Exam (elaborations)

NURS 6550 Midterm Exam

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Course
NURS 6550 (NURS6550)

Institution
Walden University

1. Question: 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 lea...

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NURS 6550 Midterm Exam – Question and Answers with Rationals – Walden University

1. Question: 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.

Answer: A, a trasdutate is essential as it shows

2. Question: 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?

Ans: D is the answer- CT( not radiography or MRI or us)

3. Question: 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 ….a high risk
factor for long term care placement?

ANS: A- men ( others are > 80, live alone, bowel and bladder incontinence, hx of fall,
dysfunctional coping and intellectual impairment).

4. Question: A patient with anterior epistaxis has been ….with 20 minutes of direct
pressure to the cartilaginous portion of the nose. Following pressure the patient is ….to
gently blow the nose. Expected findings in the patient who has been successfully
….include all of the following except a:

Ans: C, bld and clot formation occurs if bleeding stop within 20 min of directed pressure
and can be removed by gentle suction and gentle blowing of nose.

5. Question: 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:

Ans: D, streptococcus pneumonaie commonly bacteria present in head and neck
infection of immunocompetent patients, and primarily treatment target for otitis media,
bacterial sinusitis, and bacterial pharyngitis.

6. Question: 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?

Ans: D- streptococcus pneumonaie from out patient population and targeted treatment
empirically.

7. Question: Which of the following is the greatest risk factor for vascular dementia?

Ans- B, vascular disease in target organ damage in DM, hyperlipidemia and HTN

,8. Question: J.R. is a 55-year-old male who presents for a commercial driver’s license Mr. Nixon is
physical examination with a blood pressure of 170/102 mm Hg. He has no medical being treated
history and is without complaint. Which of the following findings constitutes hypertensive with
urgency?
unfractionate
Response Feedback: “A” is the correct answer. According to the Joint National
d heparin
Committee (JNC) report, hypertensive urgency is described as hypertension in the infusion for
setting of progressive target organ damage, such as renal involvement with protein acute
leaking, left ventricular hypertrophy, or retinal changes. “A” is not correct—the headache pulmonary
may or may not be relevant, but because there are many non- hypertension causes, a embolus. In
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
order to avoid
as a 1+ palpable pulse may be a normal finding--it must be taken in the context of the a potentially
rest of the examination. fatal
complication
9. Question: Because of the commonly recognized adverse effects of atypical of heparin
antipsychotics, annual laboratory assessment for patients taking these medications infusion, the
should include a: AGACNP
monitors:
Response Feedback: “C” is the correct answer. The atypical antipsychotics such as
olanzapine (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.

10. Question: 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 Feedback: “B” is the correct answer. The patient’s history is consistent with
a metal 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.

11. Question: 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 13

, 1 out of 1 points

Response “D” is the correct answer. An uncommon but potentially serious
Feedback: 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 14
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 “B” is the correct answer. Patients with psychotic disorders are
Feedback: 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.

Question 15
0 out of 1 points
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:

Response “B” is the correct answer. The accelerated GI motility and
Feedback: bradycardia are cholinergic adverse effects. Ophthalmic medications
are readily absorbed into systemic circulation. All of these
medications are used to treat glaucoma and may cause class-related
adverse effects, but cholinergic drops are the only ones shown that
will slow heart rate and accelerate GI motility.

Question 16
1 out of 1 points
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:

Response “A” is the correct answer. A panic anxiety attack requires immediate
Feedback: intervention with a short acting benzodiazepine for immediate
symptom control. A calm environment would be helpful, but is not
adequate alone to manage acute episodes characterized by physical
symptoms. Oxygen is not indicated in the absence of organic

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