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Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 10 of 50

181.

A student nurse asks the nurse caring for a patient with heart failure why strict I & O was ordered. Which of the following responses is best?

  • This is primarily to allow for early detection of fluid volume overload.

  • This is primarily to ensure she stays hydrated.

  • This is primarily to detect hemodilution.

  • This is primarily to monitor renal function.

Correct answer: This is primarily to allow for early detection of fluid volume overload.

Heart failure can lead to fluid volume retention, indicated by a greater fluid intake than fluid output. Monitoring intakes and outputs can allow for early detection of fluid volume overload. Ensuring hydration is not the primary reason for this. While fluid volume overload can lead to hemodilution, this is not the primary concern. Monitoring I & O will help monitor renal function and this is an important reason for this intervention, however, in a patient with heart failure, detecting fluid volume overload is a greater concern.

182.

You are assessing your patient's adaptation to the changes in functional status after a cerebrovascular accident (stroke). You determine that the patient is most successfully adapting if she:

  • Consistently uses assistive devices when dressing herself

  • Refuses to use modified feeding utensils

  • Gets angry with family if they interrupt a task

  • Experiences bouts of depression and irritability

Correct answer: Consistently uses assistive devices when dressing herself

Patients are evaluated as coping successfully with lifestyle changes after a stroke if they make appropriate lifestyle alterations, accept the assistance of others, and exhibit appropriate social interactions.

Refusal to use adaptive devices, inappropriate anger, and depression and irritability are not considered successful adaptive behaviors.

183.

What is the most common cause of scoliosis?

  • Scoliosis is most commonly ideopathic

  • Vertebral compression fractures

  • Injuries related to motor vehicle accidents

  • Degenerative changes

Correct answer: Scoliosis is most commonly ideopathic

There is no known etiology for 80% of cases of scoliosis, making idiopathic scoliosis the most common type of scoliosis. Vertebral compression fractures, other spinal injuries, and degenerative changes are all potential causes of scoliosis, but are not the most common causes.

184.

Cardiomyopathy is a cardiac disease involving which of the following?

  • Myocardium

  • Left anterior descending coronary artery

  • Chordae tendineae

  • Aorta

Correct answer: Myocardium 

Cardiomyopathy (CMP) is a group of diseases that directly affect the heart muscle, the myocardium. Myopathy may also involve the endocardial and pericardial layers of the heart. It is commonly divided into three categories: Dilated, hypertrophic, and restrictive.

185.

Accuracy of a pregnancy test in detecting human chorionic gonadotropin (HCG) in urine is greatest:

  • 6 weeks after last menstrual period

  • 8 weeks after last menstrual period

  • 4 weeks after last menstrual period

  • 10 weeks after last menstrual period

Correct answer: 6 weeks after last menstrual period 

The accuracy of a urine pregnancy test is greatest 6 weeks after last menstrual period.

The patient should be instructed to obtain the first morning urine specimen, and the nurse should assess for signs of pregnancy, such as breast changes and an increase in whitish vaginal discharge.

186.

While teaching your patient about coronary artery disease (CAD), you explain that the changes that occur in this condition involve:

  • Accumulation of lipid and fibrous tissue within the coronary arteries

  • Chronic vasoconstriction of coronary arteries leading to permanent vasospasm

  • Formation of fibrous tissue around coronary artery orifices

  • Diffuse involvement of plaque formation in coronary veins

Correct answer: Accumulation of lipid and fibrous tissue within the coronary arteries 

CAD is characterized by an accumulation of plaque, cholesterol, and connective tissues on the intimal wall (not orifices) of the coronary arteries (not veins) that leads to partial or total blockage of the artery. It produces thickening and hardening within the coronary artery with lipid, free fatty acid, and platelet aggregation.

CAD does not involve vasoconstriction leading to permanent vasospasm.

187.

When checking your patient's respiratory status, you observe respiratory excursion to help assess:

  • Chest movements

  • Voice sounds

  • Lung vibrations

  • Breath sounds

Correct answer: Chest movements 

You observe respiratory excursion to help assess the movement of the diaphragm and the degree to which the ribcage expands and contracts as a person breathes (chest movements). Normally, thoracic expansion is symmetrical; an unequal expansion may indicate pleural effusion, atelectasis, pneumonia, or pneumothorax (affected side will have decreased expansion).

You assess voice sounds to evaluate airflow when checking for tactile fremitus; after asking the patient to say “99,” palpate the vibrations transmitted from the bronchopulmonary system along the solid surfaces of the chest wall to your palms. You assess breath sounds during auscultation with a stethoscope.

