NRNP6566 2021 June Week 5 Knowledge Check Latest

NRNP6566 Advanced Care of Adults in Acute Settings I

Week 5 Knowledge Check  

Question 1          A 26-year-old male was injured in a motorcycle crash 3 days ago. He sustained 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?                          

Question 2          A 66-year-old man is taking warfarin due to his atrial fibrillation. He noted 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 called by the ER with the result of the INR ordered. The INR is 9.8. What is the appropriate treatment of this patient?                                    

Question 3          A 66-year-old man was evaluated for shortness of breath for the last three months. Diagnostic work up confirmed a pulmonary embolism. He is alert and oriented. 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?              

Question 4          Renee is a 56-year-old female that fell about a week ago and sprained 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 noticed 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 discolored. 1-2+ edema noted 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)?         

Question 5          A 64-year-old man diagnosed 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 be initiated and how would you discontinue the warfarin?                                

Question 6          The APRN is prescribing treatment for a 44-year-old male with DVT. He is currently on enoxaparin 90 mg subq every 12 hours. Warfarin is going to be used for oral therapy. What does and duration should be ordered for this patient?                                              

Question 7          A 56-year-old male is taking warfarin 3 mg daily for treatment of a DVT / PE. He has his INR monitored 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?                                     

Question 8          A 44-year-old male is admitted 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?                                            

Question 9          A 45-year-old male is evaluated for complaints of severe low back and left leg pain. His MRI shows a herniated disk at L4L5. He has been recommended for a lumbar laminectomy surgery to treat the herniated disk. The patient had a cardiac stent placed 3 weeks ago and is currently on Plavix post procedure. When will the patient be able to have the lumbar surgery?                                           

Question 10        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 associated 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?