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Quiz Session - Attempts With Random Questions

ANCC MEDSURG-BC Exam Questions

Page 6 of 75

101.

A patient on lithium therapy should be monitored closely for toxicity if also taking which of the following medications?

  • Thiazide diuretics

  • Beta-blockers

  • Calcium channel blockers

  • ACE inhibitors

Correct answer: Thiazide diuretics

Thiazide diuretics can increase lithium levels by reducing renal clearance, leading to an increased risk of lithium toxicity. Close monitoring of lithium levels is necessary when these drugs are used concurrently.

Beta-blockers do not significantly affect lithium levels and are not typically associated with an increased risk of lithium toxicity. Calcium channel blockers generally do not interact with lithium in a way that significantly increases the risk of toxicity. ACE inhibitors can increase lithium levels but not as significantly as thiazide diuretics. Thiazides have a more pronounced effect on lithium clearance and toxicity risk.

102.

A nurse is evaluating the outcomes of a new fall prevention program. What evidence-based practice approach should the nurse use?

  • Comparing current fall rates with those before the program was implemented

  • Assessing the current severity of injuries resulting from falls with those before the program was implemented

  • Gathering survey data from all patients involved in a fall before and after the program’s implementation

  • Gathering and comparing data on all patient safety incidents before and after the program’s implementation

Correct answer: Comparing current fall rates with those before the program was implemented

Comparing current fall rates with those before the program was implemented is a direct and quantifiable way to measure the effectiveness of the fall prevention program. This approach provides clear, objective data on whether the program has reduced the incidence of falls.

While assessing the severity of injuries can provide useful information, it does not directly measure the effectiveness of the fall prevention program in reducing the number of falls.

Gathering survey data from patients might offer subjective insights but lacks the objectivity and direct relevance to quantifying fall rates.

Gathering data on all patient safety incidents is too broad and may dilute the focus on falls, making it difficult to assess the specific impact of the fall prevention program.

103.

Which of the following is not a vasodilating agent?

  • Digoxin

  • Atenolol

  • Olmesartan

  • Amlodipine

Correct answer: Digoxin

Digoxin is an inotropic agent, affecting only cardiac rate, and is not considered a vasodilating agent. Atenolol is a beta blocker, olmesartan is an Angiotensin II Receptor Blocker (ARB), and amlodipine is a calcium channel blocker. All three of these are vasodilating agents.

104.

Which of the following type 2 diabetes mellitus medications is to be taken with the very first bite of each meal?

  • Acarbose (Precose)

  • Sitagliptin (Januvia)

  • Chlorpropamide (Diabinese)

  • Dapagliflozin (Farxiga)

Correct answer: Acarbose (Precose)

Acarbose and Miglitol are alpha-glucosidase inhibitors. They improve glycemic control in adults with diabetes by slowing the breakdown of food absorption of sugar. They must be taken at the beginning of a meal to be effective. They can cause bloating and flatulence and are contraindicated in patients with inflammatory bowel disease, colonic irritation, partial intestinal obstruction or in any gastrointestinal conditions that may deteriorate as a result of increased intestinal gas formation.

Januvia, Diabinese, and Farxiga are also type 2 diabetes medications, but only need to be taken daily, with or without food.

105.

Which of the following cardiovascular conditions is the most common type of heart disease?

  • Coronary artery disease

  • Cardiomyopathy

  • Hypertension

  • Atrial fibrillation

Correct answer: Coronary artery disease

Coronary artery disease (CAD) is a condition in which the arteries that supply blood to the heart harden and become narrow from the accumulation of plaque, cholesterol, and connective tissues inside the coronary vessels. This narrowing of the arteries (known as atherosclerosis) obstructs blood flow to the heart muscle and can cause a heart attack. CAD is a progressive disease, developing over several years, and is the most common type of heart disease, killing nearly 380,000 people annually.

Cardiomyopathy is a type of heart disease that affects the cardiac muscle itself; hypertension is a disease of the arteries and veins, not a disease of the heart itself; and atrial fibrillation is a cardiac condition affecting the electrical system of the heart.

106.

What is a healthy adult bladder capacity without having to stretch the wall of the bladder?

