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Quiz Session - Attempts With Random Questions

ANCC MEDSURG-BC Exam Questions

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1.

Prior to auscultation of heart sounds, it is important to locate the auscultatory sites. Which of the following areas is located in the second right intercostal space?

  • Aortic area

  • Tricuspid area

  • Mitral area or apex

  • Pulmonic area

Correct answer: Aortic area

The aortic area of the heart is generally auscultated in the second right intercostal space (ICS), near the sternum.

The tricuspid area is in the fourth left ICS, close to the sternum (left lower sternal border). The point of maximum impact in the mitral area lies within the fifth left ICS (midclavicular line). The pulmonic valve area is near the sternum in the second left ICS.

2.

Which of the following would the nurse most expect to see in the urinalysis results of a patient with renal cell carcinoma?

  • Hematuria

  • Proteinurea

  • Ketonuria

  • Bilirubinuria

Correct answer: Hematuria

Hematuria is present in 60% of patients who have renal cell carcinoma, and may be either microscopic or gross. Proteinurea, bilirubinuria, and ketonuria may or may not be present, but are not commonly expected in patients with renal cell carcinomas.

3.

A patient who is scheduled for coronary angiography states, "I want to be asleep during my procedure. I can't stand any kind of pain." Of the following, the nurse's best response would be:

  • "It sounds like you're feeling anxious. What has your doctor told you about your procedure?"

  • "You will have to be awake during the procedure so you can control your breathing."

  • "Don't worry. You will be given medicine to make you very sleepy, and you won't remember anything."

  • "You have to stay awake, but the procedure is painless."

Correct answer: "It sounds like you're feeling anxious. What has your doctor told you about your procedure?"

It is most therapeutic to acknowledge the patient's feelings, find out what they have been told, and not to minimize fear. Sedation pre-procedure may be ordered. The patient should be taught about the use of local anesthesia for catheter insertion, hot flash as the dye is injected, and "fluttering" sensation as the catheter is passed.

4.

The nurse is providing teaching to a patient who is being discharged after being treated for peptic ulcer disease about dietary changes. Which of the following statements by the patient indicates that further teaching is needed?

  • "I will strictly follow a bland diet for the best results."

  • "I will stop drinking caffeinated coffee."

  • "Foods may affect me that don't affect others. I should pay careful attention to what foods cause me pain."

  • "Spicy foods will make my ulcer worse."

Correct answer: "I will strictly follow a bland diet for the best results."

There is little evidence to support that a bland diet is beneficial in reducing the symptoms of peptic ulcer disease. Stopping the use of caffeine and avoiding spicy foods is recommended to avoid exacerbations. The patient should be instructed to pay attention to which foods cause pain and to avoid them, as triggering foods may vary from patient to patient.

5.

A patient in the post-anesthesia care unit (PACU) suddenly develops muscle rigidity, a rapid rise in body temperature, tachycardia, and dark-colored urine. Which postoperative complication is MOST likely occurring?

  • Malignant hyperthermia

  • Neuroleptic malignant syndrome

  • Serotonin syndrome

  • Sepsis

Correct answer: Malignant hyperthermia

Malignant hyperthermia is a life-threatening condition characterized by muscle rigidity, a rapid rise in body temperature, tachycardia, and dark-colored urine due to rhabdomyolysis. It is triggered by the use of certain anesthetic agents and can even be triggered hours after they are discontinued. This condition requires immediate treatment.

Neuroleptic malignant syndrome presents similarly but is associated with the use of neuroleptic drugs, not anesthetics, and is less likely to occur suddenly in the PACU setting.

Serotonin syndrome involves symptoms like agitation, tremor, and hyperreflexia, but not muscle rigidity or dark-colored urine. It is associated with serotonergic drugs, not anesthesia.

Sepsis presents with fever and tachycardia. Muscle rigidity and dark-colored urine are not typical features, making it less likely in this scenario.

6.

