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Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 6 of 50

101.

A patient is admitted with bleeding esophageal varices, and a Sengstaken-Blakemore tube is inserted orally to control the bleeding. Important considerations in caring for this patient include:

  • Being prepared to cut and remove the tube if gastric balloon enters the esophagus, obstructing the airway

  • Monitoring the patient for clotting of the stent

  • Avoiding ever releasing the pressure of the esophageal or gastric balloon

  • Avoiding performing oral care until the tube is removed, as this may dislodge the balloon(s)

Correct answer: Being prepared to cut and remove the tube if gastric balloon enters the esophagus, obstructing the airway

Balloon tamponade is a temporary measure used when endoscopic and pharmacologic therapy cannot control the bleeding. A multi-lumen Sengstaken-Blakemore tube is inserted nasally or orally. The gastric balloon is inflated first; if bleeding is still not controlled, then the esophageal balloon is also inflated. Heavy scissors should be kept at the patient's bedside to cut and remove the tube if the gastric balloon enters the esophagus and causes asphyxiation. Never deflate the gastric balloon alone.

A stent is not present in a tamponade tube such as a Sengstaken-Blakemore tube. The balloon should be deflated at regular intervals to prevent erosions. Frequent mouth care should be administered (not avoided) and the skin around the tube monitored to prevent necrosis from the pressure of the tube.

102.

Community-acquired pneumonia is associated with age, co-morbid illnesses, immunosuppression, and debilitation. Hospital-acquired pneumonia is associated with all of these, in addition to which of the following?

  • Intubation

  • Previous corticosteroid therapy

  • Central line placement

  • Prone position

Correct answer: Intubation

In hospital-acquired cases of pneumonia, the infecting organisms are those indigenous to the hospital. In addition to age, co-morbid illnesses, immunosuppression, and debilitation, risk factors for hospital-acquired infections include:

  • Intubation
  • Previous antibiotic therapy
  • Supine position
  • Shock

Organisms commonly causing hospital-acquired infections include:

  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Klebsiella pneumonia
  • Escherichia coli
  • MRSA

103.

A musculoskeletal injury in which a muscle is damaged is best described as which of the following?

  • A strain

  • A sprain

  • A fracture

  • A dislocation

Correct answer: A strain

A strain is a musculoskeletal injury that damages a muscle or a tendon. A sprain is a musculoskeletal injury in which there is damage to a ligament. A fracture involves damage to a bone, while a dislocation occurs when a bone is displaced from its joint. A strain may cause dislocation.

104.

The nurse suspects an acute gastrointestinal bleed in which of the following patients?

  • An arthritic elderly woman, with a pulse rate of 132 and hematemesis

  • A 30-year-old female smoker with a pulse rate of 58 and abdominal distension

  • A 90-year-old confused male with a pulse rate of 90 and a blood pressure of 160/90

  • A 20-year-old with nausea, epigastric pain, and bradycardia

Correct answer: An arthritic elderly woman, with a pulse rate of 132 and hematemesis

An elderly woman with tachycardia and bright red blood or coffee ground emesis is the most likely of these patients to have a gastrointestinal bleed. Since she is arthritic, she may also be taking medications that can cause gastric bleeding.

A 30-year-old female smoker is at risk for GI bleeding related to smoking, and abdominal distension could indicate an acute GI bleed. However, this patient's pulse is not elevated, so GI hemorrhage is unlikely. The 90-year-old patient has a somewhat increased pulse rate and is confused, but his blood pressure is elevated, not decreased, so further assessment is needed. The 20-year-old has bradycardia, rather than tachycardia, which is a sign of an acute GI bleed.

105.

Which of the following is least likely to cause Addison's disease?

  • Use of corticosteroids

  • HIV

  • Autoimmune disease

  • Tuberculosis

Correct answer: Use of corticosteroids

Use of corticosteroids can cause Cushing's disease, a condition caused by oversecretion of adrenocortical hormones. Addison's disease is caused by adrenocrotical hypofunction, and could be triggered by sudden cessation of corticosteroids, not by corticosteroids use. HIV, tuberculosis, and autoimmune disease can all cause destruction of the adrenal cortex, causing the development of Addison's disease.

106.

Which of the following diagnostic studies involves injecting a radioactive tracer into a vein to be taken up by the heart for the purpose of supplying information via pictures about contractility, perfusion, and cell damage?

  • Nuclear heart scan

  • Magnetic resonance imaging (MRI)

  • Coronary angiography

  • Cardiac catheterization

Correct answer: Nuclear heart scan

A nuclear heart scan is a test that provides important information (myocardial contractility, perfusion, and any cell injury) about the health of the heart. For this test, a safe, radioactive substance called a tracer is injected into the bloodstream through a vein. The tracer travels to the heart and releases energy. 

An MRI provides images of the heart in multiple planes and obtains information about cardiac tissue integrity, aneurysms, ejection fraction (EF), cardiac output, and patency of proximal coronary arteries. A coronary angiography involves injecting radiopaque dye directly into the coronary arteries for the purpose of evaluating the patency of these arteries and collateral circulation to the heart. A cardiac cath involves insertion of a catheter into the heart and can obtain information about O2 saturation and pressure reading within the chambers of the heart.

