Wonden met drains verzorgen
Uitwerkingen van verpleegtechnische handeling van de Prove2Move map, inclusief korte casus.
- Verzorgen van wonden met drains
LET OP! Het gaat hier om een korte uitwerking van een specifieke casus in eigen bewoording. Dit is geen samenvatting van de protocollen. Te gebruiken ter ondersteuning bij het aftoetsen.
Wonden met drains - Verpleegtechnishe Handelingen
Verpleegtechnische handelingen (Theorie) | MBO Verpleegkunde Niveau 4 | ThiemeMeulenhoff | Wonden met drains
Hoofdstukken 1: wetten, 6, 7 injecteren, 8 infuus en katheter, 16 soorten wonden, 17 drains
Samenvatting verpleegtechnisch handelen. Hoofdstukken 1 ,6 , 7, 8, 16 en 17 . Van de wet big tot wondzorg en drains. Een beknopte samenvatting voor goed resultaat
Samenvatting Verpleegtechnische handelingen, Verpleegkunde, Niveau 4, Deel B
Samenvatting Verpleegtechnische handelingen, Verpleegkunde, Niveau 4, Deel B
Hechting en drains, infuus inbrengen en vloeistof toedienen, Medicijnen toedienen per infuus en infuus verwijderen, bloedtransfusie
Oefentoets verpleegtechnische handelingen deel B
Oefentoets van verpleegtechnische handelingen deel B. Hoofdstuk 6, 7.5, 8, 8.6, 16, 17 en 33.
Wonden met hechtingen, bloedtransufsie, venapunctie, wonden met drains, infuusvloeistoffen
NR 293 Pharmacology Final Exam/ NR 293 Pharm Final (Latest): Camberlian
NR 293 Pharmacology Final Exam/ NR 293 Pharm Final (Latest): Camberlian
1. Name a dissociative drug that should be given with Ace to reduce rigidity and the eyes must be lubed.
2. Most commonly used inhalant anesthetic that is expelled through the lungs.
3. An anticholinergic pre-anesthetic drug that is used to slow down the heart rate and decreases salivation.
4. Known for its yellow color what is a phenothiazine tranquilizer that is also used as a pre-anesthetic?
5. Which sedative also goes by the name Rompum and causes 2nd degree heart block when used?
6. What is the anticonvulsant that is used for status epilepticus and an appetite stimulant? (Hint: Valium)
7. What is the anticonvulsant that could also cause liver problems when used?
8. Name the CNS stimulant that increase respiration. (Hint: Doxapram)
9. This drug reverses Xylazine and Amitraz.
10. This drug should be in an emergency kit in case the patient's heart has stopped or the patient undergoes anaphylactic shock.
11. Used for supraventricular fibrillation also known as the number one local anesthetic.
12. This drug is used to increase the contraction of the heart.
13. Name two ace-inhibitor drugs that lowers the blood pressure and dilates the blood vessels.
14. Which ace-inhibitor drug is the better choice when dealing with an animal that has kidney problems?
15. This drug is also used as a diuretic, it is used when an animal has Congestive heart failure. (Hint: Lasix)
16. When this drug is used in horses it relaxes the muscles, in dogs it can be used as an expectorant.
17. This drug is used when an animal has allergies or anxiety (behavior). (hint Generic name)
18. Helps to dilate the bronchial and also increases the heart rate, but it causes anxious activity in an animal.
19. This drug can be used as a pre-anesthetic but it is also used to block the cough reflexes when the dog has a dry cough. (Hint: Bordetella tracheobronchitis)
20. What is the drug that is used as a mucolytic but is also the antidote for tylenol toxicity?
21. This drug is initially used for urinary incontinence but it can also be used as a decongestant.
22. What is the drug that relieves vomiting and diarrhea and but it decreases the absorption of other drugs?
23. This drugs forms into a sticky paste and also binds with proteins.
24. An antiemetic that helps by speeding up gastric emptying.
25. This drug is a potent emetic
26. This drug is used to decrease HCL production also know as Tagamet
27. Used as a stool softener
28. Helps to decrease the urge to vomit also known as Cerenia
29. When an animal has diarrhea this is the number one drug to use, it is also efficient against Giardia.
30. When animals have a long estrus this drug is used to terminate the estrus. also know as Cystorelin
31. This hormone is used to maintain a pregnancy
32. It is best that pregnant women do not handle this drug, it can cause the corpus luteum to lyse.
33. Will stop an dog and cat from cycling, but also increases the risk of the animal to get a pyometra. Also known as Ovaban
34. Could cause bone marrow suppression and urinary incontinence but this drug is used to synch the estrus of animals.
35. This drug is the loop diuretic, which also is used with Congestive heart failure.
36. Which osmotic diuretic can be used to decrease cranial pressure caused by glaucoma and us usually given IV?
37. What cholinergic drug promotes the contraction of the bladder for an animal that has an Atonic bladder?
38. This drug treats diabetes insipidus
39. What is the drug that is used to stop bacteria growth and infections when an animal has a stone? This drug can cause the urine to become acidic.
40. This drug strengthens the urinary sphincter to stop a dog from dribbling urine.
41. What is the main functioning unit of the Kidney?
42. Usually used for systematic fungal infections such as Blasto and Histo given Iv but can be nephrotoxic.
43. What drug is used orally for antifungal but is hepatotoxic?
44. This oil or microil is antifungal and enhances absorption.
45. This drug is not absorbed well orally so must be used topically it is an antifungal drug.
46. This disinfectant kills Gram positive and Gram Negative viruses
47. Examples of this disinfectant are Bleach and Iodine. It gets gram positive and gram negative bacteria, fungi and viruses
48. What antiparasitic drug gets whips, rounds, hooks, and some tape worms?
49. Used to kill parasites, sarcoptic mange and ear mites
50. This antiparasitic drug mimics acetylcholine. It gets rounds and hook
51. Gets tapes
52. What is the anti parasitic drug that kills adult heartworms?
53. What is the antiparasitic that kills coccidia?
54. What anti-inflammatory drug is used for colic in horses and also causes some G.I problems? (Hint: Flunixin)
55. Taper animals off of this steroid in order to prevent addisons
56. This drug is used as a vehicle used to transport other drugs, wear gloves when using it.
57. Aspirin , Carprofen, Duramax, Manitor
58. A topical glucocorticoid
59. This is used to stop bleeding when an animals toe nail is cut too short. (caustic)
60. Topical Antifungal
61. Drains the fluid out of the tissue also known as Magna paste
62. This is a drying agent, astringent
63. What drug is used in glaucoma treatment? This drug miotic causes the eye to constrict
64. This is a dye used to check for corneal abrasions
65. Topical anesthetic for the eye
66. A mydriatic drug that dilates the pupil for eye exams
67. Used in glaucoma treatments, decreases aqueous humor
68. This is used to treat KCS and immune-mediated diseases
69. An antitumor antibiotic
70. Microorganisms lose virulence through attenuation but still provide immunity
71. Made from microbes that have been chemically killed
72. Made from live microorganisms may be fully virulent
73. Contains antibodies obtained from animals short lived protection
74. More than one antigen is present, less injections are required
75. Cidal, Beta lactam ring, side effects G.I and allergic reactions kills gram positive bacteria
76. Cidal, Kills gram positive and some gram negative. Nephrotoxic and ototoxic. Clindamycin and Gentamicin
77. Static, Don't give with milk, antacids, and iron. Broad spectrum treats blood parasites.
78. Cidal, kills gram positive and negative bacteria, don't use in growing animals (Baytril or Cipro)
79. This drug is similar to penicillin and has multiple generations given parenterally
80. Static, Broad spectrum drug, may cause KCS. SOme anti protozoal activity.
81. This is a muscle relaxant, it is spasmolytic, Used for animals with back problems
82. Treats muscle contractions, Paralytic agent.
83. Used for rumen atony is cows.
84. White, Given IV, Induction drug
NURS 6512 exam 3CA. 100% Done and Correct
• The opening of the cervix is referred to as the
b. pouch of Douglas.
c. cervical isthmus.
d. cervical os.
e. anterior fornix.
The uterus opens into the vagina at the cervical os.
REF: p. 419
• The vaginal mucosa of a woman of childbearing years should appear
a. transversely rugated.
b. moist and excoriated.
c. dry and papular.
d. smooth and pink.
e. moist with vertical ridges.
Between puberty and menopause, the vagina is transversely rugated; after menopause, it loses its rugation.
REF: p. 418
• The adnexa of the uterus are composed of the
a. corpus and cervix.
b. fallopian tubes and ovaries.
c. uterosacral and broad ligaments.
d. round ligaments and ovaries.
e. vagina and fundus.
The fallopian tubes and the ovaries are collectively referred to as the adnexa of the uterus.
REF: p. 419
• During ovulation, the cervical mucus becomes more
During ovulation the cervical mucus is increased and is stringy and elastic (spinnbarkeit)
REF: p. 421
• The pelvic joint that separates most appreciably during late pregnancy is the
b. symphysis pubis
e. sacrosciatic notch.
Of the four pelvic joints, the one that appreciably moves later in pregnancy is the symphysis pubis. The sacrosciatic notch is not a joint, and no changes occur.
REF: p. 423
• Pregnancy-related cervical changes include
a. flattening and lengthening.
b. thinning and reddening.
c. hardening and pallor.
d. shortening and reddening.
e. softening and bluish coloring.
During pregnancy, the cervix softens (Goodell sign) and then appears bluish (Chadwick sign).
REF: p. 423
• The conventional definition of menopause is
a. 3 months with no menses.
b. 1 year with no menses.
c. 6 months of progressively shorter menses.
d. 3 consecutive anovulatory cycles.
e. the cessation of ovulation.
Menopause is defined as 1 year without menses.
REF: p. 423
• Which systemic feature is related to the effects of menopause?
a. Increased intraabdominal fat deposition
b. Decreased LDL levels
c. Cold intolerant
d. Decreased cholesterol levels
e. Decreased risk of cardiovascular disease
Systemic effects of menopause include increased intraabdominal body fat, increased LDL and cholesterol levels, and hot flashes.
REF: p. 423
• Which factor is associated with an increased risk of cervical cancer?
b. Low parity
c. HPV vaccination
d. High socioeconomic status
e. Early parity
Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who were not pregnant until they were 25 years or older.
REF: p. 425
• The risk of ovarian cancer is increased by a history of
a. low-fat diet.
b. cigarette smoking.
c. age between 35 and 50 years.
d. thin body habitus.
There is a relationship between nulliparity and an increased risk of ovarian cancer. Although the risk increases with age, most ovarian cancers develop after menopause; half are found in women older than 63 years. The other choices have no relationship with ovarian cancer. REF: p. 425
• The form of gynecologic cancer that is increased in women who have taken tamoxifen is
e. perineal skin.
Tamoxifen is an antiestrogen drug that acts like an estrogen in the uterus.
REF: p. 426
• The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her daughter’s underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child’s
a. drug ingestion.
b. fluid intake.
c. risk for sexual abuse.
d. hormone responsiveness.
e. fat intake.
Vaginal discharge in a child could be related to a chemical irritation from soaps, lotions, or powders or to urinary tract infections. Concerned parents or children should be assessed for the risk of sexual abuse.
REF: p. 440
• When you enter the examination room of a patient who is scheduled for a pelvic examination, you note that she seems very anxious. You should
a. tell her that there is nothing to be afraid of.
b. try to determine the source of anxiety.
c. avoid eye contact.
d. proceed as though nothing is wrong.
e. reschedule for another time.
Most women do not have marked anxiety about a pelvic examination. If your patient does, you will need to find out why she is anxious before proceeding with the examination.
REF: p. 427
• The female patient should ideally be in which position for the pelvic examination?
Ideally, position the woman in a lithotomy position for a pelvic examination.
REF: p. 426
• During a pelvic examination, you ask the patient to perform the Valsalva maneuver while you observe for bulging and urinary incontinence, to test for the presence of
a. a cystocele.
b. a rectocele.
c. vaginal prolapse.
d. rectal prolapse.
e. hymenal remnants.
Asking the woman to bear down as you watch for anterior wall bulging and urinary incontinence is done to assess for the presence of a cystocele.
REF: p. 435
• When you plan to obtain cytologic studies, speculum introduction may be facilitated by
a. Valsalva maneuver.
b. lubrication with warm water.
c. use of plastic speculum.
d. opening the blades completely.
e. lubrication with gel.
It is generally thought that gel lubrication may interfere with cytologic studies; therefore, most clinicians lubricate the speculum with warm water.
REF: p. 431
• Which of the following findings indicates a possible gonococcal infection?
a. Vaginal prolapse
b. Discharge from urethra or Skene glands
c. Irregular urethral orifice in midline
d. Irregular vaginal edges at introitus
e. Bulging of anterior or posterior vaginal wall
When milking the Skene glands produces a discharge, it is most commonly a gonococcal infection.
REF: p. 441
• When performing a gynecologic exam, the examiner should change gloves after touching the patient’s
a. anal area.
b. Bartholin glands.
c. Skene glands.
Whenever the anal surface is touched, the examiner should change gloves to prevent bacterial cross-contamination to other genital areas.
REF: p. 430
• During digital examination of the vagina, the cervix is noted to be positioned posteriorly. Upon bimanual examination of this woman, you would expect to palpate a(n) _____ uterus.
d. laterally deviated
The position of the cervix correlates with the position of the uterus. A cervix that is pointing posteriorly indicates an anteverted uterus.
REF: p. 431
• The presence of cervical motion tenderness may indicate
c. pelvic inflammatory disease.
Painful cervical motion tenderness suggests a pelvic inflammatory disease or a ruptured tubal pregnancy. The cervix is expected to move 1 to 2 cm without discomfort under normal conditions.
REF: p. 436
• Which one of the following is a proper technique for use of a speculum during a vaginal examination?
a. Allow the labia to spread; insert the speculum slightly open.
b. Press the introitus upward; insert the closed speculum horizontally.
c. Press the introitus downward; insert the closed speculum obliquely.
d. Spread the labia; insert the closed speculum horizontally.
e. Insert one finger; insert the opened speculum.
Gently insert a finger of one hand to push the introitus down to relax the pubococcygeal muscle. Then hold the closed speculum with the other hand and insert the speculum past your finger obliquely.
REF: p. 430
• During a routine vaginal examination, you insert the speculum and visualize the cervix. The cervix projection into the vaginal vault is approximately 5 cm. Upon bimanual examination, you would expect to find the uterus
a. in the midline position.
b. in the retroverted position.
c. in the anteverted position.
d. deviated to the left or right.
e. in the retroflexed position.
Normally, the cervix protrudes into the vagina 1 to 3 cm. Longer projections suggest a pelvic or uterine mass. A pelvic mass would cause the uterus to be deviated to the right or left, but an anteverted, retroverted, or retroflexed uterus would still be in the midline regardless of its position. REF: p. 431
• Small, pale yellow, raised, and rounded areas are visualized on the surface of the cervix. You should
a. chart this as nabothian cysts.
b. chart this as a friable cervix.
c. obtain a viral culture.
d. test the pH of the cervical os.
e. chart this as an eroded cervix.
This describes nabothian cysts, which are retention cysts of the endocervical glands and are considered a normal variant. No further testing is warranted.
REF: p. 431
• An examiner rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
a. Gonococcal culture
b. Cytology smear
c. Haemophilus smear
d. Trichomonas smear
e. Fungal cultures
This describes the technique for obtaining a cytology Pap smear.
REF: p. 433
• When collecting specimens, which sample should be obtained first?
a. Chlamydia swab
b. Gonococcal culture
c. Pap smear
d. Wet mount
e. Potassium hydroxide prep
A Pap smear is performed first; then other tests for gonorrhea, Chlamydia, Trichomonas, bacterial vaginosis, or candidiasis are done. Pap smear results are affected by the presence of blood, and vaginal infections result in more friable tissues; therefore, the Pap smear should be done first.
REF: p. 433
• Dacron swabs are necessary when testing for which condition?
d. Bacterial vaginosis
DNA probe for gonorrhea and Chlamydia uses a Dacron swab because a wooden cotton-tipped applicator may interfere with the test results.
REF: p. 435
• The visualization of a large proportion of “clue cells” on your wet mount slide examination suggests
a. trichomonal infection.
b. bacterial vaginosis.
e. cervical cancer.
Clue cells are present in bacterial vaginosis. Hyphae are present in candidiasis, and flagella are present in trichomonal infection. Gonorrhea and cervical cancer cannot be identified on a wet mount.
REF: p. 435
• The presence of a fishy odor after dropping potassium hydroxide on a wet mount slide containing vaginal mucus suggests
a. bacterial vaginosis.
b. yeast infection.
c. chlamydial infection.
A positive “whiff test” suggests bacterial vaginosis.
REF: p. 435
• A fixed uterus may indicate
e. a normal finding.
The uterus should be mobile in the anteroposterior plane. A fixed uterus indicates adhesions.
REF: p. 437
• The assessment of which structure is not part of the bimanual examination?
The bimanual examination consists of assessing the cervix, uterus, adnexa, and ovaries.
REF: p. 435
• The rectovaginal examination is an important component of the total pelvic examination because it
a. is the most direct cervical examination route.
b. is a more comfortable examination for the posthysterectomy patient.
c. is an alternate source for cytology specimens.
d. allows the examiner to reach almost 2.5 cm higher into the pelvis.
e. provides better evaluation of the bladder.
The rectovaginal examination allows you to reach almost 2.5 cm higher into the pelvis to examine structures not reached with the bimanual examination. It is more uncomfortable for the patient and is not the source for cytology specimens or more complete evaluation of the bladder. REF: p. 438
• Prominent labia minora are a normal finding in
b. menopausal women.
d. pregnant women.
e. postmenopausal women.
Newborn genitalia findings are the result of maternal hormones. Both the labia majora and minora are swollen, with the minora often being more prominent.
REF: p. 439
• Swollen and bruised genitalia in a newborn are most likely related to
a. a breech delivery.
b. a congenital defect.
c. an infection.
d. maternal hormones.
e. an enlarged clitoris.
Although the genitalia of a newborn girl can be swollen because of maternal hormones, swelling and bruising are more likely from a breech delivery.
REF: p. 439
• The most common cause of a foul vaginal discharge in children is a(n)
b. foreign body.
d. ruptured hymen.
Foul vaginal discharge in a preschool child is most likely indicative of the presence of a foreign body.
REF: p. 441
• A 3-year-old girl is being seen because of a foul vaginal odor. To inspect the vagina vault, you should first
a. insert a pediatric vaginal speculum.
b. place your hand firmly against the labia and spread your fingers.
c. insert a cotton-tipped applicator and press down.
d. pull the labia anteriorly and slightly to the side.
e. place the child prone and in the fetal position.
Applying anterior labial traction allows the hymenal opening to become visible as well as the interior of the vagina, almost to the cervix. The presence of a foreign body will be visible with this maneuver.
REF: p. 440
• A mother brings her 8-year-old daughter to the clinic because the child says it hurts to urinate after she fell while riding her bicycle. Upon inspection, you find posterior vulvar and gross perineum bruising. These findings are consistent with
a. chronic masturbation.
b. congenital defects.
c. acute urinary tract infection.
d. sexual abuse.
A straddle injury from a bicycle seat is usually evident over the symphysis pubis; injuries resulting from sexual molestation are generally more posterior and may involve the perineum grossly.
REF: p. 441
• When a woman is not sexually active, cervical cancer screening should begin
a. at menarche.
b. by age 15 years.
c. by age 18 years.
d. by age 21 years.
e. by age 30 years.
Women who are not sexually active should have their first examination by the age of 21 years. Women under age 21 should not be tested.
REF: p. 437
• Softening of the uterine isthmus occurring between 6 and 8 weeks of pregnancy is the _____ sign.
Between the sixth and eighth weeks of pregnancy, the uterine isthmus softens, which is known as the Hegar sign.
REF: p. 443
• Fundal height to the level of the umbilicus normally occurs around week _____ of pregnancy.
At 20 weeks of gestation, the fundal height reaches the level of the umbilicus.
REF: p. 443
• During a pelvic examination for a postmenopausal woman, you would expect to assess
a. a wider and longer vaginal vault.
b. absence of vaginal wall rugation.
c. a nonpalpable cervical os.
d. a more mobile cervix.
e. palpable ovaries.
Expected findings in the pelvic examination for an older woman include a narrower and shorter vagina, absence of rugation, a less mobile cervix, and a palpable cervical os. The ovaries are rarely palpable because of atrophy.
REF: p. 423
• What accommodations should be used in the position of a hearing-impaired woman for a pelvic examination?
a. The patient should assume the “M” or “V” position.
b. The patient should be in the diamond-shaped position.
c. The head of the table should be elevated.
d. The lithotomy position with obstetric stirrups should be used.
e. The patient should be in the knee–chest position.
The woman with a hearing impairment will need to see the clinician or an interpreter during the examination; therefore, her head should be elevated.
REF: p. 449
• Asking the woman to close the introitus during a pelvic examination is a test for
c. cervical polyps.
d. muscle tone.
Test for muscle tone is to have the woman squeeze the vaginal opening around your finger. A rectocele can be seen as a bulge on the posterior wall. A cystocele will be seen as bulge on the anterior wall. Endometriosis is suggested with tender nodules along the uterosacral ligaments. Cervical polyps can be inspected without squeezing.
REF: p. 430
• Which of the following is a normal component of physiologic vaginitis seen on a wet mount?
a. Three to five white blood cells (WBCs)
b. Clue cells
c. Branching hyphae
e. Motile flagellates
Up to three to five WBCs on a wet mount are within normal limits.
REF: p. 457
• The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is
a. homogeneous and gray with a low pH.
b. scant and curdy with a low pH.
c. profuse and frothy with a high pH.
d. profuse and curdy with a low pH.
e. bloody and thin with a high pH.
Trichomonal infection produces a profuse, frothy discharge with a pH of 5 to 6.6 (normal is less than 4.5).
REF: p. 457
• A young, sexually active woman comes to the urgent care clinic complaining of suprapubic abdominal pain. She is afebrile with rebound tenderness to the right side. There is no dysuria or vaginal discharge or odor. A pelvic examination is done. She has pain with cervical motion, and you palpate a painful mass over the left adnexal area. Your prioritized action is to
a. swab for gonococcal infection and then dip her urine.
b. obtain a surgical consult immediately.
c. remove the foreign body.
d. dip her urine and then swab for Chlamydia.
e. diagnose ovarian cyst and schedule follow-up.
The presenting symptoms of a tubal pregnancy are a surgical emergency. The only diagnostic test should be a pregnancy test.
REF: p. 461
• A cervical polyp usually appears as a
a. grainy appearance at the ectocervical junction.
b. bright-red soft protrusion from the endocervical canal.
c. transverse or stellate scar.
d. hard granular surface at or near the os.
e. flesh-colored, firm protrusion at the cervical os.
Cervical polyps are bright red, soft, and fragile. They usually protrude from the endocervical canal.
REF: p. 431
• Mittelschmerz may occur in which phase of the menstrual cycle?
Mittelschmerz, lower abdominal pain associated with ovulation, may also be accompanied by tenderness on the side where ovulation took place that month REF: p. 437
• What breast structure drains milk from each lobe onto the surface of the nipple?
b. Lactiferous duct
c. Montgomery follicle
d. Tail of Spence
e. Coopers ligament
The lactiferous duct is the structure that drains milk from each lobe onto the surface of the nipple.
REF: p. 351
• The largest amount of glandular breast tissue lies in the
a. upper inner quadrant.
b. lower inner
c. tail of Spence.
d. upper outer quadrant.
e. lower outer.
The greatest amount of glandular tissue in the breast lies in the upper outer quadrant.
REF: p. 351
• For purposes of examination and communication of physical findings, the breast is divided into
a. halves (upper and lower).
b. thirds (left, middle, and right).
c. four quadrants plus a tail.
d. circles (six consecutive rings, each 1 inch farther away from nipple).
e. radial portions 1 through 6.
The breast is referenced according to five segments: four quadrants and a tail.
REF: p. 351
• Contraction of breast smooth muscle results in
a. benign breast lumps.
b. emptying of milk ducts.
c. nipple inversion.
d. nipple tenderness.
e. tension on the suspensory ligaments of Cooper.
Contraction of the breast smooth muscle, as a result of tactile, sensory, or autonomic stimuli, produces erection of the nipple and causes the milk ducts to empty.
REF: p. 351
• Montgomery tubercles are most prominent in the breasts of
b. patients with lung disease.
c. adolescent girls.
d. prepubertal girls.
e. pregnant women.
Montgomery tubercles undergo hypertrophy and become more prominent in the breast of pregnant and lactating women.
