×

Quiz Session - Attempts With Random Questions

ANCC MEDSURG-BC Exam Questions

Page 5 of 75

81.

In an adult patient with type 2 diabetes mellitus, the target goal for glycemic control is generally:

  • A1C < 7.0%

  • A1C < 8.0%

  • A1C < 7.5%

  • A1C < 6.5%

Correct answer: A1C < 7.0%

Hemoglobin A1C is an indicator of blood glucose control during the previous three months. Recommended glycemic target goals for adults with diabetes include an A1C of less than 7.0%, preprandial (before meals) glucose levels of 70-130 mg/dL, and postprandial (after meals) glucose levels of less than 180 mg/dL. Goals should be, however, individualized (based on factors such as comorbid conditions, pregnancy status, hypoglycemic unawareness).

82.

During a multidisciplinary team meeting, a nurse notices that a physical therapist has not been consulted about a patient's mobility issues. What is the MOST appropriate action for the nurse to take?

  • Pause the meeting and ensure that a physical therapist can be included

  • Ask the occupational therapist present to address the mobility issues

  • Develop a collaborative mobility plan as a team with the people present

  • Take responsibility as the nurse for addressing the patient's mobility issues

Correct answer: Pause the meeting and ensure that a physical therapist can be included

Pausing the meeting and ensuring that a physical therapist can be included guarantees the physical therapist’s expertise is incorporated into the care plan. This ensures comprehensive care for the patient’s mobility issues.

Asking the occupational therapist to address the mobility issues is inappropriate as occupational therapists have a different scope of practice and may not fully address the specific mobility concerns that a physical therapist would handle.

Developing a collaborative mobility plan as a team with the people present excludes the physical therapist’s specialized input, potentially leading to an incomplete or ineffective mobility plan.

The nurse taking responsibility for addressing the patient's mobility issues neglects the specialized knowledge and skills of a physical therapist, which are crucial for comprehensively addressing mobility issues.

83.

You are starting your shift and receive report on the following four patients. Which patient should you see first?

  • A patient with hypokalemia who had a run of ventricular tachycardia that resolved by itself

  • A patient who is on comfort care measures who is expected to pass at any time

  • A patient who has a MAP that has decreased from 84 to 70

  • A patient who recently received a sublingual nitroglycerin and says that his chest pain turned into a headache

Correct answer: A patient with hypokalemia who had a run of ventricular tachycardia that resolved by itself

Hypokalemia (low potassium) can lead to adverse cardiac rhythms. A run of ventricular tachycardia (V-tach) that resolved by itself could be an indicator that the patient may go into V-tach (a potentially lethal rhythm). This patient should be assessed first, even though he is not currently in V-tach. 

A patient who is on comfort care measures will not require any emergent interventions. A MAP of 100-70 is normal. A decrease is not concerning unless the downward trend continues. Nitroglycerin is used to treat angina and often causes headaches. If the nitroglycerin resolved the chest pain, then it was effective and this patient can wait to be seen until the more emergent patient has been assessed.

84.

The nurse is caring for a patient with esophageal cancer. Which statement made by the nurse is accurate regarding this diagnosis?

  • "Most cancers of the esophagus start in the epithelial lining."

  • "Individuals from China and Japan have a higher risk of developing esophageal cancer."

  • "Drinking chilled beverages frequently contributes to the risk of esophageal cancer by damaging the esophageal mucos."

  • "Women and individuals of African-American descent are more likely to develop esophageal cancer."

Correct answer: "Most cancers of the esophagus start in the epithelial lining."

The inner esophagus is made up of thin, flat cells called squamous cells. This innermost lining, called the epithelium, is where most esophageal cancers originate.

Risk factors for esophageal cancer include a history of GERD, alcohol and tobacco use, originating from the Middle East or China, being African American or male, and chronic indigestion of hot beverages.

85.

A 72-year-old patient with a history of congestive heart failure and chronic kidney disease is currently prescribed digoxin, furosemide, and potassium supplements. The patient presents with nausea, confusion, and visual disturbances. Which lab value should the nurse prioritize to assess the cause of the symptoms?

  • Serum digoxin level

  • Serum potassium

  • Blood urea nitrogen

  • Serum creatinine

Correct answer: Serum digoxin level

Serum digoxin level should be prioritized as digoxin toxicity can present with symptoms such as nausea, confusion, and visual disturbances. Monitoring digoxin levels is crucial in patients with these symptoms, especially considering the patient’s medication regimen.

While serum potassium levels are important, the symptoms described are more indicative of digoxin toxicity. Potassium levels should still be monitored, but digoxin levels take priority in this context. Blood urea nitrogen (BUN) is important for assessing renal function but does not directly correlate with the symptoms of digoxin toxicity. Serum creatinine is important for assessing kidney function but is not directly related to the symptoms of digoxin toxicity.

86.

After a right knee arthroplasty, a patient is complaining of increased calf pain and swelling. What should the nurse do next?

  • Measure the circumference of both calves

  • Apply sequential compression stockings

  • Encourage the patient to ambulate more

  • Administer pain medication as ordered

Correct answer: Measure the circumference of both calves

Measuring the circumference of both calves can help assess for signs of deep vein thrombosis (DVT), a common complication after knee arthroplasty, which may cause increased calf pain and swelling.

Applying sequential compression stockings is a preventive measure, but it is not an appropriate initial response to increased calf pain and swelling, which could indicate an active DVT. Encouraging the patient to ambulate more can help prevent DVT but is not appropriate when the patient is already experiencing symptoms indicative of a possible DVT. Administering pain medication does not address the potential underlying cause of the symptoms.

87.

What is the MOST appropriate initial intervention for a nurse to take when a patient is unresponsive?

  • Check the patient's pulse and breathing

  • Start CPR immediately

  • Call for help and retrieve the AED

  • Obtain a STAT set of vital signs

Correct answer: Check the patient's pulse and breathing

Checking the patient's pulse and breathing is the first step in assessing the patient’s condition to determine if they need immediate resuscitation measures such as CPR. This assessment guides further actions.

Starting CPR immediately without assessing the patient's pulse and breathing can be inappropriate if the patient has a pulse or is breathing. Calling for help and retrieving the AED is important if the patient is pulseless, but this response should follow the initial assessment of checking the patient's pulse and breathing.

Obtaining a STAT set of vital signs is not the priority when the patient is unresponsive; immediate assessment of their pulse and breathing is more urgent.

88.

A nurse is caring for an elderly patient with congestive heart failure. The nurse keeps in mind that respiratory changes associated with aging include diminished effectiveness of gas exchange between alveolus and capillary walls leading to:

  •  A decline in pO2 and O2 saturation

  • Thinning of pulmonary vasculature

  • Thinning of moist mucous membranes

  • An increase in pH and pCO2

Correct answer: A decline in pO2 and O2 saturation 

With age, the respiratory system changes in relation to environmental factors, heredity, and other disease processes. Pulmonary vasculature typically becomes thicker (not thinner) and fibrous, which in turn diminishes the effectiveness of gas exchange between alveolus and capillary walls; pO2 and O2 saturations decline, while pH and pCO2 remain the same (not increase). In addition, the gradual decline in body fluid composition affects moist mucous membranes, which become thick (not thin) and tenacious. Lastly, calcification of costal cartilages causes a decline in lung tissue elasticity and reduced compliance of the thorax.

89.

A patient has just started on tolbutamide (Orinase). Which of the following statements does the nurse know to be TRUE about this medication?

  • Duration of action is 6-12 hours

  • This medication is preferred over other oral sulfonylureas as it only needs to be given once daily.

  • Starting daily dose is usually 250 mg daily.

  • It is cleared through the feces.

Correct answer: Duration of action is 6-12 hours

Tolbutamide (Orinase) generally works in the body for 6 to 12 hours.

