WALDEN UNIVERSITY NURS-6560 FINAL EXAM. QUESTIONS, ANSWERS & EXPLANATIONS.
WALDEN UNIVERSITY NURS-6560 FINAL EXAM.
NURS-6560
WALDEN UNIVERSITY
... [Show More] NURS-6560 FINAL EXAM. QUESTIONS, ANSWERS & EXPLANATIONS.
Question 1
A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients 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
Explanation: Patients with an adrenal tumor will demonstrate high ACTH because the adrenal glands are stimulated to produce enough adrenocorticotropin (ACTH). If ACTH output is too high, cortisol production raises. More cortisol will be made in response to more adrenocorticotropin (ACTH production
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
Explanation: Pneumatosis with symptoms such as abdominal, discomfort, diarrhea with mucus, and excess flatulence need immediate surgical intervention. Early surgical intervention is necessary for a patient with signs of perforation. This patient is having signs of perforation due to the presence of abdominal discomfort. The patient is having indications of a severe disease. For this reason, a surgical intervention is necessary
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
Explanation: While the chest radiograph is negative, more steps are needed to ensure that the pulmonary functioning is okay. A therapy for pulmonary TB pending sputum cultures will help in the identification of any abnormalities in the chest. For this reason, the next step is 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
Explanation: The gastric cells secrete intrinsic factor and hydrochloric acid. Intrinsic factor is responsible for the absorption of vitamin B 12 as food moves down the ileum. When a gastric resection is done, the gastric cells are reduced thus less intrinsic factor will be produced. Lifelong follow up of Vitamin B12 is necessary in these patients so as to reduce the risk of vitamin B12 deficiency.
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
Explanation: Lipoma is usually smooth, fresh colored and is painless. Lipoma is soft to touch, small and commonly occurs in the neck, back, shoulders and the chest. Lipoma is only painful when grows into the nerves. M.T. denies any symptoms since there is no pain. Such kinds of lumps are associated with Lipoma because they are painless. Lipoma also had smooth boarders.
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
Explanation: A major hemolysis disorder may necessitate a splenectomy in myelodyspactic syndromes. Major hemolysis is expected to respond to the medications, failure to which will lead to a surgery. According to Coon 1985, splenectomy for patients with major hemolysis that is unresponsive to medical management is effective and successful. For this reason, considering that the major hemolysis is unresponsive to the medications, splenectomy is a primary indiciation for splenectomy.
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
Explanation: An MRI scan would be the most useful for findings consistent with a history of abuse. An MRI scan form pictures of anatomy and the physiological processes of the body. An MRI scan will give an opportunity to assess any other injuries from abuse in the head. The MRI scan will produce several images of the head structures. As a consequence, it would be easier to notice injured structures. A CT scan only focuses on the specific structures and might not help in the assessment of history of abuse.
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
Explanation: Adding a loop diuretic to the spironolactone will relieve the fluid overload and breathlessness. Spironolactone and loop diuretic can be used when a patient is at a risk of hypokalemia and weight loss. A combination of Add a loop diuretic and spironolactone will require a constant check of renal function and electrolytes to check if the dose can be increased or reduced.
Question 10
Which of the following is a true statement with respect to the use of corticosteroids in post-transplant 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
Explanation: The current corticosteroid regimens have jeopardized long-term patient survival and long-term allograft. The corticosteroid-free protocols for second-transplant recipients have promised to be the best option due to the improved metabolic profile. The corticosteroid-free protocols for second-transplant recipients have also resulted in improved blood pressure, bone density and cholesterol levels.
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
Explanation: When an ulcer surgery is performed to remove a section of the alimentary canal that is perforated, there is injury and damage to the muscles of the alimentary canal. This interferes with muscle contraction and subsequently affects peristalsis. The resulting motility dysfunction causes chronic gastroparesis which is associated with symptoms of nausea and vomiting. Therefore, chronic gastroparesis is a known complication of 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: Selected Answer
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? [Show Less]