NURS 6560 Final Exam
Question 1
A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients
... [Show More] with an adrenal tumor typically will demonstrate:
A. Low ACTH and low cortisol
B. Low ACTH and high cortisol
C. High ACTH and low cortisol
D. High ACTH and high cortisol
Question 2
Pneumatosis, or gas cysts, may form in the wall anywhere along the gastrointestinal tract; in some cases, they will produce symptoms such as abdominal discomfort, diarrhea with mucus, and excess flatulence. Treatment of pneumatosis most often involves:
A. Several days of oxygen by face mask
B. Hyperbaric oxygen
C. Surgical resection
D. Treatment of underlying disease
Question 3
Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifer’s evaluation and management should include:
A. No further care, because the chest radiograph is negative
B. Quantiferon serum assay for exposure
C. Consideration of prophylactic therapy
D. Beginning therapy for pulmonary TB pending sputum cultures
Question 4
P. E. is a 61-year-old female who presents for a postoperative visit following a gastric resection after a perforation of peptic ulcer. She reports feeling better, although it is taking longer than she expected. However, she says she is feeling better each day, her appetite is returning, and her incision is healing well. She is being discharged from surgical care and advised to continue her routine health promotion follow-up with her primary care provider. As part of her surgical discharge teaching, the AGACNP counsels P. E. that as a result of her gastric resection she will need lifelong follow-up of:
A. Blood group substances
B. Electrolytes
C. Vitamin B12
D. Gastric pH
Question 5
M. T. is a 71-year-old female who presents for evaluation of a ―lump on her chest.‖ She denies any symptoms—there is no pain, erythema, edema, ecchymosis, or open areas—it is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard; it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a:
A. Neurolemma
B. Lipoma
C. Hemangioma
D. Lymphangioma
Question 6
The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla?
A. Alpha-adrenergic antagonists
B. Beta-adrenergic antagonists
C. Intravenous vasodilators
D. Arteriolar dilators
Question 7
In myelodysplastic syndromes, the primary indications for splenectomy include:
A. Major hemolysis unresponsive to medical management
B. Severe symptoms of massive splenomegaly
C. Sustained leukocyte elevation above 30,000 cells/µL
D. Portal hypertension
Question 8
The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?
A. Radiographs
B. CT scan without contrast
C. MRI
D. PET scan
Question 9
The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s management is to:
A. Continue the current regimen
B. D/C the spironolactone and begin a loop diuretic
C. Add a loop diuretic to the spironolactone
D. Proceed to large-volume paracentesis
Question 10
Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?
A. High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant
B. There is a strong interest in developing corticosteroid-free posttransplant protocols
C. Better results are demonstrated in corticosteroid-free protocols for second-transplant
recipients
D. Evidence supports corticosteroid-free rejection protocols
Question 11
K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms; the remainder of the GI review of systems is negative. His medical
history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that:
A. He will need endoscopy to evaluate the problem
B. Chronic gastroparesis is a known complication of ulcer surgery
C. Medication is unlikely to help, and he may need another surgery
D. His symptoms occur in 5 to 10% of people after ulcer surgery
Question 12
The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal:
A. Increased MCV
B. Increased Hgb
C. Increased platelets
D. Increased albumin
Question 13
A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?
A. Isoproterenol 0.2 to 0.6 mg IV bolus
B. External pacemaking
C. Atropine 0.5 mg IV
D. Epinephrine 1 mg IV
Question 14
Ms. Carpenter is a 28-year-old female who presents in significant pain; she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?
A. Temperature > 102°F
B. White blood cell count > 14,000 cells/µL
C. Vomiting
D. Hematuria
Question 15
Which of the following is not a true statement with respect to decision making for a cognitively impaired patient?
A. Only a court can declare a patient incompetent
B. Impaired cognition does not make a person incompetent
C. Living wills typically are honored if a person is terminally ill
D. A patient can give informed consent if not declared incompetent
Question 16
Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease; its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except:
A. Gamma-aminobutyric acid (GABA)
B. Ammonia
C. False neurotransmitters
D. Serotonin
Question 17
Ross A. is a 38-year-old who has just had a kidney transplant. The AGACNP knows that, due to the characteristic and anticipated response of transplanted kidneys, the patient requires:
A. Aggressive rehydration
B. Controlled hydration
C. Hypertonic rehydration
D. Isotonic rehydration
Question 18
Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is ―really wrong.‖ She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for
a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?
