1. Q ANSWER:

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. Shif output = 800 ml, shif input =

825 ml Unchanged weight

C. Serum osmolality = 260

2. Q ANSWER:

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 adult-gerontology acute care nurse practitioner's initial treatment is to:

A. reduce serum osmolality by infusing a 5% dextrose in 0.2%

sodium chloride solution

B. reduce serum sodium concentration by infusing a 0.45% sodium

chloride solution

C. replenish volume by infusing a 0.9% sodium chloride solution

D. replenish volume by infusing a 5% dextrose in water solution.

3. Q ANSWER:

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 he denies any diarrhea. His vital signs are as follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood

pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/µL. The

AGACNP expects that physical examination will reveal:

A. + Murphy’s sign

B. + Chvostek’s sign

C. + McBurney’s sign

D. + Kernig’s sign

4. Q ANSWER:

Myasthenia gravis is best described as:

A. An imbalance of dopamine and acetylcholine in the

basal ganglia Demyelination of peripheral ascending

nerves

B. Demyelination in the central nervous system

C. An autoimmune disorder characterized by decreased neuromuscular activation

5. Q ANSWER:

Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal

resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but

throughout the course of day 1 she has complained of a mild abdominal discomfort that has

progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate

the patient for persistent and progressive discomfort. Likely causes of her symptoms include all

of the following except:

A. Colic due to return

of peristalsis

B. Leakage from the

duodenal stump

C. Gastric retention

D. Hemorrhage

6. Q ANSWER:

Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal

resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but

throughout the course of day 1 she has complained of a mild abdominal discomfort that has

progressed throughout the day. This evening the AGACNP is called to the bedside to

evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms

include all of the following except:

A. Colic due to return

of peristalsis

B. Leakage from the

duodenal stump

C. Gastric retention

D. Hemorrhage