NURS 6560 FINAL EXAM QUESTIONS WITH 100% CORRECT ANSWERS, Study Guides, Projects, Research of Pharmacology

Download NURS 6560 FINAL EXAM QUESTIONS WITH 100% CORRECT ANSWERS and more Study Guides, Projects, Research Pharmacology in PDF only on Docsity! NURS 6560 FINAL EXAM QUESTIONS WITH 100% CORRECT ANSWERS 1. Q #: 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. Serum osmolality = 260 2. Q #: A patient who has been in the intensive care unit for 17 days develops hyponatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. 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 B. reduce serum sodium concentration by infusing a 0.45% 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. Q #: 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/µL. The AGACNP expects that physical examination will reveal: A. + Murphy’s sign B. + Chvostek’s sign C. + McBurney’s sign D. + Kernig’s sign 4. Q #: 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. Q #: right upper quadrant ultrasound endoscopy 9. Q #: Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ resection following a catastrophic motor vehicle accident. Due to the nature of his injuries, a large portion of his jejunum had to be resected. In planning for his recovery and nutritional needs, the AGACNP considers that: He will probably be able to transition to oral nutrition but will have lifetime issues with diarrhea His procedure has put him at significant risk for B12 absorption problems Most jejunum absorption functions will be assumed by the ileum Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation 10.Q #: A 32-year-old man comes to the clinic because he has had pain in the back for the past 24 hours. The patient says he first noticed the pain when he awoke in the morning and had difficulty getting out of bed. He had been playing flag football the day before the pain began but did not sustain any injuries during the game. Acetaminophen has provided only minimal relief of the patient's pain. On physical examination, pain is elicited on palpation of the back on the left, lateral to the region of L2-L5. Full range of motion is noted in vertebral flexion, extension, lateral rotation, and lateral bending, with some hesitancy because of pain on the left side. Which of the following is the most appropriate initial step? Anti-inflammatory and muscle relaxant therapy Epidural injection of a corticosteroid MRI of the lumbar spine Strict bed rest and application of moist heat to the lower back 11.Q #: On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms of acute rejection, confirmed by histologic examination. The AGACNP knows that first-line treatment of acute rejection consists of: Cyclosporine Azathioprine Methylpredniso lone Sirolimus 12.Q #: H. W. is a 33-year-old female who is being evaluated after a fall from a tree. Anteroposterior and lateral radiographs of the thoracolumbosacral spine are significant for transverse process fractures at T6 and T7. The AGACNP knows that treatment for this likely will include: Observation Hyperextension casting Jewett brace Surgical intervention 13.Q #: Acute hepatitis A is usually diagnosed by: By the constitutional symptoms Within 2 weeks of exposure Detection of IgM-Anti- HAV Jaundice 14.Q #: 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 Non- Hodgkin's lyphoma Catscratch disease Syphilis 15.Q #: 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 Vitamin B12 Gastric pH 16.Q #: 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: Fasciotomy Thrombolytics Surgical reduction Casting 17.Q #: 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 Is characterized by pain- free intervals Is sharp, intense, and nonradiating 18.Q #: All of the following are expected findings in a patient with a T10 fracture except: Paraplegia Fecal retention Priapism Inability to move fingers 19.Q #: T. O. 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/µL. The AGACNP suspects: Dissecting aortic aneurysm Acute pancreatitis Perforated peptic ulcer Mallory-Weiss tear 20.Q #: 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 29.Q #: 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 Zollinger-Ellison syndrome 30.Q #: 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 Biliary cirrhosis 31.Q #: 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 Cancer Autoimmune hepatitis 32.Q #: The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s management is to: Continue the current regimen D/C the spironolactone and begin a loop diuretic Add a loop diuretic to the spironolactone Proceed to large- volume paracentesis 33.Q #: The AGACNP knows that following bilateral total adrenalectomy, the patient will require: Prednisone 15 mg qam and 10 mg qpm Tapering of IV hydrocortisone, beginning with 100 mg IV q8h on postoperative day 1 Initial fludrocortisone replacement, tapered off once maintenance hydrocortisone dose is achieved Individualized replacement of corticosteroid, mineralocorticoid, and androgen hormones 34.Q #: Josh is a 14-year-old male patient who presents for evaluation of blurred vision. His only significant injury is that over the weekend he was playing baseball and was hit in the side of the head by a flying ball. The hit was hard enough to knock him down, but he did not lose consciousness and had no remarkable symptoms. Now on Wednesday he presents with a dull headache that seems to be getting worse, and his mom wants to have him evaluated. Neurologic examination reveals a sluggish pupillary response. CT scan of