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NURS 6550 MIDTERM EXAMS, FINAL EXAMS(LATEST)| -WALDEN UNIVERSITY (2 VERSIONS)
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NURS 6550 MIDTERM EXAM / NURS6550 MIDTERM EXAM(LATEST)| -WALDEN UNIVERSITY
NURS 6550 MIDTERM EXAM / NURS6550 MIDTERM EXAM(LATEST)| -WALDEN UNIVERSITYNURS 6550 MIDTERM EXAM • Question 1 The AGACNP is caring for a patient ... [Show More] who is quite ill and has developed, among other things, a large right sided pleural effusion. Thoracentesis is sent for pleural fluid analysis. While evaluating the fluid analysis, the AGACNP knows that a fluid identified as a(n) __________ is the least worrisome type. • Question 2 Mrs. Miller is transported to the emergency department by paramedics. She is having profound, unremitting chest pain, is diaphoretic and pale. She has jugular venous distention and a widened pulse pressure. Suspecting ascending aortic aneurysm, the AGACNP order which test to confirm the diagnosis? • Question 3 Certain subgroups of the elderly population are at an increased risk for rapid deterioration and long-term care placement. Which of the following is not considered a high risk factor for long term care placement? • Question 4 A patient with anterior epistaxis has been treated with 20 minutes of direct pressure to the cartilaginous portion of the nose. Following pressure the patient is instructed to gently blow the nose. Expected findings in the patient who has been successfully treated include all of the following except a: • Question 5 Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right ear pain. He appears quite ill and says he feels nauseous. Otoscopic evaluation reveals pain to palpation, a very erythematous and bulging tympanic membrane with bullous myringitis. The AGACNP knows that antibiotic therapy must be selected to cover: • Question 6 P.M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of increasing shortness of breath. The diagnostic evaluation ultimately supports a diagnosis of community acquired pneumonia. The AGACNP appreciates right middle lobe consolidation on chest radiography. Pending sputum cultures, empiric antibiotic therapy must be initiated to cover which organism? • Question 7 Which of the following is the greatest risk factor for vascular dementia? • Question 8 J.R. is a 55-year-old male who presents for a commercial driver’s license physical examination with a blood pressure of 170/102 mm Hg. He has no medical history and is without complaint. Which of the following findings constitutes hypertensive urgency? • Question 9 Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment for patients taking these medications should include a: • Question 10 K.R. presents for an evaluation of eye discomfort. He works in a fabricating shop for a custom automobile restoration company and while working he felt like something flew into his eye. He was wearing eye protection at the time but still has the sensation that something is there. Physical examination is significant for some tearing and he reports a persistent sense of something in his eye. Which of the following is not indicated in the diagnostic evaluation? • Question 11 D.E. is a 41-year-old female who had lumbar surgery two days ago to repair a ruptured nucleus pulposus. She has been doing well postoperatively but today is complaining of resting fatigue and some shortness of breath at rest. In ruling out a pulmonary embolus the AGACNP first orders a: • Question 12 Mr. Nixon is being treated with unfractionated heparin infusion for acute pulmonary embolus. In order to avoid a potentially fatal complication of heparin infusion, the AGACNP monitors: • Question 13 Differentiating vertigo from near-syncope and ataxia is one of the goals of history-taking when a patient presents as “dizzy.” The AGACP knows that vertigo is the problem when the patient reports the primary symptom as: • Question 14 Mr. Banks has been admitted for surgical resection of a metastatic tumor, during surgery it is discovered that he has widespread, diffuse metastasis throughout the abdomen. Surgery is no longer an option, and his oncologist says that chemotherapy is unlikely to produce any meaningful benefit. Mr. Banks is concerned that his sons will not support a transfer to comfort care. The AGACNP advises that he: • Question 15 Mr. Wilkerson is a 77-year-old male who is being evaluated and treated for his cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, pulse of 100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A 12-lead ECG reveals deep ST segment depression in leads V3-V6. The AGACNP recognizes which of the following as a contraindication to rTPA therapy? • Question 16 A 71-year-old patient is recovering from a particularly severe exacerbation of chronic obstructive pulmonary disease. He has been in the hospital for almost two weeks and was on mechanical ventilation for 7 days. While discussing his discharge plan he tells you that he is really going to quit smoking this time. He acknowledges that he has been "sneaking" cigarettes in the hospital for two days, but he has established a timeline to decrease the number of cigarettes daily. According to his plan his last cigarette will be the last day of the month. This patient’s behavior is consistent with which stage of the Transtheoretical Model of Change? • Question 17 While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic disorders is: • Question 18 L.T. is an 85-year-old male who is admitted for evaluation of profound diarrhea that has produced significant dehydration. He also complains of being very tired lately, and feeling like he is going to vomit all of the time. His vital signs are significant for a pulse of 41 b.p.m. and a blood pressure of 90/60 mm Hg. A gastrointestinal evaluation including stool for blood, white blood cells, and ova and parasites is negative. He insists that he has not started any new medications or made any diet changes; the only thing new is that he got new eye drops for his glaucoma. The AGACNP correctly assumes that his new eye drops are: • Question 19 Janice is a 19-year-old female who presents to the emergency department via ambulance. She is pale, diaphoretic, agitated, and convinced she is having a stroke. Her vital signs include a temperature of 98.9° F, pulse of 114 beats per minute, respirations of 32 breaths per minute, and a blood pressure of 110/74 mm Hg. Diagnostic evaluation is negative and Janice is diagnosed with an acute panic attack. The initial treatment of choice is: 2 • Question 20 Lorraine is a 41-year-old female who presents for an asthma follow-up visit. She says she feels very well, has almost no daytime symptoms, and is using her inhaled corticosteroid medication daily as prescribed. Her PEFR is 85% of her personal best. The best approach to this patient is to: 1 • Question 21 Mr. Owen is a 37-year-old patient who has been admitted for surgical resection of a malignant tumor in his lung. His physical recovery has been uneventful and he is being prepared for discharge. While discussing his ongoing cancer therapy with Mr. Owen, the AGACNP determines that he has experienced persistent, excessive anxiety and worry almost every day for more than one year. What other aspect of Mr. Owen's psychosocial history would be required to made a diagnosis of generalized anxiety disorder? • Question 22 Kevin T. is a 49-year-old male who is being discharged after hospitalization for an acute inferior wall myocardial infarction. This is his first hospitalization and his first chronic medical diagnosis. Aside from his elevated cardiac isoenzymes and troponins, his laboratory profile was essentially within normal limits. The only apparent cardiac risk factor is an LDL cholesterol of 200 mg/dL. Initiating an HMG-CoA reductase inhibitor is an example of which level of prevention for Kevin? • Question 23 You are evaluating a patient who has been admitted to the emergency room after being arrested for starting a fight in a local sports' bar. The patient is now being cooperative, but reports that he has been in treatment for PTSD for months. He has been prescribed fluoxetine but has not noticed any improvement in symptoms, and now has been arrested for violence. The AGACNP knows that the next step in medication management is likely to include: • Question 24 Mrs. Salter is an 81-year-old lady who presents for evaluation of near-syncopal episodes. Her 12-lead ECG, complete blood count, and comprehensive metabolic panel are all essentially normal. A urinalysis shows some trace protein but is otherwise normal. A 24-hour rhythm monitor demonstrates rare premature ventricular contractions. Mrs. Salter has been in good health and had her first episode at her aerobics class. She only gets lightheaded when she exerts herself. Her heart auscultates for a grade III/VI systolic crescendo-decrescendo murmur at the second intercostal space, right sternal border. The AGACP considers that the likely cause of the syncope is: • Question 25 Who among the following patients is at greatest risk for a pulmonary embolus? • Question 26 Mrs. Birdsong is an 85-year-old female who has been admitted for surgical repair of a hip fracture. She is in remarkably good spirits and is quite talkative. She readily answers all of the questions on her intake assessment, and readily acknowledges information provided during her room orientation. Later while talking with the patient's son the AGACNP learns that the patient has had significant cognitive impairment for a few years. She has virtually no short term memory, but compensates by confabulating. Her son says she is generally very happy as long as there is no change in her day to day routine. This history is most consistent with which form of dementia? • Question 27 Mrs. Radovich is an 80-year-old female with a variety of chronic medical conditions which are reasonably well controlled. She generally enjoys a good quality of life and is active with her family. Today her only concern is that she is having problems with her vision. She notices that while trying to look at pictures of her great grandchildren she can’t seem to focus on their faces. She also reports increased trouble reading—she cannot seem to see the words that she is looking at, and her reading glasses do not help. Further evaluation of Mrs. Radovich should include assessment with: • Question 28 R.J. is a 55-year-old female who presents with acute onset left sided facial pain and an inability to move the left side of her face. She cannot smile, raise her eyebrow or even close her left eye, The