Walden nurs6550 final exam

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Walden nurs6550 final exam

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY

QUESTION 1

1.            Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes:

A.            Foley lodged in the urethra causing post-renal failure

B.            Decreased renal perfusion causing prerenal failure

C.            Age-related decreased eGFR causing prerenal failure

D.            Post-surgical rhabdomyolysis causing intrarenal failure

1 points

QUESTION 2

1.            Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of:

A.            Hashimoto’s thyroiditis

B.            Cushing’s syndrome

C.            Grave’s disease

D.            Addison’s disease

1 points

QUESTION 3

1.            Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE?

A.            Fever, normal white count, elevated sedimentation rate

B.            Hyperkalemia, hyponatremia, low blood pressure

C.            Leukocytosis, hyperglycemia, hypokalemia

D.            Joint pain, rash, fever

1 points

QUESTION 4

1.            A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be:

A.            Meclizine

B.            Diazepam

C.            Bed rest

D.            Epley’s maneuvers

1 points

QUESTION 5

1.            Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is:

A.            Osteoarthritis

B.            Drug or alcohol toxicity

C.            Hypotension

D.            Urosepsis

1 points

QUESTION 6

1.            A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities?

A.            Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg

B.            Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg

C.            Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg

D.            Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg

1 points

QUESTION 7

1.            Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates:

A.            Penetration of the cornea with resultant aqueous leak

B.            A rust ring remnant due to metal foreign body

C.            An elevated intraocular pressure

D.            Paradoxical pupil dilation in response to light

1 points

QUESTION 8

1.            Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory test is necessary to support the suspected diagnosis?

A.            An erythrocyte sedimentation rate

B.            A white blood cell differential

C.            Two sets of blood cultures

D.            Echocardiography

1 points

QUESTION 9

1.            Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness; ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess of:

A.            Serotonin

B.            Norepinephrine

C.            Acetylcholine

D.            Dopamine

1 points

QUESTION 10

1.            Mr. Lincoln is a 55-year-old male who was admitted for management of sepsis secondary to pneumonia. He has declined rapidly, and today chest radiography demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg. In order to increase his oxygenation the AGACNP knows that which of the following interventions is indicated?

A.            Increased FiO2

B.            Increased respiratory rate

C.            Increased tidal volume

D.            Increased PEEP

1 points

QUESTION 11

1.            A 29-year-old female patient presents with a complaint of palpitations. Physical examination reveals an essentially healthy female with no significant medical history and no maintenance medications; the only thing she can report is that she had a head cold a week or so ago. The vital signs include a blood pressure of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a temperature of 98.6° F. The only abnormal finding on physical examination is diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers which medication for symptom control?

A.            Ibuprofen

B.            Pseudoephedrine

C.            Propranolol

D.            Methimazole

1 points

QUESTION 18

1.            Megan K. is a 21-year-old female who presents complaining of irritated eyes. She says this happens a couple of times a year and this time it is really a problem. Both eyes are itchy and red and she has a lot of stringy discharge, especially at the end of the day. Her visual acuity is 20/25 OS, OD, and OU with her glasses on. Physical exam reveals injected conjunctiva bilaterally but there is no photophobia. Pupils are equal, round, briskly reactive, and accommodate. The AGACNP knows that immediate treatment should include ophthalmic application of:

A.            Steroids

B.            Antihistamine

C.            Antibiotic

D.            Cycloplegic

1 points

QUESTION 19

1.            Ellen is a 61-year-old female who presents with a chief complaint of neck pain. The history of present illness reveals that Ellen felt as though a bug bit her behind the neck a few days ago. A day or two later it started to hurt, and when she began to pick at it she felt drainage come out. She is here now for evaluation. Physical exam reveals an 8 cm x 8 cm draining abscess in the right post auricular region with posterior cervical lymphadenopathy. Ellen has a temperature today of 101.9° F. The AGACNP knows that in addition to incision and drainage of the abscess, effective management must include:

