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Quiz Session - Attempts With Random Questions

AACN PCCN July 2024 Exam Hanbook version 2.1.0 Exam Questions

Page 10 of 33

181.

A patient is diagnosed with a hemothorax following a motor vehicle collision. Which of the following findings is MOST likely in this condition?

  • Decreased breath sounds and hypotension

  • Increased breath sounds and tachycardia

  • Normal breath sounds and bradycardia

  • Crackles and hypertension

Correct answer: Decreased breath sounds and hypotension

Hemothorax leads to decreased breath sounds due to blood accumulating in the pleural space and hypotension due to blood loss.

Bradycardia is not a characteristic finding in hemothorax. Crackles are more commonly associated with pulmonary edema, not hemothorax.

182.

A patient's decision-making capacity is based on which of the following factors? 

  • Physical health, mental health, and the ability to be consistent in addressing issues

  • Mental health and the ability to concur with family members

  • Physical health and the ability to concur with family members

  • Mental health and the ability to concur with members of the healthcare team

Correct answer: Physical health, mental health, and the ability to be consistent in addressing issues

Capacity is an element of informed consent, reflecting a patient's ability to participate in their medical decision-making process. The capacity to make decisions is based on the patient's physical and mental health and the ability to be consistent in addressing issues. 

Capacity is not based on the ability to concur with healthcare providers or family members.

183.

The use of a ventilator with a Heat and Moisture Exchanger (HME) is indicated in which of the following scenarios? 

  • A patient with a body temperature above 37°C

  • A patient who has frank bloody secretions

  • A patient who has an uncuffed Endotracheal (ET) tube

  • A patient with a minute volume of 12 L/min

Correct answer: A patient with a body temperature above 37°C

An HME is commonly used in ventilated patients to help maintain moisture and warmth in the respiratory tract. When a patient has a body temperature above 37°C, they are at risk of increased evaporative loss of moisture. An HME is indicated in this scenario to compensate for this moisture loss and to maintain optimal humidity in the patient's airway. This helps prevent mucosal drying and maintain respiratory health.

Using an HME in a patient with bloody secretions is generally contraindicated because the filter can become clogged, leading to increased resistance and compromised ventilation. This option is not appropriate for the use of an HME, as the risk outweighs the benefit.

An HME should not be used with an uncuffed ET tube because the absence of a cuff can lead to air leaks, making it difficult to maintain adequate ventilation and humidification. The HME’s effectiveness relies on a sealed system, which is not achievable with an uncuffed ET tube.

HMEs are typically not recommended for patients with high minute volumes (usually above 10 L/min) because the HME may not be able to adequately humidify the air. High minute volumes require a more robust humidification system to ensure that the respiratory tract remains adequately moist, making this option incorrect for HME use.

184.

A 41-year-old female patient with Multiple Sclerosis (MS) is admitted to the PCU with increased muscle weakness and difficulty walking. Her vital signs are stable. 

Which treatment is MOST often used to manage an acute MS exacerbation?

  • Corticosteroids

  • Beta-blockers

  • Antibiotics

  • Anticoagulants

Correct answer: Corticosteroids

Corticosteroids, such as methylprednisolone, are commonly used to manage acute exacerbations of multiple sclerosis by reducing inflammation and suppressing immune activity.

Beta-blockers are used to manage cardiovascular conditions but are not indicated for MS exacerbations. Antibiotics treat bacterial infections but are not relevant for MS unless there is a secondary infection. Anticoagulants are used to prevent clotting disorders and have no role in managing MS exacerbations.

185.

Symptoms of MILD hypoglycemia include which of the following? 

  • Diaphoresis, tremors, irritability

  • Diaphoresis, shakiness, paresthesias

  • Diaphoresis, tremors, headache

  • Shakiness, headache, excessive hunger

Correct answer: Diaphoresis, tremors, irritability

Mild hypoglycemia typically presents with symptoms resulting from the activation of the autonomic nervous system. Common symptoms include diaphoresis (sweating), tremors, and irritability. These are early signs that the body is experiencing low blood glucose levels, prompting the release of adrenaline.

Shakiness is a common symptom, but paresthesias (tingling or numbness) are less typical in mild hypoglycemia and more often occur in severe cases.

While diaphoresis and tremors are common in mild hypoglycemia, headache tends to be associated with more significant or prolonged hypoglycemia.

While shakiness and excessive hunger can be symptoms of mild hypoglycemia, headache is less common in this stage and usually indicates more advanced hypoglycemia.

186.

According to the National Pressure Ulcer Advisory Panel (NPUAP), which stage features an exposed tendon that is directly palpable in part of the wound but is obscured by slough in other parts of the wound?

