NURS 6560 – ADVANCED PRACTICE CARE OF
ADULTS IN ACUTE CARE SETTINGS II – FINAL
EXAM 180 Questions with Solutions (Graded
A+) – Walden University
Question 1: The AGACNP is reviewing a chart of a head-injured patient.
Which of the following would alert the AGACNP to the possibility that the
patient is overhydrated, thereby increasing the risk for increased intracranial
pressure?
A) BUN = 10
B) Shift output = 800 ml, shift input = 825 ml (unchanged weight)
C) Serum osmolality = 260
D) Serum sodium = 145 mEq/L
Correct Answer:✓C) Serum osmolality = 260
Rationale: Normal serum osmolality is 285–295 mOsm/kg. A low osmolality
(260) indicates dilutional hyponatremia from overhydration, which can
worsen cerebral edema and increase ICP.
Question 2: A patient who has been in the ICU for 17 days develops
hypernatremic hyperosmolarity. The patient weighs 132 lb (59.9 kg), is
intubated, and is receiving mechanical ventilation. Serum osmolality is 320
mOsm/L. Clinical signs include tachycardia and hypotension. The AGACNP’s
initial treatment is to:
A) Reduce serum osmolality by infusing 5% dextrose in 0.2% sodium
chloride solution
B) Reduce serum sodium concentration by infusing 0.45% sodium chloride
solution
C) Replenish volume by infusing 0.9% sodium chloride solution
D) Replenish volume by infusing 5% dextrose in water solution
,Correct Answer:✓C) Replenish volume by infusing 0.9% sodium
chloride solution
Rationale: The patient is hypovolemic (tachycardia, hypotension). In
hypernatremia with hypovolemia, initial resuscitation is with isotonic saline
(0.9% NS) to restore volume. After volume repletion, free water (D5W or
hypotonic fluids) can be used to correct hypernatremia slowly.
Question 3: 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 denies diarrhea. Vital signs: T 101.9°F, P 100, R 16, BP 110/70.
WBC 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
Correct Answer:✓C) McBurney’s sign
Rationale: Fever, RLQ pain, elevated WBC, and vomiting are classic for acute
appendicitis. McBurney’s sign (tenderness at two-thirds the distance from
umbilicus to ASIS) is a key finding. Murphy’s sign is for cholecystitis;
Chvostek’s for hypocalcemia; Kernig’s for meningitis.
Question 4: Myasthenia gravis is best described as:
A) An imbalance of dopamine and acetylcholine in the basal ganglia
B) Demyelination of peripheral ascending nerves
C) Demyelination in the central nervous system
D) An autoimmune disorder characterized by decreased neuromuscular
activation
Correct Answer:✓D) An autoimmune disorder characterized by
decreased neuromuscular activation
Rationale: Myasthenia gravis is an autoimmune disorder with antibodies
against acetylcholine receptors at the neuromuscular junction, leading to
fluctuating muscle weakness.
,Question 5: When a patient is hospitalized with a possible stroke, the
AGACNP recognizes that the stroke most likely resulted from a
subarachnoid hemorrhage when the patient’s family reports that the
patient:
A) Has a history of atrial fibrillation
B) Was unable to be aroused in the morning
C) Had been complaining of a headache before losing consciousness
D) Has had several brief episodes of mental confusion and right arm and
leg weakness
Correct Answer:✓C) Had been complaining of a headache before losing
consciousness
Rationale: Subarachnoid hemorrhage often presents with a sudden, severe
“thunderclap” headache followed by loss of consciousness. Atrial fibrillation
suggests embolic stroke; transient episodes suggest TIAs.
Question 6: A 32-year-old man comes to the clinic with back pain for 24
hours. He noticed pain on awakening, had played flag football the day
before but no injury. Acetaminophen minimal relief. Exam: pain on
palpation left lateral to L2-L5, full range of motion with some hesitancy.
Which is the most appropriate initial step?
