A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate:

 

A.

Low ACTH and low cortisol

B.

Low ACTH and high cortisol

C.

High ACTH and low cortisol

D.

High ACTH and high cortisol

 

 

Question 2

 

Pneumatosis, or gas cysts, may form in the wall anywhere along the gastrointestinal tract; in some cases, they will produce symptoms such as abdominal discomfort, diarrhea with mucus, and excess flatulence. Treatment of pneumatosis most often involves:

 

A.

Several days of oxygen by face mask

B.

Hyperbaric oxygen

C.

Surgical resection

D.

Treatment of underlying disease

 

Question 3

 

Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of

injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifer’s evaluation and management should include:

 

A.

No further care, because the chest radiograph is negative

B.

Quantiferon serum assay for exposure

C.

Consideration of prophylactic therapy

D.

Beginning therapy for pulmonary TB pending sputum cultures

 

Question 4

 

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:

 

A.

Blood group substances

B.

Electrolytes

C.

Vitamin B12

D.

Gastric pH

 

 

Question 5

 

M. T. is a 71-year-old female who presents for evaluation of a ―lump on her chest.‖ She denies any symptoms—there is no pain, erythema, edema, ecchymosis, or open areas—it is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard; it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a:

 

A.

Neurolemma

B.

Lipoma

C.

Hemangioma

D.

Lymphangioma

 

Question 6

 

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?

 

A.

 

Alpha-adrenergic antagonists

B.

Beta-adrenergic antagonists

C.

Intravenous vasodilators

D.

Arteriolar dilators

 

Question 7

 

In myelodysplastic syndromes, the primary indications for splenectomy include:

 

A.

Major hemolysis unresponsive to medical management

B.

Severe symptoms of massive splenomegaly

C.

Sustained leukocyte elevation above 30,000 cells/µL

D.

Portal hypertension

 

 

Question 8

 

The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?

 

A.

Radiographs

B.

CT scan without contrast

C.

MRI

D.

PET scan

 

Question 9

 

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:

 

A.

Continue the current regimen

B.

D/C the spironolactone and begin a loop diuretic

C.

Add a loop diuretic to the spironolactone

D.

Proceed to large-volume paracentesis

 

Question 10

 

 

Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?

 

A.

High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant

B.

There is a strong interest in developing corticosteroid-free posttransplant protocols

C.

Better results are demonstrated in corticosteroid-free protocols for second-transplant recipients

D.

Evidence supports corticosteroid-free rejection protocols

 

 

Question 11

 

K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms; the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that:

 

A.

He will need endoscopy to evaluate the problem

B.

Chronic gastroparesis is a known complication of ulcer surgery

C.

Medication is unlikely to help, and he may need another surgery

D.

His symptoms occur in 5 to 10% of people after ulcer surgery

 

 

Question 12

 

The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal:

 

A.

Increased MCV

B.

Increased Hgb

C.

Increased platelets

D.

Increased albumin

 

Question 13

 

A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?

 

A.

Isoproterenol 0.2 to 0.6 mg IV bolus

B.

External pacemaking

C.

Atropine 0.5 mg IV

D.

Epinephrine 1 mg IV

 

Question 14

 

Ms. Carpenter is a 28-year-old female who presents in significant pain; she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?

 

A.

Temperature > 102°F

B.

White blood cell count > 14,000 cells/µL

C.

Vomiting

D.

Hematuria

Question 15

 

Which of the following is not a true statement with respect to decision making for a cognitively impaired patient?

 

A.

Only a court can declare a patient incompetent

B.

Impaired cognition does not make a person incompetent

C.

Living wills typically are honored if a person is terminally ill

D.

A patient can give informed consent if not declared incompetent

 

 

Question 16

 

Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease; its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except:

 

A.

Gamma-aminobutyric acid (GABA)

B.

Ammonia

C.

False neurotransmitters

D.

Serotonin

Question 17

 

Ross A. is a 38-year-old who has just had a kidney transplant. The AGACNP knows that, due to the characteristic and anticipated response of transplanted kidneys, the patient requires:

 

A.

Aggressive rehydration

B.

Controlled hydration

C.

Hypertonic rehydration

D.

Isotonic rehydration

 

Question 18

 

Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is ―really wrong.‖ She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?

 

A.

Abdominal radiographs

B.

CT scan of the abdomen with contrast

C.

Right upper quadrant ultrasound

D.

A HIDA scan

 

 

Question 19

 

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:

 

A.

Proper cleansing and covering of the laceration, along with antibiotic therapy

B.

Local anesthesia, cleansing, and wound exploration for foreign bodies

C.

