*NURSING > EXAM > NURS 6560 MIDTERM EXAM - Walden University (Score 93%) (All)

NURS 6560 MIDTERM EXAM - Walden University (Score 93%)

Document Content and Description Below

Midterm NURS 6560 Walden University (Current Diagnosis & Treatment Surgery textbook) Mr. Woodlawn is a 56-year-old male who was recently diagnosed with non-small cell lung cancer. In staging Mr... . Woodlawn to evaluate suitability for surgical resection, the AGACNP knows that which diagnostic study is critical in the staging process of the disease? Positron emission tomography CT scan of the chest Chest radiography Magnetic resonance imaging Lilly M. is a 44-year-old female who is transferred to the emergency department following a severe fall. She had been standing on the balcony of a four-story building and tried to balance on the railing. She fell and sustained numerous internal and external injuries. In the emergency room she was in profound hypovolemic shock. Bleeding appears to have been stopped, and rapid infusion of 2 L of normal saline has just been completed. The AGACNP knows that the next step in fluid resuscitation includes: A. Transfusion of packed red blood cells (PRBCs) based on hematocrit B. Infusion of 1 L of lactated Ringer’s C. 1 more liter of normal saline solution (NSS) over 10 minutes D. No additional fluid unless the systolic blood pressure (SBP) is < 90 mm Hg Sally is a type 2 diabetic scheduled for a total knee replacement. How should the AGACNP manage Sally's diabetic medications? Continue the current treatment regime as long as the preoperative HgA1C is less than 7 Discontinue all oral diabetic medication the day of surgery Start an insulin drip in the preoperative area and titrate to maintain a blood glucose of 96-120 Administer a basal dose of Lantus in the preoperative area to ensure a steady glucose level through the next 24 hours. 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 The AGACNP is evaluating a patient for a right sided tension pneumothorax. When evaluating the chest x-ray the AGACNP would expect to see a shift of the mediastinum in what direction? Right side Left side Bilateral No shift would be expected Ms. Mears is a 59-year-old female who presents for evaluation of dyspnea. Her medical history is significant for rheumatic heart disease as a child and she has always been told she has a murmur. She says she has always felt pretty well but in the last few months she has noticed worsening swelling in her legs, and now she feels like her abdomen is getting bigger. Physical exam confirms the presence of ascites and 2+ pitting lower extremity edema. Cardiac examination includes findings consistent with mitral stenosis and tricuspid regurgitation. The AGACNP anticipates which findings on a 12-lead electrocardiogram? Premature atrial contractions and left ventricular hypertrophy Multifocal premature ventricular complexes and right atrial abnormality Left axis deviation and left atrial abnormality Atrial fibrillation and right axis deviation Carolyn is a 25-year-old injection drug user who has had a long history of health problems since her early teenage years. She has preexisting mitral valve regurgitation and has had endocarditis in the past. She is now being treated for lung abscess that presumably occurred with aspiration in an intoxicated state. She was admitted and started on intravenous antibiotic therapy, IV fluids, and nutritional support. She is now on day 5 of antibiotic therapy and remains septic and febrile. The AGACNP knows that the indicated course of treatment includes: A. Continued antibiotic therapy with evaluation on day 7 B. Change to a different extended spectrum antibiotic C. Percutaneous drainage of the abscess D. Thoracotomy with open drainage (this might be next if tube clogs or doesn't work) A surgical patient who has cancer, obesity, or is on hormonal contraception have an increased post- operative risk for: Atelectasis Thromboembolism Poor wound healing Angina D. is a 61-year-old female patient who complaints of pleuritic chest pain and cough. During the history, she indicates that she occasionally has seen a little bit of blood in her sputum, but she thought it was from coughing so hard. What finally prompted her to come in was that she coughed up a “stone.” Recognizing that the patient might have broncholithiasis, the AGACNP asks about exposure to: A. Cigarettes B. Asbestos C. Bird excrement D. Swimming pools Mrs. Evans is an 82-year-old female who is on postoperative day 3 following resection of a small bowel tumor. She is alert today and her nasogastric tube is removed. The AGACNP knows that if the recovery proceeds normally, Mrs. Evans may begin clear liquids: A. Immediately B. In 24 hours C. When bowel sounds return D. After a negative swallow study The AGACNP is educating a patient newly diagnosed with venous insufficiency. All of the following are appropriate treatments except: elastic support stockings regular exercise leg elevation prolonged sitting S.B. is a 67-year-old male who is being discharged following inpatient management for unstable angina. S.B. did not know that he had coronary artery disease, and in fact had not seen a health care provider for many years. While reviewing his lifestyle habits, he admits that he is obese with poor eating habits, does not engage in any purposeful physical activity, and smokes 2 packs of cigarettes daily. The AGACNP should initiate all of the following medications except: Statin Low dose aspirin Beta adrenergic blocker Calcium channel blocker Mrs. Knickerson is an 89-year-old female who lives alone at home. She is generally in good health, and her functional status is reasonably strong. Her son and daughter-in-law