×

Quiz Session - Attempts With Random Questions

AACN PCCN NOV 2023 Exam Hanbook version 1.1.1 Exam Questions

Page 7 of 33

121.

A patient is diagnosed with hypertrophic cardiomyopathy. Which of the following is MOST likely to be part of the treatment?

  • Beta-blockers

  • Diuretics

  • Dobutamine

  • Nitroprusside

Correct answer: Beta-blockers

Beta-blockers are the mainstay of treatment for Hypertrophic Cardiomyopathy (HCM) as they help reduce the heart rate and myocardial contractility, decreasing the outflow tract obstruction and improving symptoms. By slowing the heart rate, beta-blockers also allow for better filling of the heart chambers, which can benefit patients with HCM.

Diuretics may exacerbate symptoms in HCM by reducing preload, which could increase the degree of outflow obstruction. This makes diuretics a less desirable treatment option in these patients.

Dobutamine, a positive inotrope, would increase the contractility of the heart, which could worsen the obstruction in HCM.

Nitroprusside, a vasodilator, could decrease afterload, potentially worsening outflow tract obstruction in patients with HCM. Thus, it is not typically used as a primary treatment option for this condition.

122.

What organ is the primary controller of bicarbonate levels?

  • Kidneys

  • Liver

  • Heart

  • Pancreas

Correct answer: Kidneys

Bicarbonate (HCO₃⁻) levels in the body are primarily regulated by the kidneys. The kidneys play a crucial role in maintaining acid-base balance by either reabsorbing bicarbonate or excreting it in the urine, depending on the body's pH. This process is essential to buffering acids and maintaining the blood's pH within a narrow range.

While it is involved in numerous metabolic processes, the liver does not directly control bicarbonate levels or acid-base balance.

The heart pumps blood throughout the body but does not regulate bicarbonate levels or acid-base balance.

The pancreas produces digestive enzymes and hormones such as insulin but does not control bicarbonate levels in the blood.

123.

A 79-year-old female patient with metastatic cancer has just transitioned to palliative care. Her family is struggling to understand the goal of care. 

Which statement BEST describes the goal of palliative care?

  • To relieve symptoms and improve quality of life

  • To prolong life as long as possible through aggressive treatment

  • To prepare the patient for surgical intervention

  • To continue curative treatment for the underlying disease

Correct answer: To relieve symptoms and improve quality of life

The primary goal of palliative care is to manage symptoms and improve the quality of life for patients with life-limiting illnesses, not to cure the underlying disease. It focuses on providing relief from symptoms, pain, and stress.

Prolonging life through aggressive treatment is a goal of curative care, not palliative care, which focuses on comfort. Surgical intervention is rarely a goal of care at the palliative stage unless it is necessary for symptom relief. Curative treatment is not the focus of palliative care; instead, the focus shifts to managing symptoms and enhancing the patient's comfort and well-being.

124.

A patient experiences sudden loss of muscle tone and collapses to the ground. Which type of seizure is MOST likely occurring?

 

  • Atonic seizure

  • Tonic-clonic seizure

  • Myoclonic seizure

  • Absence seizure

Correct answer: Atonic seizure

Atonic seizures are characterized by a sudden loss of muscle tone, leading to a collapse or "drop attack." These seizures are brief but can result in falls and injury.

Tonic-clonic seizures involve muscle stiffness followed by rhythmic jerking, not sudden loss of muscle tone. Myoclonic seizures are brief, shock-like jerks of a muscle or group of muscles but don’t cause complete loss of muscle tone. Absence seizures are brief episodes of staring and unresponsiveness without physical collapse.

125.

Which of the following long-acting benzodiazepines is used for sedation in critical and progressive care units only under special circumstances?

  • Diazepam

  • Lorazepam

  • Midazolam

  • Ketamine

Correct answer: Diazepam

Diazepam is a long-acting benzodiazepine that is generally not preferred for sedation in critical and progressive care units due to its long half-life and prolonged effects, which can lead to prolonged sedation and increased risk of delirium. It is typically reserved for special circumstances, such as status epilepticus or alcohol withdrawal, for which its long duration of action may be beneficial.

Lorazepam is also a benzodiazepine, but it has an intermediate duration of action and is commonly used for sedation, especially in cases requiring continuous infusion or prolonged sedation.

Midazolam is a short-acting benzodiazepine that is widely used for sedation in critical care settings due to its rapid onset and shorter duration of action, which allow for better control of sedation levels.

Ketamine is not a benzodiazepine but a dissociative anesthetic. It is used for sedation, particularly in situations when preservation of respiratory drive and maintenance of hemodynamic stability are important.

126.

An aortic aneurysm dissection begins with a tear in which of the following?

  • The intima

  • The media

  • The tunica adventitia

  • The lamina

Correct answer: The intima

The aorta is made up of three layers: the intima, the media, and the tunica adventitia. Dissection of an aortic aneurysm begins with a tear in the intima. Blood leaves the central aorta through this tear, flows through the medial layer, and creates a false lumen. As the volume of blood increases in the media, pressure in the false lumen also increases and compresses the central aorta. The compression can decrease or totally obstruct the flow of blood through the aorta and/or its arterial branches.

The lamina is part of the neural arch of a vertebra.

127.

Ketorolac usage should not exceed what time span?

  • Five days

  • 14 days

  • Two to three days

  • Seven to ten days

Correct answer: Five days

Ketorolac is a potent Nonsteroidal Anti-Inflammatory Drug (NSAID) indicated for the short-term management of moderate to severe pain that requires analgesia at the opioid level.

Prolonged use of ketorolac increases the risk of serious side effects, including gastrointestinal bleeding, ulceration, perforation, renal impairment, and cardiovascular events. Therefore, to minimize these risks, the use of ketorolac should not exceed five days in total, combining both parenteral and oral administration.

Healthcare providers must monitor patients closely when using ketorolac and adhere strictly to the recommended duration of use to avoid these serious adverse effects.

128.

You are caring for a 45-year-old female patient who has been admitted to the progressive care unit after a myocardial infarction. Her condition has stabilized, but she is experiencing significant anxiety about her recovery and the possibility of another heart attack. During a discussion with you, the patient expresses concern about the medications she is receiving, particularly a new anticoagulant that was added to her regimen. She mentions that she read online about potential severe side effects of the medication, including the risk of bleeding, and she is hesitant to continue taking it.

You understand her concerns and reassure her by explaining the medication's importance in preventing future cardiac events. You also acknowledge the risks but emphasize the need to balance those risks with the treatment's benefits. As part of this conversation, you must apply ethical principles to guide her in making an informed decision about her care.

Which ethical principle imposes the duty to do no harm?

  • Nonmaleficence

  • Beneficence

  • Justice

  • Autonomy

Correct answer: Nonmaleficence

Nonmaleficence is the ethical principle that imposes the duty to do no harm. This principle guides healthcare professionals to avoid actions or interventions that could cause harm to patients. In this context, you must ensure that the recommended treatment does not expose the patient to unnecessary harm while balancing the risks and benefits of the medication.

Beneficence involves actions that promote the well-being of patients. While your reassurance and education about the medication align with beneficence, this principle focuses on doing good rather than specifically avoiding harm.

Justice is fairness and equality in healthcare. It ensures that patients receive equitable care regardless of their background or circumstances. Although justice is important in providing care, it does not directly concern avoiding harm in the way nonmaleficence does.

Autonomy refers to respecting the patient’s right to make informed decisions about their own care. While you are supporting the patient's autonomy by providing information and allowing her to participate in decision-making, this principle does not directly address the duty to do no harm.

129.

A 45-year-old female patient with a history of multiple abdominal surgeries presents with crampy abdominal pain, distension, and vomiting. Her vital signs are BP 130/80 mmHg, HR 90 bpm, RR 18 breaths/min, SpO2 96% on room air. 

What is the MOST appropriate initial management for this patient?

  • Nasogastric tube insertion

  • Immediate surgery

  • Oral laxatives

  • High-fiber diet

Correct answer: Nasogastric tube insertion

Inserting a nasogastric tube is a common initial management step for bowel obstruction. It helps decompress the stomach, relieving symptoms such as vomiting and abdominal distension by draining accumulated gastric contents.

Immediate surgery may be required in cases of complete obstruction or if there are signs of bowel strangulation or perforation, but it is not the first step in all cases. Oral laxatives are contraindicated in bowel obstruction as they can worsen the condition by increasing bowel motility against the obstruction. A high-fiber diet is generally beneficial for preventing constipation but is not suitable for managing an acute bowel obstruction.

130.

Which physiologic adaptive mechanism is a response to a decrease in alveolar oxygen and moves capillary blood flow from a closed or atelectatic alveolus to an open alveolus? 

  • Hypoxic vasoconstriction

  • The Bohr effect

  • The Haldane effect

  • Decreased minute ventilation

Correct answer: Hypoxic vasoconstriction

Hypoxic vasoconstriction is a physiologic response in which small pulmonary arteries constrict in the presence of low alveolar oxygen (hypoxia). This mechanism helps to redirect blood flow away from poorly ventilated or atelectatic (collapsed) alveoli to better-ventilated areas of the lung. By doing this, the body optimizes gas exchange and improves overall oxygenation.

