NURS 6550 FINAL EXAM

QUESTION 1 1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter wasinserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid inf ...

QUESTION 1 1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter wasinserted 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 isthe 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 levels range 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’ssyndrome C. Grave’s disease D. Addison’s disease 1 points Answer: C. Grave's disease 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 QUESTION 5 1. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is: A. Osteoarthritis B. Drug or alcohol toxicity C. Hypotension D. Urosepsis 1 points QUESTION 6 1. A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities? A. Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg B. Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg C. Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg D. Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg Answer: Syndrome of inappropriate anti diuretic hormone is characterized by dilutionalhyponatremia.Serum sodium levels lower than 130mmol/L and urine osmolality less than 100mmol/L.Urine sodium is less than 30mmol/L.Serum level of sodium is likely to be 121 1 points QUESTION 7 1. Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates: A. Penetration of the cornea with resultant aqueousleak B. A rust ring remnant due to metal foreign body C. An elevated intraocular pressure D. Paradoxical pupil dilation in response to light 1 points Answer: • A. Penentration of the cornea with resultant aqueous leak A positive Seidel sign indicates a leakage from the anterior chamber into the cornea. It is used to diagnose corneal disorders such as corneal perforation and corneal degeneration. The AGACNP should therefore suspect Penentration of the cornea with resultant aqueous leak as indicated by the positive Seidel sign.