NURS 6560 FINAL EXAM (GRADED A
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert the AGACNP
for the possibility that the patient is over hydrated, thereby increasing the risk for increased intracranial pressure?
BUN = 10
Shift output = 800 ml, shift input = 825 ml Unchanged
weight Serum osmolality = 260
Answers available at https://bit.ly/2VNFmXT
A patient who has been in the intensive care unit for 17 days develops hypernatremic hyperosmolality. The
patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is
320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care
nurse practitioner's initial treatment is to:
reduce serum osmolality by infusing a 5% dextrose in 0.2% sodium chloride solution
reduce serum sodium concentration by infusing a 0.45% sodium chloride solution replenish volume by infusing
a 0.9% sodium chloride solution
replenish volume by infusing a 5% dextrose in water solution.
Answers available at https://bit.ly/2VNFmXT
A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of nausea and has
had one episode of vomiting, but he denies any diarrhea. His vital signs are as follows: temperature 101.9°F,
pulse 100 bpm, respirations 16 breaths per minute, and blood pressure 110/70 mm Hg. A complete blood count
reveals a WBC count of 19,100 cells/µL. The AGACNP expects that physical examination will reveal:
+ Murphy’s sign
+ Chvostek’s sign
+ McBurney’s sign
+ Kernig’s sign
Myasthenia gravis is best described as:
An imbalance of dopamine and acetylcholine in the basal ganglia Demyelination of peripheral ascending nerves
Demyelination in the central nervous system
An autoimmune disorder characterized by decreased neuromuscular activation
,Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding
ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has
complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACNP
is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her
symptoms include all of the following except:
Colic due to return of peristalsis Leakage from the duodenal stump Gastric retention
Hemorrhage
Answers available at https://bit.ly/2VNFmXT
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding
ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has
complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACNP
is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her
symptoms include all of the following except:
Colic due to return of peristalsis Leakage from the duodenal stump Gastric retention
Hemorrhage
Answers available at https://bit.ly/2VNFmXT
When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke most likely
resulted from a subarachnoid hemorrhage when the patient’s family reports that the patient:
Has a history of atrial fibrillation
Was unable to be aroused in the morning
Had been complaining of a headache before losing consciousness
Has had several brief episodes of mental confusion and right arm and leg weakness
You are asked to see a 29 year old female complaining of abdominal pain. She states she is experiencing
constant RUQ pain that radiates to her back. The pain is not relieved by bowel movements, over the counter
antacids or food. Review of initial labs shows elevated amylase and lipase and you diagnose her with acute
pancreatitis. Which test will you order next to determine the underlying cause of her pancreatitis?
serum cholesterol level blood toxicology
right upper quadrant ultrasound
endoscopy
Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ resection following a
catastrophic motor vehicle accident. Due to the nature of his injuries, a large portion of his jejunum had to be
, resected. In planning for his recovery and nutritional needs, the AGACNP considers that:
He will probably be able to transition to oral nutrition but will have lifetime issues with diarrhea His procedure
has put him at significant risk for B12 absorption problems
Most jejunum absorption functions will be assumed by the ileum
Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation
A 32-year-old man comes to the clinic because he has had pain in the back for the past 24 hours. The patient says
he first noticed the pain when he awoke in the morning and had difficulty getting out of bed. He had been
playing flag football the day before the pain began but did not sustain any injuries during the game.
Acetaminophen has provided only minimal relief of the patient's pain. On physical examination, pain is elicited
on palpation of the back on the left, lateral to the region of L2-L5. Full range of motion is noted in vertebral
flexion, extension, lateral rotation, and lateral bending, with some hesitancy because of pain on the left side.
Which of the following is the most appropriate initial step?
Anti-inflammatory and muscle relaxant therapy Epidural injection of a corticosteroid
MRI of the lumbar spine
Strict bed rest and application of moist heat to the lower back
Answers available at https://bit.ly/2VNFmXT
On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms of acute
rejection, confirmed by histologic examination. The AGACNP knows that first-line treatment of acute rejection
consists of: Cyclosporine
Azathioprine Methylprednisolone Sirolimus
H. W. is a 33-year-old female who is being evaluated after a fall from a tree. Anteroposterior and lateral
radiographs of the thoracolumbosacral spine are significant for transverse process fractures at T6 and T7. The
AGACNP knows that treatment for this likely will include:
Observation
Hyperextension casting Jewett brace
Surgical intervention
Acute hepatitis A is usually diagnosed by: By the constitutional symptoms
Within 2 weeks of exposure
Detection of IgM-Anti-HAV
Jaundice
A 30-year-old male patient presents for evaluation of a lump on his neck. He denies pain, itch, erythema, edema,
or any other symptoms. He is ^concerned because it won't ^ go away. He says, ―I noticed it a few months ago,
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert the AGACNP
for the possibility that the patient is over hydrated, thereby increasing the risk for increased intracranial pressure?
