NURS 6550 Week 6 Midterm Exam

1. Question: The AGACNP is caring for a patient who is quite ill and has developed, among other things, a large right sided pleural effusion. Thoracentes is is sent for pleural fluid analysis. While evaluating the fluid analysis, the AGACNP knows that a fluid identified as a(n) ___________is the least worrisome 2. Question: Differentiating vertigo from near-syncope and ataxia is one of the goals of history-taking when a patient presents as “dizzy.” The AGACP knows that vertigo is the problem when the patient reports the primary symptom as: 3. Question: Banks has been admitted for surgical resection of a metastatic tumor, during surgery it is discovered that he has widespread, diffuse metastasis throughout the abdomen. 4. Question: Surgery is no longer an option, and his oncologist says that chemotherapy is unlikely to produce any meaningful benefit. Banks is concerned that his sons will not support a transfer to comfort care. The AGACNP advises that he: 5. Question: Wilkerson is a 77-year-old male who is being evaluated and treated for his cardiogenic pain. His vital signs are as follows: 6. Question: A 71-year-old patient is recovering from a particularly severe exacerbation of chronic obstructive pulmonary disease. He has been in the hospital for almost two weeks and was on mechanical ventilation for 7 days. While discussing his discharge plan he tell you that he is really going to quit smoking this time. He acknowledges that he has been "sneaking" cigarettes in the hospital for two days, but he has established a timeline to decrease the number of cigarettes daily. According to his plan his last cigarette will be the last day of the month. This patient’s behavior is consistent with which stage of the Trans theoretical Model of Change? 7. Question: Certain subgroups of the elderly population are at an increased risk for rapid 8. Question: M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of increasing shortness of breath. The diagnostic evaluation ultimately supports a diagnosis of community acquired pneumonia. The AGACNP appreciates right middle lobe consolidation on chest radiography. Pending sputum cultures, empiric antibiotic therapy must be initiated to cover which organism? 9. Question: Which of the following is the greatest risk factor for vascular dementia? 10. Question: R. is a 55-year-old male who presents for a commercial driver’s license physical examination with a blood pressure of 170/102 mm Hg. He has no medical history and is without complaint. Which of the following findings constitutes hypertensive urgency? 11. Question: Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment for patients taking these medications should include a: 12. Question: R. presents for an evaluation of eye discomfort. He works in a fabricating shop for a custom automobile restoration company and while working he felt like something flew into his eye. He was wearing eye protection at the time but still has the sensation that something is there. Physical examination is significant for some tearing and he reports a persistent sense of something in his eye. Which of the following is not indicated in the diagnostic evaluation? 13. Question: E. is a 41-year-old female who had lumbar surgery two days ago to repair aruptured nucleus pulposus. She has been doing well post operatively but today is complaining of resting fatigue and some shortness of breath at rest. In ruling out a pulmonary embolus the AGACNP first ordersa: 14. Question: Nixon is being treated with unfractionated heparin infusion for acute pulmonary embolus. In order to avoid a potentially fatal complication of heparin infusion, the AGACNP monitors: 15. Question: While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic disorders is: 16. Question: T. is an 85-year-old male who is admitted for evaluation of profound diarrhea that has produced significant dehydration. He also complains of being very tired lately, and feeling like he is going to vomit all of the time. His vital signs are significant for a pulse of 41 b.p.m. and a blood pressure of 90/60 mm Hg. A gastrointestinal evaluation including stool for blood, white blood cells, and ova and parasites is negative. He insists that he has not started any new medications or made any diet changes; the only thing newisthathegotneweyedropsforhisglaucoma.TheAGACNPcorrectlyassumesthat his new eye drops are: 17. Question: Janice is a 19-year-old female who presents to the emergency department via ambulance. She is pale, diaphoretic, agitated, and convinced she is having a stroke. Her vital signs include a temperature of 98.9° F, pulse of 114 beats per minute, respirations of 32 breaths per minute, and a blood pressure of 110/74 mm Hg. Diagnostic evaluation is negative and Janice is diagnosed with an acute panic attack. The initial treatment of choice is: 18. Question: Lorraine is a 41-year-old female who presents for an asthma follow-up visit. She says she feels very well, has almost no daytime symptoms, and is using her inhaled 19. Question: Miller is transported to the emergency department by paramedics. She is having profound, unremitting chest pain, is diaphoretic and pale. She has jugular venous distention and a widened pulse pressure. Suspecting ascending aortic aneurysm, the AGACNP order which test to confirm the diagnosis? 