NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST, Exams of Nursing

Download NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST and more Exams Nursing in PDF only on Docsity! NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY • Question 1 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 1 out of 1 points analysis. While evaluating the fluid analysis, the AGACNP knows that a fluid identified as a(n) is the least worrisome type. Resp onse Feed back : “A” is the correct answer. A transudate is essentially just water and can occur as a consequence of increased hydrostatic pressure in the pulmonary vessels. It typically implies that the some condition has produced an imbalance in colloid- hydrostatic pressures, such as CHF or hypoalbuminemia. While it can represent a serious problem, it may also represent a transient imbalance. Conversely, “B” is not correct as an exudate has more protein in NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY i t a n d i m plies a condition characterized by protein leaking from vessels, such as a malignancy or some serious systemic stressor. “C” is not correct—a chyliform effusion is characterized by fat and indicates a pathology causing massive triglyceride degradation. “D” is not correct as a hemorrhagic effusion is blood and typically means traumatic injury. • Question 2 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? 0 out of 1 points Resp onse Feedback : NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY following except a: Resp onse Feed back : “C” is the correct answer. If bleeding is successfully stopped with 20 minutes of directed pressure, there will be residual blood and clot formation. This is evacuated either by gentle suction or having the patient gently blow. Residual blood and formed clot may present as a sudden gush of dark blood or discharge with or without a clot—these are all typical expected findings. However, if bleeding is not stopped, it will continue as a bright red steady trickle. When this occurs, more invasive measures are indicated. • Question 5 Kevin is a 14-year-old male who presents for evaluation of a fever of 102.5° F and significant right ear pain. He NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY appears quite ill and says he feels nauseous. Otoscopic evaluation reveals pain to palpation, a very erythematous and bulging tympanic 0 out of 1 points membrane with bullous myringitis. The AGACNP knows that antibiotic therapy must be selected to cover: Resp onse Feed back : “D” is the correct answer. Streptococcus pneumoniae is the most common bacteria that infects the head and neck in immunocompetent persons, and is the primary treatment target when treating otitis media, bacterial sinusitis, and bacterial pharyngitis. “A” is not correct— while likely on broken skin and soft tissue, it is not common in the ear, nose, or throat unless specific risk factors exist. “B” is not correct—this is much more likely in an immunocompromised patient or a patient on mechanical ventilation. “C” is not correct—it is the second most common NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY o r ganism, but strep is the primary treatment target. • Question 6 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 1 out of 1 points 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? NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY • Question 8 J.R. is a 55-year-old male who presents for a commercial driver’s license physical 1 out of 1 points 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? Resp onse Feed back : “A” is the correct answer. According to the Joint National Committee (JNC) report, hypertensive urgency is described as hypertension in the setting of progressive target organ damage, such as renal involvement with protein leaking, left ventricular hypertrophy, or retinal changes. “A” is not correct— the headache may or may not be relevant, but because there are many non- hypertension causes, a headache alone does not constitute target organ damage. “C” is not correct—it may indicate carotid NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY p l a q u e, but this is not a consequence of hypertension. “D” is not correct as a 1+ palpable pulse may be a normal finding--it must be taken in the context of the rest of the examination. • Questi on 9 0 out of 1 points Because of the commonly recognized adverse effects of atypical antipsychotics, annual laboratory assessment for patients taking these medications should include a: Response “C” is the correct answer. The atypical antipsychotics such as olanzapine NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY Feed back : (Zyprexa), clozapine (Clozaril), and quetiapine (Seroquel) are classically associated with dyslipidemia and annual lipid panels should be performed in patients of all ages who take these medications. “A” is incorrect—this is the appropriate annual screening tool for patients on lithium due to lithium-related iodine suppression of the thyroid gland. There are no specific indications for “B” and “D” unique to patients taking atypical antipsychotics. Those laboratory assessments should only be ordered as indicated by any other significant patient history. • Question 10 K.R. presents for an evaluation of eye discomfort. He works in a fabricating shop for a 1 out of 1 points custom automobile restoration company and while working he felt like something flew into his eye. NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY p u l monary embolus “C” is not accurate when after surgery, as it will be positive after surgery. • Question 