NRNP6566 Week 6 Knowledge Check - Advanced
Care of Adults Acute Settings I - Walden University
AGACNP Program 2026/2027
Time limit: 45 min | 27 items | Passing ≥ 85 % (≥ 23/27)
INSTRUCTIONS: Choose the SINGLE BEST next inpatient action for the hospitalized
adult. Assume standard hospital protocols and no allergies unless stated. Normal
values are listed at the end.
SECTION 1 – FLUID, ELECTROLYTE & ACID-BASE MANAGEMENT (Q 1-8)
Q1. A 68-y/o woman with SIADH post-TURP has Na⁺ 118 mEq/L (baseline 128 → 122 →
118 over 72 h).
Alert, no seizures.
Most appropriate INITIAL intervention?
A. 3 % saline 100 mL bolus over 10 min
B. Free-water restriction ≤ 1 L/day + stop desmopressin
C. Normal saline 125 mL/h
D. Oral salt tabs 3 g TID
Correct: B
, Rationale: Chronic asymptomatic hyponatremia → fluid restriction & remove stimulus; 3
% (A) only if severe symptoms; NS (C) may worsen SIADH.
Q2. Same patient—what is the MAXIMUM safe rise in serum Na⁺ in the FIRST 24 h to
avoid osmotic demyelination?
A. 4 mEq/L
B. 6 mEq/L
C. 8 mEq/L
D. 10 mEq/L
Correct: C
Rationale: 2026 guidelines cap at 6-8 mEq/L in 24 h for high-risk patients (elderly,
SIADH, Na < 120).
Q3. DKA protocol: insulin 0.1 U/kg/h initiated; initial K⁺ 5.5 mEq/L.
After 4 h K⁺ 3.1 mEq/L, anion gap closing, ECG normal.
Next action?
A. Stop insulin until K⁺ > 3.5
B. Add KCl 40 mEq to each liter of IVF
C. Give oral K-Dur 20 mEq now
D. Obtain repeat ABG in 2 h only
Correct: B
Care of Adults Acute Settings I - Walden University
AGACNP Program 2026/2027
Time limit: 45 min | 27 items | Passing ≥ 85 % (≥ 23/27)
INSTRUCTIONS: Choose the SINGLE BEST next inpatient action for the hospitalized
adult. Assume standard hospital protocols and no allergies unless stated. Normal
values are listed at the end.
SECTION 1 – FLUID, ELECTROLYTE & ACID-BASE MANAGEMENT (Q 1-8)
Q1. A 68-y/o woman with SIADH post-TURP has Na⁺ 118 mEq/L (baseline 128 → 122 →
118 over 72 h).
Alert, no seizures.
Most appropriate INITIAL intervention?
A. 3 % saline 100 mL bolus over 10 min
B. Free-water restriction ≤ 1 L/day + stop desmopressin
C. Normal saline 125 mL/h
D. Oral salt tabs 3 g TID
Correct: B
, Rationale: Chronic asymptomatic hyponatremia → fluid restriction & remove stimulus; 3
% (A) only if severe symptoms; NS (C) may worsen SIADH.
Q2. Same patient—what is the MAXIMUM safe rise in serum Na⁺ in the FIRST 24 h to
avoid osmotic demyelination?
A. 4 mEq/L
B. 6 mEq/L
C. 8 mEq/L
D. 10 mEq/L
Correct: C
Rationale: 2026 guidelines cap at 6-8 mEq/L in 24 h for high-risk patients (elderly,
SIADH, Na < 120).
Q3. DKA protocol: insulin 0.1 U/kg/h initiated; initial K⁺ 5.5 mEq/L.
After 4 h K⁺ 3.1 mEq/L, anion gap closing, ECG normal.
Next action?
A. Stop insulin until K⁺ > 3.5
B. Add KCl 40 mEq to each liter of IVF
C. Give oral K-Dur 20 mEq now
D. Obtain repeat ABG in 2 h only
Correct: B
