NURS 6560 FINAL EXAM
1. Q #:
The AGACNP is reviewing a chart of a head-injured patient. Which of the following would alert
the AGACNP for the possibility that the patient is over hydrated, thereby increasing the risk for
increased intracranial pressure?
A. BUN = 10
B. Shift output = 800 ml, shift input =
825 ml Unchanged weight
C. Serum osmolality = 260
2. Q #:
A patient who has been in the intensive care unit for 17 days develops hyponatremic
hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical
ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and
hypotension. The adult-gerontology acute care nurse practitioner’s initial treatment is to:
A. reduce serum osmolality by infusing a 5% dextrose in 0.2%
sodium chloride solution
B. reduce serum sodium concentration by infusing a 0.45% sodium
chloride solution
C. replenish volume by infusing a 0.9% sodium chloride solution
D. replenish volume by infusing a 5% dextrose in water solution.
3. Q #:
A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of
nausea and has had one episode of vomiting, but he denies any diarrhea. His vital signs are as
follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood
pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/µL. The
AGACNP expects that physical examination will reveal:
A. + Murphy’s sign
B. + Chvostek’s sign
C. + McBurney’s sign
D. + Kernig’s sign
4. Q #:
Myasthenia gravis is best described as:
A. An imbalance of dopamine and acetylcholine in the
basal ganglia Demyelination of peripheral ascending
nerves
B. Demyelination in the central nervous system
C. An autoimmune disorder characterized by decreased neuromuscular activation
5. Q #:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to evaluate
the patient for persistent and progressive discomfort. Likely causes of her symptoms include all
of the following except:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
6. Q #:
Mrs. Coates is a 65-year-old female who is on postoperative day 1 following a duodenal
resection for a bleeding ulcer. She had an uneventful immediate postoperative course, but
throughout the course of day 1 she has complained of a mild abdominal discomfort that has
progressed throughout the day. This evening the AGACNP is called to the bedside to
evaluate the patient for persistent and progressive discomfort. Likely causes of her symptoms
include all of the following except:
A. Colic due to return
of peristalsis
B. Leakage from the
duodenal stump
C. Gastric retention
D. Hemorrhage
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7. Q #:
When a patient is hospitalized with a possible stroke, the AGACNP recognizes that the stroke
most likely resulted from a subarachnoid hemorrhage when the patient’s family reports that
the patient:
A. Has a history of atrial fibrillation
B. Was unable to be aroused in the morning
C. Had been complaining of a headache before losing consciousness
D. Has had several brief episodes of mental confusion and right arm and leg weakness
8. Q #:
You are asked to see a 29 year old female complaining of abdominal pain. She states she is
experiencing constant RUQ pain that radiates to her back. The pain is not relieved by bowel
movements, over the counter antacids or food. Review of initial labs shows elevated amylase
and lipase and you diagnose her with acute pancreatitis. Which test will you order next to
determine the underlying cause of her pancreatitis?
serum cholesterol
level blood
toxicology
right upper quadrant
ultrasound endoscopy
9. Q #:
Jake is a 32-year-old patient who is recovering from major abdominal surgery and organ
resection following a catastrophic motor vehicle accident. Due to the nature of his injuries, a
large portion of his jejunum had to be resected. In planning for his recovery and nutritional
needs, the AGACNP considers that:
He will probably be able to transition to oral nutrition but will have lifetime
issues with diarrhea His procedure has put him at significant risk for B12
absorption problems
Most jejunum absorption functions will be assumed by the ileum
Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptation
10.Q #:
A 32-year-old man comes to the clinic because he has had pain in the back for the past 24
hours. The patient says he first noticed the pain when he awoke in the morning and had
difficulty getting out of bed. He had been playing flag football the day before the pain began
but did not sustain any injuries during the game. Acetaminophen has provided only minimal
relief of the patient’s pain. On physical examination, pain is elicited on palpation of the back on
the left, lateral to the region of L2-L5. Full range of motion is noted in vertebral flexion,
extension, lateral rotation, and lateral bending, with some hesitancy because of pain on the left
side. Which of the following is the most appropriate initial step?
Anti-inflammatory and muscle relaxant
therapy Epidural injection of a
corticosteroid
MRI of the lumbar spine
Strict bed rest and application of moist heat to the lower back
11.Q #:
On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms
of acute rejection, confirmed by histologic examination. The AGACNP knows that first-line
treatment of acute rejection consists of: Cyclosporine
Azathioprine
Methylpredniso
lone Sirolimus
12.Q #:
H. W. is a 33-year-old female who is being evaluated after a fall from a tree. Anteroposterior
and lateral radiographs of the thoracolumbosacral spine are significant for transverse process
fractures at T6 and T7. The AGACNP knows that treatment for this likely will include:
Observation
Hyperextension casting Jewett brace
Surgical intervention
13.Q #:
Acute hepatitis A is usually diagnosed by:
By the constitutional
symptoms Within 2 weeks
of exposure Detection of
IgM-Anti-HAV Jaundice
14.Q #:
A 30-year-old male patient presents for evaluation of a lump on his neck. He denies pain, itch,
erythema, edema, or any other symptoms. He is ^concerned because it won’t ^ go away. He
says, “I noticed it a few months ago, then it seemed to disappear, and now it is back.” The
AGACNP proceeds with a history and physical exam and concludes which of the following as
the leading differential diagnosis?
