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1. QUESTION/ANSWER: The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert the AGACNP for the possibility that the patient is over hydrated, thereby increasing the risk for increased intracranial pressure? A. BUN = 10 B. Shift output = 800 ml, shift input = 825 ml Unchanged weight C. 2. QUESTION/ANSWER: A patient who has been in the intensive care unit for 17 days develops hyponatremic hyperosmolality. The patient weighs 132 Ib (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H20. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to: A. reduce serum osmolality by infusing a 5% dextrose in 0.2% sodium chloride solution C. replenish volume by infusing a 0.9% sodium chloride solution D. replenish volume by infusing a 5% dextrose in water solution. 3. QUESTION/ANSWER: A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of nausea and has had one episode of vomiting, but he denies any diarrhea. His vital signs are as follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/uL. The AGACNP expects that physical examination will reveal: A. +Murphy’s sign B. + Chvostek’s sign C. + MeBurney’s sign D. +Kernig’s sign 4. QUESTION/ANSWER: Myasthenia gravis is best described as: A. An imbalance of dopamine and acetylcholine in the basal ganglia Demyelination of peripheral ascending nerves B. Demyelination in the central nervous system C. An autoimmune disorder characterized by decreased neuromuscular activation 5. QUESTION/ANSWER: Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACMP is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms include all of the following except: A. Colic due to return of peristalsis B. Leakage from the duodenal stump C. Gastric retention b. Hemorrhage 6. QUESTION/ANSWER: Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but throughout the course of day 1 she has complained of a mild abdominal discomfort that has progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms. include all of the following except: A. B. Leakage from the duodenal stump C. Gastric retention D. Hemorrhage 7. QUESTION/ANSWER: When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke most likely resulted from a subarachnoid hemorrhage when the patient’s family reports that the patient: A. B. C. Had been complaining of a headache before losing consciousness D. Has had several brief episodes of mental confusion and right arm and leg weakness 8. QUESTION/ANSWER: You are asked to see a 29 year old female complaining of abdominal pain. She states she is experiencing constant RUQ pain that radiates to her back. The pain is not relieved by bowel movements, over the counter antacids or food. Review of initial labs shows elevated amylase and lipase and you diagnose her with acute pancreatitis. Which test will you order next to determine the underlying cause of her pancreatitis? serum cholesterol level blood toxicology 13.QUESTION/ANSWER: Acute hepatitis A is usually diagnosed by: By the constitutional symptoms Within 2 weeks of exposure Jaundice 14.QUESTION/ANSWER: 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? Subclinical infection Catscratch disease Syphilis 15.QUESTION/ANSWER: P. E. is a 61-year-old female who presents for a postoperative visit following a gastric resection after a perforation of peptic ulcer. She reports feeling better, although it is taking longer than she expected. However, she says she is feeling better each day, her appetite is returning, and her incision is healing well. She is being discharged from surgical care and advised to continue her routine health promotion follow-up with her primary care provider. As part of her surgical discharge teaching, the AGACNP counsels P. E. that as a result of her gastric resection she will need lifelong follow-up of: Blood group substances Electrolyt es Gastric pH 16.QUESTION/ANSWER: T. O. is a 31-year-old male patient who is transported to the emergency department via emergency services. He was in a multivehicle accident and was trapped in a crushed car for more than 3 hours. On examination, his right lower extremity is found to be tensely swollen, with 3+ nonpitting edema. The lower leg is profoundly painful with passive range of motion. Given the history and physical findings, the AGACNP recognizes that treatment centers around: Thrombolytics Surgical reduction Casting 17.QUESTION/ANSWER: While consulting on a patient who is admitted with a chief complaint of abdominal pain, the AGACNP notes that the initial assessment described the pain as “colicky.” This means that the pain: Is a result of gas in the bowel Is intestinal in origin Ly Is sharp, intense, and nonradiating 18.QUESTION/ANSWER: All of the following are expected findings in a patient with a T10 fracture except: Paraplegia Fecal retention Priapism 19.QUESTION/ANSWER: T. 0. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600/puL. The AGACNP suspects: Dissecting aortic aneurysm Acute pancreatitis a Mallory-Weiss tear 20.QUESTION/ANSWER: The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNR—the patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here? Veracity and beneficence Beneficence and hyperlipidemia genetic predisposition hypercalcemia 25.QUESTION/ANSWER: In neurogenic shock, patients are subjected to an abnormal dilation of venules and arterioles in response to failure of the autonomic nervous system. Treatment for neurogenic shock may include all of the following except: Trendelenburg Intravenous fluids Vasoconstrics 26.QUESTION/ANSWER: Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients? High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant Better results are demonstrated in corticosteroid-free protocols for second- transplant recipients Evidence supports corticosteroid-free rejection protocols 27.QUESTION/ANSWER: The comprehensive serologic assessment of a patient with Cushing’s syndrome is likely to produce which constellation of findings? a High sodium, polycythemia, low BUN Low sodium, low potassium, high BUN High sodium, high chloride, high RBCs. 28.QUESTION/ANSWER: A patient admitted for management of sepsis is critically ill and wants to talk with a hospital representative about donating her organs if she dies. She has a fairly complex medical history that includes traumatic brain injury, breast cancer, and dialysis-dependent renal failure. The patient is advised that she is ineligible to donate due to her: Renal failure Traumatic brain injury Systemic infection 29.QUESTION/ANSWER: Elmer is a 61-year-old male who is admitted vomiting bright red blood. He has no known medical history—he has not been in the health care system for most of his adult life. He has lost a lot of volume, and his vital signs are borderline unstable with a blood pressure of 88/58 mm Hg, pulse of 118 bpm, respiratory rate of 12 bpm, and a temperature of 97.6°F. The AGACNP recognizes that the leading differentials include all of the following except: Peptic ulcer Portal hypertension Gastritis 30.QUESTION/ANSWER: T. S. is a 31-year-old female who is admitted following a catastrophic industrial accident. She had multiple injuries, and after a 10-day hospital stay that included several operations and attempts to save her, she is declared brain dead. She had an organ donor notation on her driver’s license. Which of the following circumstances precludes her from serving as a liver donor? Encephalopathy Hepatitis C infection A long history of alcohol use 31.QUESTION/ANSWER: M. N. is a 61-year-old male who is referred to the emergency department by a local retail clinic. M. N. has not had regular health care at any time in his adult life; he says he doesn’t know when he last saw a doctor. His daughter finally talked him into going to the local retail health clinic when his abdomen became so distended that he couldn’t pull his pants up. M. N. says that he has put on some weight over the last few weeks but he has not felt ill. He admits to drinking > 4 drinks of whiskey daily; he says he smokes 2 packs of cigarettes a day and is not very active. He has lived alone since his divorce 20 years ago. Physical examination reveals an adult male who is chronically ill in appearance and appears older than stated age. His vital signs are within normal limits, and physical examination is significant only for obvious ascites. Paracentesis and subsequent analysis of the fluid reveals an ascites LDH to serum LDH ratio of 0.8. The AGACNP knows that this ratio is highly suspicious for: Pancreatic disease Cirrhosis Autoimmune hepatitis 32.QUESTION/ANSWER: The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone setting up to pass the football when he was tackled and he immediately felt his knee "pop" and buckle as he fell. You, as the AGACNP, know the most important information to obtain from Tim is: Insurance information Family history Social history 37.QUESTION/ANSWER: Mrs. Nguyen is an 84-year-old female who suffered a fall in her long-term care facility. After assessing possible reasons for her fall, a physical examination is performed to look for injuries. Mrs. Nguyen has significant pain in her left upper arm and limited range of motion in her left shoulder; a shoulder trauma series is ordered to evaluate for which type of injury that frequently occurs in these circumstances? Shoulder dislocation Scapular fracture i Nursemaid’s elbow 38.QUESTION/ANSWER: A general principle in surgical oncology is that the best approach to curative surgery in a fixed tumor requires: Adjuvant therapies Neoadjuvant therapies Elective lymph node dissection 39,QUESTION/ANSWER: Intracranial pressure monitoring is instituted for a patient with a head injury. The patient’s arterial blood pressure is 92/50 mm Hg, and her intracranial pressure is 18 mm Hg. Using these values to calculate the patient’s cerebral pressure (CPP) the AGACNP determines: The CPP is adequate for normal cerebral blood flow The CPP is high and that ischemia and neuronal death are imi ent Lowering the patients blood pressure will reduce the intracranial pressure, increasing cerebral blood flow 40.QUESTION/ANSWER: Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1% packs of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his usual state of good health until a couple of hours ago, when he developed this acute onset of severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so bad he finally came in. His vital signs are as follows: temperature 99.1°F, pulse 129 bpm, respirations 22 breaths per minute, and blood pressure 137/84 mm Hg. The abdomen is diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP anticipates that which of the following laboratory tests will be abnormal? A complete blood count and RBC differential Liver function enzymes A basic metabolic panel 41.QUESTION/ANSWER: A. S. is a 31-year-old male who complains of gastric discomfort that he notices mostly on an empty stomach; for example, if he works late and does not have the opportunity to eat, he notices that it happens. It feels better when he eats something or even if he just take TUMS®. Physical examination reveals a generally healthy adult male with normal vital signs. There is a bit of mild discomfort with deep palpation to the epigastrum, but otherwise the abdominal exam is normal. The AGACNP know that the most useful laboratory analyses will include: Chest radiography A white blood cell differential Vitamin B12 42.QUESTION/ANSWER: The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal: Increased MCV Increased Hgb Increased albumin 43.QUESTION/ANSWER: Carolyn C. has a history of Crohn’s disease and has been managed with immunologic agents, with moderate success. Today she presents with severe abdominal pain that comes and goes in waves; it started shortly after she ate a little bit of cottage cheese and crackers. This has never happened before with her Crohn’s disease. She has difficulty localizing the pain but seems to indicate the general area of the umbilicus. She had one episode of diarrhea this hematoma Epidural hematoma 47.QUESTION/ANSWER: Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower quadrant. She has had this pain before and says she usually takes antibiotics and it goes away. However, this time it seems worse, and she has had it for 4 days even though she says she started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting but says she simply isn’t hungry. She had a little diarrhea yesterday but no bowel movements today. She has a temperature of 100.9°F and a pulse of 104 bpm, respirations of 20 breaths per minute, and a blood pressure of 94/60 mm Hg. She has some discomfort to deep palpation in the left lower quadrant. The AGACNP suspects: Irritable bowel syndrome Inflammatory bowel disease Appendicitis 48.QUESTION/ANSWER: T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation? A temperature of 101.5°F sete A palpable gallbladder A positive Murphy’s sign 49.QUESTION/ANSWER: Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural football game and comes to the ER complaining of severe pain. Tim tells you that he was setting up to pass the football when he was tackled and he immediately felt his knee "pop" and buckle as he fell. What physical exam tests would you perform to confirm your differential diagnosis? Talar tilt test Tinel's test McBurney's test 50.QUESTION/ANSWER: The AGACNP rounds on his brain injury patient and recognizes the development of progressive bradycardia, hypertension, and irregular respiratory pattern. This is known as Cushing’s triad and suggests: Increased intracranial pressure Brainstem compression Subarachnoid hemorrhage 51.QUESTION/ANSWER: Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didn’t want to go to the emergency room because he didn’t want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes: Proper cleansing and covering of the laceration, along with oral an tic therapy Local anesthesia, cleansing, and suture repair Cleansing, covering, antibiotic therapy, and tetanus prophylaxis 52.QUESTION/ANSWER: A 49 year old female is seen for sudden onset severe abdominal pain 10/10. On further QUESTION/ANSWERing you learn that she has experienced epigastric pain for several months after eating, which has resulted in an 11 pound weight loss. She does not take any other medications. On physical exam you note she has a low grade fever of 100.1, HR 124, RR 25 and BP is 116/72. The abdomen is rigid and there are no bowel sounds. Abdominal plain film shows free air under the diaphragm. What is your diagnosis? ruptured gallbladder ruptured spleen ascites 53.QUESTION/ANSWER: R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left which would be the first diagnostic test the AGACNP would order? Radiography of hand and wrist Check HLA — B27 Hepatitis B serology testin rheumatoid aspirate for microcrystals 58.QUESTION/ANSWER: Mr. S., a 49-year-old male, is brought to the emergency room by his roommate who relates that the patient has been vomiting bright red blood for two days. He has a history of alcohol abuse. Current vital signs are as follows: Temp 99.20 F, heart rate 110 bpm (sinus tachycardia), blood pressure 90/60 mm Hg, resp 32 bpm. He is alert but lethargic and denies current abdominal pain. Which of the following is not indicated in the initial management of this patient? Immediate IV access Laboratory screening, type and crossmatch Crystalloid infusion 59.QUESTION/ANSWER: A 38-year-old patient presents with symptoms of L5 nerve root impairment that have been ongoing for 3 weeks despite conservative treatment. All of the following statements regarding this case are true EXCEPT: | LS level is one of the most likely levels for disk herniation Sensory findings may include diminished pain on the dorsum of the distal region of the foot Motor findings may include weakness on extension of the great toe Tendon reflexes are expected to be normal at the knee and ankle 60.QUESTION/ANSWER: R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis? CBC with WBC differential Colonoscopy Barium enema 61.QUESTION/ANSWER: A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about: Lactulose taken 20 g PO daily Spironolactone taken 100 mg PO daily Protein intake of 50g dail Zolpidem taken 10 mg PO qhs. 62.QUESTION/ANSWER: Ms. Carpenter is a 28-year-old female who presents in significant