NU 665
Advanced Practice
Specialty Procedures
and Skills for Acute
Care Review Exam
Q&A
2024
, 1. A 65-year-old male patient with a history of chronic obstructive
pulmonary disease (COPD) and hypertension presents to the clinic with
dyspnea, wheezes, and productive cough. He reports that he has been
using his albuterol inhaler more frequently in the past week. His vital
signs are: blood pressure 160/90 mmHg, pulse 100 beats/min, respiratory
rate 24 breaths/min, oxygen saturation 92% on room air. What is the most
appropriate initial action by the nurse practitioner?
a) Prescribe a short course of oral corticosteroids
b) Order a chest x-ray and sputum culture
c) Refer the patient to a pulmonologist
d) *Increase the dose of his antihypertensive medication*
Rationale: The patient is experiencing an acute exacerbation of COPD,
which is a common cause of dyspnea, wheezes, and productive cough in
this population. The most appropriate initial action by the nurse
practitioner is to increase the dose of his antihypertensive medication, as
hypertension is a risk factor for worsening COPD and can lead to
pulmonary edema, heart failure, and arrhythmias. Oral corticosteroids may
be indicated for severe exacerbations, but they have significant side
effects and should not be used as first-line therapy. A chest x-ray and
sputum culture may be helpful to rule out pneumonia or other infections,
but they are not urgent and do not address the underlying cause of the
exacerbation. Referring the patient to a pulmonologist may be appropriate
for long-term management, but it does not provide immediate relief for the
patient's symptoms.
2. A 70-year-old female patient with a history of type 2 diabetes mellitus
and peripheral neuropathy presents to the clinic with a non-healing ulcer
on her left foot. She reports that she noticed the ulcer about two weeks ago
after wearing a new pair of shoes. She has been applying antibiotic
ointment and changing the dressing daily, but the ulcer has not improved.
On examination, the ulcer is 2 cm in diameter, with yellowish exudate and
surrounding erythema. There is no palpable pulse in the left dorsalis pedis
artery. The patient's blood glucose level is 250 mg/dL. What is the most
appropriate intervention by the nurse practitioner?
a) *Refer the patient to a vascular surgeon*
b) Prescribe oral antibiotics and debride the ulcer
c) Order an ankle-brachial index (ABI) and Doppler ultrasound
Advanced Practice
Specialty Procedures
and Skills for Acute
Care Review Exam
Q&A
2024
, 1. A 65-year-old male patient with a history of chronic obstructive
pulmonary disease (COPD) and hypertension presents to the clinic with
dyspnea, wheezes, and productive cough. He reports that he has been
using his albuterol inhaler more frequently in the past week. His vital
signs are: blood pressure 160/90 mmHg, pulse 100 beats/min, respiratory
rate 24 breaths/min, oxygen saturation 92% on room air. What is the most
appropriate initial action by the nurse practitioner?
a) Prescribe a short course of oral corticosteroids
b) Order a chest x-ray and sputum culture
c) Refer the patient to a pulmonologist
d) *Increase the dose of his antihypertensive medication*
Rationale: The patient is experiencing an acute exacerbation of COPD,
which is a common cause of dyspnea, wheezes, and productive cough in
this population. The most appropriate initial action by the nurse
practitioner is to increase the dose of his antihypertensive medication, as
hypertension is a risk factor for worsening COPD and can lead to
pulmonary edema, heart failure, and arrhythmias. Oral corticosteroids may
be indicated for severe exacerbations, but they have significant side
effects and should not be used as first-line therapy. A chest x-ray and
sputum culture may be helpful to rule out pneumonia or other infections,
but they are not urgent and do not address the underlying cause of the
exacerbation. Referring the patient to a pulmonologist may be appropriate
for long-term management, but it does not provide immediate relief for the
patient's symptoms.
2. A 70-year-old female patient with a history of type 2 diabetes mellitus
and peripheral neuropathy presents to the clinic with a non-healing ulcer
on her left foot. She reports that she noticed the ulcer about two weeks ago
after wearing a new pair of shoes. She has been applying antibiotic
ointment and changing the dressing daily, but the ulcer has not improved.
On examination, the ulcer is 2 cm in diameter, with yellowish exudate and
surrounding erythema. There is no palpable pulse in the left dorsalis pedis
artery. The patient's blood glucose level is 250 mg/dL. What is the most
appropriate intervention by the nurse practitioner?
a) *Refer the patient to a vascular surgeon*
b) Prescribe oral antibiotics and debride the ulcer
c) Order an ankle-brachial index (ABI) and Doppler ultrasound
