NR 571 Midterm Exam | Complex
Diagnosis & Management in Acute
Care Exam | Correctly Answered and
Graded A+ | 2024/2025 Guide |
Chamberlain
Which of the following is required to confirm a diagnosis of COPD in
most adults?
a. pre-bronchodilator FEV1/FVC < 0.70
b. post-bronchodilator FEV1/FVC > 0.70
c. post-bronchodilator FEV1/FVC < 0.70
d. pre-bronchodilator FEV1/FVC > 0.70
- Correct Answer - c. post-bronchodilator FEV1/FVC < 0.70
A 70-year-old patient with a history of COPD presents to the emergency
room for cough and increasing exertional dyspnea with newly reported
symptoms at rest. Sputum production is clear to white, but an increase in
the amount is reported. The patient's last hospitalization for COPD was 4
years ago. She is currently taking a LABA as monotherapy but is using
her rescue inhaler 3-4 times per day since her symptoms started. She is
alert and oriented, breath sounds are scattered with inspiratory and
expiratory wheezing throughout all lung fields, and there are no signs of
respiratory distress. Vital signs are T 98.0 F, BP 120/80, HR 85, RR 20,
SaO2 90 % on room air. EKG and labs including CBC, CMP, BNP,
troponin are normal. Chest x-ray reveals hyperinflation and flattened
,diaphragm without infiltrates or cardiomegaly. ABG is normal except for a
mildly decreased pO2. Which of the following is the most appropriate
treatment
- Correct Answer - b. administer supplemental oxygen, albuterol
nebulizers, and oral corticosteroids
Which of the following tests provide the best evaluation of acuteness
and severity of a COPD exacerbation?
a. alpha 1-antitrypsin measurement
b. serum chemistry
c. sputum culture
d. arterial blood gas (ABG) analysis
- Correct Answer - d. arterial blood gas (ABG) analysis
A 32-year-old male with no known past medical history presents to the
clinic to establish care. He is an endurance athlete and regularly
participates in triathlons. He reports that he has noticed shortness of
breath when he walks more than a few blocks. He denies any associated
chest pain. He denies alcohol, tobacco, or illicit drug use. He is adopted
and does not know his family medical history. He does not take any
medications other than multivitamins occasionally. The vital signs in your
office are within normal limits. He has a normal JVD, clear lungs, and a
harsh crescendo-decrescendo systolic murmur that begins slightly after
S1. His ECG suggests left ventricular hypertrophy. Which of the following
is the next step in his clinical management?
a. Start furosemide for diuresis
b. Start aspirin and Plavix
c. No further workup is warranted
,d. Order an echocardiogram - Correct Answer - d. Order an
echocardiogram
A 56-year-old patient is admitted for a new diagnosis of systolic heart
failure due to dilated cardiomyopathy. The patient has a longstanding
history of heavy alcohol consumption. Which of the following should be
included in his discharge discussion?
a. Sexual activity is contraindicated
b. Restricted dietary sodium will reverse his heart dysfunction
c. Cessation of alcohol may improve his heart function
d. Aerobic exercise can be deadly and must be avoided - Correct Answer
- c. Cessation of alcohol may improve his heart function
Which of the following cardiomyopathies is likely to be associated with a
sustained PMI, a systolic murmur, and enlargement of the
intraventricular septum?
a. Dilated
b. Restricted
c. Ischemic
d Hypertrophic - Correct Answer - d Hypertrophic
A 16-year-old patient with a history of mild, intermittent asthma is seen in
the emergency room complaining of shortness of breath. She normally
only needs her albuterol inhaler before exercise, but she is using it now
2-3 times per day for 3 days. Upon examination, the AGACNP notes the
patient's appearance as calm but tachypneic. HR is 108, O2 saturation
on room air is 91 %. A bedside peak expiratory flow measurement
reveals FEV1 at 58 % of her personal best. The AGACNP should
classify this patient's asthma as which of the following?
, a. life-threatening
b. severe
c. mild/moderate
d. the severity cannot be determined with the information given
- Correct Answer - c. mild/moderate
A 67-year-old patient with a history of bladder cancer presents to the
emergency department with acute dyspnea. Vital signs are T 37.9°C, HR
110, RR 24, BP 89/40, and SaO2 90 %. On physical exam, he is alert
and oriented but appears anxious and has an increased work of
breathing. Lung sounds and heart sounds are normal. There are no
other abnormal physical exam findings except a swollen and tender left
lower extremity. EKG and chest x-ray are normal. Labs and ABG results
are still pending. The AGACNP strongly suspects acute pulmonary
embolism. Which of the following is the next step in treating this patient?
a. Order bilateral lower extremity venous doppler ultrasound
b. Initiate rapid sequence intubation (RSI) and mechanical ventilation
c. Order a non-contrast chest CT
d. Provide oxygen, IV fluids, and consider IV vasopressors
- Correct Answer - d. Provide oxygen, IV fluids, and consider IV
vasopressors
A 72-year-old patient with a history of CAD presents to the ER with
unstable angina. TIMI score is 5. The nurse practitioner should expect
which of the following is the next step in the care for this patient?
A. coronary angiography
B. CABG
C. notify family that death is imminent
D. tPA - Correct Answer - A. coronary angiography
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