NR571 Midterm UPDATED ACTUAL Questions and CORRECT Answers
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A 16-year-old patient with a history of mild, intermittent A. mild/moderate
asthma is seen in the emergency room complaining of Rationale: The patient in the above example exhibits all of the expecting findings
shortness of breath. She normally only needs her of a patient with mild to moderate asthma as noted in the following table:
albuterol inhaler before exercise, but she is using it now Mild or Moderate
2-3 times per day for 3 days. Upon examination, the Talks in phrases, prefers to sit rather than lying down, not agitated, no accessory
AGACNP notes the patient's appearance as calm but muscle use, HR 100-120, O2 saturation 90-95 % on room air
tachypneic. HR is 108, O2 saturation on room air is 91 %. A > 50% of predicted or personal best
bedside peak expiratory flow measurement reveals FEV1 Severe
at 58 % of her personal best. The AGACNP should classify Talks in words, leans forward when sitting, appears agitated, RR>30/min,
this patient's asthma as which of the following? accessory muscle usage, HR>120, O2 saturation< 90% on room air
A. mild/moderate < 50 % of predicted or personal best
B. severe Life-threatening
C. life-threatening Unable to speak, drowsy, or confused
D. the severity cannot be determined with the information n/a
given
,A 52-year-old male patient has been admitted to the Answer: A. Ischemic dilated cardiomyopathy
heart failure unit with new atrial fibrillation (AF), volume The patient’s presentation is most consistent with ischemic dilated
overload, and hypoxia. This is his first admission for heart cardiomyopathy related to alcohol use. Ischemic dilated cardiomyopathy is more
failure (HF), and during intake he denies a past medical common in men and often presents with development of arrythmia like AF. His
history of hypertension, hyperlipidemia, or myocardial only risk factor for heart failure is alcohol use, which is a secondary cause of
infarction. All of the patient's immediate family members ischemic dilated cardiomyopathy. Hypertrophic cardiomyopathy is often
are alive and well. There is no family history of heart asymptomatic at rest, although symptoms may occur during strenuous exercise. It
disease, sudden death, or infiltrative disease. The patient most commonly presents in those in the third decade of life. Additionally,
jogs regularly and denies anginal symptoms or syncope. hypertrophic cardiomyopathy runs in families, and the patient denies any history
The patient endorses alcohol use for 20 years and states of heart disease in his family. Restrictive cardiomyopathy is associated with a
that he has tried to cut down recently. Based on this number of etiologies, including infiltrative disease, which the patient denies. It also
information, what is the most likely cause of the patient's presents with a history of poor exercise tolerance, which is not consistent with the
new heart failure? patient’s history of present illness. Takotsubo cardiomyopathy is associated with
A.Ischemic dilated cardiomyopathy extreme emotional stress and often manifests with anginal symptoms, which does
B.Hypertrophic cardiomyopathy not fit the patient’s presentation.
C.Restrictive cardiomyopathy
D.Takotsubo cardiomyopathy
Adults with a history of congenital heart disease (CHD) Answer: C. Heart failure
are at risk of what common complication? Patients with a diagnosis of CHD are monitored frequently for the development of
A.Deep vein thrombosis (DVT) heart failure. While DVT can be a result of an unrepaired congenital heart defect,
B.Myocardial infarction this is not considered a common complication in most adults. Myocardial
C.Heart failure infarction is not a frequent complication in CHD. Some women with a concurrent
D.Stillbirth diagnosis of CHD and pulmonary arterial hypertension (PAH) are counseled
against pregnancy due to the risk of maternal death; however, development of
heart failure is of concern to a wider group of these patients.
While rounding on a 70-year-old patient recently Answer: A. Compression therapy, wound care consult, and elevation of the
admitted with community-acquired pneumonia, the affected limb
AGACNP notes an ulcer on the medial malleolus. The A shallow-based ulcer with uneven edges present at the medial malleolus is
ulcer bed is shallow, and the borders are irregular. The consistent with venous statis. Compression therapy and elevation are mainstays of
surrounding skin is notable for hemosiderin staining, with treatment. Pain control, debridement, and surgical consult are indicated in the
+1 edema to both lower extremities. What is the most management of arterial ulcers, whereas the patient’s symptoms and signs are
appropriate treatment? more consistent with an ulcer related to venous insufficiency. Frequent position
A.Compression therapy, wound care consult, and changes and a pressure-reducing mattress are appropriate in the setting of a
elevation of the affected limb pressure ulcer, not a venous ulcer. Compression dressings, not wet to dry
B.Pain control, debridement, and surgical consult dressings, are the mainstay of treatment for venous ulcers. There is no indication
C.Wound care consult, frequent position changes, and a for antibacterial ointment.
