NR571 Midterm Questions
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1. A 16-year-old patient with a history of A. mild/moderate
mild, intermittent asthma is seen in Rationale: The patient in the above example ex-
the emergency room complaining of hibits all of the expecting findings of a patient with
shortness of breath. She normally only mild to moderate asthma as noted in the following
needs her albuterol inhaler before ex- table:
ercise, but she is using it now 2-3 times Mild or Moderate
per day for 3 days. Upon examination, Talks in phrases, prefers to sit rather than lying
the AGACNP notes the patient's ap- down, not agitated, no accessory muscle use, HR
pearance as calm but tachypneic. HR 100-120, O2 saturation 90-95 % on room air
is 108, O2 saturation on room air is > 50% of predicted or personal best
91 %. A bedside peak expiratory flow Severe
measurement reveals FEV1 at 58 % of Talks in words, leans forward when sitting, ap-
her personal best. The AGACNP should pears agitated, RR>30/min, accessory muscle us-
classify this patient's asthma as which age, HR>120, O2 saturation< 90% on room air
of the following? < 50 % of predicted or personal best
A. mild/moderate Life-threatening
B. severe Unable to speak, drowsy, or confused
C. life-threatening n/a
D. the severity cannot be determined
with the information given
2. A 52-year-old male patient has been Answer: A. Ischemic dilated cardiomyopathy
admitted to the heart failure unit with The patient's presentation is most consistent with
new atrial fibrillation (AF), volume over- ischemic dilated cardiomyopathy related to alco-
load, and hypoxia. This is his first ad- hol use. Ischemic dilated cardiomyopathy is more
mission for heart failure (HF), and dur- common in men and often presents with develop-
ing intake he denies a past medical his- ment of arrythmia like AF. His only risk factor for
tory of hypertension, hyperlipidemia, heart failure is alcohol use, which is a secondary
or myocardial infarction. All of the pa- cause of ischemic dilated cardiomyopathy. Hyper-
tient's immediate family members are trophic cardiomyopathy is often asymptomatic at
alive and well. There is no family history rest, although symptoms may occur during stren-
of heart disease, sudden death, or in- uous exercise. It most commonly presents in those
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filtrative disease. The patient jogs reg- in the third decade of life. Additionally, hyper-
ularly and denies anginal symptoms or trophic cardiomyopathy runs in families, and the
syncope. The patient endorses alcohol patient denies any history of heart disease in his
use for 20 years and states that he has family. Restrictive cardiomyopathy is associated
tried to cut down recently. Based on with a number of etiologies, including infiltrative
this information, what is the most likely disease, which the patient denies. It also presents
cause of the patient's new heart fail- with a history of poor exercise tolerance, which is
ure? not consistent with the patient's history of present
A.Ischemic dilated cardiomyopathy illness. Takotsubo cardiomyopathy is associated
B.Hypertrophic cardiomyopathy with extreme emotional stress and often manifests
C.Restrictive cardiomyopathy with anginal symptoms, which does not fit the
D.Takotsubo cardiomyopathy patient's presentation.
3. Adults with a history of congenital Answer: C. Heart failure
heart disease (CHD) are at risk of what Patients with a diagnosis of CHD are monitored
common complication? frequently for the development of heart failure.
A.Deep vein thrombosis (DVT) While DVT can be a result of an unrepaired con-
B.Myocardial infarction genital heart defect, this is not considered a com-
C.Heart failure mon complication in most adults. Myocardial in-
D.Stillbirth farction is not a frequent complication in CHD.
Some women with a concurrent diagnosis of CHD
and pulmonary arterial hypertension (PAH) are
counseled against pregnancy due to the risk of
maternal death; however, development of heart
failure is of concern to a wider group of these
patients.
4. While rounding on a 70-year-old pa- Answer: A. Compression therapy, wound care con-
tient recently admitted with commu- sult, and elevation of the affected limb
nity-acquired pneumonia, the AGACNP A shallow-based ulcer with uneven edges pre-
notes an ulcer on the medial malleo- sent at the medial malleolus is consistent with
lus. The ulcer bed is shallow, and the venous statis. Compression therapy and elevation
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borders are irregular. The surrounding are mainstays of treatment. Pain control, debride-
skin is notable for hemosiderin stain- ment, and surgical consult are indicated in the
ing, with +1 edema to both lower ex- management of arterial ulcers, whereas the pa-
tremities. What is the most appropriate tient's symptoms and signs are more consistent
treatment? with an ulcer related to venous insufficiency. Fre-
A.Compression therapy, wound care quent position changes and a pressure-reducing
consult, and elevation of the affected mattress are appropriate in the setting of a pres-
limb sure ulcer, not a venous ulcer. Compression dress-
B.Pain control, debridement, and sur- ings, not wet to dry dressings, are the mainstay of
gical consult treatment for venous ulcers. There is no indication
C.Wound care consult, frequent posi- for antibacterial ointment.
tion changes, and a pressure-reducing
mattress
D.Antibacterial ointment, wet to dry
dressing, and wound care consult
5. The AGACNP sees a 44-year-old patient Answer: C. Magnesium IV
who is unconscious, has an advanced The patient has a history of alcohol use disorder
airway in place, and is actively receiving and appears malnourished. These factors place
cardiopulmonary resuscitation (CPR). them at risk for hypomagnesemia, which is also
The patient's only known history is for an inciting factor for torsades de pointes, a poly-
alcohol use disorder and tobacco use. morphic form of VT that has a twisting pattern
The patient is cachectic-appearing with around the isoelectric line. Magnesium IV is the
diminished muscle mass. After comple- treatment for torsades de pointes. Although epi-
tion of a 2-minute round of CPR, the nephrine is an appropriate medication for typical
AGACNP calls for a rhythm and pulse VT, the patient has evidence of a special type of VT
check. The rhythm on the monitor ap- known as torsades de pointes, which is associated
pears to be a multi-focal ventricular with hypomagnesemia, and magnesium IV is the
tachycardia (VT) with a twisting type of appropriate treatment. Amiodarone may be used
pattern. Based on this patient's known to treat VT as a second agent after epinephrine;
history and the most likely arrythmia, however, in cases of torsades de pointes, magne-
what treatment does the AGACNP or- sium is the recommended first-line drug. Atropine
, NR571 Midterm Questions
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der? is indicated in the treatment of bradyarrhythmias
A.Epinephrine intravenously (IV) and is not a suitable choice for the patient.
B.Amiodarone IV
C.Magnesium IV
D.Atropine IV
6. The AGACNP is called to see a pa- Answer: D. Labetalol 20 mg IV push followed by
tient who is ready for discharge after continuous infusion titrated to BP <160 mmHg
a carotid endarterectomy. The patient The patient is demonstrating symptoms of cere-
is altered and began complaining of bral hyperperfusion syndrome and requires
new headache this morning. The cur- prompt control of their hypertension. Labetalol
rent vital signs are as follows: heart IV push followed by a titratable infusion will al-
rate (HR) 116 beats/min, blood pres- low correction of the hypertension and titration
sure (BP) 170/90 mmHg, and temper- as needed. While acetaminophen may be given
ature 99°F. What orders should the for headache, the patient's pain is part of a larger
AGACNP give? problem, which is cerebral hyperperfusion. The
A.Acetaminophen 650 mg orally now, priority intervention is control of the hyperperfu-
and blood cultures × 2 obtained stat sion. Blood cultures are not indicated. Diltiazem
B.Diltiazem 15 mg intravenous (IV) is useful in controlling atrial fibrillation; it will not
push followed by continuous infu- help address the primary problem for this pa-
sion at 5 mg/hr; titration to HR <90 tient. Beta blockers are a more appropriate choice.
beats/min Morphine and acetaminophen may be used as
C.Morphine 2 mg IV as needed for pain; secondary agents for this patient's pain; however,
acetaminophen 650 mg now they will not address the underlying problem and
D.Labetalol 20 mg IV push followed by may only mask the medical emergency that is un-
continuous infusion titrated to BP <160 folding. Control of the patient's BP is the priority.
