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Quiz Session - Attempts With Random Questions

AACN PCCN July 2024 Exam Hanbook version 2.1.0 Exam Questions

Page 7 of 33

121.

A 49-year-old male patient has just been intubated for respiratory failure. Which of the following is the MOST appropriate way to confirm endotracheal tube placement?

  • End-Tidal carbon dioxide (ETCO2) detector shows a consistent waveform

  • Auscultation reveals breath sounds equally on both sides of the chest

  • Patient shows visible chest rise and fall with each ventilation

  • Chest x-ray confirms the position of the endotracheal tube

Correct answer: End-Tidal carbon dioxide (ETCO2) detector shows a consistent waveform

The initial and most reliable method for confirming the placement of an Endotracheal Tube (ETT) is the use of an ETCO2 detector. This method ensures the ETT is correctly placed in the trachea, as the presence of carbon dioxide in the exhaled air indicates proper ventilation.

Auscultation and visible chest rise are secondary confirmations that can be used, but they are less specific and can sometimes be misleading, especially in cases of unilateral bronchial intubation or air leaks.

Chest x-ray is important for confirming the depth of tube placement, but it is not the initial step because it does not provide immediate feedback on whether the ETT is in the trachea.

122.

Which Angiotensin-Converting Enzyme (ACE) inhibitor, administered Intravenously (IV), causes blood pressure to decrease within 15 minutes and has effects lasting four to six hours? 

  • Enalapril

  • Captopril

  • Lisinopril

  • Ramipril

Correct answer: Enalapril

Enalapril is the only ACE inhibitor available for IV administration. After IV administration, it lowers blood pressure within 15 minutes, and its effects last four to six hours. It is commonly used in acute settings where rapid blood pressure control is necessary.

Captopril, lisinopril, and ramipril are ACE inhibitors available for oral administration. They are used for long-term management of hypertension and heart failure but do not have the rapid onset and short duration of action described.

123.

The Health Information Portability and Accountability Act (HIPAA) Privacy Rules create a legal mandate to honor the ethical obligation of which of the following?

  • Privacy and confidentiality

  • Privacy

  • Confidentiality

  • Autonomy

Correct answer: Privacy and confidentiality

HIPAA Privacy Rules establish legal requirements that safeguard both privacy and confidentiality. Privacy is an individual's right to control access to their personal health information, while confidentiality is the obligation of healthcare providers to protect the patient's information from unauthorized disclosure. HIPAA specifically mandates that healthcare providers and organizations protect both aspects when handling patient information.

Autonomy is an ethical principle related to a patient's right to make their own decisions but is not specifically addressed by HIPAA Privacy Rules.

124.

Following bariatric surgery, leakage of gastric contents at the site of the anastomosis can lead to overwhelming sepsis. Which of the following are signs and symptoms of this potentially life-threatening complication?

  • Tachycardia, left shoulder pain, tachypnea, fever

  • Fever, right shoulder pain, tachycardia, tachypnea

  • Abdominal pain, tachycardia, tachypnea

  • Fever, bradycardia, bradypnea

Correct answer: Tachycardia, left shoulder pain, tachypnea, fever

Signs and symptoms of leakage of gastric contents at the site of anastomosis include left shoulder pain, fever, tachycardia, and tachypnea. Abdominal pain may occur in some patients, but its absence does not rule out the possibility of an anastomotic leak. In some cases, unexplained tachycardia may be the only sign of a leak. 

Diagnosis involves a CT scan or a limited upper GI x-ray. Early identification and treatment are vital to ensuring a successful outcome. 

125.

A 72-year-old male patient presents to the emergency department with sudden onset of severe chest pain radiating to his back. The pain is described as tearing in nature. On examination, the patient is hypertensive and has a significant difference in blood pressure between the right and left arms. An urgent CT scan reveals an aortic dissection that begins in the ascending aorta and extends into the descending aorta.

Based on the CT scan findings, what type of aortic dissection is this?

  • Stanford Type A

  • Stanford Type B

  • DeBakey Type II

  • DeBakey Type III

Correct answer: Stanford Type A

This classification includes any dissection that involves the ascending aorta, regardless of the point of origin or extent of the dissection. The scenario describes a dissection that starts in the ascending aorta and extends into the descending aorta, fitting this classification.

Stanford Type B dissections do not involve the ascending aorta and are confined to the descending aorta.

DeBakey Type II dissections are confined to the ascending aorta without extension into the descending aorta.

DeBakey Type III dissections originate in the descending aorta without involvement of the ascending aorta.

126.

Aneurysm development is initiated in which layer of the aorta?

