Walden University NRNP 6560 Final Exam (pdf) | 2026/2027 | Acute
Care III Q&A | Advanced Practice Nursing
**1. The AGACNP is reviewing a chart of a head-injured patient. Which of the
following would alert the AGACNP for the possibility that the patient is over
hydrated, thereby increasing the risk for increased intracranial pressure?**
A) BUN = 10
B) Shift output = 800 ml, shift input = 825 ml, unchanged weight
C) Serum osmolality = 260
D) Serum sodium = 145
**Correct Answer: C**
**Rationale:** A serum osmolality of 260 mOsm/L is below the normal range
(275-295 mOsm/L) and indicates overhydration. Overhydration can lead to
cerebral edema and increased intracranial pressure (ICP). A BUN of 10 is
normal, balanced intake/output with unchanged weight suggests fluid
balance, and serum sodium of 145 is normal.
---
**2. A patient who has been in the intensive care unit for 17 days develops
hyponatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is
intubated, and is receiving mechanical ventilation. The serum osmolality is
320 mOsm/L kg H₂O. Clinical signs include tachycardia and hypotension. The
AGACNP's initial treatment is to:**
A) Reduce serum osmolality by infusing 5% dextrose in 0.2% sodium chloride
solution
B) Reduce serum sodium concentration by infusing 0.45% sodium chloride
solution
,C) Replenish volume by infusing 0.9% sodium chloride solution
D) Replenish volume by infusing 5% dextrose in water solution
**Correct Answer: C**
**Rationale:** The patient has hyperosmolar hyponatremia with signs of
volume depletion (tachycardia, hypotension). The initial treatment is to
replenish intravascular volume with isotonic fluid (0.9% normal saline).
Hypotonic fluids (0.45% NS, D5W) would worsen cerebral edema in the
setting of hyperosmolality.
---
**3. A 16-year-old male presents with fever and right lower quadrant
discomfort. He complains of nausea and has had one episode of vomiting,
but denies any diarrhea. Vital signs: temperature 101.9°F, pulse 100 bpm,
respirations 16, blood pressure 110/70. WBC count is 19,100 cells/µL.
Physical examination will most likely reveal:**
A) + Murphy's sign
B) + Chvostek's sign
C) + Rovsing's sign
D) + Kernig's sign
**Correct Answer: C**
**Rationale:** The presentation of fever, right lower quadrant pain, nausea,
vomiting, and leukocytosis is consistent with acute appendicitis. Rovsing's
sign (pain in the right lower quadrant with palpation of the left lower
quadrant) is a classic finding in appendicitis. Murphy's sign is associated with
,cholecystitis, Chvostek's sign with hypocalcemia, and Kernig's sign with
meningitis.
---
**4. A patient with an ascending thoracic aneurysm > 5.5 cm is universally
considered an indication for surgical repair. Regardless of the aneurysm's
size, all of the following are additional indications for immediate operation
EXCEPT:**
A) Comorbid Marfan's syndrome
B) Enlargement of > 1 cm since diagnosis
C) Crushing chest pain
D) History of giant cell arteritis
**Correct Answer: D**
**Rationale:** History of giant cell arteritis is not an indication for immediate
surgical repair of an aortic aneurysm. Indications include Marfan's syndrome
(due to risk of dissection), rapid enlargement (>1 cm since diagnosis), and
crushing chest pain (which may indicate dissection or rupture). Giant cell
arteritis is a vasculitis that can involve the aorta but is not itself an indication
for surgical repair.
---
**5. A 59-year-old female has been followed for several years for aortic
regurgitation. Serial echocardiography has demonstrated normal ventricular
function, but the patient was lost to follow-up for 16 months and now
presents with activity intolerance and weight gain. Physical examination
reveals a grade IV/VI diastolic aortic murmur and 2+ lower extremity edema
, to the midcalf. The AGACNP considers which of the following as the most
appropriate management strategy?**
A) Serial echocardiography every 6 months
B) Begin a calcium channel antagonist
C) Begin an angiotensin converting enzyme (ACE) inhibitor
D) Surgical consultation and intervention
**Correct Answer: D**
**Rationale:** The patient has progressed from asymptomatic aortic
regurgitation to symptomatic disease with activity intolerance, weight gain,
and edema, indicating declining left ventricular function. The grade IV/VI
murmur and edema suggest significant regurgitation and possible heart
failure. Surgical consultation and intervention (valve replacement) are
indicated.
