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Quiz Session - Attempts With Random Questions

MSNCB CMSRN Exam Questions

Page 9 of 50

161.

Baroreceptors monitor blood pressure and help us to respond to shock. These are found in the:

  • Carotid arteries and aortic arch

  • Brain and spinal cord

  • Brain and ventricular muscle tissue

  • Abdominal aorta

Correct answer: Carotid arteries and aortic arch

There are two types of receptors: baroreceptors which monitor pressure, and chemoreceptors which monitor changes in CO2 and oxygen levels in the blood. Baroreceptors are located in the carotid bodies and aortic arch; they recognize a decrease in pressure when the body goes into a state of shock.

162.

All of the following statements are true related to enoxaparin (Lovenox) except:

  • It will cause an elevated INR

  • It prevents conversion of fibrinogen to fibrin and prothrombin to thrombin

  • It is contraindicated in patients with leukemia and bleeding disorders

  • Route of administration is per subcutaneous injection

Correct answer: It will cause an elevated INR

Lovenox does not elevate the INR.

Lovenox prevents the conversion of fibrinogen to fibrin and prothrombin to thrombin; contraindications include leukemia and bleeding disorders, and route of administration is per subcutaneous injection.

163.

Which of the following is not a potential complication of brain attacks?

  • Tardive dyskinesia 

  • Increased intracranial pressure

  • Pressure ulcers

  • Spasticity

Correct answer: Tardive dyskinesia

Tardive dyskinesia causes repetitive and involuntary movement and is often the result of the long-term use of psychiatric medications. Tardive dyskinesia is not caused by brain attacks and is not a potential complication. 

Increased intracranial pressure may occur from bleeding within the cranial vault or from tissue edema after hypoxia. Pressure ulcers are more likely to occur due to decreased mobility. Spasticity is caused by changes in muscle tone that can occur after a brain attack.

164.

Which of the following patients is most likely to benefit from use of a pessary?

  • A patient with a prolapsed bladder

  • A patient with reflex incontinence

  • A patient with urinary retention caused by an enlarged prostate

  • A patient who is concerned about becoming pregnant

Correct answer: A patient with a prolapsed bladder

A pessary is placed into the vagina to reduce a prolapsed bladder or uterus. While a pessary may help with incontinence due to prolapsed bladder, reduction of the prolapsed organ is the primary indication. A patient with a prostate would never use a pessary, as they are exclusively used for female patients. Pessaries are not used as a method of birth control.

165.

You are providing teaching to a patient who has recently been diagnosed with multiple sclerosis. Which of the following statements best describes multiple sclerosis?

  • "Multiple sclerosis is a disease that causes degeneration of myelin sheaths."

  • "Multiple sclerosis is known to be a progressive viral disease."

  • "Multiple sclerosis is a progressive disease that only affects motor neurons."

  • "Multiple sclerosis may have remissions and exacerbations, but there is nothing that can be done to treat it."

Correct answer: "Multiple sclerosis is a disease that causes degeneration of myelin sheaths."

Multiple sclerosis is a condition that causes degeneration of myelin sheaths that protect nerve axons. 

The exact cause of multiple sclerosis is unknown. It is thought to be a progressive viral disease, an allergic reaction to infection, or an autoimmune condition. Multiple sclerosis is not always progressive and may have periods of remission. Multiple sclerosis also affects sensory neurons. Multiple sclerosis, while not curable, is certainly treatable.

166.

A patient with polycystic kidney disease asks their nurse what they can do to halt the progression of the disease. Which of the following guides the nurse's understanding when answering?

  • There is no known way to stop the progression of the disease.

  • Surgical evacuation of the cysts can slow or stop progression of the disease.

  • Diuretic therapy can prevent the accumulation of serous fluid, blood, and urine in the cysts, stopping the disease progression.

  • This disease typically resolves by itself, but may take several years to do so.

Correct answer: There is no known way to stop the progression of the disease.

Polycystic kidney disease is a progressive disease characterized by the development of cysts filled with serous fluid, blood, and urine. These cysts cause progressive destruction of healthy kidney tissue that cannot be stopped. Diuretic therapy and surgical evacuation of the cysts will not stop or slow progression of the disease. Polycystic kidney disease will not resolve on its own.

167.

The nurse is caring for an elderly female with osteoporosis. When teaching the patient, the nurse should include information about which major complication of osteoporosis?

  • Bone fracture

  • Loss of estrogen

  • Dowager's hump

  • Negative calcium balance

Correct answer: Bone fracture

Bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate (severe reduction of bone mass) increases the fragility of bones. It is often the first complaint to bring a patient with osteoporosis to the health care provider.

