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NRNP 6566 Week 6 Midterm Exam

1. Question: What is the most important component of clearance?
2. Question: What is the best pharmacological agent to start a patient with hypertensive emergency and acute renal failure?
3. Question: When assessing a patient with thrombocytopenia, it is important to do a medication review. Which medication can cause drug-induced thrombocytopenia?
4. Question: According to the ASH guidelines, what is the recommended anticoagulation for a cancer patient with a VTE? Coumadin, Lovenox, Plavix, or Eliquis?
5. Question: When working a patient up for a hypercoagulable state, which of the following lab tests should be ordered in the workup?
6. Question: A patient is emergently taken to the ER for altered mental status. Once placed on the monitor, blood pressure is 78 over The patient is diaphoretic with cool extremities. The CBP is elevated and the SVR is decreased. What is the diagnosis of this patient?
7. Question: A patient comes into the ER with severe headache and low urine Blood pressure reveals 220 over 107. The nurse practitioner orders a basic metabolic panel. The clinical picture and lab results point to which diagnosis. The glucose is 189, sodium 138, potassium 5, chloride 106, CO2 26, bun 40, creatinine 2.8. Which stage of hypertension is the patient in?
8. Question: The nurse practitioner is assessing a patient hit by a car in the trauma bay. The patient was intubated in the field for airway protection. The patient is hypotensive and bradycardic. What is the primary diagnosis given the clinical situation?
9. Question: The nurse practitioner is called for post-op patient recovering on the floor as he does not seem right. Upon exam, the nurse practitioner notes he is slightly confused. His blood pressure is 85 over 42 and urine output has decreased. His bilirubin is 4.8 and platelet count dropped to 50,000. What is the leading diagnosis?
10. Question: All of the following are predisposing factors in VTE except for which one?
11. Question: What rhythm has successive prolonged delay in impulses from the previous impulse resulting in prolonged PR interval that continues to lengthen in duration and eventually drops the QRS complex?
12. Question: Which CHA2DS2-VASc score would warrant a female patient newly diagnosed with atrial fibrillation to be placed on anticoagulation?
13. Question: A patient presents to the ER complaining of chest tightness and dizziness. He states he feels like he could faint any EKG is obtained. His blood pressure is 76 over 40. What is the initial treatment for this patient?
14. Question: Would it be atropine, 0.4 mg IV push, epinephrine, 1 mg IV push, cardioversion, or transcutaneous pacing?
15. Question: A patient has been diagnosed with heparin-induced thrombocytopenia. In addition to stopping all heparin-containing medications, what should be started in place of these medications?
16. Question: Which class of antihypertensives are preferred in patients with diabetes? ACE inhibitors, calcium channel blockers, thiazide diuretics, or beta blockers?
17. Question: Some drugs such as propranolol or enalapril undergo significant metabolism during a single passage through the liver. What is this known as?
18. Question: A patient in the ICU just went into The patient has a pulse and is stable. What is the initial priority treatment?
19. Question: In patients with renal insufficiency and diabetes, what is the blood pressure goal for these patients? Less than 120 over 80, less than 130 over 80, less than 135 over 80, or less than 140 over 80?
20. Question: What is the purpose of a TEE prior to cardioversion for new onset AFib?
21. Question: Which non-invasive form of monitoring can identify if a patient is hypovolemic?
22. Question: What is the preferred first-line agent for blood pressure and cardiogenic shock?
23. Question: What is important to monitor in a patient that is receiving low molecular weight heparin such as Lovenox?
24. Question: What arrhythmia occurs when there is multiple foci within the ventricles that are functioning in overdrive, leading to quivering of the ventricles and no cardiac output?
25. Question: A patient is in the ICU due to septic shock. The nurse calls the nurse practitioner to the bedside because the patient is oozing from her central line. It was also noted there was petechiae on her abdomen. Labs show prolonged PT and INR, elevated D-dimer, and thrombocytopenia. What is the primary management for this patient? Rationale:
26. Question: The nurse practitioner is coding a patient in Pulseless VTAC. High-quality CPR was initiated. A shock was delivered, and high-quality CPR is back in progress. What is the next step in the algorithm?
27. Question: Vancomycin levels must be obtained with serum levels in order to monitor its therapeutic effects where the amount of drug taken in by the patient is equal to the amount being This state of equilibrium is known as steady state, biotransformation, first pass effect, or bioequivalent.
28. Question: Antiarrhythmic medications require close monitoring due to what side effect?
29. Question: After cardioversion for atrial fibrillation, how many weeks before and after does anticoagulation need to be given?
