ing viscous mucus that obstructs the airways, pancreas, sweat ducts, and vas deferens.

Pulmonary disorder characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency.

7 What medical term is used to identify an inflammatory disorder of the skin that is often considered synonymous with dermatitis and characterized by pruritus with lesions that have an indistinct border?

Eczema

Psoriasis

Atopic dermatitis

Pityriasis rosea

8 Identify whether the description of the skin lesion matches the disorder where it is found. (Select True or False)

Elevated, firm circumscribed area less than 1 cm in diameter: Wart (verruca) or lichen planus

True

False

9 Removal of part of the liver leads to the remaining liver cells undergoing compensatory

atrophy.

metaplasia.

hyperplasia.

dysplasia.

10 Identify whether the description matches the disorder. (Select True or False) GCU NUR641E Week 8 Final Exam Paper

Abnormal dilation of the vein within the spermatic cord – Varicocele

True

False

11 The risk of which cancer is greater if the man has a history of cryptorchidism?

Penile

Testicular

Prostate

Epididymal

12 Which substance is used to correct the chronic anemia associated with chronic renal failure?

Iron

Erythropoietin

Cobalamin (vitamin B12)

Folate

13 Diabetes insipidus is a result of:

antidiuretic hormone hyposecretion.

antidiuretic hormone hypersecretion.

insulin hyposecretion.

insulin hypersecretion.

14 Obesity acts as an important risk factor for type 2 diabetes mellitus by:

reducing the amount of insulin the pancreas produces.

increasing the resistance to insulin by cells.

obstructing the outflow of insulin from the pancreas.

stimulating the liver to increase glucose production.

15 Which statement best describes Raynaud’s disease?

Inflammatory disorder of small- and medium-sized arteries in the feet and sometimes in the hands

Neoplastic disorder of the lining of the arteries and veins of the upper extremities

Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes

Autoimmune disorder of the large arteries and veins of the upper and lower extremities

16 What is the medical term for a fungal infection of the nail plate?

Paronychia

Onychomycosis

Tinea corporis

Tinea capitis

17 Which proton-pump inhibitor should be avoided in a patient taking clopidogrel? GCU NUR641E Week 8 Final Exam Paper

Omeprazole

Lansoprazole

Pantoprazole

Rabeprazole

18 All of the following are important considerations when prescribing metronidazole except?

Instruct patient to avoid alcohol intake during therapy

Can lead to development of C. difficile infection

Monitor INR closely due a DDI with warfarin

Dose adjustments should be made in patients with renal or hepatic dysfunction

19 Which clinical manifestations of a urinary tract infection may be demonstrated in an 85-year-old individual?

Confusion and poorly localized abdominal discomfort

Dysuria, frequency, and suprapubic pain

Hematuria and flank pain

Pyuria, urgency, and frequency

20 Which hormone is required for water to be reabsorbed in the distal tubule and collecting duct?

Antidiuretic hormone

Aldosterone

Cortisol

Adrenocorticotropin hormone

21 All of the following are true regarding antiepileptics except:

Carbamazepine and phenytoin have numerous drug-drug interactions.

They are safe to use during pregnancy.

Therapeutic drug monitoring is often required to ensure therapeutic drug levels.

Phenytoin is a highly protein-bound drug.

22 Alpha1 adrenergic stimulation causes:

bronchial constriction

vascular constriction.

constriction of intestinal smooth muscle.

relaxation of intestinal smooth muscle.

23 Losartan (Cozaar) lowers the blood pressure by:

blocking calcium channels in the heart and blood vessels.

directly dilating arterioles without affecting veins.

suppressing the release of angiotensin-converting enzyme.

blocking angiotensin II at its receptors.

24 One major reason to discontinue captopril (Capoten), an ACE inhibitor, is:

hypertension.

hypokalemia.

angioedema.

angina.

25 Which of the following drugs works via antagonism of 5-HT (serotonin) receptors in the GI tract?

Ondansetron

Droperidol

Prochlorperazine

Aprepitant

26 After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result? GCU NUR641E Week 8 Final Exam Paper

Iron deficiency

Aplastic

Folic acid

Pernicious

27 Orthostatic hypotension refers to a decrease of at least ___ mmHg in systolic blood pressure or a decrease of at least _____ mmHg in diastolic blood pressure within 3 minutes of moving to a standing position.

10; 5

20; 10

30; 15

40; 20

28 Cell wall inhibitors include all of the following except

penicillins.

cephalosporins.

carbapenems.

tetracylclines.