  • 300-500 mL

  • 500-700 mL

  • 100-300 mL

  • 700-900 mL

Correct answer: 300-500 mL

The bladder is a muscular storage pouch in the lower pelvis. The normal adult bladder capacity is 300-500 mL. While the bladder may stretch to hold more than 500 mL, this is not its normal, healthy function.

107.

A patient taking both clopidogrel and omeprazole is at risk for which potential issue due to the drug interaction?

  • Reduced antiplatelet effect of clopidogrel

  • Increased bleeding risk

  • Enhanced risk of gastric ulcers

  • Increased gastric pH

Correct answer: Reduced antiplatelet effect of clopidogrel

Omeprazole can reduce the antiplatelet effect of clopidogrel by inhibiting the enzyme CYP2C19, which is necessary for the activation of clopidogrel. This interaction can decrease the efficacy of clopidogrel in preventing thrombotic events.

The interaction between clopidogrel and omeprazole does not increase bleeding risk; instead, it reduces the effectiveness of clopidogrel, which could potentially increase the risk of thrombotic events.

Omeprazole decreases the risk of gastric ulcers by reducing stomach acid production, which is one of its therapeutic effects. This is not related to the interaction with clopidogrel.

While omeprazole increases gastric pH by reducing acid production, this effect is not related to the interaction with clopidogrel.

108.

The most common presenting symptoms in patients with disorders of the gastrointestinal tract include:

  • Pain, nausea/vomiting, change in bowel pattern

  • Pain, change in bowel pattern, evidence of bleeding

  • Nausea/vomiting, evidence of bleeding, weight loss

  • Evidence of bleeding, pain, nausea/vomiting

Correct answer: Pain, nausea/vomiting, change in bowel pattern

The most common presenting symptoms in patients with disorders of the GI tract include:

  • Pain, but it may not arise until significant tissue damage has occurred. Referred pain is also common.
  • Nausea/vomiting
  • Change in bowel pattern, including constipation, diarrhea, and characteristics of the stool
  • Appetite changes, including dysphagia, weight loss/gain, and food intolerance (type and/or amount)
  • Family history: GI disease and/or cancer
  • Social history: alcohol and recreational drug use, work, activity, stressors (financial, environmental, family), coping mechanisms

Evidence of bleeding is an uncommon presenting symptom with gastrointestinal tract disorders and is a cause for concern when present.

109.

Why are anticoagulants used for someone who has a deep vein thrombosis (DVT)?

  • To promote the body's natural means of breaking down the thrombus

  • To chemically degrade and break down the thrombus directly

  • To keep the DVT from growing

  • To reduce viscosity, promoting better circulation

Correct answer: To promote the body's natural means of breaking down the thrombus

The body has natural coagulative and thrombolytic processes that occur simultaneously. By inhibiting coagulation, the thrombolytic process become more predominate, helping the thrombus to be broken down by the body. 

Unlike thrombolytic medications, anticoagulants do not break down thrombi directly. While anticoagulants will help DVTs from growing, that is not the main reason for their use in patients who already have a DVT. Anticoagulants do not meaningfully contribute to blood viscosity and are not used for this purpose.

110.

A nurse witnesses a physician making a treatment decision they believe is not in the best interest of the patient. What should the nurse do first?

  • Discuss the concern with the physician privately

  • Report the physician to the hospital administration

  • Inform the patient of the nurse’s concerns

  • Recognize that the nurse is obligated to follow the physician’s decisions

Correct answer: Discuss the concern with the physician privately

Discussing the concern with the physician privately allows for professional dialogue and potential resolution, ensuring the patient's best interest is considered. This maintains professional relationships and respects the chain of command. 

Reporting the physician to hospital administration prematurely can escalate the situation unnecessarily. Informing the patient of concerns may cause unnecessary alarm and bypass proper protocols. Blindly following the physician's decisions neglects the nurse's duty to advocate for the patient's best interests.

111.

A patient with Amyotrophic Lateral Sclerosis (ALS) presents with increased difficulty swallowing. Which intervention by the nurse best illustrates evidence-based practice?