the head reveals a 1 cm epidural hematoma. The AGACNP knows that the best approach to management would be: Cautious observation An osmotic diuretic Surgical consultation Emergency evacuation 35.Q #: Mary W. is a 39-year-old female who presents with persistent abdominal discomfort. She denies actual pain but says she has this persistent sense of fullness in her abdomen that feels like it would go away if she could have a bowel movement. This finding is known as: Somatic pain Gas stoppage sign Small bowel obstruction Large bowel obstruction 36.Q #: 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. You, as the AGACNP, know the most important information to obtain from Tim is: Insurance information Family history Social history What exactly was he doing when he got hurt 37.Q #: 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 Proximal humerus fracture Nursemaid’s elbow 38.Q #: A general principle in surgical oncology is that the best approach to curative surgery in a fixed tumor requires: En bloc resection Adjuvant therapies Neoadjuvant therapies Elective lymph node dissection 39.Q #: 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 imminent The blood pressure should be increased to prevent cerebral hypoxia Lowering the patients blood pressure will reduce the intracranial pressure, increasing cerebral blood flow 40.Q #: Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of hematoma Epidural hematoma Contra-coup injury 47.Q #: 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 Diverticulitis Appendicitis 48.Q #: 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 A leukocyte count of 18,000/µL A palpable gallbladder A positive Murphy’s sign 49.Q #: 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 Valgus/varus stress test McBurney's test 50.Q #: 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: Uncal herniation Increased intracranial pressure Brainstem compression Subarachnoid hemorrhage 51.Q #: 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 antibiotic therapy Local anesthesia, cleansing, and wound exploration for foreign bodies Local anesthesia, cleansing, and suture repair Cleansing, covering, antibiotic therapy, and tetanus prophylaxis 52.Q #: A 49 year old female is seen for sudden onset severe abdominal pain 10/10. On further Q #ing 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 perforated duodenal ulcer ascites 53.Q #: 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. What is the leading diagnosis for this patient? Diverticuliti s Crohns Disease Appendiciti s Irritable small bowel disease 54.Q #: B. T. is a 49-year-old male who has been admitted for the management of an episode of diverticulitis. This is his fifth hospitalization this year, and in previous hospitalizations he has had both abscess and stricture as a consequence of his disease. His treatment this hospitalization should include: Extended-spectrum antibiotics Surgical consultation for colectomy Expectant treatment with nonabsorbable antibiotics Colonoscopy 55.Q #: Sara S. is a 41-year-old patient who has just had a bone marrow transplant. The AGACNP knows that which medication will be used to decrease her risk of graft-versus-host reaction? Immune globulin Cyclosporine Prophylactic antibiotics Systemic corticosteroids 56.Q #: The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla? Alpha-adrenergic antagonists Beta- adrenergic antagonists Arteriolar dilators 57.Q #: A 41-year-old male physician has a 6-week history of persistent painful, swollen, and stiff proximal interphalangeal joints, wrists, and ankles. Using a step wise progression model, Intravenous vasodilators Physical exam reveals limited ROM in shoulder with ecchymosis and tenderness over anterior and posterior coracoclavicular and acromioclavicular joints. 66.Q #: Based on the radiograph below, what is your working diagnosis at this time? NO PICTURE SHOWN: ac separation rotator cuff tear humorous fracture cervical neck injury 67.Q #: K. W. is a 50-year-old woman who presents for surgical resection of the liver for treatment of metastatic colon cancer. Preoperatively, the surgeon tells her that he is planning to remove 50 to 75% of her liver. The patient is concerned that she will not be able to recover normal liver function with that much removed. The AGACNP counsels her that: Such a high-volume resection is utilized only in people with markedly compromised hepatic function Major regeneration occurs within 10 days, and the process is complete by 5 weeks Liver function will probably recover to 50% baseline, but that is enough for normal function Up to 95% of the liver can be removed without any apparent consequence to the patient 68.Q #: Joshua is a 31-year-old man who presents for evaluation of acute numbness and tingling and decreased strength in his arms. It happened rather suddenly this afternoon and has never happened before. The lower extremities do not appear to be affected. While performing the history the AGACNP asks specific Q #s about the risk of: Cervical radiculopathy Hyperextension injury Panic attack Poison ingestion 69.Q #: The AGACNP is taking report on a head injured patient. The report includes scoring on the Glasgow Coma Scale of E2 M3 V5. How would you interpret this information? The patient’s eyes open to sound, they are orientated are able to obey commands The patient’s eyes open to pressure, they can utter some words but do not form sentences, and they are able to localise to trapezius pinch. The patient’s eyes open spontaneously; they are orientated and able to obey commands The patient's eyes do not respond, they are confused and do not follow commands. 