NURS 6550 WEEK 6 MIDTERM EXAM 2024-2025 FALL QTR QUESTIONS
AND ANSWERS. GRADED A+.
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.
- Answer “A” is the correct answer. A transudate is essentially just water and
& can occur as a consequence of increased hydrostatic pressure in
Rationale: the pulmonary vessels. It typically implies that the some condition
has produced an imbalance in colloid-hydrostatic pressures, such
as CHFor 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 hemorrhagiceffusion 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 whenthe patient reports the primary symptom as:
- Answer “A” is the correct answer. Dizzy is a layperson’s term and can mean
& many different things to patients and health care providers. When
Rationale: thepatient 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 atransfer to comfort care. The AGACNP advises that he:
- Answer “B” is the correct answer. If there is any concern about
& disagreementamong family members, or any concern at all that a
Rationale: 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. Livingwills are not legally enforceable documents and
when dissention arises among family members they may not be
carried out. “C” is notcorrect - 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 legalrights 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 directionis 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?
- Answer “D” is the correct answer. rTPA is not indicated in patients with ST
& segment depression; this is not a ST elevation MI. “A” is not correct
Rationale: 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
chronicobstructive 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?
- Answer “C” is the correct answer. The Transtheoretical model of change is
& characterized by 5 stages. “A” is when the patient has no intention
Rationale: tomake 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
thispatient 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
ahigh risk factor for long term care placement?
- Answer “A” is the correct answer; men are at higher risk for long-term
& careplacement than women. In addition to male gender, other risk
Rationale: factors include age over 80, living alone, bowel or bladder
incontinence, history of falls, dysfunctional coping, and
intellectualimpairment.
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
diagnosisof community acquired pneumonia. The AGACNP appreciates right middle
lobe consolidation on chest radiography. Pending sputum cultures, empiric antibiotic
therapymust be initiated to cover which organism?
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 isno indication that he has HIV/AIDS or any other condition
characterized by immunosuppression that would increase his risk
forthis 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
suchas instrumentation or known colonization.
Question 8
0 out of 1 points
Which of the following is the greatest risk factor for vascular
dementia?
- Answer “B” is the correct answer. Vascular dementia is a consequence of
& vascular disease, and is more likely to occur in patients with risk
Rationale: 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 forthis type of dementia.
Question 9
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
iswithout complaint. Which of the following findings constitutes hypertensive urgency?
- Answer “A” is the correct answer. According to the Joint National
& Committee (JNC) report, hypertensive urgency is described as
Rationale: hypertension in the setting of progressive target organ damage,
suchas 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
a1+ palpable pulse may be a normal finding--it must be taken in
the