REF: p. 353
• Approximately 75% of women are menstruating by which Tanner stage of breast development?
a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4
e. Stage 5
About one fourth of women begin menstruation at stage 4. Approximately 75% are menstruating at stage 4, the stage at which the areola forms a second mound. Some 10% of young women do not begin to menstruate until stage 5.
REF: p. 352
• During pregnancy, which of the following changes normally occurs in the breasts because of the effects of luteal and placental hormones?
a. The amount of connective tissue increases.
b. Epithelial secretory activity decreases.
c. Alveoli increase in size and number.
d. Vascularization decreases.
e. Lactiferous ducts diminish.
Breast changes during pregnancy include lactiferous duct proliferation, an increase in alveoli and glandular tissue that displaces connective tissue, and an increase in mammary vascularization. As a result, the breasts are larger, softer, and looser with a blue venous network visible through the skin.
REF: p. 353
• Milk production usually begins during which period?
a. At conception
b. During the first trimester of pregnancy
c. During the second trimester of pregnancy
d. At delivery
e. 2 to 4 days after delivery
Colostrum secretion begins after delivery and then is replaced with milk production within 2 to 4 days.
REF: p. 353
• Which breast change is typical after menopause?
a. Thickening of the inframammary ridge
b. Hypertrophy of glandular tissue
c. Increase in number of lactiferous ducts
d. Reduction of fat deposits
e. Shortening of Cooper’s ligaments
After menopause, the breast tissue atrophies and is replaced by fat deposit, the inframammary ridge at the lower edge of the breast thickens, and the breast hangs more loosely as Cooper’s ligaments relax.
REF: p. 353
• In a woman complaining of a breast lump, it is most important to ask about
a. its relationship to menses.
b. weight gain.
c. sleep patterns.
d. immunization status.
e. alcohol consumption.
Hormonal changes of menstruation can result in breast tenderness, swelling, and enlarged nodes that can be felt on palpation.
REF: p. 363
• When conducting a clinical breast examination, the examiner should
a. forgo the examination if the patient has had a recent mammogram.
b. keep the patient covered to respect modesty.
c. dim the lights to minimize anxiety.
d. inspect both breasts simultaneously.
e. begin with palpation of the breasts.
Inspection with simultaneous observation of both breasts is essential in order to detect differences between the breast size, symmetry, contour, and skin color.
REF: p. 357
• A 50-year-old woman presents as a new patient. Which finding in her personal and social history would increase her risk profile for developing breast cancer?
a. Drinking three glasses of wine per week
b. Early menopause
d. Late menarche
e. Young age at birth of first child.
Nulliparity or late age at birth of first child (after 30 years old) is a risk factor for breast cancer. Other risk factors include late menopause, early menarche, and drinking more than one alcoholic drink daily.
REF: p. 354
• If your patient has nipple discharge, you will most likely need a
a. Vacutainer tube.
b. glass slide and fixative.
c. specimen jar with formaldehyde.
d. tape strip to test pH.
e. needle and syringe.
A glass slide and fixative is used for microscopic examination of the discharge to identify the cellular makeup of the discharge. The other options are not used for this purpose.
REF: p. 355
• To begin the clinical breast examination (CBE) for a man, ask him to
a. recline on the table with his arms overhead.
b. sit with his arms hanging at his sides.
c. sit with his hands on his hips.
d. stand with his arms clasped behind his back.
e. stand leaning forward.
Inspection begins the CBE. Ask the patient to sit with his arms hanging loosely at his sides. The technique is the same for both men and women.
REF: p. 355
• Inspection of the breasts usually begins with the patient in which position?
Inspection begins with the patient in a sitting position with arms hanging loosely at the sides.
REF: p. 355
• While examining a 30-year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should
a. note the finding in the patient’s record.
b. ask the patient if she has ever had breast cancer.
c. tell the patient to get a mammogram as soon as possible.
d. tell the patient to get a mammary sonogram as soon as possible.
e. tell the patient to stop caffeine intake.
Often one breast is slightly larger than the other. This is a normal variation, and no further intervention is required.
REF: p. 365
• Which finding, found on inspection, is related to fibrotic tissue changes that occur with breast carcinoma?
a. Convex or conical shape
b. Skin dimpling or retraction
c. Pendulous and loose breasts
d. Unequal shape or contour
e. Lifelong inverted nipple
Skin dimpling or retraction signifies the contraction of fibrotic tissue that occurs with carcinoma. The other choices are normal variations without significance to cancer development. REF: p. 356
• Venous patterns on breasts are suggestive of pathology when they are
a. bilaterally visible.
b. seen in obese patients.
d. observed during pregnancy.
e. associated with a long-standing unchanging nevus.
Malignant tumors require more blood flow. Superficial veins dilate to provide more flow and can be assessed as unilateral venous patterns. Bilateral findings are of no concern and are more commonly seen in pregnant or obese women. Nevi that are long-standing, unchanging, or nontender are of little concern.
REF: p. 356
• Which of the following is a common benign variation in the breasts of a pregnant woman?
a. Unilateral leakage of bloody fluid
b. Bilateral leakage of bloody fluid
c. Bilateral pronounced venous patterns
d. Reddened areas in the tail of Spence
e. Peau d’orange appearance
Bilateral venous patterns on the breast are commonly found in pregnant and obese women and are of no clinical concern. The other choices indicate either mastitis or breast cancer, which are not common findings.
REF: p. 364
• A 23-year-old white woman has come to the clinic because she has missed two menstrual periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to
a. instruct her that this is a side effect of birth control injection therapy.
b. suggest pregnancy testing.
c. question her use of tanning beds.
d. schedule an appointment with a surgeon.
e. recommend she remove caffeine from her diet.
In light-skinned women, pregnancy produces enlarged breasts with darker areolae. Hormonal injections, caffeine, and the use of tanning beds will not change the color of the areolae as pregnancy does. Surgical consultation is not necessary.
REF: p. 364
• In patients with breast cancer, peau d’orange skin is often first evident
a. in the axilla.
b. in the upper inner quadrant.
c. on or around the nipple.
d. at the inframammary ridge.
e. in the tail of Spence.
The areola is the most common initial site to visualize peau d’orange skin.
REF: p. 356
• A peppering of nontender, nonsuppurative Montgomery tubercles is considered to be a
a. normal finding.
b. sign of carcinoma.
c. skin disease.
d. symptom of malnutrition.
e. sign of late menarche.
Montgomery tubercles are the tiny bumps scattered around the areola and are regarded as an expected finding when they are nontender and have no purulent drainage.
REF: p. 356
• Which of the following is most likely to be a variation of minor consequence?
a. Bilateral nipple inversion
b. Fixed stonelike nodule
c. Serous nipple drainage
d. Unequal nipple axis
e. Paget disease of the breast
Bilateral nipple inversion to the same extent on both breasts in not a concern. The other choices are a result of cancer growth, affecting the surrounding tissue.
REF: p. 356
• Recent unilateral inversion of a previously everted nipple suggests
c. benign breast disease.
Recent unilateral inversion or retraction of a previously everted nipple suggests malignancy rather than a benign condition.
REF: p. 357
• Which condition is more common in African American women than in white women?
a. Light areolae
b. Nipple inversion
c. Retracted areolae
d. Supernumerary nipples
e. Nipple and areolar colors do not match.
The incidence of supernumerary nipples is higher in African American women than in white women.
REF: p. 357
• When palpating breast tissue, the examiner should use the _____ at each site.
b. finger pads
c. palms of the hands
d. ulnar surface of the hands
The finger pads are used for breast palpation because they are more sensitive than the fingertips.
REF: p. 361
• Documentation of a breast mass location is
a. according to illustration, without a narrative.
b. according to clock positions from the nipple.
c. measured with calipers from the nipple.
d. measured in centimeters from the sternal notch.
e. measured in centimeters from the axilla.
Documenting a breast mass is described according to clock positions and distance from the nipple, or according to quadrants of the breast. An illustration should appear in the medical record as well.
REF: p. 361
• If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient’s breast, you should
a. ask the patient if she has a history of breast cancer.
b. refer the patient for biopsy.
c. ask the patient to have a mammogram as soon as possible.
d. record the finding in the patient’s record.
e. tell the patient to stop drinking alcohol.
The inframammary ridge thickens and can be felt more easily with age. It is an expected, normal finding without indications for further action.
REF: p. 363
• During palpation of a 30-year-old woman’s breast, she complains that the procedure is painful. You suspect that this may be because she is
b. a heavy smoker.
e. an alcoholic.
Women’s breasts are more tender during the premenstrual and menstrual periods than during any other time of the menstrual cycle because hormone changes cause the breasts to swell and increase nodularity. Clinical breast examinations should be scheduled for 1 week after the start of the menstrual flow. REF: p. 363
• A 12-year-old boy is being seen because of right-sided breast tenderness. Your examination technique includes inspection and palpation with a finding of swelling and a palpable firm, mobile, pealike mass under the areola. Recommendations to the child and parent are to
a. apply an Ace wrap compression bandage for 6 hours a day.
b. return for evaluation in 6 months if the problem persists.
c. obtain a surgical referral for needle biopsy.
d. discontinue all contact sports.
e. administer urine screen for illicit drugs.
Many boys at puberty have unilateral or bilateral subareolar masses, resulting from hormonal changes. Most of these disappear in 6 to 12 months without further intervention. Reassurance to the young man that this is a common occurrence is essential.
REF: p. 363
• The tail of Spence extends
a. into the midclavicular region.
b. toward the supraclavicular area.
c. down into the inframammary ridge.
d. into the axillae.
e. along the sternal border.
The tail of Spence extends from the upper outer breast quadrant into the axillae.
REF: p. 351
• To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with
a. her arms straight alongside her body.
b. both arms overhead with her palms upward.
c. her hands clasped just above her umbilicus.
d. one arm overhead and a pillow under her shoulder.
e. both hands pressed against her hips.
Breast tissue is spread more evenly across the chest wall when the patient raises one arm overhead with a small pillow or rolled towel under that shoulder.
REF: p. 360
• Palpation of the nipple is done by
a. depressing it behind the areola.
b. pressing it against the rib cage.
c. pulling it outward and releasing it.
d. rolling it in a clockwise motion.
e. inverting the nipple.
At the completion of the examination, return to the nipple and with two fingers gently depress the tissue inward into the well behind the areola. Your fingers and tissue should move easily inward, nipple compression to evoke discharge is no longer part of the clinical breast examination.
REF: p. 361
• When examining axillary lymph nodes, the patient’s arm is
a. raised full above the head.
b. extended at the side.
c. pressed against the hip.
d. crossed over the chest.
e. flexed at the elbow.
To examine the axilla, support the patient’s lower arm with the elbow flexed with one of your hands and use your other hand to palpate the axilla.
REF: p. 360
• Lymphatic flow of the breast primarily drains
a. inferiorly toward the abdomen.
b. laterally toward the corresponding arm.
d. medially toward the sternum.
e. inferomedially toward the xiphoid.
Each breast contains a lymphatic network that drains the breast radially and deeply to underlying lymphatics.
REF: p. 352
• The greatest concern for breast cancer is when you palpate _____ nodes.
a. anterior cervical
e. internal mammary
The supraclavicular and infraclavicular nodal areas are sentinel nodes; any enlargement in these areas is especially significant.
REF: p. 360
• You are performing a clinical breast examination for a 55-year-old woman. While palpating the supraclavicular area, you suspect that you felt a node. To improve your hooked technique, you should
a. apply lotion to your hands.
b. use both hands simultaneously.
c. ask the patient to press both palms together.
d. ask the patient to lower her shoulder on that side.
e. ask the patient to turn her head toward that side.
Having the patient turn her head toward the examination side, as well as raising the shoulder on that same side, gives your fingers more room to palpate deeper into the fossa.
REF: p. 360
• The mother of a newborn boy tells you that her baby’s breasts are swollen and sometimes look as if they are leaking milk. It is most appropriate to tell her that the
a. enlargement and leaking are caused by maternal hormones and will likely resolve without treatment.
b. infant may have a congenital heart defect.
c. infant may need genetic testing.
d. infant needs ultrasonography of the breasts to exclude a pathologic cause.
e. infant may have mastitis.
Maternal passive transfer of estrogen to the infant can result in enlarged breasts of the newborn. Squeezed gently, the breast can excrete a small amount of clear or milky white fluid. This condition resolves spontaneously within 2 weeks and rarely lasts beyond 3 months.
REF: p. 363
• Male gynecomastia associated with illicit or prescription drug use can be expected to
a. lessen when the body becomes accustomed to the drug.
b. resolve after the drug is discontinued.
c. leave permanent breast enlargement when the drug is discontinued.
d. cause purulent drainage if left untreated.
e. lead to an increased risk of breast cancer.
Gynecomastia associated with illicit or prescription drug use (antihypertensive, estrogens, or steroids) usually resolves after the offending drug is discontinued and does not require further intervention.
REF: p. 364
• A nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic breasts bilaterally. You should advise the patient to
a. massage gently and continue nursing.
b. apply warm compresses and stop nursing.
c. monitor her temperature and restrict fluids.
d. sleep with a bra and wash her breasts with antibacterial soap.
e. stop nursing and restrict fluids.
This patient has engorged breasts. The aim of treatment is to promote breast drainage. Stopping nursing will increase the risk that a breast infection will turn into a breast abscess. The other choices do not encourage breast milk flow. Only mild soaps are advised; harsh soaps can dry and crack the nipple and compound infection.
REF: p. 365
• You are conducting a clinical breast examination for a 30-year-old patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with
b. Paget disease.
d. mammary duct ectasia.
e. fibrocystic changes.
Fibrocystic changes are tender masses, usually bilateral, with multiple round, mobile, well-delineated borders. Fibroadenoma and cancer are usually nontender; Paget disease is an eczema-like condition of the nipple that signals an underlying cancer. Mammary duct ectasia most commonly occurs in menopausal women.
REF: p. 365
• Your patient is a nursing mother who asks you to look at a mole she has under her left breast at the inframammary fold. The mole is nontender and soft and has grown in size since she started nursing. There are no other changes to the mole. This mole probably represents an undiagnosed
a. retention cyst.
b. case of Paget disease.
c. supernumerary nipple.
d. fat necrosis.
e. Montgomery tubercle.
Supernumerary nipples appear as one or more extra nipples located along the embryonic mammary ridge (the “milk line”). These nipples and areolae may be pink or brown, are usually small, and are commonly mistaken for moles. Infrequently, some glandular tissue may accompany these nipples.
REF: p. 357
• The sensitivity of clinical breast exam (CBE) in detecting breast cancer ranges from
a. 10% to 20%.
b. 20% to 39%.
c. 40% to 69%.
d. 70% to 89%.
e. 88% to 99%.
The sensitivity of CBE in detecting breast cancer ranges from 40% to 69%, and the specificity ranges from 88% to 99%. The sensitivity of the CBE combined with mammography is greater than that of mammography alone because CBE can detect cancer missed by mammography.
REF: p. 358
• The structure that carries oxygenated blood to the body from the left ventricle is the
b. pulmonary artery.
c. pulmonary vein.
d. superior vena cava.
e. inferior vena cava.
The aorta carries oxygenated blood from the left ventricle to the body. The pulmonary artery carries deoxygenated blood from the right side of the heart to the lungs. The pulmonary vein carries oxygenated blood from the lungs to the left side of the heart. The superior and inferior venae cavae carry blood from the upper and lower body to the right atrium.
REF: p. 332
• The arterial pulse is produced by
a. atrial contraction.
b. ventricular systole.
c. peripheral vascular resistance.
d. diastolic pressure.
e. atrial relaxation.
Arterial pulses are palpable and at times visible during ventricular systole. During this time, the left ventricle contracts, pushing blood from the heart to the body. Atrial contraction pushes blood into the ventricles. Diastolic pressure is the force exerted against the wall of the artery when the heart is in the filling or relaxed state. Diastolic pressure is the function of peripheral vascular resistance.
REF: p. 336
• The characteristics of arterial pulses are directly affected by all of the following except
a. the volume of blood ejected.
b. peripheral arterial resistance.
c. venous valvular competence.
d. blood viscosity.
e. distensibility of aorta.
Arterial pulses are affected by stroke volume (volume of blood ejected), distensibility of the aorta and large arteries, viscosity of the blood, and peripheral arteriolar resistance. Venous valvular competence contributes to the venous blood flow back to the heart.
REF: p. 336
• The level at which the jugular venous pulse is visible gives an indication of
a. mitral valve efficiency.
b. aortic valve efficiency.
c. stroke volume.
d. left ventricular pressure.
e. right atrial pressure.
The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.
REF: p. 336
• The most prominent component of the jugular venous pulse is the
a. a wave.
b. c wave.
c. v wave.
d. x slope.
e. y slope.
The a wave is the first and most prominent component of the jugular venous pulse. The a wave represents a brief backflow of blood into the vena cava during right atrial contraction.
REF: p. 336
• In newborn infants, closure of the ductus arteriosus usually occurs
a. before the initiation of labor.
b. 12 to 14 hours after birth.
c. after 7 days of life.
d. between the second and third month.
e. during the toddler period.
The ductus arteriosus closes usually within the first 12 to 14 hours of life.
REF: p. 337
• Blood pressure normally decreases during what period?
b. First trimester of pregnancy
c. Second trimester of pregnancy
d. Third trimester of pregnancy
e. During labor and delivery
Blood pressure reaches its lowest during the second trimester. During the third trimester, hypotension most often occurs when the patient is lying in the supine position.
REF: p. 337
• During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings
a. are usual conditions during pregnancy.
b. indicate a need for hospitalization.
c. indicate the need for amniocentesis.
d. suggest that she is having twins.
e. suggest that she never lie on her side.
Explain to the patient that these are usual conditions during pregnancy. Blood in the lower extremities tends to pool in later pregnancy because of the occlusion of the pelvic veins and inferior vena cava from pressure created by the enlarged uterus. The occlusion results in an increase in dependent edema, varicosities of the legs and vulva, and hemorrhoids. Lying in the lateral recumbent position may help relieve some her symptoms. REF: p. 337
• Vascular changes expected in older adults include
a. loss of vessel elasticity.
b. decreased peripheral resistance.
c. decreased pulse pressure.
d. constriction of the aorta and major bronchi.
e. increased vasomotor tone.
With age, the walls of the arteries become calcified, and they lose their elasticity and vasomotor tone; therefore, they lose their ability to respond appropriately to changing body needs. Increased peripheral vascular resistance occurs, causing an increase in blood pressure.
REF: p. 337
• The amplitude of pulses is recorded on a(n)
a. Likert scale of absent to bounding.
b. numerical scale of 0 to 4.
c. alphabetic scale of A to E.
d. descriptive scale of mild, moderate, and severe.
e. graded scale of I to VI.
The amplitude of pulses is recorded on a numeric scale of 0 to 4: 0 is absent, not palpable; 1 is diminished, barely palpable; 2 is expected finding; 3 is full, increased; and 4 is bounding.
REF: p. 340
• Which of the following statements is true regarding the examination of peripheral arteries?
a. The thumb should never be used to assess pulses.
b. Palpate at least one pulse in each extremity, usually the most proximal one.
c. The pulses are most readily felt over arteries that lie over bones.
d. Extremity pulses do not normally generate waveforms.
e. The pads of the fourth and fifth digits of the examiner’s hands are the most sensitive.
The pulses are best palpated over arteries that are close to the surface of the body and lie over bones. The arterial pulses with the digital pads of the second and third fingers. The thumb may also be used if vessels have a tendency to move or roll when palpated by the fingers. Palpate at least one pulse, the most distal pulse, in each extremity to determine the sufficiency of the arterial circulation. Arterial pulses have contour (waveform).
REF: p. 338
• Which arterial pulse is most useful in evaluating heart activity?
Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.
REF: p. 338
• A pulsation that is diminished to the point of being barely palpable would be graded as
A pulse that is diminished and barely palpable would be graded as a 1 on a scale of 0 to 4.
REF: p. 340
• The term claudication refers to
a. pain from muscle ischemia.
b. lack of palpable pulsations.
c. visible extremity changes of arterial occlusion.
d. numbness and tingling in toes and fingers.
e. constriction or narrowing of a vessel.
Claudication is known as pain that results from muscle ischemia. This pain is described as a dull ache with muscle fatigue and can often be accompanied by cramping. It is brought on by sustained exercise and relieved by rest. Individuals with peripheral artery disease experience claudication because of a decrease in the amount of blood passing through the artery as a result of atherosclerosis, which cause the arteries to become narrow. Risk factors for claudication are hypertension, smoking, hyperlipidemia, diabetes, and old age. REF: p. 340
• Conduction system impairment should be suspected if an irregular heartbeat is
A patternless, unpredictable, irregular rate may indicate heart disease or conduction system impairment. A gallop is an abnormal regular heart rhythm with three sounds in each cycle resembling the gallop of a horse. Amplitude of the paradoxical pulse decreases on inspiration.
REF: p. 340
• In which location would carotid bruits best be heard?
a. Posterior cervical triangle
b. Anterior margin of the sternocleidomastoid muscle
c. Over the aortic valve
d. At the angle of the mandible
e. Just anterior to the ear
Carotid artery bruits are best heard at the anterior margin of the sternocleidomastoid muscle.
REF: p. 342
• You are examining Mr. S., a 79-year-old man with diabetes who is complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial insufficiency?
a. Thick, calloused skin
b. Ruddy, thin skin
c. Warmer temperature of extremity in contrast to other body parts
d. Thin atrophied skin
e. Full superficial veins with rapid filling
An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area. There may be collapsed superficial veins with delayed filling.
REF: p. 340
• A sound similar to a murmur that is heard over arteries is a
c. friction rub.
A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.
REF: p. 340
• In differentiating between an occluded artery or vein, a differentiating sign (present in venous but not arterial occlusion) is
a. color change.
c. pain with walking.
d. pain with palpation.
Deep vein thrombosis is suspected if swelling, pain, and tenderness occur over a vein. An occluded artery does not cause any swelling (edema). A positive Homan sign indicates venous thrombosis. Paralysis is a rare complication of arterial occlusion.
REF: p. 344
• To assess a patient’s jugular veins, he or she should first be placed in which position?
d. Left lateral recumbent
e. Leaning forward
To assess jugular veins, place the patient in supine position. This causes engorgement of the jugular veins. Then gradually raise the head of the bed until the jugular vein pulsating becomes visible between the angle of the jaw and the clavicle. Jugular veins cannot be palpated.
REF: p. 342
• Observation of hand veins can facilitate assessment of
a. mitral valve competency.
b. stoke volume.
c. right heart pressure.
d. pulse pressure.
e. left heart pressure.
Hand veins can be used as an auxiliary manometer of right heart pressure. Assess the hand veins while the hand is at the patient’s side. Then raise the hand until the veins collapse, and then use a ruler to measure the vertical distance between the mid-axillary line (level of the heart) and the level of the collapsed hand veins. REF: p. 343
• You are assessing Mr. Z.’s fluid volume status as a result of heart failure. If your finger depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as
a. 1 .
b. 2 .
c. 3 .
d. 4 .
e. 5 .
Pitting edema to 6 mm represents a 3 rating. This edema is noticeably deep and may last more than 1 minute; the dependent extremity looks fuller and swollen. Edema is graded on a scale of mild (1 ) through worse (4 ).
REF: . p344
• If pitting edema is unilateral, you would suspect occlusion of a
a. lymphatic duct.
b. major vein.
c. surface capillary.
d. superficial artery.
e. deep artery.
If edema is unilateral, you should suspect the occlusion of a major vein. If edema is bilateral, consider congestive heart failure. If edema occurs without pitting, suspect arterial disease and occlusion or lymphedema.
REF: p. 344
• Thrombosis of a leg vein should be suspected if the patient feels calf pain
a. after running a short distance.
b. on dorsiflexion of the foot.
c. on extending a flexed thigh.
d. while wearing high-heeled shoes.
e. flexing the knee.
Suspect deep vein thrombosis if calf pain occurs with dorsiflexion of the foot. The maneuver is referred to as a positive Homan sign.
REF: p. 344
• Which of the following statements is most accurate in describing hepatic jugular reflux?
a. It is an accurate indicator of heart failure.
b. It is exaggerated in patients with right heart failure.
c. It is normal when patients are sitting up straight.
d. It should be absent in older patients with heart failure.
e. It never elevates the jugular venous pressure (JVP) in patients without heart failure.
Hepatojugular reflux is used to evaluate right heart failure and is exaggerated when right heart failure is present. All patients will have elevation of the JVP with this maneuver, depending on the elevation of their head and their underlying venous pressure. Use your hand and apply firm pressure to the abdomen in the mid-epigastric region while the patient breathes regularly. Observe the neck for increased JVP followed by an abrupt fall in JVP when the hand pressure is released. The JVP quickly returns to its true level between the abdominal hand pressure and the release of the abdominal hand pressure. REF: p. 343
• You are performing jugular venous pressure measurement for your patient in heart failure. You see a pulse wave with the patient’s head elevated at a 45-degree angle. Your action as a result of this assessment is to
a. record this measurement as less than 9 cm H2O pressure.
b. record this measurement as more than 9 cm H2O pressure.
c. confirm that the pulsations decrease with inspirations.
d. confirm that the pulsations increase with inspirations.
e. place the patient in the supine position and recheck.
Confirmation of assessing venous pressure rather than a carotid wave pulse is necessary. Jugular venous pulse will decrease on inspiration and increases on expiration, but the carotid pulse will not be affected.
REF: p. 343
• A bounding pulse in an infant may be associated with
a. patent ductus arteriosus.
b. coarctation of the aorta.
c. decreased cardiac output.
d. peripheral vaso-occlusion.
e. painful, swollen extremities.
A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities or between femoral and radial pulses and absence of the femoral pulse suggests a coarctation of the aorta. Painful, swollen extremities are usually a sign of venous occlusion. REF: p. 345
• In infants or small children, a capillary refill time of 4 seconds
a. is normal.
b. indicates hypervolemia.
c. indicates dehydration or hypovolemic shock.
d. indicates renal artery stenosis.
e. indicates venous occlusion.
Capillary refill time represents the time it takes the capillary bed to refill after being occluded by pressure to the nail bed for several seconds. Observe the time it takes for the nail to regain its full color, which should be less than 2 seconds for an intact system. The capillary refill will be greater than 2 seconds during arterial occlusion, hypovolemic shock, hypothermia, and dehydration.
REF: p. 345
• A venous hum heard over the internal jugular vein of a child
a. usually signifies untreatable illness.
b. usually has no pathologic significance.
c. usually requires surgical intervention.
d. must be monitored until the child is grown.
e. usually indicates dehydration.
A venous hum is caused by the turbulence of blood flow in the internal jugular veins. A venous hum is common in children and usually has no pathologic significance. To detect a venous hum, auscultate over the right supraclavicular space at the medial end of the clavicle and along the anterior border of the sternocleidomastoid muscle. It is louder during diastole. REF: p. 345
• In pregnancy, blood pressure is lowest
a. at conception.
b. during the first trimester.
c. during the second trimester.
d. during the third trimester.
e. at the time of delivery.
The lowest levels occur in the second trimester and then rise but still remain below prepregnancy levels.
REF: p. 337
• An idiopathic spasm of arterioles in the digits is called
a. arteriosclerosis obliterans.
b. giant cell arteritis.
c. arteriovenous fistula.
d. peripheral arterial aneurysm.
e. Raynaud disease.
Raynaud phenomenon is an idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is the occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects arteries of the carotid, temporal, and occipital arteries. Arteriovenous fistula is a pathologic communication between an artery and a vein. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. They occur in the aorta, renal, femoral, and popliteal arteries. REF: p. 347
• A major risk factor for arterial embolic disease is
a. venous thrombosis.
b. atrial fibrillation.
d. diuretic therapy.
e. constrictive pericarditis.
Atrial fibrillation results in a disturbance of blood flow through the atrium. Blood is not pumped out completely, so it may pool and clot. An embolus can travel throughout the arterial system, causing an occlusion of small arteries and leading to necrosis of the tissue. REF: p. 347
• In children, coarctation of the aorta should be suspected if you detect
a. a delay between the radial and femoral pulses.
b. a simultaneous radial and femoral pulse.
c. an absent femoral pulse on the left.
d. bilateral absence of femoral pulses.
e. equal blood pressures in the arms and legs.
Coarctation of the aorta is a congenital stenosis or narrowing seen most commonly in the descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum. Ordinarily, the radial and femoral pulses are palpated simultaneously. When there is a delay or a palpable diminution of amplitude of the femoral pulse, coarctation must be suspected. Differences in blood pressure taken in the arms and legs should confirm the suspicion. REF: p. 348
• Kawasaki disease is suspected when assessments of a child reveal
a. conjunctival injection, strawberry tongue, and edema of the hands and feet.
b. conjunctival infection, lymphadenopathy, and a vesicular rash.
c. low-grade fever, strawberry tongue, and edema of the hands and feet.
d. dermatomal bullae rash, high fever, and cyanotic hands and feet.
e. recent streptococcal pharyngitis, vesicular rash, and geographic tongue.
Kawasaki disease is an acute small vessel vasculitic illness of uncertain cause affecting young males more often than females. Findings may include fever, conjunctival injection, strawberry tongue, and edema of the hands and feet. Findings may also include lymphadenopathy and polymorphous nonvesicular rashes.
REF: p. 349
• Cranial Nerves (1-6)
• Cranial Nerves (7-12)
8. Vestbulocochlear (Auditory)
• CN I - Olfactory Assessment
Test patient's ability to smell (coffee, vanilla, peppermint).
• CN II - Optic Assessment
o Snellen eye Chart
o Examine visual fields
• CN III, IV, VI Oculomotor, Trochlear, Abducens
o pupil size, shape, ptosis
o Shine light from side to gauge pupils reaction to light.
o EOM exam
o Convergence and accomodation
• CN V - Trigeminal
o Corneal reflex
o look for blink in both eyes
o facial sensation
o Motor - pt opens mouth, clenches teeth
• CN VII - Facial
o Facial droop
o pt looks up and wrinkles forehead
o pt shuts eyes tightly, compare each side
o frown, show teeth, puff out cheeks
• CN VIII - Vestibulocochlear (hearing)
o ask patient if they can hear you rubbing your fingers together
o Weber's Test
o Rinne's Test
• CN IX, X: Glossopharyngeal, Vagus
o Voice: hoarse or nasal.
o Pt. swallows, coughs (bovine cough: recurrent laryngeal).
o Examine palate for uvular displacement. (unilateral lesion: uvula drawn to normal side).
o Pt says "Ah": symmetrical soft palate movement.
o Gag reflex [sensory IX, motor X]:
o • Stimulate back of throat each side.
o • Normal to gag each time.
• CN XI: Accessory
o From behind, examine for trapezius atrophy, asymmetry.
o Pt. shrugs shoulders (trapezius).
o Pt. turns head against resistance: watch, palpate SCM on opposite side.
• CN XII: Hypoglossal
o Listen to articulation.
o Inspect tongue in mouth for wasting, fasciculations.
o Protrude tongue: unilateral deviates to affected side.
• The autonomic nervous system coordinates which of the following?
a. High-level cognitive function
b. Balance and affect
c. Internal organs of the body
d. Balance and equilibrium
e. Emotions and behavior
The autonomic nervous system coordinates the internal organs of the body by the sympathetic and parasympathetic nervous systems. The other options are associated with the cerebral cortex, whose function consists of determining intelligence, personality, and motor function. REF: p. 544
• A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the
c. linea alba.
The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover.
REF: p. 370
• What part of the small intestine forms a C-shaped curve around the head of the pancreas?
d. Falciform ligament
The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine.
REF: p. 372
• Peristalsis of intestinal contents is under the control of
a. cognitive processes.
c. the autonomic nervous system.
d. the fluid content of the stomach.
The movement of food and digestive products is regulated by the autonomic nervous system.
REF: p. 372
• The esophagus travels a route from
a. anterior to the trachea through the mediastinal cavity.
b. lateral to the trachea through the diaphragm.
c. left of the trachea through the peritoneum.
d. the anterior trachea through the cardiac orifice.
e. behind the trachea through the mediastinal cavity.
The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters into the stomach. The esophagus connects the pharynx to the stomach.
REF: p. 372
• Which organ is part of the alimentary tract?
The term alimentary tract refers to the continuous tract from the mouth, esophagus, stomach, small intestine, large intestine, and anus.
REF: p. 372
NURS 6560 Midterm Exam (2018): Walden University
NURS 6560-Midterm Exam (2018): Advanced Practice Care of Adults in Acute Care Settings: Walden University
S. is a 59-year-old female who has been followed for several years for aortic regurgitation. Serial echocardiography has demonstrated normal ventricular function, but the patient was lost to follow-up for the last 16 months and now presents complaining of activity intolerance and weight gain. Physical examination reveals a grade IV/VI diastolic aortic murmur and 2 lower extremity edema to the midcalf. The AGACNP considers which of the following as the most appropriate management strategy?
A. Serial echocardiography every 6 months
B. Begin a calcium channel antagonist
C. Begin an angiotensin converting enzyme (ACE) inhibitor
D. Surgical consultation and intervention
An ascending thoracic aneurysm of > 5.5 cm is universally considered an indication for surgical repair, given the poor outcomes with sudden rupture. Regardless of the aneurysm’s size, all of the following are additional indications for immediate operation except:
A. Comorbid Marfan’s syndrome
B. Enlargement of > 1 cm since diagnosis
C. Crushing chest pain
D. History of giant cell arteritis
Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat pain, and a temperature of 102.1°F. She appears ill and has foul breath. In order to evaluate for a deep neck space infection, the AGACNP orders:
A. Anteroposterior neck radiography
B. CT scan of the neck
C. White blood cell (WBC) differential
D. Aspiration and culture of fluid
Mr. Draper is a 39-year-old male recovering from an extended abdominal procedure. As a result of a serious motor vehicle accident, he has had repair of a small bowel perforation, splenectomy, and repair of a hepatic laceration. He will be on total parenteral nutrition postoperatively. The AGACNP recognizes that the most common complications of parenteral nutrition are a consequence of:
A. Poorly calculated solution
B. Resultant diarrhea and volume contraction
C. The central venous line used for infusion
D. Bowel disuse and hypomotility
Mr. Mettenberger is being discharged following his hospitalization for reexpansion of his second spontaneous pneumothorax this year. He has stopped smoking and does not appear to have any overt risk factors. While doing his discharge teaching, the AGACNP advises Mr. Mettenberger that his current risk for another pneumothorax is:
A. < 10%
D. > 90
One of the earliest findings for a patient in hypovolemic shock is:
A. A drop in systolic blood pressure (SBP) < 10 mm Hg for > 1 minute when sitting up
B. A change in mental status
C. SaO2 of < 88%
D. Hemoglobin and hematocrit (H&H) < 9 g/dL and 27%
Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more chronic form are most likely to be present with:
A. Respiratory insufficiency
C. Bowel obstruction
The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus. Initially the patient was stable, awake, alert, and oriented, but during the last several hours the patient has become increasingly lethargic. At change of shift, the oncoming staff nurse appreciates a profound change in the patient’s mental status from the day before. Vital signs and hemodynamic parameters are as follows: BP 88/54 mm Hg Pulse 110 bpm Respiratory rate 22 breaths per minute SaO2 93% on a 50% mask Systemic vascular resistance (SVR) 1600 dynes ∙ sec/cm5 Cardiac index 1.3 L/min Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most consistent with which shock state?
When counseling patients to prevent postoperative pulmonary complications, the AGACNP knows that with respect to smoking cessation, the American College of Surgeons and National Surgical Quality Improvement Program guidelines are clear that patients who stop smoking _____ weeks before surgery have no increased risk of smokingrelated pulmonary complications.
Mitch C. is a 39-year-old male who is brought to the ED by paramedics. According to the report of a neighbor, Mitch was distraught over a breakup with his fiancée and attempted to commit suicide by mixing some chemicals from under his kitchen sink and drinking them; afterward he changed his mind and knocked on his neighbor’s door asking for help. Mitch is awake but stuporous, and the neighbor has no idea what he drank. Visual inspection of his mouth and oropharynx reveals some edema and erythema. He is coughing and has large amounts of pooling saliva. Mitch is not capable of answering questions but he appears in pain. Endoscopy reveals full thickness mucosal injury with mucosal sloughing, ulceration, and exudate. The AGACNP knows that the appropriate course of treatment must include:
A.At least 6 hours of observation in the emergency department
B. Periodic esophagram
C. Aggressive fluid resuscitation
Jared V. is a 35-year-old male who presents for evaluation of a dry cough. He reports feeling well overall but notices that he gets out of breath more easily than he used to when playing soccer. A review of systems yields results that are essentially benign, although the patient does admit to an unusual rash on his legs. Physical examination reveals scattered erythematous nodules on both shins. There is no drainage, discomfort, or itch. Additionally, diffuse, mildly enlarged lymph nodes are appreciated bilaterally. Results of a comprehensive metabolic panel and complete blood count are within normal limits. Twelve-lead ECG reveals sinus bradycardia at 58 bpm. Chest radiography reveals bilateral hilar and mediastinal lymphadenopathy. The AGACNP suspects:
B. Pulmonary fibrosis
Mrs. Miller is a 44-year-old female who is on postoperative day 1 following a total abdominal hysterectomy. Her urine output overnight was approximately 200 mL. The appropriate response for the AGACNP would be to order:
A.A urinalysis and culture
B. 1 liter of NSS over 8 hours
C. Encourage increased mobility
D.Liberalize salt in the diet
All of the following are risk factors for spontaneous pneumothorax except:
A.Connective tissue disease
B. Scuba diving
C. Chronic obstructive pulmonary disease (COPD)
D.Central line insertion
The AGACNP is going over preoperative information and instructions with a patient who is having a major transverse abdominal procedure tomorrow morning. The patient is very nervous and is asking a lot of questions. The AGACNP prescribes a sleeping agent because he knows that anxiety and sleeplessness may:
A.Lead to hypoxia due to hyperventilation
B. Increase the physiologic stress response postoperatively
C. Contribute to risk of delirium and prolonged length of stay
D.Decreasep.o. intake and produce nutritional risk
In a patient with thyroid nodules, which of the following is the diagnostic study of choice to rule out thyroid cancer?
B. Percutaneous needle biopsy
C. CT scan
When counseling a patient about treatment modalities for achalasia, the AGACNP advised that which of the following is the treatment of choice?
A.Calcium channel antagonists
B. Intrasphincter botulinum injection
C. Pneumatic dilation
D.Myotomy and partial fundoplication
Mr. Liu is a 52-year-old male who has a history of thyroidectomy. He presents complaining of numbness and tingling in his legs and feet and generalized fatigue. Physical examination reveals a positive Chvostek’s sign. Which of the following laboratory studies should be ordered first?
A.Renal function tests
B. Parathyroid hormone
V. is a 75-year-old male patient who, during a recent wellness evaluation, was found to have a new onset grade II/VI crescendo-decrescendo cardiac murmur at the 2nd intercostal space, right sternal border. He is symptom free and reports no limitations to his usual daily activity. He specifically denies activity intolerance or near syncope, and he is very active physically. Echocardiography reveals a mild aortic calcification. The AGACNP knows that ongoing management for R. V. must include:
A.Annual or biannual serial echocardiography
B. Modification of activity level
C. Baseline cardiac catheterization
D. Statin therapy
The lower esophageal sphincter is characterized by periods of intermittent relaxation called transient lower esophageal sphincter relaxations. These relaxations are independent of the relaxation triggered by swallowing and are the most common cause of:
A. Physiologic reflux
B. Symptomatic esophagitis
C. Barrett’s metaplasia
While reviewing morning labs on a postoperative patient, the AGACNP notes that the patient’s basic metabolic panel is as follows: Na 132 mEq/L K 4.6 mEq/L Cl- 87 mEq/L CO2 25 mEq/L A normal saline infusion is ordered in an attempt to avoid:
C. Metabolic alkalosis
W. is a 49-year-old man who presents for evaluation. He has a long history of alcohol and tobacco use, with a 65-year pack history and an admitted 14-drink-per-week alcohol habit. He is getting worried because he can no longer swallow his bourbon. He is not a good historian but he does admit to a 1 year history of bloating, heartburn, and progressive difficulty swallowing food. He didn’t worry too much about his symptoms until he stopped being able to swallow bourbon. He thinks he has lost approximately 15 lbs in the last year. He denies any blood in his stool and has not had any vomiting. The AGACNP knows that the most likely diagnosis is:
C. Esophageal carcinoma
Which of the following treatment modalities has no role in the treatment of shock?
B. Fresh frozen plasma (FFP)
The development of coronary artery disease (CAD) and, ultimately, plaque formation is a multifactorial process that includes endothelial injury from hypertension, cigarette smoking, and dyslipidemia. These events lead to endothelial cell dysfunction, which is theorized to result in:
A.Decreased nitric oxide production
B. Smooth muscle cell atrophy
C. Collagen degradation
D.Enlarged arterial lumen
Mr. Comstock is a 71-year-old male who presents with a general sense of feeling weak and unwell; he thinks he has the flu even though he received a flu vaccination this year. He describes a vague collection of symptoms, including weakness, nausea, dizziness, and “getting out of breath” very easily. He says he can barely climb the steps anymore without stopping to rest. Of the possible differential diagnoses, coronary artery disease (CAD) is high among the probabilities because of his age and gender. His physical examination is unremarkable except that he appears weak. His vital signs are as follows: temperature 98.0°F, pulse 100 bpm, respiratory rate 16 b.p.m., and BP 178/100 mm Hg. A chest radiograph is within normal limits with no acute pulmonary infection. A 12-lead ECG reveals inverted T waves in leads V1 to V5. The AGACNP is suspicious that most of his symptoms are:
B. Early congestive heart failure (CHF)
C. Anginal equivalents
D.Normal age-related changes
Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade V/VI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes:
A. Acute mitral valve regurgitation
B. Acute aortic valve regurgitation
C. Acute cardiac tamponade
D. Acute pulmonary embolus
Mr. Nelson is a 65-year-old male who has been advised that he is a candidate for coronary artery bypass grafting. He has been doing some internet research and is asking about whether or not he should have a “beating heart” bypass. Regarding off-pump coronary bypass grafting, the AGACNP advises Mr. Nelson that:
A.There is a slightly higher risk of neurologic complications
B. Long-term results suggest that the grafts do not stay open as long as those in traditional bypass grafting
C. The incidence of off-pump bypass grafting has increased significantly in the last 10 years
D.The off-pump procedure is considerably more expensive but is correlated with better long-term outcomes
Mrs. McCallum is a 48-year-old female who presents for evaluation of a vague set of gastrointestinal symptoms. She feels generally well and has always been healthy, but lately she has had a lot of heartburn and a sense of reflux in her throat. Most recently she has had a recurring sense of food getting stuck in her throat. The AGACNP knows that which diagnostic study should be performed first?
B. Upper endoscopy
C. Esophageal manometry
D.Ambulatory pH monitoring
Mr. Key is a 53-year-old male patient who developed empyema following a serious bout of bacterial pneumonia. He presented as septic and was started immediately on intravenous antibiotics and drainage of the sinus cavity. Forty-eight hours later, he is much improved clinically and drainage has receded. The next step in his care would be:
A.A CT scan
B. Eloesser’s procedure
Mrs. Bowers is a 41-year-old patient who requires surgical management of osteomyelitis. She has a long history of methamphetamine use and has a BMI of 17.9 kg/m2 . She clearly is nutritionally depleted and volume contracted, but she has no clear chronic medical history except for unmedicated hypertension, which may be due to her chronic stimulant use. She denies alcohol use but admits to a 1½ pack a day cigarette habit. A primary postoperative concern for Mrs. Bowers is:
B. Thromboemboli development
C. Poor wound healing
The congenital diaphragmatic hernia that occurs more often in women and does not usually produce symptoms until midlife is known as:
B. Bochdalek’s hernia
C. Morgagni’s hernia
B. is a 67-year-old male who is being discharged following inpatient management for unstable angina. S. B. did not know that he had coronary artery disease (CAD) and in fact had not seen a health care provider for many years. While reviewing his lifestyle habits, he admits that he is obese, has poor eating habits, does not engage in any purposeful physical activity, and smokes two packs of cigarettes daily. He verbalizes that he is grateful that this was not a “real” heart attack and does not seem receptive to lifestyle management strategies. The AGACNP advises him that it is important to take this “warning” attack seriously because:
A. 10% of patients with unstable angina will die of cardiovascular disease within 6 months
B. 25% of patients with unstable angina will develop congestive heart failure within 6 months
C. 65% of patients with unstable angina will have an ST elevation MI within 1 year
D. 90% of patients with unstable angina will have cerebrovascular symptoms within 1 year
According to the American College of Surgeons (ACS), who among the following patients should have a chest radiograph as part of preoperative assessment?
A.All patients > 40 years of age
B. All patients who smoke cigarettes
C. All patients having thoracic procedures
D.All patients with cardiac disease
According to the Carpentier classification scheme of mitral valve regurgitation, a type I regurgitation is most likely due to:
B. Excessive leaflet motion
C. Ruptured papillary muscles
D.Rheumatic heart disease
V. is a 37-year-old female who is admitted via the emergency room after her roommate called emergency medical services (EMS). She has no significant medical history and does not know what is wrong with her. She has been feeling generally unwell for the last few days, and today she had an episode of confusion that scared her roommate to the extent that the roommate called EMS. Her physical examination reveals a temperature of 101.9°F, pulse of 110 bpm, respiratory rate of 20 breaths per minute, and blood pressure of 92/58 mm Hg. A comprehensive metabolic panel reveals a slightly elevated blood urea nitrogen (BUN)/creatinine but otherwise is normal. A white blood cell differential reveals a leukocyte count of 14,000 cells/µL with neutrophils of 83%. The AGACNP knows that these values are consistent with:
A. Systemic inflammatory response syndrome (SIRS)
B. High-output septic shock
C. Neurogenic shock
D.Multiple organ dysfunction syndrome (MODS)
Which shock state is worsened in the setting of mechanical ventilation?
B. Cardiac compressive
B. is a 41-year-old male being admitted for surgical reduction of an open femur fracture sustained in a multiple vehicle collision. Preoperative assessment reveals that he is on beta-adrenergic antagonists after having been diagnosed with coronary artery disease approximately 1 month ago. He admits that he feels a little better but says he still gets pain in his chest when he exerts himself. He is pain free now. Vital signs are as follows: temperature 98.1°F, pulse 88 bpm, respiratory rate 18 breaths per minute, and blood pressure 142/86 mm Hg. The AGACNP knows that which of the following is the most important action before R. B. goes to the operating room?
A.A cardiology consultation
B. Blood pressure control
C. Resuming beta-adrenergic antagonists
D. Pain control
Cholesteatoma is a condition characterized by a collection of desquamated keratin leading to bony erosion in the ossicular chain and inner ear. The goal of surgery in cholesteatoma is:
A. Production of a dry ear
B. Preservation of sensorineural hearing
C. Debridement of infection
D.Restoration of the tympanic membrane
The AGACNP knows that when managing a patient with acute cardiogenic shock after myocardial infarction, all of the following pharmacologic agents may be used except:
C. Beta-adrenergic antagonists
Mr. Baer is a 79-year-old man who is being admitted for a carotid endarterectomy. While performing his preoperative evaluation, the AGACNP appreciates two positive answers to the CAGE screening questionnaire. This is an indication for:
A. Perioperative benzodiazepines for withdrawal syndrome
B. Daily multivitamin and 100 mg of thiamine perioperatively
C. Further diagnostic evaluation for alcoholism
D.Delay of operation until completion of detoxification
According to the American College of Cardiology Foundation and the American Heart Association (ACCF/AHA), the recommendation regarding antiplatelet therapy in patients with cardiovascular disease preoperatively is that:
A.Antiplatelet therapy should be held for 10 days preoperatively
B. Cardiac consultation is required before an operation in patients who are on antiplatelet therapy
C. Medications should be continued unless concerns about hemostasis are significant
D.Antiplatelet therapy should be initiated in all high-risk cardiac procedures
Mr. Austin is a 64-year-old male who has a long history of mitral valve stenosis. His condition has developed to the extent that he has symptomatic congestive heart failure, and due to a variety of comorbidities he is not a candidate for surgery. Ongoing medical therapy for Mr. Austin should include:
The progression of coronary artery plaque formation can lead to a variety of pathologic conditions. When subtotal plaque disruption occurs resulting in vasoconstriction, platelet activation, and embolization, it most commonly causes which clinical phenomenon?
