NURS 6560 Midterm 18 Exam with answers –
Walden University (A Grade / School graded)
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
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
Question 3
Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection
drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse
tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat
pain, and a temperature of 102.1°F. She appears ill and has foul breath. In order to evaluate for
a deep neck space infection, the AGACNP orders:
A. Anteroposterior neck radiography B. CT scan of the neck C. White blood cell (WBC)
differential D. Aspiration and culture of fluid
Question 4
Mr. Draper is a 39-year-old male recovering from an extended abdominal procedure. As a result
of a serious motor vehicle accident, he has had repair of a small bowel perforation,
splenectomy, and repair of a hepatic laceration. He will be on total parenteral nutrition
,postoperatively. The AGACNP recognizes that the most common complications of parenteral
nutrition are a consequence of:
A. Poorly calculated solution B. Resultant diarrhea and volume contraction C. The central
venous line used for infusion D. Bowel disuse and hypomotility
Question 5
Mr. Mettenberger is being discharged following his hospitalization for reexpansion of his second
spontaneous pneumothorax this year. He has stopped smoking and does not appear to have any
overt risk factors. While doing his discharge teaching, the AGACNP advises Mr. Mettenberger
that his current risk for another pneumothorax is:
A. < 10% B. 25-50% C. 50-75% D. > 90
Question 6
One of the earliest findings for a patient in hypovolemic shock is:
A. A drop in systolic blood pressure (SBP) < 10 mm Hg for > 1 minute when sitting up B. A
change in mental status C. SaO2 of < 88% D. Hemoglobin and hematocrit (H&H) < 9 g/dL
and 27%
Question 7
, Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more
chronic form are most likely to be present with:
A. Respiratory insufficiency B. Sepsis C. Bowel obstruction D. Anemia
Question 8
The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus.
Initially the patient was stable, awake, alert, and oriented, but during the last several hours the
patient has become increasingly lethargic. At change of shift, the oncoming staff nurse
appreciates a profound change in the patient’s mental status from the day before. Vital signs
and hemodynamic parameters are as follows: BP 88/54 mm Hg Pulse 110 bpm Respiratory rate
22 breaths per minute SaO2 93% on a 50% mask Systemic vascular resistance (SVR) 1600 dynes
∙ sec/cm5 Cardiac index 1.3 L/min Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This
clinical picture is most consistent with which shock state?
A. Hypovolemic B. Cardiogenic C. Distributive D. Obstructive
Question 9
When counseling patients to prevent postoperative pulmonary complications, the AGACNP
knows that with respect to smoking cessation, the American College of Surgeons and National
Walden University (A Grade / School graded)
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
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
Question 3
Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection
drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse
tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat
pain, and a temperature of 102.1°F. She appears ill and has foul breath. In order to evaluate for
a deep neck space infection, the AGACNP orders:
A. Anteroposterior neck radiography B. CT scan of the neck C. White blood cell (WBC)
differential D. Aspiration and culture of fluid
Question 4
Mr. Draper is a 39-year-old male recovering from an extended abdominal procedure. As a result
of a serious motor vehicle accident, he has had repair of a small bowel perforation,
splenectomy, and repair of a hepatic laceration. He will be on total parenteral nutrition
,postoperatively. The AGACNP recognizes that the most common complications of parenteral
nutrition are a consequence of:
A. Poorly calculated solution B. Resultant diarrhea and volume contraction C. The central
venous line used for infusion D. Bowel disuse and hypomotility
Question 5
Mr. Mettenberger is being discharged following his hospitalization for reexpansion of his second
spontaneous pneumothorax this year. He has stopped smoking and does not appear to have any
overt risk factors. While doing his discharge teaching, the AGACNP advises Mr. Mettenberger
that his current risk for another pneumothorax is:
A. < 10% B. 25-50% C. 50-75% D. > 90
Question 6
One of the earliest findings for a patient in hypovolemic shock is:
A. A drop in systolic blood pressure (SBP) < 10 mm Hg for > 1 minute when sitting up B. A
change in mental status C. SaO2 of < 88% D. Hemoglobin and hematocrit (H&H) < 9 g/dL
and 27%
Question 7
, Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more
chronic form are most likely to be present with:
A. Respiratory insufficiency B. Sepsis C. Bowel obstruction D. Anemia
Question 8
The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus.
Initially the patient was stable, awake, alert, and oriented, but during the last several hours the
patient has become increasingly lethargic. At change of shift, the oncoming staff nurse
appreciates a profound change in the patient’s mental status from the day before. Vital signs
and hemodynamic parameters are as follows: BP 88/54 mm Hg Pulse 110 bpm Respiratory rate
22 breaths per minute SaO2 93% on a 50% mask Systemic vascular resistance (SVR) 1600 dynes
∙ sec/cm5 Cardiac index 1.3 L/min Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This
clinical picture is most consistent with which shock state?
A. Hypovolemic B. Cardiogenic C. Distributive D. Obstructive
Question 9
When counseling patients to prevent postoperative pulmonary complications, the AGACNP
knows that with respect to smoking cessation, the American College of Surgeons and National
