Western Governors University D027 Exam Questions & Answers updated 2023/2024

1. As an advanced practice nurse, you want to learn more about the CDC’s initiatives relative to asthma care and management in order to advocate for asthma sufferers at the state legislative level. Your goal is to reduce medications costs to patients. Which CDC recommendation supports your goal? (0/1 Point) The CDC recommends that payers and employers promote healthy workspaces to decrease environmental trigger exposures. The CDC recommends that providers prescribe the most cost-efficient long-acting inhalers to lower patient co-pays. The CDC recommends that providers deviate from the stepwise approach to lessen the financial impact to the patient. The CDC recommends that co-pays be removed for inhaled corticosteroids and other prescribed medications 2. What syndrome, characterized by an absent homologous X chromosome with only a single X chromosome, exhibits features that include a short stature, total chromosome count of 45, webbed neck, and a shield like chest? (0/1 Point) Cri du chat syndrome Down syndrome Klinefelter syndrome Turner syndrome 3. A female patient has been recently diagnosed with invasive ductal carcinoma. As an advanced practice nurse, you understand that she will be undergoing a multi-faceted treatment approach that will include one or more medications. Which medication is considered the “gold standard” endocrine treatment for breast cancer? (0/1 Point) Fulvestrant (Faslodex), an antiestrogen indicated for metastatic estrogen receptor-positive breast cancer in post-menopausal women Tamoxifen (Nolvadex), a prodrug that must be converted to active metabolites in order to block estrogen receptors in breast tissue Trastuzumab (Herceptin), a monoclonal antibody approved for HER2-positive metastatic breast cancer Lapatinib (Tykerb), an oral inhibitor of HER2 tyrosine kinase and EGFR tyrosine kinase, resulting in apoptosis and suppression of tumor cell growth 4. A patient with T2DM comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin? (0/1 Point) Renal disease Congestive heart failure Rheumatoid arthritis Hepatitic C virus 5. A newborn born with hypoplastic left heart syndrome is receiving intravenous infusion of prostaglandin. This medication is essential in keeping which two vessels patent? (0/1 Point) Foramen ovale Pulmonary vein Ductus arteriosus Hepatic portal vein 6. A patient in the clinic reports fever, arthralgia, a rash, and nosebleeds. What other information should the healthcare professional elicit from this patient? (0/1 Point) Family history of Marfan’s disease History of a recent bacterial infection History of any recent chest trauma Any illnesses in family members 7. Urinalysis is ordered for a diabetic patient. The results are 4+ ketones, trace leukocytes, negative nitrates, and red blood cells. Which of the following actions would the health practitioner take next? (1/1 Point) Order an ultrasound of the kidneys to rule out sub-acute renal failure Check the patient glucose level ANS: B Check the patient’s blood glucose . Presence of 4+ ketones in the urine indicates sever hyperglycemia so the health professional should further assess the patient’s status. Order a 24-hour urine test for microalbumin Assess for a history of illicit drug or alcohol use 8. A 56-year-old diabetic patient has not taken his insulin in 4 days due to him” feeling well without it”. He is admitted to the ED with an elevated blood sugar. What electrolyte should be assessed first? (1/1 Point) Calcium Sodium Potassium Insulin facilitates the intracellular transport of potassium, phosphate, and magnesium. Without insulin, potassium does not get transported to the intracellular environment and the serum potassium will rise. Chloride 9. A patient has a pulmonary capillary wedge pressure of 30mmHg. What assessment finding by the healthcare professional would be most consistent with this reading? (1/1 Point) Pink, frothy sputum Pulmonary edema usually begins to develop at a pulmonary capillary wedge pressure or left atrial pressure of 20 mmHg. Signs of pulmonary edema include dyspnea, hypoxemia, and increased work of breathing. Physical examination may reveal inspiratory crackles (rales), dullness to percussion over the lung bases, and evidence of ventricular dilation (S3 gallop and cardiomegaly). In severe edema, pink, frothy sputum is expectorated, hypoxemia worsens, and hypoventilation with hypercapnia may develop. Normal lung sounds Rhonchi Eupnea 10. A child has a disorder that resulted in the failure of bones to ossify, resulting in soft bones and skeletal deformity. What treatment plan does the healthcare professional discuss with the parents? (1/1 Point) Extremely careful handling Increasing