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Quiz Session - Attempts With Random Questions

ANCC MEDSURG-BC Exam Questions

Page 3 of 75

41.

Which of the following is LEAST likely to cause Addison's disease?

  • Use of corticosteroids

  • HIV

  • Autoimmune disease

  • Surgical removal of adrenal glands

Correct answer: Use of corticosteroids

Use of corticosteroids can cause Cushing's disease, a condition caused by oversecretion of adrenocortical hormones. Addison's disease is caused by adrenocortical hypofunction (a chronic adrenocortical insufficiency) and could be triggered by sudden cessation of corticosteroids, not by corticosteroids use. 

Other causes of primary adrenal insufficiency include autoimmune disease and diseases such as sarcoidosis and histoplasmosis, metastatic disease (rarely), radiation therapy, surgical removal of both adrenal glands, and HIV; these can all cause destruction of the adrenal cortex, leading to the development of Addison's disease.

42.

Which of the following conditions is a contraindication for metformin (Glucophage)?

  • Diabetic ketoacidosis (DKA)

  • Pancreatitis

  • History of splenectomy

  • Allergy to glipizide (Glucotrol)

Correct answer: Diabetic ketoacidosis (DKA)

DKA is caused by metabolic changes that happen when glucose is not able to enter the cells. Administering metformin will reduce the levels of sugar in the blood, but will not help sugar get into the cells. Someone who is in DKA should never receive metformin, and should instead receive insulin, which will move sugar into the cells, reversing the ketotic metabolic process. 

Pancreatitis and splenectomy are not contraindication for metformin use. Metformin is a biguanide while glipizide is a second-generation sulfonylurea. A glipizide allergy is not likely to create a metformin allergy.

43.

Which of the following best describes decorticate posturing?

  • The arms are bent inward, fists are clenched, and the legs are held out straight 

  • The arms are held out straight and turned outward, the fists are clenched, and the legs are held out straight

  • The legs are bent at the knees when the neck is flexed so that the chin touches the chest

  • The body is lying facing upward with the palms of the hands open and facing upward

Correct answer: The arms are bent inward, fists are clenched, and the legs are held out straight

Decorticate posturing is an abnormal neurological response in which the arms are bent inward, fists are clenched, and the legs are held out straight. 

The condition where the arms are held out straight and turned outward, the fists are clenched, and the legs are held out straight describes decerebrate posturing. Brudzinski's sign indicates meningeal irritation and is positive when the knees bend when the neck is flexed so that the chin touches the chest. The body is lying facing upward with the palms of the hands open and facing upward describes the anatomical position.

44.

A patient is admitted with bleeding esophageal varices, and a Sengstaken-Blakemore tube is inserted orally to control the bleeding. Important considerations in caring for this patient include:

  • Being prepared to cut and remove the tube if gastric balloon enters the esophagus, obstructing the airway

  • Monitoring the patient for clotting of the stent

  • Avoiding ever releasing the pressure of the esophageal or gastric balloon

  • Avoiding performing oral care until the tube is removed, as this may dislodge the balloon(s)

Correct answer: Being prepared to cut and remove the tube if gastric balloon enters the esophagus, obstructing the airway

Balloon tamponade is a temporary measure used when endoscopic and pharmacologic therapy cannot control the bleeding. A multi-lumen Sengstaken-Blakemore tube is inserted nasally or orally. The gastric balloon is inflated first; if bleeding is still not controlled, then the esophageal balloon is also inflated. Heavy scissors should be kept at the patient's bedside to cut and remove the tube if the gastric balloon enters the esophagus and causes asphyxiation. Never deflate the gastric balloon alone.

A stent is not present in a tamponade tube such as a Sengstaken-Blakemore tube. The balloon should be deflated at regular intervals to prevent erosions. Frequent mouth care should be administered (not avoided) and the skin around the tube monitored to prevent necrosis from the pressure of the tube.

45.

A patient is being discharged and the nurse needs to ensure they understand their follow-up care instructions. What is the best way to confirm understanding?

