NURS 6560 Final Exam Answers - Walden University

NURS 6560 Final Exam ANSWERS

Walden University

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^{A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate:A.Low ACTH and low cortisolB.Low ACTH and high cortisolC.High ACTH and low cortisolD.High ACTH and high cortisol Pneumatosis, or gas cysts, may form in the wall anywhere along the gastrointestinal tract; in some cases, they will produce symptoms such as abdominal discomfort, diarrhea with mucus, and excess flatulence. Treatment of pneumatosis most often involves:A.Several days of oxygen by face maskB.Hyperbaric oxygenC.Surgical resectionD.Treatment of underlying diseaseJennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site ofinjection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifer’s evaluation and management should include:A.No further care, because the chest radiograph is negativeB.Quantiferon serum assay for exposureC.Consideration of prophylactic therapyD.Beginning therapy for pulmonary TB pending sputum culturesP. E. is a 61-year-old female who presents for a postoperative visit following a gastric resection after a perforation of peptic ulcer. She reports feeling better, although it is taking longer than she expected. However, she says she is feeling better each day, her appetite is returning, and her incision is healing well. She is being discharged from surgical care and advised to continue her routine health promotion follow-up with her primary care provider. As part of her surgical discharge teaching, the AGACNP counsels P. E. that as a result of her gastric resection she will need lifelong follow-up of:A.Blood group substancesB.ElectrolytesC.Vitamin B12D.Gastric pH M. T. is a 71-year-old female who presents for evaluation of a ―lump on her chest.‖ She denies any symptoms—there is no pain, erythema, edema, ecchymosis, or open areas—it is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard; it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a:A.NeurolemmaB.LipomaC.HemangiomaD.LymphangiomaThe AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla?A.Alpha-adrenergic antagonistsB.Beta-adrenergic antagonistsC.Intravenous vasodilatorsD.Arteriolar dilatorsIn myelodysplastic syndromes, the primary indications for splenectomy include:A.Major hemolysis unresponsive to medical managementB.Severe symptoms of massive splenomegalyC.Sustained leukocyte elevation above 30,000 cells/µLD.Portal hypertension The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?A.RadiographsB.CT scan without contrastC.MRID.PET scanThe AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s management is to:A.Continue the current regimenB.D/C the spironolactone and begin a loop diureticC.Add a loop diuretic to the spironolactoneD.Proceed to large-volume paracentesisWhich of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?A.High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplantB.There is a strong interest in developing corticosteroid-free posttransplant protocolsC.Better results are demonstrated in corticosteroid-free protocols for second-transplant recipientsD.Evidence supports corticosteroid-free rejection protocolsK. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms; the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that:A.He will need endoscopy to evaluate the problemB.Chronic gastroparesis is a known complication of ulcer surgeryC.Medication is unlikely to help, and he may need another surgeryD.His symptoms occur in 5 to 10% of people after ulcer surgeryThe AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal:A.Increased MCVB.Increased HgbC.Increased plateletsD.Increased albumin A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?A.Isoproterenol 0.2 to 0.6 mg IV bolusB.External pacemakingC.Atropine 0.5 mg IVD.Epinephrine 1 mg IVMs. Carpenter is a 28-year-old female who presents in significant pain; she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?A.Temperature > 102°FB.White blood cell count > 14,000 cells/µLC.VomitingD.HematuriaWhich of the following is not a true statement with respect to decision making for a cognitively impaired patient?A.Only a court can declare a patient incompetentB.Impaired cognition does not make a person incompetentC.Living wills typically are honored if a person is terminally illD.A patient can give informed consent if not declared incompetent Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease; its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except:A.Gamma-aminobutyric acid (GABA)B.AmmoniaC.False neurotransmittersD.SerotoninRoss A. is a 38-year-old who has just had a kidney transplant. The AGACNP knows that, due to the characteristic and anticipated response of transplanted kidneys, the patient requires:A.Aggressive rehydrationB.Controlled hydrationC.Hypertonic rehydrationD.Isotonic rehydrationJanice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is ―really wrong.