2018 NURS6550 Walden University Clinical Analysis Final Exam Study Guide With Answers (101 Solved Questions)

Name: 2018 NURS6550 Walden University Clinical Analysis Final Exam Study Guide With Answers (101 Solved Questions)
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Strengthen your knowledge with 2018 NURS6550 Walden University Clinical Analysis Final Exam Study Guide With Answers, a powerful study tool packed with real past exams.

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NURS 6 550 FIN AL E X AM – WALDE N UNIVE RS ITY
S UM ME R 2 018
QUESTION 1
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 includes:
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
QUESTION 2
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
thyroiditis
B
.
Cushing’s
syndrome
C
.
Grave’s disease
D
.
Addison’s disease
1 points
QUESTION 3
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
QUESTION 4
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
maneuvers
1 points
QUESTION 5
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
QUESTION 6
1. A patient with SIADH would be expected to demonstrate which pattern of laboratory
abnormalities?

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
QUESTION 7
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
QUESTION 8
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

QUESTION 9
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
.
Norepinephr
ine
C
.
Acetylcholin
e
D
.
Dopamine
1 points
QUESTION 1 0
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 FiO2
B
.
Increased
respiratory rate
C
.
Increased tidal
volume
D
.
Increased PEEP
1 points
QUESTION 1 1
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
.
Pseudoephed
rine

C
.
Propranolol
D
.
Methimazole
1 points
QUESTION 1 2
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
QUESTION 1 3
1. Physical examination findings in a patient with pneumothorax is likely to reveal:
A
.
Increased tactile
fremitus
B
.
Low grade temperature
C
.
Hyperresonance to
percussion
D
.
Egophany
1 points
QUESTION 1 4
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:

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A
.
Depression
B
.
A brain tumor
C
.
Hypothyroidism
D
.
Adrenal
dysfunction
1 points
QUESTION 1 5
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
QUESTION 1 6
1. A patient with sharp, stabbing chest pain directly over the precordium has a 12-lead
ECG that demonstrates concave ST-T wave elevations in leads II, III, avR, avL, avF, and all six
precordial leads. The AGACNP expects which physical finding?
A
.
A grade IV/VI systolic murmur with radiation
to the axilla
B
.
A split S2 that increases with inspiration
C
.
A pericardial friction rub
D
.
An S4 heart sound
1 points
QUESTION 1 7
1. J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC
reveals a macrocytic anemia with a Hgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of
19%. The AGACNP suspects which type of anemia?

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A
.
Iron deficiency
B
.
Sickle cell anemia
C
.
Pernicious anemia
D
.
Anemia of chronic
disease
1 points
QUESTION 1 8
1. Megan K. is a 21-year-old female who presents complaining of irritated eyes. She
says this happens a couple of times a year and this time it is really a problem. Both eyes are
itchy and red and she has a lot of stringy discharge, especially at the end of the day. Her
visual acuity is 20/25 OS, OD, and OU with her glasses on. Physical exam reveals injected
conjunctiva bilaterally but there is no photophobia. Pupils are equal, round, briskly reactive,
and accommodate. The AGACNP knows that immediate treatment should include ophthalmic
application of:
A
.
Steroids
B
.
Antihistam
ine
C
.
Antibiotic
D
.
Cycloplegi
c
1 points
QUESTION 1 9
1. Ellen is a 61-year-old female who presents with a chief complaint of neck pain. The
history of present illness reveals that Ellen felt as though a bug bit her behind the neck a few
days ago. A day or two later it started to hurt, and when she began to pick at it she felt
drainage come out. She is here now for evaluation. Physical exam reveals an 8 cm x 8 cm
draining abscess in the right post auricular region with posterior cervical lymphadenopathy.
Ellen has a temperature today of 101.9° F. The AGACNP knows that in addition to incision
and drainage of the abscess, effective management must include:
A
.
Systemic
antibiotics
B
.
Tetanus immune
globulin
C
.
Tetanus toxoid
D
.
Antipyretics

