NURS 6560 Midterm exam-with 100% verified solutions-2024-2025.docx, Exams of Nursing

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NURS 6560 Midterm exam-with 100% verified

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Question 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. Anemia 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. Obstructive 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. A. 2 B. 4 C. 6 D. 8

Question 10 Mitch C. is a 39-year-old male who is brought to the ED by paramedics. According to the report of a neighbor, Mitch was distraught over a breakup with his fiancée and attempted to commit suicide by mixing some chemicals from under his kitchen sink and drinking them; afterward he changed his mind and knocked on his neighbor’s door asking for help. Mitch is awake but stuporous, and the neighbor has no idea what he drank. Visual inspection of his mouth and oropharynx reveals some edema and erythema. He is coughing and has large amounts of pooling saliva. Mitch is not capable of answering questions but he appears in pain. Endoscopy reveals full thickness mucosal injury with mucosal sloughing, ulceration, and exudate. The AGACNP knows that the appropriate course of treatment must include: A. At least 6 hours of observation in the emergency department B. Periodic esophagram C. Aggressive fluid resuscitation D. Esophagogastrectomy Question 11 Jared V. is a 35-year-old male who presents for evaluation of a dry cough. He reports feeling well overall but notices that he gets out of breath more easily than he used to when playing soccer. A review of systems yields results that are essentially benign, although the patient does admit to an unusual rash on his legs. Physical examination reveals scattered erythematous

nodules on both shins. There is no drainage, discomfort, or itch. Additionally, diffuse, mildly enlarged lymph nodes are appreciated bilaterally. Results of a comprehensive metabolic panel and complete blood count are within normal limits. Twelve-lead ECG reveals sinus bradycardia at 58 bpm. Chest radiography reveals bilateral hilar and mediastinal lymphadenopathy. The AGACNP suspects: A. Bronchiectasis B. Pulmonary fibrosis C. Sarcoidosis D. Lung carcinoma Question 12 Mrs. Miller is a 44-year-old female who is on postoperative day 1 following a total abdominal hysterectomy. Her urine output overnight was approximately 200 mL. The appropriate response for the AGACNP would be to order: A.A urinalysis and culture B. 1 liter of NSS over 8 hours C. Encourage increased mobility D.Liberalize salt in the diet

Question 13 All of the following are risk factors for spontaneous pneumothorax except: A. Connective tissue disease B. Scuba diving C. Chronic obstructive pulmonary disease (COPD) D. Central line insertion Question 14 The AGACNP is going over preoperative information and instructions with a patient who is having a major transverse abdominal procedure tomorrow morning. The patient is very nervous and is asking a lot of questions. The AGACNP prescribes a sleeping agent because he knows that anxiety and sleeplessness may: A. Lead to hypoxia due to hyperventilation B. Increase the physiologic stress response postoperatively C. Contribute to risk of delirium and prolonged length of stay D. Decreasep.o. intake and produce nutritional risk Question 15

In a patient with thyroid nodules, which of the following is the diagnostic study of choice to rule out thyroid cancer? A. Radioiodine scanning B. Percutaneous needle biopsy C. CT scan D. Ultrasound Question 16 When counseling a patient about treatment modalities for achalasia, the AGACNP advised that which of the following is the treatment of choice? A. Calcium channel antagonists B. Intrasphincter botulinum injection C. Pneumatic dilation D. Myotomy and partial fundoplication

Question 17 Mr. Liu is a 52-year-old male who has a history of thyroidectomy. He presents complaining of numbness and tingling in his legs and feet and generalized fatigue. Physical examination reveals a positive Chvostek’s sign. Which of the following laboratory studies should be ordered first? A. Renal function tests B. Parathyroid hormone C. Calcium D. Magnesium Question 18 V. is a 75-year-old male patient who, during a recent wellness evaluation, was found to have a new onset grade II/VI crescendo-decrescendo cardiac murmur at the 2nd intercostal space, right sternal border. He is symptom free and reports no limitations to his usual daily activity. He specifically denies activity intolerance or near syncope, and he is very active physically. Echocardiography reveals a mild aortic calcification. The AGACNP knows that ongoing management for R. V. must include: A. Annual or biannual serial echocardiography B. Modification of activity level

