NRNP 6560 Final Exam-with 100% verified solutions-2023-2024, Exams of Health sciences

Download NRNP 6560 Final Exam-with 100% verified solutions-2023-2024 and more Exams Health sciences in PDF only on Docsity! NRNP 6560 Final Exam-with 100% verified solutions-2023-2024 1. Q ANSWER: The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert the AGACNP for the possibility that the patient is over hydrated, thereby increasing the risk for increased intracranial pressure? A. BUN = 10 B. Shift output = 800 ml, shift input = 825 ml Unchanged weight C. Serum osmolality = 260 2. Q ANSWER: A patient who has been in the intensive care unit for 17 days develops hyponatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to: A. reduce serum osmolality by infusing a 5% dextrose in 0.2% sodium chloride solution B. reduce serum sodium concentration by infusing a 0.45% sodium chloride solution C. replenish volume by infusing a 0.9% sodium chloride solution D. replenish volume by infusing a 5% dextrose in water solution. 3. 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 4. 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 5. 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 6. 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 7. 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 8. 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 Casting 17.Q ANSWER: While consulting on a patient who is admitted with a chief complaint of abdominal pain, the AGACNP notes that the initial assessment described the pain as “colicky.” This means that the pain: Is a result of gas in the bowel Is intestinal in origin Is characterized by pain-free intervals Is sharp, intense, and nonradiating 18.Q ANSWER: All of the following are expected findings in a patient with a T10 fracture except: Paraplegia Fecal retention Priapism Inability to move fingers 19.Q ANSWER: 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: Dissecting aortic aneurysm Acute pancreatitis Perforated peptic ulcer Mallory-Weiss tear 20.Q ANSWER: 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? Veracity and beneficence Beneficence and nonmalfeasance Autonomy and beneficence Justice and autonomy 21.Q ANSWER: In myelodysplastic syndromes, the primary indications for splenectomy include: Major hemolysis unresponsive to medical management Severe symptoms of massive splenomegaly Sustained leukocyte elevation above 30,000 cells/µL Portal hypertension 22.Q ANSWER: Which of the following situations constitute a positive screening after a PPD (purified protein derivative) skin test for tuberculosis? A patient without risk factors who has a 13mm PPD skin test A patient with HIV who has a 3mm PPD skin test A homeless patient with a 9mm PPD skin test A patient with intravenous drug abuse (IVDA) who has an 11mm PPD skin test A healthcare worker who has a 6mm PPD skin test 23.Q ANSWER: When the patient with jaundice is evaluated, a careful history and physical exam often can help differentiate prehepatic, hepatic, and posthepatic causes. When the patient reports dark discoloration of the urine and light discoloration of the stool, the AGACNP is most suspicious for: Viral hepatitis Chronic alcoholism Extrahepatic obstruction Cholestasis 24.Q ANSWER: Jack R. is a 63-year-old male who is being seen today on rounds after being admitted for profound upper abdominal pain, nausea, and vomiting. He had markedly elevated serum amylase and lipase; he was diagnosed with pancreatitis and admitted for pain management and bowel rest. Today he feels better, but he is upset because he knows that pancreatitis is known as the “alcoholic’s disease.” He makes it clear that he is a religious man and that his religion forbids alcohol; he says he has never had an alcoholic drink in his life. The AGACNP reassures Jack that approximately 40% of cases of pancreatitis are caused by as well as a variety of other things, and that he will have a thorough diagnostic evaluation. hyperlipidemia gallstone disease genetic predisposition hypercalcemia 25.Q ANSWER: In neurogenic shock, patients are subjected to an abnormal dilation of venules and arterioles in response to failure of the autonomic nervous system. Treatment for neurogenic shock may include all of the following except: Trendelenburg Intravenous fluids Vasodilators Vasoconstrics 26.Q ANSWER: Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients? High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant There is a strong interest in developing corticosteroid-free posttransplant protocols Better results are demonstrated in corticosteroid-free protocols for second- transplant recipients Evidence supports corticosteroid-free