×

Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 3 of 50

41.

Which of the following is a type of malignancy of plasma cells in bone marrow that leads to bone marrow failure and bone destruction?

  • Multiple myeloma

  • Hodgkin's lymphoma

  • Myelodysplastic syndrome

  • Non-Hodgkin's lymphoma

Correct answer: Multiple myeloma

Hodgkin's and non-Hodgkin's lymphomas are malignancies that involve lymph tissues. Myelodysplastic syndromes are a group of hematologic disorders arising from mutations in bone marrow, where some blood cells mature and function normally, while others do not. Myelodysplastic syndromes are mutations that specifically affect how red blood cells develop from hematopoietic stem cells. Multiple myeloma, in comparison, occurs because of a malignancy in plasma cells. The malignant plasma cells occupy more and more space, leading the the destruction of bone marrow, Both conditions may ultimately have a similar effect, however, multiple myeloma's effect is indirect while myelodysplastic syndromes have a direct effect. Multiple myeloma is the only condition that describes a malignancy of plasma cells.

42.

All of the following conditions have been linked to the development of malignant ovarian tumors except:

  • Multiple pregnancies

  • Celibacy

  • Endometriosis

  • High-fat diet

Correct answer: Multiple pregnancies

Malignant ovarian tumors are linked to:

  • Nulliparity
  • Infertility
  • Endometriosis
  • Celibacy
  • Use of talc on perineum
  • High-fat diet
  • Family history
  • Previous breast or colon cancer

43.

Which of the following is true about mean arterial pressure (MAP)?

  • MAP is average blood pressure in the arteries

  • MAP is calculated by taking the average of the systolic and diastolic blood pressures

  • Any MAP over 70 is healthy

  • A patient's MAP may sometimes exceed their systolic blood pressure

Correct answer: MAP is average blood pressure in the arteries

The definition of mean arterial pressure (MAP) is the average pressure in the arteries. 

MAP is calculated by using an weighted average of the systolic and diastolic blood pressures. The formula is (SBP+2*DBP)/3. A MAP between 100-70 is generally considered healthy, but a MAP that is too high can lead to health problems. Due to the way MAP is calculated, it will never exceed a patient's systolic blood pressure.

44.

A patient with chronic glomerulonephritis asks the nurse if they can stop taking their antihypertensives, as they are feeling better than they have been and their blood pressure has been normal recently. Which of the following answers is best?

  • You should continue to take your antihypertensives, even if your blood pressure has been okay.

  • Your antihypertensives are not related to your glomerulonephritis, you should ask your cardiologist about this.

  • You can probably stop them as long as your blood pressure is normal and you are feeling better.

  • Are you experiencing anxiety about having to take these medications?

Correct answer: You should continue to take your antihypertensives, even if your blood pressure has been okay.

Antihypertensive therapy is important for patients with chronic glomerulonephritis, as this condition affects the ability of the kidneys to regulate normal blood pressures. Patients should continue to take prescribed antihypertensive therapy unless they are experiencing hypotension. Asking the patient about their anxiety does not answer their question.

45.

The nurse is providing teaching about Diabetic Ketoacidosis (DKA). Which of the following statements by the patient indicates a correct understanding of the teaching?

  • DKA is caused when the cells run out of sugar.

  • DKA can only occur in patients with type one diabetes.

  • DKA is caused by high blood glucose levels.

  • DKA raises my pH and causes my blood to become acidic.

Correct answer: DKA is caused when the cells run out of sugar.

Diabetic Ketoacidosis (DKA) is a metabolic condition that occurs when the cells are unable to obtain the glucose they need to create energy. This causes a metabolic change that results in the production of acidic ketones, causing the blood to become acidic. DKA most commonly occurs in type one diabetics, as the complete lack of insulin makes it more likely that sugar will be unable to enter the cells. Patients with a more severe case of type two diabetes, however, may also go into DKA. DKA is not caused by high blood glucose levels, although the inability of sugar to enter the cells will normally cause it to accumulate in the blood, making blood glucose levels higher. DKA does cause the blood to become acidic, but acidity is associated with a decreased pH, not an increased pH.  

46.

You are caring for a 35-year-old woman, in previous good health and on no medications, who was admitted to the hospital with petechiae mainly on her legs, hemorrhagic bullae of the oral mucosa, reddish to purple-colored spots and patches on the skin, epistaxis, and gingival bleeding. The only abnormal laboratory finding is a low platelet count of 30,000/mcL (normal is 150,000 to 400,000).

What is the most likely diagnosis?

  • Idiopathic thrombocytopenia purpura (ITP)

  • Multiple myeloma

  • Disseminated intravascular coagulation (DIC)

  • Acute myelogenous leukemia (AML)

Correct answer: Idiopathic thrombocytopenia purpura (ITP)

ITP is considered a diagnosis of exclusion. All secondary causes of thrombocytopenia must be ruled out. In this case, routine workup shows normal findings. Numerous medications can cause thrombocytopenia (heparin, alcohol, quinidine/quinine, sulfonamides), but the patient denies taking any medications.

