NRNP 6550 MIDTERM EXAM VERSION 1 (100
QUESTIONS &
ANSWERS) 100% CORRECT LATEST 2023
Question 1 ss
1 out of 1
s s s s s s
The AGACNP is caring for a patient who is quite ill and has developed, among other things, a
s s ss ss ss ss s s ss ss ss ss ss ss ss ss ss s s ss
points
s s
large right sided pleural effusion. Thoracentesis is sent for pleural fluid analysis. While
ss ss ss s s s s s s s s s s s s s s s s s s s s
evaluating the fluid analysis, the AGACNP knows that a fluid identified as a(n)
s s s s s s is the ss s s s s s s s s s s s s s s s s s s s s s s
least worrisome type.
s s s s s s
Response “A” is the correct answer. A transudate is essentially just water and can occur as a
ss ss ss ss ss ss ss ss ss ss s s ss ss s s ss
Feedbac
ss consequence of increased hydrostatic pressure in the pulmonary vessels. It
ss ss ss s s ss ss ss ss s s ss
k sstypically implies that the some condition has produced an imbalance in colloid-
ss s s s s ss ss ss ss ss ss ss s s
: hydrostatic pressures, such as CHF or ss ss s s s s s s
hypoalbuminemia. While it can represent a serious problem, it may also represent a ss ss ss ss ss ss ss ss ss ss ss ss
transient imbalance. Conversely, “B” is not correct as an exudate has more
ss s s s s s s s s s s s s s s s s s s s s s s
protein in it and implies a condition characterized by protein leaking from
s s s s s s ss s s s s s s s s s s s s s s s s
vessels, such as a malignancy or some serious systemic stressor. “C” is not
s s s s s s s s ss s s s s s s s s s s s s s s s s
correct—a chyliform effusion is characterized by fat and indicates a pathology
s s s s s s s s ss s s s s s s ss s s ss
causing massive triglyceride degradation. “D” is not correct as a
ss ss ss ss ss ss ss ss ss ss
hemorrhagic effusion is blood and typically means traumatic injury. ss ss ss ss ss ss ss ss
Question 2 ss
0 out of 1
s s s s s s
points
s s
Mrs. Miller is transported to the emergency department by paramedics. She is having profound,
ss ss ss s s ss ss ss ss ss s s ss ss ss
unremitting chest pain, is diaphoretic and pale. She has jugular venous distention and a
ss ss ss s s ss s s ss ss ss ss s s ss s s s s
widened pulse pressure.
s s s s ss
Suspecting ascending aortic aneurysm, the AGACNP order which test to confirm the diagnosis?
ss ss ss ss ss ss ss ss ss ss ss ss
Response “D” is the correct answer. It is the most widely used diagnostic tool as it
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Feedback rapidly and precisely can outline the thoracic and abdominal aorta. “A” is ss ss ss ss ss ss ss ss ss ss ss
: not the correct answer—there are radiographic findings that suggest thoracic
ss ss ss ss ss ss ss ss ss
aneurysm, but they need confirmation by CT. “B” is not the correct answer
ss ss s s s s s s s s s s s s s s s s s s s s s s
as ultrasound is not nearly as
s s s s s s s s ss s s
precise as a CT scan. “C” is not correct—MRI is only indicated when the patient
ss ss ss ss ss ss ss ss ss ss ss s s ss ss
cannot have a contrast CT.
ss ss s s s s s s
Question 3 ss
Feedback: pl
Certain subgroups of the elderly population are at an increased risk for rapid
ss ss ss ss ss ss ss ss ss ss ss ss
deterioration and long-term care placement. Which of the following is not considered a high risk
s s ss ss ss ss ss ss ss ss ss ss ss ss ss
factor for long term care placement?