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: 0 out of 1 points NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY Resp onse Feed back : “D” is the correct answer. An uncommon but potentially serious consequence of heparin infusion is heparin-induced thrombocytopenia. Some patients make autoantibodies in response to exogenous heparin that activate their own platelets. When this occurs, heparin must be immediately discontinued and thrombin inhibitors started. “A” is not correct —this is not affected by heparin, but is monitored in those on Coumadin. “B” is not correct—this is also unaffected by heparin, but monitored on Coumadin. “C” is not correct—this is monitored to assess therapeutic efficacy, but not for complications. • Questio n 13 1 out of 1 points Differentiating vertigo from near-syncope and NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY 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: Resp onse Feed back : “A” is the correct answer. Dizzy is a layperson’s term and can mean many different things to patients and health care providers. When the patient identifies the primary symptom as a sense of spinning this supports vertigo, which is usually an inner ear problem. This versus ataxia which is neurologic or near-syncope which may be cardiac, neurological, or neurocardiogenic. “B” is not correct—this may occur with vertigo, but when it is the primary symptom it is most likely ataxia and neurological causes should be considered. “C” is not correct as coincident nausea is not specific and can occur with any of these complaints. “D” is not correct as it is also not specific; while NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY 1 out of 1 points 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? Resp onse Feed back : “D” is the correct answer. rTPA is not indicated in patients with ST segment depression; this is not a ST elevation MI. “A” is not correct as age > 80 is a relative contraindication. “B” is not correct as a temperature of 99.1° F is an expected response to myocardial necrosis, and “C” is not correct—the blood pressure is not prohibitive until > 180/110 mm hg. NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY • Question 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 1 out of 1 points 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? Resp onse Feed back : NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY “ C ” i s t h e c o r rect answer. The Transtheoretical model of change is characterized by 5 stages. “A” is when the patient has no intention to make a change. “B” is when the patient is intending to make a change in the next 6 months. “C” is when the patient is ready to take action or has already taken some action, as this patient has in establishing his plan to quit by the end of the month. “D” is the overt action that attains a criterion sufficient to reduce disease risk— in this patient the action stage would be characterized by actual smoking cessation. The final phase, not presented in the answer choices here, is maintenance. • Questio n 17 1 out of 1 points While assessing a patient with a known psychiatric history, the AGACNP knows that the primary difference between a psychotic and neurotic NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY are: Resp onse Feed back : “B” is the correct answer. The accelerated GI motility and bradycardia are cholinergic adverse effects. Ophthalmic medications are readily absorbed into systemic circulation. All of these medications are used to treat glaucoma and may cause class-related adverse effects, but cholinergic drops are the only ones shown that will slow heart rate and accelerate GI motility. • Question 19 Janice is a 19-year-old female who presents to the emergency department via 1 out of 1 points 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 NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY 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: Resp onse Feed back : “A” is the correct answer. A panic anxiety attack requires immediate intervention with a short acting benzodiazepine for immediate symptom control. A calm environment would be helpful, but is not adequate alone to manage acute episodes characterized by physical symptoms. Oxygen is not indicated in the absence of organic problems. The numb hands and feet, known as “stocking-glove paresthesia,” are characteristic of respiratory alkalosis consistent with tachypnea and will resolve once the patient slows her breathing and retains CO2. While cognitive behavioral therapy is an important part of chronic anxiety NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY m a nagement, is has no role in acute management of acute panic attack. • Question 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 0 out of 1 points corticosteroid medication daily as prescribed. Her PEFR is 85% of her personal best. The best approach to this patient is to: NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY c o ntrolling that worry are required for the diagnosis. • Questio n 22 0 out of 1 points 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? Resp onse Feed back : NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY “ C ” i s t h e c o rrect answer. Controlling his LDL after a myocardial event is about trying to prevent further events or deterioration. “A” is not correct as primary prevention is about preventing disease—appropriate exercise in a healthy patient is primary prevention. “B” is not correct as secondary prevention is about screening for asymptomatic disease and intervening before disease develops—routine cholesterol screening