NURS 6550 MIDTERM EXAM
, NURS 6550 MIDTERM EXAM
Question 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.
Response “A” is the correct answer. A transudate is essentially just water
Feedback: and can occur as a consequence of increased hydrostatic
pressure in the pulmonary vessels. It typically implies that the
some condition has produced an imbalance in colloid-
hydrostatic pressures, such as CHF or hypoalbuminemia. While
it can represent a serious problem, it may also represent a
transient imbalance. Conversely, “B” is not correct as an
exudate has more protein in it and implies a condition
characterized by protein leaking from vessels, such as a
malignancy or some serious systemic stressor. “C” is not
correct—a chyliform effusion is characterized by fat and
indicates a pathology causing massive triglyceride degradation.
“D” is not correct as a hemorrhagic effusion is blood and
typically means traumatic injury.
Question 2
Mrs. Miller is transported to the emergency department by paramedics. She is
having profound, unremitting chest pain, is diaphoretic and pale. She has
jugular venous distention and a widened pulse pressure. Suspecting ascending
aortic aneurysm, the AGACNP order which test to confirm the diagnosis?
, Response “D” is the correct answer. It is the most widely used diagnostic
Feedback: tool as it rapidly and precisely can outline the thoracic and
abdominal aorta. “A” is not the correct answer—there are
radiographic findings that suggest thoracic aneurysm, but they
need confirmation by CT. “B” is not the correct answer as
ultrasound is not nearly as precise as a CT scan. “C” is not
correct—MRI is only indicated when the patient cannot have a
contrast CT.
Question 3
Certain subgroups of the elderly population are at an increased risk for rapid
deterioration and long-term care placement. Which of the following is not
considered a high risk factor for long term care placement?
Response “A” is the correct answer; men are at higher risk for long-term
Feedback: care placement than women. In addition to male gender, other
risk factors include age over 80, living alone, bowel or bladder
incontinence, history of falls, dysfunctional coping, and
intellectual impairment.
Question 4
A patient with anterior epistaxis has been treated with 20 minutes of direct
pressure to the cartilaginous portion of the nose. Following pressure the patient
is instructed to gently blow the nose. Expected findings in the patient who has
been successfully treated include all of the following except a:
Response “C” is the correct answer. If bleeding is successfully stopped
Feedback: with 20 minutes of directed pressure, there will be residual
blood and clot formation. This is evacuated either by gentle
suction or having the patient gently blow. Residual blood and
formed clot may present as a sudden gush of dark blood or
discharge with or without a clot—these are all typical expected
findings. However, if bleeding is not stopped, it will continue
as a bright red steady trickle. When this occurs, more invasive
measures are indicated.
, Question 5
Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F
and significant right ear pain. He appears quite ill and says he feels nauseous.
Otoscopic evaluation reveals pain to palpation, a very erythematous and
bulging tympanic membrane with bullous myringitis. The AGACNP knows
that antibiotic therapy must be selected to cover:
Response “D” is the correct answer. Streptococcus pneumoniae is the
Feedback: most common bacteria that infects the head and neck in
immunocompetent persons, and is the primary treatment target
when treating otitis media, bacterial sinusitis, and bacterial
pharyngitis. “A” is not correct—while likely on broken skin
and soft tissue, it is not common in the ear, nose, or throat
unless specific risk factors exist. “B” is not correct—this is
much more likely in an immunocompromised patient or a
patient on mechanical ventilation. “C” is not correct—it is the
second most common organism, but strep is the primary
treatment target.
Question 6
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?
, NURS 6550 MIDTERM EXAM
Question 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.
Response “A” is the correct answer. A transudate is essentially just water
Feedback: and can occur as a consequence of increased hydrostatic
pressure in the pulmonary vessels. It typically implies that the
some condition has produced an imbalance in colloid-
hydrostatic pressures, such as CHF or hypoalbuminemia. While
it can represent a serious problem, it may also represent a
transient imbalance. Conversely, “B” is not correct as an
exudate has more protein in it and implies a condition
characterized by protein leaking from vessels, such as a
malignancy or some serious systemic stressor. “C” is not
correct—a chyliform effusion is characterized by fat and
indicates a pathology causing massive triglyceride degradation.
“D” is not correct as a hemorrhagic effusion is blood and
typically means traumatic injury.
Question 2
Mrs. Miller is transported to the emergency department by paramedics. She is
having profound, unremitting chest pain, is diaphoretic and pale. She has
jugular venous distention and a widened pulse pressure. Suspecting ascending
aortic aneurysm, the AGACNP order which test to confirm the diagnosis?
, Response “D” is the correct answer. It is the most widely used diagnostic
Feedback: tool as it rapidly and precisely can outline the thoracic and
abdominal aorta. “A” is not the correct answer—there are
radiographic findings that suggest thoracic aneurysm, but they
need confirmation by CT. “B” is not the correct answer as
ultrasound is not nearly as precise as a CT scan. “C” is not
correct—MRI is only indicated when the patient cannot have a
contrast CT.
Question 3
Certain subgroups of the elderly population are at an increased risk for rapid
deterioration and long-term care placement. Which of the following is not
considered a high risk factor for long term care placement?
Response “A” is the correct answer; men are at higher risk for long-term
Feedback: care placement than women. In addition to male gender, other
risk factors include age over 80, living alone, bowel or bladder
incontinence, history of falls, dysfunctional coping, and
intellectual impairment.
Question 4
A patient with anterior epistaxis has been treated with 20 minutes of direct
pressure to the cartilaginous portion of the nose. Following pressure the patient
is instructed to gently blow the nose. Expected findings in the patient who has
been successfully treated include all of the following except a:
Response “C” is the correct answer. If bleeding is successfully stopped
Feedback: with 20 minutes of directed pressure, there will be residual
blood and clot formation. This is evacuated either by gentle
suction or having the patient gently blow. Residual blood and
formed clot may present as a sudden gush of dark blood or
discharge with or without a clot—these are all typical expected
findings. However, if bleeding is not stopped, it will continue
as a bright red steady trickle. When this occurs, more invasive
measures are indicated.
, Question 5
Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F
and significant right ear pain. He appears quite ill and says he feels nauseous.
Otoscopic evaluation reveals pain to palpation, a very erythematous and
bulging tympanic membrane with bullous myringitis. The AGACNP knows
that antibiotic therapy must be selected to cover:
Response “D” is the correct answer. Streptococcus pneumoniae is the
Feedback: most common bacteria that infects the head and neck in
immunocompetent persons, and is the primary treatment target
when treating otitis media, bacterial sinusitis, and bacterial
pharyngitis. “A” is not correct—while likely on broken skin
and soft tissue, it is not common in the ear, nose, or throat
unless specific risk factors exist. “B” is not correct—this is
much more likely in an immunocompromised patient or a
patient on mechanical ventilation. “C” is not correct—it is the
second most common organism, but strep is the primary
treatment target.
Question 6
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?