Tolbutamide is usually given three times daily (not once daily) and the maintenance dose is usually 1,000 mg TID. Starting daily dose is 1,000 to 2,000 mg daily, and it is cleared from the body through the liver (hepatic metabolism and biliary excretion).

90.

The respiratory center is located in the:

  • Medulla oblongata and pons

  • Medulla oblongata and thalamus

  • Medulla oblongata and midbrain

  • Pons and midbrain

Correct answer: Medulla oblongata and pons

Respiration is regulated by the respiratory center (in the medulla oblongata and pons of the brain), and the autonomic nervous system. The autonomic nervous system regulates smooth muscles of the airways via the parasympathetic and sympathetic systems.

91.

The nurse is providing teaching to a patient who has recently been diagnosed aortic stenosis. Which of the following statements indicates the need for further education?

  • This condition allows blood to flow back and forth across the valve.

  • This condition affects the valve where my blood leaves my heart to circulate in my body.

  • This condition is more likely to occur in men.

  • This condition could cause my heart muscle to thicken.

Correct answer: This condition allows blood to flow back and forth across the valve.

Valvular stenosis restricts blood flow into the next chamber or vessel, but does not allow blood to flow back and forth across the valve. This would describe insufficiency or regurgitation, not stenosis. Aortic stenosis does affect the aortic valve, the valve where blood leaves the heart via the aorta to circulate in the body. Aortic stenosis is more common in men than in women and is associated with left ventricular hypertrophy.

92.

Which of the following is least likely to be a complication of heart failure?

  • Hypovolemic shock

  • Renal failure

  • Cardiogenic shock

  • Hepatic failure

Correct answer: Hypovolemic shock

Heart failure can lead to decreased cardiac output, leading to hypoperfusion of vital organs. This can cause multisystem organ failure, or can cause single organ failure such as renal failure and hepatic failure. Decreased cardiac output caused by heart failure is classified as cardiogenic shock, as hypoperfusion of the organs is due to pump failure. Hypovolemic shock is caused by blood volume loss, and is not associated with the pathology of heart failure.

93.

A medical surgical nurse is developing a new protocol for managing hypertension in surgical patients. What is the MOST essential step to ensure the protocol is evidence-based?

  • Reviewing unbiased data from outside sources

  • Consulting with pharmaceutical representatives

  • Relying on their own clinical experience

  • Asking other nurses about their thoughts on the protocol’s design

Correct answer: Reviewing unbiased data from outside sources

Reviewing unbiased data from outside sources is the most essential step to ensure the protocol for managing hypertension is evidence-based. This approach guarantees the protocol is based on the best available evidence, which helps to develop a reliable and effective method for patient care.

Consulting with pharmaceutical representatives may introduce bias, as their goal is to sell products. Relying solely on clinical experience lacks the robustness of evidence gathered from multiple studies. While colleagues' opinions can provide insights, they should not be the primary evidence for developing a protocol.

94.

A nurse is teaching a patient with CHF about managing their condition at home. The patient expresses concerns about remembering to take their medications. What is the most effective teaching strategy to enhance the patient’s adherence?

  • Using a daily medication schedule and a pill organizer

  • Providing a detailed pamphlet on CHF management

  • Asking the patient to call the clinic if they have questions

  • Scheduling weekly follow-up phone calls from the clinic

Correct answer: Using a daily medication schedule and a pill organizer

Using a daily medication schedule and a pill organizer helps the patient develop a routine and provides a visual reminder to take their medications, enhancing adherence. This practical approach directly addresses the patient's concern about remembering their medications.

Providing a pamphlet, while informative, does not address the specific concern about remembering to take medications. Asking the patient to call the clinic if they have questions does not provide a proactive solution for medication adherence. Scheduling weekly follow-up calls may help but does not offer an immediate, daily reminder for taking medications.

95.

The posterior lobe of the pituitary gland secretes which of the following hormones?