‖ She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?A.Abdominal radiographsB.CT scan of the abdomen with contrastC.Right upper quadrant ultrasoundD.A HIDA scanJustin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didn’t want to go to the emergency room because he didn’t want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes:A.Proper cleansing and covering of the laceration, along with antibiotic therapyB.Local anesthesia, cleansing, and wound exploration for foreign bodiesC.Local anesthesia, cleansing, and suture repairD.Cleansing, covering, antibiotic therapy, and tetanus prophylaxisJustin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didn’t want to go to the emergency room because he didn’t want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes:A.Proper cleansing and covering of the laceration, along with antibiotic therapyB.Local anesthesia, cleansing, and wound exploration for foreign bodiesC.Local anesthesia, cleansing, and suture repairD.Cleansing, covering, antibiotic therapy, and tetanus prophylaxisT. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600/µL. The AGACNP suspects:A.Dissecting aortic aneurysmB.Acute pancreatitisC.Perforated peptic ulcerD.Mallory-Weiss tearA 42-year-old woman presents to the emergency department after being raped. The AGACNP examines her and realizes that the patient’s husband is the rapist. The patient does not want to press charges and wants to return home with her husband. The AGACNP’s initial action should be to:A.Report the physical assault to law enforcementB.Have the patient sign a release to go home with her husbandC.Consult psychiatry for a psych holdD.Provide counseling to the patient regarding her optionsM. 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 reportsthat 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:A.Perforated bowelB.PeritonitisC.Ischemic bowelD.Intestinal abscessC. V. is a 70-year-old African American male patient who presents for surgical consultation. His history includes 4 months of severe hypertension that has been poorly responsive to medication. He also complains of intermittent pounding headaches, palpitations, and a vague sense of anxiety with tremors. A 24-hour urine demonstrated elevated metanephrines. The AGACNP recognizes that this patient has a:A.Malignant hyperthyroidismB.Catecholamine-secreting tumorC.Pituitary adenomaD.HyperaldosteronismThe AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature?A.PyuriaB.FeverC.CVA tendernessD.Gross hematuriaB. 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:A.Extended-spectrum antibioticsB.Surgical consultation for colectomyC.Expectant treatment with nonabsorbable antibioticsD.ColonoscopyBased upon an understanding of the normal relationship between gastrin levels and acid secretion, the AGACNP recognizes that which of the following combinations is almost diagnostic of gastrinoma?A.Hypogastrinemia and acid hyposecretionB.Hypergastrinemia and acid hyposecretionC.Hypogastrinemia and acid hypersecretionD.Hypergastrinemia and acid hypersecretionThe 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?A.Veracity and beneficenceB.Beneficence and nonmalfeasanceC.Autonomy and beneficenceD.Justice and autonomyR. S. is a 66-year-old female with Cushing’s syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates:A.Rapid reversal of symptoms, with good pituitary functionB.Transient rebound release of remaining pituitary hormonesC.Markedly improved dexamethasone suppression testD.Hyponatremia and compensatory SIADHA 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 signB.+ Chvostek’s signC.+ McBurney’s signD.+ Kernig’s sign 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:A.Palpitations, headaches, and sweatingB.Polyuria, weakness, and paresthesiasC.Dry skin, straie, and unplanned weight lossD.Early satiety, tremors, and fatigueMrs. 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:A.Irritable bowel syndromeB.Inflammatory bowel diseaseC.DiverticulitisD.AppendicitisIn the majority of cases, the first clinical manifestation of physiologic stress ulcer is:A.Epigastric painB.Change in mental statusC.FeverD.Hemorrhage 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:A.Lactulose taken 20 g PO dailyB.Spironolactone taken 100 mg PO dailyC.Protein intake of 50 g dailyD.Zolpidem taken 10 mg PO qhs.R. R. is a 61-year-old male patient who presents with a chief complaint of fever and urinary symptoms. He was in his usual state of good health when for no apparent reason he developed pain in his back and perineal region, as well as fever and chills. He presents as septic. He had urinary hesitancy and decreased stream but now reports that he has not passed urine in more than 12 hours. Palpation of the lower abdomen is consistent with bladder distention. The AGACNP knows that which of the following is contraindicated in this circumstance?A.Digital prostate examinationB.Urinary catheterizationC.Fluoroquinolone antibioticsD.Drainage of prostate abscess 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:A.CyclosporineB.AzathioprineC.MethylprednisoloneD.SirolimusR. 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?A.CT scan with IV, oral, and rectal contrastB.CBC with WBC differentialC.ColonoscopyD.Barium enemaMs. O’Reilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively?A.All medications should be taken up to and including the morning of surgeryB.The beta blocker may be taken up until the day of surgery, metformin should be held the day of surgery, and the remaining medications should be d/c’d 5–7 days before surgeryC.Warfarin should be held 5 days before surgery; all other medications may be taken through the morning of surgeryD.Metformin should be held if the morning blood sugar is < 200 mg/dL; all other medications except warfarin may be given the day of surgeryMr. Novello is an 81-year old male patient who presents with crampy abdominal pain in the hypogastrum and a vague history as to his last normal bowel movement. Physical examination reveals distention and high-pitched bowel sounds. The patient says he has never has this kind of problem before and denies any history of abdominal surgery. Abdominal radiographs reveal a frame pattern of colonic distention. The AGACNP considers:A.A stimulant laxative to relieve bowel contentsB.Carcinoma of the bowel as a leading diagnosisC.Decompression of the colon with rectal tubeD.Angiography to rule out mesenteric ischemiaJane 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?A.HELLP syndromeB.Placental abruptionC.Spontaneous hepatic ruptureD.Preterm laborWhich of the following statements is true with respect to adrenal tumors that produce gender symptoms?A.Feminizing adrenal tumors are almost always carcinomasB.Feminizing adrenal tumors are the most common type of adrenal tumorC.Virilizing tumors in women are most often localized to the adrenal cortexD.Virilizing adrenal tumors are more likely to be malignant in childrenG. 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 AGACNPtreats the patient for pyelonephritis and considers which study to evaluate for vesicoureteral reflux?A.Bilateral renal ultrasoundB.CT scan of the abdomen and pelvisC.Voiding cystourethrograpyD.Radioisotope scanningIn which form of hypospadias should circumcision be deferred in order to preserve the prepuce for later surgical repair?A.Ventral displacementB.Proximal displacementC.Midscrotal hypospadiasD.Meatus proximal to the corona 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.A temperature of 101.5°FB.A leukocyte count of 18,000/µLC.A palpable gallbladderD.A positive Murphy’s signAchalasia is a risk factor for:A.Squamous cell carcinomaB.Gastroesophageal reflux diseaseC.Esophageal atrophyD.Malabsorption syndromesCarolyn 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:A.Perforated small bowelB.Ulceration through the thickness of small bowelC.Small bowel obstructionD.GastroenteritisS. B. is a 41-year-old female who presents complaining of constipation. She says she has never had problems with bowel movements in the past, although she has heard that constipation is common among women. She says that for the last month or so she has been lucky to have three bowel movements a week, and even when she has one, she doesn’t always feel empty. A review of systems is otherwise negative, and she denies taking any new medications. She denies depression or any mood disorders—she says she actually is very happy and has always felt well, but this bowel problem is bothering her. She has tried over-the-counter products such as Metamucil® and stool softeners, but nothing has helped. Her abdominal, pelvic, and rectal examinations are normal—there are good bowel sounds, no organomegaly, and no discomfort on palpation. The AGACNP considers ordering:A.Stool for occult bloodB.Colonic transit assessmentC.Contrast CT of the abdomenD.Plain film radiographyNeoadjuvant 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:A.50% of the patients treated with a given regimen demonstrate remissionB.50% of the patients treated survive to the 5-year pointC.The tumor mass has reduced by > 50%D.In 50% of cases, the tumor converts from unresectable to resectableIn the preoperative assessment of a patient for the likelihood of postoperative risk, ascorbic acid deficiency, anemia, and volume contraction are all risk factors for:A.Prolonged intubationB.ThromboembolismC.Delayed wound healingD.AtelectasisMr. Thornton is a 55-year-old man who is having an outpatient cardiac workup for the evaluation of exertional chest pain. He is not having chest pain now, but over the last several months he has had episodes of intermittent chest tightness and shortness of breath with mild to moderate exertion, such as when carrying heavy bags of groceries from the car to the house. His 12-lead ECG today reveals Q waves that range from 2 to 3 mm wide and 3–4 mm deep in leads V1 through V5. There are no other abnormal findings. This suggests that Mr. Thornton:A.Is having anterior wall ischemiaB.Is having an anterior wall infarctionC.Has a history of anterior wall NSTEMID.Has a history of anterior wall STEMIWhich of the following types of aortic aneurysms requires immediate surgical intervention?A.Type AB.Type BC.DescendingD.SymptomaticWhen examining a patient with abdominal pain, the AGACNP knows that tenderness to percussion is analogous to:A.TympanyB.GuardingC.Rebound tendernessD.Somatic painJanet is a 54-year-old female who is in the ICU following hepatic resection due to metastatic disease. She is expected to move to a general medical floor today. Morning labs are as follows:serum bilirubin approximately 2 g/dL, albumin 3.1 g/dL, and prothrombin time 20 seconds. AST and ALT are 85 and 99 respectively. The appropriate response would be to:A.Cancel the transfer and keep her in the ICUB.Infuse albumin and fresh frozen plasmaC.Repeat the labs the next