A) Anti-inflammatory and muscle relaxant therapy
B) Epidural injection of a corticosteroid
C) MRI of the lumbar spine
D) Strict bed rest and application of moist heat to the lower back
Correct Answer:✓A) Anti-inflammatory and muscle relaxant therapy
Rationale: This presentation is consistent with acute mechanical back pain
without red flags. Conservative treatment with NSAIDs and muscle relaxants
is first-line. MRI is not indicated without neurological deficits or red flags.
Question 7: H. W. is a 33-year-old female after a fall from a tree.
Radiographs show transverse process fractures at T6 and T7. The AGACNP
knows that treatment will likely include:
A) Observation
B) Hyperextension casting
, C) Jewett brace
D) Surgical intervention
Correct Answer:✓A) Observation
Rationale: Transverse process fractures are typically stable injuries that do
not involve the spinal canal or neurological elements. Treatment is
supportive with pain control and observation.
Question 8: A patient with a possible stroke is found to have a
subarachnoid hemorrhage. Which diagnostic study is most definitive?
A) Non-contrast head CT
B) Lumbar puncture
C) CT angiography
D) Transcranial Doppler
Correct Answer:✓A) Non-contrast head CT
Rationale: Non-contrast CT is the initial study of choice for SAH, with high
sensitivity within 6 hours. If negative but suspicion high, lumbar puncture is
performed.
Question 9: A patient with myasthenia gravis is admitted with respiratory
distress. The most appropriate initial intervention is:
A) Administer pyridostigmine
B) Perform plasmapheresis
C) Assess forced vital capacity and negative inspiratory force
D) Intubate immediately
Correct Answer:✓C) Assess forced vital capacity and negative
inspiratory force
Rationale: In myasthenic crisis, objective pulmonary function tests guide
need for ventilatory support. Do not automatically intubate; assess first.
Question 10: Which finding in a patient with traumatic brain injury
indicates Cushing’s triad?
A) Hypotension, bradycardia, tachypnea
B) Hypertension, bradycardia, irregular respirations
ADULTS IN ACUTE CARE SETTINGS II – FINAL
EXAM 180 Questions with Solutions (Graded
A+) – Walden University
Question 1: The AGACNP is reviewing a chart of a head-injured patient.
Which of the following would alert the AGACNP to the possibility that the
patient is overhydrated, thereby increasing the risk for increased intracranial
pressure?
A) BUN = 10
B) Shift output = 800 ml, shift input = 825 ml (unchanged weight)
C) Serum osmolality = 260
D) Serum sodium = 145 mEq/L
Correct Answer:✓C) Serum osmolality = 260
Rationale: Normal serum osmolality is 285–295 mOsm/kg. A low osmolality
(260) indicates dilutional hyponatremia from overhydration, which can
worsen cerebral edema and increase ICP.
Question 2: A patient who has been in the ICU for 17 days develops
hypernatremic hyperosmolarity. The patient weighs 132 lb (59.9 kg), is
intubated, and is receiving mechanical ventilation. Serum osmolality is 320
mOsm/L. Clinical signs include tachycardia and hypotension. The AGACNP’s
initial treatment is to:
A) Reduce serum osmolality by infusing 5% dextrose in 0.2% sodium
chloride solution
B) Reduce serum sodium concentration by infusing 0.45% sodium chloride
solution
C) Replenish volume by infusing 0.9% sodium chloride solution
D) Replenish volume by infusing 5% dextrose in water solution
,Correct Answer:✓C) Replenish volume by infusing 0.9% sodium
chloride solution
Rationale: The patient is hypovolemic (tachycardia, hypotension). In
hypernatremia with hypovolemia, initial resuscitation is with isotonic saline
(0.9% NS) to restore volume. After volume repletion, free water (D5W or
hypotonic fluids) can be used to correct hypernatremia slowly.
Question 3: 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 denies diarrhea. Vital signs: T 101.9°F, P 100, R 16, BP 110/70.
