NRNP 6550 MIDTERM EXAM VERSION 1 (100 QUESTIONS &
ANSWERS) 100% CORRECT LATEST 2023
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 can occur as a
Feedback 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
0 out of 1 points
Mrs. Miller is transported to the emergency department by paramedics. She is having profound, unremitting
chest pain, is diaphoretic and pale. She has jugular venous distention and a widened pulse pressure.
Suspecting ascending aortic aneurysm, the AGACNP order which test to confirm the diagnosis?
Response “D” is the correct answer. It is the most widely used diagnostic tool as it
Feedback rapidly and precisely can outline the thoracic and abdominal aorta. “A” is
: not the correct answer—there are radiographic findings that suggest thoracic aneurysm, but
they need confirmation by CT. “B” is not the correct answer as ultrasound is not nearly as
precise as a CT scan. “C” is not correct—MRI is only indicated when the patient cannot have a
contrast CT.
Question 3
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 4
0 out of 1 points
A patient with anterior epistaxis has been treated with 20 minutes of direct pressure to the cartilaginous
portion of the nose. Following pressure the patient is instructed to gently blow the nose. Expected findings in
the patient who has been successfully treated include all of the following except a:
Response “C” is the correct answer. If bleeding is successfully stopped with 20
Feedback minutes of directed pressure, there will be residual blood and clot
: formation. This is evacuated either by gentle suction or having the patient
gently blow. Residual blood and formed clot may present as a sudden gush
of dark blood or discharge with or without a clot—these are all typical
expected findings. However, if bleeding is not stopped, it will continue as a
bright red steady trickle. When this occurs, more invasive measures are
indicated.
Question 5
0 out of 1 points
Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right ear pain. He
appears quite ill and says he feels nauseous. Otoscopic evaluation reveals pain to palpation, a very
erythematous and bulging tympanic membrane with bullous myringitis. The AGACNP knows that antibiotic
therapy must be selected to cover:
Response “D” is the correct answer. Streptococcus pneumoniae is the most common bacteria that
Feedback infects the head and neck in immunocompetent persons, and is the primary treatment target
: when treating otitis media, bacterial sinusitis, and bacterial pharyngitis. “A” is not correct—
while likely on broken skin and soft tissue, it is not common in the ear, nose, or throat unless
specific risk factors exist. “B” is not correct—this is much more likely in an
immunocompromised patient or a patient on mechanical ventilation. “C” is not correct—it is
the second most common organism, but strep is the primary treatment target.
Question 6
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 outpatient population where the
Feedback 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 7
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 vascular disease, and is
Feedback 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 8
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 Committee (JNC) report,
Feedback 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 context of the rest of the examination.
Question 9
0 out of 1 points
Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment
for patients taking these medications should include a:
Response “C” is the correct answer. The atypical antipsychotics such as olanzapine
Feedback (Zyprexa), clozapine (Clozaril), and quetiapine (Seroquel) are classically
: associated with dyslipidemia and annual lipid panels should be performed
in patients of all ages who take these medications. “A” is incorrect—this is the appropriate
annual screening tool for patients on lithium due to lithium-related iodine suppression of the
thyroid gland. There are no specific indications for “B” and “D” unique to patients taking
atypical antipsychotics. Those laboratory assessments should only be ordered as indicated by
any other significant patient history.
, Question 10
1 out of 1 points
K.R. presents for an evaluation of eye discomfort. He works in a fabricating shop for a custom automobile
restoration company and while working he felt like something flew into his eye. He was wearing eye
protection at the time but still has the sensation that something is there. Physical examination is significant
for some tearing and he reports a persistent sense of something in his eye. Which of the following is not
indicated in the diagnostic evaluation?
Response “B” is the correct answer. The patient’s history is consistent with a metal
Feedback injury and so an MRI should be avoided. “A” may or not be indicated as the
: history progresses, but there is no contraindication to it should the examiner determine the
need to rule out an abrasion. “C” and “D” are both mechanisms to visualize behind the cornea
which may be necessary if a penetration injury (which may occur with a high-velocity injury) is
suspected.
Question 11
0 out of 1 points
D.E. is a 41-year-old female who had lumbar surgery two days ago to repair a ruptured nucleus pulposus. She
has been doing well postoperatively but today is complaining of resting fatigue and some shortness of breath
at rest. In ruling out a pulmonary embolus the AGACNP first orders a:
Response “B” is the correct answer. The D-dimer is a highly sensitive serology and is the least invasive
Feedback mechanism by which a pulmonary embolus may be ruled out; a negative D-dimer virtually
: eliminates pulmonary embolus from the differential diagnosis. “A” is not correct—while it
can be used to make the diagnosis it is more invasive and less specific than other options.
“D” is not correct—there is no indication that the patient is on warfarin, and in any event it
would not be used to rule in or out pulmonary embolus “C” is not accurate when after
surgery, as it will be positive after surgery.
Question 12
0 out of 1 points
Mr. Nixon is being treated with unfractionated heparin infusion for acute pulmonary embolus. In order to
avoid a potentially fatal complication of heparin infusion, the AGACNP monitors:
Response “D” is the correct answer. An uncommon but potentially serious consequence of heparin
Feedback infusion is heparin-induced thrombocytopenia. Some patients make autoantibodies in
: response to exogenous heparin that activate their own platelets. When this occurs, heparin
must be
immediately discontinued and thrombin inhibitors started. “A” is not correct —this is not
affected by heparin, but is monitored in those on Coumadin.
“B” is not correct—this is also unaffected by heparin, but monitored on Coumadin. “C” is not
correct—this is monitored to assess therapeutic efficacy, but not for complications.
Question 13
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:
