Walden NURS6550 FINAL EXAM Latest 2022

QUESTION 11     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

QUESTION 12     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

QUESTION 13Physical examination findings in a patient with pneumothorax is likely to reveal:

A.            Increased tactile fremitus

 B.           Low grade temperature

C.            Hyperresonance to percussion

D.            Egophany

QUESTION 14     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 tumor

C.            Hypothyroidism

D.            Adrenal dysfunction

QUESTION 15     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

QUESTION 16     A patient with sharp, stabbing chest pain directly over the precordium has a 12-lead ECG that demonstrates concave ST-T wave elevations in leads II, III, avR, avL, avF, and all six precordial leads. The AGACNP expects which physical finding?

A.            A grade IV/VI systolic murmur with radiation to the axilla

B.            A split S2 that increases with inspiration

C.            A pericardial friction rub

D.            An S4 heart sound

QUESTION 17 J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC reveals a macrocytic anemia with aHgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of 19%. The AGACNP suspects which type of anemia?

 A.           Iron deficiency

B.            Sickle cell anemia

C.            Pernicious anemia

D.            Anemia of chronic disease

QUESTION 18     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

QUESTION 19     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 109° 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

QUESTION 20

                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

QUESTION 21     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

QUESTION 22     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

QUESTION 23     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

QUESTION 24     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

QUESTION 25     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

QUESTION 26A 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

QUESTION 27     Classic radiographic features of osteoarthritis include:

A.            Soft tissue swelling

B.            Joint deformity

C.            Bone mineral loss

D.            Joint space narrowing

QUESTION 28     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

 QUESTION 29    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

QUESTION 30     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

QUESTION 31     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

QUESTION 32     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

QUESTION 33     Which of the following findings is not typically associated with testicular torsion?

A.            Acute pain

B.            Edema

C.            High riding testis

D.            Dysuria

QUESTION 34     152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes

No

QUESTION 35     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

QUESTION 36A 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

QUESTION 37     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

QUESTION 38     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

QUESTION 39     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

QUESTION 40     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

QUESTION 41     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

QUESTION 42     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

QUESTION 43     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

QUESTION 44     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

QUESTION 45     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

QUESTION 46     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

QUESTION 47     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

QUESTION 48     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

 B.           IV vasodilators

C.            Aspirin

D.            Antiepileptics

QUESTION 49     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 yesterday

B.            Lunch yesterday

C.            Dinner yesterday

D.            Bedtime snack yesterday

QUESTION 50     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 except:

A.            Skin anesthesia

B.            Violaceous bullae

 C.           Gas bubbles in tissue

D.            Lymphangetic spread