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NURS sh
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6550
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MIDTERM
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EXAM
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QUESTIONS AND ANSWERS.
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Question 1
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1 out of 1 points
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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
la
sent for pleural fluid analysis. While evaluating the fluid analysis, the
AGACNP knows that a fluid identified as a(n) __________ is the least
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worrisome type.
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la
Respons “A” is the correct answer. A transudate is essentially
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e just water and can occur as a consequence of sh
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Feedback increased hydrostatic pressure in the pulmonary
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: vessels. It typically implies that the some condition has
produced an imbalance in colloid-hydrostatic pressures,
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such as CHF or hypoalbuminemia. While it can
represent a serious problem, it may also represent a
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Sp
transient imbalance. Conversely, “B” is not correct as
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an exudate has more protein in it and implies a
condition characterized by protein leaking from
a
vessels, such as a malignancy or some serious
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l
sh
systemic stressor. “C” is not correct—a chyliform
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effusion is characterized by fat and indicates a
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pathology causing massive triglyceride degradation.
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“D” is not correct as a hemorrhagic effusion is blood
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and typically means traumatic injury.
Question 2
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1 out of 1 points
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Differentiating vertigo from near-syncope and ataxia is one of the
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goals of history-taking when a patient presents as “dizzy.” The AGACP
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knows that vertigo is the problem when the patient reports the
primary symptom as:
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Sp
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Response “A” is the correct answer. Dizzy is a layperson’s term
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Feedback and can mean many different things to patients and
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: health care providers. When the patient identifies the
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primary symptom as a sense of spinning this supports
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vertigo, which is usually an inner ear problem. This
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versus ataxia which is neurologic or near-syncope
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which may be cardiac, neurological, or
neurocardiogenic. “B” is not correct—this may occur
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with vertigo, but when it is the primary symptom it is
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most likely ataxia and neurological causes should be
considered. “C” is not correct as coincident nausea is
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not specific and can occur with any of these
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complaints. “D” is not correct as it is also not specific;
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while ataxia cannot occur when supine near-syncope
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can.
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Question 3
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Sp 1 out of 1 points
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Mr. Banks has been admitted for surgical resection of a metastatic
tumor, during surgery it is discovered that he has widespread, diffuse
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metastasis throughout the abdomen. Surgery is no longer an option,
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and his oncologist says that chemotherapy is unlikely to produce any sh
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meaningful benefit. Mr. Banks is concerned that his sons will not
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support a transfer to comfort care. The AGACNP advises that he:
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Response “B” is the correct answer. If there is any concern about
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Feedback disagreement among family members, or any concern
ne
: at all that a patient’s wishes will not be carried out, the
best action is to ensure that there is a clearly defined
a
legally executed document. “A” is not correct. Living
tz
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sh
wills are not legally enforceable documents and when
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dissention arises among family members they may not
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be carried out. “C” is not correct - while the patient
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should arrange for his care as long as he is capable of
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Sp
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, ne
sh
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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.
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“D” is not correct -- identifying the proxy is not enough
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without assigning legal rights and responsibilities.
sh
Sp
While “A,” “C,” and “D” should all be done and will
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support his care, the only way to ensure that one’s
wishes are carried out is to ensure that a legally
la
enforceable direction is in place.
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Sp
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Question 4
1 out of 1 points
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Mr. Wilkerson is a 77-year-old male who is being evaluated and treated
tz
for his cardiogenic pain. His vital signs are as follows: Temperature of
sh
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99.1° F, pulse of 100 bpm, respirations of 22 bpm, and blood pressure
ne
of 168/100 mm Hg. A 12-lead ECG reveals deep ST segment
depression in leads V3-V6. The AGACNP recognizes which of the
la
following as a contraindication to rTPA therapy?
sh
Sp
Response “D” is the correct answer. rTPA is not indicated in
ne
Feedback patients with ST segment depression; this is not a ST
: elevation MI. “A” is not correct as age > 80 is a relative
la
contraindication. “B” is not correct as a temperature of
tz
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99.1° F is an expected response to myocardial necrosis,
Sp
and “C” is not correct—the blood pressure is not
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prohibitive until > 180/110 mm hg.
la
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Sp
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Question 5
1 out of 1 points
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A 71-year-old patient is recovering from a particularly severe
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exacerbation of chronic obstructive pulmonary disease. He has been in sh
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the hospital for almost two weeks and was on mechanical ventilation
ne
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
la
been "sneaking" cigarettes in the hospital for two days, but he has
sh
established a timeline to decrease the number of cigarettes daily.
Sp
According to his plan his last cigarette will be the last day of the
ne
month. This patient’s behavior is consistent with which stage of the
a
Transtheoretical Model of Change?
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l
sh
Sp
Response “C” is the correct answer. The Transtheoretical model of
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Feedback change is characterized by 5 stages. “A” is when the
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: patient has no intention to make a change. “B” is when
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the patient is intending to make a change in the next 6
la months. “C” is when the patient is ready to take action
or has already taken some action, as this patient has in
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establishing his plan to quit by the end of the month.
sh
Sp
“D” is the overt action that attains a criterion sufficient
ne to reduce disease risk—in this patient the action stage
would be characterized by actual smoking cessation.
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The final phase, not presented in the answer choices
sh
here, is maintenance.
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Question 6
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1 out of 1 points
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Sp
Certain subgroups of the elderly population are at an increased risk for
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rapid deterioration and long-term care placement. Which of the
following is not considered a high risk factor for long term care
la
placement?
sh
Sp
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Response “A” is the correct answer; men are at higher risk for
Feedback long-term care placement than women. In addition to
la
: male gender, other risk factors include age over 80,
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living alone, bowel or bladder incontinence, history of
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Sp
falls, dysfunctional coping, and intellectual impairment.
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la
sh
Sp
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Question 7
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1 out of 1 points
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P.M. is a 71-year-old gay male patient who presents as an outpatient
sh
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for evaluation of increasing shortness of breath. The diagnostic
ne
evaluation ultimately supports a diagnosis of community acquired
pneumonia. The AGACNP appreciates right middle lobe consolidation
la
on chest radiography. Pending sputum cultures, empiric antibiotic
sh
therapy must be initiated to cover which organism?
Sp
ne
Respons “D” is the correct answer. This patient presents from
a
e the outpatient population where the most common
tz
l
sh
Feedback cause of pneumonia is Streptococcus pneumoniae, and
Sp
: is the primary treatment target for any patient being
ne
treated empirically. “A” is not correct—while the
la
patient’s sexual orientation is offered in the provided
sh
Sp
la
Sp
NURS sh
ne
la
tz
sh
Sp
ne
la
6550
sh
Sp
ne
la
MIDTERM
tz
sh
Sp
ne
EXAM
la
QUESTIONS AND ANSWERS.
sh
Sp
ne
la
tz
Question 1
sh
1 out of 1 points
Sp
ne
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
la
sent for pleural fluid analysis. While evaluating the fluid analysis, the
AGACNP knows that a fluid identified as a(n) __________ is the least
sh
worrisome type.
Sp
ne
la
Respons “A” is the correct answer. A transudate is essentially
tz
e just water and can occur as a consequence of sh
Sp
Feedback increased hydrostatic pressure in the pulmonary
ne
: vessels. It typically implies that the some condition has
produced an imbalance in colloid-hydrostatic pressures,
la
such as CHF or hypoalbuminemia. While it can
represent a serious problem, it may also represent a
sh
Sp
transient imbalance. Conversely, “B” is not correct as
ne
an exudate has more protein in it and implies a
condition characterized by protein leaking from
a
vessels, such as a malignancy or some serious
tz
l
sh
systemic stressor. “C” is not correct—a chyliform
Sp
effusion is characterized by fat and indicates a
ne
pathology causing massive triglyceride degradation.
la
“D” is not correct as a hemorrhagic effusion is blood
sh
Sp
la
Sp
, ne
sh
ne
and typically means traumatic injury.
Question 2
la
tz
sh
1 out of 1 points
Sp
Differentiating vertigo from near-syncope and ataxia is one of the
ne
goals of history-taking when a patient presents as “dizzy.” The AGACP
la
knows that vertigo is the problem when the patient reports the
primary symptom as:
sh
Sp
ne
Response “A” is the correct answer. Dizzy is a layperson’s term
la
Feedback and can mean many different things to patients and
tz
: health care providers. When the patient identifies the
sh
primary symptom as a sense of spinning this supports
Sp
vertigo, which is usually an inner ear problem. This
ne
versus ataxia which is neurologic or near-syncope
la
which may be cardiac, neurological, or
neurocardiogenic. “B” is not correct—this may occur
sh
Sp
with vertigo, but when it is the primary symptom it is
ne
most likely ataxia and neurological causes should be
considered. “C” is not correct as coincident nausea is
la
not specific and can occur with any of these
tz
complaints. “D” is not correct as it is also not specific;
sh
Sp
while ataxia cannot occur when supine near-syncope
ne
can.