immediate approach to this patient should include: • Question 29 A 78-year-old male present for a physical examination. He has no discomfort or complaints other than a general decrease in vision, but it helps when he puts things under a bright light to read. He admits that while driving at night the streetlights appear to be a bit distorted and his night vision is pretty poor. Given the likely diagnosis, the AGACNP expects which of the following physical findings? • Question 30 Jason is a 46-year-old male who is being managed for sepsis. He has HIV/AIDS and has had a prolonged hospitalization characterized by a variety of complications. He was extubated 3 days ago but continues gastric decompression with a nasogastric tube(NGT), total parenteral nutrition and antibiotic therapy via a central venous catheter, and urinary drainage via a Foley catheter. He continues to demonstrate consistent low grade fevers but all points of insertion of his tubes are normal to inspection, a chest radiograph demonstrates improvement of his pneumonia, and his urinalysis shows no bacteria, leukocytes, or nitrites. The AGACNP should next order: • Question 31 The interpretation of a chest radiography should follow a systematic approach to ensure that all vital structures are evaluated and important clinical findings are not missed. The last thing to be assessed when looking at chest radiography should be the _____________: • Question 32 The Short Confusion Assessment Method (Short-CAM) is a widely used four item tool that assesses delirium in the hospitalized patient. It includes observation of all of the following except: • Question 33 Ms. Yang has been hospitalized for 5 days for the management of a gastrointestinal bleeding. She appears to have stabilized hemodynamically, but today she had a temperature of 101.9° F and chest radiography demonstrates a diagnosis of pneumonia. The AGACNP knows that the diagnostic evaluation for hospital acquired pneumonia for all patients must include: • Question 34 Most psychosocial theories of aging center around the core concept that successful aging requires acceptance of a series of changes or losses that predictably occur later in the life span. The theory that specifically addresses coming to terms with the inevitability of death is known as: • Question 35 All of the following conditions are risk factors for pulmonary embolus except: • Question 36 A patient is diagnosed with acute descending aortic aneurysm and hypertension should be immediately started on which medication pending surgical evaluation? • Question 37 Jason is a 27-year-old with a long history of intermittently controlled asthma. He is currently prescribed Advair daily with albuterol as needed for symptoms. Today he presents to the emergency department with cough and wheezing and difficulty catching his breath. His FEV1 is 51% at the time of presentation. He is given alternating albuterol and ipratropium nebulizer treatments along with oral prednisone. After one hour his FEV1 has increased 65%. The appropriate disposition for Jason at this point is: 111 • Question 38 A patient in the intensive care unit suddenly becomes tachypneic and dyspneic. The physical examination reveals pale, cool, clammy skin and an arterial blood gas demonstrates hypocapnea and hypoxia. Pulmonary artery pressure demonstrates a pattern consistent with obstructive shock. The AGACNP knows that which of the following causes of this presentation is most likely? • Question 39 Mr. Bowers is an 81-year-old male who is being terminally extubated at the request of his family due to the presence of a large subdural hematoma with a shift; the patient is not initiating respirations on his own and the prognosis is very poor. After he is extubated he begins to initiate his own respirations and 24 hours later has not expired yet. The decision is made to leave him in the hospital on a general medical floor rather than transfer to another facility for hospice. Which of the following is the best indicator that the patient’s death is imminent? • Question 40 A patient is newly admitted to your service for open reduction and internal fixation of the left hip. She seems very down, and as you talk with her you realize that her mood is not just related to her hip fracture. Which of the following symptoms would not be consistent with major depressive disorder? • Question 41 “C” is the correct answer. Alzheimer’s dementia is statistically the most common form of dementia and is characterized by a long trajectory that progresses to include confabulation. Additionally, patients with this form of dementia are very reliant upon routine and may be distressed when it is disrupted. “A” is not correct; Lewy body dementia characteristically progresses much more quickly and produces an angry demeanor. “B” is incorrect because vascular dementia typically produces a more depressive affect and is not characterized by confabulation; additionally, patients with vascular dementia often have a medical history consistent with vascular risk factors. “D” is not correct as there is no apparent history of Parkinson’s disease. • Question 42 What is the primary purpose of using eye ointments or lubricants to patients under general anesthesia, on paralytics, or in long-term comatose states? • Question 43 When reading a 12-lead electrocardiogram, the AGACNP knows that all 12 leads are required to provide: • Question 44 A 49-year-old male presents for evaluation of chest tightness. It has happened before, but he just ignored it and it went away. Today he just could not ignore it anymore. He has always enjoyed good health and says he has never been told that he has any chronic medical conditions like high blood pressure or diabetes. A 12-lead ECG demonstrates changes consistent with inferior wall ischemia. Both his symptoms and inferior wall changes improve with the administration of sublingual nitroglycerin. Consistent with ACS protocol, this patient’s assessment is consistent with: • Question 45 Mr. Rosen is a 49-year-old male who is being managed for an acute myocardial infarction. He develops significant shortness of breath at rest and coarse rales 2/3 up bilaterally. The AGACNP suspects acute pulmonary edema due to papillary muscle rupture and acute mitral valve regurgitation. Which physical finding would support this finding? • Question 46 A patient with minor head trauma presents for evaluation. Which of the following findings should be followed up with a CT scan to rule out orbital fracture? • Question 47 Mrs. Forbes is a 69-year-old lady being discharged from the hospital after complications following a cosmetic surgical procedure. She is basically in good health. She has a history of hypothyroidism for which she takes levothyroxine daily, and mild osteoarthritis which is controlled with only prn nonsteroidal use. Her blood pressure is 148/90 mm Hg. The AGACNP knows that in accordance with the most current guidelines published in JNC 8 the appropriate action is to: • Question 48 When assessing driver safety in the older adult, the AGACNP considers that: • Question 49 The nursing staff calls to tell you that your 81-year-old male patient is having an acute change in mental status. He is a basically healthy man who was admitted three days ago for inpatient antibiotic management of community acquired pneumonia. His daughter is at the bedside and she is very distraught because she has never seen him like this. She is asking for medication to make him stop acting disoriented. Upon examination the patient is lying in bed, appears calm and happy, but does not recognize his daughter as anyone he knows. He is talking as if he is at home and has company. The AGACNP instructs the daughter that: • Question 50 While discharging a patient following her myocardial infarction, you offer some patient education about medically supervised cardiac rehabilitation. The patient expresses fear of rehab because she was on her treadmill when she had her infarction and now she is afraid of making it happen again. She doesn’t understand how the rehab can force her to exercise her heart but not make her have another cardiac event. The AGACNP explains that the patient will be monitored and that her goal heart rate will be: • Question 51 During physical examination of a 51-year-old African-American female you appreciate a decrease in her peripheral vision. The rest of her eye examination is within normal limits and she is symptom free. This presentation is consistent with: • Question 52 Mr. Moffett is a 66-year-old male with a long history of lower extremity edema. All other causes of lower extremity edema have been ruled out and his overall symptom presentation and history are strongly supportive of chronic venous insufficiency. Today he presents with increased itching of both lower legs. Physical exam reveals 2-3+ pitting edema and trophic hyperpigmentation. The AGACNP know that treatment should include: • Question 53 L.R. is an 84-year-old female patient being treated for pneumonia. Her condition is deteriorating despite aggressive broad spectrum antipseudomonal cephalosporin antibiotic therapy. Induced sputum culture reveals heavy growth of Legionella pneumophilia. The AGACNP knows that antibiotic therapy must be adjusted to include coverage with: • Question 54 The AGACNP is treating a patient with a corneal abrasion. The patient has a clear recollection of the mechanism of injury—she was scratched in the eye earlier today with her 18-month-old daughter’s fingernail. Which of the following is contraindicated in the management of this patient’s abrasion? • Question 55 M.T. is a 41-year-old male patient in the intensive care unit. He was admitted to the hospital in septic shock and has been aggressively managed with broad spectrum antibiotics. He has become progressively hypoxemic and the last arterial blood gas revealed a paO2 of 58 mm Hg. Chest radiography reveals a "white out" pattern bilaterally. The patient is intubated and ventilated. The AGACNP knows that appropriate management must include: 22 • Question 56 Teenagers and adults with acute otitis media can often be treated with "watchful waiting" given the high incidence of spontaneous resolution and low risk of poor outcomes. Which of the following is an absolute indication to begin antibiotic therapy at the time of diagnosis? • Question 57 Mr. Bowers is on mechanical ventilation for respiratory support through an episode of septic pneumonia. Due the extensive lobar consolidation it was very difficult to keep Mr. Bowers oxygenated and he required very high FIO2s and PEEP. The AGACNP knows that the primary concern with FIO2s > 60% is: 222 • Question 58 Acute respiratory distress syndrome (ARDS) occurs when an overwhelming systemic insult results in which maladaptive physiologic response? • Question 59 Acute respiratory distress syndrome is characterized by which abnormality of ventilation and perfusion? • Question 60 George Schulz is a 69-year-old male who presents for evaluation of acute foot pain. It is so painful that he cannot walk on it without assistance. At first he denies any significant medical history, but then reveals that he has been diagnosed with dyslipidemia and hypertension but stopped taking his medications because he couldn’t afford it. Pulses are not palpable but are audible by Doppler. The extremity is pale and shiny with decreased hair growth, suspecting peripheral arterial disease, the AGACNP expects which additional finding? • Question 61 G.T. is a 40-year-old male who is under your case for long term management of secondary osteoarthritis. Today he asks if he can take a medication for anxiety. Further assessment reveals that he is in a relationship that has been very stressful; his girlfriend wants very much to get married and start a family, and he does not. He admits that he no longer feels they are compatible and acknowledges that he needs to end this relationship. He is sure that this is the source of his anxiety. The best approach would be to: • Question 62 During the physical examination of a 31-year-old female, the AGACNP appreciates a bifurcate uvula. The most appropriate action would be to: • Question 63 During routine immigration screening a 29-year-old male patient from Mexico has a positive purified protein derivative (PPD) test at 17 mm induration. He reports no known history of tuberculosis (TB) infection or exposure, or vaccination with the BCG vaccine. Chest x-ray is negative for any evidence of TB exposure. The AGACNP knows that the appropriate next step is to: • Question 64 Clinical diagnostic criteria for acute respiratory distress syndrome (ARDS) include all of the following except: • Question 65 While managing a patient in acute pulmonary edema, the AGACNP monitors the pulmonary capillary wedge pressure. When this pressure falls below 12 mm Hg it suggests that: • Question 66 All of the following are important elements of the immediate management of penetrating eye injury except: • Question 67 While evaluating a patient with diastolic failure due to a long history of uncontrolled hemochromatosis, the AGACNP appreciates an extra heart sound just before the S1 heart sound. This sound is most likely a(n): • Question 68 Secondary hypertension occurs in approximately 10% of all patients with hypertension, and requires management of the underlying problem in order to eliminate the cause. Which of the following is not a secondary cause of hypertension? • Question 69 L.M, is a 26-year-old male who presents to the emergency department complaining of acute onset vertigo this morning. He describes a strong sense of the room spinning and can barely walk without feeling nauseous. The vertigo is reproducible when his neck is rotated suddenly left or right. The AGACNP knows that which of the following is not indicated? • Question 70 A 36-year-old female presents complaining of left leg swelling. She describes the onset as acute over the last day or two, and says it feels "tight and throbbing." She denies any significant medical history and says the only medication she takes is oral contraception, which she has taken since she was 15 years old. The AGACNP first orders: • Question 71 The primary neurotransmitter implicated in post-traumatic stress disorder (PTSD) is: • Question 72 Mr. Avila is an 82-year-old male being counseled about the risks and benefits of his upcoming abdominal surgery. While considering risk factors for atelectasis, pneumonia and other pulmonary complications, the AGACNP advises that the greatest risk comes from: • Question 73 The female AGACNP is practicing with a cardiology group and sees patients one day a week in the outpatient office. A 49-year-old female presents for follow-up after her admission for infective endocarditis. She is recovering well, and says that she is going to be more proactive about her health. She admits to not having had any of her regular health screenings for years, and asks if she can have her Pap performed at this office. The AGACNP: • Question 74 The AGACNP is seeing a patient who was transferred from the correctional facility for evaluation. He has a profound purulent discharge from his right eye. The conjunctive is erythematous and there is mild photosensitivity. The inmate denies any real eye pain, just says that it is extremely uncomfortable. Treatment for this patient is likely to include: • Question 75 Ms. Ewing is a 78-year-old female who lives in a long term care facility because her dementia has progressed to the point at which her family cannot provide the necessary safety measures at home. In addition to her absent short term memory she has developed some affective changes and most recently is demonstrating sexual disinhibition. While considering management options, the AGACNP knows that all of the following are medications are options for the management of disinhibition except: • Question 76 A patient recently had a nasal packing inserted for management of refractory epistaxis. One week later he presents with fatigue, a headache “inside of his nose” and a feeling generally unwell. The AGACNP considers: • Question 77 A 55-year-old female patient presents with a fever of 103.4° F. She was treated approximately 10 days ago at urgent care for a sinus infection, but two days ago the right side of her fact started to hurt, and today she has significant swelling of the right orbit and eyelid. The eyelid is very edematous and there is purulent drainage noted. The priority of care for this patient begins with: • Question 78 Which of the following is the best indicator that pulmonary rehabilitation has been successful in a patient with chronic obstructive pulmonary disease? • Question 79 Mrs. Marriott is being discharged to home after being managed for an exacerbation of congestive heart failure. She is currently feeling well but her ejection fraction after optimal diuresis and fluid management is 29%. The AGACNP knows that her discharge medications must include: • Question 80 Which of the following is an accurate statement with respect to the assessment of delirium in the geriatric patient? • Question 81 Mrs. Warner is a 57-year-old female who presents with unplanned weight loss. Chest radiography reveals diffuse hyperlucency of the left lung and in the lower half of the right lung. The AGACNP knows that the differential diagnosis for hyperlucency include all of the following except: • Question 82 When evaluating a patient with epistaxis, which of the following signs or symptoms is suggestive of a more serious etiology and posterior packing? • Question 83 R.M. is a 15-year-old male who presents to the emergency department with his mother. Mom says he has been complaining that his throat hurts so badly he cannot even swallow saliva. According to Mom R.M. is not the type to complain, but he is in so much pain with his throat he is almost crying. He has no significant medical history and takes no daily medications. He has no allergies of which his mother is aware. Upon physical examination he is febrile with a temperature of 102.4° F and he is a bit tachycardic, but other vital signs or normal. Inspection of the throat is basically unremarkable—the AGACNP does not appreciate any abscesses, edema, or exudate; there may be some slight erythema. The AGACNP becomes suspicious that the patient: • Question 84 Mr. Stossel is a 66-year-old male patient who was admitted for management of acute anterior wall myocardial infarction. Over a period of hours he has developed acute shortness of breath, coarse rales to auscultation, and Kerley B lines on chest radiography. Arterial blood gas reveals a pH of 7.34, pCO2 of 30 mm Hg, and paO2 of 59 mm Hg. The AGACNP anticipates which of the following findings on physical examination? 3 • Question 85 According to the revised criteria in DSM-V, the primary difference between panic attacks and panic disorder is that: • Question 86 Mr. Wilson is a 71-year-old male who has been treated with prn short acting anticholinergics for his COPD. Last week he developed an exacerbation that required a 4 day hospitalization for support and stabilization. He was discharged on a five day course of prednisone and now presents for follow-up. The AGACNP knows that his outpatient medication regimen should be adjusted to include: 1 • Question 87 J.T. is a 26-year-old female patient being evaluated for eye discharge. She says that for the last few days she has developed this sticky, string-like discharge in both eyes. She denies any pain or visual changes, but does admit to a sense of "something in my eyes" and that her eyes itch a lot. Physical examination reveals injected conjunctiva, rope-like discharge bilaterally; pupil response is equal and brisk in both eyes. Which factor in the patient’s history would be supportive of the most likely diagnosis? • Question 88 What is the primary difference in patient management between high risk non-ST elevation myocardial infarction (MI) and the low risk non-ST elevation MI patient? • Question 89 The pathophysiology of endogenous depression is best described as: • Question 90 The diagnostic study most supportive of a diagnosis of pericarditis is: • Question 91 A 31-year-old male presents to urgent care because he has something in his eye. He was changing the oil under his car and says that something dropped into his eye. He is not having any pain, in fact he waited a day before coming in because he thought it would work itself out. Physical exam reveals a black 1 mm foreign body visible on the corneal surface. The most appropriate intervention is to: • Question 92 A patient with pericarditis is most appropriately treated with: • Question 93 Which of the following is not a risk factor for thoracic aneurysm? • Question 94 The "MONA" acronym provides guidance for immediate interventions in the patient with: • Question 95 Mr. Sloane is a 36-year-old male patient who presents for treatment of eye pain. He has no significant medical history and does not take any daily or over-the-counter medications. His only recent history is nighttime allergies for which he takes occasional diphenhydramine with good relief. He has had some throbbing in his eye for the last few days on and off but just ignored it; today he says it is flat out painful and he had to come to the emergency department. The eye is throbbing and painful, and he reports generalized decreased vision. The pupil is dilated to 5 mm and non-reactive to light. The eye conjunctiva is reddened. The next step in the diagnostic evaluation should be: • Question 96 The AGACNP counsels a patient with recurrent epistaxis that the most common cause of nose bleeding is: • Question 97 The geriatric depression scale (GDS) is a commonly used tool to diagnose depression in the elderly population. It comes in a variety of forms for maximal utility. When administering the geriatric depression scale to patients, the AGACNP recognizes that it is extremely important to: • Question 98 Ventilator-acquired pneumonia (VAP) is a significant problem impacting morbidity, mortality and the cost of inpatient health care. Data-supported mechanisms to reduce the risk for VAP include all of the following except: • Question 99 Absolute contraindications to thrombolytic therapy in the patient having an acute myocardial infarction include all of the following except: • Question 100 Which of the following is not a true statement with respect to risk for or occurrence of elder abuse? [Show Less]
