NURS 6550N FINAL EXAM (3 VERSIONS) & NURS 6550N MIDTERM EXAM (100 CORRECT Q & A IN EACH VERSION, TOTAL: 400 Q & A)
A 21-year-old woman requests hormonal emergency contraception after a condom break during intercourse approximately 16 hours ago. Today is day 14 of her normally 27–29 day menstrual cycle. You advise her that:
Likelihood of conception is minimal and emergency contraception use is not advised
Hormonal emergency contraception can be effective up to 5 days after intercourse
When taken as advised, hormonal emergency contraception use reduces the risk of pregnancy by up to 65%
The most likely mechanism of action of hormonal emergency contraceptive is as an abortifacient
A 36-year-old man is hospitalized for alcohol poisoning. During follow-up evaluation the next day, he denies that he has a drinking problem. The best approach to assess for possible alcoholism is conducting which of the following questionnaires?
A quality improvement plan characterized by limiting variability and removing defects in a process best describes:
Continuous Quality Improvement.
Total Quality Management.
A 38-year-old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take?
Acetaminophen and caffeine (Excedrin ® Migraine)
Naproxen sodium (Aleve ® )
Almotriptan (Axert ® )
Butalbital, acetaminophen and caffeine (Fioricet ® )
All of the following are elements of malpractice except:
A duty of care to the patient.
A fee is charged for the healthcare services related to the malpractice claim.
Breach of the standard of care.
You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a:
Consequence of occupational chemical exposure.
Early sign of dementia.
Normal age-related change in hearing
While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism?
30 mg/dL protein
All of the following are examples of primary prevention strategies except:
Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination.
Performing a hemoglobin A1C for all patients admitted to the hospital.
Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk.
Immunizing all adults ≥60 years with zoster vaccine.
A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics?
Usually obliterates S2.
Becomes softer when going from a supine to standing position.
Occurs late in systole.
Has localized area of auscultation
When evaluating the value of a test, the proportion of negative results that are truly negative best describes:
Positive predictive value.
Negative predictive value.
A 16-year-old male presents for evaluation after a syncopal episode at school. He reports that he has recently been experiencing bouts of lightheadedness. His blood pressure is 126/76 mm Hg and his BMI=33 kg/m 2 . You notice velvet-like plaques at the nape of the neck. Laboratory assessment should include which of the following tests?
The NP is called to treat a 43-year-old woman for multiple contusions following a domestic violence attack. The NP realizes that one of the best predictors of a subsequent homicide of victims of domestic violence is:
History of alcohol/drug abuse by perpetrator.
Access to kitchen knives by the perpetrator.
History of perpetrator attempting to strangle the victim.
Issuance of a restraining order by the victim.
A 48-year-old woman is being evaluated with chief complaints of fatigue, weakness, lethargy, and decreased concentration. She also mentions a notable increase in facial hair over the past 6 months as well as unexplained weight gain (about 25 lbs [11.3 kg]) over the past 2 months. Her past medical history is notable for moderate persistent asthma with multiple exacerbations over the past 8 months requiring treatment with prednisone. The most likely diagnosis is:
Type 2 diabetes mellitus.
You see a 73-year-old woman with a 40 pack-year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is:
In evaluating a 62-year-old male with ischemic heart disease and mitral incompetency, you expect to find the murmur that is:
Diastolic with radiation to the neck.
Diastolic with little radiation.
Systolic with radiation to the axillae.
21-year-old camp counselor presents for evaluation with a chief complaint of generalized itchiness. He has just returned after a week of summer camp. Physical examination reveals excoriated papules along his axillary folds and at the belt line. The NP suspects scabies and prescribes permethrin (Elimite ® ) lotion. In counseling the patient on the use of permethrin, the NP mentions that:
Its use is associated with neurotoxicity risk.
Itch often persists for a few weeks after successful treatment.
A marked reduction in lesions is noted within 48 hours.
The medication should be rinsed off within 2 hours of application.
You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is:
Administering the seasonal influenza vaccine.
Screening for physical or financial abuse/Checking her blood glucose level.
Checking her blood pressure.
Adjusting her insulin dosing regimen.
A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of:
Migraine with aura.
Transient ischemic attack.
A 20-year-old college student living in a campus dormitory has been diagnosed with meningococcal meningitis. The NP decides to speak with the university health officials and inform them that:
There is little to no risk of spread of the disease to other individuals.
Only intimate partners are at risk for infection.
Individuals with household-type or more intimate contact are at risk for infection.
All individuals on campus can be considered to be at risk for infection.
You see a 54-year-old man living in subsidized housing with a history of hypertension. He states that he stopped taking his blood pressure medication about 4 months ago because of costs. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of this patient, you would expect to detect an S 4 sound heard during:
32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He presents with the following laboratory results:
Hepatitis A Panel Hepatitis B Panel Hepatitis C Panel Anti-HAV Negative HBsAg Negative Anti-HCV Positive IgM Negative Anti-HBc Negative HCV RNA Negative IgM Negative Anti-HBs Positive You recognize the patient is susceptible to:
Hepatitis A and B
Hepatitis B and C
Hepatitis B only
Hepatitis A only
When evaluating illness symptoms in older patients, the disease will often present differently from younger adults due to:
The likelihood of polypharmacy.
Decreased compensatory mechanisms in the elderly.
An increased physiologic response to illness in the elderly.
Presence of comorbid conditions.
When prioritizing risk factors for bacterial endocarditis, the nurse practitioner knows who among the following patients has the highest risk.
A 55-year-old man with 3-vessel coronary artery bypass grafts with stents.
A 23-year-old woman with mitral valve prolapse without tissue redundancy.
A 65-year-old man with nonobstructive cardiomyopathy.
A 75-year-old woman with a nonorganic prosthetic aortic valve.
The legal authority for NPs to perform healthcare services as defined by state law is called:
Duty of care.
Scope of practice.
A patient who was seen for an upper respiratory tract infection has an abnormal blood test result and requires a follow-up visit. The patient repeatedly fails to show up for the follow-up visit. Which of the following is the best approach to inform the patient of the need and urgency for a repeat test?
A voicemail or text message.
A visit to her home.
An e-mail message marked as “urgent”.
A certified letter.
A 26-year-old male presents with a chief complaint of bilateral, intermittent itchy eyes accompanied by rope-like discharge. This is most consistent with conjunctivitis caused by:
Over-exposure to smoke.
When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection?
A 27-year-old nonpregnant woman with acute, uncomplicated urinary tract infection (UTI).
A 38-year-old nonpregnant woman with 2 acute, uncomplicated UTIs in the past 9 months.
A 57-year-old man with acute bacterial prostatitis.
A 43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis.
s. Wang is a 56-year-old female who was seen 2 weeks ago for evaluation of ongoing abdominal discomfort and nausea. Laboratory assessment revealed H. pylori and she was treated for peptic ulcer disease with an appropriate antibiotic/proton-pump inhibitor combination. She returns today and admits to no real change in her symptoms. This suggests that:
Treatment was inadequate and a salvage regimen should be used.
It is too soon to expect a response and the patient should be reevaluated in four weeks.
The patient could have complicated peptic ulcer disease and should be referred for endoscopy.
Peptic ulcer disease is likely not the correct diagnosis.
The NP is called to evaluate Jane, a 43-year-old woman, who presents with a diffuse maculopapular rash that began on the trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalized lymphadenopathy and a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis?
A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a “bag of worms” and is present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous relationship for the past 4months. The most likely diagnosis is:
An 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long-acting beta-agonist, and a short-acting beta-agonist on an as needed basis. The most important component of the initial assessment includes a(n):
Continuous pulse oximetry reading
Peak expiratory flow reading
Arterial Blood Gas
A 67-year-old man is being evaluated for shortness of breath. His medical history reveals that he experienced a myocardial infarction about 2 years ago and a history of hypertension, which is well controlled by diet.. Otherwise, his medical history is unremarkable. Which of the following would you expect to find on electrocardiogram (ECG)?
T wave inversion.
Pathologic Q wave.
ST segment elevation.
Tall R wave.
A 46-year-old man is rushed to the emergency department while experiencing an acute adrenal crisis that presents with abdominal pain, severe vomiting, and low blood pressure. He appears cyanotic and confused. The most appropriate treatment for this patient is an injection of:
A 74-year-old male with asymptomatic atrial fibrillation underwent electrical cardioversion that successfully restored the heart’s rhythm. Which of the following medications can be considered for the purpose of maintaining the heart’s rhythm?
Sotalol (Betapace ® )
Digoxin (Lanoxin ® )
Dabigatran (Pradaxa ® )
Enalapril (Vasotec ® )
In considering the use of an inhaled anticholinergic, such as tiotropium bromide (Spiriva ® ), for the treatment of chronic obstructive pulmonary disease (COPD), the NP recognizes which of the following is the desired therapeutic action?
Increases mucociliary clearance.
A 14-year-old male is brought in for evaluation after he reportedly collapsed during a tennis match, though he quickly regained consciousness. His medical history is otherwise unremarkable. You suspect hypertrophic cardiomyopathy. Which of the following heart murmur characteristics would support the diagnosis?
Occurs late in systole.
Widely split S₂.
Becomes louder when going from a supine to standing position.
Murmur follows mid-systolic click.
You see a 64-year-old man with an area of erythema concentrated on the left side of his neck with clusters of vesicles forming a line. He reported pain in the area a couple of days before the eruption of the lesions. He states that he recently initiated biologic therapy for rheumatoid arthritis. Which of the following is the most likely diagnosis?
Drug-related adverse reaction.
Gary is a 63-year-old African American male who has been treated for hypertension with ACE inhibitor monotherapy for the past 6 weeks. Despite Gary’s insistence that he is taking his medication as directed, his blood pressure continues to be elevated. Gary mentions that he prefers not having to take multiple medications each day due to cost and convenience. Which of the following is the most appropriate course of action?
Continue with the current regimen as the full effects are not observed until about 8 weeks of treatment.
Add an angiotensin receptor blocker (ARB) to the regimen.
Switch to a beta blocker.
Switch to a calcium channel blocker.
An NP’s duty of care can be established:
Only in the setting of a healthcare institution (e.g., hospital, clinic, etc.).
When the NP gives professional advice or treatment in any setting.
Only when a fee is charged, either to the patient or third-party payer, for services.
Only when both the NP and patient acknowledge a patient-provider relationship.
The NP is called to evaluate a 48-year-old man who was brought to the emergency department after experiencing severe low back pain following an attempt to lift heavy furniture. He also reports a coincident loss of bowel and bladder control. This most likely indicates:
Sciatic nerve entrapment
Cauda equina syndrome
A 49-year-old woman presents with a 3-day history of burning during urination, a thin and grayish-white vaginal discharge, and vagina itching. On laboratory examination, you expect to find all of the following except:
Abundant white blood cells
Alkaline vaginal pH
The NP is called to evaluate a 34-year-old nonpregnant woman who complains of a 4-week history of anxiety, palpitations, diarrhea, unexplained weight loss, and sensitivity to heat. Her medical history is unremarkable and she is not taking any medications. Physical examination reveals warm, moist skin and exaggerated deep tendon reflexes. The NP suspects Graves’ disease. Which of the following laboratory results would best support this diagnosis?
Free T₄ =6 pmol/L (NL=10–27 pmol/L).
Thyroid stimulating hormone (TSH)=0.05 mU/L (NL=0.15–4.0 mU/L).
ESR=37 mm/h (NL <15 mm/h).
Total WBC=4,200/mm³, 10% Neutrophils w/ hypersegmentation (NL=6,000–10,000/mm³ , 50%–70% Neutrophils).
Phyllis is a 34-year-old woman who presents for a chief complaint of a migraine resulting in nausea and vomiting. She reports that she experiences multiple migraines each month. She is given a prescription for sumatriptan (Imitrex ® ) 100-mg tablets orally to treat acute migraine pain. When counseling Phyllis about the medication, the nurse practitioner advises about all of the following adverse effects except:
In managing a 58-year-old woman who is admitted for deep vein thrombosis, caution should be used with which of the following medications due to a risk of drug-induced thrombocytopenia?
A 77-year-old woman with urinary incontinence is brought in by her caregiver for evaluation of a potential urinary tract infection. She is mentally alert and responds clearly to questions. The caregiver waits in the waiting area. While performing a routine comprehensive physical examination, you notice bruises on her right and left upper arms. The most appropriate approach would be to say:
“Did someone grab you here?”
“I’m concerned about your safety regarding these bruises on your arms.”
“I notice you have similar bruising on both arms.”
“Shall I ask your caregiver about these bruises?”
A 27-year-old woman with a known sulfa allergy presents with an uncomplicated UTI. She has not received any systemic antimicrobials in the past 6 months. She is currently not pregnant and is using norelgestromin/ethinyl estradiol patch (Ortho Evra ® ) for birth control. You recommend treatment with:
Trimethoprim-sulfamethoxazole (Bactrim ® ).
Amoxicillin (Amoxil ® ).
Nitrofurantoin (Macrobid ® ).
Cephalexin (Keflex ® ).
You are examining a 64-year-old woman with a history of rheumatic heart disease. In assessing the patient for mitral stenosis, you expect to find a heart murmur characterized as:
High-pitched blowing systolic murmur heard best a third left intercostal space.
Late systolic crescendo murmur with honking quality heard best at apex.
Localized low-pitch late diastolic heard best at apex.
Early diastolic murmur heard best at left sternal border with radiation to the neck.
21-year-old female student presents at the university clinic with a nosebleed. This is her third bleeding episode in the past week. She is otherwise healthy with no history of bleeding disorders. The NP advises that the appropriate first-line intervention for anterior epistaxis is:
Application of topical thrombin.
Firm pressure to the area superior to the nasal alar cartilage.
Utilization of a dehumidifier at home.
Tertiary prevention activities for a 69-year-old woman with congestive heart failure and type 2 diabetes mellitus include:
Adjusting therapy to minimize dyspnea.
Administering the pneumococcal vaccine.
Skin survey for pre-cancerous lesions.
Assessing her creatinine clearance.
You see a 77-year-old male for treatment of a laceration on his forearm. Upon examination, you notice poor skin turgor when assessed on the arms and back of the hands. This is likely a sign of:
Normal age-related change.
Early heart failure.
All of the following practices are recommended when prescribing medications with confusing or similar-sounding names except:
Writing the purpose of the medication on the prescription order.
Considering selecting medications without nomenclature problems.
Including either the generic or brand name on the prescription order, but not both.
Providing patients with written information about their drugs.
Which of the following describes the ethical principle of veracity?
Healthcare resources are allocated so that the best is done for the greatest number of people.
The responsibility of the healthcare provider is to treat all people in the same fair manner.
The healthcare provider must be truthful and avoid deception.
The healthcare provider has an obligation to be faithful to commitments made to self and others.
Which of the following examples describes a potential malpractice scenario?
A patient with known penicillin allergy is prescribed amoxicillin but no allergic reaction occurs.
A post-myocardial infarction patient is prescribed an inappropriate dose of clopidogrel and experiences a severe bleeding episode.
A patient with a urinary tract infection does not see any improvement in signs and symptoms 3 days after given a dose-appropriate prescription for trimethoprim-sulfamethoxazole.
A patient realizes prior to taking any of the medication that the wrong drug was dispensed at the pharmacy.
An 84-year-old female patient is admitted from a local long-term care facility (illnes). The patient is normally awake, alert, and oriented. She resides in the LTCF because she has not fully recovered from a broken hip resulting from a fall 4 months ago; otherwise she is in relatively good health. She can walk short distances with a walker, though she primarily stays in a wheelchair. Today, however, the nursing staff found her to be acutely confused and unable to ambulate without falling. She was transferred to the emergency department for evaluation. Initial laboratory testing must include:
2 sets of blood cultures.
Serum thyroid stimulating hormone (TSH) level.
A 67-year-old female has a long history of chronic venous insufficiency (CVI) and was seen by the nurse practitioner for brown discoloration on her calves. The nurse practitioner diagnoses hyperpigmentation due to CVI and presented the appropriate treatment plan. When evaluating the patient’s understanding, the nurse practitioner expects that she will say:
“I should stay out of the sun or use sunscreen when my legs must be exposed.”
“I need to elevate my legs as often as I can.”
“I will use hydrocortisone cream twice a day for the next two weeks and then come back for my appointment.”
“There is really nothing to help this discoloration.”
The NP is called to evaluate a 56-year-old man complaining of severe pain in the upper right abdomen that radiates to the right shoulder, nausea and vomiting, which started soon after dinner. The NP suspects acute cholecystitis. All of the following findings would be consistent with the diagnosis except:
Elevated aminotransaminase (AST)
Elevated alkaline phosphatase (ALP)
A 43-year-old woman presents in the emergency department with a chief complaint of swelling of the ankles, hands, and face. She also reports urine that is darkly colored and foamy. Her blood pressure is 184/118 mm Hg. All of the following urinalysis findings will support a diagnosis of glomerulonephritis except:
Elevated levels of ketones.
