NSG555 / NSG 555 Exam 4: Nurse Practitioners in Primary Care I | Complete Guide with Questions and Verified Answers | (Latest 2026/2027 Update) All Modules Covered | 100% Correct | Grade A - Wilkes

NSG555 / NSG 555 Exam 4: Nurse Practitioners in Primary Care I | Complete Guide with Questions and Verified Answers | (Latest 2026/2027 Update) All Modules Covered | 100% Correct | Grade A - Wilkes What are the primary functions of the renal system? Regulates fluid and electrolytes, removes wastes, regulates acid/base balance, controls blood pressure via RAAS, and stimulates red blood cell production via erythropoietin. What triggers the RAAS system? Low blood pressure or low sodium levels. What is the role of renin in the RAAS system? Renin converts Angiotensinogen to Angiotensin I. What does Angiotensin II do? It is a vasoconstrictor that stimulates Aldosterone release to retain sodium and water. What gerontologic considerations affect renal function in older adults? Sclerosis of the glomerulus, decreased blood flow, decline in GFR, decreased bladder capacity, and higher risk of drug-drug interactions. What does an elevated BUN indicate? It measures urea nitrogen but is affected by fluid status and protein metabolism. What does a BUN to Creatinine ratio of 10:1 to 20:1 indicate? Normal range; an increase suggests dehydration, while a maintained ratio with elevated levels suggests intra-renal damage. What is the pathophysiology of a Urinary Tract Infection (UTI)? Microorganisms, usually E. coli, enter the urethra and multiply, potentially progressing from Cystitis to Pyelonephritis. What are common interventions for managing a UTI? Increase fluid intake, void frequently, avoid irritants (coffee, tea, citrus, spices, alcohol), and administer antibiotics and Pyridium. What is urinary retention? Inability to empty the bladder completely, often caused by obstruction, anesthesia, or anticholinergic medications. What are the types of urinary incontinence? Stress, urge, and functional incontinence. What are nursing interventions for urinary incontinence? Kegel exercises, bladder training, and skin care to prevent breakdown. What is CAUTI prevention? Bundle protocol including sterile insertion technique, maintaining a closed drainage system, and daily perineal care. What defines Acute Kidney Injury (AKI)? A reversible syndrome resulting in decreased GFR and oliguria. What are the causes of AKI? Pre-renal (hypoperfusion), intra-renal (nephrotoxic drugs), and post-renal (obstruction). What are the phases of AKI? Onset, oliguric, diuretic, and recovery phases. What is Chronic Kidney Disease (CKD)? Progressive, irreversible deterioration of kidney function requiring dialysis. What are the primary risk factors for CKD? Diabetes and hypertension. What is the significance of fluid management in CKD? Strict fluid restrictions and daily weights; 1 kg weight gain equals 1000 mL fluid retention. What is hemodialysis? A treatment that uses a vascular access (AV fistula or graft) to remove toxins and fluids. What should be monitored for in patients undergoing hemodialysis? Assess fistula for patency; do not use the arm for blood pressure or blood draws. What is peritoneal dialysis? A treatment that uses the peritoneal membrane for filtration. What complication indicates peritonitis in peritoneal dialysis? Cloudy drainage. What is an isotonic IV fluid? A fluid with the same osmolality as blood, used to expand volume. What is a hypotonic IV fluid? A fluid with lower osmolality than blood, moving fluid from vasculature into cells/interstitial space. What is a hypertonic IV fluid? A fluid with higher osmolality than blood, pulling fluid from cells into vasculature. What are common causes of fluid volume deficit (hypovolemia)? Vomiting, diarrhea, hemorrhage, diuretics, and diaphoresis. What are signs and symptoms of hypovolemia? Weight loss, decreased skin turgor, dry mucous membranes, hypotension, tachycardia, concentrated urine, elevated BUN to creatinine ratio. What are the complications of hypovolemia? Hypovolemic shock, characterized by hypotension, tachycardia, and cool clammy skin. What are nursing interventions for hypovolemia? Fluid replacement and daily weights. What are common causes of fluid volume excess (hypervolemia)? Heart failure, renal failure, cirrhosis, and excess sodium intake. What are signs and symptoms of hypervolemia? Weight gain, edema, jugular venous distention (JVD), crackles in lungs, S3 heart sound. What are nursing interventions for hypervolemia? Fluid restriction, diuretics, and dialysis. What is the normal serum sodium level? 