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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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41.

You are caring for a 32-year-old male patient in the Progressive Care Unit (PCU) five days post-gastric sleeve surgery. The patient complains of severe abdominal pain, shoulder pain, fever, and chills. What complication should you suspect? 

  • Anastomotic leakage

  • Gastrointestinal bleeding

  • Bowel obstruction

  • Pulmonary embolism

Correct answer: Anastomotic leakage

Anastomotic leakage is a serious complication after gastric sleeve surgery and presents with symptoms such as severe abdominal pain, shoulder pain (referred pain due to diaphragmatic irritation), fever, and chills. The initial nursing action should include assessing vital signs to determine the patient's stability and preparing for diagnostic imaging (such as a CT scan) to confirm the diagnosis and guide further treatment.

Gastrointestinal bleeding can present with symptoms like hypotension, tachycardia, and blood in the stool or vomit. However, it does not typically cause severe abdominal pain, shoulder pain, fever, and chills.

While bowel obstruction can cause severe abdominal pain, it is less likely to present with fever and chills. The symptoms described are more consistent with an anastomotic leak.

Pulmonary embolism can present with sudden shortness of breath, chest pain, and signs of hypoxia, but it does not typically cause severe abdominal pain, shoulder pain, fever, and chills.

42.

In which of the following situations would it be MOST appropriate for a surrogate decision-maker to apply the best-interests standard to the informed consent process?

  • An 18-month-old who was struck by a car

  • A 35-year-old who has suffered a brain aneurysm but has a living will

  • A patient with terminal lung cancer who is on hospice

  • The surrogate's own 78-year-old mother

Correct answer: An 18-month-old who was struck by a car

The best-interests standard allows surrogate decision-makers to arrive at a decision that is in the best interest of patients who have never been able to express their preferences related to medical decisions. Examples of patients who have never had capacity include infants, children, and people of all ages with disabilities that prevent this capacity. 

An 18-month-old is included here, whereas the patients in the other answer choices are likely to have had the opportunity to express their preferences regarding informed consent.

43.

Which of the following is the MOST common indication for initiating renal replacement therapy in acute kidney injury?

 

  • Severe hyperkalemia

  • Severe hypertension

  • Severe hypercalcemia

  • Severe hypoglycemia

Correct answer: Severe hyperkalemia

Severe hyperkalemia is one of the most common and urgent indications for initiating renal replacement therapy in patients with acute kidney injury. Elevated potassium levels can lead to life-threatening cardiac arrhythmias, making it crucial to reduce potassium levels through dialysis rapidly.

Hypertension is typically managed with antihypertensive medications and does not usually require renal replacement therapy unless it is associated with fluid overload or other complications.

Hypercalcemia is managed through hydration, medications like bisphosphonates, and sometimes dialysis, but it is a less common reason for renal replacement therapy than hyperkalemia.

Hypoglycemia is treated with glucose administration, not dialysis, and is unrelated to the initiation of renal replacement therapy.

44.

A 58-year-old patient with a history of asthma and hypertension is admitted to the Progressive Care Unit (PCU) for hypertensive crisis. The patient is prescribed IV labetalol for blood pressure management. 

Which of the following statements is TRUE about labetalol administration and its effects?

  • Labetalol can cause bronchospasm and should be used cautiously in patients with asthma

  • Labetalol selectively blocks beta-1 receptors, leading to decreased heart rate and cardiac output

  • Labetalol is administered as a continuous infusion only, not in bolus doses

  • Labetalol primarily causes peripheral vasoconstriction, increasing systemic vascular resistance

Correct answer: Labetalol can cause bronchospasm and should be used cautiously in patients with asthma

Labetalol can cause bronchospasm due to its nonselective beta-blocking effects. This is especially important in patients with asthma or other reactive airway diseases, as blocking beta-2 receptors in the lungs can lead to bronchoconstriction.

Labetalol is a nonselective beta-blocker and also has alpha-1 blocking activity. It decreases heart rate and cardiac output and causes vasodilation by blocking both beta and alpha receptors.

It can be administered both as an intermittent IV bolus and as a continuous infusion, depending on the clinical situation and the physician’s order.

Labetalol primarily causes peripheral vasodilation due to its alpha-1 blocking effects, which lowers systemic vascular resistance. It does not cause peripheral vasoconstriction.

45.

An 88-year-old male patient with end-stage Chronic Obstructive Pulmonary Disease (COPD) is receiving hospice care. Which of the following medications is MOST commonly used for pain management in end-of-life care?

  • Morphine sulfate

  • Ibuprofen

  • Fentanyl patch

  • Acetaminophen

Correct answer: Morphine sulfate

Morphine is the most commonly used opioid for managing moderate to severe pain in end-of-life care. It is effective in managing both pain and dyspnea (shortness of breath), which are common in patients with conditions like COPD.

Ibuprofen is a Nonsteroidal Anti-Inflammatory Drug (NSAID) used for mild to moderate pain relief but not typically for end-of-life care, in which opioids are preferred for severe symptoms. Fentanyl is another opioid, but it is less commonly used in end-of-life situations than morphine due to its delayed onset of action and patch format, which can be less flexible for rapid titration. Acetaminophen is useful for mild pain and fever but is insufficient for the level of pain typically experienced in end-stage conditions like COPD.

46.

In an Electrocardiogram (ECG), which wave represents ventricular muscle repolarization? 

  • T wave

  • P wave

  • U wave

  • ST segment

Correct answer: T wave

The T wave represents ventricular muscle repolarization and typically follows the QRS complex. It is usually in the same direction as the QRS complex, although this can vary depending on multiple factors, such as myocardial disease, ischemia, electrolyte levels, and drug effects. It can be upright, flat, or inverted.

The P wave represents the electrical depolarization of the atria of the heart.

The U wave is a small deflection that may follow the T wave, and it is associated with the repolarization of the Purkinje fibers or the last phase of ventricular repolarization. It is not always present on an ECG and is often more prominent in certain conditions, such as hypokalemia.

The ST segment represents the interval between the end of ventricular depolarization (end of the QRS complex) and the beginning of ventricular repolarization (start of the T wave). It reflects the period of time when the ventricles are depolarized and no electrical activity is happening, which corresponds to early ventricular repolarization.

47.

Which ethical principle affirms the right of an individual to make decisions and choose actions based on their personal values and beliefs?

  • Autonomy

  • Nonmaleficence

  • Beneficence

  • Justice

Correct answer: Autonomy

Autonomy relates to the principle that individuals have the right to self-determination and the freedom to make decisions about their own lives. This principle is foundational in healthcare, supporting the right of patients to make informed choices about their treatment options even if those choices differ from the recommendations of healthcare professionals. Respecting a patient's autonomy means acknowledging their right to decide what aligns best with their values and beliefs.

Nonmaleficence is a duty to do no harm. 

Justice is fairness and is often associated with the distribution of services (such as healthcare), goods, or burdens among a population. 

Beneficence affirms the obligation to do good to others by helping them advance and achieve their interests.

48.

A patient on the unit has Cranial Nerve VII dysfunction. Which of the following statements is MOST likely to be accurate about this patient?

  • They are unable to close the eyelid on the affected side

  • Their hearing and equilibrium are affected

  • Their gag reflex is affected

  • They cannot protrude their tongue

Correct answer: They are unable to close the eyelid on the affected side

Cranial Nerve VII (CN VII), also known as the facial nerve, is responsible for controlling the muscles of facial expression, including those that close the eyelid. Dysfunction of CN VII can lead to an inability to close the eyelid on the affected side, which is common in conditions such as Bell's palsy.

Hearing and equilibrium are primarily controlled by CN VIII (the vestibulocochlear nerve), not CN VII.

The gag reflex is controlled by CN IX (glossopharyngeal) and CN X (vagus), not CN VII.

Protruding the tongue is a function of CN XII (the hypoglossal nerve), not CN VII.

49.

Acute Kidney Injury (AKI) occurs in three clinical phases that result primarily from intrarenal injury. What change characterizes the first phase of AKI?

  • A significant rise in BUN and creatinine levels

  • An increase in urine output

  • A significant rise in BUN and creatinine levels along with acute hypokalemia

  • A drastic decline in BUN and creatinine levels

Correct answer: A significant rise in BUN and creatinine levels

The first phase of AKI, known as the initiation or oliguric phase, is characterized by the onset of kidney damage that leads to a rapid decline in kidney function, causing an accumulation of nitrogenous wastes. This accumulation leads to a significant rise (not a drastic decline) in blood urea nitrogen (BUN) and creatinine levels.

During AKI, urine output typically decreases (oliguria) or remains normal but does not increase. While BUN and creatinine levels do rise, acute hypokalemia is not typically associated with the initiation phase of AKI. Instead, hyperkalemia is more common due to the reduced excretion of potassium. 

50.

Of the following, which factor MOST influences aspiration and pneumonia risk in the enterally fed patient?

  • Patient positioning 

  • Feeding tube size 

  • The delivery rate of the feeding formula

  • Feeding tube site (mouth, nose, or gastric)

Correct answer: Patient positioning

Studies have shown that the risk of aspiration and pneumonia is significantly greater when patients who are enterally fed are supine with the head of the bed raised at less than 30 degrees. Strict use of semirecumbent positioning is the best means to decrease the risk of aspiration and associated pneumonia.

The size of the feeding tube and whether it is placed through the mouth, nose, or a gastronomy stoma do not affect the risk of aspiration and associated pneumonia. The delivery rate of the feeding may influence the risk of pneumonia and aspiration, but not to the extent that proper positioning does.

51.

A 68-year-old patient with end-stage renal disease is in the Progressive Care Unit (PCU) and has decided to discontinue dialysis. The healthcare team is faced with the ethical dilemma of respecting the patient’s right to make decisions about their own healthcare while also wanting to act in the patient’s best interest. 

Using principle-based ethical analysis, which of the following principles should guide the healthcare team’s decision-making?

  • Autonomy and beneficence

  • Autonomy and nonmaleficence

  • Beneficence and justice

  • Nonmaleficence and beneficence

Correct answer: Autonomy and beneficence

Autonomy and beneficence are key principles in this scenario. Autonomy respects the patient's right to make decisions about their own care, while beneficence involves acting in the patient’s best interest by providing compassionate care that aligns with the patient's wishes.

Nonmaleficence is an important principle but does not fully encompass the ethical responsibility to also promote good (beneficence).

Justice is important, but it pertains more to fairness and distribution of resources, which is not the primary ethical issue in this scenario.

52.

You are caring for a 23-year-old female patient admitted to the PCU with a history of intravenous drug use who presented with fever, chills, and a new heart murmur. Blood cultures are positive for Staphylococcus aureus. Her echocardiogram shows a vegetation on the mitral valve. 

Which of the following is the MOST appropriate next step in management?

  • Initiate broad-spectrum antibiotics

  • Perform emergency valve replacement surgery

  • Administer anticoagulation therapy

  • Start corticosteroids for inflammation

Correct answer: Initiate broad-spectrum antibiotics

The most appropriate next step for this patient with infective endocarditis is initiating broad-spectrum antibiotics to treat the Staphylococcus aureus infection. IV drug use and fever with a new murmur are classic signs of infective endocarditis, and timely antibiotic therapy is crucial.

Valve replacement surgery may be necessary if the infection does not respond to antibiotics or if there is significant valve damage, but antibiotics are the first-line treatment.

Anticoagulation therapy is not indicated in infective endocarditis unless there is a separate indication, such as atrial fibrillation.

Corticosteroids are not routinely used in the treatment of infective endocarditis.

53.

A 68-year-old male patient with a history of end-stage renal disease presents with hypotension, muffled heart sounds, and jugular venous distension. Despite fluid resuscitation, his blood pressure remains low, and he becomes increasingly lethargic. 

Which of the following is the MOST likely reason for the lack of response to fluids?

  • Accumulation of pericardial fluid causing cardiac tamponade

  • Decreased cardiac output due to acute myocardial infarction

  • Obstruction of blood flow due to a pulmonary embolism

  • Tension pneumothorax causing decreased venous return

Correct answer: Accumulation of pericardial fluid causing cardiac tamponade

In this case, the lack of response to fluid resuscitation, combined with the presence of muffled heart sounds and jugular venous distension, strongly indicates cardiac tamponade. The fluid accumulation compresses the heart, preventing it from filling effectively during diastole.

Acute myocardial infarction would likely present with other symptoms, such as chest pain, and while it could cause cardiogenic shock, the physical exam findings point more to tamponade. 

A pulmonary embolism could cause hypotension and shock, but hallmark symptoms like sudden dyspnea and pleuritic chest pain are missing, and muffled heart sounds are not typical. 

Tension pneumothorax causes decreased venous return and hypotension, but there would be absent breath sounds on one side, which are not mentioned here.

54.

Of the following, which is the MOST important indicator of elevated Intracranial Pressure (ICP)?

  • Change in Level of Consciousness (LOC)

  • Changes in vital signs

  • Abnormal posturing

  • Pupillary changes

Correct answer: Change in Level of Consciousness (LOC)

Early signs of increased ICP include restlessness, confusion, lethargy, disorientation, nausea and/or vomiting, headache, and visual abnormalities. The most important indicator of elevated ICP is a change in LOC.

Patients with increased ICP may develop motor deficits, and changes in vital signs may occur. An increase in systolic blood pressure may occur as the body attempts to maintain cerebral perfusion. 

Pupillary changes are most often a late sign of elevated ICP.  Abnormal posturing is also an ominous sign.

55.

A 62-year-old female patient with a history of type 2 diabetes mellitus, hypertension, and previous myocardial infarction presents to the emergency department with chest pain radiating to her left arm. The pain began two hours ago and is associated with diaphoresis and nausea. An ECG shows ST-segment elevation, and the decision is made to proceed with an urgent coronary angiography.

The patient has been on metformin for diabetes management and took her last dose this morning with breakfast. She also mentions that she had a light snack an hour before arriving at the hospital.

Considering the patient's clinical presentation and her preparation for an urgent coronary angiography, how long should she be NPO (nothing by mouth) before the procedure to minimize the risk of aspiration?

  • At least six hours

  • At least two hours

  • At least four hours

  • At least eight hours

Correct answer: At least six hours

For coronary angiography and other procedures requiring sedation, patients are typically advised to be NPO (nothing by mouth) for at least six hours to reduce the risk of aspiration during the procedure. Given the urgency of the situation, if the patient has not been NPO for the recommended duration, the medical team must weigh the risks and benefits of proceeding immediately versus waiting for the appropriate NPO period. In this scenario, the patient’s recent intake of a snack and medication must be considered, but the standard recommendation remains a minimum of six hours NPO.

56.

As you walk into your elderly patient's room, you witness the patient's son strike the patient. What is your most appropriate FIRST response?

  • Administer aid to the patient

  • Remove the son from the room

  • Call security

  • Communicate the risk of assault to other staff

Correct answer: Administer aid to the patient

As the patient's advocate, you are most concerned about the patient's needs. For this reason, administering care to the patient is your first priority. The son may or may not leave the room at your request; therefore, security may or may not need to be notified. Once the patient is safe and has been attended to, you should communicate the risk of assault to other staff (this is not the first response here). 

57.

What is the MOST common cause of respiratory failure in acutely ill patients?

  • Pneumonia

  • Chronic Obstructive Pulmonary Disease (COPD)

  • Asthma

  • Pulmonary hypertension

Correct answer: Pneumonia

Pneumonia is the most common respiratory infection and the most common cause of respiratory failure in acutely ill patients. 

The other answer choices do contribute to respiratory failure in acutely ill patients but are not as common as pneumonia. 

58.

You are caring for a 32-year-old male patient who was involved in a motor vehicle accident and lost a significant amount of blood. His blood pressure on admission was 65/45 mmHg, his heart rate was 140 bpm, and he had cold, clammy skin. He has received 3 L of intravenous fluids, and his blood pressure is 80/50 mmHg. 

What is the MOST appropriate next step in his management?

  • Administer blood products

  • Administer a vasopressor

  • Increase fluid administration

  • Monitor closely for improvement

Correct answer: Administer blood products

The patient’s low blood pressure and tachycardia suggest ongoing hypovolemic shock from hemorrhage. After fluids were administered, his blood pressure has not stabilized, indicating that blood loss is the likely cause, and blood product administration is needed to replace lost red blood cells and improve oxygen delivery.

Administering a vasopressor without addressing the underlying cause (blood loss) will not effectively restore hemodynamic stability. Further fluid administration without blood products will dilute his remaining red blood cells and will not correct the underlying issue. Monitoring without further intervention risks continued deterioration in the patient’s condition.

59.

Which clinical situations decrease the accuracy of pulse oximetry for assessing oxygen status? 

  • Hypotension, vasoconstriction, hypothermia

  • Hypertension, vasoconstriction, nail polish application

  • Hypertension, vasoactive drugs, low cardiac output

  • Nail polish application, movement of the sensor, hyperthermia

Correct answer: Hypotension, vasoconstriction, hypothermia

Clinical situations that decrease the accuracy of pulse oximetry include:

  • Hypotension
  • Vasoconstriction or vasoactive drugs
  • Hypothermia
  • Low cardiac output states
  • Poor skin adherence or movement of the sensor
  • Peripheral arterial disease 

Hypertension, nail polish application, and hyperthermia are not clinical situations that decrease the accuracy of pulse oximetry for assessing oxygen status.

60.

Which of the following statements about hospital-acquired pneumonia is TRUE? 

  • Most cases are due to aspiration of bacteria that colonize the upper gastrointestinal tract or oropharynx

  • Most cases are caused by hematogenous spread of an organism to the lung from another site in the body

  • Most cases are caused by inhalation of particles or aerosols containing organisms

  • Most cases are caused by a decreased level of consciousness and mechanical ventilation

Correct answer: Most cases are due to aspiration of bacteria that colonize the upper gastrointestinal tract or oropharynx

Hospital-Acquired Pneumonia (HAP) most commonly results from the aspiration of bacteria that colonize the oropharynx and upper gastrointestinal tract. These bacteria are often introduced into the lower respiratory tract when a patient's normal protective mechanisms, such as coughing or ciliary movement, are impaired, which is common in hospitalized patients.

Hematogenous spread to the lung is less common and is typically associated with severe systemic infections or bacteremia, rather than being the primary cause of HAP.

While inhalation of infectious aerosols can lead to pneumonia, it is not the primary route for HAP, which is more often associated with aspiration.

While a decreased level of consciousness and mechanical ventilation can increase the risk of developing hospital-acquired pneumonia, particularly Ventilator-Associated Pneumonia (VAP), they are not the direct cause. The primary cause remains the aspiration of bacteria colonizing the upper gastrointestinal tract or oropharynx.

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