Subclinical
infection NonHodgkin’s
lyphoma
Catscratch disease
Syphilis
15.Q #:
P. E. is a 61-year-old female who presents for a postoperative visit following a gastric resection
after a perforation of peptic ulcer. She reports feeling better, although it is taking longer than
she expected. However, she says she is feeling better each day, her appetite is returning, and
her incision is healing well. She is being discharged from surgical care and advised to continue
her routine health promotion follow-up with her primary care provider. As part of her surgical
discharge teaching, the AGACNP counsels P. E. that as a result of her gastric resection she will
need lifelong follow-up of: Blood group substances
Electrolyt
es
Vitamin
B12
Gastric
pH
16.Q #:
T. O. is a 31-year-old male patient who is transported to the emergency department via
emergency services. He was in a multivehicle accident and was trapped in a crushed car for
more than 3 hours. On examination, his right lower extremity is found to be tensely swollen,
with 3+ nonpitting edema. The lower leg is profoundly painful with passive range of motion.
Given the history and physical findings, the AGACNP recognizes that treatment centers around:
Fasciotomy
Thrombolytics
Surgical
reduction
Casting
17.Q #:
While consulting on a patient who is admitted with a chief complaint of abdominal pain, the
AGACNP notes that the initial assessment described the pain as “colicky.” This means that the
pain:
Is a result of gas in the
bowel Is intestinal in
origin
Is characterized by pain-free
intervals Is sharp, intense,
and nonradiating
18.Q #:
All of the following are expected findings in a patient with a T10 fracture except:
Paraplegia
Fecal
retention
Priapism
Inability to move fingers
19.Q #:
T. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper
abdominal pain. She is clear about the onset, which was profound and occurred approximately
one hour ago. She denies that the onset had any relationship to food or eating, and she denies
nausea or vomiting. On examination, she is lying on her right side with her hips and knees
flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary
guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a
white blood cell count of 15,600/µL. The AGACNP suspects:
Dissecting aortic
aneurysm Acute
pancreatitis
Perforated peptic
ulcer Mallory-Weiss
tear
20.Q #:
The AGACNP is covering an internal medicine service and is paged by staff to see a patient who
has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient
will go into respiratory failure and likely die if he is not reintubated. The patient is awake and
alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that
there is not enough time to establish a DNR—the patient needs to be reintubated immediately
and already is becoming obtunded. Which ethical principles are in conflict here?
Veracity and beneficence
Beneficence and
nonmalfeasance
Autonomy and
beneficence Justice and
autonomy
21.Q #:
In myelodysplastic syndromes, the primary indications for splenectomy include:
Major hemolysis unresponsive to medical
management Severe symptoms of massive
splenomegaly
Sustained leukocyte elevation above
30,000 cells/µL Portal hypertension
22.Q #:
Which of the following situations constitute a positive screening after a PPD (purified protein
derivative) skin test for tuberculosis?
A patient without risk factors who has a 13mm
PPD skin test A patient with HIV who has a
3mm PPD skin test
A homeless patient with a 9mm PPD skin test
A patient with intravenous drug abuse (IVDA) who has an
11mm PPD skin test A healthcare worker who has a 6mm PPD
skin test
23.Q #:
When the patient with jaundice is evaluated, a careful history and physical exam often can help
differentiate prehepatic, hepatic, and posthepatic causes. When the patient reports dark
discoloration of the urine and light discoloration of the stool, the AGACNP is most suspicious
for:
Viral hepatitis
Chronic
alcoholism
Extrahepatic
obstruction
Cholestasis
24.Q #:
Jack R. is a 63-year-old male who is being seen today on rounds after being admitted for
profound upper abdominal pain, nausea, and vomiting. He had markedly elevated serum
amylase and lipase; he was diagnosed with pancreatitis and admitted for pain management
and bowel rest. Today he feels better, but he is upset because he knows that pancreatitis is
known as the “alcoholic’s disease.” He makes it clear that he is a religious man and that his
religion forbids alcohol; he says he has never had an alcoholic drink in his life. The AGACNP
reassures Jack that approximately 40% of cases of pancreatitis are caused by as well as a
variety of other things, and that he will have a thorough diagnostic evaluation.
hyperlipidemia
gallstone disease
genetic
predisposition
hypercalcemia
25.Q #:
In neurogenic shock, patients are subjected to an abnormal dilation of venules and arterioles
in response to failure of the autonomic nervous system. Treatment for neurogenic shock may
include all of the following except: Trendelenburg
Intravenous
fluids
Vasodilators
Vasoconstrics
26.Q #:
Which of the following is a true statement with respect to the use of corticosteroids in
posttransplant patients? High-dose initial steroids are tapered to off over a period of 4
to 6 weeks posttransplant
There is a strong interest in developing corticosteroid-free posttransplant protocols
Better results are demonstrated in corticosteroid-free protocols for secondtransplant recipients Evidence supports corticosteroid-free rejection
protocols
27.Q #:
The comprehensive serologic assessment of a patient with Cushing’s syndrome is likely to
produce which constellation of findings?
Low potassium, high glucose, high white blood
cell count High sodium, polycythemia, low BUN
Low sodium, low potassium,
high BUN High sodium, high
chloride, high RBCs
28.Q #:
A patient admitted for management of sepsis is critically ill and wants to talk with a
hospital representative about donating her organs if she dies. She has a fairly complex
medical history that includes traumatic brain injury, breast cancer, and dialysis-dependent
renal failure. The patient is advised that she is ineligible to donate due to her: Renal
failure
Traumatic brain
injury Systemic
infection Breast
cancer
29.Q #:
Elmer is a 61-year-old male who is admitted vomiting bright red blood. He has no known
medical history—he has not been in the health care system for most of his adult life. He has
lost a lot of volume, and his vital signs are borderline unstable with a blood pressure of
88/58 mm Hg, pulse of 118 bpm, respiratory rate of 12 bpm, and a temperature of 97.6°F.
