NURS 6550 MIDTERM EXAM QUESTIONS AND ANSWERS.
Nurs 6550 Midterm Exam Questions and Answers
Question 1
1 out of 1 point
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 due to increased hydrostatic pressure in the pulmonary vessels. It typically implies that 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 incorrect 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 incorrect—a cheliform effusion is characterized by fat and indicates a pathology causing massive triglyceride degradation. “D” is incorrect as a hemorrhagic effusion is blood and typically means traumatic injury.
Question 2
1 out of 1 points
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:
“A” is the correct answer. Dizzy is a layperson’s term and can mean many different things to patients and healthcare providers. When the patient identifies the primary symptom as a sense of spinning, this supports vertigo, which is usually an inner ear problem. This versus ataxia, a neurologic or near-syncope, which may be cardiac, neurological, or neurocardiogenic. “B” is incorrect—this may occur with vertigo, but when it is the primary symptom, it is most likely ataxia, and neurological causes should be considered. “C” is incorrect, as coincident nausea is not specific and can occur with any of these complaints. “D” is incorrect as it is also not specific, while ataxia cannot occur when a supine near-syncope can.
Question 3
1 out of 1 point
Mr. Banks has been admitted for surgical resection of a metastatic tumor; during surgery, it was discovered that he has widespread, diffuse metastasis throughout the abdomen.
Surgery is no longer an option; his oncologist says 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:
Response Feedback:
“B” is the correct answer. If any concern about disagreement among family members or a patient’s wishes will not be carried out, the best action is to ensure a clearly defined, legally executed document. “A” is not correct. Living wills are not legally enforceable documents, and when dissension arises among family members, they may not be carried out. “C” is not correct – while the patient should arrange for his care as long as he can, if questions arise at such a time that he cannot answer, his next of kin will need to do so. “D” is incorrect — identifying the proxy is not enough without assigning legal rights and responsibilities. While “A,” “C,” and “D” should all be done and will support his care, the only way to ensure that one’s wishes are carried out is to ensure that a legally enforceable direction is in place.
Question 4
Mr. Wilkerson is a 77-year-old male being evaluated and treated for cardiogenic pain. His vital signs are as follows: Temperature of 99.1° F, the pulse of 100 bpm, respirations of 22 bpm, and blood pressure of 168/100 mm Hg. A 12-lead ECG
1 out of 1 points
Reveals deep ST segment depression in leads V3-V6. The AGACNP recognizes which of the following is a contraindication to TPA therapy?
Response Feedback:
“D” is the correct answer. rTPA is not indicated in patients with ST-segment depression; this is not an ST elevation MI. “A” is incorrect, as age > 80 is a relative contraindication. “B” is not correct as a temperature of 99.1° F is an expected response to myocardial necrosis, and “C” is not correct—the blood pressure is not prohibitive until > 180/110 mm hg.
Question 5
A 71-year-old patient is recovering from a particularly severe chronic obstructive pulmonary disease exacerbation. 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
1 out of 1 points
You know that he is 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 on the last day of the month. This patient’s behavior is consistent with which stage of the Transtheoretical Model of Change?
Response Feedback:
“C” is the correct answer. 5 stages characterize the Transtheoretical model of change. “A” is when the patient has no intention to change. “B” is when the patient intends to change in the next 6 months. “C” is when the patient is ready to take action or has already taken some action, as this patient has established his plan to quit by the end of the month. “D” is the overt action that attains a criterion sufficient to reduce disease risk—in this patient, the action stage would be characterized by actual smoking cessation. Maintenance is the final phase not presented in the answer choices here.
Question 6
Certain subgroups of the elderly population are at an increased risk for rapid.
1 out of 1 points
Deterioration and long-term care placement. Which is not considered a high-risk factor for long-term care placement?
Response Feedback:
“A” is the correct answer; men are at higher risk for long-term care placement than women. In addition to the male gender, other risk factors include age over 80, living alone, bowel or bladder incontinence, history of falls, dysfunctional coping, and intellectual impairment.
Question 7
P.M. is a 71-year-old gay male patient who presents as an outpatient for evaluation of
1 out of 1 points
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?
Response Feedback:
“D” is the correct answer. This patient presents from the outpatient population, where the most common cause of pneumonia.
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Question 8
Streptococcus pneumoniae 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 incorrect, 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 risks such as instrumentation or known colonization.
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 the 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.
Question 9
J.R. is a 55-year-old male who presents for a commercial driver’s license physical
1 out of 1 points
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?
Response Feedback:
“A” is the correct answer. According to the Joint National Committee (JNC) report, hypertensive urgency is described as hypertension in treating progressive target organ damage, such as renal involvement with protein leaking, left ventricular hypertrophy, or retinal changes. “A” is incorrect—the headache may or may not be relevant, but because there are many non-hypertension causes, a headache alone does not constitute target organ damage. “C” is not correct—it may indicate carotid plaque, but this is not a consequence of hypertension. “D” is not correct as a 1+ palpable pulse may be a normal finding–it must be taken in the
context of the rest of the examination.
Question 10