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2023-2024 BARKLEY 3P Nursing Diagnosis Actual Exam With Answers (101 Solved Questions)

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    BARKLEY 3P EXAM 2023 - 2024 ACTUAL EXAM 1 00 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ . A patient with sepsis is at risk of developing shock via which mechanism? a. Loss of syst emic vascular resistance b. Slowly evolving pump failure of the heart c. Loss of blood volume d. Loss of centrally - mediated neurogenic tone - ANSWER - a. Loss of systemic vascular resistance . Which of the following descriptors is best associated with Re ynaud's Phenomenon? a. Arterial b. Venous c. Unilateral d. Painless - ANSWER - a. Arterial . You are teaching your nursing class about the point of maximal impulse. How do you describe to the class where it is located? a. 4 th intercostal space (ICS), sternal border b. 2 nd intercostal space (ICS), midclavicular line (MCL) c. 5 th ICS, MCL d. 3 rd ICS, sternal border - ANSWER - c. 5 th ICS, MC L 19. Which of the following is a true statement regarding migraines? a. These headaches typically present with an aura in most patients b. Migraines are typically bilateral, and if caught early, respond well to ice and mild analgesics. c. Premenopausal females are the largest grou p of migraine sufferers d. Migraines occur when macrophages attack myelin sheaths in the CNS - ANSWER - c. Premenopausal females are the largest group of migraine sufferers. - menstruation is one of leading causes migraine

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    triggers. Estrogen withdrawal with m enses can be a trigger. Aura in only 20 - 25%, Unilateral, not bilateral, macrophages do not cause, are from triggers of stress, diet, sleeping patterns. 40. What factor is responsible for the hypertrophy of the myocardium associated with hypertension and c ardiac remodeling seen in heart failure? a. Increased epinephrine b. Natriuretic peptides c. Angiotensin II d. Insulin resistance - ANSWER - c. Angiotensin II 59. Kussmaul respirations are best defined by which of the following? a. It is typically seen in patients with anxiety, a cause of respiratory acidosis b. It is a compensatory mechanism to help rid the body of excessive carbon dioxide c. It indicates that the acidosis is causing damage to the respiratory compensatory muscle s. d. It indicates that more oxygen is necessary because the patient is going into respiratory distress. - ANSWER - b. It is a compensatory mechanism to help rid the body of excessive carbon dioxide - compensates for acidosis. Is an ABNL breathing pattern of series of long deep breaths in Pts w/ metabolic acidosis, diabetic ketoacidosis, NOT respiratory acidosis which = hyperventilation . 60. Which of the following is of true intention tremors? a. Resembles a snake - like movement b. Becomes worse with vol untary movement c. Disappears with sleep d. Disappears with voluntary movement - ANSWER - b. Becomes worse with voluntary movement 61. Which of the following is most likely to be effective in the treatment of acute cluster headaches? a. 6 mg subcutaneou s injection of sumatriptan b. 300 mg acetaminophen c. 40 mg riboflavin d. 240 mg verapamil. - ANSWER - a. 6 mg subcutaneous injection of sumatriptan -

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    correct drug and dose for cluster HA; verapamil & APAP not indicated for cluster, but verapamil can be u sed as prophylaxis for migraines. Riboflavin is for migraines, but dose is 400 not 40. A 68 - year - old male patient desires testosterone replacement to enhance his libido. His testosterone level is found to be 250 ng/dL. The nurse practitioner knows that a. AndroGel once daily would restore sex drive and fertility in this client b. Testosterone replacement is associated with cardiovascular risks, including myocardial infarction, and is not indicated for this patient. c. Testosterone cypionate injections w ould be a good treatment option for this patient. d. Testosterone replacement is known to suppress the development of prostate cancer, which would be a benefit. - ANSWER - b. Testosterone replacement is associated with cardiovascular risks, including myocar dial infarction, and is not indicated for this patient. A child born with Tetralogy of Fallot often squats. The practitioner knows that squatting helps to: a. Shunt more blood to the pulmonary circulation b. Reduce the heart rate c. Increase the blood pressure in the legs d. Relieve lower back pain - ANSWER - a. Shunt more blood to the pulmonary circulation A child presents with a community acquired viral pneumonia. Presenting signs and symptoms will include: a. Mild to high feve r, cough, rhinorrhea, crackles, rhonchi, and wheezes b. High fever, productive cough, and pleuritic chest pain c. Decreased breath sounds in areas of consolidation and dyspnea d. Increased respiratory rate and respiratory alkalosis - ANSWER - a. Mild to hi gh fever, cough, rhinorrhea, crackles, rhonchi, and wheezes - wheezing esp more common in children w/ viral CAP. Productive cough may be present, by pleuritic chest pain more w/ bacterial CAP, decreased breath sounds, dyspnea also more with bacterial CAP. Inc resp rathe and resp alkalosis not usually hallmark sx of CAP. A child presents with congenital phenylketonuria. Which statement is true regarding this disease?

