NURS 6550 FINAL EXAM 1 – QUESTION AND
ANSWERS
QUESTION 1
1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted
intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid
infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading
differential includes:
A. Foley lodged in the urethra causing post-renal failure
B. Decreased renal perfusion causing prerenal failure
C. Age-related decreased eGFR causing prerenal failure
D. Post-surgical rhabdomyolysis causing intrarenal failure
Answer:
D. Post-surgical rhabdomyolysis causing intrarenal failure
During surgery, muscles and injured. This can result into rhabdomyolysis, which is the breakdown of
muscles to release proteins. The excess proteins causes an increased level of creatinine.
Mr. Jeffers is from surgery (post-surgical) and his creatinine levels are above normal. The normal
creatinine levels range from 0.6mg/dl to 1.2mg/dl. Thus, the most likely differential is: Post-surgical
rhabdomyolysis causing intrarenal failure.
1 points
QUESTION 2
1. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak,
diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert,
and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg.
Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid
condition” but she never followed up on it when she was advised to see an endocrinologist. The
AGACNP anticipates a diagnosis of:
A. Hashimoto’s thyroiditis
B. Cushing’s syndrome
C. Grave’s disease
D. Addison’s disease
1 points
Answer:
C. Grave's disease
,QUESTION 3
1. Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can
prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE?
A. Fever, normal white count, elevated sedimentation rate
B. Hyperkalemia, hyponatremia, low blood pressure
C. Leukocytosis, hyperglycemia, hypokalemia
D. Joint pain, rash, fever
1 points
QUESTION 4
1. A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head
without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when
she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with
cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms.
The AGACNP knows that the most helpful intervention will probably be:
A. Meclizine
B. Diazepam
C. Bed rest
D. Epley’s maneuvers
1 points
Answer:
D. Epley's maneuvers
The patient is likely suffering from benign paroxysmoly positioning vertigo. This is indicated by
inability to turn her head and to get up from the lying position in bed. The best intervention for
benign paroxysmal positioning vertigo is Epley's maneuvers. These maneuvers effectively clear
the inner ear to relieve symptoms of vertigo
QUESTION 5
1. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status
change from the long term care facility. She is normally ambulatory and participates in lots of facility
activities. Today a nursing assistant found her in her room, appearing confused and disconnected from
her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood
pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is:
,A. Osteoarthritis
B. Drug or alcohol toxicity
C. Hypotension
D. Urosepsis
1 points
QUESTION 6
1. A patient with SIADH would be expected to demonstrate which pattern of laboratory
abnormalities?
A. Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of
900 mOsm/kg
B. Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of
300 mOsm/kg
C. Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of
850 mOsm/kg
D. Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of
420 mOsm/kg
Answer:
Syndrome of inappropriate anti diuretic hormone is characterized by
dilutionalhyponatremia.Serum sodium levels lower than 130mmol/L and urine osmolality less
than 100mmol/L.Urine sodium is less than 30mmol/L.Serum level of sodium is likely to be 121
1 points
QUESTION 7
1. Sean is a 29-year-old male who presents to the emergency department for evaluation and
treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted
unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid,
and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates:
A. Penetration of the cornea with resultant aqueous leak
B. A rust ring remnant due to metal foreign body
C. An elevated intraocular pressure
D. Paradoxical pupil dilation in response to light
1 points
, Answer:
A. Penentration of the cornea with resultant aqueous leak
A positive Seidel sign indicates a leakage from the anterior chamber into the cornea. It is used to
diagnose corneal disorders such as corneal perforation and corneal degeneration.
The AGACNP should therefore suspect Penentration of the cornea with resultant aqueous
leak as indicated by the positive Seidel sign.
QUESTION 8
1. Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of
a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw
pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-
contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and
creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory
test is necessary to support the suspected diagnosis?
A. An erythrocyte sedimentation rate
B. A white blood cell differential
C. Two sets of blood cultures
D. Echocardiography
Answer:
A. An erythrocyte sedimentation rate
Mrs. Lowen's most likely diagnosis is temporal arteritis,also known as, giant cell arteritis. The
disease presents with one-sided temporal headache accompanied with jaw pain, fatigue and
tenderness at the temples. The main diagnostic tests for temporal arteritis are erythrocyte
sedimentation rate and C-reactive protein levels
1 points
QUESTION 9
1. Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after
being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug
and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness;
ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering
psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess
of:
A. Serotonin
B. Norepinephrine
ANSWERS
QUESTION 1
1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted
intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid
infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading
differential includes:
A. Foley lodged in the urethra causing post-renal failure
B. Decreased renal perfusion causing prerenal failure
C. Age-related decreased eGFR causing prerenal failure
D. Post-surgical rhabdomyolysis causing intrarenal failure
Answer:
D. Post-surgical rhabdomyolysis causing intrarenal failure
During surgery, muscles and injured. This can result into rhabdomyolysis, which is the breakdown of
muscles to release proteins. The excess proteins causes an increased level of creatinine.
Mr. Jeffers is from surgery (post-surgical) and his creatinine levels are above normal. The normal
creatinine levels range from 0.6mg/dl to 1.2mg/dl. Thus, the most likely differential is: Post-surgical
rhabdomyolysis causing intrarenal failure.
1 points
QUESTION 2
1. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak,
diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert,
and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg.
Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid
condition” but she never followed up on it when she was advised to see an endocrinologist. The
AGACNP anticipates a diagnosis of:
A. Hashimoto’s thyroiditis
B. Cushing’s syndrome
C. Grave’s disease
D. Addison’s disease
1 points
Answer:
C. Grave's disease
,QUESTION 3
1. Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can
prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE?
A. Fever, normal white count, elevated sedimentation rate
B. Hyperkalemia, hyponatremia, low blood pressure
C. Leukocytosis, hyperglycemia, hypokalemia
D. Joint pain, rash, fever
1 points
QUESTION 4
1. A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head
without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when
she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with
cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms.
The AGACNP knows that the most helpful intervention will probably be:
A. Meclizine
B. Diazepam
C. Bed rest
D. Epley’s maneuvers
1 points
Answer:
D. Epley's maneuvers
The patient is likely suffering from benign paroxysmoly positioning vertigo. This is indicated by
inability to turn her head and to get up from the lying position in bed. The best intervention for
benign paroxysmal positioning vertigo is Epley's maneuvers. These maneuvers effectively clear
the inner ear to relieve symptoms of vertigo
QUESTION 5
1. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status
change from the long term care facility. She is normally ambulatory and participates in lots of facility
activities. Today a nursing assistant found her in her room, appearing confused and disconnected from
her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood
pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is:
,A. Osteoarthritis
B. Drug or alcohol toxicity
C. Hypotension
D. Urosepsis
1 points
QUESTION 6
1. A patient with SIADH would be expected to demonstrate which pattern of laboratory
abnormalities?
A. Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of
900 mOsm/kg
B. Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of
300 mOsm/kg
C. Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of
850 mOsm/kg
D. Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of
420 mOsm/kg
Answer:
Syndrome of inappropriate anti diuretic hormone is characterized by
dilutionalhyponatremia.Serum sodium levels lower than 130mmol/L and urine osmolality less
than 100mmol/L.Urine sodium is less than 30mmol/L.Serum level of sodium is likely to be 121
1 points
QUESTION 7
1. Sean is a 29-year-old male who presents to the emergency department for evaluation and
treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted
unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid,
and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates:
A. Penetration of the cornea with resultant aqueous leak
B. A rust ring remnant due to metal foreign body
C. An elevated intraocular pressure
D. Paradoxical pupil dilation in response to light
1 points
, Answer:
A. Penentration of the cornea with resultant aqueous leak
A positive Seidel sign indicates a leakage from the anterior chamber into the cornea. It is used to
diagnose corneal disorders such as corneal perforation and corneal degeneration.
The AGACNP should therefore suspect Penentration of the cornea with resultant aqueous
leak as indicated by the positive Seidel sign.
QUESTION 8
1. Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of
a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw
pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-
contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and
creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory
test is necessary to support the suspected diagnosis?
A. An erythrocyte sedimentation rate
B. A white blood cell differential
C. Two sets of blood cultures
D. Echocardiography
Answer:
A. An erythrocyte sedimentation rate
Mrs. Lowen's most likely diagnosis is temporal arteritis,also known as, giant cell arteritis. The
disease presents with one-sided temporal headache accompanied with jaw pain, fatigue and
tenderness at the temples. The main diagnostic tests for temporal arteritis are erythrocyte
sedimentation rate and C-reactive protein levels
1 points
QUESTION 9
1. Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after
being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug
and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness;
ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering
psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess
of:
A. Serotonin
B. Norepinephrine
