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Quiz Session - Attempts With Random Questions

AACN PCCN NOV 2023 Exam Hanbook version 1.1.1 Exam Questions

Page 9 of 33

161.

Venturi masks are often useful in patients with Chronic Obstructive Pulmonary Disease (COPD) and hypercapnia because the clinician can titrate the PaO2 to minimize which of the following?

  • Carbon dioxide retention

  • The risk of bleeding

  • Humidification loss

  • Tidal volume

Correct answer: Carbon dioxide retention

Venturi masks are often used in patients with COPD who have hypercapnia (elevated carbon dioxide in the blood) because they allow for precise control of the concentration of oxygen delivered to the patient. In patients with COPD, high levels of oxygen can suppress the hypoxic drive to breathe, leading to carbon dioxide retention. By titrating the PaO2 carefully with a Venturi mask, the clinician can minimize the risk of carbon dioxide retention while still providing adequate oxygenation.

The risk of bleeding is unrelated to the use of Venturi masks or the management of oxygen levels in COPD patients. 

Humidification loss is not directly related to the titration of oxygen levels in COPD patients. While oxygen delivery devices can impact humidification, the Venturi mask is designed for precise oxygen delivery rather than humidification.

While tidal volume can be affected by respiratory patterns and conditions, it is not a parameter that is directly managed by the titration of oxygen with a Venturi mask. The focus of using a Venturi mask in this scenario is on preventing carbon dioxide retention rather than altering tidal volume.

162.

A 55-year-old female type 2 diabetic with severe dementia was started on insulin during her stay in the Progressive Care Unit (PCU). She will be discharged with orders for blood glucose monitoring and sliding scale insulin. The patient has a 24-hour-a-day live-in caregiver who has assisted with her oral medications in the past and who has visited the patient daily in the hospital. One daughter, who is the patient's power of attorney, lives out of state and has visited only once during the patient's five-day stay in the hospital. She is leaving today. Home care nursing has been arranged for the patient following discharge.

Who is it essential for the nurse to include in instructions related to glucose testing and insulin administration?

  • The in-home caregiver

  • The power of attorney

  • The patient

  • No instructions need to be given since the patient will be receiving home care nursing services

Correct answer: The in-home caregiver

Teaching strategies need to be planned carefully. When planning for education, the patient, the nature and severity of the patient's illness, the availability of significant others, and environmental barriers need to be assessed.

The nurse must include the in-home caregiver in instructions related to care, such as glucose testing and insulin administration, because this person will be responsible for performing these functions for the patient or, at the very least, overseeing the patient when she performs them to ensure accuracy. 

The daughter with power of attorney may want to be present but will not be providing day-to-day care for the patient, so it is not essential to include her in this part of the teaching. The patient will be a part of the discharge teaching, but it is essential to include the patient's in-home caregiver, as the patient has dementia. 

163.

A 33-year-old female patient with a traumatic brain injury is being monitored in the PCU. Her Intracranial Pressure (ICP) has been steadily rising despite medical management. 

Which of the following findings is MOST likely to indicate impending brain herniation?

  • Irregular respirations, bradycardia, and hypertension

  • Bradycardia, hypotension, and hypothermia

  • Tachycardia, hypertension, and hyperthermia

  • Irregular respirations, hypotension, and tachypnea

Correct answer: Irregular respirations, bradycardia, and hypertension

Cushing's triad is a clinical phenomenon that occurs as a result of increased ICP and is often a sign of impending brain herniation. It consists of three classic signs:

  1. Hypertension: The body's response to increased ICP involves elevating systemic blood pressure in an attempt to maintain Cerebral Perfusion Pressure (CPP) and ensure adequate blood flow to the brain.
  2. Bradycardia: The elevated blood pressure triggers baroreceptors in the aortic arch and carotid sinus, leading to a reflexive slowing of the heart rate.
  3. Irregular respirations: As ICP rises, it can compress the brainstem, affecting the respiratory centers and leading to abnormal breathing patterns.

Hypotension and hypothermia are not characteristic of impending herniation; in fact, hypotension would likely decrease ICP rather than increase it.

Tachycardia, hypertension, and hyperthermia do not specifically indicate brain herniation and could be related to other physiological stress responses.

Tachypnea is not associated with brain herniation.

164.

A 49-year-old male patient with chronic heart failure is admitted for severe hyperkalemia (potassium 6.7 mEq/L) and presents with an ECG showing wide QRS complexes and peaked T waves. After treatment with calcium gluconate and insulin, his potassium level remains elevated at 6.0 mEq/L. 

What would be the BEST next step in managing this patient?

  • Initiate dialysis

  • Administer oral sodium polystyrene sulfonate

  • Increase insulin dosage

  • Administer intravenous dextrose

Correct answer: Initiate dialysis

For refractory hyperkalemia not adequately responding to medical management, dialysis is the most effective and immediate way to remove excess potassium, particularly in patients with renal insufficiency or chronic heart failure.

Oral sodium polystyrene sulfonate is slower-acting and not ideal in this acute setting. Increasing insulin might reduce potassium further but would not be as rapid or effective as dialysis. Intravenous dextrose is administered alongside insulin to prevent hypoglycemia, but it does not directly lower potassium levels.

165.

An 85-year-old female patient was admitted to the PCU from a nursing home three days ago. She has a severely painful Stage IV pressure ulcer and has been diagnosed with sepsis. The patient is confused and frequently cries for "Fred." No family has been to visit. She has no advance directives. At 2:00 a.m., while you are changing her gown, she becomes unresponsive and stops breathing.

What is the correct action for you to take?

  • Initiate CPR

  • Run a "slow" code

  • Ensure the patient is comfortable and do nothing, as she had no advance directive

  • Call the patient's physician to obtain a Do Not Resuscitate (DNR) order

Correct answer: Initiate CPR

In the absence of an advance directive, it is generally assumed that resuscitation efforts should commence immediately if the patient experiences cardiopulmonary arrest. Before any decisions regarding resuscitation are made, it is crucial to have thorough discussions with the patient or their designated surrogate. If Cardiopulmonary Resuscitation (CPR) status is not discussed, documented, or communicated, initiating a code becomes necessary, which might result in delivering care that the patient would not have wanted.

166.

Which of the following statements about tracheostomy tubes is TRUE?

  • The majority of tracheostomy tubes used in acutely ill patients are made of medical-grade plastic or silicone

  • All tracheostomy tubes are cuffed

  • A standard 15-mm adapter at the distal end ensures a universal connection to ventilator circuits

  • The tracheostomy cuff pressure is maintained at no less than 25 mmHg

Correct answer: The majority of tracheostomy tubes used in acutely ill patients are made of medical-grade plastic or silicone

Tracheostomy tubes used for critically ill patients vary in size and are most often made of silicone or medical-grade plastic, though some, called Jackson tubes, are sterling silver or stainless steel. They may be cuffed or uncuffed. 

A standard 15-mm adapter at the proximal, not distal, end ensures universal connection to ventilator circuits. Following tracheostomy tube insertion, the cuff is inflated with the minimum amount of air needed to create an effective seal. 

Cuff pressure is maintained at less than 25 mmHg (30 cm H2O). Overinflated cuffs lead to tracheal ischemia, necrosis, erosion, and potentially obstructions of the distal airway. 

167.

Which of the following statements is TRUE about the principle of double effect?

  • It helps to distinguish palliative care from assisted suicide

  • It asserts that a provider who assists in a patient's death cannot be legally charged

  • It states that the administration of medications that may inadvertently hasten death is illegal

  • It attests that inadequate pain management in palliative care patients is illegal

Correct answer: It helps to distinguish palliative care from assisted suicide

The principle of double effect is a moral and ethical concept used to justify actions that have both a positive effect and a potentially harmful secondary effect. It is often applied in palliative care to differentiate between providing medication to relieve pain, which may unintentionally hasten death, and actions intended to cause death, such as assisted suicide. The principle asserts that if the primary intention is to relieve pain and not to cause death, then the action can be ethically justified.

The principle is an ethical principle, not a legal one, and it does not protect providers from legal consequences if their actions are intended to cause death.

It specifically addresses the ethical justification for administering medications that may have the secondary effect of hastening death, as long as the primary intention is to relieve pain and not to cause death.

While inadequate pain management can be considered unethical or even negligent, it is not directly addressed by the principle of double effect.

168.

Which is TRUE about a Type II second-degree atrioventricular (AV) block?