that reveals an elevated before an MI would be secondary prevention. “D” is not correct as there is no “restorative” level of prevention. • Questio n 23 1 out of 1 points 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, NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY 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: Resp onse Feed back : “A” is the correct answer. While SSRIs, beta adrenergic antagonists, and even centrally acting antiadrenergic agonists (clonidine) are all used as first line agents depending upon symptom presentation, patients who have more severe symptoms and do not respond to initial treatments often require management with atypical antipsychotics. This patient has been treated with an SSRI, reports no improvement, and has been arrested for his behavior; these circumstances are a clear indication for escalation to the nest level of therapy. NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY — t h e c o n c e ntration of estrogen in most hormonal contraception is so low that it barely increases risk above that of the general circulation. Of the millions of women on hormonal contraception, only a handful develop DVT/PE. “B” is not correct—this patient is likely to have problems bleeding rather than clotting. “D” is not correct— while smoking is a risk factor for many things DVT is not among them. • Questio n 26 1 out of 1 points 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 NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY 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? Resp onse Feed back : “C” is the correct answer. Alzheimer’s dementia is statistically the most common form of dementia and is characterized by a long trajectory that progresses to include confabulation. Additionally, patients with this form of dementia are very reliant upon routine and may be distressed when it is disrupted. “A” is not correct; Lewy body dementia characteristically NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY p r o g r e s s e s much more quickly and produces an angry demeanor. “B” is incorrect because vascular dementia typically produces a more depressive affect and is not characterized by confabulation; additionally, patients with vascular dementia often have a medical history consistent with vascular risk factors. “D” is not correct as there is no apparent history of Parkinson’s disease. • Question 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 canno t seem to see the words that she is lookin NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY equivocal and not uniformly practiced. “D” may become necessary at some point to prevent corneal abrasion but the immediate approach should be corticosteroids. • Question 29 A 78-year-old male present for a physical examination. He has no discomfort or complaints other than a general decrease in vision, but it helps when he puts things 1 out of 1 points under a bright light to read. He admits that while driving at night the streetlights appear to be a bit distorted and his night vision is pretty poor. Given the likely diagnosis, the AGACNP expects which of the following physical findings? Resp onse Feed back : NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY “ C ” i s t h e c o r rect answer. This scenario is consistent with cataracts, a common abnormality seen in older adults. The presence of the cataract diminishes the red reflex and ultimately will obliterate it. “A” is not correct, injected conjunctiva are more consistent with inflammation. “B” is not correct—a sluggish pupil response may occur in response to a variety of conditions, including drug toxicities and poisonings, neurological, or ocular disease, but not with cataracts. “D” is not correct; white spots in the macula is most often suggestive of macular degeneration. • Questio n 30 0 out of 1 points Jason is a 46-year-old male who is being managed for sepsis. He has HIV/AIDS and has had a prolonged hospitalization characterized by a variety of complications. He was extubated 3 NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY days ago but continues gastric decompression with a nasogastric tube(NGT), total parenteral nutrition and antibiotic therapy via a central venous catheter, and urinary drainage via a Foley catheter. He continues to demonstrate consistent low grade fevers but all points of insertion of his tubes are normal to inspection, a chest radiograph demonstrates improvement of his pneumonia, and his urinalysis shows no bacteria, leukocytes, or nitrites. The AGACNP should next order: Resp onse Feed back : “C” is the correct answer. The incidence of bacterial sinusitis is significantly higher in patients with AIDS as compared to the general population and the long term NGT is a risk factor for sinus infection. A maxillofacial CT scan should be considered in any patient with AIDS to rule it out in the setting of persistent fever, especially when risk factors exist. “A” is not correct— NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY Confusion Assessment Method (Short-CAM) is a widely used four item tool that assesses delirium in the hospitalized patient. It includes observation of all of the following except: 1 out of 1 points Resp onse Feed back : “D” is the correct answer. The tool was developed to improve identification and recognition of delirium, not to diagnose causation. The four items observed with the Short-CAM method are (1) acuity of onset, (2) inattention, (3) disorganized thinking, and (4) level of consciousness. Once delirium is recognized, then clinical diagnosis of underlying cause is indicated. • Question 