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D027 PRACTICE EXAM ACTUAL
EXAM QUESTIONS WITH
DETAILED VERIFIED ANSWERS
AND RATIONALES ALREADY
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"A patient who has chronic kidney disease has hemoglobin of 7.2 mg/dL. What treatment does the healthcare professional prepare the patient for? - CORRECT ANSWER=> Intrinsic factor b. Vitamin B c. Vitamin D d. Erythropoietin Anemia of chronic kidney disease can be successfully treated with erythropoietin. Reduced erythropoietin secretion and reduced red cell production are evident in anemia resulting from chronic kidney disease. Intrinsic factor is needed for the absorption of vitamin B12. Vitamin D is important for calcium absorption." "A healthcare professional is assessing a patient who could have either pyelonephritis or cystitis. Which differentiating sign would assist the professional in making this diagnosis? - CORRECT ANSWER=> Difficulty initiating urine stream Urinalysis confirmation of white blood cell casts Spasmodic pain that radiates through the groin
Increased GFR" "James, a 22-year-old firefighter, presents to your practice with dyspnea on excretion. He reports that he has trouble keeping up with his squad and can no longer carry his 40 lb. pack. He reports 2 months of nocturnal cough, a 10 lb. weight loss and fatigue. He denies any history of smoking and he drinks 2-3 six packs of beer daily. He presented 3 weeks ago to a primary care clinic where he was told he had pneumonia and asthma. He was started on antibiotics and a B- agonist, but still does not feel well. Which of the following findings is the least specific in making a diagnosis? - CORRECT ANSWER=> Elevated JVD Wheezing Wheezing is not a sign of heart failure. S3 gallop Rales" "A patient with history of a hemithyroidectomy is attending her annual wellness exam. The healthcare provider orders a serum TSH. The results are 4.6 microunits/mL, with a normal range of 0.3 - 6 microunits/mL. The healthcare provider can draw the following conclusion about this patient's thyroid function. - CORRECT ANSWER=> TSH is normal indicating that the patient's thyroid hormone is normal. The negative feedback loop, unique to the endocrine system allows laboratory evaluation by measuring various hormones involved in the feedback loop of the endocrine organ. Thyroid stimulation hormone will fluctuate as the body needs thyroid hormone. In cases where the thyroid is not functioning at an optimal state and thyroid hormone is not being produced, the anterior pituitary gland will continue to produce TSH in attempts to stimulate the thyroid. The more the thyroid does not produce thyroid hormone, the more TSH produced. In this case, the TSH level is normal suggesting that thyroid function is operating a normal rate in this patient. TSH is normal indicating that the patient's thyroid level is low. TSH is normal indicating that the patient's thyroid hormone is elevated. TSH as a laboratory test alone is not enough data to draw a conclusion about thyroid function."
"The physiology differences which distinguishes a partial focus seizure from a generalized seizure is best represented in which of the following statements? - CORRECT ANSWER=> Patients are aware during a partial focus seizure, but not during a generalized seizure. A partial focus seizure only involves the lower half of the body. Partial focus seizures result when neural tissue is abnormal in a focal area of the brain. Partial focus seizures result when abnormal neural tissue is present in both hemispheres of the brain." "Ondansetron should be avoided in which of the following patients? Select all that apply. - CORRECT ANSWER=> A 12-year-old patient with vomiting and diarrhea for 2 days. A 52-year-old male with history of prolonged QT syndrome. A 74-year-old male with chronic renal failure admitted for electrolyte balance following dialysis. Ondansetron is contraindicated or with caution in those with prolonged QT syndrome, heart failure, electrolyte imbalance, or while taking other medications known to cause prolonged QT such as methadone. In patients with prolonged QT syndrome, the dysrhythmia torsades de pointes, occurs with increased risk when receiving ondansetron. A 32-year-old admitted for acute intoxication of methadone. 45-year-old with history of non-small cell carcinoma of the left upper lobe of lung." "A nurse has orders to give Lactulose to her patient with portal hypertension. The nurse knows that Lactulose is an osmotic laxative. This means that: - CORRECT ANSWER=> They increase the amount of water and electrolytes within the intestinal lumen by increasing secretion of water and ions into the intestine and by reducing water and electrolyte absorption. They stimulate peristalsis and soften feces by increasing secretion of water and electrolytes into the intestine and decreasing water and electrolyte absorption.
