1. Mr.
Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter
was inserted intraoperatively and remains in place. His urine output has
declined markedly despite continued IV fluid infusion. Today his morning labs
reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential

A. Foley
lodged in the urethra causing post-renal failure

B. Decreased
renal perfusion causing prerenal failure

C. Age-related
decreased eGFR causing prerenal failure

D. Post-surgical
rhabdomyolysis causing intrarenal failure

1 points


1. Janet is
admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak,
diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black
female who is awake, alert, and oriented, anxious, with moist skin and racing
pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate
are within normal limits. The patient admits to having a “thyroid condition”
but she never followed up on it when she was advised to see an endocrinologist.
The AGACNP anticipates a diagnosis of:

A. Hashimoto’s

B. Cushing’s

C. Grave’s

D. Addison’s

1 points


1. Systemic
lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can
prevent with a wide variety of manifestations. Which clinical triad should
prompt an evaluation for SLE?

A. Fever,
normal white count, elevated sedimentation rate

B. Hyperkalemia,
hyponatremia, low blood pressure

C. Leukocytosis,
hyperglycemia, hypokalemia

D. Joint
pain, rash, fever

1 points


1. A patient
presents with profound vertigo of acute onset yesterday. She can barely turn
her head without becoming very vertiginous; she is nauseous and just doesn’t
want to move. This morning when she tried to get out of bed she felt like she
was pushed back down. The vertigo is reproducible with cervical rotation. The
patient denies any hearing loss or tinnitus, she has no fever or other
symptoms. The AGACNP knows that the most helpful intervention will probably be:

A. Meclizine

B. Diazepam

C. Bed rest

D. Epley’s

1 points


1. Mrs.
Mireya is an 85-year-old female who is admitted for evaluation of acute mental
status change from the long term care facility. She is normally ambulatory and
participates in lots of facility activities. Today a nursing assistant found
her in her room, appearing confused and disconnected from her environment. When
she tried to get up she fell down. Her vital signs are stable excepting a blood
pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her
symptoms is:

A. Osteoarthritis

B. Drug or
alcohol toxicity

C. Hypotension

D. Urosepsis

1 points


1. A patient
with SIADH would be expected to demonstrate which pattern of laboratory

A. Serum Na+
119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality
of 900 mOsm/kg

B. Serum Na+
152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality
of 300 mOsm/kg

C. Serum Na+
121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality
of 850 mOsm/kg

D. Serum Na+
158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality
of 420 mOsm/kg

1 points


1. Sean is a
29-year-old male who presents to the emergency department for evaluation and
treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal
is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein
stain is applied to the lower eyelid, and a corneal abrasion ruled out but the
AGACNP notes a positive Seidel sign. This indicates:

A. Penetration
of the cornea with resultant aqueous leak

B. A rust
ring remnant due to metal foreign body

C. An
elevated intraocular pressure

D. Paradoxical
pupil dilation in response to light

1 points


1. Mrs.
Lowen is an 82-year-old female who comes to the emergency department for
evaluation of a fever of 102.9° F. She complains of a headache in the right
side of her temple and some right-sided jaw pain. A urinalysis, chest
radiograph, complete blood count (CBC) and 12-lead ECG are all
non-contributory. A comprehensive metabolic panel is significant only for a
slightly elevated BUN and creatinine. The AGACNP appreciates distinct right
temple tenderness to percussion. Which laboratory test is necessary to support
the suspected diagnosis?

A. An
erythrocyte sedimentation rate

B. A white
blood cell differential

C. Two sets
of blood cultures

D. Echocardiography

1 points


1. Ms.
Schiebel, a 31-year-old female who is brought to the emergency department by
police after being arrested for disruptive behavior in a public establishment.
The differential diagnosis includes drug and alcohol ingestion/toxicity,
central nervous system disease, severe trauma, and psychotic illness;
ultimately the alcohol and toxicology screen as well as head imaging are
negative. When considering psychotic illness, the AGACP knows that this is a
physiologic imbalance that typically involves an excess of:

A. Serotonin

B. Norepinephrine

C. Acetylcholine

D. Dopamine

1 points


1. Mr.
Lincoln is a 55-year-old male who was admitted for management of sepsis
secondary to pneumonia. He has declined rapidly, and today chest radiography
demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg.
In order to increase his oxygenation the AGACNP knows that which of the
following interventions is indicated?

