NRNP 6566 Week 6 Quiz V1 | NRNP 6566
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 6 Quiz) | Walden University
1. A 68-year-old male presents with extreme fatigue and laboratory findings indicate a
hemoglobin of 8.2 g/dL and a Mean Corpuscular Volume (MCV) of 74 fL. Which of the
following conditions is most likely responsible for these findings?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folic acid deficiency
D. Anemia of chronic disease
Answer: B
Rationale: Iron deficiency anemia is characterized by a microcytic, hypochromic
appearance where the MCV is typically below 80 fL. This condition is frequently caused by
chronic blood loss, especially in older adults with potential gastrointestinal issues. The
AGACNP must recognize that low ferritin levels are highly specific for this diagnosis.
2. When evaluating a patient for suspected Disseminated Intravascular Coagulation (DIC),
which constellation of laboratory results is most characteristic?
A. Elevated platelets and decreased Prothrombin Time
,B. Elevated fibrinogen and decreased D-dimer
C. Decreased fibrinogen and elevated D-dimer
D. Decreased Partial Thromboplastin Time and elevated platelets
Answer: C
Rationale: DIC involves the pathological overactivation of the clotting cascade, which
consumes platelets and clotting factors such as fibrinogen. The presence of elevated D-
dimer levels indicates that fibrinolysis is occurring in response to widespread thrombus
formation. These laboratory shifts are essential for distinguishing DIC from other
coagulopathies in the acute care setting.
3. A patient with a history of alcohol use disorder presents with paresthesia in the lower
extremities and a macrocytic anemia. Which deficiency should the practitioner suspect first?
A. Vitamin B12
B. Iron
C. Vitamin K
D. Zinc
Answer: A
Rationale: Vitamin B12 deficiency often manifests as macrocytic anemia with an MCV
greater than 100 fL and unique neurological symptoms like paresthesia. Alcohol use can
interfere with the absorption of various nutrients, though B12 and folate are the most
,common macrocytic causes. If left untreated, the neurological damage associated with B12
deficiency can become irreversible.
4. Which of the following is a critical initial management step for a patient in a Sickle Cell
Crisis presenting with severe pain?
A. Fluid restriction to prevent pulmonary edema
B. Aggressive intravenous hydration and oxygenation
C. Administration of cold compresses to painful joints
D. Immediate anticoagulation with Heparin
Answer: B
Rationale: Vaso-occlusive crises in sickle cell disease are triggered by the sickling of red
blood cells, which leads to tissue ischemia. Aggressive hydration helps to decrease blood
viscosity, while oxygenation ensures that the remaining functional hemoglobin is
saturated. Pain management must also be prioritized to reduce the physiological stress on
the patient during the crisis.
5. The AGACNP is monitoring a patient receiving Heparin for a pulmonary embolism and
notices the platelet count has dropped from 250,000 to 90,000 over 48 hours. What is the
most appropriate action?
A. Continue Heparin and repeat labs in 24 hours
B. Increase the Heparin dose to prevent further clotting
C. Administer a platelet transfusion immediately
, D. Discontinue Heparin immediately and initiate an alternative anticoagulant
Answer: D
Rationale: Heparin-Induced Thrombocytopenia (HIT) is a serious immune-mediated
reaction that causes a significant drop in platelet counts and increases the risk of
thrombosis. A drop of more than 50% from baseline while on Heparin is highly suspicious
for this condition. The practitioner must stop all heparin products and switch to a direct
thrombin inhibitor like Argatroban to prevent catastrophic clotting events.
6. A patient with Multiple Myeloma presents with confusion and constipation. The AGACNP
should prioritize checking which laboratory value?
A. Serum Potassium
B. Serum Sodium
C. Serum Magnesium
D. Serum Calcium
Answer: D
Rationale: Multiple Myeloma is associated with increased osteoclast activity, which
releases excessive calcium into the bloodstream. Hypercalcemia is a common oncologic
emergency in these patients and presents with symptoms like lethargy, confusion, and
gastrointestinal upset. Immediate treatment often involves intravenous fluids and
bisphosphonates to lower calcium levels and protect renal function.
Advanced Care of Adults in Acute Settings
| Actual Q&A with Rationale (NRNP6566
Week 6 Quiz) | Walden University
1. A 68-year-old male presents with extreme fatigue and laboratory findings indicate a
hemoglobin of 8.2 g/dL and a Mean Corpuscular Volume (MCV) of 74 fL. Which of the
following conditions is most likely responsible for these findings?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folic acid deficiency
D. Anemia of chronic disease
Answer: B
Rationale: Iron deficiency anemia is characterized by a microcytic, hypochromic
appearance where the MCV is typically below 80 fL. This condition is frequently caused by
chronic blood loss, especially in older adults with potential gastrointestinal issues. The
AGACNP must recognize that low ferritin levels are highly specific for this diagnosis.
2. When evaluating a patient for suspected Disseminated Intravascular Coagulation (DIC),
which constellation of laboratory results is most characteristic?
A. Elevated platelets and decreased Prothrombin Time
,B. Elevated fibrinogen and decreased D-dimer
C. Decreased fibrinogen and elevated D-dimer
D. Decreased Partial Thromboplastin Time and elevated platelets
Answer: C
Rationale: DIC involves the pathological overactivation of the clotting cascade, which
consumes platelets and clotting factors such as fibrinogen. The presence of elevated D-
dimer levels indicates that fibrinolysis is occurring in response to widespread thrombus
formation. These laboratory shifts are essential for distinguishing DIC from other
coagulopathies in the acute care setting.
3. A patient with a history of alcohol use disorder presents with paresthesia in the lower
extremities and a macrocytic anemia. Which deficiency should the practitioner suspect first?
A. Vitamin B12
B. Iron
C. Vitamin K
D. Zinc
Answer: A
Rationale: Vitamin B12 deficiency often manifests as macrocytic anemia with an MCV
greater than 100 fL and unique neurological symptoms like paresthesia. Alcohol use can
interfere with the absorption of various nutrients, though B12 and folate are the most
,common macrocytic causes. If left untreated, the neurological damage associated with B12
deficiency can become irreversible.
4. Which of the following is a critical initial management step for a patient in a Sickle Cell
Crisis presenting with severe pain?
A. Fluid restriction to prevent pulmonary edema
B. Aggressive intravenous hydration and oxygenation
C. Administration of cold compresses to painful joints
D. Immediate anticoagulation with Heparin
Answer: B
Rationale: Vaso-occlusive crises in sickle cell disease are triggered by the sickling of red
blood cells, which leads to tissue ischemia. Aggressive hydration helps to decrease blood
viscosity, while oxygenation ensures that the remaining functional hemoglobin is
saturated. Pain management must also be prioritized to reduce the physiological stress on
the patient during the crisis.
5. The AGACNP is monitoring a patient receiving Heparin for a pulmonary embolism and
notices the platelet count has dropped from 250,000 to 90,000 over 48 hours. What is the
most appropriate action?
A. Continue Heparin and repeat labs in 24 hours
B. Increase the Heparin dose to prevent further clotting
C. Administer a platelet transfusion immediately
, D. Discontinue Heparin immediately and initiate an alternative anticoagulant
Answer: D
Rationale: Heparin-Induced Thrombocytopenia (HIT) is a serious immune-mediated
reaction that causes a significant drop in platelet counts and increases the risk of
thrombosis. A drop of more than 50% from baseline while on Heparin is highly suspicious
for this condition. The practitioner must stop all heparin products and switch to a direct
thrombin inhibitor like Argatroban to prevent catastrophic clotting events.
6. A patient with Multiple Myeloma presents with confusion and constipation. The AGACNP
should prioritize checking which laboratory value?
A. Serum Potassium
B. Serum Sodium
C. Serum Magnesium
D. Serum Calcium
Answer: D
Rationale: Multiple Myeloma is associated with increased osteoclast activity, which
releases excessive calcium into the bloodstream. Hypercalcemia is a common oncologic
emergency in these patients and presents with symptoms like lethargy, confusion, and
gastrointestinal upset. Immediate treatment often involves intravenous fluids and
bisphosphonates to lower calcium levels and protect renal function.