29 Which of the following agents is considered a histamine receptor antagonist?

Maalox

Protonix

Zantac

Tums

30 Which of the following drugs is most likely to reduce the effectiveness of levofloxacin (Levaquin) when given concomitantly?

Amiodarone (Cordarone)

Metronidazole (Flagyl)

Calcium carbonate (Tums)

Warfarin (Coumadin)

31 Which stage of infection is occurring when the immune and inflammatory responses are triggered?

Incubation period

Prodromal stage

Invasion period

Convalescence

32 Which of the following is an advantage of the intravenous route of administration?

Reduced bioavailability

Avoidance of first-pass metabolism

Patient convenience

None of the above are advantages

33 Which of the following antifungal agents is known to cause significant nephrotoxicity and ototoxicity?

Caspofungin

Fluconazole

Amphotericin B

Nystatin

34 Which NSAID is generally considered the safest for use in patients with coronary artery disease?

Celecoxib

Indomethacin

Naproxen

Acetaminophen

35 An example of a beta agonist is:

Atenolol (Tenormin)

Clonidine (Catapres)

Isoproterenol (Isuprel)

Amlodipine (Norvasc)

36 Which of the following agents is a potent vasoconstrictor that can be used to manage acute GI bleeding?

Octreotide

Milrinone

Pantoprazole

Cimetidine

37 What type of fracture occurs at a site of a preexisting bone abnormality and is a result of a force that would not normally cause a fracture? GCU NUR641E Week 8 Final Exam Paper

Idiopathic

Incomplete

Pathologic

Greenstick

38 A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance?

Right heart failure

Left heart failure

Low-output failure

High-output failure

39 Your patient is taking carbamazepine, a CYP3A4 substrate, for his seizure disorder. He is experiencing signs of depression and decides to try St. John’s wort, which he purchased over-the-counter at the local pharmacy. Since St. John’s wort is a CYP3A4 inducer, which of the following may occur?

The patient may have an increased risk for seizure.

The patient may have an increased risk of carbamazepine-related toxicities.

The patient may need an increased dose of St. John’s wort.

No clinically-significant drug-drug interaction is likely to occur.

40 Advair (fluticasone/salmeterol) is a combination of which of the following?

Short-acting beta agonist and corticosteroid

Long-acting beta agonist and corticosteroid

Long-acting beta agonist and antihistamine

Short-acting beta agonist and antihistamine

41 Which of the following is true regarding adverse drug events?

They include medication errors, adverse effects, allergic reactions, and idiosyncratic reactions.

They are rarely preventable.

They are infrequent in the inpatient setting.

They are generally over-reported.

42 The function of arachnoid villi is to:

produce cerebrospinal fluid.

provide nutrients to the choroid plexuses.

transmit impulses within the meninges.

absorb cerebrospinal fluid into the cerebral venous sinuses.

43 The calcium and phosphate balance is influenced by which three substances?

Parathyroid hormone, ADH, and vitamin D

Parathyroid hormone, calcitonin, and vitamin D

Thyroid hormone, ADH, and vitamin D

Thyroid hormone, calcitonin, and vitamin D

44 The major therapeutic actions of NSAIDS include all of the following except

reduction of inflammation.

reduction of pain.

reduction of fever.

reduction of clotting factors.

45 Which of the following agents is available in an injectable form used to treat acute migraine headaches?

Sumatriptan (Imitrex)T7

Naldolol (Corgard)

Naproxen sodium (Anaprox)

Ergot preparations (Cafergot)

46 A patient presents with vomiting a coffee-ground looking substance; fatigue, postural hypotension; new onset systolic murmur; and cool, pale peripheries.

metabolic acidosis with partial respiratory compensation.

partial respiratory compensation.

metabolic acidosis.

acidosis.

47 Which statements are true regarding Koplik spots? (Select all that apply.)

Koplik spots are associated with rubeola.

They appear as white spots.

The lesions are surrounded by a red ring.

The lesions of Koplik spots are large in size.

Koplik spots are primarily found on buccal mucosa.

48 Which of the following medications is most likely to increase fall risk in the elderly?

Diazepam (Valium)

Cetirizine (Zyrtec)

Levofloxacin (Levaquin)

Lisinopril (Prinivil)

49 People with gout are at high risk for which comorbid condition?

Renal calculi

Joint trauma

Anemia

Hearing loss

50 The spread of microorganisms from mother to the baby across the placenta is termed

direct transmission.

vertical transmission.

horizontal transmission.

indirect transmission.

