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Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 2 of 50

21.

You are assigned to care for Mrs. B., who was admitted to the medical-surgical unit with a 4-day history of nausea and vomiting. She has a medical history of chronic obstructive pulmonary disease, hypertension, and diabetes. She is weak and dehydrated. Many of her electrolytes are out of normal range. You complete a Malnutrition Screening Tool and calculate a score of 3.

Of the following, what is the best action to take next?

  • Place a nutrition team screening consult in the patient's electronic chart

  • Inform the physician of your assessment findings

  • Start an IV on the patient to replace fluids

  • Do a complete blood workup and place an abdominal CT order in the patient's electronic chart

Correct answer: Place a nutrition team screening consult in the patient's electronic chart

Being a proactive nurse, you should first place a nutrition team screening consult/referral in the electronic medical record because you know a score of 2 or greater suggests malnutrition. Next, you should inform the physician of your assessment findings and follow-up referral that you placed; obtain an order from the physician before you start an IV and draw labs. The physician will likely place any necessary imaging orders in the patient's chart, not you.

22.

A Colles' fracture is most likely to be diagnosed in which of the following patients?

  • A young boy who has slipped on the ice and is complaining of severe pain in his wrist

  • An elderly woman who has fallen out of bed whose right leg is externally rotated and shorter than the left

  • A teenage girl who was hit by another player during a soccer game who reports extreme pain in her left ankle

  • A 98-pound male patient with lung cancer, complaining of pain in his right rib area

Correct answer: A young boy who has slipped on the ice and is complaining of severe pain in his wrist

A Colles' fracture occurs within the last inch of the distal radius; the distal fragment is displaced in a position of dorsal and medial deviation, producing pain in the wrist.

A Colles' fracture would have no effect on a patient's leg length or position, nor cause pain in the rib area. Extreme pain in the ankle following an injury would likely indicate a Pott's fracture.

23.

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.

24.

You are supervising a student nurse who is caring for a 43-year-old male who has chronic pancreatitis. Which of the following statements made by the student to the patient indicates that they need more teaching?

  • "The cause of chronic pancreatitis is alcohol abuse."

  • "Chronic pancreatitis tends to have periods of remission and periods of exacerbation."

  • "Most people who have chronic pancreatitis do not die because of it."

  • "Avoiding alcohol is recommended."

Correct answer: "The cause of chronic pancreatitis is alcohol abuse."

While the cause of chronic pancreatitis is alcohol abuse in about 80% of cases, this is not always true, and may not be true for this patient. 

It is true that chronic pancreatitis tends to have periods of remission and periods of exacerbation, that chronic pancreatitis is not often the cause of death for those who have it, and that alcohol use should be avoided for those with chronic pancreatitis.

25.

You are caring for a patient who has a tonic-clonic seizure. Which of the following interventions is most important during the seizure?

  • Ensure the patient's environment is safe

  • Check the patient's blood glucose level

  • Protect the patient's airway by using a tongue blade or intubating if possible

  • Hold the patient down so they do not injure themselves

Correct answer: Ensure the patient's environment is safe

If a patient is actively seizing, intervening could cause harm to yourself or to the patient, as they are not able to control their movements. Ensuring that the patient's environment is safe and that they will not harm themselves during the seizure will be the most useful intervention. 

Checking the patient's blood glucose level is important, but should not be done during a seizure. The patient may require airway management, but inserting a tongue blade or intubating the patient during the seizure is not advised. Holding the patient down will not be safe for yourself or the patient.

26.

Your patient, Mr. C., is scheduled for a gastric emptying study. You instruct him that:

  • He may be asked to drink orange juice during the study

  • He may be asked to drink barium during the study

  • A small tube (NG tube) may be inserted into his stomach so the contents can be aspirated

  • He will not be able to eat or drink for 8-12 hours prior to the test or during the test

Correct answer: He may be asked to drink orange juice during the study

For gastric emptying studies, the patient is often asked to eat a cooked egg white or to drink orange juice.

The purpose of gastric emptying studies (done via a nuclear imaging scan) is to identify functional disorders and structural defects. A radioactive isotope is injected intravenously, rather than consumed per mouth, and a scanning device picks up the radioactive emission. No preparation is needed except for teaching and verifying consent. Gastric analysis involves an NG tube inserted into the stomach and contents being aspirated for analysis.

27.

Which of the following assessments would best enable the nurse to distinguish a pleural effusion from a pneumothorax?

  • Percussion

  • Auscultation

  • Inspection

  • Palpation

Correct answer: Percussion

Percussion will be affected by the density of the underlying tissues. A pleural effusion will consist primarily of fluid, providing dullness or flatness with percussion. A pneumothorax will provide hyper-resonance or tympani percussion. Auscultation will typically reveal diminished lung sounds with either condition. Inspection may reveal tracheal deviation or less chest wall movement over the affected area, but it will not normally provide specific features that allow for either condition to be distinguished. Palpation may reveal crepitus in patients with a pneumothorax. Crepitus would conclusively indicate a pneumothorax; however, it is often not present with pneumothoraces, and its absence does not provide useful information in distinguishing the two conditions.

28.

Which of the following is least likely to be a risk factor for developing meningitis?

  • Kidney disease

  • IV drug use

  • Chemotherapy use

  • Diabetes

Correct answer: Kidney disease

Risk factors for developing meningitis include IV drug use, the use of chemotherapy, and diabetes, as all of these factors increase the risk of infection. Kidney disease does not create a meaningful increase in the risk of meningitis.

29.

Which of the following conditions does not increase the risk of an ischemic stroke?

  • Christmas disease

  • Pregnancy

  • Femur fracture

  • Atrial fibrillation

Correct answer: Christmas disease

Christmas disease, also called hemophilia B, is a disorder where a clotting factor IX deficiency increases the risk of bleeding. This condition does not increase the risk of an ischemic stroke. 

Pregnancy can increase the risk of amniotic fluid embolism, which can lead to an ischemic stroke. A femur fracture can lead to fat embolisms that can lead to an ischemic stroke. Atrial fibrillation can increase the risk of blood clots from static blood in the atrium, increasing the risk of ischemic stroke.

30.

Which of the following is least likely to be a risk factor for cystitis?

  • Recent use of antibiotics

  • Female gender

  • Recent indwelling urinary catheterization

  • Enlarged prostate gland

Correct answer: Recent use of antibiotics

Cystitis is inflammation of the bladder wall, typically caused by an infection. Recent use of antibiotics would make it less likely, not more likely, that a patient would develop cystitis. Cystitis is more common in females, but if it does occur in males, it is more likely to occur in males with an enlarged prostate gland. Recent indwelling urinary catheterization is a significant risk factor for cystitis as it increases the risk of infection.

31.

You are providing your patient with discharge education about warfarin (Coumadin), which was initiated during his hospitalization after a cardiac valve replacement. During your teaching, you explain the potential interactions of warfarin with certain medications. All of the following medications may potentiate warfarin except:

  • Acetaminophen (Tylenol)

  • Aspirin

  • Steroids

  • Glucagons

Correct answer: Acetaminophen (Tylenol)

Warfarin (Coumadin) is an anticoagulant that works by decreasing synthesis of coagulation factors to help prevent blood clots from forming. It is used for treatment of pulmonary embolus, DVT, MI, atrial dysrhythmias, and postcardiac valve replacement. If taken with steroids, aspirin, glucagons, allopurinol, or metronidazole, warfarin can have an increased action; therefore, it is advised not to take those medications while taking warfarin.

Acetaminophen does not interfere with warfarin.

32.

Which of the following interventions is least likely to promote a reduction in Intracranial Pressure (ICP)?

  • Cluster activities to promote long periods of rest

  • Pre-oxygenating prior to and after each suctioning

  • Ensure low lighting and low noise levels

  • Ensure pain is well managed

Correct answer: Cluster activities to promote long periods of rest

Clustering activities can lead to a compounding effect for activities that increase ICP, leading to significant elevations of ICP. Pre-oxygenating prior to and after each suctioning reduces hypoxia, which in turn reduces the risk of ICP elevations. Ensuring low lighting and low noise levels reduces excessive neurostimulation and noxious stimuli. Managing pain and restlessness decreases distress that can lead to elevations in ICP.

33.

You are providing teaching to a patient who asks you what causes asthma. Which of the following statements best describes the pathology of asthma?

  • "Asthma is inflammation in the airways that often is triggered by an irritant."

  • "Asthma is known to be an autoimmune condition that causes intermittent edema affecting the airways."

  • "Asthma is caused by an inflammatory process that primarily affects the alveoli."

  • "Asthma is a type of chronic obstructive pulmonary disorder that can be fatal."

Correct answer: "Asthma is inflammation in the airways that often is triggered by an irritant."

Asthma is an inflammatory condition that affects the airways by causing edema associated with the inflammatory process. This inflammatory response is often triggered by an irritant. 

While it is hypothesized that asthma is an autoimmune condition, this is not known to be the case. Asthma does cause inflammation leading to edema that is intermittent; these intermittent episodes are often triggered and do not occur spontaneously. Asthma is an inflammatory process, but primarily affects the airways, not the alveoli. While asthma was classified as a type of chronic obstructive pulmonary disorder (COPD), it is no longer considered to fall under the umbrella of COPD.

34.

Your patient is preparing for a cardiac catheterization. Primary nursing responsibilities for this patient during preparation include all of the following except:

  • Asking the patient if they have any metallic implants or electronic devices

  • Teaching the patient about use of local anesthesia

  • Confirming that the patient has been NPO for 6 to 12 hours before the procedure

  • Determining potential allergy to dye

Correct answer: Asking the patient if they have any metallic implants or electronic devices

Cardiac catheterization involves inserting a catheter into the heart and can provide information about oxygen saturation and pressure reading within chambers. Dye can be injected to assist in examining the structure and motion of the heart. The procedure is done by insertion of a catheter into a vein (for right side of heart) or an artery (for left side of heart). Prior to cardiac catheterization, the patient should be NPO for at least 6 to 12 hours, in the event that emergency intubation is required during the procedure. NPO may indicate everything except medications, which should be taken with small sips of water the day of the procedure. The nurse should teach the patient about use of local anesthesia for catheter insertion, and in the event that sedation is ordered. In addition, the nurse should determine potential allergy to dye and obtain written consent. 

Asking the patient if they have any metallic implants or electronic devices is necessary when the patient is getting an MRI performed, not a cardiac cath.

35.

In mild hypoglycemic reactions, when the patient has an intact swallowing response, which of the following should be given?

  • 15 grams of fast-acting carbohydrates

  • 25 grams of fast-acting carbohydrates

  • 25 grams of protein

  • 15 grams of protein

Correct answer: 15 grams of fast-acting carbohydrates

In mild hypoglycemic reactions, when the patient has an intact swallowing response, the 15/15 rule is generally applied: eat 15 grams of fast-acting carbohydrates and wait 15 minutes. Repeat as needed, until blood glucose levels are greater than 70 mg/dl.

In severe hypoglycemic reactions, when the patient is unconscious or unable to swallow, intramuscular or subcutaneous glucagon or intravenous glucose (dextrose 50%) should be administered.

36.

A 65-year-old patient with benign prostatic hypertrophy (BPH) doesn’t respond to medical treatment and is admitted to the facility for prostate gland surgery. Before providing preoperative and postoperative instructions to the patient, the nurse asks the surgeon which prostatectomy procedure will be performed.

What is the most widely used surgical procedure for BPH treatment?

  • Transurethral resection of prostate (TURP)

  • Transurethral incision of the prostate

  • Retropubic prostatectomy

  • Suprapubic prostatectomy

Correct answer: Transurethral resection of prostate (TURP)

TURP is the most widely used surgical procedure for BPH treatment. Because it requires no incision, TURP is especially suitable for men with relatively minor prostatic enlargements and for those who are poor surgical risks. 

Suprapubic prostatectomy, retropubic prostatectomy, and transurethral incision of the prostate are less common procedures, and they all require incisions.

37.

The most frequently reported sexually transmitted infection (STI) in the United States is:

  • Chlamydia

  • Gonorrhea

  • Human papillomavirus (HPV)

  • Syphilis

Correct answer: Chlamydia

The Centers for Disease Control (CDC) estimates there are about 20 million new infections in the United States each year, and half of all new STIs occur in young men and women. Chlamydia is the most frequently reported STI in the US, with infection rates having increased over the past 20 years. 

Chlamydia is caused by bacterium Chlamydia trachomatis; it may be passed from mother to infant during birth and treatment consists of oral antibiotic therapy for the patient as well as all sexual partners.

38.

When reviewing the chart of your patient with long-standing chronic obstructive pulmonary disease (COPD), you should pay close attention to the results of which pulmonary function test?

  • FEV1/FVC ratio

  • Residual volume

  • Total lung capacity

  • Functional residual capacity

Correct answer: FEV1/FVC ratio

The FEV1/FVC ratio (forced expiratory volume in 1 second/forced vital capacity) indicates disease progression. As COPD worsens, the ratio of FEV1 to FVC becomes smaller. Residual volume and total lung capacity reflect a loss of elastic recoil due to narrowing and obstruction of the airway. Functional residual capacity is increased in patients with obstructive bronchitis.

39.

The nurse is assessing a patient's lung sounds. Where should the nurse expect to find vesicular lung sounds?

  • In the peripheral lung fields

  • In the center fields of each lung

  • Over the sternum or trachea

  • Vesicular lung sounds are an abnormal finding, and should not be present in healthy patients

Correct answer: In the peripheral lung fields

Vesicular lung sounds are low-pitched, soft, breezy lung sounds that should be present over the peripheral aspects of the lung fields. Bronchovesicular lung sounds should be present in the center fields of each lung and bronchial lung sounds should be noted over the sternum or trachea. Vesicular lung sounds are an expected finding.

40.

Prior to auscultation of heart sounds, it is important to locate the auscultatory sites. Which of the following areas is located in the second right intercostal space?

  • Aortic area

  • Tricuspid area

  • Mitral area or apex

  • Pulmonic area

Correct answer: Aortic area

The aortic area of the heart is generally auscultated in the second right intercostal space (ICS), near the sternum.

The tricuspid area is in the fourth left ICS, close to the sternum (left lower sternal border). The point of maximum impact in the mitral area lies within the fifth left ICS (midclavicular line). The pulmonic valve area is in the second left ICS, near the sternum.

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