la
Question 3
sh
Sp 1 out of 1 points
ne
Mr. Banks has been admitted for surgical resection of a metastatic
tumor, during surgery it is discovered that he has widespread, diffuse
la
metastasis throughout the abdomen. Surgery is no longer an option,
tz
and his oncologist says that chemotherapy is unlikely to produce any sh
Sp
meaningful benefit. Mr. Banks is concerned that his sons will not
ne
support a transfer to comfort care. The AGACNP advises that he:
la
Response “B” is the correct answer. If there is any concern about
sh
Sp
Feedback disagreement among family members, or any concern
ne
: at all that a patient’s wishes will not be carried out, the
best action is to ensure that there is a clearly defined
a
legally executed document. “A” is not correct. Living
tz
l
sh
wills are not legally enforceable documents and when
Sp
dissention arises among family members they may not
ne
be carried out. “C” is not correct - while the patient
la
should arrange for his care as long as he is capable of
sh
Sp
la
Sp
, ne
sh
ne
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.
la
“D” is not correct -- identifying the proxy is not enough
tz
without assigning legal rights and responsibilities.
sh
Sp
While “A,” “C,” and “D” should all be done and will
ne
support his care, the only way to ensure that one’s
wishes are carried out is to ensure that a legally
la
enforceable direction is in place.
sh
Sp
ne
Question 4
1 out of 1 points
la
Mr. Wilkerson is a 77-year-old male who is being evaluated and treated
tz
for his cardiogenic pain. His vital signs are as follows: Temperature of
sh
Sp
99.1° F, pulse of 100 bpm, respirations of 22 bpm, and blood pressure
ne
of 168/100 mm Hg. A 12-lead ECG reveals deep ST segment
depression in leads V3-V6. The AGACNP recognizes which of the
la
following as a contraindication to rTPA therapy?
sh
Sp
Response “D” is the correct answer. rTPA is not indicated in
ne
Feedback patients with ST segment depression; this is not a ST
: elevation MI. “A” is not correct as age > 80 is a relative
la
contraindication. “B” is not correct as a temperature of
tz
sh
99.1° F is an expected response to myocardial necrosis,
Sp
and “C” is not correct—the blood pressure is not
ne
prohibitive until > 180/110 mm hg.
la
sh
Sp
ne
Question 5
1 out of 1 points
la
A 71-year-old patient is recovering from a particularly severe
tz
exacerbation of chronic obstructive pulmonary disease. He has been in sh
Sp
the hospital for almost two weeks and was on mechanical ventilation
ne
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
la
been "sneaking" cigarettes in the hospital for two days, but he has
sh
established a timeline to decrease the number of cigarettes daily.
Sp
According to his plan his last cigarette will be the last day of the
ne
month. This patient’s behavior is consistent with which stage of the
a
Transtheoretical Model of Change?
tz
l
sh
Sp
Response “C” is the correct answer. The Transtheoretical model of
ne
Feedback change is characterized by 5 stages. “A” is when the
la
: patient has no intention to make a change. “B” is when
sh
Sp
la
Sp
, ne
sh
ne
the patient is intending to make a change in the next 6
la months. “C” is when the patient is ready to take action
or has already taken some action, as this patient has in
tz
establishing his plan to quit by the end of the month.
sh
Sp
“D” is the overt action that attains a criterion sufficient
ne to reduce disease risk—in this patient the action stage
would be characterized by actual smoking cessation.
la
The final phase, not presented in the answer choices
sh
here, is maintenance.
Sp
ne
la
Question 6
tz
1 out of 1 points
sh
Sp
Certain subgroups of the elderly population are at an increased risk for
ne
rapid deterioration and long-term care placement. Which of the
following is not considered a high risk factor for long term care
la
placement?
sh
Sp
ne
Response “A” is the correct answer; men are at higher risk for
Feedback long-term care placement than women. In addition to
la
: male gender, other risk factors include age over 80,
tz
living alone, bowel or bladder incontinence, history of
sh
Sp
falls, dysfunctional coping, and intellectual impairment.
ne
la
sh
Sp
ne
Question 7
la
1 out of 1 points
tz
P.M. is a 71-year-old gay male patient who presents as an outpatient
sh
Sp
for evaluation of increasing shortness of breath. The diagnostic
ne
evaluation ultimately supports a diagnosis of community acquired
pneumonia. The AGACNP appreciates right middle lobe consolidation
la
on chest radiography. Pending sputum cultures, empiric antibiotic
sh
therapy must be initiated to cover which organism?
Sp
ne
Respons “D” is the correct answer. This patient presents from
a
e the outpatient population where the most common
tz
l
sh
Feedback cause of pneumonia is Streptococcus pneumoniae, and
Sp
: is the primary treatment target for any patient being
ne
treated empirically. “A” is not correct—while the
la
patient’s sexual orientation is offered in the provided
sh
Sp
la
Sp