Estrogen deficiencies result from menopause—not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism and health, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump (marked kyphosis of the thoracic spine) results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

168.

After change-of-shift report, which patient should the nurse assess first?

  • A 35-year-old patient with a fracture who is complaining that her new cast is tight

  • A 65-year-old patient with a recent surgical left leg amputation who is complaining of phantom pain

  • A 70-year-old patient with osteoporosis who is waiting for discharge

  • A 52-year-old patient with carpal tunnel syndrome complaining of pain

Correct answer: A 35-year-old patient with a fracture who is complaining that her new cast is tight

The patient with a cast that feels tight is at risk for circulation impairment and peripheral nerve damage. 

The needs of patients who have pain or are awaiting discharge are important, and the nurse will want to address these as soon as possible, but these concerns are less urgent than the potential risks to the patient with the tight cast.

169.

Which type of pneumothorax occurs when air has been drawn into the pleural space and is unable to escape, thus causing a build up of pressure and resulting in compression of all structures within the thorax?

  • Tension pneumothorax

  • Spontaneous pneumothorax

  • Traumatic pneumothorax

  • Inflation pneumothorax

Correct answer: Tension pneumothorax

A pneumothorax is an abnormal collection of air in the pleural space that causes an uncoupling of the lung from the chest wall; there are three types: tension, spontaneous, and traumatic.

Tension pneumothorax is an accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart. Spontaneous pneumothorax occurs suddenly without injury, usually due to a rupture of a small defect (bleb) on the surface of the lung. A traumatic pneumothorax occurs when trauma results in lung puncture, allowing air to pass into the pleural space. There is no such thing as an inflation pneumothorax.

170.

Which of the following statements is true related to autoimmune disorders?

  • Autoimmune disorders occur when the immune system, failing to distinguish self from non-self, attacks its own body cells

  • In autoimmune disorders, T cells produce autoantibodies (antibodies to host cells)

  • In autoimmune disorders, B cells become autosensitized (sensitized to host cells)

  • Idiopathic thrombocytopenic purpura (ITP) is a type of systemic autoimmune disease

Correct answer: Autoimmune disorders occur when the immune system, failing to distinguish self from non-self, attacks its own body cells

Autoimmune disorders most often start in a system other than the immune system, but the immune system is involved because of the body's normal response to a threat. The immune system starts to attack the body's own cells.

In autoimmune disorders, B cells produce autoantibodies (antibodies to host cells), while T cells become autosensitized (sensitized to host cells). ITP is an example of an organ-specific autoimmune disease, not systemic.

171.

The most common cause of low back pain (LBP) is:

  • Mechanical strain of the paravertebral muscles

  • A herniated intervertebral disc

  • Degenerative disc disease

  • Spondylolysis

Correct answer: Mechanical strain of the paravertebral muscles

LBP is defined as pain in the lumbar region of the back; the lumbar area is flexible, bears most of the body's weight, and has nerve roots, all of which make this area susceptible to trauma and/or pain. 

The most common cause of LBP is mechanical strain of the paravertebral muscles. The pain may be related to a single traumatic event but also may occur as a result of excessive micro-traumas. The other choices also cause LBP but are not as common.

172.

You are caring for a patient who just underwent a thyroidectomy. For the first 72 hours, you would assess your patient for Chvostek's sign because it would indicate:

  • Hypocalcemia

  • Hyponatremia

  • Hypokalemia

  • Hypermagnesemia

Correct answer: Hypocalcemia

This patient who has undergone a thyroidectomy is at risk for developing hypocalcemia (low calcium levels) from inadvertent removal or damage to the parathyroid gland. Chvostek's sign is elicited by tapping the patient's face lightly over the facial nerve, just below the temple. If the patient's facial muscles twitch, it indicates hypocalcemia. A patient with hypocalcemia may also exhibit other signs of tetany (twitching, paresthesia, seizure activity) and needs close monitoring.

Hyponatremia (low sodium levels) is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia (low potassium levels) causes paralytic ileus and muscle weakness. Patients with hypermagnesemia (high magnesium levels) exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.

173.

Heart rate multiplied by stroke volume equals which of the following?

  • Cardiac output

  • Mean arterial pressure (MAP)

  • Central venous pressure (CVP)

  • Systemic vascular resistance (SVR)

Correct answer: Cardiac output

Cardiac output is the amount of blood pumped by each ventricle in 1 minute, calculated by multiplying the stroke volume by the heart rate. Normal cardiac output is 4-8 L/min.

Mean arterial pressure (MAP) describes an average blood pressure in an individual. It is defined as the average arterial pressure during a single cardiac cycle. Central venous pressure (CVP) is the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Systemic vascular resistance (SVR) is the resistance the left ventricle must overcome to pump blood through the systemic circulation.

174.

A patient with brain cancer asks about the risk of metastasis. Which of the following is true about metastatic brain cancer?

  • Brain cancer seldom metastasizes to sites outside the brain.

  • The liver is commonly a site of brain metastasis. 

  • The lungs are commonly a site of brain metastasis.

  • The bones are commonly a site of brain metastasis.

Correct answer: Brain cancer seldom metastasizes to sites outside the brain.

Brain cancer is rarely metastatic to sites outside of the brain. While brain cancer rarely metastasizes to other sites, the brain is a common metastatic site for other forms of metastatic cancers.

175.

You are caring for a patient with cirrhosis (chronic liver damage) and are aware that symptoms of portal hypertension are caused by:

  • Blockage of blood flow in the portal vein

  • Blockage in the cystic and hepatic ducts

  • Infection of the liver

  • Degeneration of Kupffer cells

Correct answer: Blockage of blood flow in the portal vein

Liver damage in cirrhosis results in blockage of blood flow in the portal vein, and portal hypertension results. As a result, collateral circulation develops, and visible abdominal veins, hemorrhoids, splenomegaly, and esophageal varices are found. The most serious consequence is bleeding esophageal varices and esophageal rupture. 

While infection of the liver (hepatitis A) may predispose a patient to the development of cirrhosis, which then causes portal hypertension, most often it does not. Blockage of the cystic and hepatic ducts causes jaundice (not portal hypertension). Degeneration of Kupffer cells does not lead to portal hypertension; these cells are involved in the prevention of infection.

176.

Which of the following is least likely to be a potential cause of endocarditis?

  • High cholesterol intake

  • Poor dentition

  • Congenital heart disease

  • IV drug use

Correct answer: High cholesterol intake

High cholesterol intake is associated with several cardiac conditions, but is not considered a potential causative factor of endocarditis. Poor dentition, especially with dental abscesses, congenial heart disease, and IV drug use are all risk factors for endocarditits.

177.

You are supervising a nursing student caring for a 34-year-old male who has been diagnosed with testicular cancer. Which of the following statements made by the student to the patient requires correcting?

  • "Testicular cancer has a low survival rate." 

  • "Testicular cancer is not normally painful."

  • "It may be necessary to surgically remove your testicle."

  • "Testicular cancer does not typically lead to erectile dysfunction."

Correct answer: "Testicular cancer has a low survival rate." 

Testicular cancer has a high survival rate of about 95%.

Testicular tumors are not painful initially. Orchidectomy is a normal treatment for testicular cancer. Testicular cancer does not typically lead to erectile dysfunction, and any erectile dysfunction is generally due to decreased libido caused by impaired body image or impaired perceptions of one's sexuality, rather than having a physical cause. 

178.

Which of the following symptoms is an indicator that Alzheimer's disease has progressed beyond its early stage?

  • Neglect of ADLs

  • Presence of short-term memory loss 

  • Presence of long-term memory loss 

  • Declining job performance

Correct answer: Neglect of ADLs

Neglect of ADLs (Activities of Daily Living) is associated with middle stage Alzheimer's disease and indicates progression beyond early stage Alzheimer's. Early stage Alzheimer's disease symptoms include both short- and long-term memory loss. Declining job performance is also evident in early stage Alzheimer's disease.

179.

The nurse is assessing a patient who has recently been admitted for a Myocardial Infarction (MI). Which of the following should the nurse monitor to obtain the most sensitive measure of cardiac output?

  • Urinary output

  • Systolic blood pressure

  • Heart rate

  • Mean arterial pressure

Correct answer: Urinary output

While systolic blood pressure, mean arterial pressure, and heart rate may all be indicators of cardiac output, the most sensitive measure of cardiac output will be urinary output. Cardiac output significantly influences urinary output, with a decrease in cardiac output quickly causing a decrease in urinary output.

180.

For a patient with chronic obstructive pulmonary disease, which of the following nursing interventions would help maintain a patent airway?

  • Teaching the patient how to perform controlled coughing

  • Restricting fluid intake to 1,000 mL/day

  • Enforcing strict bedrest

  • Administering prescribed sedatives regularly and in large amounts

Correct answer: Teaching the patient how to perform controlled coughing

Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions.

A moderate fluid intake (usually 2,000-3.000 mL/day) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the patient’s ability to maintain a patent airway, causing a high risk for infection from pooled secretions.

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