A. Abdominal radiographs
B. CT scan of the abdomen with contrast
C. Right upper quadrant ultrasound
D. A HIDA scan
Question 19
Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didn’t want to go to the emergency room because he didn’t want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes:
A. Proper cleansing and covering of the laceration, along with antibiotic therapy
B. Local anesthesia, cleansing, and wound exploration for foreign bodies
C. Local anesthesia, cleansing, and suture repair
D. Cleansing, covering, antibiotic therapy, and tetanus prophylaxis
Question 20
T. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600/µL. The AGACNP suspects:
A. Dissecting aortic aneurysm
B. Acute pancreatitis
C. Perforated peptic ulcer
D. Mallory-Weiss tear
Question 21
A 42-year-old woman presents to the emergency department after being raped. The AGACNP examines her and realizes that the patient’s husband is the rapist. The patient does not want to press charges and wants to return home with her husband. The AGACNP’s initial action should be to:
A. Report the physical assault to law enforcement
B. Have the patient sign a release to go home with her husband
C. Consult psychiatry for a psych hold
D. Provide counseling to the patient regarding her options
Question 22
M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she is afraid it won’t go away on its own. She denies any nausea or vomiting, and she cannot remember precisely when her last bowel movement occurred; probably it was a few days ago. She reports that she is ―always‖ constipated. On physical examination, she is tachycardic but otherwise has normal vital signs; her abdomen is tensely rigid, but no point tenderness to palpation is appreciated. The entire abdomen percusses as tympanic—there is no distinct dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent. There is rebound tenderness to palpation. The AGACNP suspects:
A. Perforated bowel
B. Peritonitis
C. Ischemic bowel
D. Intestinal abscess
Question 23
C. V. is a 70-year-old African American male patient who presents for surgical consultation. His history includes 4 months of severe hypertension that has been poorly responsive to medication. He also complains of intermittent pounding headaches, palpitations, and a vague sense of anxiety with tremors. A 24-hour urine demonstrated elevated metanephrines. The AGACNP recognizes
that this patient has a:
A. Malignant hyperthyroidism
B. Catecholamine-secreting tumor
C. Pituitary adenoma
D. Hyperaldosteronism
Question 24
The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature?
A. Pyuria
B. Fever
C. CVA tenderness
D. Gross hematuria
Question 25
B. T. is a 49-year-old male who has been admitted for the management of an episode of diverticulitis. This is his fifth hospitalization this year, and in previous hospitalizations he has had both abscess and stricture as a consequence of his disease. His treatment this hospitalization should include:
A. Extended-spectrum antibiotics
B. Surgical consultation for colectomy
C. Expectant treatment with nonabsorbable antibiotics
D. Colonoscopy
Question 26
Based upon an understanding of the normal relationship between gastrin levels and acid secretion, the AGACNP recognizes that which of the following combinations is almost diagnostic of gastrinoma?
A. Hypogastrinemia and acid hyposecretion
B. Hypergastrinemia and acid hyposecretion
C. Hypogastrinemia and acid hypersecretion
D. Hypergastrinemia and acid hypersecretion
Question 27
The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNR—the patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here?
A. Veracity and beneficence
B. Beneficence and nonmalfeasance
C. Autonomy and beneficence
D. Justice and autonomy
Question 28
R. S. is a 66-year-old female with Cushing’s syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates:
A. Rapid reversal of symptoms, with good pituitary function
B. Transient rebound release of remaining pituitary hormones
C. Markedly improved dexamethasone suppression test
D. Hyponatremia and compensatory SIADH
Question 29
A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of nausea and has had one episode of vomiting, but he denies any diarrhea. His vital signs are as follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/µL. The AGACNP expects that physical examination will reveal:
A. + Murphy’s sign
B. + Chvostek’s sign
C. + McBurney’s sign
D. + Kernig’s sign
Question 30
N. C. is a 60-year-old female with primary hyperaldosteronism. She has been referred to your service for surgical management. Anticipated findings on clinical history would include:
A. Palpitations, headaches, and sweating
B. Polyuria, weakness, and paresthesias
C. Dry skin, straie, and unplanned weight loss
D. Early satiety, tremors, and fatigue
Question 31
Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower quadrant. She has had this pain before and says she usually takes antibiotics and it goes away. However, this time it seems worse, and she has had it for 4 days even though she says she started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting but says she simply isn’t hungry. She had a little diarrhea yesterday but no bowel movements today. She has a temperature of 100.9°F and a pulse of 104 bpm, respirations of 20 breaths per minute, and a blood pressure of 94/60 mm Hg. She has some discomfort to deep palpation in the left lower quadrant. The AGACNP suspects:
A. Irritable bowel syndrome
B. Inflammatory bowel disease
C. Diverticulitis
D. Appendicitis
Question 32
In the majority of cases, the first clinical manifestation of physiologic stress ulcer is:
A. Epigastric pain
B. Change in mental status
C. Fever
D. Hemorrhage
Question 33
A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about:
A. Lactulose taken 20 g PO daily
B. Spironolactone taken 100 mg PO daily
C. Protein intake of 50 g daily
D. Zolpidem taken 10 mg PO qhs.
Question 34
R. R. is a 61-year-old male patient who presents with a chief complaint of fever and urinary symptoms. He was in his usual state of good health when for no apparent reason he developed pain in his back and perineal region, as well as fever and chills. He presents as septic. He had
urinary hesitancy and decreased stream but now reports that he has not passed urine in more than 12 hours. Palpation of the lower abdomen is consistent with bladder distention. The AGACNP knows that which of the following is contraindicated in this circumstance?
A. Digital prostate examination
B. Urinary catheterization
C. Fluoroquinolone antibiotics
D. Drainage of prostate abscess [Show Less]