C. Baseline cardiac catheterization D. Statin therapy Question 19 The lower esophageal sphincter is characterized by periods of intermittent relaxation called transient lower esophageal sphincter relaxations. These relaxations are independent of the relaxation triggered by swallowing and are the most common cause of: A. Physiologic reflux B. Symptomatic esophagitis C. Barrett’s metaplasia D. Esophageal carcinoma Question 20 While reviewing morning labs on a postoperative patient, the AGACNP notes that the patient’s basic metabolic panel is as follows: Na+ 132 mEq/L K+ 4.6 mEq/L Cl- 87 mEq/L CO2 25 mEq/ L A normal saline infusion is ordered in an attempt to avoid: A. Hyperkalemia B. Hypernatremia

C. Metabolic alkalosis D. Metabolic acidosis Question 21 W. is a 49-year-old man who presents for evaluation. He has a long history of alcohol and tobacco use, with a 65-year pack history and an admitted 14-drink-per-week alcohol habit. He is getting worried because he can no longer swallow his bourbon. He is not a good historian but he does admit to a 1+ year history of bloating, heartburn, and progressive difficulty swallowing food. He didn’t worry too much about his symptoms until he stopped being able to swallow bourbon. He thinks he has lost approximately 15 lbs in the last year. He denies any blood in his stool and has not had any vomiting. The AGACNP knows that the most likely diagnosis is: A. Zenker’s diverticulum B. Achalasia C. Esophageal carcinoma D.Hiatal hernia Question 22 Which of the following treatment modalities has no role in the treatment of shock? A. Lactated Ringer’s

B. Fresh frozen plasma (FFP) C. Vasopressors D. Colloid solutions Question 23 The development of coronary artery disease (CAD) and, ultimately, plaque formation is a multifactorial process that includes endothelial injury from hypertension, cigarette smoking, and dyslipidemia. These events lead to endothelial cell dysfunction, which is theorized to result in: A. Decreased nitric oxide production B. Smooth muscle cell atrophy C. Collagen degradation D. Enlarged arterial lumen Question 24 Mr. Comstock is a 71-year-old male who presents with a general sense of feeling weak and unwell; he thinks he has the flu even though he received a flu vaccination this year. He describes a vague collection of symptoms, including weakness, nausea, dizziness, and “getting out of breath” very easily. He says he can barely climb the steps anymore without stopping to rest. Of the possible differential diagnoses, coronary artery disease (CAD) is high among the

probabilities because of his age and gender. His physical examination is unremarkable except that he appears weak. His vital signs are as follows: temperature 98.0°F, pulse 100 bpm, respiratory rate 16 b.p.m., and BP 178/100 mm Hg. A chest radiograph is within normal limits with no acute pulmonary infection. A 12-lead ECG reveals inverted T waves in leads V1 to V5. The AGACNP is suspicious that most of his symptoms are: A. Psychosomatic B. Early congestive heart failure (CHF) C. Anginal equivalents D. Normal age-related changes Question 25 Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade V/VI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes: A. Acute mitral valve regurgitation B. Acute aortic valve regurgitation C. Acute cardiac tamponade

D. Acute pulmonary embolus Question 26 Mr. Nelson is a 65-year-old male who has been advised that he is a candidate for coronary artery bypass grafting. He has been doing some internet research and is asking about whether or not he should have a “beating heart” bypass. Regarding off-pump coronary bypass grafting, the AGACNP advises Mr. Nelson that: A. There is a slightly higher risk of neurologic complications B. Long-term results suggest that the grafts do not stay open as long as those in traditional bypass grafting C. The incidence of off-pump bypass grafting has increased significantly in the last 10 years D. The off-pump procedure is considerably more expensive but is correlated with better long- term outcomes Question 27 Mrs. McCallum is a 48-year-old female who presents for evaluation of a vague set of gastrointestinal symptoms. She feels generally well and has always been healthy, but lately she has had a lot of heartburn and a sense of reflux in her throat. Most recently she has had a recurring sense of food getting stuck in her throat. The AGACNP knows that which diagnostic study should be performed first?

A. Barium swallow B. Upper endoscopy C. Esophageal manometry D. Ambulatory pH monitoring Question 28 Mr. Key is a 53-year-old male patient who developed empyema following a serious bout of bacterial pneumonia. He presented as septic and was started immediately on intravenous antibiotics and drainage of the sinus cavity. Forty-eight hours later, he is much improved clinically and drainage has receded. The next step in his care would be: A.A CT scan B. Eloesser’s procedure C. Decortication D. Reexpansion Question 29 Mrs. Bowers is a 41-year-old patient who requires surgical management of osteomyelitis. She has a long history of methamphetamine use and has a BMI of 17.9 kg/m2. She clearly is

nutritionally depleted and volume contracted, but she has no clear chronic medical history except for unmedicated hypertension, which may be due to her chronic stimulant use. She denies alcohol use but admits to a 1½ pack a day cigarette habit. A primary postoperative concern for Mrs. Bowers is: A.Excess bleeding B. Thromboemboli development C. Poor wound healing D. Renal failure Question 30 The congenital diaphragmatic hernia that occurs more often in women and does not usually produce symptoms until midlife is known as: A. Zenker’s hernia B. Bochdalek’s hernia C. Morgagni’s hernia D. Atraumatic hernia Question 31

B. is a 67-year-old male who is being discharged following inpatient management for unstable angina. S. B. did not know that he had coronary artery disease (CAD) and in fact had not seen a health care provider for many years. While reviewing his lifestyle habits, he admits that he is obese, has poor eating habits, does not engage in any purposeful physical activity, and smokes two packs of cigarettes daily. He verbalizes that he is grateful that this was not a “real” heart attack and does not seem receptive to lifestyle management strategies. The AGACNP advises him that it is important to take this “warning” attack seriously because: A. 10% of patients with unstable angina will die of cardiovascular disease within 6 months B. 25% of patients with unstable angina will develop congestive heart failure within 6 months C. 65% of patients with unstable angina will have an ST elevation MI within 1 year D. 90% of patients with unstable angina will have cerebrovascular symptoms within 1 year Question 32 According to the American College of Surgeons (ACS), who among the following patients should have a chest radiograph as part of preoperative assessment? A. All patients > 40 years of age B. All patients who smoke cigarettes C. All patients having thoracic procedures D. All patients with cardiac disease

Question 33 According to the Carpentier classification scheme of mitral valve regurgitation, a type I regurgitation is most likely due to: A. Cardiomyopathy B. Excessive leaflet motion C. Ruptured papillary muscles D. Rheumatic heart disease Question 34 V. is a 37-year-old female who is admitted via the emergency room after her roommate called emergency medical services (EMS). She has no significant medical history and does not know what is wrong with her. She has been feeling generally unwell for the last few days, and today she had an episode of confusion that scared her roommate to the extent that the roommate called EMS. Her physical examination reveals a temperature of 101.9°F, pulse of 110 bpm, respiratory rate of 20 breaths per minute, and blood pressure of 92/58 mm Hg. A comprehensive metabolic panel reveals a slightly elevated blood urea nitrogen (BUN)/creatinine but otherwise is normal. A white blood cell differential reveals a leukocyte count of 14,000 cells/μL with neutrophils of 83%. The AGACNP knows that these values are consistent with: A. Systemic inflammatory response syndrome (SIRS)

B. High-output septic shock C. Neurogenic shock D. Multiple organ dysfunction syndrome (MODS) Question 35 Which shock state is worsened in the setting of mechanical ventilation? A. Septic B. Cardiac compressive C. Neurogenic D. Cardiogenic Question 36 B. is a 41-year-old male being admitted for surgical reduction of an open femur fracture sustained in a multiple vehicle collision. Preoperative assessment reveals that he is on beta- adrenergic antagonists after having been diagnosed with coronary artery disease approximately 1 month ago. He admits that he feels a little better but says he still gets pain in his chest when he exerts himself. He is pain free now. Vital signs are as follows: temperature 98.1°F, pulse 88 bpm, respiratory rate 18 breaths per minute, and blood pressure 142/86 mm Hg. The AGACNP knows that which of the following is the most important action before R. B. goes to the operating room?

