Question 1
S. is a 59-year-old female who has been followed for several years for aortic regurgitation. Serial
echocardiography has demonstrated normal
... [Show More] ventricular function, but the patient was lost to
follow-up for the last 16 months and now presents complaining of activity intolerance and
weight gain. Physical examination reveals a grade IV/VI diastolic aortic murmur and 2+ lower
extremity edema to the midcalf. The AGACNP considers which of the following as the most
appropriate management strategy?
A. Serial echocardiography every 6 months
B. Begin a calcium channel antagonist
C. Begin an angiotensin converting enzyme (ACE) inhibitor
D. Surgical consultation and intervention
Question 2
An ascending thoracic aneurysm of > 5.5 cm is universally considered an indication for surgical
repair, given the poor outcomes with sudden rupture. Regardless of the aneurysm’s size, all of
the following are additional indications for immediate operation except:
A. Comorbid Marfan’s syndrome B. Enlargement of > 1 cm since diagnosis
C. Crushing chest pain D. History of giant cell arteritis
Question 3
Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection
drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse
tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat
pain, and a temperature of 102.1°F. She appears ill and has foul breath. In order to evaluate for
a deep neck space infection, the AGACNP orders:
A. Anteroposterior neck radiography B. CT scan of the neck C. White blood cell (WBC)
differential D. Aspiration and culture of fluid
Question 4
Mr. Draper is a 39-year-old male recovering from an extended abdominal procedure. As a result
of a serious motor vehicle accident, he has had repair of a small bowel perforation,
splenectomy, and repair of a hepatic laceration. He will be on total parenteral nutrition
postoperatively. The AGACNP recognizes that the most common complications of parenteral
nutrition are a consequence of:
A. Poorly calculated solution B. Resultant diarrhea and volume contraction C. The central
venous line used for infusion D. Bowel disuse and hypomotility
Question 5
Mr. Mettenberger is being discharged following his hospitalization for reexpansion of his second
spontaneous pneumothorax this year. He has stopped smoking and does not appear to have any
overt risk factors. While doing his discharge teaching, the AGACNP advises Mr. Mettenberger
that his current risk for another pneumothorax is:
A. < 10% B. 25-50% C. 50-75% D. > 90
Question 6
One of the earliest findings for a patient in hypovolemic shock is:
A. A drop in systolic blood pressure (SBP) < 10 mm Hg for > 1 minute when sitting up B. A
change in mental status C. SaO2 of < 88% D. Hemoglobin and hematocrit (H&H) < 9 g/dL
and 27%
Question 7
Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more
chronic form are most likely to be present with:
A. Respiratory insufficiency B. Sepsis C. Bowel obstruction D. Anemia
Question 8
The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus.
Initially the patient was stable, awake, alert, and oriented, but during the last several hours the
patient has become increasingly lethargic. At change of shift, the oncoming staff nurse
appreciates a profound change in the patient’s mental status from the day before. Vital signs
and hemodynamic parameters are as follows: BP 88/54 mm Hg Pulse 110 bpm Respiratory rate
22 breaths per minute SaO2 93% on a 50% mask Systemic vascular resistance (SVR) 1600 dynes
∙ sec/cm5 Cardiac index 1.3 L/min Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This
clinical picture is most consistent with which shock state?
A. Hypovolemic B. Cardiogenic C. Distributive D. Obstructive
Question 9
When counseling patients to prevent postoperative pulmonary complications, the AGACNP
knows that with respect to smoking cessation, the American College of Surgeons and National
Surgical Quality Improvement Program guidelines are clear that patients who stop smoking
_____ weeks before surgery have no increased risk of smokingrelated pulmonary complications.
A. 2 B. 4 C. 6 D. 8
Question 10
Mitch C. is a 39-year-old male who is brought to the ED by paramedics. According to the report
of a neighbor, Mitch was distraught over a breakup with his fiancée and attempted to commit
suicide by mixing some chemicals from under his kitchen sink and drinking them; afterward he
changed his mind and knocked on his neighbor’s door asking for help. Mitch is awake but
stuporous, and the neighbor has no idea what he drank. Visual inspection of his mouth and
oropharynx reveals some edema and erythema. He is coughing and has large amounts of
pooling saliva. Mitch is not capable of answering questions but he appears in pain. Endoscopy
reveals full thickness mucosal injury with mucosal sloughing, ulceration, and exudate. The
AGACNP knows that the appropriate course of treatment must include:
A.At least 6 hours of observation in the emergency department B. Periodic esophagram
C. Aggressive fluid resuscitation D.Esophagogastrectomy
Question 11
Jared V. is a 35-year-old male who presents for evaluation of a dry cough. He reports feeling well
overall but notices that he gets out of breath more easily than he used to when playing soccer. A
review of systems yields results that are essentially benign, although the patient does admit to
an unusual rash on his legs. Physical examination reveals scattered erythematous nodules on
both shins. There is no drainage, discomfort, or itch. Additionally, diffuse, mildly enlarged lymph
nodes are appreciated bilaterally. Results of a comprehensive metabolic panel and complete
blood count are within normal limits. Twelve-lead ECG reveals sinus bradycardia at 58 bpm.
Chest radiography reveals bilateral hilar and mediastinal lymphadenopathy. The AGACNP
suspects:
A.Bronchiectasis B. Pulmonary fibrosis C. Sarcoidosis D.Lung carcinoma
Question 12
Mrs. Miller is a 44-year-old female who is on postoperative day 1 following a total abdominal
hysterectomy. Her urine output overnight was approximately 200 mL. The appropriate response
for the AGACNP would be to order:
A.A urinalysis and culture B. 1 liter of NSS over 8 hours C. Encourage increased mobility
D.Liberalize salt in the diet
Question 13
All of the following are risk factors for spontaneous pneumothorax except:
A.Connective tissue disease B. Scuba diving C. Chronic obstructive pulmonary disease
(COPD) D.Central line insertion.........................................continued [Show Less]