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    a. The nucleus if red blood cells is defective in this disorder b. This disease is due to a deficiency of phenylalanine hydroxylase c. This disease is an X - linked disorder seen in male offspring d. This disease is passed from fathers to sons on sex chromosomes - ANSWER - b. This disease is due to a deficiency of phenylalanine hydroxylase A male patient requests a phosphodiesterase inhibitor to treat erectile dysfunction. Which of the following is appropriate? a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week. b. Varden afil (Levitra), 5 mg, may be taken with a high - fat meal four hours before sexual activity c. Sildenafil (Viagra), 50 mg, may be taken one hour before sexual activity as long as the patient has a resting blood pressure below 170/110 mm Hg d. Avanafil (Ste ndra) is recommended at 50 mg for all patients, and may be taken 30 minutes before sexual activity. - ANSWER - a. Tadalafil (Cialis) may be used at a dose of 2.5 mg daily if sexual activity will take place two or more times per week. A neonate is born with fetal alcohol syndrome. Which of the following abnormalities may be observed? a. Alveolar collapse and flail chest b. Cognitive impairment and facial anomalies c. Incompetent semilunar valves (ex aortic and pulmonic). d. Esophage al stricture and short gut syndrome - ANSWER - b. Cognitive impairment and facial anomalies A patient is diagnosed with a methicillin - resistant Staphylococcus aureus infection. A medication that may be used for treatment is: a. Metronidazole (Flagyl) b. Amoxicillin (Moxatag) c. Fidaxomicin (Dificid) d. Daptomycin (Cubicin ) - ANSWER - d. Daptomycin (Cubicin) - 6mg/kg once per day is recommended tx. Metronidazole for anaerobic infection, Amox has 0 effect on MRSA, does well w/ Anthrax & H pylori, Fidamoxicin for C - diff only.

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    a patient is diagnosed with acute inflammatory demyelinating polyneuropathy and resulting Gillian - Barre syndrome. The patient needs to be assessed for which of the following? a. Cerebrospinal fluid high in protein (500 mg/dl) without c ellular abnormality b. Decreased levels if acetylcholine c. Asymmetric paralysis d. Demyelination of the central nervous system nerves - ANSWER - a. Cerebrospinal fluid high in protein (500 mg/dl) without cellular abnormality - Most will have when it is vir al or bacterial. Acetylcholine is not affected by GBS, effect on DTR's or numbness/ paralysis will be symmetric, demyelination of peripheral nerve system NOT CNS A patient is diagnosed with general anxiety disorder. This diagnosis is based on a history wh ich indicated a span of at least how many months spent worrying excessively? a. 3 b. 6 c. 9 d. 12 - ANSWER - b. 6 - 3 months not long enough, could still indicate panic, anxiety or depression. 9 - 12 months = too long and could indicate other psychiatric d isorders as well, including psychosis . A patient is diagnosed with primary Raynaud's disease. In simple terms, this disorder may be explained to the patient as: a. An inflammatory disorder of small - and medium - sized arteries in the feet and sometimes in the hands b. A neoplastic disorder of the lining of the arteries and veins of the upper extremities c. A vasospastic disorder of the small arteries and arteriole s of the fingers, and less commonly the toes d. An autoimmune disorder of the large arteries and veins of the upper and lower extremities - ANSWER - c. A vasospastic disorder of the small arteries and arterioles of the fingers, and less commonly the toes. - v asospasm of smaller arteries & limits circulation/ inhibits blood supply to skin. Not caused by tumors. Secondary Reynaud's can be concomitantly with autoimmune, no autoimmune in Primary A patient is started on levodopa for the treatment of Parkinson's di sease. The practitioner will advise the patient with which of the following? a. "If you experience symptoms of psychosis while on this drug, then we will add haloperidol to your regimen." b. "If you eat protein in your diet, space it out evenly througho ut the day."