ss ss s s s s s s s s
Response “A” is the correct answer; men are at higher risk for long-term care
ss ss ss ss ss ss ss ss ss ss ss ss
,1 out of 1 points
s s s s s s ss
, Question 4 ss
0 out of 1
s s s s s s
A patient with anterior epistaxis has been treated with 20 minutes of direct pressure to
s s s s s s s s s s s s s s s s s s s s s s s s s s s s
points
s s
the cartilaginous portion of the nose. Following pressure the patient is instructed to gently blow
s s ss s s ss ss ss s s ss s s s s ss ss s s ss ss
the nose. Expected findings in the patient who has been successfully treated include all of the
ss ss ss ss s s s s ss s s s s ss s s s s s s ss ss ss
following except a:
ss s s ss
Response “C” is the correct answer. If bleeding is successfully stopped with 20
ss ss ss ss ss ss ss ss ss ss ss
Feedback minutes of directed pressure, there will be residual blood and clot
ss ss ss ss ss ss ss ss ss ss
: formation. This is evacuated either by gentle suction or having the patient
ss ss ss ss ss ss ss ss ss ss ss
gently blow. Residual blood and formed clot may present as a
ss s s s s s s s s ss ss ss s s ss
s s sudden gush of dark blood or discharge with or without a
ss s s s s s s s s s s s s s s s s s s
s s clot—these are all typical expected findings. However, if bleeding is
s s s s ss s s ss ss ss ss ss
ss not stopped, it will continue as a bright red steady trickle. When
ss ss ss ss s s ss ss ss ss s s s s
s s this occurs, more invasive measures are
ss ss ss ss s s
indicated.
Question 5 ss
0 out of 1
s s s s s s
points
s s
Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right
ss ss s s ss ss ss s s ss ss ss ss ss ss ss ss ss ss
ear pain. He appears quite ill and says he feels nauseous. Otoscopic evaluation reveals
ss s s ss s s s s s s s s s s s s s s s s s s s s s s
pain to palpation, a very erythematous and bulging tympanic membrane with bullous
s s s s s s s s s s ss s s s s s s s s s s s s
myringitis. The AGACNP knows that antibiotic therapy must be selected to cover:
s s s s s s s s s s ss s s s s s s s s s s s s
Response “D” is the correct answer. Streptococcus pneumoniae is the most common bacteria that
ss ss ss ss ss ss ss ss ss ss ss ss
Feedbac
ss
infects the head and neck in immunocompetent persons, and is the primary treatment
ss ss ss ss ss ss ss ss ss s s ss ss s s
k target when treating otitis media, bacterial sinusitis, and bacterial pharyngitis.
ss s s s s s s s s s s s s s s s s s s
: “A” is not correct— while likely on broken skin and soft tissue, it is not
s s s s s s ss s s ss s s s s s s s s s s s s s s s s ss
common in the ear, nose, or throat unless specific risk factors exist. “B” is
s s ss s s s s s s ss s s ss s s s s s s s s s s s s
not correct—this is much more likely in an immunocompromised patient or a
s s s s s s s s s s s s s s ss s s s s s s s s
patient on mechanical ventilation. “C” is not correct—it is
s s ss ss s s s s s s s s ss s s
the second most common organism, but strep is the primary treatment target.
ss ss ss ss ss ss ss ss ss ss ss
Question 6 ss
1 out of 1
s s s s s s
P.M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of increasing
ss ss ss ss ss s s ss ss ss ss s s ss s s ss ss
points
s s
shortness of breath. The diagnostic evaluation ultimately supports a diagnosis of community
ss ss ss ss ss s s s s s s ss s s ss ss
acquired pneumonia. The AGACNP appreciates right middle lobe consolidation on chest
s s ss s s s s s s s s ss ss s s ss ss
radiography. Pending sputum cultures, empiric antibiotic therapy must be initiated to
s s s s ss s s s s s s s s s s s s s s s s
cover which organism?
s s s s s s
, Response “D” is the correct answer. This patient presents from the outpatient population where
ss ss ss ss s s ss ss ss ss ss ss ss
Feedbac
ss
the most common cause of pneumonia is Streptococcus pneumoniae, and is the primary
ss ss ss ss ss ss ss ss ss ss ss ss ss
k treatment target for any patient being treated empirically. “A” is not
ss s s s s s s s s s s s s s s s s s s s s
: correct—while the patient’s sexual orientation is offered in the provided history,
s s s s ss s s ss ss s s ss ss ss s s
there is no indication that he has HIV/AIDS or any other condition
s s ss s s ss s s ss s s s s s s s s s s s s
characterized by immunosuppression that would increase his risk for this
s s s s s s s s s s ss s s s s s s s s
organism. “B” is not correct, as this organism is not typically
s s s s s s s s s s s s s s s s s s s s s s
seen in the outpatient population without specific risk, e.g. immunosuppression or
ss ss ss ss ss ss ss ss ss ss
chronic ventilator therapy. “C” is not the correct answer as this organism is
ss ss s s s s s s s s s s s s s s s s s s s s s s
not likely absent specific risk such
s s s s s s ss s s s s
as instrumentation or known colonization.
ss ss ss ss
Question 7 ss
0 out of 1 points Which of the following is the greatest risk factor for vascular
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ss dementia?
Response “B” is the correct answer. Vascular dementia is a consequence of vascular disease, and
ss ss ss ss ss ss ss ss ss ss ss ss ss
Feedbac
ss
is more likely to occur in patients with risk factors for target organ
ss ss s s s s s s s s s s s s s s s s s s s s s s
k damage, such as hypertension, dyslipidemia, and diabetes. “A” is not a distinct
s s s s s s ss ss ss ss ss ss ss ss ss
: risk factor for vascular dementia; it is a risk for Alzheimer’s dementia. “C”
s s ss s s ss ss s s s s s s s s s s s s s s s s
likewise increases risk for
s s s s s s s s
Parkinson’s dementia, but does not present a risk for vascular dementia. “D”
ss s s ss ss ss ss s s ss ss s s ss
is not a risk factor for vascular dementia. Although there may be some familial
s s ss s s ss s s s s s s ss ss ss ss ss ss ss
risk for certain vascular diseases that may lead to vascular dementia,
ss s s ss ss s s s s s s s s s s s s s s
there is no clear familial tendency for this type of
s s s s s s s s s s ss s s s s s s s s
dementia.
Question 8 ss 1 out of 1
s s s s s s
points
s s
J.R. is a 55-year-old male who presents for a commercial driver’s license physical examination with a
ss ss ss ss ss ss ss ss ss s s ss ss ss ss s s
ssblood pressure of 170/102 mm Hg. He has no medical history and is without complaint.
ss s s s s s s s s s s s s s s s s s s s s s s s s s s
s sWhich of the following findings constitutes hypertensive urgency?
s s s s ss s s s s s s s s
Response “A” is the correct answer. According to the Joint National Committee (JNC) report,
ss ss ss ss ss ss ss ss ss ss ss ss
Feedbac
ss
hypertensive urgency is described as hypertension in the setting of progressive target
ss ss ss ss ss ss ss ss ss ss ss ss
k organ damage, such as renal involvement with protein leaking, left
ss s s s s s s s s s s s s s s s s s s
: ventricular hypertrophy, or
s s ss s s
retinal changes. “A” is not correct— the headache may or may not be
s s s s s s s s s s s s s s s s s s s s s s s s
relevant, but because there are many non-hypertension causes, a headache alone
s s s s ss s s ss ss ss ss ss ss ss
does not constitute target organ damage. “C” is not correct—it may indicate
ss ss ss ss s s s s ss ss ss s s ss s s
carotid plaque, but this is not a consequence of hypertension. “D” is not
s s s s ss ss ss ss s s ss s s s s s s s s s s
correct as a 1+ palpable pulse may be a
s s s s s s s s s s s s s s s s s s
normal finding--it must be ss ss ss
taken in the context of the rest of the examination.
ss ss ss ss ss ss ss ss ss 0 out of 1
s s s s s s
points
s s
Question 9 ss
Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory
ss ss ss ss s s ss ss ss ss ss ss
assessment for patients taking these medications should include a:
ss s s s s s s s s s s s s s s s s
Response “C” is the correct answer. The atypical antipsychotics such as olanzapine
ss ss ss ss ss ss ss ss ss ss
Feedback (Zyprexa), clozapine (Clozaril), and quetiapine (Seroquel) are classically ss ss ss ss ss ss ss
: associated with dyslipidemia and annual lipid panels should be ss ss ss ss ss ss ss ss
ss performed in patients of all ages who take these medications. “A” is
ss s s s s s s s s s s s s s s s s s s s s
s s incorrect—this is the s s s s
QUESTIONS &
ANSWERS) 100% CORRECT LATEST 2023
Question 1 ss
1 out of 1
s s s s s s
The AGACNP is caring for a patient who is quite ill and has developed, among other things, a
s s ss ss ss ss s s ss ss ss ss ss ss ss ss ss s s ss
points
s s
large right sided pleural effusion. Thoracentesis is sent for pleural fluid analysis. While
ss ss ss s s s s s s s s s s s s s s s s s s s s
evaluating the fluid analysis, the AGACNP knows that a fluid identified as a(n)
s s s s s s is the ss s s s s s s s s s s s s s s s s s s s s s s
least worrisome type.
