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NURS 6550 Final Exam / NURS6550 Final Exam (100 Q/A)(2020/21):Walden university

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NURS 6550 Final Exam / NURS6550 Final Exam (V2)(100 Q/A)(2020/21, All Correct Answers):Walden university

NURS 6550 Final Exam / NURS6550 Final Exam (LATEST 2020)

 

QUESTION 1

1.       A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be:

 

A.

Meclizine

 

B.

Diazepam

 

C.

Bed rest

 

D.

Epley’s maneuvers

 

QUESTION 2

1.       Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is:

 

A.

Osteoarthritis

 

B.

Drug or alcohol toxicity

 

C.

Hypotension

 

D.

Urosepsis

 

QUESTION 3

1.       A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities?

 

A.

Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg

 

B.

Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg

 

C.

Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg

 

D.

Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg

 

QUESTION 4

1.       Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes:

 

A.

Foley lodged in the urethra causing post-renal failure

 

B.

Decreased renal perfusion causing prerenal failure

 

C.

Age-related decreased eGFR causing prerenal failure

 

D.

Post-surgical rhabdomyolysis causing intrarenal failure

 

QUESTION 5

1.       Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of:

 

A.

Hashimoto’s thyroiditis

 

B.

Cushing’s syndrome

 

C.

Grave’s disease

 

D.

Addison’s disease

 

QUESTION 6

1.       Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE?

 

A.

Fever, normal white count, elevated sedimentation rate

 

B.

Hyperkalemia, hyponatremia, low blood pressure

 

C.

Leukocytosis, hyperglycemia, hypokalemia

 

D.

Joint pain, rash, fever

 

 

QUESTION 7

1.       Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates:

 

A.

Penetration of the cornea with resultant aqueous leak

 

B.

A rust ring remnant due to metal foreign body

 

C.

An elevated intraocular pressure 

 

D.

Paradoxical pupil dilation in response to light

 

QUESTION 8

1.       Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory test is necessary to support the suspected diagnosis?

 

A.

An erythrocyte sedimentation rate

 

B.

A white blood cell differential

 

C.

Two sets of blood cultures

 

D.

Echocardiography

 

QUESTION 9

1.       Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness; ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess of:

 

A.

Serotonin

 

B.

Norepinephrine

 

C.

Acetylcholine

 

D.

Dopamine

 

QUESTION 10

1.       Mr. Lincoln is a 55-year-old male who was admitted for management of sepsis secondary to pneumonia. He has declined rapidly, and today chest radiography demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg. In order to increase his oxygenation the AGACNP knows that which of the following interventions is indicated?

 

A.

Increased FiO2

 

B.

Increased respiratory rate

 

C.

Increased tidal volume

 

D.

Increased PEEP

 

QUESTION 11

1.       A 29-year-old female patient presents with a complaint of palpitations. Physical examination reveals an essentially healthy female with no significant medical history and no maintenance medications; the only thing she can report is that she had a head cold a week or so ago. The vital signs include a blood pressure of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a temperature of 98.6° F. The only abnormal finding on physical examination is diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers which medication for symptom control?

 

A.

Ibuprofen

 

B.

Pseudoephedrine

 

C.

Propranolol

 

D.

Methimazole

 

QUESTION 12

1.       Jennifer is an 18-year-old homeless female who was found unresponsive. She was admitted to the hospital for management of severe bleeding after a spontaneous abortion escalated to a uterine hemorrhage. An underlying infection and dehydration were corrected and nutritional supplements were started. Her volume status is stable, morning labs were all within normal limits and she is to be discharged today. When the AGACNP enters the room to prepare the patient for discharge, she finds her agitated, pale, and diaphoretic with vital signs to include a pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a temperature is 97.9° F. The most appropriate action would be to:

 

A.

Order a CBC to assess for recurrent bleeding

 

B.

Request and abdominal CT to assess for bleeding

 

C.

Evaluate the patient for anxiety/panic attack

 

D.

Prescribe alprazolam 1 mg now

 

QUESTION 13

1.       Physical examination findings in a patient with pneumothorax is likely to reveal:

 

A.

Increased tactile fremitus

 

B.

Low grade temperature

 

C.

Hyperresonance to percussion

 

D.

Egophany

 

QUESTION 14

1.       Mr. Parker brings his 73-year-old wife to a clinic appointment because he is worried about her. She has a long history of hypertension and dyslipidemia, but he says she has taken medication for years and everything has been OK. His concern today is that for a long time she has been very forgetful, and he has tried to help her by keeping a strict routine around the house. Over the past few months, she just seems more and more forgetful, does not seem interested in doing anything, and now seems to be forgetting how to do simple everyday tasks. Yesterday she could not figure out which dollar bills to use at the store to pay the cashier. The AGACNP knows Mrs. Parker should first be screened for:

 

A.