  • Unstageable pressure ulcer

  • Stage II pressure ulcer

  • Stage III pressure ulcer

  • Stage IV pressure ulcer

Correct answer: Unstageable pressure ulcer

An unstageable pressure ulcer is characterized by full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. When the extent of tissue damage cannot be determined because the base of the wound is obscured by slough or eschar, the wound is classified as unstageable.

Stage II ulcers do not have full-thickness tissue loss or exposed tendon.

While Stage III ulcers can have slough, the presence of exposed tendon in the wound disqualifies it from this stage.

Stage IV involves full-thickness tissue loss with exposed bone, tendon, or muscle. The key here is that the extent of tissue loss is fully visible. Since slough covers part of the wound, preventing complete assessment, it is classified as unstageable until enough of the slough is removed to allow full visualization.

187.

A 78-year-old male patient with a history of hypertension presents with sudden, severe chest pain radiating to his back. 

Which finding is MOST likely associated with acute aortic dissection?

  • Blood pressure difference between the arms

  • Sharp, pleuritic chest pain with deep breaths

  • Diffuse ST-elevation on ECG

  • Jugular venous distension

Correct answer: Blood pressure difference between the arms

In an Acute Aortic Dissection (AAD), a key finding is a significant (more than 20 mmHg) blood pressure difference between the arms due to compromised blood flow in one branch of the aorta. 

Sharp, pleuritic chest pain with deep breaths is more indicative of pleuritis or pericarditis. Diffuse ST-elevation on ECG is suggestive of pericarditis or myocardial infarction, not AAD. Jugular venous distension is more characteristic of right-sided heart failure or cardiac tamponade.

188.

Which of the following are clinical signs and symptoms specific to right-sided Heart Failure (HF)?

  • Dependent edema, nausea and vomiting, pansystolic murmur at the lower left sternal border

  • Dependent edema, nausea and vomiting, pansystolic murmur at the apex

  • Rales, pulsus alternans, dizziness and syncope

  • Dependent edema, rales, pansystolic murmur at the apex

Correct answer: Dependent edema, nausea and vomiting, pansystolic murmur at the lower left sternal border

Right-sided heart failure specifically affects the right side of the heart, which is responsible for pumping blood to the lungs. Clinical signs and symptoms of right-sided heart failure include dependent edema (due to fluid accumulation in the lower extremities), nausea and vomiting (caused by congestion of the gastrointestinal tract), and a pansystolic murmur at the lower left sternal border, which can be associated with tricuspid regurgitation, a condition often seen in right-sided heart failure.

A pansystolic murmur at the apex is more commonly associated with mitral regurgitation, which is related to left-sided heart failure. Rales, pulsus alternans, dizziness, and syncope indicate left-sided heart failure, which affects the left side of the heart and its ability to pump blood to the rest of the body. Rales are crackling sounds heard in the lungs due to pulmonary congestion, which is a hallmark of left-sided heart failure.

189.

What step is included in planning in the process of ethical analysis?

  • Identifying the risks and benefits likely to arise from each action

  • Choosing a plan and acting

  • Anticipating objections

  • Identifying what harm or good occurred as a result of the action

Correct answer: Identifying the risks and benefits likely to arise from each action

In the process of ethical analysis, planning includes the identification of the risks and benefits likely to arise from each action. This step involves evaluating the potential outcomes of different courses of action to ensure that the decision-making process considers all possible consequences, both positive and negative.

Choosing a plan and acting come after planning in the ethical decision-making process. Once the risks and benefits have been identified and considered, the next step is to choose the best course of action and implement it.

While anticipating objections is important in ethical analysis, it is more closely associated with the process of evaluating and justifying decisions than with the initial planning phase.

Identifying the harm or good resulting from the action is done during the evaluation phase after an action has been taken. It involves reflecting on the outcomes to learn from the experience and improve future ethical decision-making processes.

190.

The low stretch protocol, or low tidal volume ventilation, is used to reduce the risk of what potential complication of mechanical ventilation that results from high pressures from large-volume ventilation in patients with Acute Respiratory Distress Syndrome (ARDS)?

  • Volutrauma

  • Barotrauma

  • Auto-PEEP

  • Broggins trauma

Correct answer: Volutrauma

The low stretch protocol (or low tidal volume ventilation) is used to reduce the risk of volutrauma. Volutrauma is damage to the alveoli due to the high pressures resulting from large-volume ventilation in patients with ARDS.

Different from barotrauma, volutrauma results in alveolar fractures and flooding of alveoli. It is linked to the use of tidal volumes (VTs) greater than 6 mL/kg in patients with ARDS. 