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    c. "This drug may turn your sweat, tears, and urine orange - red. This is a normal side effect." d. "Your blood pressure will likely increase while on this medication. We will have to monitor it." - ANSWER - b. "If you eat protein in your diet, space it out evenly throughout the day." A patient is taking furosemide (Lasix) for stage three heart failure. Along with Lisinopril, an aspirin a day, warfarin, atorvastatin, and metoprolol, which other medication should this patient be prescribed? a. Tenecteplase b. Amitriptyline c. Phytonadione d. Potassium Chloride - ANSWER - d. Potassium Chloride A patient presents with chronic neuropathic pain in his feet secondary to type 2 diabetes. Of the following, the best therapeutic choice would be: a. Phe nobarbital (Luminal) b. Carbidopa (Lodosyn) c. Tiaganine (Gabitril) d. Gabapentin (Neurontin) - ANSWER - d. Gabapentin (Neurontin) A patient presents with pustular lesions on her perineum and groin. She has some oral mucous membranes lesions, a warty ras h on her hands and feet, lymphadenopathy, and pruritis. A presumptive diagnosis would be: a. Herpes simplex b. Syphilis c. Chlamydia d. Trichomonas - ANSWER - b. Syphilis A patient who has suffered a cerebrovascular accident has speech dysphasia involving word finding and difficulty writing. Which area of the brain has most likely been affected?

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    a. Parietal lobe b. Left frontal lobe c. Temporal lobe d. Limbic system. - ANSWER - b. Left frontal lobe - Broca's area is in left frontal lobe is one of language centers= non fluency w/ sparse output, agrammatism, impaired repetition, affects writing r/t to speech. Parietal lobe= agnosia, Temporal lobe = word deafness, limbic = e motional instability A patient with hepatic encephalopathy is most at risk of death due to: a. Synthesis of ammonia by brain cells b. Toxicity of ammonia to the central nervous system c. Renal toxicity of ammonia accumulating in the kidneys d. Bleedin g of esophageal varices made weak by ammonia - ANSWER - b. Toxicity of ammonia to the central nervous system A patient with kidney stones also presents with hypercalcemia and mental confusion. The practitioner should evaluate the patient for which of the fo llowing? a. Cushing Syndrome b. Conn's Syndrome c. Hyperparathyroidism d. Addison's disease - ANSWER - c. Hyperparathyroidism Adenosine triphosphate levels decrease in ischemia. What effect does this have on cells? a. Cells shrink because of an influx of calcium b. Cells shrink because of the influx of potassium c. Cells swell because of the influx of sodium

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    d. Cells swell because of the influx of nitric oxide. - ANSWER - c. Cells swell because of the influx of sodi um All of the following facial movements are still possible after a cerebrovascular accident except: a. Raising the eyebrows b. Wrinkling the forehead c. Raising both sides of the mouth d. Closing both eyes - ANSWER - c. Raising both sides of the mouth Assuming these do not present with symptoms other than those stated, antibiotic use is most likely to be appropriate for which of the following patients? a. The 2 - year - old with onset of mucopurulent rhinitis two days ago b. The 10 - year - old with dry cou gh lasting 7 days c. The 60 - year - old with clear rhinorrhea for 3 weeks. d. The 5 - year - old with cough and mucopurulent rhinitis for 3 weeks - ANSWER - d. The 5 - year - old with cough and mucopurulent rhinitis for 3 weeks Azole antifungals are most likely to c ause torsades de pointes in which patient population? a. Patients taking isoproterenol b. African - Americans c. Females d. Adults over the age of 65 - ANSWER - c. Females - Azole can cause in Men and women, but 2 - 3x more common in Women. Prolonged QT inter val is 10 microseconds longer in women= more recorded dysrhythmias. Isoproterenol is beta agonist used in tx of torsades & no significant interaction w/ azoles. African Americans less susceptible to torsades than Caucasians, & most common ages 35 - 50. Benj amin, age 22, comes into your practice complaining of extreme pain in his lower abdomen. You use a stethoscope to listen to his bowel sounds and hear nothing. Which of the following is not a cause of hypoactive bowel sounds?

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    a. Peritonitis b. Constipati on c. Paralytic ileus d. Norovirus - ANSWER - d. Norovirus Beta blockers are not used for which of the following conditions? a. Performance anxiety b. Migraine prophylaxis c. Reduction of perioperative mortality d. Insulin induced hypoglycemia - ANSWER - d. Insulin induced hypoglycemia. - will not aid, more likely to retard recovery. Low dose can be used for performance enhancement, treat migraines, and decrease perioperative mortality of cardiac Pts. Cecilia, age 56, comes into the clinic with severe abdominal cramping. During the physical exam, you ask her to lie on her back, and you press into her abdomen about 2 - 3 inches to determine the skin surface and musculature. Which test are you performing? a. Deep Pal pation b. Blumberg's sign c. Light palpation d. Voluntary guarding - ANSWER - a. Deep Palpation - checks for abdominal muscles, Blumberg's slowly push in and rapid pull back, light palpation is 1 cm, guarding judges rigidity of muscles d/t involuntarily mo vement. Early detection of acute leukemia would include which of the following symptoms? a. Dizziness, dehydration, palpitations, hypotension b. Dyspnea, paresthesia, malaise

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