Local anesthesia, cleansing, and suture repair

D.

Cleansing, covering, antibiotic therapy, and tetanus prophylaxis

 

Question 20

 

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:

 

A.

Dissecting aortic aneurysm

B.

Acute pancreatitis

C.

Perforated peptic ulcer

D.

Mallory-Weiss tear

 

 

Question 1

 

A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate:

 

A.

Low ACTH and low cortisol

B.

Low ACTH and high cortisol

C.

High ACTH and low cortisol

D.

High ACTH and high cortisol

 

 

Question 2

 

Pneumatosis, or gas cysts, may form in the wall anywhere along the gastrointestinal tract; in some cases, they will produce symptoms such as abdominal discomfort, diarrhea with mucus, and excess flatulence. Treatment of pneumatosis most often involves:

 

A.

Several days of oxygen by face mask

B.

Hyperbaric oxygen

C.

Surgical resection

D.

Treatment of underlying disease

 

Question 3

 

Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of

injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifer’s evaluation and management should include:

 

A.

No further care, because the chest radiograph is negative

B.

Quantiferon serum assay for exposure

C.

Consideration of prophylactic therapy

D.

Beginning therapy for pulmonary TB pending sputum cultures

 

Question 4

 

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:

 

A.

Blood group substances

B.

Electrolytes

C.

Vitamin B12

D.

Gastric pH

 

 

Question 5

 

M. T. is a 71-year-old female who presents for evaluation of a ―lump on her chest.‖ She denies any symptoms—there is no pain, erythema, edema, ecchymosis, or open areas—it is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard; it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a:

 

A.

Neurolemma

B.

Lipoma

C.

Hemangioma

D.

Lymphangioma

 

Question 6

 

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?

 

A.

 

Alpha-adrenergic antagonists

B.

Beta-adrenergic antagonists

C.

Intravenous vasodilators

D.

Arteriolar dilators

 

Question 7

 

In myelodysplastic syndromes, the primary indications for splenectomy include:

 

A.

Major hemolysis unresponsive to medical management

B.

Severe symptoms of massive splenomegaly

C.

Sustained leukocyte elevation above 30,000 cells/µL

D.

Portal hypertension

 

 

Question 8

 

The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?

 

A.

Radiographs

B.

CT scan without contrast

C.

MRI

D.

PET scan

 

Question 9

 

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:

 

A.

Continue the current regimen

B.

D/C the spironolactone and begin a loop diuretic

C.

Add a loop diuretic to the spironolactone

D.

Proceed to large-volume paracentesis

 

Question 10

 

 

Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?

 

A.

High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant

B.

There is a strong interest in developing corticosteroid-free posttransplant protocols

C.

Better results are demonstrated in corticosteroid-free protocols for second-transplant recipients

D.

Evidence supports corticosteroid-free rejection protocols

 

 

Question 11

 

K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms; the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that:

 

A.

He will need endoscopy to evaluate the problem

B.

Chronic gastroparesis is a known complication of ulcer surgery

C.

Medication is unlikely to help, and he may need another surgery

D.

His symptoms occur in 5 to 10% of people after ulcer surgery

 

 

Question 12

 

The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal:

 

A.

Increased MCV

B.

Increased Hgb

C.

Increased platelets

D.

Increased albumin

 

Question 13

 

A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?

 

A.

Isoproterenol 0.2 to 0.6 mg IV bolus

B.

External pacemaking

C.

Atropine 0.5 mg IV

D.

Epinephrine 1 mg IV

 

Question 14

 

Ms. Carpenter is a 28-year-old female who presents in significant pain; she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?

 

A.

Temperature > 102°F

B.

White blood cell count > 14,000 cells/µL

C.

Vomiting

D.

Hematuria

Question 15

 

Which of the following is not a true statement with respect to decision making for a cognitively impaired patient?

 

A.

Only a court can declare a patient incompetent

B.

Impaired cognition does not make a person incompetent

C.

Living wills typically are honored if a person is terminally ill

D.

A patient can give informed consent if not declared incompetent

Question 1

S. is a 59-year-old female who has been followed for several years for aortic regurgitation. Serial echocardiography has demonstrated normal ventricular function, but the patient was lost to follow-up for the last 16 months and now presents complaining of activity intolerance and weight gain. Physical examination reveals a grade IV/VI diastolic aortic murmur and 2+ lower extremity edema to the midcalf. The AGACNP considers which of the following as the most appropriate management strategy?