135 to 145 mEq/L; changes affect neurological status. What is the normal serum potassium level? 3.5 to 5.0 mEq/L; changes affect cardiac status. What is the Glasgow Coma Scale (GCS)? A scale that scores eye, motor, and verbal responses; a score of 8 or less indicates severe issues requiring intubation. What does PERRLA stand for in pupil assessment? Pupils Equal, Round, Reactive to Light and Accommodation. What is the pronator drift test? A test assessing motor function; one arm drifting down indicates motor deficit. What are gerontologic changes in neurological assessment? Slower reaction times, decreased cerebral blood flow, and declines in short-term memory. What is an ischemic stroke? A stroke caused by a blockage (thrombus or embolus) leading to ischemia and infarct. What is the treatment for an ischemic stroke? tPA (IV thrombolysis) must be given within a specific window after ruling out bleeding via CT scan. What is the penumbra in stroke terminology? The ischemic but salvageable tissue surrounding the infarct; the goal is to save this tissue. What is a hemorrhagic stroke? A stroke caused by bleeding into the brain, such as from a ruptured aneurysm or hypertension. What are symptoms of a hemorrhagic stroke? Severe 'thunderclap' headache. What are nursing priorities in stroke management? Immediate CT scan to determine stroke type; perform a swallow screen before any oral intake. What are the phases of a seizure? Preictal (aura), Ictal (the seizure event), Postictal (recovery period). What is status epilepticus? A seizure lasting more than 5 minutes; considered a medical emergency requiring airway management. What are nursing interventions during a seizure? Ensure safety, do not restrain the patient, position on the side to maintain airway. What are signs and symptoms of meningitis? Fever, headache, photophobia, nuchal rigidity. What are Kernig and Brudzinski signs? Kernig: Pain when extending the leg with hip flexed; Brudzinski: Neck flexion causes involuntary hip/knee flexion. What is autonomic dysreflexia? Occurs in injuries above T6; caused by a strong sensory trigger like a full bladder. What are symptoms of autonomic dysreflexia? Severe hypertension, headache, bradycardia, flushing above the injury level. What is neurogenic shock? Loss of sympathetic tone resulting in hypotension and bradycardia. What is osteoporosis? A condition where bone resorption exceeds formation, leading to brittle bones. What is the treatment for osteoporosis? Bisphosphonates, calcium, and vitamin D. What is osteomalacia? Softening of bones due to vitamin D deficiency. What is the management for osteomyelitis? Long-term IV antibiotics via PICC line; monitor antibiotic trough levels. What are precautions for total hip arthroplasty (THA)? Do not flex hip more than 90 degrees, do not cross legs, avoid internal rotation. What is the care for amputations? Use prone positioning for 20 to 30 minutes daily to prevent hip contractures. What is phantom pain? Pain perceived in the area of an amputated limb; treat as real pain using medications or alternative therapies. What is the primary medication class used to treat UTIs and what is a common example? Antibiotics; common examples include trimethoprim-sulfamethoxazole (Bactrim) or nitrofurantoin (Macrobid). What is the purpose of phenazopyridine (Pyridium) in UTI management? It is a urinary analgesic that provides symptomatic relief from dysuria, burning, and urgency by numbing the urinary tract mucosa. It does NOT treat the infection itself and will turn urine orange/red. What medication is commonly used to manage hypertension, a primary risk factor for CKD? ACE inhibitors (e.g., lisinopril) or ARBs (e.g., losartan) are often preferred as they can also offer renal protection. What class of medications is used to manage fluid volume excess in CKD and heart failure? Diuretics, such as loop diuretics (e.g., furosemide) or thiazide diuretics (e.g., hydrochlorothiazide). What is a key medication used to treat hyperkalemia in AKI or CKD? Potassium binders like sodium polystyrene sulfonate (Kayexalate) or patiromer (Veltassa) bind to potassium in the gut to promote its excretion. Insulin and glucose can also be used