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NSG 5002 Final Exam – Question and Answers – South University

1. As patients that entrust our care to another individual, we always expect honesty to avoid leading us down a deceptive pathway in our healthcare decisions. Adherence to which principle compels providers to be truthful
2. What purpose does the principle of fidelity serve in the provider/patient relationship?
3. We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:
4. Chronic, non-communicable diseases account for disproportionate costs to the healthcare system. According to the World Health Organization, what percent of preventable deaths and disabilities occur in the Americas related to chronic non-communicable diseases?
5. Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?
6. Encouragement of patients to take effective actions in their own healthcare refers to the concept of:
7. Population disease management is a term used to describe:
8. Changes in Medicare are a method the government uses to make changes to reimbursement schedules for healthcare. Currently, Medicare reimburses nurse practitioners for all services, even those deemed to be exclusive to nursing?
9. Medicare covers inpatient hospital services under which part of the Medicare insurance?
10. Medicare hospital insurance (Part A) is funded through what system?
11. Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes.
12. Eligibility for Medicaid includes the following:
13. Narrowed coronary arteries or plague rupture within the arteries of the coronary system may directly cause which condition?
14. What happens to coronary flow related to CAD?
15. In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade.
16. What is considered the first-line initial approach to test for CAD?
17. What are two of the most common forms of Exercise Stress Tests used today?
18. Maintenance of an Isometric ST-segment during exercise is the response of?
19. By standard criteria, how is a positive stress test defined?
20. Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segYour patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment. What do you need to know about these changes to manage your patient’s care?Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment. What do you need to know about these changes to manage your patient’s care?ment. What do you need to know about these changes to manage your patient’s care?
21. After completion of the exercise stress test, you would measure the ST-segment depression after the J point of the QRS. The J point is located where in relation to the QRS?
22. What ECG changes can reduce the specificity of the ETT?
23. Why would inability to exercise reduce the specificity of the routine ETT?
24. The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?
25. Specifically, when is an ETT considered to be negative?
26. Your mentor says that you should be prepared to know how to determine the maximum heart rate for your patient during the ETT. How is the age-predicted maximum heart rate during an ETT determined?
27. Your patient has a maximum age-predicted heart rate of 180. During the exercise, he reaches a heart rate of 140 and then states he can no longer exercise. You see no evidence of ischemia on the ECG. This would be diagnostic for what condition?
28. Your patient has a maximum age-predicted heart rate of 180. During the exercise he reaches a heart rate of 140 and then states he can no longer exercise. You see evidence of ischemic changes on the ECG. This would be predictive of what condition?
29. Ischemic changes on ECG during ETT is highly predictive of CAD. What is another important strong predictor of CAD that you might see during an ETT?
30. The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD.
31. Your practice partner just ordered an exercise echocardiography 2DE for a patient with suspected cardiovascular risk. This patient has known resting wall motion abnormalities. Why would this not be the best test to assess this patient’s cardiac risk?
32. You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT. You-select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT?
33. On the echocardiography during the ETT you notice the following change: abnormal left ventricular ejection fraction. What do these changes suggest related to this patient?
34. Your patient cannot sit on a bicycle and has difficulties walking a treadmill with limited capacity for exercising. Still, you know that the ETT is the preferred test for CAD. You consider adding a pharmacological agent to get to maximum heart rate. What agent would be the most commonly used agent to assist in an ETT?
35. Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?
36. You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise. While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic, you know that this test will be considered to be what type of result?
37. Of the answers below, which would be included in defining a positive Exercise Echocardiogram?
38. What three conditions definitely alter the results of echocardiography in determining CAD?
39. Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing?
40. Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study?
41. What is the leading cause of death for women in the United States?
42. A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities. You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?
43. The diagnostic accuracy of stress testing is …..among women compared to men for what reasons?
44. You are counseling a patient diagnosed with stress-induced ischemia. You base your discussion on your knowledge that stress-induced ischemia is …..to be …..by what phenomena?
45. In women, you need to know the limitations of certain tests for CAD. For example, single-photon emissions CT imaging, while an acceptable test for most men and some women, is technically limited in women for two reasons. From the following, choose the best possible answer.
46. A 35 year old female arrives at your clinic. She has had diabetes and peripheral artery disease for the past 5 years. You decide to obtain an ETT. The insurance company argues that this is inappropriate. You justify the ETT because you are planning secondary strategies to prevent future heart disease. Where could one find the supporting data for these guidelines?
47. A 55-year old man is …..to your clinic. He has been sedentary all of his life, is gaining weight and wishes to get into better physical shape. He has never had any chest pain or shortness of breath when walking or climbing a flight of stairs. Before recommending a vigorous exercise routine for this patient, you order what test?
48. All patients, even is asymptomatic, require risk stratification according to the Farmingham risk score. At present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients without addiitonal justification. From the list below, what could be …..to justify a ETT in an asymptomatic patient?
49. For women with known CAD and diabetes, which is most appropriate to assess CAD risk?
50. The most important partnership in a primary setting is between what two partners?
51. The goal of self-management is to specifically do what?
52. When there is a consequential loss of structural integrity of the abdominal aorta, the resulting issue is what condition?
53. Aortic aneurysms are …..based on their shape. Aneurysms may be fusiform or saccular. When an aneurysm forms as a weakness or bleb on one side of the aorta, it is described as what form of aneurysm?
54. You receive a report back on the suspected abdominal aortic aneurysm for your patient. It confirms your suspicion of AAA. The report describes the aneurysm as a symmetric weakness of the entire circumference of the aorta. You know that this form of aneurysm is …..to as what kind of aneurysm?
55. What is one of the common causes of a Saccular Abdominal Aneurysm?
56. Your patient has an AAA that you have been watching. It is now progressed to greater than 4.0cm in size. What action should you consider at this juncture in patient management of this condition?
57. Overall, the risk for abdominal aortic aneurysm is greater among nsg 5002 final exam
58. A 65-year old white male arrives in your clinic with general complaints of slight abdominal discomfort. He has a known history of smoking two packs per day for 40 years and hypertension. He also has COPD and has been …..numerous times with oral steroids. You consider several optional diagnoses. Of the ones listed below, which should be …..as a potential top suspect in your choice of diagnosis?
59. Abdominal aortic aneurysms are often asymptomatic. What percent of AAA’s are …..in asymptomatic patients?
60. Your patient asks you what causes a rupture of an abdominal aortic aneurysm. You know the answer is most often nsg 5002 final exam
61. At what point is elective repair of an abdominal aortic aneurysm (AAA) for a healthy patient …..appropriate?
62. You have confirmed that your patient does indeed have an abdominal aortic aneurysm. In teaching your patient about symptoms to report immediately to the vascular surgeon, you instruct the patient to report which of the following?
63. In a person with diagnosed abdominal aortic aneurysm, which symptoms might indicate impending rupture?
64. More than half of all cardiac arrhythmias involve the atria.
65. At what age is atria fibrillation most common?
66. What are the most common mechanisms to produce cardiac arrhythmias?
67. Automaticity is a property common to all cardiac cells. Is this statement true or false?
68. What are the most common symptoms …..by tachyarrhythmias?
69. Tachyarrhythmias cause a drop in commonly blood pressure, cardiac output, syncope, shortness of breath, and chest pain. What phenomenon most often occurs during these arrhythmias to cause these symptoms?
70. Your patient was recently …..for tachycardia and now has a normalized heart rate and rhythm. On examination, you notice a new S3 heart sound. What condition are you concerned with at this time based on this new finding?
71. Your patient is newly …..with persistent Atria Fibrillation. You consider electrocardioversion. Before undergoing this procedure you should order the following examination to assess thrombus risk.
72. Your patient presents with tachycardia. The QRS is …..at 0.10 seconds. Which of the following tachycardias would be an appropriate conclusion based on this information alone?
