NURS 6550 Midterm Exam Latest
QUESTION 31
1. When examining a patient with a skin presentation suggestive of necrotizing fasciitis, the AGACNP knows that the most important and sensitive diagnostic test is:
A. A complete blood count
B. Plain film radiographs
C. The finger test
D. CT scan
QUESTION 32
1. While evaluating a patient with abdominal pain, the AGACP knows that when the pain is described as coming in waves or cycles, with periods of relief in between, the cause likely centers around:
A. Peristalsis of bowel
B. Disorders of pelvic organs
C. Organ inflammation
D. Hyperacidity
QUESTION 33
1. Which of the following findings is not typically associated with testicular torsion?
A. Acute pain
B. Edema
C. High riding testis
D. Dysuria
QUESTION 34
1. 152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?
Yes
No
QUESTION 35
1. While preparing to perform an incision and drainage on a 7 cm fluctuant abscess on a patients posterior thorax, the AGACNP knows that the most important part of the procedure is:
A. Immediate coverage with antistaphylococcal antibiotics
B. Maintaining sterility with topical betadine and drapes
C. Breaking up loculations and aggressive irrigation
D. Proper injection of local anesthetic
QUESTION 36
1. A patient is being evaluated with significant nausea, fatigue, and a general sense of feeling unwell; mild jaundice is noted on physical examination. Transaminases are markedly elevated and a hepatitis screening is done. Results are as follows:
+ HbsAb
+ anti-HAV IgM
– anti-HCV
The correct interpretation of these findings is:
A. The patient has acute hepatitis A
B. The patient has acute hepatitis B
C. The patient has chronic hepatitis B
D. The patient has acute hepatitis C
QUESTION 37
1. When treating a patient with an unknown overdose or toxicity, the AGACNP knows that all of the following should be administered except:
A. Dextrose 50%
B. Thiamine 100 mg
C. Nalaxone 0.4 mg
D. Ativan 4 mg
QUESTION 38
1. The AGACNP is evaluating 29-year-old female who presents by ambulance and is unresponsive. There is no witness and no history available; the patient is not wearing any sort of medic alert bracelet. While assessing for toxicity or overdose, the patient is found to have vital signs as follows: Temp of 96.2° F, pulse of 48 b.p.m., respirations of 10 b.p.m., and blood pressure of 84/50 mm Hg. The patient’s pupils are constricted, but do react briskly to light to 1 mm. The AGACNP suspects which type of substance?
A. Cholinesterase inhibiting drugs
B. Stimulants such as MDMA
C. Anticholinergics
D. Ethanol or opiates
QUESTION 39
1. The AGACNP knows that the one class of pain medication that is effective to some extent for all forms of pain is:
A. NSAIDs
B. Antidepressants
C. Antiepileptics
D. Opiates
QUESTION 40
1. K.P. is a 76-year-old male admitted for antibiotic management of urosepsis. His medical history is significant for a CVA with resultant right-sided hemiparesis. He is nonverbal, maintained on enteral nutritional support and has an indwelling Foley catheter. The AGACNP knows that which of the following bacteria is the primary treatment target for this patient’s urosepsis?
A. Proteus mirabilis
B. Pseudomonas aeruginosa
C. Staphylococcus aureus
D. Streptococcus pneumoniae
QUESTION 41
1. A patient is admitted for a COPD exacerbation and placed on mechanical ventilation. His settings are as follows: FiO2 of 40%, TV of 700mL, SIMV of 12. His morning ABG reveals a pH of 7.37, paCO2 of 51 mm Hg, paO2 of 84 mm Hg and HCO3 of 30 mm Hg. The AGACNP knows that the appropriate response is to:
A. Leave the ventilator settings as is
B. Increase the SIMV to 16 b.p.m.
C. Increase the FiO2 to 50%
D. Repeat the ABG in one hour
QUESTION 42
1. All of the following are required for a diagnosis of systemic inflammatory response syndrome (SIRS) except:
A. White blood cell count < 4000 or > 12,000 cells/uL
B. Heart rate > 90 b.p.m.
C. Respiratory rate > 20 b.p.m. or paCO2 < 32 mm Hg
D. Two sets of positive blood cultures
QUESTION 43
1. J.T. is a 41-year-old female patient who presents with a chief complaint of “heartburn.” She says that it doesn’t really seem to be related to meals or food—it occurs at random times. She does note, when asked, that it seems to happen a lot at night and occasionally wakes her up. Her only other symptom complaint is an occasional cough. It does not produce mucus, and she admits to assuming it was a “nervous” cough. The next appropriate action for the AGACNP would be to:
A. Order an H. pylori test
B. Request a GI consult for endoscopy
C. Order a proton pump inhibitor 30 minutes before breakfast
D. Request a 72-hour diet history
QUESTION 44
1. Your patient has diabetes insipidus (DI). Anticipated physical assessment findings include:
A. Dry skin, tachycardia, hypertension
B. Weak pulse, dry skin, decreased skin turgor
C. Thin hair, thready pulse, dry mucous membranes
D. Hypothermia, jugular venous distention, bradycardia
QUESTION 45
1. The AGACNP is beginning medical management of a patient newly diagnosed with T2DM. The patient has a BMI of 39 and has been unsuccessful in making significant diet and lifestyle changes over the last six months. Other than her weight, her physical examination is essentially within normal limits. Her HgbA1c is 9.5%. A basic metabolic panel is within normal limits. The medication of choice to begin therapy will be:
A. A sulfonyurea
B. A meglitinide
C. A biguanide
D. An incretin mimetic
QUESTION 46
1. Felty’s syndrome is a condition of immune neutropenia seen sometimes in patients with:
A. Polymyalgia rheumatica
B. Giant cell arteritis
C. Systemic lupus erythematosus
D. Rheumatoid arthritis
QUESTION 47
1. When treating a patient for the profound cough of acute bronchitis, the AGACNP knows that the most appropriate pharmacotherapy consists of:
A. An opiate based cough suppressant
B. Oral prednisone
C. A first generation-antihistamine combination
D. An inhaled anticholinergic
QUESTION 48
1. Mr. Truman is transferred to the emergency department by ambulance. His wife called 911 this morning because he was acting “funny” when he woke up. Both the patient and his wife went to bed last night at approximately 10:30 and everything was normal. This morning he could not communicate orally and seemed confused about how to ambulate. Upon arrival to the emergency department his vital signs are as follows: Temperature 100.9° F, pulse 89 b.p.m., respirations 14 b.p.m. and blood pressure 168/94 mm Hg. A non-contrast CT scan of the head reveals thrombotic CVA. The AGACNP know that immediate management of this patient should include:
A. Thrombolytics
B. IV vasodilators
C. Aspirin
D. Antiepileptics
QUESTION 49
1. Your patient is complaining of profound nausea and vomiting that started at bedtime last night and kept him awake all night long. Early this morning he started having abdominal cramping and explosive diarrhea. Based upon the character of symptoms you are suspicious of infection with Staphylococcus aureus. To assess risk for exposure to this organism, you ask the patient about which meal?
A. Breakfast yesterday
B. Lunch yesterday
C. Dinner yesterday
D. Bedtime snack yesterday
QUESTION 50
1. D.R. is a 54-year-old male patient who was admitted for the management of cellulitis and treated with parenteral antibiotics. He has not been responding as well as anticipated. During today’s exam the AGACNP appreciates a couple of changes. All of the following indicate the need for immediate surgical evaluation except:
A. Skin anesthesia
B. Violaceous bullae
C. Gas bubbles in tissue
D. Lymphangetic spread
QUESTION 51
1. R. O. is a 21-year-old female who comes to the emergency department because of a severe headache. Her vital signs and neurological examination are within normal limits. She complains of a pulse-like pain in her right temple and admits that she has almost vomited. Her mother gets the same type of headache and the last time this happened R.O. took one of her mother’s prescription headache pills. They helped a lot, but this time her mother told her she had to come be evaluated. The AGACNP knows that which of the following is the appropriate action?
A. A non-contrast CT scan of the head
B. Administration of a 5HT agonist
C. Dilaudid 2 mg IM x 1 dose
D. Requesting a headache diary
QUESTION 52
1. A 39-year-old female presents for evaluation of a rash. She denies any significant medical history, and has no other complaints. The rash appeared suddenly on both forearms approximately one week ago, and she is concerned because it is not going away. It does not itch or hurt—it is just there. Physical examination reveals a diffuse macular hypopigmentation on both forearms that extends to the hands. The patient denies any drug or alcohol use; she is single and has had 4 unprotected sexual partners in the last year. The AGACNP knows that initial laboratory testing must include a(n):
A. FTA-Abs
B. Fungal skin scraping
C. RPR screening
D. CBC
QUESTION 53
1. J.S. is a African-American female who presents for a wellness examination. Her medical history is significant for beta thalassemia minor. Anticipated red blood cell differential would include which of the following patterns?