Presence of white blood cells.
Elevated levels of protein.
Presence of red blood cell casts.
While conducting an examination of a 15-year-old female accompanied by her mother regarding a potential sexually transmitted disease, the NP knows that the best approach to the visit would be to:
Ensure the mother is present at all times.
Ask the adolescent if she wishes the mother to be included in the interview and examination.
Interview the adolescent with the mother and then asking the mother to leave for the physical examination.
Interview and examine the adolescent in the absence of the mother.
A 23-year-old college student presents with a 2-day history of severe sore throat and difficulty eating or drinking due to trouble swallowing. A physical examination reveals exudative pharyngitis and minimally tender anterior and posterior cervical lymphadenopathy. The NP suspects infectious mononucleosis and would expect which of the following laboratory findings?
Neutrophilia with reactive forms.
Lymphocytosis with atypical lymphocytes.
Diminished ALT/AST levels.
A 45-year-old male is being prepared for release after receiving analgesic treatment for low back pain due to an acute lumbosacral strain. He is in otherwise good health and typically exercises on a daily basis. He asks when he will be able to start exercising again. The most appropriate response is:
You should not exercise until you are completely pain-free.
Conditioning exercises should be started immediately.
Leg numbness is to be expected with muscle-strengthening exercises.
Back-strengthening exercises may cause mild muscle soreness.
Mrs. Gonzalez is a 53-year-old female who is being evaluated for routine follow-up care. Her medical history includes dyslipidemia, hypertension, and rheumatoid arthritis. Laboratory analysis reveals elevated serum alanine transaminase (ALT) and aspartate transaminase (AST). The long-term use of which of the following medications is the most likely cause of this finding?
Calcium channel blocker
“Incident-to” services are defined as those which are “an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness”. As long as certain criteria are met, “incident to” billing is an option in all of the following settings except:
A 78-year-old male is being treated for a hypoglycemic episode. He has a long history of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently taking basal insulin with a sulfonylurea. What is the acceptable A1C goal for this patient?
A 47-year-old woman reports that her long-time boyfriend was recently diagnosed with liver cancer possibly caused by a chronic hepatitis B infection. Though she does not have any symptoms, she wants to be checked for hepatitis B. She can’t recall if she has ever been vaccinated for hepatitis B. The laboratory results are as follows:
Hepatitis B surface antigen (HBsAg): Positive Hepatitis B surface antibody (Anti-HBs): Negative Total hepatitis B core antibody (Anti-HBc): Positive IgM antibody to hepatitis B core antigen: Negative These findings are most consistent with:
Evidence of effective hepatitis B immunization.
Evidence of hepatitis B infection in the past.
Immunity against future hepatitis B infection.
Chronic hepatitis B.
You see a 74-year-old male who is accompanied by his granddaughter who lives with him. He has hypertension, a prior myocardial infarction, long-standing type 2 diabetes, and recently underwent a lower limb amputation secondary to diabetes. He is currently taking an ACE inhibitor, statin, low-dose aspirin, biguanide, and insulin. The granddaughter reports that since the amputation, her grandfather sometimes becomes withdrawn, irritable and moody for no apparent reason, does not want to participate in the typical activities he enjoys, and often does not appear to eat much during the day. She also states that he often complains of being tired but normally wakes up in the early morning hours. The most appropriate action is to evaluate the patient for:
A 15-year-old male is brought in to the emergency department by his parents following a 12-hour history of nausea, vomiting, and abdominal pain. Physical examination reveals obturator and psoas signs and a temperature of 102.6ºF (39.2ºC). Anticipated white blood cell (WBC) with differential results are as follows:
Total WBC=18,100/mm 3 , Neutrophils=50%, Bands=1%, Lymphocytes=40%
Total WBC=14,000/mm 3 , Neutrophils=55%, Bands=3%, Lymphocytes=38%
Total WBC=4,500/mm 3 , Neutrophils=35%, Bands=2%, Lymphocytes=45%–55% with reactive forms
Total WBC=16,500/mm 3 , Neutrophils=66%, Bands=8%, Lymphocytes=22%
A 42-year-old male presents with a sudden onset of inability to tightly close the eye lid, frown, or smile on the right side. His examination is otherwise unremarkable and past medical history is unremarkable. This likely represents paralysis of cranial nerve (CN):
Which of the following activities best demonstrates fulfillment of the nursing leadership role?
Screening a 36-year-old woman for hypertension.
Collaborating with a local health clinic on strategies to improve adult vaccination rates.
Volunteering to teach a group of high school students about the dangers of prescription drug abuse.
Collaborating with an infectious disease specialist on the care of a patient with community-acquired pneumonia.
In considering treatment for Jane in the previous question, which of the following would be most appropriate if she has a history of penicillin allergy?
Amoxicillin (Amoxil ® ).
Doxycycline (Doryx ® ).
Famciclovir (Famvir ® ).
Ciprofloxacin (Cipro ® ).
A 17-year-old high school wrestler presents with an 8 cm-diameter area of warm, red, edematous area on his left arm with sharply demarcated borders. The patient is otherwise healthy and without fever. Given a concern for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection, the most appropriate treatment option for this patient is:
High-dose amoxicillin (Amoxil ® ).
Amoxicillin-clavulanate (Augmentin ® ).
Trimethoprim-sulfamethoxazole (Bactrim ® ).
Daptomycin (Cubicin ® ).
You see a 58-year-old man who complains of a persistent dry, hacking cough. He reports that he recently started taking a medication to treat high blood pressure. He is most likely taking a(n):
Angiotensin-converting enzyme (ACE) inhibitor
Angiotensin receptor blocker
A 77-year-old woman is accompanied by her husband for evaluation. She is currently being treated with metoprolol (Lopressor ® ) for hypertension and digoxin (Lanoxin ® ) for atrial fibrillation. He reports that his wife is becoming increasingly forgetful over the past year, failing to note important family events such as birthdays, and sometimes becomes confused with driving directions to familiar locations. She has no previous psychiatric history. The most likely diagnosis is:
Early stage of congestive heart failure.
The NP is called to evaluate a 51-year-old man with acute bacterial rhinosinusitis. He currently smokes 1 PPD and has a 30 pack-year cigarette smoking history. His medical history shows that he is allergic to penicillin. Two weeks ago, he was treated with a macrolide for “bronchitis”. You now prescribe:
Clarithromycin (Biaxin ® ).
Levofloxacin (Levaquin ® ).
Cephalexin (Keflex ® ).
Amoxicillin-clavulanate (Augmentin ® ).
Which of the following is most consistent with the hepatic enzyme profile of a person with non-alcoholic fatty liver disease?
AST=1208 U/L, ALT=560 U/L.
AST=45 U/L, ALT=88 U/L.
AST=678 U/L, ALT=990 U/L.
AST=98 U/L, ALT=149 U/L.
A 32-year-old woman in her second trimester of pregnancy presents with fever, flank pain, and hematuria. The NP suspects pyelonephritis. Which of the following urinalysis results would be most indicative of pyelonephritis?
>100 red blood cells (RBCs) per high power field (HPF)
Protein ≥300 mg/dL
White blood cell (WBC) casts
Laboratory findings of a 28-year-old male suspected of heatstroke can include all of the following except:
Elevated total creatine kinase.
Mrs. Conner is a 76-year-old woman living in a long-term care facility and has been bedridden with a respiratory infection for the past 4 days. She is brought in for evaluation and you note signs of dehydration as well as a section of epidermal skin loss about 3 cm in diameter on her right hip. The dermal layer appears intact. This would be considered a pressure ulcer of Stage:
Which of the following represents the highest level of scientific evidence when evaluating clinical research?
A randomized controlled trial.
Systematic review/ Meta-analysis of randomized controlled troals.
A 24-year-old with a history of major depressive disorder is rushed to the emergency department by his friends after taking an overdose of antidepressant medication. The ingestion of which of the following medications poses the greatest risk of death for this patient?
A 4-day supply of diazepam (Valium ® )
A 3-week supply of Bupropion (Wellbutrin ® )
A 2-week supply of nortriptyline (Pamelor ® )
A 3-week supply of duloxetine (Cymbalta ® )
The NP is called to evaluate a 72-year-old woman with community-acquired pneumonia. Her vital signs include temperature 101.6ºF (38.7ºC), BP 106/68 mm Hg, and heart rate 78 bpm. Physical examination reveals increased tactile fremitus and dullness to percussion at the left lung base. These findings are consistent with:
A 64-year-old woman with chronic kidney disease presents with a chief complaint of lethargy. His hemogram is as follows: -Hemoglobin (Hg)=9.9 g/dL (12–14 g/dL -Hematocrit (Hct)=30% (36%–42%) -Mean cell volume (MCV)=81 fL (80–96 fL -Reticulocytes=0.7% (1%–2%) These findings are most consistent with:
Iron deficiency anemia.