20. Question: Owen is a 37-year-old patient who has been admitted for surgical resection ofa 21. Question: Kevin T. is a 49-year-old male who is being discharged after hospitalization for an acute inferior wall myocardial infarction. This is his first hospitalization and his first chronic medical diagnosis. Aside from his elevated cardiac isoenzymes and troponins, his laboratory profile was essentially within normal limits. The only apparent cardiac risk factor is an LDL cholesterol of 200 mg/dL. Initiating an HMG-CoA reductase inhibitor is an example of which level of prevention for Kevin? 22. Question: You are evaluating a patient who has been admitted to the emergency room after being arrested for starting a fight in a local sports' bar. The patient is now being cooperative, but reports that he has been in treatment for PTSD for months. He has been prescribed fluoxetine but has not noticed any improvement in symptoms, and now has been arrested for violence. The AGACNP knows that the next step in medication management is likely to include: 23. Question: Salter is an 81-year-old lady who presents for evaluation of near-syncopal episodes. Her 12-lead ECG, complete blood count, and comprehensive metabolic panel are all essentially normal. A urinalysis shows some trace protein but is otherwise normal. A 24- hour rhythm monitor demonstrates rare premature ventricular contractions. Mrs. Salter has been in good health and had her first episode at her aerobics class. She only gets lightheaded when she exerts herself. Her heart auscultates for a grade III/VI systolic crescendo-decrescendo murmur at the second intercostal space, right sternal border. The AGACP considers that the likely cause of the syncope is: 24. Question: Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right ear pain. He appears quite ill and says he feels nauseous. Otoscopic evaluation reveals pain to palpation, a very erythematous and bulging tympanic 25. Question: Who among the following patients is at greatest risk for a pulmonary embolus? 26. Question: Birdsong is an 85-year-old female who has been admitted for surgical repair of A hip fracture. She is in remarkably good spirits and is quite talkative. She readily answers all of the questions on her intake assessment, and readily acknowledges information provided during her room orientation. Later while talking with the patient's son the AGACNP learns that the patient has had significant cognitive impairment for a few years. She has virtually no short term memory, but compensates by confabulating. Her 27. Question: Radovich is an 80-year-old female with a variety of chronic medical conditions which are reasonably well controlled. She generally enjoys a good quality of life and is active with her family. Today her only concern is that she is having problems with her vision. She notices that while trying to look at pictures of her great grandchildren she can’t seem to focus on their faces. She also reports increased trouble reading—she cannot seem to see the words that she is looking at, and her reading glasses do not help. Further evaluation of Mrs. Radovich should include assessment with: 28. Question: J. is a 55-year-old female who presents with acute onset left sided facial pain and an inability to move the left side of her face. She cannot smile, raise her eyebrow or even close her left eye, The immediate approach to this patient should include: 29. Question: A 78-year-old male present for a physical examination. He has no discomfort or 30. Question: Jason is a 46-year-old male who is being managed for sepsis. He has HIV/AIDS and has had a prolonged hospitalization characterized by a variety of complications. He was extubated 3 days ago but continues gastric decompression with a nasogastric tube(NGT), total parenteral nutrition and antibiotic therapy via a central venous catheter, and urinary drainage via a Foley catheter. He continues to demonstrate consistent low grade fevers but all points of insertion of his tubes are normal to inspection, a chest radiograph demonstrates improvement of his pneumonia, and his urinalysis shows no bacteria, leukocytes, or nitrites. The AGACNP should next order: 31. Question: The interpretation of a chest radiography should follow a systematic approach to ensure that all vital structures are evaluated and important clinical findings are not missed. The last thing to be assessed when looking at chest radiography should be the 32. Question: The Short Confusion Assessment Method (Short-CAM) is a widely used four item tool that assesses delirium in the hospitalized patient. It includes observation of all of the following except: 33. Question: Yang has been hospitalized for 5 days for the management of a gastrointestinal bleeding. She appears to have stabilized hemodynamically, but today she had a 34. Question: Most psychosocial theories of aging center around the core concept that successful aging requires acceptance of a series of changes or losses that predictably occur later in the life span. The theory that specifically addresses coming to terms with the inevitability of death is known as: 35. Question: All of the following conditions are risk factors for pulmonary embolus except: 36. Question: A patient is diagnosed with acute descending aortic aneurysm and hypertension should be immediately started on which medication pending surgical evaluation? 