NRNP 6560
FINAL
EXAM
QNS & ANS
2023/2024
1. Q ANSWER:
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:
A. + Murphy’s sign
B. + Chvostek’s sign
C. + McBurney’s sign
D. + Kernig’s sign
2. Q ANSWER:
Myasthenia gravis is best described as:
A. An imbalance of dopamine and acetylcholine in the
basal ganglia Demyelination of peripheral ascending
nerves
B. Demyelination in the central nervous system
C. An autoimmune disorder characterized by decreased neuromuscular activation
3. Q ANSWER:
,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:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
4. Q ANSWER:
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:
A. Has a history of atrial fibrillation
B. Was unable to be aroused in the morning
C. Had been complaining of a headache before losing consciousness
D. Has had several brief episodes of mental confusion and right arm and leg weakness
5. Q ANSWER:
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
6. Q ANSWER:
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
7. Q ANSWER:
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
8. Q ANSWER:
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
Methylpredniso
lone Sirolimus
9. Q ANSWER:
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
, 13.Q ANSWER:
Acute hepatitis A is usually diagnosed by:
By the constitutional
symptoms Within 2 weeks
of exposure Detection of
IgM-Anti-HAV Jaundice
14.Q ANSWER:
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, then it seemed to disappear, and now it is back.” The
AGACNP proceeds with a history and physical exam and concludes which of the following as
the leading differential diagnosis?
Subclinical
infection Non-
Hodgkin's
lyphoma
Catscratch disease
Syphilis
15.Q ANSWER:
P. E. is a 61-year-old female who presents for a postoperative visit following a gastric resection
after a perforation of peptic ulcer. She reports feeling better, although it is taking longer than
she expected. However, she says she is feeling better each day, her appetite is returning, and
her incision is healing well. She is being discharged from surgical care and advised to continue
her routine health promotion follow-up with her primary care provider. As part of her surgical
discharge teaching, the AGACNP counsels P. E. that as a result of her gastric resection she will
need lifelong follow-up of: Blood group substances
Electrolyt
es
Vitamin
B12
Gastric
pH
16.Q ANSWER:
T. O. is a 31-year-old male patient who is transported to the emergency department via
emergency services. He was in a multivehicle accident and was trapped in a crushed car for
more than 3 hours. On examination, his right lower extremity is found to be tensely swollen,
with 3+ nonpitting edema. The lower leg is profoundly painful with passive range of motion.
Given the history and physical findings, the AGACNP recognizes that treatment centers around:
Fasciotomy
Thrombolytics
Surgical
reduction
FINAL
EXAM
QNS & ANS
2023/2024
1. Q ANSWER:
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:
A. + Murphy’s sign
B. + Chvostek’s sign
C. + McBurney’s sign
D. + Kernig’s sign
2. Q ANSWER:
Myasthenia gravis is best described as:
A. An imbalance of dopamine and acetylcholine in the
basal ganglia Demyelination of peripheral ascending
nerves
B. Demyelination in the central nervous system
C. An autoimmune disorder characterized by decreased neuromuscular activation
3. Q ANSWER:
,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:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
4. Q ANSWER:
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:
A. Has a history of atrial fibrillation
B. Was unable to be aroused in the morning
C. Had been complaining of a headache before losing consciousness
D. Has had several brief episodes of mental confusion and right arm and leg weakness
5. Q ANSWER:
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
6. Q ANSWER:
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
7. Q ANSWER:
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
8. Q ANSWER:
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
Methylpredniso
lone Sirolimus
9. Q ANSWER:
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
, 13.Q ANSWER:
Acute hepatitis A is usually diagnosed by:
By the constitutional
symptoms Within 2 weeks
of exposure Detection of
IgM-Anti-HAV Jaundice
14.Q ANSWER:
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, then it seemed to disappear, and now it is back.” The
AGACNP proceeds with a history and physical exam and concludes which of the following as
the leading differential diagnosis?
Subclinical
infection Non-
Hodgkin's
lyphoma
Catscratch disease
Syphilis
15.Q ANSWER:
P. E. is a 61-year-old female who presents for a postoperative visit following a gastric resection
after a perforation of peptic ulcer. She reports feeling better, although it is taking longer than
she expected. However, she says she is feeling better each day, her appetite is returning, and
her incision is healing well. She is being discharged from surgical care and advised to continue
her routine health promotion follow-up with her primary care provider. As part of her surgical
discharge teaching, the AGACNP counsels P. E. that as a result of her gastric resection she will
need lifelong follow-up of: Blood group substances
Electrolyt
es
Vitamin
B12
Gastric
pH
16.Q ANSWER:
T. O. is a 31-year-old male patient who is transported to the emergency department via
emergency services. He was in a multivehicle accident and was trapped in a crushed car for
more than 3 hours. On examination, his right lower extremity is found to be tensely swollen,
with 3+ nonpitting edema. The lower leg is profoundly painful with passive range of motion.
Given the history and physical findings, the AGACNP recognizes that treatment centers around:
Fasciotomy
Thrombolytics
Surgical
reduction
