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Quiz Session - Attempts With Random Questions

AACN PCCN July 2024 Exam Hanbook version 2.1.0 Exam Questions

Page 9 of 33

161.

A 63-year-old male patient with diabetes and Chronic Obstructive Pulmonary Disease (COPD) develops Hospital-Acquired Pneumonia (HAP) during a prolonged hospital stay. His vital signs are heart rate 112 bpm, respiratory rate 22 breaths per minute, blood pressure 138/92 mmHg, temperature 101.3°F, and oxygen saturation 90%. 

Based on this scenario, which comorbidity is MOST likely to complicate his HAP treatment?

  • COPD

  • Diabetes

  • Obesity

  • Hypertension

Correct answer: COPD

COPD is most likely to complicate HAP treatment because it can impair lung function and increase susceptibility to respiratory infections, making airway clearance more difficult.

Diabetes can contribute to infection risk due to impaired immune responses, but in this case, the direct impact on lung function is less significant than that of COPD. Obesity can affect respiratory mechanics, but it is not as central to complicating HAP treatment as COPD. Hypertension is a common comorbidity but does not directly complicate HAP treatment unless it is associated with heart failure or other conditions.

162.

Acute Respiratory Failure (ARF) can occur as a result of many abnormalities, but regardless of the specific underlying condition, its etiology in adults can be categorized into four main components: impaired ventilation, impaired gas exchange, airway obstruction, and ventilation-perfusion abnormalities. 

Which of the following conditions causes airway obstruction?

  • Asthma

  • Phrenic nerve damage

  • Spinal cord injury at C4 or higher

  • Pulmonary embolism

Correct answer: Asthma

Asthma is a condition that causes airway obstruction due to inflammation, bronchoconstriction, and increased mucus production in the airways. This obstruction can lead to difficulty breathing and is a key feature of asthma, making it a common cause of airway obstruction.

Phrenic nerve damage and spinal cord injury at C4 or higher can impair ventilation by affecting the muscles involved in breathing, but they do not directly cause airway obstruction. A pulmonary embolism obstructs blood flow in the pulmonary arteries but does not cause airway obstruction; it primarily causes ventilation-perfusion mismatch rather than direct airway blockage.

163.

A 59-year-old male patient with a history of coronary artery disease presents with sinus tachycardia, chest pain, and shortness of breath. His heart rate is 125 beats per minute and blood pressure is 90/60 mmHg. Which of the following is MOST likely contributing to his sinus tachycardia?

  • Cardiogenic shock

  • Medication overdose

  • Electrolyte imbalance

  • Hyperthyroidism

Correct response: Cardiogenic shock

The combination of tachycardia, low blood pressure, chest pain, and shortness of breath in a patient with coronary artery disease suggests inadequate cardiac output leading to shock.

Medication overdose might cause various cardiac arrhythmias and hemodynamic changes, but it is less likely in the context of the patient's history and presenting symptoms.

Electrolyte imbalance can contribute to cardiac arrhythmias and symptoms, but the history of coronary artery disease and the clinical presentation make cardiogenic shock more likely.

Hyperthyroidism can cause tachycardia, but it is less likely to cause the acute presentation of chest pain, low blood pressure, and shortness of breath seen in this patient.

164.

What is the normal range for levels of base excess in Arterial Blood Gases (ABGs)?

  • -2 to +2 mEq/L

  • 0 to 2 mEq/L

  • 10 to 20 mEq/L

  • 21 to 28 mEq/L

Correct answer: -2 to +2 mEq/L

Base Excess (BE) measures the amount of excess or insufficient level of bicarbonate in the system. A BE within this range generally indicates a normal acid-base balance, reflecting that the metabolic component of the acid-base status is well maintained.

Bicarbonate (HCO3-) is the metabolic component of the acid-base system and is primarily controlled by the kidneys. Normal values of HCO3- range from 21 to 28 mEq/L.  

165.

What is the ability of the pacing stimulus to result in depolarization of the chamber being paced?

  • Capture

  • Sensing

  • Threshold 

  • Refractory period

Correct answer: Capture

Capture is the ability of the pacing stimulus to successfully depolarize the cardiac chamber being paced. This means the electrical impulse generated by the pacemaker leads to the contraction of the heart muscle, which is essential for effective cardiac pacing.

Sensing is the pacemaker's ability to detect the heart's intrinsic electrical activity, which ensures the pacemaker delivers stimuli appropriately based on the heart's natural rhythm. It does not directly relate to the depolarization of the chamber.

The threshold is the minimum amount of electrical energy required to consistently achieve capture. While it is related to the concept of capture, it specifically measures the energy level needed rather than the occurrence of depolarization itself.