A.Endothelial cell dysfunction
B. Prinzmetal’s angina
C. Transmural myocardial infarction
D.Non-ST elevation myocardial infarction
D. is a 29-year-old male who presents with a chief complaint of profound dizziness for the past 2 to 3 days. Further clarification reveals that he is having brief but intense episodes of a sense of the room spinning. He denies any history of head injury or discharge from the ear. The vertigo is reproduced easily with cervical rotation. The AGACNP knows that the most likely cause is:
B. Ménière’s disease
C. Adverse drug effect
D.Benign paroxysmal positional vertigo (BPPV)
P.T. is a 61-year-old male who is seen in follow-up. He was initially seen for evaluation of dysphagia. An endoscopy was negative for malignancy and subsequent esophageal manometry supported a diagnosis of esophageal achalasia. While discussing implications and treatment options with P.T., the AGACNP tells him that the primary complication of achalasia is:
A. Progressive esophageal discomfort
B. Aspiration pneumonia
C. Squamous cell carcinoma
D.Long-term malabsorption problems
R. is a 51-year-old female who presents in shock following a penetrating injury to the spinal cord—her boyfriend reportedly stabbed her in the back with an unidentified kitchen utensil. The patient’s mental status is deteriorating, and her vital signs are as follows: temperature 97.2°F, heart rate 131 bpm, respirations 14 breaths per minute, and blood pressure 79/49 mm Hg. The AGACNP presumes neurogenic shock, with the injury likely:
A.Not fully transecting the spinal cord
B. At the level of T10
C. Precipitating sepsis
D. Producing cardiovascular decompensation
Janet is a 34-year-old female with no significant medical history who is being evaluated for a planned uterine ablation. She has significant history of menorrhagia and has been unresponsive to a variety of medical therapies to try to stop the bleeding. Her history and physical examination are within normal limits. The AGACNP knows that Janet will require which one of the following preoperative diagnostic studies?
B. Complete blood count
C. 12-lead electrocardiogram
Best practices for assessing diseases of the thyroid gland include a thorough but targeted history, systematic physical examination, and selective use of appropriate diagnostic evaluation. The AGACNP knows that although serum T3 and T4 are not indicated routinely, a free T4 test is most useful in evaluating patients:
A.With profound symptoms of hypothyroidism
B. Following treatment for Graves’ disease
C. To rule out autonomous toxic nodule
D. At risk for thyroid cancer
Evaluation of cardiac valve disease must include:
B. 12-lead ECG
D.Chemical stress test
Jolene L. is a 36-year-old female who presents for an emergent cholecystectomy; she has had progressive acute pain for almost 1 week and now there is concern about gangrenous tissue. Of particular concern is the fact that she has Graves’ disease and has not been adherent to treatment. On admission, her temperature is 102.7°F, pulse is 158 bpm, and blood pressure is 180/114 mm Hg. She is tremulous and anxious. A 12-lead ECG reveals uncontrolled atrial fibrillation. Before cholecystectomy, Jolene must be treated with:
A.Digitalis for heart rate control
B. Radioactive ablation
C. Beta-adrenergic antagonists
W. is discussing his postoperative hip replacement expectations. He is advised that although he will have some discomfort, he should be vocal about asking for pain medication, because it is essential that he get out of bed and begin ambulating as soon as possible after his surgery. He expresses some fear and is concerned that his hip won’t heal properly if he walks on it. The AGACNP reassures him that he must begin ambulating quickly in order to decrease risk for:
B. Scar tissue formation
H. is a 71-year-old male with small cell lung cancer; he has been treated with chemotherapy. Initially he had symptom improvement but now appears to have had a recurrence. On examination today, he is quite edematous and has gained 12 lbs since his office visit 1 week ago. A metabolic panel reveals a serum Na of 119 mEq/dL. The AGACNP knows that J. H. likely has:
B. Congestive heart failure (CHF)
C. Syndrome of inappropriate antidiuretic hormone (SIADH)
According to the American College of Surgeons (ACS) and the National Surgical Quality Improvement Program (NSQIP) guidelines for preoperative evaluation of the geriatric patient, the preoperative evaluation should include all of the following except:
B. Functional status
C. Competency assessment
D. Frailty score
Improvements in both equipment and technique have led to the evolution of video-assisted thoracoscopic surgery (VATS) as being used most commonly for:
A.Mediastinal lymph node dissection
B. Resection of malignant tumor
D.Thoracic vertebral discectomy
Which of the following is a normal finding on postoperative day 8 of a carotid endarterectomy?
A.A temperature of 100.5°F
B. Serosanguinous drainage with some tenderness
C. A flesh-colored induration along the entire length of the incision
D.A fluctuant collection of milky fluid
Mrs. Evans is an 82-year-old female who is on postoperative day 3 following resection of a small bowel tumor. She is alert today and her nasogastric tube is removed. The AGACNP knows that if the recovery proceeds normally, Mrs. Evans may begin clear liquids:
B. In 24 hours
C. When bowel sounds return
D.After a negative swallow study
When writing the initial postoperative progress note, the AGACNP should be sure to include all of the following except:
A.A summary of the procedure and any significant deviations from normal
B. An outline of the plan for postoperative management and follow-up
C. The plan for ongoing monitoring
D. Mechanism of DVT prophylaxis
T. is a 39-year-old male who presents to the hospital emergency room with a chief complaint of profound substernal chest pain. Results of the 12-lead ECG and cardiac enzymes test are normal. Vital signs are as follows: temperature 101.9°F, pulse 129 bpm, respirations 26 breaths per minute, and blood pressure 90/60 mm Hg. The patient is pale and clearly unwell, and physical examination reveals a systolic pericardial crunching sound. Which of the following additional pieces of history would make the AGACNP suspect acute mediastinitis?
A.A 48 pack year smoke history
B. A 2-day history of vomiting
C. Aortic valve regurgitation
Mrs. Van Doern is being examined on postop day 3 following surgical resection following a bowel obstruction. The postoperative course been unremarkable. Upon removal of the dressing, the incision is dry with staples intact. There is an approximately 0.5 cm erythema around the incision. There is no exudate. The patient demonstrates some discomfort on palpation of the site. The most appropriate approach to this patient includes:
A.Leaving the wound open to air and medicating for pain
B. Ordering a topical antibiotic, replacing the dressing with a nonadherent dressing, and following up in 2 days
C. Beginning systemic antibiotics to cover skin flora
D.Obtaining a white blood cell differential, redress the wound and reassess in the a.m.
K.T. is a 38-year-old female with a BMI of 39 kg/m2 who needs surgical reduction of a hiatal hernia. She is asking about the recovery process and says that she has read about something called the obesity paradox. She wants to know what that means with respect to her healing. The AGACNP explains that the paradox refers to the fact that:
A. Obesity correlates with poor outcomes for some surgical procedures but not others.
B. There is an inverse relationship between weight and surgical outcomes.
C. Underweight patients have more surgical complications than obese patients.
D. Planned weight loss preoperatively is indicated only when the BMI is > 40 kg/m2 .
Esophageal motility disorders are sometimes a consequence of systemic diseases such as scleroderma, Raynaud’s disease, and systemic lupus erythematosus. When patients with these diseases have gastroparesis, which medication should be added to the regimen?
A. A proton pump inhibitor
B. A histamine 2 receptor antagonist
C. A calcium channel antagonist
D. A promotility agent
S. is a 46-year-old female with metastatic breast cancer. She is currently off cycle for chemotherapy and generally is feeling well. Today, however, she presents feeling acutely unwell. She says that she has had coldlike symptoms over the last few days, including cough, nasal congestion, headache, and a hoarse voice in the mornings. Today she became acutely concerned because she feels as though her face and even shoulders look swollen and a bit discolored—bluish. She denies any nausea or vomiting but admits to feeling generally fatigued; she attribute it to her cancer. Recognizing the likely diagnosis, the AGACNP knows that treatment will likely include:
D. Expansile stents
D. is a 61-year-old female patient who complaints of pleuritic chest pain and cough. During the history, she indicates that she occasionally has seen a little bit of blood in her sputum, but she thought it was from coughing so hard. What finally prompted her to come in was that she coughed up a “stone.” Recognizing that the patient might have broncholithiasis, the AGACNP asks about exposure to:
C. Bird excrement
D. Swimming pools
Heart transplant is the surgical option for patients with congestive heart failure for whom medical therapies have failed. All of the following are contraindications to transplant except:
A.New York Heart Association (NYHA) class IV status
C. Elevated pulmonary vascular resistance
Kelly T. is a 49-year-old female who is being admitted for aortic valve replacement. Her preoperative evaluation revealed an ascending thoracic aneurysm of 4.8 cm in diameter. Kelly has not had any aneurysm symptoms and is generally considered a very strong surgical candidate. The AGACNP knows that the standard of care dictates:
A. Postponing her valve surgery due to the aneurysm
B. Annual imaging of the aneurysm after her valve replacement
C. Surgical repair of the aneurysm at the same time as valve replacement
D. Surgical repair of the aneurysm after successful recovery from valve replacement
K. is a 39-year-old female who was admitted for evaluation of progressive activity intolerance, and chest radiography revealed a large right lower lobe pleural effusion. A pleural fluid tap was performed, but fluid analysis results were inconclusive and the cause of the effusion could not be identified. The AGACNP knows that which diagnostic study is most appropriate to identify the cause of pleural effusion when fluid analysis is inadequate?
A. Scalene biopsy
B. Video-assisted thoracoscopic surgery (VATS)
C. Pleural needle biopsy
D.Open surgical biopsy
While on call, the AGACNP is asked to evaluate a deteriorating patient. The patient was admitted for exacerbation of pneumonia and congestive heart failure (CHF). The systolic blood pressure is < 90 mm Hg, and the urine output is < 10 mL/hr. A 12-lead ECG reveals no acute processes but reveals previously noted changes that are consistent with bilateral atrial and ventricular enlargement and a marked left axis deviation. You insert a pulmonary artery (PA) line and anticipate which of the following pressures? (CI, cardiac index; PAOP, pulmonary artery occlusion pressure ; RAP, right atrial pressure)
A.CI 1.3 L/min, PAOP 27 mm Hg, RAP 18 mm Hg
B. CI 1.9 L/min, PAOP 12 mm Hg, RAP 6 mm Hg
C. CI 2.4 L/min, PAOP 18 mm Hg, RAP 8 mm Hg
D.CI 1.4 L/min, PAOP 7 mm Hg, RAP 4 mm Hg
A critically ill patient with multiple traumatic injuries sustained during a motor vehicle accident has had a pulmonary artery line inserted to follow cardiac pressures. Which of the following sets of pressures would be consistent with hypovolemic shock? (CI, cardiac index; CVP, central venous pressure; PCWP, pulmonary capillary wedge pressure)
A.CI 1.3 L/min, PCWP 27 mm Hg, CVP 18 mm Hg
B. CI 1.3 L/min, PCWP 6 mm Hg, CVP 4 mm Hg
C. CI 2.3 L/min, PCWP 12 mm Hg, CVP 8 mm Hg
D.CI 2.9 L/min, PCWP 16 mm Hg, CVP 6 mm Hg
Aggressive fluid resuscitation is indicated in all of the following shock states except:
The risk-benefit ratio always is considered when evaluating patients with mitral valve disease as surgical candidates for valve correction. Who among the following patients is not considered a good operative candidate?
A. A patient with severe mitral regurgitation and endocarditis with systemic embolization
B. A patient with severe mitral regurgitation and left ventricular dysfunction
C. A patient with severe mitral regurgitation and normal ventricular function
D. A patient with severe mitral regurgitation and pulmonary hypertension
T. is a 29-year-old male who is recovering from an open fixation of a femur fracture sustained in a diving accident. He has an order for Dilaudid 1 mg IV q2h p.r.n. for pain. He is still having pain and requests more medication. The AGACNP considers that:
A.This is the maximum dose for Dilaudid and nonpharmacologic measures should be maximized
B. The dose may be increased to 2 mg and response assessed
C. He may be opiate addicted, and this should be explored before the dose is increased
D.An adjunct medication such as ibuprofen should be added to his regimen
Mrs. Saraceno is a 71-year-old female who had an episode of acute pulmonary edema following an endovascular aneurysm repair. She was managed successfully with a loop diuretic and is ultimately discharged on furosemide 60 mg daily and instructed to follow up with cardiology. She is seen in the office postoperatively 2 weeks after discharge. She has not yet seen a cardiologist but has continued all discharge medications. Her metabolic panel is as follows: Na 126 mEq/L K 4.0 mEq/L Cl- 93 mEq/L CO2 28 mEq/L BUN 40 mg/dL Cr 1.3 mg/dL The AGACNP recognizes that the patient likely has which abnormality as a consequence of diuretic overuse?
