nurs 6550 midterm exam 1 – question and answers 2023
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NURS 6550 MIDTERM EXAM 1 – QUESTION AND ANSWERS
2023
• Question 1
1 out of 1 points
The AGACNP is caring for a patient who is quite ill and has developed, among other
things, a large right sided pleural effusion. Thoracentesis is sent for pleural fluid
analysis. While evaluating the fluid analysis, the AGACNP knows that a fluid identified as
a(n) is the least worrisome type.
Response “A” is the correct answer. A transudate is essentially just water and can
Feedback occur as a consequence of increased hydrostatic pressure in the pulmonary
: vessels. It typically implies that the some condition has produced an
imbalance in colloid-hydrostatic pressures, such as CHF or
hypoalbuminemia. While it can represent a serious problem, it may also
represent a transient imbalance. Conversely, “B” is not correct as an
exudate has more protein in it and implies a condition characterized by
protein leaking from vessels, such as a malignancy or some serious
systemic stressor. “C” is not correct—a chyliform effusion is characterized
by fat and indicates a pathology causing massive triglyceride degradation.
“D” is not correct as a hemorrhagic effusion is blood and typically means
traumatic injury.
• Question 2
0 out of 1 points
Mrs. Miller is transported to the emergency department by paramedics. She is having
profound, unremitting chest pain, is diaphoretic and pale. She has jugular venous
distention and a widened pulse pressure. Suspecting ascending aortic aneurysm, the
AGACNP order which test to confirm the diagnosis?
Response “D” is the correct answer. It is the most widely used diagnostic tool as it
Feedback rapidly and precisely can outline the thoracic and abdominal aorta. “A” is
: not the correct answer—there are radiographic findings that suggest
thoracic aneurysm, but they need confirmation by CT. “B” is not the correct
answer as ultrasound is not nearly as precise as a CT scan. “C” is not
correct—MRI is only indicated when the patient cannot have a contrast CT.
• Question 3
1 out of 1 points
Certain subgroups of the elderly population are at an increased risk for rapid
,NURS 6550 MIDTERM EXAM 1 – QUESTION AND ANSWERS
2023
deterioration and long-term care placement. Which of the following is not considered a
high risk factor for long term care placement?
Response “A” is the correct answer; men are at higher risk for long-term care
Feedback: placement than women. In addition to male gender, other risk factors
include age over 80, living alone, bowel or bladder incontinence, history of
falls, dysfunctional coping, and intellectual impairment.
• Question 4
0 out of 1 points
A patient with anterior epistaxis has been treated with 20 minutes of direct pressure to
the cartilaginous portion of the nose. Following pressure the patient is instructed to
gently blow the nose. Expected findings in the patient who has been successfully
treated include all of the following except a:
Response “C” is the correct answer. If bleeding is successfully stopped with 20
Feedback minutes of directed pressure, there will be residual blood and clot
: formation. This is evacuated either by gentle suction or having the patient
gently blow. Residual blood and formed clot may present as a sudden gush
of dark blood or discharge with or without a clot—these are all typical
expected findings. However, if bleeding is not stopped, it will continue as a
bright red steady trickle. When this occurs, more invasive measures are
indicated.
• Question 5
0 out of 1 points
Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and
significant right ear pain. He appears quite ill and says he feels nauseous. Otoscopic
evaluation reveals pain to palpation, a very erythematous and bulging tympanic
membrane with bullous myringitis. The AGACNP knows that antibiotic therapy must be
selected to cover:
Response “D” is the correct answer. Streptococcus pneumoniae is the most common
Feedback bacteria that infects the head and neck in immunocompetent persons, and
: is the primary treatment target when treating otitis media, bacterial
sinusitis, and bacterial pharyngitis. “A” is not correct—while likely on
broken skin and soft tissue, it is not common in the ear, nose, or throat
unless specific risk factors exist. “B” is not correct—this is much more likely
in an immunocompromised patient or a patient on mechanical ventilation.
“C” is not correct—it is the second most common organism, but strep is the
primary treatment target.
• Question 6
1 out of 1 points
P.M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of
increasing shortness of breath. The diagnostic evaluation ultimately supports a
diagnosis of community acquired pneumonia. The AGACNP appreciates right middle lobe
consolidation on chest radiography. Pending sputum cultures, empiric antibiotic therapy
must be initiated to cover which organism?
