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Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 8 of 50

141.

Chronic bronchitis is characterized by which of the following clinical manifestations?

  • Pulmonary hypertension in the late stages

  • Chronic non-productive cough

  • Respiratory alkalosis

  • Left-sided heart failure in the late stages

Correct answer: Pulmonary hypertension in the late stages

Clinical manifestations of chronic bronchitis include:

  • Chronic cough, with production of large amounts of thick, tenacious mucus (not non-productive)
  • Wheezing and rhonchi
  • Cyanosis and hypoxemia that leads to hypercapnia and respiratory acidosis (not respiratory alkalosis)
  • Right-sided congestive heart failure (not left), and pulmonary hypertension

142.

Which of the following is melena most likely to indicate?

  • A slow gastrointestinal bleed

  • A small bowel obstruction

  • Inadequate digestion of fatty foods

  • Gastrointestinal infection

Correct answer: A slow gastrointestinal bleed

Melena is dark, tarry stool that is caused by slow gastrointestinal bleeding. A small bowel obstruction will result in the absence of stool or in runny, scant amounts of stool. Steatorrhea is indicative of inadequate digestion of fatty foods. Melena does not indicate gastrointestinal infection unless the infection has led to slow bleeding, which is uncommon.

143.

The most common respiratory cause of death in the United States is:

  • Chronic obstructive pulmonary disease (COPD)

  • Status asthmaticus

  • Pneumonia

  • Pulmonary embolism

Correct answer: Chronic obstructive pulmonary disease (COPD)

COPD is characterized by airflow limitation that is not fully reversible; chronic bronchitis and emphysema are common conditions associated with COPD.

COPD is the fourth most common cause of death, and the most common respiratory cause of death in the United States; 16 million individuals in the US have symptomatic COPD. Cigarette smoking is the primary cause of COPD.

144.

All of the following medications are sodium channel blockers except:

  • Clonazepam (Klonopin)

  • Lamotrigine (Lamictal)

  • Carbamazepine (Tegretol)

  • Phenytoin (Dilantin)

Correct answer: Clonazepam (Klonopin)

Clonazepam is not a sodium channel blocker. It is a benzodiazepine, specifically a GABA receptor agonist, which increases inhibitory neurotransmitters in the prevention of seizure activity. It is the first-line drug for treatment and prevention of myoclonic seizures.

145.

A gastric emptying study is an example of which of the following?

  • A nuclear imaging scan

  • Ultrasonography

  • A computerized tomography (CT) scan

  • Endoscopy

Correct answer: A nuclear imaging scan

Nuclear imaging scans show the size, shape, and position of organs. They may also identify functional disorders and structural defects; gastric emptying studies and liver/spleen scans are examples. A radioactive isotope is injected intravenously, and a scanning device picks up the radioactive emission. Only tracer doses of radioactive isotopes are used. For gastric emptying, the patient may be asked to eat a cooked egg white or to drink orange juice prior to the study.

Ultrasonography can detect masses (tumors, gallstones, etc.) abscesses, cysts, and cirrhotic liver tissue. CT scans are used primarily for the biliary tract, liver, and pancreatic disorders. Endoscopic procedures (including gastroscopy, duodenoscopy, colonoscopy) provide direct visualization of the area of concern within the GI tract with a lighted, flexible endoscope inserted orally or rectally.

146.

Which of the following routes is not used to administer nitroglycerin in treating cardiac ischemia?

  • Subcutaneously

  • Sublingual

  • Intravenously

  • Topically

Correct answer: Subcutaneously

Routes for administering nitroglycerine in treating cardiac ischemia include sublingually, intravenously, topically, and orally. 

Subcutaneous nitroglycerine is not used to treat cardiac ischemia and is generally contraindicated except in rare circumstances.

147.

Complications of gastroesophageal reflux disease (GERD) include all of the following except:

  • Esophageal varices

  • Esophagitis

  • Asthma and cough

  • Barrett's esophagus

Correct answer: Esophageal varices

GERD is an abnormal reflux of gastric or duodenal contents into the esophagus and involves the presence of gastric contents (HCL acid, enzymes [pepsin] causes inflammation and irritation of the esophagus). It occurs due to a weakened lower esophageal tone, resulting in a backward flow (reflux) of gastric contents into the esophagus. Complications of GERD include esophagitis, respiratory complications such as asthma, cough (especially at night), bronchospasm, wheezing; all caused by irritation of the upper airway due to gastric secretions, and Barrett's esophagus. 

Esophageal varices are not a complication of GERD, but rather a complication of liver failure (most often a consequence of portal hypertension, commonly due to cirrhosis).

148.

Which of the following tests would not be useful in diagnosing pulmonary fibrosis?

  • Chloride sweat test

  • Chest radiograph

  • Chest CT scan

  • Pulmonary function test

Correct answer: Chloride sweat test

A chloride sweat test is the gold standard for diagnosing cystic fibrosis, but is not useful in diagnosing pulmonary fibrosis. Chest radiographs, chest CT scans, and pulmonary function tests are all used in diagnosing pulmonary fibrosis.

