NURS 6560 FINAL EXAM
1. Q #:
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert
the AGACNP for the
... [Show More] possibility that the patient is over hydrated, thereby increasing the risk for
increased intracranial pressure?
A. BUN = 10
B. Shift output = 800 ml, shift input =
825 ml Unchanged weight
C. Serum osmolality = 260
2. Q #:
A patient who has been in the intensive care unit for 17 days develops hyponatremic
hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical
ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and
hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to:
A. reduce serum osmolality by infusing a 5% dextrose in 0.2%
sodium chloride solution
B. reduce serum sodium concentration by infusing a 0.45% sodium
chloride solution
C. replenish volume by infusing a 0.9% sodium chloride solution
D. replenish volume by infusing a 5% dextrose in water solution.
3. Q #:
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
4. Q #:
Myasthenia gravis is best described as:
A. An imbalance of dopamine and acetylcholine in the
basal ganglia Demyelination of peripheral ascending
nerves
B. Demyelination in the central nervous system
C. An autoimmune disorder characterized by decreased neuromuscular activation
5. Q #:Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate
the patient for persistent and progressive discomfort. Likely causes of her symptoms include all
of the following except:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
6. Q #:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to
evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms
include all of the following except:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
7. Q #:
When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke
most likely resulted from a subarachnoid hemorrhage when the patient’s family reports that
the patient:
A. Has a history of atrial fibrillation
B. Was unable to be aroused in the morning
C. Had been complaining of a headache before losing consciousness
D. Has had several brief episodes of mental confusion and right arm and leg weakness
8. Q #:
You are asked to see a 29 year old female complaining of abdominal pain. She states she is
experiencing constant RUQ pain that radiates to her back. The pain is not relieved by bowel
movements, over the counter antacids or food. Review of initial labs shows elevated amylase
and lipase and you diagnose her with acute pancreatitis. Which test will you order next to
determine the underlying cause of her pancreatitis?
serum cholesterol
level blood
toxicologyright upper quadrant
ultrasound endoscopy
9. Q #:
Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ
resection following a catastrophic motor vehicle accident. Due to the nature of his injuries, a
large portion of his jejunum had to be resected. In planning for his recovery and nutritional
needs, the AGACNP considers that:
He will probably be able to transition to oral nutrition but will have lifetime
issues with diarrhea His procedure has put him at significant risk for B12
absorption problems
Most jejunum absorption functions will be assumed by the ileum
Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation
10.Q #:
A 32-year-old man comes to the clinic because he has had pain in the back for the past 24
hours. The patient says he first noticed the pain when he awoke in the morning and had
difficulty getting out of bed. He had been playing flag football the day before the pain began
but did not sustain any injuries during the game. Acetaminophen has provided only minimal
relief of the patient's pain. On physical examination, pain is elicited on palpation of the back on
the left, lateral to the region of L2-L5. Full range of motion is noted in vertebral flexion,
extension, lateral rotation, and lateral bending, with some hesitancy because of pain on the left
side. Which of the following is the most appropriate initial step?
Anti-inflammatory and muscle relaxant
therapy Epidural injection of a
corticosteroid
MRI of the lumbar spine
Strict bed rest and application of moist heat to the lower back
11.Q #:
On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms
of acute rejection, confirmed by histologic examination. The AGACNP knows that first-line
treatment of acute rejection consists of: Cyclosporine
Azathioprine
Methylpredniso
lone Sirolimus
12.Q #:
H. W. is a 33-year-old female who is being evaluated after a fall from a tree. Anteroposterior
and lateral radiographs of the thoracolumbosacral spine are significant for transverse process
fractures at T6 and T7. The AGACNP knows that treatment for this likely will include:
Observation
Hyperextension casting Jewett brace
Surgical intervention13.Q #:
Acute hepatitis A is usually diagnosed by:
By the constitutional
symptoms Within 2 weeks
of exposure Detection of
IgM-Anti-HAV Jaundice
14.Q #:
A 30-year-old male patient presents for evaluation of a lump on his neck. He denies pain, itch,
erythema, edema, or any other symptoms. He is ^concerned because it won't ^ go away. He
says, “I noticed it a few months ago, then it seemed to disappear, and now it is back.” The
AGACNP proceeds with a history and physical exam and concludes which of the following as
the leading differential diagnosis?
Subclinical
infection NonHodgkin's
lyphoma
Catscratch disease
Syphilis
15.Q #:
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: Blood group substances
Electrolyt
es
Vitamin
B12
Gastric
pH
16.Q #:
T. O. is a 31-year-old male patient who is transported to the emergency department via
emergency services. He was in a multivehicle accident and was trapped in a crushed car for
more than 3 hours. On examination, his right lower extremity is found to be tensely swollen,
with 3+ nonpitting edema. The lower leg is profoundly painful with passive range of motion.
