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Quiz Session - Attempts With Random Questions

ANCC MEDSURG-BC Exam Questions

Page 9 of 75

161.

A nurse is counseling a 60-year-old male patient who smokes and has type 2 diabetes. Which of the following vaccinations is MOST critical for him?

  • Pneumococcal vaccine

  • Hepatitis B vaccine

  • Human papillomavirus vaccine

  • Measles, mumps, and rubella vaccine

Correct answer: Pneumococcal vaccine

The pneumococcal vaccine is critical for a 60-year-old patient who smokes and has type 2 diabetes because these conditions significantly increase the risk of pneumonia and its complications. This vaccine helps prevent pneumococcal disease, which can be severe and potentially life-threatening in older adults with comorbidities.

The Hepatitis B vaccine is not as critical for this patient’s age and health profile, as it is more crucial for individuals with higher risk factors for hepatitis B, such as healthcare workers or those with multiple sexual partners.

The human papillomavirus vaccine is primarily recommended for younger individuals to prevent HPV-related cancers and is not a priority for a 60-year-old male.

The measles, mumps, and rubella vaccine is generally administered in childhood, and unless there is a specific risk factor or outbreak, it is not a critical vaccine for a 60-year-old.

162.

A patient's lab results show a critically high potassium level. What is the nurse's priority action?

  • Notify the physician immediately

  • Hold any ordered insulin

  • Encourage the patient to drink more fluids

  • Repeat the test in an hour to assess the value’s trend.

Correct answer: Notify the physician immediately

Critically high potassium levels can lead to life-threatening cardiac arrhythmias. Notifying the physician immediately ensures that prompt medical interventions can be taken to stabilize the patient.

Insulin can contribute to lowering potassium levels, making this intervention unlikely to be used. Encouraging the patient to drink more fluids is not appropriate as it does not address the immediate danger posed by hyperkalemia. Treatment usually involves specific medications and monitoring. Repeating the test in an hour delays necessary treatment and does not address the urgent need to manage high potassium levels.

163.

Neurological changes related to hyperthyroidism include all of the following except:

  • Exophthalmos

  • Tremor

  • Heat intolerance

  • Hyperreflexia

Correct answer: Exophthalmos

Hyperthyroidism is a disorder of the thyroid gland in which there is a hypersecretion of thyroid hormones. Neurological changes related to hyperthyroidism include:

  • Tremor
  • Excessive sweating
  • Hyperreflexia
  • Heat intolerance

Exophthalmos is a specific, miscellaneous change related to Graves' disease (an autoimmune disease affecting the thyroid, and the most common cause of hyperthyroidism); it is characterized by a protrusion of the eyes caused by a collection of mucoproteins behind the eyeball, and is not related to any neurological changes.

164.

Thyroid-stimulating hormone (TSH) is secreted by the:

  • Anterior pituitary gland

  • Posterior pituitary gland

  • Hypothalamus

  • Adrenal glands

Correct answer: Anterior pituitary gland

The pituitary gland is often considered the most important part of the endocrine system because it produces hormones that control many functions of other endocrine glands. It is a small pea-sized gland located at the base of the brain and is anatomically divided into two major lobes: anterior (adenohypophysis) and posterior (neurohypophysis).

The anterior is the largest lobe of the pituitary gland and secretes several hormones: adrenocorticotropic hormone (ACTH), TSH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin.

165.

Which of the following statements is true related to laryngeal cancer?

  • Tumors that develop from squamous cells are the largest cause of malignant laryngeal cancer

  • Tumors of the subglottis are the most common form of laryngeal cancer

  • Race is not a risk factor for the development of this disease, but it is more likely to occur in women

  • Diagnosis of laryngeal cancer is by CT scan

Correct answer: Tumors that develop from squamous cells are the largest cause of malignant laryngeal cancer

Tumors of the glottis (vocal cords), not the subglottis, are the most common form of laryngeal cancer; subglottic tumors are the least common. Race is a risk factor, as it is more commonly found in African-American males than in white males, and men are more likely to have laryngeal cancer than women. Diagnosis of laryngeal cancer is by visualization via laryngoscopy and biopsy (not CT scan).

166.

Which of the following patients with an MI is least likely to need surgical intervention?

  • A patient with a troponin greater than 1.2 ng/mL

  • A patient with 80% blockage of the left main coronary artery

  • A patient with 95% blockage of at least two coronary arteries

  • A patient who has not responded to medical management

Correct answer: A patient with a troponin greater than 1.2 ng/mL

Indications for surgical intervention of myocardial infarction include a significant (>75%) blockage of any two coronary arteries or the left main coronary artery. Ineffective medical management is also an indication for surgical intervention. Surgical intervention is not typically determined based exclusively on the troponin level.

167.

The nurse is providing care for a patient who only speaks Spanish. What option is the best to communicate with the patient during an emergency situation?

  • Using the hospital's phone-based interpreter system

  • Using a patient's family member who can speak both languages

  • Using a hospital staff member who speaks both languages

  • Communicating using drawings and hand gestures 

Correct answer: Using the hospital's phone-based interpreter system

The nurse should use the hospital's established interpreter service to ensure the accuracy of interpretation. Use of a family member or a hospital staff member is not recommended, as they can be unreliable. Using language alternatives is not recommended as a method of communication.

168.

What is the amount of force the ventricle must exert to eject blood into the arterial system known as?

  • Afterload

  • Systolic pressure

  • Diastolic pressure

  • Pulse pressure

Correct answer: Afterload

Afterload is the end load against which the heart contracts to eject blood.

Systolic pressure is the peak pressure exerted against the arteries when the heart contracts. Diastolic pressure is residual pressure within the arterial system during cardiac relaxation. Pulse pressure is the difference between the systolic and diastolic pressures.

169.

You are caring for a patient who has been diagnosed with Christmas disease who asks you what causes this condition. Which of the following responses is best?

  • "This condition is another name for hemophilia B and occurs because your body does not make a certain clotting factor."

  • "This condition is caused by high sodium intake and is often worse when you eat salty foods like the foods people eat over the holidays."

  • "This disease occurs because you have clotting throughout your body, which depletes clotting factors and makes bleeding more likely."

  • "This disease is a complication of infections that are most common in the winter months."

Correct answer: "This condition is another name for hemophilia B and occurs because your body does not make a certain clotting factor."

Christmas disease is another name for hemophilia B and is caused by the body not producing sufficient amounts of factor IX. This condition is named after Doctor Stephen Christmas, and the nomenclature has nothing to do with the holiday season. Systemic clotting leading to depletion of clotting factor is disseminated intravascular coagulation (DIC), not Christmas disease.

170.

Which of the following BEST describes the pathology of acute pancreatitis?

  • Pancreatic enzymes become active within the pancreas

  • Inflammation occurs due to an autoimmune response

  • Alcohol causes irritation and inflammation of the pancreas

  • Inflammation occurs due to an infection affecting the pancreas

Correct answer: Pancreatic enzymes become active within the pancreas

Pancreatitis occurs when pancreatic enzymes are activated while still within the pancreas. This premature activation of pancreatic enzymes may be promoted by alcohol use or infection. However, these two etiologies do not directly cause the inflammation in the pancreas themselves. Pancreatitis is not caused by an autoimmune disorder.

171.

When evaluating the urine of a patient with renal failure, the nurse understands which of the following is correct?

  • Sodium excretion decreases in pre-renal kidney failure and increases in intra-renal kidney failure.

  • Sodium excretion increases in both pre-renal kidney failure and intra-renal kidney failure.

  • Sodium excretion increases in pre-renal kidney failure and decreases in intra-renal kidney failure.

  • For sodium urine results to be valid, the sample must be obtained prior to diuretics, and urine must be less than 24 hours old.