  • It occurs below the AV node in the bundle of His or bundle-branch system

  • It is often referred to as a Wenckebach block

  • It is more common than a Type I second-degree AV block and rarely requires treatment

  • It is also known as a complete block

Correct answer: It occurs below the AV node in the bundle of His or bundle-branch system

A Type II second-degree AV block, also known as Mobitz II, typically occurs below the AV node, usually in the bundle of His or the bundle-branch system. This type of block is characterized by sudden, unpredictable drops of QRS complexes without a preceding lengthening of the PR interval.

A Wenckebach block is a Type I second-degree AV block (Mobitz I), in which the PR interval progressively lengthens until a QRS complex is dropped.

Type II AV block is less common than Type I and is more serious, often requiring treatment, such as a pacemaker, due to the risk of progression to complete heart block.

A complete block is a third-degree AV block, in which there is no communication between the atria and the ventricles and the atrial and ventricular rhythms are completely independent.

169.

A 44-year-old male patient is being treated with benzodiazepines for alcohol withdrawal. He becomes lethargic, his respiratory rate decreases to eight breaths per minute, and his oxygen saturation drops to 89%. 

What is the MOST appropriate nursing intervention?

  • Administer flumazenil

  • Administer naloxone

  • Increase the dose of benzodiazepines

  • Provide supplemental oxygen

Correct answer: Administer flumazenil

Flumazenil is a benzodiazepine antagonist and is used to reverse the effects of benzodiazepines, which can cause respiratory depression.

Naloxone is for reversal of opioids, not benzodiazepines. Increasing the dose of benzodiazepines would worsen the respiratory depression. Supplemental oxygen alone will not reverse the sedative effects of benzodiazepines.

170.

Signs and symptoms of oxygen toxicity (hyperoxia) mainly target which systems?

  • Pulmonary and central nervous systems

  • Pulmonary and musculoskeletal systems

  • Pulmonary and endocrine systems

  • Central nervous system and musculoskeletal system

Correct answer: Pulmonary and central nervous systems

High concentrations of oxygen can lead to lung damage, including symptoms like coughing, chest pain, and difficulty breathing. Prolonged exposure can result in Acute Respiratory Distress Syndrome (ARDS) due to oxygen-induced lung injury.

High levels of oxygen can also cause CNS toxicity, leading to symptoms such as headaches, dizziness, seizures, and, in severe cases, loss of consciousness. This is especially a concern with hyperbaric oxygen therapy or in environments with elevated oxygen levels.

The musculoskeletal and endocrine systems are not primarily affected by oxygen toxicity.

171.

A 68-year-old male patient with diabetes and hypertension underwent a knee replacement four days ago. His wound is erythematous with serosanguinous drainage, and his temperature is 100.8°F. 

Which of the following factors places him at the HIGHEST risk of developing a surgical site infection?

  • Comorbid diabetes

  • Age

  • Hypertension

  • Serosanguinous wound drainage

Correct answer: Comorbid diabetes

Diabetes is a significant risk factor for surgical site infection due to impaired wound healing and increased susceptibility to infection.

Older age can increase the risk of infection but is not as significant a factor as diabetes. Hypertension is not a major risk factor for surgical site infections. Serosanguinous drainage is a common finding in healing wounds and does not specifically indicate infection.

172.

A 72-year-old male patient with advanced dementia and multiple comorbidities, including Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD), is admitted to the PCU with a severe respiratory infection. The patient is nonverbal and unable to make decisions for himself. His advance directive indicates a preference for comfort measures only, but the family is requesting aggressive treatment, including intubation and mechanical ventilation. 

In considering the best-interest standard, which of the following actions should the healthcare team prioritize?

  • Prioritize the patient's advance directive and focus on providing comfort measures, avoiding aggressive interventions

  • Comply with the family’s request for aggressive treatment, including intubation and mechanical ventilation

  • Seek a court order to resolve the conflict between the patient’s advance directive and the family’s wishes

  • Delay a decision until the patient’s condition worsens, allowing for a more definitive outcome

Correct answer: Prioritize the patient's advance directive and focus on providing comfort measures, avoiding aggressive interventions

The best-interest standard is an ethical guideline used when making decisions for individuals who cannot do so for themselves. It focuses on what would most likely benefit the patient, taking into consideration their values, preferences, and overall well-being. In this case, the patient's advance directive clearly indicates a preference for comfort measures only, suggesting that the patient would not want aggressive treatment. Therefore, the healthcare team should honor the patient's wishes as expressed in the advance directive, focusing on comfort measures and avoiding unnecessary suffering.

While family input is important, the best-interest standard requires prioritizing the patient's known preferences.