A. Serial echocardiography every 6 months

B. Begin a calcium channel antagonist

C. Begin an angiotensin converting enzyme (ACE) inhibitor

D. Surgical consultation and intervention

Question 2

An ascending thoracic aneurysm of > 5.5 cm is universally considered an indication for surgical repair, given the poor outcomes with sudden rupture. Regardless of the aneurysm’s size, all of the following are additional indications for immediate operation except:

A. Comorbid Marfan’s syndrome

B. Enlargement of > 1 cm since diagnosis

C. Crushing chest pain

D. History of giant cell arteritis

Question 3

Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat pain, and a temperature of 102.1°F. She appears ill and has foul breath. In order to evaluate for a deep neck space infection, the AGACNP orders:

A. Anteroposterior neck radiography

B. CT scan of the neck

C. White blood cell (WBC) differential

D. Aspiration and culture of fluid

Question 4

Mr. Draper is a 39-year-old male recovering from an extended abdominal procedure. As a result of a serious motor vehicle accident, he has had repair of a small bowel perforation, splenectomy, and repair of a hepatic laceration. He will be on total parenteral nutrition postoperatively. The AGACNP recognizes that the most common complications of parenteral nutrition are a consequence of:

A. Poorly calculated solution

B. Resultant diarrhea and volume contraction

C. The central venous line used for infusion

D. Bowel disuse and hypomotility

Question 5

Mr. Mettenberger is being discharged following his hospitalization for reexpansion of his second spontaneous pneumothorax this year. He has stopped smoking and does not appear to have any overt risk factors. While doing his discharge teaching, the AGACNP advises Mr. Mettenberger that his current risk for another pneumothorax is:

A. < 10%

B. 25-50%

C. 50-75%

D. > 90

Question 6

One of the earliest findings for a patient in hypovolemic shock is:

A. A drop in systolic blood pressure (SBP) < 10 mm Hg for > 1 minute when sitting up

B. A change in mental status

C. SaO2 of < 88%

D. Hemoglobin and hematocrit (H&H) < 9 g/dL and 27%

Question 7

Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more chronic form are most likely to be present with:

A. Respiratory insufficiency

B. Sepsis

C. Bowel obstruction

D. Anemia

Question 8

The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus. Initially the patient was stable, awake, alert, and oriented, but during the last several hours the patient has become increasingly lethargic. At change of shift, the oncoming staff nurse appreciates a profound change in the patient’s mental status from the day before. Vital signs and hemodynamic parameters are as follows: BP 88/54 mm Hg Pulse 110 bpm Respiratory rate 22 breaths per minute SaO2 93% on a 50% mask Systemic vascular resistance (SVR) 1600 dynes ∙ sec/cm5 Cardiac index 1.3 L/min Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most consistent with which shock state?

A. Hypovolemic

B. Cardiogenic

C. Distributive

D. Obstructive

 

Question 9

When counseling patients to prevent postoperative pulmonary complications, the AGACNP knows that with respect to smoking cessation, the American College of Surgeons and National Surgical Quality Improvement Program guidelines are clear that patients who stop smoking _____ weeks before surgery have no increased risk of smokingrelated pulmonary complications.

A. 2

B. 4

C. 6

D. 8

Question 10

Mitch C. is a 39-year-old male who is brought to the ED by paramedics. According to the report of a neighbor, Mitch was distraught over a breakup with his fiancée and attempted to commit suicide by mixing some chemicals from under his kitchen sink and drinking them; afterward he changed his mind and knocked on his neighbor’s door asking for help. Mitch is awake but stuporous, and the neighbor has no idea what he drank. Visual inspection of his mouth and oropharynx reveals some edema and erythema. He is coughing and has large amounts of pooling saliva. Mitch is not capable of answering questions but he appears in pain. Endoscopy reveals full thickness mucosal injury with mucosal sloughing, ulceration, and exudate. The AGACNP knows that the appropriate course of treatment must include:

A.At least 6 hours of observation in the emergency department

B. Periodic esophagram

C. Aggressive fluid resuscitation

D.Esophagogastrectomy

Question 11

Jared V. is a 35-year-old male who presents for evaluation of a dry cough. He reports feeling well overall but notices that he gets out of breath more easily than he used to when playing soccer. A review of systems yields results that are essentially benign, although the patient does admit to an unusual rash on his legs. Physical examination reveals scattered erythematous nodules on both shins. There is no drainage, discomfort, or itch. Additionally, diffuse, mildly enlarged lymph nodes are appreciated bilaterally. Results of a comprehensive metabolic panel and complete blood count are within normal limits. Twelve-lead ECG reveals sinus bradycardia at 58 bpm. Chest radiography reveals bilateral hilar and mediastinal lymphadenopathy. The AGACNP suspects:

A.Bronchiectasis

B. Pulmonary fibrosis

C. Sarcoidosis

D.Lung carcinoma

Question 12

Mrs. Miller is a 44-year-old female who is on postoperative day 1 following a total abdominal hysterectomy. Her urine output overnight was approximately 200 mL. The appropriate response for the AGACNP would be to order:

A.A urinalysis and culture

 B. 1 liter of NSS over 8 hours

C. Encourage increased mobility

D.Liberalize salt in the diet

Question 13

All of the following are risk factors for spontaneous pneumothorax except:

A.Connective tissue disease

B. Scuba diving

C. Chronic obstructive pulmonary disease (COPD)

D.Central line insertion

Question 14

The AGACNP is going over preoperative information and instructions with a patient who is having a major transverse abdominal procedure tomorrow morning. The patient is very nervous and is asking a lot of questions. The AGACNP prescribes a sleeping agent because he knows that anxiety and sleeplessness may:

A.Lead to hypoxia due to hyperventilation

B. Increase the physiologic stress response postoperatively

C. Contribute to risk of delirium and prolonged length of stay

D.Decreasep.o. intake and produce nutritional risk

Question 15

In a patient with thyroid nodules, which of the following is the diagnostic study of choice to rule out thyroid cancer?

A.Radioiodine scanning

B. Percutaneous needle biopsy

C. CT scan

D.Ultrasound

Question 1

S. is a 59-year-old female who has been followed for several years for aortic regurgitation. Serial echocardiography has demonstrated normal ventricular function, but the patient was lost to follow-up for the last 16 months and now presents complaining of activity intolerance and weight gain. Physical examination reveals a grade IV/VI diastolic aortic murmur and 2+ lower extremity edema to the midcalf. The AGACNP considers which of the following as the most appropriate management strategy?

A. Serial echocardiography every 6 months

B. Begin a calcium channel antagonist

C. Begin an angiotensin converting enzyme (ACE) inhibitor

D. Surgical consultation and intervention

Question 2

An ascending thoracic aneurysm of > 5.5 cm is universally considered an indication for surgical repair, given the poor outcomes with sudden rupture. Regardless of the aneurysm’s size, all of the following are additional indications for immediate operation except:

A. Comorbid Marfan’s syndrome

B. Enlargement of > 1 cm since diagnosis

C. Crushing chest pain

D. History of giant cell arteritis

Question 3

Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat pain, and a temperature of 102.1°F. She appears ill and has foul breath. In order to evaluate for a deep neck space infection, the AGACNP orders:

A. Anteroposterior neck radiography

B. CT scan of the neck

C. White blood cell (WBC) differential

D. Aspiration and culture of fluid

Question 4

Mr. Draper is a 39-year-old male recovering from an extended abdominal procedure. As a result of a serious motor vehicle accident, he has had repair of a small bowel perforation, splenectomy, and repair of a hepatic laceration. He will be on total parenteral nutrition postoperatively. The AGACNP recognizes that the most common complications of parenteral nutrition are a consequence of:

A. Poorly calculated solution

B. Resultant diarrhea and volume contraction

C. The central venous line used for infusion

D. Bowel disuse and hypomotility

Question 5

Mr. Mettenberger is being discharged following his hospitalization for reexpansion of his second spontaneous pneumothorax this year. He has stopped smoking and does not appear to have any overt risk factors. While doing his discharge teaching, the AGACNP advises Mr. Mettenberger that his current risk for another pneumothorax is:

A. < 10%

B. 25-50%

C. 50-75%

D. > 90

Question 6

One of the earliest findings for a patient in hypovolemic shock is:

A. A drop in systolic blood pressure (SBP) < 10 mm Hg for > 1 minute when sitting up

B. A change in mental status

C. SaO2 of < 88%

D. Hemoglobin and hematocrit (H&H) < 9 g/dL and 27%

Question 7

Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more chronic form are most likely to be present with:

A. Respiratory insufficiency

B. Sepsis

C. Bowel obstruction

D. Anemia

Question 8

The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus. Initially the patient was stable, awake, alert, and oriented, but during the last several hours the patient has become increasingly lethargic. At change of shift, the oncoming staff nurse appreciates a profound change in the patient’s mental status from the day before. Vital signs and hemodynamic parameters are as follows: BP 88/54 mm Hg Pulse 110 bpm Respiratory rate 22 breaths per minute SaO2 93% on a 50% mask Systemic vascular resistance (SVR) 1600 dynes ∙ sec/cm5 Cardiac index 1.3 L/min Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most consistent with which shock state?