51 Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host DNA is the cause of which disease?

Hemolytic anemia

Pernicious anemia

Systemic lupus erythematosus

Myasthenia gravis

52 Thomas is admitted for symptoms of acute coronary syndrome. You determine that a nitroglycerin drip is indicated for his chest pain. What medication must you make sure he is not taking before writing this order?

An antihistamine

Sildenafil

A long-acting opioid

An anticoagulant

53 Which of the following laxatives is safest for long-term use?

Mineral oil

Methylcellulose (Citrucel)

Magnesium hydroxide (Milk of Magnesia)

Sennosides (Ex-lax)

54 Identify whether the term matches the corresponding characteristics. (Select True or False)

Gluten sensitivity – Celiac sprue

True

False

55 Identify whether the description of the skin lesion matches the disorder where it is found. (Select True or False)

Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in diameter: Psoriasis or seborrheic and actinic keratoses

True

False

56 During the history portion of a respiratory assessment, it is particularly important to ask if the patient takes which of the following drugs that may contribute to symptoms of a chronic cough?

Beta-2 agonists

Calcium channel blockers

Angiotensin-converting enzyme (ACE) inhibitor

Birth control pills

57 Which laboratory value is consistently low in a patient with diabetes insipidus (DI)?

Urine-specific gravity

Serum sodium

Urine protein

58 Which compensatory mechanism is spontaneously used by children diagnosed with Tetralogy of Fallot to relieve hypoxic spells?

Lying on their left side

Performing the Valsalva maneuver

Squatting

59 When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice?

Erythrocytes are destroyed in the spleen.

Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.

The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT).

The erythrocytes are coated with an immunoglobulin.

60 The nurse has a patient who has been on multidrug therapy for pulmonary tuberculosis. When planning patient education, the nurse knows the patient needs to watch for which symptom of an adverse effect of multidrug therapy?

Hearing loss

Changes in vision

Generalized pruritus

Jaundice

61 The drug of choice for a patient with right-sided infective endocarditis caused by S. aureus is

vancomycin.

Daptomycin

Telavancin

Clindamycin

62 Which of the following side effects is not commonly seen with ondansetron (Zofran)?

Constipation

Headache

QT-prolongation

Movement disorders

63 Which age group should be targeted for testicular cancer education and screening?

15 to 35 year olds

20 to 45 year olds

30 to 55 year olds

45 to 70 year olds

64 The collateral blood flow to the brain is provided by the:

carotid arteries.

basal artery.

Circle of Willis.

vertebral arteries.

65 Which of the following drugs acts on the parasympathetic nervous system?

Epinephrine

Atropine

Dopamine

Dobutamine

66 What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

Immature immune system

Small alveoli

Surfactant deficiency

Anemia

67 Which of the following drugs has coverage against pseudomonas?

Ceftriaxone (Rocephin)

Linezolid (Zyvox)

Piperacillin/Tazobactam (Zosyn)

Azithromycin (Zithromax)

68 Which of the following agents is considered first-line for management of opioid-induced constipation?

Methylcellulose

Mineral oil

Polyethylene glycol

Docusate

69 Sylvia, age 59, has acute hepatitis. You are told it is from a drug overdose. Which drug do you suspect?

Metronidazole (Flagyl)

Acetaminophen (Tylenol)

Sumatriptan (Imitrex)

Hydrocortisone (Cortisone)

70 What are the primary adverse effects associated with SSRIs?

Weight gain and decreased libido

Weight loss and decreased appetite

Sedation and QT-prolongation

Insomnia and hypertension

71 Identify whether the description of the skin lesion matches the disorder where it is found. (Select True or False)

Elevated circumscribed, superficial lesion filled with serous fluid, less than 1 cm in diameter: Urticaria, allergic reaction

True

False

72 An insufficient dietary intake of which vitamin can lead to rickets in children?

C

B12

B6

D

73 Bacteria that produce endotoxins that stimulate the release of inflammatory mediators that produce fever are called

pyrogenic bacteria.

true bacteria.

Exotoxins.

Spirochetes.

74 Serum levels of which of the following antiseizure drugs must be corrected based on the patient’s albumin level due to its high protein binding?