Anemia of chronic disease.
Folate deficiency anemia.
The NP is called to evaluate a 57-year-old man who reports episodes of acute angina with physical exertion. He is currently taking an ACE inhibitor and low-dose aspirin. The NP considers which of the following approaches at the start of anginal symptoms?
An oral dose of a P2Y 12 inhibitor.
An extra dose of the ACE inhibitor.
A dose of nitroglycerin via sublingual spray.
Supplemental oxygen therapy for 10 minutes.
You see a 71-year-old man with atrial fibrillation and chronic obstructive pulmonary disease (COPD) who is diagnosed with community-acquired pneumonia. His medical history does not show any drug allergies and he completed a course of a respiratory fluoroquinolone for the treatment of acute bacterial sinusitis within the past month. Which of the following would you consider the most appropriate choice of antimicrobial?
Cefpodoxime (Vantin ® )
Amoxicillin (Amoxil ® ) with doxycycline (Doryx ® )
Azithromycin (Zithromax ® )
Moxifloxacin (Avelox ® )
A 27-year-old woman is being evaluated for a 7-day history of acute bacterial rhinosinusitis. She is otherwise healthy and has not received any antimicrobial therapy in the past 6 months. She also has no history of drug allergy. In considering a first-line antimicrobial treatment, all of the following would be appropriate except :
Amoxicillin (Amoxil ® ).
Cefuroxime (Ceftin ® ).
Azithromycin (Zithromax ® ).
Levofloxacin (Levaquin ® ).
When managing elderly patients with diminished cognitive function, which of the following statements is true regarding patient competence for making informed healthcare decisions?
First-degree relatives can declare a person incompetent.
Healthcare providers do not have the ability to determine whether a patient can provide informed consent.
A pattern of impaired judgment can be used to declare a patient incompetent.
Only a court can appoint a guardian to make decisions for a patient declared incompetent.
n 18-year-old female is being evaluated for wheezing that occurs on an intermittent basis. Symptoms occur about 3–4-times weekly, but not daily. Nighttime awakenings due to wheezing or coughing occur about once per week. Her FEV 1 is 85% predicted and Asthma Control Test (ACT) score is 22. The patient is diagnosed with mild persistent asthma and initiated on Step 2 treatment, which will include:
Short-acting beta 2 -agonist (SABA) on an as needed basis only.
Low-dose inhaled corticosteroid (ICS) only.
Medium-dose ICS plus LABA.
A 57-year-old female presents for a flu shot as she has heard reports that it will be “a bad flu season”. She has had no primary care for more than 10 years as she lacked health insurance. She admits to a 30 pack-year cigarette smoking history, currently smoking 1 pack-per-day (PPD). Her history and examination are unremarkable. Which screening test will you recommend?
Fasting serum triglycerides
A 46-year-old woman presents with a 12-hour history of fever, severe pain in the upper right abdomen, and positive Murphy’s sign. Her medical history is unremarkable and she is in otherwise good health. The most likely diagnosis is:
Acute viral hepatitis.
You see a 68-year-old woman who is being treated for moderate depression. She complains that her medication is causing symptoms of dry mouth and constipation. She is most likely taking which of the following medications?
Venlafaxine (Effexor ® )
Citalopram (Celexa ® )
Fluoxetine (Prozac ® )
Nortriptyline (Pamelor ® )
Bill is a 46-year-old man who is rushed to the emergency department after experiencing sudden onset of edema of the lips and face and a sensation of “throat tightness and difficulty breathing” following a wasp sting. His blood pressure is 78/52 mm Hg, heart rate 120 bpm, and respiratory rate 32/min. The first course of action in caring for Bill is to administer:
Diphenhydramine (Benadryl ® ).
Epinephrine (EpiPen ® ).
Nitroglycerin (Nitrolingual ® ).
Ranitidine (Zantac ® ).
You are evaluating a 44-year-old woman with community-acquired pneumonia. She has no comorbidities, no reported history of drug allergy, and has not received any antimicrobial therapy in the past 6 months. Which of the following is the most appropriate treatment choice?
Ceftriaxone (Rocephin ® ).
Azithromycin (Zithromax ® ).
Linezolid (Zyvox ® ).
Moxifloxacin (Avelox ® ).
Bettie is a 33-year-old mother of two children who presents for treatment of a lower urinary tract infection. This is her third episode in the past 6 months. She is prescribed appropriate antibiotic therapy and is taught strategies to decrease urinary tract infection. Which of the following is recommended for the prevention of recurrent UTI in at-risk patients?
Voiding before and after coitus.
Drinking two glasses of cranberry juice each day.
Use of lactobacillus probiotics.
Continuous low-dose antimicrobial prophylaxis.
A 26-year-old woman presents with uncomplicated UTI. She is otherwise healthy, has not received any systemic antimicrobials in the past year, does not have a sulfa allergy, and is not taking any medications. She is currently not pregnant and is using etonogestrel/ethinyl estradiol vaginal ring (NuvaRing ® ) for contraception. The local E. coli resistance rate to TMP/SMX is about 12%. The preferred therapy for this patient is:
Trimethoprim-sulfamethoxazole (Bactrim ® ).
Amoxicillin (Amoxil ® ).
Nitrofurantoin (Macrobid ® ).
Cephalexin (Keflex ® ).
A 78-year-old man is brought in by his neighbor who reports that she found him sitting in the front yard. She reports that he mumbled something about waiting for his wife, though she passed away more than 10 years ago. The neighbor says that the patient lives by himself and that this is the first time he has acted in this manner. The patient is calm but has trouble understanding simple directions and is unable to respond promptly to simple questions. Suspecting delirium, the most appropriate first course of action is to:
Administer an antipsychotic.
Refer for neurological consult.
Identify the underlying illness.
Order a head computed tomography (CT) scan with contrast.
A 19-year-old college freshman has been urged by her friends to be evaluated for lethargy, loss of appetite, and hypersomnia over the past 2 weeks. You administer the Beck Depression Inventory (BDI) assessment and she scores a 22. This would indicate:
The healthcare principle that promotes actions that lead to achieving the greatest good for the greatest number is known as:
A 43-year-old man who smokes 1 pack-per-day (PPD) and has an 18 pack-year smoking history presents with a chief complaint of increasing shortness of breath, chronic cough, and sputum production. In considering chronic obstructive pulmonary disease (COPD), which of the following would most support the diagnosis?
FEV₁ >70% predicted.
FEV₁ <85% predicted.
FEV₁ /FVC <1.0.
A 75-year-old man presents with chief complaints of headache, nausea, and muscle weakness. His creatinine level is 2.1 mg/dL (185.6 μmol/L) and GFR is 30 mL/min/1.73 m 2 . He currently takes a thiazide diuretic for the management of hypertension. Which of the following statements is false regarding the use of diuretics in the elderly?
Thiazide diuretics are less effective when creatinine level is ≥1.8 mg/dL (159.1 mol/L).
Thiazide diuretic use is an independent risk factor for the development of type 2 diabetes mellitus.
Loop diuretics are contraindicated when GFR is ≤40 mL/min/1.73 m².
Thiazide diuretic use leads to low volume sodium depletion resulting in peripheral vascular resistance (PVR) reduction.
All of the following persons are eligible for Medicare services except:
A 74-year-old ex-smoker with COPD and high income from assets.
A 69-year-old undocumented resident in the US with atrial fibrillation.
A 62-year-old with a permanent physical disability due to a motor vehicle accident.
A 72-year-old permanent legal resident (non-US citizen) with type 1 diabetes mellitus.
A 35-year-old woman presents with a chief complaint of being unable to close her right eyelid tightly, frown, or smile on the right side. She is otherwise healthy with no significant prior medical history. An appropriate diagnostic test for this patient would be:
Erythrocyte sedimentation rate (ESR).
Alanine transaminase/aspartate transaminase (ALT/AST) levels.
Lyme disease antibody titer.
Thyroid stimulating hormone (TSH) level.
A 23-year-old man is admitted after experiencing a seizure. A witness to the seizure described how the patient fell to the ground with rigid extension of the arms and legs that was then followed by a period of jerking movements and loss of consciousness. This best describes which type of seizure?
Tonic-clonic (grand mal).