A. Hypovolemic

B. Cardiogenic

C. Distributive

D. Obstructive

 

Question 9

When counseling patients to prevent postoperative pulmonary complications, the AGACNP knows that with respect to smoking cessation, the American College of Surgeons and National Surgical Quality Improvement Program guidelines are clear that patients who stop smoking _____ weeks before surgery have no increased risk of smokingrelated pulmonary complications.

A. 2

B. 4

C. 6

D. 8

Question 10

Mitch C. is a 39-year-old male who is brought to the ED by paramedics. According to the report of a neighbor, Mitch was distraught over a breakup with his fiancée and attempted to commit suicide by mixing some chemicals from under his kitchen sink and drinking them; afterward he changed his mind and knocked on his neighbor’s door asking for help. Mitch is awake but stuporous, and the neighbor has no idea what he drank. Visual inspection of his mouth and oropharynx reveals some edema and erythema. He is coughing and has large amounts of pooling saliva. Mitch is not capable of answering questions but he appears in pain. Endoscopy reveals full thickness mucosal injury with mucosal sloughing, ulceration, and exudate. The AGACNP knows that the appropriate course of treatment must include:

A.At least 6 hours of observation in the emergency department

B. Periodic esophagram

C. Aggressive fluid resuscitation

D.Esophagogastrectomy

NR392 Quality Improvement in Nursing

Project Milestone 1

 

Directions: Prior to completing this template, carefully review Course Project Milestone 1 Guidelines paying particular attention to how to name the document and all rubric requirements. After saving the document to your computer, type your answers directly on this template and save again. This assignment is due by Sunday end of Week 1 by 11:59 p.m. Mountain Time.

Your Name:__________________________

Assignment Criteria

Your Answers:

NOTE: See Milestone 1 Rubric for details required in each area.

What precautions does the nurse take when giving any type of Chemo medications

2. What is Superior vena cava syndrome and what are the symptoms associated with this syndrome

3. What will the nurse do for a patient following a prostatectomy and what should be done for dark red urine output?

4. What post-op care should be provided after a mastectomy

5. What labs should the nurse be concerned with when caring for the cancer patient. Ex: Neutropenia, Thrombocytopenia, etc…

6. Know all signs/symptoms of Neutropenia and Thrombocytopenia

7. What kind of education would you give someone receivingexternal radiation

8. Know the stages of cancer development; malignant transformation occurs through…

9. Know how to interpret the TNM staging system

10. What drug does the physician order for the chemo patient with low hemoglobin levels

11. What the normal ranges for platelet counts and what nursing intervention should the nurse do for a low platelet count

12. What intervention/education should the nurse suggest to the early diagnosed cancer patient concerning memory problems

13. What is mucositis and what interventions does the nurse do to treat it 

14. What is the difference between Basal Cell and Squamous cell carcinomas 

15. What type of behavior does cancer cells exhibit

16. What interventions are used for nausea/vomiting associated with cancer treatment

17. What education would the nurse give to lessen the impact on the development of cancer

18. What is Tumor lysis syndrome 19. What interventions would the nurse incorporate for the patient diagnosed with a brain tumor 

20. What type of education will the nurse teach the patient who takes herbal medications when receiving treatment for cancer

21. Ginger helps the cancer patient with what?

22. What herbal supplement should the patient avoid when taking estrogen

 23. Why should the surgical patient stop taking ginger, bilberry, feverfew, and garlic 

24. What is the association between cancer and T’ai Chi

 25. What types of interventions can the nurse provide for cancer comfort

26. What is Palliative care and what purpose does treatment do for this type of patient

 27. What is Hospice and the role of the nurse working with the patient and family 

28. What is the difference between agonal breathing, apneustic breathing, and cheyne-stokes respiration 

29. What are signs/symptoms of impending death and which sign does the nurse determine is showing nearing death 

30. What is the most important treatment the nurse does for the dying patient

 31. What are advance directives and what education does the nurse provide the patient/family 

32. What is actions should the nurse take for the death of the patient and their families 

33. What is the difference between hospice and palliative care

 34. How does one identify pain in the cancer patient 

35.What task are unlicensed staff allowed to do for the dying patient

36. What interventions does the nurse do for “death rattle”

37. What are the catholic custom associated with death and dying

38. What is terminal dehydration 

39. What is the purpose of proportional palliative sedation [Show less]

  101.   The level of TSH in Graves’ disease is usually:

a.

high.

b.

low.

c.

normal.

 

 

____ 102.   Upon palpation of the neck of a patient with Graves’ disease, what would the nurse expect to find?

a.

Normal-sized thyroid

b.

Small discrete thyroid nodule

c.

Multiple discrete thyroid nodules

d.

