Download NURS 6550 Midterm Review Questions with Complete Solutions and more Exams Nursing in PDF only on Docsity!
NURS 6550 Midterm Review Questions
with complete solutions
The least worrisome type of fluid seen as a result of pleural fluid analysis - CORRECT ANSWER-Transudate pleural fluid What test should be ordered to confirm a suspected ascending aortic aneurysm? - CORRECT ANSWER-CT Scan with contrast Name risk factors for long-term care placement for the elderly population. - CORRECT ANSWER-Male gender 80 y.o.+ Living Alone bowel/bladder incontinence Hx of falls dysfunctional coping Intellectual impairment A patient with anterior epistaxis has been treated with direct pressure for 20 minutes. What are expected findings when the patient is instructed to gently blow their nose? - CORRECT ANSWER-Successful treatment will be indicated by dark residual blood or clots being discharged from the nose. If bleeding has not stopped you will see a bright red steady trickle of blood requiring more invasive measures.
What is the most common organism in treating otitis media, bacterial sinusitis, bacterial pharyngitis, AND community-acquired pneumonia? - CORRECT ANSWER- Streptococcus pneumoniae What is the greatest risk factor for vascular dementia? - CORRECT ANSWER- Vascular diseases that result in target organ damage such as: hypertension dyslipidemia diabetes Hypertensive urgency vs emergency - CORRECT ANSWER-- Hypertensive urgency: BP >200/120 w/o sx; Tx with PO furosemide, clonidine or captopril
- Hypertensive emergency: BP >200/120 WITH sx or evidence of end organ damage; Tx with IV nitroprusside, labetalol or nicardipine *Both req immediate treatment What annual lab testing should be done for patients taking atypical antipsychotics? - CORRECT ANSWER-Lipid Panel Name some atypical antipsychotics - CORRECT ANSWER-OLAnzapine CLOZapine QUETIapine RISPERidone Aripiprazole Ziprasidone
Transtheoretical Model of Change - CORRECT ANSWER-1. Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance psychotic disorder vs neurotic disorder - CORRECT ANSWER-psychotic: distinct alteration in perception of reality Neurotic: remain aware and interactive with reality Cholinergics (Miotics) - CORRECT ANSWER-Pilocarpine Pilocarpine adverse effects - CORRECT ANSWER-increased GI motility and bradycardia Initial treatment for a panic attack in the ER - CORRECT ANSWER-short-acting benzodiazepine for immediate symptom control diazepam or lorazepam Aside from symptom control, medication use and PEFR testing, what should be included as part of the assessment for an asthmatic patient? - CORRECT ANSWER- validated asthma questionnaire such as the ACT.
What is required for a diagnosis of Generalized Anxiety Disorder? - CORRECT ANSWER-The patient will report both excessive anxiety and worry, and difficulty controlling that worry, for more days than not in the last six months Levels of Prevention - CORRECT ANSWER-Primary: prevent/promotion Secondary: screen-early detection Tertiary: treat- to prevent further deterioration, rehab For a patient being treated with an SSRI such as fluoxetine for PTSD that shows no improvement in symptoms after two months of treatment, what is the next line thearpy? - CORRECT ANSWER-atypical antipsychotics What murmur is heard in systole at the second ICS? - CORRECT ANSWER-Aortic stenosis Ms. ARD Mr. ASS What is the primary risk factor for pulmonary embolus? - CORRECT ANSWER-1. DVT DVT risks: polycythemia and stasis. Differentiate between dementia types - CORRECT ANSWER-Alzheimer's: long trajectory that progresses to confabulations Lewy Body: rapid progression w/angry demeanor Vascular: depressive affect, no confabulations, PMHx of vascular disease Parkinson's: PMHx of parkinson's
What is the last thing that should be assessed when looking at a chest XR? - CORRECT ANSWER-Lungs are LAST. Correct order:
- Mediastinum and hila
- thoracic cage
- Extrathoracic bones and soft tissues
- Lungs What is the correct order of interpreting an EKG? - CORRECT ANSWER-1. Rate
- Rhythm
- Intervals
- Axis 5.Morphology The Short Confusion Assessment Method (Short-CAM) assesses delirium in hospitalized patients. What is observed with this method? - CORRECT ANSWER-1. Acuity of Onset
- Inattention
- Disorganized Thinking
- Level of Consciousness True or False: the Short-CAM was developed to identify causes of delirium. - CORRECT ANSWER-False; it helps improve identification and recognition of delirium.