emergently to shift potassium into cells. What is the primary medication class used to treat ischemic stroke? Thrombolytics, such as alteplase (tPA), which dissolve blood clots. Anticoagulants (e.g., heparin, warfarin) and antiplatelets (e.g., aspirin, clopidogrel) are used for prevention and management. What class of medications is used to manage blood pressure in hemorrhagic stroke? Antihypertensives, particularly calcium channel blockers (e.g., nimodipine), are used to control blood pressure and prevent vasospasm. Anticoagulants are contraindicated. What is the first-line medication for status epilepticus? Benzodiazepines, such as lorazepam (Ativan) or diazepam (Valium), are administered IV to quickly stop seizure activity. What medications are commonly prescribed for migraine headaches? Triptans (e.g., sumatriptan) are abortive medications that constrict blood vessels. NSAIDs and antiemetics may also be used. What is the primary medication class used to treat osteoporosis? Bisphosphonates (e.g., alendronate) slow bone resorption. Calcium and Vitamin D supplements are also crucial. What medications are used to manage pain in phantom limb sensation? Various analgesics, including NSAIDs, opioids, anticonvulsants (e.g., gabapentin), and antidepressants, may be used. What factors can affect urinary elimination? Personal factors (anxiety, time, privacy), sociocultural factors, nutrition (caffeine, alcohol, salt), hydration, medications (diuretics, anticholinergics, nephrotoxins), surgery/anesthesia, pathological conditions (obstruction, inflammation, neurological disorders), immobility, and cognitive changes. What are examples of nephrotoxic medications? Some antibiotics (gentamicin, amphotericin B) and high doses or long-term use of aspirin and ibuprofen. What is the nursing priority when assessing a patient with suspected AKI? Monitor intake and output (I&O), daily weights, and laboratory values (BUN, creatinine, electrolytes) closely, especially during the oliguric phase. What is a key nursing intervention during the diuretic phase of AKI? Carefully replace fluids and monitor electrolytes to prevent dehydration and electrolyte depletion, as the damaged tubules cannot concentrate urine effectively. What is the most accurate indicator of fluid loss or gain in an acutely ill patient? Daily weights. A 1 kg weight gain is equivalent to 1000 mL of fluid retention. What are the primary risk factors for Chronic Kidney Disease (CKD)? Diabetes mellitus and hypertension are the primary risk factors. Others include chronic glomerulonephritis, pyelonephritis, obstructions, hereditary lesions, vascular disorders, and long-term exposure to medications or toxins. What nursing interventions are crucial for managing fluid status in CKD patients? Assess for signs of fluid volume excess, maintain accurate I&O, monitor daily weights, enforce prescribed fluid restrictions, and provide frequent oral hygiene. What is the goal of hemodialysis? To extract toxic nitrogenous substances from the blood and remove excess fluid using diffusion, osmosis, and ultrafiltration. What is a critical nursing consideration for patients with an arteriovenous (AV) fistula or graft for hemodialysis? Protect the access site; assess for patency and signs of infection. Do not use the arm with the fistula/graft for blood pressure measurements or blood draws. What complication of peritoneal dialysis requires immediate attention? Cloudy drainage, which is a sign of peritonitis. What is the primary role of the nervous system? To control all bodily functions, including motor, sensory, autonomic, cognitive, and behavioral activities. What are the two main types of nerve cells and their functions? Neurons are impulse-conducting cells facilitating communication (afferent/sensory, efferent/motor, interneurons). Neuroglia support, nourish, and protect neurons and form the myelin sheath. What is the significance of the myelin sheath? It insulates nerve axons and helps conduct electrical impulses faster. What is a synapse? The site where electrical impulses travel from one neuron to another neuron, gland, or muscle, often involving neurotransmitters. What is the primary neurotransmitter of the sympathetic nervous system? Norepinephrine. What is the primary neurotransmitter of the parasympathetic nervous system? Acetylcholine. What is the most reliable indicator of neurological deterioration? Changes