A.            Systemic antibiotics

B.            Tetanus immune globulin

C.            Tetanus toxoid

D.            Antipyretics

1 points

QUESTION 20

1.            A 13-year-old male presents with a chief complaint of ear drainage. The patient and his mother both indicate that the patient has not had any pain or any systemic complaints, but the pus-like discharge from the ear is very persistent. According to Mom they went to a retail clinic two weeks ago and the patient was prescribed both oral antibiotics and ear drops, but it didn’t help. Physical exam of the ear reveals a painless pinna; otoscope exam reveals only a large amount of mucopurulent drainage—the tympanic membrane could not be visualized. The AGACNP knows the diagnosis is most likely:

A.            Acute otitis media

B.            Acute otitis externa

C.            Cholesteatoma

D.            Otitis media with effusion

1 points

QUESTION 21

1.            A 71-year-old male patient with lung cancer is admitted for treatment of sepsis related to his chemotherapy-induced immunosuppression. He seems to be improving from an infectious perspective, but during today’s assessment the AGACNP appreciates coarse rales in the lung fields, a blood pressure of 140-100 mm Hg, a bounding pulse, and trace pretibial edema. The urine output via Foley catheter has only been 100 mL in the last 8 hours. Suspicious for syndrome of inappropriate antidiuretic hormone (SIADH), the AGACNP orders a basic metabolic panel anticipating which of the following abnormalities?

A.            Hypokalemia

B.            Hypocalcemia

C.            Hyponatremia

D.            Hypochloremia

1 points

QUESTION 22

1.            A crescendo-decrescendo systolic murmur best appreciated at the second intercostal space, right sternal border with radiation to the carotid artery is most likely an indicator of:

A.            Aortic stenosis

B.            Aortic regurgitation

C.            Tricuspid stenosis

D.            Tricuspid regurgitation

1 points

QUESTION 23

1.            The AGACNP knows that diagnostic findings consistent with rheumatoid arthritis include:

A.            Soft tissue swelling of the metacarpals

B.            Radiographic joint space narrowing

C.            Heberden’s nodes

D.            Subungal hemorrhages

1 points

QUESTION 24

1.            C.T. is a 39-year-old female who presents for evaluation of what she thinks is her “rosacea acting up.” She has a history of acne rosacea and has medicated on and off for years with tetracycline and topical metronidazole. Today however she presents with a pronounced red/purple area on her left cheek extending to the nasal border. It is very warm to the touch. The borders of the affected area are very well defined and raised. C.T. also has a temperature of 100.7° F and a generalized headache. The AGACNP appreciates tender submandibular and cervical lymphadenopathy. The likely diagnosis is:

A.            Complex rosacea

B.            Cellulitis

C.            Erysipelas

D.            Allergic reaction

1 points

QUESTION 25

1.            Mr. Lopez is a 51-year-old male patient who is being treated for T2DM. His HgbA1c is 15.6% and initial management will include aggressive attempts for weight reduction as his body mass index (BMI) is 45. He says he is unable to participate in any meaningful exercise because he very often has back pain; he has had it for years and has tried all sort of over the counter medicines with little relief. He describes it as a profound ache that occurs across the lower part of his back bilaterally; it does not travel down either leg. The physical inspection is normal, but he has significant paraspinal tenderness to palpation bilaterally. He cannot identify any injury or accident that preceded the pain. The history and physical exam is noncontributory. The AGACP knows that the likely diagnosis is:

A.            Lumbar radiculopathy

B.            Ankylosing spondylitis

C.            Lumbar sacral strain

D.            Degenerative disk disease

1 points

QUESTION 26

1.            A patient presents with acute onset of vesicular lesions on her vulva. They are surrounded by areas of redness and they hurt. The patient says that she has even more of them now then she did when she woke up this morning. There is also inguinal lymphadenopathy. The AGACNP is suspicious for:

A.            Human papilloma virus

B.            Primary syphilis

C.            Gonorrhea

D.            Herpes simplex virus

1 points

QUESTION 27

1.            Classic radiographic features of osteoarthritis include:

A.            Soft tissue swelling

B.            Joint deformity

C.            Bone mineral loss

D.            Joint space narrowing

1 points

QUESTION 28

1.            Mrs. Sandoval is a 72-year-old female who presents with a chief complaint of transient verbal confusion. She was speaking with her friend on the phone this morning when she suddenly couldn’t get words out. Her friend went over to her home and found Mrs. Sandoval awake, alert, and oriented, responding appropriately with non-verbal gestures, but she could not properly articulate her thoughts. By the time she arrived at the office this had passed, although during the examination she appeared to have infrequent difficulty finding a single word. The patient denies any contributory medical history, but a 12-lead ECG in the office reveals atrial fibrillation with a ventricular response of 91 b.p.m. The blood pressure is 140/94 mm Hg; remaining vital signs are normal. The AGACNP knows that management should include:

A.            Antiplatelet therapy

B.            Anticoagulation

C.            Blood pressure control

D.            Speech therapy

1 points

QUESTION 29

1.            C.L. is a 48-year-old female who presents complaining of activity intolerance. She is usually very active and fit^. She jogs regularly and typically does 4-5 miles a day. About a week ago she became so tired she had to stop, and lately she has become aware of becoming easily fatigued while going up and down stairs. She admits that she thinks she is beginning menopause—she is having a lot of bleeding with her periods, and her periods seem to be more frequent. A complete blood count (CBC) reveals the following results:

Hgb 10.1 g/dL

Hct 30%

MCV 75 fL

RDW 21%

The AGACNP orders which of the following laboratory test to confirm the suspected diagnosis?

A.            Vitamin B12

B.            Folate

C.            Ferritin

D.            Hemoglobin electrophoresis

1 points

QUESTION 30

1.            Kevin H. is a 61-year-old male who presents for treatment of profound anxiety. He has been treated on and off for years—most recently he was taking escitalopram 20 mg p.o. daily, and although he does admit to some improvement, he still cannot function appropriately thoughout the day. He has been counseled about poor work performance and is concerned about losing his job, but he is just so worried all of the time he cannot concentrate on work. The AGACNP knows that the most appropriate action is to:

A.            Increase the dose of escitalopram to 40 mg daily

B.            Refer Kevin for a psychiatric consultation

C.            Stop escitalopram and begin venlafaxine

D.            Discuss therapeutic expectations with Kevin

1 points

QUESTION 31

1.            When examining a patient with a skin presentation suggestive of necrotizing fasciitis, the AGACNP knows that the most important and sensitive diagnostic test is:

A.            A complete blood count

B.            Plain film radiographs

C.            The finger test

D.            CT scan

1 points

QUESTION 32

1.            While evaluating a patient with abdominal pain, the AGACP knows that when the pain is described as coming in waves or cycles, with periods of relief in between, the cause likely centers around:

A.            Peristalsis of bowel

B.            Disorders of pelvic organs

C.            Organ inflammation

D.            Hyperacidity

1 points

QUESTION 33

1.            Which of the following findings is not typically associated with testicular torsion?

A.            Acute pain

B.            Edema

C.            High riding testis

D.            Dysuria

1 points

QUESTION 34

1.            152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes

No

1 points

QUESTION 35

1.            While preparing to perform an incision and drainage on a 7 cm fluctuant abscess on a patients posterior thorax, the AGACNP knows that the most important part of the procedure is:

A.            Immediate coverage with antistaphylococcal antibiotics

B.            Maintaining sterility with topical betadine and drapes

C.            Breaking up loculations and aggressive irrigation

D.            Proper injection of local anesthetic

1 points

QUESTION 36

1.            A patient is being evaluated with significant nausea, fatigue, and a general sense of feeling unwell; mild jaundice is noted on physical examination. Transaminases are markedly elevated and a hepatitis screening is done. Results are as follows:

+ HbsAb

+ anti-HAV IgM

– anti-HCV

The correct interpretation of these findings is:

A.            The patient has acute hepatitis A

B.            The patient has acute hepatitis B

C.            The patient has chronic hepatitis B

D.            The patient has acute hepatitis C

1 points

QUESTION 37

1.            When treating a patient with an unknown overdose or toxicity, the AGACNP knows that all of the following should be administered except:

A.            Dextrose 50%

B.            Thiamine 100 mg

C.            Nalaxone 0.4 mg

D.            Ativan 4 mg

1 points

QUESTION 38

1.            The AGACNP is evaluating 29-year-old female who presents by ambulance and is unresponsive. There is no witness and no history available; the patient is not wearing any sort of medic alert bracelet. While assessing for toxicity or overdose, the patient is found to have vital signs as follows: Temp of 96.2° F, pulse of 48 b.p.m., respirations of 10 b.p.m., and blood pressure of 84/50 mm Hg. The patient’s pupils are constricted, but do react briskly to light to 1 mm. The AGACNP suspects which type of substance?

A.            Cholinesterase inhibiting drugs

B.            Stimulants such as MDMA

C.            Anticholinergics

D.            Ethanol or opiates

1 points

QUESTION 39

1.            The AGACNP knows that the one class of pain medication that is effective to some extent for all forms of pain is:

A.            NSAIDs

B.            Antidepressants

C.            Antiepileptics

D.            Opiates

1 points

QUESTION 40

1.            K.P. is a 76-year-old male admitted for antibiotic management of urosepsis. His medical history is significant for a CVA with resultant right-sided hemiparesis. He is nonverbal, maintained on enteral nutritional support and has an indwelling Foley catheter. The AGACNP knows that which of the following bacteria is the primary treatment target for this patient’s urosepsis?

A.            Proteus mirabilis

B.            Pseudomonas aeruginosa

C.            Staphylococcus aureus

D.            Streptococcus pneumoniae

1 points

QUESTION 41

1.            A patient is admitted for a COPD exacerbation and placed on mechanical ventilation. His settings are as follows: FiO2 of 40%, TV of 700mL, SIMV of 12. His morning ABG reveals a pH of 7.37, paCO2 of 51 mm Hg, paO2 of 84 mm Hg and HCO3 of 30 mm Hg. The AGACNP knows that the appropriate response is to:

A.            Leave the ventilator settings as is

B.            Increase the SIMV to 16 b.p.m.

C.            Increase the FiO2 to 50%

D.            Repeat the ABG in one hour

1 points

QUESTION 42

1.            All of the following are required for a diagnosis of systemic inflammatory response syndrome (SIRS) except:

A.            White blood cell count < 4000 or > 12,000 cells/uL

B.            Heart rate > 90 b.p.m.

C.            Respiratory rate > 20 b.p.m. or paCO2 < 32 mm Hg D.            Two sets of positive blood cultures 1 points   QUESTION 43 1.            J.T. is a 41-year-old female patient who presents with a chief complaint of “heartburn.” She says that it doesn’t really seem to be related to meals or food—it occurs at random times. She does note, when asked, that it seems to happen a lot at night and occasionally wakes her up. Her only other symptom complaint is an occasional cough. It does not produce mucus, and she admits to assuming it was a “nervous” cough. The next appropriate action for the AGACNP would be to: A.            Order an H. pylori test B.            Request a GI consult for endoscopy C.            Order a proton pump inhibitor 30 minutes before breakfast D.            Request a 72-hour diet history 1 points   QUESTION 44 1.            Your patient has diabetes insipidus (DI). Anticipated physical assessment findings include: A.            Dry skin, tachycardia, hypertension B.            Weak pulse, dry skin, decreased skin turgor C.            Thin hair, thready pulse, dry mucous membranes D.            Hypothermia, jugular venous distention, bradycardia 1 points   QUESTION 45 1.            The AGACNP is beginning medical management of a patient newly diagnosed with T2DM. The patient has a BMI of 39 and has been unsuccessful in making significant diet and lifestyle changes over the last six months. Other than her weight, her physical examination is essentially within normal limits. Her HgbA1c is 9.5%. A basic metabolic panel is within normal limits. The medication of choice to begin therapy will be: A.            A sulfonyurea B.            A meglitinide C.            A biguanide D.            An incretin mimetic 1 points   QUESTION 46 1.            Felty’s syndrome is a condition of immune neutropenia seen sometimes in patients with: A.            Polymyalgia rheumatica B.            Giant cell arteritis C.            Systemic lupus erythematosus D.            Rheumatoid arthritis 1 points   QUESTION 47 1.            When treating a patient for the profound cough of acute bronchitis, the AGACNP knows that the most appropriate pharmacotherapy consists of: A.            An opiate based cough suppressant B.            Oral prednisone C.            A first generation-antihistamine combination D.            An inhaled anticholinergic 1 points   1 points   1 points   QUESTION 57 1.            The AGACNP is evaluating a patient with systemic lupus erythematosis who complains of fatigue. Based upon his knowledge of the most commonly affected visceral organ, which of the following diagnostic studies should be ordered? A.            Echocardiogram B.            Chest radiography C.            Hepatic function enzymes D.            Urinalysis with microscopic 1 points   QUESTION 58 1.            All of the following are true statements about post-traumatic stress disorders (PTSD) except: A.            It is more common in women than men B.            It is unlikely to occur in children especially < 10 years old C.            It is differentiated from acute stress reaction by time D.            It is not likely in persons with no preexisting psychiatric disease 1 points   QUESTION 59 1.            Ray M., a 49-year-old male, walks into the emergency room complaining of back pain. He has never had this problem before and cannot identify any injury, but he is in such severe pain he is sure something is wrong. He states that his back has been hurting so badly sometimes he has to stop whatever he is doing and bend forward at the waist. The pain also travels along the outer edge of his left thigh to mid-calf, and he reports a small area of numbness on his anterior thigh. His history and physical examination are otherwise negative. He is an insurance attorney and is not especially active at work, but goes to the gym 5 days a week. He is not overweight, and his vital signs are normal. Physical examination reveals no paraspinal tenderness, and his straight leg raise is negative. A few times during the exam he lay back on the table and grabbed his left leg, flexed both hip, and pulled his knee to his chest, because it helped the pain. The AGACNP knows that immediate pain relief measures must include: A.            An opiate analgesic B.            Systemic steroids C.            Physical therapy D.            Bedrest for 72 hours 1 points   QUESTION 60 1.            A patient with peptic ulcer disease is admitted to the hospital with significant upper abdominal discomfort. She has guarding and rebound tenderness on examination. Abdominal radiography demonstrates free air in the abdomen. The AGACNP knows that the immediate priority is to: A.            Obtain a stat surgical consult B.            Begin an IV proton pump inhibitor C.            Order an abdominal CT scan D.            Obtain a stat gastroenterology consult 1 points   QUESTION 61 1.            Jennifer is a 15-year-old female who attempted suicide by taking a bottle of acetaminophen. She took 30, 500 mg tablets approximately six hours ago, but then became frightened and told her mother what she did. Her mother said that Jennifer seems OK, other than being a little sick to her stomach, she has no complaints. The AGACNP knows that the first step in her care includes: A.            N-acetycysteine in tapering doses over the next 24 hours B.            Oral administration of activated charcoal C.            Psychiatric assessment D.            Discharge to home with follow-up LFTs in 4 days 1 points   QUESTION 62 1.            Mrs. Glassman is a 55-year-old female who presents with a chief complaint of fever. Her vital signs reveal a temperature of 100.0° F, blood pressure of 100/60 mm Hg, pulse of 114 b.p.m. and respirations of 20 b.p.m. Her cardiac auscultation reveals a grade III/VI systolic murmur at the left lower sternal border. Her history is significant for an eyebrow lift 4 months ago. The AGACNP orders which test to confirm the suspected diagnosis? A.            Three sets of blood cultures B.            A chest radiograph C.            A 12-lead ECG D.            Induced sputum culture 1 points   QUESTION 63 1.            John is a 17-year-old male who is in the emergency department with abdominal pain. He is quite uncomfortable and says that it started yesterday and seemed to be “in the middle of his stomach” but today it has moved over to the right lower side. During physical examination the abdomen is not distended, but he is guarded, and right lower quadrant palpation produces significant discomfort, especially upon release of the palpating hand. He has appreciable pain when his right knee and hip are bent to a 90° angle. John admits to some nausea but has not vomited; he has not had a normal bowel movement in two days. His vital signs are as follows: Temperature 100.9° F, pulse 110 b.p.m. respiratory rate 22 b.p.m., and blood pressure 118/77 mm Hg. The AGACNP orders which of the following tests to confirm the suspected diagnosis? A.            Complete blood count B.            Ultrasound C.            CT scan D.            Urinalysis 1 points   QUESTION 64 1.            Which of the following signs is expected in patients with cholecystitis? A.            McBurney’s B.            Cullen’s C.            Spurling’s D.            Murphy’s 1 points   QUESTION 65 1.            According to the World Health Organization’s step-wise approach to pain management, initial approaches to step 2 might include all of the following except: A.            A weak opiate B.            A strong opiate C.            A non-steroidal antiinflammatory agent D.            An antidepressant. 1 points   QUESTION 66 1.            A patient’s Weber test lateralizes to the right ear and the Rinne test in both ears is normal. The patient has a: A.            Sensorineural hearing loss in the left ear B.            Sensorineural hearing loss in the right ear C.            Conductive hearing loss in the left ear D.            Conductive hearing loss in the right ear 1 points   QUESTION 67 1.            J.B. is a 62-year-old male who was admitted three days ago for management of diverticulitis. Today the AGACNP is called to the bedside to evaluate new onset swelling of the right lower extremity. According to the staff nurse it was not present yesterday but on today’s assessment the patient had 2A+ edema up to the thigh. Initial diagnostic evaluation should include: A.            Homan’s sign B.            A venogram C.            A D-dimer D.            CT of the chest 1 points   QUESTION 68 1.            Based upon clinical examination and laboratory assessment the AGACNP diagnoses a patient with giant cell arteritis. The next step in the patient management should be to: A.            Consult surgery for a temporal artery biopsy B.            Consult rheumatology for medical management C.            Order 60 mg of prednisone now and q.d. D.            Order ceftriaxone 1 mg IV now 1 points   QUESTION 72 1.            L.W. is a 41-year-old woman with a history of systemic lupus erythematosus which has been managed primarily with symptom control. Today she presents for evaluation of fatigue which has been slowly progressive over the last few months. She has a history of gastric bypass surgery 10 years ago and has maintained a 100 lb weight loss, but she maintains that she has been very adherent to her vitamin and mineral replacement regimen. Other than chronically heavy menses, for which she takes hormonal contraception, she is without complaint. A complete blood count is as follows: Hgb 10.3 g/dL Hct 31% MCV 88 fL RDW 15% The AGACNP suspects that the patient’s fatigue is most likely due to: A.            Iron deficiency anemia B.            Anemia of chronic disease C.            Pernicious anemia D.            Folic acid deficiency 1 points   QUESTION 73 1.            A patient presents for follow up after being started on an ACE inhibitor for hypertension. Her blood pressure has improved, but her pulse is 56 b.p.m down from 76 b.p.m. at her last visit. The AGACNP knows that the patient should assessed for: A.            Hypercalcemia B.            Hypernatremia C.            Hyperkalemia D.            