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NRNP 6540 FINAL EXAM LATEST 2025/NRNP6540 FINAL
EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS)
|WALDEN UNIVERSITY
- Mrs. Williams is 76 years old and comes in to have a wound checked on her right leg. She fell a month ago and the wound has not healed. She is concerned that something is wrong. The nurse practitioner examines the wound and sees that it has been cleaned properly and has no signs of infection. The edges are approximated, but the skin around the wound is red and tender to touch. The best response regarding Mrs. Williams' concern is:
- Wound healing for older people may take up to four times longer than it does for younger people.
- Let us talk about what you are eating.
- Had you come in earlier, I would have ordered medicine that would have healed that right up.
- I will order an antibiotic to prevent infection. - CORRECT ANSWER >>> 1. Answer: 1 Page: 96 Feedback
Skin renewal turnover time increases to approximately 87 days in older adults, compared with 20 days during youth.
The perceived extended healing time is not related to diet.
This is false hope, as there is no medication that will heal this wound quickly.
Prophylactic antibiotics are not appropriate when there are no signs or symptoms of infection.
- The nurse practitioner is conducting patient rounds in a long-term care facility. As she talks with Mrs. Jones, she notices that her arms and elbows are excoriated and the skin is shearing. The nurse practitioner explains to the staff that Mrs. Jones needs frequent assessment of her skin and protection provided to prevent skin breakdown because:
- Her lack of activity causes the skin to tear.
- Fat has redistributed to the abdomen and thighs, leaving bony surfaces in areas such as the face, hands, and sacrum. This can result in injury.
- She has lost weight and is in jeopardy of falling.
- She picks at herself and causes skin breakdown. - CORRECT ANSWER >>> 2. Answer: 2 Page: 96 Feedback
Lack of activity alone does not cause skin breakdown.
Fat is redistributed to the abdomen and thighs, leaving bony surfaces, such as the face, hands, and sacrum, exposed to potential injury, especially skin tears from shearing, friction forces and pressure ulcer development.
Although losing weight may be a risk factor for falling, it is not directly related to skin breakdown.
There is no evidence that she is picking at herself, as there is nothing reported anywhere else on her arms.
- The nurse practitioner assesses a patient's skin and finds an infectious lesion on the lower leg. The lesion is considered a secondary lesion. The nurse practitioner explains that a secondary lesion is one that:
- Arises from changes to a primary lesion.
- Is a complication of an underlying disease.
- Is difficult to treat.
- Is a normal sign of aging. - CORRECT ANSWER >>> 4. Answer: 1 Page: 97 Feedback
Secondary lesions (infections) arise from changes to the primary lesion.
Secondary lesions are not necessarily the result of an underlying disease.
Secondary lesions can be treated with medications or surgery.
Secondary lesions arise as a condition not normal to aging.
- Ms. Rose, 88 years old, comes to the nurse practitioner with a complaint about a growth on her hand. She wants to have a biopsy done. The nurse practitioner asks the following question:
- Have you injured your hand recently?
- Are you using a different detergent?
- Has this growth changed, bled, or is it painful?
- Has this growth made it difficult to put on your rings? - CORRECT ANSWER >>> 5. Answer: 3 Page: 97 Feedback
An injury would not stimulate growth.
A reaction to a detergent would more likely be a rash.
Lesions that warrant biopsy are those that have changed, bleed, or are painful.
The ability to put on her ring is not the problem.
- A 60-year-old male enters the burn center for triage and treatment due to a burn he received at a campfire. His left arm has an area that is erythematous and painful, and another area has a blister. What does the nurse practitioner record as the degree of burn?
- First degree
- Second degree
- First and second degree
- Second and third degree - CORRECT ANSWER >>> 6. Answer: 3 Page: 98 Feedback
Threatening refusal of care is not ethical.
The patient is at risk, not the family.
The fact that the patient smokes is not the issue; safety is the issue.
- The nurse practitioner is conducting a safety class with community-living older adults. Which of the following should she include in her teaching of risks of burns for this population? Select all that apply.
- Thinner skin.
- Less vascularity.
- Diminished nerve function.
- A weakened immune system.
- The burden of various comorbidities leading to enhanced wound healing and reepithelialization after burn injury. - CORRECT ANSWER >>> 8. Answer: 1, 2, 3, 4 Page: 98 Feedback
As one ages, there are significant changes in the skin, which becomes thinner, providing a less effective barrier to external stimuli.