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NURS 6550 MIDTERM EXAM / NURS6550 MIDTERM EXAM(LATEST)| -WALDEN UNIVERSITY
NURS 6550 MIDTERM EXAM / NURS6550 MIDTERM EXAM(LATEST)| -WALDEN UNIVERSITYNURS 6550 MIDTERM EXAM • Question 1 The AGACNP is caring for a patient ... [Show More] who is quite ill and has developed, among other things, a large right sided pleural effusion. Thoracentesis is sent for pleural fluid analysis. While evaluating the fluid analysis, the AGACNP knows that a fluid identified as a(n) __________ is the least worrisome type. • Question 2 Mrs. Miller is transported to the emergency department by paramedics. She is having profound, unremitting chest pain, is diaphoretic and pale. She has jugular venous distention and a widened pulse pressure. Suspecting ascending aortic aneurysm, the AGACNP order which test to confirm the diagnosis? • Question 3 Certain subgroups of the elderly population are at an increased risk for rapid deterioration and long-term care placement. Which of the following is not considered a high risk factor for long term care placement? • Question 4 A patient with anterior epistaxis has been treated with 20 minutes of direct pressure to the cartilaginous portion of the nose. Following pressure the patient is instructed to gently blow the nose. Expected findings in the patient who has been successfully treated include all of the following except a: • Question 5 Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right ear pain. He appears quite ill and says he feels nauseous. Otoscopic evaluation reveals pain to palpation, a very erythematous and bulging tympanic membrane with bullous myringitis. The AGACNP knows that antibiotic therapy must be selected to cover: • Question 6 P.M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of increasing shortness of breath. The diagnostic evaluation ultimately supports a diagnosis of community acquired pneumonia. The AGACNP appreciates right middle lobe consolidation on chest radiography. Pending sputum cultures, empiric antibiotic therapy must be initiated to cover which organism? • Question 7 Which of the following is the greatest risk factor for vascular dementia? • Question 8 J.R. is a 55-year-old male who presents for a commercial driver’s license physical examination with a blood pressure of 170/102 mm Hg. He has no medical history and is without complaint. Which of the following findings constitutes hypertensive urgency? • Question 9 Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment for patients taking these medications should include a: • Question 10 K.R. presents for an evaluation of eye discomfort. He works in a fabricating shop for a custom automobile restoration company and while working he felt like something flew into his eye. He was wearing eye protection at the time but still has the sensation that something is there. Physical examination is significant for some tearing and he reports a persistent sense of something in his eye. Which of the following is not indicated in the diagnostic evaluation? • Question 11 D.E. is a 41-year-old female who had lumbar surgery two days ago to repair a ruptured nucleus pulposus. She has been doing well postoperatively but today is complaining of resting fatigue and some shortness of breath at rest. In ruling out a pulmonary embolus the AGACNP first orders a: • Question 12 Mr. Nixon is being treated with unfractionated heparin infusion for acute pulmonary embolus. In order to avoid a potentially fatal complication of heparin infusion, the AGACNP monitors: • Question 13 Differentiating vertigo from near-syncope and ataxia is one of the goals of history-taking when a patient presents as “dizzy.” The AGACP knows that vertigo is the problem when the patient reports the primary symptom as: • Question 14 Mr. Banks has been admitted for surgical resection of a metastatic tumor, during surgery it is discovered that he has widespread, diffuse metastasis throughout the abdomen. Surgery is no longer an option, and his oncologist says that chemotherapy is unlikely to produce any meaningful benefit. Mr. Banks is concerned that his sons will not support a transfer to comfort care. The AGACNP advises that he: • Question 15 Mr. Wilkerson is a 77-year-old male who is being evaluated and treated for his cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, pulse of 100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A 12-lead ECG reveals deep ST segment depression in leads V3-V6. The AGACNP recognizes which of the following as a contraindication to rTPA therapy? • Question 16 A 71-year-old patient is recovering from a particularly severe exacerbation of chronic obstructive pulmonary disease. He has been in the hospital for almost two weeks and was on mechanical ventilation for 7 days. While discussing his discharge plan he tells you that he is really going to quit smoking this time. He acknowledges that he has been "sneaking" cigarettes in the hospital for two days, but he has established a timeline to decrease the number of cigarettes daily. According to his plan his last cigarette will be the last day of the month. This patient’s behavior is consistent with which stage of the Transtheoretical Model of Change? • Question 17 While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic disorders is: • Question 18 L.T. is an 85-year-old male who is admitted for evaluation of profound diarrhea that has produced significant dehydration. He also complains of being very tired lately, and feeling like he is going to vomit all of the time. His vital signs are significant for a pulse of 41 b.p.m. and a blood pressure of 90/60 mm Hg. A gastrointestinal evaluation including stool for blood, white blood cells, and ova and parasites is negative. He insists that he has not started any new medications or made any diet changes; the only thing new is that he got new eye drops for his glaucoma. The AGACNP correctly assumes that his new eye drops are: • Question 19 Janice is a 19-year-old female who presents to the emergency department via ambulance. She is pale, diaphoretic, agitated, and convinced she is having a stroke. Her vital signs include a temperature of 98.9° F, pulse of 114 beats per minute, respirations of 32 breaths per minute, and a blood pressure of 110/74 mm Hg. Diagnostic evaluation is negative and Janice is diagnosed with an acute panic attack. The initial treatment of choice is: 2 • Question 20 Lorraine is a 41-year-old female who presents for an asthma follow-up visit. She says she feels very well, has almost no daytime symptoms, and is using her inhaled corticosteroid medication daily as prescribed. Her PEFR is 85% of her personal best. The best approach to this patient is to: 1 • Question 21 Mr. Owen is a 37-year-old patient who has been admitted for surgical resection of a malignant tumor in his lung. His physical recovery has been uneventful and he is being prepared for discharge. While discussing his ongoing cancer therapy with Mr. Owen, the AGACNP determines that he has experienced persistent, excessive anxiety and worry almost every day for more than one year. What other aspect of Mr. Owen's psychosocial history would be required to made a diagnosis of generalized anxiety disorder? • Question 22 Kevin T. is a 49-year-old male who is being discharged after hospitalization for an acute inferior wall myocardial infarction. This is his first hospitalization and his first chronic medical diagnosis. Aside from his elevated cardiac isoenzymes and troponins, his laboratory profile was essentially within normal limits. The only apparent cardiac risk factor is an LDL cholesterol of 200 mg/dL. Initiating an HMG-CoA reductase inhibitor is an example of which level of prevention for Kevin? • Question 23 You are evaluating a patient who has been admitted to the emergency room after being arrested for starting a fight in a local sports' bar. The patient is now being cooperative, but reports that he has been in treatment for PTSD for months. He has been prescribed fluoxetine but has not noticed any improvement in symptoms, and now has been arrested for violence. The AGACNP knows that the next step in medication management is likely to include: • Question 24 Mrs. Salter is an 81-year-old lady who presents for evaluation of near-syncopal episodes. Her 12-lead ECG, complete blood count, and comprehensive metabolic panel are all essentially normal. A urinalysis shows some trace protein but is otherwise normal. A 24-hour rhythm monitor demonstrates rare premature ventricular contractions. Mrs. Salter has been in good health and had her first episode at her aerobics class. She only gets lightheaded when she exerts herself. Her heart auscultates for a grade III/VI systolic crescendo-decrescendo murmur at the second intercostal space, right sternal border. The AGACP considers that the likely cause of the syncope is: • Question 25 Who among the following patients is at greatest risk for a pulmonary embolus? • Question 26 Mrs. Birdsong is an 85-year-old female who has been admitted for surgical repair of a hip fracture. She is in remarkably good spirits and is quite talkative. She readily answers all of the questions on her intake assessment, and readily acknowledges information provided during her room orientation. Later while talking with the patient's son the AGACNP learns that the