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Quiz Session - Attempts With Random Questions

AACN PCCN NOV 2023 Exam Hanbook version 1.1.1 Exam Questions

Page 10 of 33

181.

A 62-year-old male patient with a history of hypertension is admitted with acute left-sided hemiplegia. During the NIHSS assessment, his score on the motor arm section is inconsistent with his overall clinical presentation. What should you do?

  • Reassess the motor arm section to ensure accuracy

  • Document the inconsistency and move on to the next section 

  • Ignore the inconsistency as it might be an error 

  • Consult with another nurse to verify the findings

Correct answer: Reassess the motor arm section to ensure accuracy

Reassessing the motor arm section ensures the accuracy of the NIHSS score. Precise and reliable data is crucial to appropriate stroke management.

Documenting the inconsistency without reassessment does not address the potential error and can lead to misinterpretation. Ignoring it could result in inaccurate assessment and impact patient care. Consulting with another nurse can be helpful, but initially the nurse should reassess the section to verify findings.

182.

A 45-year-old male patient with chronic kidney disease underwent an interventional cardiac catheterization for angioplasty. Post-procedure, his creatinine level increases from 1.5 mg/dL to 2.2 mg/dL. 

Which of the following interventions is MOST appropriate to prevent further renal deterioration?

  • Hydration with intravenous fluids

  • Administration of a diuretic

  • Re-catheterization to assess blood flow

  • Immediate dialysis

Correct answer: Hydration with intravenous fluids

The most appropriate intervention in this context is hydration with intravenous fluids (normal saline), which helps flush the contrast dye from the kidneys and reduce the risk of contrast-induced nephropathy, a common complication after cardiac catheterization.

Administering a diuretic is inappropriate because it can further dehydrate the patient and worsen renal function. Re-catheterization is unnecessary and exposes the patient to further risk without addressing the kidney issue. Placing the patient on dialysis immediately is not warranted unless there is evidence of severe renal failure or other indications for dialysis, such as hyperkalemia or fluid overload.

183.

A 43-year-old male patient presents with fever, chills, and confusion. Which of the following is the MOST common early sign of sepsis?

  • Tachycardia

  • Bradycardia

  • Hypothermia

  • Hypertension

Correct answer: Tachycardia

In the early stages of sepsis, the body often responds to infection with an increased heart rate (tachycardia) as a compensatory mechanism to maintain cardiac output and tissue perfusion.

Hypertension is generally not an early sign of sepsis; instead, hypotension is more commonly observed as sepsis progresses. Bradycardia is uncommon in the early stages of sepsis and typically suggests another cause or a late-stage deterioration. Hypothermia can occur in sepsis, particularly in older adults, but it is less common than fever and is typically a later sign.

184.

In which of the following situations would it be MOST appropriate for a surrogate decision-maker to apply the best-interests standard to the informed consent process?

  • An 18-month-old who was struck by a car

  • A 35-year-old who has suffered a brain aneurysm but has a living will

  • A patient with terminal lung cancer who is on hospice

  • The surrogate's own 78-year-old mother

Correct answer: An 18-month-old who was struck by a car

The best-interests standard allows surrogate decision-makers to arrive at a decision that is in the best interest of patients who have never been able to express their preferences related to medical decisions. Examples of patients who have never had capacity include infants, children, and people of all ages with disabilities that prevent this capacity. 

An 18-month-old is included here, whereas the patients in the other answer choices are likely to have had the opportunity to express their preferences regarding informed consent.

185.

An 88-year-old male patient with end-stage Chronic Obstructive Pulmonary Disease (COPD) is receiving hospice care. Which of the following medications is MOST commonly used for pain management in end-of-life care?

  • Morphine sulfate

  • Ibuprofen

  • Fentanyl patch

  • Acetaminophen

Correct answer: Morphine sulfate

Morphine is the most commonly used opioid for managing moderate to severe pain in end-of-life care. It is effective in managing both pain and dyspnea (shortness of breath), which are common in patients with conditions like COPD.