pressure-reducing mattress
D.Antibacterial ointment, wet to dry dressing, and wound
care consult
, The AGACNP sees a 44-year-old patient who is Answer: C. Magnesium IV
unconscious, has an advanced airway in place, and is The patient has a history of alcohol use disorder and appears malnourished. These
actively receiving cardiopulmonary resuscitation (CPR). factors place them at risk for hypomagnesemia, which is also an inciting factor for
The patient's only known history is for alcohol use torsades de pointes, a polymorphic form of VT that has a twisting pattern around
disorder and tobacco use. The patient is cachectic- the isoelectric line. Magnesium IV is the treatment for torsades de pointes.
appearing with diminished muscle mass. After completion Although epinephrine is an appropriate medication for typical VT, the patient has
of a 2-minute round of CPR, the AGACNP calls for a evidence of a special type of VT known as torsades de pointes, which is
rhythm and pulse check. The rhythm on the monitor associated with hypomagnesemia, and magnesium IV is the appropriate
appears to be a multi-focal ventricular tachycardia (VT) treatment. Amiodarone may be used to treat VT as a second agent after
with a twisting type of pattern. Based on this patient's epinephrine; however, in cases of torsades de pointes, magnesium is the
known history and the most likely arrythmia, what recommended first-line drug. Atropine is indicated in the treatment of
treatment does the AGACNP order? bradyarrhythmias and is not a suitable choice for the patient.
A.Epinephrine intravenously (IV)
B.Amiodarone IV
C.Magnesium IV
D.Atropine IV
The AGACNP is called to see a patient who is ready for Answer: D. Labetalol 20 mg IV push followed by continuous infusion titrated to
discharge after a carotid endarterectomy. The patient is BP <160 mmHg
altered and began complaining of new headache this The patient is demonstrating symptoms of cerebral hyperperfusion syndrome and
morning. The current vital signs are as follows: heart rate requires prompt control of their hypertension. Labetalol IV push followed by a
(HR) 116 beats/min, blood pressure (BP) 170/90 mmHg, titratable infusion will allow correction of the hypertension and titration as
and temperature 99°F. What orders should the AGACNP needed. While acetaminophen may be given for headache, the patient’s pain is
give? part of a larger problem, which is cerebral hyperperfusion. The priority
A.Acetaminophen 650 mg orally now, and blood cultures intervention is control of the hyperperfusion. Blood cultures are not indicated.
× 2 obtained stat Diltiazem is useful in controlling atrial fibrillation; it will not help address the
B.Diltiazem 15 mg intravenous (IV) push followed by primary problem for this patient. Beta blockers are a more appropriate choice.
continuous infusion at 5 mg/hr; titration to HR <90 Morphine and acetaminophen may be used as secondary agents for this patient’s
beats/min pain; however, they will not address the underlying problem and may only mask
C.Morphine 2 mg IV as needed for pain; acetaminophen the medical emergency that is unfolding. Control of the patient’s BP is the priority.
650 mg now
D.Labetalol 20 mg IV push followed by continuous
infusion titrated to BP <160 mmHg
When managing a cardiac arrest patient, which Answer: A. Place endotracheal tube (ETT), obtain EKG, monitor, and optimize
interventions should the AGACNP prioritize after respiratory and hemodynamic parameters
achieving return of spontaneous circulation? The stabilization phase occurs after return of spontaneous circulation (ROSC) is
A.Place endotracheal tube (ETT), obtain EKG, monitor, achieved. During this time, the ETT is placed, the EKG is obtained, and respiratory
and optimize respiratory and hemodynamic parameters and hemodynamic parameters are monitored and optimized. Transfer to a higher
B.Transfer to higher level of care, initiate sedation, and level of care and obtaining expert consultation occur in the emergent activities
consult cardiology phase following the stabilization phase. High-quality CPR is the primary goal in
C.Administer high-quality cardiopulmonary resuscitation achieving ROSC. This occurs prior to the stabilization phase. Calling for help and
(CPR) with an emphasis on quality of compressions and securing the scene are the initial steps in performing advanced cardiac life
minimization of interruptions support and occur before ROSC and the stabilization phase.
