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question 1 The AGACNP is making rounds on a patient who has been…
question 1
The AGACNP is making rounds on a patient who has been transferred to inpatient hospice care. The patient was admitted last week after identification of end stage carcinoma. Today the patient is very quiet, barely acknowledging the presence of her caregivers. According to the nursing notes this is a marked change in her affect. Up until today she was at various times talkative, expressing anger about her illness and even yelling at staff. Now she is just lying there, occasionally quietly tearful. This suggests that:
Her cancer is progressing rapidly.
There may be a need to increase her pain medication.
She is moving through the stages of grief.
The reality of her diagnosis has upset her
question 2
The AGACNP is reviewing a 12-lead ECG on an elderly patient who has been admitted for exacerbation of congestive heart failure. There are no acute changes, but there is a biphasic p wave noted in lead V1. Which of the following conditions most likely produced this change?
Mitral valve stenosis
Hypertensive heart disease
A remote history of anterior wall infarction
A left axis deviation
question 3
With respect to pulmonary function test assessment, the AGACNP recognizes that restrictive lung disease is characterized by a total lung capacity, residual volume, and/or functional residual capacity < 80% predicted. These measures indicate: Difficulty moving air at the end of expiration. Inability to retain normal volumes at various points in the respiratory cycle. A high risk of developing shunt. A high risk of developing dead space. question 4 Patients who begin drug therapy for active pulmonary tuberculosis need baseline testing of liver function and: Visual acuity Renal function Cranial nerve function Stool for occult blood question 5 All of the following are indications for a serotonin norepinephrine reuptake inhibitor except: Unresponsiveness to an SSRI Comorbid chronic pain Safety concerns with a tricyclic antidepressant Failure of cognitive behavioral intervention question 6 A 75-year-old patient presents for a follow-up after being hospitalized for 37 days. Originally admitted with abdominal pain, the patient suffered a variety of complications including septic shock. The cause of his original abdominal pain was never identified. He ultimately recovered and is here today for his first follow-up. He reports feeling surprisingly well. His only complaint is that he cannot hear properly out of his right ear. The ears are both normal to otoscope examination. A Weber test lateralizes to the right ear and the Rinne test is normal in both ears. The AGACNP suspects: A sensorineural hearing loss A conductive hearing loss An age-related hearing loss A transient hearing loss question 7 While evaluating a 46-year-old female patient with a chief complaint of fatigue and fever, the AGACNP appreciates a grade IV/VI holosystolic murmur. The patient says that she has never been diagnosed with a heart murmur before. Physical examination must include an assessment for: Left ventricular hypertrophy. Bilateral pedal edema. Trophic changes to the lower extremities. Violaceous nodules on the hands and feet. question 8 Mr. Walsh is an 87-year-old male who presents to the ED with a fever. He is alert and oriented but does not engage in conversation. The patient's daughter insists on answering all questions and becomes angry when the AGACNP addresses questions directly to the patient. The daughter says that the patient is stupid and doesn't know anything. The AGACNP should further assess for: Psychological abuse Hypothyroidism Substance abuse Alzheimer's dementia question 9 A patient with Alzheimer's dementia has been started on donepezil (Aricept) 10 mg daily. Patient education should include information about which of the following sets of adverse effects? Vomiting and diarrhea Palpitations and agitation Dry mouth and abdominal discomfort Weight gain and fatigue question 10 The AGACNP is rounding on a 79-year-old patient in the emergency department (ED) who is being evaluated for an acute onset of mental status change. Her 51-year-old son stopped by to check on her this morning because she was not answering her phone. When he arrived at her house, he said she was "acting goofy" and so he brought her to the ED. Upon physical examination, she appears a bit disheveled. She is alert but confused and disoriented. Vital signs include a temperature of 98.6° F, a pulse of 92 beats per minute, respiratory rate of 20 per minute, and a blood pressure of 148/72 mm Hg. The next most important diagnostic test is a: Urinalysis CT of the head Toxicology screen Blood cultures
