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Quiz Session - Attempts With Random Questions

AACN PCCN NOV 2023 Exam Hanbook version 1.1.1 Exam Questions

Page 4 of 33

61.

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.

62.

A 61-year-old female patient with a history of chronic pain is prescribed morphine sulfate for pain management. Which of the following instructions would you MOST likely provide to the patient to minimize her risk of side effects?

  • Increase fluid and fiber intake

  • Take the medication with food

  • Avoid operating heavy machinery

  • Take the medication only when pain is severe

Correct answer: Increase fluid and fiber intake

The nurse should likely instruct the patient to increase fluid and fiber intake to minimize the risk of constipation, a common side effect of morphine sulfate. Adequate hydration and dietary fiber can help maintain bowel regularity.

Taking the medication with food might help reduce gastrointestinal upset, but it does not address the most common side effect.

Avoiding operating heavy machinery is important to prevent injury due to potential sedation, but this advice does not mitigate side effects like constipation.

Taking the medication only when pain is severe may lead to ineffective pain management and does not prevent side effects. It is important to take opioids as prescribed, whether for continuous or breakthrough pain.

63.

A 49-year-old male patient presents with a blood pressure of 230/120 mmHg and headache. You explain that a hypertensive emergency differs from hypertensive urgency in what way?

  • The involvement of acute organ damage

  • Elevated blood pressure

  • Administration of blood pressure medications

  • Inpatient care

Correct answer: The involvement of acute organ damage

A hypertensive emergency is defined by the presence of acute organ damage (e.g., encephalopathy, stroke, myocardial infarction) alongside severely elevated blood pressure. This is what distinguishes it from hypertensive urgency, which involves severely elevated blood pressure without target organ damage.

Elevated blood pressure alone is not sufficient to differentiate between hypertensive urgency and emergency, as both conditions present with high blood pressure. While medication is required for both hypertensive emergency and urgency, urgency typically does not need the same rapid intervention as an emergency. Though hospitalization is often necessary for both, hypertensive urgency may be managed with outpatient care.

64.

Congenital Long-QT Syndromes (LQTSs) involve mutations in several genes that control which of the following?

  • Potassium or sodium channels on cardiac cells

  • Potassium or chloride channels on cardiac cells

  • Chloride or sodium channels on cardiac cells

  • Chloride channels only on cardiac cells

Correct answer: Potassium or sodium channels on cardiac cells

LQTSs are primarily associated with mutations in genes that control potassium and sodium channels in cardiac cells. These ion channels are critical for the proper regulation of the heart's electrical activity. Potassium channels help in the repolarization phase of the cardiac action potential, while sodium channels are involved in the depolarization phase. Mutations in these channels can lead to prolonged QT intervals, increasing the risk of life-threatening arrhythmias.

Chloride channels are not typically associated with the pathophysiology of congenital long-QT syndromes. The most common mutations involve potassium and sodium channels.

65.

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.

66.

A patient on the unit has Cranial Nerve VII dysfunction. Which of the following statements is MOST likely to be accurate about this patient?

  • They are unable to close the eyelid on the affected side

  • Their hearing and equilibrium are affected

  • Their gag reflex is affected

  • They cannot protrude their tongue

Correct answer: They are unable to close the eyelid on the affected side

Cranial Nerve VII (CN VII), also known as the facial nerve, is responsible for controlling the muscles of facial expression, including those that close the eyelid. Dysfunction of CN VII can lead to an inability to close the eyelid on the affected side, which is common in conditions such as Bell's palsy.

Hearing and equilibrium are primarily controlled by CN VIII (the vestibulocochlear nerve), not CN VII.

The gag reflex is controlled by CN IX (glossopharyngeal) and CN X (vagus), not CN VII.

Protruding the tongue is a function of CN XII (the hypoglossal nerve), not CN VII.

67.

Which of the following is the leading cause of acute liver failure in the United States?

  • Acetaminophen toxicity

  • Hepatitis A

  • Hepatitis B

  • Nonalcoholic fatty liver disease

Correct answer: Acetaminophen toxicity

Acute liver failure, also known as fulminant hepatic failure, results in massive cell necrosis and leads to multiorgan dysfunction. Its leading cause in Europe and the US is acetaminophen overdose. Other causes include viral hepatitis (A, B, and E), shock, and thrombosis.

Nonalcoholic fatty liver disease is one of the most common causes of chronic liver disease in the Western world.

68.

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.

69.

Of the following, which is the LEAST expected clinical manifestation in a patient who has a serum magnesium level of 1.1 mEq/L?