---
**6. Which of the following findings is characteristic of cardiogenic shock?**
A) High cardiac index, low SVR, low PCWP
B) Low cardiac index, high SVR, high PCWP
C) High cardiac index, high SVR, low PCWP
D) Low cardiac index, low SVR, high PCWP
**Correct Answer: B**
Care III Q&A | Advanced Practice Nursing
**1. The AGACNP is reviewing a chart of a head-injured patient. Which of the
following would alert the AGACNP for the possibility that the patient is over
hydrated, thereby increasing the risk for increased intracranial pressure?**
A) BUN = 10
B) Shift output = 800 ml, shift input = 825 ml, unchanged weight
C) Serum osmolality = 260
D) Serum sodium = 145
**Correct Answer: C**
**Rationale:** A serum osmolality of 260 mOsm/L is below the normal range
(275-295 mOsm/L) and indicates overhydration. Overhydration can lead to
cerebral edema and increased intracranial pressure (ICP). A BUN of 10 is
normal, balanced intake/output with unchanged weight suggests fluid
balance, and serum sodium of 145 is normal.
---
**2. A patient who has been in the intensive care unit for 17 days develops
hyponatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is
intubated, and is receiving mechanical ventilation. The serum osmolality is
320 mOsm/L kg H₂O. Clinical signs include tachycardia and hypotension. The
AGACNP's initial treatment is to:**
A) Reduce serum osmolality by infusing 5% dextrose in 0.2% sodium chloride
solution
B) Reduce serum sodium concentration by infusing 0.45% sodium chloride
solution
,C) Replenish volume by infusing 0.9% sodium chloride solution
D) Replenish volume by infusing 5% dextrose in water solution
**Correct Answer: C**
**Rationale:** The patient has hyperosmolar hyponatremia with signs of
volume depletion (tachycardia, hypotension). The initial treatment is to
replenish intravascular volume with isotonic fluid (0.9% normal saline).
Hypotonic fluids (0.45% NS, D5W) would worsen cerebral edema in the
setting of hyperosmolality.
---
**3. A 16-year-old male presents with fever and right lower quadrant
discomfort. He complains of nausea and has had one episode of vomiting,
but denies any diarrhea. Vital signs: temperature 101.9°F, pulse 100 bpm,
respirations 16, blood pressure 110/70. WBC count is 19,100 cells/µL.
Physical examination will most likely reveal:**
A) + Murphy's sign
B) + Chvostek's sign
C) + Rovsing's sign
D) + Kernig's sign
**Correct Answer: C**
**Rationale:** The presentation of fever, right lower quadrant pain, nausea,
vomiting, and leukocytosis is consistent with acute appendicitis. Rovsing's
sign (pain in the right lower quadrant with palpation of the left lower
quadrant) is a classic finding in appendicitis. Murphy's sign is associated with
,cholecystitis, Chvostek's sign with hypocalcemia, and Kernig's sign with
meningitis.
---
**4. A patient with an ascending thoracic aneurysm > 5.5 cm is universally
considered an indication for surgical repair. Regardless of the aneurysm's
size, all of the following are additional indications for immediate operation
EXCEPT:**
A) Comorbid Marfan's syndrome
B) Enlargement of > 1 cm since diagnosis
C) Crushing chest pain
D) History of giant cell arteritis
**Correct Answer: D**
**Rationale:** History of giant cell arteritis is not an indication for immediate
surgical repair of an aortic aneurysm. Indications include Marfan's syndrome
(due to risk of dissection), rapid enlargement (>1 cm since diagnosis), and
crushing chest pain (which may indicate dissection or rupture). Giant cell
arteritis is a vasculitis that can involve the aorta but is not itself an indication
for surgical repair.
---
**5. A 59-year-old female has been followed for several years for aortic
regurgitation. Serial echocardiography has demonstrated normal ventricular
function, but the patient was lost to follow-up for 16 months and now
presents with activity intolerance and weight gain. Physical examination
reveals a grade IV/VI diastolic aortic murmur and 2+ lower extremity edema
, to the midcalf. The AGACNP considers which of the following as the most
appropriate management strategy?**
A) Serial echocardiography every 6 months
B) Begin a calcium channel antagonist
C) Begin an angiotensin converting enzyme (ACE) inhibitor
D) Surgical consultation and intervention
**Correct Answer: D**
**Rationale:** The patient has progressed from asymptomatic aortic
regurgitation to symptomatic disease with activity intolerance, weight gain,
and edema, indicating declining left ventricular function. The grade IV/VI
murmur and edema suggest significant regurgitation and possible heart
failure. Surgical consultation and intervention (valve replacement) are
indicated.
---
**6. Which of the following findings is characteristic of cardiogenic shock?**
A) High cardiac index, low SVR, low PCWP
B) Low cardiac index, high SVR, high PCWP
C) High cardiac index, high SVR, low PCWP
D) Low cardiac index, low SVR, high PCWP
**Correct Answer: B**