dayD.Prepare for reoperationLester R. is a 58-year-old male who is being evaluated for nocturia. He reports that he has to get up 2 to 3 times nightly to void. Additional assessment reveals urinary urgency and appreciable post-void dribbling. A digital rectal examination reveals a normal-sized prostate with no appreciable hypertrophy. The best approach to this patient includes:A.Administration of the American Urological Association (AUA) Symptom ScaleB.Laboratory assessment to include a PSAC.Ordering a prostate ultrasoundD.Assessment of nonprostate causes of nocturiaJake 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:A.He will probably be able to transition to oral nutrition but will have lifetime issues with diarrheaB.His procedure has put him at significant risk for B12 absorption problemsC.Most jejunum absorption functions will be assumed by the ileumD.Enteral nutrition will need to be delayed for 3 to 6 months to facilitate adaptationMr. Costigan is a 50-year-old male patient who recently had a screening colonoscopy because it was recommended by his primary care provider as a screening measure. He received a report that noted inflammatory polyps. He is concerned because one of his friends had polyps that ―turnedinto‖ cancer. While advising Mr. Costigan, the AGACNP tells him that:A.The polyps are considered precancerous, but if he has a colonoscopy every 3 to 5 years,any new polyps can be removed before they become malignantB.The primary danger is when there is a family history of colon cancer; he should discuss with his mother and father the presence of any colon cancer in the familyC.There is no chance that these polyps could become cancerous, and their presence does not require any additional action or concern on his partD.He would be best served at this point to discuss with an oncologist the risks and benefits of aggressive versus conservative treatment.Question 81Henna is a 41-year-old female who presents to the emergency room complaining of sudden hearing loss. She is generally very healthy—she denies any significant medical history, and her only daily medication is a combined oral contraceptive. She does admit that she is just getting over a ―head cold,‖ but other than that she offers no relevant history. A comprehensive history and physical examination results in a diagnosis of sudden sensorineural hearing loss (SSHL) of unknown origin. The AGACNP knows that the next step in the patient’s management should include:A.AcyclovirB.FurosemideC.WarfarinD.Hyperbaric oxygenQuestion 84A patient presents with a 2-day history of abdominal pain, fever, vomiting, and diarrhea. A surgical abdomen is ruled out, and radiography demonstrates inflammation of the small bowel and colon. Microscopy supports a diagnosis of Campylobacter jejuni, and the patient is prepared for discharge from the emergency room. Important patient education includes advising her that:A.The bacteria may be spread for as long as she has diarrheaB.The disorder should resolve on its own; recurrence is rare but represents a much more serious conditionC.She will need to take a 10-day course of antibioticsD.There is no readily identified food source of this bacteriaWhile reviewing the head CT scan of a patient following a motor vehicle accident, the AGACNP appreciates a crescent-shaped fluid collection. This most likely represents:A.Acute subdural hematomaB.Acute epidural hematomaC.Acute uncal herniationD.Acute brainstem compressionSara 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?A.Immune globulinB.CyclosporineC.Prophylactic antibioticsD.Systemic corticosteroidsH. 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:A.ObservationB.Hyperextension castingC.Jewett braceD.Surgical interventionWhen 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?A.Severe epigastric pain with radiation to the backB.Abdominal guarding and rigidityC.Grey Turner signD.Obturator signP. T. is a 58-year-old female who is admitted with chest pain and shortness of breath and is found to have a large pulmonary embolus. Her systolic blood pressure is falling, and a diagnosis of obstructive shock is made. Cardiac pressure would likely demonstrate:A.Elevated atrial and decreased ventricular pressuresB.Elevated right-sided and decreased left-sided pressuresC.Elevated left ventricular pressure and decreased cardiac outputD.Elevated left ventricular pressure and decreased systemic vascular resistanceMrs. Jenner is a 41-year-old female who is being evaluated for persistent nausea. She had an abdominal CT scan that reported three hepatic hemangiomas ranging from 3 to 5 cm. The AGACNP knows that the appropriate response to this report is to:A.Arrange for large-bore needle biopsyB.Order hepatic ultrasound annually to follow progressionC.Consult surgery for resectionD.Document the finding in the patient’s chartA 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:A.Renal failureB.Traumatic brain injuryC.Gram negative infectionD.Breast cancerMr. 