NURS 6550 MIDTERM EXAM QUESTIONS AND
ANSWERS.
Question 1
1 out of 1 points
The AGACNP is caring for a patient who is quite ill and has developed, among other things,
a large right sided pleural effusion. Thoracentesis 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 type.
Response “A” is the correct answer. A transudate is essentially just water and
Feedback: can occur as a consequence of increased hydrostatic pressure in the
pulmonary vessels. It typically implies that the some condition has
produced an imbalance in colloid-hydrostatic pressures, such as CHF
or hypoalbuminemia. While it can represent a serious problem, it
may also represent a transient imbalance. Conversely, “B” is not
correct as an exudate has more protein in it and implies a condition
characterized by protein leaking from vessels, such as a malignancy
or some serious systemic stressor. “C” is not correct—a chyliform
effusion is characterized by fat and indicates a pathology causing
massive triglyceride degradation. “D” is not correct as a hemorrhagic
effusion is blood and typically means traumatic injury.
Question 2
1 out of 1 points
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:
Response “A” is the correct answer. Dizzy is a layperson’s term and can mean
Feedback: many different things to patients and health care providers. When
the patient identifies the primary symptom as a sense of spinning
this supports vertigo, which is usually an inner ear problem. This
versus ataxia which is neurologic or near-syncope which may be
cardiac, neurological, or neurocardiogenic. “B” is not correct—this
may occur with vertigo, but when it is the primary symptom it is
most likely ataxia and neurological causes should be considered. “C”
is not correct as coincident nausea is not specific and can occur with
any of these complaints. “D” is not correct as it is also not specific;
while ataxia cannot occur when supine near-syncope can.
, Question 3
1 out of 1 points
Mr. 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.
Surgery is no longer an option, and his oncologist says that chemotherapy is unlikely to
produce any meaningful benefit. Mr. Banks is concerned that his sons will not support
a transfer to comfort care. The AGACNP advises that he:
Response “B” is the correct answer. If there is any concern about disagreement
Feedback: among family members, or any concern at all that a patient’s wishes
will not be carried out, the best action is to ensure that there is a
clearly defined legally executed document. “A” is not correct. Living
wills are not legally enforceable documents and when dissention
arises among family members they may not be carried out. “C” is not
correct - while the patient should arrange for his care as long as he is
capable of doing so, if questions arise at such a time that he is not
capable of answering his next of kin will need to do so. “D” is not
correct -- identifying the proxy is not enough without assigning legal
rights and responsibilities. While “A,” “C,” and “D” should all be
done and will support his care, the only way to ensure that one’s
wishes are carried out is to ensure that a legally enforceable direction
is in place.
Question 4
1 out of 1 points
Mr. Wilkerson is a 77-year-old male who is being evaluated and treated for his
cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, pulse of
100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A 12-lead
ECG
reveals deep ST segment depression in leads V3-V6. The AGACNP recognizes which of
the following as a contraindication to rTPA therapy?
Response
Feedback: “D” is the correct answer. rTPA is not indicated in patients with ST
segment depression; this is not a ST elevation MI. “A” is not correct
as age > 80 is a relative contraindication. “B” is not correct as a
temperature of 99.1° F is an expected response to myocardial
necrosis, and “C” is not correct—the blood pressure is not
prohibitive until > 180/110 mm hg.
Question 5
A 71-year-old patient is recovering from a particularly severe exacerbation of chronic 1 out of 1 points
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
tells
,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
Transtheoretical Model of Change?
Response “C” is the correct answer. The Transtheoretical model of change is
Feedback: characterized by 5 stages. “A” is when the patient has no intention to
make a change. “B” is when the patient is intending to make a
change in the next 6 months. “C” is when the patient is ready to take
action or has already taken some action, as this patient has in
establishing his plan to quit by the end of the month. “D” is the overt
action that attains a criterion sufficient to reduce disease risk—in
this patient the action stage would be characterized by actual
smoking cessation. The final phase, not presented in the answer
choices here, is maintenance.
Question 6
1 out of 1 points
Certain subgroups of the elderly population are at an increased risk for rapid
deterioration and long-term care placement. Which of the following is not considered a
high risk factor for long term care placement?