stop by once or twice a week and help her with some household chores. Mrs. Knickerson’s only medical diagnosis is hypertension, for which she has taken HCTZ 12.5 mg for as long as she can remember. Today when her son went into the home, he found her in bed, clearly unwell and a bit disoriented. Upon hospital admission, she is found to have vital signs as follows: temperature 100.9°F, pulse 122 bpm, respirations 22 breaths per minute, and blood pressure 82/53 mm Hg. Her saO2 on 2 L of nasal oxygen is 89%. Chest radiograph is clear, and 12-lead ECG demonstrates sinus tachycardia. Urinalysis reveals +++ white blood cells, + nitrites, + red blood cells, and ++ bacteriuria. The AGACNP suspects which of the following shock states? A. Hypovolemic (r/t diuresis, not drinking, infection) B. Cardiogenic C. Obstructive D. Neurogenic T. is a 39-year-old male who presents to the hospital emergency room with a chief complaint of profound substernal chest pain. Results of the 12-lead ECG and cardiac enzymes test are normal. Vital signs are as follows: temperature 101.9°F, pulse 129 bpm, respirations 26 breaths per minute, and blood pressure 90/60 mm Hg. The patient is pale and clearly unwell, and physical examination reveals a systolic pericardial crunching sound. Which of the following additional pieces of history would make the AGACNP suspect acute mediastinitis? A. A 48 pack year smoke history B. A 2-day history of vomiting C. Aortic valve regurgitation D. Cardiac tamponade Cardiac tamponade, tension pneumothorax, abdominal distention, and encroachment of the abdominal viscera into the chest are all causes of which type of shock : Hypovolemic Distributive septic Cardiac compressive Neurogenic The AGACNP is reviewing the ankle-brachial index (ABI) they ordered on a patient with suspected peripheral arterial disease. Which ABI result would indicate severe peripheral arterial disease causing pain at rest? 1.7 1.0 0.7 0.3 Mrs. Glasgow is a 55-year-old female who is day 4 post open cholecystectomy. She has had some unanticipated postoperative ectopy and remains hospitalized. This morning her temperature is 100.9°F. While assessing her for infection, the AGACNP knows that which finding would be most consistent with an infectious process? A. Neutrophilia of 82% of the white blood cell differential B. A blood urea nitrogen (BUN)/creatinine ratio of > 20 C. Pain to palpation at the incision site D. A significant decrease in appetite Mr. Mireya is a 66-year-old male who is admitted for elective surgery with a history of stage IV chronic kidney disease. The AGACNP should carefully assess his preoperative labs for: Anemia Hypercalcemia Eosinophilia Hypokalemia H. is a 71-year-old male with small cell lung cancer; he has been treated with chemotherapy. Initially he had symptom improvement but now appears to have had a recurrence. On examination today, he is quite edematous and has gained 12 lbs since his office visit 1 week ago. A metabolic panel reveals a serum Na+ of 119 mEq/dL. The AGACNP knows that J. H. likely has: A. Brain metastasis B. Congestive heart failure (CHF) C. Syndrome of inappropriate antidiuretic hormone (SIADH) D. Metabolic alkalosis Mr. Snyder is a 71-year-old male who weighs 70 Kg who was just transferred from the recovery room following resection of the left lower lobe for limited non-small cell lung carcinoma. He has a left chest tube in place. The AGACNP should order which of the following for fluid and electrolyte management? D5 0.5NS with 40 KCL at 125 cc per hour D5 NS at 100 cc per hour D 5 NS with 30 KCl at 50 cc per hour plus volume equal to chest to output to be administered every four hours D5 0.5 NS at 50 cc per hour The AGACNP is evaluating a 21 year old male that was just diagnosed with Marfan's syndrome. The AGACNP should assess the patient or which of the following conditions? Dilated cardiomyopathy Ascending aortic aneurysm Rheumatoid arthritis Chronic renal failure According to the American College of Surgeons (ACS), who among the following patients should have a chest radiograph as part of preoperative assessment? A. All patients > 40 years of age B. All patients who smoke cigarettes C. All patients having thoracic procedures (Lung disease and major operations-card, thor, vasc, abdominal) D. All patients with cardiac disease Mr. Quigley is a 56-year-old male patient who presents for evaluation of difficulty swallowing. Physical examination of the oropharynx reveals a pink irregular mass of approximately 4 cm in the posterior pharynx. The patient is advised that he appears to have an abnormal growth and will need to be referred to otolaryngology. He asks how he got a tumor in his throat. The AGACNP replies that the greatest risk factor(s) for oropharyngeal tumors is(are): A. Tobacco and alcohol use B. Human papillomavirus (HPV) C. Family history of a first degree relative D. Female gender Preop lab results show hypoalbuminemia. This is critical to prescribing because: Distribution of drugs to target tissue may be affected The solubility of the drug will not match the site of absorption There will be no free drug available to generate an effect Drugs bound to albumin are readily excreted by the kidneys The AGACNP is writing orders for the day of surgery. The AGACNP would correctly order which of the following? Patient with diabetes should be started on an insulin gtt to maintain serum glucose < 150 mg/dL Patients on beta adrenergic antagonists should continue therapy Patients with WBC of 16 or over should have one dose of antibiotics prior to surgery Patients with a Hgb > 9 mg/dL should be transfused with packed red blood cells 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 (orthostatic) B. A change in mental status C. SaO2 of < 88% D. Hemoglobin and hematocrit (H&H) < 9 g/dL and 27% A 92 year old female admitted with urosepsis has become hypotensive and is presenting with a blood pressure of 89/48 and HR of 119. The best prognostic lab test you can order is CBC with diff Sed rate ANA lactic acid Mr. Zuckerman is a 62-year-old man who presents for evaluation of a sense of difficulty swallowing and food getting stuck. He also reports that sometimes he can hear or “feel” a gurgling sound in his throat. He had a barium swallow study that demonstrated a large pharyngoesophageal (Zenker’s) diverticulum. The AGACNP knows that which of the following additional diagnostic studies is not indicated? A. Esophageal manometry B. Chest radiograph C. Endoscopy (dangerous, may perf) D. Ambulatory pH monitoring J.K. is a 36 year-old male with bacterial endocarditis. He is an injection drug user and has a history of mitral valve disease since childhood. He has been treated with three different courses of antibiotics in the last six weeks, but he continues to have positive blood cultures. The AGACNP knows that J.K. needs: Direct access intrathoracic antibiotic infusion A documented 2 month drug-free cycle Intravenous antifungal therapy Surgical replacement of the valve W.P. is a 79-year-old male patient admitted with a diagnoses of lung cancer with pleural effusion. He became acutely dyspneic and required a therapeutic drain of the effusion for lung reexpansion. A chest tube is inserted and 50 ml of fluid drained; the patient says he still feels short of breath but is a little bit better. The AGACNP knows that the next step in his care is to: Clamp the tube for 1 hour and then drain an additional 500 cc Clamp the tube for 1 hour and then reassess for symptoms Increase draining at up to 1L/hr until the effusion is drained Continue draining at up to 500 mL/hr until the effusion is drained Kelly is a 50-year-old female who had chest radiography as part of a preoperative history and physical examination before an elective cosmetic procedure. She has no significant medical history and takes no daily medications except hormone therapy for menopausal symptoms. The radiology report of her chest film includes a 4-mm coin lesion in the right middle lobe. Kelly reports her health as excellent and has no clear risk factors for malignancy. The AGACNP knows that the next step in her management should be: A. Repeat radiography in 6 months B. CT scan of the chest C. Needle biopsy of the lesion D. A pulmonology consult A 49 year old female is seen for sudden onset severe abdominal pain 10/10. On further questioning you learn that she has experienced epigastric pain for several months after eating, which has resulted in an 11 pound weight loss. She does not take any other medications. On physical exam you note she has a low grade fever of 100.1, HR 124, RR 25 and BP is 116/72. The abdomen is rigid and there are no bowel sounds. Abdominal plain film shows free air under the diaphragm. What is your diagnosis? ruptured gallbladder ruptured spleen perforated duodenal ulcer ascites B. is a 41-year-old male being admitted for surgical reduction of an open femur fracture sustained in a multiple vehicle collision. Preoperative assessment reveals that he is on beta-adrenergic antagonists after having been diagnosed with coronary artery disease approximately 1 month ago. He admits that he feels a little better but says he still gets pain in his chest when he exerts himself. He is pain free now. Vital signs are as follows: temperature 98.1°F, pulse 88 bpm, respiratory rate 18 breaths per minute, and blood pressure 142/86 mm Hg. The AGACNP knows that which of the following is the most important action before R. B. goes to the operating room? A. A cardiology consultation B. Blood pressure control C. Resuming beta-adrenergic antagonists D. Pain control Jamie is a 51-year-old male who presents with profound, constant, crushing chest pain. He has a history of aortic insufficiency and giant cell arteritis. The AGACNP knows that this is most consistent with: Descending thoracic aneurysm Ascending thoracic aneurysm Genetic thoracic aneurysm Acquired thoracic aneurysm Ms. Carson is a 71-year-old female who presents with significant pleuritic-type chest pain. She has no known cardiopulmonary history and does not smoke cigarettes. Her history is significant only for an upper endoscopy this morning for evaluation of severe gastroesophageal reflux disease (GERD). She tolerated the procedure well and was discharged home. Over the afternoon she developed worsening pain on the left side of her chest and finally had to come to the emergency department. Her vital signs are as follows: temperature 100.0°F, pulse 116 bpm, respiratory rate 22 breaths per minute, and blood pressure 96/60 mm Hg. The AGACNP orders which of the following diagnostic studies to confirm the suspected diagnosis? A. Chest radiograph B. 12-lead ECG C. Upper endoscopy D. Esophagogram (check for tear, perforation) The 32 year old post-operative appendectomy who presented with a ruptured appendix has now developed signs of septic shock. Your treatment goals include maintaining urine output at 0.5/ml/kg per hour frequent blood transfusions to ensure H&H remain at or above normal intubation with a high Fi02 to prevent ARDS keeping the lactate level >3mmol/L Which of the following treatment modalities has no role in the treatment of shock? A. Lactated Ringer’s (Crystalloid, also NS) B. Fresh frozen plasma (FFP) (but needs to be thawed) C. Vasopressors D. Colloid solutions (volume expanders) (more costly, low inventory, only use if desperate) J.Z. is a 71-year-old man who