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, NURS 6550 Midterm Exam
Question 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.
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
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
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 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
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
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
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?
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