rejection protocols 27.Q ANSWER: The comprehensive serologic assessment of a patient with Cushing’s syndrome is likely to produce which constellation of findings? Low potassium, high glucose, high white blood cell count High sodium, polycythemia, low BUN Low sodium, low potassium, high BUN High sodium, high chloride, high RBCs 28.Q ANSWER: A patient admitted for management of sepsis is critically ill and wants to talk with a hospital representative about donating her organs if she dies. She has a fairly complex medical history that includes traumatic brain injury, breast cancer, and dialysis-dependent renal failure. The patient is advised that she is ineligible to donate due to her: Renal failure Traumatic brain injury Systemic infection Breast cancer setting up to pass the football when he was tackled and he immediately felt his knee "pop" and buckle as he fell. You, as the AGACNP, know the most important information to obtain from Tim is: Insurance information Family history Social history What exactly was he doing when he got hurt 37.Q ANSWER: Mrs. Nguyen is an 84-year-old female who suffered a fall in her long-term care facility. After assessing possible reasons for her fall, a physical examination is performed to look for injuries. Mrs. Nguyen has significant pain in her left upper arm and limited range of motion in her left shoulder; a shoulder trauma series is ordered to evaluate for which type of injury that frequently occurs in these circumstances? Shoulder dislocation Scapular fracture Proximal humerus fracture Nursemaid’s elbow 38.Q ANSWER: A general principle in surgical oncology is that the best approach to curative surgery in a fixed tumor requires: En bloc resection Adjuvant therapies Neoadjuvant therapies Elective lymph node dissection 39.Q ANSWER: Intracranial pressure monitoring is instituted for a patient with a head injury. The patient’s arterial blood pressure is 92/50 mm Hg, and her intracranial pressure is 18 mm Hg. Using these values to calculate the patient’s cerebral pressure (CPP) the AGACNP determines: The CPP is adequate for normal cerebral blood flow The CPP is high and that ischemia and neuronal death are imminent The blood pressure should be increased to prevent cerebral hypoxia Lowering the patients blood pressure will reduce the intracranial pressure, increasing cerebral blood flow 40.Q ANSWER: Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1½ packs of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his usual state of good health until a couple of hours ago, when he developed this acute onset of severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so bad he finally came in. His vital signs are as follows: temperature 99.1°F, pulse 129 bpm, respirations 22 breaths per minute, and blood pressure 137/84 mm Hg. The abdomen is diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP anticipates that which of the following laboratory tests will be abnormal? A complete blood count and RBC differential Liver function enzymes Serum amylase, lipase, and glucose A basic metabolic panel 41.Q ANSWER: A. S. is a 31-year-old male who complains of gastric discomfort that he notices mostly on an empty stomach; for example, if he works late and does not have the opportunity to eat, he notices that it happens. It feels better when he eats something or even if he just take TUMS®. Physical examination reveals a generally healthy adult male with normal vital signs. There is a bit of mild discomfort with deep palpation to the epigastrum, but otherwise the abdominal exam is normal. The AGACNP know that the most useful laboratory analyses will include: Helicobacter pylori antibodies Chest radiography A white blood cell differential Vitamin B12 42.Q ANSWER: 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: Increased MCV Increased Hgb Increased platelets Increased albumin 43.Q ANSWER: 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: Perforated small bowel Ulceration through the thickness of small bowel Small bowel obstruction Gastroenteritis 44.Q ANSWER: A 30 year old female nurse comes to your office with complaints of epigastric pain that awakens her at night. She admits to being under a lot of stress at work and takes 2400 mg of ibuprofen for menstrual cramps and low back pain 5-6 times a week, especially after heavy lifting. She smokes a pack of cigarettes a day. Her physical exam is unremarkable but she does have positive heme stools. She is referred for an upper endoscopy which reveals a duodenal ulcer. Given this history,what is the most likely etiology of her ulcer? Non steroidal anti-inflammatory drug use Stress related ulcerations Heliobacter pylori infection