patient has had significant cognitive impairment for a few years. She has virtually no short term memory, but compensates by confabulating. Her son says she is generally very happy as long as there is no change in her day to day routine. This history is most consistent with which form of dementia? • Question 27 Mrs. Radovich is an 80-year-old female with a variety of chronic medical conditions which are reasonably well controlled. She generally enjoys a good quality of life and is active with her family. Today her only concern is that she is having problems with her vision. She notices that while trying to look at pictures of her great grandchildren she can’t seem to focus on their faces. She also reports increased trouble reading—she cannot seem to see the words that she is looking at, and her reading glasses do not help. Further evaluation of Mrs. Radovich should include assessment with: • Question 28 R.J. is a 55-year-old female who presents with acute onset left sided facial pain and an inability to move the left side of her face. She cannot smile, raise her eyebrow or even close her left eye, The immediate approach to this patient should include: • Question 29 A 78-year-old male present for a physical examination. He has no discomfort or complaints other than a general decrease in vision, but it helps when he puts things under a bright light to read. He admits that while driving at night the streetlights appear to be a bit distorted and his night vision is pretty poor. Given the likely diagnosis, the AGACNP expects which of the following physical findings? • Question 30 Jason is a 46-year-old male who is being managed for sepsis. He has HIV/AIDS and has had a prolonged hospitalization characterized by a variety of complications. He was extubated 3 days ago but continues gastric decompression with a nasogastric tube(NGT), total parenteral nutrition and antibiotic therapy via a central venous catheter, and urinary drainage via a Foley catheter. He continues to demonstrate consistent low grade fevers but all points of insertion of his tubes are normal to inspection, a chest radiograph demonstrates improvement of his pneumonia, and his urinalysis shows no bacteria, leukocytes, or nitrites. The AGACNP should next order: • Question 31 The interpretation of a chest radiography should follow a systematic approach to ensure that all vital structures are evaluated and important clinical findings are not missed. The last thing to be assessed when looking at chest radiography should be the _____________: • Question 32 The Short Confusion Assessment Method (Short-CAM) is a widely used four item tool that assesses delirium in the hospitalized patient. It includes observation of all of the following except: • Question 33 Ms. Yang has been hospitalized for 5 days for the management of a gastrointestinal bleeding. She appears to have stabilized hemodynamically, but today she had a temperature of 101.9° F and chest radiography demonstrates a diagnosis of pneumonia. The AGACNP knows that the diagnostic evaluation for hospital acquired pneumonia for all patients must include: • Question 34 Most psychosocial theories of aging center around the core concept that successful aging requires acceptance of a series of changes or losses that predictably occur later in the life span. The theory that specifically addresses coming to terms with the inevitability of death is known as: • Question 35 All of the following conditions are risk factors for pulmonary embolus except: • Question 36 A patient is diagnosed with acute descending aortic aneurysm and hypertension should be immediately started on which medication pending surgical evaluation? • Question 37 Jason is a 27-year-old with a long history of intermittently controlled asthma. He is currently prescribed Advair daily with albuterol as needed for symptoms. Today he presents to the emergency department with cough and wheezing and difficulty catching his breath. His FEV1 is 51% at the time of presentation. He is given alternating albuterol and ipratropium nebulizer treatments along with oral prednisone. After one hour his FEV1 has increased 65%. The appropriate disposition for Jason at this point is: 111 • Question 38 A patient in the intensive care unit suddenly becomes tachypneic and dyspneic. The physical examination reveals pale, cool, clammy skin and an arterial blood gas demonstrates hypocapnea and hypoxia. Pulmonary artery pressure demonstrates a pattern consistent with obstructive shock. The AGACNP knows that which of the following causes of this presentation is most likely? • Question 39 Mr. Bowers is an 81-year-old male who is being terminally extubated at the request of his family due to the presence of a large subdural hematoma with a shift; the patient is not initiating respirations on his own and the prognosis is very poor. After he is extubated he begins to initiate his own respirations and 24 hours later has not expired yet. The decision is made to leave him in the hospital on a general medical floor rather than transfer to another facility for hospice. Which of the following is the best indicator that the patient’s death is imminent? • Question 40 A patient is newly admitted to your service for open reduction and internal fixation of the left hip. She seems very down, and as you talk with her you realize that her mood is not just related to her hip fracture. Which of the following symptoms would not be consistent with major depressive disorder? • Question 41 “C” is the correct answer. Alzheimer’s dementia is statistically the most common form of dementia and is characterized by a long trajectory that progresses to include confabulation. Additionally, patients with this form of dementia are very reliant upon routine and may be distressed when it is disrupted. “A” is not correct; Lewy body dementia characteristically progresses much more quickly and produces an angry demeanor. “B” is incorrect because vascular dementia typically produces a more depressive affect and is not characterized by confabulation; additionally, patients with vascular dementia often have a medical history consistent with vascular risk factors. “D” is not correct as there is no apparent history of Parkinson’s disease. • Question 42 What is the primary purpose of using eye ointments or lubricants to patients under general anesthesia, on paralytics, or in long-term comatose states? • Question 43 When reading a 12-lead electrocardiogram, the AGACNP knows that all 12 leads are required to provide: • Question 44 A 49-year-old male presents for evaluation of chest tightness. It has happened before, but he just ignored it and it went away. Today he just could not ignore it anymore. He has always enjoyed good health and says he has never been told that he has any chronic medical conditions like high blood pressure or diabetes. A 12-lead ECG demonstrates changes consistent with inferior wall ischemia. Both his symptoms and inferior wall changes improve with the administration of sublingual nitroglycerin. Consistent with ACS protocol, this patient’s assessment is consistent with: • Question 45 Mr. Rosen is a 49-year-old male who is being managed for an acute myocardial infarction. He develops significant shortness of breath at rest and coarse rales 2/3 up bilaterally. The AGACNP suspects acute pulmonary edema due to papillary muscle rupture and acute mitral valve regurgitation. Which physical finding would support this finding? • Question 46 A patient with minor head trauma presents for evaluation. Which of the following findings should be followed up with a CT scan to rule out orbital fracture? • Question 47 Mrs. Forbes is a 69-year-old lady being discharged from the hospital after complications following a cosmetic surgical procedure. She is basically in good health. She has a history of hypothyroidism for which she takes levothyroxine daily, and mild osteoarthritis which is controlled with only prn nonsteroidal use. Her blood pressure is 148/90 mm Hg. The AGACNP knows that in accordance with the most current guidelines published in JNC 8 the appropriate action is to: • Question 48 When assessing driver safety in the older adult, the AGACNP considers that: • Question 49 The nursing staff calls to tell you that your 81-year-old male patient is having an acute change in mental status. He is a basically healthy man who was admitted three days ago for inpatient antibiotic management of community acquired pneumonia. His daughter is at the bedside and she is very distraught because she has never seen him like this. She is asking for medication to make him stop acting disoriented. Upon examination the patient is lying in bed, appears calm and happy, but does not recognize his daughter as anyone he knows. He is talking as if he is at home and has company. The AGACNP instructs the daughter that: • Question 50 While discharging a patient following her myocardial infarction, you offer some patient education about medically supervised cardiac rehabilitation. The patient expresses fear of rehab because she was on her treadmill when she had her infarction and now she is afraid of making it happen again. She doesn’t understand how the rehab can force her to exercise her heart but not make her have another cardiac event. The AGACNP explains that the patient will be monitored and that her goal heart rate will be: • Question 51 During physical examination of a 51-year-old African-American female you appreciate a decrease in her peripheral vision. The rest of her eye examination is within normal limits and she is symptom free. This presentation is consistent with: • Question 52 Mr. Moffett is a 66-year-old male with a long history of lower extremity edema. All other causes of lower extremity edema have been ruled out and his overall symptom presentation and history are strongly supportive of chronic venous insufficiency. Today he presents with increased itching of both lower legs. Physical exam reveals 2-3+ pitting edema and trophic hyperpigmentation. The AGACNP know that treatment should include: • Question 53 L.R. is an 84-year-old female patient being treated for pneumonia. Her condition is deteriorating despite aggressive broad spectrum antipseudomonal cephalosporin antibiotic therapy. Induced sputum culture reveals heavy growth of Legionella pneumophilia. The AGACNP knows that antibiotic therapy must be adjusted to include coverage with: • Question 54 The AGACNP is treating a patient with a corneal abrasion. The patient has a clear recollection of the mechanism of injury—she was scratched in the eye earlier today with her 18-month-old