A 54-year-old man is being evaluated for pain related to acute bacterial prostatitis. In considering the diagnosis and management, the NP realizes that:
Gram-positive organisms are the most common cause of infection.
Length of antibiotic therapy is usually 1 week.
Perineal pain with defecation is a common complaint.
Cephalosporins are first-line therapy.
A 25-year-old landscaper with a 6 cm abscess on the left upper arm presents one week post incision and drainage for a follow-up appointment. The area is much improved, but has some residual erythema and discomfort. The nurse practitioner correctly interprets that:
The healing process is proceeding normally and he should continue to monitor progress.
The presence of discomfort one week after incision and drainage suggests residual infection and antibiotics should be started.
The wound should be packed with iodoform gauze and irrigated with normal saline twice daily.
The patient should be referred for a surgical evaluation.
The Privacy Rule established by the U.S. Department of Health and Human Services in 1996 implemented the requirements for:
Electronic medical records at every healthcare institution.
Health Insurance Portability and Accountability Act (HIPAA).
Expanding Medicare to those <65 years of age who meet certain criteria.
Mandatory psychological screening for all Federal employees.
In the patient diagnosed with infectious mononucleosis, the use of amoxicillin should be avoided due to the risk of:
Toxic epidermal necrolysis.
When initiating therapy with spironolactone for a patient who is also on an ACE inhibitor, you advise the patient to return in 5 days to check which of the following laboratory parameters?
A 27-year-old male is rushed to the emergency department after experiencing a series of seizures. He has no history of neurologic disorder. His girlfriend states that he was taking multiple medications for mood disorder but recently stopped taking one of them. The most likely medication the patient discontinued is a:
Selective serotonin reuptake inhibitor (SSRI).
Serotonin-norepinephrine reuptake inhibitor (SNRI).
Second-generation tricyclic antidepressant.
When considering an end-of-life decision for a terminally ill person with Alzheimer-type dementia who can no longer communicate, all of the following can be used as an advanced directive except:
Testimony from a family member or close friend
A living will.
A “do not resuscitate” order.
A durable power of attorney for healthcare.
Which of the following types of clinical studies represents the lowest level of evidence used to guide medical decisions?
Clinical experience of renowned expert in field.
Non-randomized controlled study.
Which of the following electrocardiogram (ECG) changes do you expect to find in a person with myocardial ischemia?calcium
Pathologic Q wave
Tall R wave
T wave inversion
ST segment elevation
You see a 62-year-old woman experiencing a painful episode of acute gouty arthritis. All of the following are appropriate treatment choices to relieve her condition except:
Naproxen sodium (Aleve ® ).
Intraarticular corticosteroid injection.
Allopurinol (Aloprim ® ).
Colchicine (Colcrys ® ).
As part of the Deficit Reduction Act of 2005, Medicare will incorporate quality payment adjustments for certain hospital-acquired conditions, including all of the following except:
Catheter-associated urinary tract infection.
Deep vein thrombosis.
In which of the following situations is parental consent usually needed prior to treatment?
A 15-year-old requesting information about contraception.
A 17-year-old who wants help with anxiety.
A 16-year-old requesting treatment for acne vulgaris.
An 18-year-old who requires treatment for depression
A 17-year-old male with intermittent asthma presents for routine follow-up. He explains that he experiences asthma symptoms once or twice each week, usually during physical activity. Symptoms are promptly relieved each time with albuterol per MDI with spacer. He does not report any nighttime awakenings due to his asthma. His ACT score is 24 and vital signs are all within normal limits. According to the NAEPP EPR-3, what is the next step in the management of his asthma?
Continued use of SABA on an as needed basis.
Initiation of a long-acting beta-agonist.
Initiation of low-dose inhaled corticosteroids.
Restrict physical activity.
A 41-year-old woman is diagnosed with hypertension that requires medication. She is otherwise healthy but currently taking drospirenone/ethinyl estradiol (Yasmin ® ) for birth control. Which of the following antihypertensive medications would be least preferred for this patient?
Angiotensin-converting enzyme inhibitor
Calcium channel blocker
Angiotensin receptor blocker
A 71-year-old male presents to the emergency department. He is complaining of severe abdominal pain in the right lower quadrant. Diagnostic findings to support a ruptured appendix would include all of the following except:
Fever >102ºF (>38.9ºC).
Symptoms lasting more than 48 hours.
Absence of bowel sounds.
A 57-year-old woman presents with a 6-month history of numbness of the fingertips and oral irritation. Physical examination reveals pale conjunctiva and a heart murmur. She is otherwise healthy, exercises regularly, has a BMI of 22 kg/m 2 , and she states that she is a vegan. Hemogram results are as follows: -Hg=8.2 g/dL (12–16 g/dL) -Hct=23% (36%–42%) -MCV=135 fL (80–96 fL) -Red blood cell distribution width (RDW)=17% (11%–15%) These findings are most consistent with:
Vitamin B12 deficiency.
Anemia of chronic disease.
Which of the following statements is false regarding end-of-life decision-making for a patient that is hopelessly and terminally ill?
A durable power of attorney for healthcare can be used to authorize another person to make healthcare decisions.
A videotaped or audiotaped discussion with the patient can include advanced directives.
Advanced directives are legally binding and recognized in all 50 states.
Living wills and do not resuscitate orders are examples of advanced directives.
You see a 24-year-old woman of Asian ancestry who is being evaluated for a neurologic disorder. A thorough laboratory analysis is conducted and the hemogram results are as follows: -Hemoglobin (Hg)=10.4 g/dL -Hematocrit (Hct)=32% -Mean cell volume (MCV)=71 fL -Red blood cell distribution width (RDW)=13% -Red blood cells (RBC)=5.5 million The most likely condition associated with these hemogram results is:
Acute blood loss.
Beta thalassemia minor.
Iron deficiency anemia.
The nurse practitioner is evaluating a 19-year-old male suffering from a severe headache. He has a history of headaches that tend to occur in clusters over a few days. He has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headache?
Dietary reduction of amines.
A 68-year-old woman who resides in a long-term care facility is being treated for a urinary tract infection. Her medical history includes hypertension, peripheral artery disease, and a 35 pack-year smoking history. During the evaluation, she brings to your attention a painless, pearly nodule on the upper lip. This clinical presentation most likely represents a(n):
Squamous cell carcinoma
Basal cell carcinoma
A 23-year-old male patient is evaluated in the early morning hours for nausea with vomiting. He had eaten some food from the fridge the night before that “was probably too old.” The NP suspects acute gastroenteritis and would expect the course of the disease over the next 48–72 hours to involve:
Continued clinical evidence of dehydration, even with proper fluid uptake
Resolution of vomiting but onset of diarrhea
Continued episodes of vomiting but have improved appetite
Complete resolution of symptoms and be feeling well
A 47-year-old man is being evaluated for severe eye pain and sudden onset of reduced visual acuity. The NP suspects acute angle-closure glaucoma. Which of the following is most likely to be found on funduscopic examination to support this diagnosis?
Low intraocular pressure.
A deeply-cupped optic disc.
A 73-year-old man is being evaluated following an episode of dizziness leading to a fall that did not cause any injury. Cardiac and neurologic examination did not reveal the cause of dizziness. In preparation for discharge planning, the patient undergoes a formal balance assessment using which of the following tests?
McMurray test .
All of the following are required Medicare terms and conditions for paying NP services except:
The services are within the NP’s scope of practice as defined by state law.
The services performed are those for which a physician would be able to bill Medicare.
The services are performed in collaboration with a physician.
Separate charges are billed for NP services and facility charges.
A 21-year-old college student presents with new-onset pain and swelling in the feet and ankles as well as conjunctivitis, oral lesions, and dysuria. She reports that she has had multiple sexual partners and does not use any form of protection. The most important test result to obtain is:
A 17-year-old male is admitted after experiencing sudden, severe pain in the scrotum during the night. Physical examination reveals swelling of the scrotum and the loss of the cremasteric reflex. His heart rate is 110 bpm, blood pressure 150/80 mm Hg, and temperature 99.8ºF (37.7ºC). This most likely represents:
You see a 48-year-old man with a chief complaint of pain during urination. Imaging reveals the presence of a kidney stone in the ureter. You consider all of the following management options except:
Increased fluid uptake with water or citrus drinks.
Alpha blocker use.
Thiazide diuretic use.
According to the Consolidated Omnibus Reconciliation Act (COBRA), the spouse of an eligible employee will be eligible for COBRA coverage in all of the following circumstances except when the eligible employee:
Divorces the spouse.
Becomes eligible for Medicare.
Has his or her hours reduced.
Is terminated for misconduct.
You see a 14-year-old soccer player with an ankle sprain. Physical examination reveals complete ankle instability, significant swelling, and moderate to severe ecchymosis. You would grade this sprain as:
A 28-year-old male with asthma presents with a chief complaint that he has to use his rescue inhaler multiple times each day. An evaluation reveals that he has moderate-to-severe asthma and requires Step 4 treatment. An appropriate regimen would include:
Low-dose inhaled corticosteroid (ICS)
Medium-dose ICS plus a long-acting beta₂-agonist (LABA)
High-dose ICS plus LABA plus omalizumab (Xolair ® )
A 19-year-old is diagnosed with meningococcal meningitis. In order to prevent secondary infections among adults who had close contact with the patient, all of the following are recommended except:
Administer appropriate meningococcal vaccine if previously unvaccinated.
Prophylaxis with acyclovir (Zovirax ® ).
Prophylaxis with ciprofloxacin (Cipro ® ).
Prophylaxis with Ceftriaxone (Rocephin ® ).
You see a 26-year-old man with moderate persistent asthma who is experiencing a severe exacerbation. Which of the following would you most likely expect when evaluating this patient?
A 62-year-old woman presents in the emergency department complaining of severe toe pain that originated overnight. She has a history of renal disease and is currently taking a thiazide diuretic. Her BMI is 37 kg/m 2 . In considering a diagnosis of acute gouty arthritis, the nurse practitioner knows that the best diagnostic indicator is:
Serum uric acid.
Erythrocyte sedimentation rate (ESR).
Analysis of joint aspirate for urate crystals.
Which of the following is the most appropriate antibiotic for a 57-year-old man with acute bacterial rhinosinusitis and who has type 2 diabetes mellitus, COPD and a beta-lactam allergy?
Cephalexin (Keflex ® ).
Amoxicillin-clavulanate (Augmentin ® ).
Trimethoprim with or without sulfamethoxazole (Primsol ® , Bactrim ® ).
Levofloxacin (Levaquin ® )
While taking the history on a 61-year-old female patient, the nurse practitioner learns that she has a 15-year history of poorly-controlled hypertension. The patient admits that another provider had told her that the high blood pressure had affected her eyes. As a result, the nurse practitioner expects that funduscopic examination will likely reveal:
General vessel narrowing
Optic disc atrophy
A 28-year-old woman presents who complains of tugging chest pain unrelated to physical activity. She is generally in good health, a non-smoker, has a BMI of 23 kg/m², and denies dyspnea or dizziness. Physical examination reveals a grade 2/6 late systolic murmur that follows a midsystolic click at the 5th intercostal space, mid-clavicular line. An echocardiogram fails to reveal mitral valve tissue redundancy. This clinical presentation is most consistent with:
Silent myocardial infarction.
Mitral valve prolapse.
Atrial septal defect.
A physician employs an NP to provide services at a satellite acute care clinic. If the physician is never present at the clinic, which of the following statements is true?
“Incident to” billing is applicable for the services provided by the NP.
The NP services should be billed under the NP’s provider number.
Medicare will pay 100% of the physician rate for the NP services.
The physician must cosign any documentation of services in order to bill Medicare under the physician’s provider number.
Which of the following describes the ethical principle of beneficence?
The obligation of the healthcare provider to help people in need.
The duty of healthcare provider to do no harm.
The responsibility of the healthcare provider to treat all in the same fair manner.
The right of the competent person to choose a personal plan of life and action.
NURS 6550 Midterm Exam / NURS6550 Midterm Exam (Latest): Walden University
Walden University NURS 6550 Midterm Exam / Walden University NURS6550 Midterm Exam
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.
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?
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?
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:
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:
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?
7. Which of the following is the greatest risk factor for vascular dementia?
8. 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?
9. Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment for patients taking these medications should include a:
10. 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?
11. 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:
12. 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:
13. 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:
14. 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:
15. 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?
16. 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?
17. While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic disorders is:
18. L.T. is an 85-year-old male who is admitted for evaluation of profound diarrhea that has produced significant dehydration. He also complains of being very tired lately, and feeling like he is going to vomit all of the time. His vital signs are significant for a pulse of 41 b.p.m. and a blood pressure of 90/60 mm Hg. A gastrointestinal evaluation including stool for blood, white blood cells, and ova and parasites is negative. He insists that he has not started any new medications or made any diet changes; the only thing new is that he got new eye drops for his glaucoma. The AGACNP correctly assumes that his new eye drops are:
19. Janice is a 19-year-old female who presents to the emergency department via ambulance. She is pale, diaphoretic, agitated, and convinced she is having a stroke. Her vital signs include a temperature of 98.9° F, pulse of 114 beats per minute, respirations of 32 breaths per minute, and a blood pressure of 110/74 mm Hg. Diagnostic evaluation is negative and Janice is diagnosed with an acute panic attack. The initial treatment of choice is:
20. Lorraine is a 41-year-old female who presents for an asthma follow-up visit. She says she feels very well, has almost no daytime symptoms, and is using her inhaled corticosteroid medication daily as prescribed. Her PEFR is 85% of her personal best. The best approach to this patient is to:
21. Mr. Owen is a 37-year-old patient who has been admitted for surgical resection of a malignant tumor in his lung. His physical recovery has been uneventful and he is being prepared for discharge. While discussing his ongoing cancer therapy with Mr. Owen, the AGACNP determines that he has experienced persistent, excessive anxiety and worry almost every day for more than one year. What other aspect of Mr. Owen’s psychosocial history would be required to made a diagnosis of generalized anxiety disorder?
22. Kevin T. is a 49-year-old male who is being discharged after hospitalization for an acute inferior wall myocardial infarction. This is his first hospitalization and his first chronic medical diagnosis. Aside from his elevated cardiac isoenzymes and troponins, his laboratory profile was essentially within normal limits. The only apparent cardiac risk factor is an LDL cholesterol of 200 mg/dL. Initiating an HMG-CoA reductase inhibitor is an example of which level of prevention for Kevin?
23. You are evaluating a patient who has been admitted to the emergency room after being arrested for starting a fight in a local sports’ bar. The patient is now being cooperative, but reports that he has been in treatment for PTSD for months. He has been prescribed fluoxetine but has not noticed any improvement in symptoms, and now has been arrested for violence. The AGACNP knows that the next step in medication management is likely to include:
24. Mrs. Salter is an 81-year-old lady who presents for evaluation of near-syncopal episodes. Her 12-lead ECG, complete blood count, and comprehensive metabolic panel are all essentially normal. A urinalysis shows some trace protein but is otherwise normal. A 24-hour rhythm monitor demonstrates rare premature ventricular contractions. Mrs. Salter has been in good health and had her first episode at her aerobics class. She only gets lightheaded when she exerts herself. Her heart auscultates for a grade III/VI systolic crescendo-decrescendo murmur at the second intercostal space, right sternal border. The AGACP considers that the likely cause of the syncope is:
25. Who among the following patients is at greatest risk for a pulmonary embolus?
26. Mrs. Birdsong is an 85-year-old female who has been admitted for surgical repair of a hip fracture. She is in remarkably good spirits and is quite talkative. She readily answers all of the questions on her intake assessment, and readily acknowledges information provided during her room orientation. Later while talking with the patient’s son the AGACNP learns that the patient has had significant cognitive impairment for a few years. She has virtually no short term memory, but compensates by confabulating. Her son says she is generally very happy as long as there is no change in her day to day routine. This history is most consistent with which form of dementia?
27. Mrs. Radovich is an 80-year-old female with a variety of chronic medical conditions which are reasonably well controlled. She generally enjoys a good quality of life and is active with her family. Today her only concern is that she is having problems with her vision. She notices that while trying to look at pictures of her great grandchildren she can’t seem to focus on their faces. She also reports increased trouble reading—she cannot seem to see the words that she is looking at, and her reading glasses do not help. Further evaluation of Mrs. Radovich should include assessment with:
28. R.J. is a 55-year-old female who presents with acute onset left sided facial pain and an inability to move the left side of her face. She cannot smile, raise her eyebrow or even close her left eye, The immediate approach to this patient should include:
29. A 78-year-old male present for a physical examination. He has no discomfort or complaints other than a general decrease in vision, but it helps when he puts things under a bright light to read. He admits that while driving at night the streetlights appear to be a bit distorted and his night vision is pretty poor. Given the likely diagnosis, the AGACNP expects which of the following physical findings?
