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NURS 6550 Midterm Exam Walden – Questions and Answers

NURS 6550 Midterm Exam Walden – Questions and Answers

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NURS 6550 Midterm Exam Walden – Questions and Answers

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  • Question 1

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 Feedback: “B” is the correct answer. The D-dimer is a highly sensitive serology and is the least invasive 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 2

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:

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Response Feedback: “D” is the correct answer. An uncommon but potentially serious consequence of heparin 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 3

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:

 

Response Feedback: “A” is the correct answer. Dizzy is a layperson’s term and can mean many different things to patients and health care providers. When the patient identifies the primary symptom as a sense of spinning this supports vertigo, which is usually an inner ear problem. This versus ataxia which is neurologic or near-syncope which may be cardiac, neurological, or neurocardiogenic. “B” is not correct—this may occur with vertigo, but when it is the primary symptom it is most likely ataxia and neurological causes should be considered. “C” is not correct as coincident nausea is not specific and can occur with any of these complaints. “D” is not correct as it is also not specific; while ataxia cannot occur when supine near-syncope can.
  • Question 4

1 out of 1 points

Mr. Banks has been admitted for surgical resection of a metastatic tumor, during surgery it is discovered that he has widespread, diffuse metastasis throughout the abdomen. Surgery is no longer an option, and his oncologist says that chemotherapy is unlikely to produce any meaningful benefit. Mr. Banks is concerned that his sons will not support a transfer to comfort care. The AGACNP advises that he:

 

Response Feedback: “B” is the correct answer. If there is any concern about disagreement among family members, or any concern at all that a patient’s wishes will not be carried out, the best action is to ensure that there is a clearly defined legally executed document. “A” is not correct. Living wills are not legally enforceable documents and when dissention arises among family members they may not be carried out. “C” is not correct – while the patient should arrange for his care as long as he is capable of 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. “D” is not correct — identifying the proxy is not enough without assigning legal rights and responsibilities. While “A,” “C,” and “D” should all be done and will support his care, the only way to ensure that one’s wishes are carried out is to ensure that a legally enforceable direction is in place.
  • Question 5

1 out of 1 points

Mr. Wilkerson is a 77-year-old male who is being evaluated and treated for his cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, pulse of 100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A 12-lead ECG reveals deep ST segment depression in leads V3-V6. The AGACNP recognizes which of the following as a contraindication to rTPA therapy?

 

Response Feedback: “D” is the correct answer. rTPA is not indicated in patients with ST segment depression; this is not a ST elevation MI. “A” is not correct as age > 80 is a relative contraindication. “B” is not correct as a temperature of 99.1° F is an expected response to myocardial necrosis, and “C” is not correct—the blood pressure is not prohibitive until > 180/110 mm hg.
  • Question 6

1 out of 1 points

A 71-year-old patient is recovering from a particularly severe exacerbation of chronic obstructive pulmonary disease. He has been in the hospital for almost two weeks and was on mechanical ventilation 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 been “sneaking” cigarettes in the hospital for two days, but he has established a timeline to decrease the number of cigarettes daily. According to his plan his last cigarette will be the last day of the month. This patient’s behavior is consistent with which stage of the Transtheoretical Model of Change?

 

Response Feedback: “C” is the correct answer. The Transtheoretical model of change is characterized by 5 stages. “A” is when the patient has no intention to make a change. “B” is when the patient is intending to make a change in the next 6 months. “C” is when the patient is ready to take action or has already taken some action, as this patient has in establishing his plan to quit by the end of the month. “D” is the overt action that attains a criterion sufficient to reduce disease risk—in this patient the action stage would be characterized by actual smoking cessation. The final phase, not presented in the answer choices here, is maintenance.
  • Question 7

1 out of 1 points

While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic disorders is:

 

Response Feedback: “B” is the correct answer. Patients with psychotic disorders are characterized by a distinct alteration in their perception of reality which may be manifest by visual or auditory hallucinations or impaired thought processes. Neurotic disorders, while many times very serious, are seen in patients who remain aware and interactive with the reality. “A” is incorrect as neurotic disorders may be characterized by a tendency or actual act of harm, such as the self-mutilating actions classic of a borderline personality, suicide by a depressed patient, or even murder or torture committed by an antisocial personality. While dangerous, none of those disorders include a dis-connect from reality as part of the presentation. “C” is incorrect as antipsychotic medications are used to manage a variety of neurotic disorders such as depression or oppositional defiant disorder. “D” is incorrect as lack of conscience and remorse is typical of antisocial personalities.

