Rationale: Serum lipase is highly specific to the pancreas and is considered the preferred
biomarker for diagnosing acute pancreatitis. While amylase rises early, it lacks specificity
as it can be found in salivary glands and other tissues. Lipase remains elevated longer than
amylase, which provides a wider diagnostic window for patients presenting later in the
course of the disease.
2. A 55-year-old male is admitted with suspected non-biliary acute pancreatitis. According to
Ranson’s Criteria, which factor at admission indicates a higher risk of mortality?
A. Blood urea nitrogen increase > 5 mg/dL
,B. Serum calcium < 8 mg/dL
C. Hematocrit drop > 10%
D. White blood cell count > 16,000/mm3
Answer: D
Rationale: Ranson’s Criteria are divided into those assessed at admission and those
assessed within the first 48 hours. At admission, a WBC count greater than 16,000/mm3 is
one of the five predictors of severity for non-biliary pancreatitis. The other admission
criteria include age over 55, blood glucose over 200 mg/dL, AST over 250 U/L, and LDH
over 350 U/L.
3. A patient presents with acute epigastric pain radiating to the back, nausea, and vomiting.
On physical exam, the NP notes periumbilical ecchymosis. This finding is known as:
A. Grey Turner’s sign
B. Cullen’s sign
C. Murphy’s sign
D. Rovsing’s sign
Answer: B
Rationale: Cullen’s sign refers to superficial edema and bruising in the subcutaneous fatty
tissue around the umbilicus. It is a clinical sign of retroperitoneal hemorrhage, often
,associated with severe acute necrotizing pancreatitis. Identifying this sign is critical as it
suggests a high-severity case with significant potential for systemic complications.
4. Which of the following is the most common cause of acute upper gastrointestinal bleeding
(UGIB)?
A. Esophageal varices
B. Mallory-Weiss tears
C. Peptic ulcer disease
D. Arteriovenous malformations
Answer: C
Rationale: Peptic ulcer disease (PUD) remains the most frequent cause of upper
gastrointestinal bleeding, accounting for approximately 50% of cases. Risk factors for PUD
include H. pylori infection and chronic use of nonsteroidal anti-inflammatory drugs
(NSAIDs). Rapid identification via endoscopy is necessary to control bleeding and initiate
appropriate acid-suppression therapy.
5. A patient with cirrhosis presents with confusion and a characteristic ‘flapping tremor’ of
the hands. What is the initial pharmacological treatment for this condition?
A. Lactulose
B. Neomycin
C. Rifaximin
, D. Spironolactone
Answer: A
Rationale: Lactulose is the first-line treatment for hepatic encephalopathy, which is
characterized by cognitive impairment and asterixis (flapping tremor). It works by
converting ammonia to non-absorbable ammonium in the gut and promoting its excretion
through osmotic laxation. The goal of therapy is typically achieving 2 to 3 soft bowel
movements per day.
6. What is the primary diagnostic test used to confirm the presence of esophageal varices?
A. Barium swallow
B. Abdominal CT scan
C. Abdominal ultrasound
D. Esophagogastroduodenoscopy (EGD)
Answer: D
Rationale: Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosing and
grading esophageal varices in patients with portal hypertension. It allows for direct
visualization of the varices and the assessment of ‘red wale’ signs, which indicate a high
risk of rupture. Furthermore, EGD provides a therapeutic pathway for interventions like
variceal band ligation.
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 5 Quiz) | Walden University
1. Which of the following laboratory findings is most specific for a diagnosis of acute
pancreatitis in the emergency department setting?
A. Elevated serum amylase
B. Decreased serum calcium
C. Elevated white blood cell count
D. Elevated serum lipase
Answer: D
Rationale: Serum lipase is highly specific to the pancreas and is considered the preferred
biomarker for diagnosing acute pancreatitis. While amylase rises early, it lacks specificity
as it can be found in salivary glands and other tissues. Lipase remains elevated longer than
amylase, which provides a wider diagnostic window for patients presenting later in the
course of the disease.
2. A 55-year-old male is admitted with suspected non-biliary acute pancreatitis. According to
Ranson’s Criteria, which factor at admission indicates a higher risk of mortality?
A. Blood urea nitrogen increase > 5 mg/dL
,B. Serum calcium < 8 mg/dL
C. Hematocrit drop > 10%
D. White blood cell count > 16,000/mm3
Answer: D
Rationale: Ranson’s Criteria are divided into those assessed at admission and those
assessed within the first 48 hours. At admission, a WBC count greater than 16,000/mm3 is
one of the five predictors of severity for non-biliary pancreatitis. The other admission
criteria include age over 55, blood glucose over 200 mg/dL, AST over 250 U/L, and LDH
over 350 U/L.
3. A patient presents with acute epigastric pain radiating to the back, nausea, and vomiting.
On physical exam, the NP notes periumbilical ecchymosis. This finding is known as:
A. Grey Turner’s sign
B. Cullen’s sign
C. Murphy’s sign
D. Rovsing’s sign
Answer: B
Rationale: Cullen’s sign refers to superficial edema and bruising in the subcutaneous fatty
tissue around the umbilicus. It is a clinical sign of retroperitoneal hemorrhage, often
,associated with severe acute necrotizing pancreatitis. Identifying this sign is critical as it
suggests a high-severity case with significant potential for systemic complications.
4. Which of the following is the most common cause of acute upper gastrointestinal bleeding
(UGIB)?
A. Esophageal varices
B. Mallory-Weiss tears
C. Peptic ulcer disease
D. Arteriovenous malformations
Answer: C
Rationale: Peptic ulcer disease (PUD) remains the most frequent cause of upper
gastrointestinal bleeding, accounting for approximately 50% of cases. Risk factors for PUD
include H. pylori infection and chronic use of nonsteroidal anti-inflammatory drugs
(NSAIDs). Rapid identification via endoscopy is necessary to control bleeding and initiate
appropriate acid-suppression therapy.
5. A patient with cirrhosis presents with confusion and a characteristic ‘flapping tremor’ of
the hands. What is the initial pharmacological treatment for this condition?
A. Lactulose
B. Neomycin
C. Rifaximin
, D. Spironolactone
Answer: A
Rationale: Lactulose is the first-line treatment for hepatic encephalopathy, which is
characterized by cognitive impairment and asterixis (flapping tremor). It works by
converting ammonia to non-absorbable ammonium in the gut and promoting its excretion
through osmotic laxation. The goal of therapy is typically achieving 2 to 3 soft bowel
movements per day.
6. What is the primary diagnostic test used to confirm the presence of esophageal varices?
A. Barium swallow
B. Abdominal CT scan
C. Abdominal ultrasound
D. Esophagogastroduodenoscopy (EGD)
Answer: D
Rationale: Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosing and
grading esophageal varices in patients with portal hypertension. It allows for direct
visualization of the varices and the assessment of ‘red wale’ signs, which indicate a high
risk of rupture. Furthermore, EGD provides a therapeutic pathway for interventions like
variceal band ligation.