  • Referring the patient to a speech therapist for a swallowing assessment and therapy

  • Advising the patient to drink only water to reduce the risk of aspiration

  • Encouraging the patient to avoid solid foods

  • Implementing a low-fiber diet

Correct answer: Referring the patient to a speech therapist for a swallowing assessment and therapy

Referring the patient to a speech therapist for a swallowing assessment and therapy is the correct intervention because it involves a specialist trained in managing dysphagia. This ensures the patient receives comprehensive and individualized care based on evidence-based guidelines.

Advising the patient to drink only water is an oversimplified approach that does not address all aspects of dysphagia management.

Encouraging the avoidance of solid foods is a generalized recommendation that fails to consider the individualized care necessary for the patient.

Implementing a low-fiber diet does not specifically target the swallowing difficulties and lacks evidence for managing dysphagia in ALS patients.

112.

A patient with streptococcal pneumonia is admitted to the medical-surgical unit. The patient in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?

  • Inflamed lung tissue

  • Abrupt onset

  • Elevated white blood cell (WBC) count

  • Responsiveness to penicillin

Correct answer: Inflamed lung tissue

The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent.

Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. 

Antibiotic therapy is the primary treatment for most types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with antibiotics.

Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, do not.

113.

Which of the following diagnostic studies best identifies abnormal cardiac rhythms?

  • Electrocardiogram

  • Echocardiogram

  • Stress test

  • Cardiac catheterization

Correct answer: Electrocardiogram

An electrocardiogram (ECG) is a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias), and can detect damage to the heart's electrical conduction.

An echocardiogram, or echo, uses sound waves to evaluate the heart's chambers and valves, as well as its pumping function. A stress test is done to monitor the heart, breathing, and blood pressure of a patient whose heart is stressed by exercise or medication, and may be used to detect coronary artery disease or to determine safe levels of exercise after a heart attack or heart surgery.

Cardiac catheterization is a comprehensive test showing arterial narrowing, heart chamber size, how well the heart pumps, and how well the valves open and close, as well as a measurement of the pressures within the heart chambers and arteries. It involves the insertion of a catheter into the heart. Cardiac catheterization does not identify abnormal electrical activity in the heart.

114.

A nurse is leading a journal club focused on evidence-based practice. Which approach will best engage the participants and enhance their learning?

  • Assigning articles to be read beforehand and discussing key points

  • Reading the articles aloud during the meeting

  • Having participants summarize articles as they read them during the meeting

  • Limiting discussion to articles that support a change in practice

Correct answer: Assigning articles to be read beforehand and discussing key points

Assigning articles to be read beforehand and discussing key points engages participants by encouraging preparation and critical thinking, leading to more meaningful discussions and a deeper understanding of the material.

Reading the articles aloud during the meeting is passive and does not encourage active engagement or critical analysis by the participants.

Having participants summarize articles as they read them during the meeting can be disjointed and may not allow for comprehensive understanding or critical discussions of the material like reviewing them beforehand would.

Limiting the discussion to articles that support a change in practice restricts the scope of learning and critical thinking, as it does not consider a balanced view of the evidence.

115.

A patient with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea. Which intervention should the nurse implement first?

  • Position the patient in high Fowler's position

  • Administer prescribed bronchodilators

  • Encourage pursed-lip breathing

  • Increase the oxygen flow rate

Correct answer: Position the patient in high Fowler's position

Positioning the patient in high Fowler's position helps to maximize lung expansion and ease the work of breathing. This is an intervention that can directly address dyspnea and can be performed quickly, providing more time for assessment and planning the next interventions.

Administering bronchodilators is important but should follow immediate measures to improve breathing and assessment. Encouraging pursed-lip breathing could be beneficial but positioning is a more immediate intervention to relieve dyspnea. Pursed-lip breathing also requires the patient’s involvement, while repositioning is a passive intervention that can be immediately performed more effectively. Increasing the oxygen flow rate without assessing the patient's current oxygen level and needs can lead to complications, especially in patients with COPD.

116.

A nurse suspects that a fellow nurse is under the influence of alcohol while on duty. What is the nurse's most appropriate action?