s s s s s s
Response “A” is the correct answer. A transudate is essentially just water and can occur as a
ss ss ss ss ss ss ss ss ss ss s s ss ss s s ss
Feedbac
ss consequence of increased hydrostatic pressure in the pulmonary vessels. It
ss ss ss s s ss ss ss ss s s ss
k sstypically implies that the some condition has produced an imbalance in colloid-
ss s s s s ss ss ss ss ss ss ss s s
: hydrostatic pressures, such as CHF or ss ss s s s s s s
hypoalbuminemia. While it can represent a serious problem, it may also represent a ss ss ss ss ss ss ss ss ss ss ss ss
transient imbalance. Conversely, “B” is not correct as an exudate has more
ss s s s s s s s s s s s s s s s s s s s s s s
protein in it and implies a condition characterized by protein leaking from
s s s s s s ss s s s s s s s s s s s s s s s s
vessels, such as a malignancy or some serious systemic stressor. “C” is not
s s s s s s s s ss s s s s s s s s s s s s s s s s
correct—a chyliform effusion is characterized by fat and indicates a pathology
s s s s s s s s ss s s s s s s ss s s ss
causing massive triglyceride degradation. “D” is not correct as a
ss ss ss ss ss ss ss ss ss ss
hemorrhagic effusion is blood and typically means traumatic injury. ss ss ss ss ss ss ss ss
Question 2 ss
0 out of 1
s s s s s s
points
s s
Mrs. Miller is transported to the emergency department by paramedics. She is having profound,
ss ss ss s s ss ss ss ss ss s s ss ss ss
unremitting chest pain, is diaphoretic and pale. She has jugular venous distention and a
ss ss ss s s ss s s ss ss ss ss s s ss s s s s
widened pulse pressure.
s s s s ss
Suspecting ascending aortic aneurysm, the AGACNP order which test to confirm the diagnosis?
ss ss ss ss ss ss ss ss ss ss ss ss
Response “D” is the correct answer. It is the most widely used diagnostic tool as it
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Feedback rapidly and precisely can outline the thoracic and abdominal aorta. “A” is ss ss ss ss ss ss ss ss ss ss ss
: not the correct answer—there are radiographic findings that suggest thoracic
ss ss ss ss ss ss ss ss ss
aneurysm, but they need confirmation by CT. “B” is not the correct answer
ss ss s s s s s s s s s s s s s s s s s s s s s s
as ultrasound is not nearly as
s s s s s s s s ss s s
precise as a CT scan. “C” is not correct—MRI is only indicated when the patient
ss ss ss ss ss ss ss ss ss ss ss s s ss ss
cannot have a contrast CT.
ss ss s s s s s s
Question 3 ss
Feedback: pl
Certain subgroups of the elderly population are at an increased risk for rapid
ss ss ss ss ss ss ss ss ss ss ss ss
deterioration and long-term care placement. Which of the following is not considered a high risk
s s ss ss ss ss ss ss ss ss ss ss ss ss ss
factor for long term care placement?