30. Question: A patient has a new diagnosis of His CHADS VASc score is 3. What is included in the plan?
31. Question: Why do anesthetic gases easily cross the blood-brain barrier?
32. Question: A 62-year-old patient comes to the ED with the following rhythm. The patient is lightheaded, diaphoretic, and complains of shortness of breath and chest What is the best intervention for this patient?
33. Question: If a patient goes into SVT and is stable, what is the initial treatment to break the arrhythmia?
34. Question: A patient in the ICU goes into sustained V-fib. The nurse recognizes and immediately starts What is the next step in the algorithm for managing a patient in V-fib?
35. Question: All of the following statements are true regarding hypertensive emergency except which of the following. Patients with hypertensive emergency will require ICU admission with anti-hypertensives via IV. Blood pressure should not be reduced more than 40% in the first hour. The blood pressure should be lowered to 160 over 100 in the 2 to 6 hours following the first After the first 2 to 6 hours, the blood pressure should be reduced to normal in 24 to 48 hours. The statement that is not true regarding hypertensive emergency is:
36. Question: Which statement about drug absorption is false?
37. Question: When using Coumadin for anticoagulation, what is the INR goal? 1 to 2, 2 to 3, 3 to 4, or 3.5 to 5?
38. Question: Which statement is false regarding arrhythmias in the gerontological population?
39. Question: The nurse practitioner is starting a patient on the Factor XA inhibitor Rivaroxaban for atrial fibrillation. The patient expresses worry to the nurse about the possibility of bleeding and if anything can be done to stop What is the appropriate response from the nurse?
40. Question: The nurse practitioner rounding on the floor gets a page from a nurse that her patient is bradycardic with a heart rate of 48. Blood pressure is 120 over 70. The patient does not have any complaints at this What is the next course of action?
41. Question: A patient comes to the ER complaining of intermittent chest palpitations. EKG shows AFib with RBR. Blood pressure is 100 over 64. What is the priority intervention for rate control? Give 5 mg metoprolol IV push, cardioversion at 120 joules. Hemiodarone bolus, 300 mg IV over 15 minutes, followed by a drip. Defibrillate at 200 joules.
42. Question: The nurse practitioner is evaluating a patient that came in for mucocutaneous bleeding in Purpura. She states she recently had a viral infection. Her labs show elevated LDH, low haptoglobin, severe thrombocytopenia, and schistocytes on the peripheral blood smear. What is the first-line treatment for this patient?
43. Question: All of the following are reversible causes of cardiac arrest, except hypovolemia, hyperthermia, tension pneumothorax, thrombosis, hypoxia.
44. Question: All of the following affect distribution of a drug except cardiac decompensation, age of the patient, renal failure, body composition.
45. Question: A patient in SVT with sustained rate at 160, which drug can be given to diagnose the dysrhythmia and sometimes terminate the tachycardia?
46. Question: When prescribing therapeutic dosage of Leuvenoxin, the nurse practitioner knows which dose to prescribe. 30 milligrams twice a day, 40 milligrams daily, 1 milligram per kilogram for 12 hours, 2 milligrams per kilogram daily.
47. Question: A patient presents to the ER with bleeding gums and anemia. She was diagnosed with immune thrombocytopenia. What is the best treatment for this patient?
48. Question: Non-selective beta blockers are contraindicated in all of the following except first-degree AV block, cardiogenic shock, bronchial asthma, acute decompensated cardiac failure.
49. Question: What best describes bioavailability?
50. Question: The nurse practitioner is called by the med-surg nurse regarding a patient post-op day 5 from a Whipple The patient is confused, febrile, and tachycardic. Blood pressure reveals 85 over 56 and a pulse of 130. What is the initial action by the nurse practitioner?
51. Question: The nurse practitioner is reviewing the labs of a patient. She takes metoprolol 25mg BID, amiodarone 200mg BID, Synthroid 75mg daily, multivitamin daily. Which medication is likely responsible for the abnormal labs?
52. Question: If AFib is present for greater than 48 hours or unknown period of time, the patient is at high risk for MI, cardiomyopathy, heart failure, stroke.
53. Question: Some drugs are initially administered as an inactive compound to help improve absorption and side effects. This is known as a blank catalyst lipophilic drug biotransformation prodrug.
54. Question: All of the following medications are included in first-line therapy for stage 2 hypertension with no underlying cardiovascular disease except calcium channel blockers, ACE inhibitors, beta blockers, or thiazide diuretics.
55. Question: A patient in the ICU goes into AFib with Blood pressure is 132 over 85. Patient denies any symptoms. Metoprolol 5 mg IV push times 3 is given with no resolve. What is the best medication to give to this patient for rhythm control?
