Walden University NRNP 6560 Midterm Exam (pdf) | 2026/2027 |
Acute Care III Q&A | Advanced Practice Nursing
**1. S. is a 59-year-old female who has been followed for several years for
aortic regurgitation. Serial echocardiography has demonstrated 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
**Correct Answer: D**
**Rationale:** The patient has progressed from asymptomatic aortic
regurgitation to symptomatic disease with activity intolerance, weight gain,
and edema, indicating declining left ventricular function. The grade IV/VI
murmur and edema suggest significant regurgitation and possible heart
failure. Surgical consultation and intervention (valve replacement) are
indicated. ACE inhibitors and calcium channel blockers are not first-line for
severe aortic regurgitation, and serial echocardiography is no longer
appropriate given symptom progression.
---
**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
**Correct Answer: D**
**Rationale:** History of giant cell arteritis is not an indication for immediate
surgical repair of an aortic aneurysm. Indications include Marfan's syndrome
(due to risk of dissection), rapid enlargement (>1 cm since diagnosis), and
crushing chest pain (which may indicate dissection or rupture). Giant cell
arteritis is a vasculitis that can involve the aorta but is not itself an indication
for surgical repair.
---
**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
**Correct Answer: B**
,**Rationale:** CT scan of the neck with contrast is the imaging study of
choice for evaluating deep neck space infections. It provides detailed
visualization of the fascial planes and can identify abscesses, cellulitis, and
airway compromise. Plain radiography is not sensitive enough, WBC
differential is supportive but not diagnostic, and aspiration should be guided
by imaging findings.
---
**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. 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%
**Correct Answer: B**
**Rationale:** A change in mental status (confusion, lethargy, agitation) is
one of the earliest findings in hypovolemic shock due to decreased cerebral
perfusion. Orthostatic hypotension, hypoxia, and anemia are also signs but
may occur later or indicate other issues. Early recognition of mental status
changes is critical for prompt intervention.
---
, **5. Traumatic diaphragmatic hernias present in both acute and chronic
forms. Patients with a more chronic form are most likely to present with:**
A) Respiratory insufficiency
B) Sepsis
C) Bowel obstruction
D) Anemia
**Correct Answer: C**
**Rationale:** Chronic traumatic diaphragmatic hernias are most likely to
present with bowel obstruction due to herniation of abdominal contents into
the thoracic cavity. Respiratory insufficiency is more common in acute
presentations, while sepsis and anemia are not typical presenting features.
---
**6. 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. 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, SVR 1600 dynes-sec/cm5, Cardiac index
1.3 L/min, PCWP 8 mm Hg. This clinical picture is most consistent with which
shock state?**
A) Hypovolemic
B) Cardiogenic
C) Distributive
Acute Care III Q&A | Advanced Practice Nursing
**1. S. is a 59-year-old female who has been followed for several years for
aortic regurgitation. Serial echocardiography has demonstrated 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
**Correct Answer: D**
**Rationale:** The patient has progressed from asymptomatic aortic
regurgitation to symptomatic disease with activity intolerance, weight gain,
and edema, indicating declining left ventricular function. The grade IV/VI
murmur and edema suggest significant regurgitation and possible heart
failure. Surgical consultation and intervention (valve replacement) are
indicated. ACE inhibitors and calcium channel blockers are not first-line for
severe aortic regurgitation, and serial echocardiography is no longer
appropriate given symptom progression.
---
**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
**Correct Answer: D**
**Rationale:** History of giant cell arteritis is not an indication for immediate
surgical repair of an aortic aneurysm. Indications include Marfan's syndrome
(due to risk of dissection), rapid enlargement (>1 cm since diagnosis), and
crushing chest pain (which may indicate dissection or rupture). Giant cell
arteritis is a vasculitis that can involve the aorta but is not itself an indication
for surgical repair.
---
**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
**Correct Answer: B**
,**Rationale:** CT scan of the neck with contrast is the imaging study of
choice for evaluating deep neck space infections. It provides detailed
visualization of the fascial planes and can identify abscesses, cellulitis, and
airway compromise. Plain radiography is not sensitive enough, WBC
differential is supportive but not diagnostic, and aspiration should be guided
by imaging findings.
---
**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. 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%
**Correct Answer: B**
**Rationale:** A change in mental status (confusion, lethargy, agitation) is
one of the earliest findings in hypovolemic shock due to decreased cerebral
perfusion. Orthostatic hypotension, hypoxia, and anemia are also signs but
may occur later or indicate other issues. Early recognition of mental status
changes is critical for prompt intervention.
---
, **5. Traumatic diaphragmatic hernias present in both acute and chronic
forms. Patients with a more chronic form are most likely to present with:**
A) Respiratory insufficiency
B) Sepsis
C) Bowel obstruction
D) Anemia
**Correct Answer: C**
**Rationale:** Chronic traumatic diaphragmatic hernias are most likely to
present with bowel obstruction due to herniation of abdominal contents into
the thoracic cavity. Respiratory insufficiency is more common in acute
presentations, while sepsis and anemia are not typical presenting features.
---
**6. 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. 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, SVR 1600 dynes-sec/cm5, Cardiac index
1.3 L/min, PCWP 8 mm Hg. This clinical picture is most consistent with which
shock state?**
A) Hypovolemic
B) Cardiogenic
C) Distributive
