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Quiz Session - Attempts With Random Questions

AACN PCCN NOV 2023 Exam Hanbook version 1.1.1 Exam Questions

Page 8 of 33

141.

Acute Respiratory Failure (ARF) can occur as a result of many abnormalities, but regardless of the specific underlying condition, the etiology of ARF 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 impairs gas exchange?

  • Pneumonia

  • Pleural effusion

  • Pulmonary embolism

  • Chronic Obstructive Pulmonary Disease (COPD)

Correct answer: Pneumonia

Pneumonia leads to impaired gas exchange because the infection causes inflammation and consolidation in the alveoli, preventing proper oxygenation of blood.

Pleural effusion primarily causes impaired ventilation due to fluid accumulation in the pleural space, preventing full lung expansion, rather than directly impairing gas exchange.

Pulmonary embolism causes ventilation-perfusion mismatching but does not directly impair gas exchange within the alveoli. 

While COPD can contribute to impaired ventilation and ventilation-perfusion mismatching, it primarily leads to obstructive airway issues rather than directly impairing gas exchange.

142.

What is the MOST common effect of opioids on the urinary system?

 

  • Urinary retention

  • Increased urine production

  • Renal failure

  • Decreased risk of urinary tract infection

Correct answer: Urinary retention

Opioids commonly cause urinary retention by increasing sphincter tone and reducing bladder contractility, leading to difficulty emptying the bladder and a higher risk of urinary tract infection.

Increased urine production is not typically associated with opioids. Renal failure is a serious condition but is not a direct effect of opioid use.

143.

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. 

144.

Supplementation of which of the following is most often indicated in patients with Acute Kidney Injury (AKI)?

  • Folic acid, pyridoxine, and water-soluble vitamins

  • Folic acid, niacin, and water-soluble vitamins

  • Pyridoxine, phosphorus, and water-soluble vitamins

  • Folic acid, ascorbic acid, and fat-soluble vitamins

Correct answer: Folic acid, pyridoxine, and water-soluble vitamins

In patients with AKI, supplementation of folic acid (a B vitamin), pyridoxine (vitamin B6), and other water-soluble vitamins is often indicated. This is because patients with AKI, particularly those who are undergoing renal replacement therapies such as dialysis, can lose water-soluble vitamins through the dialysis process. Additionally, these patients may have dietary restrictions that limit their intake of certain nutrients, making supplementation necessary to prevent deficiencies.

Niacin (vitamin B3) and fat-soluble vitamins are not typically required as part of the supplementation regimen in AKI unless there is a specific deficiency. Phosphorus is generally restricted in AKI because impaired kidney function can lead to hyperphosphatemia, which can cause additional complications. Ascorbic acid (vitamin C) is a water-soluble vitamin that may be supplemented, but the focus is usually on a broad spectrum of water-soluble vitamins, particularly the B vitamins like folic acid and pyridoxine.

145.

A 40-year-old male patient presents with a head injury after being struck by a falling object. He is initially alert but later shows signs of unilateral pupil dilation, decreased motor response on the right side, and worsening level of consciousness. 

Which finding is MOST indicative of an epidural hematoma?

  • Lucid interval followed by rapid deterioration

  • Severe headache

  • Nausea and vomiting

  • Neck stiffness

Correct answer: Lucid interval followed by rapid deterioration

A lucid interval followed by rapid deterioration is a hallmark sign of an epidural hematoma. This occurs because the patient may initially recover consciousness after the injury, leading to a period of apparent recovery before a rapid decline as the hematoma expands and increases intracranial pressure.

Severe headache can occur with many types of head injuries but is not specific to epidural hematoma. Nausea and vomiting are common symptoms of increased intracranial pressure but are not unique to epidural hematoma. Neck stiffness is more typically associated with meningitis or subarachnoid hemorrhage, not epidural hematoma.

146.

A 40-year-old male patient with a history of hyperlipidemia and smoking presents with stable angina. Which physiological process is MOST likely responsible for his symptoms?

  • Partial obstruction of coronary arteries by atherosclerotic plaque

  • Total occlusion of a coronary artery by a thrombus

  • Increased oxygen delivery to myocardial tissue

  • Complete rupture of an atherosclerotic plaque

Correct answer: Partial obstruction of coronary arteries by atherosclerotic plaque

Stable angina typically occurs when atherosclerotic plaques partially obstruct coronary arteries and limit blood flow to the heart, particularly during times of increased oxygen demand, such as exercise. This mismatch between oxygen supply and demand leads to the chest pain characteristic of angina.

