Posted: August 1st, 2022

NURS 6550 MIDTERM EXAM Essay 4

NURS 6550 MIDTERM EXAM Essay 4

1. The AGACNP is caring for a affected person who is kind of in poor health and has developed, amongst different issues, a big proper sided pleural effusion. Thoracentesis is distributed for pleural fluid Assessment. Whereas evaluating the fluid Assessment, the AGACNP is aware of that a fluid recognized as a(n) __________ is the least worrisome kind.

2. Mrs. Miller is transported to the emergency division by paramedics. She is having profound, unremitting chest ache, is diaphoretic and pale. She has jugular venous distention and a widened pulse stress. Suspecting ascending aortic aneurysm, the AGACNP order which take a look at to verify the analysis?

Three. Sure subgroups of the aged inhabitants are at an elevated threat for speedy deterioration and long-term care placement. Which of the next shouldn’t be thought-about a excessive threat issue for long run care placement?

4. A affected person with anterior epistaxis has been handled with 20 minutes of direct stress to the cartilaginous portion of the nostril. Following stress the affected person is instructed to softly blow the nostril. Anticipated findings within the affected person who has been efficiently handled embody all the following besides a:

5. Kevin is a 14-year-old male who presents for analysis of a fever of 102.5° F and vital proper ear ache. He seems fairly in poor health and says he feels nauseous. Otoscopic analysis reveals ache to palpation, a really erythematous and bulging tympanic membrane with bullous myringitis. The AGACNP is aware of that antibiotic remedy have to be chosen to cowl:

7. Which of the next is the best threat issue for vascular dementia?

eight. J.R. is a 55-year-old male who presents for a industrial driver’s license bodily examination with a blood stress of 170/102 mm Hg. He has no medical historical past and is with out criticism. Which of the next findings constitutes hypertensive urgency? NURS 6550 MIDTERM EXAM Essay 4

9. Due to the generally acknowledged adversarial results of atypical antipsychotics, annual laboratory Assessment for sufferers taking these medicines ought to embody a:

10. Ok.R. presents for an analysis of eye discomfort. He works in a fabricating store for a customized car restoration firm and whereas working he felt like one thing flew into his eye. He was carrying eye safety on the time however nonetheless has the feeling that one thing is there. Bodily examination is important for some tearing and he experiences a persistent sense of one thing in his eye. Which of the next shouldn’t be indicated within the diagnostic analysis?

11. D.E. is a 41-year-old feminine who had lumbar surgical procedure two days in the past to restore a ruptured nucleus pulposus. She has been doing properly postoperatively however at this time is complaining of resting fatigue and a few shortness of breath at relaxation. In ruling out a pulmonary embolus the AGACNP first orders a:

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12. Mr. Nixon is being handled with unfractionated heparin infusion for acute pulmonary embolus. In an effort to keep away from a doubtlessly deadly complication of heparin infusion, the AGACNP displays:

13. Differentiating vertigo from near-syncope and ataxia is among the objectives of history-taking when a affected person presents as “dizzy.” The AGACP is aware of that vertigo is the issue when the affected person experiences the first symptom as:

14. Mr. Banks has been admitted for surgical resection of a metastatic tumor, throughout surgical procedure it’s found that he has widespread, diffuse metastasis all through the stomach. Surgical procedure is not an choice, and his oncologist says that chemotherapy is unlikely to supply any significant profit. Mr. Banks is worried that his sons is not going to Help a switch to consolation care. The AGACNP advises that he:

15. Mr. Wilkerson is a 77-year-old male who’s being evaluated and handled for his cardiogenic ache. His very important indicators are as follows: Temperature of 99.1° F, pulse of 100 bpm, respirations of 22 bpm, and blood stress of 168/100 mm Hg. A 12-lead ECG reveals deep ST section despair in leads V3-V6. The AGACNP acknowledges which of the next as a contraindication to rTPA remedy?