73. Your patient presents with an atria arrhythmia with defined P waves. She is in stable condition and her hemodymics are stable. What would you suggest as a first line therapy in this case?
74. What criterion does the American Heart Association use to classify relative bradycardia? nsg 5002 final exam
75. Your 56-year old patient presents with bradycardia with a rate of 55 and first degree AV block. nsg 5002 final exam The patient is hemodynamically stable and is not experiencing any syncope or chest pain. History includes previous myocardial infarction. Home medications include beta blockers, daily aspirin. Lab work is non-significant for electrolyte imbalance. You decided to treat this patient for the arrhythmia to prevent future destabilization. From the choices below, which might be the appropriate first measure to consider?
76. What are the two types of bradycardia …..by the American Heart Association?
77. Any patient presenting with symptomatic bradycardia should be …..to a cardiologist for management. Is this statement true or false?
78. The majority of all strokes are non-ischemic. Is this statement true or false?
79. Heart failure is a complex syndrome …..by the heart’s failure to do which of the following?
80. What are the two main types of heart failure?
81. What is the most common cause of systolic heart failure?
82. Your patient of 58 years of age has chronic hypertension. You follow the guidelines for management as …..by the American Heart Association and now have your patient fully medicated and dosed with three separate antihypertensive medications without control of the blood pressure. What should be your next step in the management of this patient?
83. You see a 60-year old African American male in your clinic with a recent diagnosis of hypertension. He asks you what he should restrict in his diet, and is particularly …..in limiting his sodium intake. What amount of sodium intake would you recommend on a daily basis for this patient? nsg 5002 final exam
84. When a murmur is first heard, it is important to determine if it is due to a pathological condition or benign. For an experienced practitioner, it is always easy to determine the cause of a murmur merely by listening to the sound. Is this statement true or false?
85. You tell a patient that he has a murmur. He says he has …..this before, but wonders what causes the unique sounds of a murmur. Which of the following  would be your best option?
86. You see a 75-year old female in your clinic today complaining of urinary incontinence. She is otherwise healthy based upon her last visit. She states that her mother told her this would happen someday because it happens to every woman at some age. What would you tell this patient? nsg 5002 final exam
87. Your patient presents complaining of incontinence of urine. He states that this happens every time soon after he urinates. What type of incontinence is your patient experiencing?
88. BPH is not a risk factor for Prostate cancer. Is this statement true or false?
89. Your 60-year old male patient arrives for his appointment. He complains of general malaise and fever over the past several days with low back pain. He also states that he is getting up at night more often to urinate and never feels his bladder is completely empty. What differential diagnosis should you consider in this patient?
90. You see a 35-year old male in the office for the first time. He states that he has been …..with recurrent urinary tract infections. You know that urinary tract infections are uncommon among men less than 50 years of age and are …..a complicated infection in this age group. On physical examination, the patient is ….. and he denies homosexual activities. What other assessment or history might be most pertinent in managing this patient?
91. Your patient has uncomplicated pyelonephritis. In deciding your recommended treatment, you consider the most common pathogenic reason for this diagnosis. What pathogen accounts for the majority of pyelonephritis?
92. There is a wide range of antibiotic agents that can be …..to treat a urinary tract infection. Unfortunately, there is often failure of treatment ….. From the list below, which would be …..a common reason for treatment failure in UTI?
93. What is the treatment of choice for uncomplicated community-acquired cystitis? nsg 5002 final exam
94. For an uncomplicated UTI you choose to order TMP-SMZ for your patient. What is the recommended duration of therapy that you should considered?
95. What sexually transmitted disease is most widespread in the USA today?
96. Sexual partners of a patient with a diagnosed STI should always be ….and treated. Is this statement true or false?
97. The reason for the increase in chlamydia diagnosis is thought to be ….to what event?
98. Spread of genital herpes only occurs during the time period with active lesions. Is this statement true or false?
99. Skin cancer is the most common malignant neoplasm in males in the US. What is the second leading cause of cancer deaths in men greater than 50 years of age?