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Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 4 of 50

61.

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.

62.

Which of the following is least likely to be a complication caused by gastroesophageal reflux disease (GERD)?

  • Peptic ulcer disease

  • Asthma

  • Esophagitis

  • Barrett's esophagus

Correct answer: Peptic ulcer disease

Peptic ulcer disease is not likely to be caused by gastroesophageal reflux disease (GERD). GERD can lead to respiratory complications, such as asthma due to the increased acidity of the pharynx. Esophagitis and Barrett's esophagus are both more likely to occur with GERD due to increased acidity in the esophagus.

63.

Primary adrenocortical hypofunction involving destruction of the adrenal cortex is known as:

  • Addison's disease

  • Pituitary Cushing's disease

  • Adrenal Cushing's syndrome

  • Ectopic Cushing's syndrome

Correct answer: Addison's disease

Adrenocortical hypofunction results in decreased, or absent production of adrenocortical hormones and is known as Addison's Disease; this condition involves the destruction of the adrenal cortex and is autoimmune in nature, typically resulting from an infection (TB, CMV, fungi), HIV, hemorrhage, or infiltrative disorders.

Cushing's disease/syndrome is the result of the oversecretion, not the decreased or absent production of adrenocortical hormones.

64.

The primary neurotransmitter involved in the recovery from hypoglycemia is:

  • Epinephrine

  • Corticotropin-releasing hormone (CRH)

  • Adrenocorticotropic hormone (ACTH)

  • Cortisol

Correct answer: Epinephrine

The nervous, endocrine, and immune systems are intimately related. Recovery from hypoglycemia involves the concerted effort of the autonomic nervous system and the endocrine system. The primary neurotransmitter involved in this process is epinephrine.

CRH, ACTH, and cortisol are involved in the recovery from hypoglycemia but these, along with glucagon and insulin, are endocrine hormones, not neurotransmitters.

65.

Which of the following is not an example of a proton pump inhibitor (PPI)?

  • Famotidine (Pepcid) 

  • Pantoprazole (Protonix)

  • Omeprazole (Prilosec)

  • Rabeprazole (Aciphex)

Correct answer: Famotidine (Pepcid)

Famotidine (Pepcid) is a histamine blocker (H₂ receptor antagonist), not a proton pump inhibitor (PPI). It works by blocking the action of histamine at the H₂ receptors of the parietal cells in the stomach and decreasing hydrogen ion production, which in turn increases stomach pH, providing symptom relief. 

Pantoprazole (Protonix), omeprazole (Prilosec), and rabeprazole (Aciphex) are PPIs. They work by blocking the H+K+ pump ("proton pump"), which is the final pathway of HCl into the stomach, thereby blocking all gastric acid secretion. They are used for GERD, PUD, and hypersecretory conditions. They are the most potent inhibitors of acid secretion available.

66.

Factors that may play a role in the development of peptic ulcer disease include all of the following except:

  • Decreased hydrochloric acid production in the stomach

  • The chronic use of aspirin

  • The inflammation of mucosa due to H. pylori

  • Cigarette smoking

Correct answer: Decreased hydrochloric acid production in the stomach 

An increased (not decreased) production of hydrochloric acid in the stomach, possibly due to an increased number of parietal cells (cells that line the inside of the stomach and produce hydrochloric acid in response to histamine, acetylcholine, and gastrin), can lead to the formation of peptic ulcer disease (PUD).

Other contributing factors include the chronic use of aspirin, nonsteroidal anti-inflammatory drugs, alcohol, cigarette smoking (which increases gastric contents), stress, personality (type A), and familial history. Also, the presence of the bacteria H. pylori causes inflammation of the mucosa, leading to PUD if left untreated.

67.

All of the following statements about bilirubin are true except:

  • The indirect value indicates conjugated bilirubin

  • Bilirubin is conjugated with an acid in the liver

  • Most bilirubin is excreted from the liver into the duodenum as a part of bile

  • Bilirubin is a product of red blood cell (RBC) breakdown

Correct answer: The indirect value indicates conjugated bilirubin

The indirect value indicates unconjugated bilirubin. The direct value indicates conjugated bilirubin.

Bilirubin is a product of red blood cell breakdown and is normally found in the circulation in small amounts. In the liver, bilirubin is conjugated with an acid that makes it water-soluble. Most bilirubin is excreted from the liver into the duodenum as part of bile. In the small intestine, bacterial activity converts bilirubin to urobilinogen. Direct and indirect serum bilirubin levels describe the liver's ability to excrete and conjugate bilirubin.

68.

While completing the admission assessment of a patient who is non-ambulatory and is unable to move or reposition himself in bed, you note an intact blood-filled blister on the heel. You should document this wound as which of the following?