17. Whereas assessing a affected person with a identified psychiatric historical past, the AGACNP is aware of that the first distinction between a psychotic and neurotic problems is:

18. L.T. is an 85-year-old male who’s admitted for analysis of profound diarrhea that has produced vital dehydration. He additionally complains of being very drained these days, and feeling like he’s going to vomit all the time. His very important indicators are vital for a pulse of 41 b.p.m. and a blood stress of 90/60 mm Hg. A gastrointestinal analysis together with stool for blood, white blood cells, and ova and parasites is destructive. He insists that he has not began any new medicines or made any food plan adjustments; the one factor new is that he bought new eye drops for his glaucoma. The AGACNP appropriately assumes that his new eye drops are:

19. Janice is a 19-year-old feminine who presents to the emergency division by way of ambulance. She is pale, diaphoretic, agitated, and satisfied she is having a stroke. Her very important indicators embody a temperature of 98.9° F, pulse of 114 beats per minute, respirations of 32 breaths per minute, and a blood stress of 110/74 mm Hg. Diagnostic analysis is destructive and Janice is recognized with an acute panic assault. The preliminary therapy of selection is:

20. Lorraine is a 41-year-old feminine who presents for an bronchial asthma follow-up go to. She says she feels very properly, has nearly no daytime signs, and is utilizing her inhaled corticosteroid treatment every day as prescribed. Her PEFR is 85% of her private finest. One of the best strategy to this affected person is to:

21. Mr. Owen is a 37-year-old affected person who has been admitted for surgical resection of a malignant tumor in his lung. His bodily restoration has been uneventful and he’s being ready for discharge. Whereas discussing his ongoing most cancers remedy with Mr. Owen, the AGACNP determines that he has skilled persistent, extreme nervousness and fear nearly on daily basis for a couple of yr. What different side of Mr. Owen’s psychosocial historical past can be required to made a analysis of generalized nervousness dysfunction?

22. Kevin T. is a 49-year-old male who’s being discharged after hospitalization for an acute inferior wall myocardial infarction. That is his first hospitalization and his first continual medical analysis. Apart from his elevated cardiac isoenzymes and troponins, his laboratory profile was primarily inside regular limits. The one obvious cardiac threat issue is an LDL ldl cholesterol of 200 mg/dL. Initiating an HMG-CoA reductase inhibitor is an instance of which stage of prevention for Kevin?

24. Mrs. Salter is an 81-year-old woman who presents for analysis of near-syncopal episodes. Her 12-lead ECG, full blood depend, and complete metabolic panel are all primarily regular. A urinalysis exhibits some hint protein however is in any other case regular. A 24-hour rhythm monitor demonstrates uncommon untimely ventricular contractions. Mrs. Salter has been in good well being and had her first episode at her aerobics class. She solely will get lightheaded when she exerts herself. Her coronary heart auscultates for a grade III/VI systolic crescendo-decrescendo murmur on the second intercostal house, proper sternal border. The AGACP considers that the doubtless reason behind the syncope is:

25. Who among the many following sufferers is at best threat for a pulmonary embolus?

26. Mrs. Birdsong is an 85-year-old feminine who has been admitted for surgical restore of a hip fracture. She is in remarkably good spirits and is kind of talkative. She readily solutions all the questions on her consumption Assessment, and readily acknowledges data supplied throughout her room orientation. Later whereas speaking with the affected person’s son the AGACNP learns that the affected person has had vital cognitive impairment for just a few years. She has just about no quick time period reminiscence, however compensates by confabulating. Her son says she is mostly very completely happy so long as there isn’t a change in her daily routine. This historical past is most according to which type of dementia?

27. Mrs. Radovich is an 80-year-old feminine with a wide range of continual medical circumstances that are fairly properly managed. She typically enjoys high quality of life and is energetic together with her household. Right this moment her solely concern is that she is having issues together with her imaginative and prescient. She notices that whereas attempting to take a look at footage of her nice grandchildren she will be able to’t appear to concentrate on their faces. She additionally experiences elevated hassle studying—she can not appear to see the phrases that she is taking a look at, and her studying glasses don’t Help. Additional analysis of Mrs. Radovich ought to embody Assessment with:

28. R.J. is a 55-year-old feminine who presents with acute onset left sided facial ache and an incapability to maneuver the left facet of her face. She can not smile, increase her eyebrow and even shut her left eye, The quick strategy to this affected person ought to embody:

29. A 78-year-old male current for a bodily examination. He has no discomfort or complaints apart from a basic lower in imaginative and prescient, nevertheless it helps when he places issues underneath a shiny mild to learn. He admits that whereas driving at evening the streetlights look like a bit distorted and his evening imaginative and prescient is fairly poor. Given the doubtless analysis, the AGACNP expects which of the next bodily findings?