Response “A” is the correct answer; men are at higher risk for long-term care
Feedback: placement than women. In addition to male gender, other risk
factors include age over 80, living alone, bowel or bladder
incontinence, history of falls, dysfunctional coping, and intellectual
impairment.
Question 7
1 out of 1 points
P.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?
Response “D” is the correct answer. This patient presents from the
Feedback: outpatient population where the most common cause of
pneumonia
, is Streptococcus pneumoniae, and is the primary treatment target for
any patient being treated empirically. “A” is not correct—while the
patient’s sexual orientation is offered in the provided history, there
is no indication that he has HIV/AIDS or any other condition
characterized by immunosuppression that would increase his risk for
this organism. “B” is not correct, as this organism is not typically
seen in the outpatient population without specific risk, e.g.
immunosuppression or chronic ventilator therapy. “C” is not the
correct answer as this organism is not likely absent specific risk such
as instrumentation or known colonization.
Question 8
0 out of 1 points
Which of the following is the greatest risk factor for vascular dementia?
Response “B” is the correct answer. Vascular dementia is a consequence of
Feedback: vascular disease, and is more likely to occur in patients with risk
factors for target organ damage, such as hypertension, dyslipidemia,
and diabetes. “A” is not a distinct risk factor for vascular dementia;
it is a risk for Alzheimer’s dementia. “C” likewise increases risk for
Parkinson’s dementia, but does not present a risk for vascular
dementia. “D” is not a risk factor for vascular dementia. Although
there may be some familial risk for certain vascular diseases that
may lead to vascular dementia, there is no clear familial tendency for
this type of dementia.
Question 9
1 out of 1 points
J.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?
Response “A” is the correct answer. According to the Joint National
Feedback: Committee (JNC) report, hypertensive urgency is described as
hypertension in the setting of progressive target organ damage, such
as renal involvement with protein leaking, left ventricular
hypertrophy, or retinal changes. “A” is not correct—the headache
may or may not be relevant, but because there are many non-
hypertension causes, a headache alone does not constitute target
organ damage. “C” is not correct—it may indicate carotid plaque,
but this is not a consequence of hypertension. “D” is not correct as a
1+ palpable pulse may be a normal finding--it must be taken in the
ANSWERS.
Question 1
1 out of 1 points
The AGACNP is caring for a patient who is quite ill and has developed, among other things,
a large right sided pleural effusion. Thoracentesis 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 type.
Response “A” is the correct answer. A transudate is essentially just water and
Feedback: can occur as a consequence of increased hydrostatic pressure in the
pulmonary vessels. It typically implies that the some condition has
produced an imbalance in colloid-hydrostatic pressures, such as CHF
or hypoalbuminemia. While it can represent a serious problem, it
may also represent a transient imbalance. Conversely, “B” is not
correct as an exudate has more protein in it and implies a condition
characterized by protein leaking from vessels, such as a malignancy
or some serious systemic stressor. “C” is not correct—a chyliform
effusion is characterized by fat and indicates a pathology causing
massive triglyceride degradation. “D” is not correct as a hemorrhagic
effusion is blood and typically means traumatic injury.
Question 2
1 out of 1 points
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:
Response “A” is the correct answer. Dizzy is a layperson’s term and can mean
Feedback: many different things to patients and health care providers. When
the patient identifies the primary symptom as a sense of spinning
this supports vertigo, which is usually an inner ear problem. This
versus ataxia which is neurologic or near-syncope which may be
cardiac, neurological, or neurocardiogenic. “B” is not correct—this
may occur with vertigo, but when it is the primary symptom it is
most likely ataxia and neurological causes should be considered. “C”
is not correct as coincident nausea is not specific and can occur with
any of these complaints. “D” is not correct as it is also not specific;
while ataxia cannot occur when supine near-syncope can.
, Question 3
1 out of 1 points
Mr. 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.
