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Quiz Session - Attempts With Random Questions

AACN PCCN July 2024 Exam Hanbook version 2.1.0 Exam Questions

Page 6 of 33

101.

Which of the following signs and symptoms would lead you to suspect aortic insufficiency?

  • Widened pulse pressure, diastolic murmur, bounding pulses

  • Narrowed pulse pressure, systolic murmur, and weak pulses

  • Elevated jugular venous pressure, systolic murmur, and peripheral edema

  • Bradycardia, diastolic murmur, and irregular pulse

Correct answer: Widened pulse pressure, diastolic murmur, bounding pulses

In aortic insufficiency, the backflow of blood from the aorta into the left ventricle during diastole leads to several characteristic clinical features. The widened pulse pressure occurs due to increased stroke volume during systole and reduced diastolic pressure because of regurgitation. The diastolic murmur is caused by blood flowing back through the incompetent aortic valve. Bounding pulses, also known as "water hammer" pulses, result from increased stroke volume and a rapid decrease in arterial pressure during diastole.

Narrowed pulse pressure and weak pulses are more commonly associated with conditions like aortic stenosis, in which there is an obstruction of blood flow, not regurgitation.

Elevated jugular venous pressure, systolic murmur, and peripheral edema are more indicative of right-sided heart failure or conditions like tricuspid regurgitation or pulmonary hypertension than of aortic insufficiency.

Bradycardia and an irregular pulse are not typical findings in aortic insufficiency.

102.

A 49-year-old female patient with diabetes is admitted for surgery. During her stay, you notice that her Electronic Health Record (EHR) has been accessed by multiple staff members who are not directly involved in her care. 

What is the LEAST likely reason for this access?

  • Quality improvement audit

  • Staff curiosity

  • Billing and coding processes

  • System error

Correct answer: Quality improvement audit

A quality improvement audit is the least likely reason for unauthorized staff access to the patient’s EHR. These audits are typically conducted by designated personnel and do not involve random access by multiple staff members not involved in patient care.

Unfortunately, staff curiosity can sometimes lead to unauthorized access, which is unethical and illegal. Billing and coding processes may require access to specific portions of the EHR, but this access should be limited to those roles. A system error could result in unintended access, but this would be an anomaly and should be investigated.

103.

A 75-year-old female patient is admitted to the PCU following a stroke. During a family meeting, the patient's daughter expresses concerns about her mother's quality of life and the healthcare team's obligations to ensure her mother's well-being. You discuss the ethical principles guiding the team's care, emphasizing the commitment to preventing harm and promoting the patient’s best interests.

Which ethical principle affirms this obligation?

  • Beneficence

  • Nonmaleficence

  • Justice

  • Autonomy

Correct answer: Beneficence

Beneficence is the ethical principle that affirms an obligation to prevent harm, remove harm, and promote good by actively helping others. It involves taking positive steps to improve the patient's well-being.

Nonmaleficence is the principle of doing no harm, focusing on avoiding actions that might harm the patient.

Justice is fairness in the distribution of resources and the equitable treatment of all patients.

Autonomy means respecting the patient's right to make their own decisions regarding their healthcare.

104.

Which of the following statements is TRUE about insulin administration?

  • Humalog peaks within 30 to 90 minutes, while Humulin R peaks in two to three hours

  • Humalog peaks within two to three hours, while Humulin R peaks within 30 to 90 minutes

  • Novolin R has a duration of less than five hours, while Humulin R has a duration of eight hours

  • Humulin R has a duration of three to five hours, while Novolin R has a duration of less than three hours

Correct answer: Humalog peaks within 30 to 90 minutes, while Humulin R peaks in two to three hours

Humalog (insulin lispro) is a rapid-acting insulin that peaks within 30 to 90 minutes, making it effective for controlling blood sugar spikes after meals. Humulin R (regular insulin) is a short-acting insulin that peaks in two to three hours, making it suitable for mealtime blood sugar control as well but with a slightly longer action profile.

Novolin R and Humulin R are both brands of regular insulin with similar pharmacokinetic profiles. Both typically have a duration of action of five to eight hours.

105.

A 65-year-old male patient presents to the emergency department with fever, tachycardia, and hypotension. His laboratory results are as follows:

  • Procalcitonin: 2.5 ng/mL (elevated)
  • Lactate: 4 mmol/L (elevated)
  • C-reactive protein: 150 mg/L (elevated)
  • Interleukin-6: 100 pg/mL (elevated)

Which of the following laboratory findings MOST likely confirms the diagnosis of sepsis in this patient?

  • Procalcitonin

  • Serum lactate

  • C-reactive protein

  • Interleukin-6

Correct answer: Procalcitonin

In this scenario, procalcitonin is the biomarker most commonly associated with sepsis. Elevated procalcitonin levels are highly suggestive of a bacterial infection and sepsis, particularly in the context of the patient's clinical presentation. 

While lactate, CRP, and interleukin-6 are also elevated, they are less specific to sepsis. Lactate indicates tissue hypoperfusion and can be elevated in various conditions, including shock. CRP is a general marker of inflammation, and interleukin-6 is involved in the inflammatory response, but neither is as specifically indicative of sepsis as procalcitonin.

106.

A 63-year-old male patient with Amyotrophic Lateral Sclerosis (ALS) is experiencing increased difficulty swallowing and speaking. His vital signs are HR 88 bpm, BP 110/72 mmHg, RR 14 breaths per minute, temperature 98.9°F. 

Based on this presentation, which of the following complications is MOST likely to occur?

  • Aspiration pneumonia

  • Renal failure

  • Myocardial infarction

  • Deep vein thrombosis

Correct answer: Aspiration pneumonia

Patients with ALS often develop difficulty swallowing (dysphagia) as the disease progresses, putting them at high risk of aspiration pneumonia due to food or liquids entering the lungs.

Renal failure is not typically associated with ALS unless secondary complications arise. Myocardial infarction is a cardiovascular event and is unrelated to ALS itself. Deep vein thrombosis may occur in immobilized patients but is less directly linked to the presentation described here.

107.

A 16-year-old male patient with a known diagnosis of congenital Long-QT syndrome type 3 (LQT3) is admitted to the progressive care unit after experiencing a syncopal episode. The patient's family history reveals that his father also has LQT3 and had similar episodes in his youth. You are reviewing the patient’s condition and educating the family about the dysrhythmia events associated with LQT3.

In patients with congenital LQT3, when are dysrhythmia events MOST likely to occur?

  • During sleep or rest

  • During physical exercise

  • During emotional stress

  • Upon sudden standing or change in posture

Correct answer: During sleep or rest

In LQT3, dysrhythmia events are most likely to occur during periods of low heart rate, such as sleep or rest. The mutation associated with LQT3 affects the sodium channels in the heart, leading to prolonged repolarization during these times.

While physical exercise can trigger dysrhythmias in some forms of long-QT syndrome, it is not typically associated with LQT3. Emotional stress can trigger dysrhythmias in some forms of long-QT syndrome, but it is not the primary trigger for LQT3. Dysrhythmias triggered by sudden changes in posture are not characteristic of LQT3.

108.

Which of the following is NOT appropriate for the treatment of Torsades de Pointes (TdP)? 

  • Teach the patient lifestyle modifications such as avoidance of swimming and startling loud noises like alarm clocks

  • Manage the patient with pacing and magnesium as temporary strategies until the underlying cause of the disorder can be eliminated

  • Overdrive atrial or ventricular pacing at a rate of 80 beats per minute or faster to prevent the pauses that may precipitate episodes of TdP

  • Defibrillate with an unsynchronized shock to terminate the episode if TdP degenerates into ventricular fibrillation

Correct answer: Teach the patient lifestyle modifications such as avoidance of swimming and startling loud noises like alarm clocks

Lifestyle modifications may be necessary and appropriate for managing congenital long-QT syndromes, but not for TdP.

TdP is a rare and distinct type of polymorphic ventricular tachycardia marked by a gradual change in the amplitude and twisting of the QRS complexes. It is linked to a prolonged QT interval, which can be either congenital or acquired.

While TdP often resolves on its own, it tends to recur and can lead to ventricular fibrillation. Treatment involves identifying and addressing the underlying cause, discontinuing any causative medications, and correcting any electrolyte imbalances. Intravenous magnesium may be administered to help control episodes of TdP until the root cause is managed.

109.

You are caring for a 27-year-old female patient admitted after a car accident. She is complaining of a worsening headache and confusion. CT imaging shows a subdural hematoma. 

Which of the following is MOST likely contributing to her delayed symptom onset?

  • Slow venous bleeding

  • Rapid blood clot formation

  • Increased blood pressure

  • Compression of the cerebellum

Correct answer: Slow venous bleeding

Subdural hematomas typically involve venous bleeding, which can accumulate slowly over time, leading to a delayed onset of symptoms such as headache and confusion.

Rapid blood clot formation would lead to more immediate symptoms. Increased blood pressure may exacerbate symptoms but does not directly cause the slow onset. Compression of the cerebellum typically causes coordination issues rather than delayed confusion or headaches.

110.

You are caring for a 65-year-old male patient with maroon-colored stools and weakness. His vital signs include BP 90/60 mmHg, HR 110 bpm, RR 20 breaths/min, and SpO2 94% on room air. 

Based on the patient’s symptoms and presentation, which of the following is the MOST likely source of his Gastrointestinal (GI) bleeding?

  • Colonic diverticulosis

  • Duodenal ulcer

  • Esophageal varices

  • Mallory-Weiss tear

Correct answer: Colonic diverticulosis

Maroon-colored stools suggest a source of bleeding in the mid-to-lower GI tract, such as colonic diverticulosis, which is a common cause of lower GI bleeding in older adults.

A duodenal ulcer typically causes melena (black, tarry stools) due to its location in the upper GI tract. Esophageal varices cause hematemesis or melena, not maroon stools, as the bleeding originates in the upper GI tract. Mallory-Weiss tears are associated with vomiting blood, typically after episodes of forceful vomiting, and do not present with maroon-colored stools.

111.

Of the following interventions, which is the LEAST appropriate in the management of a basilar skull fracture?

  • Maintaining the head of the bed at fewer than 15 degrees of elevation

  • Lumbar puncture to drain cerebrospinal fluid that is compressing the healing dura

  • Antibiotic therapy

  • Surgical repair of cerebrospinal fluid leaks

Correct answer: Maintaining the head of the bed at fewer than 15 degrees of elevation

Management of CSF leaks associated with basilar skull fractures may include:

  • Elevating the head of the bed
  • Administering antibiotic therapy
  • Lumbar drainage of CSF if needed to decrease pressure on the healing dura

Although most cerebrospinal fluid leaks stop spontaneously, those that persist may require surgical repair.

112.

A 39-year-old female patient with a history of asthma presents with wheezing, dyspnea, and a cough unresponsive to home albuterol use. Her respiratory rate is 26 breaths per minute, heart rate is 112 bpm, and peak flow is 35% of predicted. 

Which of the following diagnostic findings is MOST likely in this patient?

  • Increased PaCO2 and decreased PaO2 on Arterial Blood Gas (ABG)

  • Normal PaO2 and decreased PaCO2 on ABG

  • Elevated white blood cell count and normal chest x-ray

  • Decreased hemoglobin level

Correct answer: Increased PaCO2 and decreased PaO2 on Arterial Blood Gas (ABG)

In a severe asthma exacerbation, patients may experience respiratory fatigue leading to elevated PaCO2 (carbon dioxide retention) and decreased PaO2 (hypoxia), indicating worsening gas exchange.

Normal PaO2 and decreased PaCO2 occur in hyperventilation, not severe asthma. Elevated white blood cell count and normal chest x-ray may suggest infection but not necessarily asthma. A decreased hemoglobin level is unrelated to acute asthma exacerbations.

113.

A 56-year-old male patient with recent acute myocardial infarction shows signs of cardiogenic shock, including hypotension and tachycardia. What is the FIRST action you should take to manage this patient?

  • Administer intravenous fluids

  • Prepare for an urgent cardiac catheterization

  • Increase the dose of antihypertensive medications

  • Provide supplemental oxygen

Correct answer: Administer intravenous fluids

Administering intravenous fluids should be the first action to manage a patient with cardiogenic shock. This intervention helps to improve blood volume and cardiac output, aiding in perfusion and stabilizing blood pressure.

Cardiac catheterization may be necessary later to assess and manage underlying coronary artery issues, but the immediate need is to stabilize the patient’s condition with fluid resuscitation.

Increasing the dose of antihypertensive medications is not appropriate in cardiogenic shock as it may further lower blood pressure. The priority is to stabilize the patient’s blood pressure and improve cardiac output.

Supplemental oxygen is important for improving oxygenation but does not address the immediate need to improve blood volume and cardiac function, which is critical in managing cardiogenic shock.

114.

The diagnosis of acute pancreatitis is based on at least two of three criteria. Which of the following is NOT one of these criteria? 

  • Elevated liver enzymes

  • Elevated serum lipase or amylase levels

  • Characteristic abdominal pain

  • Radiological evidence of pancreatitis

Correct answer: Elevated liver enzymes

While elevated liver enzymes may occur in various conditions, they are not specific diagnostic criteria for acute pancreatitis. Liver enzyme elevation can occur due to liver-related conditions or other systemic issues but is not used as a primary marker for pancreatitis. 

Elevated levels of pancreatic enzymes, such as lipase or amylase, are a key diagnostic criterion for acute pancreatitis. These enzymes are typically elevated due to pancreatic inflammation and damage.

Characteristic abdominal pain is part of the typical presentation of acute pancreatitis, which includes severe, often radiating abdominal pain. This clinical symptom is another primary criterion for diagnosis.

Imaging studies, such as an abdominal ultrasound or CT scan, can show inflammation, swelling, or other characteristic features of acute pancreatitis. Radiological evidence is the third key diagnostic criterion.

115.

Initially, when caring for a patient with a temporary pacemaker, stimulation threshold testing should be done:

  • Every shift

  • Hourly

  • By the physician

  • Every 24 hours

Correct answer: Every shift

Stimulation threshold testing should be done every shift (until a stable threshold is reached) to ensure that the pacemaker is consistently capturing and pacing the heart effectively. This frequent monitoring helps to promptly identify and address any changes in the threshold that can occur due to various factors, such as lead displacement, changes in the patient's condition, or battery depletion.

Hourly testing is typically not necessary unless specific concerns about pacemaker function or the patient's condition warrant such frequent monitoring.

Every 24 hours may not be frequent enough to catch issues promptly, as changes in the stimulation threshold can occur more rapidly, necessitating more frequent checks.

Nurses and other healthcare providers are trained to perform threshold testing, so requiring the physician to handle routine monitoring is not practical. The physician would be involved in more complex troubleshooting or adjustments as needed.

116.

Of the distributive shock syndromes, which is MOST common in the acute care setting?

  • Septic shock

  • Anaphylactic shock

  • Neurogenic shock

  • Adrenal crisis

Correct answer: Septic shock

Septic shock is the most common type of distributive shock seen in the acute care setting. It results from a severe infection leading to systemic inflammation, vasodilation, and subsequent hypotension and organ dysfunction. Rapid identification and management are crucial to improve patient outcomes.

Anaphylactic shock, while potentially life-threatening, is less common than septic shock. It results from a severe allergic reaction causing vasodilation, bronchoconstriction, and hypotension, but it is typically managed quickly with epinephrine and supportive care.

Neurogenic shock occurs due to a loss of sympathetic tone often from spinal cord injury, leading to vasodilation and hypotension. It is less common in the acute care setting than septic shock.

Adrenal crisis is a rare condition resulting from insufficient production of cortisol and aldosterone, leading to hypotension and shock. It requires prompt recognition and treatment with steroids but is not as common as septic shock.

117.

You are caring for a 45-year-old female patient following abdominal surgery. Her pain is being managed with a Patient-Controlled Analgesia (PCA) pump delivering morphine. Twelve hours postoperatively, the patient begins complaining of intense itching on her arms and chest despite no visible rash. You suspect that the pruritus is related to the opioid medication she is receiving.

Which of the following medications is MOST appropriate for treating opioid-induced pruritus in this patient?

  • Nalbuphine (Nubain)

  • Methylnaltrexone (Relistor)

  • Diphenhydramine (Benadryl)

  • Metoclopramide (Reglan)

Correct answer: Nalbuphine (Nubain)

Nalbuphine is an opioid agonist-antagonist that can be used effectively to treat opioid-induced pruritus without significantly affecting pain control. It works by binding to the opioid receptors responsible for the itching sensation and providing relief.

Methylnaltrexone is used primarily to treat opioid-induced constipation by blocking opioid effects in the gut without affecting analgesia.

Diphenhydramine, an antihistamine, is often used to treat allergic reactions but is less effective for opioid-induced pruritus because the itching is not caused by histamine release.

Metoclopramide is a prokinetic agent used to treat gastroparesis and nausea, and it is not effective in treating opioid-induced pruritus.

118.

A 68-year-old patient with type 2 diabetes is admitted to the Progressive Care Unit (PCU) with severe dehydration, altered mental status, and a blood glucose level of 950 mg/dL. Laboratory results indicate a serum osmolality of 320 mOsm/kg and absent ketones in the urine. 

Which of the following is the MOST likely diagnosis?

  • Hyperosmolar Hyperglycemic State (HHS)

  • Diabetic Ketoacidosis (DKA)

  • Hypoglycemia

  • Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Correct answer: Hyperosmolar Hyperglycemic State (HHS)

HHS is characterized by extremely high blood glucose levels, severe dehydration, elevated serum osmolality, and absent or minimal ketones. The clinical presentation described fits the diagnosis of HHS.

DKA is characterized by hyperglycemia, metabolic acidosis, and the presence of ketones in the urine or blood. The absence of ketones and very high blood glucose level in this case point away from DKA.

SIADH is associated with hyponatremia and low serum osmolality due to excessive release of antidiuretic hormone, which does not fit the presentation of high serum osmolality and hyperglycemia.

119.

What is the normal range for blood bicarbonate levels?

  • 22–26 mEq/L

  • 35–45 mmHg

  • 22–26 mmHg

  • 80–100 mmHg

Correct answer: 22–26 mEq/L

Arterial Blood Gas (ABG) samples are obtained by direct puncture of an artery (usually the radial artery) or by withdrawing blood via an indwelling arterial catheter system. An arterial blood sample is analyzed for oxygen and carbon dioxide tension and pH using a blood gas analyzer. From these measurements, bicarbonate (HCO3-) can be analyzed, among other parameters. Normal blood levels of HCO3- are 22–26 mEq/L (not mmHg). 

Normal levels of carbon dioxide (PaCO2) are 35–45 mmHg. Normal levels of oxygen (PaO2) in the blood are 80–100 mmHg. 

120.

A 60-year-old female patient is admitted to the Progressive Care Unit (PCU) with pulmonary disease. She and her family speak very little English. Which of the following actions is MOST appropriate for you to take to help the patient and family understand what evaluation for hypoxemia will involve?

  • Show the patient and her family the unit's simple, printed brochure describing the evaluation, which includes a picture of a treadmill, and write out simple instructions

  • Explain the procedure in English using short sentences

  • Request a respiratory therapist come to the unit to demonstrate the procedure

  • Assume the pulmonary technician will explain the evaluation procedure

Correct answer: Show the patient and her family the unit's simple, printed brochure describing the evaluation, which includes a picture of a treadmill, and write out simple instructions

This teaching incorporates individualized education into patient care, involves the family, and is based on their needs and level of understanding.

Explaining the procedure in English will not best facilitate understanding, even if you use short sentences.

While requesting a Respiratory Therapist (RT) to demonstrate the procedure could be useful, the most appropriate intervention is to start with a brochure with pictures and simple instructions. 

Do not assume someone else will explain the procedure.

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