70.Q #: 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 Paralytic ileus Complete bowel obstruction Intestinal volvulus 71.Q #: 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? Plain radiographs MRI of his knee CT scan Diagnostic arthroscopy 72.Q #: 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 Spontaneous hepatic rupture Preterm labor 73.Q #: 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.Q #: 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 × 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 Actinic keratoses Atopic dermatitis 75.Q #: 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 Right knee joint synovial fluid examination Serum rheumatoid factor Serum erythrocyte sedimentation rate 76.Q #: 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 unconjugated bilirubin 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: An erythrocyte sedimentation rate (ESR) of 75 mm/hr A microcytic, hypochromic anemia Elevated liver function enzymes Positive antinuclear antibodies 85.Q #: M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she is afraid it won’t go away on its own. She denies any nausea or vomiting, and she cannot remember precisely when her last bowel movement occurred; probably it was a few days ago. She reports that she is “always” constipated. On physical examination, she is tachycardic but otherwise has normal vital signs; her abdomen is tensely rigid, but no point tenderness to palpation is appreciated. The entire abdomen percusses as tympanic—there is no distinct dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent. There is rebound tenderness to palpation. The AGACNP suspects: Perforated bowel Peritonitis Ischemic bowel Intestinal abscess 86.Q #: A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate: Low ACTH and low cortisol Low ACTH and high cortisol High ACTH and low cortisol High ACTH and high cortisol 87.Q #: A 25-year-old medical student is stuck with a hollow needle during a procedure on a patient known to have hepatitis B viral infection but who is HIV-negative. The student’s baseline laboratory studies include serology: HBsAG negative, total Anti-HBc negative, IgM Anti-HBc -, Anti-HBs +. Which of the following is true regarding this medical student’s hepatitis status? Prior vaccination with hepatitis B vaccine. Acute infection with hepatitis B virus. The student was vaccinated for hepatitis B, but is not immune. 88.Q #: A 55-year-old man with a past medical history of hypertension and hyperlipidemia presents to your office with an acute onset of fevers, chills, dysuria, urinary frequency and right CVA tenderness. On exam he appears to be moderately ill, with a temperature of 39.3°C, pulse of 105/min and a blood pressure of 115/60mmHg. His cardiopulmonary and abdominal exam are negative. A urine dip in the office reveals 2+ blood, 2+ leukocytes and negative nitrates. Of the following tests, which is most likely to lead to the correct diagnosis? Urine culture Renal ultrasound Blood cultures CT scan of the abdomen 89.Q #: S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 g/dL, an MCV of 72 fL and a platelet count of 65,000/µL; the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include: Splenectomy Monoclonal antibody therapy such as rituximab Prednisone 60 mg daily until platelets normal Avoidance of elective surgery and nonessential medications 90.Q #: Elliot is a 47-year-old male who is being treated for throat cancer with combination therapy that includes radiation. He is asking Q #s about what adverse effects he may anticipate. The AGACNP advises Elliot that the most significant toxic effects in the acute / early postradiation period are: A product of mucositis and include yeast superinfection, desquamation, and pain Nephrotic syndrome and organ failure More commonly permanent than toxic effects of other cancer treatments Atrophy and burn, with subsequent dysfunction of the area surrounding targeted tissues 91.Q #: The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature? Pyur ia Feve r CVA tenderness Gross hematuria 92.Q #: G. D. is a 13-year-old male patient who has a history of recurrent fever and flank pain. His parents traditionally are not believers in the health care system, and he has not been seen by a health care provider for many years. Today he has fever, chills, and costovertebral angle tenderness. Urinalysis reveals findings consistent with acute urinary infection. The AGACNP treats the patient for pyelonephritis and considers which study to evaluate for vesicoureteral reflux? Bilateral renal ultrasound CT scan of the abdomen and pelvis Voiding cystourethrograpy Radioisotope scanning 93.Q #: Maxine is being seen in follow-up after removal of an aldosteronoma. The AGACNP expects specifically that which of the following aldosterone-related abnormalities will be cured? Hypertensi on Hyponatre mia Hypokalem ia Hypoglyce mia 94.Q #: Acute hepatitis B is diagnosed by: Presence of HAV-IgM Detection of HbsAg Anti-HBc- IgM B and C 95.Q #: A 19-year-old woman presents to your office with a 3-day history of dysuria and foul-smelling urine. She also notes some suprapubic pressure and noted some chills and she thinks she had a fever yesterday. She reports no vaginal bleeding or discharge and reports no nausea or vomiting. She denies any significant past medical history. On exam she has a temperature of