mmHg
7. When managing a cardiac arrest pa- Answer: A. Place endotracheal tube (ETT), obtain
tient, which interventions should the EKG, monitor, and optimize respiratory and hemo-
AGACNP prioritize after achieving re- dynamic parameters
turn of spontaneous circulation? The stabilization phase occurs after return of
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1. A 16-year-old patient with a history of A. mild/moderate
mild, intermittent asthma is seen in Rationale: The patient in the above example ex-
the emergency room complaining of hibits all of the expecting findings of a patient with
shortness of breath. She normally only mild to moderate asthma as noted in the following
needs her albuterol inhaler before ex- table:
ercise, but she is using it now 2-3 times Mild or Moderate
per day for 3 days. Upon examination, Talks in phrases, prefers to sit rather than lying
the AGACNP notes the patient's ap- down, not agitated, no accessory muscle use, HR
pearance as calm but tachypneic. HR 100-120, O2 saturation 90-95 % on room air
is 108, O2 saturation on room air is > 50% of predicted or personal best
91 %. A bedside peak expiratory flow Severe
measurement reveals FEV1 at 58 % of Talks in words, leans forward when sitting, ap-
her personal best. The AGACNP should pears agitated, RR>30/min, accessory muscle us-
classify this patient's asthma as which age, HR>120, O2 saturation< 90% on room air
of the following? < 50 % of predicted or personal best
A. mild/moderate Life-threatening
B. severe Unable to speak, drowsy, or confused
C. life-threatening n/a
D. the severity cannot be determined
with the information given
2. A 52-year-old male patient has been Answer: A. Ischemic dilated cardiomyopathy
admitted to the heart failure unit with The patient's presentation is most consistent with
new atrial fibrillation (AF), volume over- ischemic dilated cardiomyopathy related to alco-
load, and hypoxia. This is his first ad- hol use. Ischemic dilated cardiomyopathy is more
mission for heart failure (HF), and dur- common in men and often presents with develop-
ing intake he denies a past medical his- ment of arrythmia like AF. His only risk factor for
tory of hypertension, hyperlipidemia, heart failure is alcohol use, which is a secondary
or myocardial infarction. All of the pa- cause of ischemic dilated cardiomyopathy. Hyper-
tient's immediate family members are trophic cardiomyopathy is often asymptomatic at
alive and well. There is no family history rest, although symptoms may occur during stren-
of heart disease, sudden death, or in- uous exercise. It most commonly presents in those
, NR571 Midterm Questions
Study online at https://quizlet.com/_gjzrrw
filtrative disease. The patient jogs reg- in the third decade of life. Additionally, hyper-
ularly and denies anginal symptoms or trophic cardiomyopathy runs in families, and the
syncope. The patient endorses alcohol patient denies any history of heart disease in his
use for 20 years and states that he has family. Restrictive cardiomyopathy is associated
tried to cut down recently. Based on with a number of etiologies, including infiltrative
this information, what is the most likely disease, which the patient denies. It also presents
cause of the patient's new heart fail- with a history of poor exercise tolerance, which is
ure? not consistent with the patient's history of present
A.Ischemic dilated cardiomyopathy illness. Takotsubo cardiomyopathy is associated
B.Hypertrophic cardiomyopathy with extreme emotional stress and often manifests
C.Restrictive cardiomyopathy with anginal symptoms, which does not fit the
D.Takotsubo cardiomyopathy patient's presentation.
3. Adults with a history of congenital Answer: C. Heart failure
heart disease (CHD) are at risk of what Patients with a diagnosis of CHD are monitored
common complication? frequently for the development of heart failure.
A.Deep vein thrombosis (DVT) While DVT can be a result of an unrepaired con-
B.Myocardial infarction genital heart defect, this is not considered a com-
C.Heart failure mon complication in most adults. Myocardial in-
D.Stillbirth farction is not a frequent complication in CHD.
Some women with a concurrent diagnosis of CHD
and pulmonary arterial hypertension (PAH) are
counseled against pregnancy due to the risk of
maternal death; however, development of heart
failure is of concern to a wider group of these
patients.
4. While rounding on a 70-year-old pa- Answer: A. Compression therapy, wound care con-
tient recently admitted with commu- sult, and elevation of the affected limb
nity-acquired pneumonia, the AGACNP A shallow-based ulcer with uneven edges pre-
notes an ulcer on the medial malleo- sent at the medial malleolus is consistent with
lus. The ulcer bed is shallow, and the venous statis. Compression therapy and elevation
, NR571 Midterm Questions
Study online at https://quizlet.com/_gjzrrw
borders are irregular. The surrounding are mainstays of treatment. Pain control, debride-
skin is notable for hemosiderin stain- ment, and surgical consult are indicated in the
ing, with +1 edema to both lower ex- management of arterial ulcers, whereas the pa-
tremities. What is the most appropriate tient's symptoms and signs are more consistent
treatment? with an ulcer related to venous insufficiency. Fre-
A.Compression therapy, wound care quent position changes and a pressure-reducing
consult, and elevation of the affected mattress are appropriate in the setting of a pres-
limb sure ulcer, not a venous ulcer. Compression dress-
B.Pain control, debridement, and sur- ings, not wet to dry dressings, are the mainstay of
gical consult treatment for venous ulcers. There is no indication
C.Wound care consult, frequent posi- for antibacterial ointment.
tion changes, and a pressure-reducing
mattress
D.Antibacterial ointment, wet to dry
dressing, and wound care consult
5. The AGACNP sees a 44-year-old patient Answer: C. Magnesium IV
who is unconscious, has an advanced The patient has a history of alcohol use disorder
airway in place, and is actively receiving and appears malnourished. These factors place
cardiopulmonary resuscitation (CPR). them at risk for hypomagnesemia, which is also
The patient's only known history is for an inciting factor for torsades de pointes, a poly-
alcohol use disorder and tobacco use. morphic form of VT that has a twisting pattern
The patient is cachectic-appearing with around the isoelectric line. Magnesium IV is the
diminished muscle mass. After comple- treatment for torsades de pointes. Although epi-
tion of a 2-minute round of CPR, the nephrine is an appropriate medication for typical
AGACNP calls for a rhythm and pulse VT, the patient has evidence of a special type of VT
check. The rhythm on the monitor ap- known as torsades de pointes, which is associated
pears to be a multi-focal ventricular with hypomagnesemia, and magnesium IV is the
tachycardia (VT) with a twisting type of appropriate treatment. Amiodarone may be used
pattern. Based on this patient's known to treat VT as a second agent after epinephrine;
history and the most likely arrythmia, however, in cases of torsades de pointes, magne-
what treatment does the AGACNP or- sium is the recommended first-line drug. Atropine
, NR571 Midterm Questions
Study online at https://quizlet.com/_gjzrrw
der? is indicated in the treatment of bradyarrhythmias
A.Epinephrine intravenously (IV) and is not a suitable choice for the patient.
B.Amiodarone IV
C.Magnesium IV
D.Atropine IV
6. The AGACNP is called to see a pa- Answer: D. Labetalol 20 mg IV push followed by
tient who is ready for discharge after continuous infusion titrated to BP <160 mmHg
a carotid endarterectomy. The patient The patient is demonstrating symptoms of cere-
is altered and began complaining of bral hyperperfusion syndrome and requires
new headache this morning. The cur- prompt control of their hypertension. Labetalol
rent vital signs are as follows: heart IV push followed by a titratable infusion will al-
rate (HR) 116 beats/min, blood pres- low correction of the hypertension and titration
sure (BP) 170/90 mmHg, and temper- as needed. While acetaminophen may be given
ature 99°F. What orders should the for headache, the patient's pain is part of a larger
AGACNP give? problem, which is cerebral hyperperfusion. The
A.Acetaminophen 650 mg orally now, priority intervention is control of the hyperperfu-
and blood cultures × 2 obtained stat sion. Blood cultures are not indicated. Diltiazem
B.Diltiazem 15 mg intravenous (IV) is useful in controlling atrial fibrillation; it will not
push followed by continuous infu- help address the primary problem for this pa-
sion at 5 mg/hr; titration to HR <90 tient. Beta blockers are a more appropriate choice.
beats/min Morphine and acetaminophen may be used as
C.Morphine 2 mg IV as needed for pain; secondary agents for this patient's pain; however,
acetaminophen 650 mg now they will not address the underlying problem and
D.Labetalol 20 mg IV push followed by may only mask the medical emergency that is un-
continuous infusion titrated to BP <160 folding. Control of the patient's BP is the priority.
mmHg
7. When managing a cardiac arrest pa- Answer: A. Place endotracheal tube (ETT), obtain
tient, which interventions should the EKG, monitor, and optimize respiratory and hemo-
AGACNP prioritize after achieving re- dynamic parameters
turn of spontaneous circulation? The stabilization phase occurs after return of
