NRNP 6550 Final Exam

NRNP 6550 Final Exam 

Question 4

An unidentified patient is brought to the emergency department by ambulance after being hit by a motor vehicle. She has multiple injuries and an estimated blood loss of 2 liters.  The hematocrit is 19%. The AGACNP expects that the mean cell volume (MCV) would most likely be:

Question 5

When examining a new patient in the hospital, the AGACNP finds impaired vibratory and position sense as well as spastic weakness.  Upon questioning, he also reports paresthesia in his fingers and toes.  When reviewing the laboratory data, the AGACNP finds a hemoglobin of 9.  What is the most likely cause of this patient’s anemia?

Question 6

The AGACNP is assessing a new patient with a large variety of complaints.  Which of the following symptoms would indicate the need for further workup for possible cancers?

Question 7

A 40 year-old man is status postcraniotomy for clipping of an aneurysm.    His serum sodium is 115 mEq/L and he complains of nausea and vomiting.  His urine sodium is 30 mEq/L and there is a decreased serum osmolality with inappropriately increased urine osmolality of 190 mOsm/kg.    Initial treatment for this patient would include:

Question 8

J.L. is an 81-year-old female who is admitted from home after her daughter found her confused and unkempt.   The daughter states her mom was fine a week ago. .J.L.’s vital signs are as follows: Temperature 101.4o F, pulse 99 b.p.m., respirations 22 b.p.m., and blood pressure 90/58 mm Hg. Her urinalysis is shows +++ leukocytes, + RBC, and + nitrites. Her metabolic panel reveals a BUN of 39 mg/dL and creatinine of 1.5 mg/dL. The AGACNP knows that J.L has findings consistent with:

Question 9

Acute tubular necrosis (ATN) is classified as which type of renal failure?

Question 10

The most common type of allogeneic transfusion reaction from packed red blood cells is:

Question 11

Mrs. V, a 60 y/o woman status post small bowel resection is admitted to the  Surgical Intensive Care Unit (SICU). She has a history of hypothyroidism and is lethargic.  Her temperature is 94.6° F.  Myxedema coma is suspected.

An appropriate intervention for Mrs. V would be:

Question 12

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?

Question 13

Ms. Johnson has been on long term steroid therapy for her Multiple Sclerosis.  She abruptly stopped taking it five days ago.  The AGACNP suspects she is having an adrenal crisis.  Her current blood sugar is 50.   What is the BEST initial treatment for Ms. Johnson?  

Question 14

A general principle in surgical oncology is that the best approach to curative surgery in a fixed tumor requires:

Question 15

You see a 28-year-old woman who is taking ferrous sulfate for treatment of iron deficiency anemia.  She complains of gastric upset after taking the medication on an empty stomach.  While some options are not ideal, which of the following would you NOT recommend to help resolve this problem?

Question 16

The AGACNP suspects that her patient has adrenal insufficiency.  What lab findings would you expect to find in this patient?

Question 17

The AGACNP is planning treatment for a 42 year old male undergoing chemotherapy for lung cancer.    How many days after chemotherapy is started will the patient have the highest risk of infection due to a decrease in WBCs?

Question 18

A 22-year-old male presents to the Emergency Department after being stabbed multiple times in the chest and abdomen. He is hemodynamically stable. During the primary survey, special attention must be given to which of the following

Question 19

Pernicious anemia results in which of the following RBC indices?

Question 20

A trauma patient was resuscitated 3 days ago with 7 liters of crystalloid.The AGACNP is reviewing his morning labs and notices that he has a serum Na of 128. Which of the following orders reflect the most appropriate treatment the AGACNP can institute?

Question 21

Question 22

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: 

Question 23

The AGACNP is examining a patient with generalized muscle weakness and suspects hypothyroidism. Which exam finding would support the diagnosis of hypothyroidism?

Question 24

Patients in advanced stages of chronic kidney disease are at greatest risk for which of the following conditions?

Question 25

Patients with diabetes insipidus will have significant volume loss, but it is usually a self-limiting condition. Many patients are successfully treated with fluid support. For those who need the next level of care, which is the indicated agent?

