NURS 6550 Midterm Exam and final exams

NURS 6550 Midterm Exam / NURS6550 Midterm Exam (Latest): Walden University Walden NURS 6550 Midterm Exam / Walden NURS6550 Midterm Exam 1. A patient with anterior epistaxis has been treated with 20 minutes of direct pr ...

NURS 6550 Midterm Exam / NURS6550 Midterm Exam (Latest): Walden University Walden NURS 6550 Midterm Exam / Walden NURS6550 Midterm Exam 1. 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: 2. 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: 3. 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? 4. 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. 5. 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? 6. 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? 7. Which of the following is the greatest risk factor for vascular dementia? 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? 9. Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment for patients taking these medications should include a: 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? 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: 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: 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: 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: 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? 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? 17. While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic disorders is: 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: 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: 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: 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? 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? 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: 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: 25. Who among the following patients is at greatest risk for a pulmonary embolus? 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? 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: 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: