NURS 6550 FINAL EXAM – WALDEN UNIVERSITY SUMMER (UPDATED)

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY SUMMER 2019(UPDATED) QUESTION 1 1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes: A. Foley lodged in the urethra causing post-renal failure B. Decreased renal perfusion causing prerenal failure C. Age-related decreased eGFR causing prerenal failure D. Post-surgicalrhabdomyolysis causing intrarenal failure Answer: • D. Post-surgical rhabdomyolysis causing intrarenal failure During surgery, muscles and injured. This can result into rhabdomyolysis, which is the breakdown of muscles to release proteins. The excess proteins causes an increased level of creatinine. Mr. Jeffers is from surgery (post-surgical) and his creatinine levels are above normal. The normal creatinine levelsrange from 0.6mg/dl to 1.2mg/dl. Thus, the most likely differential is: Post-surgical rhabdomyolysis causing intrarenal failure. 1 points QUESTION 2 1. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of: A. Hashimoto’sthyroiditis B. Cushing’s syndrome Page 1 of 84 lOMoAR cPSD| Downloaded by charity nimo () C. Grave’s disease D. Addison’s disease 1 points Answer: C. Grave's disease Page 2 of 84 lOMoAR cPSD| Downloaded by charity nimo () QUESTION 3 1. Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE? A. Fever, normal white count, elevated sedimentation rate B. Hyperkalemia, hyponatremia, low blood pressure C. Leukocytosis, hyperglycemia, hypokalemia D. Joint pain, rash, fever 1 points QUESTION 4 1. A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be: A. Meclizine B. Diazepam C. Bed rest D. Epley’s maneuvers 1 points Answer: • D. Epley's maneuvers The patient is likely suffering from benign paroxysmoly positioning vertigo. This is indicated by inability to turn her head and to get up from the lying position in bed. The best intervention for benign paroxysmal positioning vertigo is Epley's maneuvers. These maneuvers effectively clear the inner ear to relieve symptoms of vertigo