in the Level of Consciousness (LOC). What does a Glasgow Coma Scale (GCS) score of 8 or less indicate? Severe neurological issues, often prompting the mnemonic 'Less than 8, intubate'. What are the four main components of a basic neurological assessment? Level of Consciousness (LOC), Pupillary Response, Motor Function, and Sensory Function. What is pronator drift? A test of motor function where one arm drifting downward and pronating suggests a motor deficit, often indicating an upper motor neuron lesion. What are common gerontologic changes in neurological assessment? Slower reaction times, decreased cerebral blood flow, decreased tactile sensation, diminished temperature and pain perception, and potential decline in short-term memory and mental efficiency. What is the difference between an ischemic and a hemorrhagic stroke? An ischemic stroke is caused by a blockage (thrombus or embolus), while a hemorrhagic stroke is caused by bleeding into the brain. What is a critical nursing priority immediately after a suspected stroke? Perform a bedside swallow screen before any oral intake to prevent aspiration. What are the three phases of a seizure? Preictal (aura), Ictal (the seizure event), and Postictal (recovery period). What are key nursing interventions during a seizure? Ensure patient safety (bed low, padded rails), do not restrain the patient, position on the side to maintain airway, and have suction and oxygen readily available. What are the classic signs and symptoms of meningitis? Fever, severe headache, nuchal rigidity (stiff neck), photophobia (sensitivity to light), nausea, and vomiting. What are Kernig's and Brudzinski's signs, and what do they indicate? Both are physical exam findings indicative of meningeal irritation. Kernig's sign: pain and resistance on leg extension with hip flexed. Brudzinski's sign: passive neck flexion causes involuntary hip and knee flexion. What are the symptoms of autonomic dysreflexia? Severe hypertension (often 300 mmHg systolic), pounding headache, bradycardia or tachycardia, diaphoresis and flushing above the injury level, and pallor below the injury level. What are the primary nursing interventions for osteoporosis? Promote understanding of the condition and treatment, relieve pain, improve bowel elimination, and prevent injury through physical activity and safety measures. What is a key diagnostic finding that helps differentiate osteomalacia from osteoporosis? Elevated Alkaline Phosphatase (ALP) levels are characteristic of osteomalacia, whereas ALP levels are typically normal in osteoporosis. What are the nursing considerations for a patient with osteomyelitis? Administer IV antibiotics (monitor peak and trough levels), manage pain, immobilize the affected limb, promote circulation, perform neurovascular assessments, and implement strict wound care. What are the precautions for a patient who has undergone a total hip arthroplasty (THA)? Avoid flexing the hip more than 90 degrees, do not cross the legs, and avoid internal rotation of the hip. What is phantom pain after an amputation? Pain perceived in the area of the amputated limb; it should be treated as real pain using appropriate analgesics or alternative therapies. What are nursing considerations for patients with altered LOC? Monitor respiratory status, maintain airway (HOB elevated, positioning, suctioning), prevent injury (skin breakdown, falls, DVT), maintain fluid balance, and provide sensory stimulation/orientation. What is the significance of a sudden change in pupil size or reactivity? It can indicate a serious neurological emergency such as a stroke, brain injury, drug overdose, or hypoxia. What are the nursing priorities for a patient experiencing a seizure? Ensure safety, protect the airway, administer medications as prescribed, monitor respiratory status, and document the seizure activity. What are the nursing considerations for managing meningitis? Administer antibiotics, manage symptoms (fever, pain), maintain fluid balance, perform frequent neurological assessments, and implement droplet precautions. What are the nursing interventions for autonomic dysreflexia? Monitor BP closely, administer antihypertensives, identify and remove the noxious stimulus (e.g., empty bladder, relieve constipation), loosen restrictive clothing, and elevate HOB. What is the priority nursing action for a patient experiencing autonomic