The Bohr effect is the physiological phenomenon in which increased carbon dioxide levels in the blood result in hemoglobin releasing oxygen more readily. This is not directly related to alveolar oxygen levels or blood flow redistribution.

The Haldane effect occurs when deoxygenated hemoglobin increases its ability to carry carbon dioxide, which is a process occurring at the level of gas exchange but is not involved in the redirection of blood flow.

Decreased minute ventilation is a reduction in the total amount of air moved into and out of the lungs per minute. It is not the mechanism by which blood flow is redirected in response to alveolar oxygen levels.

131.

Which diagnostic test results would you MOST likely expect in a patient with an early acute upper Gastrointestinal (GI) bleed?

  • Respiratory alkalosis, elevated white blood cell count, elevated serum sodium

  • Respiratory acidosis, elevated white blood cell count, elevated serum sodium

  • Respiratory alkalosis, elevated white blood cell count, decreased serum sodium

  • Metabolic alkalosis, elevated white blood cell count, elevated serum sodium

Correct answer: Respiratory alkalosis, elevated white blood cell count, elevated serum sodium

Early in acute upper GI bleeding, arterial blood gases typically reveal respiratory alkalosis, which occurs due to hyperventilation often caused by pain or anxiety. The white blood cell count is elevated in response to inflammation. Initially, serum sodium levels are usually elevated due to hemoconcentration, a result of fluid loss and decreased plasma volume. As the condition progresses and if severe shock and hypoxemia occur, metabolic acidosis can develop.

132.

A 20-year-old female patient with newly diagnosed diabetes mellitus is being discharged. Which nursing action is MOST likely to ensure the patient is capable of self-administering insulin injections at home?

  • Observing the patient as she performs an insulin injection in the hospital

  • Asking the patient to verbally describe the steps of insulin administration

  • Demonstrating the insulin injection process and providing written instructions

  • Providing the patient with a video tutorial on insulin administration

Correct answer: Observing the patient as she performs an insulin injection in the hospital

Observation of the patient performing the injection provides the nurse with direct evidence that the patient is capable of self-administering insulin. This hands-on practice in a controlled setting allows the nurse to assess the patient’s technique, provide feedback, and address any questions or concerns. This method is particularly effective in ensuring the patient is comfortable with the procedure before discharge.

Verbal descriptions of the steps are helpful for understanding but do not confirm that the patient can physically perform the injection. There may be a gap between knowing the steps and actually executing them.

Demonstrating the process and providing written instructions are useful teaching methods but do not ensure that the patient can replicate the procedure independently.

A video tutorial is a valuable educational tool but, like written instructions, does not guarantee the patient’s ability to perform the injection without errors.

133.

A 52-year-old male patient is admitted to the Progressive Care Unit (PCU) with acute pain due to a kidney stone. He rates his pain as eight out of ten on the pain scale. The physician orders Toradol (ketorolac) 30 mg IV every six hours for pain management. The patient has a history of hypertension, chronic kidney disease (Stage 3), and gastritis.

Which of the following actions is MOST appropriate to take before administering the first dose of Toradol? 

  • Verify the order with the physician due to the patient's history of chronic kidney disease

  • Administer the medication as prescribed and monitor for pain relief

  • Administer the medication with an antacid to prevent gastritis exacerbation

  • Increase the patient's fluid intake to promote renal clearance of the medication

Correct answer: Verify the order with the physician due to the patient's history of chronic kidney disease

Toradol (ketorolac) is a Nonsteroidal Anti-Inflammatory Drug (NSAID) that can worsen kidney function, especially in patients with existing chronic kidney disease. Administering Toradol without verifying the appropriateness of the order could lead to adverse effects on renal function. Therefore, it is essential to verify the order before administering the medication.

While monitoring for pain relief is important, administering the medication without verifying it could be harmful given the patient's renal condition.

Although protecting the stomach lining is necessary, the primary concern here is the patient's renal function, not just the potential for gastritis exacerbation.

Increasing fluid intake might be beneficial, but it does not address the risk of renal impairment due to Toradol.

134.

For treatment of Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (PVT), Advanced Cardiac Life Support (ACLS) guidelines recommend an initial energy of how many joules (J) with a monophasic defibrillator?

  • 360 J

  • 200 J

  • 50–100 J

  • 400 J

Correct answer: 360 J

According to ACLS guidelines, the recommended initial energy dose for a monophasic defibrillator to treat VF or PVT is 360 J. Monophasic defibrillators deliver a single shock of electricity, which requires a higher energy level than biphasic defibrillators.

A defibrillation at 200 J is the manufacturer's recommended energy level for biphasic defibrillators, while 50–100 J is the typical initial energy level for cardioversion.

135.

Which of the following is TRUE about Antidiuretic Hormone (ADH)? 