vitamin D intake This description characterizes rickets. Growing bone fails to mineralize because of a problem with vitamin D intake, absorption, or excretion. Treatment includes supplemental vitamin D. Extremely careful handling would be appropriate for osteogenesis imperfecta. Revascularization procedures would benefit a child with osteochondrosis. Containment and motion are the principles of treating Legg-Calvé-Perthes disease. Revascularization Containment and motion therapy 11. A health professional is caring for a child that was sexually abused. She is trying to decide which medication option she should provide to the child. What should she know before providing the treatment option? (1/1 Point) The age and weight of the child A Treatment depends on the age and weight of the child The race of the child The height of the child The developmental stage 12. The physician prescribes the patient a loop diuretic. As the nurse you know that this type of diuretic causes diuresis by affecting which structure in the nephron? (0/1 Point) Distal convoluted tubule Descending limb of the loop of Henle Proximal convoluted tubule Ascending limb of the loop of Henle 13. A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient’s blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer? (1/1 Point) No insulin should be administered NPH 70/30 mix Lispro (Humalog) Regular insulin is indicated for sliding scale coverage. Insulin is definitely indicated for this high blood sugar level. NPH is used for scheduled insulin doses and is a longer-acting insulin. A 70/30 mix is also used for scheduled insulin coverage. 14. A patient is in severe shock and is receiving vasopressin. A family member asks the health care professional to explain the rationale for this type of treatment. What response by the professional is most accurate? (1/1 Point) “Antidiuretic hormone causes vasoconstriction to help increase blood pressure.” ADH in high doses causes vasoconstriction and a resulting increase in arterial blood pressure which would be important to the patient in shock. “Antidiuretic hormone causes serum osmolality to be increased.” “Antidiuretic hormone leads to better insulin utilization.” “Antidiuretic hormone conserves fluid when urine output is less than 20 mL/hr.” 15. A patient will begin taking fexofenadine [Allegra] for hay fever. The nurse teaching this patient will tell the patient that: (1/1 Point) Fexofenadine should be taken with food to prevent gastrointestinal (GI) symptoms. The medication may be taken once or twice daily. Fexofenadine may be given 60 mg twice daily or 180 mg once daily. Fexofenadine does not need to be given with food. Sedation is not a common side effect of fexofenadine. There is no caution to reduce the dosage or increase the dosing interval in patients with renal impairment who take fexofenadine. Tolerance to sedation will occur in a few weeks. With renal impairment, this drug should be taken every other day. 16. A patient has recently started taking an anti-depressant. She complains to you that she has been taking this medication for two weeks and hasn’t started to feel any better. What would be your response to the patient? (1/1 Point) “I understand your concern. I’m going to try another medication to see if that medication will work better for you”. “I understand your frustration, I will up the dosage of your medication”. “I understand your concern, but it can take up to 12 weeks before you could see a response from the medication” It can take up to three weeks before a patient can feel the effects of the medication. “You’re right, you should have started to see a response from the medication by now”. 17. Four patients are in the intensive care unit with different types of shock. Which patient would the healthcare professional assess as the priority? (1/1 Point) Septic Hypovolemic Anaphylactic Anaphylactic shock is characterized by massive vasodilation and widespread inflammation that can lead to death in minutes if treatment is not instituted immediately. If all else is equal, the healthcare professional should assess the patient with anaphylactic shock first. Neurogenic 18. A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception? (1/1 Point) A 45-year-old married woman with four children. A 30-year-old monogamous married woman. An 18-year-old woman with multiple sexual partners. Women at risk for sexually transmitted diseases (STDs) should not use an IUD, because the risk of infection is higher. Women who have multiple sexual partners are especially at risk for STDs. Monogamous married women are less apt to contract STDs. Women with rosacea can use an IUD. A 35-year-old woman with a history of rosacea. 