NRNP 6560 FINAL 2023-2024 VERSION 2 EXAM 100 QUESTIONS AND CORRECT ANSWERS, Exams of Nursing

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NRNP 6560 FINAL 2023-2024 VERSION 2 EXAM 100

QUESTIONS AND CORRECT ANSWERS

Question 1 A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate: A. Low ACTH and low cortisol B. Low ACTH and high cortisol C. High ACTH and low cortisol D. High ACTH and high cortisol Question 2 Pneumatosis, or gas cysts, may form in the wall anywhere along the gastrointestinal tract; in some cases, they will produce symptoms such as abdominal discomfort, diarrhea with mucus, and excess flatulence. Treatment of pneumatosis most often involves: A. Several days of oxygen by face mask B. Hyperbaric oxygen C. Surgical resection D. Treatment of underlying disease Question 3

Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifer’s evaluation and management should include: A. No further care, because the chest radiograph is negative B. Quantiferon serum assay for exposure C. Consideration of prophylactic therapy D. Beginning therapy for pulmonary TB pending sputum cultures Question 4 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: A. Blood group substances B. Electrolytes C. Vitamin B D. Gastric pH

Question 5 M. T. is a 71 - year-old female who presents for evaluation of a ―lump on her chest.‖ She denies any symptoms—there is no pain, erythema, edema, ecchymosis, or open areas—it is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard; it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a: A. Neurolemma B. Lipoma C. Hemangioma D. Lymphangioma Question 6 The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla? A. Alpha-adrenergic antagonists B. Beta-adrenergic antagonists C. Intravenous vasodilators D. Arteriolar dilators

Question 7 In myelodysplastic syndromes, the primary indications for splenectomy include: A. Major hemolysis unresponsive to medical management B. Severe symptoms of massive splenomegaly C. Sustained leukocyte elevation above 30,000 cells/μL D. Portal hypertension Question 8 The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse? A. Radiographs B. CT scan without contrast C. MRI D. PET scan Question 9

The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s management is to: A. Continue the current regimen B. D/C the spironolactone and begin a loop diuretic C. Add a loop diuretic to the spironolactone D. Proceed to large-volume paracentesis Question 10 Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients? A. High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant B. There is a strong interest in developing corticosteroid-free posttransplant protocols C. Better results are demonstrated in corticosteroid-free protocols for second-transplant recipients D. Evidence supports corticosteroid-free rejection protocols Question 11 K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms; the remainder of the GI review of systems is negative. His medical

history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that: A. He will need endoscopy to evaluate the problem B. Chronic gastroparesis is a known complication of ulcer surgery C. Medication is unlikely to help, and he may need another surgery D. His symptoms occur in 5 to 10% of people after ulcer surgery Question 12 The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal: A. Increased MCV B. Increased Hgb C. Increased platelets D. Increased albumin Question 13 A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient? A. Isoproterenol 0.2 to 0.6 mg IV bolus B. External pacemaking

C. Atropine 0.5 mg IV D. Epinephrine 1 mg IV Question 14 Ms. Carpenter is a 28-year-old female who presents in significant pain; she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic? A. Temperature > 102°F B. White blood cell count > 14,000 cells/μL C. Vomiting D. Hematuria Question 15 Which of the following is not a true statement with respect to decision making for a cognitively impaired patient? A. Only a court can declare a patient incompetent B. Impaired cognition does not make a person incompetent C. Living wills typically are honored if a person is terminally ill D. A patient can give informed consent if not declared incompetent Question 16

Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease; its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except: A. Gamma-aminobutyric acid (GABA) B. Ammonia C. False neurotransmitters D. Serotonin Question 17 Ross A. is a 38-year-old who has just had a kidney transplant. The AGACNP knows that, due to the characteristic and anticipated response of transplanted kidneys, the patient requires: A. Aggressive rehydration B. Controlled hydration C. Hypertonic rehydration D. Isotonic rehydration Question 18 Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is ―really wrong.‖ She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for

a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause? A. Abdominal radiographs B. CT scan of the abdomen with contrast C. Right upper quadrant ultrasound D. A HIDA scan Question 19 Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didn’t want to go to the emergency room because he didn’t want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes: A. Proper cleansing and covering of the laceration, along with antibiotic therapy B. Local anesthesia, cleansing, and wound exploration for foreign bodies C. Local anesthesia, cleansing, and suture repair D. Cleansing, covering, antibiotic therapy, and tetanus prophylaxis Question 20

T. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600/μL. The AGACNP suspects: A. Dissecting aortic aneurysm B. Acute pancreatitis C. Perforated peptic ulcer D. Mallory-Weiss tear Question 21 A 42-year-old woman presents to the emergency department after being raped. The AGACNP examines her and realizes that the patient’s husband is the rapist. The patient does not want to press charges and wants to return home with her husband. The AGACNP’s initial action should be to: A. Report the physical assault to law enforcement B. Have the patient sign a release to go home with her husband C. Consult psychiatry for a psych hold D. Provide counseling to the patient regarding her options

Question 22 M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she is afraid it won’t go away on its own. She denies any nausea or vomiting, and she cannot remember precisely when her last bowel movement occurred; probably it was a few days ago. She reports that she is ―always‖ constipated. On physical examination, she is tachycardic but otherwise has normal vital signs; her abdomen is tensely rigid, but no point tenderness to palpation is appreciated. The entire abdomen percusses as tympanic—there is no distinct dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent. There is rebound tenderness to palpation. The AGACNP suspects: A. Perforated bowel B. Peritonitis C. Ischemic bowel D. Intestinal abscess Question 23 C. V. is a 70-year-old African American male patient who presents for surgical consultation. His history includes 4 months of severe hypertension that has been poorly responsive to medication. He also complains of intermittent pounding headaches, palpitations, and a vague sense of anxiety with tremors. A 24-hour urine demonstrated elevated metanephrines. The AGACNP recognizes

that this patient has a: A. Malignant hyperthyroidism B. Catecholamine-secreting tumor C. Pituitary adenoma D. Hyperaldosteronism Question 24 The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature? A. Pyuria B. Fever C. CVA tenderness D. Gross hematuria Question 25 B. T. is a 49-year-old male who has been admitted for the management of an episode of diverticulitis. This is his fifth hospitalization this year, and in previous hospitalizations he has had both abscess and stricture as a consequence of his disease. His treatment this hospitalization should include: A. Extended-spectrum antibiotics B. Surgical consultation for colectomy C. Expectant treatment with nonabsorbable antibiotics

D. Colonoscopy Question 26 Based upon an understanding of the normal relationship between gastrin levels and acid secretion, the AGACNP recognizes that which of the following combinations is almost diagnostic of gastrinoma? A. Hypogastrinemia and acid hyposecretion B. Hypergastrinemia and acid hyposecretion C. Hypogastrinemia and acid hypersecretion D. Hypergastrinemia and acid hypersecretion Question 27 The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNR—the patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here? A. Veracity and beneficence B. Beneficence and nonmalfeasance C. Autonomy and beneficence

D. Justice and autonomy Question 28 R. S. is a 66-year-old female with Cushing’s syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates: A. Rapid reversal of symptoms, with good pituitary function B. Transient rebound release of remaining pituitary hormones C. Markedly improved dexamethasone suppression test D. Hyponatremia and compensatory SIADH Question 29 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 Question 30

N. C. is a 60-year-old female with primary hyperaldosteronism. She has been referred to your service for surgical management. Anticipated findings on clinical history would include: A. Palpitations, headaches, and sweating B. Polyuria, weakness, and paresthesias C. Dry skin, straie, and unplanned weight loss D. Early satiety, tremors, and fatigue Question 31 Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower quadrant. She has had this pain before and says she usually takes antibiotics and it goes away. However, this time it seems worse, and she has had it for 4 days even though she says she started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting but says she simply isn’t hungry. She had a little diarrhea yesterday but no bowel movements today. She has a temperature of 100.9°F and a pulse of 104 bpm, respirations of 20 breaths per minute, and a blood pressure of 94/60 mm Hg. She has some discomfort to deep palpation in the left lower quadrant. The AGACNP suspects: A. Irritable bowel syndrome B. Inflammatory bowel disease C. Diverticulitis D. Appendicitis

Question 32 In the majority of cases, the first clinical manifestation of physiologic stress ulcer is: A. Epigastric pain B. Change in mental status C. Fever D. Hemorrhage Question 33 A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about: A. Lactulose taken 20 g PO daily B. Spironolactone taken 100 mg PO daily C. Protein intake of 50 g daily D. Zolpidem taken 10 mg PO qhs. Question 34 R. R. is a 61-year-old male patient who presents with a chief complaint of fever and urinary symptoms. He was in his usual state of good health when for no apparent reason he developed pain in his back and perineal region, as well as fever and chills. He presents as septic. He had

urinary hesitancy and decreased stream but now reports that he has not passed urine in more than 12 hours. Palpation of the lower abdomen is consistent with bladder distention. The AGACNP knows that which of the following is contraindicated in this circumstance? A. Digital prostate examination B. Urinary catheterization C. Fluoroquinolone antibiotics D. Drainage of prostate abscess Question 35 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: A. Cyclosporine B. Azathioprine C. Methylprednisolone D. Sirolimus Question 36 R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis?

A. CT scan with IV, oral, and rectal contrast B. CBC with WBC differential C. Colonoscopy D. Barium enema Question 37 Ms. O’Reilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively? A. All medications should be taken up to and including the morning of surgery B. The beta blocker may be taken up until the day of surgery, metformin should be held the day of surgery, and the remaining medications should be d/c’d 5–7 days before surgery C. Warfarin should be held 5 days before surgery; all other medications may be taken through the morning of surgery D. Metformin should be held if the morning blood sugar is < 200 mg/dL; all other medications except warfarin may be given the day of surgery Question 38 Mr. Novello is an 81-year old male patient who presents with crampy abdominal pain in the hypogastrum and a vague history as to his last normal bowel movement. Physical examination

reveals distention and high-pitched bowel sounds. The patient says he has never has this kind of problem before and denies any history of abdominal surgery. Abdominal radiographs reveal a frame pattern of colonic distention. The AGACNP considers: A. A stimulant laxative to relieve bowel contents B. Carcinoma of the bowel as a leading diagnosis C. Decompression of the colon with rectal tube D. Angiography to rule out mesenteric ischemia Question 39 Jane S. is a 35-year-old female patient who is at 30 weeks gestation. She is being followed regularly for prenatal care and has always been healthy; she just had an office visit and was told everything was fine. Tonight she presents to the emergency room complaining of significant pain in the upper abdomen. Her vital signs reveal a temperature of 98.4°F, pulse of 110 bpm, respirations of 20 breaths per minute, and blood pressure of 144/90 mm Hg. A urinalysis reveals proteinuria, and a metabolic panel is significant for increased transaminases. Her hemogram is normal, but the CVC reveals platelets of 85,000. The AGACNP knows that which of the following must be evaluated as a cause of her abdominal pain? A. HELLP syndrome B. Placental abruption C. Spontaneous hepatic rupture D. Preterm labor Question 40

Which of the following statements is true with respect to adrenal tumors that produce gender symptoms? A. Feminizing adrenal tumors are almost always carcinomas B. Feminizing adrenal tumors are the most common type of adrenal tumor C. Virilizing tumors in women are most often localized to the adrenal cortex D. Virilizing adrenal tumors are more likely to be malignant in children Question 41 G. D. is a 13-year-old male patient who has a history of recurrent fever and flank pain. His parents traditionally are not believers in the health care system, and he has not been seen by a health care provider for many years. Today he has fever, chills, and costovertebral angle tenderness. Urinalysis reveals findings consistent with acute urinary infection. The AGACNP treats the patient for pyelonephritis and considers which study to evaluate for vesicoureteral reflux? A. Bilateral renal ultrasound B. CT scan of the abdomen and pelvis C. Voiding cystourethrograpy D. Radioisotope scanning Question 42 In which form of hypospadias should circumcision be deferred in order to preserve the prepuce

for later surgical repair? A. Ventral displacement B. Proximal displacement C. Midscrotal hypospadias D. Meatus proximal to the corona Question 43 T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation? A. A temperature of 101.5°F B. A leukocyte count of 18,000/μL C. A palpable gallbladder D. A positive Murphy’s sign Question 44 Achalasia is a risk factor for: A. Squamous cell carcinoma B. Gastroesophageal reflux disease C. Esophageal atrophy D. Malabsorption syndromes

