KAPLAN MN556 Unit 10 Quiz Latest 2017 June Question # 00599680 Subject: Education Due on: 03/20/2019 Posted On: 03/20/2019 05:17 AM Tutorials: 1 Rating: 4.7/5

MN556
Primary Care Across the Adult Age Continuum III

Unit 10 Quiz

Question 1

A 30 year old female stopped by the primary care office near
work on the way back from lunch. She
experienced a sudden onset of hives on her back and stomach that is
progressively spreading. She stated,
“my chest feels tight, my tongue feels numb and I am having difficulty
breathing. I did have asthma as a
child.” Which the most appropriate
intervention by the APN?

Question options:

Give epinephrine 1:1,000 intramuscularly immediately

Administer nebulized albuterol mixed with saline and repeat
PRN

Order a stat chest x-ray

Prescribe 50mg Benadryl (diphenhydramine) PO now and recheck
in 24 hours

Question 2

A 65 year old male presented for a yearly physical exam with
complaints of nausea, trembling and fatigue.
A 12 lead ECG revealed new onset atrial fibrillation with a heart rate
of 60 beats per minute. Current
medications included: Lanoxin (digoxin),
Lasix (Furosemide) and Aspirin. The
patient stated, “Should I go straight to the ER with the way I am
feeling?” Which of these
interventions is most appropriate by the APN?

Question options:

Refer to a cardiologist immediately

Order a stat TSH, electrolyte panel, and digoxin level

Discontinue Lanoxin (digoxin) and admit to the hospital for
further diagnostic tests

Call 911 with a referral to the emergency department

Question 3

A 40 year old male client with Down’s syndrome presented to
his primary care APN with complaints of difficulty at work. He stated, “I can’t remember what I need
to do and the boss keeps yelling at me.
I have done this job for many years, I don’t know how to do anything
else.” Physical exam: no
abnormalities noted with heart rate 70
beats per minute, respirations 18 breaths per minute, oxygen saturation 98% on
room air, blood pressure 148/84, and CBC with differential and serum
chemistries with electrolytes normal.

Question options:

Order stat CT scan of the head

Consult with physician specializing in adults with
developmental disabilities

Consider the finding normal and recommend recheck in 3
months

Call employer for detailed record of client’s actions

Question 4

Advance practice nurses secure the right to practice legally
from which collection of documents?

Question options:

State laws in which the practitioner resides

Nurse Practice Act of the state where the practitioner is
licensed

Approval by the board of executives at the state board of
nursing where the practitioner resides

Successful passage of national certification exam from the
American Nurses’ Credentialing Center

Question 5

Which statement best describes the mechanism of action for
RhoGAM?

Question options:

Increases manufacturing of maternal antibodies to destroy Rh
positive and negative fetal blood antigens

Promotes the destruction of maternal antibodies against Rh
negative fetal blood cells

Stimulates manufacturing of maternal antibodies to decrease
risk for hemolysis with a Rh negative fetus

Destroys maternal antibodies for Rh positive fetal red blood
cells

Question 6

Which client should the APN in the emergency department
assess first?

Question options:

A 2 year old with a history of possibly swallowing a dime

A 30 year old female complaining of pain when urinating and
intermittent nausea

A 40 year old male with electrical burns on his hands and
face from a work site accident

A 25 year old male with a 4 inch long and 0.5 inch wide
laceration on his left upper arm suffered after fight

Question 7

A 15 year old male with Down’s Syndrome presented to his
primary care clinic for a required physical to join the wrestling team. The mother expressed concerns regarding
injuries and special needs due to his disability. Which statement if the appropriate response
by the APN?

Question options:

“I will need to refer your son to a neurologist for
further evaluation to assure he is healthy for wrestling.”

“I can perform the physical however based on legal
concerns I will not certify your son healthy to wrestle.”

“He must be cleared of cervical instability and then he
can play some sports preferably those with less contact.”

“Your son can play wearing traditional protective gear
and has no limitations

Question 8

A client is admitted to the emergency department for first
and second degree burns on the face, neck, anterior chest and hands. What is the next best action by the APN?

Question options:

Administer 4mg Morphine Sulfate intravenously

Begin intravenous infusion of Normal Saline at at 175
ml/hour

Assess for dyspnea or stridor

Cover the secondary burns with dry sterile dressings

Question 9

Which client should the APN assess first in the emergency
department?

Question options:

18 year old female admitted 1 hour earlier after a possible
rape, awaiting a consult with social work.

20 year old admitted 8 hours prior after a motor vehicle
accident with complaints of severe headache and occasional nausea

40 year old admitted 4 hours earlier with exacerbation of
sickle cell crisis who received their last dose of Dilaudid (hydromorphone HCl)
30 minutes earlier

78 year old with history of CVA 8 years earlier admitted 12
hours earlier for rule out dementia

Question 10

Which client should the APN assess first in the emergency
department?

Question options:

30 year old drug overdose admitted 112 hours prior with a
urine output of 200ml in 8 hours

70 year old with chronic renal failure admitted 6 hours
prior with a possible hip fracture
after falling

Client with cirrhosis admitted 2 hours ago with confusion,
coughing, and hematemesis

Client admitted 1 hour prior, NPO for rule out acute
pancreatitis and complaining of pain

Question 11

In order to be an effective counselor concerning sexuality
for a pregnant mother, an APN must first?

Question options:

Be aware of her own feelings, values, and attitudes toward
sex

Interview the spouse concerning sexual desires

Complete an in-depth study of the sexual behaviors of
pregnant females

Have in-depth knowledge about the client and her needs

Question 12

After the occurrence of a potential bioterrorism disaster,
what is the best initial action by the APN acting as leader of the disaster
response team?

Question options:

Begin to triage victims

Set up a command area near the disaster site

Call for additional emergency management personnel

Assess the scene to determine area safety

Question 13

The mother of a 14 year old boy is concerned her son is
developing at a slower pace than other boys his age. He has small testes with no pubic or facial
hair. The physical exam is unremarkable
except for the identifed areas of concern.
What is the appropriate response by the APN?

Question options:

Assure the mother her son is developing as expected

Suggest a referral to a pediatric endocrinologist for
further evaluation

Recommend a recheck with possible hormone levels if no
improvement in 6 months

Admit to the hospital for further diagnostic tests and
evaluation

Question 14

Which is the best choice by an APN for the initial
management of a second degree burn on the left forearm?

Question options:

Irrigate with chlorhexidine and apply a dry dressing

Debride the wound and apply a saline wet to dry dressing

Irrigate the wound with normal saline and apply Silvadence
cream to the effected area twice daily

Administer 800mg Motrin (ibuprophen) PO and cover the wound
with a sterile dressing

Question 15

Which statements are accurate regarding licensure for an
advanced practice nurse? (select all that apply)

Question options:

Licensure as an advanced practice nurse requires
verification of educational training from an accredited graduate program

Once licensed as an advanced practice nurse, any
governmental agency may review the status of the license

Licensure is required to claim status as an advance practice
nurse and treat clients under the direction of a physician

All 50 states require passage of the national certification
exam to treat clients as an advance practice nurse

The national certification exam ensures a minimum level of
competency to practice

Question 16

A 55 year old male presented to a walk in clinic at a local
pharmacy complaining of chest pain radiating to the lower jaw. He is pale, diaphoretic with a blood pressure
of 90/40 and a heart rate of 50 beats per minute. What is the next best action by the APN?

Question options:

Call 911

Administer a 81mg Aspirin PO stat

Obtain a 12 lead electrocardiogram

Assess the lungs bilaterally

Question 17

Which statements regarding protocol agreements are
true? (select all that apply)

Question options:

A protocol agreement with a physician is no a requirement
for an APN in this country

Protocol agreements should be reviewed annually by the
physician and the APN.

If an APN is sued for negligence, the physician engaged in
the protocol agreement is not held liable

A protocol agreement with a physician is a requirement for
the APN to practice in the United States

A protocol agreement can protect an APN from certain
lawsuits

Question 18

Which of these clients do not require parental consent for
treatment by an APN? (select all that apply)

Question options:

16 year old male showing signs and symptoms of type 1 diabetes

15 year old female asking for birth control pills

14 year old female asking for a serum pregnancy test

17 year old male needing treatment for chlamydia

16 year old female asking for help with dysmenorrhea

Question 19

A 40 year old landscape worker presented to the ED with a
snake bite from a coral snake on the right index finger. The bite occurred 15 minutes earlier. The client reported no difficulty breathing
or swallowing only severe discomfort at the bite site. What is the most appropriate action by the
APN?

Question options:

Call the regional poison control center for treatment
recommendations

Consult with the neurologist on staff

Refer the client to a hematologist

Apply a tourniquet to the right upper extremity

Question 20

A 20 year old presented to the emergency department with a
confirmed brown recluse spider bite on the right hand. The bite occurred approximately 24 hours
earlier and has now become edematous, erythematous and draining a purulent,
foul smelling liquid. The wound is painful
and extremely wam on palpation. What is
the appropriate action by the APN?

Question options:

Order Magnetic Resonance Imaging (MRI) of the wound

Call the poison control center and obtain most current
recommended treatment regimen

Begin Keflex (cephalexin) PO and refer to an infectious
disease specialist

Immediate referral to a soft tissue surgeon

Question 21

A 40 year old presented to a primary care office
approximately 30 minutes after a sting by a bee. The client stated, “I was scared since
the last time I was stung by a bee I had difficulty breathing”. The site of the bite is painful with slight
bleeding and edema. What is the next
best response by the APN?

Question options:

“Have you taken any medications since you were
stung?”

“What were you doing when you were stung?”

“Please describe what happened the last time you were
stung.”

“Are you short of breath right now?”

Question 22

A 20 year old male presented to the emergency department
(ED) with an acute exacerbation of asthma.
Initial treatment was nebulized Proventil (Albuterol) and 100% oxygen
via a non-rebreather. A recheck 30
minutes post treatment revealed a lethargic client with a heart rate of 90
beats per minute, respiratory rate of 18 breaths per minute, temperature of
99.8 degrees Fahrenheit, and a blood pressure of 10268. The results of an arterial blood gas (ABG)
showed a pH of 7.32, PaCO2 of 47mm Hg, HCO3 24, and a PaO2 of 86%. The most appropriate action by the APN would
be?

Question options:

Begin intravenous Aminophylline and order a d-dimer STAT

Treat with intravenous and inhaled steroids and recheck ABG
in 30 minutes

Admit to the intensive care unit (ICU) and order a consult
with a pulmonologist

Prepare for intubation with signs of impending respiratory
failure

Question 23

A 16 year old client presented to the ED with circumoral
cyanosis and bilateral wheezes on auscultation.
The client appeared anxious and is leaning forward with the upper
extremities flared out. After initiating
oxygen via 2 Liters nasal cannula, an ABG revealed pH 7.36, pCO2 52 mmHg, HCO3
of 26 mEq/L and PaO2 of 60 mm Hg. What
is the next best intervention by the APN?

Question options:

Switch oxygen delivery to 55% via Venturi Mask

Refer to a pulmonologist immediately

Order Proventil (Albuterol) 2 puffs followed with Prednisone
20mg PO for one dose

Administer Ativan (Lorazepam) 2mg IV

Question 24

An 80 year old male client presented the ED complaining of
acute, severe abdominal pain that came on suddenly in the middle of the
night. Three years prior he suffered a
myocardial infarction (MI) and has been on Lopressor (Metoprolol) 50mg PO twice
daily since that time. The abdominal
assessment revealed a non-tender abdomen on palpation with no pulsatile masses. Heart rate 110 beats per minute, blood pressure
80/50, respirations 28 breaths per minute, oxygen saturation 88% on 2 liters
nasal cannula and hemeoccult positive in the stool. What should the APN consider the most likely
diagnosis?

Question options:

Peritonitis

Esophageal varices

Mesenteric ischemia

Ruptured appendix

Question 25

The APN is called to examine a client who was ready for
discharge after resolution of gastrointestinal bleeding as a sequelae to peptic
ulcer disease but has now spiked a temperature of 102.4 degrees Farenheit with
slight abdominal discomfort. No nausea
or vomiting were reported. The client
had been in the hospital for 2 days with no complaints and the bleeding
resolved with IV fluids and proton pump inhibitors. What should the APN include in the diagnostic
tests? (select all that apply)

Question options:

Arterial blood gas

Electrolyte panel

Liver biopsy

Abdominal ultrasound

CT scan of the abdomen

Barium swallow

CBC with differential

Question 26

Which complaint paired with acute abdominal pain would
necessitate an immediate referral by the APN to a gastric surgeon?