A. Hgb 10.2 g/dL, Hct 30%, MCV 70 fL, RDW 12.6%
B. Hgb 9.9 g/dL, Hct 28%, MCV 83 fL, RDW 13.9%
C. Hgb 11.5 g/dL, Hct 35%, MCV 94 fL, RDW 15.8%
D. Hgb 12.8 g/dL, Hct 38%, MCV 105 fL, RDW 18.1%
QUESTION 54
1. M.T. presents complaining of acute pain in his left eye, nausea, and one episode of vomiting. He denies any significant medical problems, and says that the only medication that he takes is an occasional over-the-counter sleeping pill. Physical examination reveals a steamy red cornea and conjunctiva with a pupil that is 5 mm and not reactive to light. The AGACNP knows that diagnostic testing should include:
A. A CT scan of the head
B. An MRI of the orbit
C. A toxicology screen
D. A measurement of intraocular pressure
QUESTION 55
1. Justin is a 23-year-old male who is being managed for an acute manic episode. Justin was diagnosed with bipolar disorder several years ago, but his home life has been unstable and he has not been very adherent to a medication regimen. Most recently he was started on the SNRI venlafaxine by his primary care provider, which he has been taking as prescribed for about 6 weeks, but he began a manic episode a few days ago which peaked this evening. The AGACNP considers that:
A. The manic episode is probably a result of medication instability and he should continue his current regimen with a follow-up in 6-8 weeks
B. A mood stabilizing agent should be added to the venlafaxine
C. All medication should be held for 6-8 weeks and the then the patient should be reevaluated
D. The SNRI should be stopped and a mood stabilizing agent started
QUESTION 56
1. Mr. Livingston is a 79-year-old male who presents from a long term care facility with a change in mental status. His medical history is significant for T2DM, CAD, CHF, hypothyroidism, Alzheimer’s dementia and osteoarthritis. He has been stable, but over the last few days the staff say he has been a bit disconnected. This morning he was found in his bed in a stuporous state. His vital signs include a temperture of 98.9° F, pulse of 103 b.p.m., respiratory rate of 20 b.p.m., and a blood pressure of 92/64 mm Hg. His metabolic panel demonstrates a Na+ of 129 mEq/L, K+ of 3.3 mEq/L, Cl- of 100 mEq/L, CO2 of 24 mEq/L, glucose of 644 mg/dL, BUN of 51 mg/dL and creatinine of 1.9 mg/dL. The AGACNP knows that the primary problem is most likely:
A. Diabetic ketoacidosis
B. Hypertonic hyponatremia
C. Myxedema coma
D. Hyperosmolar hyperglycemic coma
QUESTION 57
1. The AGACNP is evaluating a patient with systemic lupus erythematosis who complains of fatigue. Based upon his knowledge of the most commonly affected visceral organ, which of the following diagnostic studies should be ordered?
A. Echocardiogram
B. Chest radiography
C. Hepatic function enzymes
D. Urinalysis with microscopic
QUESTION 58
1. All of the following are true statements about post-traumatic stress disorders (PTSD) except:
A. It is more common in women than men
B. It is unlikely to occur in children especially < 10 years old
C. It is differentiated from acute stress reaction by time
D. It is not likely in persons with no preexisting psychiatric disease
QUESTION 59
1. Ray M., a 49-year-old male, walks into the emergency room complaining of back pain. He has never had this problem before and cannot identify any injury, but he is in such severe pain he is sure something is wrong. He states that his back has been hurting so badly sometimes he has to stop whatever he is doing and bend forward at the waist. The pain also travels along the outer edge of his left thigh to mid-calf, and he reports a small area of numbness on his anterior thigh. His history and physical examination are otherwise negative. He is an insurance attorney and is not especially active at work, but goes to the gym 5 days a week. He is not overweight, and his vital signs are normal. Physical examination reveals no paraspinal tenderness, and his straight leg raise is negative. A few times during the exam he lay back on the table and grabbed his left leg, flexed both hip, and pulled his knee to his chest, because it helped the pain. The AGACNP knows that immediate pain relief measures must include:
A. An opiate analgesic
B. Systemic steroids
C. Physical therapy
D. Bedrest for 72 hours
QUESTION 60
1. A patient with peptic ulcer disease is admitted to the hospital with significant upper abdominal discomfort. She has guarding and rebound tenderness on examination. Abdominal radiography demonstrates free air in the abdomen. The AGACNP knows that the immediate priority is to:
A. Obtain a stat surgical consult
B. Begin an IV proton pump inhibitor
C. Order an abdominal CT scan
D. Obtain a stat gastroenterology consult
QUESTION 61
1. Jennifer is a 15-year-old female who attempted suicide by taking a bottle of acetaminophen. She took 30, 500 mg tablets approximately six hours ago, but then became frightened and told her mother what she did. Her mother said that Jennifer seems OK, other than being a little sick to her stomach, she has no complaints. The AGACNP knows that the first step in her care includes:
A. N-acetycysteine in tapering doses over the next 24 hours
B. Oral administration of activated charcoal
C. Psychiatric assessment
D. Discharge to home with follow-up LFTs in 4 days
QUESTION 62
1. Mrs. Glassman is a 55-year-old female who presents with a chief complaint of fever. Her vital signs reveal a temperature of 100.0° F, blood pressure of 100/60 mm Hg, pulse of 114 b.p.m. and respirations of 20 b.p.m. Her cardiac auscultation reveals a grade III/VI systolic murmur at the left lower sternal border. Her history is significant for an eyebrow lift 4 months ago. The AGACNP orders which test to confirm the suspected diagnosis?
A. Three sets of blood cultures
B. A chest radiograph
C. A 12-lead ECG
D. Induced sputum culture
QUESTION 63
1. John is a 17-year-old male who is in the emergency department with abdominal pain. He is quite uncomfortable and says that it started yesterday and seemed to be “in the middle of his stomach” but today it has moved over to the right lower side. During physical examination the abdomen is not distended, but he is guarded, and right lower quadrant palpation produces significant discomfort, especially upon release of the palpating hand. He has appreciable pain when his right knee and hip are bent to a 90° angle. John admits to some nausea but has not vomited; he has not had a normal bowel movement in two days. His vital signs are as follows: Temperature 100.9° F, pulse 110 b.p.m. respiratory rate 22 b.p.m., and blood pressure 118/77 mm Hg. The AGACNP orders which of the following tests to confirm the suspected diagnosis?
A. Complete blood count
B. Ultrasound
C. CT scan
D. Urinalysis
QUESTION 64
1. Which of the following signs is expected in patients with cholecystitis?
A. McBurney’s
B. Cullen’s
C. Spurling’s
D. Murphy’s
QUESTION 65
1. According to the World Health Organization’s step-wise approach to pain management, initial approaches to step 2 might include all of the following except:
A. A weak opiate
B. A strong opiate
C. A non-steroidal antiinflammatory agent
D. An antidepressant.
QUESTION 66
1. A patient’s Weber test lateralizes to the right ear and the Rinne test in both ears is normal. The patient has a:
A. Sensorineural hearing loss in the left ear
B. Sensorineural hearing loss in the right ear
C. Conductive hearing loss in the left ear
D. Conductive hearing loss in the right ear
QUESTION 67
1. J.B. is a 62-year-old male who was admitted three days ago for management of diverticulitis. Today the AGACNP is called to the bedside to evaluate new onset swelling of the right lower extremity. According to the staff nurse it was not present yesterday but on today’s assessment the patient had 2A+ edema up to the thigh. Initial diagnostic evaluation should include:
A. Homan’s sign
B. A venogram
C. A D-dimer
D. CT of the chest
QUESTION 68
1. Based upon clinical examination and laboratory assessment the AGACNP diagnoses a patient with giant cell arteritis. The next step in the patient management should be to:
A. Consult surgery for a temporal artery biopsy
B. Consult rheumatology for medical management
C. Order 60 mg of prednisone now and q.d.
D. Order ceftriaxone 1 mg IV now
QUESTION 69
1. According to the JNC VIII criteria, a patient with a new diagnosis of hypertension who has comorbid chronic kidney disease should be started on which of the following classes of medications?
A. A thiazide diuretic
B. A calcium channel blocker
C. An ACE inhibitor
D. A beta adrenergic antagonist
QUESTION 70
1. Denise is a 45-year-old female who presents with significant lower abdominal pain. It started a few days ago and has just gotten steadily worse. She denies any hematuria or dysuria, but when she voids she feels like “everything is coming out. A physical examination reveals an abdomen that is tender to palpation but there is no guarding or rebound. Her vital signs are stable excepting a temperature of 100.9° F. The next step in the evaluation must include:
A. A complete blood count
B. An abdominal flat plate
C. A pelvic examination
D. A CT scan of the abdomen
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