NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 SUMMER 2018


1. Mr. Jeffers was admitted 2 days ago for 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

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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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



1. Systemic
lupus erythematosis (SLE) is a multi-organsystem 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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 6

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

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


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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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


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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

B. Increased
respiratory rate

C. Increased
tidal volume

D. Increased

1 points


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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 12

1. Jennifer
is an 18-year-old homeless female who was found unresponsive. She was admitted
to the hospital for management of severe bleeding after a spontaneous abortion
escalated to a uterine hemorrhage. An underlying infection and dehydration were
corrected and nutritional supplements were started. Her volume status is
stable, morning labs were all within normal limits and she is to be discharged
today. When the AGACNP enters the room to prepare the patient for discharge,
she finds her agitated, pale, and diaphoretic with vital signs to include a
pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a
temperature is 97.9° F. The most appropriate action would be to:

A. Order a
CBC to assess for recurrent bleeding

B. Request
and abdominal CT to assess for bleeding

C. Evaluate
the patient for anxiety/panic attack

D. Prescribe
alprazolam 1 mg now

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 13

1. Physical
examination findings in a patient with pneumothorax is likely to reveal:

A. Increased
tactile fremitus

B. Low grade

C. Hyperresonance
to percussion

D. Egophany

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 14

1. Mr.
Parker brings his 73-year-old wife to a clinic appointment because he is
worried about her. She has a long history of hypertension and dyslipidemia, but
he says she has taken medication for years and everything has been OK. His
concern today is that for a long time she has been very forgetful, and he has
tried to help her by keeping a strict routine around the house. Over the past
few months, she just seems more and more forgetful, does not seem interested in
doing anything, and now seems to be forgetting how to do simple everyday tasks.
Yesterday she could not figure out which dollar bills to use at the store to
pay the cashier. The AGACNP knows Mrs. Parker should first be screened for:

A. Depression

B. A brain

C. Hypothyroidism

D. Adrenal

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 15

1. M.R. is a
40-year-old female who has a known history of peptic ulcer disease. She has
been admitted through the emergency room with a diagnosis of GI bleeding—she is
vomiting dark blood and had a nasogastric tube placed. When attached to low
intermittent suction it initially drained 400 cc of dark brown/black drainage,
but now it is starting to drain lighter red colored blood. The AGACNP knows
that immediate priorities of care include:

A. Ensuring
hemodynamic stability

B. Beginning
a parenteral proton pump inhibitor

C. Beginning
gastric lavage

D. Ordering
a gastrointestinal consult

1 points


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

B. Folate

C. Ferritin

D. Hemoglobin

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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


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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

D. Hyperacidity

1 points


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

A. Acute

B. Edema

C. High
riding testis

D. Dysuria

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 34

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



1 points


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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

B. Thiamine
100 mg

C. Nalaxone
0.4 mg

D. Ativan 4

1 points


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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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:


B. Antidepressants

C. Antiepileptics

D. Opiates

1 points


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

B. Pseudomonas

C. Staphylococcus

D. Streptococcus

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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


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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

B. A

C. A

D. An
incretin mimetic

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 46

1. Felty’s
syndrome is a condition of immune neutropenia seen sometimes in patients with:

A. Polymyalgia

B. Giant
cell arteritis

C. Systemic
lupus erythematosus

D. Rheumatoid

1 points


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

C. A first
generation-antihistamine combination

D. An
inhaled anticholinergic

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 48

1. Mr.
Truman is transferred to the emergency department by ambulance. His wife called
911 this morning because he was acting “funny” when he woke up. Both the
patient and his wife went to bed last night at approximately 10:30 and
everything was normal. This morning he could not communicate orally and seemed
confused about how to ambulate. Upon arrival to the emergency department his
vital signs are as follows: Temperature 100.9° F, pulse 89 b.p.m., respirations
14 b.p.m. and blood pressure 168/94 mm Hg. A non-contrast CT scan of the head
reveals thrombotic CVA. The AGACNP know that immediate management of this
patient should include:

A. Thrombolytics


C. Aspirin

D. Antiepileptics

1 points


1. Your
patient is complaining of profound nausea and vomiting that started at bedtime
last night and kept him awake all night long. Early this morning he started
having abdominal cramping and explosive diarrhea. Based upon the character of
symptoms you are suspicious of infection with Staphylococcus aureus. To assess
risk for exposure to this organism, you ask the patient about which meal?