19. Which of the following is a cornerstone for treatment of a patient in heart failure? (1/1 Point) Digoxin Calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors Beta Blockers and ACE inhibitors are the cornerstone treatment for heart failure. Nitrates 20. When the nurse is providing educational material for a new medication regimen to her newly diagnosed heart failure patient, she must remember to: (Select all that apply) (1/1 Point) Focus on main points. Place important information last. Select images or drawings that have a purpose or that reinforce a point in the handout. Materials should be written at a higher education level that can be understood by most patients. Use common terms in short, simple sentences that patients can easily understand. 21. Which choice below describes a patient being impacted by social and community context? (1/1 Point) A patient with heart failure attends the heart failure clinic weekly, but occasionally forgets his afternoon furosemide dose. A patient with renal failure is traveling and searching for a dialysis center in her vacation destination. A patient with coronary artery disease is unable to afford his medications. A patient reports feeling isolated and depressed after the death of her spouse. Choice A would correlate more closely with health/healthcare, Choice B would correlate more closely with neighborhood and built environment and health/healthcare, choice C would correlate more closely with economic stability, but choice D speaks to the loss of a social outlet via the spouse and is the most appropriate. 22. Healthy People 2020 endorses the completion of a high school education primarily to enable a person to: (1/1 Point) Secure a better job Increase the quality of life Make healthy lifestyle choices One of the goals of Healthy People 2020 is to increase the number of persons graduating from high school so that they have a better education basis on which to make healthy lifestyle choices. Maintain the family unit 23. The healthcare professional is caring for a 7-year-old patient. She is trying to determine the best way to make sure the patient adheres to his new medication regimen. What is a key factor she must consider in making sure the child adheres to his medication? (1/1 Point) Allow the child to decide if he would like to take the medication that day. Educate the parents and/or care giver about the child’s medication and reinforce the information with written instructions. ANS B It is important that child’s caregivers are educated about the medication and its importance to the child’s wellbeing. Providing written information such as brochures help to reinforce the information that was discussed. Suggest keeping the medication in a warm spot on the counter so it can be easily seen and remembered. Allow the child to administer his own medication and have him log it into a daily journal. 24. The Center for Medicare and Medicaid Innovations created the 'Accountable Health Communities' with the aim to do which one of the following? (1/1 Point) Improve screening for common diseases leading to mortality in the United States Monitoring adherence to Health Information Technology guidelines. Connecting Medicare and Medicaid beneficiaries with community resources. ANS: C - The Accountable Health Communities Program aims to provide resources to address health- related social needs. Ensuring all Medicare and Medicaid beneficiaries are adhering to medication formulary restrictions. 25. A parent wants to know how to prevent type 1 diabetes in the newborn. The healthcare professional explains that prevention is not possible, because of which characteristic being associated with type 1 diabetes mellitus? (1/1 Point) Partial insulin secretion An autoimmune process A strong association between type 1 diabetes and the presence of several human leukocyte antigen (HLA) class II alleles indicate that type 1 diabetes mellitus is an autoimmune disease. The remaining options are associated with type 2 diabetes. Insulin resistance Obesity as a common risk factor 26. How does the normal aging process effect wound healing? Select all that apply (1/1 Point) Decreased cell proliferation ANS: A, B, C Decreased cell proliferation, decreased blood supply, and depressed immune responses delay wound healing in aging skin. Decreased nutrition can affect the healing process, but that is not a normal age-related change. Decreased cognitive function is not related to wound healing. Decreased blood supply ANS: A, B, C Decreased cell proliferation, decreased blood supply, and depressed immune responses delay wound healing in aging skin. Decreased nutrition can affect the healing process, but that is not a normal age-related change. Decreased cognitive function is not related to wound healing. Depressed immune responses ANS: A, B, C Decreased cell proliferation, decreased blood supply, and depressed immune responses delay wound healing in aging skin. Decreased nutrition can affect the healing process, but that is not a normal age-related change. Decreased cognitive function is not related to wound healing. Depressed appetite Decreased cognitive function 27. A pediatric patient with Down syndrome has had repeated infections over the last few months and now presents with bruising in all extremities. Which lab would be important to check? (1/1 Point) WBC count since leukemia is 10-20 times more likely to develop in patients with Down Syndrome Trisomy 21 (Down syndrome) is the most common genetic defect linked to the development of acute leukemia. Children with Down syndrome have a 10- to 20-fold increased risk of developing acute lymphoblastic and myelogenous leukemia and a higher risk for developing acute megakaryocytic leukemia. No current research supports the other choices. HgbA1c since there is a genetic predisposition in patients with Down Syndrome to develop Type 1 Diabetes RBC since the bruising suggests increased internal bleeding No labs are recommended at this time because repeated infections and frequent bruising is normal in patients with Down syndrome 28. Which of the following is not a risk factor for hypertension? (1/1 Point) Race Family history Sexual orientation Gender is a risk factor but not sexual orientation. Men are more likely than women to have high blood pressure until about age 45. The rates of disease are similar between men and women from age 45 to 64 but after that women are at much higher risk (American Heart Association). Subgroups within an incarcerated population at higher risk of hypertension include youth, African American men and young women. Alcohol use 29. What is a common side effect of a stimulant medication such as Adderall? (1/1 Point) Elevated liver enzymes Blood dyscrasias Difficulty falling asleep at night A common side effect of a stimulant is difficulty sleeping Mania 30. Infant mortality rates are based on infant deaths that occur: (1/1 Point) At birth, per 1000 deliveries Before 1 year of age, per 1000 live births Infant mortality is reported on deaths occurring before the age of 1 year per 1000 live births. From infection and congenital disorders, per 1000 live births From unexplained causes, per 1000 live births 31. A healthcare professional is caring for four postop patients. Based on an understanding of the physiologic process of nociceptors, the nurse expects to give more pain medication to which patient? (1/1 Point) Right dislocated shoulder replacement Ovary cyst removal Repair of several crushed fingers The variable nature and distribution of nociceptors affect the relative sensitivity to pain in different areas of the body; the tips of the fingers have more nociceptors than the skin on the back, and all skin has many more nociceptors than the internal organs including bone. Repair of a ruptured spleen 32. The healthcare professional is caring for a patient with a severe traumatic brain injury. Despite other extensive injuries, this patient shows no signs of pain. Which pain relay center of the body may have been impacted by the patient's injuries? (1/1 Point) Thalamus Midbrain Basal ganglia Although the organization of all of the ascending tracts is complex, the principal target for nociceptive afferents is the thalamus, which, in general, is the major relay station of sensory information. The Aδ and C fibers synapse in the laminae of the dorsal horn, cross over to the contralateral spinothalamic tract, and then ascend to synapse in the midbrain through the neospinothalamic and paleospinothalamic tracts. Impulses are then conducted to the sensory cortex. Descending pain inhibition is initiated in the cerebral cortex or from the midbrain and medulla. The hypothalamus has a major role in temperature regulation. A complex interaction of neural networks and neurotransmitters promote wakefulness and sleep. The hypothalamus, brainstem, and basal forebrain are involved in promoting wakefulness. Hypothalamus 33. What is the most influential factor in whether a person will experience a stress reaction? (1/1 Point) General state of physical health Spiritual belief system Intellectual abilities Ability to cope ANS: D A person does not have a stress reaction unless the stress exceeds his or her coping abilities. General health, spiritual belief systems, and intellectual abilities do not have the same degree of influence on stress reaction 34. A severely stressed patient has hypoglycemia each time the patient’s blood glucose is checked. The healthcare professional should order laboratory tests to measure which hormone in the patient’s