What should be included for diagnostic evaluation for hospital acquired pneumonia? - CORRECT ANSWER-Sputum culture ABG Blood cultures. What theory addresses the inevitability of death as a part of the aging process? - CORRECT ANSWER-Levinson's Theory What genetic risk factors increase a patient's likelihood for pulmonary embolus? - CORRECT ANSWER-Factor V Protein C & S deficiencies A patient is diagnosed with acute descending aortic aneurysm and hypertension should be immediately started on which medication pending surgical evaluation?
- CORRECT ANSWER-Beta adrenergic antagonist (aka beta blockers): decreases force of contraction, decreases force on aortic aneurysm preventing aortic dissection. When should a patient with asthma be admitted from the ER? - CORRECT ANSWER-If FEV1 remains below 70% after one hour of emergency care. Patient can be discharged if FEV1>70% What is an indication for intubating a patient with acute asthma exacerbation? - CORRECT ANSWER-FEV1 not improving after treatment and approaching 40%. What are the most common causes of pulmonary obstructive shock? - CORRECT ANSWER-Pulmonary embolus, cardiac tamponade, & pneumothorax
A 49-year-old male is being managed for an acute myocardial infarction. He develops significant shortness of breath at rest and coarse rales 2/3 up bilaterally. The AGACNP suspects acute pulmonary edema due to papillary muscle rupture and acute mitral valve regurgitation. Which physical finding would support this finding? - CORRECT ANSWER-A systolic murmur auscultated at the 5th ICS, midclavicular line. A patient with minor head trauma presents for evaluation. Which of the following findings should be followed up with a CT scan to rule out orbital fracture? - CORRECT ANSWER-the presence of periorbital ecchymosis (aka black eye) A 69-year-old female is being discharged from the hospital after complications following a cosmetic surgical procedure. She is basically in good health. She has a history of hypothyroidism for which she takes levothyroxine daily, and mild osteoarthritis which is controlled with only prn nonsteroidal use. Her blood pressure is 148/90 mm Hg. The AGACNP knows that in accordance with the most current guidelines published in JNC 8 the appropriate action is to - CORRECT ANSWER-Proceed with normal health promotion. The patient is >60yo and does not have CKD or DM, therefore her goal BP is 150/90. She is at goal; no medications indicated. When assessing for driving safety in the older adult the NP should consider what factors? - CORRECT ANSWER-Mental Status Visual Acuity Hearing Loss decreased neck mobility ability to respond quickly to complex stimuli.
What is a contraindication for medication therapy in the setting of hospital induced delerium? - CORRECT ANSWER-A patient who is delerious but calm, in no distress or danger. Determining the underlying cause of delerium is the priority of care, not medicating it. Phases of Cardiac Rehab - CORRECT ANSWER-Phase 1: begins in the hospital immediately following acute treatment. Phase 2: Medically supervised heart reconditioning Phase 3: rest of patient's life, 30 mins moderately strenuous activity at least 5 days per week. In phase 2, goal heart rate is calculated by 10 BPM below ischemic change. An African American patient presents with decreased peripheral vision and no other symptoms. What is the most likely diagnosis? - CORRECT ANSWER-Open angle glaucoma What is the symptom presentation of stasis dermatitis and how is it treated? - CORRECT ANSWER-Hx of lower extremity edema with chronic venous insufficiency. Itching of bilateral lower legs with 2-3+ pitting edema and trophic hyperpigmentation. Treatment is to promote venous return from the lower extremities. An 84-year-old female patient is being treated for pneumonia. Her condition is deteriorating despite aggressive broad spectrum antipseudomonal cephalosporin antibiotic therapy. Induced sputum culture reveals heavy growth of Legionella pneumophilia. The AGACNP knows that antibiotic therapy must be adjusted to include coverage with - CORRECT ANSWER-Azithromycin 500mg PO daily Clarithromycin 500mg PO BID
Acute respiratory distress syndrome is characterized by which abnormality of ventilation and perfusion? - CORRECT ANSWER-Right to left shunting. A shunt occurs when blood flows from the right side of the heart to the left side of the heart without any contact with aerated alveoli as occurs in ARDS. The NP is examining a patient with acute foot pain, unable to bear weight, with a hx of dyslipidemia and hypertension who stopped taking his medications. Pulses are not audible via doppler, the extremity is pale and shiny with decreased hair growth. Suspecting peripheral arterial disease, what is an additional finding expected with this patient? - CORRECT ANSWER-widespread dilation that causes the foot to turn bright red when placed in a dependent position. The NP notes a patient to have a bifurcate uvula on physical exam which is a ________ exam finding. - CORRECT ANSWER-normal variant For a patient who has a positive PPD but negative Chest XR are considered _______ and should have what treatment regimen? - CORRECT ANSWER-Exposed but not infected; Prophylactic treatment regimen with isoniazid (INH) and vitamin B What is NOT diagnositic of ARDS? - CORRECT ANSWER-Hypoxemia; which can have many causes besides ARDS. Hypoxemia with high O2 flow is an anticipated finding. Diagnostic criteria for ARDS - CORRECT ANSWER-Bilateral infiltrates on Chest XR Hypoxemia refractory to high flow O Acute onset
Decreased paO2/FIO2 ratio When pulmonary capillary wedge pressure (PCWP) falls below 12 mm Hg it suggests that: - CORRECT ANSWER-Colloid osmotic pressure is higher than hydrostatic pressure which can result in extravasation of fluid into interstitial spaces—and in the case of the pulmonary vasculature, the alveoli When managing penetrating or open globe eye injuries, it is critical to avoid: - CORRECT ANSWER-applying pressure to the affected eye. What is hemochromatosis? - CORRECT ANSWER-an autosomal recessive disease that is characterized by excess iron deposition symptoms include jaundice, slate gray skin discoloration Can lead to diastolic heart failure- S Secondary hypertension occurs in 10% of patients who have hypertension. Name some causes of secondary hypertension. - CORRECT ANSWER-Renal artery stenosis endocrine disorders that cause vascular constriction A defect in natriuresis is a theorized cause of PRIMARY HTN A 36-year-old female presents complaining of left leg swelling. She describes the onset as acute over the last day or two, and says it feels "tight and throbbing." She denies any significant medical history and says the only medication she takes
A 55-year-old female patient presents with a fever of 103.4° F. She was treated approximately 10 days ago at urgent care for a sinus infection, but two days ago the right side of her face started to hurt, and today she has significant swelling of the right orbit and eyelid. The eyelid is very edematous and there is purulent drainage noted. The priority of care for this patient begins with: - CORRECT ANSWER-Initiating antibiotic therapy to cover streptococcus pneumoniae for orbital cellulitis. Antibx: Clindamycin or Bactrim PLUS Augmentin or Cefdinir Which of the following is the best indicator that pulmonary rehabilitation has been successful in a patient with chronic obstructive pulmonary disease? - CORRECT ANSWER-Subjective improvement of quality of life. The goal is to help patients learn how to most effectively manage activities in the setting of chronic hypoxemia. What is included as first line therapy for patients with CHF? - CORRECT ANSWER- ACE inhibitor and Beta blocker Diuretic when symptomatic What consistently describes the assessment of delirium in the geriatric patient? - CORRECT ANSWER-Delirium is a symptom of some underlying disorder or imbalance, and while that may include a cerebral event, most commonly the causes in the geriatric patient are abnormalities outside of the CNS, e.g., urinary, pulmonary, soft tissue, or blood infection, adverse drug effects, fecal impaction, hypoxia, hepatic or renal failure, or any variety of other systemic causes Define hyperlucency - CORRECT ANSWER-Hyperlucency means that there is more air, less tissue, or less vein perfusion—or a combination. Atelectasis has the OPPOSITE characteristics of hyperlucency.