The refractory period is the time during which the cardiac cells are unable to respond to a new stimulus following depolarization. It is crucial in preventing arrhythmias but is not directly related to the concept of achieving capture with a pacing stimulus.

166.

A 69-year-old male patient is admitted with fatigue and dyspnea on exertion. His blood pressure is 130/80 mmHg, and auscultation reveals a harsh systolic murmur. 

Which of the following valvular conditions is MOST likely causing his symptoms?

  • Aortic stenosis

  • Mitral regurgitation

  • Pulmonic stenosis

  • Tricuspid regurgitation

Correct answer: Aortic stenosis

A harsh systolic murmur characterizes aortic stenosis and often presents in older adults with symptoms of fatigue, dyspnea on exertion, and sometimes syncope. The calcification of the aortic valve is common in the elderly and can result in significant stenosis over time.

Mitral regurgitation causes a systolic murmur, but it is usually softer and best heard at the apex of the heart rather than over the aortic area. Pulmonic stenosis is rare and typically congenital, more often affecting younger patients. Tricuspid regurgitation causes a holosystolic murmur best heard over the lower left sternal border and is less likely to cause significant symptoms unless severe.

167.

A 72-year-old patient is admitted to the progressive care unit following hip replacement surgery. Which of the following is the MOST effective VTE (Venous Thromboembolism) prophylaxis strategy for this patient?

  • Early ambulation and mechanical compression devices

  • Intermittent pneumatic compression devices only

  • Oral anticoagulation with warfarin

  • Low-dose aspirin therapy

Correct answer: Early ambulation and mechanical compression devices

Early ambulation is a key strategy to prevent VTE, and mechanical compression devices, such as Sequential Compression Devices (SCDs), further enhance venous return and reduce the risk of clot formation. This combination is considered highly effective for VTE prophylaxis. 

While intermittent pneumatic compression devices are useful, relying solely on mechanical compression without encouraging early ambulation may not provide optimal prophylaxis.

Warfarin is effective for VTE prophylaxis but requires monitoring and may not be the first choice immediately after surgery due to the risk of bleeding. Other anticoagulants, like low-molecular-weight heparin, are often preferred in the immediate postoperative period.

Aspirin is sometimes used for VTE prophylaxis, but it is not as effective as other methods, such as anticoagulation or mechanical compression, especially in high-risk patients like those post-hip replacement surgery.

168.

A 63-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted with worsening dyspnea. His PaCO2 is elevated, but he is not in acute distress. 

What is the MOST likely explanation for his ABG results?

  • Chronic respiratory failure

  • Acute respiratory failure

  • Metabolic acidosis

  • Pneumothorax

Correct answer: Chronic respiratory failure

Chronic respiratory failure is common in patients with conditions like COPD, in which the body adapts to elevated PaCO2 over time. This patient’s history and lack of acute distress suggest that his elevated PaCO2 is consistent with chronic respiratory failure.

Acute respiratory failure presents more dramatically, with sudden symptoms and worsening ABG results. Metabolic acidosis does not explain the elevated PaCO2, as it primarily involves a decrease in bicarbonate (HCO3-). Pneumothorax causes sudden respiratory distress, which this patient does not exhibit.

169.

Surgical intervention is indicated in many conditions related to aortic aneurysms but not in all situations. In which scenario can an aortic aneurysm be treated without surgery? 

  • Asymptomatic patient with a fusiform aneurysm 4 cm in diameter

  • Aortic dissection in the ascending aorta

  • Aortic dissection refractory to medical therapy

  • Acute aneurysm rupture

Correct answer: Asymptomatic patient with a fusiform aneurysm 4 cm in diameter

A fusiform aneurysm is characterized by distension of the entire circumference of the affected portion of the aorta. Asymptomatic patients with a fusiform aneurysm 4 cm in diameter do not require surgery.

Surgery is indicated in the following situations:

  • Acute aneurysm rupture
  • Aortic dissection in the ascending aorta
  • Aortic dissection refractory to medical therapy 
  • Asymptomatic patient with a fusiform aneurysm 6 cm or more in diameter (normal diameter is 2.5–3 cm)

170.

Which cardiac biomarker is MOST commonly used to diagnose acute myocardial infarction?

 

  • Troponin

  • BNP

  • CK-MB

  • Myoglobin

Correct answer: Troponin

Troponin is highly specific for cardiac injury and remains elevated for a longer period, allowing for effective diagnosis even hours after the onset of symptoms.

BNP (B-type Natriuretic Peptide) is used to assess heart failure, not to diagnose myocardial infarction.

CK-MB (Creatine Kinase-MB) was once widely used to diagnose myocardial infarction, but it is less specific than troponin for cardiac injury.

Myoglobin is an early marker of muscle injury, including in the heart, but is not specific to myocardial infarction and rises in various conditions.

171.

