NURS 6560 FINAL EXAM
1. QUESTION/ANSWER:
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert
the AGACNP for
... [Show More] the 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. QUESTION/ANSWER:
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. QUESTION/ANSWER:
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. QUESTION/ANSWER:
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. QUESTION/ANSWER: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. QUESTION/ANSWER:
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. QUESTION/ANSWER:
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. QUESTION/ANSWER:
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. QUESTION/ANSWER:
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.QUESTION/ANSWER:
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.QUESTION/ANSWER:
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.QUESTION/ANSWER:
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.QUESTION/ANSWER:
Acute hepatitis A is usually diagnosed by:
By the constitutional
symptoms Within 2 weeks
of exposure Detection of
IgM-Anti-HAV Jaundice
14.QUESTION/ANSWER:
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.QUESTION/ANSWER:
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.QUESTION/ANSWER:
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.QUESTION/ANSWER:
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.QUESTION/ANSWER:
All of the following are expected findings in a patient with a T10 fracture except:
Paraplegia
Fecal
retention
Priapism
Inability to move fingers
19.QUESTION/ANSWER:
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.QUESTION/ANSWER:
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 and [Show Less]