D.Call for help and assess the scene for safety
)
A 16-year-old patient with a history of mild, intermittent A. mild/moderate
asthma is seen in the emergency room complaining of Rationale: The patient in the above example exhibits all of the expecting findings
shortness of breath. She normally only needs her of a patient with mild to moderate asthma as noted in the following table:
albuterol inhaler before exercise, but she is using it now Mild or Moderate
2-3 times per day for 3 days. Upon examination, the Talks in phrases, prefers to sit rather than lying down, not agitated, no accessory
AGACNP notes the patient's appearance as calm but muscle use, HR 100-120, O2 saturation 90-95 % on room air
tachypneic. HR is 108, O2 saturation on room air is 91 %. A > 50% of predicted or personal best
bedside peak expiratory flow measurement reveals FEV1 Severe
at 58 % of her personal best. The AGACNP should classify Talks in words, leans forward when sitting, appears agitated, RR>30/min,
this patient's asthma as which of the following? accessory muscle usage, HR>120, O2 saturation< 90% on room air
A. mild/moderate < 50 % of predicted or personal best
B. severe Life-threatening
C. life-threatening Unable to speak, drowsy, or confused
D. the severity cannot be determined with the information n/a
given
,A 52-year-old male patient has been admitted to the Answer: A. Ischemic dilated cardiomyopathy
heart failure unit with new atrial fibrillation (AF), volume The patient’s presentation is most consistent with ischemic dilated
overload, and hypoxia. This is his first admission for heart cardiomyopathy related to alcohol use. Ischemic dilated cardiomyopathy is more
failure (HF), and during intake he denies a past medical common in men and often presents with development of arrythmia like AF. His
history of hypertension, hyperlipidemia, or myocardial only risk factor for heart failure is alcohol use, which is a secondary cause of
infarction. All of the patient's immediate family members ischemic dilated cardiomyopathy. Hypertrophic cardiomyopathy is often
are alive and well. There is no family history of heart asymptomatic at rest, although symptoms may occur during strenuous exercise. It
disease, sudden death, or infiltrative disease. The patient most commonly presents in those in the third decade of life. Additionally,
jogs regularly and denies anginal symptoms or syncope. hypertrophic cardiomyopathy runs in families, and the patient denies any history
The patient endorses alcohol use for 20 years and states of heart disease in his family. Restrictive cardiomyopathy is associated with a
that he has tried to cut down recently. Based on this number of etiologies, including infiltrative disease, which the patient denies. It also
information, what is the most likely cause of the patient's presents with a history of poor exercise tolerance, which is not consistent with the
new heart failure? patient’s history of present illness. Takotsubo cardiomyopathy is associated with
A.Ischemic dilated cardiomyopathy extreme emotional stress and often manifests with anginal symptoms, which does
B.Hypertrophic cardiomyopathy not fit the patient’s presentation.
C.Restrictive cardiomyopathy
D.Takotsubo cardiomyopathy
Adults with a history of congenital heart disease (CHD) Answer: C. Heart failure
are at risk of what common complication? Patients with a diagnosis of CHD are monitored frequently for the development of
A.Deep vein thrombosis (DVT) heart failure. While DVT can be a result of an unrepaired congenital heart defect,
B.Myocardial infarction this is not considered a common complication in most adults. Myocardial
C.Heart failure infarction is not a frequent complication in CHD. Some women with a concurrent
D.Stillbirth diagnosis of CHD and pulmonary arterial hypertension (PAH) are counseled
against pregnancy due to the risk of maternal death; however, development of
heart failure is of concern to a wider group of these patients.
While rounding on a 70-year-old patient recently Answer: A. Compression therapy, wound care consult, and elevation of the
admitted with community-acquired pneumonia, the affected limb
AGACNP notes an ulcer on the medial malleolus. The A shallow-based ulcer with uneven edges present at the medial malleolus is
ulcer bed is shallow, and the borders are irregular. The consistent with venous statis. Compression therapy and elevation are mainstays of
surrounding skin is notable for hemosiderin staining, with treatment. Pain control, debridement, and surgical consult are indicated in the
+1 edema to both lower extremities. What is the most management of arterial ulcers, whereas the patient’s symptoms and signs are
appropriate treatment? more consistent with an ulcer related to venous insufficiency. Frequent position
A.Compression therapy, wound care consult, and changes and a pressure-reducing mattress are appropriate in the setting of a
elevation of the affected limb pressure ulcer, not a venous ulcer. Compression dressings, not wet to dry
B.Pain control, debridement, and surgical consult dressings, are the mainstay of treatment for venous ulcers. There is no indication
C.Wound care consult, frequent position changes, and a for antibacterial ointment.