  • Suspected deep tissue injury

  • Stage II pressure ulcer

  • Unstageable pressure ulcer

  • Stage I pressure ulcer

Correct answer: Suspected deep tissue injury

Suspected deep tissue injury is defined as purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.

Stage II pressure ulcers are defined as partial thickness loss of dermis or an intact or open/ruptured serum-filled blister. Unstageable pressure ulcers are defined as full thickness tissue loss. Stage I pressure ulcers are defined as intact skin with non-blanchable redness.

69.

A patient who has just been diagnosed with epilepsy asks their nurse, "Can I ever come off my epilepsy medications?" Which of the following responses is best?

  • Many people with epilepsy can be successfully withdrawn from medications after a period without seizures.

  • You will only need to take these medications for 30 days.

  • You will need to take epilepsy medications for the rest of your life.

  • You have the right to choose if you would like to take the medications you have been prescribed or not.

Correct answer: Many people with epilepsy can be successfully withdrawn from medications after a period without seizures.

75% of seizure-free patients can be successfully withdrawn from epilepsy medications after 2–5 years. Epilepsy medications will need to be continued for more than 30 days. Epilepsy medications may need to be continuously taken, but there is a good chance this will not be necessary. While the patient does have the right to choose to take medications or not, this is not the question being asked.

70.

All of the following statements related to sputum specimens are correct except:

  • Broad spectrum antibiotics should started initially until a specimen can be collected

  • The specimen must come from the lung, not from the oropharynx

  • Only a single specimen is required for culturing to identify pulmonary infections

  • Sputum specimens can be used to identify cancer cells

Correct answer: Broad spectrum antibiotics should be started initially until a specimen can be collected

Culture and sensitivity specimens are obtained before initiating antibiotic therapy.

Broad spectrum antibiotics are started initially until an organism is identified on a culture specimen, and the antibiotic is changed to one to which the organism is sensitive.

71.

The nurse suspects a patient of having meningitis. Which of the following interventions would best help the nurse assess for this condition?

  • Flex the patient's neck

  • Raise the patient's arms to a 90-degree angle from their body

  • Have the patient rapidly touch their finger to their nose, then the nurse's finger and back

  • Administer Tylenol and monitor the patient's response

Correct answer: Flex the patient's neck

Flexing the patient's neck and observing for flexion in the hips and knees is how Brudzinski's sign is assessed. Positive flexion of the hips and knees indicates irritation of the meningitis and indicates that meningitis may be present. Raising the patient's arms to a 90-degree angle from their body and observing for drift is a method of assessing for stroke. Having the patient rapidly touch their finger to their nose, then the nurse's finger and back is a method of assessing for ataxia, but this is not an ideal assessment to determine the presence of meningeal irritation. Administering Tylenol and monitoring the patient's response will not help assess for meningitis.

72.

Which of the following describes Buck's traction?

  • A type of skin traction applied to a leg

  • A type of skeletal traction that is used on an arm

  • A type of skeletal traction applied to a leg

  • Manual traction applied to an arm to reduce shoulder subluxations

Correct answer: A type of skin traction applied to a leg

Buck's traction is a skin traction that is applied to a leg, typically used to reduce discomfort caused by hip fractures or to immobilize a knee. 

Buck's traction is not skeletal traction; skeletal traction is applied directly to bone. Buck's traction is not a type of manual traction and is not used to reduce any type of subluxation. 

73.

Which of the following is the most common complication of peptic ulcer disease?

  • GI hemorrhage

  • Pyloric sphincter obstruction

  • Perforation

  • Barretts esophagus

Correct answer: GI hemorrhage

Gastrointestinal hemorrhage is the most common complication of peptic ulcer disease. While pyloric sphincter obstruction and perforation are potential serious complications of peptic ulcer disease, they are less common than GI hemorrhage. Barretts esophagus is not a complication of peptic ulcer disease.

74.

The nurse understands that which of the following is true about a pheochromocytoma?

  • A pheochromocytoma can cause hypertension

  • A pheochromocytoma is a type of tumor that releases adrenocorticotropic hormone (ACTH)

  • A pheochromocytoma is type of benign skin lesion that is often found in patients with liver disease

  • A pheochromocytoma that is big enough should be palpated during assessment to accurately determine its size

Correct answer: A pheochromocytoma can cause hypertension

Hormones secreted by a pheochromocytoma can often cause hypertension as a symptom. Pheochromocytomas release epinephrine, norepinephrine, and/or dopamine.

Pituitary tumors may release ACTH, but pheochromocytomas do not. A pheochromocytoma is not a type of skin lesion, but a type of tumor that typically is found in the adrenal glands. Palpation of pheochromocytomas should be avoided, as this can stimulate the secretion of more hormones or cause rupture of an encapsulated pheochromocytoma.