A.A cardiology consultation B. Blood pressure control C. Resuming beta-adrenergic antagonists D. Pain control Question 37 Cholesteatoma is a condition characterized by a collection of desquamated keratin leading to bony erosion in the ossicular chain and inner ear. The goal of surgery in cholesteatoma is: A. Production of a dry ear B. Preservation of sensorineural hearing C. Debridement of infection D. Restoration of the tympanic membrane Question 38 The AGACNP knows that when managing a patient with acute cardiogenic shock after myocardial infarction, all of the following pharmacologic agents may be used except: A. Opioids B. Diuretics

C. Beta-adrenergic antagonists D. Anticholinergics Question 39 Mr. Baer is a 79-year-old man who is being admitted for a carotid endarterectomy. While performing his preoperative evaluation, the AGACNP appreciates two positive answers to the CAGE screening questionnaire. This is an indication for: A. Perioperative benzodiazepines for withdrawal syndrome B. Daily multivitamin and 100 mg of thiamine perioperatively C. Further diagnostic evaluation for alcoholism D. Delay of operation until completion of detoxification Question 40 According to the American College of Cardiology Foundation and the American Heart Association (ACCF/AHA), the recommendation regarding antiplatelet therapy in patients with cardiovascular disease preoperatively is that: A. Antiplatelet therapy should be held for 10 days preoperatively B. Cardiac consultation is required before an operation in patients who are on antiplatelet therapy

C. Medications should be continued unless concerns about hemostasis are significant D. Antiplatelet therapy should be initiated in all high-risk cardiac procedures Question 41 Mr. Austin is a 64-year-old male who has a long history of mitral valve stenosis. His condition has developed to the extent that he has symptomatic congestive heart failure, and due to a variety of comorbidities he is not a candidate for surgery. Ongoing medical therapy for Mr. Austin should include: A. Anticoagulants B. Diuretics C. Antibiotics D. Inotropes Question 42 The progression of coronary artery plaque formation can lead to a variety of pathologic conditions. When subtotal plaque disruption occurs resulting in vasoconstriction, platelet activation, and embolization, it most commonly causes which clinical phenomenon? A. Endothelial cell dysfunction

B. Prinzmetal’s angina C. Transmural myocardial infarction D. Non-ST elevation myocardial infarction Question 43 D. is a 29-year-old male who presents with a chief complaint of profound dizziness for the past 2 to 3 days. Further clarification reveals that he is having brief but intense episodes of a sense of the room spinning. He denies any history of head injury or discharge from the ear. The vertigo is reproduced easily with cervical rotation. The AGACNP knows that the most likely cause is: A. Cerebral tumor B. Ménière’s disease C. Adverse drug effect D. Benign paroxysmal positional vertigo (BPPV) Question 44 P.T. is a 61-year-old male who is seen in follow-up. He was initially seen for evaluation of dysphagia. An endoscopy was negative for malignancy and subsequent esophageal manometry supported a diagnosis of esophageal achalasia. While discussing implications and treatment options with P.T., the AGACNP tells him that the primary complication of achalasia is:

A. Progressive esophageal discomfort B. Aspiration pneumonia C. Squamous cell carcinoma D. Long-term malabsorption problems Question 45 R. is a 51-year-old female who presents in shock following a penetrating injury to the spinal cord —her boyfriend reportedly stabbed her in the back with an unidentified kitchen utensil. The patient’s mental status is deteriorating, and her vital signs are as follows: temperature 97.2°F, heart rate 131 bpm, respirations 14 breaths per minute, and blood pressure 79/49 mm Hg. The AGACNP presumes neurogenic shock, with the injury likely: A. Not fully transecting the spinal cord B. At the level of T10 C. Precipitating sepsis D. Producing cardiovascular decompensation Question 46 Janet is a 34-year-old female with no significant medical history who is being evaluated for a planned uterine ablation. She has significant history of menorrhagia and has been unresponsive