Total occlusion of a coronary artery by a thrombus would lead to an acute myocardial infarction, not stable angina. Increased oxygen delivery to myocardial tissue would reduce the likelihood of angina. Complete rupture of an atherosclerotic plaque typically leads to unstable angina or myocardial infarction, not stable angina.

147.

A 60-year-old male patient with a history of congestive heart failure is being monitored in the progressive care unit. Why is continuous cardiac monitoring MOST important for this patient?

  • To detect arrhythmias early and prevent complications

  • To provide a detailed view of myocardial ischemia 

  • To diagnose structural heart abnormalities

  • To monitor electrolyte levels continuously

Correct answer: To detect arrhythmias early and prevent complications

Continuous cardiac monitoring is most important for detecting arrhythmias early and preventing complications such as stroke or sudden cardiac arrest, especially in patients with heart failure who are at a higher risk of these events.

A detailed view of myocardial ischemia is achieved through other methods, like stress tests or specific ECG changes, not primarily through continuous monitoring.

Structural heart abnormalities are diagnosed using imaging techniques like echocardiography or MRI, not continuous cardiac monitoring.

Electrolyte levels are monitored using blood tests, not continuous cardiac monitoring.

148.

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.

149.

A 54-year-old patient is in the Progressive Care Unit (PCU) recovering from acute respiratory failure and has been on mechanical ventilation for five days. The healthcare team is considering extubation. 

Which of the following criteria must be met before proceeding with extubation?

  • PaO2 > 60 mmHg on FiO2 ≤ 40%, stable hemodynamics, and adequate cough reflex

  • PaO2 > 80 mmHg on FiO2 ≤ 50%, no need for sedation, and minimal secretions

  • PaCO2 < 60 mmHg, normal chest x-ray, and the ability to follow instructions

  • PaCO2 < 50 mmHg on FiO2 ≤ 60%, strong gag reflex, and spontaneous tidal volume > 5 mL/kg

Correct answer: PaO2 > 60 mmHg on FiO2 ≤ 40%, stable hemodynamics, and adequate cough reflex

A PaO2 > 60 mmHg on FiO2 ≤ 40%, stable hemodynamics, and adequate cough reflex are essential criteria for safe extubation. These criteria ensure the patient has sufficient oxygenation, cardiovascular stability, and ability to protect their airway.

While PaO2 > 80 mmHg and no need for sedation are favorable, the requirement of FiO2 ≤ 50% is less stringent, and minimal secretions alone do not ensure a safe extubation.

PaCO2 < 60 mmHg and the ability to follow instructions are important, but a normal chest x-ray is not a necessary criterion for extubation.

PaCO2 < 50 mmHg on FiO2 ≤ 60%, strong gag reflex, and spontaneous tidal volume > 5 mL/kg are important parameters, but the higher FiO2 requirement indicates the patient might still need significant oxygen support.

150.

You are caring for a 67-year-old male patient from a non-English-speaking background who has been admitted to the PCU with chest pain. You should FIRST consider which of the following when addressing the patient's healthcare needs?

  • Cultural beliefs about illness

  • Health literacy

  • Age-related communication barriers

  • Dietary preferences

Correct answer: Cultural beliefs about illness

Understanding a patient's cultural beliefs is essential to providing culturally competent care. Cultural beliefs can influence how a patient perceives illness, treatment, and interactions with healthcare providers.

Health literacy is important but follows an understanding of cultural context, as language or cultural differences may create barriers before literacy becomes a concern.

Age-related communication barriers are less relevant in this scenario, as the patient’s primary concern appears to be related to language or cultural differences rather than age.

The patient’s dietary preferences are important but not as urgent in this initial assessment phase of care.

151.

Which laboratory result would MOST likely indicate that a 45-year-old female patient with fatigue has iron deficiency anemia?