149.

Which of the following is least likely to increase the risk of Gastroesophageal Reflux Disease (GERD)?

  • Dumping syndrome

  • Pregnancy

  • Smoking

  • Hiatal hernia

Correct answer: Dumping syndrome

Dumping syndrome occurs when gastric emptying occurs too rapidly. Delayed gastric emptying, not rapid gastric emptying, is associated with an increased risk of GERD. Pregnancy, smoking, and the presence of a hiatal hernia all increase the risk of GERD.

150.

Which of the following is not a symptom of hypoglycemia?

  • Polyuria

  • Tremors

  • Confusion

  • Hunger

Correct answer: Polyuria

Polyuria is a symptom of hyperglycemia, not hypoglycemia. Tremors, confusion, and hunger are all symptoms of hypoglycemia. Because hypoglycemia is a medical emergency, it is important that patients are able to recognize it.

151.

The earliest presenting symptom of renal cell carcinoma is typically:

  • Hematuria

  • Flank pain

  • Weight loss

  • Palpable flank mass

Correct answer: Hematuria

Renal cell carcinoma is a malignant renal neoplasm; it is the most common cancer of the renal system, accounting for 80% of all renal cancers, and can occur anywhere in the kidney. The early stages are usually silent. Only 10% of cases present with symptoms that represent advanced stage. Hematuria (presence of red blood cells in the urine) is the most common and earliest presenting symptom of renal cell carcinoma.

Other symptoms of renal cell carcinoma include:

  • Flank pain (usually dull and aching)
  • Weight loss
  • Palpable flank mass (easier noted in thin people)
  • Fatigue
  • Intermittent fever
  • Anemia
  • Altered liver function
  • Hypertension

152.

Your patient, Mr. S., was admitted to the medical-surgical unit for a gastrointestinal bleed associated with a duodenal ulcer. You are completing an admission assessment on him. Which of the following statements do you know is true related to clinical manifestations of gastrointestinal bleeding?

  • Vasomotor instability is the most sensitive indicator of blood loss

  • Dark, tarry stools indicate rapid blood loss

  • Platelet counts initially decrease due to delayed coagulation process

  • Massive blood loss leads to venous, then peripheral artery dilation

Correct answer: Vasomotor instability is the most sensitive indicator of blood loss

90% of all upper GI bleeds are associated with peptic ulcers and account for the majority of gastrointestinal hemorrhages. When caring for a patient with a GI bleed, vasomotor instability is the most sensitive indicator of blood loss; changes of 20 bpm or 10 mm Hg systolic indicate a loss of 15%-20% of total blood volume.

Massive blood loss leads to venous constriction, then peripheral artery constriction. Dark, tarry stool are indicative of a slow bleed, while frank blood indicates either sigmoid or rectal bleeding, or a massive lesion higher in the colon. Platelet counts increase due to instant coagulation process as the body attempts to stop the bleeding.

153.

Which of the following groups has higher mortality rates from asthma?

  • Women

  • Men

  • Whites

  • Hispanics

Correct answer: Women

Mortality rates from asthma are higher in women than they are in men. Mortality rates are also significantly higher for African-Americans than they are for whites or Hispanics.

154.

Enteral feeding products come from manufacturers in ready-to-feed cans, powders that require reconstituting, or in pre-filled bags that are ready to be spiked. Bacterial contamination of the formula can be reduced by:

  • Hanging formula at room temperature for no more than 4 to 8 hours for open systems

  • Mixing, diluting, and reconstituting formulas in the patient's room to avoid cross-contamination

  • Discarding refillable bags every 48 hours

  • Refrigerating reconstituted formulas for a maximum of 72 hours

Correct answer: Hanging formula at room temperature for no more than 4 to 8 hours for open systems

Reduce bacterial contamination of enteral formulas by adhering to hanging formula at room temperature for 4 to 8 hours for open systems, and up to 24 hours for closed systems. Always follow manufacturer's recommendations.

Mixing, diluting, and reconstituting formulas should be completed in a central location (formulary room or pharmacy) and not the patient's room. Refillable bags should be discarded after 24 hours. Reconstituted formulas can be stored in the refrigerator for a maximum of 48 hours.

155.

A patient is admitted with an initial blood glucose of 652 mg/dl and negative urine ketones. Which of the following conditions would the nurse infer that the patient has?

  • Hyperosmolar hyperglycemic syndrome

  • Diabetic ketoacidosis

  • Type one diabetes mellitus

  • Acute pancreatitis

Correct answer: Hyperosmolar hyperglycemic syndrome

A blood glucose of greater than 600 mg/dl is normally indicative of Hyperosmolar Hyperglycemic Syndrome (HHS). Diabetic Ketoacidosis (DKA) could be a possibility, although it does not normally result in hyperglycemia to that extent. The absence of urine ketones, however, rules out DKA. HHS is almost always associated with type two diabetes mellitus. While acute pancreatitis can cause HHS, it would be more reasonable to infer that this patient has HHS than to infer a potential cause of HHS.

