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Quiz Session - Attempts With Random Questions

ANCC MEDSURG-BC Exam Questions

Page 8 of 75

141.

Which of the following conditions is strongly associated with the HLA-B27 antigen?

  • Ankylosing spondylitis

  • Osteoarthritis (OA)

  • Fibromyalgia syndrome

  • Spinal stenosis

Correct answer: Ankylosing spondylitis

Ankylosing spondylitis is a type of arthritis in which there is long-term inflammation of the joints of the spine; the sacroiliac joint (between the spine and the pelvis) is also often affected.

Human leukocyte antigen (HLA)-B27 is an antigen found ankylosing spondylitis, as well as in rheumatoid arthritis (RA).

142.

A nurse is teaching a patient with rheumatoid arthritis about joint protection techniques. Which advice is MOST appropriate?

  • Use large joints instead of small ones when possible

  • Avoid using joints as much as possible

  • Perform high-impact exercises to strengthen the joints

  • Avoid swimming as a form of exercise

Correct answer: Use large joints instead of small ones when possible

Using large joints instead of small ones helps to distribute the weight and effort over a larger area, reducing stress on smaller, more vulnerable joints. This practice is a key technique in joint protection for individuals with rheumatoid arthritis.

Avoiding the use of joints entirely is impractical and can lead to muscle atrophy and decreased joint function. Performing high-impact exercises can exacerbate joint damage and increase pain in patients with rheumatoid arthritis. Swimming is recommended as a low-impact exercise that can improve joint mobility and overall fitness without stressing the joints.

143.

Your patient, Mr. S., was admitted to the medical-surgical unit for a gastrointestinal bleed associated with a duodenal ulcer. You are completing an admission assessment on him. Which of the following statements do you know is true related to clinical manifestations of gastrointestinal bleeding?

  • Vasomotor instability is the most sensitive indicator of blood loss

  • Dark, tarry stools indicate rapid blood loss

  • Platelet counts initially decrease due to delayed coagulation process

  • Massive blood loss leads to venous, then peripheral artery dilation

Correct answer: Vasomotor instability is the most sensitive indicator of blood loss

90% of all upper GI bleeds are associated with peptic ulcers and account for the majority of gastrointestinal hemorrhages. When caring for a patient with a GI bleed, vasomotor instability is the most sensitive indicator of blood loss; changes of 20 bpm or 10 mm Hg systolic indicate a loss of 15%-20% of total blood volume.

Massive blood loss leads to venous constriction, then peripheral artery constriction. Dark, tarry stool are indicative of a slow bleed, while frank blood indicates either sigmoid or rectal bleeding, or a massive lesion higher in the colon. Platelet counts increase due to instant coagulation process as the body attempts to stop the bleeding.

144.

Which of the following is an endogenous chemical that is released in response to excessive stretching of the heart muscle cells?

  • Brain natriuretic peptide (BNP)

  • Creatinine phosphokinase (CPK)

  • Myoglobin

  • Troponin

Correct answer: Brain natriuretic peptide (BNP)

Brain natriuretic peptide (BNP) is an endogenous chemical secreted by the ventricles of the heart in response to elevated pulmonary capillary wedge pressure, or excessive stretching of the heart muscle cells. The most important use of natriuretic peptides is in helping to establish the diagnosis of heart failure in a patient; a level greater than 100 pg/mL is indicative of heart failure. This test does not need to be drawn while fasting.

145.

As an emergency department nurse, you are mandated to report which of the following?

  • Sexual abuse

  • Severe physical injury

  • A suspicious death

  • Intimate partner violence (IPV)

Correct answer: Sexual abuse 

The emergency department nurse is required (mandated) to report any suspected abuse or injury that might have resulted from abuse or neglect. The reporter is protected by statute from retaliatory actions as a result of their report to protective services or local law enforcement.

The emergency room nurse must be familiar with IPV reporting laws in the state or location in which s/he is employed, as expectations vary between jurisdictions. Every state in the United States has some form of legislation that offers protection to IPV victims, but not all states require mandatory reporting of IPV. 

Severe physical injury and suspicious death are not grounds for mandatory reporting unless they are a direct result of abuse or neglect (or the nurses suspects them to be). 

146.

The exchange of gases and nutrients between blood and tissues is a major function of:

  • Capillaries

  • Veins

  • Arteries

  • Arterioles

Correct answer: Capillaries

Capillaries are the smallest of the body's blood and lymph vessels that make up the microcirculation of the peripheral vascular system. Their thin endothelial linings are only one cell layer thick, with no elastic or muscle tissue present. They help to enable the exchange of water, oxygen, carbon dioxide, and many other nutrients and waste substances between the blood and the tissues surrounding them.

Veins are large-diameter, thin-walled vessels that, in most cases, return oxygen-depleted blood to the right atrium of the heart. Arteries are muscular-walled tubes by which blood (mainly that which has been oxygenated) is conveyed from the heart to all parts of the body. Arterioles are small branches of an artery leading into capillaries; their smooth muscle allows them to constrict or dilate easily.

147.

The nurse is assessing a patient with endocarditis. Where would the nurse expect to find Janeway lesions? 

  • On the palms of the patient's hands

  • On the patient's back

  • Anywhere on the patients limbs

  • In the patient's hairline

Correct answer: On the palms of the patient's hands

Janeway lesions are hemorrhagic macules that are usually seen with acute bacterial endocarditis. They normally occur on the palms of the hands or on the soles of the feet, and are not likely to be found on the back, limbs, or hairline.

148.

A nurse is planning discharge teaching for a patient with congestive heart failure. Which patient statement indicates the teaching has been effective?

  • "I will report any sudden weight gain."

  • "I can drink as much fluid as I want."

  • "I will only stop taking my medication once I feel better."

  • "I should maintain a moderate salt intake to ensure a balanced fluid status."

Correct answer: "I will report any sudden weight gain."

Reporting sudden weight gain is crucial, as it is an early indicator of fluid retention and worsening heart failure.

Drinking as much fluid as desired can lead to fluid overload and exacerbate congestive heart failure. Stopping medication once feeling better can lead to a recurrence or worsening of heart failure symptoms. Medications should be maintained until they are discontinued by the physician. Maintaining moderate salt intake is insufficient; patients often need to follow a low-sodium diet to manage fluid balance and blood pressure effectively.

149.

Which of the following is not a contraindication for treating a myocardial infarction using thrombolytic therapy?

  • Systolic blood pressure greater than 160 mm Hg

  • Pregnancy

  • Traumatic cardiopulmonary resuscitation

  • Recent brain attack

Correct answer: Systolic blood pressure greater than 160 mm Hg

A systolic blood pressure of 180 mm Hg or greater, not 160 mm Hg, is a contraindication for using thrombolytic therapy when treating an MI (Myocardial Infarction). Pregnancy, traumatic cardiopulmonary resuscitation, and a recent stroke are all contraindications for using thrombolytic therapy to treat an MI.

150.

Which of the following is NOT a risk factor for a urinary tract infection (UTI)?

  • Glomerulonephritis

  • Enlarged prostate

  • Diabetes mellitus

  • Pregnancy

Correct answer: Glomerulonephritis

Infection of the urinary tract is more likely in women who are pregnant or in men with an enlarged prostate. Diabetes mellitus increases the glucose content of the urine, making it more likely to grow bacteria and cause a UTI.

Glomerulonephritis is inflammation of the glomeruli and does not cause UTIs.

151.

A patient is prescribed warfarin for atrial fibrillation. Which food should the nurse educate the patient to consume consistently to avoid fluctuations in INR (international normalized ratio) levels?

  • Spinach

  • Bananas

  • Oranges

  • Chicken

Correct answer: Spinach

Spinach is high in vitamin K, which can affect the efficacy of warfarin by lowering INR levels. Consistency in vitamin K intake is crucial to maintain stable INR levels and avoid fluctuations in anticoagulant effects.

Oranges, bananas, and chicken do not have a vitamin K content and have minimal impact on INR levels. They do not necessitate consistent consumption for warfarin patients.

152.

The physician has just ordered ferrous sulfate (iron) for a patient with iron-deficiency anemia. Which of the following instructions is appropriate for the nurse to give the patient related to this new order?

  • Ferrous sulfate may be taken with juice

  • If the medication causes stomach upset, take with milk or an antacid

  • Ferrous sulfate often causes hard, clay-colored stools

  • Ferrous sulfate may decrease the amount of thyroid medication the patient needs to take

Correct answer: Ferrous sulfate may be taken with juice

Ferrous sulfate may be taken with juice, but not with milk or antacids because these reduce the bioavailability of the iron supplement.

Iron often causes dark-colored, not clay-colored stools. Ferrous sulfate may decrease the absorption of thyroid drugs; this could potentially cause an increase (not a decrease), in the amount of thyroid medication needed.

To avoid interactions with thyroid drugs, the patient should be told to separate the two medications by at least four hours. The nurse should also make sure the physician is aware the patient is taking a thyroid medication.

153.

Which of the following is not true about the posterior pituitary gland?

  • It is larger than the anterior pituitary gland

  • It is located within the intracranial vault

  • It secretes oxytocin

  • It is also called the neurohypophysis

Correct answer: It is larger than the anterior pituitary gland

The posterior pituitary gland is smaller than, not larger than, the anterior pituitary gland. The anterior pituitary gland is also called the adenophyophysis while the posterior pituitary gland is called the neurohypophysis. It is located within the intracranial vault at the base of the brain and secretes oxytocin and antidiuretic hormone.

154.

A nurse is caring for a patient with diabetes who is not managing their blood sugar levels effectively. Which interdisciplinary team member should the nurse involve for patient education?

  • Diabetes educator

  • Pharmacist

  • Endocrinologist

  • Dietitian

Correct answer: Diabetes educator

The diabetes educator is the best choice for patient education because they have specialized knowledge in diabetes management, including blood sugar monitoring, medication adherence, and lifestyle modifications.

Pharmacists can provide information about medications but do not typically offer comprehensive diabetes education. Endocrinologists are experts in hormonal disorders, including diabetes, but they may not have the time to provide detailed patient education. Dietitians can offer nutritional advice but may not cover all aspects of diabetes management like a diabetes educator would.