Hyperchloremia 1 points   QUESTION 74 1.            A young-adult male patient was dropped off outside of the emergency department and some staff members brought him inside. The patient is restless, irritable, and either unwilling or unable to participate in her own care. No history is available. His vital signs are essentially stable, finger stick blood sugar is 111 mg/dL, there are no signs of trauma, and no physical findings consistent with common drug or alcohol use. A toxicology screen is pending. The AGACNP orders acute psychiatric stabilization with a combination of haloperidol and lorazepam and considers which of the following mediations to decrease the risk of adverse effects? A.            Risperidone B.            Olanzapine C.            Benztropine D.            Zolpidem 1 points   QUESTION 75 1.            Amy is a 21-year-old female who presents with acute nephrolithiasis. CT scan reveals a 2 mm stone in the left ureter. The AGACNP knows that the appropriate course of action is: A.            Pain control and IV fluid B.            Consultation for stent placement C.            Lithotripsy stone destruction D.            Transurethral stone destruction 1 points   QUESTION 76 1.            B.T. is a 49-year-old male being admitted for lung volume reduction surgery. His preoperative pulmonary function tests are as follows: FVC 66% predicted FEV1 60% predicted PEFR 69% predicted TLC 104% predicted RV 90% predicted The AGACNP knows that the pulmonary function studies are consistent with: A.            Mild restrictive disease B.            Moderate restrictive disease C.            Mild obstructive disease D.            Moderate obstructive disease 1 points   QUESTION 77 1.            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? A.            Subclinical infection B.            Non-Hodgkin’s lymphoma C.            Catscratch disease D.            Syphilis 1 points   QUESTION 78 1.            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 stiffness, but seems to get better after an hour or so of activity. When considering a diagnosis of polymyalgia rheumatica, laboratory assessment may be expected to reveal: A.            An erythrocyte sedimentation rate (ESR) of 75 mm/hr B.            A microcytic, hypochromic anemia C.            Elevated liver function enzymes D.            Positive antinuclear antibodies 1 points   QUESTION 79 1.            When a patient has lower abdominal discomfort, cervical wall motion tenderness, and adnexal tenderness, the AGACNP knows that this will likely be treated with: A.            Ceftriaxone and azithromycin B.            Metronidazole and ciprofloxacin C.            Trimethoprim/sulfamethoxazole D.            IV fluid and pain control 1 points   QUESTION 80 1.            J.L. is an 81-year-old female who is admitted from home after her daughter found her confused and unkempt. She is not a good historian, and her daughter cannot provide any information—when she saw her mother a week ago, she was fine. J.L.’s vital signs are as follows: Temperature 101.4° F, pulse 99 b.p.m., respirations 22 b.p.m., and blood pressure 90/58 mm Hg. Her urinalysis is shows +++ leukocytes, + RBC, and + nitrites. Her metabolic panel reveals a BUN of 39 mg/dL and creatinine of 1.5 mg/dL. The AGACNP knows that J.L has findings consistent with: A.            Pre-renal failure B.            Intra-renal failure C.            Post-renal failure D.            Chronic renal failure 1 points   1 points   QUESTION 97 1.            Mr. Riley is a 61-year-old male who just had bilateral knee replacements. There was more fluid loss than intended during the procedure. The AGACNP knows that metabolic alkalosis is the most common postoperative acid-base imbalance and is best treated with: A.            Normal saline infusion B.            An insulin drip C.            Low volume hydrochloric acid D.            Albumin 1 points   QUESTION 98 1.            Patients in advanced stages of chronic kidney disease are at greatest risk for which of the following conditions? A.            Polycythemia B.            Hypokalemia C.            Metabolic alkalosis D.            Anemia 1 points   QUESTION 99 1.            The diagnostic study of choice in mesenteric ischemia is: A.            Ultrasound B.            CT angiography C.            MR angiography D.            Diagnostic peritoneal lavage 1 points   QUESTION 100 1.            Mr. Maxwell is a 58-year-old male who presents with left foot pain. Physical examination reveals a foot that is normal in appearance with DP and PT pulses that are barely audible by Doppler. The AGACNP has the patient cross the leg with the left foot resting on the right knee; after 30 seconds that left foot is briskly lowered to the floor. Instantly the left foot turns bright red. This is known as: A.            Venous insufficiency B.            Brawny hyperpigmentation C.            Homan’s sign D.            Dependent rubor 1 points   QUESTION 101 1.            152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?                 Yes                 No

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