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Quiz Session - Attempts With Random Questions

AACN PCCN July 2024 Exam Hanbook version 2.1.0 Exam Questions

Page 5 of 33

81.

You are caring for a 42-year-old male patient with crush injury-induced rhabdomyolysis. He has received aggressive fluid resuscitation, and his serum Creatine Kinase (CK) levels have decreased, but his urine output remains low despite normal fluid balance. 

Which of the following additional therapies is LEAST likely to be beneficial at this stage?

  • Diuretics to increase urine output

  • Dialysis for worsening renal function

  • Alkalinization of urine with sodium bicarbonate

  • Continuous Renal Replacement Therapy (CRRT)

Correct answer: Diuretics to increase urine output

Diuretics are not typically recommended in rhabdomyolysis unless there is clear evidence of fluid overload, as they may not improve the underlying renal dysfunction and can exacerbate electrolyte imbalances.

Dialysis may be needed if acute kidney injury progresses despite initial treatment. Alkalinization of urine with sodium bicarbonate can help reduce myoglobin-induced renal toxicity. CRRT is beneficial for patients with severe kidney failure and fluid management issues in critical care settings.

82.

Which of the following diagnostic tests would MOST likely be used to assess right heart strain due to a pulmonary embolism?

  • Echocardiogram

  • Arterial blood gas

  • Ventilation-perfusion scan

  • Electrocardiogram (ECG)

Correct answer: Echocardiogram

An echocardiogram is useful for assessing right heart strain in the setting of a pulmonary embolism, which can occur due to increased pressure in the pulmonary arteries. 

Arterial blood gas may show hypoxemia but does not directly assess heart strain. A ventilation-perfusion scan helps diagnose PE, but it does not assess right heart strain. An ECG can show changes like right axis deviation but is not specific for heart strain.

83.

Which of the following statements about asthma is MOST accurate?

  • Bronchoconstriction results from mediators released from mast cells

  • First and foremost, asthma exacerbations are due to bronchospasm

  • Triggers often cause asthma exacerbations

  • Unlike patients who have chronic obstructive pulmonary disease, asthma patients do not exhibit airway remodeling

Correct answer: Bronchoconstriction results from mediators released from mast cells

Bronchoconstriction in asthma results from the release of mediators such as histamine, leukotrienes, and prostaglandins from mast cells. These mediators cause the smooth muscles surrounding the airways to constrict, leading to the characteristic narrowing of the airways seen in asthma.

Attributing asthma exacerbations primarily to bronchospasm oversimplifies the condition. While bronchospasm is a key component, inflammation and mucus production also play critical roles in exacerbations.

Triggers often cause asthma exacerbations, but this does not specifically address the underlying mechanisms of asthma, which makes it less accurate in the context of this question.

In chronic asthma, airway remodeling can indeed occur, leading to persistent changes in the airway structure much like in COPD.

84.

A 67-year-old male patient is admitted with a Chronic Obstructive Pulmonary Disease (COPD) exacerbation. The patient has a history of smoking and asthma. 

Which of the following is MOST likely to explain his exacerbation?

  • Viral respiratory infection

  • Continued smoking

  • Medication noncompliance

  • Uncontrolled asthma

Correct answer: Viral respiratory infection

Respiratory infections, particularly viral infections (pneumonia, bronchitis), are the most common cause of COPD exacerbations. These infections lead to increased mucus production and inflammation in the airways, worsening symptoms.

Continued smoking can worsen COPD over time but is less likely to be the immediate cause of an acute exacerbation. Medication noncompliance may contribute to poor control but is not the most common immediate trigger for an exacerbation. Uncontrolled asthma is another chronic lung condition, but COPD exacerbations are more commonly triggered by infections than by asthma flare-ups.

85.

You are caring for a 45-year-old female patient who has been admitted to the progressive care unit after a myocardial infarction. Her condition has stabilized, but she is experiencing significant anxiety about her recovery and the possibility of another heart attack. During a discussion with you, the patient expresses concern about the medications she is receiving, particularly a new anticoagulant that was added to her regimen. She mentions that she read online about potential severe side effects of the medication, including the risk of bleeding, and she is hesitant to continue taking it.

You understand her concerns and reassure her by explaining the medication's importance in preventing future cardiac events. You also acknowledge the risks but emphasize the need to balance those risks with the treatment's benefits. As part of this conversation, you must apply ethical principles to guide her in making an informed decision about her care.

Which ethical principle imposes the duty to do no harm?

  • Nonmaleficence

  • Beneficence

  • Justice

  • Autonomy

Correct answer: Nonmaleficence

Nonmaleficence is the ethical principle that imposes the duty to do no harm. This principle guides healthcare professionals to avoid actions or interventions that could cause harm to patients. In this context, you must ensure that the recommended treatment does not expose the patient to unnecessary harm while balancing the risks and benefits of the medication.

Beneficence involves actions that promote the well-being of patients. While your reassurance and education about the medication align with beneficence, this principle focuses on doing good rather than specifically avoiding harm.

Justice is fairness and equality in healthcare. It ensures that patients receive equitable care regardless of their background or circumstances. Although justice is important in providing care, it does not directly concern avoiding harm in the way nonmaleficence does.

Autonomy refers to respecting the patient’s right to make informed decisions about their own care. While you are supporting the patient's autonomy by providing information and allowing her to participate in decision-making, this principle does not directly address the duty to do no harm.

86.

A patient with Wolff-Parkinson-White (WPW) syndrome is noted to have atrial fibrillation. Which of the following agents is LEAST likely to be used in the treatment of this patient's arrhythmia? 

  • Verapamil

  • Ibutilide

  • Flecainide

  • Procainamide

Correct answer: Verapamil

Using Verapamil in WPW syndrome can be dangerous because it can block the Atrioventricular (AV) node, potentially facilitating conduction through the accessory pathway (Bundle of Kent). This can lead to rapid conduction of atrial fibrillation directly to the ventricles, resulting in dangerously high heart rates and potentially causing ventricular fibrillation.

Ibutilide is a Class III antiarrhythmic that works by prolonging repolarization. It is used in the acute management of atrial fibrillation or atrial flutter, including in patients with WPW syndrome. It does not block the AV node alone and is generally safe in this context.

Flecainide is a Class IC antiarrhythmic drug that slows conduction throughout the heart, including accessory pathways. It is often used for rhythm control in patients with WPW and atrial fibrillation and can help restore normal sinus rhythm without the risk of causing dangerous conduction patterns.

Procainamide is a Class IA antiarrhythmic that slows conduction through normal and accessory pathways. It is often used in the acute management of atrial fibrillation in patients with WPW syndrome because it effectively controls the arrhythmia without facilitating accessory pathway conduction.

87.

A 68-year-old male patient with a history of type 2 diabetes mellitus and peripheral vascular disease is admitted to the PCU following a stroke. He is currently bedridden and has limited mobility. You perform a thorough skin assessment and notice an area of intact skin with non-blanchable erythema on the patient's sacrum. 

The National Pressure Ulcer Advisory Panel (NPUAP) classifies this area as which of the following? 

  • Stage 1 pressure injury

  • Stage 2 pressure injury

  • Stage 3 pressure injury

  • Unstageable pressure injury

Correct answer: Stage 1 pressure injury

Stage 1 pressure injury is characterized by intact skin with non-blanchable redness, which is the initial sign of pressure-related tissue damage. The presence of non-blanchable erythema means the underlying tissue is already affected even though the surface skin remains intact.

Stage 2 pressure injury is marked by partial-thickness skin loss with exposed dermis, appearing as an open ulcer with a red or pink wound bed. It can also look like an intact or ruptured serum-filled blister, which is not the case in this patient.

Stage 3 pressure injury involves full-thickness skin loss, and subcutaneous fat might be visible in the ulcer. Granulation tissue and rolled wound edges (epibole) frequently occur, and slough or eschar may also be present, though they are not mentioned in this scenario.

Unstageable pressure injury involves full-thickness skin and tissue loss. The extent of damage cannot be assessed because it is covered by slough or eschar.

88.

A 66-year-old woman presents to the emergency department with severe chest pain and shortness of breath. Her blood pressure is 160/100 mmHg, heart rate is 110 beats per minute, and troponin levels are elevated. She is diagnosed with Non-ST Segment Elevation Myocardial Infarction (NSTEMI). 

Which intervention is MOST appropriate to decrease myocardial oxygen demand?

  • Administer beta-blockers

  • Perform immediate Percutaneous Coronary Intervention (PCI)

  • Administer thrombolytics

  • Administer sublingual nitroglycerin

Correct answer: Administer beta-blockers

Beta-blockers reduce heart rate and myocardial oxygen demand in patients with NSTEMI. By decreasing the heart's workload, beta-blockers help prevent further ischemic damage.

Immediate PCI is typically reserved for STEMI patients or those with refractory symptoms in NSTEMI cases. Thrombolytics are not indicated for NSTEMI as there is no complete coronary artery occlusion. Sublingual nitroglycerin can relieve chest pain but is not the most effective intervention for reducing myocardial oxygen demand in this scenario.

89.

You are assessing a patient who has been admitted with Ogilvie syndrome. This condition PRIMARILY affects which of the following? 

  • The colon

  • The lower extremities

  • The pancreas

  • The kidneys

Correct answer: The colon

Ogilvie syndrome, also known as acute colonic pseudo-obstruction, primarily affects the colon. It is characterized by a massive dilation of the colon without any mechanical obstruction. This condition typically occurs in hospitalized or immobilized patients and, if not managed promptly, can lead to complications including perforation and ischemia.

90.

A 28-year-old male patient presents with sudden onset of chest pain and shortness of breath. His vital signs are BP 125/80 mmHg, HR 105 bpm, RR 30 breaths/min, and SpO2 90%. 

Which assessment finding is MOST likely to confirm a diagnosis of pneumothorax?

  • Absent breath sounds on one side

  • Wheezing throughout lung fields

  • Bilateral crackles

  • Pericardial friction rub

Correct answer: Absent breath sounds on one side

Absent breath sounds on one side are most likely to confirm a diagnosis of pneumothorax. This finding indicates that air is present in the pleural space, preventing lung expansion and airflow.

Wheezing throughout lung fields suggests airway constriction, which is more commonly associated with conditions like asthma or chronic obstructive pulmonary disease.

Bilateral crackles are typically heard in cases of fluid accumulation in the lungs, such as in pulmonary edema or pneumonia.

A pericardial friction rub is heard in pericarditis and involves a scratchy sound not associated with pneumothorax.

91.

You are caring for a 68-year-old male patient who was admitted to the PCU following a tracheostomy performed due to prolonged mechanical ventilation. His vital signs are stable, and he is currently on a ventilator with the following settings: FiO2 40%, PEEP 5 cm H2O, and tidal volume 450 mL. During your assessment, you notice that he is beginning to show signs of discomfort and slight agitation. You suspect that the tracheostomy cuff pressure is contributing to his discomfort.

What should the tracheostomy cuff pressure be to prevent complications such as tracheal injury and aspiration?

  • Less than 25 mmHg

  • Less than 2.5 mmHg

  • Greater than 25 mmHg

  • Less than 30 mmHg

Correct answer: Less than 25 mmHg

Once an endotracheal or tracheostomy tube has been successfully inserted, the cuff should be inflated with just enough air to create an effective seal. The tracheostomy cuff pressure should be maintained at less than 25 mmHg (30 mm H20). This ensures that the cuff is adequately inflated to prevent aspiration without damaging the tracheal mucosa. 

Pressures below this range may not provide an adequate seal, increasing the risk of aspiration, while pressures above this range may lead to tracheal injury due to excessive pressure on the tracheal walls.

92.

A patient is diagnosed with hypertrophic cardiomyopathy. Which of the following is MOST likely to be part of the treatment?

  • Beta-blockers

  • Diuretics

  • Dobutamine

  • Nitroprusside

Correct answer: Beta-blockers

Beta-blockers are the mainstay of treatment for Hypertrophic Cardiomyopathy (HCM) as they help reduce the heart rate and myocardial contractility, decreasing the outflow tract obstruction and improving symptoms. By slowing the heart rate, beta-blockers also allow for better filling of the heart chambers, which can benefit patients with HCM.

Diuretics may exacerbate symptoms in HCM by reducing preload, which could increase the degree of outflow obstruction. This makes diuretics a less desirable treatment option in these patients.

Dobutamine, a positive inotrope, would increase the contractility of the heart, which could worsen the obstruction in HCM.

Nitroprusside, a vasodilator, could decrease afterload, potentially worsening outflow tract obstruction in patients with HCM. Thus, it is not typically used as a primary treatment option for this condition.

93.

A 32-year-old female patient undergoing a blood transfusion reports back pain and chills 20 minutes after the transfusion starts. Her blood pressure drops to 90/60 mmHg, her heart rate is 110 bpm, and her respiratory rate is 20.

Which type of transfusion reaction is MOST likely occurring?

  • Acute hemolytic reaction

  • Febrile non-hemolytic transfusion reaction

  • Allergic reaction

  • Transfusion-associated circulatory overload

Correct answer: Acute hemolytic reaction

Acute hemolytic reactions typically occur within the first 15–30 minutes of the transfusion and are the result of ABO incompatibility, leading to hemolysis. Symptoms include chest and back pain, chills, fever, hypotension, tachypnea, and tachycardia, as seen in this patient. Immediate discontinuation of the transfusion and supportive care are critical.

Febrile non-hemolytic reactions can cause chills and fever but usually occur later in the transfusion and do not present with hypotension or back pain. Allergic reactions are typically mild, causing itching, hives, or anaphylaxis. Back pain and hypotension are less likely in mild allergic reactions. Transfusion-associated circulatory overload involves dyspnea, pulmonary edema, and hypertension, not hypotension or back pain.

94.

A 68-year-old female patient with a history of diabetes and hypertension has been admitted to the Progressive Care Unit (PCU) following a stroke. She has limited mobility and requires assistance with repositioning. On her third day in the unit, you notice a purple, localized area of discolored intact skin on her sacral area, along with a blood-filled blister. The skin surrounding the area is intact.

According to the National Pressure Ulcer Advisory Panel (NPUAP), how should you classify this finding?

  • Deep tissue injury

  • Stage 1 pressure injury

  • Stage 2 pressure injury

  • Unstageable-unknown depth pressure injury

Correct answer: Deep tissue injury

A deep tissue injury is characterized by a purple or maroon localized area of discolored intact skin or a blood-filled blister. This type of injury indicates damage to the underlying soft tissue from pressure and/or shear. The skin remains intact, but the damage has occurred in the deeper layers of the tissue, which can progress rapidly to more severe pressure ulcers if not managed appropriately.

A Stage 1 pressure injury involves intact skin with discoloration (non-blanchable erythema). 

A Stage 2 pressure injury is characterized by partial-thickness tissue loss and a pink or red wound bed.

An unstageable-unknown depth pressure injury involves full-thickness tissue loss, and the wound base is covered with slough or eschar, so it is not visible. 

95.

A 32-year-old male patient is brought to the emergency department by his friends after they found him unresponsive at a party. They report that he had been using cocaine throughout the evening.

Which of the following are signs and symptoms of cocaine overdose?

  • Agitation, hypertension, hyperthermia, and chest pain

  • Bradycardia, hypotension, hypothermia, and lethargy

  • Miosis, respiratory depression, hypoglycemia, and euphoria

  • Polyuria, dry skin, hyperglycemia, and abdominal pain

Correct answer: Agitation, hypertension, hyperthermia, and chest pain

Cocaine overdose often presents with signs and symptoms such as agitation, hypertension, hyperthermia, and chest pain. These symptoms are due to the stimulant effects of cocaine, which increase sympathetic nervous system activity, leading to cardiovascular and neurological complications.

Bradycardia, hypotension, hypothermia, and lethargy are more characteristic of depressant overdoses, such as those from opioids or sedatives, than of overdoses on stimulants like cocaine.

Miosis (constricted pupils), respiratory depression, hypoglycemia, and euphoria are also more indicative of opioid overdose. Cocaine, a stimulant, usually causes mydriasis (dilated pupils) rather than miosis.

Polyuria, dry skin, hyperglycemia, and abdominal pain are not typically associated with cocaine overdose. These symptoms might occur in conditions like diabetes mellitus or certain endocrine disorders.

96.

A 45-year-old male patient with a high cervical spinal cord injury is at an increased risk of respiratory complications. How would an in-exsufflator MOST likely benefit this patient?

  • By assisting in clearing mucus from the lungs and preventing pneumonia

  • By delivering medication directly into the lungs

  • By stabilizing the patient's blood pressure

  • By reducing the need for mechanical ventilation

Correct answer: By assisting in clearing mucus from the lungs and preventing pneumonia

The in-exsufflator, or Mechanical Insufflation-Exsufflation (MI-E) device, is designed to assist patients with weak cough mechanisms by simulating a natural cough. This is especially important for patients with high cervical spinal cord injuries, as their ability to cough effectively is often compromised due to weakened or paralyzed respiratory muscles. By helping to clear mucus from the lungs, the in-exsufflator can significantly reduce the risk of respiratory complications, such as pneumonia, which is a leading cause of morbidity in these patients.

Delivering medication directly into the lungs would require a nebulizer or metered-dose inhaler, not an in-exsufflator.

Stabilizing the patient’s blood pressure is not a function of the in-exsufflator; this would be managed by other interventions, such as medications or fluid management.

Reducing the need for mechanical ventilation is an indirect benefit of using an in-exsufflator, as preventing mucus accumulation and infections can decrease respiratory complications. However, the primary purpose of the in-exsufflator is to assist with mucus clearance rather than directly reducing the need for ventilation.

97.

Which action is recommended to prevent hospital-acquired pneumonia in a ventilated patient?

  • Implement a comprehensive oral hygiene program that includes teeth brushing and the use of oral chlorhexidine gluconate

  • Avoid supine positioning and, unless medically contraindicated, keep the head of the bed elevated at 45–60 degrees at all times

  • Perform tracheostomy care and suctioning under clean conditions

  • If a suction catheter is to be used for reentry into the patient's lower respiratory tract, use clean fluid to remove secretions from the catheter

Correct answer: Implement a comprehensive oral hygiene program that includes teeth brushing and the use of oral chlorhexidine gluconate

The development and implementation of an oral hygiene program, including daily chlorhexidine baths, is one of the evidence-based practice guidelines for the prevention of Ventilator-Associated Pneumonia (VAP).

The head of the bed should be kept elevated at 30–45 degrees unless medically contraindicated to prevent VAP. Tracheostomy care should always be performed under aseptic conditions. If a suction catheter is to be used for reentry into the patient's lower respiratory tract, use only sterile fluid to remove secretions from the catheter.

98.

A 53-year-old male patient with Chronic Obstructive Pulmonary Disease (COPD) and an Endotracheal (ET) tube is becoming increasingly agitated, with a heart rate of 120 beats per minute and an oxygen saturation of 88% despite being on mechanical ventilation. You suspect the patient needs suctioning. What should you do FIRST?

  • Perform a thorough respiratory assessment

  • Suction the patient immediately

  • Increase the oxygen concentration on the ventilator

  • Administer a sedative to calm the patient

Correct answer: Perform a thorough respiratory assessment

Before suctioning, it is essential to perform a thorough respiratory assessment to confirm that the agitation and drop in oxygen saturation are due to airway secretions. This ensures that suctioning is necessary and appropriate, reducing the risk of unnecessary interventions.

Suctioning the patient immediately without assessing the need could cause harm if secretions are not the cause of the agitation. Increasing the oxygen concentration might temporarily improve oxygen saturation but does not address the underlying issue if the problem is related to secretions. Administering a sedative could mask symptoms and delay the identification of the true cause of the agitation and hypoxia.

99.

Which of the following is the MOST common cause of distributive shock?

  • Sepsis

  • Myocardial infarction

  • Hypovolemia

  • Pulmonary embolism

Correct answer: Sepsis

Distributive shock most commonly results from sepsis, in which widespread vasodilation occurs due to the body's response to infection, leading to hypotension and inadequate tissue perfusion.

Myocardial infarction is associated with cardiogenic shock rather than distributive shock. Hypovolemia leads to hypovolemic shock due to fluid loss, not distributive shock. Pulmonary embolism is a cause of obstructive shock, not distributive shock.

100.

Which of the following statements is TRUE about the use of pharmacologic therapy with endoscopy in the treatment of upper Gastrointestinal (GI) bleeding?

  • The goal of pharmacologic treatment via endoscopy is to control bleeding by tamponade, vasoconstriction, and/or an inflammatory reaction following the injection of the selected agent

  • In the United States, ethanolamine is the pharmacologic agent of choice to control rapid bleeding

  • These treatments are costly and carry a significant risk of GI perforation

  • One important advantage of epinephrine is that it can be used alone in the endoscopic treatment of GI bleeding

Correct answer: The goal of pharmacologic treatment via endoscopy is to control bleeding by tamponade, vasoconstriction, and/or an inflammatory reaction following the injection of the selected agent

In the United States, epinephrine is the agent of choice to control rapid bleeding. It is not recommended to use epinephrine alone; combination therapy with epinephrine and mechanical compression or ablative therapy has become the standard treatment for actively bleeding ulcers. Pharmacologic treatments are inexpensive, easy to use, and available in most settings. Endoscopy carries a risk of complications, including GI perforation, but these rarely occur.

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