Seeking a court order is typically a last resort and may be unnecessary if the patient’s wishes are clearly documented in an advance directive.

Delaying a decision until the patient’s condition worsens is inappropriate in this scenario.

173.

A 54-year-old male patient on mechanical ventilation is undergoing a spontaneous breathing trial. His current vital signs are heart rate 85 beats per minute, respiratory rate 22 breaths per minute, oxygen saturation 97%, and blood pressure 120/70 mmHg. Based on these values, what is the MOST appropriate action?

  • Continue the spontaneous breathing trial

  • Increase the PEEP

  • Decrease the FiO2

  • Discontinue the spontaneous breathing trial

Correct answer: Continue the spontaneous breathing trial

The patient's vital signs are within normal limits, indicating that he is tolerating the spontaneous breathing trial well. Therefore, continuing the trial is the most appropriate action.

Increasing the PEEP would be necessary if there were signs of alveolar collapse or hypoxemia, neither of which is present based on the given vital signs.

Decreasing the FiO2 might be considered if the patient was receiving high levels of supplemental oxygen, but this action should follow a successful trial rather than being done during the trial.

Discontinuing the spontaneous breathing trial would be appropriate if the patient showed signs of distress or instability, which is not the case here.

174.

A 70-year-old male patient is admitted to the PCU after experiencing sudden right-sided weakness and slurred speech. 

What is the primary cause of ischemic stroke?

  • Thrombus formation blocking a cerebral artery

  • Vasospasm leading to cerebral vessel constriction

  • Hemorrhage in the subarachnoid space

  • Cerebral Arteriovenous Malformation (AVM)

Correct answer: Thrombus formation blocking a cerebral artery

A thrombus blocking a cerebral artery is the most common cause of ischemic stroke, in which blood flow to a part of the brain is interrupted. Immediate identification of the type of stroke is crucial for determining treatment.

Vasospasm can lead to restricted blood flow, but this is more commonly associated with subarachnoid hemorrhage, not ischemic stroke. Hemorrhages involve ruptured vessels and are causes of hemorrhagic strokes, not ischemic strokes. AVMs can cause hemorrhagic strokes if they rupture, but they do not directly cause ischemic strokes.

175.

A 52-year-old female patient with Chronic Kidney Disease (CKD) has been hospitalized for electrolyte imbalances. Her blood pressure is 135/85 mmHg, heart rate 72 bpm, and potassium level 5.9 mEq/L. 

Which nursing action reflects systems thinking in coordinating her care?

  • Consulting the dietitian to adjust her potassium intake

  • Administering the prescribed potassium-lowering medication

  • Monitoring her intake and output closely

  • Encouraging her to follow a low-potassium diet at home

Correct answer: Consulting the dietitian to adjust her potassium intake

Systems thinking emphasizes collaboration and interdisciplinary communication to address patient care issues comprehensively. By consulting with the dietitian, you ensure that dietary adjustments align with the medical plan to manage the patient's potassium levels.

Administering medication is an individual nursing action, not a reflection of systems thinking. Monitoring intake and output is important but doesn’t involve broader system coordination. Encouraging the patient to follow a low-potassium diet is an educational intervention but doesn’t reflect interdisciplinary systems engagement.

176.

Of the following bronchodilators, which are examples of a combination Long-Acting Beta-2 Agonist (LABA) and a corticosteroid used in the treatment of Chronic Obstructive Pulmonary Disease (COPD)?

  • Salmeterol and fluticasone

  • Albuterol and ipratropium bromide

  • Salmeterol and formoterol

  • Albuterol and fluticasone

Correct answer: Salmeterol and fluticasone

Salmeterol and fluticasone are a combination of an LABA and a corticosteroid commonly used in the treatment of COPD. Salmeterol helps to relax the muscles around the airways, making breathing easier, while fluticasone reduces inflammation in the airways, improving symptoms and lung function.

Albuterol and ipratropium bromide are a combination used primarily for acute relief in COPD. Albuterol is a Short-Acting Beta-2 Agonist (SABA), and ipratropium is an anticholinergic agent.

Salmeterol and formoterol are both LABAs and are not combined with a corticosteroid. They are used for long-term control of COPD but not in combination with each other or a corticosteroid.

Albuterol and fluticasone are not a standard combination for COPD treatment. Albuterol is an SABA used for quick relief, while fluticasone is a corticosteroid. The combination of an LABA with a corticosteroid is preferred for long-term management of COPD.

177.

Which of the following is LEAST likely to be a primary objective in the management of patients with acute exacerbation of hypertension?

  • Maintenance of cerebral perfusion pressure

  • Reduction of arterial pressure

  • Accurate arterial blood pressure measurement

  • Preparation and planning for continuous and consistent outpatient follow-up

Correct answer: Maintenance of cerebral perfusion pressure

While maintaining cerebral perfusion pressure is important in certain clinical scenarios, it is not a primary focus in the acute management of hypertension unless the patient is experiencing a specific condition like hypertensive encephalopathy. The primary goals are more focused on systemic issues.

Reducing arterial pressure is one of the main objectives in managing acute exacerbation of hypertension to prevent immediate complications such as stroke, myocardial infarction, and renal failure.

Accurate measurement of arterial BP is critical for diagnosing the severity of hypertension and guiding treatment decisions. It ensures that interventions are appropriately targeted and effective.

Once the acute phase is managed, planning for continuous follow-up becomes crucial for preventing future exacerbations and managing chronic hypertension.

178.

Initially, when caring for a patient with a temporary pacemaker, stimulation threshold testing should be done:

  • Every shift

  • Hourly

  • By the physician

  • Every 24 hours

Correct answer: Every shift

Stimulation threshold testing should be done every shift (until a stable threshold is reached) to ensure that the pacemaker is consistently capturing and pacing the heart effectively. This frequent monitoring helps to promptly identify and address any changes in the threshold that can occur due to various factors, such as lead displacement, changes in the patient's condition, or battery depletion.

Hourly testing is typically not necessary unless specific concerns about pacemaker function or the patient's condition warrant such frequent monitoring.

Every 24 hours may not be frequent enough to catch issues promptly, as changes in the stimulation threshold can occur more rapidly, necessitating more frequent checks.

Nurses and other healthcare providers are trained to perform threshold testing, so requiring the physician to handle routine monitoring is not practical. The physician would be involved in more complex troubleshooting or adjustments as needed.

179.

You are working in a hospital’s step-down unit for the day, caring for a 50-year-old male patient admitted with nausea, vomiting, and severe abdominal pain radiating to his back. His medical history includes chronic alcohol use and hyperlipidemia. Laboratory tests show elevated serum amylase and lipase levels. Imaging confirms the diagnosis of acute pancreatitis.

What are the leading causes of acute pancreatitis that should be considered in this patient's case?

  • Gallstones and chronic alcohol use

  • Viral infections and genetic mutations

  • Hypercalcemia and medications

  • Abdominal trauma and autoimmune disease

Correct answer: Gallstones and chronic alcohol use

Gallstones and chronic alcohol use are the leading causes of acute pancreatitis. This patient’s history of chronic alcohol use and typical presentation align with these common etiologies.

While viral infections, genetic mutations, hypercalcemia, certain medications, abdominal trauma, and autoimmune diseases can cause pancreatitis, they are less common causes than gallstones and chronic alcohol use, and they do not align with the patient's history and symptoms.

180.

A 30-year-old male patient presents to the emergency department with a headache, fever, neck stiffness, and photophobia. He has a history of recent sinusitis. Upon further questioning, he reports no recent travel, no exposure to individuals with known infections, and no immunocompromising conditions. His vital signs are as follows:

  • Temperature: 102°F (38.9°C)
  • Heart rate: 110 beats per minute
  • Blood pressure: 120/80 mmHg
  • Respiratory rate: 18 breaths per minute

Given this information, which of the following findings in this patient’s history would NOT indicate he is at risk of meningitis?

  • No recent travel

  • Recent sinusitus

  • Neck stiffness

  • Fever

Correct answer: No recent travel

The absence of recent travel in this patient’s history is the finding that most likely indicates he is not at risk of meningitis. Travel to areas endemic with certain infectious agents, particularly those associated with meningitis, can increase the risk of contracting the disease. However, his symptoms are more indicative of meningitis, as sinus infections can lead to complications like meningitis. Therefore, the lack of recent travel is the least indicative of a risk of meningitis in this context.

Sinusitis is a known risk factor for meningitis, especially bacterial meningitis, as it can serve as a source of infection that may spread to the meninges.

Neck stiffness is a classic symptom of meningitis, indicating irritation of the meninges.

Fever is a common symptom of meningitis, reflecting the body’s response to infection and inflammation.

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