107.

You are caring for a patient who is being admitted after an MVC. The patient tells you that their nose has been running constantly with clear drainage since the accident, and that they have a headache that is getting worse and worse. Which of the following interventions would be most important?

  • Testing the glucose content of the patient's nasal secretions

  • Giving the patient tissues and telling them to blow their nose vigorously to remove potential debris from the accident

  • Proving the patient with pain medications

  • Placing a nasal tampon to help manage secretions

Correct answer: Testing the glucose content of the patient's nasal secretions

Clear drainage from this patient's nose could be cerebral spinal fluid (CSF) caused by a skull fracture that occurred during the accident. This possibility is further supported by a worsening headache that may occur as CSF is lost. CSF is high in glucose, and the glucose content of the nasal secretions can indicate if these secretions are CSF. 

Telling the patient to blow their nose vigorously is not recommended, as this can worsen the cranial trauma that may be present and still needs to be ruled out. Providing pain medications will be necessary but is not as important as determining if the patient is leaking CSF. Placing a nasal tampon to manage the drainage is not needed and may cause further trauma.

108.

The nurse is assessing a male patient diagnosed with gonorrhea. Which symptom most likely prompted the patient to seek medical attention?

  • Foul-smelling discharge from the penis

  • Rashes on the palms of the hands and soles of the feet

  • Cauliflower-like warts on the penis

  • Painful red papules on the shaft of the penis

Correct answer: Foul-smelling discharge from the penis

Symptoms of gonorrhea in men include heavy, foul-smelling, green-yellow purulent discharge from the penis, dysuria, and urinary frequency. 

Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus (HPV). Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

109.

The outermost layer of the kidney is referred to as the:

  • Cortex

  • Medulla

  • Renal pelvis

  • Hilum

Correct answer: Cortex

The cortex of the kidney is the outermost layer; it is located just under the tightly adhering fibrous capsule.

The medulla is the middle layer of the kidney. The renal pelvis is the point of division between the cortex and the medulla.

110.

Cardiopulmonary complications related to obesity include:

  • Hypertension, elevated triglycerides, coronary artery disease

  • Hypertension, hyperventilation syndrome, coronary artery disease

  • Hyperventilation syndrome, elevated triglycerides, coronary artery disease

  • Hypotension, hypoventilation syndrome, coronary artery disease

Correct answer: Hypertension, elevated triglycerides, coronary artery disease

Complications related to obesity are multisystemic. By system, these complications include:

  • Cardiopulmonary: hypertension, elevated triglycerides, coronary artery disease, hypoventilation syndrome
  • Musculoskeletal: arthritic conditions, gout
  • Gastrointestinal: GERD, fatty liver (can result in liver failure), gallstones
  • Endocrine: diabetes mellitus due to hyperinsulinemia and insulin resistance

Other complications associated with obesity include an increased risk for cancer and psychosocial complications including social stigma/discrimination and depression.

111.

The most common diagnostic study used to assess the musculoskeletal system and monitor effects of treatment is:

  • X-ray

  • Magnetic resonance imaging (MRI)

  • Computed tomography (CT) scan

  • Bone scan

Correct answer: X-ray

Dense bones show as white on standard x-ray, providing information about bone deformity, joint congruity, bone density, and calcification, and are the most common diagnostic study used. 

MRIs, CTs, and bone scans are also diagnostic studies used frequently, but not the most common.

112.

A patient is admitted to the hospital with deep partial thickness burns over 20% of his body. The nurse expects these burns to:

  • Take longer than 2 weeks to heal with subsequent scarring involved

  • Heal within 2 weeks with little scar formation

  • Develop blisters with weeping involved

  • Have a waxy grayish appearance in color

Correct answer: Take longer than 2 weeks to heal with subsequent scarring involved

Deep partial thickness burns:

  • Involve the epidermis and deeper areas of the dermis
  • Are red with white waxy patches, not gray in color
  • Are usually dry, not characterized by blisters or weeping
  • May take longer than 2 weeks to heal with scarring and disruption of the nails, glands, and hair

113.

You are preparing your patient for an abdominal CT to evaluate for possible appendicitis. Which of the following instructions is correct?

  • The only thing that you need do to prepare for this exam is to change into a hospital gown.

  • You cannot eat for four hours before this test because it can affect the accuracy of the imaging.

  • You will need to swallow barium during this procedure to help the doctor visualize your intestinal tract better.

  • This exam will be more helpful and accurate if you have a full bladder during the test.

Correct answer: The only thing that you need do to prepare for this exam is to change into a hospital gown.

No preparation is needed for an abdominal CT besides ensuring there is nothing metal the patient is wearing that could interfere with the imaging. This can be addressed by having the patient change into a hospital gown. 

While a patient suspected of appendicitis should be NPO for potential surgery, being NPO is not necessary for the accuracy of a CT. Barium swallows would not be needed for this test and are more commonly used for evaluating the upper GI tract. Having a full bladder is necessary for obstetric ultrasounds, not for abdominal CTs.

114.

A patient with herpes zoster is newly admitted to the hospital. Based on your nursing knowledge of this disease, which statement is correct?