30. Jason is a 46-year-old male who is being managed for sepsis. He has HIV/AIDS and has had a prolonged hospitalization characterized by a variety of complications. He was extubated 3 days ago but continues gastric decompression with a nasogastric tube(NGT), total parenteral nutrition and antibiotic therapy via a central venous catheter, and urinary drainage via a Foley catheter. He continues to demonstrate consistent low grade fevers but all points of insertion of his tubes are normal to inspection, a chest radiograph demonstrates improvement of his pneumonia, and his urinalysis shows no bacteria, leukocytes, or nitrites. The AGACNP should next order:
31. The interpretation of a chest radiography should follow a systematic approach to ensure that all vital structures are evaluated and important clinical findings are not missed. The last thing to be assessed when looking at chest radiography should be the _____________:
32. The Short Confusion Assessment Method (Short-CAM) is a widely used four item tool that assesses delirium in the hospitalized patient. It includes observation of all of the following except:
33. Ms. Yang has been hospitalized for 5 days for the management of a gastrointestinal bleeding. She appears to have stabilized hemodynamically, but today she had a temperature of 101.9° F and chest radiography demonstrates a diagnosis of pneumonia. The AGACNP knows that the diagnostic evaluation for hospital acquired pneumonia for all patients must include:
34. Most psychosocial theories of aging center around the core concept that successful aging requires acceptance of a series of changes or losses that predictably occur later in the life span. The theory that specifically addresses coming to terms with the inevitability of death is known as:
35. All of the following conditions are risk factors for pulmonary embolus except:
36. A patient is diagnosed with acute descending aortic aneurysm and hypertension should be immediately started on which medication pending surgical evaluation?
37. Jason is a 27-year-old with a long history of intermittently controlled asthma. He is currently prescribed Advair daily with albuterol as needed for symptoms. Today he presents to the emergency department with cough and wheezing and difficulty catching his breath. His FEV1 is 51% at the time of presentation. He is given alternating albuterol and ipratropium nebulizer treatments along with oral prednisone. After one hour his FEV1 has increased 65%. The appropriate disposition for Jason at this point is:
38. A patient in the intensive care unit suddenly becomes tachypneic and dyspneic. The physical examination reveals pale, cool, clammy skin and an arterial blood gas demonstrates hypocapnea and hypoxia. Pulmonary artery pressure demonstrates a pattern consistent with obstructive shock. The AGACNP knows that which of the following causes of this presentation is most likely?
39. Mr. Bowers is an 81-year-old male who is being terminally extubated at the request of his family due to the presence of a large subdural hematoma with a shift; the patient is not initiating respirations on his own and the prognosis is very poor. After he is extubated he begins to initiate his own respirations and 24 hours later has not expired yet. The decision is made to leave him in the hospital on a general medical floor rather than transfer to another facility for hospice. Which of the following is the best indicator that the patient’s death is imminent?
40. A patient is newly admitted to your service for open reduction and internal fixation of the left hip. She seems very down, and as you talk with her you realize that her mood is not just related to her hip fracture. Which of the following symptoms would not be consistent with major depressive disorder?
41. “C” is the correct answer. Alzheimer’s dementia is statistically the most common form of dementia and is characterized by a long trajectory that progresses to include confabulation. Additionally, patients with this form of dementia are very reliant upon routine and may be distressed when it is disrupted. “A” is not correct; Lewy body dementia characteristically progresses much more quickly and produces an angry demeanor. “B” is incorrect because vascular dementia typically produces a more depressive affect and is not characterized by confabulation; additionally, patients with vascular dementia often have a medical history consistent with vascular risk factors. “D” is not correct as there is no apparent history of Parkinson’s disease.
42. What is the primary purpose of using eye ointments or lubricants to patients under general anesthesia, on paralytics, or in long-term comatose states?
43. When reading a 12-lead electrocardiogram, the AGACNP knows that all 12 leads are required to provide:
44. A 49-year-old male presents for evaluation of chest tightness. It has happened before, but he just ignored it and it went away. Today he just could not ignore it anymore. He has always enjoyed good health and says he has never been told that he has any chronic medical conditions like high blood pressure or diabetes. A 12-lead ECG demonstrates changes consistent with inferior wall ischemia. Both his symptoms and inferior wall changes improve with the administration of sublingual nitroglycerin. Consistent with ACS protocol, this patient’s assessment is consistent with:
45. Mr. Rosen is a 49-year-old male who is being managed for an acute myocardial infarction. He develops significant shortness of breath at rest and coarse rales 2/3 up bilaterally. The AGACNP suspects acute pulmonary edema due to papillary muscle rupture and acute mitral valve regurgitation. Which physical finding would support this finding?
46. A patient with minor head trauma presents for evaluation. Which of the following findings should be followed up with a CT scan to rule out orbital fracture?
47. Mrs. Forbes is a 69-year-old lady being discharged from the hospital after complications following a cosmetic surgical procedure. She is basically in good health. She has a history of hypothyroidism for which she takes levothyroxine daily, and mild osteoarthritis which is controlled with only prn nonsteroidal use. Her blood pressure is 148/90 mm Hg. The AGACNP knows that in accordance with the most current guidelines published in JNC 8 the appropriate action is to:
48. When assessing driver safety in the older adult, the AGACNP considers that:
49. The nursing staff calls to tell you that your 81-year-old male patient is having an acute change in mental status. He is a basically healthy man who was admitted three days ago for inpatient antibiotic management of community acquired pneumonia. His daughter is at the bedside and she is very distraught because she has never seen him like this. She is asking for medication to make him stop acting disoriented. Upon examination the patient is lying in bed, appears calm and happy, but does not recognize his daughter as anyone he knows. He is talking as if he is at home and has company. The AGACNP instructs the daughter that:
50. While discharging a patient following her myocardial infarction, you offer some patient education about medically supervised cardiac rehabilitation. The patient expresses fear of rehab because she was on her treadmill when she had her infarction and now she is afraid of making it happen again. She doesn’t understand how the rehab can force her to exercise her heart but not make her have another cardiac event. The AGACNP explains that the patient will be monitored and that her goal heart rate will be:
51. During physical examination of a 51-year-old African-American female you appreciate a decrease in her peripheral vision. The rest of her eye examination is within normal limits and she is symptom free. This presentation is consistent with:
52. Mr. Moffett is a 66-year-old male with a long history of lower extremity edema. All other causes of lower extremity edema have been ruled out and his overall symptom presentation and history are strongly supportive of chronic venous insufficiency. Today he presents with increased itching of both lower legs. Physical exam reveals 2-3+ pitting edema and trophic hyperpigmentation. The AGACNP know that treatment should include:
53. L.R. is an 84-year-old female patient being treated for pneumonia. Her condition is deteriorating despite aggressive broad spectrum antipseudomonal cephalosporin antibiotic therapy. Induced sputum culture reveals heavy growth of Legionella pneumophilia. The AGACNP knows that antibiotic therapy must be adjusted to include coverage with:
54. The AGACNP is treating a patient with a corneal abrasion. The patient has a clear recollection of the mechanism of injury—she was scratched in the eye earlier today with her 18-month-old daughter’s fingernail. Which of the following is contraindicated in the management of this patient’s abrasion?
55. M.T. is a 41-year-old male patient in the intensive care unit. He was admitted to the hospital in septic shock and has been aggressively managed with broad spectrum antibiotics. He has become progressively hypoxemic and the last arterial blood gas revealed a paO2 of 58 mm Hg. Chest radiography reveals a “white out” pattern bilaterally. The patient is intubated and ventilated. The AGACNP knows that appropriate management must include:
56. Teenagers and adults with acute otitis media can often be treated with “watchful waiting” given the high incidence of spontaneous resolution and low risk of poor outcomes. Which of the following is an absolute indication to begin antibiotic therapy at the time of diagnosis?
57. Mr. Bowers is on mechanical ventilation for respiratory support through an episode of septic pneumonia. Due the extensive lobar consolidation it was very difficult to keep Mr. Bowers oxygenated and he required very high FIO2s and PEEP. The AGACNP knows that the primary concern with FIO2s > 60% is:
58. Acute respiratory distress syndrome (ARDS) occurs when an overwhelming systemic insult results in which maladaptive physiologic response?
59. Acute respiratory distress syndrome is characterized by which abnormality of ventilation and perfusion?
60. George Schulz is a 69-year-old male who presents for evaluation of acute foot pain. It is so painful that he cannot walk on it without assistance. At first he denies any significant medical history, but then reveals that he has been diagnosed with dyslipidemia and hypertension but stopped taking his medications because he couldn’t afford it. Pulses are not palpable but are audible by Doppler. The extremity is pale and shiny with decreased hair growth, suspecting peripheral arterial disease, the AGACNP expects which additional finding?