Depression

 

B.

A brain tumor

 

C.

Hypothyroidism

 

D.

Adrenal dysfunction

 

QUESTION 15

1.       M.R. is a 40-year-old female who has a known history of peptic ulcer disease. She has been admitted through the emergency room with a diagnosis of GI bleeding—she is vomiting dark blood and had a nasogastric tube placed. When attached to low intermittent suction it initially drained 400 cc of dark brown/black drainage, but now it is starting to drain lighter red colored blood. The AGACNP knows that immediate priorities of care include:

 

A.

Ensuring hemodynamic stability

 

B.

Beginning a parenteral proton pump inhibitor

 

C.

Beginning gastric lavage

 

D.

Ordering a gastrointestinal consult

 

QUESTION 16

1.       A patient with sharp, stabbing chest pain directly over the precordium has a 12-lead ECG that demonstrates concave ST-T wave elevations in leads II, III, avR, avL, avF, and all six precordial leads. The AGACNP expects which physical finding?

 

A.

A grade IV/VI systolic murmur with radiation to the axilla

 

B.

A split S2 that increases with inspiration

 

C.

A pericardial friction rub

 

D.

An S4 heart sound

 

QUESTION 17

1.       J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC reveals a macrocytic anemia with aHgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of 19%. The AGACNP suspects which type of anemia?

 

A.

Iron deficiency

 

B.

Sickle cell anemia

 

C.

Pernicious anemia

 

D.

Anemia of chronic disease

 

QUESTION 18

1.       Megan K. is a 21-year-old female who presents complaining of irritated eyes. She says this happens a couple of times a year and this time it is really a problem. Both eyes are itchy and red and she has a lot of stringy discharge, especially at the end of the day. Her visual acuity is 20/25 OS, OD, and OU with her glasses on. Physical exam reveals injected conjunctiva bilaterally but there is no photophobia. Pupils are equal, round, briskly reactive, and accommodate. The AGACNP knows that immediate treatment should include ophthalmic application of:

 

A.

Steroids

 

B.

Antihistamine

 

C.

Antibiotic

 

D.

Cycloplegic

 

QUESTION 19

1.       Ellen is a 61-year-old female who presents with a chief complaint of neck pain. The history of present illness reveals that Ellen felt as though a bug bit her behind the neck a few days ago. A day or two later it started to hurt, and when she began to pick at it she felt drainage come out. She is here now for evaluation. Physical exam reveals an 8 cm x 8 cm draining abscess in the right post auricular region with posterior cervical lymphadenopathy. Ellen has a temperature today of 101.9° F. The AGACNP knows that in addition to incision and drainage of the abscess, effective management must include:

 

A.

Systemic antibiotics 

 

B.

Tetanus immune globulin

 

C.

Tetanus toxoid

 

D.

Antipyretics

 

QUESTION 20

1.       A 13-year-old male presents with a chief complaint of ear drainage. The patient and his mother both indicate that the patient has not had any pain or any systemic complaints, but the pus-like discharge from the ear is very persistent. According to Mom they went to a retail clinic two weeks ago and the patient was prescribed both oral antibiotics and ear drops, but it didn’t help. Physical exam of the ear reveals a painless pinna; otoscope exam reveals only a large amount of mucopurulent drainage—the tympanic membrane could not be visualized. The AGACNP knows the diagnosis is most likely:

 

A.

Acute otitis media

 

B.

Acute otitis externa

 

C.

Cholesteatoma

 

D.

Otitis media with effusion

 

QUESTION 21

1.       A 71-year-old male patient with lung cancer is admitted for treatment of sepsis related to his chemotherapy-induced immunosuppression. He seems to be improving from an infectious perspective, but during today’s assessment the AGACNP appreciates coarse rales in the lung fields, a blood pressure of 140-100 mm Hg, a bounding pulse, and trace pretibial edema. The urine output via Foley catheter has only been 100 mL in the last 8 hours. Suspicious for syndrome of inappropriate antidiuretic hormone (SIADH), the AGACNP orders a basic metabolic panel anticipating which of the following abnormalities?

 

A.

Hypokalemia

 

B.

Hypocalcemia

 

C.

Hyponatremia

 

D.

Hypochloremia

 

QUESTION 22

1.       A crescendo-decrescendo systolic murmur best appreciated at the second intercostal space, right sternal border with radiation to the carotid artery is most likely an indicator of:

 

A.

Aortic stenosis

 

B.

Aortic regurgitation

 

C.

Tricuspid stenosis

 

D.