The AGACNP recognizes that the leading differentials include all of the following except:
Peptic ulcer
Portal
hypertension
Gastritis
Zollinger-Ellison syndrome
30.Q #:
T. S. is a 31-year-old female who is admitted following a catastrophic industrial accident. She
had multiple injuries, and after a 10-day hospital stay that included several operations and
attempts to save her, she is declared brain dead. She had an organ donor notation on her
driver’s license. Which of the following circumstances precludes her from serving as a liver
donor?
Encephalopathy
Hepatitis C
infection
A long history of
alcohol use Biliary
cirrhosis
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31.Q #:
M. N. is a 61-year-old male who is referred to the emergency department by a local retail
clinic. M. N. has not had regular health care at any time in his adult life; he says he doesn’t
know when he last saw a doctor. His daughter finally talked him into going to the local retail
health clinic when his abdomen became so distended that he couldn’t pull his pants up. M. N.
says that he has put on some weight over the last few weeks but he has not felt ill. He admits
to drinking > 4 drinks of whiskey daily; he says he smokes 2 packs of cigarettes a day and is not
very active. He has lived alone since his divorce 20 years ago. Physical examination reveals an
adult male who is chronically ill in appearance and appears older than stated age. His vital
signs are within normal limits, and physical examination is significant only for obvious ascites.
Paracentesis and subsequent analysis of the fluid reveals an ascites LDH to serum LDH ratio of
0.8. The AGACNP knows that this ratio is highly suspicious for:
Pancreatic
disease
Cirrhosis
Cancer
Autoimmune hepatitis
32.Q #:
The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone
daily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s
management is to:
Continue the current regimen
D/C the spironolactone and begin a
loop diuretic Add a loop diuretic to
the spironolactone Proceed to largevolume paracentesis
33.Q #:
The AGACNP knows that following bilateral total adrenalectomy, the
patient will require: Prednisone 15 mg qam and 10 mg qpm
Tapering of IV hydrocortisone, beginning with 100 mg IV q8h on postoperative day 1
Initial fludrocortisone replacement, tapered off once maintenance hydrocortisone dose
is achieved Individualized replacement of corticosteroid, mineralocorticoid, and
androgen hormones
34.Q #:
Josh is a 14-year-old male patient who presents for evaluation of blurred vision. His only
significant injury is that over the weekend he was playing baseball and was hit in the side of
the head by a flying ball. The hit was hard enough to knock him down, but he did not lose
consciousness and had no remarkable symptoms. Now on Wednesday he presents with a dull
headache that seems to be getting worse, and his mom wants to have him evaluated.
Neurologic examination reveals a sluggish pupillary response. CT scan of the head reveals a 1
cm epidural hematoma. The AGACNP knows that the best approach to management would be:
Cautious
observation An
osmotic diuretic
Surgical
consultation
Emergency
evacuation
35.Q #:
Mary W. is a 39-year-old female who presents with persistent abdominal discomfort. She
denies actual pain but says she has this persistent sense of fullness in her abdomen that feels
like it would go away if she could have a bowel movement. This finding is known as:
Somatic pain
Gas stoppage sign
Small bowel
obstruction Large
bowel obstruction
36.Q #:
Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural
football game and comes to the ER complaining of severe pain. Tim tells you that he was
setting up to pass the football when he was tackled and he immediately felt his knee “pop” and
buckle as he fell. You, as the AGACNP, know the most important information to obtain from
Tim is:
Insurance
information
Family history
Social history
What exactly was he doing when he got hurt
37.Q #:
Mrs. Nguyen is an 84-year-old female who suffered a fall in her long-term care facility. After
assessing possible reasons for her fall, a physical examination is performed to look for injuries.
Mrs. Nguyen has significant pain in her left upper arm and limited range of motion in her left
shoulder; a shoulder trauma series is ordered to evaluate for which type of injury that
frequently occurs in these circumstances?
Shoulder
dislocation
Scapular
fracture
Proximal humerus
fracture Nursemaid’s
elbow
38.Q #:
A general principle in surgical oncology is that the best approach to curative surgery in a
fixed tumor requires: En bloc resection
Adjuvant therapies
Neoadjuvant therapies
Elective lymph node
dissection
39.Q #:
Intracranial pressure monitoring is instituted for a patient with a head injury. The patient’s
arterial blood pressure is 92/50 mm Hg, and her intracranial pressure is 18 mm Hg. Using these
values to calculate the patient’s cerebral pressure (CPP) the AGACNP determines:
The CPP is adequate for normal cerebral blood flow
The CPP is high and that ischemia and neuronal death
are imminent The blood pressure should be increased
to prevent cerebral hypoxia
Lowering the patients blood pressure will reduce the intracranial pressure, increasing cerebral
blood flow
40.Q #:
Mr. Jefferson is a 59-year-old male who presents to the emergency department complaining of
severe abdominal pain. His medical history is significant for dyslipidemia, and he takes 40 mgof
simvastatin daily. He admits to drinking 6 to 10 bottles of beer nightly and to smoking 1½ packs
of cigarettes a day. He denies any history of chest pain or cardiovascular disease. He was in his
usual state of good health until a couple of hours ago, when he developed this acute onset of
severe pain in the upper abdomen. He says that he tried to wait it out at home but it was so
bad he finally came in. His vital signs are as follows: temperature 99.1°F, pulse 129 bpm,
respirations 22 breaths per minute, and blood pressure 137/84 mm Hg. The abdomen is
diffusely tender to palpation with some guarding but no rebound tenderness. The AGACNP
anticipates that which of the following laboratory tests will be abnormal?