Diffuse thyroid enlargement

 

 

____ 103.   What are clinical manifestations of hypothyroidism?

a.

Intolerance to heat, tachycardia, and weight loss

b.

Oligomenorrhea, fatigue, and warm skin

c.

Restlessness, increased appetite, and metrorrhagia

d.

Constipation, decreased heat rate, and lethargy

 

 

____ 104.   Diagnosing thyroid carcinoma is best done with:

a.

measurement of serum thyroid levels.

b.

radioisotope scanning.

c.

ultrasonography.

d.

fine-needle aspiration biopsy.

 

 

____ 105.   Renal failure is the most common cause of _____ hyperparathyroidism.

a.

primary

b.

secondary

c.

exogenous

d.

inflammatory

 

 

____ 106.   What is the most common cause of hypoparathyroidism?

a.

Pituitary hyposecretion

b.

Parathyroid adenoma

c.

Parathyroid gland damage

d.

Autoimmune parathyroid disease

 

 

____ 107.   An adult female had a thyroidectomy this morning. She develops muscle spasms, increased deep tendon reflexes, and laryngeal spasm. What is the most common cause of these findings?

a.

Calcium deficit due to reduced parathormone

b.

Overuse of radioactive iodine given pre-operatively

c.

A history of insufficient dietary intake of iodine

d.

An increase in serum phosphorous caused by reduced calcitonin

 

 

____ 108.   What is the most probable cause of low serum calcium following thyroidectomy?

a.

Hyperparathyroidism secondary to Graves’ disease

b.

Myxedema secondary to surgery

c.

Hypoparathyroidism caused by surgical injury

d.

Hypothyroidism caused by lack of thyroid replacement

 

 

____ 109.   A male patient with diabetic ketoacidosis (DKA) has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; urine glucose and ketones positive; serum K⁺ 2 mEq/L; serum Na⁺ 130 mEq/L. He reports that he has been sick with the “flu” for 1 week. What relationship do these values have to his insulin deficiency?

a.

Increased glucose use causes the shift of fluid from the intravascular to the intracellular space.

b.

Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.

c.

Increased glucose and fatty acids stimulate renal diuresis, electrolyte loss, and metabolic alkalosis.

d.

Decreased glucose use results in protein catabolism, tissue wasting, respiratory acidosis, and electrolyte loss.

 

 

____ 110.   What is a description of diabetes mellitus type 2?

a.

There is a resistance to insulin by insulin-sensitive tissues.

b.

The patient uses lispro instead of regular insulin.

c.

There is an increased glucagon secretion from -cells of the pancreas.

d.

There are insulin autoantibodies that destroy ß-cells in the pancreas.

 

 

____ 111.   A patient with diabetes mellitus type 1 experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion. What is the most probable cause of these symptoms?

a.

Hyperglycemia caused by incorrect insulin administration

b.

Dawn phenomenon from eating a snack before bed time

c.

Hypoglycemia caused by increased exercise

d.

Somogyi effect from insulin sensitivity

 

 

____ 112.   Which clinical finding occurs first in metabolic acidosis of the patient with type 1 diabetes mellitus?

a.

Ketones in the urine

b.

Palpitations, anxiety, and confusion

c.

Hyperlipidemia

d.

Kussmaul respirations

 

 

____ 113.   Why does hyperkalemia develop in diabetic ketoacidosis?

a.

Because sodium is low, which stimulates aldosterone to retain sodium and potassium

b.

Because hydrogen shifts into the cell in exchange for potassium to compensate for metabolic acidosis

c.

Because phosphorus shifts into the cell in exchange for potassium due to the lack of insulin

d.

Because the blood is concentrated due to the loss of water from polyuria

 

 

____ 114.   What is a difference in clinical manifestations between diabetic ketoacidosis and hyperglycemic, hyperosmolar non-ketosis syndrome?

a.

Fluid loss

b.

Glycosuria

c.

Increased serum glucose

d.

Kussmaul respirations

 

 

____ 115.   Hypoglycemia followed by rebound hyperglycemia is seen in:

a.

the Somogyi effect.

b.

the dawn phenomenon.

c.

diabetic ketoacidosis (DKA).

d.

hyperosmolar hyperglycemic nonketosis syndrome (HHNKS).

 

What is the expected electrocardiogram (ECG) pattern when a thrombus in  a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the  epicardium?

How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe:

Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of   cardiomyopathy?

A disproportionate thickening of the interventricular septum is the hallmark of which form of  cardiomyopathy?

Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of  cardiomyopathy?

 

Which condition is a cause of acquired aortic  regurgitation?

Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease?

Which disorder causes a transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center, making them appear as a ringworm?