75.

Urine estrogen levels are typically used to detect all of the following except:

  • Intrauterine pregnancy

  • Ovarian pathology

  • Hyperadrenalism

  • Ectopic pregnancy

Correct answer: Intrauterine pregnancy

Urine estrogen levels are used to detect ovarian pathology, hyperadrenalism, ectopic pregnancy, interstitial cell tumors of the testes, and liver disease. They require a 24-hour urine collection, and urine must be kept refrigerated.

Human chorionic gonadotropin (HCG) is detected in a urine pregnancy test to ascertain intrauterine pregnancy (normal pregnancy).

76.

Which of the following is least likely to cause chronic pyelonephritis?

  • Bacterial infections

  • Drug toxicity

  • Autoimmune response

  • Metabolic inflammation

Correct answer: Bacterial infections

Acute pyelonephritis, not chronic pyelonephritis, is likely to be caused by bacterial infections. Chronic pyelonephritis is typically caused by inflammation that is caused by drug toxicity, immunological causes, or metabolic causes.

77.

You are providing teaching to a patient with ulcerative colitis. Which of the following statements indicates the need for further teaching?

  • "Ulcerative colitis can appear anywhere in my intestines."

  • "Ulcerative colitis can cause bleeding in my intestines."

  • "Ulcerative colitis is not associated with race, gender, or social class."

  • "Ulcerative colitis will make it harder for me to absorb nutrients."

Correct answer: "Ulcerative colitis can appear anywhere in my intestines."

Ulcerative colitis only affects the large intestine. Ulcerative colitis can lead to bleeding due to mucosal fragility. It is not associated with race, gender, or social class, and it does decrease the absorption of nutrients.

78.

Which of the following conditions is least likely to increase the risk of fracture?

  • Hypoparathyroidism

  • Osteoporosis

  • Cushing's syndrome

  • Anorexia

Correct answer: Hypoparathyroidism

The parathyroid hormone regulates calcium levels in the bloodstream by increasing or decreasing the absorption of calcium from the bones. Hypoparathyroidism causes decreased calcium levels in the bloodstream by retaining more calcium in the bones. While hyperparathyroidism would lead to increased risk of fractures, hypoparathyroidism is less likely to increase the risk of fractures and may even help to prevent fractures. 

Osteoporosis occurs when bone tissue is absorbed faster than it is replaced, leading to weak and brittle bones that are more likely to fracture. Cushing's syndrome is caused by high level of cortisol, which leads to weaker bone structure and an increased risk of fracture. Anorexia causes decreased nutrition which affects calcium intake. This leads to the body using calcium from the bones, reducing the strength of the bones and increasing the risk of fractures.

79.

Which of the following patients is most at risk of developing endocarditis?

  • A 65-year-old male with a dental abscess who has just undergone a hematopoietic stem cell transplantation

  • A 22-year-old female who has started heavily using marijuana concentrates over the last two months and was just involved in an MVC

  • A 91-year-old male who is unable to undergo a needed coronary artery bypass surgery due to severe heart failure

  • A 17-year-old male with a history of asthma who underwent open thoracic surgery to repair a right lung bullet wound

Correct answer: A 65-year-old male with a dental abscess who has just undergone a hematopoietic stem cell transplantation

Poor dentition and immunocompromised status are both risk factors for endocarditis. A patient who is undergoing hematopoietic stem cell transplantation has a highly compromised immune system at the time of the procedure. 

Intravenous drug use is a risk factor, but marijuana concentrates are not used intravenously. Myocardial infarction (MI), the reason coronary artery bypass surgery would be needed, and heart failure are not risks for endocarditis. Any surgical procedure creates a risk for endocarditis but, primarily, dental surgeries are the main concern. The patient receiving thoracic surgery would be less at risk than the patient with poor dentition who is immunocompromised.

80.

All of the following pain management medications are likely to be ordered during the first 48-72 hours (acute phase) of burn care for a patient with deep partial thickness burns of the face and neck except:

  • IV acetaminophen (Tylenol) with codeine

  • IV hydromorphone (Dilaudid)

  • IV morphine

  • IV lorazepam (Ativan)

Correct answer: IV acetaminophen (Tylenol) with codeine 

Deep partial thickness burns of the face and neck are likely to be extremely painful, especially in the acute phase. Initial pain management treatment includes IV morphine, hydromorphone (Dilaudid), lorazepam (Ativan), and/or fentanyl. All of these need to be tapered in the recovery phase.

Acetaminophen (Tylenol) with codeine and morphine sulfate (MS Contin) are usually administered PO (by mouth) to burn victims after the initial treatment or acute phase.

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