Question 1
S. is a 59-year-old female who has been followed for several years for aortic regurgitation. Serial echocardiography has demonstrated
... [Show More] normal 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
Question 14
The AGACNP is going over preoperative information and instructions with a patient who is having a major transverse abdominal procedure tomorrow morning. The patient is very nervous and is asking a lot of questions. The AGACNP prescribes a sleeping agent because he knows that anxiety and sleeplessness may:
A. Lead to hypoxia due to hyperventilation
B. Increase the physiologic stress response postoperatively
C. Contribute to risk of delirium and prolonged length of stay
D. Decreasep.o. intake and produce nutritional risk
Question 15
In a patient with thyroid nodules, which of the following is the diagnostic study of choice to rule out thyroid cancer?
A. Radioiodine scanning
B. Percutaneous needle biopsy
C. CT scan
D. Ultrasound
Question 16
When counseling a patient about treatment modalities for achalasia, the AGACNP advised that which of the following is the treatment of choice?
A. Calcium channel antagonists
B. Intrasphincter botulinum injection
C. Pneumatic dilation
D. Myotomy and partial fundoplication
Question 17
Mr. Liu is a 52-year-old male who has a history of thyroidectomy. He presents complaining of numbness and tingling in his legs and feet and generalized fatigue. Physical examination reveals a positive Chvostek’s sign. Which of the following laboratory studies should be ordered first?
A. Renal function tests
B. Parathyroid hormone
C. Calcium
D. Magnesium
Question 18
V. is a 75-year-old male patient who, during a recent wellness evaluation, was found to have a new onset grade II/VI crescendo-decrescendo cardiac murmur at the 2nd intercostal space, right sternal border. He is symptom free and reports no limitations to his usual daily activity. He specifically denies activity intolerance or near syncope, and he is very active physically. Echocardiography reveals a mild aortic calcification. The AGACNP knows that ongoing management for R. V. must include:
A. Annual or biannual serial echocardiography
B. Modification of activity level
C. Baseline cardiac catheterization
D. Statin therapy
Question 19
The lower esophageal sphincter is characterized by periods of intermittent relaxation called transient lower esophageal sphincter relaxations. These relaxations are independent of the relaxation triggered by swallowing and are the most common cause of:
A. Physiologic reflux
B. Symptomatic esophagitis
C. Barrett’s metaplasia
D. Esophageal carcinoma
Question 20
While reviewing morning labs on a postoperative patient, the AGACNP notes that the patient’s basic metabolic panel is as follows: Na+ 132 mEq/L K+ 4.6 mEq/L Cl- 87 mEq/L CO2 25 mEq/ L A normal saline infusion is ordered in an attempt to avoid:
A. Hyperkalemia
B. Hypernatremia
C. Metabolic alkalosis
D. Metabolic acidosis
Question 21
W. is a 49-year-old man who presents for evaluation. He has a long history of alcohol and tobacco use, with a 65-year pack history and an admitted 14-drink-per-week alcohol habit. He is getting worried because he can no longer swallow his bourbon. He is not a good historian but he does admit to a 1+ year history of bloating, heartburn, and progressive difficulty swallowing food. He didn’t worry too much about his symptoms until he stopped being able to swallow bourbon. He thinks he has lost approximately 15 lbs in the last year. He denies any blood in his stool and has not had any vomiting. The AGACNP knows that the most likely diagnosis is:
A. Zenker’s diverticulum
B. Achalasia
C. Esophageal carcinoma
D.Hiatal hernia
Question 22
Which of the following treatment modalities has no role in the treatment of shock?
A. Lactated Ringer’s
B. Fresh frozen plasma (FFP)
C. Vasopressors
D. Colloid solutions
Question 23
The development of coronary artery disease (CAD) and, ultimately, plaque formation is a multifactorial process that includes endothelial injury from hypertension, cigarette smoking, and dyslipidemia. These events lead to endothelial cell dysfunction, which is theorized to result in:
A. Decreased nitric oxide production
B. Smooth muscle cell atrophy
C. Collagen degradation
D. Enlarged arterial lumen
Question 24
Mr. Comstock is a 71-year-old male who presents with a general sense of feeling weak and unwell; he thinks he has the flu even though he received a flu vaccination this year. He describes a vague collection of symptoms, including weakness, nausea, dizziness, and “getting out of breath” very easily. He says he can barely climb the steps anymore without stopping to rest. Of the possible differential diagnoses, coronary artery disease (CAD) is high among the
probabilities because of his age and gender. His physical examination is unremarkable except that he appears weak. His vital signs are as follows: temperature 98.0°F, pulse 100 bpm, respiratory rate 16 b.p.m., and BP 178/100 mm Hg. A chest radiograph is within normal limits with no acute pulmonary infection. A 12-lead ECG reveals inverted T waves in leads V1 to V5. The AGACNP is suspicious that most of his symptoms are:
A. Psychosomatic
B. Early congestive heart failure (CHF)
C. Anginal equivalents
D. Normal age-related changes
Question 25
Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade V/VI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes: [Show Less]