Ibuprofen is a Nonsteroidal Anti-Inflammatory Drug (NSAID) used for mild to moderate pain relief but not typically for end-of-life care, in which opioids are preferred for severe symptoms. Fentanyl is another opioid, but it is less commonly used in end-of-life situations than morphine due to its delayed onset of action and patch format, which can be less flexible for rapid titration. Acetaminophen is useful for mild pain and fever but is insufficient for the level of pain typically experienced in end-stage conditions like COPD.

186.

Which of the following factors is MOST likely to increase a patient's risk of developing a Central-Line-Associated Bloodstream Infection (CLABSI)?

  • Infrequent dressing changes on the central line

  • Using sterile technique during catheter insertion

  • Daily assessment for central line necessity

  • Removal of unnecessary central lines

Correct answer: Infrequent dressing changes on the central line

Infrequent dressing changes can allow bacteria to colonize the site, increasing the risk of CLABSI. Proper maintenance and regular dressing changes are crucial to preventing infection.

Using sterile technique during catheter insertion is essential to preventing CLABSI. Daily assessment for central line necessity reduces the risk of CLABSI by ensuring unnecessary lines are promptly removed. The removal of unnecessary central lines lowers the chance of infection, as the presence of a central line increases infection risk.

187.

Which of the following are elements of the doctrine of informed consent?

  • Disclosure, comprehension, voluntariness, and competence

  • Disclosure, comprehension, and competence

  • Disclosure, comprehension, and voluntariness

  • Disclosure and competence

Correct answer: Disclosure, comprehension, voluntariness, and competence

Informed consent is a fundamental doctrine in healthcare, ensuring that patients make informed decisions about their care. It involves several key elements:

  • Disclosure: The healthcare provider must provide all relevant information about the proposed treatment or procedure, including potential risks, benefits, and alternatives.
  • Comprehension: The patient must be able to understand the information provided. This includes being able to ask questions and receive answers in terms they can understand.
  • Voluntariness: The patient's decision to accept or decline treatment must be made freely, without coercion or undue influence.
  • Competence: The patient must be mentally capable of making the decision. This involves having the cognitive ability to process the information and make an informed choice.

These elements are critical in ensuring the patient’s autonomy and rights are respected throughout the healthcare process.

188.

Regarding hospital-acquired infections, which of the following is TRUE? 

  • Urinary tract infections are the most common hospital-acquired infections in the progressive care setting

  • Pneumonias are the most common hospital-acquired infections in the progressive care setting

  • It is estimated that at least 65% of progressive care patients acquire some type of infection

  • If a urinary catheter is placed in an emergency situation, it should be left in place and antibiotics should be initiated rather than increasing the risk of infection by replacing the catheter

Correct answer: Urinary tract infections are the most common hospital-acquired infections in the progressive care setting.

Urinary Tract Infections (UTIs) are indeed the most common hospital-acquired infections, particularly due to the frequent use of urinary catheters in these settings. This is well documented in medical literature and hospital infection control data.

While pneumonias, especially Ventilator-Associated Pneumonia (VAP), are a significant concern in critical care settings, they are less common hospital-acquired infections than UTIs in these settings.

Hospital-acquired infections are a serious concern, but the rate is not typically as high as 65% in progressive care settings. It is estimated that 20% to 60% of progressive care patients acquire some type of infection.

Best practices suggest that catheters placed in emergency situations should be reassessed and replaced as soon as possible under sterile conditions to reduce the risk of infection. They should not simply be left in place alongside antibiotic treatment.

189.

A 43-year-old female patient presents with nausea, confusion, and a serum sodium level of 115 mEq/L. Her vital signs are BP 135/85 mmHg, HR 82 bpm, RR 16 breaths/min, and SpO2 97%. 

Based on these findings, which of the following treatments is MOST likely to be effective?

  • Hypertonic saline infusion

  • Fluid restriction

  • Furosemide administration

  • Increased sodium intake with diet

Correct answer: Hypertonic saline infusion

Severe hyponatremia (the serum sodium level in hyponatremia is below 136 mEq/L) with neurological symptoms such as confusion warrants careful correction using hypertonic saline to raise sodium levels and prevent further complications, like seizures or coma.

Fluid restriction is helpful in less severe cases or when hyponatremia is due to excess fluid intake (e.g., in SIADH), but in this case, the patient needs urgent sodium correction. Furosemide might further decrease sodium by increasing its excretion.
Increasing dietary sodium will not correct the severe acute imbalance quickly enough.

190.

A 38-year-old male patient presents with confusion, fruit-scented breath, and deep, labored breathing. His blood glucose is 600 mg/dL, and his vital signs include HR 110 bpm, BP 100/60 mmHg, and RR 28. 

Based on these findings, what is the MOST appropriate initial intervention?

  • Initiate an insulin infusion

  • Administer 50% dextrose IV push

  • Encourage the patient to eat

  • Administer oral glucose

Correct answer: Initiate an insulin infusion

This patient is showing signs of Diabetic Ketoacidosis (DKA), which includes hyperglycemia, fruity breath, and Kussmaul respirations. An insulin infusion is necessary to bring down the elevated blood glucose and correct the underlying metabolic derangements.

Administering dextrose would worsen the hyperglycemia. Encouraging the patient to eat is inappropriate in DKA. Administering oral glucose would also be inappropriate as this patient has hyperglycemia, not hypoglycemia.

191.

A 69-year-old male patient with Pulmonary Artery Hypertension (PAH) is being considered for advanced therapy due to worsening symptoms despite standard treatment. His current regimen includes oxygen therapy, diuretics, and calcium channel blockers. 

What is the MOST appropriate next step in his management?

  • Initiate prostacyclin therapy

  • Increase the dose of diuretics

  • Discontinue calcium channel blockers

  • Switch to oral anticoagulants

Correct answer: Initiate prostacyclin therapy

Prostacyclin therapy is an advanced treatment for PAH. It is indicated in patients who have worsening symptoms despite standard therapy, as it helps to dilate pulmonary arteries and improve symptoms.

Increasing the dose of diuretics may help manage fluid overload but will not address the underlying pulmonary hypertension. 

Discontinuing calcium channel blockers is not appropriate unless they are proven ineffective or cause side effects. 

Oral anticoagulants may be used in PAH with a specific indication (e.g., chronic thromboembolic disease), but they are not the next step in managing worsening PAH symptoms in this context.

192.

A patient with a tracheostomy spontaneously opens their eyes to verbal stimuli and obeys verbal commands. What is the patient's Glasgow Coma Scale (GCS) score?

  • 9T

  • 11

  • 10

  • 0 or NA

Correct answer: 9T

The GCS is used to assess a patient’s level of consciousness. It is scored based on three components: Eye opening (E), Verbal response (V), and Motor response (M). Since the patient has a tracheostomy, they cannot give a verbal response, so the Verbal response score is replaced with T (for Tracheostomy), and the Verbal response component is not included in the score.

The components in this scenario are scored as follows:

  • Eye Opening (E): Spontaneously to verbal stimuli = three points
  • Verbal Response (V): T (Tracheostomy), not scored numerically
  • Motor Response (M): Obeys verbal commands = six points

The GCS score in this scenario is calculated as follows:

3 (E) + 6 (M) = 9

However, because the Verbal response cannot be assessed due to the tracheostomy, the GCS score is recorded as 9T, indicating the inability to score the verbal component.

193.

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.

194.

Which of the following statements about shock is TRUE?

  • All three types of shock activate the sympathetic nervous system

  • Cardiogenic shock activates the sympathetic nervous system; hypovolemic and distributive shock activate the parasympathetic nervous system

  • All three types of shock activate the parasympathetic nervous system

  • Cardiogenic shock activates the parasympathetic nervous system; hypovolemic and distributive shock activate the sympathetic nervous system

Correct answer: All three types of shock activate the sympathetic nervous system

The sympathetic nervous system (SNS) is activated in response to shock, regardless of the type (cardiogenic, hypovolemic, or distributive). The SNS triggers the release of catecholamines, such as adrenaline, which increases heart rate, constricts blood vessels, and raises blood pressure in an attempt to maintain perfusion to vital organs.

  • Cardiogenic shock occurs when the heart fails to pump effectively, leading to decreased cardiac output. The SNS is activated to compensate by increasing heart rate and peripheral vasoconstriction.
  • Hypovolemic shock results from a significant loss of blood or fluids, reducing circulating volume. The SNS response includes vasoconstriction and an increase in heart rate to preserve blood flow to essential organs.
  • Distributive shock includes conditions like septic, anaphylactic, and neurogenic shock, in which there is abnormal distribution of blood flow. The SNS is activated to counteract the peripheral vasodilation typical in distributive shock.

195.

A 65-year-old patient with Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) is admitted to the progressive care unit with acute respiratory distress. Despite the healthcare team's recommendation for intubation and mechanical ventilation to manage the acute episode, the patient refuses the intervention, citing previous traumatic experiences with intubation and a desire for quality of life over life extension. The patient's family is divided: some members support the patient's decision, and others insist on following the medical advice for intubation.

Which of the following is the BEST potential referral for the nurse to consider making? 

  • Referral to the hospital ethics committee to facilitate a resolution

  • Referral to social services to address the family's concerns

  • Referral to a palliative care specialist to explore alternative comfort measures

  • Referral to the legal department to ensure all decisions are documented properly

Correct answer: Referral to the hospital ethics committee to facilitate a resolution

The ANA Code of Ethics emphasizes the importance of respecting patient autonomy while also addressing conflicts that may arise among family members and healthcare providers. An ethics committee can provide a multidisciplinary approach to facilitate communication, mediate conflicts, and ensure that ethical principles are upheld in decision-making processes.

While social services can help address family concerns, they may not have the specific expertise needed to resolve ethical conflicts related to patient care decisions.

A palliative care specialist can offer valuable insights into alternative comfort measures, but this referral does not directly address the ethical conflict between the patient's wishes and the family's disagreement.

The legal department can ensure proper documentation, but it does not provide the necessary ethical guidance to resolve the disagreement about care decisions.

196.

Which of the following is used to control nausea and vomiting often related to opioid use and carries the risk of seizures and tardive dyskinesia?

  • Metoclopramide (Reglan)

  • Scopolamine

  • Prochlorperazine (Compazine)

  • Ondansetron (Zofran)

Correct answer: Metoclopramide (Reglan)

Metoclopramide is commonly used to treat nausea and vomiting, particularly when these symptoms are related to opioid use. However, it carries significant risks, including the potential to cause seizures and tardive dyskinesia, a serious condition involving involuntary, repetitive body movements.

Scopolamine is used to treat motion sickness and postoperative nausea and vomiting but does not carry the risks of seizures and tardive dyskinesia. 

Prochlorperazine is an antihistamine that can also be used to treat nausea and vomiting. While it has its own set of potential side effects, the risk of seizures and tardive dyskinesia is less pronounced than with metoclopramide.

Ondansetron is a serotonin 5-HT3 receptor antagonist used to prevent nausea and vomiting, often associated with chemotherapy, radiation therapy, or surgery. It does not carry the same risk of seizures and tardive dyskinesia as metoclopramide.

197.

The loss of the Frank-Starling response occurs in which of the following?

  • Cardiogenic shock

  • Hypovolemic shock

  • Septic shock

  • Anaphylactic shock

Correct answer: Cardiogenic shock

The Frank-Starling mechanism is the heart's ability to increase stroke volume in response to an increase in venous return. In cardiogenic shock, the heart's ability to pump effectively is compromised, often due to severe myocardial dysfunction. As a result, the Frank-Starling mechanism is blunted or lost because the heart cannot respond appropriately to increases in venous return, leading to decreased cardiac output despite adequate or increased preload.