When evaluating a patient with epistaxis, which of the following signs or symptoms is suggestive of a more serious etiology and posterior packing? - CORRECT ANSWER-Swallowing blood which indicates a posterior bleed inaccessible by anterior nasal packing. Posterior packing will be required to stop bleeding. A 15 yo M presents to the ER complaining of severe throat pain. Upon physical examination he is febrile with a temperature of 102.4° F and he is a bit tachycardic, but other vital signs or normal. Inspection of the throat is basically unremarkable—the AGACNP does not appreciate any abscesses, edema, or exudate; there may be some slight erythema. The AGACNP becomes suspicious that the patient has: - CORRECT ANSWER-Epiglottitis Patient needs immediate intubation. A 66 yo M patient is admitted for management of an acute anterior wall myocardial infarction. Over a period of hours he has developed acute shortness of breath, coarse rales to auscultation, and Kerley B lines on chest radiography. Arterial blood gas reveals a pH of 7.34, pCO2 of 30 mm Hg, and paO2 of 59 mm Hg. The AGACNP anticipates which of the following findings on physical examination? - CORRECT ANSWER-S3 heart sounds which implies acute left ventricular overload. Patient has acute pulmonary edema. According to the revised criteria in DSM-V, the primary difference between panic attacks and panic disorder is that - CORRECT ANSWER-Panic disorder is characterized by unexpected attacks that occur suddenly without any external provocation or cues; panic attacks (without panic disorder) may be expected and occur in response to an identified situation
he thought it would work itself out. Physical exam reveals a black 1 mm foreign body visible on the corneal surface. The most appropriate intervention is to: - CORRECT ANSWER-Attempt to remove the foreign body with a saline soaked sterile swab since it is visible on exam. A patient with pericarditis is most appropriately treated with - CORRECT ANSWER- an NSAID What are risk factors for thoracic aneurysm? - CORRECT ANSWER-Aortic valve disease, family history, smoking, and atherosclerosis. 1 out of 1 points The "MONA" acronym provides guidance for immediate interventions in the patient with: - CORRECT ANSWER-Acute Coronary Syndrome. Morphine Oxygen Nitrates Aspirin Correct Order: ANOM 3 doses of nitro max A 36-year-old male patient who presents for treatment of eye pain. He has no significant medical history and does not take any daily or over-the-counter medications. His only recent history is nighttime allergies for which he takes occasional diphenhydramine with good relief. He has had some throbbing in his eye for the last few days on and off but just ignored it; today he says it is flat out painful and he had to come to the emergency department. The eye is throbbing and painful, and he reports generalized decreased vision. The pupil is dilated to 5 mm and non-reactive to light. The eye conjunctiva is reddened. The next step in the diagnostic evaluation should be: - CORRECT ANSWER-Assessment of intraocular pressure via tonometry to confirm angle closure glaucoma diagnosis.
The AGACNP counsels a patient with recurrent epistaxis that the most common cause of nose bleeding is: - CORRECT ANSWER-irritation of the nose (nose picking) The geriatric depression scale (GDS) is a commonly used tool to diagnose depression in the elderly population. It comes in a variety of forms for maximal utility. When administering the geriatric depression scale to patients, the AGACNP recognizes that it is extremely important to - CORRECT ANSWER-use yes/no answers Ventilator-acquired pneumonia (VAP) is a significant problem impacting morbidity, mortality and the cost of inpatient health care. Data-supported mechanisms to reduce the risk for VAP include: - CORRECT ANSWER-Endotracheal tube cuff biofilm formation and bacterial colonization Absolute contraindications to thrombolytic therapy in the patient having an acute myocardial infarction include all of the following except - CORRECT ANSWER- hemorrhagic ophthalmic condition. Weigh the risk vs benefit. True or False: The greater the stressors and/or burden on the caregiver, the greater the likelihood of some form of caregiver abuse, whether psychological, physical, or neglect. - CORRECT ANSWER-True