C. Metabolic acidosis
Mrs. Hoffman is an 82-year-old female who is on postoperative day 4 following mastectomy for breast cancer. This morning her vital signs include a temperature of 101.2°F, pulse of 110 bpm, respiratory rate of 20 breaths per minute, and blood pressure of 100/70 mm Hg. The incisions look good and there is no physical finding or symptom of incision infection. The only abnormal physical finding is a significant tender edema on the right cheek and neck. In addition to ordering increased intravenous hydration and parenteral antibiotics to target Staphylococcus aureus, the AGACNP orders:
A. Loop diuretics
B. Chewing gum
Kelly is a 50-year-old female who had chest radiography as part of a preoperative history and physical examination before an elective cosmetic procedure. She has no significant medical history and takes no daily medications except hormone therapy for menopausal symptoms. The radiology report of her chest film includes a 4-mm coin lesion in the right middle lobe. Kelly reports her health as excellent and has no clear risk factors for malignancy. The AGACNP knows that the next step in her management should be:
A.Repeat radiography in 6 months
B. CT scan of the chest
C. Needle biopsy of the lesion
D.A pulmonology consult
Which of the following esophageal foreign objects should not have endoscopic removal attempted? A.Impacted meat
B. Pointed nail
C. Button battery
Mrs. Glasgow is a 55-year-old female who is day 4 post open cholecystectomy. She has had some unanticipated postoperative ectopy and remains hospitalized. This morning her temperature is 100.9°F. While assessing her for infection, the AGACNP knows that which finding would be most consistent with an infectious process?
A.Neutrophilia of 82% of the white blood cell differential
B. A blood urea nitrogen (BUN)/creatinine ratio of > 20
C. Pain to palpation at the incision site
D.A significant decrease in appetite
L. is a 48-year-old female who has suffered with profound GERD symptoms for several years. She has had aggressive trials of medical therapies and has been adherent to nonpharmacologic interventions. She is now in the aggressive diagnostic phase of evaluation and is preparing for 24-hour ambulatory pH monitoring. The AGACNP advises that in preparation for this test, M. L. should:
A.Continue her current proton pump inhibitor (PPI) therapy consistent with the way she has been taking it
B. Eat consistently with her normal eating habits up until the procedure
C. Avoid straining for a bowel movement while the monitor is in place
D.Not do anything differently as compared with her normal daily life
Mr. Rowley is a 79-year-old male patient who is having a surgical repair of a thoracic aneurysm. He has significant underlying chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD), and his early postoperative course will require ventilator support, nutritional support, and a variety of drains and other apparatuses. His wife has asked that he not be told about the ventilator because he is afraid of it—he watched his brother struggle with ventilator therapy. The best approach would be to tell Mrs. Rowley that:
A.The patient will be sedated and will not remember the ventilator after he recovers
B. Her wishes will be respected and the ventilator specifically will not be discussed
C. Being prepared for his postoperative treatment will lessen his anxiety and fear
D.Every effort will be made to avoid ventilator support
Ludwig’s angina is a potentially fatal condition characterized by neck pain, neck edema, edema of the base of the mouth, and tongue displacement. The AGACNP knows that the underlying cause is a consequence of:
D.Adverse drug effect
When counseling a 41-year-old female patient who requires mitral valve surgery for severe mitral stenosis, the AGACNP helps differentiate among options. She advises the patient that in most circumstances, given her age, she is likely to do best with which type of procedure?
A.Bioprosthetic valve replacement
B. Mechanical valve replacement
C. Native valve debridement
D.Catheter-based balloon valvotomy
Alan is a 14-year-old male who has been referred for evaluation of a previously undiagnosed cardiac murmur. According to his parents, Alan has no significant medical history and has always been a healthy child. His growth and development have been within normal limits and his well-child checks have been normal. His cardiac murmur was identified during a soccer preparticipation physical examination. During today’s exam, he denies any cardiopulmonary symptoms. He admits that he gets out of breath when he is running during soccer but assumed it was just because he was running. Physical examination reveals a grade III/VI systolic murmur at the 2nd intercostal space, left sternal border, and a clearly fixed split S2 heart sound. The AGACNP knows that this murmur is probably:
B. Aortic stenosis
C. Atrial septal defect
D. Still’s murmur
The AGACNP is evaluating a patient who he believes has fungal pneumonia. The patient says she has just relocated to Pennsylvania from Scottsdale, Arizona. When considering specific types of fungal etiology, the AGACNP knows that which type is endemic to the Arizona desert?
With respect to management of chronic illness on the morning of surgery, which of the following is a true statement?
A. Patient with diabetes should be started on an insulin gtt to maintain serum glucose < 150 mg/dL
B. Patients with coronary artery disease should have antiplatelet agents held
C. Patients on beta adrenergic antagonists should continue therapy
D. Patients with Hgb < 9 mg/dL should be transfused with packed red blood cells
Mr. Mireya is a 66-year-old male who is admitted for palliative surgery for a glioblastoma. He has borderline stage III-IV chronic kidney disease. The AGACNP realizes that he is at increased risk in the perioperative period for:
Barrett’s esophagus is best described as:
A.A symptomatic condition of gastric reflux
B. A condition that occurs more commonly in women of childbearing age
C. A metaplastic adaptation to repeated irritation
D.A secondary motility disorder
Ms. Carson is a 71-year-old female who presents with significant pleuritic-type chest pain. She has no known cardiopulmonary history and does not smoke cigarettes. Her history is significant only for an upper endoscopy this morning for evaluation of severe gastroesophageal reflux disease (GERD). She tolerated the procedure well and was discharged home. Over the afternoon she developed worsening pain on the left side of her chest and finally had to come to the emergency department. Her vital signs are as follows: temperature 100.0°F, pulse 116 bpm, respiratory rate 22 breaths per minute, and blood pressure 96/60 mm Hg. The AGACNP orders which of the following diagnostic studies to confirm the suspected diagnosis?
B. 12-lead ECG
C. Upper endoscopy
Lilly M. is a 44-year-old female who is transferred to the emergency department following a severe fall. She had been standing on the balcony of a four-story building and tried to balance on the railing. She fell and sustained numerous internal and external injuries. In the emergency room she was in profound hypovolemic shock. Bleeding appears to have been stopped, and rapid infusion of 2 L of normal saline has just been completed. The AGACNP knows that the next step in fluid resuscitation includes:
A.Transfusion of packed red blood cells (PRBCs) based on hematocrit
B. Infusion of 1 L of lactated Ringer’s
C. 1 more liter of normal saline solution (NSS) over 10 minutes
D.No additional fluid unless the systolic blood pressure (SBP) is < 90 mm Hg
W. is a 67-year-old male with a history of significant coronary artery disease, who now presents in acute cardiogenic shock. His blood pressure is 82/50 mm Hg, and the pulse is in sinus bradycardia at 44 bpm. He is awake and oriented but lethargic and says he feels lightheaded. The treatment of choice for this patient is:
A. Transvenous pacing
B. Aggressive fluid resuscitation
C. Atropine 0.5 mg q2min × 4
D. Epinephrine 1 mg IV
Jeff Z. is a 49-year-old male who is on the heart transplant list due to myocarditis-related end stage congestive heart failure. While counseling Jeff about bridge devices that allow him to be discharged from the hospital, the AGACNP tells Jeff that the most frequently used device is:
A.Ideal for smaller-framed patients
B. Implanted below the diaphragm
C. Independent of external power for up to 24 hours
D.Good for up to 2 years
Mrs. Brownlee is a 63-year-old female who is admitted for surgical replacement of her aortic valve. She has a history of symptomatic aortic stenosis, osteoarthritis, and hypothyroidism. She has always been very thin, and her admitting height and weight are 5’4” and 110 lbs. In considering her postoperative nutritional needs, the AGACNP recognizes that:
A. Postoperative calorie requirements are higher than baseline because of the hypermetabolic response to physiologic stress
B. The parasympathetic response to thoracic surgery requires a proportionally greater increase in protein calories
C. Calorie requirements will not change postoperatively, as the increased stress response is balanced by bedrest and decreased activity calorie use.
D.Nutritional requirements are individualized postoperatively, and it is not possible to predict postoperative needs in
Mr. Cortez is a 41-year-old male with a long history of chronic allergic rhinitis. He has not had health insurance for most of his adult life, so he has self-treated his nasal symptoms with a combination of over-the-counter agents including antihistamines, decongestants, and nasal sprays. He recently obtained coverage under the Affordable Care Act and presents more regularly for care of his chronic nasal symptoms; he cannot go longer than a few hours without using his nasal spray. The nasal mucosa is edematous and hyperemic on inspection. The AGACNP know that this patient suffers from:
B. Rhinitis medicamentosa
C. Adverse drug effect
D. Psychological dependence
Mrs. Knickerson is an 89-year-old female who lives alone at home. She is generally in good health, and her functional status is reasonably strong. Her son and daughter-in-law stop by once or twice a week and help her with some household chores. Mrs. Knickerson’s only medical diagnosis is hypertension, for which she has taken HCTZ 12.5 mg for as long as she can remember. Today when her son went into the home, he found her in bed, clearly unwell and a bit disoriented. Upon hospital admission, she is found to have vital signs as follows: temperature 100.9°F, pulse 122 bpm, respirations 22 breaths per minute, and blood pressure 82/53 mm Hg. Her saO2 on 2 L of nasal oxygen is 89%. Chest radiograph is clear, and 12-lead ECG demonstrates sinus tachycardia. Urinalysis reveals white blood cells, nitrites, red blood cells, and bacteriuria. The AGACNP suspects which of the following shock states?
Which of the following is a true statement with respect to needle lung biopsy?
A.It is the preferred method of biopsy in patients with comorbid pulmonary hypertension
B. It is highly sensitive, yielding diagnostic data in > 90% of patients
C. Serious complications are very rare
D.There is concern about spreading a tumor in patients with localized disease
S. is a 55-year-old male patient with obstructive sleep apnea. He is motivated to control his condition and has been adherent to conservative therapeutic options. He has lost almost 65 lbs and now has a body mass index of 29. He drinks alcohol < 1 x monthly and does not smoke cigarettes. He had difficulty adjusting to bilevel positive airway pressure (BiPAP) but has used it for several months, with only marginal improvement. He presents today to talk about surgical options. The AGACNP counsels J. S. that:
A.He is not a strong candidate for surgical success
B. Before the operation, he needs to reduce his BMI to 25
C. The first step would be tonsillectomy and adenoidectomy
D.The best out outcomes occur with multilevel surgery
The process by which an assessment of the patient is performed, before an operation, to evaluate overall health and identify risk factors for intra- and postoperative complications is known as:
A. Preoperative evaluation
B. Diagnostic evaluation
C. Preoperative preparation
Mrs. Carroll is an 81-year-old female who is going to have a surgical procedure for removal of an obstructing large-bowel tumor. While assessing her nutritional status, the AGACNP knows that which of the following is a severe risk factor for poor surgical outcome?
A.Admitting body mass index of 18.1 kg/m2
B. 3 day dietary history of < 1200 calories daily
C. A serum albumin of 3.2 g/dL
D.Unplanned weight loss of 8 lbs. in the last 6 months.
Carolyn is a 25-year-old injection drug user who has had a long history of health problems since her early teenage years. She has preexisting mitral valve regurgitation and has had endocarditis in the past. She is now being treated for lung abscess that presumably occurred with aspiration in an intoxicated state. She was admitted and started on intravenous antibiotic therapy, IV fluids, and nutritional support. She is now on day 5 of antibiotic therapy and remains septic and febrile. The AGACNP knows that the indicated course of treatment includes:
A.Continued antibiotic therapy with evaluation on day 7
B. Change to a different extended spectrum antibiotic
C. Percutaneous drainage of the abscess
D.Thoracotomy with open drainage
Mr. Zuckerman is a 62-year-old man who presents for evaluation of a sense of difficulty swallowing and food getting stuck. He also reports that sometimes he can hear or “feel” a gurgling sound in his throat. He had a barium swallow study that demonstrated a large pharyngoesophageal (Zenker’s) diverticulum. The AGACNP knows that which of the following additional diagnostic studies is not indicated?
B. Chest radiograph
D.Ambulatory pH monitoring
Which of the following foreign bodies in the ear canal is considered a surgical emergency that requires immediate intervention by otolaryngology (ENT) without any attempt to remove by a non-ENT provider?
A.A popcorn kernel
B. A cockroach
C. A button battery
D.A piece of cotton
When a patient has suspected postoperative bleeding, the immediate priority of care is to:
A.Identify the bleeding site
B. Ensure hemodynamic stability
C. Transfuse packed red blood cells
D.Obtain a stat surgical consult
Mr. Quigley is a 56-year-old male patient who presents for evaluation of difficulty swallowing. Physical examination of the oropharynx reveals a pink irregular mass of approximately 4 cm in the posterior pharynx. The patient is advised that he appears to have an abnormal growth and will need to be referred to otolaryngology. He asks how he got a tumor in his throat. The AGACNP replies that the greatest risk factor(s) for oropharyngeal tumors is(are):
A.Tobacco and alcohol use
B. Human papillomavirus (HPV)
C. Family history of a first degree relative
D. Female gender