Auto-PEEP occurs when a delivered breath is not fully exhaled before the onset of the next inspiration; ventilated patients with Chronic Obstructive Pulmonary Disease (COPD) are at a higher risk of this complication. 

Broggins trauma is not associated with mechanical ventilation. 

191.

You are caring for a 29-year-old Latina woman who is recovering from surgery. Her family members, who are very involved in her care, frequently express their opinions about the treatment plan. 

How should you BEST respond to address the family’s involvement?

  • Incorporate the family’s input while maintaining focus on the patient’s needs

  • Discuss the treatment plan directly with the patient, excluding family input

  • Limit family involvement to reduce confusion during patient care

  • Ask the patient if she prefers to have her family less involved in decision-making

Correct answer: Incorporate the family’s input while maintaining focus on the patient’s needs

In many cultures, family involvement is a key aspect of decision-making. You should respect this while ensuring the patient’s needs and autonomy are central to the care process.

Discussing the plan directly with the patient without family input may disregard the cultural value placed on family involvement. Limiting family involvement may cause distress or lead to misunderstandings, especially in cultures in which family plays a key role in healthcare decisions. Asking the patient about family involvement is an option, but it may be perceived as dismissive if the family traditionally plays a central role in care.

192.

In communicating with families and patients, what is the LEAST therapeutic interaction by the nurse?

  • Elicit care provider preferences

  • Apologize for inconveniences

  • Use open-ended questions

  • Provide concise explanations without using medical shorthand

Correct answer: Elicit care provider preferences

In communicating with families and patients, the least therapeutic interaction by the nurse is to elicit care provider preferences; accommodating requests for preferred care providers should be avoided. 

Communication with the patient and the family should be open and honest. Clinicians should keep promises, describe expectations (avoiding medical shorthand and complicated medical terminology), and use open-ended questions. This type of questioning fosters a more comprehensive understanding and supports patient-centered care. 

Apologizing for inconveniences is also appropriate and builds rapport between patient and nurse. 

193.

You are caring for a 76-year-old male patient with a history of chronic heart failure, admitted with shortness of breath and swelling in his legs. His vital signs are blood pressure 132/86 mmHg, heart rate 85 beats per minute, respiratory rate 20 breaths per minute, and SpO2 94% on room air. He has a history of chronic heart failure. 

Which of the following is the MOST common cause of heart failure exacerbation?

  • Noncompliance with medications

  • Myocardial infarction

  • Atrial fibrillation

  • Hypertension

Correct answer: Noncompliance with medications

Noncompliance with prescribed heart failure medications, particularly diuretics, is the most common cause of heart failure exacerbations. Patients may skip their medications for various reasons, leading to fluid overload and decompensation of heart failure.

Myocardial infarction can exacerbate heart failure but is less common than noncompliance. Atrial fibrillation can also lead to exacerbations but usually in combination with other factors. Hypertension is a common contributing factor in chronic heart failure, but poorly controlled blood pressure is not the most frequent cause of exacerbation in stable heart failure patients.

194.

Which of the following statements is FALSE about the safe and effective use of Intermittent Pneumatic Compression Devices (IPCs)?

  • The use of these devices is contraindicated in ambulatory patients

  • Assessment for correct fit needs to be ongoing as changes in weight and fluid shifts occur

  • The devices need to be closely monitored to make sure they are being worn and are correctly placed

  • Ensure the devices do not impede the patient's ambulation

Correct answer: The use of these devices is contraindicated in ambulatory patients

IPCs are not contraindicated in ambulatory patients, and care should be taken to ensure the devices do not impede the patient's ambulation.

IPC devices help to prevent DVT and pulmonary embolism. Follow the manufacturer's recommendations for the correct fit, including patient measurement. Assessment for correct fit needs to be ongoing as changes in weight and fluid shifts occur. The devices need to be closely monitored to make sure they are being worn and are correctly placed.

195.

A 72-year-old female patient is being treated for a lower Gastrointestinal (GI) bleed secondary to diverticulosis. After receiving 2 L of normal saline, her blood pressure has improved to 110/70 mmHg and her heart rate has decreased to 88 bpm. 

Which of the following interventions is MOST likely to further improve patient outcomes?

  • Starting a blood transfusion

  • Increasing the fluid infusion rate

  • Administering vasopressors

  • Performing an urgent colonoscopy

Correct answer: Starting a blood transfusion

A blood transfusion is the next step in managing significant GI bleeding, particularly if there is ongoing blood loss or the patient is symptomatic despite initial fluid resuscitation. Restoring hemoglobin levels improves oxygen delivery and patient outcomes.