37. Question: Jason is a 27-year-old with a long history of intermittently controlled asthma. Heis currently prescribed Advair daily with albuterol as needed for symptoms. Today he 38. Question: A patient in the intensive care unit suddenly becomes tachypneic and dyspneic.The physical examination reveals pale, cool, clammy skin and an arterial blood gas demonstrates hypocapnea and hypoxia. Pulmonary artery pressure demonstrates a pattern consistent with obstructive shock. The AGACNP knows that which of the following causes of this presentation is most likely? 39. Question: Bowers is an 81-year-old male who is being terminally extubated at the request of his family due to the presence of a large subdural hematoma with a shift; the patient is not initiating respirations on his own and the prognosis is very poor. After he is extubated he begins to initiate his own respirations and 24 hours later has not expired 40. Question: A patient is newly admitted to your service for open reduction and internal fixation of 41. Question: “C” is the correct answer. Alzheimer’s dementia is statistically the most common form of dementia and is characterized by a long trajectory that progresses to include confabulation. Additionally, patients with this form of dementia are very reliant upon routine and may be distressed when it is disrupted. “A” is not correct; Lewy body dementia characteristically progresses much more quickly and produces an angry demeanor. “B” is incorrect because vascular dementia typically produces a more depressive affect and is not characterized by confabulation; additionally, patients with vascular dementia often have a medical history consistent with vascular risk factors. “D” is not correct as there is no apparent history of Parkinson’s disease. 42. Question: What is the primary purpose of using eye ointments or lubricants to patients under general anesthesia, on paralytics, or in long-term comatose states? 43. Question: When reading a 12-lead electrocardiogram, the AGACNP knows that all 12 leads are required to provide: 44. Question: A 49-year-old male presents for evaluation of chest tightness. It has happened before, but he just ignored it and it went away. Today he just could not ignore it anymore. He has always enjoyed good health and says he has never been told that he has any chronic medical conditions like high blood pressure or diabetes. A 12-lead ECG demonstrates changes consistent with inferior wall ischemia. Both his symptoms and inferior wall changes improve with the administration of sublingual nitroglycerin. Consistent with ACS protocol, this patient’s assessment is consistent with: 45. Question: Rosen is a 49-year-old male who is being managed for an acute myocardial infarction. He develops significant shortness of breath at rest and coarse rales 2/3 up bilaterally. The AGACNP suspects acute pulmonary edema due to papillary muscle 46. Question: A patient with minor head trauma presents for evaluation. Which of the following findings should be followed up with a CT scan to rule out orbital fracture? 47. Question: Forbes is a 69-year-old lady being discharged from the hospital after complications following a cosmetic surgical procedure. She is basically in good health. She has a history of hypothyroidism for which she takes levothyroxine daily, and mild osteoarthritis which is controlled with only prn non steroidal use. Her blood pressure is 148/90 mm Hg. The AGACNP knows that in accordance with the most current guidelines published in JNC 8 the appropriate action is to: 48. Question: When assessing driver safety in the older adult, the AGACNP considers that: 49. Question: The nursing staff calls to tell you that your 81-year-old male patient is having an acute change in mental status. He is a basically healthy man who was admitted three days ago for inpatient antibiotic management of community acquired pneumonia. His daughter is at the bedside and she is very distraught because she has never seen him like this. She is asking for medication to make him stop acting disoriented. Upon examination the patient is lying in bed, appears calm and happy, but does not recognize his daughter as anyone he knows. He is talking as if he is at home and has The AGACNP instructs the daughter that: 50. Question: While discharging a patient following her myocardial infarction, you offer some patient education about medically supervised cardiac rehabilitation. The patient expresses fear of rehab because she was on her treadmill when she had her infarction and now she is afraid of making it happen again. She doesn’t understand how the rehab can force her to 