,NURS 6550 MIDTERM EXAM 1 – QUESTION AND ANSWERS
2023
Response “D” is the correct answer. This patient presents from the outpatient
Feedback population where the most common cause of pneumonia is Streptococcus
: pneumoniae, and is the primary treatment target for any patient being
treated empirically. “A” is not correct—while the patient’s sexual orientation
is offered in the provided history, there is no indication that he has
HIV/AIDS or any other condition characterized by immunosuppression that
would increase his risk for this organism. “B” is not correct, as this
organism is not typically seen in the outpatient population without specific
risk, e.g. immunosuppression or chronic ventilator therapy. “C” is not the
correct answer as this organism is not likely absent specific risk such as
instrumentation or known colonization.
• Question 7
0 out of 1 points
Which of the following is the greatest risk factor for vascular dementia?
Response “B” is the correct answer. Vascular dementia is a consequence of vascular
Feedback disease, and is more likely to occur in patients with risk factors for target
: organ damage, such as hypertension, dyslipidemia, and diabetes. “A” is not
a distinct risk factor for vascular dementia; it is a risk for Alzheimer’s
dementia. “C” likewise increases risk for Parkinson’s dementia, but does
not present a risk for vascular dementia. “D” is not a risk factor for
vascular dementia. Although there may be some familial risk for certain
vascular diseases that may lead to vascular dementia, there is no clear
familial tendency for this type of dementia.
• Question 8
1 out of 1 points
J.R. is a 55-year-old male who presents for a commercial driver’s license physical
examination with a blood pressure of 170/102 mm Hg. He has no medical history and is
without complaint. Which of the following findings constitutes hypertensive urgency?
Response “A” is the correct answer. According to the Joint National Committee (JNC)
Feedback report, hypertensive urgency is described as hypertension in the setting of
: progressive target organ damage, such as renal involvement with protein
leaking, left ventricular hypertrophy, or retinal changes. “A” is not correct—
the headache may or may not be relevant, but because there are many
non-hypertension causes, a headache alone does not constitute target
organ damage. “C” is not correct—it may indicate carotid plaque, but this
is not a consequence of hypertension. “D” is not correct as a 1+ palpable
pulse may be a normal finding--it must be taken in the context of the rest
of the examination.
• Question 9
0 out of 1 points
Because of the commonly recognized adverse effects of atypical antipsychotics, annual
laboratory assessment for patients taking these medications should include a:
Response “C” is the correct answer. The atypical antipsychotics such as olanzapine
, NURS 6550 MIDTERM EXAM 1 – QUESTION AND ANSWERS
2023
Feedback (Zyprexa), clozapine (Clozaril), and quetiapine (Seroquel) are classically
: associated with dyslipidemia and annual lipid panels should be performed
in patients of all ages who take these medications. “A” is incorrect—this is
the appropriate annual screening tool for patients on lithium due to
lithium-related iodine suppression of the thyroid gland. There are no
specific indications for “B” and “D” unique to patients taking atypical
antipsychotics. Those laboratory assessments should only be ordered as
indicated by any other significant patient history.
• Question 10
1 out of 1 points
K.R. presents for an evaluation of eye discomfort. He works in a fabricating shop for a
custom automobile restoration company and while working he felt like something flew
into his eye. He was wearing eye protection at the time but still has the sensation that
something is there. Physical examination is significant for some tearing and he reports a
persistent sense of something in his eye. Which of the following is not indicated in the
diagnostic evaluation?
Response “B” is the correct answer. The patient’s history is consistent with a metal
Feedback injury and so an MRI should be avoided. “A” may or not be indicated as the
: history progresses, but there is no contraindication to it should the
examiner determine the need to rule out an abrasion. “C” and “D” are both
mechanisms to visualize behind the cornea which may be necessary if a
penetration injury (which may occur with a high-velocity injury) is
suspected.
• Question 11
0 out of 1 points
D.E. is a 41-year-old female who had lumbar surgery two days ago to repair a ruptured
nucleus pulposus. She has been doing well postoperatively but today is complaining of
resting fatigue and some shortness of breath at rest. In ruling out a pulmonary embolus
the AGACNP first orders a:
Response “B” is the correct answer. The D-dimer is a highly sensitive serology and is
Feedback 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 12
0 out of 1 points
Mr. Nixon is being treated with unfractionated heparin infusion for acute pulmonary
embolus. In order to avoid a potentially fatal complication of heparin infusion, the
AGACNP monitors:
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