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NR 571 MIDTERM EXAM NEWEST 2024 -2025 ACTUAL
EXAM COMPLETE 85 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
The AGACNP is called to see a patient who is ready for discharge after a carotid endarterectomy. The patient is altered and began complaining
of new headache this morning. The current vital signs are as follows:
heart rate (HR) 116 beats/min, blood pressure (BP) 170/90 mmHg, and temperature 99°F. What orders should the AGACNP give?A.Acetaminophen 650 mg orally now, and blood cultures × 2 obtained stat B.Diltiazem 15 mg intravenous (IV) push followed by continuous infusion at 5 mg/hr; titration to HR <90 beats/min C.Morphine 2 mg IV as needed for pain; acetaminophen 650 mg now D.Labetalol 20 mg IV push followed by continuous infusion titrated to
BP <160 mmHg - CORRECT ANSWER -Answer: D. Labetalol 20 mg
IV push followed by continuous infusion titrated to BP <160 mmHg The patient is demonstrating symptoms of cerebral hyperperfusion syndrome and requires prompt control of their hypertension. Labetalol IV push followed by a titratable infusion will allow correction of the hypertension and titration as needed. While acetaminophen may be given for headache, the patient's pain is part of a larger problem, which is cerebral hyperperfusion. The priority intervention is control of the hyperperfusion. Blood cultures are not indicated. Diltiazem is useful in controlling atrial fibrillation; it will not help address the primary problem for this patient. Beta blockers are a more appropriate choice. 1 / 4
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Morphine and acetaminophen may be used as secondary agents for this patient's pain; however, they will not address the underlying problem and may only mask the medical emergency that is unfolding. Control of the patient's BP is the priority.
When managing a cardiac arrest patient, which interventions should the AGACNP prioritize after achieving return of spontaneous circulation?A.Place endotracheal tube (ETT), obtain EKG, monitor, and optimize respiratory and hemodynamic parameters B.Transfer to higher level of care, initiate sedation, and consult cardiology C.Administer high-quality cardiopulmonary resuscitation (CPR) with an emphasis on quality of compressions and minimization of interruptions D.Call for help and assess the scene for safety - CORRECT ANSWER -
Answer: A. Place endotracheal tube (ETT), obtain EKG, monitor, and
optimize respiratory and hemodynamic parameters The stabilization phase occurs after return of spontaneous circulation (ROSC) is achieved. During this time, the ETT is placed, the EKG is obtained, and respiratory and hemodynamic parameters are monitored and optimized. Transfer to a higher level of care and obtaining expert consultation occur in the emergent activities phase following the stabilization phase. High-quality CPR is the primary goal in achieving ROSC. This occurs prior to the stabilization phase. Calling for help and securing the scene are the initial steps in performing advanced cardiac life support and occur before ROSC and the stabilization phase.
A 76-year-old female patient presents with a report of having "passed out." The event was preceded by a feeling of lightheadedness and a 2 / 4
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fluttering in the chest. What differential diagnosis is most consistent with this presentation?A.Vasovagal syncope B.Orthostatic hypotension C.Arrythmia
D.Seizure - CORRECT ANSWER -Answer: C. Arrythmia
Arrhythmogenic syncope may be preceded by palpitations, chest discomfort, diaphoresis, and a feeling of lightheadedness. Orthostatic hypotension uncommonly results in syncope and is preceded by a sudden change in position from sitting or lying to standing. Syncope that is preceded by an aura and that includes fecal or urinary incontinence is highly suspicious for a seizure. Vasovagal syncope is associated with noxious stimuli including fear, anxiety, or pain.
Which choice of therapeutics is most likely to be efficacious in treatment of symptoms associated with all types of cardiomyopathy?A.Diuretics, beta blockers, and calcium channel blockers B.Aspirin, statins, and beta blockers C.Nitrates, diuretics, and norepinephrine D.Aspirin, statins, and implantable defibrillator - CORRECT ANSWER -
Answer: A. Diuretics, beta blockers, and calcium channel blockers
Patients presenting with cardiomyopathy often present with heart failure (HF) symptoms and volume overload regardless of the type of cardiomyopathy. These symptoms are best treated with HF recommended medications, including diuretics to decrease volume overload and beta blockers and calcium channel blockers to decrease heart rate and increase time for ventricular filling. Aspirin and statins are 3 / 4
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not recommended to treat cardiomyopathy. While nitrates and diuretics may be useful in the treatment of volume overload in patients with cardiomyopathy, norepinephrine is an afterload-increasing agent and would likely worsen symptoms of HF in these patients. An implantable defibrillator may be indicated for some patients with cardiomyopathy who are at risk of sudden cardiac death, but it is not appropriate for all patients. Additionally, aspirin and statins are not indicated.
The AGACNP admits a patient who presents with fever, chills, and dyspnea. The patient notes that they recently recovered from COVID-19 viral infection. The AGACNP suspects myocarditis and knows the
definitive diagnosis is made by:
A.Transthoracic echocardiogram B.Myocardial biopsy C.Transesophageal echocardiogram D.Cardiac magnetic resonance imaging (MRI) - CORRECT ANSWER -
Answer: B. Myocardial biopsy
Myocardial biopsy confirms the diagnosis of myocarditis. The classic histological findings include lymphocytic infiltrates with myocyte necrosis, as described by the Dallas criteria. While myocardial biopsy is rarely done, it is the gold standard for diagnosis. Echocardiogram and cardiac MRI can contribute information to suggest myocarditis but cannot confirm the diagnosis.
The AGACNP admits a patient who presents with acute chest pain that is relieved by leaning forward. On physical exam, the patient is tachycardic and has a pericardial friction rub and normal lung sounds.The AGACNP suspects that the primary diagnosis is:
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