Question options:

Vomiting nearly every hour since the onset of the abdominal
pain 6 hours prior

Vomiting beginning 8 hours post onset of severe abdominal
pain

Vomiting starting 4 hours prior to the onset of the
abdominal pain

Lack of vomiting with severe abdominal pain of 2 hours
duration

Question 27

A 48 year old female was presented to the ED by paramedics
after a serious motor vehicle accident intubated, unresponsive, with IV Normal
Saline and Dopamine at 5 mcg/kg/min infusing.
The client’s son meets her at the ED and states, “My mother has a
living will and all treatment should be stopped now. This is not what she wanted.” What is appropriate response by the APN?

Question options:

“We will continue care until the risk management unit
can arrive to speak with you.”

“Do you have power of attorney to make this
decision?”

“We will not go any further until we see the living
will.”

“I must evaluate the client to determine if the living
will is applicable in this situation.”

Question 28

While obtaining consent for an exploratory laparotomy, the
client stated, “I am a Jehovah’s Witness and we do not believe in blood
transfusions. I will not consent to a
blood transfusion.” What is the
appropriate response by the APN?

Question options:

“I understand your right to choose. I have reviewed the risks for the procedure
and would ask that you sign this informed consent checking the box indicating
refusal of a blood transfusion.”

“I would suggest you consider an autologous blood
transfusion which should not violate your religious beliefs.”

“You may need a blood transfusion. I suggest you speak with the physician before
refusing this possible life saving treatment.”

“This procedure has a great risk of significant blood
loss. I am unable to move forward
without your consent.”

Question 29

Which statement is accurate regarding reimbursement through
Medicare for services provided by an APN?

Question options:

The APN can only receive Medicare reimbursement for primary
care services and not in hospital fees.

State laws guiding Medicaid dispersal directly effect
Medicare reimbursement for the APN

Medicare reimbursement can be obtained for ANP services at
85% of physician reimbursement for provided in collaboration with a physician

Part A covers outpatient care and part B provides
reimbursement for inpatient care

Question 30

A newly licensed ANP accepted a position at a major tertiary
care facility. The liability coverage
offered in the employment package contains claims-made malpractice insurance
coverage as part of the compensation.
What is the best action by the new APN?

Question options:

No further coverage is needed and any incident should be
protected

Refuse company coverage and negotiate for payment of a
liability plan chosen by the APN

Request tail coverage
and an occurrence based policy as additional terms of the employment
contract

Hire an attorney specializing in workplace contracts to
review the document before accepting the position

Question 31

When obtaining informed consent the APN knows the client
must understand: (select all that apply)

Question options:

Adverse effects of the treatment

Risks of the treatment

Benefits of the treatment

Alternatives for treatment

Anticipated costs

Knowledge of the diagnosis

Nature and purpose of the treatment

Question 32

A 70 year old client receiving palliative care in hospice
stated, “I don’t want a CT scan of my head. I do not understand how this will improve my
comfort.” When the APN explains the
CT scan will not impact palliative care for care, which ethical duty is being
implemented?

Question options:

Veracity

Autonomy

Justice

Beneficence

Question 33

Which statement is accurate when explaining the National
Practitioner Data Bank?

Question options:

A compilation of legal actions levied against advanced
practice nurses and physicians.

A collection of volutary listings for APN’s based on
professional area of licensure and expertise

A governmental resource of current and past legislation
pertinent the APN

This Data Bank is a professional registry for APN’s

Question 34

Which choices are goals of pain management in palliative
care?

Question options:

support of family care givers

determination of effective pain managment regimens

establishing the cause of pain

alleviation of all pain

prevention of pain

Question 35

Which statements about hospice care are accurate? (select all that apply)

Question options:

Medicare will not pay for in home hospice care

Referrals to hospice care can only initiated by a physician

Medicare guidelines for referral to hospice care specific
that life expectancy of the client should be less than 1 year

Medicare guidelines for referral to hospice care specific
that life expectany of the client should be less than 6 months

Hospice is available to terminally ill clients

Question 36

Which client is considered an appropriate referral to
hospice?

Question options:

A 58 year old male admitted for insertion of a automated
implantable cardiac defibrillator (AICD)

A 33 year old male with human immunodeficiency virus (HIV)
infection with Kaposi’s sarcoma

A 65 year old male admitted for exacerbation of COPD

A 45 year old female with metastatic breast cancer admitted
with liver and brain metastasis unable to stand, speak or eat.

