NRNP 6566 Week 5 Knowledge Check (Collection)

(NRNP 6566 Week 5 Knowledge Check)

NRNP 6566 Week 5 Knowledge Check (Version 1)

1. Question: Renee is a 56-year-old female that fell about a week ago and … her R ankle. She states she has been taking it easy and laying around her home for most of the last week so it would heal. Yesterday she … that her calf was sorer than it had been, and her R foot and ankle were more swollen than they had been. She came to urgent care today because she was afraid that the injury was worse than she thought it was. T 99.2 BP 128/77 HR 88 RR 18 Wt 126 pounds Heart S1S2 regular rate and rhythm, Lungs clear, Abdomen soft R ankle is swollen but not …. 1-2+ edema … Dorsiflexion causes some discomfort in the ankle and calf area. Pedal pulses equal bilaterally… The APRN orders a duplex ultrasound of the right leg. Radiology reports that the ultrasound is positive for a deep vein thrombosis. How would you manage this patient (include labs and meds)?
2. Question: A 26-year-old female is currently on Lovenox 80 mg subq daily. What labs should the APRN order to monitor this patient?
3. Question: A 64-year man is recovering from a transurethral resection of the prostate for treatment of benign prostate hyperplasia. The patient is receiving intravenous antibiotics for the urinary tract infection. The post-operative course has been smooth and the APRN is removing the 3-way Foley catheter when there is a sudden release of bright red blood with many blood clots in the Foley bag. The patient becomes hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms and legs. The patient was immediately … to the surgical intensive care unit (SICU) and a stat hematology consult was … Stat CBC, d-dimer, peripheral blood smear, partial thromboplastin time, Prothrombin time/international normalization ratio (INR), and fibrinogen labs were drawn. Results were:
4. Question: A 66-year-old man is taking warfarin due to his atrial fibrillation. He … that his gums were bleeding yesterday while eating. Today he had a coughing spell and has been spitting up bright red blood ever since. The APRN is … by the ER with the result of the INR … The INR is 9.8. What is the appropriate treatment of this patient?
5. Question: A 64-year-old man … with a pulmonary embolism is currently on warfarin. His INR readings have been very inconsistent, and the decision is made to change his medication to Rivaroxaban (Xarelto). What dose should … and how would you discontinue the warfarin?
6. Question: Diagnostic work up … a pulmonary embolism. He is alert and … Vital signs are stable. He is ambulatory. He has a stable home environment and good support from his wife. He is on day 2 of treatment with Lovenox 90 mg every 12 hours. The patient wants to go home. Would you discharge him? How would you manage his medications?
7. A 26-year-old male was … in a motorcycle crash 3 days ago. He … an acute subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury and resulting paralysis. He has a warm swollen right lower leg. Duplex ultrasound of the right lower leg is positive. What is the best treatment for this patient?
8. Question: A 45-year-old male is … for complaints of severe low back and left leg pain. His MRI shows a … disk at L4L5. He has been … for a lumbar laminectomy surgery to treat the … disk. The patient had a cardiac stent … 3 weeks ago and is currently on Plavix post procedure. When will the patient … able to have the lumbar surgery?
9. Question: The APRN is prescribing treatment for a 44-year-old male with… He is currently on enoxaparin 90 mg subq every 12 hours. Warfarin is going to … for oral therapy. What does and duration should … for this patient?
10. Question: A 56-year-old male is taking warfarin 3 mg daily for treatment of a DVT / PE. He has his INR … every 4 weeks. His INR today is 3.1 and his last INR is 2.9. There have been no changes in his medications or health.

NRNP 6566 Week 5 Knowledge Check (Version 2)

1. Question: A 54-year women is 3 days post abdominal surgery for removal of a cancerous mass in her abdomen. She develops acute shortness of breath … with tachycardia and hypotension. CT Scan of the chest is positive for multiple small pulmonary embolism. What medication and dosing would you order initially to treat the pulmonary embolism?
2. Question:A 64-year man is recovering from a transurethral resection of the prostate for treatment of benign prostate hyperplasia. The patient is receiving intravenous antibiotics for the urinary tract infection. The post-operative course has been smooth and the APRN is removing the 3-way Foley catheter when there is a sudden release of bright red blood with many blood clots in the Foley bag. The patient becomes hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms and legs. The patient was immediately … to the surgical intensive care unit (SICU) and a stat hematology consult was … Stat CBC, d-dimer, peripheral blood smear, partial thromboplastin time, Prothrombin time/international normalization ratio (INR), and fibrinogen labs were drawn. Results were:… CBC with markedly … platelet count, peripheral blood smear … number of platelets and presence of large platelets and … red cells (schistocytes), prothrombin time … as was the partial thromboplastin time. The d-dimer was markedly …, and fibrinogen level was low…. Based on the clinical presentation and laboratory data …, what is your working diagnosis?
3. Question: A 26-year-old male was … in a motorcycle crash 3 days ago. He … an acute subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury and resulting paralysis. He has a warm swollen right lower leg. Duplex ultrasound of the right lower leg is positive. What is the best treatment for this patient?
4. Question: A 44-year-old male is … to the orthopedic unit following a motor vehicle crash. He has a femur fracture of the right leg. He is not actively bleeding and healthy. He weighs 185 pounds. What should the APRN order as DVT prophylaxis?
5. Question: A 16-year-old male is brought to the Urgent Care by her mother who states that the girl has had an abnormal number of bruises and “funny looking red splotches” on her legs. Bruises were … about 2 weeks ago and have … in number since this time. There is no history of trauma to explain the bruising. Past medical history not remarkable and she takes no medications. The mother does state the girl is recovering from a “bad case of mono” and was on bedrest at home for the past 3 weeks. The girl … that her gums were slightly bleeding when she … her teeth that morning.Lab work … show a normal hemoglobin and hematocrit with normal white blood cell (WBC) count and differential. Platelet count of 50,000/mm3 was the only abnormal finding. The staff also … that the venipuncture site … for a few minutes after pressure was released. Immune thrombocytopenia purpura (ITP) is suspected. What additional diagnostics should … ? If this diagnosis is …, how would you treat it?
6. Question: A 44-year-old female with a mechanical mitral heart valve is … for elective abdominal surgery next week. The patient currently takes warfarin 5 mg daily for prevention of thrombus. The patient is high risk for blood clot formation and needs to … once her warfarin is … for surgery. How would you manage this patient’s anticoagulants during the pre- and post-operative period?
7. Question: A 56-year-old male is taking warfarin 3 mg daily for treatment of a DVT / PE. He has his INR … every 4 weeks. His INR today is 3.1 and his last INR is 2.9. There have been no changes in his medications or health.What is his INR goal? How would you manage his INR today?
8. Question: A 66-year-old man is taking warfarin due to his atrial fibrillation. He … that his gums were bleeding yesterday while eating. Today he had a coughing spell andhas been spitting up bright red blood ever since. The APRN is … by the ER with the result of the INR … The INR is 9.8. What is the appropriate treatment of this patient?
9. Question: A 64-year-old man … with a pulmonary embolism is currently on warfarin. His INR readings have been very inconsistent, and the decision is made to change his medication to Rivaroxaban (Xarelto). What dose should … and how would you discontinue the warfarin?
10. Question: Renee is a 56-year-old female that fell about a week ago and … her R ankle. She states she has been taking it easy and laying around her home for most of the last week so it would heal. Yesterday she … that her calf was sorer than it had been, and her R foot and ankle were more swollen than they had been. She came to urgent care today because she was afraid that the injury was worse than she thought it was.T 99.2 BP 128/77 HR 88 RR 18 Wt 126 pounds Heart S1S2 regular rate and rhythm, Lungs clear, Abdomen soft R ankle is swollen but not … 1-2+ edema … Dorsiflexion causes some discomfort in the ankle and calf area. Pedal pulses equal bilaterally The APRN orders a duplex ultrasound of the right leg. Radiology reports that the ultrasound is positive for a deep vein thrombosis. How would you manage this patient (include labs and meds)?