A nurse notices a patient from a different cultural background avoids eye contact during conversations. What is the MOST appropriate response by the nurse?

  • Understand that this may be a cultural norm and adjust accordingly

  • Ask if the patient is paying attention

  • Document the patient’s evasive actions

  • Ask the patient if their culture prohibits eye contact with others

Correct answer: Understand that this may be a cultural norm and adjust accordingly

Understanding that avoiding eye contact may be a cultural norm allows the nurse to respect and adapt to the patient’s cultural practices, fostering a trusting relationship. This approach recognizes and values cultural differences in communication styles.

Asking if the patient is paying attention can be perceived as confrontational and does not respect their cultural background. Documenting the patient’s actions as evasive without understanding the cultural context could lead to misinterpretation of the patient’s behavior. Asking the patient if their culture prohibits eye contact with others can be intrusive and may make the patient uncomfortable.

7.

During this phase of the menstrual cycle, the endometrial thickness increases six-fold due to a spike in estrogen levels, and the cervical mucus changes to become more favorable to sperm:

  • Proliferative phase

  • Menstrual phase

  • Secretory phase

  • Ischemic phase

Correct answer: Proliferative phase

During the proliferative phase of the menstrual cycle (days 6 to 14), the endometrium significantly thickens as estrogen levels increase, and cervical mucus becomes more favorable to sperm as it becomes thin, watery, clear, and more alkaline.

The menstrual phase (days 1 to 5) is when menses occurs if fertilization does not take place and the endometrium is shed. The secretory phase (days 15 to 26) includes ovulation, and finally the ischemic phase (days 27 to 28) only occurs if fertilization does not take place, and estrogen and progesterone levels drop sharply.

8.

Which of the following is a key component of evidence-based practice in nursing?

  • Integrating clinical expertise with the best available research

  • Reading all professional journals relating to a nurse’s field of practice

  • Integrating clinical evidence with personal experience to guide practice

  • Using only procedures that have gained mainstream acceptance

Correct answer: Integrating clinical expertise with the best available research

Integrating clinical expertise with the best available research ensures patient care is grounded in the most current and robust scientific evidence. This approach allows for a balanced and effective application of both empirical evidence and practical knowledge in patient care.

Reading professional journals can be important for staying informed, but it does not directly constitute evidence-based practice, which requires actively integrating research with clinical expertise. Additionally, reading all available journals may not be a practical approach.

Relying solely on personal experience or using procedures based only on mainstream acceptance fails to incorporate the critical element of utilizing the best available research, making these approaches insufficient for true evidence-based practice.

9.

Which of the following is the location where fertilization occurs?

  • Fallopian tubes

  • Uterus

  • Ovaries

  • Vagina

Correct answer: Fallopian tubes

The fallopian tubes are bilateral ducts that enter the uterus on either side; they conduct ova via peristalsis from the space around the ovary to the uterus, and fertilization usually occurs here, in the distal two-thirds of the tube (ampulla). 

The uterus is the site of fetal development; the ovaries secrete hormones and develop and release eggs; the vagina serves as the birth canal, connecting the uterus to the outside, and lies between the urethra and the rectum.

10.

A first-year resident physician examining a patient who has recently undergone a right knee replacement orders a chest x-ray to evaluate for suspected atelectasis. What is the best rationale for questioning this order?

  • This order should not be questioned.

  • A chest x-ray is unlikely to show whether atelectasis is present or not.

  • The patient is not at risk for atelectasis.

  • The patient has been using their incentive spirometer regularly.

Correct answer: This order should not be questioned.

Atelectasis is a potential post-surgical complication, meaning that the patient is at risk for developing atelectasis. Regular use of incentive spirometry can decrease the risk of atelectasis developing, but it is still a potential risk. Atelectasis will typically be evident on a chest x-ray.

11.

Which of the following statements is true related to autoimmune disorders?

  • Myasthenia gravis is not considered a systemic autoimmune disease.

  • In autoimmune disorders, T cells produce autoantibodies (antibodies to host cells).

  • In autoimmune disorders, B cells become autosensitized (sensitized to host cells).

  • Idiopathic thrombocytopenic purpura (ITP) is a type of systemic autoimmune disease.

Correct answer: Myasthenia gravis is not considered a systemic autoimmune disease.

Autoimmune disorders most often start in a system other than the immune system, but the immune system is involved because of the body's normal response to a threat. The immune system starts to attack the body's own cells.

In autoimmune disorders, B cells produce autoantibodies (antibodies to host cells), while T cells become autosensitized (sensitized to host cells). ITP and myasthenia gravis are organ-specific autoimmune diseases.

12.

The nurse is part of a care team that is helping a patient plan end-of-life care. The patient states "I want to focus on quality of life." Which of the following responses by the nurse is correct?

  • Question the patient about what they mean

  • Explore the patient's feelings

  • Reassure the patient that this is possible

  • Explain to the patient that extending their life as long as possible is better

Correct answer: Question the patient about what they mean

While the definition of quality of life is well established in the field of healthcare, the patient may have a different meaning in mind. It is always best practice to ask the patient to define their terms. Exploring the patient's feelings will not be as helpful to end-of-life care planning as ensuring their meaning is understood. Reassurance is a correct intervention, but it is first necessary to ensure the patient's meaning is understood. The nurse should not attempt to promote their own view of what the patient should do but should try to understand their wishes.

13.

A nurse is implementing fall precautions for a patient with orthostatic hypotension. Which measure should be included?

  • Educate the patient to rise slowly from a sitting or lying position

  • Use a wheelchair for all patient transfers

  • Keep the patient in bed at all times

  • Ensure the patient does not transfer without staff assistance

Correct answer: Educate the patient to rise slowly from a sitting or lying position

Educating the patient to rise slowly from a sitting or lying position helps prevent sudden drops in blood pressure that can lead to dizziness and falls in someone with orthostatic hypotension. This gradual movement allows the body to adjust and maintain a steady mean arterial pressure.

Using a wheelchair for all patient transfers is not necessary and can reduce the patient's mobility and independence. Keeping the patient in bed at all times is not recommended as it can lead to deconditioning and other complications. Encouraging safe, gradual movement is more beneficial. Ensuring the patient does not transfer without staff assistance is not always feasible and can be overly restrictive. Teaching the patient safe techniques is more practical and empowering.

14.

During a team meeting, a nurse learns that a colleague has been consistently late in administering medications. What is the nurse's ethical duty in this situation?

  • Report the behavior to the supervisor

  • Recognize that the nurse is not responsible for how other nurses practice

  • Discuss the issue with the colleague privately

  • Document the colleague’s tardiness in the affected patients’ charts

Correct answer: Report the behavior to the supervisor

Reporting the behavior to the supervisor is the nurse’s ethical duty to ensure that patient care standards are maintained and any potential risks to patient safety are addressed promptly. This action ensures appropriate measures are taken to correct the behavior and maintain high standards of care.

Assuming the nurse is not responsible for how other nurses practice ignores the duty to ensure patient safety and uphold professional standards. Discussing the issue with the colleague privately may not be sufficient to address or correct the behavior effectively. Documenting the colleague’s tardiness without further action does not actively address the problem or ensure timely intervention.

15.

Your patient is scheduled to have a pulmonary function test. You recognize further instruction is needed when the patient states:

  • "I should use my albuterol right before the test."

  • "I shouldn't smoke for 6 hours before the test."

  • "I should only breathe through my mouth."

  • "This test will help identify the cause of my shortness of breath."

Correct answer: "I should use my albuterol right before the test."

Patients are to avoid smoking or use of bronchodilators for 6 hours before testing; albuterol is a bronchodilator that must be withheld 6 hours before the procedure as not to skew the results. 

All of the other statements reflect understanding on the patient's part.

16.