A complete blood count and RBC
differential Liver function enzymes
Serum amylase, lipase, and
glucose A basic metabolic
panel
41.Q #:
A. S. is a 31-year-old male who complains of gastric discomfort that he notices mostly on an
empty stomach; for example, if he works late and does not have the opportunity to eat, he
notices that it happens. It feels better when he eats something or even if he just take TUMS®.
Physical examination reveals a generally healthy adult male with normal vital signs. There is a
bit of mild discomfort with deep palpation to the epigastrum, but otherwise the abdominal
exam is normal. The AGACNP know that the most useful laboratory analyses will include:
Helicobacter pylori
antibodies Chest
radiography
A white blood cell
differential Vitamin B12
42.Q #:
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:
Increased
MCV
Increased Hgb
Increased
platelets
Increased
albumin
43.Q #:
Carolyn C. has a history of Crohn’s disease and has been managed with immunologic agents,
with moderate success. Today she presents with severe abdominal pain that comes and goes
in waves; it started shortly after she ate a little bit of cottage cheese and crackers. This has
never happened before with her Crohn’s disease. She has difficulty localizing the pain but
seems to indicate the general area of the umbilicus. She had one episode of diarrhea this
morning.
Abdominal examination is nonspecific, producing mild tenderness on palpation. Plain
abdominal films reveal a dilated small bowel with air fluid levels. The AGACNP suspects:
Perforated small bowel
Ulceration through the thickness of small
bowel Small bowel obstruction
Gastroenteritis
44.Q #:
A 30 year old female nurse comes to your office with complaints of epigastric pain that
awakens her at night. She admits to being under a lot of stress at work and takes 2400 mg of
ibuprofen for menstrual cramps and low back pain 5-6 times a week, especially after heavy
lifting. She smokes a pack of cigarettes a day. Her physical exam is unremarkable but she does
have positive heme stools. She is referred for an upper endoscopy which reveals a duodenal
ulcer. Given this history,what is the most likely etiology of her ulcer?
Non steroidal anti-inflammatory
drug use Stress related
ulcerations
Heliobacter pylori
infection Cigarette
smoking
45.Q #:
An open fracture is considered an orthopedic emergency. Emergency room management of
open fracture must include: Immediate covering with iodine-soaked gauze
Ceftriaxone and tetanus
prophylaxis Proximal and distal
exploration of the wound Removal
of all bone fragments
46.Q #:
Grant Pass is a 20 year old downhill skier for the U. S Olympic team. He was on a practice run
in Salt Lake City and caught a ski tip on a mogul and became airborn and crashed into the
padded barriers on the side of the course. He was momentarily stunned, but was walking
around unassisted and was conversant when the ski patrol paramedics arrived. The
paramedics placed him on a backboard and began to slowly ski down to the end of the course
where an ambulance was waiting to take him to the local trauma center. When Grant was
placed in the ambulance, the paramedics noted that Grant was somnolent and not responsive
to verbal commands. They noted that his left pupil was dilated and sluggish to respond to light.
Based on the above information, you, as the ACNP in the ER, suspect that Grant suffered which
of the following?
Basilar skull
fracture
Subdural
hematoma
Epidural
hematoma
Contra-coup
injury
47.Q #:
Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower
quadrant. She has had this pain before and says she usually takes antibiotics and it goes away.
However, this time it seems worse, and she has had it for 4 days even though she says she
started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting
but says she simply isn’t hungry. She had a little diarrhea yesterday but no bowel movements
today. She has a temperature of 100.9°F and a pulse of 104 bpm, respirations of 20 breaths per
minute, and a blood pressure of 94/60 mm Hg. She has some discomfort to deep palpation in
the left lower quadrant. The AGACNP suspects:
Irritable bowel
syndrome
Inflammatory bowel
disease Diverticulitis
Appendicitis
48.Q #:
T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but
has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a
clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting.
Which of the following findings suggests a complication that requires a surgical evaluation?
A temperature of 101.5°F
A leukocyte count of
18,000/µL A palpable
gallbladder
A positive Murphy’s sign
49.Q #:
Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural
football game and comes to the ER complaining of severe pain. Tim tells you that he was
setting up to pass the football when he was tackled and he immediately felt his knee “pop” and
buckle as he fell. What physical exam tests would you perform to confirm your differential
diagnosis?