51. Question: During physical examination of a 51-year-old African-American female you appreciate a decrease in her peripheral vision. The rest of her eye examination is within normal limits and she is symptom free. This presentation is consistent with: 52. Question: Moffett is a 66-year-old male with a long history of lower extremity edema. All other causes of lower extremity edema have been ruled out and his overall symptom 53. Question: R. is an 84-year-old female patient being treated for pneumonia. Her condition is deteriorating despite aggressive broad spectrum antipseudomonal cephalosporin antibiotic therapy. Induced sputum culture reveals heavy growth ofLegionella 54. Question: The AGACNP is treating a patient with acornealabrasion. The patient has a clear 55. Question: T. is a 41-year-old male patient in the intensive care unit. He was admitted to the hospital in septic shock and has been aggressively managed with broad spectrum antibiotics. He has become progressively hypoxemic and the last arterial blood gas revealed a paO2 of 58 mm Hg. Chest radiography reveals a "white out" pattern 56. Question: Teenagers and adults with acute otitis media can often be treated with "watchful waiting"given the high incidence of spontaneous resolution and low risk of poor outcomes.Which of the following is an absolute indication to begin antibiotic therapy at the time of diagnosis? 57. Question: Bowers is on mechanical ventilation for respiratory support through an episode of 58. Question: Acute respiratory distress syndrome (ARDS) occurs when an overwhelming systemic insult results in which maladaptive physiologicresponse? 59. Question: Acute respiratory distress syndrome is characterized by which abnormality of ventilation and perfusion? 60. Question: George Schulz is a 69-year-old male who presents for evaluation of acute foot pain. It is so painful that he cannot walk on it without assistance. At first he denies any significant medical history, but then reveals that he has been diagnosed with dyslipidemia and hypertension but stopped taking his medications because he couldn’t afford it. Pulses are not palpable but are audible by Doppler. The extremity is pale and shiny with decreased hair growth, suspecting peripheral arterial disease, the AGACNP expects which additional finding? 61. Question: T. is a 40-year-old male who is under your case for long term management of 62. Question: During the physical examination of a 31-year-old female, the AGACNP appreciates a 63. Question: During routine immigration screening a 29-year-old male patient from Mexico has a 64. Question: Clinical diagnostic criteria for acute respiratory distress syndrome (ARDS) include all of the following except: 65. Question: While managing a patient in acute pulmonary edema, the AGACNP monitors the pulmonary capillary wedge pressure. When this pressure falls below 12 mm Hgit suggests that: 66. Question: All of the following are important elements of the immediate management of penetrating eye injury except: 67. Question: While evaluating a patient with diastolic failure due to a long history of uncontrolled hemochromatosis sound, the AGACNP appreciates an extra heart sound just before the S1 heart sound. This is most likely a(n): 68. Question: Secondary hypertension occurs in approximately 10% of all patients with hypertension and requires management of the underlying problem in order to eliminate the cause.Which of the following is not a secondary cause of hypertension? 69. Question: M, is a 26-year-old male who presents to the emergency department complaining of 70. Question: A 36-year-old female presents complaining of left leg swelling. She describes the onset as acute over the last day or two, and says it feels "tight and throbbing." She denies any significant medical history and says the only medication she takes is oral contraception, which she has taken since she was 15 years old. The AGACNP first orders: 71. Question: The primary neurotransmitter implicated in post-traumatic stress disorder (PTSD)is: 72. Question: Avila is an 82-year-old male being counseled about the risks and benefits ofhis 73. Question: The female AGACNP is practicing with a cardiology group and sees patients one day a week in the outpatient office. A 49-year-old female presents for follow-up after her admission for infective endocarditis. She is recovering well, and says that she is going to be more proactive about her health. She admits to not having had any of her regular health screenings for years, and asks if she can have her Pap performed at this office. 74. Question: The AGACNP is seeing a patient who was transferred from the correctional facility for evaluation. He has a profound purulent discharge from his right eye. The conjunctive is erythematous and there is mild photo sensitivity. The inmate denies any real eye pain, just says that it is extremely uncomfortable. Treatment for this patient is likely to include: 75. Question: Ewing is a 78-year-old female who lives in a long term care facility because her 76. Question: A patient recently had a nasal packing inserted for management of refractory epistaxis. One week later he presents with fatigue, a headache “inside of his nose” and a feeling generally unwell. The AGACNP considers: 77. Question: A 55-year-old female patient presents with a fever of 103.4° F. She was treated 78. Question: Which of the following is the best indicator that pulmonary rehabilitation has been successful in a patient with chronic obstructive pulmonary disease? 