  • Medial

  • Intima

  • Tunica adventitia

  • Fusiform

Correct answer: Medial

Aneurysm development typically begins in the medial layer of the aorta. The media is the middle layer of the aortic wall, composed primarily of smooth muscle cells and elastic fibers. Degeneration of this layer, often due to conditions such as hypertension or connective tissue disorders, leads to the weakening of the aortic wall and the formation of an aneurysm.

The intima is the innermost layer of the aorta, and while it can be involved in the process, aneurysm formation primarily starts in the medial layer.

The tunica adventitia is the outermost layer of the aorta, providing structural support, but is not typically where aneurysm formation initiates.

Fusiform is a type of aneurysm shape, not a layer of the aorta.

127.

You are caring for a 67-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) and atrial fibrillation following an acute exacerbation. He is currently on mechanical ventilation and requires sedation to tolerate the ventilator. The physician orders a continuous infusion of propofol for sedation. The patient is also receiving anticoagulation therapy with warfarin for atrial fibrillation. During your shift, you notice that the patient’s blood pressure has decreased significantly, and he has developed a new onset of confusion.

Which of the following actions is the MOST appropriate to address the patient's current condition?

  • Administer a bolus of normal saline and notify the physician about the patient's hypotension and confusion

  • Increase the propofol infusion rate to ensure adequate sedation and prevent agitation

  • Discontinue the propofol infusion and switch to a benzodiazepine for sedation

  • Order an immediate CT scan of the head to rule out an intracranial hemorrhage

Correct answer: Administer a bolus of normal saline and notify the physician about the patient's hypotension and confusion

Administering a bolus of normal saline and notifying the physician about the patient's hypotension and confusion address the acute changes in the patient's condition, which could be related to propofol infusion or other underlying issues.

Increasing the propofol infusion rate may worsen hypotension. Discontinuing propofol and switching to a benzodiazepine might not immediately address the hypotension and confusion. A CT scan could be considered later, but immediate hemodynamic stabilization is crucial.

128.

A comatose patient on the Progressive Care Unit (PCU) has a durable power of attorney for healthcare, which indicates that both her adult son and daughter are assigned to make decisions in her place. These two adult children support opposing courses of treatment for their mother, making it unclear which course of action should be taken. 

Which type of ethical problem is this an example of?

  • Locus of authority

  • Allocation of resources

  • Moral distress

  • Ethical dilemma

Correct answer: Locus of authority

In locus-of-authority situations, two or more individuals have a claim to the role of decision-maker but do not agree on the course of action.

In a problem with allocation of resources, a decision is required about how to distribute a finite supply of goods or resources among a group of people. 

In moral distress, the moral agent knows the right action to take but is unable to take that action. 

In an ethical dilemma, the moral agent identifies two opposing but equally justifiable courses of action.

129.

A 28-year-old female patient is in the Progressive Care Unit (PCU) following a motor vehicle accident. She wants her seven-year-old son to visit but is concerned he will be frightened by all the equipment. Which of the following actions could demonstrate caring practices by the nurse?

  • Arrange a brief visit for the son, providing a simple explanation of the equipment and ensuring a calm environment

  • Explain to the patient that it is not appropriate for young children to visit the PCU

  • Suggest that the patient use video calls to communicate with her son instead of an in-person visit

  • Allow the son to visit without any special preparations or explanations

Correct answer: Arrange a brief visit for the son, providing a simple explanation of the equipment and ensuring a calm environment

This action demonstrates caring by acknowledging the patient's emotional needs and facilitating family presence in a way that minimizes fear. Preparing the son with age-appropriate explanations and ensuring a calm environment can help ease his anxiety.

Explaining to the patient that it is not appropriate for young children to visit the PCU does not address the patient's emotional needs or demonstrate caring practices. It dismisses the patient's request without considering potential solutions.

While video calls can be a useful alternative, this option does not fully address the patient's desire for an in-person visit and may not provide the same level of comfort and connection.

Allowing the son to visit without any special preparations or explanations does not demonstrate caring practices as it fails to consider the anxiety the child might experience without proper preparation.

130.

A 63-year-old female patient with COVID-19 and a history of chronic heart failure presents with increasing dyspnea and a productive cough. Her vital signs are BP 140/90 mmHg, HR 115 bpm, RR 30 breaths/min, and O2 saturation 88% on room air. 

Which factor is MOST likely contributing to her worsening respiratory status?

  • Progression of COVID-19 pneumonia

  • Acute exacerbation of heart failure

  • Pulmonary embolism

  • Bacterial superinfection

Correct answer: Progression of COVID-19 pneumonia

The combination of worsening dyspnea, cough, and significant hypoxia in a patient with COVID-19 suggests the progression of COVID-19 pneumonia, which is known to cause severe respiratory distress and hypoxemia.

An acute exacerbation of heart failure could contribute to dyspnea, but the productive cough and known COVID-19 infection point more directly to worsening pneumonia. A pulmonary embolism could cause sudden hypoxia, but the gradual worsening of respiratory symptoms is more consistent with pneumonia. Bacterial superinfection is possible, but the scenario is more indicative of viral progression than of a new bacterial process.

131.

A 35-year-old male patient is admitted to the Progressive Care Unit (PCU) after a traumatic brain injury. Upon assessment, he opens his eyes to painful stimuli, makes incomprehensible sounds, and withdraws from pain. What is his Glasgow Coma Scale (GCS) score?

  • 8

  • 7

  • 9

  • 10

Correct answer: 8

The Glasgow Coma Scale (GCS) is used to assess the level of consciousness in a patient with a brain injury. It consists of three components:

  1. Eye opening (E): Opens eyes to painful stimuli, two points
  2. Verbal response (V): Makes incomprehensible sounds, two points
  3. Motor response (M): Withdraws from pain, four points

The total GCS score is calculated by adding the scores from each category: 2 + 2 + 4 = 8.

132.

In an adult, which of the following generally indicates severe bronchoconstriction?

  • An absolute peak flow measurement of less than 100 L/minute

  • An absolute peak flow measurement of less than 275 L/minute

  • An absolute peak flow measurement of less than 200 L/minute

  • An absolute peak flow measurement of less than 500 L/minute

Correct answer: An absolute peak flow measurement of less than 100 L/minute

A peak flow measurement of less than 100 L/minute generally indicates severe bronchoconstriction, suggesting a significant reduction in airflow that is often seen in severe asthma exacerbations or other conditions causing extreme airway narrowing.

A peak flow measurement of less than 275 L/minute or 200 L/minute suggests moderate obstruction but is not typically classified as severe. A peak flow measurement of less than 500 L/minute is closer to normal values for many adults and does not indicate severe bronchoconstriction.

133.

A 52-year-old female patient with a history of mitral regurgitation undergoes a mitral clip procedure. Postoperatively, she develops increasing shortness of breath and bilateral lung crackles. 

Which of the following findings is LEAST likely to be related to the mitral clip procedure?

  • Acute myocardial infarction

  • Left ventricular failure

  • Pulmonary edema

  • Severe mitral regurgitation recurrence

Correct answer: Acute myocardial infarction

While acute myocardial infarction is possible in any patient, it is least likely to be directly related to the mitral clip procedure itself. The mitral clip primarily affects mitral valve function, not the coronary arteries.

Left ventricular failure is a possible complication after mitral valve repair, particularly if the left ventricle has been overloaded. Pulmonary edema can occur if mitral valve function is still compromised, leading to backflow into the lungs. Severe mitral regurgitation recurrence could cause worsening symptoms post-procedure, such as shortness of breath.

134.

A 59-year-old male patient with a history of chronic kidney disease and recent dialysis presents with a positive Trousseau's sign and confusion. His serum calcium level is 7.2 mg/dL. 

What is the MOST likely cause of his symptoms?

  • Hypocalcemia due to renal failure

  • Hypercalcemia from calcium supplements

  • Hyperphosphatemia from dietary intake

  • Hyponatremia due to fluid overload

Correct answer: Hypocalcemia due to renal failure

The patient’s low serum calcium level, confusion, and positive Trousseau's sign strongly suggest that his symptoms are due to hypocalcemia, a common consequence of chronic kidney disease and dialysis.

Hypercalcemia causes different symptoms, such as muscle weakness and constipation, rather than Trousseau's sign. 

Hyperphosphatemia often accompanies hypocalcemia in renal failure, but it is the hypocalcemia that is causing the symptoms in this case.

Hyponatremia can cause confusion but not a positive Trousseau's sign.

135.

A 72-year-old female patient with a history of chronic hypothyroidism is admitted to the PCU with suspected myxedema coma. Despite appropriate treatment with intravenous levothyroxine and supportive care, the patient remains comatose and hemodynamically unstable. 

What factor is MOST likely contributing to her poor prognosis?

  • Delayed initiation of thyroid hormone replacement

  • Severe underlying cardiac disease

  • Concurrent sepsis

  • Advanced age

Correct answer: Delayed initiation of thyroid hormone replacement

In myxedema coma, the prognosis heavily depends on the timing of the intervention. A delay in initiating thyroid hormone replacement can lead to irreversible damage and a poor outcome. The longer the condition remains untreated, the higher the risk of death or severe complications.

Severe underlying cardiac disease may contribute to the patient’s instability but is not the primary factor in the poor response to treatment. Concurrent sepsis could exacerbate the situation, but the delay in treatment is the most critical factor. Advanced age is a risk factor for poor outcomes in general, but timely and appropriate treatment can significantly improve the prognosis in elderly patients with myxedema coma.

136.

A 78-year-old male patient is being monitored for respiratory depression after receiving a high dose of hydromorphone for pain control. He becomes drowsy with a respiratory rate of 8 breaths per minute. His blood pressure is 102/65 mmHg, heart rate is 64 bpm, and oxygen saturation is 92%. 

Which factor is MOST likely contributing to his respiratory depression?

  • Hydromorphone’s CNS depressant effects

  • Age-related changes in drug metabolism

  • The patient's oxygen saturation

  • The patient's heart rate and blood pressure

Correct answer: Hydromorphone’s CNS depressant effects. 

Hydromorphone, an opioid, depresses the CNS, which can result in slowed respiratory drive.

Age-related changes in drug metabolism can influence the intensity of drug effects, but the primary cause here is the drug's CNS depression. Oxygen saturation is within a normal range, but this doesn't affect respiratory drive. A normal heart rate and blood pressure do not contribute to respiratory depression in this context.

137.

Goals in patient management of acute Heart Failure (HF) revolve around four general principles. Which of the following is one of these principles?

  • Improve ventricular function

  • Increase preload and decrease afterload

  • Micromanage hemodynamic parameters

  • Manage fluid volume deficits

Correct answer: Improve ventricular function

One of the primary goals in managing acute heart failure is to improve ventricular function, which can help alleviate symptoms, enhance cardiac output, and improve overall patient outcomes.

While managing preload and afterload is important in heart failure, the goal is typically to decrease preload to reduce congestion and to decrease afterload to reduce the workload on the heart rather than increasing preload.

Monitoring hemodynamic parameters is important, but the goal is not micromanagement. It is to maintain overall stability and address the underlying issues.

In acute heart failure, the primary concern is often managing fluid overload rather than deficits. Managing fluid volume typically involves diuretics and fluid restrictions to prevent congestion and edema.

138.

Which of the following are included in the exclusion criteria for the use of a Ventricular Assist Device (VAD)? 

  • Cancer with metastasis, coagulopathy, severe pulmonary disease 

  • Cancer with metastasis, severe pulmonary disease, urine output > 30 mL/h

  • Mean arterial pressure > 60 mmHg, severe peripheral vascular disease, severe hepatic disease

  • Left or right atrial pressure > 20 mmHg, urine output > 30 mL/h, coagulopathy

Correct answer: Cancer with metastasis, coagulopathy, severe pulmonary disease 

The exclusion criteria for use of a VAD are as follows: 

  • Cancer with metastasis
  • Coagulopathy
  • Severe pulmonary disease
  • Acute cerebral vascular damage
  • Renal failure (unrelated to cardiac failure)
  • Severe hepatic disease
  • Sepsis resistant to therapy
  • Severe peripheral vascular disease
  • Psychological instability

139.

You are a Progressive Care Certified Nurse (PCCN) working in an industrial plant's medical facility. A 35-year-old male worker is brought in by his colleagues after a chemical spill involving cyanide. The worker is unconscious, has a low blood pressure of 85/55 mmHg, and is showing signs of respiratory distress with a blood oxygen saturation of 82% despite supplemental oxygen. The worker’s colleagues report that he was exposed to cyanide gas. You need to quickly determine the appropriate antidote for his condition.

Given the scenario, what is the specific antidote for cyanide poisoning?

  • Kelocyanor

  • Naloxone

  • Flumazenil

  • Atropine

Correct answer: Kelocyanor

Kelocyanor is a specific antidote for cyanide poisoning. It binds to cyanide ions, forming a stable compound that can be excreted by the body.

Naloxone is an antidote for opioid overdose. Flumazenil is an antidote for benzodiazepine overdose. Atropine is used to treat bradycardia and certain types of poisoning, such as organophosphate poisoning but is not specific to cyanide poisoning.

140.

A 65-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) and recent rib fractures from a motor vehicle accident is admitted to the intensive care unit. The patient suddenly develops severe respiratory distress, and a chest x-ray reveals a large pneumothorax on the right side. A chest tube is indicated to remove the air from the pleural space.

Given the patient's condition and the purpose of the chest tube, where would you expect the chest tube to be inserted? 

  • Second intercostal space, midclavicular line

  • Second intercostal space, midaxillary line

  • Fifth intercostal space, midclavicular line

  • Fifth intercostal space, midaxillary line

Correct answer: Second intercostal space, midclavicular line

The second Intercostal Space (ICS) at the midclavicular line is the standard site for inserting a chest tube to remove air. This location is chosen because air rises to the highest point in the pleural cavity, making it the most effective site for air evacuation.

If fluid is to be removed from the pleural space (hemothorax or pleural effusion), the chest tube is inserted in the fifth or sixth ICS, midaxillary line. This location is too low for effective air removal.

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