dysreflexia? Immediately check for and relieve potential triggers, such as a distended bladder or bowel impaction. What is the immediate nursing priority in managing a patient with a suspected stroke? Time is brain. Rapid assessment, CT scan to determine stroke type, and administration of tPA if indicated are critical. What are the nursing considerations for managing a patient with a hemorrhagic stroke? Strict blood pressure control, ongoing neurological assessments, monitoring for vasospasm, and managing potential complications like re-bleeding. What are the nursing interventions for impaired swallowing post-stroke? Perform bedside swallow screens, consult speech therapy, implement aspiration precautions, and ensure proper head-of-bed elevation during and after meals. What are the nursing interventions for stress management? Promote health, manage anxiety/fear/anger, teach stress management techniques (relaxation), identify support systems, and provide crisis intervention if needed. What are the nursing considerations for a patient in crisis? Assess the situation, ensure safety, defuse anxiety, determine the problem, decide on help needed, and assist the patient to return to a precrisis level of functioning. What are the nursing considerations for managing low back pain? Administer pain medications, encourage non-pharmacological interventions (heat/ice, PT), teach proper body mechanics, and assess vital signs for pain manifestations. What are the nursing considerations for a patient with a herniated nucleus pulposus (herniated disc)? Administer pain and corticosteroid medications, position for comfort (e.g., high Fowler's with pillow under knee), encourage ROM, and teach proper body mechanics. What are the nursing interventions for a patient with a spinal cord injury (SCI) regarding respiratory function? Support respiratory function through airway clearance techniques, coughing assistance, suctioning as needed, and monitoring respiratory status. What are the nursing interventions for a patient with a spinal cord injury (SCI) regarding cardiovascular status? Administer IV fluids and vasopressors as ordered, prevent DVT (compression stockings, anticoagulants), and monitor vital signs closely for hypotension and bradycardia. What are the nursing considerations for a patient undergoing external fixation (Ex-fix)? Perform meticulous pin site care, assess for signs of infection or loosening, maintain neurovascular status, and support the extremity and frame when moving. What are the key nursing interventions post-Total Knee Arthroplasty (TKA)? Perform neurovascular checks, encourage early mobility, manage pain effectively, implement DVT prevention, monitor wound drainage, and educate on signs of infection and home safety. What is a critical NCLEX pearl regarding pillows after a TKA? Do not place a pillow behind the knee, as this can promote flexion contractures and impede circulation. What are the nursing priorities for a patient with a fracture? ABCs first, immobilize the limb above and below the injury, perform neurovascular assessments, prevent infection, and manage pain. What are the signs and symptoms of compartment syndrome, a serious fracture complication? The 6 P's: Pain (out of proportion), Paresthesia, Paralysis, Pallor, Pulselessness, and Poikilothermia. What is the immediate nursing action if compartment syndrome is suspected? Notify the provider immediately. Do NOT elevate the limb, as this can further compromise blood flow. What are the nursing considerations for a patient with a pelvic fracture? Monitor for hemorrhage, neurovascular status, bladder/urethral injury, and bowel injury. Ensure appropriate immobilization and early mobilization as ordered. What are the restrictions for a patient with a posterior approach Total Hip Arthroplasty (THA)? Hip flexion must be less than 90 degrees, avoid crossing legs (adduction past midline), and avoid internal rotation of the hip. What are the nursing considerations for a patient who has undergone an amputation? Manage pain (including phantom pain), promote wound healing, achieve physical mobility (positioning, ROM, strengthening), and provide psychological support. What is a key nursing intervention for promoting wound healing and preventing contractures in an amputee? Encourage prone positioning for 20-30 minutes daily to help prevent hip contractures and promote proper limb shaping.