Given the history and physical findings, the AGACNP recognizes that treatment centers around:
Fasciotomy
Thrombolytics
Surgical
reductionCasting
17.Q #:
While consulting on a patient who is admitted with a chief complaint of abdominal pain, the
AGACNP notes that the initial assessment described the pain as “colicky.” This means that the
pain:
Is a result of gas in the
bowel Is intestinal in
origin
Is characterized by pain-free
intervals Is sharp, intense,
and nonradiating
18.Q #:
All of the following are expected findings in a patient with a T10 fracture except:
Paraplegia
Fecal
retention
Priapism
Inability to move fingers
19.Q #:
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:
Dissecting aortic
aneurysm Acute
pancreatitis
Perforated peptic
ulcer Mallory-Weiss
tear
20.Q #:
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?
Veracity and beneficence
Beneficence andnonmalfeasance
Autonomy and
beneficence Justice and
autonomy
21.Q #:
In myelodysplastic syndromes, the primary indications for splenectomy include:
Major hemolysis unresponsive to medical
management Severe symptoms of massive
splenomegaly
Sustained leukocyte elevation above
30,000 cells/µL Portal hypertension
22.Q #:
Which of the following situations constitute a positive screening after a PPD (purified protein
derivative) skin test for tuberculosis?
A patient without risk factors who has a 13mm
PPD skin test A patient with HIV who has a
3mm PPD skin test
A homeless patient with a 9mm PPD skin test
A patient with intravenous drug abuse (IVDA) who has an
11mm PPD skin test A healthcare worker who has a 6mm PPD
skin test
23.Q #:
When the patient with jaundice is evaluated, a careful history and physical exam often can help
differentiate prehepatic, hepatic, and posthepatic causes. When the patient reports dark
discoloration of the urine and light discoloration of the stool, the AGACNP is most suspicious
for:
Viral hepatitis
Chronic
alcoholism
Extrahepatic
obstruction
Cholestasis
24.Q #:
Jack R. is a 63-year-old male who is being seen today on rounds after being admitted for
profound upper abdominal pain, nausea, and vomiting. He had markedly elevated serum
amylase and lipase; he was diagnosed with pancreatitis and admitted for pain management
and bowel rest. Today he feels better, but he is upset because he knows that pancreatitis is
known as the “alcoholic’s disease.” He makes it clear that he is a religious man and that his
religion forbids alcohol; he says he has never had an alcoholic drink in his life. The AGACNP
reassures Jack that approximately 40% of cases of pancreatitis are caused by as well as a
variety of other things, and that he will have a thorough diagnostic evaluation.hyperlipidemia
gallstone disease
genetic
predisposition
hypercalcemia
25.Q #:
In neurogenic shock, patients are subjected to an abnormal dilation of venules and arterioles
in response to failure of the autonomic nervous system. Treatment for neurogenic shock may
include all of the following except: Trendelenburg
Intravenous
fluids
Vasodilators
Vasoconstrics
26.Q #:
Which of the following is a true statement with respect to the use of corticosteroids in
posttransplant patients? High-dose initial steroids are tapered to off over a period of 4
to 6 weeks posttransplant
There is a strong interest in developing corticosteroid-free posttransplant protocols
Better results are demonstrated in corticosteroid-free protocols for secondtransplant recipients Evidence supports corticosteroid-free rejection
protocols
27.Q #:
The comprehensive serologic assessment of a patient with Cushing’s syndrome is likely to
produce which constellation of findings?
Low potassium, high glucose, high white blood
cell count High sodium, polycythemia, low BUN
Low sodium, low potassium,
high BUN High sodium, high
chloride, high RBCs
28.Q #:
A patient admitted for management of sepsis is critically ill and wants to talk with a
hospital representative about donating her organs if she dies. She has a fairly complex
medical history that includes traumatic brain injury, breast cancer, and dialysis-dependent
renal failure. The patient is advised that she is ineligible to donate due to her: Renal
failure
Traumatic brain
injury Systemic
infection Breast
cancer29.Q #:
Elmer is a 61-year-old male who is admitted vomiting bright red blood. He has no known
medical history—he has not been in the health care system for most of his adult life. He has
lost a lot of volume, and his vital signs are borderline unstable with a blood pressure of
88/58 mm Hg, pulse of 118 bpm, respiratory rate of 12 bpm, and a temperature of 97.6°F.