  • Ask the patient to repeat the instructions back to the nurse

  • Ask the patient to acknowledge understanding the teaching point by point

  • Provide a written quiz that tests the main points that were taught

  • Schedule a follow-up call to assess the patient’s retention of the information

Correct answer: Ask the patient to repeat the instructions back to the nurse

Asking the patient to repeat the instructions back to the nurse ensures they have understood the information and can recall it accurately. This technique, known as the teach-back method, is effective in confirming patient comprehension.

Asking the patient to acknowledge understanding point by point does not ensure they have truly comprehended the information and can recall it accurately. Providing a written quiz can be stressful for the patient and may not accurately reflect their understanding of the instructions. Scheduling a follow-up call is helpful but does not confirm understanding at the time of discharge.

46.

Antidiuretic hormone (ADH) is synthesized in the:

  • Hypothalamus

  • Pituitary gland

  • Thalamus

  • Pineal gland

Correct answer: Hypothalamus

Antidiuretic hormone is an example of a neuroendocrine hormone; it has components of both the endocrine and the nervous system. It is synthesized in the hypothalamus and travels along axons that terminate adjacent to capillaries in the posterior pituitary.

47.

Heberden's nodes are finger joint deformities associated with which of the following conditions?

  • Osteoarthritis

  • Rheumatoid arthritis

  • Osteomyelitis

  • Gout

Correct answer: Osteoarthritis

Osteoarthritis is a joint disease characterized by degenerative changes in articular cartilage; joint pain and functional impairments are the hallmarks of this disease. Bony overgrowths on the finger joint closest to the fingernail (distal interphalangeal joints) are called Heberden's nodes and are commonly seen in osteoarthritis patients as joints begin to exhibit deformities, appearing enlarged and swollen.

Heberden's and Bouchard's nodes (bony growths on the proximal interphalangeal joints) are more often associated with moderate to severe osteoarthritis rather than rheumatoid arthritis though they can also present with rheumatoid arthritis. Heberden's nodes are not associated with osteomyelitis (infection of the bone) or gout (uric acid and crystal deposits in the joints).

48.

All of the following statements concerning exercise as it relates to diabetes mellitus are true except:

  • Exercise can be effective in improving blood glucose control, especially in individuals with type 1 diabetes

  • Exercise enhances glucose transport into exercising muscle

  • Exercise improves insulin sensitivity

  • The blood glucose-lowering effects of exercise occur during exercise and can persist for several hours following exercise

Correct answer: Exercise can be effective in improving blood glucose control, especially in individuals with type 1 diabetes

Exercise can be effective in improving blood glucose control, especially in individuals with type 2 diabetes mellitus (DM). In patients with type 1 DM, some effects of exercise on blood glucose control may be blunted due to the need to treat hypoglycemia. 

Regardless of whether the person has diabetes type 1 or type 2, the benefits of exercise are extremely important. The blood glucose-lowering effects of exercise occur during exercise and can persist for several hours following exercise. Exercise improves insulin sensitivity and enhances glucose transport into the exercising muscle(s).

49.

Most cases of acute pyelonephritis are caused by:

  • Escherichia coli invasion

  • Proteus invasion

  • Klebsiella invasion

  • Fungal or viral infections

Correct answer: Escherichia coli invasion

Pyelonephritis is an infection of the renal pelvis and interstitium (spaces between the renal tubules); it is usually caused by bacteria ascending through the ureters from the bladder and urethra, and may also enter the kidney from the bloodstream. 

Approximately 85% of pyelonephritis cases are related to Escherichia coli (E. coli) bacteria invasions. Proteus and Klebsiella are less common causative agents; fungal or viral infections are not impossible.

50.

Which of the following nitrates is not rapid acting? 

  • Isosorbide monoitrate

  • Isosorbide dinoitrate

  • Nitroglycerin

  • Amyl nitrate

Correct answer: Isosorbide monoitrate

Long acting nitrates can be used to manage stable angina. Amyl nitrate is a rapid acting nitrate isosorbide dinitrate and nitroglycerin can both be either long acting and rapid. Isosorbide mononitrate is exclusively a long acting nitrate.

