Walden NURS6550 Midterm exam

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Walden NURS6550 Midterm exam

Course NURS-6550N-2/NURS-6550F-2-Adv
Prac Care in Acute Set I2016 Winter Qtr 11/28-02/19-PT27

Test Week 6 –
Exam

• Question
1

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.

• Question
2

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?

• Question
3

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?

• Question
4

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:

• Question
5

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:

• Question
6

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?

• Question
7

Which
of the following is the greatest risk factor for vascular dementia?

• Question
8

J.R. is
a 55-year-old male who presents for a commercial driver’s license physical
examination with a blood pressure of 170/102 mm Hg. He has no medical history
and is without complaint. Which of the following findings constitutes
hypertensive urgency?

• Question
9

Because
of the commonly recognized adverse effects of atypical antipsychotics, annual
laboratory assessment for patients taking these medications should include a:

• Question
10

K.R.
presents for an evaluation of eye discomfort. He works in a fabricating shop
for a custom automobile restoration company and while working he felt like
something flew into his eye. He was wearing eye protection at the time but
still has the sensation that something is there. Physical examination is
significant for some tearing and he reports a persistent sense of something in
his eye. Which of the following is not indicated in the diagnostic evaluation?

• Question
11

D.E. is
a 41-year-old female who had lumbar surgery two days ago to repair a ruptured
nucleus pulposus. She has been doing well postoperatively but today is
complaining of resting fatigue and some shortness of breath at rest. In ruling
out a pulmonary embolus the AGACNP first orders a:

• Question
12

Mr.
Nixon is being treated with unfractionated heparin infusion for acute pulmonary
embolus. In order to avoid a potentially fatal complication of heparin
infusion, the AGACNP monitors:

• Question
13

Differentiating
vertigo from near-syncope and ataxia is one of the goals of history-taking when
a patient presents as “dizzy.” The AGACP knows that vertigo is the problem when
the patient reports the primary symptom as:

• Question
14

Mr.
Banks has been admitted for surgical resection of a metastatic tumor, during
surgery it is discovered that he has widespread, diffuse metastasis throughout
the abdomen. Surgery is no longer an option, and his oncologist says that
chemotherapy is unlikely to produce any meaningful benefit. Mr. Banks is
concerned that his sons will not support a transfer to comfort care. The AGACNP
advises that he:

• Question
15

Mr.
Wilkerson is a 77-year-old male who is being evaluated and treated for his
cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, pulse
of 100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A
12-lead ECG reveals deep ST segment depression in leads V3-V6. The AGACNP
recognizes which of the following as a contraindication to rTPA therapy?

• Question
16

A
71-year-old patient is recovering from a particularly severe exacerbation of
chronic obstructive pulmonary disease. He has been in the hospital for almost
two weeks and was on mechanical ventilation for 7 days. While discussing his
discharge plan he tells you that he is really going to quit smoking this time.
He acknowledges that he has been “sneaking” cigarettes in the
hospital for two days, but he has established a timeline to decrease the number
of cigarettes daily. According to his plan his last cigarette will be the last
day of the month. This patient’s behavior is consistent with which stage of the
Transtheoretical Model of Change?

• Question
17

While
assessing a patient with a known psychiatric history, the AGACNP knows that the
primary difference between a psychotic and neurotic disorders is:

• Question
18

L.T. is
an 85-year-old male who is admitted for evaluation of profound diarrhea that
has produced significant dehydration. He also complains of being very tired
lately, and feeling like he is going to vomit all of the time. His vital signs
are significant for a pulse of 41 b.p.m. and a blood pressure of 90/60 mm Hg. A
gastrointestinal evaluation including stool for blood, white blood cells, and
ova and parasites is negative. He insists that he has not started any new
medications or made any diet changes; the only thing new is that he got new eye
drops for his glaucoma. The AGACNP correctly assumes that his new eye drops
are:

• Question
19

Janice
is a 19-year-old female who presents to the emergency department via ambulance.
She is pale, diaphoretic, agitated, and convinced she is having a stroke. Her
vital signs include a temperature of 98.9° F, pulse of 114 beats per minute,
respirations of 32 breaths per minute, and a blood pressure of 110/74 mm Hg.
Diagnostic evaluation is negative and Janice is diagnosed with an acute panic
attack. The initial treatment of choice is:

• Question
20

Lorraine
is a 41-year-old female who presents for an asthma follow-up visit. She says
she feels very well, has almost no daytime symptoms, and is using her inhaled
corticosteroid medication daily as prescribed. Her PEFR is 85% of her personal
best. The best approach to this patient is to:

• Question
21

Mr.
Owen is a 37-year-old patient who has been admitted for surgical resection of a
malignant tumor in his lung. His physical recovery has been uneventful and he
is being prepared for discharge. While discussing his ongoing cancer therapy
with Mr. Owen, the AGACNP determines that he has experienced persistent,
excessive anxiety and worry almost every day for more than one year. What other
aspect of Mr. Owen’s psychosocial history would be required to made a diagnosis
of generalized anxiety disorder?

• Question
22

Kevin
T. is a 49-year-old male who is being discharged after hospitalization for an
acute inferior wall myocardial infarction. This is his first hospitalization
and his first chronic medical diagnosis. Aside from his elevated cardiac
isoenzymes and troponins, his laboratory profile was essentially within normal
limits. The only apparent cardiac risk factor is an LDL cholesterol of 200
mg/dL. Initiating an HMG-CoA reductase inhibitor is an example of which level
of prevention for Kevin?

• Question
23

You are
evaluating a patient who has been admitted to the emergency room after being
arrested for starting a fight in a local sports’ bar. The patient is now being
cooperative, but reports that he has been in treatment for PTSD for months. He
has been prescribed fluoxetine but has not noticed any improvement in symptoms,
and now has been arrested for violence. The AGACNP knows that the next step in
medication management is likely to include:

• Question
24

Mrs.
Salter is an 81-year-old lady who presents for evaluation of near-syncopal
episodes. Her 12-lead ECG, complete blood count, and comprehensive metabolic panel
are all essentially normal. A urinalysis shows some trace protein but is
otherwise normal. A 24-hour rhythm monitor demonstrates rare premature
ventricular contractions. Mrs. Salter has been in good health and had her first
episode at her aerobics class. She only gets lightheaded when she exerts
herself. Her heart auscultates for a grade III/VI systolic
crescendo-decrescendo murmur at the second intercostal space, right sternal
border. The AGACP considers that the likely cause of the syncope is:

• Question
25

Who
among the following patients is at greatest risk for a pulmonary embolus?

• Question
26

Mrs.
Birdsong is an 85-year-old female who has been admitted for surgical repair of a
hip fracture. She is in remarkably good spirits and is quite talkative. She
readily answers all of the questions on her intake assessment, and readily
acknowledges information provided during her room orientation. Later while
talking with the patient’s son the AGACNP learns that the patient has had
significant cognitive impairment for a few years. She has virtually no short
term memory, but compensates by confabulating. Her son says she is generally
very happy as long as there is no change in her day to day routine. This
history is most consistent with which form of dementia?

• Question
27

Mrs.
Radovich is an 80-year-old female with a variety of chronic medical conditions
which are reasonably well controlled. She generally enjoys a good quality of
life and is active with her family. Today her only concern is that she is
having problems with her vision. She notices that while trying to look at
pictures of her great grandchildren she can’t seem to focus on their faces. She
also reports increased trouble reading—she cannot seem to see the words that
she is looking at, and her reading glasses do not help. Further evaluation of
Mrs. Radovich should include assessment with:

• Question
28

R.J. is
a 55-year-old female who presents with acute onset left sided facial pain and
an inability to move the left side of her face. She cannot smile, raise her
eyebrow or even close her left eye, The immediate approach to this patient
should include:

• Question
29

A
78-year-old male present for a physical examination. He has no discomfort or
complaints other than a general decrease in vision, but it helps when he puts
things under a bright light to read. He admits that while driving at night the
streetlights appear to be a bit distorted and his night vision is pretty poor.
Given the likely diagnosis, the AGACNP expects which of the following physical
findings?