daughter’s fingernail. Which of the following is contraindicated in the management of this patient’s abrasion? • Question 55 M.T. is a 41-year-old male patient in the intensive care unit. He was admitted to the hospital in septic shock and has been aggressively managed with broad spectrum antibiotics. He has become progressively hypoxemic and the last arterial blood gas revealed a paO2 of 58 mm Hg. Chest radiography reveals a "white out" pattern bilaterally. The patient is intubated and ventilated. The AGACNP knows that appropriate management must include: 22 • Question 56 Teenagers and adults with acute otitis media can often be treated with "watchful waiting" given the high incidence of spontaneous resolution and low risk of poor outcomes. Which of the following is an absolute indication to begin antibiotic therapy at the time of diagnosis? • Question 57 Mr. Bowers is on mechanical ventilation for respiratory support through an episode of septic pneumonia. Due the extensive lobar consolidation it was very difficult to keep Mr. Bowers oxygenated and he required very high FIO2s and PEEP. The AGACNP knows that the primary concern with FIO2s > 60% is: 222 • Question 58 Acute respiratory distress syndrome (ARDS) occurs when an overwhelming systemic insult results in which maladaptive physiologic response? • Question 59 Acute respiratory distress syndrome is characterized by which abnormality of ventilation and perfusion? • Question 60 George Schulz is a 69-year-old male who presents for evaluation of acute foot pain. It is so painful that he cannot walk on it without assistance. At first he denies any significant medical history, but then reveals that he has been diagnosed with dyslipidemia and hypertension but stopped taking his medications because he couldn’t afford it. Pulses are not palpable but are audible by Doppler. The extremity is pale and shiny with decreased hair growth, suspecting peripheral arterial disease, the AGACNP expects which additional finding? • Question 61 G.T. is a 40-year-old male who is under your case for long term management of secondary osteoarthritis. Today he asks if he can take a medication for anxiety. Further assessment reveals that he is in a relationship that has been very stressful; his girlfriend wants very much to get married and start a family, and he does not. He admits that he no longer feels they are compatible and acknowledges that he needs to end this relationship. He is sure that this is the source of his anxiety. The best approach would be to: • Question 62 During the physical examination of a 31-year-old female, the AGACNP appreciates a bifurcate uvula. The most appropriate action would be to: • Question 63 During routine immigration screening a 29-year-old male patient from Mexico has a positive purified protein derivative (PPD) test at 17 mm induration. He reports no known history of tuberculosis (TB) infection or exposure, or vaccination with the BCG vaccine. Chest x-ray is negative for any evidence of TB exposure. The AGACNP knows that the appropriate next step is to: • Question 64 Clinical diagnostic criteria for acute respiratory distress syndrome (ARDS) include all of the following except: • Question 65 While managing a patient in acute pulmonary edema, the AGACNP monitors the pulmonary capillary wedge pressure. When this pressure falls below 12 mm Hg it suggests that: • Question 66 All of the following are important elements of the immediate management of penetrating eye injury except: • Question 67 While evaluating a patient with diastolic failure due to a long history of uncontrolled hemochromatosis, the AGACNP appreciates an extra heart sound just before the S1 heart sound. This sound is most likely a(n): • Question 68 Secondary hypertension occurs in approximately 10% of all patients with hypertension, and requires management of the underlying problem in order to eliminate the cause. Which of the following is not a secondary cause of hypertension? • Question 69 L.M, is a 26-year-old male who presents to the emergency department complaining of acute onset vertigo this morning. He describes a strong sense of the room spinning and can barely walk without feeling nauseous. The vertigo is reproducible when his neck is rotated suddenly left or right. The AGACNP knows that which of the following is not indicated? • Question 70 A 36-year-old female presents complaining of left leg swelling. She describes the onset as acute over the last day or two, and says it feels "tight and throbbing." She denies any significant medical history and says the only medication she takes is oral contraception, which she has taken since she was 15 years old. The AGACNP first orders: • Question 71 The primary neurotransmitter implicated in post-traumatic stress disorder (PTSD) is: • Question 72 Mr. Avila is an 82-year-old male being counseled about the risks and benefits of his upcoming abdominal surgery. While considering risk factors for atelectasis, pneumonia and other pulmonary complications, the AGACNP advises that the greatest risk comes from: • Question 73 The female AGACNP is practicing with a cardiology group and sees patients one day a week in the outpatient office. A 49-year-old female presents for follow-up after her admission for infective endocarditis. She is recovering well, and says that she is going to be more proactive about her health. She admits to not having had any of her regular health screenings for years, and asks if she can have her Pap performed at this office. The AGACNP: • Question 74 The AGACNP is seeing a patient who was transferred from the correctional facility for evaluation. He has a profound purulent discharge from his right eye. The conjunctive is erythematous and there is mild photosensitivity. The inmate denies any real eye pain, just says that it is extremely uncomfortable. Treatment for this patient is likely to include: • Question 75 Ms. Ewing is a 78-year-old female who lives in a long term care facility because her dementia has progressed to the point at which her family cannot provide the necessary safety measures at home. In addition to her absent short term memory she has developed some affective changes and most recently is demonstrating sexual disinhibition. While considering management options, the AGACNP knows that all of the following are medications are options for the management of disinhibition except: • Question 76 A patient recently had a nasal packing inserted for management of refractory epistaxis. One week later he presents with fatigue, a headache “inside of his nose” and a feeling generally unwell. The AGACNP considers: • Question 77 A 55-year-old female patient presents with a fever of 103.4° F. She was treated approximately 10 days ago at urgent care for a sinus infection, but two days ago the right side of her fact started to hurt, and today she has significant swelling of the right orbit and eyelid. The eyelid is very edematous and there is purulent drainage noted. The priority of care for this patient begins with: • Question 78 Which of the following is the best indicator that pulmonary rehabilitation has been successful in a patient with chronic obstructive pulmonary disease? • Question 79 Mrs. Marriott is being discharged to home after being managed for an exacerbation of congestive heart failure. She is currently feeling well but her ejection fraction after optimal diuresis and fluid management is 29%. The AGACNP knows that her discharge medications must include: • Question 80 Which of the following is an accurate statement with respect to the assessment of delirium in the geriatric patient? • Question 81 Mrs. Warner is a 57-year-old female who presents with unplanned weight loss. Chest radiography reveals diffuse hyperlucency of the left lung and in the lower half of the right lung. The AGACNP knows that the differential diagnosis for hyperlucency include all of the following except: • Question 82 When evaluating a patient with epistaxis, which of the following signs or symptoms is suggestive of a more serious etiology and posterior packing? • Question 83 R.M. is a 15-year-old male who presents to the emergency department with his mother. Mom says he has been complaining that his throat hurts so badly he cannot even swallow saliva. According to Mom R.M. is not the type to complain, but he is in so much pain with his throat he is almost crying. He has no significant medical history and takes no daily medications. He has no allergies of which his mother is aware. Upon physical examination he is febrile with a temperature of 102.4° F and he is a bit tachycardic, but other vital signs or normal. Inspection of the throat is basically unremarkable—the AGACNP does not appreciate any abscesses, edema, or exudate; there may be some slight erythema. The AGACNP becomes suspicious that the patient: • Question 84 Mr. Stossel is a 66-year-old male patient who was admitted for management of acute anterior wall myocardial infarction. Over a period of hours he has developed acute shortness of breath, coarse rales to auscultation, and Kerley B lines on chest radiography. Arterial blood gas reveals a pH of 7.34, pCO2 of 30 mm Hg, and paO2 of 59 mm Hg. The AGACNP anticipates which of the following findings on physical examination? 