What is the most common cause of infective  endocarditis?

What is the most common cardiac disorder associated with acquired immunodeficiency  syndrome (AIDS)

A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular  resistance?

What cardiac pathologic condition contributes to ventricular   remodeling?

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke  volume?

What is the cause of the dyspnea resulting from a thoracic   aneurysm?

Which statement is true concerning the cells’ ability to synthesize cholesterol?

What is the trigger for angina  pectoris?

Individuals being effectively managed for type 2 diabetes mellitus often experience a healthydecline in blood pressure as a result of what   intervention?

Which statements are true regarding fatty streaks? (Select all that   apply.) Fatty streaksprogressively damage vessel walls.

Fatty streaks are capable of producing toxic oxygen radials.

When present, inflammatory changes occur to the vessel walls.

Oxidized low-density lipoproteins (LDLs) are involved in their formation.

What factors contribute to the development of orthostatic   hypotension? (Select all that apply.)

Altered body chemistry

Drug action of certain antihypertensive agents

Prolonged immobility

Effects of aging on postural  reflexes

Which assessment findings are clinical manifestations of aortic   stenosis? (Select all that apply.)

Which risk factors are associated with infective endocarditis? (Select all that apply.)

Match the descriptions with the corresponding  terms.

          A. Impairs flow from left atrium to left  ventricle

          B. Impairs flow from the left  ventricle

          C. Backflow into left atrium

          D. Backflow into right atrium

          E. Backflow into left ventricle

Aortic stenosis

Aortic regurgitation

 

Mitral stenosis

Tricuspid regurgitation

Mitral regurgitation

What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?

Which inflammatory cytokines are released when endothelial cells are injured?

When endothelia cells are injured, what alteration contributes to atherosclerosis?

Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?

What pathologic change occurs to the kidney’s glomeruli as a result of hypertension?

What effect does atherosclerosis have on the development of an aneurysm?

Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot  formation?

What is the usual source of pulmonary  emboli?

Which factor can trigger an immune response in the bloodstream that may result in an embolus?

Which statement best describes thromboangiitis obliterans (Buerger disease)?

Which statement best describes Raynaud  disease?

What change in a vein supports the development of varicose   veins?

Superior vena cava syndrome is a result of a progressive increase of which process?

What term is used to identify when a cell is temporarily deprived of blood supply?

The risk of developing coronary artery disease is increased up to threefold by which factor?

Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic   lipoprotein?

Nicotine increases atherosclerosis by the release of which neurotransmitter?

Which substance is manufactured by the liver and primarily contains cholesterol and protein?

Which elevated value may be protective of the development of atherosclerosis?

Which laboratory test is an indirect measure of atherosclerotic   plaque?

Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes?

Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary  arteries?

When is the scar tissue that is formed after a myocardial infarction (MI) most vulnerable to injury?

An individual who is demonstrating elevated levels of troponin, creatine kinase–isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which  condition?

Before donning gloves to perform a procedure, proper hand hygiene is essential. The nurse understands that the most important aspect of hand hygiene is the amount of

A nurse is demonstrating postoperative deep breathing and coughing exercises to a client about to undergo emergency abdominal surgery for appendicitis. The nurse realizes the client may be unprepared to learn if the client

A client comes to the emergency department reporting that he has had diarrhea for 4 days and is urinating less than usual. When assessing the client’s skin turgor, the nurse should

A nurse is planning interventions for a group of

clients who are obese. What can the nurse do to

improve their commitment to a long term goal of weight loss?

When admitting a client, the nurse records which information in the client’s record first?

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Friction

reports severe pain.

grasp a fold of skin on the chest under the clavicle, release it, and note if it springs back.

Attempt to develop the clients’ self-motivation.

Assessment of the client

1/27 5/25/2019

StudyBlue Flashcard Printing of ATI Final

A nurse tells a client that the provider has prescribed IV fluids. The client appears to be upset about the IV catheter insertion, but says nothing to the nurse. Which of the following of the following is an appropriate nursing response?

A client who is unstable and requires frequent vital signs has an electronic blood pressure machine automatically measuring his blood

pressure every 15 min. However, the machine is reading the client’s blood pressure at more frequent intervals, and the readings are not similar. The nurse checks the machine settings and observes the additional readings, but the problem continues. Which of the following is the appropriate nursing action?

A nurse is caring for a client just diagnosed with type 1 diabetes mellitus. The client is resistant to learning self injection of insulin and asks the nurse to administer all the injections. The nurse explains the importance of learning self care and appropriately adds which of the following statements?