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  1. 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.
  2. 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?
  3. 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?
  4. 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:
  5. 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:
  6. 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? NURS 6550 Midterm Exam Walden – Questions and Answers
  7. Which of the following is the greatest risk factor for vascular dementia?
  8. 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? NURS 6550 Midterm Exam Walden – Questions and Answers
  9. Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment for patients taking these medications should include a:
  10. 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? NURS 6550 Midterm Exam Walden – Questions and Answers
  11. 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:
  12. 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:
  13. 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:
  14. Mr. Banks has been admitted for surgical resection of a metastatic tumor, during surgery it is discovered that he has widespread, diffuse metastasis throughout the abdomen. Surgery is no longer an option, and his oncologist says that chemotherapy is unlikely to produce any meaningful benefit. Mr. Banks is concerned that his sons will not support a transfer to comfort care. The AGACNP advises that he:
  15. Mr. Wilkerson is a 77-year-old male who is being evaluated and treated for his cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, pulse of 100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A 12-lead ECG reveals deep ST segment depression in leads V3-V6. The AGACNP recognizes which of the following as a contraindication to rTPA therapy? NURS 6550 Midterm Exam Walden – Questions and Answers
  16. A 71-year-old patient is recovering from a particularly severe exacerbation of chronic obstructive pulmonary disease. He has been in the hospital for almost two weeks and was on mechanical ventilation 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 been “sneaking” cigarettes in the hospital for two days, but he has established a timeline to decrease the number of cigarettes daily. According to his plan his last cigarette will be the last day of the month. This patient’s behavior is consistent with which stage of the Transtheoretical Model of Change?
  17. While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic disorders is: NURS 6550 Midterm Exam Walden – Questions and Answers
  18. L.T. is an 85-year-old male who is admitted for evaluation of profound diarrhea that has produced significant dehydration. He also complains of being very tired lately, and feeling like he is going to vomit all of the time. His vital signs are significant for a pulse of 41 b.p.m. and a blood pressure of 90/60 mm Hg. A gastrointestinal evaluation including stool for blood, white blood cells, and ova and parasites is negative. He insists that he has not started any new medications or made any diet changes; the only thing new is that he got new eye drops for his glaucoma. The AGACNP correctly assumes that his new eye drops are:
  19. Janice is a 19-year-old female who presents to the emergency department via ambulance. She is pale, diaphoretic, agitated, and convinced she is having a stroke. Her vital signs include a temperature of 98.9° F, pulse of 114 beats per minute, respirations of 32 breaths per minute, and a blood pressure of 110/74 mm Hg. Diagnostic evaluation is negative and Janice is diagnosed with an acute panic attack. The initial treatment of choice is:
  20. Lorraine is a 41-year-old female who presents for an asthma follow-up visit. She says she feels very well, has almost no daytime symptoms, and is using her inhaled corticosteroid medication daily as prescribed. Her PEFR is 85% of her personal best. The best approach to this patient is to:
  21. Mr. Owen is a 37-year-old patient who has been admitted for surgical resection of a malignant tumor in his lung. His physical recovery has been uneventful and he is being prepared for discharge. While discussing his ongoing cancer therapy with Mr. Owen, the AGACNP determines that he has experienced persistent, excessive anxiety and worry almost every day for more than one year. What other aspect of Mr. Owen’s psychosocial history would be required to made a diagnosis of generalized anxiety disorder?
  22. Kevin T. is a 49-year-old male who is being discharged after hospitalization for an acute inferior wall myocardial infarction. This is his first hospitalization and his first chronic medical diagnosis. Aside from his elevated cardiac isoenzymes and troponins, his laboratory profile was essentially within normal limits. The only apparent cardiac risk factor is an LDL cholesterol of 200 mg/dL. Initiating an HMG-CoA reductase inhibitor is an example of which level of prevention for Kevin?
  23. You are evaluating a patient who has been admitted to the emergency room after being arrested for starting a fight in a local sports’ bar. The patient is now being cooperative, but reports that he has been in treatment for PTSD for months. He has been prescribed fluoxetine but has not noticed any improvement in symptoms, and now has been arrested for violence. The AGACNP knows that the next step in medication management is likely to include:
  24. Mrs. Salter is an 81-year-old lady who presents for evaluation of near-syncopal episodes. Her 12-lead ECG, complete blood count, and comprehensive metabolic panel are all essentially normal. A urinalysis shows some trace protein but is otherwise normal. A 24-hour rhythm monitor demonstrates rare premature ventricular contractions. Mrs. Salter has been in good health and had her first episode at her aerobics class. She only gets lightheaded when she exerts herself. Her heart auscultates for a grade III/VI systolic crescendo-decrescendo murmur at the second intercostal space, right sternal border. The AGACP considers that the likely cause of the syncope is:
  25. Who among the following patients is at greatest risk for a pulmonary embolus?
  26. Mrs. Birdsong is an 85-year-old female who has been admitted for surgical repair of a hip fracture. She is in remarkably good spirits and is quite talkative. She readily answers all of the questions on her intake assessment, and readily acknowledges information provided during her room orientation. Later while talking with the patient’s son the AGACNP learns that the patient has had significant cognitive impairment for a few years. She has virtually no short term memory, but compensates by confabulating. Her son says she is generally very happy as long as there is no change in her day to day routine. This history is most consistent with which form of dementia?
  27. Mrs. Radovich is an 80-year-old female with a variety of chronic medical conditions which are reasonably well controlled. She generally enjoys a good quality of life and is active with her family. Today her only concern is that she is having problems with her vision. She notices that while trying to look at pictures of her great grandchildren she can’t seem to focus on their faces. She also reports increased trouble reading—she cannot seem to see the words that she is looking at, and her reading glasses do not help. Further evaluation of Mrs. Radovich should include assessment with:
  28. R.J. is a 55-year-old female who presents with acute onset left sided facial pain and an inability to move the left side of her face. She cannot smile, raise her eyebrow or even close her left eye, The immediate approach to this patient should include:
  29. A 78-year-old male present for a physical examination. He has no discomfort or complaints other than a general decrease in vision, but it helps when he puts things under a bright light to read. He admits that while driving at night the streetlights appear to be a bit distorted and his night vision is pretty poor. Given the likely diagnosis, the AGACNP expects which of the following physical findings?
  30. Jason is a 46-year-old male who is being managed for sepsis. He has HIV/AIDS and has had a prolonged hospitalization characterized by a variety of complications. He was extubated 3 days ago but continues gastric decompression with a nasogastric tube(NGT), total parenteral nutrition and antibiotic therapy via a central venous catheter, and urinary drainage via a Foley catheter. He continues to demonstrate consistent low grade fevers but all points of insertion of his tubes are normal to inspection, a chest radiograph demonstrates improvement of his pneumonia, and his urinalysis shows no bacteria, leukocytes, or nitrites. The AGACNP should next order: NURS 6550 Midterm Exam Walden – Questions and Answers
  31. The interpretation of a chest radiography should follow a systematic approach to ensure that all vital structures are evaluated and important clinical findings are not missed. The last thing to be assessed when looking at chest radiography should be the _____________:
  32. The Short Confusion Assessment Method (Short-CAM) is a widely used four item tool that assesses delirium in the hospitalized patient. It includes observation of all of the following except: NURS 6550 Midterm Exam Walden – Questions and Answers