• Question
30

Jason
is a 46-year-old male who is being managed for sepsis. He has HIV/AIDS and has
had a prolonged hospitalization characterized by a variety of complications. He
was extubated 3 days ago but continues gastric decompression with a nasogastric
tube(NGT), total parenteral nutrition and antibiotic therapy via a central
venous catheter, and urinary drainage via a Foley catheter. He continues to
demonstrate consistent low grade fevers but all points of insertion of his
tubes are normal to inspection, a chest radiograph demonstrates improvement of
his pneumonia, and his urinalysis shows no bacteria, leukocytes, or nitrites.
The AGACNP should next order:

• Question
31

The
interpretation of a chest radiography should follow a systematic approach to
ensure that all vital structures are evaluated and important clinical findings
are not missed. The last thing to be assessed when looking at chest radiography
should be the _____________:

• Question
32

The
Short Confusion Assessment Method (Short-CAM) is a widely used four item tool
that assesses delirium in the hospitalized patient. It includes observation of
all of the following except:

• Question
33

Ms.
Yang has been hospitalized for 5 days for the management of a gastrointestinal
bleeding. She appears to have stabilized hemodynamically, but today she had a
temperature of 101.9° F and chest radiography demonstrates a diagnosis of
pneumonia. The AGACNP knows that the diagnostic evaluation for hospital
acquired pneumonia for all patients must include:

• Question
34

Most
psychosocial theories of aging center around the core concept that successful
aging requires acceptance of a series of changes or losses that predictably
occur later in the life span. The theory that specifically addresses coming to
terms with the inevitability of death is known as:

• Question
35

All of
the following conditions are risk factors for pulmonary embolus except:

• Question
36

A
patient is diagnosed with acute descending aortic aneurysm and hypertension
should be immediately started on which medication pending surgical evaluation?

• Question
37

Jason
is a 27-year-old with a long history of intermittently controlled asthma. He is
currently prescribed Advair daily with albuterol as needed for symptoms. Today
he presents to the emergency department with cough and wheezing and difficulty
catching his breath. His FEV1 is 51% at the time of presentation. He is given
alternating albuterol and ipratropium nebulizer treatments along with oral
prednisone. After one hour his FEV1 has increased 65%. The appropriate
disposition for Jason at this point is:

• Question
38

A
patient in the intensive care unit suddenly becomes tachypneic and dyspneic.
The physical examination reveals pale, cool, clammy skin and an arterial blood
gas demonstrates hypocapnea and hypoxia. Pulmonary artery pressure demonstrates
a pattern consistent with obstructive shock. The AGACNP knows that which of the
following causes of this presentation is most likely?

• Question
39

Mr.
Bowers is an 81-year-old male who is being terminally extubated at the request
of his family due to the presence of a large subdural hematoma with a shift;
the patient is not initiating respirations on his own and the prognosis is very
poor. After he is extubated he begins to initiate his own respirations and 24
hours later has not expired yet. The decision is made to leave him in the
hospital on a general medical floor rather than transfer to another facility
for hospice. Which of the following is the best indicator that the patient’s
death is imminent?

• Question
40

A
patient is newly admitted to your service for open reduction and internal
fixation of the left hip. She seems very down, and as you talk with her you
realize that her mood is not just related to her hip fracture. Which of the
following symptoms would not be consistent with major depressive disorder?

• Question
41

“C” is
the correct answer. Alzheimer’s dementia is statistically the most common form
of dementia and is characterized by a long trajectory that progresses to
include confabulation. Additionally, patients with this form of dementia are
very reliant upon routine and may be distressed when it is disrupted. “A” is
not correct; Lewy body dementia characteristically progresses much more quickly
and produces an angry demeanor. “B” is incorrect because vascular dementia
typically produces a more depressive affect and is not characterized by
confabulation; additionally, patients with vascular dementia often have a
medical history consistent with vascular risk factors. “D” is not correct as
there is no apparent history of Parkinson’s disease.

• Question
42

What is
the primary purpose of using eye ointments or lubricants to patients under
general anesthesia, on paralytics, or in long-term comatose states?

• Question
43

When
reading a 12-lead electrocardiogram, the AGACNP knows that all 12 leads are
required to provide:

• Question
44

A
49-year-old male presents for evaluation of chest tightness. It has happened
before, but he just ignored it and it went away. Today he just could not ignore
it anymore. He has always enjoyed good health and says he has never been told
that he has any chronic medical conditions like high blood pressure or
diabetes. A 12-lead ECG demonstrates changes consistent with inferior wall
ischemia. Both his symptoms and inferior wall changes improve with the
administration of sublingual nitroglycerin. Consistent with ACS protocol, this
patient’s assessment is consistent with:

• Question
45

Mr.
Rosen is a 49-year-old male who is being managed for an acute myocardial
infarction. He develops significant shortness of breath at rest and coarse
rales 2/3 up bilaterally. The AGACNP suspects acute pulmonary edema due to
papillary muscle rupture and acute mitral valve regurgitation. Which physical
finding would support this finding?

• Question
46

A
patient with minor head trauma presents for evaluation. Which of the following
findings should be followed up with a CT scan to rule out orbital fracture?

• Question
47

Mrs.
Forbes is a 69-year-old lady being discharged from the hospital after
complications following a cosmetic surgical procedure. She is basically in good
health. She has a history of hypothyroidism for which she takes levothyroxine
daily, and mild osteoarthritis which is controlled with only prn nonsteroidal
use. Her blood pressure is 148/90 mm Hg. The AGACNP knows that in accordance
with the most current guidelines published in JNC 8 the appropriate action is
to:

• Question
48

When
assessing driver safety in the older adult, the AGACNP considers that:

• Question
49

The
nursing staff calls to tell you that your 81-year-old male patient is having an
acute change in mental status. He is a basically healthy man who was admitted
three days ago for inpatient antibiotic management of community acquired
pneumonia. His daughter is at the bedside and she is very distraught because
she has never seen him like this. She is asking for medication to make him stop
acting disoriented. Upon examination the patient is lying in bed, appears calm
and happy, but does not recognize his daughter as anyone he knows. He is
talking as if he is at home and has company. The AGACNP instructs the daughter
that:

• Question
50

While
discharging a patient following her myocardial infarction, you offer some
patient education about medically supervised cardiac rehabilitation. The
patient expresses fear of rehab because she was on her treadmill when she had her
infarction and now she is afraid of making it happen again. She doesn’t
understand how the rehab can force her to exercise her heart but not make her
have another cardiac event. The AGACNP explains that the patient will be
monitored and that her goal heart rate will be:

• Question
51

During
physical examination of a 51-year-old African-American female you appreciate a
decrease in her peripheral vision. The rest of her eye examination is within
normal limits and she is symptom free. This presentation is consistent with:

• Question
52

Mr.
Moffett is a 66-year-old male with a long history of lower extremity edema. All
other causes of lower extremity edema have been ruled out and his overall
symptom presentation and history are strongly supportive of chronic venous
insufficiency. Today he presents with increased itching of both lower legs.
Physical exam reveals 2-3+ pitting edema and trophic hyperpigmentation. The
AGACNP know that treatment should include:

• Question
53

L.R. is
an 84-year-old female patient being treated for pneumonia. Her condition is
deteriorating despite aggressive broad spectrum antipseudomonal cephalosporin
antibiotic therapy. Induced sputum culture reveals heavy growth of Legionella
pneumophilia. The AGACNP knows that antibiotic therapy must be adjusted to
include coverage with:

• Question
54

The
AGACNP is treating a patient with a corneal abrasion. The patient has a clear
recollection of the mechanism of injury—she was scratched in the eye earlier
today with her 18-month-old daughter’s fingernail. Which of the following is
contraindicated in the management of this patient’s abrasion?

• Question
55

M.T. is
a 41-year-old male patient in the intensive care unit. He was admitted to the
hospital in septic shock and has been aggressively managed with broad spectrum
antibiotics. He has become progressively hypoxemic and the last arterial blood
gas revealed a paO2 of 58 mm Hg. Chest radiography reveals a “white
out” pattern bilaterally. The patient is intubated and ventilated. The
AGACNP knows that appropriate management must include:

• Question
56

Teenagers
and adults with acute otitis media can often be treated with “watchful
waiting” given the high incidence of spontaneous resolution and low risk
of poor outcomes. Which of the following is an absolute indication to begin
antibiotic therapy at the time of diagnosis?

• Question
57

Mr.
Bowers is on mechanical ventilation for respiratory support through an episode
of septic pneumonia. Due the extensive lobar consolidation it was very difficult
to keep Mr. Bowers oxygenated and he required very high FIO2s and PEEP. The
AGACNP knows that the primary concern with FIO2s > 60% is:

• Question
58

Acute
respiratory distress syndrome (ARDS) occurs when an overwhelming systemic
insult results in which maladaptive physiologic response?

• Question
59

Acute
respiratory distress syndrome is characterized by which abnormality of
ventilation and perfusion?