3 • Question 85 According to the revised criteria in DSM-V, the primary difference between panic attacks and panic disorder is that: • Question 86 Mr. Wilson is a 71-year-old male who has been treated with prn short acting anticholinergics for his COPD. Last week he developed an exacerbation that required a 4 day hospitalization for support and stabilization. He was discharged on a five day course of prednisone and now presents for follow-up. The AGACNP knows that his outpatient medication regimen should be adjusted to include: 1 • Question 87 J.T. is a 26-year-old female patient being evaluated for eye discharge. She says that for the last few days she has developed this sticky, string-like discharge in both eyes. She denies any pain or visual changes, but does admit to a sense of "something in my eyes" and that her eyes itch a lot. Physical examination reveals injected conjunctiva, rope-like discharge bilaterally; pupil response is equal and brisk in both eyes. Which factor in the patient’s history would be supportive of the most likely diagnosis? • Question 88 What is the primary difference in patient management between high risk non-ST elevation myocardial infarction (MI) and the low risk non-ST elevation MI patient? • Question 89 The pathophysiology of endogenous depression is best described as: • Question 90 The diagnostic study most supportive of a diagnosis of pericarditis is: • Question 91 A 31-year-old male presents to urgent care because he has something in his eye. He was changing the oil under his car and says that something dropped into his eye. He is not having any pain, in fact he waited a day before coming in because he thought it would work itself out. Physical exam reveals a black 1 mm foreign body visible on the corneal surface. The most appropriate intervention is to: • Question 92 A patient with pericarditis is most appropriately treated with: • Question 93 Which of the following is not a risk factor for thoracic aneurysm? • Question 94 The "MONA" acronym provides guidance for immediate interventions in the patient with: • Question 95 Mr. Sloane is a 36-year-old male patient who presents for treatment of eye pain. He has no significant medical history and does not take any daily or over-the-counter medications. His only recent history is nighttime allergies for which he takes occasional diphenhydramine with good relief. He has had some throbbing in his eye for the last few days on and off but just ignored it; today he says it is flat out painful and he had to come to the emergency department. The eye is throbbing and painful, and he reports generalized decreased vision. The pupil is dilated to 5 mm and non-reactive to light. The eye conjunctiva is reddened. The next step in the diagnostic evaluation should be: • Question 96 The AGACNP counsels a patient with recurrent epistaxis that the most common cause of nose bleeding is: • Question 97 The geriatric depression scale (GDS) is a commonly used tool to diagnose depression in the elderly population. It comes in a variety of forms for maximal utility. When administering the geriatric depression scale to patients, the AGACNP recognizes that it is extremely important to: • Question 98 Ventilator-acquired pneumonia (VAP) is a significant problem impacting morbidity, mortality and the cost of inpatient health care. Data-supported mechanisms to reduce the risk for VAP include all of the following except: • Question 99 Absolute contraindications to thrombolytic therapy in the patient having an acute myocardial infarction include all of the following except: • Question 100 Which of the following is not a true statement with respect to risk for or occurrence of elder abuse? [Show Less]
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NURS 6550 FINAL EXAM / NURS6550 FINAL EXAM(LATEST)| -WALDEN UNIVERSITY
NURS 6550 FINAL EXAM / NURS6550 FINAL EXAM(LATEST)| -WALDEN UNIVERSITYQuestion 1. The Valsalva maneuver and the squat-to-stand maneuver are likely to incre... [Show More] ase the sound of a cardiac murmur associated with which of these conditions? Hypertrophic cardiomyopathy 2. Which of the following conditions may result in lower extremity edema? Nephrotic syndrome Decompensated congestive heart failure Cirrhosis Renal failure Deep venous thrombosis Late-stage pregnancy All of the above 3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial infarction. He has now developed significant dyspnea at rest and, per physical exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-valve regurgitation. Question: Which of the following physical findings would support this diagnostic hypothesis? A palpable diastolic murmur maximal in the second intercostal space (ICS) at the left sternal border A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the left sternal border A holosystolic systolic murmur heard maximally in the fifth ICS at the midclavicular line 4. The most common ECG finding in a patient with a cardiomyopathy is an ST-elevation MI. True False 5. Nina Martinez is a 70-year-old female who experienced an episode of acute pulmonary edema following an endovascular aneurysm repair. She was discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is now seen in the office at 2 weeks post discharge. Her metabolic panel includes the following lab values: • Na 126 mEq/L • K 4.0 mEq/L • Cl 93 mEq/L • CO2 28 mEq/L • BUN 40 mg/dL • Cr 1.3 mg/dL Question: This patient has which of the following abnormalities as a likely consequence of diuretic overuse? Hyponatremia Hypokalemia Metabolic acidosis 6. Which of the following are primary cardiomyopathy categories, as described by the World Health Organization (WHO) in 1995? Dilated cardiomyopathy Symbol Hypertrophic cardiomyopathy (HCM) Symbol Restrictive cardiomyopathy Symbol Arrhythmogenic right ventricular dysplasia Symbol Unclassified All of the above 7. What is the most common cause of sudden cardiac death in young people? What is the most common cause of sudden cardiac death in young people? Myocardial infarction Hypertrophic cardiomyopathy Supraventricular tachycardia Arrhythmogenic right ventricular dysplasia; aka arrhythmogenic right ventricular cardiomyopathy (ARVC) 8. Which of the following are treatment options for a patient who presents with peripartum cardiomyopathy while still carrying the fetus? (Select all that apply.) ACE inhibitors Induction if stable Emergent cesarean section if unstable Digoxin Nitroglycerin 9. What are the 3 major clinical complications related to cardiomyopathies? Arrhythmias; including ventricular tachycardia and ventricular fibrillation Thromboembolic complications; including DVT, PE, and ventricular thrombi Acute pulmonary edema 10. Some patients with primary cardiomyopathies remain asymptomatic throughout their lifetime. True False 11. A 38-year -old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take? Acetaminophen and caffeine (Excedrin ® Migraine) Naproxen sodium (Aleve ® ) Almotriptan (Axert ® ) Butalbital, acetaminophen and caffeine (Fioricet ® ) 12. You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a: Drug-related reaction. Consequence of occupational chemical exposure. Early sign of dementia. Normal age-related change in hearing 13. While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism? Nitrites 30 mg/dL protein Epithelial cells pH>8 14. All of the following are examples of primary prevention strategies except: Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination. Performing a hemoglobin A1C for all patients admitted to the hospital. Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk. Immunizing all adults ?60 years with zoster vaccine. 15. A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics? Usually obliterates S2. Becomes softer when going from a supine to standing position. Occurs late in systole. Has localized area of auscultation 16. You see a 73-year-old woman with a 40 pack- year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is: Pressure ulcer Pyoderma gangrenosum Venous ulcer Arterial ulcer 17. You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is: Administering the seasonal influenza vaccine. Screening for physical or financial abuse/Checking her blood glucose level. Checking her blood pressure. Adjusting her insulin dosing regimen. 18. A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of: Migraine with aura. Cluster headache. Transient ischemic attack. Tension-type headache. 19. You see a 54-year-old man living in subsidized housing with a history of hypertension. He states that he stopped taking his blood pressure medication about 4 months ago because of costs. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of this patient, you would expect to detect an S 4 sound heard during: Early systole. Late systole. Early diastole. Late diastole. 20. 32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He presents with the following laboratory results: Hepatitis A Panel Hepatitis B Panel Hepatitis C Panel Anti-HAV Negative HBsAg Negative Anti-HCV Positive IgM Negative Anti-HBc Negative HCV RNA Negative IgM NegativeAnti-HBs Positive You recognize the patient is susceptible to: Hepatitis A and B Hepatitis B and C Hepatitis B only Hepatitis A only 21. When evaluating illness symptoms in older patients, the disease will often present differently from younger adults due to: The likelihood of polypharmacy. Decreased compensatory mechanisms in the elderly. An increased physiologic response to illness in the elderly. Presence of comorbid conditions. 22. When prioritizing risk factors for bacterial endocarditis, the nurse practitioner knows who among the following patients has the highest risk. A 55-year-old man with 3-vessel coronary artery bypass grafts with stents. A 23-year-old woman with mitral valve prolapse without tissue redundancy. A 65-year-old man with nonobstructive cardiomyopathy. A 75-year-old woman with a nonorganic prosthetic aortic valve. 23. The legal authority for NPs to perform healthcare services as defined by state law is called: Duty of care. Non-malfeasance. Autonomy. Scope of practice. 24. When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection? A 27-year-old nonpregnant woman with acute, uncomplicated urinary tract infection (UTI). A 38-year-old nonpregnant woman with 2 acute, uncomplicated UTIs in the past 9 months. A 57-year-old man with acute bacterial prostatitis. A 43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis. 25. The NP is called to evaluate Jane, a 43-year- old woman, who presents with a diffuse maculopapular rash that began on the trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalized lymphadenopathy and a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis? Primary syphilis. Secondary syphilis. Genital herpes. Gonorrhea. 26. A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a “bag of worms” and is present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous relationship for the past 4months. The most likely diagnosis is: Testicular torsion. Syphilis. Varicocele. Testicular cancer. 27. An 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long- acting beta-agonist, and a short-acting beta-agonist on an as needed basis. The most important component of the initial assessment includes a(n): Continuous pulse oximetry reading Peak expiratory flow reading Chest X-ray Arterial Blood Gas 28. A 67-year-old man is being evaluated for shortness of breath. His medical history reveals that he experienced a myocardial infarction about 2 years ago and a history of hypertension, which is well controlled by diet.. Otherwise, his medical history is unremarkable. Which of the following would you expect to find on electrocardiogram (ECG)? T wave inversion. Pathologic Q wave. ST segment elevation. Tall R wave. 29. A 74-year-old male with asymptomatic atrial fibrillation underwent electrical cardioversion that successfully restored the heart’s rhythm. Which of the following medications can be considered for the purpose of maintaining the heart’s rhythm? Sotalol (Betapace ® ) Digoxin (Lanoxin ® ) Dabigatran (Pradaxa ® ) Enalapri 30. A 14-year-old male is brought in for evaluation after he reportedly collapsed during a tennis match, though he quickly regained consciousness. His medical history is otherwise unremarkable. You suspect hypertrophic cardiomyopathy. Which of the following heart murmur characteristics would support the diagnosis? Occurs late in systole. Widely split S?. Becomes louder when going from a supine to standing position. Murmur follows mid-systolic click. 