  • Low hemoglobin and low ferritin levels

  • Low hemoglobin and high ferritin levels

  • High hemoglobin and low ferritin levels

  • High hemoglobin and high ferritin levels

Correct answer: Low hemoglobin and low ferritin levels

Low hemoglobin combined with low ferritin levels is most likely indicative of iron deficiency anemia. Hemoglobin testing measures the amount of oxygen-carrying protein in the blood, and ferritin testing reflects the body’s iron stores. If both are low, it suggests there is not enough iron to produce adequate hemoglobin.

Low hemoglobin with high ferritin suggests another type of anemia, such as anemia of chronic disease, in which iron stores are normal or elevated but not used effectively to produce hemoglobin.

High hemoglobin with low ferritin is an unusual combination, as high hemoglobin generally indicates the body has adequate oxygen-carrying capacity, which is unlikely with low iron stores.

High hemoglobin and ferritin does not align with iron deficiency anemia; instead, this may suggest conditions such as hemochromatosis, or iron overload.

152.

Of the following nursing interventions, which is LEAST likely to help maintain skin integrity?

  • Using an inflatable cushion or donut for the head

  • Repositioning every hour

  • Elevating the heels off of the mattress

  • Using elbow protectors

Correct answer: Using an inflatable cushion or donut for the head

An inflatable cushion or donut should never be used for the sacrum or the head, as this can increase pressure on the surrounding skin surfaces.

Repositioning should occur minimally at two-hour intervals—more frequently if the patient is incontinent, currently has areas of skin breakdown, or is severely debilitated. 

Elevating the heels off of the mattress is recommended to prevent skin breakdown. 

The use of elbow protectors is recommended to protect bony surfaces.

153.

A 66-year-old male patient with terminal cancer has expressed a desire to discontinue treatment. His family, however, insists on continuing all possible interventions. What ethical principles are MOST likely in conflict in this scenario?

  • Autonomy and beneficence

  • Nonmaleficence and justice

  • Justice and autonomy

  • Beneficence and nonmaleficence

Correct answer: Autonomy and beneficence

The conflict here is between the patient's autonomy (his wish to discontinue treatment) and beneficence (the family's desire to continue treatment for his well-being). You must balance respect for the patient’s wishes with respect for the family’s intention to act in his best interest.

Nonmaleficence and justice do not apply in this scenario because the dilemma is not about avoiding harm or fairness in resource distribution. 

Justice and autonomy would be relevant if there were concerns about equal treatment, which is not the case here. 

Beneficence and nonmaleficence would relate to doing good versus avoiding harm, but the central issue is the patient’s right to decide.

154.

A 68-year-old male patient with a history of end-stage renal disease presents with hypotension, muffled heart sounds, and jugular venous distension. Despite fluid resuscitation, his blood pressure remains low, and he becomes increasingly lethargic. 

Which of the following is the MOST likely reason for the lack of response to fluids?

  • Accumulation of pericardial fluid causing cardiac tamponade

  • Decreased cardiac output due to acute myocardial infarction

  • Obstruction of blood flow due to a pulmonary embolism

  • Tension pneumothorax causing decreased venous return

Correct answer: Accumulation of pericardial fluid causing cardiac tamponade

In this case, the lack of response to fluid resuscitation, combined with the presence of muffled heart sounds and jugular venous distension, strongly indicates cardiac tamponade. The fluid accumulation compresses the heart, preventing it from filling effectively during diastole.

Acute myocardial infarction would likely present with other symptoms, such as chest pain, and while it could cause cardiogenic shock, the physical exam findings point more to tamponade. 

A pulmonary embolism could cause hypotension and shock, but hallmark symptoms like sudden dyspnea and pleuritic chest pain are missing, and muffled heart sounds are not typical. 

Tension pneumothorax causes decreased venous return and hypotension, but there would be absent breath sounds on one side, which are not mentioned here.

155.

The framework of principle-based ethics is one of the most influential perspectives in biomedical ethics today. Inherent in this viewpoint is the belief that four basic principles and derivative rules are binding, but not absolute, and define the essence of ethical obligations in human society. 

What are the four basic principles used in principle-based ethics?

  • Autonomy, beneficence, nonmaleficence, and justice

  • Confidentiality, autonomy, privacy, and justice

  • Beneficence, veracity, autonomy, and fidelity

  • Nonmaleficence, justice, fidelity, and confidentiality

Correct answer: Autonomy, beneficence, nonmaleficence, and justice

Principle-based ethics is a framework widely used in biomedical ethics and is built on four basic principles: autonomy, beneficence, nonmaleficence, and justice.

