NURS 6560 FINAL EXAM QUESTIONS WITH ANSWERS CORRECTLY VERIFIED, Exams of Nursing

Download NURS 6560 FINAL EXAM QUESTIONS WITH ANSWERS CORRECTLY VERIFIED and more Exams Nursing in PDF only on Docsity! NURS 6560 FINAL EXAM QUESTIONS WITH ANSWERS CORRECTLY VERIFIED 1. Q #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 13.Q #: Acute hepatitis A is usually diagnosed by: By the constitutional symptoms Within 2 weeks of exposure Detection of IgM-Anti- HAV Jaundice 14.Q #: 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 #: 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 #: 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 Casting 17.Q #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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. daily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s management is to: Continue the current regimen D/C the spironolactone and begin a loop diuretic Add a loop diuretic to the spironolactone Proceed to large- volume paracentesis 33.Q #: The AGACNP knows that following bilateral total adrenalectomy, the patient will require: Prednisone 15 mg qam and 10 mg qpm Tapering of IV hydrocortisone, beginning with 100 mg IV q8h on postoperative day 1 Initial fludrocortisone replacement, tapered off once maintenance hydrocortisone dose is achieved Individualized replacement of corticosteroid, mineralocorticoid, and androgen hormones 34.Q #: Josh is a 14-year-old male patient who presents for evaluation of blurred vision. His only significant injury is that over the weekend he was playing baseball and was hit in the side of the head by a flying ball. The hit was hard enough to knock him down, but he did not lose consciousness and had no remarkable symptoms. Now on Wednesday he presents with a dull headache that seems to be getting worse, and his mom wants to have him evaluated. Neurologic examination reveals a sluggish pupillary response. CT scan of the head reveals a 1 cm epidural hematoma. The AGACNP knows that the best approach to management would be: Cautious observation An osmotic diuretic Surgical consultation Emergency evacuation 35.Q #: Mary W. is a 39-year-old female who presents with persistent abdominal discomfort. She denies actual pain but says she has this persistent sense of fullness in her abdomen that feels like it would go away if she could have a bowel movement. This finding is known as: Somatic pain Gas stoppage sign Small bowel obstruction Large bowel obstruction 36.Q #: Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural football game and comes to the ER complaining of severe pain. Tim tells you that he was 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 50.Q #: The AGACNP rounds on his brain injury patient and recognizes the development of progressive bradycardia, hypertension, and irregular respiratory pattern. This is known as Cushing’s triad and suggests: Uncal herniation Increased intracranial pressure Brainstem compression Subarachnoid hemorrhage 51.Q #: 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: Proper cleansing and covering of the laceration, along with oral antibiotic therapy Local anesthesia, cleansing, and wound exploration for foreign bodies Local anesthesia, cleansing, and suture repair Cleansing, covering, antibiotic therapy, and tetanus prophylaxis 52.Q #: A 49 year old female is seen for sudden onset severe abdominal pain 10/10. On further Q #ing you learn that she has experienced epigastric pain for several months after eating, which has resulted in an 11 pound weight loss. She does not take any other medications. On physical exam you note she has a low grade fever of 100.1, HR 124, RR 25 and BP is 116/72. The abdomen is rigid and there are no bowel sounds. Abdominal plain film shows free air under the diaphragm. What is your diagnosis? ruptured gallbladder ruptured spleen perforated duodenal ulcer ascites 53.Q #: 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. What is the leading diagnosis for this patient? Diverticuliti s Crohns Disease Appendiciti s Irritable small bowel disease 54.Q #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: to obey commands The patient's eyes do not respond, they are confused and do not follow commands. 70.Q #: L. S. is a 49-year-old female with a history of colorectal cancer for which she has had surgical resection and chemotherapy. She presents with profound abdominal pain. She has not vomited, and she is not certain when she had her last normal bowel movement; her bowel habits have been irregular for some time. A CBC demonstrates a mild microcytic anemia but is otherwise normal; her WBC differential is normal. Results of a metabolic panel support minor volume contraction but show no significant electrolyte abnormalities. Abdominal radiographs demonstrate dilation of the proximal colon, air fluid levels, and a complete absence of air in the rectum. The AGACNP diagnoses the patient with: Perforated colon Paralytic ileus Complete bowel obstruction Intestinal volvulus 71.Q #: Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural football game and comes to the ER complaining of severe pain. Tim tells you that he was setting up to pass the football when he was tackled and he immediately felt his knee "pop" and buckle as he fell. Which of the following diagnostics would the AGACNP order first? Plain radiographs MRI of his knee CT scan Diagnostic arthroscopy 72.Q #: 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? HELLP syndrome Placental abruption Spontaneous hepatic rupture Preterm labor 73.Q #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 #: 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 student was vaccinated for hepatitis B, but is not immune. 88.Q #: A 55-year-old man with a past medical history of hypertension and hyperlipidemia presents to your office with an acute onset of fevers, chills, dysuria, urinary frequency and right CVA tenderness. On exam he appears to be moderately ill, with a temperature of 39.3°C, pulse of 105/min and a blood pressure of 115/60mmHg. His cardiopulmonary and abdominal exam are negative. A urine dip in the office reveals 2+ blood, 2+ leukocytes and negative nitrates. Of the following tests, which is most likely to lead to the correct diagnosis? Urine culture Renal ultrasound Blood cultures CT scan of the abdomen 89.Q #: S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 g/dL, an MCV of 72 fL and a platelet count of 65,000/µL; the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include: Splenectomy Monoclonal antibody therapy such as rituximab Prednisone 60 mg daily until platelets normal Avoidance of elective surgery and nonessential medications 90.Q #: Elliot is a 47-year-old male who is being treated for throat cancer with combination therapy that includes radiation. He is asking Q #s about what adverse effects he may anticipate. The AGACNP advises Elliot that the most significant toxic effects in the acute / early postradiation period are: A product of mucositis and include yeast superinfection, desquamation, and pain Nephrotic syndrome and organ failure More commonly permanent than toxic effects of other cancer treatments Atrophy and burn, with subsequent dysfunction of the area surrounding targeted tissues 91.Q #: The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature? Pyur ia Feve r CVA tenderness Gross hematuria 92.Q #: 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 #: 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 #: Acute hepatitis B is diagnosed by: Presence of HAV-IgM Detection of HbsAg Anti-HBc- IgM B and C 95.Q #: 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 #: 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 #: 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 # truthfully Consult the attending physician Ask the daughter to leave the bedside Tell the patient you do not have any information 98.Q #: 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