188.

A patient begins vomiting dark vomitus with a "coffee ground" appearance. The nurse recognizes that which of the following is most likely?

  • The patient has been bleeding internally for some time.

  • The patient has an acute gastrointestinal hemorrhage.

  • The appearance of the vomitus is likely due to something the patient ate.

  • The patient has a gastrointestinal obstruction.

Correct answer: The patient has been bleeding internally for some time.

Dark, coffee ground vomitus is indicative of gastrointestinal bleeding that has spent some time in contact with stomach contents. An acute gastrointestinal hemorrhage will have bright red blood. This finding is not likely due to something that was ingested and is not indicative of gastrointestinal obstruction.

189.

Which of the following best describes crepitus?

  • A crackling or grating sensation

  • Air trapped under the skin

  • A joint that does move smoothly

  • A type of breathing pattern that occurs immediately preceding death

Correct answer: A crackling or grating sensation

Crepitus refers to a crackling or grating sensation that typically is noted with joints that do not move smoothly, sometimes called "creaky joints," or with air that is trapped under the skin. 

Air trapped under the skin is technically subcutaneous emphysema. While crepitus is used to describe the crackling sensation caused by subcutaneous emphysema, it is not the definition of this condition, but a description of the sensation it causes. Crepitus can also be used to describe the creaky or grating sensations in joints that do not move smoothly. Again, crepitus is not the condition itself, but a descriptor of the sensations caused by this condition. Crepitus does not have anything to do with breathing patterns that occur prior to death.

190.

Which of the following is least likely to be a cause of central apnea?

  • Airway obstruction

  • Stroke

  • Head trauma

  • Medication side effects

Correct answer: Airway obstruction

Central apnea is apnea that has a neurological cause, ultimately causing a cessation of respiratory effort that lasts for more than 10 seconds. Central apnea can be caused by neurological damage, such as a stroke or head trauma. Central apnea can also be caused by medications affecting the central nervous system, such as opioids. While airway obstruction can cause apnea, this is not central apnea, as the patient is still able to attempt respiratory effort.

191.

The family member of a patient who has just developed unilateral weakness and is suspected of having a stroke asks the nurse what the chances are that this stroke is caused by bleeding instead of a blockage. The nurses answer is guided by her understanding that which of the following is true?

  • Ischemic strokes account for 87% of all strokes while hemorrhagic strokes account for 13% of strokes.

  • Ischemic strokes account for 62% of all strokes while hemorrhagic strokes account for 38% of strokes.

  • Ischemic strokes account for 96% of all strokes while hemorrhagic strokes account for 4% of strokes.

  • Ischemic strokes account for 45% of all strokes while hemorrhagic strokes account for 55% of strokes.

Correct answer: Ischemic strokes account for 87% of all strokes while hemorrhagic strokes account for 13% of strokes.

Ischemic strokes are much more common than hemorrhagic strokes, accounting for 87% of all strokes. The incidence of hemorrhagic strokes, however, is not negligible with 13% of all strokes occurring due to hemorrhage. Understanding this data is important for the nurse to be able to correctly convey the relative risks to the patient's family.

192.

Cancer of the posterior pituitary gland is most likely to affect which of the following?

  • Urination

  • Thyroid function

  • Lactation

  • Heart function

Correct answer: Urination

The posterior pituitary gland produces two hormones, oxytocin and antidiuretic hormone. The antidiuretic hormone plays an important role in restricting urine production and cancer affecting the posterior pituitary gland would likely have an impact on urine production. Thyroid function, lactation, and heart function could all be influenced by hormones produced in the anterior pituitary gland, not the posterior pituitary gland.

193.

Which of the following interventions will help to enhance mobility and recovery in a patient who has just had a total hip arthroplasty?

  • The patient should begin ambulating as soon as possible once they return from the surgery

  • The patient will need continuous passive motion (CMP) to help maintain range of motion

  • The patient should exercise by moving the leg side to side as far as it will go each way

  • The patient should try to move the hip for as little as possible for the first 48 hours until the swelling at the surgical site has decreased

Correct answer: The patient should begin ambulating as soon as possible once they return from the surgery

Early mobilization of the joint is recommended to promote an earlier and more complete recovery. 

CPM is used for patients who have had a knee replacement, not a hip replacement. Patients who have recently had a hip replacement should not allow the surgical leg to cross the midline, as this increases the risk of dislocating the joint. Limiting mobility of the joint is not recommended following a total hip arthroplasty.

194.

You are providing discharge teaching to a patient who was admitted for peptic ulcer disease (PUD). Which of the following statements by the patient indicates the need for further teaching?

