NURS 6550 Midterm Review Exam
Graded A+
A 15 yo M presents to the ER complaining of severe throat pain. 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 has: - ANSWER-
Epiglottitis
Patient needs immediate intubation.
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? - ANSWER-
Symptoms occurring bilaterally supports the dx of allergic conjunctivitis.
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: - ANSWER-Attempt to remove
the foreign body with a saline soaked sterile swab since it is visible on exam.
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: -
ANSWER-A d-dimer test.
(Least invasive/expensive)
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: - ANSWER-
Assessment of intraocular pressure via tonometry to confirm angle closure glaucoma
diagnosis.
, A 41-year-old male patient is in the intensive care unit with 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 bilaterally. The patient is intubated and
ventilated. The AGACNP knows that appropriate management must include -
ANSWER-Adjust the PEEP as the patient is experiencing ARDS
A 49-year-old male 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 rupture and acute mitral valve
regurgitation. Which physical finding would support this finding? - ANSWER-A systolic
murmur auscultated at the 5th ICS, midclavicular line.
A 55-year-old female patient presents with a fever of 103.4° F. She was treated
approximately 10 days ago at urgent care for a sinus infection, but two days ago the
right side of her face started to hurt, and today she has significant swelling of the right
orbit and eyelid. The eyelid is very edematous and there is purulent drainage noted. The
priority of care for this patient begins with: - ANSWER-Initiating antibiotic therapy to
cover streptococcus pneumoniae for orbital cellulitis.
Antibx: Clindamycin or Bactrim PLUS Augmentin or Cefdinir
A 55-year-old female 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: - ANSWER-
Corticosteroids
She has Bell's Palsy
A 66 yo M patient is admitted for management of an acute anterior wall myocardial
infarction. Over a period of hours he has developed acute shortness of breath, coarse
rales to auscultation, and Kerley B lines on chest radiography. Arterial blood gas reveals
a pH of 7.34, pCO2 of 30 mm Hg, and paO2 of 59 mm Hg. The AGACNP anticipates
which of the following findings on physical examination? - ANSWER-S3 heart sounds
which implies acute left ventricular overload.
Patient has acute pulmonary edema.
A 69-year-old female is 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 nonsteroidal 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 - ANSWER-Proceed with normal health promotion.
The patient is >60yo and does not have CKD or DM, therefore her goal BP is 150/90.
She is at goal; no medications indicated.
A 78-year-old male present for a physical examination. He has no discomfort or
complaints other than a general decrease in vision, but it helps when he puts things
Graded A+
A 15 yo M presents to the ER complaining of severe throat pain. 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 has: - ANSWER-
Epiglottitis
Patient needs immediate intubation.
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? - ANSWER-
Symptoms occurring bilaterally supports the dx of allergic conjunctivitis.
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: - ANSWER-Attempt to remove
the foreign body with a saline soaked sterile swab since it is visible on exam.
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: -
ANSWER-A d-dimer test.
(Least invasive/expensive)
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: - ANSWER-
Assessment of intraocular pressure via tonometry to confirm angle closure glaucoma
diagnosis.
, A 41-year-old male patient is in the intensive care unit with 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 bilaterally. The patient is intubated and
ventilated. The AGACNP knows that appropriate management must include -
ANSWER-Adjust the PEEP as the patient is experiencing ARDS
A 49-year-old male 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 rupture and acute mitral valve
regurgitation. Which physical finding would support this finding? - ANSWER-A systolic
murmur auscultated at the 5th ICS, midclavicular line.
A 55-year-old female patient presents with a fever of 103.4° F. She was treated
approximately 10 days ago at urgent care for a sinus infection, but two days ago the
right side of her face started to hurt, and today she has significant swelling of the right
orbit and eyelid. The eyelid is very edematous and there is purulent drainage noted. The
priority of care for this patient begins with: - ANSWER-Initiating antibiotic therapy to
cover streptococcus pneumoniae for orbital cellulitis.
Antibx: Clindamycin or Bactrim PLUS Augmentin or Cefdinir
A 55-year-old female 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: - ANSWER-
Corticosteroids
She has Bell's Palsy
A 66 yo M patient is admitted for management of an acute anterior wall myocardial
infarction. Over a period of hours he has developed acute shortness of breath, coarse
rales to auscultation, and Kerley B lines on chest radiography. Arterial blood gas reveals
a pH of 7.34, pCO2 of 30 mm Hg, and paO2 of 59 mm Hg. The AGACNP anticipates
which of the following findings on physical examination? - ANSWER-S3 heart sounds
which implies acute left ventricular overload.
Patient has acute pulmonary edema.
A 69-year-old female is 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 nonsteroidal 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 - ANSWER-Proceed with normal health promotion.
The patient is >60yo and does not have CKD or DM, therefore her goal BP is 150/90.
She is at goal; no medications indicated.
A 78-year-old male present for a physical examination. He has no discomfort or
complaints other than a general decrease in vision, but it helps when he puts things