33 Ms. Yang has been hospitalized for 5 days for the management of a gastrointestinal bleeding. She appears to have stabilized hemodynamically, but today she had a 1 out of 1 points temperature of 101.9° F and chest radiography NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY demonstrates a diagnosis of pneumonia. The AGACNP knows that the diagnostic evaluation for hospital acquired pneumonia for all patients must include: Resp onse Feed back : “A” is the correct answer. At a minimum, the American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) guidelines suggest induced sputum, arterial blood gas, and blood cultures for all patients with nosocomial pneumonia (acquired after a hospitalization of > 72 hours). “B” is not correct—neither viral cultures nor CT of the chest are routinely mandated for all patients, although they may be necessary in selected circumstances. “C” is not correct thoracentesis is only indicated for large effusions or any effusion in which the patient appears toxic. Similarly, bronchoscopy is not routinely indicated but may be useful in some NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY c i r cumstances. “D” is not correct as thoracentesis, as previously noted, is not routinely indicated. • Question 34 Most psychosocial theories of aging center around the core concept that successful 0 out of 1 points aging requires acceptance of a series of changes or losses that predictably occur later in the life span. The theory that specifically addresses coming to terms with the NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY A patient is diagnosed with acute descending aortic aneurysm and hypertension should be immediately started on which medication pending surgical evaluation? Resp onse Feed back : “A” is the correct answer. Beta adrenergic antagonists decrease the force of contraction therefore decreasing shear force exerted on the dissection. “B” is not correct, intravenous vasodilators are not used initially although are a second option to reduce systolic blood pressure but . “C” and “D” are not correct as other medical management strategies have not demonstrated improved outcomes. Ultimately these patients will require surgical intervention. • Question 37 Jason is a 27-year-old with a long history of intermittently controlled asthma. He is curren tly prescr ibed NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY Advair daily with albuterol as needed for symptoms. Today he 0 out of 1 points presents to the emergency department with cough and wheezing and difficulty catching his breath. His FEV1 is 51% at the time of presentation. He is given alternating albuterol and ipratropium nebulizer treatments along with oral prednisone. After one hour his FEV1 has increased 65%. The appropriate disposition for Jason at this point is: Resp onse Feed back “B” is the correct answer. The EPR-3 guidelines for management of asthma in the urgent and emergency care setting indicate that if the FEV1 remains NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY : below 70% after one hour of emergency care that the patient should be admitted. “A” is not correct—he does not have an indication for intubation as his FEV1 is improving and is not approaching the 40% that would indicate intubation. “C” is not correct— he has already been assessed and treated for one hour and at this point admission is indicated. “D” is not correct —he cannot be discharged to home unless his FEV1 is > 70% • Question 38 A patient in the intensive care unit suddenly becomes tachypneic and dyspneic. The physical examination reveals pale, cool, clammy skin and an arterial blood gas demonstrates hypocapnea and hypoxia. Pulmonary artery pressure demonstrates a pattern consistent with obstructive shock. The AGACNP knows that which of the following causes of this presen tation is most likely? NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY b e i n g p roduced, the combination of volume contraction and electrolyte and metabolic imbalance will cause death very quickly. The cessation of urine output is the strongest marker of the answer choices provided to predict imminent cardiac arrest. • Question 40 A patient is newly admitted to your service for open reduction and internal fixation of 0 out of 1 points the left hip. She seems very down, and as you talk with her you realize that her mood is not just related to her hip fracture. Which of the following symptoms would not be consistent with major depressive disorder? NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY Resp onse Feed back: “D” is the correct answer. Major depressive disorder is not diagnosed when the symptoms may be attributed to bereavement over a loss of < 2 months duration. Conversely, “A,” “B,” and “C” are all consistent with a diagnosis of major depressive disorder. • Question 41 A 31-year-old male presents to urgent care because he has something in his eye. He 1 out of 1 points was changing the oil under his car and says that something dropped into his eye. He is not having any pain, in fact he waited a day before coming in because 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: NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY Resp onse Feed back : “C” is the correct answer. The nature of the injury suggests an external foreign body and it is visible to inspection. The absence of symptoms suggests that this is a simple external foreign body that will be easily removed with a saline soaked sterile swab. If unable to remove it this way, the more invasive Morgan lens or another method of eye irrigation may be utilized - but the