A. Breakfast

B. Lunch

C. Dinner

D. Bedtime
snack yesterday

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 50

1. D.R. is a
54-year-old male patient who was admitted for the management of cellulitis and
treated with parenteral antibiotics. He has not been responding as well as
anticipated. During today’s exam the AGACNP appreciates a couple of changes.
All of the following indicate the need for immediate surgical evaluation

A. Skin

B. Violaceous

C. Gas
bubbles in tissue

D. Lymphangetic

1 points


1. R. O. is
a 21-year-old female who comes to the emergency department because of a severe
headache. Her vital signs and neurological examination are within normal
limits. She complains of a pulse-like pain in her right temple and admits that
she has almost vomited. Her mother gets the same type of headache and the last
time this happened R.O. took one of her mother’s prescription headache pills.
They helped a lot, but this time her mother told her she had to come be
evaluated. The AGACNP knows that which of the following is the appropriate

A. A
non-contrast CT scan of the head

B. Administration
of a 5HT agonist

C. Dilaudid
2 mg IM x 1 dose

D. Requesting
a headache diary

1 points


1. A
39-year-old female presents for evaluation of a rash. She denies any
significant medical history, and has no other complaints. The rash appeared
suddenly on both forearms approximately one week ago, and she is concerned
because it is not going away. It does not itch or hurt—it is just there. Physical
examination reveals a diffuse macular hypopigmentation on both forearms that
extends to the hands. The patient denies any drug or alcohol use; she is single
and has had 4 unprotected sexual partners in the last year. The AGACNP knows
that initial laboratory testing must include a(n):

A. FTA-Abs

B. Fungal
skin scraping



1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 53

1. J.S. is a
African-American female who presents for a wellness examination. Her medical
history is significant for beta thalassemia minor. Anticipated red blood cell
differential would include which of the following patterns?

A. Hgb 10.2
g/dL, Hct 30%, MCV 70 fL, RDW 12.6%

B. Hgb 9.9
g/dL, Hct 28%, MCV 83 fL, RDW 13.9%

C. Hgb 11.5
g/dL, Hct 35%, MCV 94 fL, RDW 15.8%

D. Hgb 12.8
g/dL, Hct 38%, MCV 105 fL, RDW 18.1%

1 points


1. M.T.
presents complaining of acute pain in his left eye, nausea, and one episode of
vomiting. He denies any significant medical problems, and says that the only
medication that he takes is an occasional over-the-counter sleeping pill.
Physical examination reveals a steamy red cornea and conjunctiva with a pupil that
is 5 mm and not reactive to light. The AGACNP knows that diagnostic testing
should include:

A. A CT scan
of the head

B. An MRI of
the orbit

C. A
toxicology screen

D. A
measurement of intraocular pressure

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 55

1. Justin is
a 23-year-old male who is being managed for an acute manic episode. Justin was
diagnosed with bipolar disorder several years ago, but his home life has been
unstable and he has not been very adherent to a medication regimen. Most
recently he was started on the SNRI venlafaxine by his primary care provider,
which he has been taking as prescribed for about 6 weeks, but he began a manic
episode a few days ago which peaked this evening. The AGACNP considers that:

A. The manic
episode is probably a result of medication instability and he should continue
his current regimen with a follow-up in 6-8 weeks

B. A mood
stabilizing agent should be added to the venlafaxine

C. All
medication should be held for 6-8 weeks and the then the patient should be

should be stopped and a mood stabilizing agent started

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 QUESTION 56

1. Mr.
Livingston is a 79-year-old male who presents from a long term care facility
with a change in mental status. His medical history is significant for T2DM,
CAD, CHF, hypothyroidism, Alzheimer’s dementia and osteoarthritis. He has been
stable, but over the last few days the staff say he has been a bit
disconnected. This morning he was found in his bed in a stuporous state. His
vital signs include a temperture of 98.9° F, pulse of 103 b.p.m., respiratory
rate of 20 b.p.m., and a blood pressure of 92/64 mm Hg. His metabolic panel
demonstrates a Na+ of 129 mEq/L, K+ of 3.3 mEq/L, Cl- of 100 mEq/L, CO2 of 24
mEq/L, glucose of 644 mg/dL, BUN of 51 mg/dL and creatinine of 1.9 mg/dL. The
AGACNP knows that the primary problem is most likely:

A. Diabetic

B. Hypertonic

C. Myxedema

D. Hyperosmolar
hyperglycemic coma

1 points

NURS 6550 FINAL EXAM – WALDEN UNIVERSITY Walden nurs6550 final exam 2019 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

C. Hepatic
function enzymes

D. Urinalysis
with microscopic

1 points


1. All of
the following are true statements about post-traumatic stress disorders (PTSD)

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


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

B. Systemic

C. Physical

D. Bedrest
for 72 hours

1 points


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


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

D. Discharge
to home with follow-up LFTs in 4 days

1 points


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

C. A 12-lead

D. Induced
sputum culture

1 points


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


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


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

B. A strong

C. A
non-steroidal antiinflammatory agent

D. An antidepressant.

1 points


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


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

B. A venogram

C. A D-dimer

D. CT of the

1 points


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

B. Non-Hodgkin’s

C. Catscratch

D. Syphilis

1 points


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


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


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

B. Intra-renal

C. Post-renal

D. Chronic
renal failure

1 points


1. Patients
with giant cell arteritis are at increased risk of:

A. Cerebrovascular

B. Rheumatoid

C. Polymyalgia

D. Osteoarthritis

1 points


1. The
AGACNP is called to the bedside for a patient who is in cardiopulmonary arrest.
The monitor demonstrates ventricular fibrillation which will not convert
despite several attempts to defibrillate at maximal voltage. While being
briefed by the staff nurse on the patient medical history, he learns that the
patient has a history of Cushing’s syndrome. The AGACNP recognizes that the
patient is probably failing to convert due to:

A. Advanced
atherosclerotic disease

B. Hypokalemia

C. Hypocalcemia

D. Catecholamine

1 points


1. When
performing an evaluation of a patient following seizure activity, the AGACNP
knows that the most important component of that evaluation is:

A. A CT scan
of the head

B. Eyewitness


D. Administering
a benzodiazepine

1 points


1. Which of
the following etiologic organisms is most likely to appear as lobar
consolidation on chest radiography?

A. Legionella

B. Streptococcus

C. Pneumocystis

D. Mycoplasma

1 points


1. A patient
with chronic kidney disease presents with an eGFR of 30 mL/min/1.73m2. The
AGACNP knows that the most compelling implication of this value is:

A. Control
of risk factors for renal deterioration

B. Careful
attention to renal dosing of medications

C. Referring
the patient for shunt placement

D. Preventing
occurrence of renal ischemia

1 points


1. Differential
diagnosis of hematuria include all of the following except:

A. Bladder

B. Nephrolithiasis
in the renal parenchyma

C. Urinary
tract infection

D. Prerenal

1 points


1. A
29-year-old male patient presents with acute scrotal pain and dysuria. He has a
temperature of 101.8° F and a pulse of 115 b.p.m. but otherwise vital signs are
within normal limits. He gets some relief of the scrotal discomfort when his
scrotum is elevated on a rolled towel. This is known as:

A. Varicocele

B. Prehn’s

C. Cremasteric

D. Testicular

1 points


1. The
AGACNP knows that patients with psoriasis are at greater risk for:

A. Arthritis

B. Eczema

C. Cellulitis

D. Melanoma

1 points


1. Mr.
McCarran is a 68-year-old male with a long history of poorly controlled T2DM.
He has had progressive burning pain in both feet for the last year or so, but
in the last few months it has become increasingly worse. He has tried taking
ibuprofen and naproxyn over-the-counter with no improvement. Now, he is
presenting for more effective pain management. The AGACNP knows that the
medication of choice will be from which drug class?


B. Opiates

C. Antiepileptics

D. Anesthetics

1 points


1. Mr.
Starwood is a 61-year-old male who was admitted last night for the management
of acute pancreatitis. He was admitted n.p.o and started on intravenous fluid
and opiate pain management. This morning he reports feeling significantly
better. His C-reactive protein this a.m. is 5 mg/dL, amylase and lipase are
both just over 2 x upper limits of normal, and his Ransom score is 2. The
AGACNP knows that the next step in his care is to:

A. Begin
clear liquids as tolerated

B. Order an
abdominal CT

C. Order an

D. Continue
the current management for 24 hours

1 points


1. When
beginning pharmacotherapy for depression, the AGACNP discusses with the patient
that a primary safety consideration includes the:

A. Increased
risk of suicide when patients begin antidepressant therapy

B. Potential
for sexual adverse effects

C. Better
likelihood of success when medications and therapy are used together

D. High
incidence of serotonin syndrome

1 points


1. When
ruling out meningitis in a patient, the AGACP appreciates that the spinal fluid
is cloudy and the glucose content is 20 cells/microliter. This is most
consistent with:

A. Aseptic

B. Septic

C. Chemical

D. Chronic

1 points


1. A
44-year-old male patient presents in a hypertensive crisis. The blood pressure
is 240/136 mm Hg, pulse is 128 b.p.m. and the patient is complaining of a
severe, pounding headache. His skin is diaphoretic and he is visibly tremulous.
The first diagnostic study to evaluate the suspected diagnosis should be a:

A. 24 hour
urine for catecholamine metabolites

B. Serum
epinephrine and metanephrines

C. T scan of
the abdomen

D. MRI of
the abdomen

1 points


1. An
unidentified patient is brought to the emergency department by ambulance after
being hit by a motor vehicle. She has multiple injuries and an estimated blood
loss of 2 liters. The hematocrit is 19%. The AGACNP expects that the mean cell
volume (MCV) would most likely be:

A. 70 fL

B. 80 fL

C. 90 fL

D. 110 fL

1 points


1. Mrs.
Oliver is a 71-year-old petite Caucasian female. During a routine dexa
screening she was found to have a T-score of -3.0. The AGACNP knows that the
first intervention should include:

A. Calcium

B. Vitamin D

C. Bisphosphonates

D. Estrogen

1 points


1. When
evaluating a family with suspected carbon monoxide exposure, the AGACNP knows
that assessment should include all of the following except:

A. Vital

B. Pulse

C. Cardiac
rhythm strip

D. Carboxyhemoglobin

1 points


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


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

D. Anemia

1 points


1. The
diagnostic study of choice in mesenteric ischemia is:

A. Ultrasound



D. Diagnostic
peritoneal lavage

1 points


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

B. Brawny

C. Homan’s

D. Dependent

1 points


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