BUN = 10
Shift output = 800 ml, shift input = 825 ml Unchanged
weight Serum osmolality = 260
Answers available at https://bit.ly/2VNFmXT
A patient who has been in the intensive care unit for 17 days develops hypernatremic hyperosmolality. The
patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is
320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care
nurse practitioner's initial treatment is to:
reduce serum osmolality by infusing a 5% dextrose in 0.2% sodium chloride solution
reduce serum sodium concentration by infusing a 0.45% sodium chloride solution replenish volume by infusing
a 0.9% sodium chloride solution
replenish volume by infusing a 5% dextrose in water solution.
Answers available at https://bit.ly/2VNFmXT
A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of nausea and has
had one episode of vomiting, but he denies any diarrhea. His vital signs are as follows: temperature 101.9°F,
pulse 100 bpm, respirations 16 breaths per minute, and blood pressure 110/70 mm Hg. A complete blood count
reveals a WBC count of 19,100 cells/µL. The AGACNP expects that physical examination will reveal:
+ Murphy’s sign
+ Chvostek’s sign
+ McBurney’s sign
+ Kernig’s sign
Myasthenia gravis is best described as:
An imbalance of dopamine and acetylcholine in the basal ganglia Demyelination of peripheral ascending nerves
Demyelination in the central nervous system
An autoimmune disorder characterized by decreased neuromuscular activation
,Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding
ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has
complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACNP
is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her
symptoms include all of the following except:
Colic due to return of peristalsis Leakage from the duodenal stump Gastric retention
Hemorrhage
Answers available at https://bit.ly/2VNFmXT
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding
ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has
complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACNP
is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her
symptoms include all of the following except:
Colic due to return of peristalsis Leakage from the duodenal stump Gastric retention
Hemorrhage
Answers available at https://bit.ly/2VNFmXT
When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke most likely
resulted from a subarachnoid hemorrhage when the patient’s family reports that the patient:
Has a history of atrial fibrillation
Was unable to be aroused in the morning
Had been complaining of a headache before losing consciousness
Has had several brief episodes of mental confusion and right arm and leg weakness
You are asked to see a 29 year old female complaining of abdominal pain. She states she is experiencing
constant RUQ pain that radiates to her back. The pain is not relieved by bowel movements, over the counter
antacids or food. Review of initial labs shows elevated amylase and lipase and you diagnose her with acute
pancreatitis. Which test will you order next to determine the underlying cause of her pancreatitis?
serum cholesterol level blood toxicology
right upper quadrant ultrasound
endoscopy
Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ resection following a
catastrophic motor vehicle accident. Due to the nature of his injuries, a large portion of his jejunum had to be
, resected. In planning for his recovery and nutritional needs, the AGACNP considers that:
He will probably be able to transition to oral nutrition but will have lifetime issues with diarrhea His procedure
has put him at significant risk for B12 absorption problems
Most jejunum absorption functions will be assumed by the ileum
Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation
A 32-year-old man comes to the clinic because he has had pain in the back for the past 24 hours. The patient says
he first noticed the pain when he awoke in the morning and had difficulty getting out of bed. He had been
playing flag football the day before the pain began but did not sustain any injuries during the game.
Acetaminophen has provided only minimal relief of the patient's pain. On physical examination, pain is elicited
on palpation of the back on the left, lateral to the region of L2-L5. Full range of motion is noted in vertebral
flexion, extension, lateral rotation, and lateral bending, with some hesitancy because of pain on the left side.
Which of the following is the most appropriate initial step?
Anti-inflammatory and muscle relaxant therapy Epidural injection of a corticosteroid
MRI of the lumbar spine
Strict bed rest and application of moist heat to the lower back
Answers available at https://bit.ly/2VNFmXT
On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms of acute
rejection, confirmed by histologic examination. The AGACNP knows that first-line treatment of acute rejection
consists of: Cyclosporine
Azathioprine Methylprednisolone Sirolimus
H. W. is a 33-year-old female who is being evaluated after a fall from a tree. Anteroposterior and lateral
radiographs of the thoracolumbosacral spine are significant for transverse process fractures at T6 and T7. The
AGACNP knows that treatment for this likely will include:
Observation
Hyperextension casting Jewett brace
Surgical intervention
Acute hepatitis A is usually diagnosed by: By the constitutional symptoms
Within 2 weeks of exposure
Detection of IgM-Anti-HAV
Jaundice
A 30-year-old male patient presents for evaluation of a lump on his neck. He denies pain, itch, erythema, edema,
or any other symptoms. He is ^concerned because it won't ^ go away. He says, ―I noticed it a few months ago,