Tricuspid regurgitation

 

QUESTION 23

1.       The AGACNP knows that diagnostic findings consistent with rheumatoid arthritis include:

 

A.

Soft tissue swelling of the metacarpals

 

B.

Radiographic joint space narrowing

 

C.

Heberden’s nodes

 

D.

Subungal hemorrhages

 

QUESTION 24

1.       C.T. is a 39-year-old female who presents for evaluation of what she thinks is her “rosacea acting up.” She has a history of acne rosacea and has medicated on and off for years with tetracycline and topical metronidazole. Today however she presents with a pronounced red/purple area on her left cheek extending to the nasal border. It is very warm to the touch. The borders of the affected area are very well defined and raised. C.T. also has a temperature of 100.7° F and a generalized headache. The AGACNP appreciates tender submandibular and cervical lymphadenopathy. The likely diagnosis is:

 

A.

Complex rosacea 

 

B.

Cellulitis

 

C.

Erysipelas

 

D.

Allergic reaction

 

QUESTION 25

1.       Mr. Lopez is a 51-year-old male patient who is being treated for T2DM. His HgbA1c is 15.6% and initial management will include aggressive attempts for weight reduction as his body mass index (BMI) is 45. He says he is unable to participate in any meaningful exercise because he very often has back pain; he has had it for years and has tried all sort of over the counter medicines with little relief. He describes it as a profound ache that occurs across the lower part of his back bilaterally; it does not travel down either leg. The physical inspection is normal, but he has significant paraspinal tenderness to palpation bilaterally. He cannot identify any injury or accident that preceded the pain. The history and physical exam is noncontributory. The AGACP knows that the likely diagnosis is:

 

A.

Lumbar radiculopathy

 

B.

Ankylosing spondylitis

 

C.

Lumbar sacral strain

 

D.

Degenerative disk disease

 

QUESTION 26

1.       A patient presents with acute onset of vesicular lesions on her vulva. They are surrounded by areas of redness and they hurt. The patient says that she has even more of them now then she did when she woke up this morning. There is also inguinal lymphadenopathy. The AGACNP is suspicious for:

 

A.

Human papilloma virus

 

B.

Primary syphilis

 

C.

Gonorrhea

 

D.

Herpes simplex virus

 

QUESTION 27

1.       Classic radiographic features of osteoarthritis include:

 

A.

Soft tissue swelling

 

B.

Joint deformity

 

C.

Bone mineral loss

 

D.

Joint space narrowing

 

QUESTION 28

1.       Mrs. Sandoval is a 72-year-old female who presents with a chief complaint of transient verbal confusion. She was speaking with her friend on the phone this morning when she suddenly couldn’t get words out. Her friend went over to her home and found Mrs. Sandoval awake, alert, and oriented, responding appropriately with non-verbal gestures, but she could not properly articulate her thoughts. By the time she arrived at the office this had passed, although during the examination she appeared to have infrequent difficulty finding a single word. The patient denies any contributory medical history, but a 12-lead ECG in the office reveals atrial fibrillation with a ventricular response of 91 b.p.m. The blood pressure is 140/94 mm Hg; remaining vital signs are normal. The AGACNP knows that management should include:

 

A.

Antiplatelet therapy

 

B.

Anticoagulation

 

C.

Blood pressure control

 

D.

Speech therapy

 

QUESTION 29

1.       C.L. is a 48-year-old female who presents complaining of activity intolerance. She is usually very active and fit^. She jogs regularly and typically does 4-5 miles a day. About a week ago she became so tired she had to stop, and lately she has become aware of becoming easily fatigued while going up and down stairs. She admits that she thinks she is beginning menopause—she is having a lot of bleeding with her periods, and her periods seem to be more frequent. A complete blood count (CBC) reveals the following results: 

Hgb 10.1 g/dL 
Hct 30% 
MCV 75 fL 
RDW 21% 

The AGACNP orders which of the following laboratory test to confirm the suspected diagnosis?

 

A.

Vitamin B12

 

B.

Folate

 

C.

Ferritin

 

D.

Hemoglobin electrophoresis

 

QUESTION 30

1.       Kevin H. is a 61-year-old male who presents for treatment of profound anxiety. He has been treated on and off for years—most recently he was taking escitalopram 20 mg p.o. daily, and although he does admit to some improvement, he still cannot function appropriately thoughout the day. He has been counseled about poor work performance and is concerned about losing his job, but he is just so worried all of the time he cannot concentrate on work. The AGACNP knows that the most appropriate action is to:

 

A.

Increase the dose of escitalopram to 40 mg daily

 

B.

Refer Kevin for a psychiatric consultation

 

C.

Stop escitalopram and begin venlafaxine

 

D.

Discuss therapeutic expectations with Kevin

 

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

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