pain; she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic? Temperature > 102°F White blood cell count > 14,000 cells/uL Vomiting 63. QUESTION/ANSWER: A 32-year-old patient who underwent an open splenectomy for a ruptured spleen is preparing for discharge. An adult- gerontology acute care nurse practitioner reviews the potential complications with the patient. The nurse practitioner emphasizes which instruction to the patient? Continue antibiotics for 14 days No international travel for five years No weight lifting restrictions 64. QUESTION/ANSWER: When evaluating a patient with acute pancreatitis, which of the following physical or diagnostic findings is an ominous finding that indicates a seriously ill/potentially moribund patient? Severe epigastric pain with radiation to the back Abdominal guarding and rigidity Obturator sign 65.QUESTION/ANSWER: Ted is a 22 year old male who fell on his right shoulder 2 days ago during a martial arts class. He is complaining of inability to sleep on his right side and has pain whenever he tries to use his arm. He denies any sensory changes in his hand. Nothing seems to make it better, even the ibuprofen he has been taking several times a day. to obey commands The patient's eyes do not respond, they are confused and do not follow commands. 70.QUESTION/ANSWER: L. S. is a 49-year-old female with a history of colorectal cancer for which she has had surgical resection and chemotherapy. She presents with profound abdominal pain. She has not vomited, and she is not certain when she had her last normal bowel movement; her bowel habits have been irregular for some time. A CBC demonstrates a mild microcytic anemia but is otherwise normal; her WBC differential is normal. Results of a metabolic panel support minor volume contraction but show no significant electrolyte abnormalities. Abdominal radiographs demonstrate dilation of the proximal colon, air fluid levels, and a complete absence of air in the rectum. The AGACNP diagnoses the patient with: Perforated colon Intestinal volvulus 71.QUESTION/ANSWER: Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural football game and comes to the ER complaining of severe pain. Tim tells you that he was setting up to pass the football when he was tackled and he immediately felt his knee "pop" and buckle as he fell. Which of the following diagnostics would the AGACNP order first? MRI of his knee CT scan Diagnostic arthroscopy 72.QUESTION/ANSWER: Jane S. is a 35-year-old female patient who is at 30 weeks’ gestation. She is being followed regularly for prenatal care and has always been healthy; she just had an office visit and was told everything was fine. Tonight she presents to the emergency room complaining of significant pain in the upper abdomen. Her vital signs reveal a temperature of 98.4°F, pulse of 110 bpm, respirations of 20 breaths per minute, and blood pressure of 144/90 mm Hg. A urinalysis reveals proteinuria, and a metabolic panel is significant for increased transaminases. Her hemogram is normal, but the CVC reveals platelets of 85,000. The AGACNP knows that which of the following must be evaluated as a cause of her abdominal pain? HELLP syndrome Placental abruption Preterm labor 73.QUESTION/ANSWER: A 52-year-old male comes to the clinic in preparation for an overseas trip next year. He has already searched the internet and knows that Hepatitis A and Hepatitis B are endemic in the country that he will be visiting. What will you recommend to this patient? No immunizations are needed. It is highly unlikely that he’ll be exposed to hepatitis since he’s traveling with a tour group. Recommend Hepatitis C IgG to prevent getting an acute illness. Recommend two doses of Hepatitis A and 3 doses of Hepatitis B vaccine. Recommend one dose of Hepatitis A and Hepatitis B vaccine. 74.QUESTION/ANSWER: Mr. Warner is a 64-year-old male who presents with multiple skin lesions scattered about his head, neck, shoulders, and arms. They range in size from 3 mm to 1.2 cm. They do not hurt, burn, or itch, but they are rough to palpation—like sandpaper. Mr. Warner has a history of basal cell carcinoma x 3 and wants to know if these are also skin cancer. The AGACNP tells him that these lesions may be precancerous and are known as: Solar lentigo Bowen's disease Atopic dermatitis 75.QUESTION/ANSWER: Brad Berry, a 30-year-old male, presents to the ED with the chief complaint of a red, hot, swollen, painful right knee. He first noticed the problem last night, and feels it has gotten worse over the past 14 hours.Your medical history reveals that Mr. Berry denies problems with any other joints or recent injury to his right knee. He is not sexually active and currently is attending seminary school. He denies urethral discharge or urinary symptoms, recent rash, IV drug use, chronic illness, or recent camping. His temperature is 102.2 F. Physical exam reveals normal general survey, cardiorespiratory and abdominal examination. The right knee is markedly swollen with + fluid wave. There are no inguinal lymph nodes palpated. Which of the following would be the first diagnostic test for the AGACNP to order? Right knee AP, lateral, and sunrise view radiograph Serum rheumatoid factor Serum erythrocyte sedimentation rate 76.QUESTION/ANSWER: The AGACNP screens a new admit patient for liver disease. Elevations of all of the following would confirm your suspicion that this patient has liver disease, EXCEPT 