• Question
60

George
Schulz is a 69-year-old male who presents for evaluation of acute foot pain. It
is so painful that he cannot walk on it without assistance. At first he denies
any significant medical history, but then reveals that he has been diagnosed
with dyslipidemia and hypertension but stopped taking his medications because
he couldn’t afford it. Pulses are not palpable but are audible by Doppler. The
extremity is pale and shiny with decreased hair growth, suspecting peripheral
arterial disease, the AGACNP expects which additional finding?

• Question
61

G.T. is
a 40-year-old male who is under your case for long term management of secondary
osteoarthritis. Today he asks if he can take a medication for anxiety. Further
assessment reveals that he is in a relationship that has been very stressful;
his girlfriend wants very much to get married and start a family, and he does
not. He admits that he no longer feels they are compatible and acknowledges
that he needs to end this relationship. He is sure that this is the source of
his anxiety. The best approach would be to:

• Question
62

During
the physical examination of a 31-year-old female, the AGACNP appreciates a
bifurcate uvula. The most appropriate action would be to:

• Question
63

During
routine immigration screening a 29-year-old male patient from Mexico has a
positive purified protein derivative (PPD) test at 17 mm induration. He reports
no known history of tuberculosis (TB) infection or exposure, or vaccination
with the BCG vaccine. Chest x-ray is negative for any evidence of TB exposure.
The AGACNP knows that the appropriate next step is to:

• Question
64

Clinical
diagnostic criteria for acute respiratory distress syndrome (ARDS) include all
of the following except:

• Question
65

While
managing a patient in acute pulmonary edema, the AGACNP monitors the pulmonary
capillary wedge pressure. When this pressure falls below 12 mm Hg it suggests
that:

• Question
66

All of
the following are important elements of the immediate management of penetrating
eye injury except:

• Question
67

While
evaluating a patient with diastolic failure due to a long history of
uncontrolled hemochromatosis, the AGACNP appreciates an extra heart sound just
before the S1 heart sound. This sound is most likely a(n):

• Question
68

Secondary
hypertension occurs in approximately 10% of all patients with hypertension, and
requires management of the underlying problem in order to eliminate the cause.
Which of the following is not a secondary cause of hypertension?

• Question
69

L.M, is
a 26-year-old male who presents to the emergency department complaining of
acute onset vertigo this morning. He describes a strong sense of the room
spinning and can barely walk without feeling nauseous. The vertigo is
reproducible when his neck is rotated suddenly left or right. The AGACNP knows
that which of the following is not indicated?

• Question
70

A
36-year-old female presents complaining of left leg swelling. She describes the
onset as acute over the last day or two, and says it feels “tight and
throbbing.” She denies any significant medical history and says the only
medication she takes is oral contraception, which she has taken since she was
15 years old. The AGACNP first orders:

• Question
71

The
primary neurotransmitter implicated in post-traumatic stress disorder (PTSD)
is:

• Question
72

Mr.
Avila is an 82-year-old male being counseled about the risks and benefits of
his upcoming abdominal surgery. While considering risk factors for atelectasis,
pneumonia and other pulmonary complications, the AGACNP advises that the
greatest risk comes from:

• Question
73

The
female AGACNP is practicing with a cardiology group and sees patients one day a
week in the outpatient office. A 49-year-old female presents for follow-up
after her admission for infective endocarditis. She is recovering well, and
says that she is going to be more proactive about her health. She admits to not
having had any of her regular health screenings for years, and asks if she can
have her Pap performed at this office. The AGACNP:

• Question
74

The
AGACNP is seeing a patient who was transferred from the correctional facility
for evaluation. He has a profound purulent discharge from his right eye. The
conjunctive is erythematous and there is mild photosensitivity. The inmate
denies any real eye pain, just says that it is extremely uncomfortable.
Treatment for this patient is likely to include:

• Question
75

Ms.
Ewing is a 78-year-old female who lives in a long term care facility because
her dementia has progressed to the point at which her family cannot provide the
necessary safety measures at home. In addition to her absent short term memory
she has developed some affective changes and most recently is demonstrating
sexual disinhibition. While considering management options, the AGACNP knows
that all of the following are medications are options for the management of
disinhibition except:

• Question
76

A
patient recently had a nasal packing inserted for management of refractory
epistaxis. One week later he presents with fatigue, a headache “inside of his
nose” and a feeling generally unwell. The AGACNP considers:

• Question
77

A
55-year-old female patient presents with a fever of 103.4° F. She was treated
approximately 10 days ago at urgent care for a sinus infection, but two days
ago the right side of her fact started to hurt, and today she has significant
swelling of the right orbit and eyelid. The eyelid is very edematous and there
is purulent drainage noted. The priority of care for this patient begins with:

• Question
78

Which
of the following is the best indicator that pulmonary rehabilitation has been
successful in a patient with chronic obstructive pulmonary disease?

• Question
79

Mrs.
Marriott is being discharged to home after being managed for an exacerbation of
congestive heart failure. She is currently feeling well but her ejection
fraction after optimal diuresis and fluid management is 29%. The AGACNP knows
that her discharge medications must include:

• Question
80

Which
of the following is an accurate statement with respect to the assessment of
delirium in the geriatric patient?

• Question
81

Mrs.
Warner is a 57-year-old female who presents with unplanned weight loss. Chest
radiography reveals diffuse hyperlucency of the left lung and in the lower half
of the right lung. The AGACNP knows that the differential diagnosis for
hyperlucency include all of the following except:

• Question
82

When
evaluating a patient with epistaxis, which of the following signs or symptoms
is suggestive of a more serious etiology and posterior packing?

• Question
83

R.M. is
a 15-year-old male who presents to the emergency department with his mother.
Mom says he has been complaining that his throat hurts so badly he cannot even
swallow saliva. According to Mom R.M. is not the type to complain, but he is in
so much pain with his throat he is almost crying. He has no significant medical
history and takes no daily medications. He has no allergies of which his mother
is aware. Upon physical examination he is febrile with a temperature of 102.4°
F and he is a bit tachycardic, but other vital signs or normal. Inspection of
the throat is basically unremarkable—the AGACNP does not appreciate any
abscesses, edema, or exudate; there may be some slight erythema. The AGACNP
becomes suspicious that the patient:

• Question
84

Mr.
Stossel is a 66-year-old male patient who was admitted for management of acute
anterior wall myocardial infarction. Over a period of hours he has developed
acute shortness of breath, coarse rales to auscultation, and Kerley B lines on
chest radiography. Arterial blood gas reveals a pH of 7.34, pCO2 of 30 mm Hg,
and paO2 of 59 mm Hg. The AGACNP anticipates which of the following findings on
physical examination?

• Question
85

According
to the revised criteria in DSM-V, the primary difference between panic attacks
and panic disorder is that:

• Question
86

Mr.
Wilson is a 71-year-old male who has been treated with prn short acting
anticholinergics for his COPD. Last week he developed an exacerbation that
required a 4 day hospitalization for support and stabilization. He was
discharged on a five day course of prednisone and now presents for follow-up.
The AGACNP knows that his outpatient medication regimen should be adjusted to
include:

• Question
87

J.T. is
a 26-year-old female patient being evaluated for eye discharge. She says that
for the last few days she has developed this sticky, string-like discharge in
both eyes. She denies any pain or visual changes, but does admit to a sense of
“something in my eyes” and that her eyes itch a lot. Physical
examination reveals injected conjunctiva, rope-like discharge bilaterally;
pupil response is equal and brisk in both eyes. Which factor in the patient’s
history would be supportive of the most likely diagnosis?

• Question
88

What is
the primary difference in patient management between high risk non-ST elevation
myocardial infarction (MI) and the low risk non-ST elevation MI patient?

• Question
89

The
pathophysiology of endogenous depression is best described as:

• Question
90

The
diagnostic study most supportive of a diagnosis of pericarditis is:

• Question
91

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:

• Question 92

A
patient with pericarditis is most appropriately treated with:

• Question
93

Which
of the following is not a risk factor for thoracic aneurysm?

• Question
94

The
“MONA” acronym provides guidance for immediate interventions in the
patient with:

• Question
95

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:

• Question
96

The
AGACNP counsels a patient with recurrent epistaxis that the most common cause
of nose bleeding is:

• Question
97

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:

• Question
98

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:

• Question
99

Absolute
contraindications to thrombolytic therapy in the patient having an acute
myocardial infarction include all of the following except:

• Question
100

Which
of the following is not a true statement with respect to risk for or occurrence
of elder abuse?

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