30. Jason is a 46-year-old male who’s being managed for sepsis. He has HIV/AIDS and has had a protracted hospitalization characterised by a wide range of issues. He was extubated Three days in the past however continues gastric decompression with a nasogastric tube(NGT), complete parenteral vitamin and antibiotic remedy by way of a central venous catheter, and urinary drainage by way of a Foley catheter. He continues to exhibit constant low grade fevers however all factors of insertion of his tubes are regular to inspection, a chest radiograph demonstrates enchancment of his pneumonia, and his urinalysis exhibits no micro organism, leukocytes, or nitrites. The AGACNP ought to subsequent order:

31. The interpretation of a chest radiography ought to observe a scientific strategy to make sure that all very important constructions are evaluated and essential scientific findings usually are not missed. The very last thing to be assessed when taking a look at chest radiography ought to be the _____________:

34. Most psychosocial theories of growing old middle across the core idea that profitable growing old requires acceptance of a sequence of adjustments or losses that predictably happen later within the life span. The idea that particularly addresses coming to phrases with the inevitability of dying is called:

35. All the following circumstances are threat components for pulmonary embolus besides:

36. A affected person is recognized with acute descending aortic aneurysm and hypertension ought to be instantly began on which treatment pending surgical analysis?

37. Jason is a 27-year-old with a protracted historical past of intermittently managed bronchial asthma. He’s at the moment prescribed Advair every day with albuterol as wanted for signs. Right this moment he presents to the emergency division with cough and wheezing and problem catching his breath. His FEV1 is 51% on the time of presentation. He’s given alternating albuterol and ipratropium nebulizer therapies together with oral prednisone. After one hour his FEV1 has elevated 65%. The suitable disposition for Jason at this level is:

38. A affected person within the intensive care unit all of the sudden turns into tachypneic and dyspneic. The bodily examination reveals pale, cool, clammy pores and skin and an arterial blood fuel demonstrates hypocapnea and hypoxia. Pulmonary artery stress demonstrates a sample according to obstructive shock. The AGACNP is aware of that which of the next causes of this presentation is most definitely?

39. Mr. Bowers is an 81-year-old male who’s being terminally extubated on the request of his household because of the presence of a giant subdural hematoma with a shift; the affected person shouldn’t be initiating respirations on his personal and the prognosis may be very poor. After he’s extubated he begins to provoke his personal respirations and 24 hours later has not expired but. The choice is made to go away him within the hospital on a basic medical ground somewhat than switch to a different facility for hospice. Which of the next is the most effective indicator that the affected person’s dying is imminent?

40. A affected person is newly admitted to your service for open discount and inside fixation of the left hip. She appears very down, and as you speak together with her you notice that her temper is not only associated to her hip fracture. Which of the next signs wouldn’t be according to main depressive dysfunction?

42. What’s the major goal of utilizing eye ointments or lubricants to sufferers underneath basic anesthesia, on paralytics, or in long-term comatose states?

43. When studying a 12-lead electrocardiogram, the AGACNP is aware of that every one 12 leads are required to offer: NURS 6550 MIDTERM EXAM Essay 4

44. A 49-year-old male presents for analysis of chest tightness. It has occurred earlier than, however he simply ignored it and it went away. Right this moment he simply couldn’t ignore it anymore. He has at all times loved good well being and says he has by no means been informed that he has any continual medical circumstances like hypertension or diabetes. A 12-lead ECG demonstrates adjustments according to inferior wall ischemia. Each his signs and inferior wall adjustments enhance with the administration of sublingual nitroglycerin. According to ACS protocol, this affected person’s Assessment is according to:

45. Mr. Rosen is a 49-year-old male who’s being managed for an acute myocardial infarction. He develops vital shortness of breath at relaxation and coarse rales 2/Three up bilaterally. The AGACNP suspects acute pulmonary edema as a result of papillary muscle rupture and acute mitral valve regurgitation. Which bodily discovering would Help this discovering?

46. A affected person with minor head trauma presents for analysis. Which of the next findings ought to be adopted up with a CT scan to rule out orbital fracture?

47. Mrs. Forbes is a 69-year-old woman being discharged from the hospital after issues following a beauty surgical process. She is mainly in good well being. She has a historical past of hypothyroidism for which she takes levothyroxine every day, and gentle osteoarthritis which is managed with solely prn nonsteroidal use. Her blood stress is 148/90 mm Hg. The AGACNP is aware of that in accordance with essentially the most present tips revealed in JNC eight the suitable motion is to:

48. When assessing driver security within the older grownup, the AGACNP considers that:

49. The nursing employees calls to let you know that your 81-year-old male affected person is having an acute change in psychological standing. He’s a mainly wholesome man who was admitted three days in the past for inpatient antibiotic administration of neighborhood acquired pneumonia. His daughter is on the bedside and she or he may be very distraught as a result of she has by no means seen him like this. She is asking for treatment to make him cease performing disoriented. Upon examination the affected person is mendacity in mattress, seems calm and completely happy, however doesn’t acknowledge his daughter as anybody he is aware of. He’s speaking as if he’s at house and has firm. The AGACNP instructs the daughter that:

50. Whereas discharging a affected person following her myocardial infarction, you provide some affected person schooling about medically supervised cardiac rehabilitation. The affected person expresses concern of rehab as a result of she was on her treadmill when she had her infarction and now she is afraid of constructing it occur once more. She doesn’t perceive how the rehab can drive her to train her coronary heart however not make her have one other cardiac occasion. The AGACNP explains that the affected person will likely be monitored and that her objective coronary heart fee will likely be:

51. Throughout bodily examination of a 51-year-old African-American feminine you recognize a lower in her peripheral imaginative and prescient. The remainder of her eye examination is inside regular limits and she or he is symptom free. This presentation is according to:

52. Mr. Moffett is a 66-year-old male with a protracted historical past of decrease extremity edema. All different causes of decrease extremity edema have been dominated out and his general symptom presentation and historical past are strongly supportive of continual venous insufficiency. Right this moment he presents with elevated itching of each decrease legs. Bodily examination reveals 2-Three+ pitting edema and trophic hyperpigmentation. The AGACNP know that therapy ought to embody: NURS 6550 MIDTERM EXAM Essay 4

54. The AGACNP is treating a affected person with a corneal abrasion. The affected person has a transparent recollection of the mechanism of damage—she was scratched within the eye earlier at this time together with her 18-month-old daughter’s fingernail. Which of the next is contraindicated within the administration of this affected person’s abrasion?

55. M.T. is a 41-year-old male affected person within the intensive care unit. He was admitted to the hospital in septic shock and has been aggressively managed with broad spectrum antibiotics. He has grow to be progressively hypoxemic and the final arterial blood fuel revealed a paO2 of 58 mm Hg. Chest radiography reveals a “white out” sample bilaterally. The affected person is intubated and ventilated. The AGACNP is aware of that acceptable administration should embody:

56. Youngsters and adults with acute otitis media can usually be handled with “watchful ready” given the excessive incidence of spontaneous decision and low threat of poor outcomes. Which of the next is an absolute indication to start antibiotic remedy on the time of analysis?

57. Mr. Bowers is on mechanical air flow for respiratory Help by an episode of septic pneumonia. Due the in depth lobar consolidation it was very troublesome to maintain Mr. Bowers oxygenated and he required very excessive FIO2s and PEEP. The AGACNP is aware of that the first concern with FIO2s > 60% is:

58. Acute respiratory misery syndrome (ARDS) happens when an awesome systemic insult outcomes by which maladaptive physiologic response?

