CEN Practice Test 1 with Rationale

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BCEN Practice Test 1 with Rationale

Question 1.    
A patient with a peritonsillar abscess will likely have which of these?
(a) Stridor.
(b) Wheezing.
(c) Whooping cough.
(d) Hot potato voice.
Answer:
(d) Hot potato voice.

A patient with a peritonsillar abscess will likely have a hot potato voice. In this condition, patients speak as if they have hot food in the mouth. Stridor is a high-pitched sound heard on inspiration. Causes of stridor include epiglottitis, croup, and foreign-body aspiration. Whooping cough is a paroxysmal cough seen in children with pertussis. Wheezing is a high-pitched sound heard due to obstruction of small to medium airways. Causes of wheezing include bronchitis, foreign body aspiration, and asthma.

Question 2.    
A patient who presents to the ER with anterior epistaxis secondary to drying of the mucosa from extreme weather is being managed with silver nitrate. Which of the following options best describes the action of silver nitrate?
(a) Anesthesia.
(b) Vasoconstriction.
(c) Lubrication.
(d) Cauterization.
Answer:
(d) Cauterization.

Silver nitrate is an anti-infective agent used to cauterize open wounds and tissues. It is applied to bleeding sites with an applicator stick. Electrocauterization can be used in place of silver nitrate.

Question 3.    
A patient who presents to the ER with acute kidney injury is placed on a low-potassium diet. Which of these foods is most appropriate?
(a) Bone broth. 
(b) Bananas. 
(c) Baked potatoes.
(d) Pasta.
Answer:
(d) Pasta.

Potassium-rich foods include beans, chicken, poultry, oranges, spinach, broccoli, bananas, raisins, prunes, mushrooms, cucumbers, sweet potatoes, and cantaloupe. Therefore, pasta, which is not rich in potassium, is the best option for this patient.

Question 4.    
An adult cognitive-impaired patient is brought to the ER due to suspected postoperative complications. He has difficulty speaking. The nurse suspects the patient might be experiencing pain. What would be the most suitable approach for the nurse to assess the patient’s pain level?
(a) Have the patient fill out a detailed questionnaire.
(b) Employ the graphic pain scale for the patient to indicate their pain level.
(c) Solely depend on observation of the patient’s behavior and movements.
(d) Ask the family to describe any changes in the patient’s usual behavior.
Answer:
(b) Employ the graphic pain scale for the patient to indicate their pain level.

The graphic pain scale can be helpful for children and adults who have difficulty communicating verbally, whether due to cognitive impairment, language barriers, or other issues. It provides a visual way for patients to communicate their pain intensity.

Question 5.    
Which of the following is a discrete variable?
(a) Number of neonates in the NICU.
(b) Occipitofrontal circumference.
(c) Height.
(d) Weight. 
Answer:
(a) Number of neonates in the NICU.

A discrete variable is counted, while a continuous variable is measured. This is because discrete variables are finite, while continuous variables are infinite. For example, a discrete variable includes counting the number of beds in a ward, the number of neonates in the NICU, or the number of patients who present to the ER with burns injuries. A discrete variable often involves a particular place and time.

Question 6.    
Which of the following is not a risk factor for epistaxis?
(a) Hypertension.
(b) Drug abuse.
(c) Foreign bodies.
(d) Autoimmune response.
Answer:
(d) Autoimmune response.

Local trauma is the most common cause of epistaxis. Trauma may be caused by nose blowing, nose picking, or drying of the nasal mucosa from very cold weather. Other causes are vestibulitis, coagulopathies, perforation of the nasal septum, foreign bodies, tumors, arteriosclerosis, and systemic disorders. An autoimmune response is not a risk factor for epistaxis. 

Question 7.    
A 55-year-old hypertensive male is being managed in the ER for NSTEMI. Which of the following treatment modalities is inappropriate for this patient?
(a) Angiography.
(b) Fibrinolytic therapy.
(c) ACE inhibitors.
(d) Morphine.
Answer:
(b) Fibrinolytic therapy.

Fibrinolytic therapy is contraindicated in patients with NSTEMI and unstable angina. The preferable mode of treatment is emergency angiography to diagnose patients with a need for PCI or CABG. Fibrinolytic therapy is used for patients with STEMI who do not have access to immediate PCI.

Question 8.    
A 56-year-old hypertensive male is being managed for STEMI secondary to atherosclerosis. [Which of the following eliminates the need for thrombolytic therapy?
(a) Previous history of myocardial infarction.
(b) Available PCI.
(c) Recent aspirin use.
(d) The onset of symptoms 12 hours before arrival.
Answer:
(b) Available PCI.

PCI (percutaneous coronary intervention) should be done within 90 minutes for all patients who present with STEMI. If PCI is not available, thrombolytic therapy must be commenced. Thrombolytic therapy is contraindicated for patients who present with symptoms of STEMI that are present for more than 24 hours. Aspirin is used as part of supportive therapy for all patients who present with myocardial infarction.