  • Oxytocin

  • Prolactin

  • Thyroid-stimulating hormone (TSH)

  • Adrenocorticotropic hormone (ACTH)

Correct answer: Oxytocin

The posterior lobe of the pituitary gland is the smaller lobe and secretes two major hormones, oxytocin and antidiuretic hormone (ADH). Oxytocin is secreted during labor, during lactation, and sexual intercourse. ADH increases water permeability of the distal nephron and is released in response to plasma osmolality. ADH release may also be stimulated in response to a drop in effective blood volume.

ACTH, TSH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and growth hormone (GH) are all secreted by the anterior lobe of the pituitary gland (the larger lobe).

96.

Which of the following statements is TRUE related to cardiac valvular disorders?

  • Rheumatic fever is the most common cause of valvular disorders worldwide.

  • Valve stenosis refers to the inability of the valve to completely close, allowing backflow of blood.

  • Mitral insufficiency is more common in women than in men.

  • Left ventricular hypertrophy is associated with mitral stenosis.

Correct answer: Rheumatic fever is the most common cause of valvular disorders worldwide

Rheumatic fever causes lesions to develop on valve leaflets and leads to their inability to function effectively.

Valvular insufficiency (such as regurgitation or prolapse), not stenosis, refers to the inability of the valve to completely close. Mitral insufficiency is more common in men, and mitral stenosis is more common in women. Left ventricular hypertrophy is associated with aortic stenosis, not mitral stenosis.

97.

The nurse understands that the patient with pernicious anemia will have which of the following distinguishing laboratory findings?

  • Absent intrinsic factor

  • Elevated Schilling's test

  • Sedimentation rate of 16 mm/hr

  • Red blood cell count of 5 million

Correct answer: Absent intrinsic factor 

The defining characteristic of pernicious anemia is the lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of red blood cells (RBCs).

An elevated excretion of the injected radioactive vitamin B12, which is protocol for the Schilling test, indicates that the patient has the intrinsic factor and can absorb vitamin B12 from the intestinal tract. A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation (not specific to anemias). A red blood cell count of 5 million is a normal value for both men and women and does not indicate anemia.

98.

Which of the following types of stones is most likely to be formed in a patient whose diet is high in shellfish, wine, and organ meats?

  • Uric acid stones

  • Calcium phosphate stones

  • Calcium oxalate stones

  • Cystine stones

Correct answer: Uric acid stones

Uric acid stones are more likely to be formed with a diet that is high in purines. Shellfish, wine, and organ meats are all foods that are high in purines. Calcium phosphate stones are more likely to form with foods high in calcium and calcium oxalate stones are more likely to form with foods high in oxalates. Cystine stones are more likely to occur with high dietary intake of cystine.

99.

If the SA node becomes damaged and nonfunctional, which of the following is the MOST likely to occur?

  • Another part of the heart, possibly the AV node, will become the pacemaker.

  • The heart will stop.

  • The ventricles will continue contracting, but the atria will stop.

  • The atria will keep contracting normally, but at a slower rate.

Correct answer: Another part of the heart, possibly the AV node, will become the pacemaker

The SA node, referred to as the usual pacemaker, initiates atrial depolarization. If this component of the conduction system stops working, the atria and ventricles can continue to contract as long as the pacing is taken over by another pacer, likely the AV node. While the atria may continue to contract, if they are paced by another part of the heart, they may not be synchronized as they would be by the SA node.

100.

Which nursing intervention is MOST appropriate to implement to monitor fluid balance accurately for a patient experiencing acute renal failure?

  • Measuring daily weight

  • Restricting protein intake

  • Administering diuretics

  • Encouraging increased fluid intake

Correct answer: Measuring daily weight

Measuring daily weight provides a precise and objective measure of fluid balance, detecting subtle changes in fluid retention or loss.

Restricting protein intake is a dietary intervention that can help manage renal function but does not monitor fluid balance. Administering diuretics may help manage fluid overload but does not provide an accurate measure of fluid balance. Encouraging increased fluid intake can worsen fluid overload in acute renal failure and does not monitor fluid balance.

×