pressure-reducing mattress
D.Antibacterial ointment, wet to dry dressing, and wound
care consult
, The AGACNP sees a 44-year-old patient who is Answer: C. Magnesium IV
unconscious, has an advanced airway in place, and is The patient has a history of alcohol use disorder and appears malnourished. These
actively receiving cardiopulmonary resuscitation (CPR). factors place them at risk for hypomagnesemia, which is also an inciting factor for
The patient's only known history is for alcohol use torsades de pointes, a polymorphic form of VT that has a twisting pattern around
disorder and tobacco use. The patient is cachectic- the isoelectric line. Magnesium IV is the treatment for torsades de pointes.
appearing with diminished muscle mass. After completion Although epinephrine is an appropriate medication for typical VT, the patient has
of a 2-minute round of CPR, the AGACNP calls for a evidence of a special type of VT known as torsades de pointes, which is
rhythm and pulse check. The rhythm on the monitor associated with hypomagnesemia, and magnesium IV is the appropriate
appears to be a multi-focal ventricular tachycardia (VT) treatment. Amiodarone may be used to treat VT as a second agent after
with a twisting type of pattern. Based on this patient's epinephrine; however, in cases of torsades de pointes, magnesium is the
known history and the most likely arrythmia, what recommended first-line drug. Atropine is indicated in the treatment of
treatment does the AGACNP order? bradyarrhythmias and is not a suitable choice for the patient.
A.Epinephrine intravenously (IV)
B.Amiodarone IV
C.Magnesium IV
D.Atropine IV
The AGACNP is called to see a patient who is ready for Answer: D. Labetalol 20 mg IV push followed by continuous infusion titrated to
discharge after a carotid endarterectomy. The patient is BP <160 mmHg
altered and began complaining of new headache this The patient is demonstrating symptoms of cerebral hyperperfusion syndrome and
morning. The current vital signs are as follows: heart rate requires prompt control of their hypertension. Labetalol IV push followed by a
(HR) 116 beats/min, blood pressure (BP) 170/90 mmHg, titratable infusion will allow correction of the hypertension and titration as
and temperature 99°F. What orders should the AGACNP needed. While acetaminophen may be given for headache, the patient’s pain is
give? part of a larger problem, which is cerebral hyperperfusion. The priority
A.Acetaminophen 650 mg orally now, and blood cultures intervention is control of the hyperperfusion. Blood cultures are not indicated.
× 2 obtained stat Diltiazem is useful in controlling atrial fibrillation; it will not help address the
B.Diltiazem 15 mg intravenous (IV) push followed by primary problem for this patient. Beta blockers are a more appropriate choice.
continuous infusion at 5 mg/hr; titration to HR <90 Morphine and acetaminophen may be used as secondary agents for this patient’s
beats/min pain; however, they will not address the underlying problem and may only mask
C.Morphine 2 mg IV as needed for pain; acetaminophen the medical emergency that is unfolding. Control of the patient’s BP is the priority.
650 mg now
D.Labetalol 20 mg IV push followed by continuous
infusion titrated to BP <160 mmHg
When managing a cardiac arrest patient, which Answer: A. Place endotracheal tube (ETT), obtain EKG, monitor, and optimize
interventions should the AGACNP prioritize after respiratory and hemodynamic parameters
achieving return of spontaneous circulation? The stabilization phase occurs after return of spontaneous circulation (ROSC) is
A.Place endotracheal tube (ETT), obtain EKG, monitor, achieved. During this time, the ETT is placed, the EKG is obtained, and respiratory
and optimize respiratory and hemodynamic parameters and hemodynamic parameters are monitored and optimized. Transfer to a higher
B.Transfer to higher level of care, initiate sedation, and level of care and obtaining expert consultation occur in the emergent activities
consult cardiology phase following the stabilization phase. High-quality CPR is the primary goal in
C.Administer high-quality cardiopulmonary resuscitation achieving ROSC. This occurs prior to the stabilization phase. Calling for help and
(CPR) with an emphasis on quality of compressions and securing the scene are the initial steps in performing advanced cardiac life
minimization of interruptions support and occur before ROSC and the stabilization phase.
D.Call for help and assess the scene for safety
