NURS 6560 MIDTERM EXAM LATEST
UPDATE NEW!!!!! 2 Exam (elaborations)
WALDEN UNIVERSITY NRNP 6560 FINAL
EXAM (GRADED A) LATEST 3 Exam
(elaborations) NRNP 6560 FINAL EXAM
LATEST VERSION 1 EXAM 10.
**Question 1**
S. is a 59-year-old female who has been followed for several years for
aortic regurgitation. Serial echocardiography has demonstrated normal
ventricular function, but the patient was lost to follow-up for the last 16
months and now presents complaining of activity intolerance and
weight gain. Physical examination reveals a grade IV/VI diastolic aortic
murmur and 2+ lower extremity edema to the midcalf. The AGACNP
considers which of the following as the most appropriate management
strategy?
A. Serial echocardiography every 6 months
B. Begin a calcium channel antagonist
C. Begin an angiotensin converting enzyme (ACE) inhibitor
D. Surgical consultation and intervention
,**Answer: C. Begin an angiotensin converting enzyme (ACE) inhibitor**
*Rationale: The patient is exhibiting signs of worsening aortic
regurgitation with activity intolerance and edema. ACE inhibitors lower
blood pressure, which reduces the workload on the left ventricle and
helps manage the underlying conditions that worsen heart murmurs.
Surgery is indicated only when valves are severely damaged or leaking,
not as initial management in this presentation .*
---
**Question 2**
An ascending thoracic aneurysm of > 5.5 cm is universally considered
an indication for surgical repair, given the poor outcomes with sudden
rupture. Regardless of the aneurysm's size, all of the following are
additional indications for immediate operation except:
A. Comorbid Marfan's syndrome
B. Enlargement of > 1 cm since diagnosis
C. Crushing chest pain
D. History of giant cell arteritis
**Answer: D. History of giant cell arteritis**
,*Rationale: Indications for immediate surgical repair of thoracic aortic
aneurysms include size >5.5 cm, connective tissue disorders like
Marfan's syndrome, rapid enlargement (>1 cm per year), and symptoms
such as crushing chest pain suggesting impending rupture. Giant cell
arteritis is a vasculitis affecting medium and large arteries but is not an
independent indication for immediate surgical repair of an aneurysm .*
---
**Question 3**
A patient with suspected Cushing's syndrome is being evaluated to
establish the diagnosis and cause. Patients with an adrenal tumor
typically will demonstrate:
A. Low ACTH and low cortisol
B. Low ACTH and high cortisol
C. High ACTH and low cortisol
D. High ACTH and high cortisol
**Answer: B. Low ACTH and high cortisol**
*Rationale: Adrenal tumors autonomously produce cortisol, which
through negative feedback suppresses ACTH production from the
pituitary. This results in low ACTH levels with elevated cortisol,
, distinguishing it from pituitary causes (Cushing's disease) where both
ACTH and cortisol are elevated .*
---
**Question 4**
The AGACNP is reviewing a chart of a head-injured patient. Which of
the following would alert the AGACNP to the possibility that the patient
is overhydrated, thereby increasing the risk for increased intracranial
pressure?
A. BUN = 10
B. Shift output = 800 ml, shift input = 825 ml, unchanged weight
C. Serum osmolality = 260
D. Serum sodium = 145
**Answer: C. Serum osmolality = 260**
*Rationale: Normal serum osmolality ranges from 275-295 mOsm/kg. A
value of 260 indicates overhydration (dilutional hyponatremia), which
can lead to cerebral edema and increased intracranial pressure in head-
injured patients. BUN of 10 is within normal range, balanced
input/output suggests euvolemia, and sodium of 145 is normal to
slightly elevated .*
UPDATE NEW!!!!! 2 Exam (elaborations)
WALDEN UNIVERSITY NRNP 6560 FINAL
EXAM (GRADED A) LATEST 3 Exam
(elaborations) NRNP 6560 FINAL EXAM
LATEST VERSION 1 EXAM 10.
**Question 1**
S. is a 59-year-old female who has been followed for several years for
aortic regurgitation. Serial echocardiography has demonstrated normal
ventricular function, but the patient was lost to follow-up for the last 16
months and now presents complaining of activity intolerance and
weight gain. Physical examination reveals a grade IV/VI diastolic aortic
murmur and 2+ lower extremity edema to the midcalf. The AGACNP
considers which of the following as the most appropriate management
strategy?
A. Serial echocardiography every 6 months
B. Begin a calcium channel antagonist
C. Begin an angiotensin converting enzyme (ACE) inhibitor
D. Surgical consultation and intervention
,**Answer: C. Begin an angiotensin converting enzyme (ACE) inhibitor**
*Rationale: The patient is exhibiting signs of worsening aortic
regurgitation with activity intolerance and edema. ACE inhibitors lower
blood pressure, which reduces the workload on the left ventricle and
helps manage the underlying conditions that worsen heart murmurs.
Surgery is indicated only when valves are severely damaged or leaking,
not as initial management in this presentation .*
---
**Question 2**
An ascending thoracic aneurysm of > 5.5 cm is universally considered
an indication for surgical repair, given the poor outcomes with sudden
rupture. Regardless of the aneurysm's size, all of the following are
additional indications for immediate operation except:
A. Comorbid Marfan's syndrome
B. Enlargement of > 1 cm since diagnosis
C. Crushing chest pain
D. History of giant cell arteritis
**Answer: D. History of giant cell arteritis**
,*Rationale: Indications for immediate surgical repair of thoracic aortic
aneurysms include size >5.5 cm, connective tissue disorders like
Marfan's syndrome, rapid enlargement (>1 cm per year), and symptoms
such as crushing chest pain suggesting impending rupture. Giant cell
arteritis is a vasculitis affecting medium and large arteries but is not an
independent indication for immediate surgical repair of an aneurysm .*
---
**Question 3**
A patient with suspected Cushing's syndrome is being evaluated to
establish the diagnosis and cause. Patients with an adrenal tumor
typically will demonstrate:
A. Low ACTH and low cortisol
B. Low ACTH and high cortisol
C. High ACTH and low cortisol
D. High ACTH and high cortisol
**Answer: B. Low ACTH and high cortisol**
*Rationale: Adrenal tumors autonomously produce cortisol, which
through negative feedback suppresses ACTH production from the
pituitary. This results in low ACTH levels with elevated cortisol,
, distinguishing it from pituitary causes (Cushing's disease) where both
ACTH and cortisol are elevated .*
---
**Question 4**
The AGACNP is reviewing a chart of a head-injured patient. Which of
the following would alert the AGACNP to the possibility that the patient
is overhydrated, thereby increasing the risk for increased intracranial
pressure?
A. BUN = 10
B. Shift output = 800 ml, shift input = 825 ml, unchanged weight
C. Serum osmolality = 260
D. Serum sodium = 145
**Answer: C. Serum osmolality = 260**
*Rationale: Normal serum osmolality ranges from 275-295 mOsm/kg. A
value of 260 indicates overhydration (dilutional hyponatremia), which
can lead to cerebral edema and increased intracranial pressure in head-
injured patients. BUN of 10 is within normal range, balanced
input/output suggests euvolemia, and sodium of 145 is normal to
slightly elevated .*
