NURS 6560 Final Exam
Question 1A 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 highcortisol
C. High ACTH and lowcortisol
D. High ACTH and high cortisol
Question 2Pneumatosis, 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 facemask
B. Hyperbaricoxygen
C. Surgical resection
D. Treatment of underlyingdisease
Question 3Jennifer 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 forexposure
C. Consideration of prophylactictherapy
D. Beginning therapy for pulmonary TB pending sputumcultures
Question 4P. 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 groupsubstances
B. Electrolytes
C. Vitamin B12
D. Gastric pH
Question 5M. 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 6The 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. Intravenousvasodilators
D. Arteriolardilators
Question 7In myelodysplastic syndromes, the primary indications for splenectomy include:
A. Major hemolysis unresponsive to medicalmanagement
B. Severe symptoms of massivesplenomegaly
C. Sustained leukocyte elevation above 30,000cells/µL
D. Portalhypertension
Question 8The 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 withoutcontrast
C. MRI
D. PETscan
Question 9The 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 loopdiuretic
C. Add a loop diuretic to thespironolactone
D. Proceed to large-volumeparacentesis
Question 10Which 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 weeksposttransplant
B. There is a strong interest in developing corticosteroid-free posttransplantprotocols
C. Better results are demonstrated in corticosteroid-free protocols forsecond-transplant recipients
D. Evidence supports corticosteroid-free rejectionprotocols
Question 11K. 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 ulcersurgery
C. Medication is unlikely to help, and he may need anothersurgery
D. His symptoms occur in 5 to 10% of people after ulcersurgery
Question 12The 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. IncreasedMCV
B. IncreasedHgb
C. Increasedplatelets
D. Increasedalbumin
Question 13A 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 IVbolus
B. External pacemaking
C. Atropine 0.5 mgIV
D. Epinephrine 1 mgIV
Question 14Ms. 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 > 14,000cells/µL
C. Vomiting
D. Hematuria
Question 15Which 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 patientincompetent
B. Impaired cognition does not make a personincompetent
C. Living wills typically are honored if a person is terminally ill
D. A patient can give informed consent if not declared incompetent
Question 16Hepatic 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. Falseneurotransmitters
D. Serotonin
Question 17Ross 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. Hypertonicrehydration
D. Isotonic rehydration
Question 18Janice 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. Abdominalradiographs
B. CT scan of the abdomen with contrast
C. Right upper quadrant ultrasound
D. A HIDAscan
Question 19Justin 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 antibiotictherapy
B. Local anesthesia, cleansing, and wound exploration for foreignbodies
C. Local anesthesia, cleansing, and suturerepair
D. Cleansing, covering, antibiotic therapy, and tetanusprophylaxis
Question 20T. 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 aorticaneurysm
B. Acutepancreatitis
C. Perforated pepticulcer
D. Mallory-Weisstear
Question 21A 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 lawenforcement
B. Have the patient sign a release to go home with herhusband
C. Consult psychiatry for a psych hold
D. Provide counseling to the patient regarding heroptions
Question 22M. 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 thatshe is ?always?constipated.On physicalexamination,sheis tachycardicbutotherwisehas 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 AGACNPsuspects:
A. Perforated bowel
B. Peritonitis
C. Ischemicbowel
D. Intestinal abscess
Question 23C. 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 24The 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. CVAtenderness
D. Grosshematuria
Question 25B. 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 forcolectomy
C. Expectant treatment with nonabsorbableantibiotics
D. Colonoscopy
Question 26Based 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 acidhyposecretion
B. Hypergastrinemia and acidhyposecretion
C. Hypogastrinemia and acidhypersecretion
D. Hypergastrinemia and acidhypersecretion
Question 27The 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 andnonmalfeasance
C. Autonomy and beneficence
D. Justice andautonomy
Question 28R. 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 pituitaryfunction
B. Transient rebound release of remaining pituitaryhormones
C. Markedly improved dexamethasone suppressiontest
D. Hyponatremia and compensatorySIADH
Question 29A 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 30N. 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, andsweating
B. Polyuria, weakness, andparesthesias
C. Dry skin, straie, and unplanned weightloss
D. Early satiety, tremors, andfatigue