They secrete water, thereby softening and enlarging the fecal mass; fecal swelling promotes peristalsis. They retain water and thereby softens the feces; fecal swelling promotes peristalsis." "A 74-year-old patient is admitted to the hospital with a diagnosis of hypertension, dementia and hyperlipidemia. The patient also has a history of a pulmonary embolism. Her son brought in a bag of her mediations which included warfarin, ginkgo biloba, low dose aspirin, hydrochlorothiazide, lisinopril and echinacea. The health care provider should be concerned over which medication as a potential drug to drug interaction? - CORRECT ANSWER=> Echinacea and warfarin Lisinopril and hydrochlorothiazide Lisinopril and echinacea Warfarin and gingko biloba Warfarin and blood thinners interact with gingko biloba as designed to improve memory. All herbal supplements should be evaluated with current pharmacological medications. The other options do not have drug interaction." "A 70-year old patient is concerned that he is becoming forgetful. He wants the APRN to recommend ways to prevent this from happening. Which of the following is an evidenced based recommendation? - CORRECT ANSWER=> Begin to take a vitamin B12 supplement Make sure to get 8-9 hours of sleep per night Stay well hydrated with 8 glasses of fluid per day Play cards or word games with friends several times a week" "A patient needs to purchase a new prescription of Eliquis but does not have stable employment nor health insurance. Which 2 social determinants of health are primarily impacting this patient's ability to access the medication he needs? - CORRECT ANSWER=> Economic stability and health/healthcare
Bile from bilirubin Heme from animal protein The primary source of iron is heme from animal protein. A small portion of iron comes from recycling of old red blood cells." "A clinic-based task force is assigned with designing practices that help providers prioritize patient care. They decide to initiate which of the following? - CORRECT ANSWER=> Increased patient appointment times to facilitate appropriate treatment plans Web-linked electronic health records that facilitate identification of clinical options based on clinical decision support tools EHRs have long been recognized as effective tools for patient prioritization, but have never been effectively used. The other choices are not presented in the article as possible options. More accurate, patient-specific nursing care plans that include patient decision-making Increased hiring of providers to efficiently and successfully develop appropriate patient treatment plans." "A self-management priority for a patient with asthma is to provide quick relief therapy for: - CORRECT ANSWER=> Bronchospasm Hives Triggers Wheezing" "A healthcare professional is working with providers in a developing country to find appropriate asthma treatment guidelines. The most appropriate website related to asthma treatment for providers in countries with limited resources is: - CORRECT ANSWER=> Centers for Disease Control and Prevention website
Center for Disease Prevention and Health Promotion website Food and Drug Administration website Global Initiative for Asthma website" "Which of the following should be obtained in a 7-year-old patient starting the stimulant methylphenidate? Select all that apply. - CORRECT ANSWER=> Height Weight Rationale: Stimulant agents can cause poor appetite. Obtaining baseline height and weight will allow trending of this adverse effect. Urine drug test Audiometry testing Visual acuity testing" "CYP450 is responsible for which one of the following? - CORRECT ANSWER=> Activation of recessive gene traits. Absorption of drugs through passive binding in the small intestine Metabolism of drugs Located in the mitochondria or endoplasmic reticulum, CYPs metabolize numerous drugs, hormones, vitamin D and also involved in production of cholesterol. Children under 1 year of age have varying rates of hepatic metabolism, so medication dosages are set by a board of pharmacists for all pediatric patients." "The health care professional is working with a patient who is dealing with depression. The patient continues to complain of being tired and not being able to sleep at night. Which antidepressant would be best for this patient? - CORRECT ANSWER=> Fluoxetine
diabetes prior to surgery demonstrates a lack of understanding of stress induced hyperglycemia. Option C is incorrect, there is no evidence in the questions other than elevated blood sugar levels that would support a diagnosis of diabetes." "36.A patient arrives to the clinic reporting last two weeks of feeling overwhelmingly sad, wanting to be left alone, and difficulty focusing. The health care provider has diagnosed the patient with mild depression. What is the recommended approach in management of mild depression? - CORRECT ANSWER=> Drug therapy or psychotherapy A combination of drug therapy and psychotherapy Electroconvulsive therapy Transcranial magnetic stimulation" "37.Diagnostic criteria for generalized anxiety disorder include all the following except: - CORRECT ANSWER=> Difficulty concentrating Excessive hunger Easily fatigued Irritability" "38.The least important factor in the evaluation of a patient with clinical depression would be: - CORRECT ANSWER=> Their thinking process Evidence of past physical harm Basic personality type All of the above are important factors to consider for a diagnosis of depression. Personality type is not important. Potential for suicide"
"39.A patient is given a prescription for clozapine. The healthcare professional educates the patient that this drug blocks which neurotransmitter receptor? - CORRECT ANSWER=> Norepinephrine Dopamine Clozapine is a second-generation atypical antipsychotic drug that works by blocking dopamine receptors. Gamma-aminobutyric acid Serotonin" "40.A patient asks the nurse what can be given to alleviate severe, chronic pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider? - CORRECT ANSWER=> Fentanyl [Duragesic] transdermal patch Hydrocodone [Vicodin] PO Meperidine [Demerol] PO Pentazocine [Talwin] PO" "41.A healthcare worker planning a research project related to teenage pregnancy in his community would include in the initial assessment the health status of the target population. Health status could be best evaluated by the examination of the: - CORRECT ANSWER=> Birth rate, disease morbidity, and life expectancy Birth rate statistics identify age of mother; death rates include infant mortality and age of mother; access to health care may affect a teenager's ability to obtain adequate prenatal care Birth rate, access to health care, and death rate Disease morbidity, life expectancy, and health insurance coverage. Health insurance coverage, death rate, and access to health care."