In high-risk patients, HIV/AIDS should also be ruled out as a possible etiology of thrombocytopenia.

47.

A patient has a kidney stone that is composed of uric acid. Which of the following foods should the nurse instruct the patient to avoid?

  • Organ meats

  • Eggs

  • Fruits

  • Raw vegetables

Correct answer: Organ meats

Uric acid stones accumulate due to the inefficient metabolism of purine proteins and are therefore controlled by a low-purine diet. Foods that are high in purine are organ meats, meat extracts, shellfish, and red wines.

Fruits, raw vegetables, and eggs do not need to be avoided on a low-purine diet.

48.

You are caring for a patient who is sensitive to the opioid pain medications you have administered and develops bradypnea with an O2 sat that dips to 85%. Which of the following would you expect to see on the patient's ABG?

  • Uncompensated respiratory acidosis

  • Uncompensated respiratory alkalosis

  • Compensated respiratory acidosis

  • Compensated respiratory alkalosis

Correct answer: Uncompensated respiratory acidosis

The patient's slow rate of breathing will cause the patient to retain carbon dioxide and will also lead to hypoxia. The ABG will likely show an elevated carbon dioxide level. This will cause the pH to drop. The bicarbonate levels are controlled by the kidneys and respond more slowly. If the patient was in this condition for several weeks, which would be very unlikely, the kidneys would increase the levels of bicarbonate to compensate for the acidosis caused by the carbon dioxide, bringing the pH into a normal range. Because this is an acute condition, the patient would be uncompensated, and the patient would be developing acidosis that is related to a respiratory cause.

49.

A patient who is being treated for kidney stones asks you what he can do to reduce his risk of kidney stones in the future. Which of the following responses is least correct?

  • "Be sure to empty your bladder more frequently."

  • "Drink plenty of water and avoid sugary or caffeinated drinks."

  • "Stay as active as you can and exercise regularly."

  • "Avoid foods that contain calcium, oxalates, and purines."

Correct answer: "Be sure to empty your bladder more frequently."

Kidney stones can form from stasis of urine in the kidneys or ureters, but emptying your bladder frequently does not significantly reduce urinary stasis that is proximal to the bladder. While urinary retention may be a cause of kidney stones in some cases, this is not typically caused because the patient is not frequently emptying their bladder. 

Staying hydrated, avoiding a sedentary lifestyle, and avoiding foods that contribute to stone formation are all good interventions for reducing the risk of kidney stones.

50.

What reflex grade would be assigned to a patient with a hypoactive patellar reflex?

  • Grade 1+

  • Grade 0

  • Grade 2+

  • Grade 3+

Correct answer: Grade 1+

Deep tendon reflex testing is part of the neurological assessment of a patient; reflexes are involuntary motor responses by the nervous system to a specific stimulus. Responses are graded on a 0 to 4+ scale:

  • Grade 0: absent reflex
  • Grade 1+: hypoactive
  • Grade 2+: normal
  • Grade 3+: brisk
  • Grade 4+: hyperactive with clonus (involuntary contraction)

51.

The outer serous membrane of the wall of the heart is the:

  • Epicardium

  • Myocardium

  • Endocardium

  • Pericardium

Correct answer: Epicardium

The wall of the heart consists of three layers: Endocardium: inner lining, myocardium: middle layer, and epicardium: outer serous layer.

Tips to remember the layers of the heart based on the suffixes:

  1. Endo- means within or inside
  2. Myo- means muscle
  3. Epi- means above or over

The pericardium is the membrane that encloses the heart, but is not part of the heart.

52.

Which of the following is least likely to be a cause of acute incontinence?

  • Increased bladder pressure

  • Medications

  • Delirium

  • Stool impaction

Correct answer: Increased bladder pressure

Increased bladder pressure should not cause incontinence in most adults. Those who do experience incontinence with increased bladder pressure have stress incontinence, not acute incontinence. Medications, delirium, and stool impaction can all be causes of acute incontinence.

53.

Which of the following is least likely to be a cause of esophageal obstruction?

  • Barrett's esophagus

  • Tumors

  • Strictures

  • Congenital anomaly

Correct answer: Barrett's esophagus

While Barrett's esophagus does increase the risk of cancers that may cause esophageal obstruction, it is unlikely to cause esophageal obstruction. Tumors, strictures, and congenital anomalies can all lead to esophageal obstruction.

54.

Of the following, follicle-stimulating hormone (FSH) is primarily responsible for:

  • Spermatogenesis

  • Stimulating ovulation

  • Testosterone production

  • Maintaining the corpus luteum

Correct answer: Spermatogenesis

FSH is a hormone associated with reproduction and the development of sperm in men (spermatogenesis) and eggs (oocytes) in women; it is secreted by the anterior pituitary gland. FSH levels can be used to help determine the reason for a low sperm count in men. 

Luteinizing hormone (LH) stimulates ovulation in females and testosterone secretion in males, while estrogen and progesterone maintain the corpus luteum.

55.

Which of the following statements is true related to first degree burns?

  • They never blister

  • They will likely lead to permanent scarring

  • They do not extend into the epidermis

  • They may develop into second degree burns as the inflammatory response develops

Correct answer: They never blister

First degree (superficial) burns:

  • Extend into the epidermis
  • Never blister
  • Are painful
  • Heal in 3 to 4 days without scarring

First degree burns do extend into the epidermis, do not cause permanent scarring, and do not develop into second degree burns. While pressure ulcers may advance in stage, burns do not.

56.

A patient is being admitted for a constellation of symptoms that includes emotional liability, decreased libido, hirsutism, bruising, obesity, and hypertension. Which of the following would be least likely to be a potential cause of this patient's symptoms?

  • A tumor affecting the posterior pituitary gland

  • A tumor affecting the adrenal cortex

  • A malignant tumor that secretes adrenocorticotropic hormone

  • Chronic corticosteroid therapy

Correct answer: A tumor affecting the posterior pituitary gland

The patient has symptoms that are consistent with Cushing's disease. Cushing's disease involves the oversecretion of adrenocrotical hormones and can be caused by a pituitary tumor that increases the secretion of Adrenocorticotropic Hormone (ACTH). ACTH is secreted by the anterior pituitary gland, not the posterior pituitary gland. Cushing's disease can also be caused by a tumor affecting the adrenal cortex, resulting in excess cortisol production. Cushing's disease can be ectopic, caused by a malignant tumor that secretes ATCH. Cushing's disease can additionally be exogenous, caused by chronic corticosteroid therapy.

57.

You are caring for a 68-year-old woman who was admitted to the hospital with complaints of painless vaginal bleeding. You should make certain the patient is tested for which of the following health problems?

  • Uterine or cervical cancer

  • Ovarian cyst

  • Endometriosis

  • Hormonal imbalances

Correct answer: Uterine or cervical cancer

Painless, abnormal uterine bleeding is an early and common symptom of cancers of the uterus and cervix. Due to this finding, the patient should be tested for cancer.

Ovarian cyst and endometriosis are not probable, given the patient's age; hormonal imbalances may cause bleeding, but is less urgent than the threat of cancer.

58.

This disorder is characterized by massive systemic activation of blood coagulation, which results in generation and deposition of fibrin, leading to microvascular thrombi in various organs followed by bleeding and hemorrhage throughout the circulatory system. It is called:

  • Disseminated Intravascular Coagulation (DIC)

  • Myelodysplastic syndrome (MDS)

  • Human Immunodeficiency Virus (HIV)

  • Idiopathic thrombocytopenia purpura (ITP)

Correct answer: Disseminated Intravascular Coagulation (DIC)

Consumption and subsequent exhaustion of coagulation proteins and platelets (from ongoing activation of coagulation) may induce severe bleeding. DIC is most commonly seen in severe sepsis and septic shock.

Trauma, especially neurotrauma, is also frequently associated with DIC as is malignancy, organ destruction (pancreatitis), obstetric complications (placental abruption, eclampsia), and severe hepatic failure.

59.

You are caring for a patient with heart failure who is having problems breathing due to her condition and is on 2 LPM of O2 via nasal cannula with an O2 sat of 94%. The patient has rales in the bilateral lower lobes. Which of the following interventions would likely be most helpful to the patient?

  • Administering a diuretic

  • Increasing the oxygen to 6 LPM

  • Transfering the patient to ICU as soon as possible

  • Obtaining a chest X-ray

Correct answer: Administering a diuretic

The patient seems to be retaining fluid in her lungs due to her heart failure. Administering a diuretic will help to remove the excess fluid and enhance gas exchange in the alveoli. 

Increasing the patient's O2 to 6 LPM would be excessive, given that her O2 sat is 94% on 2 LPM. An adjustment to 3 LPM will likely raise the O2 sat to 95% or above. The patient can be treated with a diuretic on the medical surgical floor; transfer to ICU is not necessary. Obtaining a chest X-ray would help to better evaluate if the patient has fluid accumulation due to her heart failure, but the information present can be used to make that determination. Delaying diuretic treatment to wait for an X-ray to be performed and read is not recommended.

60.

Which of the following organs is not part of the endocrine system?

  • The spleen

  • The adrenal glands

  • The testes

  • The hypothalamus

Correct answer: The spleen

The endocrine system uses hormones to regulate body activities. The major organs of the endocrine system produce and release hormones that send signals throughout the body. The adrenal glands, testes, and hypothalamus all produce important hormones and play a role in the endocrine system. While the spleen plays important physiological roles, it does not produce hormones and is not a part of the endocrine system.

×