Cigarette smoking 45.Q ANSWER: An open fracture is considered an orthopedic emergency. Emergency room management of open fracture must include: Immediate covering with iodine-soaked gauze Ceftriaxone and tetanus prophylaxis Proximal and distal exploration of the wound Removal of all bone fragments 46.Q ANSWER: Grant Pass is a 20 year old downhill skier for the U. S Olympic team. He was on a practice run in Salt Lake City and caught a ski tip on a mogul and became airborn and crashed into the padded barriers on the side of the course. He was momentarily stunned, but was walking around unassisted and was conversant when the ski patrol paramedics arrived. The paramedics placed him on a backboard and began to slowly ski down to the end of the course where an ambulance was waiting to take him to the local trauma center. When Grant was placed in the ambulance, the paramedics noted that Grant was somnolent and not responsive to verbal commands. They noted that his left pupil was dilated and sluggish to respond to light. Based on the above information, you, as the ACNP in the ER, suspect that Grant suffered which of the following? Basilar skull fracture Subdural lower quadrant. What is the leading diagnosis for this patient? Diverticuliti s Crohns Disease Appendiciti s Irritable small bowel disease 54.Q ANSWER: 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: Extended-spectrum antibiotics Surgical consultation for colectomy Expectant treatment with nonabsorbable antibiotics Colonoscopy 55.Q ANSWER: Sara S. is a 41-year-old patient who has just had a bone marrow transplant. The AGACNP knows that which medication will be used to decrease her risk of graft-versus-host reaction? Immune globulin Cyclosporine Prophylactic antibiotics Systemic corticosteroids 56.Q ANSWER: 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? Alpha-adrenergic antagonists Beta- adrenergic antagonists Arteriolar dilators 57.Q ANSWER: A 41-year-old male physician has a 6-week history of persistent painful, swollen, and stiff proximal interphalangeal joints, wrists, and ankles. Using a step wise progression model, Intravenous vasodilators which would be the first diagnostic test the AGACNP would order? Radiography of hand and wrist Check HLA – B27 Hepatitis B serology testing Rheumatoid factor and anti-nuclear antibody Joint aspirate for microcrystals 58.Q ANSWER: Mr. S., a 49-year-old male, is brought to the emergency room by his roommate who relates that the patient has been vomiting bright red blood for two days. He has a history of alcohol abuse. Current vital signs are as follows: Temp 99.2o F, heart rate 110 bpm (sinus tachycardia), blood pressure 90/60 mm Hg, resp 32 bpm. He is alert but lethargic and denies current abdominal pain. Which of the following is not indicated in the initial management of this patient? Immediate IV access Laboratory screening, type and crossmatch Endoscopy Crystalloid infusion 59.Q ANSWER: A 38-year-old patient presents with symptoms of L5 nerve root impairment that have been ongoing for 3 weeks despite conservative treatment. All of the following statements regarding this case are true EXCEPT: Normal findings on plain radiographs should be followed up with a CT Scan or MRI immediately The L5 level is one of the most likely levels for disk herniation Sensory findings may include diminished pain on the dorsum of the distal region of the foot Motor findings may include weakness on extension of the great toe Tendon reflexes are expected to be normal at the knee and ankle 60.Q ANSWER: 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? CT scan with IV, oral, and rectal contrast CBC with WBC differential Colonoscopy Barium enema 61.Q ANSWER: 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: Lactulose taken 20 g PO daily Spironolactone taken 100 mg PO daily Protein intake of 50 g daily Zolpidem taken 10 mg PO qhs. 62.Q ANSWER: 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? Temperature > 102°F White blood cell count > 14,000 cells/µL Vomiting Hematuria 63.Q ANSWER: A 32-year-old patient who underwent an open splenectomy for a ruptured spleen is preparing for discharge. An adult- gerontology acute care nurse practitioner reviews the potential complications with the patient. The nurse practitioner emphasizes which instruction to the patient? Continue antibiotics for 14 days Follow up with primary care provider for vaccinations No international travel for five years No weight lifting restrictions 64.Q ANSWER: When evaluating a patient with acute pancreatitis, which of the following physical or diagnostic findings is an ominous finding that indicates a seriously ill/potentially moribund