In hypovolemic shock, the Frank-Starling mechanism may still be intact; however, there is insufficient preload to generate an adequate cardiac output. 

In septic shock and anaphylactic shock, the primary issues are systemic vasodilation and capillary leak, which lead to relative hypovolemia. However, the heart may still be able to respond to increases in preload with an appropriate increase in stroke volume, although other factors also play a role.

198.

Which of the following is a potentially life-threatening complication of bariatric surgery that may be difficult to detect but can lead to overwhelming sepsis?

  • Anastomotic leakage

  • Small bowel obstruction

  • Dumping syndrome

  • Nutritional deficiencies

Correct answer: Anastomotic leakage

An anastomotic leak is a serious complication following bariatric surgery, particularly after procedures like gastric bypass. It occurs when there is a breakdown at the surgical connection (anastomosis) between two sections of the gastrointestinal tract, allowing gastric contents to leak into the peritoneal cavity. This leakage can be difficult to detect because symptoms may be subtle or nonspecific, such as tachycardia, fever, or vague abdominal pain. However, if not identified and managed promptly, an anastomotic leak can lead to peritonitis and overwhelming sepsis, which can be life-threatening.

Small bowel obstruction can also occur after bariatric surgery, typically due to adhesions or internal hernias. While this condition can cause significant abdominal pain, nausea, and vomiting, it is not as immediately life-threatening as an anastomotic leak leading to sepsis.

Dumping syndrome is another complication of bariatric surgery, particularly after gastric bypass, but it is not associated with sepsis. It involves rapid gastric emptying into the small intestine, leading to symptoms such as nausea, diarrhea, and hypoglycemia.

Lastly, nutritional deficiencies can result from malabsorption after bariatric surgery. These are typically chronic complications rather than acute, life-threatening conditions like an anastomotic leak leading to sepsis.

199.

A 35-year-old male patient with a history of Brugada syndrome presents to the emergency department with palpitations. His vital signs are BP 120/80 mmHg, HR 110 bpm, RR 18 breaths/min, and SpO2 98%. His ECG shows a coved ST segment elevation in leads V1–V3. 

What is the MOST appropriate immediate intervention?

  • Administer antiarrhythmic medication

  • Perform immediate defibrillation

  • Provide reassurance and discharge home

  • Start Intravenous (IV) fluids

Correct answer: Administer antiarrhythmic medication

For a patient with Brugada syndrome presenting with palpitations and characteristic ECG findings, the immediate administration of antiarrhythmic medication is indicated to prevent potential progression to life-threatening arrhythmias.

Immediate defibrillation is indicated in cases of cardiac arrest or unstable ventricular arrhythmias, not for a patient who is hemodynamically stable with palpitations.

Providing reassurance and discharging the patient home without treatment is inappropriate given the risk of serious arrhythmias associated with Brugada syndrome.

IV fluids may be helpful in some scenarios but are not the primary intervention for managing arrhythmias in Brugada syndrome.

200.

A 71-year-old male patient with a history of heart failure is admitted with shortness of breath and dizziness. His hemoglobin is 8.5 g/dL, and his heart failure is worsening despite optimal medical management. 

Which of the following is the BEST approach to managing his anemia in this situation?

  • Administer a blood transfusion

  • Start iron supplementation

  • Prescribe erythropoietin-stimulating agents

  • Increase diuretics to control heart failure

Correct answer: Administer a blood transfusion

In a patient with heart failure and symptomatic anemia (shortness of breath, dizziness), a blood transfusion is the most effective treatment to rapidly increase oxygen-carrying capacity and improve symptoms. Managing anemia in heart failure patients is crucial to prevent worsening cardiac function.

Iron supplementation would not provide immediate relief in a patient with symptomatic anemia and heart failure. Erythropoietin-stimulating agents can be used in chronic anemia, but they are slower-acting and are not ideal in an acute, symptomatic scenario. Increasing diuretics would not address the underlying anemia and may even exacerbate hypotension or electrolyte imbalance.

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