56. Question: A patient’s status post-GI bleed is recovering in the hospital. The patient has a history of DBTs. What is the best treatment to prevent a pulmonary embolism?
57. Question: SVR is expected to decrease in which type of shock? Disruptive, cardiogenic, hypovolemic, obstructive.
58. Question: A patient just underwent placement of a bare metal set. The patient asked the nurse practitioner how long she will need to be on anticoagulation. What is the nurse practitioner’s response?
59. Question: A trauma patient is on therapeutic dose lovinox for a DVT. The patient needs to go back to the OR with ortho to place an X-fix on the right ankle. What is the American College of Surgeons guidelines on starting and stopping low molecular weight heparin?
60. Question: Which of the following is not part of Virchow’s triad? Damage to the blood vessel wall, hypothermia, hypercoagulable state, arterial or venous stasis.

NRNP 6566 Week 6 Mid-term Study Guide Week 1 to 5

1. Question: Describe the cytochrome P450 system. Describe how inducers and inhibitors affect the cytochrome system and how that affects the half-life of medications.
2. Question: Describe the affect on low and high albumin levels on active drug levels especially for drugs that are highly protein bound.
3. Question: Describe ways to lessen the hepatic first pass effect
4. Question: Be able to calculate creatinine clearance using the Cockgraft Gault equation
5. Question: Describe what determines the frequency of drug administration
6. Question: Be familiar with the Beers criteria and how to use it
7. Question: Describe factors that affect absorption, distribution, metabolism and excretion
8. Question: Define narrow therapeutic index How would you monitor a patient with a narrow the rapeutic index?
9. Question: Describe how aging affect absorption, distribution, metabolism, andexcretion
10. Question: Identify and describe 12 lead EKGs that demonstrate:
11. Question: Identify and describe the medications to treat each one of the EKGS listed in#1
12. Question: Distinguish between dihydropyridine and non-dihydropyridine calcium channel blocker. Know what conditions each class would be used to treat.
13. Question: Describe the medications to treat atrial fibrillation (rate, rhythm, and embolus prevention). Know the side effects, needed monitoring, and interaction for each of these medications for rate control.
14. Question: Calculate a CHADS2 score and describe treatment based on the score
15. Question: Describe the symptoms of hyperthyroidism, lab values that are altered, and medications to treat the disease and symptoms.
16. Question: Identify when cardioversion is … and relevant testing that should occur prior toit.
17. Question: Describe ACLS guidelines
18. Question: Know the diagnostic criteria for hypertension, hypertensive urgency, and hypertensive Describe goals of treatment (goalBP)
19. Question: Identify medications to treat hypertension … on ethnicity and co-existingconditions. Be very familiar with JNC guidelines. Be familiar with dosing and side effects of each medication class (ACE-I, ARB, Beta blockers,diuretics)
20. Question: Describe medication, side effects, and drugs for IV treatment ofhypertensive emergencies.
21. Question: Describe end organ damage related to hypertension. Identify what diagnostics are … and medications to treat hypertension (all stages … in#1).
22. Question: Identify the 4 types of shock and be able to distinguish between all Know the classic presentation (symptoms), medications to treat, and hemodynamic readings that would lead to diagnosis of each.
23. Question: Know the Surviving Sepsis guidelines for diagnosis, monitoring, and medications to treat.
24. Question: Be able to distinguish the 4 stages of sepsis. Differentiate the stages bysymptoms.
25. Question: Interpret a WBC differential. Distinguish between a bacterial and viral infections based on the differential.
26. Question: Explain the    mechanism    of    action    and    common    side    effects    of   dobutamine, norepinephrine, labetalol, and amiodarone.
27. Question: Distinguish the actions and effects between dopamine and dobutamine.
28. Question: Be very familiar with the CHEST guidelines on anticoagulation management
29. Question: Identify medications and dosages to treat an acute pulmonary embolism. Include the medications, dosages, and transition from injectable to oral medications
30. Question: Describe medications used to prevent PE in surgical, orthopedic, and trauma patients. Know dosages and length of treatment suggested.
31. Question: Describe how to manage warfarin (initiation, monitoring, and dose adjustments)
32. Question: Identify what patients would not be eligible for oral anti coagulants
33. Question: Describe how to bridge a patient taking warfar in that is undergoing Distinguish between HIT, TTP, ITP, and DIC. Describe diagnostics and treatment for all three
34. Question: Describe appropriate labs and monitoring guidelines for all anti coagulant medications.
35. Question: Identify INR goals for all diagnosis