Valproic acid (Depakote)

Phenobarbital (Luminal)

Phenytoin (Dilantin)

Carbamazepine (Tegretol)

75 After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are the results of which mechanism? GCU NUR641E Week 8 Final Exam Paper

Anaphylactic reaction in which chemical mediators, such as histamine, prostaglandins, and leukotrienes, relax vascular smooth muscles, causing shock

Postoperative hemorrhage during which a large volume of blood is lost, causing hypotension with compensatory tachycardia

Concentrated bolus that moves from the stomach into the small intestine, causing hyperglycemia and resulting in polyuria and eventually hypovolemic shock

Rapid gastric emptying and the creation of a high osmotic gradient in the small intestine, causing a sudden shift of fluid from the blood vessels to the intestinal lumen

76 A person diagnosed with type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. The most probable cause of these symptoms is:

hyperglycemia caused by incorrect insulin administration.

dawn phenomenon from eating a snack before bedtime.

hypoglycemia caused by increased exercise.

Somogyi effect from insulin sensitivity.

77 Which of the following agents is preferred for the treatment of a patient who is asymptomatic with a serum sodium of 126?

3% NaCl

Tolvaptan

0.45% NaCl

0.9% NaCl

78 What is the most common cause of uncomplicated urinary tract infections?

Staphylococcus

Klebsiella

Proteus

Escherichia coli

79 Renal failure is the most common cause of which type of hyperparathyroidism?

Primary

Secondary

Exogenous

Inflammatory

80 Dilation of the ipsilateral pupil, following herniation, is the result of pressure on which cranial nerve (CN)?

Optic (CN I)

Abducens (CN VI)

Oculomotor (CN III)

Trochlear (CN IV)

81 Which of the following places a patient at risk for polypharmacy?

Lack of understanding of their medication regimen

Using multiple pharmacies

Seeing multiple providers

All of the above place a patient at risk for polypharmacy

82 Where is antidiuretic hormone (ADH) synthesized, and where does it act?

Hypothalamus; renal tubular cells

Renal tubules; renal collecting ducts

Anterior pituitary; posterior pituitary

Posterior pituitary; loop of Henle

83 Which diuretic acts by inhibiting sodium chloride reabsorption in the thick ascending limb of the loop of Henle?

Furosemide (Lasix)

Mannitol (Osmitrol)

Hydrochlorathiazide (HCTZ)

Acetazolamide (Diamox)

84 Which medical diagnosis is described as a chronic inflammatory joint disease characterized by stiffening and fusion of the spine and sacroiliac joints?

Ankylosing spondylitis

Rheumatoid arthritis

Paget disease

Fibromyalgia

85 Which antimicrobial should be avoided in children because it is deposited in tissues undergoing calcification and can stunt growth?

Tetracycline

Ciprofloxacin

Vancomycin

Amoxicillin

86 The nurse is caring for a patient who has chronic renal failure and hypertension. The correct classification for the hypertension is

primary.

secondary.

tertiary.

87 What type of immunity is produced when an immunoglobulin crosses the placenta?

Passive-acquired immunity

Active-acquired immunity

Passive-innate immunity

Active-innate immunity

88 Which agent is used to treat hepatic encephalopathy and works via “ion trapping,’ converting ammonia into ammonium in the GI tract?

Rifaximin

Lactulose

Octreotide

Neomycin

89 Which of the following is a potential risk associated with overuse of proton-pump inhibitors?

C. difficile infection

Gastroparesis

Hyponatremia

Esophageal cancer

90 What is the effect of increased secretions of epinephrine, glucagon, and growth hormone?

Hyperglycemia

Hypertension

Bronchodilation

Pupil dilation

91 Identify whether the description matches the disorder. (Select True or False) GCU NUR641E Week 8 Final Exam Paper

Rotation of a testis, which twists blood vessels of the spermatic cord – Testicular torsion

True

False

92 Which of the following agents is useful to treat COPD because of its anticholinergic effects?

Salmeterol (Serevent)

Tiotropium (Spiriva)

Albuterol (Proventil)

Prednisone (Deltasone)

93 Which disorder is characterized by the formation of abnormal new bone at an accelerated rate beginning with excessive resorption of spongy bone?

Osteomalacia

Paget’s disease

Osteoporosis

Osteosarcoma

94 Jaundice can be attributed to the following except?

Cholecystitis

Pyelonephritis

Sickle-cell anemia

Pancreatitis

95 Which of the following agents is considered a long-acting beta-agonist (LABA)?

Albuterol

Salmeterol

Fluticasone

Ipratropium

96 An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole, as well as a bounding pulse and a thrill on palpation. These clinical findings are consistent with which congenital heart defect?