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.A complete blood count and RBC differentialB.Liver function enzymesC.Serum amylase, lipase, and glucoseD.A basic metabolic panelMelanie is a 31-year-old patient who is being evaluated following a routine urinalysis that revealed microscopic hematuria. She was between menses and has no other identifiable explanation for hematuria. She has no significant medical history and otherwise is without complaint. The AGACNP knows that workup for Melanie should include:A.A urology consultationB.CT urogramC.Upper urinary imagingD.CystoscopyThe comprehensive serologic assessment of a patient with Cushing’s syndrome is likely to produce which constellation of findings?A.Low potassium, high glucose, high white blood cell countB.High sodium, polycythemia, low BUNC.Low sodium, low potassium, high BUND.High sodium, high chloride, high RBCsWhile participating in sports, it is not uncommon for people to be subjected to sudden rotational injuries that result in the abrupt rotation of the cerebral cortex around the more fixed midbrain structures. This can interrupt input and outflow from the reticular activating system and result in what clinical phenomenon?A.Epidural hematomaB.Uncal herniationC.ConcussionD.Contrecoup injuryL. D. is a 24-year-old male who is transported to the emergency department after being assaulted in a neighborhood bar. The history is unclear, but witnesses agree that L. D. was assaulted and repeatedly had his head banged against the hard granite surface of the bar. On presentation he has marked edema of his face, multiple ecchymoses including both periorbital regions, and a Glasgow Coma Scale (GCS) score of 9. He has had 1 L of NSS infused by emergency medical services. His vital signs reveal a pulse of 128 bpm and a blood pressure of 88/60 mm Hg. With respect to his hypotension, the AGACNP recognizes that:A.Vasopressors are contraindicated in traumatic head injuryB.Hypotension doubles the risk of mortality from traumatic head injuryC.His blood pressure is likely a physiologic response to traumatic head injuryD.Stabilizing the head injury is more important that identifying the cause of hypotensionWith respect to tumor nomenclature, the AGACNP knows that the term carcinoma describes:A.Malignant neoplasms of internal structureB.Tumors that have lost normal growth regulationC.A dysfunctional metaplastic adaptationD.Neoplasms of epithelial originThe Brain Trauma Foundation recommends intracranial pressure monitoring for all of the following patients except those with :A.GCS of 3 to 8 and abnormal head CTB.GCS of 3 to 8 and hypotensionC.GCS of 3 to 8 and > 40 years oldD.GCS of 3 to 8 and bradycardiaA general principle in surgical oncology is that the best approach to curative surgery in a fixed tumor requires:A.En bloc resectionB.Adjuvant therapiesC.Neoadjuvant therapiesD.Elective lymph node dissectionThe relationship between abdominal pain and vomiting typically can be characterized by saying:A.When the vomiting precedes pain, the likelihood of surgical abdomen increases appreciablyB.Conditions that may produce only mild nausea in the younger patient often will cause vomiting in older patientsC.The majority of surgical abdomens do not produce vomiting as a primary symptomD.The presence of bile in vomitus suggests pyloric stenosis 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:A.Such a high-volume resection is utilized only in people with markedly compromised hepatic functionB.Major regeneration occurs within 10 days, and the process is complete by 5 weeksC.Liver function will probably recover to 50% baseline, but that is enough for normal functionA student AGACNP just beginning his clinical rotation isobserving his preceptor perform a physical survey on a patientwho is brought in following a serious motor vehicle accident. Thestudent observes that the physical examination includesrectovaginal examination, inspection of the urethral meatus, andpalpation of the pelvic landmarks. The student knows the patientis being assessed for:A.Peritoneal bleedingB.Retroperitoneal bleedingC.ParesthesiaD.Pelvic fracture 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:A.Avoidance of elective surgery and nonessential medicationsB.Prednisone 60 mg daily until platelets normalC.Monoclonal antibody therapy such as rituximabD.SplenectomyThe AGACNP is counseling a patient about various methods of tumor biopsy. Which of the following is not an accurate statement?A.Incisional biopsy is preferred to excisional biopsy when possibleB.Core needle biopsy has a higher rate of false positive than does fine needle aspirationC.Fine needle aspiration does not allow grading of tumorsD.Core needle and incisional biopsies are virtually identical in terms of false resultsThe AGACNP recognizes that which of the following diagnostic studies is essential in all cases of acute abdomen?A.Abdominal radiographB.Contrast radiographyC.Chest radiographyD.Ultrasonography Flexion-distraction injuries of the thoracolumbar spine are most commonly caused by:A.Blunt traumaB.Rotational injuryC.Seat beltsD.Gunshot woundsT.    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?A.EncephalopathyB.Hepatitis C infectionC.A long history of alcohol useD.Biliary cirrhosisWhen counseling a patient about his surgical options for an ulcer that has been refractory to medical therapy, the AGACNP advises the patient that he will need:A.Lifelong vitamin D replacementB.Excision of the ulcer, which produces an 80% cure rateC.To eat much smaller, more frequent mealsD.Some form of vagotomy}