Exam (elaborations)
NURS 6550 Advanced Practice Care Of Adults In Acute Care Settings I
NURS 6550 Advanced Practice Care Of Adults In Acute Care Settings I
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Question 11 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.
Respons “A” is the correct answer. A transudate is essentially
e just water and can occur as a consequence of
Feedback 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
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 “A” is the correct answer. Dizzy is a layperson’s term
Feedback 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 3
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 “B” is the correct answer. If there is any concern about
Feedback 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 4
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 “D” is the correct answer. rTPA is not indicated in
Feedback 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 5
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 “C” is the correct answer. The Transtheoretical model of
Feedback 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 6
1 out of 1 points
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?
Response “A” is the correct answer; men are at higher risk for
Feedback long-term care 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 7
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?
Respons “D” is the correct answer. This patient presents from
e the outpatient population where the most common
Feedback 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
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