Question 37

While treating a 30 year old man for viral pneumonia, an HIV
test returns positive. The man refuses
to tell his wife and threatens the APN with a lawsuit if the wife finds
out. What is the appropriate response by
the APN?

Question options:

Refer the client to an infectious disease specialist and
refuse further care due to ethical concerns regarding the wife

Explain to the client the importance of informing his wife
and the need to support his family

Set up an appointment with the wife to discuss her husband’s
HIV status

Contact the local health department with the results

Question 38

When caring for a 42 year old female with stage IV
metastatic breast cancer, the client refuses further treatment and states,
“I won’t to go home and be with my family” By discharing the client, which ethical
principle is the APN upholding?

Question options:

Autonomy

Veracity

Beneficence

Nonmaleficence

Question 39

While caring for a 90 year old client suffering from
respiratory and heart failure, what should the APN consider when determining
futility of care? (select all that apply)

Question options:

Recommendations by interdisciplinary care team

Stated family preference if available

Stated client preference if available

Quality of life

Financial burden of extending care

Question 40

What areas should the APN consider vital components of
informed consent? (select all that apply)

Question options:

Legal cases outstanding against the physician performing the
procedure

Prognosis without treatment

Prognosis with treatment

Alternatives to the proposed treatment

Cost of proposed treatment

Purpose of proposed treatment

The type of proposed treatment

Question 41

When explaining the purpose of a diagnostic related group
(DRG) to a nurse, the appropriate response by the APN would include:

Question options:

A treatment classification system that assigns a fixed
hospital payment rate

A previously determined percent of cost paid by the client

A classification of payment for the uninsured

A graduated scale of cost based on insured and uninsured
stats

Question 42

A new APN working at a primary care clinic asks her mentor
to explain capitation. What is the
appropriate response by the senior APN?

Question options:

Basic fee for service provided

A fixed fee paid to the provider per patient per month
for those patients enrolled in that
particular insurance plan

Maximum amount paid by an insurer per patient for
preventative healthcare

Maximum amount of eligibility for coverage for in hospital
treatment

Question 43

Which individual may issue a certificate of death? (select
all that apply)

Question options:

Representative from applicable insurance provider

Medical Examiner

Advance practice nurse

Coroner

Physician

Hospital administrator

Question 44

A 20 year old male with Down’s syndrome presented for a
yearly physical exam. He stated,
“This paper says you will do a functional status exam. Will that hurt?” What is the appropriate response by the APN?

Question options:

“This exam will require you to read and write.”

“No. I will talk
with you about what you do everyday, listen to your heart and lungs and talk
with you about how you feel.”

“We don’t do that exam in the office you will be
referred for out patient services at the hospital.”

“I don’t do that exam but the physician in this
practice will take a look at you.”

Question 45

A mother presents her 4 year old to the primary care office
and states,”We just found out all the paint in our old house has
lead. My child has been vomiting on and
off for a week and I am concerned about lead poisoning.” What is the next best intervention by the
APN?

Question options:

Call the poison control hotline

Immediately refer the child to a pediatric
gastroenterologist

Order an abdominal ultrasound

Obtain blood for serum lead level

Question 46

A 20 year old male presented to the ED after suffering a
suffering multiple human bites on his right hand and forearm. What the next best intervention by the APN?

Question options:

Refer for a surgical consult

Irrigate the wound and leave open to air for drainage

Obtain x-rays of the effected limb to ascertain depth of
puncture and possible fractures

Begin Keflex(Cephalexin) 500mg twice daily PO and recheck in
7 days

Question 47

A 50 year old plumber presented the ED after spilling drain
cleaner in both eyes. He stated, “I
washed both eyes out at the job site with my emergency saline kit but they
still burn and are painful.” What
is the next best intervention by the APN?

Question options:

Administer 800mg Motrin (Ibuprophen) PO STAT

Phone the poison control hotline

Assess visual acuity

Refer to an opthamologist

Question 48

An APN student asked the instructor, “Could you explain
the meaning of statue of limitations?”
What is the correct response by the nursing instructor?

Question options:

A rule allowing a client to add facilities and ancillary
personnel to a suit claiming malpractice

The first date allowable for a client to file a suit
claiming malpractice

The amount of proof required to win a legal case of
negligence

A rule which establishes the maximum time allowed for a
legal suit to be filed for a particular incident.