NURS-6550 Mid Term Exam Questions and Answers

NURS-6550 Mid Term Exam Questions and Answers – Advanced Practice Care of Adults in Acute Care Settings

• Question 1

1 out of 1 points

	The AGACNP is caring for a patient who is quite ill and has developed, among other things, a large right sided pleural effusion. Thoracentesis is sent for pleural fluid analysis. While evaluating the fluid analysis, the AGACNP knows that a fluid identified as a(n) __________ is the least worrisome type.
	Response Feedback: “A” is the correct answer. A transudate is essentially just water and can occur as a consequence of increased hydrostatic pressure in the pulmonary vessels. It typically implies that the some condition has produced an imbalance in colloid-hydrostatic pressures, such as CHF or hypoalbuminemia. While it can represent a serious problem, it may also represent a transient imbalance. Conversely, “B” is not correct as an exudate has more protein in it and implies a condition characterized by protein leaking from vessels, such as a malignancy or some serious systemic stressor. “C” is not correct—a chyliform effusion is characterized by fat and indicates a pathology causing massive triglyceride degradation. “D” is not correct as a hemorrhagic effusion is blood and typically means traumatic injury.

• Question 2

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0 out of 1 points

	Mrs. Miller is transported to the emergency department by paramedics. She is having profound, unremitting chest pain, is diaphoretic and pale. She has jugular venous distention and a widened pulse pressure. Suspecting ascending aortic aneurysm, the AGACNP order which test to confirm the diagnosis?
	Response Feedback: “D” is the correct answer. It is the most widely used diagnostic tool as it rapidly and precisely can outline the thoracic and abdominal aorta. “A” is not the correct answer—there are radiographic findings that suggest thoracic aneurysm, but they need confirmation by CT. “B” is not the correct answer as ultrasound is not nearly as precise as a CT scan. “C” is not correct—MRI is only indicated when the patient cannot have a contrast CT.

• Question 3

1 out of 1 points

	Certain subgroups of the elderly population are at an increased risk for rapid deterioration and long-term care placement. Which of the following is not considered a high risk factor for long term care placement?
	NURS-6550 Mid Term Exam Questions and Answers – Advanced Practice Care of Adults in Acute Care Settings Response Feedback: “A” is the correct answer; men are at higher risk for long-term care placement than women. In addition to male gender, other risk factors include age over 80, living alone, bowel or bladder incontinence, history of falls, dysfunctional coping, and intellectual impairment.

• Question 4

0 out of 1 points

	A patient with anterior epistaxis has been treated with 20 minutes of direct pressure to the cartilaginous portion of the nose. Following pressure the patient is instructed to gently blow the nose. Expected findings in the patient who has been successfully treated include all of the following except a:
	Response Feedback: “C” is the correct answer. If bleeding is successfully stopped with 20 minutes of directed pressure, there will be residual blood and clot formation. This is evacuated either by gentle suction or having the patient gently blow. Residual blood and formed clot may present as a sudden gush of dark blood or discharge with or without a clot—these are all typical expected findings. However, if bleeding is not stopped, it will continue as a bright red steady trickle. When this occurs, more invasive measures are indicated.

• Question 5

0 out of 1 points

	Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right ear pain. He appears quite ill and says he feels nauseous. Otoscopic evaluation reveals pain to palpation, a very erythematous and bulging tympanic membrane with bullous myringitis. The AGACNP knows that antibiotic therapy must be selected to cover:
	Response Feedback: “D” is the correct answer. Streptococcus pneumoniae is the most common bacteria that infects the head and neck in immunocompetent persons, and is the primary treatment target when treating otitis media, bacterial sinusitis, and bacterial pharyngitis. “A” is not correct—while likely on broken skin and soft tissue, it is not common in the ear, nose, or throat unless specific risk factors exist. “B” is not correct—this is much more likely in an immunocompromised patient or a patient on mechanical ventilation. “C” is not correct—it is the second most common organism, but strep is the primary treatment target.

• Question 6

1 out of 1 points

	P.M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of increasing shortness of breath. The diagnostic evaluation ultimately supports a diagnosis of community acquired pneumonia. The AGACNP appreciates right middle lobe consolidation on chest radiography. Pending sputum cultures, empiric antibiotic therapy must be initiated to cover which organism?
	NURS-6550 Mid Term Exam Questions and Answers – Advanced Practice Care of Adults in Acute Care Settings Response Feedback: “D” is the correct answer. This patient presents from the outpatient population where the most common cause of pneumonia is Streptococcus pneumoniae, and is the primary treatment target for any patient being treated empirically. “A” is not correct—while the patient’s sexual orientation is offered in the provided history, there is no indication that he has HIV/AIDS or any other condition characterized by immunosuppression that would increase his risk for this organism. “B” is not correct, as this organism is not typically seen in the outpatient population without specific risk, e.g. immunosuppression or chronic ventilator therapy. “C” is not the correct answer as this organism is not likely absent specific risk such as instrumentation or known colonization.

• Question 7

0 out of 1 points

	Which of the following is the greatest risk factor for vascular dementia?
	Response Feedback: “B” is the correct answer. Vascular dementia is a consequence of vascular disease, and is more likely to occur in patients with risk factors for target organ damage, such as hypertension, dyslipidemia, and diabetes. “A” is not a distinct risk factor for vascular dementia; it is a risk for Alzheimer’s dementia. “C” likewise increases risk for Parkinson’s dementia, but does not present a risk for vascular dementia. “D” is not a risk factor for vascular dementia. Although there may be some familial risk for certain vascular diseases that may lead to vascular dementia, there is no clear familial tendency for this type of dementia.

NURS-6550 Mid Term Exam Questions and Answers – Advanced Practice Care of Adults in Acute Care Settings

• Question 91

1 out of 1 points

	A 31-year-old male presents to urgent care because he has something in his eye. He was changing the oil under his car and says that something dropped into his eye. He is not having any pain, in fact he waited a day before coming in because he thought it would work itself out. Physical exam reveals a black 1 mm foreign body visible on the corneal surface. The most appropriate intervention is to:
	Response Feedback: “C” is the correct answer. The nature of the injury suggests an external foreign body and it is visible to inspection. The absence of symptoms suggests that this is a simple external foreign body that will be easily removed with a saline soaked sterile swab. If unable to remove it this way, the more invasive Morgan lens or another method of eye irrigation may be utilized – but the least invasive acceptable method should always be tried first. “A” is not correct—there are not symptoms consistent with corneal abrasion. “B” is not correct as the history does not suggest an embedded or internal foreign body.

• Question 92

0 out of 1 points

	A patient with pericarditis is most appropriately treated with:
	Response Feedback: “C” is the correct answer. Pericarditis is an inflammation of the pericardium, most often due to viral infection. The medication of choice is an NSAID. “A” is not correct—although isolated cases of pericardial inflammation are bacterial and require antibiotics, this is very uncommon. “B” is incorrect—NSAIDs generally control pain adequately and the escalation to opiate analgesia is rarely indicated. “D” is incorrect—as with choice “C” NSAIDs control pain adequately in most cases and use of corticosteroids while appropriate for NSAID-refractory cases, is uncommon.

• Question 93

0 out of 1 points

	Which of the following is not a risk factor for thoracic aneurysm?
	Response Feedback: “B” is the correct answer. There are multiple risk factors for thoracic aneurysm, including “A,” “C,” and “D” above. However, aortic valve disease, not mitral valve disease, is correlated with increased risk. A variety of other factors including family history, smoking, and atherosclerosis, also increase risk.

• Question 94

1 out of 1 points

	The “MONA” acronym provides guidance for immediate interventions in the patient with:
	NURS-6550 Mid Term Exam Questions and Answers – Advanced Practice Care of Adults in Acute Care Settings Response Feedback: “A” is the correct answer. MONA stands for Morphine, Oxygen, Nitroglycerin, and Aspirin, and should be considered for every patient with acute coronary syndrome. Morphine may not always be used—the general guideline is to administer to any patient who does not get pain relief with three doses of nitroglycerin—but it should be considered and administered if appropriate.

• Question 95

1 out of 1 points

	Mr. Sloane is a 36-year-old male patient who presents for treatment of eye pain. He has no significant medical history and does not take any daily or over-the-counter medications. His only recent history is nighttime allergies for which he takes occasional diphenhydramine with good relief. He has had some throbbing in his eye for the last few days on and off but just ignored it; today he says it is flat out painful and he had to come to the emergency department. The eye is throbbing and painful, and he reports generalized decreased vision. The pupil is dilated to 5 mm and non-reactive to light. The eye conjunctiva is reddened. The next step in the diagnostic evaluation should be:
	Response Feedback: “A” is the correct answer. This is a classic presentation of acute angle closure glaucoma, the patient likely had an underlying anatomic abnormality that was exacerbated by the anticholinergic properties of diphenhydramine. Assessment of intraocular pressure via tonometry must be performed and if elevated will confirm diagnosis. Once elevated pressure is confirmed, the condition will be treated. “B” and “C” are not correct—the first diagnostic evaluation must be tonometric pressure; if pressure is normal, acute angle closure glaucoma is ruled out and then imaging may be indicted depending upon the differential diagnoses. “D” is not correct; if glaucoma is confirmed than ophthalmology will be consulted.

• Question 96

1 out of 1 points

	The AGACNP counsels a patient with recurrent epistaxis that the most common cause of nose bleeding is:
	Response Feedback: “A” is the correct answer. Statistically most nose bleeding is cause by the irritation of nose picking, and patients of all ages should be evaluated for this when presenting with a complaint of recurrent nose bleed. “B,” “C,” and “D” are also causes and are all part of the differential diagnosis and will guide the history of present illness, but “A” is most common and the first thing to be considered; similarly, while patients may not realize or acknowledge that this is a factor, if no cause is identified, counseling about the avoidance of nose picking may ultimately result in improvement of symptoms.

• Question 97

0 out of 1 points

	The geriatric depression scale (GDS) is a commonly used tool to diagnose depression in the elderly population. It comes in a variety of forms for maximal utility. When administering the geriatric depression scale to patients, the AGACNP recognizes that it is extremely important to:
	NURS-6550 Mid Term Exam Questions and Answers – Advanced Practice Care of Adults in Acute Care Settings Response Feedback: “B” is the correct answer. All forms of the GDS require one word “yes/no” answers; the tool cannot be scored with more ambiguous or scaled scoring. “A” is incorrect—the tool helps establish a diagnosis of depression, and then the etiology will be pursued. “C” is not correct, in fact the one word answer format, different from most tools that use “1 to 5” scaled scoring, allows the tool to be used in those with more significant cognitive impairment. “D” is not correct as the tool can evaluate change after initiation or change in drug therapy.

• Question 98

1 out of 1 points

	Ventilator-acquired pneumonia (VAP) is a significant problem impacting morbidity, mortality and the cost of inpatient health care. Data-supported mechanisms to reduce the risk for VAP include all of the following except:
	Response Feedback: “B” is the correct answer. Strategies both pre and post intubation to reduce the likelihood of VAP have been extensively studied, and there are numerous data-supported strategies including those presented in choices “A,” “C,” and “D” above. Conversely, while “B” has been proposed as a possible strategy, data are conflicted. Endotracheal tube cuff biofilm formation and bacterial colonization are proposed mechanisms by which ventilator acquired pneumonia occurs, and there are several strategies in use to target this, such as antibiotic impregnated, chlorhexidine coated and silver coated endotracheal tubes. Cost and effectiveness data continue to emerge.

• Question 99

0 out of 1 points

	Absolute contraindications to thrombolytic therapy in the patient having an acute myocardial infarction include all of the following except:
	Response Feedback: “D” is the correct answer. A history of hemorrhagic ophthalmic condition is a relative contraindication; a risk benefit analysis must be considered and thrombolytics may be used. Conversely, “A,” “B,” and “C” above are all absolute contraindications to thrombolytic therapy.

• Question 100

1 out of 1 points

	Which of the following is not a true statement with respect to risk for or occurrence of elder abuse?
	Response Feedback: “D” is the correct answer. There are a variety of theories regarding the etiology of caregiver abuse, and a common theme is that the greater the stressors and/or burden on the caregiver, the greater the likelihood of some form of caregiver abuse, whether psychological, physical, or neglect. Otherwise “healthy” people can become abusive if the demands placed upon them are great enough; this is one of the reasons that respite care is so important. “A,” “B,” and “C” are true statements. Caregiver stress is a risk factor, the cycle of learned violence suggests that those subjected to violence are at greater risk of becoming violent, and the greater the physical and/or mental impairment of the patient, the higher the risk for an abusive situation.NURS-6550 Mid Term Exam Questions and Answers – Advanced Practice Care of Adults in Acute Care Settings

 

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