patient? Severe epigastric pain with radiation to the back Abdominal guarding and rigidity Grey Turner sign Obturator sign 65.Q ANSWER: Ted is a 22 year old male who fell on his right shoulder 2 days ago during a martial arts class. He is complaining of inability to sleep on his right side and has pain whenever he tries to use his arm. He denies any sensory changes in his hand. Nothing seems to make it better, even the ibuprofen he has been taking several times a day. A 52-year-old male comes to the clinic in preparation for an overseas trip next year. He has already searched the internet and knows that Hepatitis A and Hepatitis B are endemic in the country that he will be visiting. What will you recommend to this patient? No immunizations are needed. It is highly unlikely that he’ll be exposed to hepatitis since he’s traveling with a tour group. Recommend Hepatitis C IgG to prevent getting an acute illness. Recommend two doses of Hepatitis A and 3 doses of Hepatitis B vaccine. Recommend one dose of Hepatitis A and Hepatitis B vaccine. 74.Q ANSWER: Mr. Warner is a 64-year-old male who presents with multiple skin lesions scattered about his head, neck, shoulders, and arms. They range in size from 3 mm to 1.2 cm. They do not hurt, burn, or itch, but they are rough to palpation—like sandpaper. Mr. Warner has a history of basal cell carcinoma × 3 and wants to know if these are also skin cancer. The AGACNP tells him that these lesions may be precancerous and are known as: Solar lentigo Bowen’s disease Actinic keratoses Atopic dermatitis 75.Q ANSWER: Brad Berry, a 30-year-old male, presents to the ED with the chief complaint of a red, hot, swollen, painful right knee. He first noticed the problem last night, and feels it has gotten worse over the past 14 hours.Your medical history reveals that Mr. Berry denies problems with any other joints or recent injury to his right knee. He is not sexually active and currently is attending seminary school. He denies urethral discharge or urinary symptoms, recent rash, IV drug use, chronic illness, or recent camping. His temperature is 102.2 F. Physical exam reveals normal general survey, cardiorespiratory and abdominal examination. The right knee is markedly swollen with + fluid wave. There are no inguinal lymph nodes palpated. Which of the following would be the first diagnostic test for the AGACNP to order? Right knee AP, lateral, and sunrise view radiograph Right knee joint synovial fluid examination Serum rheumatoid factor Serum erythrocyte sedimentation rate 76.Q ANSWER: The AGACNP screens a new admit patient for liver disease. Elevations of all of the following would confirm your suspicion that this patient has liver disease, EXCEPT unconjugated bilirubin conjugated bilirubin urine bilirubin aspartate aminotransferase 77.Q ANSWER: 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: Palpitations, headaches, and sweating Polyuria, weakness, and paresthesia Dry skin, straie, and unplanned weight loss Early satiety, tremors, and fatigue 78.Q ANSWER: 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? Abdominal radiographs CT scan of the abdomen with contrast Right upper quadrant ultrasound A HIDA scan 79.Q ANSWER: The AGACNP knows that early diagnostic findings consistent with rheumatoid arthritis include: Soft tissue swelling of the metacarpals Radiographic joint space narrowing Heberden's nodes Subungal hemorrhages 80.Q ANSWER: The ethical principle of veracity refers to: Telling the patient the truth Ensuring that the patient gets what he deserves The patient’s right to self determination The duty to do no harm 81.Q ANSWER: Mr. Huckabee is a 51-year-old male who had a CT scan of the abdomen to evaluate refractory left lower quadrant discomfort. The scan reported an incidental finding of cholelithiasis with calcified gallbladder. While counseling Mr. Huckabee about the results, the AGACNP advises that the appropriate approach to these findings is: No further evaluation indicated A surgical evaluation To treat with oral emulsification agents To follow annually with ultrasound 82.Q ANSWER: Mr. Miller is a 56-year-old male who is being managed for portal hypertension. The AGACNP knows that of the many causes of portal hypertension, alcoholic liver disease typically is the cause when the patient has: Elevated hepatic vein pressures Elevated transaminases Decreased prothrombin time Decreased alkaline phosphatase 83.Q ANSWER: 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: 50% of the patients treated with a given regimen demonstrate remission 50% of the patients treated survive to the 5- year point The tumor mass has reduced by > 50% In 50% of cases, the tumor