The AGACNP recognizes that the leading differentials include all of the following except:
Peptic ulcer
Portal
hypertension
Gastritis
Zollinger-Ellison syndrome
30.Q #:
T. S. is a 31-year-old female who is admitted following a catastrophic industrial accident. She
had multiple injuries, and after a 10-day hospital stay that included several operations and
attempts to save her, she is declared brain dead. She had an organ donor notation on her
driver’s license. Which of the following circumstances precludes her from serving as a liver
donor?
Encephalopathy
Hepatitis C
infection
A long history of
alcohol use Biliary
cirrhosis
31.Q #:
M. N. is a 61-year-old male who is referred to the emergency department by a local retail
clinic. M. N. has not had regular health care at any time in his adult life; he says he doesn’t
know when he last saw a doctor. His daughter finally talked him into going to the local retail
health clinic when his abdomen became so distended that he couldn’t pull his pants up. M. N.
says that he has put on some weight over the last few weeks but he has not felt ill. He admits
to drinking > 4 drinks of whiskey daily; he says he smokes 2 packs of cigarettes a day and is not
very active. He has lived alone since his divorce 20 years ago. Physical examination reveals an
adult male who is chronically ill in appearance and appears older than stated age. His vital
signs are within normal limits, and physical examination is significant only for obvious ascites.
Paracentesis and subsequent analysis of the fluid reveals an ascites LDH to serum LDH ratio of
0.8. The AGACNP knows that this ratio is highly suspicious for:
Pancreatic
disease
Cirrhosis
Cancer
Autoimmune hepatitis
32.Q #:
The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactonedaily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s
management is to:
Continue the current regimen
D/C the spironolactone and begin a
loop diuretic Add a loop diuretic to
the spironolactone Proceed to largevolume paracentesis
33.Q #:
The AGACNP knows that following bilateral total adrenalectomy, the
patient will require: Prednisone 15 mg qam and 10 mg qpm
Tapering of IV hydrocortisone, beginning with 100 mg IV q8h on postoperative day 1
Initial fludrocortisone replacement, tapered off once maintenance hydrocortisone dose
is achieved Individualized replacement of corticosteroid, mineralocorticoid, and
androgen hormones
34.Q #:
Josh is a 14-year-old male patient who presents for evaluation of blurred vision. His only
significant injury is that over the weekend he was playing baseball and was hit in the side of
the head by a flying ball. The hit was hard enough to knock him down, but he did not lose
consciousness and had no remarkable symptoms. Now on Wednesday he presents with a dull
headache that seems to be getting worse, and his mom wants to have him evaluated.
Neurologic examination reveals a sluggish pupillary response. CT scan of the head reveals a 1
cm epidural hematoma. The AGACNP knows that the best approach to management would be:
Cautious
observation An
osmotic diuretic
Surgical
consultation
Emergency
evacuation
35.Q #:
Mary W. is a 39-year-old female who presents with persistent abdominal discomfort. She
denies actual pain but says she has this persistent sense of fullness in her abdomen that feels
like it would go away if she could have a bowel movement. This finding is known as:
Somatic pain
Gas stoppage sign
Small bowel
obstruction Large
bowel obstruction
36.Q #:
Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural
football game and comes to the ER complaining of severe pain. Tim tells you that he wassetting up to pass the football when he was tackled and he immediately felt his knee "pop" and
buckle as he fell. You, as the AGACNP, know the most important information to obtain from
Tim is:
Insurance
information
Family history
Social history
What exactly was he doing when he got hurt
37.Q #:
Mrs. Nguyen is an 84-year-old female who suffered a fall in her long-term care facility. After
assessing possible reasons for her fall, a physical examination is performed to look for injuries.
Mrs. Nguyen has significant pain in her left upper arm and limited range of motion in her left
shoulder; a shoulder trauma series is ordered to evaluate for which type of injury that
frequently occurs in these circumstances?
Shoulder
dislocation
Scapular
fracture
Proximal humerus
fracture Nursemaid’s
elbow
38.Q #:
A general principle in surgical oncology is that the best approach to curative surgery in a
fixed tumor requires: En bloc resection
Adjuvant therapies
Neoadjuvant therapies
Elective lymph node
dissection
39.Q #:
Intracranial pressure monitoring is instituted for a patient with a head injury. The patient’s
arterial blood pressure is 92/50 mm Hg, and her intracranial pressure is 18 mm Hg. Using these
values to calculate the patient’s cerebral pressure (CPP) the AGACNP determines:
The CPP is adequate for normal cerebral blood flow
The CPP is high and that ischemia and neuronal death
are imminent The blood pressure should be increased
to prevent cerebral hypoxia
Lowering the patients blood pressure will reduce the intracranial pressure, increasing cerebral
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