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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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61.

You are working in the emergency department today, caring for a 27-year-old pregnant female patient at 24 weeks gestation who presented with fever, cough, and malaise. Her vital signs are HR 112, BP 110/68, RR 22, SpO2 93%. You suspect influenza.

Which of the following actions is MOST appropriate in managing this patient?

  • Administer antiviral medication within 48 hours of symptom onset

  • Wait for laboratory confirmation of influenza before starting treatment

  • Administer corticosteroids to manage inflammation from the virus

  • Admit to the ICU for immediate mechanical ventilation

Correct answer: Administer antiviral medication within 48 hours of symptom onset

Antiviral treatment should be initiated as early as possible, ideally within 48 hours of symptom onset, especially in high-risk populations such as pregnant women, to reduce the severity of symptoms and prevent complications.

Waiting for lab confirmation can delay treatment and is not necessary in cases with high clinical suspicion, especially in high-risk patients.

Corticosteroids are generally not indicated in the routine management of uncomplicated influenza unless there are underlying conditions that warrant their use (e.g., asthma exacerbation).

The patient’s current vital signs do not indicate the need for ICU admission or mechanical ventilation. This step would be necessary only if there were signs of respiratory failure or severe complications.

62.

A 60-year-old male, post-Coronary Artery Bypass Graft (CABG) surgery, is being evaluated for discharge. His vital signs are stable and he reports feeling well, but his telemetry shows occasional Premature Ventricular Contractions (PVCs). 

What is the MOST appropriate action?

  • Continue to monitor telemetry without intervention

  • Administer amiodarone prophylactically

  • Delay discharge for further cardiac evaluation

  • Start potassium supplementation immediately

Correct answer: Continue to monitor telemetry without intervention

PVCs are common after cardiac surgery and often do not require intervention unless they are frequent or are associated with symptoms. Monitoring without immediate intervention is appropriate.

Administering amiodarone prophylactically is unnecessary in the absence of frequent or symptomatic arrhythmias. Delaying discharge for further evaluation is not warranted unless the patient exhibits signs of more severe arrhythmias. Potassium supplementation should be initiated only if the patient has documented hypokalemia, which has not been mentioned in this scenario.

63.

You are caring for a patient who just returned from surgery. The patient is very frightened and states there are bugs on the ceiling. What is your most appropriate FIRST response to this patient? 

  • Minimize the patient's fear by saying, for example, "Hello, I'm your nurse. You are in the hospital. I will stay here with you."

  • Minimize the patient's fear by turning off the lights so they cannot see the "bugs"

  • Administer a sedative-hypnotic medication

  • Turn on the television to distract the patient's attention from the "bugs"

Correct answer: Minimize the patient's fear by saying, for example, "Hello, I'm your nurse. You are in the hospital. I will stay here with you."

Repeating orientation cues will help to minimize fear and confusion and should be the nurse's first action.

A well-lit rather than a darkened room will help to minimize the patient's confusion; darkness may only escalate the patient's fear. Medication for managing delirious behavior is reserved for cases in which behavioral interventions have failed. Background noise often increases anxiety, as the patient may have difficulty processing the noise and content. 

64.

Which of the following electrolyte imbalances is LEAST likely to occur as a result of liver failure?

  • Hyperglycemia

  • Hypokalemia

  • Hypomagnesemia

  • Hypocalcemia

Correct answer: Hyperglycemia 

Hyperglycemia is the least likely electrolyte imbalance to occur directly as a result of liver failure. Liver failure often leads to hypoglycemia due to impaired gluconeogenesis. 

Other electrolyte disturbances, such as hypokalemia, hypomagnesemia, and hypocalcemia, are more commonly seen due to malnutrition, poor dietary intake, or altered renal function associated with liver failure.

65.

A patient's Level of Consciousness (LOC) is assessed by a physician who applies a left trapezius squeeze to elicit a response. The patient responds by lifting their right arm to their left shoulder.

You recognize this action as a pain response. What is it called?

  • Localization

  • Withdrawal

  • Decorticate posturing

  • Decerebrate posturing

Correct answer: Localization

Localization is a purposeful response to pain in which the patient moves a limb toward the source of the stimulus to try to remove or minimize it. This response indicates that the patient’s brain is functioning at a level that allows it to recognize the source of pain and attempt to respond to it purposefully.

Localizing is important in neurological assessments because it suggests a higher level of brain function than other pain responses, like withdrawal, decorticate (flexor) posturing, or decerebrate (extensor) posturing.

66.

Following educational interventions, what is the NEXT essential step?

  • Determine whether the education outcomes have been achieved

  • Prioritize information

  • Organize information gathered in the assessment into a format that is meaningful to the learner

  • Assess learners for readiness to learn

Correct answer: Determine whether the education outcomes have been achieved

After educational interventions, it is crucial to assess whether the intended learning outcomes have been met. This evaluation ensures that the patient or learner has understood and can apply the information provided. It is an essential step in the education process to determine the effectiveness of the intervention and identify any areas where further instruction may be needed. Achieving the desired outcomes is the ultimate goal of any educational intervention.

While prioritizing information is important during the planning and delivery of educational interventions, it is not the most crucial step following the intervention.

Organizing information in a meaningful way is an important step in the educational process, particularly during the planning phase. However, this step is not the primary focus after the intervention has been delivered.

Assessing readiness to learn is an important consideration before beginning an educational intervention. It ensures that the learner is prepared to engage with the material. However, after the intervention, the primary focus should shift to evaluating whether the learning objectives have been achieved.

67.

Of the following, which insulin would be expected to peak the fastest?

  • Glulisine

  • Aspart

  • Humulin N

  • Regular

Correct answer: Glulisine

Glulisine is a rapid-acting insulin, which means it has the fastest onset and peak of action among the options provided. It typically starts to work within ten to 15 minutes after injection and peaks around one to two hours.

Aspart is also a rapid-acting insulin with a similar onset and peak to glulisine, but glulisine is slightly faster. Regular insulin is a short-acting insulin that peaks in two to four hours. Humulin N is an intermediate-acting insulin with a peak effect occurring four to 12 hours after administration, making it the slowest to peak among the listed insulins.

68.

You are caring for a 75-year-old woman with advanced heart failure who has been scheduled for a high-risk surgery. Your patient expresses uncertainty about the procedure and mentions she feels pressured by her family to go through with it despite her own reservations. She confides in you, expressing her fear and desire to explore less invasive options.

What should you do to BEST advocate for your patient?

  • Notify the surgeon and request a meeting to discuss alternatives with the patient

  • Inform the patient's family that she is refusing the surgery

  • Encourage the patient to discuss her concerns with her family

  • Assure the patient that the surgery is in her best interest and encourage her to proceed

Correct answer: Notify the surgeon and request a meeting to discuss alternative options with the patient

Advocacy involves supporting the patient's autonomy and ensuring she has all the information needed to make an informed decision about her care. By notifying the surgeon and requesting a meeting, you facilitate a discussion about her concerns and potential alternatives, empowering her to make a choice that aligns with her values and wishes.

Informing the patient's family that she is refusing the surgery does not address the patient's need for information and support to explore her options. It also may not respect her privacy and autonomy.

Encouraging the patient to discuss her concerns with her family does not directly address her need for professional guidance and exploration of medical alternatives.

False assurance disregards the patient's expressed fears and desire for less invasive options, failing to respect her autonomy and preferences.

69.

Which of the following principles argues for a thoughtful and comprehensive approach when making decisions involving the allocation of nursing resources?

  • Justice

  • Paternalism

  • Resource availability

  • Veracity

Correct answer: Justice

The principle of justice in healthcare argues for fairness in the distribution of resources, including nursing resources. It emphasizes that decisions regarding the allocation of nursing resources should be made thoughtfully and comprehensively to ensure that all patients receive fair and equitable care.

Paternalism refers to making decisions for others, typically for their own good, but does not directly relate to the fair distribution of resources.

Resource availability refers to the actual presence of resources but does not specifically address the ethical principle of how those resources should be allocated.

Veracity is the principle of truth-telling or honesty in interactions with patients, which is important but not directly related to resource allocation.

70.

A patient presents with status epilepticus in the emergency department. What is the MOST appropriate first-line medication to administer?

  • Lorazepam

  • Valproic acid

  • Phenytoin

  • Lamotrigine

Correct answer: Lorazepam

Lorazepam is commonly used as a first-line treatment for status epilepticus due to its rapid onset of action and effectiveness in terminating seizures. It can be administered intravenously, which provides quick therapeutic effects. Other benzodiazepines, such as diazepam or midazolam, may also be used, but lorazepam is often preferred in clinical settings due to its longer duration of action. The goal of this treatment is to quickly control the seizure activity and prevent further complications, such as hypoxia, acidosis, and neuronal injury.

The second medication given is often phenytoin, fosphenytoin, or levetiracetam, but these medications are not benzodiazepines. 

Valproic acid and lamotrigine may be used in ongoing treatment for seizure control, but they are not benzodiazepines.

71.

You are caring for a 60-year-old female patient with abdominal distension and constipation for four days. She has a history of surgery for ovarian cysts ten years ago. Her abdominal x-ray reveals dilated loops of small bowel with air-fluid levels. 

What is the MOST likely cause of her symptoms?

  • Small bowel obstruction 

  • Diabetic gastroparesis

  • Functional ileus

  • Peptic ulcer disease

Correct answer: Small bowel obstruction 

The patient’s presentation and the x-ray findings strongly indicate small bowel obstruction. The history of prior abdominal surgery suggests that adhesions could be the cause.

Diabetic gastroparesis primarily affects gastric motility and presents with stomach symptoms, such as early satiety, rather than bowel symptoms. Functional ileus is a temporary cessation of peristalsis and usually occurs postoperatively, but her symptoms and x-ray findings are more consistent with a mechanical obstruction. Peptic ulcer disease generally presents with epigastric pain, not with the bowel distension and x-ray findings described here.

72.

A 45-year-old female patient with a history of multiple abdominal surgeries presents with crampy abdominal pain, distension, and vomiting. Her vital signs are BP 130/80 mmHg, HR 90 bpm, RR 18 breaths/min, SpO2 96% on room air. 

What is the MOST appropriate initial management for this patient?

  • Nasogastric tube insertion

  • Immediate surgery

  • Oral laxatives

  • High-fiber diet

Correct answer: Nasogastric tube insertion

Inserting a nasogastric tube is a common initial management step for bowel obstruction. It helps decompress the stomach, relieving symptoms such as vomiting and abdominal distension by draining accumulated gastric contents.

Immediate surgery may be required in cases of complete obstruction or if there are signs of bowel strangulation or perforation, but it is not the first step in all cases. Oral laxatives are contraindicated in bowel obstruction as they can worsen the condition by increasing bowel motility against the obstruction. A high-fiber diet is generally beneficial for preventing constipation but is not suitable for managing an acute bowel obstruction.

73.

Which of the following statements about the compensatory stage of shock is FALSE? 

  • Hypovolemia and resultant hypotension lead to activation of the parasympathetic nervous system

  • Renal blood flow is reduced, which activates a hormonal response

  • Angiotensin I, present in the blood, is converted to angiotensin II in the lungs

  • Patients become restless and agitated due to respiratory alkalosis

Correct answer: Hypovolemia and resultant hypotension lead to activation of the parasympathetic nervous system

During the compensatory stage of shock, hypovolemia and resultant hypotension lead to activation of the sympathetic nervous system, not the parasympathetic nervous system. 

The sympathetic nervous system initiates neural, hormonal, and chemical compensatory mechanisms causing peripheral vasoconstriction and elevation of blood pressure.

74.

What is the MOST common cause of upper Gastrointestinal (GI) bleeding?

  • Peptic Ulcer Disease (PUD)

  • Gastritis

  • Esophageal varices

  • Mallory-Weiss tears

Correct answer: Peptic Ulcer Disease (PUD)

PUD is the MOST common cause of upper GI bleeding. PUD occurs when open sores or ulcers form on the inner lining of the stomach or the upper part of the small intestine, often due to infection with Helicobacter pylori or the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). These ulcers can erode into blood vessels, leading to significant bleeding, which manifests as hematemesis (vomiting blood) or melena (black, tarry stools).

Other causes of upper GI bleeding, such as esophageal varices, gastritis, and Mallory-Weiss tears, are less common but still important to consider in clinical practice. However, PUD remains the leading cause.

75.

A patient tells the nurse, "I don't know if I want to get better. My life is meaningless." 

Which of the following is TRUE about this and similar statements?

  • A psychiatric referral is warranted for further assessment of the patient

  • The nurse should avoid asking whether the person is feeling suicidal

  • Verbalizing thoughts of self-harm can be a cover for wanting to talk about fear or loneliness

  • Asking a person whether they are suicidal promotes thoughts of self-harm

Correct answer: A psychiatric referral is warranted for further assessment of the patient

When a patient expresses feelings of hopelessness or statements such as "My life is meaningless," it is essential to take these expressions seriously, as they may indicate underlying depression or suicidal ideation. A psychiatric referral is warranted to ensure that the patient receives a thorough mental health assessment and appropriate interventions. This approach prioritizes patient safety and addresses any potential risks.

Asking directly about suicidal thoughts does not increase the risk of self-harm and is, in fact, an essential part of assessing the patient’s mental state.

While patients might express these feelings for various reasons, any mention of self-harm or hopelessness must be taken seriously and warrants further evaluation rather than dismissal as a cover for other emotions.

Research shows that asking about suicidal thoughts does not increase the likelihood of self-harm. Instead, it opens a dialogue that can lead to essential support and intervention.

76.

Many emergent bradycardiac rhythms require immediate temporary pacing. Which type of pacing usually requires sedation and analgesia?