Question 45 Carolyn C. has a history of Crohn’s disease and has been managed with immunologic agents, with moderate success. Today she presents with severe abdominal pain that comes and goes in waves; it started shortly after she ate a little bit of cottage cheese and crackers. This has never happened before with her Crohn’s disease. She has difficulty localizing the pain but seems to indicate the general area of the umbilicus. She had one episode of diarrhea this morning. Abdominal examination is nonspecific, producing mild tenderness on palpation. Plain abdominal films reveal a dilated small bowel with air fluid levels. The AGACNP suspects: A. Perforated small bowel B. Ulceration through the thickness of small bowel C. Small bowel obstruction D. Gastroenteritis Question 46 S. B. is a 41-year-old female who presents complaining of constipation. She says she has never had problems with bowel movements in the past, although she has heard that constipation is common among women. She says that for the last month or so she has been lucky to have three bowel movements a week, and even when she has one, she doesn’t always feel empty. A review of systems is otherwise negative, and she denies taking any new medications. She denies depression or any mood disorders—she says she actually is very happy and has always felt well, but this bowel problem is bothering her. She has tried over-the-counter products such as Metamucil® and stool softeners, but nothing has helped. Her abdominal, pelvic, and rectal examinations are normal—there are good bowel sounds, no organomegaly, and no discomfort on

palpation. The AGACNP considers ordering: A. Stool for occult blood B. Colonic transit assessment C. Contrast CT of the abdomen D. Plain film radiography Question 47 Neoadjuvant chemotherapy treatment for cancer is given to facilitate surgical resection. When the outcomes of cancer therapies are evaluated, the terms complete response and partial response often are used. Partial response means that: A. 50% of the patients treated with a given regimen demonstrate remission B. 50% of the patients treated survive to the 5-year point C. The tumor mass has reduced by > 50% D. In 50% of cases, the tumor converts from unresectable to resectable Question 48 In the preoperative assessment of a patient for the likelihood of postoperative risk, ascorbic acid deficiency, anemia, and volume contraction are all risk factors for: A. Prolonged intubation B. Thromboembolism C. Delayed wound healing

D. Atelectasis Question 49 Mr. Thornton is a 55-year-old man who is having an outpatient cardiac workup for the evaluation of exertional chest pain. He is not having chest pain now, but over the last several months he has had episodes of intermittent chest tightness and shortness of breath with mild to moderate exertion, such as when carrying heavy bags of groceries from the car to the house. His 12-lead ECG today reveals Q waves that range from 2 to 3 mm wide and 3–4 mm deep in leads V1 through V5. There are no other abnormal findings. This suggests that Mr. Thornton: A. Is having anterior wall ischemia B. Is having an anterior wall infarction C. Has a history of anterior wall NSTEMI D. Has a history of anterior wall STEMI Question 50 Which of the following types of aortic aneurysms requires immediate surgical intervention? A. Type A B. Type B C. Descending D. Symptomatic

Question 51 When examining a patient with abdominal pain, the AGACNP knows that tenderness to percussion is analogous to: A. Tympany B. Guarding C. Rebound tenderness D. Somatic pain Question 52 Janet is a 54-year-old female who is in the ICU following hepatic resection due to metastatic disease. She is expected to move to a general medical floor today. Morning labs are as follows: serum bilirubin approximately 2 g/dL, albumin 3.1 g/dL, and prothrombin time 20 seconds. AST and ALT are 85 and 99 respectively. The appropriate response would be to: A. Cancel the transfer and keep her in the ICU B. Infuse albumin and fresh frozen plasma C. Repeat the labs the next day D. Prepare for reoperation Question 53 Lester R. is a 58-year-old male who is being evaluated for nocturia. He reports that he has to get up 2 to 3 times nightly to void. Additional assessment reveals urinary urgency and appreciable