least invasive acceptable method should always be tried first. “A” is not correct—there are not symptoms consistent with corneal abrasion. “B” is not correct as the history does not suggest an embedded or internal foreign body. • Question 42 A patient with pericarditis is most appropriately treated with: 0 out of 1 points NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY g e t pain relief with three doses of nitroglycerin—but it should be considered and administered if appropriate. • Questio n 45 1 out of 1 points Mr. Sloane is a 36-year-old male patient who presents for treatment of eye pain. He has NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY 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: Resp onse Feed back : “A” is the correct answer. This is a classic presentation of acute angle closure glaucoma, the patient likely had an underlying anatomic abnormality that was exacerbated by the anticholinergic properties of diphenhydramine. Assessment of intraocular pressure via NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY t o n o m e t r y m ust be performed and if elevated will confirm diagnosis. Once elevated pressure is confirmed, the condition will be treated. “B” and “C” are not correct—the first diagnostic evaluation must be tonometric pressure; if pressure is normal, acute angle closure glaucoma is ruled out and then imaging may be indicted depending upon the differential diagnoses. “D” is not correct; if glaucoma is confirmed than ophthalmology will be consulted. • Questio n 46 1 out of 1 points The AGACNP counsels a patient with recurrent epistaxis that the most common cause of nose bleeding is: Resp onse Feed back : NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY initiation or change in drug therapy. • Question 48 Ventilator-acquired pneumonia (VAP) is a significant problem impacting morbidity, 1 out of 1 points mortality and the cost of inpatient health care. Data-supported mechanisms to reduce the risk for VAP include all of the following except: Resp onse Feed back : “B” is the correct answer. Strategies both pre and post intubation to reduce the likelihood of VAP have been extensively studied, and there are numerous data- supported strategies including those presented in choices “A,” “C,” and “D” above. Conversely, while “B” has been proposed as a possible strategy, data are conflicted. Endotracheal tube cuff biofilm formation and bacterial colonization are proposed mechanisms by which ventilator acquired pneumonia occurs, and there are NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY s e v e r al strategies in use to target this, such as antibiotic impregnated, chlorhexidine coated and silver coated endotracheal tubes. Cost and effectiveness data continue to emerge. • Question 49 Absolute contraindications to thrombolytic therapy in the patient having an acute myocardial infarction include all of the following except: 0 out of 1 points Resp onse Feed back: “D” is the correct answer. A history of hemorrhagic ophthalmic condition is a relative contraindication; a risk benefit analysis must be considered and thrombolytics may be used. Conversely, “A,” “B,” and “C” above are all absolute contraindications to thrombolytic therapy. NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY • Question 50 Which of the following is not a true statement with respect to risk for or occurrence of elder abuse? 1 out of 1 points Response Feedback : “D” is the correct answer. There are a variety of theories regarding the etiology of caregiver abuse, and a common theme is NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY : with open angle glaucoma and this patient is from a high risk group (African- American population). “A” is incorrect because macular degeneration is a disease of central vision change/loss. “B” is incorrect— increased intraocular pressure is consistent with glaucoma but not intracranial pressure. “C” is incorrect —dacrocystitis is an acute inflammation of the lacrimal apparatus and presents as an acute abscess at the medial aspect of the eye and nasal border. • Questio n 52 1 out of 1 points Mr. Moffett is a 66-year-old male with a long history of lower extremity edema. All other causes of lower extremity edema have been ruled out and his overall symptom presentation and history are strongly supportive of chronic venous insufficiency. Today he presents with increased NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY itching of both lower legs. Physical exam reveals 2-3+ pitting edema and trophic hyperpigmentation. The AGACNP know that treatment should include: Resp onse Feed back : “D” is the correct answer. The only useful approach to stasis dermatitis due to chronic venous insufficiency is to promote venous return from the lower extremities. “A” is not correct—there is no infection and no indication for peroxide. “B” is not correct—treatment may transiently include this measure to reduce itch but it does not treat the underlying problem. “C” likewise is not the best answer—symptom control may be an adjunct, but primary treatment strategies for any problem should center upon eliminating or controlling the cause. • Question 53 L.R. is an 84- NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY year-old female patient 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: 0 out of 1 points Resp onse Feed back : “D” is the correct answer. While beta lactam antibiotics are typically an important part of the regimen for treating inpatient pneumonia because of Streptococcus pneumoniae; This patient has a positive culture for Legionella which is an atypical