  • Report the suspicion to the nurse manager immediately

  • Notify law enforcement of someone practicing under the influence

  • Discuss their suspicions with the nurse and explain their responsibility to report the situation

  • Gather enough information to be absolutely certain prior to reporting

Correct answer: Report the suspicion to the nurse manager immediately

Reporting the suspicion to the nurse manager immediately is the correct action to ensure patient safety and allow the situation to be handled promptly and appropriately by those in supervisory roles. This action adheres to protocols for addressing such concerns within the healthcare setting.

Notifying law enforcement directly bypasses the proper internal reporting mechanisms and is not suitable for this context unless some form of harm occurs. This is a drastic step that should be taken by the nurse manager if necessary.

Discussing suspicions with the nurse and explaining the responsibility to report does not address the immediate risk and could compromise patient safety. Delaying reporting to gather more information can unnecessarily endanger patients and is not necessary if a reasonable suspicion exists.

117.

What is a key intervention to prevent infection in a postoperative patient with a surgical wound?

  • Maintaining a clean and dry dressing

  • Applying a heating pad to the wound

  • Administering pain medication as needed

  • Encouraging a high-protein diet

Correct answer: Maintaining a clean and dry dressing

Keeping the surgical wound clean and dry is essential in preventing infection. A clean and dry dressing protects the wound from bacteria and other contaminants, thereby reducing the risk of infection.

Applying a heating pad to the wound can increase blood flow and may cause damage to the underlying tissues, potentially promoting bacterial growth and increasing the risk of infection. Administering pain medication as needed is important for patient comfort but does not directly prevent infection. Encouraging a high-protein diet can aid in wound healing but does not specifically prevent infection in a postoperative wound.

118.

A patient who has nephrolithiasis is found to have a  single stone measuring 3mm in diameter. The nurse understands that which of the following is most likely to be true?

  • The stone will likely pass with conservative management.

  • Surgical intervention will likely be necessary for this patient.

  • Planning should begin for extracoporeal shock wave lithotripsy .

  • The stone could pass on its own, but a cystoscope will probably be necessary to facilitate passage of the stone.

Correct answer: The stone will likely pass with conservative management.

Stones that are less than 5mm will typically pass on their own without any interventions beyond conservative management, as long as the pain can be managed and oral hydration is possible. Other interventions are not likely to be necessary for a stone this small.

119.

Which type of burn is characterized by damage resulting from heat made by a flowing current?

  • Electrical burn

  • Thermal burn

  • Chemical burn

  • Radiation burn

Correct answer: Electrical burn

The causes of burns include thermal, chemical, electrical, and radiation. Electrical burns are damage resulting from heat made by flowing current. The nerves and blood vessels are very good conductors in this type of burn, and electrical current travels through most conductive tissue.

Thermal burns are burns to the skin caused by any external heat source, such as an open flame or a scald from steam or hot liquid. Chemical burns occur when the skin or eyes come into contact with an irritant, such as an acid or a base chemical agent. Radiation burns occur due to exposure to radiation particles or waves.

120.

Noninvasive diagnostic studies of the cardiovascular system include:

  • MRI, phonocardiogram, echocardiogram

  • MRI, phonocardiogram, nuclear cardiology

  • Echocardiogram, nuclear cardiology, thallium imaging

  • MRI, nuclear cardiology, echocardiogram

Correct answer: MRI, phonocardiogram, echocardiogram

Noninvasive diagnostic studies of the cardiovascular system include MRI, phonocardiogram, echocardiogram, EKG, and chest x-ray. 

MRI (magnetic resonance imaging) provides images in multiple planes with uniformly good resolutions. It cannot be used in persons with any implanted ferromagnetic metallic devices unless they are MRI safe. Phonocardiograms and echocardiograms are also noninvasive procedures because they do not involve the injection of any substances. A phonocardiogram uses microphones to record cardiac activity, and an echocardiogram uses ultrasound to record the activity of the heart.

Nuclear cardiology involves the injection of a radioactive isotope, and thallium imaging involves the injection of thallium. Since both of these procedures require the infusion of substances, they are considered to be invasive procedures.

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