Increasing the fluid infusion rate can support hemodynamic stability, but transfusion is more appropriate to replace lost red blood cells after significant blood loss. Vasopressors may be needed if the patient continues to exhibit hypotension despite adequate fluid and blood resuscitation, but it is not the first choice in this scenario. An urgent colonoscopy can help identify the source of the bleeding for definitive treatment, but stabilizing the patient with fluids and transfusions is the priority before proceeding to diagnostics.

196.

The Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS Guidelines, recommend that which of the following should be considered first-line treatment for non-neuropathic pain in the acute care setting?

  • Opioids

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • Acetaminophen

  • Corticosteroids

Correct answer: Opioids

According to the PADIS Guidelines, intravenous opioids should be considered the first-line treatment for non-neuropathic pain in the acute care setting. These medications are recommended due to their rapid onset of action, effectiveness in managing moderate to severe pain, and ability to be titrated to achieve the desired level of analgesia.

NSAIDS, acetaminophen, and corticosteroids are used for pain management but are not first-line treatments for non-neuropathic pain in this setting. 

197.

Which of the following statements is TRUE about Positive End-Expiratory Pressure (PEEP)?

  • The application of positive pressure to the airways during expiration may keep alveoli open and prevent early closure during exhalation in conjunction with any of the ventilator modes

  • Use of PEEP may decrease the risk of barotrauma due to lower mean and peak airway pressures during ventilation

  • PEEP may decrease intracranial pressure and increase renal perfusion

  • PEEP may decrease hepatic congestion

Correct answer: The application of positive pressure to the airways during expiration may keep alveoli open and prevent early closure during exhalation in conjunction with any of the ventilator modes

Lung compliance and ventilation-perfusion matching are often improved by prevention of early alveolar closure. 

Use of PEEP may increase, not decrease, the risk of barotrauma due to higher mean and peak airway pressures during ventilation. It may increase intracranial pressure, decrease renal perfusion, and lead to hepatic congestion. It may also increase hepatic congestion.

198.

A 50-year-old female patient with a history of gastric bypass surgery presents with dizziness and weakness. Her lab results reveal macrocytic anemia. 

Which of the following treatments is MOST likely indicated for this patient?

  • Vitamin B12 supplementation

  • Iron supplementation

  • Folic acid supplementation

  • Erythropoietin injections

Correct answer: Vitamin B12 supplementation

Patients with a history of gastric bypass surgery are at higher risk of vitamin B12 deficiency because the surgery limits the absorption of B12, leading to macrocytic anemia. Supplementation is necessary to correct this deficiency and resolve the anemia.

Iron supplementation would not be effective here, as the anemia is not due to iron deficiency. Folic acid supplementation may help with some forms of macrocytic anemia but is less likely to be the primary issue in this patient. Erythropoietin injections are indicated for chronic kidney disease but not for anemia caused by vitamin B12 deficiency.

199.

A patient who has been receiving Intravenous (IV) antibiotics is transitioning to oral medications. To facilitate patient learning, what is the BEST action for the nurse to take?

  • Explain the purpose of the new medication to the patient and family

  • Describe the potential side effects of the medication

  • Ensure the patient remembers the name of the new medication

  • Ensure the patient knows when to expect the next dose of medication

Correct answer: Explain the purpose of the new medication to the patient and family

The BEST action for the nurse to take is to give the patient and family basic information about what the purpose of the medicine is.

Nursing staff will continue to be responsible for dose administration, and at this point, it is not essential for the patient to remember the name of the drug. Too much information is likely to overwhelm the patient. 

Informing the patient of potential side effects may be beneficial but will not facilitate patient learning. 

200.

A 55-year-old male patient with a history of atrial fibrillation is experiencing palpitations and dizziness. His ECG shows an Atrioventricular (AV) block. What is the MOST likely effect of an AV block on his heart function?

  • Impaired transmission of electrical impulses from atria to ventricles

  • Increased automaticity of the ventricles causing tachycardia 

  • Enhanced synchronization of atrial and ventricular contractions

  • Improved efficiency of ventricular ejection fraction

Correct answer: Impaired transmission of electrical impulses from atria to ventricles

An AV block impairs the transmission of electrical impulses from the atria to the ventricles, which can lead to symptoms such as palpitations and dizziness due to inefficient heart function.

Increased automaticity of the ventricles causing tachycardia is not related to an AV block but to ectopic pacemaker activity.

Enhanced synchronization of atrial and ventricular contractions is the opposite of what happens in an AV block, in which synchronization is actually impaired.

Improved efficiency of ventricular ejection fraction is not a result of an AV block; an AV block can reduce the efficiency of the heart's pumping action.

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