BADNAP NP4 Final Exam
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Free BADNAP NP4 Final Exam Questions
A patient is admitted to the emergency department with possible renal trauma after an automobile accident. Which prescribed intervention will the nurse implement first?
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Check blood pressure and heart rate.
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Administer morphine sulfate 4 mg IV.
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Transport to radiology for an intravenous pyelogram.
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Insert a urethral catheter and obtain a urine specimen.
Explanation
Correct Answer: (A) Check blood pressure and heart rate.
In a client with possible renal trauma following a motor vehicle accident, the priority is hemodynamic assessment. The kidneys are highly vascular organs and renal trauma can cause significant internal hemorrhage leading to hypovolemic shock. Checking blood pressure and heart rate first allows the nurse to rapidly identify signs of hemodynamic instability such as hypotension and tachycardia, which require immediate intervention and guide all subsequent care decisions.
Why Other Options are Incorrect:
B. Administering morphine for pain management is important but is not the first priority. Hemodynamic stability must be assessed and established before pain medication is administered, as opioids can cause vasodilation and worsen hypotension in a hemorrhaging client.
C. Transporting to radiology for an intravenous pyelogram is a diagnostic procedure that is performed after the client is hemodynamically stabilized, not before assessing vital signs.
D. Inserting a urethral catheter and obtaining a urine specimen is an important assessment for hematuria in renal trauma, but catheterization should not be the first intervention before confirming hemodynamic stability and ruling out urethral injury.
When admitting a client in possible respiratory failure with a high PaCO2, which assessment information will be of most concern to the RN?
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The client's Glasgow Coma Scale (GCS) score is 9.
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The client's PaO2 is 64 mm Hg.
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The client complains of overall weakness and tingling sensations.
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The client's blood pressure is 162/94.
Explanation
Correct Answer: (A) The client's Glasgow Coma Scale (GCS) score is 9.
A GCS score of 9 indicates a significant alteration in level of consciousness and neurological status. In the context of hypercapnic respiratory failure with elevated PaCO2, a GCS of 9 signals CO2 narcosis, a dangerous state where carbon dioxide buildup causes central nervous system depression that can rapidly progress to respiratory arrest. This is the most immediately life-threatening finding and requires urgent intervention including possible intubation.
Why Other Options are Incorrect:
B. A PaO2 of 64 mm Hg indicates hypoxemia and is concerning, but it is less immediately life-threatening than a severely decreased level of consciousness that signals imminent respiratory arrest.
C. Overall weakness and tingling sensations are symptoms of hypercapnia and hypoxia but are not as urgent as an altered level of consciousness indicating impending neurological and respiratory decompensation.
D. A blood pressure of 162/94 mm Hg is elevated and requires monitoring, but hypertension in respiratory failure is often a compensatory response and is not the most immediately concerning finding compared to a GCS of 9.
Which of these findings is of highest priority? (1) (2) What should the nurse do next? (3)
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BP 98/60
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HR 102 bpm
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RR 24
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Temp 98.2°F (36.7°C)
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SpO2 84% on 2L/min via nasal cannula.
Explanation
Correct Answer:
Finding 1: SpO2 84% on 2L/min via nasal cannula.
Finding 2: Respiratory rate of 24/min.
Finding 3: Reassess the patient immediately and increase supplemental oxygen, then notify the provider.
An SpO2 of 84% is critically low and represents severe hypoxemia that is immediately life-threatening, making it the highest priority finding. A normal SpO2 should be 95% or above, and 84% indicates the patient is not receiving adequate oxygenation despite being on 2L/min nasal cannula. The elevated respiratory rate of 24/min confirms respiratory distress and the body's attempt to compensate for inadequate oxygenation. The hypotension of 98/60 and tachycardia of 102 bpm also reflect hemodynamic compromise consistent with acute decompensated heart failure.
The nurse must immediately go to the bedside to personally reassess the patient, increase the oxygen delivery to a higher flow rate or upgrade to a non-rebreather mask, and promptly notify the provider of the deteriorating respiratory and hemodynamic status to initiate urgent interventions including possible diuresis, vasopressors, or respiratory support.
Which observation of the patient made by the nurse is most indicative of Parkinson's disease?