bacteria in that is has no cell wall. Therefore, “A,” “B,” and “C” are all not correct because there are all beta lactam options whose primary mechanism of action is the inhibition of cell wall synthesis. These drugs, while highly NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY blood gas revealed a paO2 of 58 mm Hg. Chest radiography reveals a "white out" pattern 1 out of 1 points bilaterally. The patient is intubated and ventilated. The AGACNP knows that appropriate management must include: Resp onse Feed back : “B” is the correct answer. This presentation is classic acute respiratory distress syndrome and the patient requires PEEP in order to maximize alveolar-capillary contact and facilitate gas exchange. “A” is not the correct answer—the FIO2 will be increased to whatever is required, along with PEEP, to keep the patient out of respiratory failure. However, an FIO2 of 100% may cause pulmonary fibrosis and should be avoided unless absolutely necessary “C” is not correct—this is too much volume; volumes for ARDS are moderate at 6-8 mL/kg. “D” is not correct—the ventilator setting and NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY r a te is not mandated and determined based upon patient response. • Question 56 Teenagers and adults with acute otitis media can often be treated with "watchful waiting" given the high incidence of spontaneous resolution and low risk of poor 0 out of 1 points outcomes. Which of the following is an absolute indication to begin antibiotic therapy at the time of diagnosis? Resp onse Feed back : “B” is the correct answer. Fever > 102.2° F or moderate to severe ear pain are indicators of severe infection in the setting of otitis media and require antibiotics at the time of diagnosis. “A” is incorrect as the fever cited is not high enough to constitute severe infection. “C” is not correct ; while two infections in the last year may warrant investigation into the cause of repeat infection in the adult NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY p o p u l a t ion, it is not in itself a reason to go right to antibiotics. “D” is not correct—many adults have a history of perforated tympanic membrane as a child. They heal and return to normal function, and have no direct relevance to disease in adulthood. • Question 57 Mr. Bowers is on mechanical ventilation for respiratory support through an episode of 1 out of 1 points septic pneumonia. Due the extensive lobar consolidation it was very difficult to keep Mr. Bowers oxygenated and he required very high FIO2s and PEEP. The AGACNP knows that NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY a n increase in hydrostatic pressure and ultimately water leaking into the alveoli. • Questio n 59 0 out of 1 points Acute respiratory distress syndrome is characterized by which abnormality of ventilation and perfusion? Resp onse Feed back : “B” is the correct answer. 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. “A” is not correct—dead space occurs when the alveoli are inflated but no venous blood comes into contact with it— this is the case in pulmonary emboli in which emboli block the vessel and the inflated alveoli are wasted “C” is not correct—this is not a ventilation or NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY p e r f u sion problem; increased retrosternal airspace occurs with the long term retention seen in COPD. “D” is not correct —ARDS results in fibroproliferation which will decrease compliance. • Questio n 60 0 out of 1 points George Schulz is a 69-year-old male who presents for evaluation of acute foot pain. It is so painful that he cannot walk on it without assistance. At first he denies any significant medical history, but then reveals that he has been diagnosed with dyslipidemia and hypertension but stopped taking his medications because he couldn’t afford it. Pulses NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY are not palpable but are audible by Doppler. The extremity is pale and shiny with decreased hair growth, suspecting peripheral arterial disease, the AGACNP expects which additional finding? Resp onse Feed back : “D” is the correct answer. When patients have severe arterial disease, the microcirculation tries to compensate with widespread dilation and the foot will turn bright red when placed in a dependent position. “A” is not correct —this is more consistent with venous insufficiency as increased venous pressure moves fluid into the interstitial. “B” is not correct—this is also consistent with venous disease and the distended interstitium stimulates melanocytes which increases pigmentation. “C” is not correct, this is more consistent with neuropathy as is seen in diabetes. • Question 61 NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY u v u l a is not among the anatomical risk factors for sleep apnea, and “D” is not correct— stimulation will not cause spasm. Stimulation is a concern when epiglottitis is suspected. • Question 63 During routine immigration screening a 29- year-old male patient from Mexico has a 0 out of 1 points positive purified protein derivative (PPD) test at 17 mm induration. He reports no known NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY history of tuberculosis (TB) infection or exposure, or vaccination with the BCG vaccine. Chest x-ray is negative for any evidence of TB exposure. The AGACNP knows that the appropriate next step is to: Resp onse Feed back : “B” is the correct answer. Patients who have a + PPD but negative chest radiography are considered exposed but not infected, and the Centers for Disease Control (CDC) and Prevention recommend