  • T wave inversion and ST segment sagging and prolongation

  • Positive Chvostek's sign

  • Positive Trousseau's sign

  • Prolonged PR and QT intervals

Correct answer: T wave inversion and ST segment sagging and prolongation

T wave inversion and ST segment sagging and prolongation are the least expected clinical manifestations in a patient with a serum magnesium level of 1.1 mEq/L, which indicates hypomagnesemia. These specific ECG changes are more commonly associated with other electrolyte imbalances, such as potassium abnormalities, than with low magnesium levels.

A positive Chvostek's sign is a clinical manifestation commonly seen in hypomagnesemia. This sign is facial muscle spasm upon tapping the facial nerve and indicates neuromuscular irritability, which is a result of low magnesium levels.

A positive Trousseau's sign is another manifestation often seen in hypomagnesemia. It is a carpal spasm induced by occluding the blood flow to the arm, typically with a blood pressure cuff. Like Chvostek's sign, it reflects neuromuscular excitability due to electrolyte imbalance.

Prolonged PR and QT intervals are expected findings in hypomagnesemia. Low magnesium levels can cause these specific changes on an Electrocardiogram (ECG) because magnesium plays a critical role in cardiac conduction and the stabilization of cellular membranes.

70.

Which of the following statements is TRUE about sinus dysrhythmia?

  • It frequently occurs as a normal phenomenon and is often associated with the phases of respiration

  • It occurs as a normal response to emotion and exercise

  • Digitalis is the treatment of choice

  • It may occur as a response to vagal stimulation or be a normal finding in athletes or during sleep

Correct answer: It frequently occurs as a normal phenomenon and is often associated with the phases of respiration

Sinus dysrhythmia is common in healthy individuals, especially children and young adults, and is related to changes in the autonomic tone during the different phases of respiration, causing slight variations in heart rate.

Sinus tachycardia, not sinus dysrhythmia, occurs as a normal response to emotion and exercise. 

Digitalis toxicity may cause the condition, and digitalis is not the treatment of choice.

Sinus bradycardia, rather than sinus dysrhythmia, can be a normal finding during sleep or in athletes and may be a response to vagal stimulation, such as vomiting, ocular pressure, or carotid sinus massage.

71.

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.

72.

A 67-year-old female patient with a history of hypertension presents with a hypertensive emergency, showing a blood pressure of 220/120 mmHg, altered mental status, and chest pain. Despite treatment with intravenous antihypertensives, her blood pressure remains high, and her symptoms worsen. 

Which of the following is the BEST next step in her management?

  • Transfer to the intensive care unit for continuous monitoring and further treatment

  • Administer a second antihypertensive agent orally

  • Initiate mechanical ventilation to control her breathing

  • Schedule an urgent cardiology consult

Correct answer: Transfer to the intensive care unit for continuous monitoring and further treatment

When initial treatment is not effectively controlling the blood pressure and symptoms are worsening, transferring the patient to the Intensive Care Unit (ICU) for continuous monitoring and more aggressive treatment is indicated. The ICU provides an environment for closer monitoring and the ability to escalate care as needed, including adjusting intravenous antihypertensives or adding additional agents.

Administering a second antihypertensive agent orally may not be appropriate in this acute setting, where rapid control of blood pressure is required. Intravenous agents are preferred for their quick onset and easier titration. Mechanical ventilation is typically considered in cases of respiratory failure, which is not indicated by the information provided. While an urgent cardiology consult may be necessary, it is secondary to the immediate need for critical care management in the ICU.

73.

What is the MOST common cause of tracheal deviation seen on chest x-ray?

  • Pneumothorax

  • Pleural effusion

  • Atelectasis

  • Emphysema

Correct answer: Pneumothorax

On chest x-ray, the trachea should appear midline, with the carina at the level of the aortic knob or second intercostal space. Pneumothorax, which is the most common cause of tracheal deviation, causes a mediastinal and tracheal shift to the area away from the pneumothorax.

Pleural effusion and atelectasis can also cause tracheal deviation from the midline; however, pneumothorax is the most common cause. 

Emphysema does not typically cause tracheal deviation. More common chest x-ray findings in emphysema include hyperinflated lungs, a flattened diaphragm, and widened intercostal spaces.

74.

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.

75.

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.

76.

Which of the following is an Intravenous (IV) medication used in the treatment of Pulmonary Arterial Hypertension (PAH)?

  • Epoprostenol

  • Bosentan

  • Ambrisentan

  • Sildenafil

Correct answer: Epoprostenol

PAH is a progressive, life-threatening condition characterized by high pulmonary arterial pressures leading from the right side of the heart to the lungs. This persistently high blood pressure in the lungs ultimately leads to right ventricular failure. IV epoprostenol was the first medication therapy for PAH.

Bosentan and ambrisentan are oral endothelin receptor antagonists used in the treatment of PAH but are not administered intravenously. Sildenafil is an oral phosphodiesterase-5 (PDE-5) inhibitor used in the treatment of PAH and is not typically administered intravenously.

77.

A 70-year-old male patient is admitted to the PCU following a stroke. During your routine assessment, you notice the patient is lying in bed with closed eyes and does not respond when you enter the room. You call his name and speak to him, but he does not respond. He appears to be breathing normally, and his vital signs are stable: BP 140/85 mmHg, HR 76 beats per minute, RR 16 breaths per minute, and SpO2 96% on room air.

Since the patient is not responding to verbal cues, what is the next step to assess the patient’s Level of Consciousness (LOC)?

  • Tactile stimulation

  • Auditory stimulation

  • Painful stimulation

  • Administering oxygen

Correct answer: Tactile stimulation

Observing the patient's ability to communicate, behavior, and appearance is the primary step in assessing the LOC. A patient is described as alert if they respond meaningfully to the examiner without needing stimulation. If stimulation is required, auditory stimuli are used first. 

Tactile stimulation, such as gently touching or shaking the patient, is the next step if there is no response to verbal cues. 

Painful stimulation, such as a sternal rub, is used when both verbal and tactile stimulation fail to elicit a response. It helps assess deeper levels of unresponsiveness. 

Administering oxygen is appropriate if there are signs of hypoxia or respiratory distress, but this is not directly related to the initial assessment of LOC.

78.

A 70-year-old female patient with a history of diabetes and hypertension is MOST likely to present with which of the following symptoms of Peripheral Artery Disease (PAD)?

  • Intermittent claudication

  • Edema in the lower extremities

  • Warm, flushed skin

  • Increased pulses in the feet

Correct answer: Intermittent claudication

Intermittent claudication, characterized by leg pain with exertion that is relieved by rest, is the hallmark symptom of PAD. It occurs due to insufficient blood flow to the muscles during activity.

Edema in the lower extremities is more commonly associated with venous insufficiency or heart failure, not PAD. Warm, flushed skin typically occurs in conditions with increased blood flow or infection, whereas PAD often presents with cool or pale skin. PAD usually causes diminished or absent pulses in the feet due to narrowed arteries.

79.

A 56-year-old female patient with chronic heart failure is admitted to the PCU with a worsening cough, fatigue, and a weight gain of five pounds in the past week. Her vital signs are blood pressure 120/72 mmHg, heart rate 92 beats per minute, respiratory rate 24 breaths per minute, and SpO2 92% on 2L oxygen. Despite adherence to her medication regimen, she reports feeling progressively more tired. 

What is the NEXT step in her management?

  • Assess for non-cardiac causes of symptoms

  • Increase her diuretic dose

  • Start an inotropic agent

  • Refer for advanced heart failure therapy

Correct answer: Assess for non-cardiac causes of symptoms

Given this patient’s adherence to her medication regimen and the gradual onset of fatigue and weight gain, the most appropriate next step is to assess for non-cardiac causes of her symptoms. Conditions such as renal insufficiency, anemia, or thyroid dysfunction may contribute to the worsening of heart failure symptoms.

Increasing the diuretic dose could help with fluid retention but might not address the root cause if non-cardiac factors are contributing. Inotropic agents are used in advanced heart failure when the patient has refractory symptoms despite maximal therapy, which is not indicated yet. Referral for advanced heart failure therapy (e.g., LVAD, heart transplant) would be considered if the patient has deteriorated significantly, which is not evident at this point.

80.

During diastole, which valve's improper closure allows blood to flow backward from the aorta into the left ventricle?

  • Aortic valve

  • Mitral valve

  • Tricuspid valve

  • Pulmonary valve

Correct answer: Aortic valve

If the aortic valve does not close properly, blood flows backward from the aorta into the left ventricle during diastole. This can seriously affect forward blood flow into the aorta and thus significantly impact cardiac output.

Adequate closure of the mitral valve is essential to ensure blood is being ejected forward into the aorta, not backward into the left atrium, during ventricular systole.

Incomplete closure or damage to the tricuspid valve causes abnormal ejection into the right atrium. 

An insufficient pulmonary valve allows blood to flow backward into the right ventricle during diastole. 

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