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Large, embellished handwriting
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Weakness of one leg resulting in a limping walk
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Difficulty in rising from a chair and beginning to walk
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Onset of muscle spasms occurring with involuntary movement
Explanation
Correct Answer: (C) Difficulty in rising from a chair and beginning to walk.
Difficulty rising from a chair and initiating walking is a hallmark manifestation of Parkinson's disease known as akinesia, or the difficulty initiating voluntary movement. This is directly related to the dopamine deficiency affecting the basal ganglia, which impairs the ability to start and smoothly execute voluntary motor movements. Freezing of gait and postural instability are classic features of Parkinson's disease.
Why Other Options are Incorrect:
A. Large, embellished handwriting is the opposite of what is seen in Parkinson's disease. Parkinson's produces micrographia, which is abnormally small and cramped handwriting, as a result of the rigidity and bradykinesia affecting fine motor control.
B. Weakness of one leg causing a limping gait is more characteristic of an upper motor neuron lesion such as a stroke or multiple sclerosis. Parkinson's disease primarily causes rigidity, bradykinesia, and tremor rather than unilateral leg weakness causing a limp.
D. Muscle spasms with involuntary movement describe conditions such as dystonia or chorea seen in Huntington's disease. Parkinson's disease is characterized by a resting tremor that decreases with intentional movement, not spasms with involuntary movement.
The Glasgow Coma Scale (GCS) uses which categories to assess neurological function? Select all that apply.
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Motor response
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Limb ataxia
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Verbal response
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Facial palsy
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Eye response
Explanation
Correct Answer: (A) Motor response, (C) Verbal response, and (E) Eye response.
The Glasgow Coma Scale is a standardized neurological assessment tool that evaluates three specific categories. Eye opening response is scored from 1 to 4, assessing whether the client opens their eyes spontaneously, to voice, to pain, or not at all. Verbal response is scored from 1 to 5, assessing the quality of the client's speech from oriented conversation to no verbal response. Motor response is scored from 1 to 6, assessing the best motor response from following commands to no movement. The maximum total score is 15 indicating full consciousness, and a score of 8 or below indicates a coma.
Why Other Options are Incorrect:
B. Limb ataxia is assessed as part of the National Institutes of Health Stroke Scale and other neurological tools, not the Glasgow Coma Scale.
D. Facial palsy is also assessed in stroke-specific tools such as the NIH Stroke Scale but is not one of the three components of the Glasgow Coma Scale.
The nurse is caring for a post operative renal transplant recipient patient. The nurse becomes concerned about hypovolemia based on which clinical criteria? Select the two (2) that apply.
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High CVP reading of 16mm Hg
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Bradycardia and diaphoresis
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Low CVP reading of 1 mm Hg
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Tachycardia and diaphoresis
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Jugular vein distention
Explanation
Correct Answer: (C) Low CVP reading of 1 mm Hg and (D) Tachycardia and diaphoresis.
In hypovolemia, there is insufficient circulating blood volume. A low CVP of 1 mm Hg indicates reduced venous return and decreased right-sided filling pressure, which is a direct hemodynamic marker of hypovolemia. Tachycardia is the compensatory response to decreased cardiac output and tissue hypoperfusion, while diaphoresis reflects sympathetic nervous system activation in response to circulatory compromise. Together these findings confirm hypovolemia in the post-transplant client.
Why Other Options are Incorrect:
A. A high CVP of 16 mm Hg indicates fluid overload or right heart failure, which is the opposite of hypovolemia.
B. Bradycardia is not associated with hypovolemia. The compensatory response to volume depletion is tachycardia, not bradycardia.
E. Jugular vein distention is a sign of fluid overload or elevated right-sided venous pressure, which is the opposite finding of hypovolemia.
Order: KCL 40 mEq per liter of D5W IV to infuse at 2 mEq per hour. The rate of infusion is (1) ________________ (mL/hr) mL per hour.
Explanation
Correct Answer: (1) 50 mL/hr
To solve this, use the following calculation:
The bag contains 40 mEq of KCL in 1000 mL (1 liter) of D5W. The ordered rate is 2 mEq per hour.
First, find the concentration: 1000 mL ÷ 40 mEq = 25 mL per mEq.
Then multiply by the desired rate: 25 mL/mEq × 2 mEq/hr = 50 mL/hr.