ss ss s s s s s s s s
Response “A” is the correct answer; men are at higher risk for long-term care
ss ss ss ss ss ss ss ss ss ss ss ss
,1 out of 1 points
s s s s s s ss
, Question 4 ss
0 out of 1
s s s s s s
A patient with anterior epistaxis has been treated with 20 minutes of direct pressure to
s s s s s s s s s s s s s s s s s s s s s s s s s s s s
points
s s
the cartilaginous portion of the nose. Following pressure the patient is instructed to gently blow
s s ss s s ss ss ss s s ss s s s s ss ss s s ss ss
the nose. Expected findings in the patient who has been successfully treated include all of the
ss ss ss ss s s s s ss s s s s ss s s s s s s ss ss ss
following except a:
ss s s ss
Response “C” is the correct answer. If bleeding is successfully stopped with 20
ss ss ss ss ss ss ss ss ss ss ss
Feedback minutes of directed pressure, there will be residual blood and clot
ss ss ss ss ss ss ss ss ss ss
: formation. This is evacuated either by gentle suction or having the patient
ss ss ss ss ss ss ss ss ss ss ss
gently blow. Residual blood and formed clot may present as a
ss s s s s s s s s ss ss ss s s ss
s s sudden gush of dark blood or discharge with or without a
ss s s s s s s s s s s s s s s s s s s
s s clot—these are all typical expected findings. However, if bleeding is
s s s s ss s s ss ss ss ss ss
ss not stopped, it will continue as a bright red steady trickle. When
ss ss ss ss s s ss ss ss ss s s s s
s s this occurs, more invasive measures are
ss ss ss ss s s
indicated.
Question 5 ss
0 out of 1
s s s s s s
points
s s
Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right
ss ss s s ss ss ss s s ss ss ss ss ss ss ss ss ss ss
ear pain. He appears quite ill and says he feels nauseous. Otoscopic evaluation reveals
ss s s ss s s s s s s s s s s s s s s s s s s s s s s
pain to palpation, a very erythematous and bulging tympanic membrane with bullous
s s s s s s s s s s ss s s s s s s s s s s s s
myringitis. The AGACNP knows that antibiotic therapy must be selected to cover:
s s s s s s s s s s ss s s s s s s s s s s s s
Response “D” is the correct answer. Streptococcus pneumoniae is the most common bacteria that
ss ss ss ss ss ss ss ss ss ss ss ss
Feedbac
ss
infects the head and neck in immunocompetent persons, and is the primary treatment
ss ss ss ss ss ss ss ss ss s s ss ss s s
k target when treating otitis media, bacterial sinusitis, and bacterial pharyngitis.
ss s s s s s s s s s s s s s s s s s s
: “A” is not correct— while likely on broken skin and soft tissue, it is not
s s s s s s ss s s ss s s s s s s s s s s s s s s s s ss
common in the ear, nose, or throat unless specific risk factors exist. “B” is
s s ss s s s s s s ss s s ss s s s s s s s s s s s s
not correct—this is much more likely in an immunocompromised patient or a
s s s s s s s s s s s s s s ss s s s s s s s s
patient on mechanical ventilation. “C” is not correct—it is
s s ss ss s s s s s s s s ss s s
the second most common organism, but strep is the primary treatment target.
ss ss ss ss ss ss ss ss ss ss ss
Question 6 ss
1 out of 1
s s s s s s
P.M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of increasing
ss ss ss ss ss s s ss ss ss ss s s ss s s ss ss
points
s s
shortness of breath. The diagnostic evaluation ultimately supports a diagnosis of community
ss ss ss ss ss s s s s s s ss s s ss ss
acquired pneumonia. The AGACNP appreciates right middle lobe consolidation on chest
s s ss s s s s s s s s ss ss s s ss ss
radiography. Pending sputum cultures, empiric antibiotic therapy must be initiated to
s s s s ss s s s s s s s s s s s s s s s s
cover which organism?
s s s s s s
, Response “D” is the correct answer. This patient presents from the outpatient population where
ss ss ss ss s s ss ss ss ss ss ss ss
Feedbac
ss
the most common cause of pneumonia is Streptococcus pneumoniae, and is the primary
ss ss ss ss ss ss ss ss ss ss ss ss ss
k treatment target for any patient being treated empirically. “A” is not
ss s s s s s s s s s s s s s s s s s s s s
: correct—while the patient’s sexual orientation is offered in the provided history,
s s s s ss s s ss ss s s ss ss ss s s
there is no indication that he has HIV/AIDS or any other condition
s s ss s s ss s s ss s s s s s s s s s s s s
characterized by immunosuppression that would increase his risk for this
s s s s s s s s s s ss s s s s s s s s
organism. “B” is not correct, as this organism is not typically
s s s s s s s s s s s s s s s s s s s s s s
seen in the outpatient population without specific risk, e.g. immunosuppression or
ss ss ss ss ss ss ss ss ss ss
chronic ventilator therapy. “C” is not the correct answer as this organism is
ss ss s s s s s s s s s s s s s s s s s s s s s s
not likely absent specific risk such
s s s s s s ss s s s s
as instrumentation or known colonization.
