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NURS 6550 Midterm Exam 1.
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NURS 6550 Midterm Exam 1.
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1Course NURS-6550N-2/NURS-6550F-2-Adv Prac Care in Acute
Test Week 6 - Exam
Status Completed
Time Elapsed 2 hours, 29 minutes out of 2 hours and 30 minutes
Results Displayed Feedback
• 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.
Response “A” is the correct answer. A transudate is essentially just water and can occur as a
Feedback: 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
1 out of 1 points
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 rapidly and
Feedback: 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
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 long-term care placement than women.
Feedback: 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
1 out of 1 points
, 2
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 minutes of directed
Feedback: 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
0 out of 1 points
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 bacteria that
Feedback: 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
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?
Response “D” is the correct answer. This patient presents from the outpatient population where the
Feedback: 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 is no indication that he
has HIV/AIDS or any other condition characterized by immunosuppression that would
increase his risk for this 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 such as instrumentation or known colonization.
• Question 7
1 out of 1 points
Which of the following is the greatest risk factor for vascular dementia?
, 3
Response “B” is the correct answer. Vascular dementia is a consequence of vascular disease, and is
Feedback: more likely to occur in patients with risk 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 for this type of
dementia.
• Question 8
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 is without complaint. Which of the following
findings constitutes hypertensive urgency?
Response “A” is the correct answer. According to the Joint National Committee (JNC) report,
Feedback: hypertensive urgency is described as hypertension in the setting of progressive target organ
damage, such as 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 a 1+ palpable pulse may be a normal finding--it must be
taken in the context of the rest of the examination.
• Question 9
0 out of 1 points
Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment
for patients taking these medications should include a:
Response “C” is the correct answer. The atypical antipsychotics such as olanzapine (Zyprexa),
Feedback: 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.
• Question 10
1 out of 1 points
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?
, 4
Response “B” is the correct answer. The patient’s history is consistent with a metal injury and so an
Feedback: 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.
• Question 11
0 out of 1 points
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 “B” is the correct answer. The D-dimer is a highly sensitive serology and is the least
Feedback: 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 12
0 out of 1 points
Mr. Nixon is being treated with unfractionated heparin infusion for acute pulmonary embolus. In order to
avoid a potentially fatal complication of heparin infusion, the AGACNP monitors:
Response “D” is the correct answer. An uncommon but potentially serious consequence of heparin
Feedback: 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 13
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 and can mean many different
Feedback: 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
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