The nurse is teaching a patient with chronic obstructive pulmonary disease (COPD) about breathing exercises. Which technique should the nurse teach to help improve ventilation?

  • Diaphragmatic breathing

  • Shallow, rapid breathing

  • Kussmaul breathing

  • Holding breath for extended periods

Correct answer: Diaphragmatic breathing

Diaphragmatic breathing helps improve ventilation by allowing more air to enter the lower lungs, enhancing oxygen exchange.

Shallow, rapid breathing is inefficient and can lead to inadequate oxygenation and ventilation while increasing the overall work of breathing. 

Kussmaul breathing is a deep, labored breathing pattern associated with metabolic acidosis and is not a technique taught to improve ventilation in COPD. Holding breath for extended periods is counterproductive as it reduces oxygen intake and increases carbon dioxide levels.

17.

The heart sound that is best heard in the left fifth intercostal space (ICS) along the midclavicular line, and whose soft lub sound indicates closure of the tricuspid and mitral (AV) valves is:

  • S1

  • S2

  • S3

  • S4

Correct answer: S1

Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. There are two normal heart sounds (in healthy adults) often described as a lub and a dub, that occur in sequence with each heartbeat. These include the first heart sound (S1 lub) and second heart sound (S2 dub), produced by the closing of the AV valves and semilunar (aortic and pulmonic) valves, respectively.

The rarer extra heart sounds, S3 and S4, form gallop rhythms and are heard in both normal and abnormal situations. S3 is an additional sound heard after S1 and S2. S4 falls late in the cycle; so late, that on auscultation, it seems to precede the next S1-S2.

18.

A nurse manager wants to implement a new protocol for reducing Central Line-Associated Bloodstream Infections (CLABSIs). What initial step should the nurse take to ensure the protocol is evidence-based?

  • Reviewing current evidence and guidelines on CLABSI prevention

  • Gathering baseline data on the unit's current CLABSI rates

  • Implementing a new protocol immediately, adjusting it based on observational data

  • Using protocols from other hospitals that reduced their CLABSI rates

Correct answer: Reviewing current evidence and guidelines on CLABSI prevention.

The initial step to ensure the new protocol for reducing CLABSIs is evidence-based is to review current evidence and guidelines. This ensures the protocol is grounded in the most effective and up-to-date practices.

Gathering baseline data is necessary for evaluating the protocol's impact but does not guarantee evidence-based practices. Immediate implementation with adjustments based on observations can lead to trial and error rather than best practices. Using other hospitals' protocols without verifying their evidence basis might not yield the best outcomes.

19.

The emergency department nurse knows that all the following are entitlement programs in the United States, except:

  • 401K programs

  • Social Security

  • Medicare 

  • Medicaid 

Correct answer: 401K programs 

Entitlement programs are government-based programs that guarantee certain benefits (granted by federal law) to citizens and select noncitizens who legally reside in the United States and meet specific criteria. Examples include Veteran Administration programs, Medicare, Social Security, and Medicaid. 

The 401K program is a retirement program that is regulated by the federal government but does not guarantee benefits to individuals participating in this program.

20.

Which of the following is least likely to occur from a Roux-en-Y surgery?

  • Aplastic anemia

  • Iron deficiency anemia

  • Anemia from blood loss

  • Pernicious anemia

Correct answer: Aplastic anemia

Aplastic anemia is a type of anemia that occurs when red blood cells are not produced by bone marrow and is unlikely to be caused by a surgery affecting the stomach or intestines.

Iron deficiency anemia can be caused by malabsorption of iron that can be related to decreased absorption of nutrients that may occur with a gastric bypass surgery. Anemia from blood loss during surgery is a possibility. Pernicious anemia is often due to decreased secretion of intrinsic factor, which is needed to absorb vitamin B12 and is secreted in the stomach. Gastric bypass surgeries, such as a Roux-en-Y, can disrupt secretion of intrinsic factor, leading to pernicious anemia.

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