  • Autonomy requires respect for the decision-making capacities of autonomous persons.
  • Beneficence involves acting in the best interests of the patient or others.
  • Nonmaleficence means to do no harm, avoiding actions that cause unnecessary harm or injury.
  • Justice is fairness and equality in the distribution of benefits and risks.

These principles are binding but not absolute, meaning that in certain situations, one principle might need to be prioritized over another. The other options list important ethical concepts, but they do not represent the four core principles of the principle-based ethics framework.

156.

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.

157.

A 16-year-old male patient with a known diagnosis of congenital Long-QT syndrome type 3 (LQT3) is admitted to the progressive care unit after experiencing a syncopal episode. The patient's family history reveals that his father also has LQT3 and had similar episodes in his youth. You are reviewing the patient’s condition and educating the family about the dysrhythmia events associated with LQT3.

In patients with congenital LQT3, when are dysrhythmia events MOST likely to occur?

  • During sleep or rest

  • During physical exercise

  • During emotional stress

  • Upon sudden standing or change in posture

Correct answer: During sleep or rest

In LQT3, dysrhythmia events are most likely to occur during periods of low heart rate, such as sleep or rest. The mutation associated with LQT3 affects the sodium channels in the heart, leading to prolonged repolarization during these times.

While physical exercise can trigger dysrhythmias in some forms of long-QT syndrome, it is not typically associated with LQT3. Emotional stress can trigger dysrhythmias in some forms of long-QT syndrome, but it is not the primary trigger for LQT3. Dysrhythmias triggered by sudden changes in posture are not characteristic of LQT3.

158.

You are caring for a 65-year-old male patient who presents with palpitations and an irregular heartbeat. You explain that Purkinje fibers play a role in which aspect of his heart function?

  • Coordinating ventricular contraction

  • Regulating atrial contraction 

  • Maintaining coronary artery perfusion 

  • Balancing electrolyte levels in the myocardium

Correct answer: Coordinating ventricular contraction

Purkinje fibers ensure the synchronized contraction of the ventricles by rapidly conducting electrical impulses, which is crucial for effective heart function.

Atrial contraction is regulated primarily by the atrial conduction system, including the SA node and atrial muscle fibers.

Maintaining coronary artery perfusion is related to the function of the coronary arteries and does not directly involve Purkinje fibers.

Balancing electrolyte levels in the myocardium involves cellular processes and ion channels and is not specifically the function of Purkinje fibers.

159.

Which of the following are routes by which opioids can be administered?

  • Oral, intravenous, subcutaneous, transdermal

  • Oral, inhaled, topical, rectal

  • Intramuscular, sublingual, intranasal, subcutaneous

  • Oral, intravenous, intraosseous, inhaled

Correct answer: Oral, intravenous, subcutaneous, transdermal

Opioids can be administered via multiple routes, depending on the clinical scenario and patient needs. Common ways opioids are administered in clinical practice include oral administration for ease and convenience, intravenous for rapid onset, subcutaneous for slow and sustained release, and transdermal for continuous delivery through the skin.

Each of the other options includes at least one route not typically used for opioid administration or combines routes incorrectly.

160.

The low stretch protocol, or low tidal volume ventilation, is used to reduce the risk of what potential complication of mechanical ventilation that results from high pressures from large-volume ventilation in patients with Acute Respiratory Distress Syndrome (ARDS)?

  • Volutrauma

  • Barotrauma

  • Auto-PEEP

  • Broggins trauma

Correct answer: Volutrauma

The low stretch protocol (or low tidal volume ventilation) is used to reduce the risk of volutrauma. Volutrauma is damage to the alveoli due to the high pressures resulting from large-volume ventilation in patients with ARDS.

Different from barotrauma, volutrauma results in alveolar fractures and flooding of alveoli. It is linked to the use of tidal volumes (VTs) greater than 6 mL/kg in patients with ARDS. 

Auto-PEEP occurs when a delivered breath is not fully exhaled before the onset of the next inspiration; ventilated patients with Chronic Obstructive Pulmonary Disease (COPD) are at a higher risk of this complication. 

Broggins trauma is not associated with mechanical ventilation. 

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