The infusion rate is therefore 50 mL/hr.
An older client is admitted to the hospital with a sodium level of 113 mEq/L and potassium level of 5.2 mEq/L. He does not recognize family members and is aggressive and confused. The family asks what is going on. What would be the correct reply by the nurse?
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"Most older clients get confused when they come to the hospital."
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"His behavior is a result of his elevated potassium level causing dehydration."
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"His sodium level is low and the confusion may resolve as the levels reach normal."
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"He may be suffering from dementia and being in the hospital has worsened his confusion."
Explanation
Correct Answer: (C) "His sodium level is low and the confusion may resolve as the levels reach normal."
A sodium level of 113 mEq/L is critically low, well below the normal range of 135 to 145 mEq/L, indicating severe hyponatremia. Hyponatremia causes neurological symptoms including confusion, agitation, aggression, and altered level of consciousness due to cerebral edema from osmotic fluid shifts into brain cells. The nurse's response accurately identifies the cause of the behavior and provides the family with realistic hope that symptoms may improve with treatment.
Why Other Options are Incorrect:
A. Dismissing the confusion as a normal occurrence in older hospitalized clients is inaccurate, potentially dangerous, and does not address the underlying critical electrolyte imbalance causing the symptoms.
B. While the potassium of 5.2 mEq/L is slightly elevated, it is not critically abnormal and does not cause the aggressive confusion observed. The primary cause is the severe hyponatremia, not the potassium level.
D. Assuming dementia without assessment or diagnostic confirmation is inappropriate. The acute onset of confusion directly correlates with the critically low sodium level and must be attributed to hyponatremia until proven otherwise.
A client has been admitted to the emergency department with multiple injuries including flail chest. Respiratory rate is 18 and pulse oximeter shows 92% SpO2. Because of the client's fractured ribs, the RN should assess for signs of which of the following?
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Metabolic alkalosis.
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Metabolic acidosis.
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Respiratory alkalosis.
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Respiratory acidosis.
Explanation
Correct Answer: (D) Respiratory acidosis.
Flail chest caused by multiple rib fractures results in paradoxical chest wall movement that severely compromises effective ventilation. The inability to breathe adequately leads to hypoventilation, causing carbon dioxide to accumulate in the blood. This retention of CO2 results in respiratory acidosis, characterized by a decreased pH and elevated PaCO2. The SpO2 of 92% already reflects the early stages of this respiratory compromise.
Why Other Options are Incorrect:
A. Metabolic alkalosis results from conditions such as prolonged vomiting, excessive antacid use, or nasogastric suctioning, none of which are related to the mechanical breathing impairment caused by flail chest.
B. Metabolic acidosis results from conditions such as DKA, renal failure, or severe diarrhea involving a loss of bicarbonate or gain of metabolic acids, which is not the primary mechanism in flail chest injury.
C. Respiratory alkalosis results from hyperventilation causing excessive CO2 elimination. In flail chest, the paradoxical movement causes hypoventilation and CO2 retention, which is the opposite of what produces respiratory alkalosis.
A patient has been intubated for 9 days on SIMV. The physician would like to strengthen the patient to prepare him for extubation. Which ventilator mode does the nurse anticipate the physician will order?
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Assist Control
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Pressure Control
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Pressure Support
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Pressure Regulated Volume Control
Explanation
Correct Answer: (C) Pressure Support.
Pressure Support Ventilation is the mode used to wean and strengthen a patient in preparation for extubation. In pressure support mode, the ventilator delivers a set level of positive pressure assistance with each breath the patient initiates, but the patient controls the rate, timing, and tidal volume. This mode exercises and strengthens the respiratory muscles by requiring the patient to do more of their own work of breathing while still providing support, making it ideal for weaning after prolonged mechanical ventilation.
Why Other Options are Incorrect:
A. Assist Control delivers a full machine breath with every patient-triggered effort and provides a backup rate. It provides too much support for weaning as it does not require sufficient respiratory muscle effort from the patient.
B. Pressure Control delivers breaths at a set pressure and rate controlled by the ventilator, providing full ventilatory support without requiring the patient to strengthen their respiratory muscles independently.
D. Pressure Regulated Volume Control combines pressure control with volume targeting and is used for full ventilatory support in patients with poor respiratory drive, not for weaning preparation.
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