61. G.T. is a 40-year-old male who is under your case for long term management of secondary osteoarthritis. Today he asks if he can take a medication for anxiety. Further assessment reveals that he is in a relationship that has been very stressful; his girlfriend wants very much to get married and start a family, and he does not. He admits that he no longer feels they are compatible and acknowledges that he needs to end this relationship. He is sure that this is the source of his anxiety. The best approach would be to:
62. During the physical examination of a 31-year-old female, the AGACNP appreciates a bifurcate uvula. The most appropriate action would be to:
63. During routine immigration screening a 29-year-old male patient from Mexico has a positive purified protein derivative (PPD) test at 17 mm induration. He reports no known history of tuberculosis (TB) infection or exposure, or vaccination with the BCG vaccine. Chest x-ray is negative for any evidence of TB exposure. The AGACNP knows that the appropriate next step is to:
64. Clinical diagnostic criteria for acute respiratory distress syndrome (ARDS) include all of the following except:
65. While managing a patient in acute pulmonary edema, the AGACNP monitors the pulmonary capillary wedge pressure. When this pressure falls below 12 mm Hg it suggests that:
66. All of the following are important elements of the immediate management of penetrating eye injury except:
67. While evaluating a patient with diastolic failure due to a long history of uncontrolled hemochromatosis, the AGACNP appreciates an extra heart sound just before the S1 heart sound. This sound is most likely a(n):
68. Secondary hypertension occurs in approximately 10% of all patients with hypertension, and requires management of the underlying problem in order to eliminate the cause. Which of the following is not a secondary cause of hypertension?
69. L.M, is a 26-year-old male who presents to the emergency department complaining of acute onset vertigo this morning. He describes a strong sense of the room spinning and can barely walk without feeling nauseous. The vertigo is reproducible when his neck is rotated suddenly left or right. The AGACNP knows that which of the following is not indicated?
70. A 36-year-old female presents complaining of left leg swelling. She describes the onset as acute over the last day or two, and says it feels “tight and throbbing.” She denies any significant medical history and says the only medication she takes is oral contraception, which she has taken since she was 15 years old. The AGACNP first orders:
71. The primary neurotransmitter implicated in post-traumatic stress disorder (PTSD) is:
72. Mr. Avila is an 82-year-old male being counseled about the risks and benefits of his upcoming abdominal surgery. While considering risk factors for atelectasis, pneumonia and other pulmonary complications, the AGACNP advises that the greatest risk comes from:
73. The female AGACNP is practicing with a cardiology group and sees patients one day a week in the outpatient office. A 49-year-old female presents for follow-up after her admission for infective endocarditis. She is recovering well, and says that she is going to be more proactive about her health. She admits to not having had any of her regular health screenings for years, and asks if she can have her Pap performed at this office. The AGACNP:
74. The AGACNP is seeing a patient who was transferred from the correctional facility for evaluation. He has a profound purulent discharge from his right eye. The conjunctive is erythematous and there is mild photosensitivity. The inmate denies any real eye pain, just says that it is extremely uncomfortable. Treatment for this patient is likely to include:
75. Ms. Ewing is a 78-year-old female who lives in a long term care facility because her dementia has progressed to the point at which her family cannot provide the necessary safety measures at home. In addition to her absent short term memory she has developed some affective changes and most recently is demonstrating sexual disinhibition. While considering management options, the AGACNP knows that all of the following are medications are options for the management of disinhibition except:
76. A patient recently had a nasal packing inserted for management of refractory epistaxis. One week later he presents with fatigue, a headache “inside of his nose” and a feeling generally unwell. The AGACNP considers:
77. A 55-year-old female patient presents with a fever of 103.4° F. She was treated approximately 10 days ago at urgent care for a sinus infection, but two days ago the right side of her fact started to hurt, and today she has significant swelling of the right orbit and eyelid. The eyelid is very edematous and there is purulent drainage noted. The priority of care for this patient begins with:
78. Which of the following is the best indicator that pulmonary rehabilitation has been successful in a patient with chronic obstructive pulmonary disease?
79. Mrs. Marriott is being discharged to home after being managed for an exacerbation of congestive heart failure. She is currently feeling well but her ejection fraction after optimal diuresis and fluid management is 29%. The AGACNP knows that her discharge medications must include:
80. Which of the following is an accurate statement with respect to the assessment of delirium in the geriatric patient?
81. Mrs. Warner is a 57-year-old female who presents with unplanned weight loss. Chest radiography reveals diffuse hyperlucency of the left lung and in the lower half of the right lung. The AGACNP knows that the differential diagnosis for hyperlucency include all of the following except:
82. When evaluating a patient with epistaxis, which of the following signs or symptoms is suggestive of a more serious etiology and posterior packing?
83. R.M. is a 15-year-old male who presents to the emergency department with his mother. Mom says he has been complaining that his throat hurts so badly he cannot even swallow saliva. According to Mom R.M. is not the type to complain, but he is in so much pain with his throat he is almost crying. He has no significant medical history and takes no daily medications. He has no allergies of which his mother is aware. Upon physical examination he is febrile with a temperature of 102.4° F and he is a bit tachycardic, but other vital signs or normal. Inspection of the throat is basically unremarkable—the AGACNP does not appreciate any abscesses, edema, or exudate; there may be some slight erythema. The AGACNP becomes suspicious that the patient:
84. Mr. Stossel is a 66-year-old male patient who was admitted for management of acute anterior wall myocardial infarction. Over a period of hours he has developed acute shortness of breath, coarse rales to auscultation, and Kerley B lines on chest radiography. Arterial blood gas reveals a pH of 7.34, pCO2 of 30 mm Hg, and paO2 of 59 mm Hg. The AGACNP anticipates which of the following findings on physical examination?
85. According to the revised criteria in DSM-V, the primary difference between panic attacks and panic disorder is that:
86. Mr. Wilson is a 71-year-old male who has been treated with prn short acting anticholinergics for his COPD. Last week he developed an exacerbation that required a 4 day hospitalization for support and stabilization. He was discharged on a five day course of prednisone and now presents for follow-up. The AGACNP knows that his outpatient medication regimen should be adjusted to include:
What is the primary difference in patient management between high risk non-ST elevation myocardial infarction (MI) and the low risk non-ST elevation MI patient?
J.T. is a 26-year-old female patient being evaluated for eye discharge. She says that for the last few days she has developed this sticky, string-like discharge in both eyes. She denies any pain or visual changes, but does admit to a sense of “something in my eyes” and that her eyes itch a lot. Physical examination reveals injected conjunctiva, rope-like discharge bilaterally; pupil response is equal and brisk in both eyes. Which factor in the patient’s history would be supportive of the most likely diagnosis?
The pathophysiology of endogenous depression is best described as
The diagnostic study most supportive of a diagnosis of pericarditis is:
A 31-year-old male presents to urgent care because he has something in his eye. He was changing the oil under his car and says that something dropped into his eye. He is not having any pain, in fact he waited a day before coming in because he thought it would work itself out. Physical exam reveals a black 1 mm foreign body visible on the corneal surface. The most appropriate intervention is to:
A patient with pericarditis is most appropriately treated with:
Which of the following is not a risk factor for thoracic aneurysm?
The “MONA” acronym provides guidance for immediate interventions in the patient with:
Mr. Sloane is a 36-year-old male patient who presents for treatment of eye pain. He has no significant medical history and does not take any daily or over-the-counter medications. His only recent history is nighttime allergies for which he takes occasional diphenhydramine with good relief. He has had some throbbing in his eye for the last few days on and off but just ignored it; today he says it is flat out painful and he had to come to the emergency department. The eye is throbbing and painful, and he reports generalized decreased vision. The pupil is dilated to 5 mm and non-reactive to light. The eye conjunctiva is reddened. The next step in the diagnostic evaluation should be:
The AGACNP counsels a patient with recurrent epistaxis that the most common cause of nose bleeding is
The geriatric depression scale (GDS) is a commonly used tool to diagnose depression in the elderly population. It comes in a variety of forms for maximal utility. When administering the geriatric depression scale to patients, the AGACNP recognizes that it is extremely important to:
Ventilator-acquired pneumonia (VAP) is a significant problem impacting morbidity, mortality and the cost of inpatient health care. Data-supported mechanisms to reduce the risk for VAP include all of the following except:
Absolute contraindications to thrombolytic therapy in the patient having an acute myocardial infarction include all of the following except:
Which of the following is not a true statement with respect to risk for or occurrence of elder abuse?
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