Surgery is no longer an option, and his oncologist says that chemotherapy is unlikely to
produce any meaningful benefit. Mr. Banks is concerned that his sons will not support
a transfer to comfort care. The AGACNP advises that he:
Response “B” is the correct answer. If there is any concern about disagreement
Feedback: among family members, or any concern at all that a patient’s wishes
will not be carried out, the best action is to ensure that there is a
clearly defined legally executed document. “A” is not correct. Living
wills are not legally enforceable documents and when dissention
arises among family members they may not be carried out. “C” is not
correct - while the patient should arrange for his care as long as he is
capable of doing so, if questions arise at such a time that he is not
capable of answering his next of kin will need to do so. “D” is not
correct -- identifying the proxy is not enough without assigning legal
rights and responsibilities. While “A,” “C,” and “D” should all be
done and will support his care, the only way to ensure that one’s
wishes are carried out is to ensure that a legally enforceable direction
is in place.
Question 4
1 out of 1 points
Mr. Wilkerson is a 77-year-old male who is being evaluated and treated for his
cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, pulse of
100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A 12-lead
ECG
reveals deep ST segment depression in leads V3-V6. The AGACNP recognizes which of
the following as a contraindication to rTPA therapy?
Response
Feedback: “D” is the correct answer. rTPA is not indicated in patients with ST
segment depression; this is not a ST elevation MI. “A” is not correct
as age > 80 is a relative contraindication. “B” is not correct as a
temperature of 99.1° F is an expected response to myocardial
necrosis, and “C” is not correct—the blood pressure is not
prohibitive until > 180/110 mm hg.
Question 5
A 71-year-old patient is recovering from a particularly severe exacerbation of chronic 1 out of 1 points
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
tells
,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
Transtheoretical Model of Change?
Response “C” is the correct answer. The Transtheoretical model of change is
Feedback: characterized by 5 stages. “A” is when the patient has no intention to
make a change. “B” is when the patient is intending to make a
change in the next 6 months. “C” is when the patient is ready to take
action or has already taken some action, as this patient has in
establishing his plan to quit by the end of the month. “D” is the overt
action that attains a criterion sufficient to reduce disease risk—in
this patient the action stage would be characterized by actual
smoking cessation. The final phase, not presented in the answer
choices here, is maintenance.
Question 6
1 out of 1 points
Certain subgroups of the elderly population are at an increased risk for rapid
deterioration and long-term care placement. Which of the following is not considered a
high risk factor for long term care placement?
Response “A” is the correct answer; men are at higher risk for long-term care
Feedback: placement than women. In addition to male gender, other risk
factors include age over 80, living alone, bowel or bladder
incontinence, history of falls, dysfunctional coping, and intellectual
impairment.
Question 7
1 out of 1 points
P.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?
Response “D” is the correct answer. This patient presents from the
Feedback: outpatient population where the most common cause of
pneumonia
, is Streptococcus pneumoniae, and is the primary treatment target for
any patient being treated empirically. “A” is not correct—while the
patient’s sexual orientation is offered in the provided history, there
is no indication that he has HIV/AIDS or any other condition
characterized by immunosuppression that would increase his risk for
this organism. “B” is not correct, as this organism is not typically
seen in the outpatient population without specific risk, e.g.
immunosuppression or chronic ventilator therapy. “C” is not the
correct answer as this organism is not likely absent specific risk such
as instrumentation or known colonization.
Question 8
0 out of 1 points
Which of the following is the greatest risk factor for vascular dementia?
Response “B” is the correct answer. Vascular dementia is a consequence of
Feedback: vascular disease, and is more likely to occur in patients with risk
factors for target organ damage, such as hypertension, dyslipidemia,
and diabetes. “A” is not a distinct risk factor for vascular dementia;
it is a risk for Alzheimer’s dementia. “C” likewise increases risk for
Parkinson’s dementia, but does not present a risk for vascular
dementia. “D” is not a risk factor for vascular dementia. Although
there may be some familial risk for certain vascular diseases that
may lead to vascular dementia, there is no clear familial tendency for
this type of dementia.
Question 9
1 out of 1 points
J.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?
Response “A” is the correct answer. According to the Joint National
Feedback: Committee (JNC) report, hypertensive urgency is described as
hypertension in the setting of progressive target organ damage, such
as renal involvement with protein leaking, left ventricular
hypertrophy, or retinal changes. “A” is not correct—the headache
may or may not be relevant, but because there are many non-
hypertension causes, a headache alone does not constitute target
organ damage. “C” is not correct—it may indicate carotid plaque,
but this is not a consequence of hypertension. “D” is not correct as a
1+ palpable pulse may be a normal finding--it must be taken in the