With aging, there are fewer appendages and decreased vascularity.
Thinner skin and diminished nerve function often result in a higher incidence of deeper burns.
Advanced age results in a weakened immune system.
Along with the burden of various comorbidities, the fragility of older skin leads to delayed wound healing and reepithelialization after burn injury.
- Mr. Edwards is 76 years old and received a burn on his leg when he dozed off and dropped his cigarette. The nurse practitioner examines his leg for the degree of burn and classifies it as second degree with some third degree in the center. Mr. Edwards asks what that means and why it hurts so much. What is the best answer? Select all that apply.
- It means that this is a serious, deep burn in the center, and a less deep burn around the sides.
- It hurts because the nerve endings are exposed in the second-degree area.
- It means that the burn is advancing and getting worse.
- It hurts because the nerves are destroyed.
- It hurts because the nerves in the second-degree areas are exposed to the outside and are stimulated. - CORRECT ANSWER >>> 9. Answer: 1, 2 Page: 98 Feedback
Deep dermal burns extend further into the dermis; third-degree burns involve the full dermis, extending into the subcutaneous tissue.
In these burns there is pain from exposed nerve endings, but by the second day, pain is often described more as pressure.
The first step in treatment is to stop the burn.
For small surface area burns, it is good to remove any loose tissue during cleansing and allow intact blisters to remain.
First-degree burns do not exhibit blisters, and third-degree burns do not exhibit pain.
- Mr. Watson,75 years old, comes to the urgent care center with complaints of fever, fast heartbeat, a swollen gland under his right arm, and redness in his upper left arm that has hurt for 2 to 3 days. The patient says that he has had the redness in his arm for months without any difficulty. The nurse practitioner suspects which of the following? Select all that apply.
- Influenza
- Upper respiratory infection
- Cellulitis of upper left arm
- Necrotizing fasciitis
- Lymphangitis - CORRECT ANSWER >>> 11. Answer: 3 Page: 103 Feedback
Influenza is systemic and not localized in any one area.
The patient has no respiratory symptoms.
Signs of cellulitis include worsening of erythema, edema, tenderness, and pain that has occurred for a few days. Symptoms are usually sudden. Systemic symptoms which indicate serious toxicity include fever, hypotension, and tachycardia.
Necrotizing fasciitis exhibits diffuse swelling of an arm or leg with bullae.
Systemic symptoms that indicate serious toxicity include fever, hypotension, tachycardia, leucocytosis, lymphadenopathy, and lymphangitis.
- The treatment for cellulitis includes which of the following? Select all that apply.
- Patients with mild cellulitis may be given oral antibiotics.
- One drug of choice is dicloxacillin, 500 mg four times a day.
- Treatment is dependent on the culture of the cells affected.
- The drug of choice is given for a minimum of 3 days.
- Administration of a tetanus booster injection. - CORRECT ANSWER >>> 12. Answer: 1, 2 Page: 103 Feedback
Oral antibiotics are sufficient for mild cellulitis and IV antibiotics for organisms such as MRSA.
There are several drugs effective with cellulitis; dicloxacillin is one of them.
Treatment of MRSA should be guided by wound culture results, but not cellulitis.
The drug of choice is typically given for 7 days.
The patient has initial contact with VZV in the form of chicken pox. Individuals who are immunosuppressed are more likely to develop herpes zoster.
Herpes zoster is characterized by pain along the dermatomes and vesicles, which is not symptomatic of influenza.
This infection is most common in adults over 55 years old. The risk of herpes zoster increases with age.
- Mrs. Person, 82 years old, comes to the well clinic to see a nurse practitioner for a bump on her ear. This growth has been there for almost a year but has recently grown. The area around the growth appears inflamed. Why would the nurse practitioner suggest a biopsy? Select all that apply.
- The growth is elevated and increasing in size.
- The ear has high exposure to the sun.
- There is inflammation around the growth.
- The patient is 82 years old and reports having lived in the south of the United States for many years.
- There is no concern about familial tendencies. - CORRECT ANSWER >>> 14. Answer: 1, 2, 3, 4 Page: 118 Feedback
Signs of malignancy include elevation; the original lesion may also have enlarged in size.
Common locations for skin cancers are the scalp, ears, lower lip, and dorsal side of the hands.
Signs of malignancy include inflammation of the lesion.
The incidence of all types of skin cancers increases with age and the degree and intensity of sun exposure.
Certain genetic predispositions can contribute to the development of skin cancer, and there is a familial tendency to develop melanoma.
- The nurse practitioner is making patient rounds in a long-term care facility and is visiting Mr. Smith, 95 years old, who has a large amount of fungus growing from his toenails. The staff nurse asks what can be done to help alleviate this nail fungus. What does the nurse practitioner advise? Select all that apply.
- Wash and completely dry the feet and toes daily.
- Keep the patient's feet cool and dry.
- Use aluminum acetate solution (Burow's solution).
- Have the patient wear occlusive footwear.
- Use clotrimazole (ointment, cream, or lotion). - CORRECT ANSWER >>> 15. Answer: 1, 2, 3 Page: 123 Feedback
The key to prevention of recurrence is to keep the area dry. Use a hairdryer to thoroughly dry the area after bathing.
After auscultation of the carotid and subclavian arteries, the clinician should proceed to palpation of the brachial, radial, and ulnar arteries.
After auscultation and palpation, careful inspection should be performed of the distal fingers and the nail beds.
Diagnostic testing is usually ordered when areas of concern are found.
- Which of the following conditions is signaled by symptoms of swelling of the affected body part, usually the limb, because of impaired flow of lymph fluid?
- Abdominal aortic aneurysm (AAA)
- Venous ulcers
- Peripheral vascular disease (PVD)
- Lymphedema - CORRECT ANSWER >>> 2. Answer: 4 Page: 218 Feedback
AAA presents the signal symptoms of persistent or intermittent pain in the middle or lower abdomen, radiating to the lower back.
Venous leg ulcers present signal symptoms of swelling that subside with elevation of lower extremities, eczematous skin changes, dull ache in lower extremities, and presence of varicosities.
PVD is a disease that alters blood flow to or from the extremities and vital organs other than the heart. It presents signal symptoms of pain, intermittent claudication of the feet, and tissue loss in affected leg/arm.
Lymphedema presents the signal symptoms of swelling of the affected body part, usually the limb, because of impaired flow of lymph fluid.
- In the initial screening for a diagnosis of AAA, which of the following is the best screening test?
- CT scan
- Complete blood count (CBC)
- Ultrasound in the abdominal area
- Angiography - CORRECT ANSWER >>> 3. Answer: 3 Page: 216 Feedback
CT screening is indicated when surgery is planned.
CBC may be a secondary screening when surgery is planned.
Ultrasound in the abdominal area is the best initial screening test for AAA.
Angiography screening is indicated when surgery is planned.
- Internist - CORRECT ANSWER >>> 5. Answer: 1 Page: 217 Feedback
A vascular surgeon is a specialist who is highly trained to treat diseases of the vascular system.
A neurosurgeon is a physician who specializes in the diagnosis and surgical treatment of disorders of the central and peripheral nervous system.
A cardiologist is a doctor who specializes in the study or treatment of heart diseases and heart abnormalities.
Internists are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum, from health to complex illness.
- Anne is a 50-year-old post-mastectomy patient diagnosed with secondary lymphedema. Based on her surgical history, which of the following may be the contributing factor to the lymphedema?
- Gynecological cancer
- Breast cancer
- Urological cancer
- Infection - CORRECT ANSWER >>> 6. Answer: 2 Page: 218
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Gynecological cancer is a contributing factor for secondary lymphedema, but it is not the best option for this scenario because of Anne's history.
Breast cancer is the best option and is a contributing factor for secondary lymphedema in Anne's case because of the previous mastectomy.
Urological cancer is a contributing factor for secondary lymphedema, but it is not the best option for this scenario because of Anne's history.
Infection is a contributing factor for secondary lymphedema, but it is not the best option for this scenario because of Anne's history.
- PVD is a disease that alters blood flow to or from the extremities and vital organs other than the heart. According to studies, which of the following remains the most important risk factor for PVD?
- Smoking
- Hypertension
- Family history
- Hypercoagulopathy - CORRECT ANSWER >>> 7. Answer: 1 Page: 219 Feedback