presents to the emergency department with chest pain. A 12-lead ECG is essentially normal excepting a mild left atrial abnormality. Cardiac isoenzymes are negative. Vital signs are as follows: Temperature 97.9o F, pulse 76 b.p.m., respirations 14 b.p.m., and blood pressure 144/86 mm Hg. Physical examination reveals reproducible tenderness over the anterior chest wall bilaterally. There is no erythema, edema, or ecchymoses, no subcutaneous emphysema. Chest radiography is negative. He was diagnosed with costochondritis and was treated with a course of nonsteroidal anti-inflammatory drugs. He presents today in follow-up four weeks later and is still having pain and some chest wall swelling. The AGACNP knows that the next step in the treatment of J.Z. will likely be: Oral steroids Intravenous antibiotics Cartilage excision External compression Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath, and has coarse rales on auscultation. Physical examination reveals a grade V/VI systolic murmur loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes: Acute aortic valve regurgitation Acute mitral valve regurgitation Acute cardiac tamponade Acute pulmonary embolus 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 L. is a 48-year-old female who has suffered with profound GERD symptoms for several years. She has had aggressive trials of medical therapies and has been adherent to nonpharmacologic interventions. She is now in the aggressive diagnostic phase of evaluation and is preparing for 24-hour ambulatory pH monitoring. The AGACNP advises that in preparation for this test, M. L. should: A. Continue her current proton pump inhibitor (PPI) therapy consistent with the way she has been taking it B. Eat consistently with her normal eating habits up until the procedure C. Avoid straining for a bowel movement while the monitor is in place D. Not do anything differently as compared with her normal daily life L.D. is a 59-year-old male who presents for consultation. He was diagnosed with a descending thoracic aneurysm 3 years ago and has annual imaging to assess progression. His most recent scan reveals that the aneurysm is now 3.3 cm, up from 3.1 cm last year. L.D. remains asymptomatic. The AGACNP knows that at this point treatment should include: Surgical evaluation Volume reduction with loop diuretics Blood pressure reduction with beta adrenergic antagonists Aortic stenting W. is discussing his postoperative hip replacement expectations. He is advised that although he will have some discomfort, he should be vocal about asking for pain medication, because it is essential that he get out of bed and begin ambulating as soon as possible after his surgery. He expresses some fear and is concerned that his hip won’t heal properly if he walks on it. The AGACNP reassures him that he must begin ambulating quickly in order to decrease risk for: A. Decubitus ulcers B. Scar tissue formation C. Pneumonia D. Anxiety Jonathan is a 45 year old male who is post operative day 4 following lumbar spine surgery. He complaints to the AGACNP that he must have pulled a calf muscle in his right leg. He has slight pain in the right leg and mild swelling of the ankle. What is the most appropriate order for the AGACNP to provide? Physical therapy order to evaluate and treat Warm compresses to the right lower leg Duplex ultrasound of the right lower leg Flexeril 10 mg one po tid for muscle spasms Esophageal motility disorders are sometimes a consequence of systemic diseases such as scleroderma, Raynaud’s disease, and systemic lupus erythematosus. When patients with these diseases have gastroparesis, which medication should be added to the regimen? A. A proton pump inhibitor (for GERD related issues) B. A histamine 2 receptor antagonist C. A calcium channel antagonist D. A promotility agent The AGACNP would suspect tuberculosis in a patient that exhibits which of the following symptoms? Cough, night sweats, hemopytsis, pleuritic pain Cough, night sweats, green sputum, pleuritic pain Fever, lung consolidation, clear sputum, epigastric pain Fever, green sputum, epigastric pain , cough V. is a 37-year-old female who is admitted via the emergency room after her roommate called emergency medical services (EMS). She has no significant medical history and does not know what is wrong with her. She has been feeling generally unwell for the last few days, and today she had an episode of confusion that scared her roommate to the extent that the roommate called EMS. Her physical examination reveals a temperature of 101.9°F, pulse of 110 bpm, respiratory rate of 20 breaths per minute, and blood pressure of 92/58 mm Hg. A comprehensive metabolic panel reveals a slightly elevated blood urea nitrogen (BUN)/creatinine but otherwise is normal. A white blood cell differential reveals a leukocyte count of 14,000 cells/µL with neutrophils of 83%. The AGACNP knows that these values are consistent with: A. Systemic inflammatory response syndrome (SIRS) B. High-output septic shock C. Neurogenic shock D. Multiple organ dysfunction syndrome (MODS) Sally complains of chest pain, and dysphagia. She has had a negative cardiac work up. The AGACNP orders and esophageal manometry because it is the key diagnostic test for which of the following esophageal disorders? Gastroesophageal reflux disease Nutcracker esophagus Achalasia Zenker diverticulum Mr. Cain is a 51-year-old male who is postoperative day 3 following the removal of a benign peritoneal mass. Today his pulse is 108 b.p.m., his blood pressure is 104/62 mm Hg, and he is reporting a bit more discomfort in his abdomen than he had yesterday. In order to assess for internal bleeding, the AGACNP orders: A complete blood count A comprehensive metabolic panel A kidney/ureters/bladder (KUB) radiograph A white blood cell differential Mrs. McCallum is a 48-year-old female who presents for evaluation of a vague set of gastrointestinal symptoms. She feels generally well and has always been healthy, but lately she has had a lot of heartburn and a sense of reflux in her throat. Most recently she has had a recurring sense of food getting stuck in her throat. The AGACNP knows that which diagnostic study should be performed first? A. Barium swallow (characterizes hiatal hernia, strictures, diverticulum, or mass) B. Upper endoscopy (check muscosal surface esophagitis and mass and biopsies can be done) C. Esophageal manometry D. Ambulatory pH monitoring T. is a 29-year-old male who is recovering from an open fixation of a femur fracture sustained in a diving accident. He has an order for Dilaudid 1 mg IV q2h p.r.n. for pain. He is still having pain and requests more medication. The AGACNP considers that: A. This is the maximum dose for Dilaudid and nonpharmacologic measures should be maximized B. The dose may be increased to 2 mg and response assessed (1-4mg q3-6h ) C. He may be opiate addicted, and this should be explored before the dose is increased D. An adjunct medication such as ibuprofen should be added to his regimen The following sign is associated with cholecystitis Murphy’s sign Homan's sign Obturator sign Psoas sign Mr. Mireya is a 66-year-old male who is admitted for palliative surgery for a glioblastoma. He has borderline stage III-IV chronic kidney disease. The AGACNP realizes that he is at increased risk in the perioperative period for: A. Hypercalcemia B. Hypokalemia C. Thrombocytopenia D. Eosinophilia The AGACNP has debrided a 6 cm traumatic wound to the patient’s left thigh that presented with discharge and devitalized tissue. Your wound management approach is to Use staples and dermabond to close the wound for a cosmetic appearance apply mupirocin ointment and leave open to air so eschar can form pack with wet to moist sterile gauze pack with wet to moist sterile gauze W. is a 49-year-old man who presents for evaluation. He has a long history of alcohol and tobacco use, with a 65-year pack history and an admitted 14-drink-per-week alcohol habit. He is getting worried because he can no longer swallow his bourbon. He is not a good historian, but he does admit to a 1+ year history of bloating, heartburn, and progressive difficulty swallowing food. He didn’t worry too much about his symptoms until he stopped being able to swallow bourbon. He thinks he has lost approximately 15 lbs in the last year. He denies any blood in his stool and has not had any vomiting. The AGACNP knows that the most likely diagnosis is: A. Zenker’s diverticulum B. Achalasia C. Esophageal carcinoma D. Hiatal hernia The AGACNP is trying to discern if the patient has neurogenic shock or hypovolemic shock. The key finding for neurogenic shock would be: hypertension hypotension bradycardia tachycardia Charlie is a 52 year old male that was diagnosed with a DVT. He was 1 week post abdominal surgery when the DVT occurred. He asks the AGACNP how long he will need to be on the anticoagulation medication? The best response is: 3 months 6 months 9 months 12 months Janet is a 34-year-old female with no significant medical history who is being evaluated for a planned uterine ablation. She has significant history of menorrhagia and has been unresponsive to a variety of medical therapies to try to stop the bleeding. Her history and physical examination are within normal limits. The AGACNP knows that Janet will require which one of the following preoperative diagnostic studies? A. Urinalysis B. Complete blood count C. 12-lead electrocardiogram D. Chest radiography S. is a 55-year-old male patient with obstructive sleep apnea. He is motivated to control his condition and has been adherent to conservative therapeutic options. He has lost almost 65 lbs and now has a body mass index of 29. He drinks alcohol < 1 x monthly and does not smoke cigarettes. He had difficulty adjusting to bilevel positive airway pressure (BiPAP) but has used it for several months, with only marginal improvement. He presents today to talk about surgical options. The AGACNP counsels J. S. that: A. He is not a strong candidate for surgical success B. Before the operation, he needs to reduce his BMI to 25 C. The first step would be tonsillectomy and adenoidectomy D. The best out outcomes occur with multilevel surgery The primary goal of the preoperative assessment include all of the following except: Risk factors for bleeding Undiagnosed liver disease Immune Competence Undiagnosed cardiac disease Mr. Chen is a 52-year-old male who has a history of thyroidectomy. He presents complaining of numbness and tingling in his legs and feet and generalized fatigue. Physical examination reveals a positive Chvostek sign. Which of the following laboratory studies should be ordered first? Calcium Renal function tests Parathyroid hormone Magnesium Sandra is a 36-year-old female who presents with complaints of activity intolerance. Her physical exam is essentially normal, but her pulse is irregular at 81 b.p.m. A 12-lead ECG reveals notched p waves in leads II and III consistent with left atrial enlargement. Cardiac auscultation reveals a grade III/VI non-radiating diastolic murmur at the 5th intercostal space, midclavicular line. The AGACNP anticipates which valve abnormality on echocardiogram? Tricuspid valve stenosis Mitral valve stenosis Mitral valve regurgitation Tricuspid valve regurgitation. Mr. Doherty is a 65-year-old male with an exacerbation of COPD. He has been discontinued from mechanical