NURS 6550 Midterm Exam – Question and Answers with
Rationals – Walden University
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.
Answer: A, a trasdutate is essential as it shows
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?
Ans: D is the answer- CT( not radiography or MRI or us)
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 ….a high risk factor for long term care placement?
ANS: A- men ( others are > 80, live alone, bowel and bladder incontinence, hx of
fall, dysfunctional coping and intellectual impairment).
4. A patient with anterior epistaxis has been ….with 20 minutes of direct
pressure to the cartilaginous portion of the nose. Following pressure the
patient is ….to gently blow the nose. Expected findings in the patient who
has been successfully ….include all of the following except a:
Ans: C, bld and clot formation occurs if bleeding stop within 20 min of directed
pressure and can be removed by gentle suction and gentle blowing of nose.
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:
Ans: D, streptococcus pneumonaie commonly bacteria present in head and neck
infection of immunocompetent patients, and primarily treatment target for otitis
media, bacterial sinusitis, and bacterial pharyngitis.
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?
Ans: D- streptococcus pneumonaie from out patient population and targeted
treatment empirically.
pg. 1
, 7. Which of the following is the greatest risk factor for vascular dementia?
Ans- B, vascular disease in target organ damage in DM, hyperlipidemia and HTN
pg. 2
, 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 …..in the diagnostic evaluation?
11.D.E. is a 41-year-old female who had lumbar surgery two days ago to repair
a ….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 ….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 ….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 ….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
pg. 3
Rationals – Walden University
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.
Answer: A, a trasdutate is essential as it shows
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?
Ans: D is the answer- CT( not radiography or MRI or us)
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 ….a high risk factor for long term care placement?
ANS: A- men ( others are > 80, live alone, bowel and bladder incontinence, hx of
fall, dysfunctional coping and intellectual impairment).
4. A patient with anterior epistaxis has been ….with 20 minutes of direct
pressure to the cartilaginous portion of the nose. Following pressure the
patient is ….to gently blow the nose. Expected findings in the patient who
has been successfully ….include all of the following except a:
Ans: C, bld and clot formation occurs if bleeding stop within 20 min of directed
pressure and can be removed by gentle suction and gentle blowing of nose.
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:
Ans: D, streptococcus pneumonaie commonly bacteria present in head and neck
infection of immunocompetent patients, and primarily treatment target for otitis
media, bacterial sinusitis, and bacterial pharyngitis.
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?
Ans: D- streptococcus pneumonaie from out patient population and targeted
treatment empirically.
pg. 1
, 7. Which of the following is the greatest risk factor for vascular dementia?
Ans- B, vascular disease in target organ damage in DM, hyperlipidemia and HTN
pg. 2
, 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 …..in the diagnostic evaluation?
11.D.E. is a 41-year-old female who had lumbar surgery two days ago to repair
a ….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 ….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 ….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 ….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
pg. 3