155.

A nurse and a physical therapist are collaborating on a patient's rehabilitation plan. Which statement by the nurse best demonstrates effective interdisciplinary communication?

  • "Here are the patient's mobility limitations and goals."

  • "The patient seems fine to me; I’d recommend just following your usual protocol."

  • "I will take full responsibility for the patient's outcomes."

  • "I will discuss the patient's progress after I have finished my other tasks."

Correct answer: "Here are the patient's mobility limitations and goals."

Explaining the patient's mobility limitations and goals provides specific information about the patient's condition and objectives which are essential for effective interdisciplinary collaboration. This statement helps the physical therapist tailor the rehabilitation plan to the patient’s needs.

Stating that the patient seems fine and recommending following the usual protocol is dismissive and does not provide the necessary detail for personalized care.

Taking full responsibility for the patient's outcomes undermines the collaborative nature of interdisciplinary work and does not foster shared accountability.

Delaying the discussion until after other tasks are finished does not prioritize collaboration and may hinder timely decision-making.

156.

The nurse is caring for a patient who has developed an acute Gastrointestinal (GI) hemorrhage. The patient's wife asks, "Could this kill him?" Which of the following answers is best?

  • "A small percentage of people with this type of bleeding do have negative outcomes, but we are doing everything we can to help him."

  • "It is likely that this could be fatal, but we will do our best to make sure he pulls through."

  • "Modern advances make it very unlikely that he will die from this."

  • "We will need you to go to the waiting room until we have him stabilized."

Correct answer: "A small percentage of people with this type of bleeding do have negative outcomes, but we are doing everything we can to help him."

The overall mortality rate for GI hemorrhage ranges from 6–13%. Telling the patient's wife that he is likely to die is incorrect, as is saying that this is very unlikely. The patient's wife should be told the truth, that there is a small likelihood of death, but the nurse should also emphasize that the best care possible is being provided. Ignoring the questions is not a correct response.

157.

A nurse suspects a patient is being abused but the patient denies it when asked. What is the nurse’s ethical obligation?

  • Report the suspicions to the appropriate authorities

  • Respect the patient’s denial and drop the matter

  • Examine the patient further, only reporting the situation if findings are conclusive

  • Encourage the patient to discuss their situation openly

Correct answer: Report the suspicions to the appropriate authorities

The nurse has a legal and ethical obligation to report suspicions of abuse to the appropriate authorities to ensure the safety and well-being of the patient. This duty persists regardless of the patient's denial because the nurse's primary responsibility is to protect vulnerable individuals from harm.

Respecting the patient’s denial and dropping the matter is incorrect because it could leave the patient in a harmful situation; it fails to comply with mandatory reporting laws.

Waiting for conclusive findings before reporting may delay crucial interventions and is not aligned with the nurse’s duty to act when there is reasonable suspicion. While encouraging the patient to discuss their situation openly is supportive, it does not meet the legal obligation to report suspected abuse.

158.

A medical-surgical RN needs to delegate the task of administering oral medications to a stable patient. Which healthcare team member is most appropriate for this task?

  • Licensed practical nurse

  • Nursing assistant

  • Medical assistant

  • Physician assistant

Correct answer: Licensed practical nurse

Licensed practical nurses (LPNs) are qualified to administer medications, including oral medications, under the supervision of an RN or physician, making them the appropriate choice.

Nursing assistants are not licensed to administer medication, as this task requires specific training and licensure. Medical assistants may administer medication in some settings, but typically under direct supervision and are more limited in their scope of practice compared to LPNs. Physician assistants are overqualified for administering routine oral medications and should focus on more complex clinical tasks and patient assessments.

159.

The nurse is providing teaching to a patient who has recently been diagnosed with heart failure. Which of the following statements by the patient requires further teaching?

  • I should limit my potassium intake.

  • I should limit my sodium intake.

  • I should limit my cholesterol intake.

  • I should limit my fluid intake.

Correct answer: I should limit my potassium intake.

Potassium is a necessary electrolyte for heart health and cell signaling. The body is quite sensitive to changes potassium ranges, and potassium intake should not be limited just based on a diagnosis of heart failure. Sodium and fluid intake should both be limited to avoid fluid volume overload, exacerbating heart failure. Cholesterol intake should be limited to optimize heart health.

160.

A 60-year-old woman with a family history of breast cancer is concerned about her risk. Which intervention is MOST appropriate to recommend during her annual health examinations?

  • Annual mammography

  • Genetic testing

  • No screening is needed until age 65

  • Breast ultrasound

Correct answer: Annual mammography

Annual mammography is the most appropriate screening method for breast cancer in women aged 60, particularly with a family history, as it allows for early detection and treatment.

Genetic testing can be useful but is not routinely recommended for all women with a family history of breast cancer unless there are multiple family members affected or other risk factors. Delaying screening until age 65 is not appropriate for someone with a family history of breast cancer, as earlier detection can significantly improve outcomes. Breast ultrasound is typically used as a supplementary tool rather than the primary screening method and is not as effective as mammography for routine breast cancer screening.

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