ventilation and initially appeared to be doing well, but then he became notably lethargic and his saO2 on 50% mask dropped to 82%. His blood pressure has fallen to 80/51 mm Hg and pulse is 129 b.p.m. He complaints of difficulty taking deep breaths and some sharp, right-sided chest pain. Breath sounds are decreased on the right side, and there is right sided hyper-resonance to percussion. The AGACNP orders a chest radiograph suspecting: Pulmonary embolus Exacerbation of COPD Pneumothorax Pneumonia Which of the following foreign bodies in the ear canal is considered a surgical emergency that requires immediate intervention by otolaryngology (ENT) without any attempt to remove by a non-ENT provider? A.A popcorn kernel B. A cockroach C. A button battery D.A piece of cotton 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 Mr. Anderson presents with acute, tearing, constant chest pain. He denies any significant medical history except for kidney stones about 10 years ago. His physical exam now reveals a middle aged adult male in acute pain who is pale, diaphoretic, and restless. His vital signs are as follows: Temperature 98.9o F, pulse of 119 b.p.m. respirations of 24 b.p.m., and blood pressure of 171/100 mm Hg. Pulse oximetry is 96% on 2L of nasal oxygen. A 12-lead ECG reveals nonspecific ST changes in multiple leads but nothing suggestive of acute myocardial infarction. Chest radiography reveals a widened mediastinum. The AGACNP then orders: Cardiac isoenzymes Echocardiogram CT of the chest Cardiac stress test Mr. Liu is a 52-year-old male who has a history of thyroidectomy. He presents complaining of numbness and tingling in his legs and feet and generalized fatigue. Physical examination reveals a positive Chvostek’s sign. Which of the following laboratory studies should be ordered first? A. Renal function tests B. Parathyroid hormone C. Calcium D. Magnesium Susie is 66 year old female brought to the ER with severe bleeding. Her admission Hg is 6.9 . The hospital blood bank is low on packed red blood cells. Which of the following is acceptable blood products to administer to Susie? Only Type A and Rh positive Rh positive blood is acceptable Type O negative is the only acceptable transfusion WIth hold transfusion until the transfused blood matches her type and Rh factor Mrs. Abernathy is a 53-year-old patient who presents for evaluation of fatigue. Her history is significant for vague symptoms including constipation, joint pain, elevated blood pressure, and a mildly depressed affect. A screening metabolic panel is significant only for a serum calcium of 13 mEq/L. Suspecting hyperparathyroidism, the AGACNP orders: Serum phosphate Parathyroid hormone Thyroid ultrasound Vitamin D levels Which shock state is worsened in the setting of mechanical ventilation? A. Septic B. Cardiac compressive C. Neurogenic D. Cardiogenic Mr Denny underwent an abdominal CT for work up of abdominal pain. A incidental finding was the presence of a thoracic aneurysm. Which of the following best describes management of thoracic aneurysms? As long as the patient is asymptomatic no screening or surgery is indicated Annual screenings is indicated only when the aneurysm reaches 4.0 cm in size Aneurysms have a predictable growth rate of 1-2 cm per year so biannual screenings are all that is indicated Surgical intervention is consider once the aneurysm reaches 5.5 cm Alan is a 14-year-old male who has been referred for evaluation of a previously undiagnosed cardiac murmur. According to his parents, Alan has no significant medical history and has always been a healthy child. His growth and development have been within normal limits and his well-child checks have been normal. His cardiac murmur was identified during a soccer preparticipation physical examination. During today’s exam, he denies any cardiopulmonary symptoms. He admits that he gets out of breath when he is running during soccer but assumed it was just because he was running. Physical examination reveals a grade III/VI systolic murmur at the 2nd intercostal space, left sternal border, and a clearly fixed split S2 heart sound. The AGACNP knows that this murmur is probably: A. Mitral regurgitation B. Aortic stenosis C. Atrial septal defect D. Still’s murmur The AGACNP would observe which of the following symptoms in a patient that is in the earliest states of hypovolemic shock? A change in mental status Postural hypotension SaO2 of < 88% Hemoglobin and hematocrit < 9 g/dL and 27% The AGACNP is evaluating a patient with severe right lower extremity pain, right foot is pale, right ankle is pulseless, and the right foot is numb and tingling. The AGACNP should immediately order: Thoracic surgery consult Intravenous heparin Right leg arteriogram TPA 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 Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade V/VI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes: A. Acute mitral valve regurgitation B. Acute aortic valve regurgitation C. Acute cardiac tamponade D. Acute pulmonary embolus Carole is a 31 year old female with history of mitral valve prolapse. The AGACNP orders which of the following test to evaluate the valve's function? Chest radiography Echocardiography 12-lead ECG Chemical stress test The AGACNP knows that when managing a patient with acute cardiogenic shock after myocardial infarction, all of the following pharmacologic agents may be used except: A. Opioids B. Diuretics C. Beta-adrenergic antagonists D. Anticholinergics (increased risk of CV death) Mr. Baer is a 79-year-old man who is being admitted for a carotid endarterectomy. While performing his preoperative evaluation the AGACNP identifies a score of 2 