NRNP 6568 WEEK 11 FINAL EXAM QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+...
Question 1
A 72-year-old male presents with acute confusion, inattention, and fluctuating level of consciousness that
developed over 24 hours following hip surgery. He is restless and attempts to pull out his IV line. Which
intervention is the priority?
A. Administer haloperidol immediately to control agitation
B. Identify and treat the underlying cause while ensuring patient safety
C. Apply physical restraints to prevent self-harm
D. Obtain a psychiatric consultation for dementia evaluation
🟢 Correct Answer:
B. Identify and treat the underlying cause while ensuring patient safety
🔴 RATIONALE:
Delirium is a medical emergency and often indicates an underlying physiologic disturbance such as infection,
hypoxia, medication effect, or metabolic imbalance. The priority is to identify and treat the cause while
maintaining safety. Antipsychotics and restraints are secondary measures; psychiatric consultation for dementia
is inappropriate in the acute setting.
Question 2
A 58-year-old female with type 2 diabetes and hypertension presents with a 3-day history of fever, productive
cough, and dyspnea. Blood pressure is 88/54 mm Hg, heart rate 112 bpm, respiratory rate 28, temperature
38.9°C, and oxygen saturation 88% on room air. Which is the most appropriate initial action?
A. Initiate broad-spectrum antibiotics after obtaining blood cultures and lactate
,B. Administer a beta-blocker for heart rate control
C. Give oral antihypertensive to raise blood pressure
D. Order an outpatient chest x-ray and follow up in 2 days
🟢 Correct Answer:
A. Initiate broad-spectrum antibiotics after obtaining blood cultures and lactate
🔴 RATIONALE:
The patient meets criteria for sepsis with suspected pneumonia. Early recognition and prompt administration of
broad-spectrum antibiotics after cultures and lactate measurement are essential to reduce mortality. Beta-
blockers are contraindicated in shock; oral antihypertensives would worsen hypotension; outpatient
management is unsafe.
Question 3
A 30-year-old primigravida at 36 weeks gestation presents with severe headache, visual disturbances, and
epigastric pain. Blood pressure is 170/110 mm Hg. Which medication should the nurse practitioner prepare to
administer first?
A. Labetalol or hydralazine for acute blood pressure control
B. Magnesium sulfate for seizure prophylaxis
C. Nifedipine immediate release orally
D. Furosemide for pulmonary edema
🟢 Correct Answer:
B. Magnesium sulfate for seizure prophylaxis
🔴 RATIONALE:
The presentation is consistent with preeclampsia with severe features. Magnesium sulfate is the first-line agent
,for seizure prophylaxis in severe preeclampsia and should be initiated promptly. While blood pressure control
with labetalol or hydralazine is important, seizure prophylaxis is the priority intervention.
Question 4
A 64-year-old male with atrial fibrillation not on anticoagulation presents with acute-onset right-sided
weakness, facial droop, and aphasia. Symptom onset was 30 minutes ago. Which is the priority action?
A. Administer aspirin immediately
B. Obtain a noncontrast CT scan of the head
C. Start an IV heparin infusion
D. Measure blood glucose and administer dextrose if low
🟢 Correct Answer:
B. Obtain a noncontrast CT scan of the head
🔴 RATIONALE:
Acute stroke management requires immediate noncontrast CT to differentiate ischemic from hemorrhagic
stroke before administering thrombolytics or antithrombotics. Aspirin and heparin are contraindicated until
hemorrhage is excluded. Blood glucose should be checked, but imaging is the priority.
Question 5
A 45-year-old female with major depressive disorder has been taking fluoxetine 40 mg daily for 8 weeks with
minimal improvement. She reports continued low mood, anhedonia, and fatigue. Which is the most appropriate
next step?
A. Discontinue fluoxetine abruptly and start phenelzine
B. Augment with bupropion or switch to an SNRI such as venlafaxine
C. Add a benzodiazepine for depressive symptoms
D. Increase fluoxetine to 120 mg daily
, 🟢 Correct Answer:
B. Augment with bupropion or switch to an SNRI such as venlafaxine
🔴 RATIONALE:
For inadequate response to an SSRI, evidence-based strategies include switching to another agent, such as an
SNRI, or augmenting with bupropion. Combining fluoxetine with an MAOI is contraindicated; benzodiazepines
do not treat core depression; exceeding maximum fluoxetine dose is unsafe.
Question 6
A 2-year-old child presents with a barking cough, stridor at rest, and intercostal retractions. Oxygen saturation is
92% on room air. Which is the most appropriate initial treatment?
A. Oral amoxicillin
B. Nebulized epinephrine and oral dexamethasone
C. Inhaled albuterol only
D. Reassurance and home observation
🟢 Correct Answer:
B. Nebulized epinephrine and oral dexamethasone
🔴 RATIONALE:
The presentation is consistent with moderate-to-severe croup. Nebulized epinephrine provides rapid reduction
of airway edema, and dexamethasone reduces inflammation. Antibiotics are not indicated for viral croup;
albuterol is not first-line; home observation is unsafe with stridor at rest.
Question 7
A 55-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and nystagmus. Which
treatment should be initiated immediately?