Correct answer: Sodium excretion decreases in pre-renal kidney failure and increases in intra-renal kidney failure.

When analyzing a patient's urine sample for sodium, valid results must be obtained prior to diuretics and on urine less than 30 minutes old (not within 24 hours).

Sodium excretion decreases in pre-renal kidney failure because the body is attempting to compensate for a perceived volume loss by retaining sodium and fluid. Sodium excretion increases in intra-renal kidney failure because of abnormal kidney function, causing excessive sodium loss.

172.

The nurse is performing an admission assessment on a 44-year-old female with abdominal pain. The patient appears acutely ill with severe pain, guarding, and a rigid abdomen. The patient denies smoking or recreational drug use, but does report drinking 10–12 glasses of wine each week. Initial labs show an elevated amylase and mild hypokalemia. Which of the following best fits this patient's presentation?

  • Acute pancreatitis

  • Cirrhosis

  • Cholecystitis

  • Small bowel obstruction

Correct answer: Acute pancreatitis

The patient's symptoms combined with an elevated amylase are indicative of pancreatitis. When combined with the fact that the patient is a heavy alcohol user (defined as more than seven drinks a week for a female), this condition becomes much more likely to be the best fit.

173.

The nurse is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make?

  • Testicular cancer is a highly curable type of cancer

  • Testicular cancer occurs most frequently in men over the age of 50

  • Testicular cancer is the number one cause of cancer death in males

  • Testicular cancer is very difficult to diagnose

Correct answer: Testicular cancer is a highly curable type of cancer

Testicular cancer is highly curable, particularly when it is treated in its early stage; it is most often unilateral and has a 95% cure rate.

Self-examinations allow early detection and facilitate the early initiation of treatment. The highest mortality rates from cancer among men are in men with lung cancer. Testicular cancer is found more commonly in men aged 15-35.

174.

Your patient has been prescribed hydrocodone. You conclude that the medication is having the intended effect if the patient experiences:

  • Decreased coughing

  • Decreased respiratory secretions

  • Decreased nausea and vomiting

  • Decreased nasal congestion

Correct answer: Decreased coughing

Hydrocodone is an opioid, but it is also an example of a locally-acting antitussive. Antitussives work by mostly suppressing the cough center in the medulla of the brain. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of coughing without eliminating the cough reflex. Antitussives should be used cautiously because a cough is typically a mechanism the body uses to clear secretions and protect the airway. Benzonatate, codeine, and dextromethorphan are other examples of antitussives.

Expectorants and mucolytics decrease the viscosity of respiratory secretions. Vasoconstrictors decrease congestion. Antiemetics decrease nausea and vomiting.

175.

A 42-year-old male patient presents with a skin infection caused by Streptococcus pyogenes (a group A beta-hemolytic bacterium). The patient's lower leg is infected from the deep dermis to the subcutaneous fat.

What skin disorder does this describe?

  • Cellulitis

  • Impetigo

  • Folliculitis 

  • Skin abscess 

Correct answer: Cellulitis

Cellulitis is a diffuse, acute bacterial infection of the skin and subcutaneous tissues usually caused by Group A beta-hemolytic streptococci or Staphylococcus aureus. It may also be caused by non-group A Streptococcus, Haemophilus influenzae type B, Pseudomonas aeruginosa, or Campylobacter fetus. Common sites of cellulitis include the lower extremities, surgical and traumatic wounds, and tube and drain sites.

Impetigo is a bacterial infection of the skin that is most common in young children. It most often affects exposed skin, such as around the nose and mouth or on the arms or legs. Symptoms include red, itchy sores that break open and leak a clear fluid or pus for a few days. 

Folliculitis is a common skin condition that happens when hair follicles become inflamed. It's often caused by an infection from bacteria. At first, it may look like small pimples around the tiny pockets where each hair grows (hair follicles), and will get larger and more uncomfortable if left untreated. The armpits are a common site for folliculitis. 

Skin abscesses are another common type of skin infection, are also often bacterial in nature, and cause a collection of pus under the skin. 

176.

The lowest fasting plasma glucose level suggestive of a diagnosis of diabetes mellitus (DM) in nonpregnant adults is:

  • 127 mg/dL

  • 90 mg/dL

  • 180 mg/dL

  • 112 mg/dL

Correct answer: 127 mg/dL

Criteria for the diagnosis of diabetes mellitus in nonpregnant adults include the following:

  • Symptoms and random plasma glucose concentration of > 200 mg/dL, or
  • Fasting plasma glucose level > 126 mg/dL following an overnight fast of at least 8 hours, or
  • A1C > 6.5%, or
  • 2-hour plasma glucose > 200 mg/dL during an oral glucose tolerance test

177.

A nurse wants to improve patient outcomes by using evidence-based practice for managing chronic obstructive pulmonary disease (COPD). What is the most important initial step for ensuring widespread adoption?

  • Ensuring that staff understand the evidence supporting the changes

  • Incentivizing staff financially to adopt new standards of practice

  • Making staff education on the new changes mandatory

  • Allowing staff latitude to explore the evidence supporting the changes on their own

Correct answer: Ensuring that staff understand the evidence supporting the changes

Ensuring that staff understand the evidence supporting the changes is crucial because comprehension of the rationale behind the new practices enhances buy-in and adherence to evidence-based guidelines. This initial step lays a strong foundation for consistent and effective implementation.

Financial incentives alone may not lead to genuine acceptance or understanding of the new practices. Mandatory education can foster resistance if staff do not understand or see the value in the new changes. Allowing staff to explore evidence on their own lacks structure and may lead to inconsistent understanding and implementation.

178.

A nurse observes a colleague taking a shortcut that compromises patient safety. According to deontological ethics, what is the nurse's ethical obligation?

  • Report the behavior to the appropriate authority

  • Ignore the behavior if no immediate harm is observed

  • Confront the colleague privately and discuss the concerns

  • Determine if the shortcut was taken to improve the quality of care for all the colleague’s patients in general

Correct answer:

According to deontological ethics, the nurse's ethical obligation is to report the behavior to the appropriate authority. This approach emphasizes adherence to moral duties and principles, ensuring that patient safety and established protocols are maintained.

Ignoring the behavior, even if no immediate harm is observed, violates the duty to uphold safety and ethical standards and is contrary to deontological ethics.

Confronting the colleague privately addresses the issue but does not fulfill the formal duty to report unsafe practices and is not consistent with deontological ethics.

Determining the colleague’s intentions focuses on outcomes rather than the deontological commitment to ethical standards and patient safety.

179.

A patient is admitted with an initial blood glucose of 652 mg/dl and negative urine ketones. Which of the following conditions would the nurse infer that the patient has?

  • Hyperosmolar hyperglycemic syndrome

  • Diabetic ketoacidosis

  • Type one diabetes mellitus

  • Acute pancreatitis

Correct answer: Hyperosmolar hyperglycemic syndrome

A blood glucose of greater than 600 mg/dl is normally indicative of Hyperosmolar Hyperglycemic Syndrome (HHS). Diabetic Ketoacidosis (DKA) could be a possibility, although it does not normally result in hyperglycemia to that extent. The absence of urine ketones, however, rules out DKA. HHS is almost always associated with type two diabetes mellitus. While acute pancreatitis can cause HHS, it would be more reasonable to infer that this patient has HHS than to infer a potential cause of HHS.

180.

Which of the following groups is at a higher risk for developing a gastric ulcer?

  • Women

  • Men

  • Those with a type A personality

  • Younger populations

Correct answer: Women

Gastric ulcers are more common in women than they are in men. Peptic ulcers, not gastric ulcers, are more common in younger populations, in men, and in those with type A personalities.

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