Question 55
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:
A.Immediately B. In 24 hours C. When bowel sounds return D.After a negative swallow
study
Question 56
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
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Question 57
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
D.Cardiac tamponade
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Question 58
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.
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Question 59
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 .
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Question 60
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
Question 61
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:
A.Radiation B. Surgery C. Fibrinolytics D. Expansile stents
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Question 62
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:
A.Cigarettes B. Asbestos C. Bird excrement D. Swimming pools
Question 63
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 B. Obesity C. Elevated pulmonary
vascular resistance D.Recent malignancy
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Question 64
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
Question 65
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
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Question 66
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
Question 67
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
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Question 68
Aggressive fluid resuscitation is indicated in all of the following shock states except:
A.Hypovolemic B. Cardiogenic C. Obstructive D.Distributive
Question 69
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
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Question 70
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
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Question 71
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?
A.Hyponatremia B. Hypokalemia C. Metabolic acidosis D.Intrarenal failure
Question 72
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 C. Ambulation D.Incentive spirometry
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Question 73
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
Question 74
Which of the following esophageal foreign objects should not have endoscopic removal
attempted? A.Impacted meat B. Pointed nail C. Button battery D.Cocaine packet
Question 75
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
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Question 76
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
Question 77
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 m 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
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Question 78
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:
A.Arteriolar constriction B. Hypersensitivity C. Infection D.Adverse drug effect
Question 79
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
Question 80
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:
A.Mitral regurgitation B. Aortic stenosis C. Atrial septal defect D. Still’s murmur
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Question 81
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?
A.Histoplasmosis B. Blastomycosis C. Coccidioidomycosis D.Aspergillosis P
Question 82
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 Question 82
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
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Question 83
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:
A.Hypercalcemia B. Hypokalemia C. Thrombocytopenia D.Eosinophilia
Question 84
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
Question 85
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?
A.Chest radiograph B. 12-lead ECG C. Upper endoscopy D.Esophagram
Question 86
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
Question 87
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 Question 88 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
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Question 89
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
Question 90
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:
A.Chronic sinusitis B. Rhinitis medicamentosa C. Adverse drug effect D. Psychological
dependence
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Question 91
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 12lead ECG demonstrates sinus tachycardia. Urinalysis reveals +++ white blood cells, +
nitrites, + red blood cells, and ++ bacteriuria. The AGACNP suspects which of the following
shock states?
A.Hypovolemic B. Cardiogenic C. Obstructive D.Neurogenic
Question 92
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
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Question 93
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
Question 94
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
D.Diagnostic preparation
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Question 95
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.
Question 96
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
Question 97
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?
A.Esophageal manometry B. Chest radiograph C. Endoscopy D.Ambulatory pH monitoring
Question 98
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
Question 99
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
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Question 100
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