  • If a person has not had chickenpox, they could contract herpes zoster

  • Herpes zoster can only be diagnosed by skin stains

  • The virus is located in the basement membrane zone of the skin

  • Herpes zoster can appear in a healthy person at anytime

Correct answer: If a person has not had chickenpox, they could contract herpes zoster

Herpes zoster (shingles) is caused by the reactivation of varicella virus which has remained dormant in nerve root ganglion, not in the basement membrane zone of the skin until reactivated. However, the herpes zoster virus can be spread from a person with the virus to someone who has never had chickenpox. 

Skin cultures and antinuclear antibody tests can also diagnose shingles (not just skin stains). The risk of contracting herpes zoster tends to increase with age and immunosuppression, and is more likely to appear in individuals who have had a history of chickenpox; rarely in a healthy person.

115.

Which form of hepatitis is primarily spread through blood-to-blood contact, such as sharing needles or blood transfusions?

  • Hepatitis C (HCV)

  • Hepatitis B (HBV)

  • Hepatitis E (HEV)

  • Hepatitis A (HAV)

Correct answer: Hepatitis C (HCV)

Hepatitis C (HCV) is primarily transmitted through blood-to-blood contact, such as through sharing needles, unsterile medical equipment, or blood transfusions. Hepatitis C can also be transmitted through sexual contact, though this is less common. It has a slow onset with an incubation period ranging from 20 to 90 days, and there is no available vaccine.

Hepatitis B (HBV) can also spread via the parenteral route and through close contact, including sexual transmission, but it differs from Hepatitis C in that there is a vaccine available for prevention.

Hepatitis E (HEV) is primarily transmitted through contaminated water, especially in areas with poor sanitation.

Hepatitis A (HAV) is typically spread through the fecal-oral route, often through contaminated food or water.

116.

Which of the following symptoms is not a likely symptom of hyperthyroidism?

  • Cold intolerance

  • Palpitations

  • Diarrhea

  • Excessive sweating

Correct answer: Cold intolerance

Heat intolerance, not cold intolerance, is a symptom of hyperthyroidism. 

Symptoms of hyperthyroidism are related to the evaluated metabolic rate this disease causes, and include heat intolerance, palpitations, diarrhea, and excessive sweating.

117.

A patient is admitted with the following symptoms: weight loss, shortness of breath, heart sounds auscultated with murmurs and rubs, cough, temperature 102 degrees F, and Osler's nodes. 

Of the following choices, which diagnosis does the nurse suspect?

  • Infective endocarditis

  • Pneumonia

  • Congestive heart failure

  • Silent ischemia

Correct answer: Infective endocarditis

Infective endocarditis occurs when infective agents in the bloodstream are carried through the system and deposited on valve leaflets. 

Subjective symptoms of infective endocarditis include:

  • Fever/chills
  • Cough
  • Malaise and fatigue
  • Shortness of breath
  • A history of recent dental work, minor surgery, strep or viral infection

Objective symptoms of infective endocarditis include:

  • Weight loss
  • Heart sounds auscultated with murmurs and rubs
  • Temperature > 101
  • Signs of congestive heart failure
  • Vascular manifestations such as Osler's nodes, which are painful, red, raised lesions on the hands and feet; Janeway's lesions, which are similar but are not painful; and splinter hemorrhages, which are tiny blood clots that run vertically under the fingernail.

118.

A patient who has recently had a stroke has also developed fecal incontinence. Her family asks the nurse if the fecal incontinence will ever go away. Which of the following answers is best?

  • The fecal incontinence will probably resolve within a couple of weeks.

  • The fecal incontinence will be permanent; she will always need to wear an adult diaper.

  • It is impossible to guess how long it could take for fecal incontinence to resolve, or if it will ever resolve.

  • The fecal incontinence is not associated with her stroke, we will need to do more testing to determine what caused it.

Correct answer: The fecal incontinence will probably resolve within a couple of weeks.

Fecal incontinence following a stroke typically resolves within two weeks for most patients. It is unlikely that the fecal incontinence will be permanent. While absolutely knowing how long the fecal incontinence will take to resolve is technically not possible, the nurse's answer can be guided by what the typically expected clinical course will be. Fecal incontinence is common after a stroke and is normally caused by the immobility, inadequate fluid intake, and other changes associated with the stroke.

119.

Which of the following is not a mainstay of treatment for status asthmaticus?

  • IV benzodiazepines

  • IV corticosteroids

  • Bronchodilators

  • Mechanical ventilation

Correct answer: IV benzodiazepines

IV benzodiazepines can certainly be used to treat anxiety in patients with status asthmaticus, but are not a mainstay of treatment for this emergency condition. Mainstays of treatment include IV corticosteroids, bronchodilators, and mechanical ventilation.

120.

Type 2 diabetes mellitus (DM) accounts for what percentage of the DM population globally?

  • 90%

  • 80%

  • 60%

  • 70%

Correct answer: 90%

Type 2 diabetes mellitus (DM) is increasing exponentially, especially among the minority populations of the United States. Approximately 90% of the DM population is diagnosed with type 2 diabetes.

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