A. Increased

B. Increased
respiratory rate

C. Increased
tidal volume

D. Increased

1 points


1. A
29-year-old female patient presents with a complaint of palpitations. Physical
examination reveals an essentially healthy female with no significant medical
history and no maintenance medications; the only thing she can report is that
she had a head cold a week or so ago. The vital signs include a blood pressure
of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a
temperature of 98.6° F. The only abnormal finding on physical examination is
diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers
which medication for symptom control?

A. Ibuprofen

B. Pseudoephedrine

C. Propranolol

D. Methimazole

1 points


1. Jennifer
is an 18-year-old homeless female who was found unresponsive. She was admitted
to the hospital for management of severe bleeding after a spontaneous abortion
escalated to a uterine hemorrhage. An underlying infection and dehydration were
corrected and nutritional supplements were started. Her volume status is
stable, morning labs were all within normal limits and she is to be discharged
today. When the AGACNP enters the room to prepare the patient for discharge,
she finds her agitated, pale, and diaphoretic with vital signs to include a
pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a
temperature is 97.9° F. The most appropriate action would be to:

A. Order a
CBC to assess for recurrent bleeding

B. Request
and abdominal CT to assess for bleeding

C. Evaluate
the patient for anxiety/panic attack

D. Prescribe
alprazolam 1 mg now

1 points


1. Physical
examination findings in a patient with pneumothorax is likely to reveal:

A. Increased
tactile fremitus

B. Low grade

C. Hyperresonance
to percussion

D. Egophany

1 points


1. Mr.
Parker brings his 73-year-old wife to a clinic appointment because he is
worried about her. She has a long history of hypertension and dyslipidemia, but
he says she has taken medication for years and everything has been OK. His
concern today is that for a long time she has been very forgetful, and he has
tried to help her by keeping a strict routine around the house. Over the past
few months, she just seems more and more forgetful, does not seem interested in
doing anything, and now seems to be forgetting how to do simple everyday tasks.
Yesterday she could not figure out which dollar bills to use at the store to
pay the cashier. The AGACNP knows Mrs. Parker should first be screened for:

A. Depression

B. A brain

C. Hypothyroidism

D. Adrenal

1 points


1. M.R. is a
40-year-old female who has a known history of peptic ulcer disease. She has
been admitted through the emergency room with a diagnosis of GI bleeding—she is
vomiting dark blood and had a nasogastric tube placed. When attached to low
intermittent suction it initially drained 400 cc of dark brown/black drainage,
but now it is starting to drain lighter red colored blood. The AGACNP knows
that immediate priorities of care include:

A. Ensuring
hemodynamic stability

B. Beginning
a parenteral proton pump inhibitor

C. Beginning
gastric lavage

D. Ordering
a gastrointestinal consult

1 points


1. C.L. is a
48-year-old female who presents complaining of activity intolerance. She is
usually very active and fit^. She jogs regularly and typically does 4-5 miles a
day. About a week ago she became so tired she had to stop, and lately she has
become aware of becoming easily fatigued while going up and down stairs. She
admits that she thinks she is beginning menopause—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?

A. Vitamin

B. Folate

C. Ferritin

D. Hemoglobin

1 points


1. Kevin H.
is a 61-year-old male who presents for treatment of profound anxiety. He has
been treated on and off for years—most recently he was taking escitalopram 20
mg p.o. daily, and although he does admit to some improvement, he still cannot
function appropriately thoughout the day. He has been counseled about poor work
performance and is concerned about losing his job, but he is just so worried
all of the time he cannot concentrate on work. The AGACNP knows that the most
appropriate action is to:

A. Increase
the dose of escitalopram to 40 mg daily

B. Refer
Kevin for a psychiatric consultation

C. Stop
escitalopram and begin venlafaxine

D. Discuss
therapeutic expectations with Kevin

1 points


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