  • "Peptic ulcer disease is never caused by infections."

  • "I should try to take Tylenol instead of Aleve for my joint pain."

  • "If I stop smoking, it will reduce my risk of peptic ulcer disease in the future."

  • "Stress reduction will help me to avoid having worsening of my peptic ulcer disease."

Correct answer: "Peptic ulcer disease is never caused by infections."

Peptic ulcer disease is caused by lifestyle choices, genetic factors, and H. pylori infections. NSAID use, smoking, and stress are all factors that increase the risk of PUD.

195.

Your patient has just returned to the medical-surgical floor from the post-anesthesia care unit following bowel resection surgery. To best prevent dehiscence, you should:

  • Keep the abdominal binder in place

  • Remove the abdominal binder and encourage deep breathing every 2 hours

  • Administer enoxaparin (Lovenox) as ordered

  • Make sure the patient is fully awake before offering fluids per mouth

Correct answer: Keep the abdominal binder in place

Dehiscence (wound ruptures along a surgical incision) is a serious surgical complication, especially with abdominal incisions, which may occur when sutures start to give way and may be caused by infection, marked abdominal distention, strenuous coughing, increasing age, and poor nutritional status. It is best prevented by using and keeping an abdominal binder in place.

Administering enoxaparin (Lovenox) as ordered (for DVT prophylaxis) and making sure the patient is fully awake before offering fluids per mouth are both important postoperative nursing interventions, but will not prevent dehiscence.

196.

The nurse is providing discharge teaching for a patient who was admitted with urinary retention. Which of the following statements made by the patient indicates the need for further teaching?

  • I will reduce my fluid intake to avoid overdistension of my bladder.

  • I should use Kegal exercises regularly.

  • I will drink prune juice every day to avoid constipation.

  • I should try to void every two hours.

Correct answer: I will reduce my fluid intake to avoid overdistension of my bladder.

Fluid intake should be increased, not decreased, to encourage the production of more urine. Avoiding overdistension of the bladder should be done by facilitating emptying of the bladder, not by avoiding filling of the bladder. Kegal exercises, avoiding constipation, and voiding frequently and regularly will help reduce urinary retention.

197.

To reduce the likelihood of aspiration in a patient who is receiving enteral feeding, all of the following measures are appropriate except:

  • Flush tube with 30 mL of warm water before and after each medication administration, after checking residuals, after intermittent feedings, and every 4 hours during continuous feeding

  • Providing frequent oral hygiene

  • Verifying position of feeding tube

  • Removing the feeding tube as soon as possible

Correct answer: Flush tube with 30 mL of warm water before and after each medication administration, after checking residuals, after intermittent feedings, and every 4 hours during continuous feeding

Routinely flushing the tube is a preventative measure of mechanical complications such as tube obstruction, not aspiration. 

To reduce the likelihood of aspiration in a patient who is receiving enteral feeding, the following measures are appropriate: maintaining meticulous oral hygiene, verifying appropriate placement of feeding tube, and removing the feeding tube as soon as possible.

198.

Which of the following statements regarding urine specific gravity determination is false?

  • Increase in specific gravity indicates increased renal perfusion

  • The dipstick method is the most common method of measuring specific gravity

  • Normal is 1.010 to 1.025

  • Increase in specific gravity indicates urine that is more highly concentrated than normal

Correct answer: Increase in specific gravity indicates increased renal perfusion

Specific gravity can be measured by dipstick, refractometer, or urinometer, with the dipstick being the most common and urinometer being the least common.

Normal specific gravity for urine is 1.010 to 1.025. An increase in specific gravity indicates the urine is more highly concentrated than normal. This can occur with dehydration, poor or decreased renal perfusion, or increased ADH (anti-diuretic hormone).

199.

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.

200.

You are admitting a 54-year-old female who came to the ER for changes in mental status. Upon assessment, you note ascites, icterus, and confusion. The patient has a history of GERD, alcoholism, asthma, and atrial fibrillation. Which of the following is most likely the cause of the patient's confusion?

  • Elevated ammonia levels

  • Thrombosis in the brain

  • Fluid in the lungs, causing hypoxia

  • Inflammation of the airways, causing hypoxia

Correct answer: Elevated ammonia levels

Ascites and icterus are both symptoms of liver failure. Coupled with the patient's history of alcoholism, liver failure is the likely cause of the patient's symptoms. Elevated ammonia levels caused by liver failure are the source of confusion or changes in mental status that occur with liver failure. 

Ischemic stroke or hypoxia from any cause are not likely the source of this patient's confusion.

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