blood? (1/1 Point) Epinephrine Norepinephrine Cortisol One of the primary effects of cortisol is the stimulation of gluconeogenesis or the formation of glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver. Neither reaction is a result of the effects of any of the other hormones. Growth hormone 35. A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss: (1/1 Point) Changing the medication to another drug class Discontinuing the medication immediately Hospitalizing the patient for closer monitoring Patients with depression often think of suicide, and during treatment with antidepressants, these thoughts often increase for a time. Patients whose risk of suicide is especially high should be hospitalized. All antidepressants carry this risk, so changing medication is not recommended. Discontinuing the medication is not recommended. More frequent clinic visits are recommended for patients with a low to moderate risk of suicide Requiring more frequent clinic visits for this patient 36. The recommended length of time, for a patient diagnosed with major depression for the first time, to continue taking an antidepressant once the therapeutic level is reached is: (0/1 Point) Six months Two years One month Lifelong 37. A patient is given a prescription for clozapine for treatment-resistant schizophrenia. Which of the following symptoms should the patient seek medical attention? Select all that apply. (0/1 Point) Nausea Polydipsia Seizures Clozapine is an anti-psychotic agent used to treat various mental health conditions. A serious adverse effect common to this agent is hypernatremia. Manifestations of hypernatremia include excessive thirst, orthostatic hypotension and possibly seizures. Syncope Clozapine is an anti-psychotic agent used to treat various mental health conditions. A serious adverse effect common to this agent is hypernatremia. Manifestations of hypernatremia include excessive thirst, orthostatic hypotension and possibly seizures. Metallic taste in the mouth 38. Comparing the ulcerative colitis to Crohn's disease, the nurse understands that Crohn's disease includes which of the following? Select all that apply. (0/1 Point) Presence of Skip Lesions in the intestinal wall Bloody stools Genetic predisposition Entire intestinal wall affected Localized to the colon and rectum 39. Which hospitalized patient does the healthcare professional assess as a priority for the development of delirium? (1/1 Point) A 70-year-old diabetic patient A depressed Hispanic woman An elderly male on post-op day 2 of hip replacement surgery Delirium is associated with autonomic nervous system overactivity and typically develops in 2 to 3 days, most commonly in critical care units, post surgically, or during withdrawal from CNS depressants (e.g., alcohol, narcotic agents). A woman recently diagnosed with schizophrenia 40. An 18-month-old male arrives to the emergency room with acute onset respiratory distress following 2 days of runny nose and mild cough. On exam, the patient is 97% on room air, respiratory rate of 32, inspiratory stridor, barky cough, suprasternal, intercostal and subcostal retractions. Lung sounds are clear in all lobes. Which medication should the nurse anticipate giving promptly? (0/1 Point) albuterol racemic epinephrine dexamethasone prednisolone 41. Which of the following are expected findings in a patient with SIADH? Select all that apply (0/1 Point) polyuria oliguria low serum osmolality Syndrome of inappropriate anti-diuretic hormone is the result of pathology (ectopic masses, oncologic process) which yields excess ADH secretion. The physiologic response is renal retention of water. This causes decreased urine output (oliguria), diluted blood leading to high serum osmolality and dilutional hyponatremia. high serum osmolality hyponatremia Syndrome of inappropriate anti-diuretic hormone is the result of pathology (ectopic masses, oncologic process) which yields excess ADH secretion. The physiologic response is renal retention of water. This causes decreased urine output (oliguria), diluted blood leading to high serum osmolality and dilutional hyponatremia. hypernatremia 42. Your goal as the intensive care unit coordinator is to reduce falls. Upon review of hospital data, you find that most of the falls are occurring in the patient population, ages 65 and older. As a result, you coordinate a fall reduction initiative after researching the etiology of falls in the elderly. Which action should be included in the protocol? (1/1 Point) Encourage slow position changes since orthostatic hypotension is a significant risk factor for falls. Allocate budgetary resources for walkers to be in every room at all times since falls cannot be predicted. Initiate depression screening on all new admissions since depressed affect has been indicated in fall etiology. Decrease the number of situations that require patient standing and walking, as upright positions result in higher incidence of falls. 