Question 26

Most common cause(s) of megloblastic, macrocytic anemia is/are:

Question 27

Pernicious anemia is usually caused by:

Question 28

Patients with sickle cell disease may be prone to severe infections because:

Question 29

One month into therapy for pernicious anemia, the AGACNP wants to assess the efficacy of the treatment.  The BEST lab test to order at this point is a:

Question 30

In which of the following clients would you suspect vitamin B12 deficiency?

Question 31

A patient is seen in follow-up 12 weeks after being started on levothyroxine, 75 mcg daily. Today the patient reports feeling well and offers no complaints. Vital signs are normal. Serum TSH is 4.7 mIU/L. The next step in the management of this patient is to:

Question 33

A patient with SIADH would be expect to demonstrate which pattern of laboratory abnormalities?

Question 34

Which of the following is not part of the primary survey?

Question 35

C.L. is a 48-year-old female who presents complaining of activity intolerance.   She normally jogs 4 miles a day but now states that she is tired just going up and down the stairs.   She is having a lot of bleeding with her periods, and her periods seem to be more frequent.  A complete blood count (CBC) reveals the following results:

         Hgb 10.1 g/dL

         Hct 30%

         MCV 75 fL

         RDW 21%

The AGACNP orders which of the following laboratory test to confirm the suspected diagnosis?

Question 36

Ms D. is a 34 y/o female who is complaining of increased irritability, weight loss despite eating, and diarrhea. She always feels exhausted, but can’t seem to sleep. She states she “feels like she could jump out of her skin”.   If excess thyroid hormone is the cause of her symptoms, which of the following might be noted?

Question 37

The primary advantage of targeted molecular therapies for cancer, such as monoclonal antibodies (e.g., trastuzumab, cetuximab), is that they:

Question 38

Management of patients in Addisonian crisis must center upon which of the following?

Question 39

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:

Question 41

Which of the following infectious organisms is not routinely tested for on donor blood collected for transfusion:

Question 43

Sally is a type 2 diabetic scheduled for a total knee replacement.  How should the AGACNP manage Sally’s diabetic medications? 

Question 44

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?

Question 45

Your patient has diabetes insipidus (DI). Anticipated physical assessment findings include:

Question 46

Brian, an 18 year with an intracerebral hematoma from a Motor Vehicle Crash (MVC) has SIADH.    The AGACNP knows that this is caused by:  

Question 47

A 68 year old man presents with a complaint of shortness of breath upon exertion.  Physical exam reveals conjunctive pallor.  Hg 7.5, MCV 81, MCHC  36%,  Ferritin level 210.  The most like clinical problem is:

Question 50

The AGACNP is called to admit a patient with presumed myxedema coma. Expected physical examination findings include:

Differential diagnosis of hematuria include all of the following except:

Question 52

A 48 year old woman developed iron deficiency anemia due to gastrointestinal bleeding.  Her hematocrit level is 25% and she is taking 325 mg of ferrus sulfate three times a day.  At 5 days into therapy, you expect to find:

Question 53

J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC reveals a macrocytic anemia with a Hgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of 19%. The AGACNP suspects which type of anemia?

Question 54

The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature?

Question 55

Which of the following statements about anemia due to folate deficiency is incorrect?

Question 56

Mr. Hogle is a 65-year-old male patient who presents with a burning-type discomfort in the epigastrum. He notices it most at night, but says that sometimes he appreciates it when he is really hungry. It actually seems to get better when he eats. His vital signs are all within normal limits. A stool for occult blood is negative. His CBC reveals an Hgb of 10.1 g/dL and hematocrit of 30%. The MCV is 74 fL. The AGACNP knows that the next appropriate step is to order:

Question 58

A 26-year-old male presents to the trauma bay after being involved in a high-speed motorcycle collision. You note that he is obtunded and has bilateral open lower extremity fractures with exposed bone and muscle. What is the first priority when first assessing this patient?

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Question 59

J.S. is a African-American female who presents for a wellness examination. Her medical history is significant for beta thalassemia minor. Anticipated red blood cell differential would include which of the following patterns?

Question 60

J.H. is a 71-year-old male with small cell lung cancer. On exam today he is quite edematous and has gained 12 lbs since his office visit one week ago. A metabolic panel reveals a serum Na+ of 119 mEq/dL.   His urine output is plus 2 lites over his intake.  The AGACNP knows that J.H. likely has: