NRNP 6566 Final Exam Questions and Answers Latest Update (Score 100%)

Which statement is correct about fluoroquinolones? fluoroquinolones are effective treatment for urinary tract infections and pyelonephritis Fluoroquinolones are recommended treatment in uncomplicated skin infections fluoroquinolones are not associated with tendon rupture fluoroquinolones are never indicated in the treatment of pediatric infections Question 2 A 42 year old year old women was admitted to the ICU with a severe asthmatic exacerbation. On rounds today, the patients T is 102.2. Her central IV line site is red, tender, and warm. Your remove the central line and order blood cultures along with IV cefepime. MRSA has been prevalent in this ICU. What additional medication should you order? po vancomycin IV gentamycin IV vancomycin IV pipercillin Question 3 A 66-year-old male involved in a motor vehicle collision is admitted to the trauma unit with multiplesbone fractions and left hemothorax with chest tube placement. Current vital signs are BP 88/52 HR 120 T 98.4 RR 22. Past medical history is positive for end stage renal disease requiring hemodialysis three times a week. How should the NP manage his renal disease? Hemodialysis Peritoneal dialysis Continuous renal replacement therapy No intervention until his blood pressure stabilizes Question 4 What crucial feature of a penicillin is involved in its mechanism of action? Carboxylic acid β-lactam ring Acyl side chain Thiazolidin e ring Question 5 Which drug should the APRN select to treat a patient with an infected post operative surgical wound infected with a positive culture result for MRSA? gentamycin ampicillin/sulbac t am vancomycin amphoteracin Question 6 Mr. D is a 56 year old male with newly diagnosed multiple myeloma who is admitted through the ER with back pain after falling against a bookcase at home. Chest x-ray shows a rib fracture. Electrolytes reveal a serum calcium of 12.7 mg/dl. How would you treat Mr. D? Normal saline and loop diuretics Normal saline and thiazide diuretics Kayexalate enema Glucose, insulin, and magnesium Question 7 A 13-year-old thin, female comes to your office with a 6-month history of nondeliberate weight loss, polyuria and polydypsia. She has no other significant illnesses. There are no abnormalities on physical examination except a random venous blood sugar of 237. Which of the following statements regarding this case is FALSE? Type 1 diabetes is confirmed by this test A glucose tolerance test is not necessary to confirm diagnosis Obtain a fasting blood glucose Insulin will probably be required Question 8 A patient who is allergic to penicillins may also be allergic to a Erythromycin b Neomycin c Tetracycline . d Cefazolin Question 9 Joe is a 46 year old man with normal renal function diagnosed with heparin induced thrombocytopenia (HIT). In addition to stopping all unfractionated heparin products, the next appropriate step in treating this patient would be the addition of? Low molecular weight heparin aspirin Agratroba n Plavix Question 10 A 24-year-old male is a newly diagnosed type 1 diabetic. He weighs 62 kg and you decide to start him on insulin therapy because his blood glucose . . . is high and he has ketonuria. His total daily dose of insulin to start with should be: 31 units 40 units 46 units 56 units Question 11 A 48-year-old female wt 70 kg, is in the ICU with acute pancreatitis. Her vital signs are as follows: BP 92/60 mm Hg; heart rate 116 bpm; She is intubated with current ventilator settings of VT 700 mL, assist control (AC) rate 12 bpm, FiO2 0.85, and positive end expiratory pressure (PEEP) 5.0 cm H 2O. Her ABG reveals a pH of 7.31, PaCO2 of 53 mm Hg, and a PaO 2 of 62 mm Hg. Her chest radiograph shows diffuse, fluffy infiltrates. Based upon this assessment the ACNP would order a decrease of PEEP to 5.0 an increase of rate to 16 change to SIMV an increase of VT to 900 ml Question 12 A 22 year old patient is transitioning from oral agents to insulin. He will be taking 20 units of lantus at bedtime and regular insulin before meals. What instructions should the NP provide about the timing and dose of regular insulin? Take 5 units of regular insulin immediately after each meal Take 5 units of regular insulin for each 15 grams of carbohydrate consumed immediately after each meal. Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal Take 1 unit of regular insulin for each 5 grams of carbohydrate to be consumed 30 minutes before each meal. Question 13 All of the following statements about Type 2 diabetes mellitus are correct EXCEPT: Higher risk for development Question 18 A 22 year old female patient with type 1 diabetes presents with abdominal pain and T 100.1. Arterial blood gases reveal pH 7.2, pCO2 of 24, HCO3 12. What other finding would you expect on this patient? Decreased anion gap Decreased respirations Decreased urine output Increased serum ketones of CAD, peripheral vascular disease, and acute myocardial infarction Have insulin resistance Have more problems with ketosis than patients with Type 1 diabetes mellitus Obesity is found in the majority of patients Question 14 The NP is managing a male patient with bilateral lower extremity swelling, erythema, and draining blisters. The patient states the blisters have been there about a week but now there is redness around the blisters and moving up the leg. He has been having chills and thinks he has been running a temperature but does not own a thermometer. Vital signs are within normal limits except for an elevated temperature of 101.1 The patient has no known drug allergies. What medication should the NP prescribe? IV Vancomycin IV Cefazolin IV piperacillin IV ciprofloxin Question 15 Amy calls the office and states that her fasting blood sugar has been over 225 for the past three mornings. What adjustments should the AGACNP make? Increase her basal insulin dose at bedtime Decrease her basal insulin dose at bedtime Increase her regular insulin dose before dinner Add a dose of regular insulin before bedtime Question 16 Which statement is correct about macrolide antibiotics? first generation macrolides are not associated with GI side effects e.g., nausea and vomiting macrolide resistance is not a concern due to infrequent use of this category prolonged QT intervals are an adverse effect associated with macrolides use of macrolides during pregnancy is associated with elevated renal function tests Question 17 Cicely is a known diabetic with COPD who admitted to the hospital for pneumonia and acute COPD exacerbation. What treatment would the ACNP prescribe to manage her blood sugars? Continue her BID day dose of 70/30 insulin Every four hour BS readings with sliding scale insulin administration Administer Lantus at bed time and timed administration of regular insulin before meals Continue her 70/30 coverage but increase the dose by 10% to account for the stress of the illness Question 18 A 22 year old female patient with type 1 diabetes presents with abdominal pain and T 100.1. Arterial blood gases reveal pH 7.2, pCO2 of 24, HCO3 12. What other finding would you expect on this patient? Decreased anion gap Decreased respirations Decreased urine output Increased serum ketones Question 19 A patient with end stage renal disease misses three dialysis appointments. Which of the following arterial blood gases would indicate the patient is in metabolic acidosis? PHof7.43,PCO2of3 6,HCO3of26 PHof7.41,PCO2of4 9,HCO3of30 PHof7.3 , PCO2of35,HCO3of1 7 PHof7.25,PCO2of5 6,HCO3of28 Question 20 The most common cause of low serum sodium and high serum osmolality is: a Hyperglycemia . b Hypothyroidism . c Adrenal insufficiency . d K+ sparing diuretic . Question 21 Which antibiotics would NOT be appropriate to empirically treat an E. Coli infection? Penicillin VK (Pen VK) Cephalexin (Keflex) Nitrofurantoin (Macrobid) Trimethoprim-Sulfamethoxazole (Bactri m DS) Question 22 The NP is managing a 66 year old female admitted to the ICU with a serum potassium level of 8.9 mEg/L. Hemodialysis will be started as soon as the on-call staff can arrive. What intervention should the NP order now? Dextrose 50% , insulin and ,sodium bicarbonate Sodium bicarbonate and ipratropium bromide (Atrovent) Calcium gluconate and calcium acetate (PhosLo) Sodium polystyrene (Kayexalate) PO and Kayexalate enema Question 23 The APRN is treating a patient with type 2 diabetes. The patient is on the maximum dose of metformin and glucotrol. Current weight 212 pounds. Labs from this morning indicate a fasting blood sugar of 312 and HbA1C of 9. The APRN wants to start the patient on Lantus 0.2 unit/kg. What dose and instructions should the APRN provide? Give 2 units of Lantus subcutaneously prior to lunch every day Give 19 units of Lantus subcutaneously prior to bedtime. Give 24 units of Lantus subcutaneously prior to dinner Give 42 units of Lantus subcutaneously prior to bedtime. Question 24 When prescribing sildenafil (Viagra) to a patient, the patient should be screened for which of the following? Select all that apply. Use of a statin medication Use of a nitrate medication History of coronary artery disease Use of opiods History of priapism Question 25 The NP is assessing a patient receiving benzodiazepines who is experiencing confusion, dizziness, slurred speech, and difficulty breathing. What medication should the NP order to counter the effects? Ropivacaine Naloxone Bromaze pa m Flumazenil Question 26 The AGACNP orders a renal angiogram for a patient with suspected renal artery stenosis. Which of the following medications would be contraindicated for the patient? a Calcium channel . blockers b Alpha blockers c Beta blockers d ACE inhibitors Question 27 The AGACNP is assessing a patient in the urgent care area. The patient is a 44 year old women in her third round of chemotherapy for breast cancer. She presents today with complains of generalize malaise and fever that has gradually increased over the past 12 hours, BP 110/62 P 96 T 102.6 RR 18 . . . WBC 4.2 ANC 300 The best initial treatment by the AGACNP is: Begin oral cephlosporin until causative organism is identified Monitor in the observation area for 12 hours to see if temperature is sustained before starting treatment Broad spectrum empiric antibiotic coverage