NURS 6550 FINAL EXAM – WALDEN UNIVERSITY SUMMER 2018

QUESTION 1 1. Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes: A . Foley lodged in the urethra causing postrenal failure B . Decreased renal perfusion causing prerenal failure C . Age-related decreased eGFR causing prerenal failure D . Post-surgical rhabdomyolysis causing intrarenal failure 1 points QUESTION 2 1. Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of: A . Hashimoto’s thyroiditis B . Cushing’s syndrome C . Grave’s disease D . Addison’s disease 1 points QUESTION 3 1. Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE? A . Fever, normal white count, elevated sedimentation rate B . Hyperkalemia, hyponatremia, low blood pressure C . Leukocytosis, hyperglycemia, hypokalemia D . Joint pain, rash, fever 1 points QUESTION 4 1. A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be: A . Meclizine B . Diazepam C . Bed rest D . Epley’s maneuvers 1 points QUESTION 5 1. Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is: A . Osteoarthritis B . Drug or alcohol toxicity C . Hypotension D . Urosepsis 1 points QUESTION 6 1. A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities? A . Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg B . Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg C . Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg D . Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg 1 points QUESTION 7 1. Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates: A . Penetration of the cornea with resultant aqueous leak B . A rust ring remnant due to metal foreign body C . An elevated intraocular pressure D . Paradoxical pupil dilation in response to light 1 points QUESTION 8 1. Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory test is necessary to support the suspected diagnosis? A . An erythrocyte sedimentation rate B . A white blood cell differential C . Two sets of blood cultures D . Echocardiography 1 points QUESTION 9 1. Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness; ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess of: A . Serotonin B . Norepinephr ine C . Acetylcholin e D . Dopamine 1 points QUESTION 10 1. Mr. Lincoln is a 55-year-old male who was admitted for management of sepsis secondary to pneumonia. He has declined rapidly, and today chest radiography demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg. In order to increase his oxygenation the AGACNP knows that which of the following interventions is indicated? A . Increased FiO2 B . Increased respiratory rate C . Increased tidal volume D . Increased PEEP 1 points QUESTION 11 1. A 29-year-old female patient presents with a complaint of palpitations. Physical examination reveals an essentially healthy female with no significant medical history and no maintenance medications; the only thing she can report is that she had a head cold a week or so ago. The vital signs include a blood pressure of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a temperature of 98.6° F. The only abnormal finding on physical examination is diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers which medication for symptom control? A . Ibuprofen B . Pseudoephed rine C . Propranolol D . Methimazole 1 points QUESTION 12 1. Jennifer is an 18-year-old homeless female who was found unresponsive. She was admitted to the hospital for management of severe bleeding after a spontaneous abortion escalated to a uterine hemorrhage. An underlying infection and dehydration were corrected and nutritional supplements were started. Her volume status is stable, morning labs were all within normal limits and she is to be discharged today. When the AGACNP enters the room to prepare the patient for discharge, she finds her agitated, pale, and diaphoretic with vital signs to include a pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a temperature is 97.9° F. The most appropriate action would be to: A . Order a CBC to assess for recurrent bleeding B . Request and abdominal CT to assess for bleeding C . Evaluate the patient for anxiety/panic attack D . Prescribe alprazolam 1 mg now 1 points QUESTION 13 1. Physical examination findings in a patient with pneumothorax is likely to reveal: A . Increased tactile fremitus B . Low grade temperature C . Hyperresonance to percussion D . Egophany 1 points QUESTION 14 1. Mr. Parker brings his 73-year-old wife to a clinic appointment because he is worried about her. She has a long history of hypertension and dyslipidemia, but he says she has taken medication for years and everything has been OK. His concern today is that for a long time she has been very forgetful, and he has tried to help her by keeping a strict routine around the house. Over the past few months, she just seems more and more forgetful, does not seem interested in doing anything, and now seems to be forgetting how to do simple everyday tasks. Yesterday she could not figure out which dollar bills to use at the store to pay the cashier. The AGACNP knows Mrs. Parker should first be screened for: A . Depression B . A brain tumor C . Hypothyroidism D . Adrenal dysfunction 1 points QUESTION 15 1. M.R. is a 40-year-old female who has a known history of peptic ulcer disease. She has been admitted through the emergency room with a diagnosis of GI bleeding—she is vomiting dark blood and had a nasogastric tube placed. When attached to low intermittent suction it initially drained 400 cc of dark brown/black drainage, but now it is starting to drain lighter red colored blood. The AGACNP knows that immediate priorities of care include: A . Ensuring hemodynamic stability B . Beginning a parenteral proton pump inhibitor C . Beginning gastric lavage D . Ordering a gastrointestinal consult