What are the three categories scored on the Glasgow Coma Scale (GCS)?

  • Eye opening, motor response, verbal response

  • Eye opening, motor response, respiratory response

  • Pupil reactivity, verbal response, motor response

  • Pupil reactivity, respiratory response, verbal response

Correct answer: Eye opening, motor response, verbal response

The GCS is often used to monitor neurologic status in patients with traumatic brain injuries because it provides a standardized approach to assessing and documenting a patient's level of consciousness. Patient response is determined by verbal and motor responses and eye opening. 

Each response is scored and results are added; scores range from 3 to 15, and a high score of 15 indicates a fully alert and oriented patient who can follow commands.

Respiratory response and pupil reactivity are not categories of the GCS.

172.

Aortic dissections are classified as acute if they have occurred within what time frame?

  • Less than two weeks since the onset of symptoms

  • Less than eight weeks since the onset of symptoms

  • Less than four weeks since the onset of symptoms

  • Less than six weeks since the onset of symptoms

Correct answer: Less than two weeks since the onset of symptoms

Patients seldom demonstrate early signs of an aortic aneurysm. The diagnosis is often made during a chest x-ray or a routine physical examination. Dissections are classified as acute if they have occurred less than two weeks since the onset of symptoms and chronic if they occurred more than two weeks since the onset of symptoms.

173.

The Affordable Care Act (ACA) requires hospitals to report quality indicators (e.g., the rate of hospital-acquired infections) and then ties these indicators to financial reimbursement. In this way, the ACA offers a legal manifestation of which ethical principle?

  • Justice

  • Beneficence

  • Nonmaleficence

  • Autonomy

Correct answer: Justice

Justice is fairness and equality in healthcare. By requiring hospitals to report quality indicators and linking these to financial reimbursement, the ACA aims to ensure that all patients receive a fair standard of care and that hospitals are held accountable for providing equitable healthcare services.

Beneficence means acting to promote the patient's well-being. Nonmaleficence means "do no harm." While improving hospital quality indicators can promote patient welfare and reduce harm (e.g., hospital-acquired infections), the primary focus of the ACA’s policy is ensuring fairness and accountability.

Autonomy refers to respecting the patients' rights to make their own healthcare decisions. The ACA's reporting requirements and financial incentives do not directly relate to patient decision-making but to institutional accountability and quality improvement.

174.

Which of the following is the MOST common indication for pacemaker insertion?

 

  • Symptomatic bradycardia

  • Atrial fibrillation

  • Ventricular tachycardia

  • Heart failure

Correct answer: Symptomatic bradycardia

A temporary or permanent pacemaker is indicated if a patient cannot maintain adequate cardiac output. Symptomatic bradycardia is the most common indication for pacemaker insertion. Pacemakers are primarily used to treat conditions in which the heart rate is too slow, which can lead to dizziness, fatigue, or fainting. 

Atrial fibrillation is typically managed with other interventions, such as rate control or rhythm control medications.

Ventricular tachycardia is usually treated with antiarrhythmic drugs or defibrillation rather than a pacemaker. 

Heart failure may be managed with pacemakers in certain situations, such as in Cardiac Resynchronization Therapy (CRT), but it is not the most common indication.

175.

An 89-year-old Asian male patient in the terminal stages of lung cancer has many family members visiting at all hours of the day and night. His family brings various foods and performs ritualistic activities. 

Which of the following actions should the nurse take?

  • Provide comfort and privacy for the patient and family by keeping the other bed in the room unassigned

  • Post large signs above the bed and on the door stating that the patient is not allowed to have solid food

  • Limit visiting hours so other patients are not disturbed

  • Notify the patient's physician of the unusual activities

Correct answer: Provide comfort and privacy for the patient and family by keeping the other bed in the room unassigned

The family's access to the patient is vital, and open visitation is to be encouraged. Each family system is unique and varies by culture, religion, values, socioeconomic status, previous experience with crisis, role expectations, psychological integrity, communication patterns, ages, and health beliefs. 

It is crucial to assess the family's needs and resources and support family collaboration with the healthcare team rather than limiting their activities or visiting hours unnecessarily.

176.

A 52-year-old female patient is being evaluated for worsening hypothyroidism despite taking levothyroxine as prescribed. Her TSH remains elevated, and she reports no significant improvement in symptoms. Upon further assessment, you discover she takes her medication with breakfast, including calcium supplements. 

What is the MOST likely cause of her persistent hypothyroidism?

  • Poor medication absorption

  • Incorrect dosage of levothyroxine

  • Progressive thyroid failure

  • Nonadherence to treatment

Correct answer: Poor medication absorption

Calcium supplements taken with levothyroxine can significantly reduce the absorption of the medication, leading to persistent hypothyroid symptoms despite appropriate dosing.

Incorrect dosage may contribute, but the timing and interaction with calcium are more likely to affect absorption. Progressive thyroid failure is possible but less likely in a patient who is already on treatment with no improvement. Nonadherence might explain persistent hypothyroidism, but since the patient is taking the medication, this is less likely than interference from calcium supplements.

177.

In caring for a patient with diabetic acidosis, which of the following would you expect laboratory results to reveal? 

  • High serum glucose, increased acidity, low carbon dioxide

  • Low serum glucose, increased acidity, high carbon dioxide

  • Low serum glucose, decreased acidity, low carbon dioxide

  • Elevated serum glucose, normal acidity, high carbon dioxide

Correct answer: High serum glucose, increased acidity, low carbon dioxide

DKA is characterized by hyperglycemia (high serum glucose) due to insulin deficiency, metabolic acidosis (increased acidity), and a compensatory respiratory response leading to low carbon dioxide (CO2) levels. When the body is in a state of acidosis, it attempts to compensate by hyperventilating to blow off excess CO2. This process, known as Kussmaul respiration, helps to partially correct the acid-base imbalance.

High CO2 levels indicate respiratory failure or an inadequate respiratory compensatory mechanism, which is not a typical feature of DKA. High carbon dioxide indicates a lack of respiratory compensation.

178.

A 52-year-old male patient with a history of type 2 diabetes mellitus presents to the emergency department with severe hyperglycemia. His initial laboratory results show a blood glucose level of 580 mg/dL, serum potassium of 5.6 mEq/L, serum phosphate of 3.0 mg/dL, and serum magnesium of 1.8 mg/dL. The patient is started on an insulin infusion to lower his blood glucose. 

Given these laboratory values, which of the following infusions is MOST appropriate to administer simultaneously with the insulin infusion?

  • Potassium chloride

  • Potassium phosphate

  • Magnesium

  • Calcium

Correct answer: Potassium chloride

When administering insulin to treat hyperglycemia, particularly when it's severe, it’s crucial to monitor and manage serum potassium levels. Although this patient initially presents with hyperkalemia (serum potassium of 5.6 mEq/L), insulin drives potassium into cells, often leading to a rapid decrease in serum potassium levels, which can result in hypokalemia. Therefore, even though the patient’s potassium is elevated at presentation, potassium chloride is the most appropriate infusion to prepare for the expected drop in potassium levels as insulin is administered.

While phosphate replacement might be necessary in some cases, this patient's phosphate level is within a manageable range, and the immediate concern is managing potassium levels during insulin administration.

Magnesium supplementation might be considered if the magnesium level is low, but the patient’s magnesium level is not critically low, making it less of an immediate concern compared to potassium.

Calcium supplementation is not indicated as there is no evidence of hypocalcemia and no indication for calcium infusion.

179.

A 72-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted for pneumonia. Which intervention is MOST likely to prevent the development of hospital-acquired pneumonia?

  • Implementing a strict oral care protocol

  • Providing noninvasive ventilation as needed

  • Initiating early ambulation and mobilization

  • Limiting fluid intake to prevent pulmonary edema

Correct answer: Implementing a strict oral care protocol

Implementing a strict, comprehensive oral care protocol is essential in preventing hospital-acquired pneumonia, particularly in patients with COPD. Regular oral care reduces the colonization of pathogens in the oropharynx, which can be aspirated into the lungs, leading to pneumonia.

Noninvasive ventilation can support respiratory function but does not specifically prevent pneumonia. Early ambulation is beneficial for overall patient recovery but is not directly related to pneumonia prevention. Limiting fluid intake may prevent pulmonary edema but is unrelated to hospital-acquired pneumonia prevention.

180.

A 49-year-old male patient with a known spinal cord injury at the T8 level presents with new onset of urinary incontinence and muscle weakness in the lower extremities. He also complains of back pain that radiates down both legs. 

Which of the following actions is the MOST appropriate next step?

  • Obtain an urgent Magnetic Resonance Imaging (MRI) scan

  • Administer pain medication

  • Consult physical therapy for gait training

  • Monitor the patient’s symptoms closely

Correct answer: Obtain an urgent Magnetic Resonance Imaging (MRI) scan

In a patient with a history of spinal cord injury presenting with new urinary incontinence, muscle weakness, and radicular back pain, it is critical to rule out spinal cord compression or other significant pathology. An urgent MRI is the most appropriate next step to identify any new lesions, hematomas, or other causes of compression that could require immediate intervention.

Pain medication may provide symptom relief but does not address the underlying cause of these new symptoms. Consulting physical therapy for gait training would be premature without first understanding the cause of the new weakness. Monitoring the patient’s symptoms closely is important but would delay potentially life-saving treatment if there is a serious underlying cause.

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