WBC 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
Correct Answer:✓C) McBurney’s sign
Rationale: Fever, RLQ pain, elevated WBC, and vomiting are classic for acute
appendicitis. McBurney’s sign (tenderness at two-thirds the distance from
umbilicus to ASIS) is a key finding. Murphy’s sign is for cholecystitis;
Chvostek’s for hypocalcemia; Kernig’s for meningitis.
Question 4: Myasthenia gravis is best described as:
A) An imbalance of dopamine and acetylcholine in the basal ganglia
B) Demyelination of peripheral ascending nerves
C) Demyelination in the central nervous system
D) An autoimmune disorder characterized by decreased neuromuscular
activation
Correct Answer:✓D) An autoimmune disorder characterized by
decreased neuromuscular activation
Rationale: Myasthenia gravis is an autoimmune disorder with antibodies
against acetylcholine receptors at the neuromuscular junction, leading to
fluctuating muscle weakness.
,Question 5: When a patient is hospitalized with a possible stroke, the
AGACNP recognizes that the stroke most likely resulted from a
subarachnoid hemorrhage when the patient’s family reports that the
patient:
A) Has a history of atrial fibrillation
B) Was unable to be aroused in the morning
C) Had been complaining of a headache before losing consciousness
D) Has had several brief episodes of mental confusion and right arm and
leg weakness
Correct Answer:✓C) Had been complaining of a headache before losing
consciousness
Rationale: Subarachnoid hemorrhage often presents with a sudden, severe
“thunderclap” headache followed by loss of consciousness. Atrial fibrillation
suggests embolic stroke; transient episodes suggest TIAs.
Question 6: A 32-year-old man comes to the clinic with back pain for 24
hours. He noticed pain on awakening, had played flag football the day
before but no injury. Acetaminophen minimal relief. Exam: pain on
palpation left lateral to L2-L5, full range of motion with some hesitancy.
Which is the most appropriate initial step?
A) Anti-inflammatory and muscle relaxant therapy
B) Epidural injection of a corticosteroid
C) MRI of the lumbar spine
D) Strict bed rest and application of moist heat to the lower back
Correct Answer:✓A) Anti-inflammatory and muscle relaxant therapy
Rationale: This presentation is consistent with acute mechanical back pain
without red flags. Conservative treatment with NSAIDs and muscle relaxants
is first-line. MRI is not indicated without neurological deficits or red flags.
Question 7: H. W. is a 33-year-old female after a fall from a tree.
Radiographs show transverse process fractures at T6 and T7. The AGACNP
knows that treatment will likely include:
A) Observation
B) Hyperextension casting
, C) Jewett brace
D) Surgical intervention
Correct Answer:✓A) Observation
Rationale: Transverse process fractures are typically stable injuries that do
not involve the spinal canal or neurological elements. Treatment is
supportive with pain control and observation.
Question 8: A patient with a possible stroke is found to have a
subarachnoid hemorrhage. Which diagnostic study is most definitive?
A) Non-contrast head CT
B) Lumbar puncture
C) CT angiography
D) Transcranial Doppler
Correct Answer:✓A) Non-contrast head CT
Rationale: Non-contrast CT is the initial study of choice for SAH, with high
sensitivity within 6 hours. If negative but suspicion high, lumbar puncture is
performed.
Question 9: A patient with myasthenia gravis is admitted with respiratory
distress. The most appropriate initial intervention is:
A) Administer pyridostigmine
B) Perform plasmapheresis
C) Assess forced vital capacity and negative inspiratory force
D) Intubate immediately
Correct Answer:✓C) Assess forced vital capacity and negative
inspiratory force
Rationale: In myasthenic crisis, objective pulmonary function tests guide
need for ventilatory support. Do not automatically intubate; assess first.
Question 10: Which finding in a patient with traumatic brain injury
indicates Cushing’s triad?
A) Hypotension, bradycardia, tachypnea
B) Hypertension, bradycardia, irregular respirations