ss ss ss ss
Question 7 ss
0 out of 1 points Which of the following is the greatest risk factor for vascular
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
ss dementia?
Response “B” is the correct answer. Vascular dementia is a consequence of vascular disease, and
ss ss ss ss ss ss ss ss ss ss ss ss ss
Feedbac
ss
is more likely to occur in patients with risk factors for target organ
ss ss s s s s s s s s s s s s s s s s s s s s s s
k damage, such as hypertension, dyslipidemia, and diabetes. “A” is not a distinct
s s s s s s ss ss ss ss ss ss ss ss ss
: risk factor for vascular dementia; it is a risk for Alzheimer’s dementia. “C”
s s ss s s ss ss s s s s s s s s s s s s s s s s
likewise increases risk for
s s s s s s s s
Parkinson’s dementia, but does not present a risk for vascular dementia. “D”
ss s s ss ss ss ss s s ss ss s s ss
is not a risk factor for vascular dementia. Although there may be some familial
s s ss s s ss s s s s s s ss ss ss ss ss ss ss
risk for certain vascular diseases that may lead to vascular dementia,
ss s s ss ss s s s s s s s s s s s s s s
there is no clear familial tendency for this type of
s s s s s s s s s s ss s s s s s s s s
dementia.
Question 8 ss 1 out of 1
s s s s s s
points
s s
J.R. is a 55-year-old male who presents for a commercial driver’s license physical examination with a
ss ss ss ss ss ss ss ss ss s s ss ss ss ss s s
ssblood pressure of 170/102 mm Hg. He has no medical history and is without complaint.
ss s s s s s s s s s s s s s s s s s s s s s s s s s s
s sWhich of the following findings constitutes hypertensive urgency?
s s s s ss s s s s s s s s
Response “A” is the correct answer. According to the Joint National Committee (JNC) report,
ss ss ss ss ss ss ss ss ss ss ss ss
Feedbac
ss
hypertensive urgency is described as hypertension in the setting of progressive target
ss ss ss ss ss ss ss ss ss ss ss ss
k organ damage, such as renal involvement with protein leaking, left
ss s s s s s s s s s s s s s s s s s s
: ventricular hypertrophy, or
s s ss s s
retinal changes. “A” is not correct— the headache may or may not be
s s s s s s s s s s s s s s s s s s s s s s s s
relevant, but because there are many non-hypertension causes, a headache alone
s s s s ss s s ss ss ss ss ss ss ss
does not constitute target organ damage. “C” is not correct—it may indicate
ss ss ss ss s s s s ss ss ss s s ss s s
carotid plaque, but this is not a consequence of hypertension. “D” is not
s s s s ss ss ss ss s s ss s s s s s s s s s s
correct as a 1+ palpable pulse may be a
s s s s s s s s s s s s s s s s s s
normal finding--it must be ss ss ss
taken in the context of the rest of the examination.
ss ss ss ss ss ss ss ss ss 0 out of 1
s s s s s s
points
s s
Question 9 ss
Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory
ss ss ss ss s s ss ss ss ss ss ss
assessment for patients taking these medications should include a:
ss s s s s s s s s s s s s s s s s
Response “C” is the correct answer. The atypical antipsychotics such as olanzapine
ss ss ss ss ss ss ss ss ss ss
Feedback (Zyprexa), clozapine (Clozaril), and quetiapine (Seroquel) are classically ss ss ss ss ss ss ss
: associated with dyslipidemia and annual lipid panels should be ss ss ss ss ss ss ss ss
ss performed in patients of all ages who take these medications. “A” is
ss s s s s s s s s s s s s s s s s s s s s
s s incorrect—this is the s s s s