  • Transcutaneous pacing

  • Epicardial pacing

  • Transvenous ventricular pacing

  • Zero transducer pacing

Correct answer: Transcutaneous pacing

Transcutaneous pacing delivers electrical impulses to the heart through electrodes placed on the skin, typically on the chest. This method can be uncomfortable and often painful for the patient because it involves high-energy electrical stimulation across the skin and chest muscles. Therefore, sedation and analgesia are typically required to manage discomfort and pain.

Epicardial pacing is usually used post-cardiac surgery. Leads are attached directly to the epicardium of the heart. While some discomfort might occur, especially if pacing is prolonged, it generally does not require immediate sedation and analgesia in the same way transcutaneous pacing does.

Transvenous ventricular pacing involves placing a pacing lead via a vein into the heart. While the procedure to insert the lead may require sedation, the pacing itself, once the lead is in place, is usually not painful and thus does not typically require ongoing sedation and analgesia.

Zero transducer pacing is not a recognized form of pacing in clinical practice.

77.

A 59-year-old male patient presents with melena and is tachycardic. Which diagnostic test is likely to be ordered FIRST?

  • Upper endoscopy

  • Colonoscopy

  • Abdominal x-ray

  • Liver function tests

Correct answer: Upper endoscopy

An upper endoscopy should be ordered first to identify the source of upper gastrointestinal bleeding, which is suggested by melena (black, tarry stools) and tachycardia.

A colonoscopy is used to detect lower gastrointestinal bleeding, which is less likely given the presentation of melena.

An abdominal x-ray is not the initial diagnostic test for gastrointestinal bleeding; it’s used for other abdominal issues.

Liver function tests can be part of the assessment but do not directly diagnose the source of bleeding.

78.

A 61-year-old female patient with a history of chronic pain is prescribed morphine sulfate for pain management. Which of the following instructions would you MOST likely provide to the patient to minimize her risk of side effects?

  • Increase fluid and fiber intake

  • Take the medication with food

  • Avoid operating heavy machinery

  • Take the medication only when pain is severe

Correct answer: Increase fluid and fiber intake

The nurse should likely instruct the patient to increase fluid and fiber intake to minimize the risk of constipation, a common side effect of morphine sulfate. Adequate hydration and dietary fiber can help maintain bowel regularity.

Taking the medication with food might help reduce gastrointestinal upset, but it does not address the most common side effect.

Avoiding operating heavy machinery is important to prevent injury due to potential sedation, but this advice does not mitigate side effects like constipation.

Taking the medication only when pain is severe may lead to ineffective pain management and does not prevent side effects. It is important to take opioids as prescribed, whether for continuous or breakthrough pain.

79.

A 34-year-old female patient is diagnosed with Disseminated Intravascular Coagulation (DIC) following placental abruption. Which laboratory value is MOST likely to be elevated in a patient with DIC?

  • Fibrin Degradation Products (FDPs)

  • Platelet count

  • Prothrombin Time (PT)

  • Fibrinogen level

Correct answer: Fibrin Degradation Products (FDPs)

FDPs are elevated due to the widespread fibrinolysis occurring in DIC, in which fibrin is broken down, releasing degradation products into circulation.

Platelet count is typically decreased in DIC due to the consumption of platelets during the formation of clots. PT is prolonged, but the elevation of FDPs is more specific to fibrinolysis. Fibrinogen levels are decreased in DIC because fibrinogen is consumed during clot formation.

80.

You are a Progressive Care Certified Nurse (PCCN) working in a busy hospital. One of your colleagues recently overheard a conversation about the State Board of Nursing and their role in regulating nursing practice. They approach you for clarification and share a specific concern: they have been asked by a physician to perform a task they feel may be outside their scope of practice. They want to know who to contact and what resources they can use to ensure they are practicing safely and within legal boundaries.

Based on the role of the State Boards of Nursing, what actions should your colleague take to address their concern?

  • Refer to the state-specific Nurse Practice Act and contact the State Board of Nursing for guidance

  • Perform the task as instructed by the physician, since the physician is responsible for their actions

  • Decline to perform the task and immediately report the physician to the hospital administration

  • Seek advice from a senior nurse on the unit and follow their instructions without further action

Correct answer: Refer to the state-specific Nurse Practice Act and contact the State Board of Nursing for guidance

The Nurse Practice Act provides detailed information about the scope of practice for nurses in a specific state. Contacting the State Board of Nursing is the appropriate step for the nurse to ensure their actions are in compliance with state regulations and to receive clear guidance.

Nurses are individually responsible for understanding and adhering to their scope of practice. Performing a task outside of this scope can result in legal and professional repercussions. While declining to perform the task may be appropriate if it is outside her scope, immediately reporting the physician without further investigation may not be the best course of action. It is important to first seek guidance and clarification.

While seeking advice from a senior nurse can be helpful, it is essential to refer to official regulations and guidelines provided by the State Board of Nursing to ensure that the guidance aligns with legal requirements.

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