31. You see a 64-year-old man with an area of erythema concentrated on the left side of his neck with clusters of vesicles forming a line. He reported pain in the area a couple of days before the eruption of the lesions. He states that he recently initiated biologic therapy for rheumatoid arthritis. Which of the following is the most likely diagnosis? Impetigo. Herpes zoster. Drug-related adverse reaction. Viral exanthem. 32. An NP’s duty of care can be established: Only in the setting of a healthcare institution (e.g., hospital, clinic, etc.). When the NP gives professional advice or treatment in any setting. Only when a fee is charged, either to the patient or third-party payer, for services. Only when both the NP and patient acknowledge a patient-provider relationship. 33. In managing a 58-year- old woman who is admitted for deep vein thrombosis, caution should be used with which of the following medications due to a risk of drug-induced thrombocytopenia? Warfarin (Coumadin®) Clopidogrel (Plavix®) Dabigatran (Pradaxa®) Unfractionated heparin 34. An 84-year-old female patient is admitted from a local long-term care facility (illnes). The patient is normally awake, alert, and oriented. She resides in the LTCF because she has not fully recovered from a broken hip resulting from a fall 4 months ago; otherwise she is in relatively good health. She can walk short distances with a walker, though she primarily stays in a wheelchair. Today, however, the nursing staff found her to be acutely confused and unable to ambulate without falling. She was transferred to the emergency department for evaluation. Initial laboratory testing must include: 2 sets of blood cultures. Serum thyroid stimulating hormone (TSH) level. Urinalysis. Lumbar puncture. 35. A 23-year-old college student presents with a 2-day history of severe sore throat and difficulty eating or drinking due to trouble swallowing. A physical examination reveals exudative pharyngitis and minimally tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious mononucleosis and would expect which of the following laboratory findings? Neutrophilia with reactive forms. Thrombocytosis. Lymphocytosis with atypical lymphocytes. Diminished ALT/AST levels. 36. "Incident-to" services are defined as those which are "an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness". As long as certain criteria are met, “incident to” billing is an option in all of the following settings except: Office visits. Hospital. Nursing home. Home visits. 37. A 78-year- old male is being treated for a hypoglycemic episode. He has a long history of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently taking basal insulin with a sulfonylurea. What is the acceptable A1C goal for this patient? = 6.5% = 7.0% = 8.0% = 9.0% 38. You see a 74- year-old male who is accompanied by his granddaughter who lives with him. He has hypertension, a prior myocardial infarction, long-standing type 2 diabetes, and recently underwent a lower limb amputation secondary to diabetes. He is currently taking an ACE inhibitor, statin, low-dose aspirin, biguanide, and insulin. The granddaughter reports that since the amputation, her grandfather sometimes becomes withdrawn, irritable and moody for no apparent reason, does not want to participate in the typical activities he enjoys, and often does not appear to eat much during the day. She also states that he often complains of being tired but normally wakes up in the early morning hours. The most appropriate action is to evaluate the patient for: Dementia. Depression. Delirium. Drug interaction. 39. You see a 58-year-old man who complains of a persistent dry, hacking cough. He reports that he recently started taking a medication to treat high blood pressure. He is most likely taking a(n): Angiotensin-converting enzyme (ACE) inhibitor Alpha-adrenergic antagonist Angiotensin receptor blocker Beta-adrenergic antagonist 40. A 77-year-old woman is accompanied by her husband for evaluation. She is currently being treated with metoprolol (Lopressor ® ) for hypertension and digoxin (Lanoxin ® ) for atrial fibrillation. He reports that his wife is becoming increasingly forgetful over the past year, failing to note important family events such as birthdays, and sometimes becomes confused with driving directions to familiar locations. She has no previous psychiatric history. The most likely diagnosis is: Parkinson’s disease. Delirium. Dementia. Early stage of congestive heart failure. 41. Mrs. Conner is a 76- year-old woman living in a long-term care facility and has been bedridden with a respiratory infection for the past 4 days. She is brought in for evaluation and you note signs of dehydration as well as a section of epidermal skin loss about 3 cm in diameter on her right hip. The dermal layer appears intact. This would be considered a pressure ulcer of Stage: 1 2 3 4 42. Which of the following represents the highest level of scientific evidence when evaluating clinical research? A randomized controlled trial. Systematic review/ Meta-analysis of randomized controlled troals. Observational study. Cohort study. 43. A 64-year- old woman with chronic kidney disease presents with a chief complaint of lethargy. His hemogram is as follows: -Hemoglobin (Hg)=9.9 g/dL (12–14 g/dL -Hematocrit (Hct)=30% (36%–42%) -Mean cell volume (MCV)=81 fL (80–96 fL -Reticulocytes=0.7% (1%–2%) These findings are most consistent with: Iron deficiency anemia. Anemia of chronic disease. Folate deficiency anemia. Thalassemia trait. 44. You see a 68-year-old woman who is being treated for moderate depression. She complains that her medication is causing symptoms of dry mouth and constipation. She is most likely taking which of the following medications? Venlafaxine (Effexor ® ) Citalopram (Celexa ® ) Fluoxetine (Prozac ® ) Nortriptyline (Pamelor ® ) 45. All of the following persons are eligible for Medicare services except: A 74-year-old ex-smoker with COPD and high income from assets. A 69-year-old undocumented resident in the US with atrial fibrillation. A 62-year-old with a permanent physical disability due to a motor vehicle accident. A 72-year-old permanent legal resident (non-US citizen) with type 1 diabetes mellitus. 46. When initiating therapy with spironolactone for a patient who is also on an ACE inhibitor, you advise the patient to return in 5 days to check which of the following laboratory parameters? Sodium Calcium Potassium Chloride 47. When considering an end-of-life decision for a terminally ill person with Alzheimer-type dementia who can no longer communicate, all of the following can be used as an advanced directive except: Testimony from a family member or close friend A living will. A “do not resuscitate” order. A durable power of attorney for healthcare. 48. Which of the following types of clinical studies represents the lowest level of evidence used to guide medical decisions? Clinical experience of renowned expert in field. Non-randomized controlled study. Observational study. Case-control study. 49. Which of the following electrocardiogram (ECG) changes do you expect to find in a person with myocardial ischemia?calcium Pathologic Q wave Tall R wave T wave inversion ST segment elevation 50. Which of the following statements is false regarding end-of-life decision-making for a patient that is hopelessly and terminally ill? A durable power of attorney for healthcare can be used to authorize another person to make healthcare decisions. A videotaped or audiotaped discussion with the patient can include advanced directives. Advanced directives are legally binding and recognized in all 50 states. Living wills and do not resuscitate orders are examples of advanced directives. 51. The nurse practitioner is evaluating a 19-year- old male suffering from a severe headache. He has a history of headaches that tend to occur in clusters over a few days. He has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headache? Oxygen therapy. Beta-adrenergic blockade. Tricyclic antidepressant. Dietary reduction of amines. 52. All of the following are required Medicare terms and conditions for paying NP services except: The services are within the NP’s scope of practice as defined by state law. The services performed are those for which a physician would be able to bill Medicare. The services are performed in collaboration with a physician. Separate charges are billed for NP services and facility charges. 53. A 28- year- old male with asthma presents with a chief complaint that he has to use his rescue inhaler multiple times each day. An evaluation reveals that he has moderate-to-severe asthma and requires Step 4 treatment. An appropriate regimen would include: Low-dose inhaled corticosteroid (ICS) Medium-dose ICS Medium-dose ICS plus a long-acting beta?-agonist (LABA) High-dose ICS plus LABA plus omalizumab (Xolair ® ) 54. A 62-year-old woman presents in the emergency department complaining of severe toe pain that originated overnight. She has a history of renal disease and is currently taking a thiazide diuretic. Her BMI is 37 kg/m 2 . In considering a diagnosis of acute gouty arthritis, the nurse practitioner knows that the best diagnostic indicator is: Serum uric acid. Joint X-ray. Erythrocyte sedimentation rate (ESR). Analysis of joint aspirate for urate crystals. 55. Which of the following is the most appropriate antibiotic for a 57-year-old man with acute bacterial rhinosinusitis and who has type 2 diabetes mellitus, COPD and a beta-lactam allergy? Cephalexin (Keflex ® ). Amoxicillin-clavulanate (Augmentin ® ). Trimethoprim with or without sulfamethoxazole (Primsol ® , Bactrim ® ). Levofloxacin (Levaquin ® ) [Show Less]
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NURS 6550 FINAL EXAM 100- CORRECT / NURS6550 FINAL EXAM 100- CORRECT(LATEST)| -WALDEN UNIVERSITY
NURS 6550 FINAL EXAM 100- CORRECT / NURS6550 FINAL EXAM 100- CORRECT(LATEST)| -WALDEN UNIVERSITYNURS 6550 FINAL EXAM
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