51.

Which of the following medications is NOT associated with developing hyperosmolar hyperglycemic syndrome?

  • Insulin

  • Corticosteroids

  • Potassium-wasting diuretics

  • Phenytoin (Dilantin)

Correct answer: Insulin

Hyperosmolar hyperglycemic syndrome (HHS) is a serious metabolic derangement that occurs in patients with diabetes mellitus (DM) and can be a life-threatening emergency. It most commonly occurs in elderly patients unable to meet fluid needs or in individuals with a history of type 2 DM who have some concomitant illness that leads to reduced fluid intake. Infection is the most common preceding illness, but many other conditions can cause altered mentation, dehydration, or both. HHS is characterized by hyperglycemia, hyperosmolarity, and severe dehydration without significant ketoacidosis.

Some medications associated with the development of HHS include:

  • Corticosteroids: These increase insulin resistance and gluconeogenesis
  • Potassium-wasting diuretics (such as thiazides and furosemide): These reduce insulin secretion through hypokalemia
  • Phenytoin: This inhibits insulin secretion

Insulin is part of the treatment plan in the patient with HHS, along with fluid and electrolyte replacement therapy, and correction of the underlying condition.

52.

The hemoglobin A1c level indicates a patient's blood glucose control over which of the following approximate times?

  • The previous 2 to 3 months

  • The previous 2 to 3 weeks

  • The previous 3 to 4 months

  • The previous 3 to 4 weeks

Correct answer: The previous 2 to 3 months

Hemoglobin A1C levels reflect the plasma glucose level during the past 2-3 months and give a general indication of an individual's blood glucose control over this period. A Hemoglobin A1C of less than 7% reflects good control and decreased risk of complications, whereas greater than or equal to 8% indicates poor glycemic control and increased risk of complications.

In general, an A1C of 4%-7% correlates with an average blood glucose level of approximately 60-150 mg/dL.

53.

A nurse is aware of a medication error but is unsure who is responsible. What should the nurse do?

  • Report the error to the nurse manager immediately.

  • Take no action since the responsible person is unknown.

  • Figure out who is responsible so they can make an accurate report.

  • Contact law enforcement to conduct an investigation.

Correct answer: Report the error to the nurse manager immediately.

Reporting the error to the nurse manager immediately ensures the error is addressed promptly and prioritizes patient safety. This action maintains the integrity of the healthcare system and ensures appropriate corrective measures are taken.

Taking no action neglects patient safety and fails to address potential harm.

Figuring out who is responsible before reporting delays intervention and focuses more on blame than resolution. This approach may also delay necessary intervention.

Contacting law enforcement is inappropriate; this situation should be handled within healthcare protocols.

54.

The med/surg nurse is assessing a patient who was recently diagnosed with hyperthyroidism. Which of the following symptoms would the nurse not expect to see?

  • Constipation

  • Tachycardia

  • Arrhythmias

  • Tremors

Correct answer: Constipation

Hyperthyroidism causes an increased metabolic rate that can lead to tachycardia, arrhythmias, tremors, and diarrhea. Constipation is very unlikely to occur with hyperthyroidism, and is more common with hypothyroidism.

55.

Which of the following statements related to leiomyomas of the uterus is true?

  • They are tumors that develop from smooth muscle cells in the myometrium

  • They are more common in Caucasian women than in women of other races

  • These tumors become malignant, and treatment often includes cryosurgery

  • The incidence of these tumors increases after menopause

Correct answer: They are tumors that develop from smooth muscle cells in the myometrium

Leiomyomas are also called myomas, fibromyomas, or fibroids; they are benign tumors that develop from smooth muscle cells in the myometrium. Although they have an unknown etiology, their growth is related to estrogen.

They are more common in African-American women than in Caucasian women and are often untreated unless symptomatic. They often shrink and usually cease after menopause.

