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Quiz Session - Attempts With Random Questions

AACN PCCN July 2024 Exam Hanbook version 2.1.0 Exam Questions

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1.

Hydroxyurea is a medication sometimes prescribed to help prevent complications due to what condition?

  • Sickle cell disease

  • Acute renal failure

  • Myasthenia gravis

  • Chronic renal failure

Correct answer: Sickle cell disease

Hydroxyurea increases the production of fetal hemoglobin (HbF), which helps to reduce the frequency of sickle cell crises, pain episodes, and the need for blood transfusions. It can also help decrease the risk of acute chest syndrome and other severe complications associated with sickle cell disease.

Hydroxyurea is not indicated in the treatment of Acute Renal Failure (ARF), myasthenia gravis, or chronic renal failure.

2.

A 72-year-old male patient was treated for a STEMI with successful Percutaneous Coronary Intervention (PCI). His repeat troponin levels have decreased, and his symptoms have resolved. 

Before discharge, what is the MOST important consideration to prevent future cardiac events?

  • Prescribing dual antiplatelet therapy

  • Scheduling a follow-up stress test

  • Referring the patient for cardiac rehabilitation

  • Ordering an echocardiogram

Correct answer: Prescribing dual antiplatelet therapy

Dual antiplatelet therapy (aspirin and a P2Y12 inhibitor) is crucial after PCI to prevent stent thrombosis and future coronary events. This key intervention has been shown to reduce recurrent myocardial infarction and improve long-term outcomes.

A follow-up stress test may help evaluate the patient’s exercise tolerance, but it is not as important as preventing further thrombotic events with dual antiplatelet therapy. Cardiac rehabilitation is essential for long-term recovery, but antiplatelet therapy is a more immediate priority for preventing reinfarction. An echocardiogram may be useful for assessing cardiac function but is not the most urgent consideration for preventing future events.

3.

A 67-year-old female patient with end-stage renal disease presents to the emergency department with shortness of breath, confusion, and swelling in her legs. Her blood pressure is 160/100 mmHg, heart rate is 100 beats per minute, and serum potassium level is 7.0 mEq/L. 

Which intervention is MOST likely to be implemented FIRST to address the patient’s condition?

  • Administer calcium gluconate intravenously

  • Start Continuous Renal Replacement Therapy (CRRT)

  • Administer insulin and glucose

  • Administer sodium polystyrene sulfonate orally

Correct answer: Administer calcium gluconate intravenously

In cases of severe hyperkalemia (serum potassium level greater than 6.5 mEq/L), the first-line intervention is the administration of intravenous calcium gluconate. This medication stabilizes the cardiac membrane, reducing the risk of life-threatening arrhythmias, which are a significant concern in hyperkalemia.

CRRT is a definitive treatment for hyperkalemia in a patient with end-stage renal disease, but it would not be the immediate first intervention due to the time required to set up and initiate this therapy.

Administering insulin and glucose is another treatment for hyperkalemia, as it helps shift potassium from the extracellular space into cells, temporarily lowering serum potassium levels. However, it would typically follow the administration of calcium gluconate in a critical situation.

Administering sodium polystyrene sulfonate (Kayexalate) orally or rectally can help remove potassium from the body, but this intervention works slowly and would not be the initial treatment in a life-threatening hyperkalemia scenario.

4.

Treatment with folinic acid is suggested in the management of which of the following conditions?

  • Methanol overdose

  • Phenobarbital overdose

  • Lithium overdose

  • Acetaminophen overdose

Correct answer: Methanol overdose

Folinic acid (leucovorin) is used as an adjunct treatment in methanol poisoning to help enhance the conversion of formic acid, a toxic metabolite of methanol, into less harmful substances, reducing the risk of metabolic acidosis and other severe toxic effects.

Phenobarbital overdose is typically managed with supportive care and possibly activated charcoal if early ingestion is suspected. Lithium overdose is managed with supportive care, hydration, and, in severe cases, hemodialysis. Acetaminophen overdose is treated with N-acetylcysteine (NAC) to prevent liver toxicity.

5.

During diastole, which valve's improper closure allows blood to flow backward from the aorta into the left ventricle?

  • Aortic valve

  • Mitral valve

  • Tricuspid valve

  • Pulmonary valve

Correct answer: Aortic valve

If the aortic valve does not close properly, blood flows backward from the aorta into the left ventricle during diastole. This can seriously affect forward blood flow into the aorta and thus significantly impact cardiac output.

Adequate closure of the mitral valve is essential to ensure blood is being ejected forward into the aorta, not backward into the left atrium, during ventricular systole.

Incomplete closure or damage to the tricuspid valve causes abnormal ejection into the right atrium. 

An insufficient pulmonary valve allows blood to flow backward into the right ventricle during diastole. 

6.

A 69-year-old male patient with Pulmonary Artery Hypertension (PAH) is being considered for advanced therapy due to worsening symptoms despite standard treatment. His current regimen includes oxygen therapy, diuretics, and calcium channel blockers. 

What is the MOST appropriate next step in his management?

  • Initiate prostacyclin therapy

  • Increase the dose of diuretics

  • Discontinue calcium channel blockers

  • Switch to oral anticoagulants

Correct answer: Initiate prostacyclin therapy

Prostacyclin therapy is an advanced treatment for PAH. It is indicated in patients who have worsening symptoms despite standard therapy, as it helps to dilate pulmonary arteries and improve symptoms.

Increasing the dose of diuretics may help manage fluid overload but will not address the underlying pulmonary hypertension. 

Discontinuing calcium channel blockers is not appropriate unless they are proven ineffective or cause side effects. 

Oral anticoagulants may be used in PAH with a specific indication (e.g., chronic thromboembolic disease), but they are not the next step in managing worsening PAH symptoms in this context.

7.

Which of the following statements related to dysarthria is TRUE?

  • Dysarthria is difficulty with speech production

  • The two primary categories of dysarthria are motor and sensory

  • The two primary categories of dysarthria are conduction and anomic

  • The two primary categories of dysarthria are comprehension and repetition

Correct answer: Dysarthria is difficulty with speech production

Dysarthria is difficulty with speech production due to weakness or lack of coordination of the muscles of speech. A patient with dysarthria has slurred speech and is difficult to understand, but the content of their speech is appropriate. Dysarthria often becomes apparent during the assessment of mental status.

Aphasia is difficulty with language. There are two major categories of aphasia: motor and sensory.

8.

Which of the following frameworks for ethical analysis seeks to protect the relationships at risk in the situation?

  • Care-based

  • Utilitarian

  • Principle-based

  • Duty-based

Correct answer: Care-based

The care-based framework, also known as the ethics of care, focuses on the importance of relationships and the responsibilities that arise from them. It emphasizes empathy, compassion, and the nurturing of interpersonal connections, seeking to protect and maintain relationships that might be at risk in a given situation. This approach is concerned with the context of moral decisions and the well-being of all parties involved, particularly in preserving the integrity of relationships.

The utilitarian framework is concerned with the outcomes of actions, aiming to maximize overall happiness or minimize overall suffering. It evaluates actions based on their consequences rather than the relationships involved.

The principle-based framework relies on fundamental ethical principles such as autonomy, justice, beneficence, and nonmaleficence. It provides a structured approach to ethical decision-making based on adherence to these principles, without a primary focus on relationships.

The duty-based framework, also known as deontological ethics, emphasizes following moral rules or duties. It focuses on the inherent rightness or wrongness of actions themselves rather than their consequences or the relationships they impact.

9.

A 19-year-old male patient is admitted to the PCU after a motor vehicle accident. He becomes verbally aggressive and threatens staff when asked to follow treatment protocols. His heart rate is 105 beats per minute, blood pressure is 145/85 mmHg, and respiratory rate is 22 breaths per minute. 

What is the MOST appropriate nursing action at this moment?

  • Remain calm and ask the patient what is bothering him

  • Call and request an order for immediate sedation

  • Confront the patient about his aggressive tone

  • Physically restrain the patient for staff safety

Correct answer: Remain calm and ask the patient what is bothering him

In this situation, the best course of action is to remain calm and seek to understand the cause of the patient’s aggression. Asking open-ended questions helps deescalate tension and may provide insight into the patient's frustration, fear, or discomfort.

Sedation or restraints should be reserved for situations when a patient is actively threatening or harming themselves or others. Confrontation may escalate the situation and could increase the patient's aggression.

10.

You are caring for a 35-year-old female patient who developed hives, facial swelling, and hypotension following an injection of contrast dye for a CT scan. She received intramuscular epinephrine and intravenous fluids, but her symptoms are not improving. 

What is the MOST appropriate next step in managing this patient?

  • Administer a second dose of epinephrine

  • Administer corticosteroids

  • Intubate and mechanically ventilate

  • Initiate continuous intravenous vasopressor support

Correct answer: Administer a second dose of epinephrine

If the patient is not responding to the initial dose of epinephrine and is still in anaphylaxis, a second dose is often required to achieve the desired effects. Epinephrine is the cornerstone of anaphylactic shock management.

Corticosteroids can help reduce inflammation and prevent prolonged reactions, but they act slowly and are not immediately life-saving. Intubation is necessary if airway compromise is severe, but this should be considered after additional epinephrine if airway obstruction is still developing. Vasopressors can be considered if fluid resuscitation and epinephrine fail to raise blood pressure, but the priority is epinephrine administration.

11.

Assessment of pupil size and reaction to light provides information about the function of which cranial nerves?

  • II and III

  • I and II

  • I and III

  • III and IV

Correct answer: II and III

Cranial Nerve II (CN II, the optic nerve) and CN III (the oculomotor nerve) are involved in assessing pupil size and reaction to light. CN II is responsible for sensing light, while CN III controls pupil constriction in response to light.

CN I (the olfactory nerve) is responsible for the sense of smell and is not involved in pupil size or reaction to light.

CN IV (the trochlear nerve) controls the movement of the superior oblique muscle of the eye and does not affect pupil size or reaction to light.

12.

A 68-year-old female patient with a history of small-cell lung cancer is admitted with confusion, seizures, and low serum sodium. Which of the following is MOST likely to explain the pathophysiology of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

  • Increased secretion of antidiuretic hormone despite low serum osmolality

  • Increased renal excretion of sodium

  • Decreased release of antidiuretic hormone in response to dehydration

  • Excessive water loss due to polyuria

Correct answer: Increased secretion of antidiuretic hormone despite low serum osmolality

SIADH involves excessive release of Antidiuretic Hormone (ADH), causing water retention despite low serum osmolality, which results in hyponatremia.

Increased renal excretion of sodium would lead to hypernatremia, not hyponatremia. Decreased release of antidiuretic hormone would result in fluid loss and dehydration, the opposite of SIADH. Excessive water loss due to polyuria is more typical in diabetes insipidus, not SIADH.

13.

Which of the following is the LEAST appropriate intervention to prevent disagreements between staff and family regarding family needs? 

  • Relying on nurses to fulfill all family needs

  • Establishing methods to contact and communicate with the patient's family

  • Identifying a family spokesperson

  • Providing information according to family needs

Correct answer: Relying on nurses to fulfill all family needs

Relying on nurses to fulfill all family needs places an unrealistic burden on nurses, creates tension and frustration, and does not utilize a team approach to address family needs. It can lead to conflicts and unmet expectations. Hospital resources must be utilized, and the family must be assessed to determine which of those resources can best assist them.

Effective communication channels help ensure that the family is informed and can express their concerns and priorities, preventing misunderstandings.

Designating a spokesperson helps streamline communication and ensures that the family's views and priorities are clearly represented to the healthcare team.

Tailoring information to meet the specific needs of the family helps build trust and ensures that their concerns and priorities are addressed appropriately.

14.

Which of the following is the BEST method of evaluating aspiration risk for patients who are receiving enteral feedings?

  • Assess cough reflex

  • Assess gag reflex

  • Routinely measure gastric residual volume

  • Test tracheal secretions for the presence of glucose

Correct answer: Assess cough reflex

The cough and swallow reflexes are important to airway protection and are the best method of evaluating aspiration risk for patients receiving enteral feedings. The least reliable protective reflex in assessing aspiration risk is the gag reflex. 

The idea that Gastric Residual Volume (GRV) is a valid measure of enteral nutrition tolerance and the link between the amount of GRV and the risk of aspiration pneumonia events have not been proven. Furthermore, GRV measurement is poorly standardized and should not be routinely incorporated into practice.

Testing tracheal secretions for the presence of glucose can indicate aspiration if enteral feeding contents enter the airway, but it is more of a diagnostic tool after aspiration has occurred rather than a preventive measure.

15.

Which of the following is TRUE about Antidiuretic Hormone (ADH)? 

  • It is produced by the hypothalamus

  • It is produced by the posterior pituitary gland

  • It is stored in the hypothalamus

  • It is stored in the anterior pituitary gland

Correct answer: It is produced by the hypothalamus

ADH, also known as vasopressin, is produced by the hypothalamus. Once synthesized, it is transported down the axons of hypothalamic neurons to the posterior pituitary gland, where it is stored and eventually released into the bloodstream in response to various stimuli, such as increased plasma osmolality or decreased blood volume.

16.

Which of the following statements about peritoneal dialysis is FALSE?

  • With an optimally functioning catheter, it takes approximately one hour for 2 L of fluid to infuse

  • During peritoneal dialysis, dialysate flows into the peritoneal cavity by gravity

  • In peritoneal dialysis, diffusion and convection occur across the peritoneal membrane

  • Peritoneal dialysis is contraindicated in patients with respiratory distress

Correct answer: With an optimally functioning catheter, it takes approximately one hour for 2 L of fluid to infuse

Dialysate flows into the peritoneal cavity by gravity; it takes approximately ten minutes for 2 L of fluid to infuse.

The dialysate remains in the cavity for a predetermined amount of time (dwell time) and then is drained. During the dwell time, diffusion and convection occur across the peritoneal membrane. Peritoneal dialysis is contraindicated in patients who have recently undergone abdominal surgery and in those with respiratory distress, abdominal infection, or bowel diseases.