43. What evidence does the nurse expect to see in her assessment when a patient experiences trauma to the hypothalamus? Select all that apply. (0/1 Point) Uneven expression of mood The hypothalamus forms the base of the diencephalon. Hypothalamic function controls autonomic nervous system (ANS) function, regulation of body temperature, endocrine function (e.g., unstable glucose levels), and regulation of emotional expression. Visual and gastrointestinal symptoms would not likely be related to hypothalamus function. Unstable blood glucose levels Nausea, vomiting, and symptoms of gastroesophageal reflux disease Visual disturbances such as blurred vision Poor regulation of body temperature The hypothalamus forms the base of the diencephalon. Hypothalamic function controls autonomic nervous system (ANS) function, regulation of body temperature, endocrine function (e.g., unstable glucose levels), and regulation of emotional expression. Visual and gastrointestinal symptoms would not likely be related to hypothalamus function. 44. The health care professional is caring for a neonate patient in the hospital. She is trying to determine the optimal drug dosage of medication for the infant. She knows it is essential that she monitor the patient for as a component of optimizing patient’s dosage. (1/1 Point) Therapeutic and adverse responses The timing of the therapeutic response The intensity of the adverse reaction The timing 45. A 4-year-old Catherine has been on high dose Vitamin D therapy. You see her for an urgent care visit 4 weeks into treatment. Which of the following symptom clusters would make you more concerned for Vitamin D toxicity? (1/1 Point) Poor appetite, abdominal pain, fever Cough, vomiting, myalgias Nausea, vomiting, abdominal pain, muscle weakness Nausea, vomiting, abdominal pain, muscle weakness are all symptoms of toxicity Abdominal pain, poor appetite, bloody stools 46. A patient newly diagnosed with type II diabetes asks the healthcare provider if there are any herbal products to help improve this diagnosis. The healthcare provider may recommend which one of the following herbal products to reduce blood sugar? (1/1 Point) Cinnamon Cinnamon is an effective agent that reduces cholesterol and can improve glucose transport into cells further reducing circulating glucose. Cinnamon alone is not recommended to treat these diagnoses but may be helpful in minimizing severity and possibly reducing the need for multiple prescription medications. St. John's wort Elderberry Black licorice 47. Which of the following statements are true regarding the condition, positional orthostatic tachycardia syndrome (POTS)? Select all that apply. (0/1 Point) POTS is diagnosed using the tilt test POTS is more common in males than females Patients with POTS will often have a history of recently treated bacterial infection 50% of patients with POTS have had a recent viral Infection. Preceding bacterial infection is not associated with this condition. A rise in norepinephrine levels upon standing may be the cause of the patient's symptoms Otherwise known as hyperadrenergic POTS, 30 to 60% of patients with POTS will have this exaggerated adrenergic response of norepinephrine secretion with standing causing the tachycardia. Diagnostic criteria require symptoms to be present for at least three months 48. A patient taking chlorpromazine understands that this drug work by blocking receptors involved with which neurotransmitter? (1/1 Point) Norepinephrine Serotonin Dopamine chlorpromazine is a drug used to treat mental health conditions like schizophrenia and works by blocking receptors in the brain that bind with dopamine. Acetylcholine 49. Radioactive iodine is used to decrease viability of which endocrine organ? (1/1 Point) Thyroid gland Radioactive iodine is a treatment used for chronic hyperthyroidism otherwise known as Graves disease. Parathyroid gland Ovaries Adrenal gland 50. A food insecurity screening tool is completed for a new patient. This is would fall under which Social Determinant of Health domain? (0/1 Point) Education Access & Quality Neighborhood & Built Environment Economic Stability Healthcare Access & Quality Social & Community Context Go back to thank you page This content is created by the owner of the form. The data you submit will be sent to the form owner. Microsoft is not responsible for the privacy or security practices of its customers, including those of this form owner. Never give out your password. Powered by Microsoft Forms | Privacy and cookies | Terms of use