56.

You are caring for a patient who has been admitted to the hospital with an intestinal obstruction. All of the following are appropriate nursing interventions for this patient except:

  • Educate the patient on enteral nutrition

  • Monitor hemodynamics closely

  • Prepare patient and family for surgical procedure and potential ostomy

  • Provide pain management as ordered

Correct answer: Educate the patient on enteral nutrition

With intestinal obstructions, intestinal contents are unable to be passed due to a mechanical or functional blockage of the intestines, preventing the normal movement of the products of digestion. The patient is likely to be in pain and will need pain management as ordered, as well as close hemodynamic monitoring, including fluid and electrolyte monitoring, and preparation for surgery to relieve the obstruction (educate the patient on possible ostomy placement if indicated).

Enteral nutrition is not indicated with intestinal obstructions; it is more commonly instituted in inflammatory bowel disease, especially with Crohn's disease.

57.

In an EKG, the P wave represents:

  • Depolarization of the atria

  • Repolarization of the atria

  • Depolarization of the ventricles

  • Repolarization of the ventricles

Correct answer: Depolarization of the atria

The P wave on an EKG represents atrial depolarization. 

Repolarization of the atria is not observed in an EKG; it is masked by the depolarization of the ventricles (represented by the QRS complex). Repolarization of the ventricles is represented by the T wave of an EKG.

58.

Which of the following is true for vital signs in the shock patient?

  • The pulse will increase, and the respirations will increase

  • The pulse will increase, and the respirations will decrease

  • The pulse will decrease, and the respirations will increase

  • The pulse will decrease, and the respirations will decrease

Correct answer: The pulse will increase, and the respirations will increase 

In shock, the pulse increases (tachycardia) to help improve cardiac output, and respirations increase (tachypnea) to help maximize oxygenation of circulating blood.

59.

A 45-year-old vegan patient is admitted to the medical-surgical unit with anemia. During the initial assessment, which of the following approaches best demonstrates the nurse's skills in therapeutic communication?

  • "Can you tell me about your dietary habits and any supplements you take?"

  • "Your diet is likely to be a factor in your anemia."

  • "Your diet shows that you have a strong moral compass."

  • "Would you be open to considering a different diet?"

Correct answer: "Can you tell me about your dietary habits and any supplements you take?"

Asking the patient to describe their dietary habits and supplements they take uses open-ended questioning, encouraging the patient to provide detailed information and facilitating a therapeutic conversation. This approach respects the patient's perspective and helps gather important information.

Telling the patient that their diet is likely to be a factor in their anemia is judgmental and does not encourage the patient to share information or feel understood. Telling the patient their diet shows they have a strong moral compass is unrelated to the medical issue and does not facilitate a therapeutic conversation about health and diet.

Asking the patient if they would be open to considering a different diet may feel confrontational and does not respect the patient's current dietary choices, potentially leading to defensiveness.

60.

A patient is at risk for falls. Which intervention should the nurse implement to promote patient safety?

  • Keep the bed in the lowest position with the wheels locked

  • Apply the least restrictive method of physical restraints

  • Ensure the patient is wearing yellow socks

  • Place a "Fall Risk" sign on the patient's door

Correct answer: Keep the bed in the lowest position with the wheels locked

Keeping the bed in the lowest position with the wheels locked reduces the risk of injury if the patient falls out of bed and ensures stability, preventing accidental rolling or movement of the bed. This intervention directly minimizes the risk of falls and potential injuries.

Applying the least restrictive method of physical restraints is generally not recommended as a first-line intervention for fall prevention due to the risk of injury and reduced mobility. Restraints are not typically a good or ethical method of preventing falls unless there is no other alternative.

Ensuring the patient is wearing yellow socks can help identify the patient as a fall risk, but it does not directly prevent falls. Socks with grips are more effective in helping prevent falls than socks of a specific color.

Placing a "Fall Risk" sign on the patient's door is useful for alerting staff but does not actively prevent falls. Direct measures to enhance patient safety are more effective.

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