NURS 6560 MIDTERM EXAM
NURS 6560 MIDTERM EXAM
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. Anemi
a
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. Obstructi
ve 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 Surgical Quality Improvement Program guidelines are clear
that patients who stop smoking
weeks before surgery have no increased risk of smokingrelated
pulmonary complications.
NURS 6560 MIDTERM EXAM
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. Anemi
a
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. Obstructi
ve 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 Surgical Quality Improvement Program guidelines are clear
that patients who stop smoking
weeks before surgery have no increased risk of smokingrelated
pulmonary complications.