59. Acute respiratory misery syndrome is characterised by which abnormality of air flow and perfusion?

60. George Schulz is a 69-year-old male who presents for analysis of acute foot ache. It’s so painful that he can not stroll on it with out help. At first he denies any vital medical historical past, however then reveals that he has been recognized with dyslipidemia and hypertension however stopped taking his medicines as a result of he couldn’t afford it. Pulses usually are not palpable however are audible by Doppler. The extremity is pale and glossy with decreased hair progress, suspecting peripheral arterial illness, the AGACNP expects which extra discovering? NURS 6550 MIDTERM EXAM Essay 4

61. G.T. is a 40-year-old male who’s underneath your case for long run administration of secondary osteoarthritis. Right this moment he asks if he can take a drugs for nervousness. Additional Assessment reveals that he’s in a relationship that has been very irritating; his girlfriend needs very a lot to get married and begin a household, and he doesn’t. He admits that he not feels they’re appropriate and acknowledges that he wants to finish this relationship. He’s positive that that is the supply of his nervousness. One of the best strategy can be to:

62. Through the bodily examination of a 31-year-old feminine, the AGACNP appreciates a bifurcate uvula. Probably the most acceptable motion can be to:

64. Medical diagnostic standards for acute respiratory misery syndrome (ARDS) embody all the following besides:

65. Whereas managing a affected person in acute pulmonary edema, the AGACNP displays the pulmonary capillary wedge stress. When this stress falls under 12 mm Hg it means that: NURS 6550 MIDTERM EXAM Essay 4

66. All the following are essential parts of the quick administration of penetrating eye damage besides:

67. Whereas evaluating a affected person with diastolic failure as a result of a protracted historical past of uncontrolled hemochromatosis, the AGACNP appreciates an additional coronary heart sound simply earlier than the S1 coronary heart sound. This sound is most definitely a(n):

68. Secondary hypertension happens in roughly 10% of all sufferers with hypertension, and requires administration of the underlying downside with a purpose to remove the trigger. Which of the next shouldn’t be a secondary reason behind hypertension?

69. L.M, is a 26-year-old male who presents to the emergency division complaining of acute onset vertigo this morning. He describes a powerful sense of the room spinning and might barely stroll with out feeling nauseous. The vertigo is reproducible when his neck is rotated all of the sudden left or proper. The AGACNP is aware of that which of the next shouldn’t be indicated?

70. A 36-year-old feminine presents complaining of left leg swelling. She describes the onset as acute over the past day or two, and says it feels “tight and throbbing.” She denies any vital medical historical past and says the one treatment she takes is oral contraception, which she has taken since she was 15 years previous. The AGACNP first orders:

71. The first neurotransmitter implicated in post-traumatic stress dysfunction (PTSD) is:

72. Mr. Avila is an 82-year-old male being recommended in regards to the dangers and advantages of his upcoming belly surgical procedure. Whereas contemplating threat components for atelectasis, pneumonia and different pulmonary issues, the AGACNP advises that the best threat comes from:

73. The feminine AGACNP is practising with a cardiology group and sees sufferers at some point per week within the outpatient workplace. A 49-year-old feminine presents for follow-up after her admission for infective endocarditis. She is recovering properly, and says that she goes to be extra proactive about her well being. She admits to not having had any of her common well being screenings for years, and asks if she will be able to have her Pap carried out at this workplace. The AGACNP:

74. The AGACNP is seeing a affected person who was transferred from the correctional facility for analysis. He has a profound purulent discharge from his proper eye. The conjunctive is erythematous and there may be gentle photosensitivity. The inmate denies any actual eye ache, simply says that this can be very uncomfortable. Remedy for this affected person is prone to embody:

76. A affected person lately had a nasal packing inserted for administration of refractory epistaxis. One week later he presents with fatigue, a headache “within his nostril” and a sense typically unwell. The AGACNP considers: NURS 6550 MIDTERM EXAM Essay 4

77. A 55-year-old feminine affected person presents with a fever of 103.4° F. She was handled roughly 10 days in the past at pressing take care of a sinus an infection, however two days in the past the proper facet of her truth began to harm, and at this time she has vital swelling of the proper orbit and eyelid. The eyelid may be very edematous and there may be purulent drainage famous. The precedence of take care of this affected person begins with:

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