converts from unresectable to resectable In a patient with a perforated duodenal ulcer, the most likely source of peritonitis is amylase gastric contents liver enzymes breaking down the mesentry blood 84.Q ANSWER: Ms. Teller presents with a chief complaint of weight loss. She reports an unplanned 10 lb weight loss over the last 5-6 months. She has no significant medical history, but review of systems reveals bilateral shoulder discomfort and some impaired range of motion -- she has trouble pulling clothing over her head. Over the last few months she has generalized upper body r CVA tenderness Gross hematuria 92.Q ANSWER: 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? Bilateral renal ultrasound CT scan of the abdomen and pelvis Voiding cystourethrograpy Radioisotope scanning 93.Q ANSWER: Maxine is being seen in follow-up after removal of an aldosteronoma. The AGACNP expects specifically that which of the following aldosterone-related abnormalities will be cured? Hypertensi on Hyponatre mia Hypokalem ia Hypoglyce mia 94.Q ANSWER: Acute hepatitis B is diagnosed by: Presence of HAV-IgM Detection of HbsAg Anti-HBc- IgM B and C 95.Q ANSWER: A 19-year-old woman presents to your office with a 3-day history of dysuria and foul-smelling urine. She also notes some suprapubic pressure and noted some chills and she thinks she had a fever yesterday. She reports no vaginal bleeding or discharge and reports no nausea or vomiting. She denies any significant past medical history. On exam she has a temperature of 38°C, a pulse of 105/min and a blood pressure of 120/75mmHg. Her abdominal exam reveals some suprapubic tenderness. Her back exam reveals no costovertebral angle tenderness. Urine dip demonstrates 2+ leukocytes. What should be done next? Admit the patient for empiric intravenous antibiotic therapy Start empiric oral antibiotic therapy Admit the patient for intravenous hydration therapy Check a urine culture and await results Check a CT of her abdomen/pelvis 96.Q ANSWER: Brad Berry, a 30-year-old male, presents to the ED with the chief complaint of a red, hot, swollen, painful right knee. He first noticed the problem last night, and feels it has gotten worse over the past 14 hours.Your medical history reveals that Mr. Berry denies problems with any other joints or recent injury to his right knee. He is not sexually active and currently is attending seminary school. He denies urethral discharge or urinary symptoms, recent rash, IV drug use, chronic illness, or recent camping. His temperature is 102.2 F. Physical exam reveals normal general survey, cardiorespiratory and abdominal examination. The right knee is markedly swollen with + fluid wave. There are no inguinal lymph nodes palpated. In your immediate consideration of differential diagnoses for Mr. Berry's knee problem, which of the following would be the least likely? Trauma Septic arthritis Rheumatoid arthritis Acute gout 97.Q ANSWER: The AGACNP is evaluating a 79-year-old male in the emergency department. He is extremely anxious and requires significant reassurance that he is not going to die. He subsequently rules in for an anterolateral myocardial infarction. His daughter asks you not to tell the patient the truth. She is afraid that it will compound his anxiety, agitate him, and worsen his condition. The patient becomes upset and demands to be told precisely what his condition is. The most appropriate action would be to: Answer the patient’s Q ANSWER truthfully Consult the attending physician Ask the daughter to leave the bedside Tell the patient you do not have any information 98.Q ANSWER: Mrs. Knickerson is a 77-year-old female admitted for management of urinary tract infection. Her complete blood count reveals a white blood cell differential as follows: Total leukocyte count 57,000 cells/uL, neutrophils of 16%, lymphocytes 77%, monocytes 3%, eosinophils 3% basophils 1%. The AGACNP is suspicious for: Urosepsis Immunosuppre ssion Drug-induced leukocytosis Chronic lymphocytic leukemia 99.Q ANSWER: A 54-year-old man with a history of metastatic lung cancer comes to the office because he had sudden onset of pain in the lower back and both legs 24 hours ago. Which of the following findings would indicate that a lumbar disk herniation rather than a cauda equina syndrome is the cause of his pain? Saddle anesthesia Bilateral weakness of legs Impotence Pain radiating to one buttock Urinary incontinence 100. Q ANSWER: The Ranson’s Criteria of Severity is a morbidity and mortality index used to predict risk in patients with acute pancreatitis. A Ranson score of 3 indicates: Endoscopic sphincterotomy Surgical intervention Severe disease Peritoneal lavage