a prophylactic regimen; while isoniazid (INH) and vitamin B6 are the classic combination other regimens do exist. “A” is not correct—the negative chest radiography makes this a non-reportable event. “C” is not correct—sputum cultures are collected when the chest radiograph is positive. “D” is not correct—the patient may ultimately elect not to take prophylactic therapy and be discharged from care, but before that decision is made prophylactic therapy should be NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY o ffered and considered. • Questio n 64 1 out of 1 points Clinical diagnostic criteria for acute respiratory distress syndrome (ARDS) include all of the following except: Resp onse Feed back : “D” is the correct answer. Hypoxemia may be due to any number or respiratory abnormalities and in itself is not among criteria for ARDS; however hypoxemia that is refractory to high oxygen flow concentrations is an anticipated clinical finding. “A,” “B,” and “C” are all among the clinical diagnostic criteria for ARDS—it is virtually always acute in onset, occurring over a matter of hours; chest radiography demonstrates classic characteristic bilateral infiltrates. The NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY management of penetrating eye injury except: 0 out of 1 points Resp onse Feed back : “B” is the correct answer. With penetrating, or open globe injuries, it is critical to avoid pressure on the globe. The eye should never be patched— a rigid shield may be placed to protect the eye from further insult pending ophthalmologist examination. “A” is not true—penetrating eye injuries can lead to infection rapidly so tetanus status should be ensured and parenteral antibiotics started. “C” is not true—an ophthalmologist should be consulted immediately. “D” is not true—antiemetics should be administered to prevent vomiting which increases pressure on the globe. Likewise patients should be discouraged from coughing or sneezing. NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY • Question 67 While evaluating a patient with diastolic failure due to a long history of uncontrolled 1 out of 1 points hemochromatosis, the AGACNP appreciates an extra heart sound just before the S1 heart sound. This sound is most likely a(n): Resp onse Feed back : “B” is the correct answer. Diastolic failure is relaxation failure, and this is sometimes characterized by a ventricular vibration in response to forceful ventricular filling that occurs at the end of diastole when the atria contracts—this is known as S4. “A” is not correct—and S3 sound occurs when a weak walled ventricle vibrates in response to passive filling that occurs early in diastole. “C” is not correct—a split S2 occurs sometimes as a normal variant, or as a response to septal defects, and occurs at the very beginning of diastole when the aortic and pulmonic NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY v a l ve close. “D” is not correct. Mitral stenosis does not produce an extra heart sound—it produces a diastolic murmur. • Questio n 68 1 out of 1 points Secondary hypertension occurs in approximately 10% of all patients with hypertension, and requires management of the underlying problem in order to eliminate the cause. Which of the following is not a secondary cause of hypertension? Response “C” is the correct answer. A defect in natriuresis, the kidney’s ability to NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY a s s e ssment of nystagmus to complete the physical examination and differentiate the more common peripheral vertigo from central vertigo. • Questio n 70 0 out of 1 points 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 is oral contraception, which she has taken since she was 15 years old. The AGACNP first orders: Resp onse Feed back : “B” is the correct answer. The D-dimer is a highly sensitive blood test that suggests activation of the clotting cascade. It requires only venipuncture and is less NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY i n v a s i v e a n d l e ss expensive than other tests for deep vein thrombosis. A negative D-dimer essentially rules out a DVT and the diagnostic evaluation can proceed to rule out other differentials. “A” is not correct— it is not ordered first, but rather follows a positive D-dimer to confirm the presence of a DVT. c" is not correct—a venogram of the affected extremity may be ordered when clinical suspicion is very high and the Doppler inconclusive, but it is not an initial test. “D”A comprehensive metabolic panel may be ordered, but it does not contribute to the diagnosis and is indicated to rule DVT in or out. • Questio n 71 0 out of 1 points NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY The primary neurotransmitter implicated in post-traumatic stress disorder (PTSD) is: Resp onse Feed back : “C” is the correct answer. There are several theories that implicate the role of catecholamine’s such as dopamine and serotonin, as well as secondary stress hormones such as cortisol, but these most of these are not uniformly accepted in terms of the neurobiology of PTSD. Conversely, norepinephrine is universally accepted as a key neurotransmitter in both initial neurological response to an extreme stressor and the subsequent PTSD attacks. Increased exposure to norepinephrine at the time of initial stressor is linked to the development of PTSD, and norepinephrine is an integral component of the symptoms of subsequent attacks. • Question 72 NURS6550Midterm exam (100Q & As) BEST EXAM SOLUTION 100% CORRECTLY/VERIFIED ANSWERS LATEST UPDATE DOWNLOAD A+ GRADE 2023/2024 WALDEN UNIVERSITY