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 cortisol

B.

Low ACTH and high cortisol

C.

High ACTH and low cortisol

D.

High ACTH and high cortisol

 

 

Question 2

 

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 mask

B.

Hyperbaric oxygen

C.

Surgical resection

D.

Treatment of underlying disease

 

Question 3

 

Jennifer 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 of

injection. 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 negative

B.

Quantiferon serum assay for exposure

C.

Consideration of prophylactic therapy

D.

Beginning therapy for pulmonary TB pending sputum cultures

 

Question 4

 

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:

 

A.

Blood group substances

B.

Electrolytes

C.

Vitamin B12

D.

Gastric pH

 

 

Question 5

 

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.

Neurolemma

B.

Lipoma

C.

Hemangioma

D.

Lymphangioma

 

Question 6

 

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?

 

A.

 

Alpha-adrenergic antagonists

B.

Beta-adrenergic antagonists

C.

Intravenous vasodilators

D.

Arteriolar dilators

 

Question 7

 

In myelodysplastic syndromes, the primary indications for splenectomy include:

 

A.

Major hemolysis unresponsive to medical management

B.

Severe symptoms of massive splenomegaly

C.

Sustained leukocyte elevation above 30,000 cells/µL

D.

Portal hypertension

 

 

Question 8

 

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.

Radiographs

B.

CT scan without contrast

C.

MRI

D.

PET scan

 

Question 9

 

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:

 

A.

Continue the current regimen

B.

D/C the spironolactone and begin a loop diuretic

C.

Add a loop diuretic to the spironolactone

D.

Proceed to large-volume paracentesis

 

Question 10 — Advanced Practice Care of Adults

 

 

Which 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 posttransplant

B.

There is a strong interest in developing corticosteroid-free posttransplant protocols

C.

Better results are demonstrated in corticosteroid-free protocols for second-transplant recipients

D.

Evidence supports corticosteroid-free rejection protocols

 

 

Question 11 —Advanced Practice Care of Adults

 

K. 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 problem

B.

Chronic gastroparesis is a known complication of ulcer surgery

C.

Medication is unlikely to help, and he may need another surgery

D.

His symptoms occur in 5 to 10% of people after ulcer surgery

 

 

Question 12

 

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:

 

A.

Increased MCV

B.

Increased Hgb

C.

Increased platelets

D.

Increased albumin

 

Question 13

 

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 bolus

B.

External pacemaking

C.

Atropine 0.5 mg IV

D.

Epinephrine 1 mg IV

 

Question 14

 

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?

 

A.

Temperature > 102°F

B.

White blood cell count > 14,000 cells/µL

C.

Vomiting

D.

Hematuria

Question 15

 

Which 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 incompetent

B.

Impaired cognition does not make a person incompetent

C.

Living wills typically are honored if a person is terminally ill

D.

A patient can give informed consent if not declared incompetent

 

 

Question 16

 

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.

Ammonia

C.

False neurotransmitters

D.

Serotonin

Question 17

 

Ross 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 rehydration

B.

Controlled hydration

C.

Hypertonic rehydration

D.

Isotonic rehydration

 

Question 18

 

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?

 

A.

Abdominal radiographs

B.

CT scan of the abdomen with contrast

C.

Right upper quadrant ultrasound

D.

A HIDA scan

 

 

Question 19

 

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:

 

A.

Proper cleansing and covering of the laceration, along with antibiotic therapy

B.

Local anesthesia, cleansing, and wound exploration for foreign bodies

C.

Local anesthesia, cleansing, and suture repair

D.

Cleansing, covering, antibiotic therapy, and tetanus prophylaxis

 

Question 20

 

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:

 

A.

Dissecting aortic aneurysm

B.

Acute pancreatitis

C.

Perforated peptic ulcer

D.

Mallory-Weiss tear

---

Advanced Practice Care of Adults