Talar tilt
test
Tinel’s
test
Valgus/varus
stress test
McBurney’s test
50.Q #:
The AGACNP rounds on his brain injury patient and recognizes the development of progressive
bradycardia, hypertension, and irregular respiratory pattern. This is known as Cushing’s triad
and suggests:
Uncal herniation
Increased intracranial
pressure Brainstem
compression
Subarachnoid
hemorrhage
51.Q #:
Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal
surface of his right forearm. He says he was working with his brother-in-law yesterday morning
building a deck on the back of his home. A pile of wooden planks fell on top of him, and he
sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water
but didn’t want to go to the emergency room because he didn’t want to risk being in the
waiting room for hours. He wrapped up his arm and went back to work, and then took a
normal shower and went to bed last night. This morning the cut on his arm was still flapping
open, and he realized he needed sutures. The appropriate management of this patient
includes:
Proper cleansing and covering of the laceration, along with oral
antibiotic therapy Local anesthesia, cleansing, and wound
exploration for foreign bodies
Local anesthesia, cleansing, and suture repair
Cleansing, covering, antibiotic therapy, and tetanus prophylaxis
52.Q #:
A 49 year old female is seen for sudden onset severe abdominal pain 10/10. On further Q #ing
you learn that she has experienced epigastric pain for several months after eating, which has
resulted in an 11 pound weight loss. She does not take any other medications. On physical
exam you note she has a low grade fever of 100.1, HR 124, RR 25 and BP is 116/72. The
abdomen is rigid and there are no bowel sounds. Abdominal plain film shows free air under
the diaphragm. What is your diagnosis?
ruptured gallbladder
ruptured spleen
perforated duodenal
ulcer ascites
53.Q #:
R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as
cramping but has become more constant over the last day. She reports constipation over the
last few days but admits that for as long as she can remember she has had variable bowel
habits. Her vital signs are normal, but physical examination reveals some tenderness in the left
lower quadrant. What is the leading diagnosis for this patient?
Diverticuliti
s Crohns
Disease
Appendiciti
s
Irritable small bowel disease
54.Q #:
B. T. is a 49-year-old male who has been admitted for the management of an episode of
diverticulitis. This is his fifth hospitalization this year, and in previous hospitalizations he has had
both abscess and stricture as a consequence of his disease. His treatment this hospitalization
should include:
Extended-spectrum
antibiotics Surgical
consultation for colectomy
Expectant treatment with nonabsorbable
antibiotics Colonoscopy
55.Q #:
Sara S. is a 41-year-old patient who has just had a bone marrow transplant. The AGACNP
knows that which medication will be used to decrease her risk of graft-versus-host reaction?
Immune globulin
Cyclosporine
Prophylactic
antibiotics
Systemic
corticosteroids
56.Q #:
The AGACNP is receiving report from the recovery room on a patient who just had surgical
resection for pheochromocytoma. He knows that which class of drugs should be available
immediately to manage hypertensive crisis, a possible consequence of physical manipulation
of the adrenal medulla?
Alpha-adrenergic
antagonists Betaadrenergic antagonists
Intravenous
vasodilators Arteriolar
dilators
57.Q #:
A 41-year-old male physician has a 6-week history of persistent painful, swollen, and stiff
proximal interphalangeal joints, wrists, and ankles. Using a step wise progression model,
which would be the first diagnostic test the AGACNP would order?
Radiography of hand
and wrist Check HLA –
B27
Hepatitis B serology testing
Rheumatoid factor and anti-nuclear
antibody Joint aspirate for
microcrystals
58.Q #:
Mr. S., a 49-year-old male, is brought to the emergency room by his roommate who relates
that the patient has been vomiting bright red blood for two days. He has a history of alcohol
abuse. Current vital signs are as follows: Temp 99.2o F, heart rate 110 bpm (sinus tachycardia),
blood pressure 90/60 mm Hg, resp 32 bpm. He is alert but lethargic and denies current
abdominal pain. Which of the following is not indicated in the initial management of this
patient?
Immediate IV access
Laboratory screening, type and
crossmatch Endoscopy
Crystalloid infusion
59.Q #:
A 38-year-old patient presents with symptoms of L5 nerve root impairment that have been
ongoing for 3 weeks despite conservative treatment. All of the following statements regarding
this case are true EXCEPT:
Normal findings on plain radiographs should be followed up with a CT Scan
or MRI immediately The L5 level is one of the most likely levels for disk
herniation
Sensory findings may include diminished pain on the dorsum of the distal
region of the foot Motor findings may include weakness on extension of the
great toe
Tendon reflexes are expected to be normal at the knee and ankle
60.Q #:
R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as
cramping but has become more constant over the last day. She reports constipation over the
last few days but admits that for as long as she can remember she has had variable bowel
habits. Her vital signs are normal, but physical examination reveals some tenderness in the left
lower quadrant. Which diagnostic test is most likely to support the leading differential
diagnosis? CT scan with IV, oral, and rectal contrast
CBC with WBC differential
Colonoscopy
Barium enema
61.Q #:
A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching
centers upon long-term management strategies to prevent ammonia accumulation. Teaching
for this patient includes instruction about: Lactulose taken 20 g PO daily
Spironolactone taken 100 mg
PO daily Protein intake of 50 g
daily
Zolpidem taken 10 mg PO qhs.
62.Q #:
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?
Temperature > 102°F
White blood cell count > 14,000
cells/µL Vomiting
Hematuria
63.Q #:
A 32-year-old patient who underwent an open splenectomy for a ruptured spleen is
preparing for discharge. An adult- gerontology acute care nurse practitioner reviews the
potential complications with the patient. The nurse practitioner emphasizes which
instruction to the patient?
Continue antibiotics for 14 days
Follow up with primary care provider for
vaccinations No international travel for
five years
No weight lifting restrictions
64.Q #:
When evaluating a patient with acute pancreatitis, which of the following physical or diagnostic
findings is an ominous finding that indicates a seriously ill/potentially moribund patient?
Severe epigastric pain with radiation to
the back Abdominal guarding and rigidity
Grey Turner
sign
Obturator
sign
65.Q #:
Ted is a 22 year old male who fell on his right shoulder 2 days ago during a martial arts class.
He is complaining of inability to sleep on his right side and has pain whenever he tries to use
his arm. He denies any sensory changes in his hand. Nothing seems to make it better, even the
ibuprofen he has been taking several times a day.
Physical exam reveals limited ROM in shoulder with ecchymosis and tenderness over anterior
and posterior coracoclavicular and acromioclavicular joints.
66.Q #:
Based on the radiograph below, what is your working
diagnosis at this time? NO PICTURE SHOWN:
ac separation
rotator cuff
tear humorous
fracture
cervical neck
injury
67.Q #:
K. W. is a 50-year-old woman who presents for surgical resection of the liver for treatment of
metastatic colon cancer. Preoperatively, the surgeon tells her that he is planning to remove 50
to 75% of her liver. The patient is concerned that she will not be able to recover normal liver
function with that much removed. The AGACNP counsels her that:
Such a high-volume resection is utilized only in people with markedly compromised
hepatic function Major regeneration occurs within 10 days, and the process is
complete by 5 weeks
Liver function will probably recover to 50% baseline, but that is enough
for normal function Up to 95% of the liver can be removed without any
apparent consequence to the patient
68.Q #:
Joshua is a 31-year-old man who presents for evaluation of acute numbness and tingling and
decreased strength in his arms. It happened rather suddenly this afternoon and has never
happened before. The lower extremities do not appear to be affected. While performing the
history the AGACNP asks specific Q #s about the risk of:
Cervical
radiculopathy
Hyperextension
injury Panic
attack
Poison ingestion
69.Q #:
The AGACNP is taking report on a head injured patient. The report includes scoring on the
Glasgow Coma Scale of E2 M3 V5. How would you interpret this information?
The patient’s eyes open to sound, they are orientated are able to obey commands
The patient’s eyes open to pressure, they can utter some words but do not form sentences, and
they are able to localise to trapezius pinch.
The patient’s eyes open spontaneously; they are orientated and able
to obey commands The patient’s eyes do not respond, they are
confused and do not follow commands.
70.Q #:
L. S. is a 49-year-old female with a history of colorectal cancer for which she has had surgical
resection and chemotherapy. She presents with profound abdominal pain. She has not
vomited, and she is not certain when she had her last normal bowel movement; her bowel
habits have been irregular for some time. A CBC demonstrates a mild microcytic anemia but is
otherwise normal; her WBC differential is normal. Results of a metabolic panel support minor
volume contraction but show no significant electrolyte abnormalities. Abdominal radiographs
demonstrate dilation of the proximal colon, air fluid levels, and a complete absence of air in
the rectum. The AGACNP diagnoses the patient with: Perforated colon
Paralytic ileus
Complete bowel
obstruction Intestinal
volvulus
71.Q #:
Tim is an 20 year old junior at Notre Dame and injured his right knee during an intramural
football game and comes to the ER complaining of severe pain. Tim tells you that he was
setting up to pass the football when he was tackled and he immediately felt his knee “pop” and
buckle as he fell. Which of the following diagnostics would the AGACNP order first?
Plain radiographs
MRI of his
knee CT
scan
Diagnostic arthroscopy
72.Q #:
Jane S. is a 35-year-old female patient who is at 30 weeks’ gestation. She is being followed
regularly for prenatal care and has always been healthy; she just had an office visit and was
told everything was fine. Tonight she presents to the emergency room complaining of
significant pain in the upper abdomen. Her vital signs reveal a temperature of 98.4°F, pulse of
110 bpm, respirations of 20 breaths per minute, and blood pressure of 144/90 mm Hg. A
urinalysis reveals proteinuria, and a metabolic panel is significant for increased transaminases.
Her hemogram is normal, but the CVC reveals platelets of 85,000. The AGACNP knows that
which of the following must be evaluated as a cause of her abdominal pain?
HELLP
syndrome
Placental
abruption
Spontaneous hepatic
rupture Preterm labor
73.Q #:
A 52-year-old male comes to the clinic in preparation for an overseas trip next year. He has
already searched the internet and knows that Hepatitis A and Hepatitis B are endemic in the
country that he will be visiting. What will you recommend to this patient?
No immunizations are needed. It is highly unlikely that he’ll be exposed to hepatitis since he’s
traveling with a tour group.
Recommend Hepatitis C IgG to prevent getting an acute illness.
Recommend two doses of Hepatitis A and 3 doses of Hepatitis
B vaccine. Recommend one dose of Hepatitis A and Hepatitis
B vaccine.
74.Q #:
Mr. Warner is a 64-year-old male who presents with multiple skin lesions scattered about his
head, neck, shoulders, and arms. They range in size from 3 mm to 1.2 cm. They do not hurt,
burn, or itch, but they are rough to palpation—like sandpaper. Mr. Warner has a history of basal
cell carcinoma × 3 and wants to know if these are also skin cancer. The AGACNP tells him that
these lesions may be precancerous and are known as:
Solar lentigo
Bowen’s
disease
Actinic
keratoses
Atopic
dermatitis
75.Q #:
Brad Berry, a 30-year-old male, presents to the ED with the chief complaint of a red, hot,
swollen, painful right knee. He first noticed the problem last night, and feels it has gotten
worse over the past 14 hours.Your medical history reveals that Mr. Berry denies problems with
any other joints or recent injury to his right knee. He is not sexually active and currently is
attending seminary school. He denies urethral discharge or urinary symptoms, recent rash, IV
drug use, chronic illness, or recent camping. His temperature is 102.2 F. Physical exam reveals
normal general survey, cardiorespiratory and abdominal examination. The right knee is
markedly swollen with + fluid wave. There are no inguinal lymph nodes palpated. Which of the
following would be the first diagnostic test for the AGACNP to order?
Right knee AP, lateral, and sunrise view
radiograph Right knee joint synovial fluid
examination
Serum rheumatoid factor
Serum erythrocyte sedimentation rate
76.Q #:
The AGACNP screens a new admit patient for liver disease. Elevations of all of the following
would confirm your suspicion that this patient has liver disease, EXCEPT
unconjugated
bilirubin
conjugated
bilirubin urine
bilirubin
aspartate aminotransferase
77.Q #:
N. C. is a 60-year-old female with primary hyperaldosteronism. She has been referred to your
service for surgical management. Anticipated findings on clinical history would include:
Palpitations, headaches, and
sweating Polyuria, weakness, and
paresthesia
Dry skin, straie, and unplanned
weight loss Early satiety, tremors,
and fatigue
78.Q #:
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?
Abdominal radiographs
CT scan of the abdomen with
contrast Right upper
quadrant ultrasound
A HIDA scan
79.Q #:
The AGACNP knows that early diagnostic findings consistent with
rheumatoid arthritis include: Soft tissue swelling of the metacarpals
Radiographic joint space narrowing
Heberden’s nodes
Subungal
hemorrhages
80.Q #:
The ethical principle of veracity refers to:
Telling the patient the truth
Ensuring that the patient gets what he
deserves The patient’s right to self
determination
The duty to do no harm
81.Q #:
Mr. Huckabee is a 51-year-old male who had a CT scan of the abdomen to evaluate refractory
left lower quadrant discomfort. The scan reported an incidental finding of cholelithiasis with
calcified gallbladder. While counseling Mr. Huckabee about the results, the AGACNP advises
that the appropriate approach to these findings is:
No further evaluation
indicated A surgical
evaluation
To treat with oral
emulsification agents To follow
annually with ultrasound
82.Q #:
Mr. Miller is a 56-year-old male who is being managed for portal hypertension. The AGACNP
knows that of the many causes of portal hypertension, alcoholic liver disease typically is the
cause when the patient has:
Elevated hepatic vein
pressures Elevated
transaminases
Decreased prothrombin
time Decreased alkaline
phosphatase
83.Q #:
Neoadjuvant chemotherapy treatment for cancer is given to facilitate surgical resection. When
the outcomes of cancer therapies are evaluated, the terms complete response and partial
response often are used. Partial response means that: 50% of the patients treated with a given
regimen demonstrate remission
50% of the patients treated survive to the 5-
year point The tumor mass has reduced by >
50%
In 50% of cases, the tumor converts from unresectable to resectable
In a patient with a perforated duodenal ulcer, the most likely source of
peritonitis is amylase
gastric contents
liver enzymes breaking down the
mesentry blood
84.Q #:
Ms. Teller presents with a chief complaint of weight loss. She reports an unplanned 10 lb weight
loss over the last 5-6 months. She has no significant medical history, but review of systems
reveals bilateral shoulder discomfort and some impaired range of motion — she has trouble
pulling clothing over her head. Over the last few months she has generalized upper body
stiffness, but seems to get better after an hour or so of activity. When considering a diagnosis of
polymyalgia rheumatica, laboratory assessment may be expected to reveal:
An erythrocyte sedimentation rate (ESR) of
75 mm/hr A microcytic, hypochromic
anemia
Elevated liver function
enzymes Positive
antinuclear antibodies
85.Q #:
M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which
she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she
is afraid it won’t go away on its own. She denies any nausea or vomiting, and she cannot
remember precisely when her last bowel movement occurred; probably it was a few days ago.
She reports that she is “always” constipated. On physical examination, she is tachycardic but
otherwise has normal vital signs; her abdomen is tensely rigid, but no point tenderness to
palpation is appreciated. The entire abdomen percusses as tympanic—there is no distinct
dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent.
There is rebound tenderness to palpation. The AGACNP suspects:
Perforated
bowel
Peritonitis
Ischemic
bowel
Intestinal
abscess
86.Q #:
A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and
cause. Patients with an adrenal tumor typically will demonstrate:
Low ACTH and low
cortisol Low ACTH
and high cortisol High
ACTH and low
cortisol High ACTH
and high cortisol
87.Q #:
A 25-year-old medical student is stuck with a hollow needle during a procedure on a patient
known to have hepatitis B viral infection but who is HIV-negative. The student’s baseline
laboratory studies include serology: HBsAG negative, total Anti-HBc negative, IgM Anti-HBc -,
Anti-HBs +. Which of the following is true regarding this medical student’s hepatitis status?
Prior vaccination with hepatitis B
vaccine. Acute infection with
hepatitis B virus.
The student was vaccinated for hepatitis B, but is not immune.
88.Q #:
A 55-year-old man with a past medical history of hypertension and hyperlipidemia presents to
your office with an acute onset of fevers, chills, dysuria, urinary frequency and right CVA
tenderness. On exam he appears to be moderately ill, with a temperature of 39.3°C, pulse of
105/min and a blood pressure of 115/60mmHg. His cardiopulmonary and abdominal exam are
negative. A urine dip in the office reveals 2+ blood, 2+ leukocytes and negative nitrates. Of the
following tests, which is most likely to lead to the correct diagnosis?