Atrial septal defect (ASD)

Ventricular septal defect (VSD)

Patent ductus arteriosus (PDA)

Atrioventricular canal (AVC) defect

97 Which of the following best describes a Phase IV clinical trial?

Dose-finding study in healthy volunteers

Post-marketing study to detect potentially rare adverse effects

Randomized clinical trial in patients with the disease of interest done prior to FDA approval

Exploratory study done in animals to assess potential toxicities

98 Which second-generation antipsychotic comes in an injectable formulation approved for use in acute psychosis?

Olanzapine

Quetiapine

Aripiprazole

Ziprasidone

99 Which of the following benzodiazepines is preferred for the treatment of alcohol withdrawal in the inpatient setting due to its short half-life?

Lorazepam

Chlordiazepoxide

Clonazepam

100 Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of:

epinephrine and aldosterone.

norepinephrine and cortisol.

epinephrine and norepinephrine.

acetylcholine and cortisol. GCU NUR641E Week 8 Final Exam Paper

 

MORE INFO 

Treatment of hyperkalemia with insulin

Introduction

The use of insulin to treat hyperkalemia is a controversial topic. Some people believe it works, while others believe it’s harmful. I’ve been using this medication for years and have had great success with it, so I’d like to share my experience with you.

Policy

Insulin is used to treat hyperkalemia. If a patient has uncontrolled diabetes, or if their blood sugar is extremely high, they may need insulin therapy. However, there are no good guidelines for how much insulin should be given to treat hyperkalemia in patients who do not have diabetes.

While the goal of treating hypokalemia with insulin is to lower the level of potassium in your blood and restore normal function to your heart muscle cells (which rely on potassium), the treatment protocol varies widely depending on what type of medication you take and how well it works at reducing your symptoms.

Claims Filing Indicators

• Quantity Limit

You will need to notify your doctor if you have a high potassium level and require insulin therapy for more than five days in a row, or if the amount of insulin needed increases more than 20% from the previous dosage. This is because the treatment of hyperkalemia with insulin can lead to hypoglycemia (low blood sugar).

• Prior Approval

The manufacturer’s instructions must be followed when using this medication as prescribed by your doctor; otherwise, there may be serious side effects such as coma or death resulting from overdose on this medication due to its potential for abuse by people who are unaware that they are taking an illegal substance such as cocaine or heroin without their knowledge – which could result in death!

1. Quantity Limit

Insulin is a drug that can be used to treat hyperkalemia. It comes in different forms, including:

• Insulin lispro combined with dextrose (a mixture of glucose and water)

• Insulin aspart combined with dextrose (a mixture of glucose and water)

Insulin dosing should be based on the patient’s weight, because it is easier to take more insulin when you are underweight than when you are overweight or obese.

2. Prior Approval

Prior approval is the process by which a patient’s health care provider determines that they are eligible to receive certain services or drugs. Prior approval can be obtained through the patient’s primary physician or another licensed healthcare professional, such as a pharmacist or nurse practitioner who specializes in diabetes management.

If you have received prior approval for an outpatient treatment plan, it means that your provider has reviewed all of your medical records and determined that:

• You are eligible for this treatment plan;

• There are no contraindications (prohibitive conditions) to using this drug; and

• That there are no acute side effects likely to occur if you begin taking this drug today.

3. Initial Approval Period

After a patient has been placed on insulin therapy, he or she must follow the treatment plan specified by his or her doctor. If you have any questions about this, ask your doctor.

The initial approval period is 30 days and can be followed by either:

• A follow-up visit within 30 days after starting insulin therapy; or

• Another follow-up visit after 30 days of insulin therapy; or

• Another follow-up visit after 60 days of insulin therapy

4. Follow-up Visits and Exams

The frequency of follow-up visits and exams depends on the type of condition being treated. Some conditions require frequent monitoring, while others may only need regular checks at 3-month intervals or annually.

Follow-up visits and exams are necessary to monitor your progress with treatment for hyperkalemia. If you have been diagnosed with hyperkalemia and if it has been more than 6 weeks since you began taking insulin, then it is recommended that you see a doctor for an update on how things are going before your next appointment (e.g., if blood levels are still high).

Conclusion

We hope that this article has been helpful in understanding how to treat hyperkalemia with insulin. If you have any questions or concerns about your own health, please feel free to contact us for more information.