positive answers on the CAGE screening questionnaire. This is an indication for: Delay of operation until completion of detoxification Further diagnostic evaluation for alcoholism Perioperative benzodiazepine administration to prevent withdrawal syndrome Monitoring the postoperative Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) score The AGACNP knows that a patient in which shock state will initially have an increased cardiac output followed by a decreased cardiac output : Cardiogenic Hypovolemic Distributive Obstrutive The AGACNP is counseling a patient about the potential complications of a pacemaker. Which of the following are potential complications that patients should be made aware of? Lead dislodgement, punctured lung, bleeding Lead dislodgement, venous thrombosis, stroke Punctured lung, stroke, venous thrombosis Stroke, punctured heart, infection According to the Carpentier classification scheme of mitral valve regurgitation, a type I regurgitation is most likely due to: A. Cardiomyopathy B. Excessive leaflet motion C. Ruptured papillary muscles D. Rheumatic heart disease Mr. Austin is a 64-year-old male who has a long history of mitral valve stenosis. His condition has developed to the extent that he has symptomatic congestive heart failure, and due to a variety of comorbidities he is not a candidate for surgery. Ongoing medical therapy for Mr. Austin should include: A. Anticoagulants B. Diuretics C. Antibiotics D. Inotropes Evaluation of cardiac valve disease must include: A. Chest radiography B. 12-lead ECG C. Echocardiography D. Chemical stress test Margaret is a 48-year-old female who has suffered with profound GERD symptoms for several years. She has had aggressive trials of medical therapies and has been very adherent to nonpharmacologic interventions. She is now in the more aggressive diagnostic phase of evaluation and is preparing for 24 hour ambulatory pH monitoring. The AGACNP advises that in preparation for this test, Margaret should: Continue her current PPI therapy twice a day - the same as she has been taking it Avoid straining for a bowel movement while the monitor is in place Continue her normal eating habits up until the procedure Avoid any strenuous exercise for 48 hours prior to the procedure Salma is a 65 year old female that had percutaneous placement of a left anterior stent 2 months ago. She has severe sciatic pain and has been recommended to have lumbar disk surgery. She asks the AGACNP if she can have the disk surgery soon. The AGACNPs best response is: Yes, youn can stop your Plavix for 10 days to have the surgery. Yes, there is no need to stop the Plavix for surgery. No, you will need to wait until you are six months post stent placement to stop the Plavix. No, you cannot have another surgery until we are sure your stent is working. Kelly T. is a 49-year-old female who is being admitted for aortic valve replacement. Her preoperative evaluation revealed an ascending thoracic aneurysm of 4.8 cm in diameter. Kelly has not had any aneurysm symptoms and is generally considered a very strong surgical candidate. The AGACNP knows that the standard of care dictates: A. Postponing her valve surgery due to the aneurysm B. Annual imaging of the aneurysm after her valve replacement C. Surgical repair of the aneurysm at the same time as valve replacement D. Surgical repair of the aneurysm after successful recovery from valve replacement While on call, the AGACNP is asked to evaluate a deteriorating patient. The patient was admitted for exacerbation of pneumonia and congestive heart failure (CHF). The systolic blood pressure is < 90 mm Hg, and the urine output is < 10 mL/hr. A 12-lead ECG reveals no acute processes but reveals previously noted changes that are consistent with bilateral atrial and ventricular enlargement and a marked left axis deviation. You insert a pulmonary artery (PA) line and anticipate which of the following pressures? (CI, cardiac index; PAOP, pulmonary artery occlusion pressure ; RAP, right atrial pressure) A. CI 1.3 L/min, PAOP 27 mm Hg, RAP 18 mm Hg B. CI 1.9 L/min, PAOP 12 mm Hg, RAP 6 mm Hg C. CI 2.4 L/min, PAOP 18 mm Hg, RAP 8 mm Hg D. CI 1.4 L/min, PAOP 7 mm Hg, RAP 4 mm Hg The AGACNP is performing an incision and drainage of an abscess. Which of the following is NOT correct? There is no need to pack the wound after draining the fluid. Use hemostats to break any sacs or septa in the abscess. Sterile draping is always required even though the wound is contaminated Lidocaine should be injected around the edges of the abscess. Herman is a 54 year old male just diagnosed with coronary artery disease (CAD). The AGACNP advises him that the most important intervention for him to manage his CAD is to: Lose weight Stop smoking Control his hypertension Exercise 30 minutes every day A critically ill patient with multiple traumatic injuries sustained during a motor vehicle accident has had a pulmonary artery line inserted to follow cardiac pressures. Which of the following sets of pressures would be consistent with hypovolemic shock? (CI, cardiac index; CVP, central venous pressure; PCWP, pulmonary capillary wedge pressure) A. CI 1.3 L/min, PCWP 27 mm Hg, CVP 18 mm Hg B. CI 1.3 L/min, PCWP 6 mm Hg, CVP 4 mm Hg C. CI 2.3 L/min, PCWP 12 mm Hg, CVP 8 mm Hg D. CI 2.9 L/min, PCWP 16 mm Hg, CVP 6 mm Hg Mr. Quigley is a 56-year-old male patient who presents for evaluation of difficulty swallowing. Physical examination of the oropharynx reveals a pink irregular mass of approximately 4 cm in the posterior pharynx. The patient is advised that he appears to have an abnormal growth and will need to be referred to otolaryngology. He asks how he got a tumor in his throat. The AGACNP replies that the greatest risk factor for oropharyngeal tumors is(are): Human papilloma virus Tobacco and alcohol use Male gender Family history of a first degree relative Aggressive fluid resuscitation is indicated in all of the following shock states except: A. Hypovolemic B. Cardiogenic C. Obstructive D. Distributive A 26-year-old developmentally disabled female presents with a foreign body in the ear. While considering whether or not to attempt removal under direct visualization vs referral to otolaryngology (ENT), the AGACNP knows that the difficulty of removal without ENT referral are much higher for which of the following types of objects? Irregular Soft Spherical Pliable Lab tests that the AGACNP should order to monitor a patient taking low molecular weight heparin (LMWH) include: PT INR Platelets CBC aPTTMrs. Saraceno is a 71-year-old female who had an episode of acute pulmonary edema following an endovascular aneurysm repair. She was managed successfully with a loop diuretic and is ultimately discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is seen in the office postoperatively 2 weeks after discharge. She has not yet seen a cardiologist but has continued all discharge medications. Her metabolic panel is as follows: Na+ 126 mEq/L K+ 4.0 mEq/L Cl- 93 mEq/L CO2 28 mEq/L BUN 40 mg/dL Cr 1.3 mg/dL The AGACNP recognizes that the patient likely has which abnormality as a consequence of diuretic overuse? A. Hyponatremia B. Hypokalemia C. Metabolic acidosis D. Intrarenal failure The AGACNP should utilize which of the following assessments to determine the adequacy of fluid resuscitation in the hypovolemic patient? Blood pressure, heart rate, urine output Blood pressure, urine output, mental status Peripheral perfusion, urine output, mental status Heart rate, peripheral perfusion, mental status Mr. Comstock is a 71-year-old male who presents with a general sense of feeling weak and unwell. He complains of weakness, nausea, dizziness, and "getting out of breath" very easily. He can barely climb the steps anymore without stopping to rest. While considering the differential diagnoses, coronary artery disease is high among the probabilities because of his age and gender. His physical examination is unremarkable except that he appears weak. His vital signs are as follows: temperature 98.0o F, pulse 100 b.p.m., respiratory rate 16 b.p.m., and BP 178/100 mm Hg. A chest radiograph is within normal limits with no acute pulmonary infection. A 12- lead ECG reveals inverted T waves in leads V1 to V5. The AGACNP is suspicious that most of his symptoms are: Psychosomatic Early congestive heart failure Normal age-related changes Angina Mrs. Medina is a 71-year-old female who had an episode of acute pulmonary edema following an endovascular aneurysm repair. She was managed successfully with a loop diuretic and ultimately discharged on furosemide 60 mg daily and instructed to follow-up with cardiology. She is seen in the office postoperatively 2 weeks after discharge. She has not seen a cardiologist yet but has continued all discharge medications. Her metabolic panel is as follows: Na+ 126 mEq/L K+ 4.0 mEq/L Cl- 93 mEq/L CO2 28 mEq/L BUN 40 mg/dL Cr 1.3 mg/dL The AGACNP recognizes that the patient likely has which abnormality as a consequence of diuretic overuse? Intrarenal failure Metabolic acidosis Hypokalemia Hyponatremia The AGACNP is suturing a 3 mm laceration on the knuckle of a 15 year old. Which of the following statements is true? Only absorbable 3-0 suture should be used The knuckle should be immobilized for the duration of wound healing Lidocaine with epinephine should always be used in the digits Prophylactic antibiotic therapy is indicated for all wounds that are sutured. The AGACNP is evaluating a patient for Hashimoto's thyroiditis. The patient reports fatigue, cold sensitivity, joint stiffness and depression. Which of the following laboratory studies is almost always abnormally elevated in Hashimoto's thyroiditis? MCV T4 TSH ESR The AGACNP is triaging a burn victim. In assessing the skin the AGACNP finds a red weeping wound that is painful. The skin can easily be wiped away. Which of the following correctly describes the depth of the burn injury? First degree Second degree - superficial Second degree - deep Third degree Mr Diamond is postoperative day 1 of an elective hip replacement. The AGACNP is notified of oral temperature of 100.1o F. The patient feels well, has eaten some breakfast, but has not moved around in bed very much. He also has not ambulated. yet. The most appropriate order for the AGACNP to provide would be to: Begin acetaminophen 500 mg q.4.h. Obtain a CBC with differential Encourage incentive spirometry q.1.h. Send a urine culture and sensitivity [Show More]

Last updated: 9 months ago

Preview 1 out of 17 pages

Reviews( 0 )

$11.50

Add to cart

Instant download

Can't find what you want? Try our AI powered Search

OR

GET ASSIGNMENT HELP
325
5

Document information


Connected school, study & course


About the document


Uploaded On

Apr 02, 2020

Number of pages

17

Written in

Seller


seller-icon
Kirsch

Member since 4 years

902 Documents Sold


Additional information

This document has been written for:

Uploaded

Apr 02, 2020

Downloads

 5

Views

 325

Recommended For You


$11.50
What is Browsegrades

In Browsegrades, a student can earn by offering help to other student. Students can help other students with materials by upploading their notes and earn money.

We are here to help

We're available through e-mail, Twitter, Facebook, and live chat.
 FAQ
 Questions? Leave a message!

Follow us on
 Twitter

Copyright © Browsegrades · High quality services·