An assistive personnel (AP) says to the nurse, “This client is incontinent of stool three or four times a day. | get angry, and | think that the client is doing it just to get attention. | think we should put adult diapers on her.” Which is the appropriate nursing response?

A nurse’s neighbor is scheduled for elective surgery. The neighbor’s provider indicated that a moderate amount of blood loss is expected during the surgery, and the neighbor is anxious about acquiring an infection from a blood transfusion. Which of the following is appropriate for the nurse to suggest?

“Is there something about this procedure that concerns you?”

Disconnect the machine, and measure the blood pressure manually every 15 min.

“Tell me what | can do to help you overcome your fear of giving yourself injections.”

“It is very upsetting to see an adult client regress.”

Donating autologous blood before the surgery

2/27 5/25/2019

At a mobile screening clinic, a nurse is assessing a client who reports a history of a heart murmur due to aortic stenosis. To auscultate the aortic valve, the nurse should place the stethoscope at which location?

A client is admitted to the hospital with decreased circulation in the left leg. During the admission assessment, which is the most important nursing action initially?

A nurse is caring for a client who requires rectal temperature monitoring. Available at the client’s bedside is a thermometer is with a long, slender tip. Which of the following is the appropriate action for the nurse to take?

A nurse is teaching a client who has cardiovascular disease how to reduce his intake of sodium and cholesterol. The nurse understands that the most significant factor in planning dietary changes for this client is the

A nurse is caring for an older adult client who is confused and continually grabs at the nurses. Which of the following is an nursing action?

StudyBlue Flashcard Printing of ATI Final

Second intercostal space to the right of the sternum.

Evaluate the pedal pulses.

Obtain a thermometer with a short, blunt insertion end.

involvement of the client in planning the change.

Firmly tell him to not grab

3/27 5/25/2019

An assistive personnel (AP) tells the nurse, “I am unable to find a large blood pressure cuff for a client who is obese. Can | just use the regular cuff if | can get it to stay on?” The nurse replies

that taking the blood pressure of a morbidly obese client with a regular blood pressure cuff will result in a reading that is

Which of the following should the nurse do first when preparing to provide tracheostomy care?

A 3 year old child has had multiple tooth extractions while under general anesthesia. The client returns from the postanesthesia care crying, but awake, from the recovery room. Which approach is likely to be successful?

A nurse admits a client to a same-day surgery center for an exploratory laparotomy procedure this morning. The client’s surgeon asks the nurse to witness the signing of the preoperative consent form. In signing the form as a witness, the nurse affirms that

To use proper body mechanics while making an occupied bed for a client on bed rest, the nurse should

StudyBlue Flashcard Printing of ATI Final

high

Perform hand hygiene.

Examine the mouth last.

the signature on the preoperative consent form is the client’s.

place the bed in a high horizontal position.

4127 5/25/2019

Which of the following should a group of community health nurses plan as part of a primary prevention program for occupational pulmonary diseases?

When initiating cardiopulmonary resuscitation (CPR), the nurse must confirm which of the following assessment findings prior to beginning chest compressions?

A nurse on a rehabilitation unit is transferring a client from a bed to a chair. To avoid a back injury, which of the following techniques should the nurse use?

An older adult client appears agitated when the nurse requests that the client’s dentures be removed prior to surgery and states, “| never go anywhere without my teeth.” Which of the following is an appropriate nursing response?

To use the nursing process correctly, the nurse must first

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Elimination of the exposure

Absence of pulse

Bend at the knees while maintaining a wide stance and a straight back, with the client’s hands on the nurse’s shoulders, and the nurse’s hands under the client’s axillae.

“You seem worried. Are you concerned someone may see you without your teeth?”

obtain information about the client.

5/27 5/25/2019

A postoperative client has been diagnosed with paralytic ileus. When performing auscultation of the client’s abdomen, the nurse expects the bowel sounds to be

While starting an intravenous infusion (IV) for a client, the nurse notices that her gloved hands get spotted with blood. The client has not been diagnosed with any infection transmitted via the bloodstream. Which of the following should the nurse do as soon as the task is completed?

A nurse is precepting a newly licensed nurse who is preparing to help a client perform tracheostomy care. The nurse should intervene if the equipment the preceptee gathered included

A nurse is caring for a client diagnosed with a terminal illness. The client asks several questions about the nurse’s religious beliefs related to death and dying. An appropriate nursing response is to

When assessing a client’s heart sounds, the nurse hears a scratching sound during both systole and diastole. These sounds become more distinct when the nurse has the client sit up and lean forward. The nurse should document the presence of a(n)

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Absent

Throw gloves away, perform hand hygiene

Cotton balls

encourage the client to express his thoughts about death and

dying.

pericardial friction rub.