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Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 7 of 50

121.

Which of the following conditions is recognized as a central pain syndrome?

  • Fibromyalgia

  • Osteoarthritis (OA)

  • Rheumatoid arthritis (RA)

  • Systemic lupus erythematosus (SLE)

Correct answer: Fibromyalgia

Fibromyalgia is a connective tissue disorder now recognized as one of the central pain syndromes; it may coexist with other inflammatory diseases, such as rheumatoid arthritis or systemic lupus erythematosus.

Fibromyalgia is manifested by widespread bilateral pain above and below the waist, as well as along the axial skeleton for more than three months.

122.

A patient is diagnosed with pneumonia and the infectious organism is found to be Streptococcus pneumoniae. Which of the following can be inferred about this patients' infection?

  • It is community-acquired.

  • It is hospital-acquired.

  • It is opportunistic.

  • An inference on its classification cannot be made.

Correct answer: It is community-acquired.

The type of organism that has caused pneumonia can often allow for inferences to be made about how or where it was acquired. Streptococcus pneumoniae is normally associated with community-acquired pneumonia.

123.

Which of the following statements is true related to range of motion (ROM)?

  • ROM is the amount of motion available to a joint within the anatomic limits of its structure

  • It is measured by grades

  • Passive ROM is typically assessed before active range of motion

  • If crepitus is encountered during ROM, passive manipulation of the joint must immediately cease

Correct answer: ROM is the amount of motion available to a joint within the anatomic limits of its structure

ROM is measured in degrees, not by grades. In active ROM, the patient moves the joint, either independently or with minimal assistance (active assisted ROM); this is typically assessed first. In passive ROM, the examiner moves the joint while the patient's muscles are relaxed.

Joint crepitus (audible crackling when the joint is moved) may be encountered and should be noted, but is not an indication to cease ROM. Passive manipulation of joints must immediately cease if pain is encountered upon resistance.

124.

During this phase of the menstrual cycle, the endometrial thickness increases six-fold due to a spike in estrogen levels, and the cervical mucus changes to become more favorable to sperm:

  • Proliferative phase

  • Menstrual phase

  • Secretory phase

  • Ischemic phase

Correct answer: Proliferative phase

During the proliferative phase of the menstrual cycle (days 6 to 14), the endometrium significantly thickens as estrogen levels increase, and cervical mucus becomes more favorable to sperm as it becomes thin, watery, clear, and more alkaline.

The menstrual phase (days 1 to 5) is when menses occurs if fertilization does not take place and the endometrium is shed. The secretory phase (days 15 to 26) includes ovulation, and finally the ischemic phase (days 27 to 28) only occurs if fertilization does not take place, and estrogen and progesterone levels drop sharply.

125.

The  peripheral vascular system includes:

  • Aorta and pulmonary artery, arterioles, capillaries and venules, veins returning blood to the heart

  • Corpus callosum, arterioles, capillaries and venules, veins returning blood to the heart

  • Sinoatrial (SA) and atrioventricular (AV) nodes, arterioles, capillaries and venules, veins returning blood to the heart

  • Pulmonary artery and superior vena cava, corpus callosum, capillaries and venules, veins returning blood to the heart

Correct answer: Aorta and pulmonary artery, arterioles, capillaries and venules, veins returning blood to the heart

The peripheral vascular system includes:

  1. The aorta and the pulmonary artery (large arteries): a dispersal system
  2. The arterioles: the arterial pressure regulatory or resistance system
  3. The capillaries and venules (microcirculation): the tissue exchange system
  4. The veins returning blood to the heart: the collecting system

Superior and inferior vena cavae are the largest veins that empty directly into the right side of the heart. The SA and AV nodes are parts of the cardiac conduction system, not the peripheral vascular system. The corpus callosum is brain structure, not part of the vascular system.

126.

Mr. J., your elderly patient, is recovery following bowel resection surgery. When removing his abdominal bandage to complete daily wound care, you note that the surgical wound has eviscerated. Your best response is to:

  • Cover the protruding portion with gauze soaked in normal saline, and notify the physician

  • Continue with the dressing change as ordered and chart your findings, as this is expected following bowel resection procedures

  • Cover the protruding part with the dressing that was just removed, and notify the physician

  • Using a sterile saline-soaked Q-tip, gently reinsert the protrusion into the incision, and notify the physician

Correct answer: Cover the protruding portion with gauze soaked in normal saline, and notify the physician

Evisceration of a wound (protrusion of wound contents) is a serious complication, especially with abdominal incisions. You should cover the protruding part with gauze soaked in normal saline, rather than the dressing that was just removed and is contaminated, and notify the surgeon immediately for content replacement and reclosure. Maintain the patient on bed rest and monitor his vital signs closely.

127.

Acute gastrointestinal hemorrhage is characterized by which of the following clinical manifestations?

  • Body will attempt to expand plasma volume for 6-8 hours through the action of antidiuretic and aldosterone

  • Decreased platelet counts due to decreased coagulation process

  • Decreased BUN as blood proteins are depleted

  • Decreased creatinine level

Correct answer: Body will attempt to expand plasma volume for 6-8 hours through the action of antidiuretic and aldosterone

Gastrointestinal hemorrhage is defined as acute loss of blood from the upper GI tract. "Acute" or "massive" bleeding is defined as loss of 25% of circulating volume (approximately 1,500 mL in adults). Clinically, the patient's body will attempt to expand plasma volume due to the action of antidiuretic and aldosterone; platelet counts will increase due to instant (not decreased) coagulation process. BUN and creatinine levels will elevate as blood proteins accumulate (not deplete) in the intestine. Other manifestations include decreased blood pressure as blood is lost; venous and peripheral artery constriction causing oliguria, and skin that is cold, clammy, and pale; hematochezia; and hematemesis.

128.

A hospitalized patient with chronic obstructive pulmonary disease (COPD) is taking a bronchodilator and tells you that he is going to begin a smoking cessation program when he is discharged. You should tell the patient to notify the doctor if his smoking pattern changes because he:

  • May need his medication dosage adjusted

  • Will require an increase in antitussive medication

  • May no longer need annual influenza immunizations

  • Will not derive as much benefit from inhaler use

Correct answer: May need his medication dosage adjusted 

Changes in smoking patterns should be discussed with the physician because they have an impact on the amount of medication needed.

Patients with COPD are placed on expectorants, not antitussives. An annual influenza vaccine is recommended for all those with lung disease, and benefits from inhaler use will be increased when the patient stops smoking.

129.

The nurse is caring for a patient with a renal adeonma. The nurse understands that which of the following is true about this form of cancer?

  • It is bengin.

  • It is a common form of renal cancer.

  • It can occur anywhere in the kidney.

  • It occurs almost exclusively in females.

Correct answer: It is bengin.

Renal adenomas are a rare form of benign cancer. The incidence of this form of cancer may be slightly higher in females; however, gender does not significantly impact incidence. Renal adenomas occur near the cortex of the kidneys, not anywhere in the kidney.

130.

The conduction system is an electrical system that controls the heart rate, generates electrical impulses, and conducts them throughout the muscle of the heart, stimulating the heart to contract and pump blood. The sequence of travel by an action potential through the heart is:

  • Sinoatrial (SA) node, intra-atrial pathways, atrioventricular (AV) node, bundle of His, right and left branches, Purkinje fibers

  • Intra-atrial pathways, atrioventricular (AV) node, sinoatrial (SA) node, bundle of His, right and left branches, Purkinje fibers

  • Atrioventricular (AV) bundle, atrioventricular (AV) node, sinoatrial (SA) node, intra-atrial pathways, right and left branches, Purkinje fibers

  • Purkinje fibers, atrioventricular (AV) bundle, atrioventricular (AV) node, sinoatrial (SA) node, right and left branches, intra-atrial pathways

Correct answer: Sinoatrial (SA) node, intra-atrial pathways, atrioventricular (AV) node, bundle of His, right and left branches, Purkinje fibers

Electrical signals arising in the SA node (located in the right atrium) stimulate the atria to contract and travel to the AV node (through the intra-atrial pathways). After a delay, the stimulus diverges and is conducted through the left and right bundle of His to the respective Purkinje fibers for each side of the heart, as well as to the endocardium at the apex of the heart, then finally to the ventricular epicardium.

131.

Which of the following is considered the first-line treatment for idiopathic thrombocytopenia purpura (ITP)?

  • Corticosteroids

  • High-dose immunoglobulin therapy

  • Platelet transfusion

  • Splenectomy

Correct answer: Corticosteroids

In ITP, if the patient is asymptomatic, intervention may not be warranted until platelet count falls below 30,000. Once warranted, prednisone is the first-line treatment to decrease antibody formation, suppress platelet destruction by macrophages in the spleen, decrease fragility and bleeding time, and increase the lifespan of platelets; 80% of patients treated will see platelet counts return to normal within 1-3 weeks.

Splenectomy is indicated for that 20% of patients who are unresponsive to steroid therapy. Platelet transfusions and high-dose immunoglobulin therapy are indicated when the patient is actively bleeding, counts fall below 10,000-20,000 uL, and in otherwise unresponsive cases.

132.

You are caring for a patient who is on 6 LPM of O2 via nasal cannula and has an O2 sat of 93%. While trying to reach the ordered goal of a 95% O2 sat, which of the following is important to keep in mind?

  • O2 that is given via nasal cannula should be humidified if the flow rate is over 6 LPM

  • The next step for this patient must be either CPAP or BiPAP

  • A non-rebreather is necessary for this patient to reach a goal of 95%

  • The patient will like be okay with an O2 sat of 93%

Correct answer: O2 that is given via nasal cannula should be humidified if the flow rate is over 6 LPM

When oxygen is given at a rate that is over 6 liters per minute via nasal cannula, a patient may experience dehydration of the mucous membranes, causing epistaxis or congestion. Oxygen given at a rate that is over 6 liters per minute via nasal cannula should be humidified. 

CPAP or BiPAP does not have to be the next step for this patient. They are close to their oxygenation goal, and an adjustment of their oxygen flow or other means of oxygen delivery may also be considered. A non-rebreather may be indicated, but there is nothing to indicate that the non-rebreather is necessary to reach the patient's oxygenation goals; the information provided is not sufficient to infer that. The patient has an ordered goal of a sat of 95%; they should not be left at 93% if the ordered goal is higher.

133.

You are completing an assessment of a 90-year-old patient who was admitted to the hospital for congestive heart failure. You know that many typical physiologic changes are associated with aging. With this knowledge in mind, which of the following statements is true about your elderly patient's cardiovascular system?

  • Increased heart rates are not well tolerated, and may result in worsening congestive heart failure

  • Heart valves become thin with age

  • Cardiac output declines

  • Functional systolic murmurs decrease with age

Correct answer: Increased heart rates are not well tolerated, and may result in worsening congestive heart failure

Typical physiologic changes associated with aging include slower heart rates that can range from 44 to 108 beats/min. Increased heart rates are not well tolerated, and may result in worsening congestive heart failure (CHF) for the patient. 

With age, the cardiac valves become thick and rigid, not thin, because of calcium deposits, fibrosis, and sclerosis; generalized calcification of coronary arteries occur. Cardiac output does not decline. Rather, peripheral vascular resistance, coronary disease, or changes in heart rate may cause decline. Functional murmurs increase with age, not decrease, and are heard at the base and aortic areas of the heart.

134.

The most common cause of transudative pleural effusion is:

  • Congestive heart failure

  • Infection

  • Cancer

  • Liver failure

Correct answer: Congestive heart failure

Pleural effusions are described by their etiology: transudate, exudate, emphysema, hemothorax, hemorrhagic, and chylothorax are the different types of pleural effusions. Transudative pleural effusion occurs when fluid accumulates in the pleural space as a result of increased hydrostatic pressure or low plasma proteins. Congestive heart failure (CHF) is the most common cause of transudative pleural effusions. Less common causes include chronic kidney disease, liver failure, and malignancy.

Exudative pleural effusions occur when increased fluid formation is a result of increased capillary permeability or disrupted lymphatic drainage, and common causes are infection, systemic inflammation, pulmonary infarction, and cancer.

135.

All of the following statements related to scoliosis are true except:

  • Scoliosis is the lateral curvature that only occurs in the thoracic spine

  • A majority of scoliosis cases are of idiopathic etiology

  • Leg length discrepancy can cause functional scoliosis

  • Congenital scoliosis results from malformation of vertebral structures

Correct answer: Scoliosis is the lateral curvature that only occurs in the thoracic spine

Scoliosis refers to a lateral curvature of the spine with vertebral rotation; although the most common curvature is right thoracic, it may occur in any area of the spine (not just thoracic).

The term "idiopathic" refers to an unknown cause; 80% of cases are idiopathic in etiology. Congenital scoliosis results from malformation of vertebral structures, whereas scoliosis from osteoporosis results from vertebral compression fractures. Curvature produces an asymmetric waistline, and leg length discrepancy can cause functional scoliosis.

136.

You are receiving shift report. Which of the following patients should you see first?

  • A patient admitted for asthma exacerbation complaining of shortness of breath after using a bronchodilator inhaler

  • A patient admitted with viral meningitis who needs to receive IV antibiotics

  • A client with chronic obstructive pulmonary disease who has a pulse oximetry reading of 91% and clubbing fingers

  • A patient with possible C-diff who needs a stool specimen sent to laboratory

Correct answer: A patient admitted for asthma exacerbation complaining of shortness of breath after using a bronchodilator inhaler

The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications. This patient’s needs are urgent.

The other patients need to be assessed as soon as possible, but none of them is urgent. In chronic obstructive pulmonary disease (COPD) clients, pulse oximetry oxygen saturations greater than 90% and clubbing of fingers are acceptable findings because this is a chronic condition.

137.

An obese, type 2 diabetic patient who is non-insulin dependent is best controlled by weight loss for which of the following reasons?

  • Because obesity reduces insulin binding at receptor sites

  • Because obesity reduces the number of insulin receptors

  • Because obesity reduces pancreatic islet cell exhaustion

  • Because obesity reduces pancreatic insulin production

Correct answer: Because obesity reduces insulin binding at receptor sites

Obesity reduces insulin binding at the receptor sites (insulin resistance), which leads to pancreatic hypersecretion of insulin and eventual pancreatic cell exhaustion.

Diet, exercise, and weight loss are extremely important to improve insulin sensitivity and resistance.

138.

All of the following are examples of antihistamines except:

  • Guaifenesin (Mucinex)

  • Acrivastine (Semprex)

  • Cetirizine (Zyrtec)

  • Fexofenadine (Allegra)

Correct answer: Guaifenesin (Mucinex)

Guaifenesin is an expectorant and works by decreasing the viscosity of respiratory secretions to assist the bringing up of phlegm from the airways in acute respiratory tract infections.

Acrivastine, cetirizine, and fexofenadine are all examples of antihistamines. They work by inhibiting histamine action at the histamine receptor sites, blunting characteristic signs and symptoms of allergic reactions, particularly in the skin, eyes, nose, and throat.

139.

Which of the following patients is most likely to have a stroke between the ages of 45–85?

  • An African-American male

  • An African-American female

  • A Caucasian male

  • A Caucasian female

Correct answer: An African-American male

Males are more likely than females to have strokes until age 85, when the risk becomes roughly equal. African-Americans have about twice the risk of having a stroke when compared to Caucasians. This means that African-American males have the highest risk for stroke of the options available until age 85, when their risk becomes similar to African-American females.

140.

A female patient has just been diagnosed with human papillomavirus (HPV). What information is appropriate to tell this patient?

  • This condition puts her at higher risk for cervical cancer; she should have a Pap smear every 6 months

  • The potential for transmission to her sexual partner(s) will be eliminated if condoms are used every time she engages in sexual intercourse

  • The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days

  • HPV causes lesions called condylomata acuminata that cannot be transmitted during oral sex

Correct answer: This condition puts her at higher risk for cervical cancer; she should have a Pap smear every 6 months

HPV is the most common viral sexually transmitted infection (STI); (although chlamydia is the most frequently reported STI). Women with condylomata acuminata (HPV) are at risk for cancer of the cervix and vulva. Yearly Pap smears are crucial for early detection; if diagnosed, Paps are necessary every 6 months to monitor for cervical changes. 

Because condylomata acuminata is a virus, there is no permanent cure. Other treatments include topical cytotoxic medications, cryotherapy, electrocautery, or surgery. 

Because it can occur on the vulva, a condom won’t protect sexual partners. HPV can be transmitted to her parts of the body, such as the mouth, oropharynx, and larynx; HPV can be transmitted during oral sex.

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