  • It is produced by the hypothalamus

  • It is produced by the posterior pituitary gland

  • It is stored in the hypothalamus

  • It is stored in the anterior pituitary gland

Correct answer: It is produced by the hypothalamus

ADH, also known as vasopressin, is produced by the hypothalamus. Once synthesized, it is transported down the axons of hypothalamic neurons to the posterior pituitary gland, where it is stored and eventually released into the bloodstream in response to various stimuli, such as increased plasma osmolality or decreased blood volume.

136.

A 59-year-old male patient with a history of hypertension presents with a blood pressure of 200/120 mmHg, blurred vision, and chest discomfort. His oxygen saturation is 95%, and his heart rate is 90 beats per minute. The nurse prepares to administer intravenous antihypertensive medication. 

What is the MOST appropriate next step after administration?

  • Monitor for a rapid decrease in blood pressure

  • Encourage the patient to rest in a sitting position

  • Reassess blood pressure after five minutes

  • Restrict fluid intake

Correct answer: Monitor for a rapid decrease in blood pressure

The priority after administering intravenous antihypertensive medications is monitoring for rapid changes in blood pressure to avoid complications such as hypotension, which can lead to organ hypoperfusion.

Encouraging rest may be helpful but is not the priority in this scenario. Restricting fluid intake is not immediately necessary unless there is a concern about fluid overload. Blood pressure should be reassessed regularly but not necessarily after five minutes for all medications.

137.

What is the MOST essential principle of collaboration in a multidisciplinary team?

  • Effective communication

  • Mutual respect

  • Shared goals

  • Leadership support

Correct answer: Effective communication

Effective communication is the foundation of successful collaboration in healthcare. Without clear communication, even the most skilled team may face challenges in providing coordinated care. Sharing information accurately and within an ideal time frame helps to prevent misunderstandings and ensures that all members are aligned toward the same patient care goals.

Mutual respect is important but builds on communication. Shared goals are the desired outcome of collaboration, but without communication, these goals cannot be achieved. Leadership support is crucial to collaboration but does not directly reflect the practice of collaboration itself.

138.

A multidisciplinary team is planning care for a 70-year-old female patient with heart failure. During rounds, you notice a delay in medication delivery from the pharmacy. 

Which question would MOST effectively demonstrate a "systems thinking" approach to this issue?

  • How can the team work to prevent delays in medication delivery in the future?

  • Is the delay in medication the pharmacy’s responsibility?

  • Should the nurse contact the pharmacy to expedite the delivery?

  • Will this delay affect only this patient’s treatment plan?

Correct answer: How can the team work to prevent delays in medication delivery in the future?

Systems thinking focuses on understanding system-level issues and improving processes. By asking how the team can prevent future delays, you effectively address the broader system's functionality rather than focusing on blame or short-term fixes.

Focusing on assigning responsibility or expediting the delivery addresses immediate concerns but misses the opportunity to explore system-wide solutions. Assuming the delay affects only this patient overlooks the systemic nature of healthcare processes.

139.

A 58-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is being sedated with dexmedetomidine. His vital signs are heart rate 78 beats per minute, blood pressure 130/75 mmHg, respiratory rate 20 breaths per minute, and oxygen saturation 95% on 2 L per minute of oxygen. What should the nurse monitor MOST closely in this patient?

  • Bradycardia and hypotension

  • Increased respiratory rate and oxygen 

  • Hyperglycemia and hypokalemia

  • Signs of infection and fever

Correct answer: Bradycardia and hypotension

Dexmedetomidine, an alpha-2 adrenergic agonist, has anesthetic and sedative properties and can cause significant bradycardia and hypotension. Close monitoring of these vital signs is essential to ensure patient safety and appropriate medication titration.

Increased respiratory rate and oxygen saturation are less likely to be directly impacted by dexmedetomidine, which generally does not cause respiratory depression.

Hyperglycemia and hypokalemia are not common side effects of dexmedetomidine, so monitoring for these is not a primary concern.

Signs of infection and fever are always important to monitor in any patient, but they are not directly related to the effects of dexmedetomidine.

140.

A patient with an aortic aneurysm needs to be medically managed. How frequently will follow-up chest x-rays, CT scans, MRI scans, and/or ultrasounds be needed?

  • At six-month intervals

  • At three-month intervals

  • Annually

  • At six-week intervals

Correct answer: At six-month intervals

For patients with an aortic aneurysm being managed medically, follow-up imaging studies such as chest x-rays, CT scans, MRI scans, or ultrasounds are typically recommended at six-month intervals. This frequency allows healthcare providers to monitor the size and growth rate of the aneurysm and adjust management plans if needed. Regular monitoring helps to assess the risk of rupture or other complications and determine whether surgical intervention becomes necessary.

×