17.

A 57-year-old male patient presents to the emergency department with a syncopal episode. An Electrocardiogram (ECG) shows a prolonged QT interval. 

Which arrhythmia is MOST associated with a prolonged QT interval?

  • Torsades de pointes

  • Ventricular fibrillation 

  • Atrial fibrillation 

  • Supraventricular tachycardia 

Correct answer: Torsades de pointes

Torsades de Pointes (TdP) is a specific type of ventricular tachycardia associated with a prolonged QT interval on an ECG. It is characterized by a twisting of the points on the ECG, which is a hallmark finding. This condition can lead to sudden cardiac arrest if not treated promptly.

Ventricular fibrillation is a life-threatening arrhythmia but is not typically associated with a prolonged QT interval. It involves chaotic electrical activity in the ventricles, leading to an inability of the heart to pump effectively.

Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of the heart experience chaotic electrical signals, but it is not directly related to a prolonged QT interval. 

Supraventricular tachycardia refers to a group of arrhythmias that originate above the ventricles and is not characterized by a prolonged QT interval.

18.

What longer-acting synthetic analog of somatostatin produces the same results as vasopressin in the control of acute variceal bleeding, but with significantly fewer adverse effects? 

  • Octreotide

  • Propranolol

  • Pantoprazole

  • Ibutilide

Correct answer: Octreotide

Octreotide is a synthetic analog of somatostatin, which inhibits the release of several gastrointestinal hormones and reduces splanchnic blood flow. This effect helps to control acute variceal bleeding similarly to vasopressin. However, octreotide is preferred due to its longer duration of action and lower incidence of systemic adverse effects compared to vasopressin. It is commonly used in conjunction with other therapies, such as endoscopic band ligation, to manage variceal bleeding effectively.

Propranolol is a beta-blocker that treats high blood pressure, angina (chest pain), irregular heartbeat, migraine headaches, and tremors and lowers the risk of repeated heart attacks.

Pantoprazole is a Proton Pump Inhibitor (PPI) that treats Gastroesophageal Reflux Disease (GERD) and damage to the esophagus. It also treats high levels of acid in the stomach caused by a tumor (such as Zollinger-Ellison syndrome).

Ibutilide is an antiarrhythmic that is indicated for conversion of recent-onset atrial fib and atrial flutter to normal sinus rhythm. It is associated with minimal hemodynamic effects and has not been shown to worsen heart failure or to lower blood pressure.

19.

You are caring for a 32-year-old female patient with Graves' disease who presents with severe palpitations, tremors, and diarrhea. Her heart rate is 145 bpm, her blood pressure is 145/90 mmHg, and her temperature is 103°F. 

Which of the following interventions is most likely indicated FIRST?

  • Administer propranolol

  • Administer hydrocortisone

  • Begin intravenous fluid resuscitation

  • Administer levothyroxine

Correct answer: Administer propranolol

Beta-blockers (propranolol, esmolol) are indicated to control the cardiovascular effects of hyperthyroidism, such as tachycardia and palpitations, especially in a thyroid storm. They blunt the sympathetic nervous system receptors, helping to stabilize the heart rate while addressing the underlying hyperthyroid state.

Hydrocortisone is used in thyroid storms for adrenal support but is not the first-line treatment in this acute situation. Intravenous fluids may be needed for hydration, but controlling the heart rate and symptoms of thyroid storm is more urgent. Levothyroxine is used to treat hypothyroidism, not hyperthyroidism or thyroid storm, so it would not be appropriate in this context.

20.

Which of the following statements about the postsurgical care of the cardiac transplantation patient is TRUE?

  • If dysrhythmias such as Supraventricular Tachycardia (SVT) occur, calcium channel blockers or beta-blockers are used

  • Patients usually have a lower resting heart rate than normal

  • In cases of chronic rejection with diffuse coronary artery disease, patients may experience severe angina

  • With the loss of vagal tone, and if the sinus rate increases, there is a greater potential for junctional rhythms to develop

Correct answer: If dysrhythmias such as Supraventricular Tachycardia (SVT) occur, calcium channel blockers or beta blockers are used

For dysrhythmias such as SVT in post-cardiac transplantation patients, calcium channel blockers or beta-blockers are used to decrease the heart rate.

Following cardiac transplantation, the patient usually has a higher resting heart rate than normal due to the loss of vagal influence. 

Cardiac denervation creates a concern in cardiac transplantation patients as pain impulses are not transmitted to the brain. This occurs in cases of chronic rejection, in which even diffuse coronary artery disease does not cause the patient to experience angina. Following cardiac transplantation, patients require more stabilization before position changes or exercise to avoid orthostasis. 

Due to the loss of vagal tone, and if the sinus rate decreases, the risk of developing junctional rhythms increases.

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