  33. Ms. Yang has been hospitalized for 5 days for the management of a gastrointestinal bleeding. She appears to have stabilized hemodynamically, but today she had a temperature of 101.9° F and chest radiography demonstrates a diagnosis of pneumonia. The AGACNP knows that the diagnostic evaluation for hospital acquired pneumonia for all patients must include:
  34. Most psychosocial theories of aging center around the core concept that successful aging requires acceptance of a series of changes or losses that predictably occur later in the life span. The theory that specifically addresses coming to terms with the inevitability of death is known as:
  35. All of the following conditions are risk factors for pulmonary embolus except:
  36. A patient is diagnosed with acute descending aortic aneurysm and hypertension should be immediately started on which medication pending surgical evaluation?
  37. Jason is a 27-year-old with a long history of intermittently controlled asthma. He is currently prescribed Advair daily with albuterol as needed for symptoms. Today he presents to the emergency department with cough and wheezing and difficulty catching his breath. His FEV1is 51% at the time of presentation. He is given alternating albuterol and ipratropium nebulizer treatments along with oral prednisone. After one hour his FEV1 has increased 65%. The appropriate disposition for Jason at this point is:
  38. A patient in the intensive care unit suddenly becomes tachypneic and dyspneic. The physical examination reveals pale, cool, clammy skin and an arterial blood gas demonstrates hypocapnea and hypoxia. Pulmonary artery pressure demonstrates a pattern consistent with obstructive shock. The AGACNP knows that which of the following causes of this presentation is most likely? NURS 6550 Midterm Exam Walden – Questions and Answers
  39. Mr. Bowers is an 81-year-old male who is being terminally extubated at the request of his family due to the presence of a large subdural hematoma with a shift; the patient is not initiating respirations on his own and the prognosis is very poor. After he is extubated he begins to initiate his own respirations and 24 hours later has not expired yet. The decision is made to leave him in the hospital on a general medical floor rather than transfer to another facility for hospice. Which of the following is the best indicator that the patient’s death is imminent?
  40. A patient is newly admitted to your service for open reduction and internal fixation of the left hip. She seems very down, and as you talk with her you realize that her mood is not just related to her hip fracture. Which of the following symptoms would not be consistent with major depressive disorder?
  41. “C” is the correct answer. Alzheimer’s dementia is statistically the most common form of dementia and is characterized by a long trajectory that progresses to include confabulation. Additionally, patients with this form of dementia are very reliant upon routine and may be distressed when it is disrupted. “A” is not correct; Lewy body dementia characteristically progresses much more quickly and produces an angry demeanor. “B” is incorrect because vascular dementia typically produces a more depressive affect and is not characterized by confabulation; additionally, patients with vascular dementia often have a medical history consistent with vascular risk factors. “D” is not correct as there is no apparent history of Parkinson’s disease.
  42. What is the primary purpose of using eye ointments or lubricants to patients under general anesthesia, on paralytics, or in long-term comatose states? NURS 6550 Midterm Exam Walden – Questions and Answers
  43. When reading a 12-lead electrocardiogram, the AGACNP knows that all 12 leads are required to provide:
  44. A 49-year-old male presents for evaluation of chest tightness. It has happened before, but he just ignored it and it went away. Today he just could not ignore it anymore. He has always enjoyed good health and says he has never been told that he has any chronic medical conditions like high blood pressure or diabetes. A 12-lead ECG demonstrates changes consistent with inferior wall ischemia. Both his symptoms and inferior wall changes improve with the administration of sublingual nitroglycerin. Consistent with ACS protocol, this patient’s assessment is consistent with:
  45. Mr. Rosen is a 49-year-old male who is being managed for an acute myocardial infarction. He develops significant shortness of breath at rest and coarse rales 2/3 up bilaterally. The AGACNP suspects acute pulmonary edema due to papillary muscle rupture and acute mitral valve regurgitation. Which physical finding would support this finding?
  46. A patient with minor head trauma presents for evaluation. Which of the following findings should be followed up with a CT scan to rule out orbital fracture? NURS 6550 Midterm Exam Walden – Questions and Answers
  47. Mrs. Forbes is a 69-year-old lady being discharged from the hospital after complications following a cosmetic surgical procedure. She is basically in good health. She has a history of hypothyroidism for which she takes levothyroxine daily, and mild osteoarthritis which is controlled with only prn nonsteroidal use. Her blood pressure is 148/90 mm Hg. The AGACNP knows that in accordance with the most current guidelines published in JNC 8 the appropriate action is to:
  48. When assessing driver safety in the older adult, the AGACNP considers that:
  49. The nursing staff calls to tell you that your 81-year-old male patient is having an acute change in mental status. He is a basically healthy man who was admitted three days ago for inpatient antibiotic management of community acquired pneumonia. His daughter is at the bedside and she is very distraught because she has never seen him like this. She is asking for medication to make him stop acting disoriented. Upon examination the patient is lying in bed, appears calm and happy, but does not recognize his daughter as anyone he knows. He is talking as if he is at home and has company. The AGACNP instructs the daughter that: NURS 6550 Midterm Exam Walden – Questions and Answers
  50. While discharging a patient following her myocardial infarction, you offer some patient education about medically supervised cardiac rehabilitation. The patient expresses fear of rehab because she was on her treadmill when she had her infarction and now she is afraid of making it happen again. She doesn’t understand how the rehab can force her to exercise her heart but not make her have another cardiac event. The AGACNP explains that the patient will be monitored and that her goal heart rate will be:
  51. During physical examination of a 51-year-old African-American female you appreciate a decrease in her peripheral vision. The rest of her eye examination is within normal limits and she is symptom free. This presentation is consistent with:
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  53. Mr. Moffett is a 66-year-old male with a long history of lower extremity edema. All other causes of lower extremity edema have been ruled out and his overall symptom presentation and history are strongly supportive of chronic venous insufficiency. Today he presents with increased itching of both lower legs. Physical exam reveals 2-3+ pitting edema and trophic hyperpigmentation. The AGACNP know that treatment should include:
  54. L.R. is an 84-year-old female patient being treated for pneumonia. Her condition is deteriorating despite aggressive broad spectrum antipseudomonal cephalosporin antibiotic therapy. Induced sputum culture reveals heavy growth of Legionella pneumophilia. The AGACNP knows that antibiotic therapy must be adjusted to include coverage with:
  55. The AGACNP is treating a patient with a corneal abrasion. The patient has a clear recollection of the mechanism of injury—she was scratched in the eye earlier today with her 18-month-old daughter’s fingernail. Which of the following is contraindicated in the management of this patient’s abrasion?
  56. M.T. is a 41-year-old male patient in the intensive care unit. He was admitted to the hospital in septic shock and has been aggressively managed with broad spectrum antibiotics. He has become progressively hypoxemic and the last arterial blood gas revealed a paO2of 58 mm Hg. Chest radiography reveals a “white out” pattern bilaterally. The patient is intubated and ventilated. The AGACNP knows that appropriate management must include:
  57. Teenagers and adults with acute otitis media can often be treated with “watchful waiting” given the high incidence of spontaneous resolution and low risk of poor outcomes. Which of the following is an absolute indication to begin antibiotic therapy at the time of diagnosis?
  58. Mr. Bowers is on mechanical ventilation for respiratory support through an episode of septic pneumonia. Due the extensive lobar consolidation it was very difficult to keep Mr. Bowers oxygenated and he required very high FIO2s and PEEP. The AGACNP knows that the primary concern with FIO2s > 60% is
  59. Acute respiratory distress syndrome (ARDS) occurs when an overwhelming systemic insult results in which maladaptive physiologic response?
  60. NURS 6550 Midterm Exam Walden – Questions and Answers
  61. Acute respiratory dist
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