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1 points
QUESTION 2 0
1. A 13-year-old male presents with a chief complaint of ear drainage. The patient and
his mother both indicate that the patient has not had any pain or any systemic complaints,
but the pus-like discharge from the ear is very persistent. According to Mom they went to a
retail clinic two weeks ago and the patient was prescribed both oral antibiotics and ear
drops, but it didn’t help. Physical exam of the ear reveals a painless pinna; otoscope exam
reveals only a large amount of mucopurulent drainage—the tympanic membrane could not
be visualized. The AGACNP knows the diagnosis is most likely:
A
.
Acute otitis media
B
.
Acute otitis externa
C
.
Cholesteatoma
D
.
Otitis media with
effusion
1 points
QUESTION 2 1
1. A 71-year-old male patient with lung cancer is admitted for treatment of sepsis
related to his chemotherapy-induced immunosuppression. He seems to be improving from
an infectious perspective, but during today’s assessment the AGACNP appreciates coarse
rales in the lung fields, a blood pressure of 140-100 mm Hg, a bounding pulse, and trace
pretibial edema. The urine output via Foley catheter has only been 100 mL in the last 8
hours. Suspicious for syndrome of inappropriate antidiuretic hormone (SIADH), the AGACNP
orders a basic metabolic panel anticipating which of the following abnormalities?
A
.
Hypokalemi
a
B
.
Hypocalcem
ia
C
.
Hyponatrem
ia
D
.
Hypochlore
mia
1 points
QUESTION 2 2
1. A crescendo-decrescendo systolic murmur best appreciated at the second intercostal
space, right sternal border with radiation to the carotid artery is most likely an indicator of:
A
.
Aortic stenosis
B
.
Aortic
regurgitation

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C
.
Tricuspid stenosis
D
.
Tricuspid
regurgitation
1 points
QUESTION 2 3
1. The AGACNP knows that diagnostic findings consistent with rheumatoid arthritis
include:
A
.
Soft tissue swelling of the
metacarpals
B
.
Radiographic joint space
narrowing
C
.
Heberden’s nodes
D
.
Subungal hemorrhages
1 points
QUESTION 2 4
1. C.T. is a 39-year-old female who presents for evaluation of what she thinks is her
“rosacea acting up.” She has a history of acne rosacea and has medicated on and off for
years with tetracycline and topical metronidazole. Today however she presents with a
pronounced red/purple area on her left cheek extending to the nasal border. It is very warm
to the touch. The borders of the affected area are very well defined and raised. C.T. also has
a temperature of 100.7° F and a generalized headache. The AGACNP appreciates tender
submandibular and cervical lymphadenopathy. The likely diagnosis is:
A
.
Complex
rosacea
B
.
Cellulitis
C
.
Erysipelas
D
.
Allergic
reaction
1 points
QUESTION 2 5
1. Mr. Lopez is a 51-year-old male patient who is being treated for T2DM. His HgbA1c is
15.6% and initial management will include aggressive attempts for weight reduction as his
body mass index (BMI) is 45. He says he is unable to participate in any meaningful exercise
because he very often has back pain; he has had it for years and has tried all sort of over
the counter medicines with little relief. He describes it as a profound ache that occurs across
the lower part of his back bilaterally; it does not travel down either leg. The physical
inspection is normal, but he has significant paraspinal tenderness to palpation bilaterally. He

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cannot identify any injury or accident that preceded the pain. The history and physical exam
is noncontributory. The AGACP knows that the likely diagnosis is:
A
.
Lumbar
radiculopathy
B
.
Ankylosing
spondylitis
C
.
Lumbar sacral strain
D
.
Degenerative disk
disease
1 points
QUESTION 2 6
1. A patient presents with acute onset of vesicular lesions on her vulva. They are
surrounded by areas of redness and they hurt. The patient says that she has even more of
them now then she did when she woke up this morning. There is also inguinal
lymphadenopathy. The AGACNP is suspicious for:
A
.
Human papilloma
virus
B
.
Primary syphilis
C
.
Gonorrhea
D
.
Herpes simplex
virus
1 points
QUESTION 2 7
1. Classic radiographic features of osteoarthritis include:
A
.
Soft tissue
swelling
B
.
Joint deformity
C
.
Bone mineral
loss
D
.
Joint space
narrowing
1 points
QUESTION 2 8
1. Mrs. Sandoval is a 72-year-old female who presents with a chief complaint of
transient verbal confusion. She was speaking with her friend on the phone this morning
when she suddenly couldn’t get words out. Her friend went over to her home and found Mrs.
Sandoval awake, alert, and oriented, responding appropriately with non-verbal gestures, but

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University

Walden University

Subject

Nursing

2018 NURS6550 Walden University Clinical Analysis Final Exam Study Guide With Answers (101 Solved Questions)

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