"45.A pediatric patient is diagnosed with chickenpox. The parent is asking about medications that would help the patient with symptoms. The best response would be: (Select all that apply) - CORRECT ANSWER=> Diphenhydramine Aspirin Acetaminophen Ibuprofen" "46.A 22-year-old male arrives to the emergency room following a motor vehicle accident. Physical examination reveals increased trouble breathing with decreased breath sounds on the left side. The patient's trachea appears to be deviating to the right when examining the neck. Which intervention is highest in priority? - CORRECT ANSWER=> placement of a chest tube to the left side placement of a test tube to the right side needle decompression on the left side needle decompression the right side" "47.A newborn with sickle cell disease treat is placed on twice-daily oral penicillin. This is acceptable management according to which of the following rationales? - CORRECT ANSWER=> individuals who have not received the pneumococcal vaccine are at an increased risk for pneumococcal infections which penicillin prevents individuals with sickle cell disease are at an increased risk for sepsis therefore daily antibiotics are indicated newborns are immunodeficient therefore antibiotics are appropriate additional information is required to make management decisions about this patient"
"48.Which of the following laboratory values would suggest simvastatin has been effective? - CORRECT ANSWER=> LDL 89 mg/dL LDL <100 mg/dL is normal range HDL 32 mg/dL Total cholesterol 210 mg/dL Triglycerides 174 mg/dL" "49.A chromosomal deletion occurs when: - CORRECT ANSWER=> An error is made in the DNA transcription process. Gene coding is missing on a specific chromosome. A chromosome is missing. An autosomal chromosome is fragmented." "50.Which properties of the angiotensin can enzyme (ACE)inhibitors are advantageous when treating conditions like hypertension? Select all that apply. - CORRECT ANSWER=> Vasoconstriction Vasodilation Diuresis Increasing contractile force of the heart Cholinergic effects" “During the body's inflammatory process, what causes edema? Vasodilation of blood vessels
People with type 2 diabetes mellitus suffer from insulin resistance. Obesity causes this resistance so their cells have difficulty using insulin. Obesity does not lead to reduced insulin production, obstructed insulin outflow, or stimulation of glucose production. Obstructed outflow of insulin from the pancreas Stimulation of glucose production by the liver" "When evaluating a patient for hypertensive target organ damage, the APRN looks for evidence of: - CORRECT ANSWER=> Lipid abnormality Insulin resistance Left ventricular hypertrophy Clotting disorders" "On ultrasound a patient had 4-chamber dilation with an ejection fraction of 15% and a pleural effusion on chest x-ray. Elevated liver function tests, hypokalemia, and hypomagnesema are seen on lab results. Blood pressure is 115/60 and heart rate is 110 bpm with regular rate and rhythm, respiratory rate 30 bpm and O2 saturation is 88% on room air. Initial therapy should include all of the following except: - CORRECT ANSWER=> Diuretic ACE Inhibitor Digoxin Beta Blocker" "A patient in the emergency department is suspected of having a myocardial infarction (MI). The initial cardiac troponin 1 level was negative. What action by the healthcare professional is best? - CORRECT ANSWER=> Administer thrombolytic therapy. Discharge the patient. Schedule repeat troponin within a few hours.
Several cardiac biomarkers exist including the most specific, cardiac troponin 1 (cTnI), cTnI begins to rise within 2 to 4 hours after cardiac injury, so if the initial result is normal, the test should be repeated within 6 to 9 hours and again at 12 to 24 hours. It is not known yet if the patient has had an MI so treatment with thrombolytic therapy and/or catheterization would be premature. The patient should not be discharged since the professional suspected an MI. Prepare the patient for cardiac catheterization." "Which patient would the healthcare professional assess for elevated levels of antidiuretic hormone (ADH) secretion? - CORRECT ANSWER=> Being treated for small cell carcinoma of the stomach Taking high dose acetaminophen (Tylenol) for arthritis Had a hip replacement operation 14 days ago Has long-standing kidney disease from diabetes" "A post-operative patient with gallbladder surgery has an epidural infusion of Astramorph. The patients respiratory rate starts to decline to 9 breaths/minute. Which medication should the healthcare provider anticipate administering to this patient? Protamine sulfate Mucomyst Naloxone Naloxone is a narcotic antagonist that can reverse the effect of both adverse and therapeutic use of opioid narcotic analgesics. Solu-Medrol - CORRECT ANSWER=> " "A patient is brought to the Emergency Department with a gunshot wound to the chest. The healthcare professional assesses an abnormality involving a pleural rupture that acts as a one-