156.

Sucralfate (Carafate) is commonly used in the treatment of duodenal ulcers and GERD. This medication:

  • Forms a protective barrier over the ulcer site

  • Suppresses the secretion of gastric acid

  • Inhibits the action of histamine

  • Neutralizes gastric acid

Correct answer: Forms a protective barrier over the ulcer site

Sucralfate, often used as a pharmacologic therapy in the treatment of GERD and peptic ulcers, forms a protective barrier over the ulcer site of the gastric mucosa. It also promotes bicarbonate and prostaglandin secretion and suppresses the growth of H. pylori. This medication is not recommended in the case of acute GI hemorrhage as it may obscure visualization during endoscopy.

Proton pump inhibitors suppress the secretion of gastric acids. Histamine blockers block the production of gastric acid by inhibiting the action of histamine. Antacids neutralize acids to keep gastric pH > 5.

157.

A patient who has COPD asks the nurse how they can reduce their risk of developing pneumonia. Which of the following answers is best?

  • Get all recommended vaccinations.

  • Avoid eating raw fruits and vegetables.

  • Take prophylactic antibiotics.

  • Avoid healthcare settings.

Correct answer: Get all recommended vaccinations.

Influenza, pneumococcal, and COVID-19 vaccinations can all help to reduce the risk of developing pneumonia. Avoiding raw fruits and vegetables can help reduce the risk of infections for patients on neutropenic precautions, but is not useful in reducing the risk of pneumonia. Taking prophylactic antibiotics is not recommended, as this can increase the risk or resistant organisms developing. Avoiding healthcare settings may reduce the risk of developing pneumonia, but is not recommended, as the patient should seek medical care when needed. 

158.

The most important factor for regulating respiratory rate is:

  • CO2 level in the blood

  • Bicarbonate level in the cells

  • Oxygen levels in the cells

  • Urea concentration in the blood

Correct answer: CO2 level in the blood

Respiration is regulated by the respiratory center in the brain and the autonomic nervous system. Central chemoreceptors respond to changes in pH, PaO2, and PaCO2 (partial pressure of carbon dioxide). Small changes in the PaCO2 in the systemic arterial blood flowing to the medulla produce pronounced changes in ventilation; thus, CO2 is the single most important factor for regulation of respiratory rate. Oxygen levels in the blood will also have a significant role in regulating the respiratory rate, but the oxygen level in the cells does not.

159.

You are caring for Mr. H., who was admitted for an exacerbation of ulcerative colitis (UC). You gather the following data during your admission assessment:

  • Objective: Temperature: 101 degrees F, pulse 108, blood pressure: 101/55, respiratory rate: 20, O2 saturation: 98% room air
  • Subjective: frequent bloody stools, increased abdominal pain, decreased appetite with a 6-pound unexpected weight loss. noncompliance with pharmaceutical treatment plan due to financial restraints.

All of the following are appropriate nursing diagnoses for Mr. H except:

  • Risk for excess fluid volume

  • Diarrhea

  • Imbalanced nutrition: less than body requirements

  • Acute pain

Correct answer: Risk for excess fluid volume

Risk for imbalanced fluid volume (more likely deficient fluid volume, not excess) would be an appropriate nursing diagnosis for this patient related to frequent diarrhea, decreased appetite, and weight loss. 

Diarrhea, imbalanced nutrition, and acute pain are all appropriate diagnoses for this patient.

160.

A 62-year-old male patient with a recent history of rheumatic fever is admitted to the medical-surgical unit with the following symptoms:

  • Subjective: Shortness of breath, chest pain, syncope
  • Objective: Peripheral edema, neck vein distension, weight gain, cyanosis, hepatomegaly, bounding pulses, cardiac arrhythmia

Which of the following is most likely this patient's primary diagnosis?

  • Aortic valve stenosis

  • Endocarditis

  • Left heart failure

  • Abdominal aortic aneurysm

Correct answer: Aortic valve stenosis

Subjective clinical manifestations of valvular disorders include:

  • Shortness of breath
  • Palpitations
  • Chest pain
  • Activity intolerance
  • Fatigue/Malaise
  • Anorexia
  • Dizziness
  • Syncope

Objective clinical manifestations of valvular disorders include:

  • Peripheral edema (pitting)
  • Lungs auscultate with crackles in all fields
  • Heart sounds auscultate with murmurs
  • Arrhythmias
  • Weight gain
  • Fluid retention
  • Cyanosis
  • Pulmonary edema
  • Neck vein distention
  • Hepatomegaly
  • Stasis ulcerations
  • Orthopnea
  • Bounding pulses
  • Clubbing of fingers

While the patient's symptomatology may seem to also match left heart failure, the history of rheumatic fever makes aortic valve stenosis more likely.

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