79. Question: Marriott is being discharged to home after being managed for an exacerbation of 80. Question: Which of the following is an accurate statement with respect to the assessment of delirium in the geriatric patient? 81. Question: Warner is a 57-year-old female who presents with unplanned weight loss. Chest radiography reveals diffuse hyperlucency of the left lung and in the lower half of the 82. Question: When evaluating a patient with epistaxis, which of the following signs or symptoms is suggestive of a more serious etiology and posterior packing? 83. Question: M. is a 15-year-old male who presents to the emergency department with his mother. Mom says he has been complaining that his throat hurts so badly he cannot even swallow saliva. According to Mom R.M. is not the type to complain, but he is in so much pain with his throat he is almost crying. He has no significant medical history and takes no daily medications. He has no allergies of which his mother is aware. Upon physical examination he is febrile with a temperature of 102.4° F and he is a bit tachycardic, but other vital signs or normal. Inspection of the throat is basically unremarkable—the AGACNP does not appreciate any abscesses, edema, or exudate; there may be some slight erythema. The AGACNP becomes suspicious that the patient: 84. Question: Stossel is a 66-year-old male patient who was admitted for management of acute anterior wall myocardial infarction. Over a period of hours he has developed acute 85. Question: According to the revised criteria in DSM-V, the primary difference between panic attacks and panic disorder is that: 86. Question: Wilson is a 71-year-old male who has been treated with prn short acting 87. Question: T. is a 26-year-old female patient being evaluated for eye discharge. She says that for the last few days she has developed this sticky, string-like discharge in both eyes. She denies any pain or visual changes, but does admit to a sense of "something in my eyes" and that her eyes itch a lot. Physical examination reveals injected conjunctiva, rope-like discharge bilaterally; pupil response is equal and brisk in both eyes. Which factor in the patient’s history would be supportive of the most likely diagnosis? 88. Question: What is the primary difference in patient management between high risk non-ST elevation myocardial infarction (MI) and the low risk non-ST elevation MI patient? 89. Question: The pathophysiology of endogenous depression is best described as: 90. Question: The diagnostic study most supportive of a diagnosis of pericarditis is: 91. Question: A 31-year-old male presents to urgent care because he has something in his eye. He was changing the oil under his car and says that something dropped into his eye. He is not having any pain, in fact he waited a day before coming in because he thought it would work itself out. Physical exam reveals a black 1 mm foreign body visible on the corneal surface. The most appropriate intervention is to: 92. Question: A patient with pericarditis is most appropriately treated with: 93. Question: Which of the following is not a risk factor for thoracic aneurysm? 94. Question: The "MONA" acronym provides guidance for immediate interventions in the patient with: 95. Question: Sloane is a 36-year-old male patient who presents for treatment of eye pain. He has no significant medical history and does not take any daily or over-the-counter medications. His only recent history is nighttime allergies for which he takes occasional diphenhydramine with good relief. He has had some throbbing in his eye for the last few days on and off but just ignored it; today he says it is flat out painful and he had to come to the emergency department. The eye is throbbing and painful, and he reports generalized decreased vision. The pupil is dilated to 5 mm and non-reactive to light. The eye conjunctiva is reddened. The next step in the diagnostic evaluation should be: 96. Question: The AGACNP counsels a patient with recurrent epistaxis that the most common cause of nose bleeding is: 97. Question: The geriatric depression scale (GDS) is a commonly used tool to diagnose depression in the elderly population. It comes in a variety of forms for maximal utility. When administering the geriatric depression scale to patients, the AGACNP recognizes that it is extremely important to: 98. Question: Ventilator-acquired pneumonia (VAP) is a significant problem impacting morbidity, 99. Question: Absolute contraindications to thrombolytic therapy in the patient having an acute myocardial infarction include all of the following except: 100. Question: Which of the following is not a true statement with respect to risk for or occurrence of elder abuse?