Urine culture
Renal
ultrasound
Blood
cultures
CT scan of the abdomen
89.Q #:
S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months
he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of
ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 g/dL, an MCV of 72 fL
and a platelet count of 65,000/µL; the remainder of the CBC is normal. Coagulation studies are
normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this
patient will include:
Splenectomy
Monoclonal antibody therapy such as
rituximab Prednisone 60 mg daily until
platelets normal
Avoidance of elective surgery and nonessential medications
90.Q #:
Elliot is a 47-year-old male who is being treated for throat cancer with combination therapy
that includes radiation. He is asking Q #s about what adverse effects he may anticipate. The
AGACNP advises Elliot that the most significant toxic effects in the acute / early postradiation
period are:
A product of mucositis and include yeast superinfection,
desquamation, and pain Nephrotic syndrome and organ failure
More commonly permanent than toxic effects of other cancer treatments
Atrophy and burn, with subsequent dysfunction of the area surrounding targeted tissues
91.Q #:
The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which
of the following is not a common feature?
Pyur
ia
Feve
r
CVA
tenderness
Gross
hematuria
92.Q #:
G. D. is a 13-year-old male patient who has a history of recurrent fever and flank pain. His
parents traditionally are not believers in the health care system, and he has not been seen by a
health care provider for many years. Today he has fever, chills, and costovertebral angle
tenderness. Urinalysis reveals findings consistent with acute urinary infection. The AGACNP
treats the patient for pyelonephritis and considers which study to evaluate for vesicoureteral
reflux?
Bilateral renal ultrasound
CT scan of the abdomen
and pelvis Voiding
cystourethrograpy
Radioisotope scanning
93.Q #:
Maxine is being seen in follow-up after removal of an aldosteronoma. The AGACNP expects
specifically that which of the following aldosterone-related abnormalities will be cured?
Hypertensi
on
Hyponatre
mia
Hypokalem
ia
Hypoglyce
mia
94.Q #:
Acute hepatitis B is diagnosed by:
Presence of
HAV-IgM
Detection of
HbsAg Anti-HBcIgM
B and C
95.Q #:
A 19-year-old woman presents to your office with a 3-day history of dysuria and foul-smelling
urine. She also notes some suprapubic pressure and noted some chills and she thinks she had a
fever yesterday. She reports no vaginal bleeding or discharge and reports no nausea or
vomiting. She denies any significant past medical history. On exam she has a temperature of
38°C, a pulse of 105/min and a blood pressure of 120/75mmHg. Her abdominal exam reveals
some suprapubic tenderness. Her back exam reveals no costovertebral angle tenderness. Urine
dip demonstrates 2+ leukocytes. What should be done next?
Admit the patient for empiric intravenous
antibiotic therapy Start empiric oral antibiotic
therapy
Admit the patient for intravenous
hydration therapy Check a urine culture
and await results
Check a CT of her abdomen/pelvis
96.Q #:
Brad Berry, a 30-year-old male, presents to the ED with the chief complaint of a red, hot,
swollen, painful right knee. He first noticed the problem last night, and feels it has gotten
worse over the past 14 hours.Your medical history reveals that Mr. Berry denies problems with
any other joints or recent injury to his right knee. He is not sexually active and currently is
attending seminary school. He denies urethral discharge or urinary symptoms, recent rash, IV
drug use, chronic illness, or recent camping. His temperature is 102.2 F. Physical exam reveals
normal general survey, cardiorespiratory and abdominal examination. The right knee is
markedly swollen with + fluid wave. There are no inguinal lymph nodes palpated. In your
immediate consideration of differential diagnoses for Mr. Berry’s knee problem, which of the
following would be the least likely?
Trauma
Septic arthritis
Rheumatoid
arthritis Acute
gout
97.Q #:
The AGACNP is evaluating a 79-year-old male in the emergency department. He is extremely
anxious and requires significant reassurance that he is not going to die. He subsequently rules
in for an anterolateral myocardial infarction. His daughter asks you not to tell the patient the
truth. She is afraid that it will compound his anxiety, agitate him, and worsen his condition.
The patient becomes upset and demands to be told precisely what his condition is. The most
appropriate action would be to:
Answer the patient’s Q #
truthfully Consult the
attending physician
Ask the daughter to leave the bedside
Tell the patient you do not have any information
98.Q #:
Mrs. Knickerson is a 77-year-old female admitted for management of urinary tract infection. Her
complete blood count reveals a white blood cell differential as follows: Total leukocyte count
57,000 cells/uL, neutrophils of 16%, lymphocytes 77%, monocytes 3%, eosinophils 3% basophils
1%. The AGACNP is suspicious for:
Urosepsis
Immunosuppre
ssion
Drug-induced
leukocytosis Chronic
lymphocytic leukemia
99.Q #:
A 54-year-old man with a history of metastatic lung cancer comes to the office because he had
sudden onset of pain in the lower back and both legs 24 hours ago. Which of the following
findings would indicate that a lumbar disk herniation rather than a cauda equina syndrome is
the cause of his pain?
Saddle anesthesia
Bilateral weakness
of legs Impotence
Pain radiating to one
buttock Urinary
incontinence
100. Q #:
The Ranson’s Criteria of Severity is a morbidity and mortality index used to predict risk in
patients with acute pancreatitis. A Ranson score of 3 indicates:
Endoscopic
sphincterotomy
Surgical intervention
Severe disease
Peritoneal lavage