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+...
Question 1
A 72-year-old male presents with acute confusion, inattention, and fluctuating level of consciousness that
developed over 24 hours following hip surgery. He is restless and attempts to pull out his IV line. Which
intervention is the priority?
A. Administer haloperidol immediately to control agitation
B. Identify and treat the underlying cause while ensuring patient safety
C. Apply physical restraints to prevent self-harm
D. Obtain a psychiatric consultation for dementia evaluation
🟢 Correct Answer:
B. Identify and treat the underlying cause while ensuring patient safety
🔴 RATIONALE:
Delirium is a medical emergency and often indicates an underlying physiologic disturbance such as infection,
hypoxia, medication effect, or metabolic imbalance. The priority is to identify and treat the cause while
maintaining safety. Antipsychotics and restraints are secondary measures; psychiatric consultation for dementia
is inappropriate in the acute setting.
Question 2
A 58-year-old female with type 2 diabetes and hypertension presents with a 3-day history of fever, productive
cough, and dyspnea. Blood pressure is 88/54 mm Hg, heart rate 112 bpm, respiratory rate 28, temperature
38.9°C, and oxygen saturation 88% on room air. Which is the most appropriate initial action?
A. Initiate broad-spectrum antibiotics after obtaining blood cultures and lactate
,B. Administer a beta-blocker for heart rate control
C. Give oral antihypertensive to raise blood pressure
D. Order an outpatient chest x-ray and follow up in 2 days
🟢 Correct Answer:
A. Initiate broad-spectrum antibiotics after obtaining blood cultures and lactate
🔴 RATIONALE:
The patient meets criteria for sepsis with suspected pneumonia. Early recognition and prompt administration of
broad-spectrum antibiotics after cultures and lactate measurement are essential to reduce mortality. Beta-
blockers are contraindicated in shock; oral antihypertensives would worsen hypotension; outpatient
management is unsafe.
Question 3
A 30-year-old primigravida at 36 weeks gestation presents with severe headache, visual disturbances, and
epigastric pain. Blood pressure is 170/110 mm Hg. Which medication should the nurse practitioner prepare to
administer first?
A. Labetalol or hydralazine for acute blood pressure control
B. Magnesium sulfate for seizure prophylaxis
C. Nifedipine immediate release orally
D. Furosemide for pulmonary edema
🟢 Correct Answer:
B. Magnesium sulfate for seizure prophylaxis
🔴 RATIONALE:
The presentation is consistent with preeclampsia with severe features. Magnesium sulfate is the first-line agent
,for seizure prophylaxis in severe preeclampsia and should be initiated promptly. While blood pressure control
with labetalol or hydralazine is important, seizure prophylaxis is the priority intervention.
Question 4
A 64-year-old male with atrial fibrillation not on anticoagulation presents with acute-onset right-sided
weakness, facial droop, and aphasia. Symptom onset was 30 minutes ago. Which is the priority action?
A. Administer aspirin immediately
B. Obtain a noncontrast CT scan of the head
C. Start an IV heparin infusion
D. Measure blood glucose and administer dextrose if low
🟢 Correct Answer:
B. Obtain a noncontrast CT scan of the head
🔴 RATIONALE:
Acute stroke management requires immediate noncontrast CT to differentiate ischemic from hemorrhagic
stroke before administering thrombolytics or antithrombotics. Aspirin and heparin are contraindicated until
hemorrhage is excluded. Blood glucose should be checked, but imaging is the priority.
Question 5
A 45-year-old female with major depressive disorder has been taking fluoxetine 40 mg daily for 8 weeks with
minimal improvement. She reports continued low mood, anhedonia, and fatigue. Which is the most appropriate
next step?
A. Discontinue fluoxetine abruptly and start phenelzine
B. Augment with bupropion or switch to an SNRI such as venlafaxine
C. Add a benzodiazepine for depressive symptoms
D. Increase fluoxetine to 120 mg daily
, 🟢 Correct Answer:
B. Augment with bupropion or switch to an SNRI such as venlafaxine
🔴 RATIONALE:
For inadequate response to an SSRI, evidence-based strategies include switching to another agent, such as an
SNRI, or augmenting with bupropion. Combining fluoxetine with an MAOI is contraindicated; benzodiazepines
do not treat core depression; exceeding maximum fluoxetine dose is unsafe.
Question 6
A 2-year-old child presents with a barking cough, stridor at rest, and intercostal retractions. Oxygen saturation is
92% on room air. Which is the most appropriate initial treatment?
A. Oral amoxicillin
B. Nebulized epinephrine and oral dexamethasone
C. Inhaled albuterol only
D. Reassurance and home observation
🟢 Correct Answer:
B. Nebulized epinephrine and oral dexamethasone
🔴 RATIONALE:
The presentation is consistent with moderate-to-severe croup. Nebulized epinephrine provides rapid reduction
of airway edema, and dexamethasone reduces inflammation. Antibiotics are not indicated for viral croup;
albuterol is not first-line; home observation is unsafe with stridor at rest.
Question 7
A 55-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and nystagmus. Which
treatment should be initiated immediately?
