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?
Prescribe 50mg Benadryl (diphenhydramine) PO now and recheck in 24 hours
Order a stat chest x-ray
Administer nebulized albuterol mixed with saline and repeat PRN
Give epinephrine 1:1,000 intramuscularly immediately
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?Call 911 with a referral to the emergency departmentDiscontinue Lanoxin (digoxin) and admit to the hospital for further diagnostic testsOrder a stat TSH, electrolyte panel, and digoxin levelRefer to a cardiologist immediately
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.Order stat CT scan of the headConsult with physician specializing in adults with developmental disabilitiesConsider the finding normal and recommend recheck in 3 monthsCall employer for detailed record of client’s actions
Question 4. Advance practice nurses secure the right to practice legally from which collection of documents?State laws in which the practitioner residesNurse Practice Act of the state where the practitioner is licensedApproval by the board of executives at the state board of nursing where the practitioner residesSuccessful passage of national certification exam from the American Nurses’ Credentialing Center
Question 5. Which statement best describes the mechanism of action for RhoGAM?Destroys maternal antibodies for Rh positive fetal red blood cellsStimulates manufacturing of maternal antibodies to decrease risk for hemolysis with a Rh negative fetusPromotes the destruction of maternal antibodies against Rh negative fetal blood cellsIncreases manufacturing of maternal antibodies to destroy Rh positive and negative fetal blood antigens
Question 6. Which client should the APN in the emergency department assess first?A 25 year old male with a 4 inch long and 0.5 inch wide laceration on his left upper arm suffered after fightA 40 year old male with electrical burns on his hands and face from a work site accidentA 30 year old female complaining of pain when urinating and intermittent nauseaA 2 year old with a history of possibly swallowing a dime
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?”Your son can play wearing traditional protective gear and has no limitations”He must be cleared of cervical instability and then he can play some sports preferably those with less contact.””I can perform the physical however based on legal concerns I will not certify your son healthy to wrestle.””I will need to refer your son to a neurologist for further evaluation to assure he is healthy for wrestling.”
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?Cover the secondary burns with dry sterile dressingsAssess for dyspnea or stridorBegin intravenous infusion of Normal Saline at at 175 ml/hourAdminister 4mg Morphine Sulfate intravenously
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