Question 9.    
A 57-year-old female presents to the ER with diaphoresis, shortness of breath, and crushing chest pain. A diagnosis of acute coronary syndrome is made. Which of the following is not a component of care given before diagnosis is confirmed?
(a) Oxygen therapy.
(b) Nitrates.
(c) Beta-blockers.
(d) Angiography.
Answer:
(d) Angiography.

Angiography is from a component of care given before diagnosis is confirmed. It is a component of treatment for patients with NSTEMI. Components of prehospital care are oxygen therapy, nitrates, morphine, beta-blockers (where indicated), aspirin, and anticoagulant therapy.

Question 10.    
Which of the following is most appropriate for a 46-year-old male being managed for uncomplicated NSTEMI?
(a) Emergency angiography.
(b) Fibrinolytic therapy.
(c) Beta-blockers.
(d) CABG. 
Answer:
(c) Beta-blockers.

Treatment modalities for patients with stable NSTEMI are supportive management with oxygen, beta-blockers, aspirin, diuretics, and anticoagulants. Angiography is done about 24 to 48 hours after hospitalization. This is because the risk of a completely blocked coronary artery has been ruled out. Angiography is done to identify the need for a PCI or a CABG. Fibrinolytic therapy is contraindicated in all patients with NSTEMI.

Question 11.    
A 57-year-old male is being managed in the ER for unstable angina. Which of the following is not a presentation of this condition?
(a) Angina at rest.
(b) New-onset angina.
(c) Progressive angina.
(d) ST elevation.
Answer:
(d) ST elevation.

Clinical features of unstable angina are angina that occurs at rest and lasts more than 20 minutes and new-onset angina that increases in intensity, duration, and frequency. These anginas also have a low threshold. However, unlike acute myocardial infarction, the levels of the cardiac biomarkers are much lower. ECG findings include elevation/depression of the ST segment and inversion of the T waves. These findings are short-lived.

Question 12.    
Which of the following patients is least at risk of aspiration?
(a) A 56-year-old male with status epilepticus.
(b) A 36-year-old female with myasthenia gravis.
(c) A 23-year-old male with upper GI bleeding.
(d) A 45-year-old male with chronic bronchitis.
Answer:
(d) A 45-year-old male with chronic bronchitis.

The risk factors for aspiration are impaired consciousness, gastrointestinal procedures, impaired swallowing, vomiting, GERD, and respiratory and dental procedures. Therefore, the patient in Option D is least at risk of aspiration. 

Question 13.    
A patient presents to the ER complaining of sudden chest pain and shortness of breath. A chest X-rayiis essential for which of the following reasons?
(a) It can definitively diagnose a myocardial infarction.
(b) It can depict lung inflation and any potential lung collapses or pneumothorax.
(c) It provides a detailed view of the coronary arteries and potential blockages.
(d) It can depict the brain and help medical professionals rule out a stroke.
Answer:
(b) It can depict lung inflation and any potential lung collapses or pneumothorax.

A chest X-ray is a diagnostic tool that provides visualization of the lungs, heart, and other structures within the chest. It is relevant for diagnosing conditions such as pneumothorax, pneumonia, or lung collapses.

Question 14.    
Which of the following antibiotics is most suitable for treating a 45-year-old male being managed in the ER for aspiration pneumonitis secondary to opioid overdose?
(a) Clindamycin.
(b) Doxycycline.    
(c) Erythromycin.
(d) Streptomycin.
Answer:
(a) Clindamycin.

Antibiotics for treating aspiration pneumonia are clindamycin, a beta-lactamase inhibitor like tazobactam, clavulanic acid, sulbactam, or a carbapenem.

Question 15.    
Which of the following treatment modalities is not indicated in managing a four-year- old male who ingested paint thinner an hour before presentation?
(a) Gastric lavage.
(b) Oxygen supplementation.
(c) IV fluids.
(d) Vital sign monitoring. 
Answer:
(a) Gastric lavage.

Gastric emptying is contraindicated for a patient who has hydrocarbon poisoning in order to avoid the risk of aspiration pneumonia. Treatment modalities in this patient are largely supportive. Patients who do not show signs of pneumonitis are discharged about six hours after admission.

Question 16.    
Which of the following investigations is not required in diagnosing myasthenia gravis in a 35-year-old female who presents to the ER with diplopia, ptosis, and weakness of the distal muscles?
(a) Electromyography.
(b) CT of the thorax.
(c) Serum AChR antibodies.
(d) Ice pack test.
Answer:
(b) CT of the thorax.

Myasthenia gravis is confirmed with electromyography and measuring serum levels of AChR antibodies. Electromyography is sensitive in about 60 percent of patients, while serum AChR antibodies are sensitive in about 95 percent of patients with generalized myasthenia gravis. The ice pack test is a bedside test used for screening. CT of the thorax is only done after confirmation of the diagnosis to exclude or confirm hyperplasia of the thymus or thymoma.

Question 17.    
A patient who presents to the ER with ptosis, dysphagia, and diplopia is being managed with pyridostigmine for myasthenia gravis. The patient should be informed of which of the following side effects?
(a) Diarrhea.
(b) Tachycardia.
(c) Urinary retention.
(d) Conjunctivitis.
Answer:
(a) Diarrhea.

Pyridostigmine is an anticholinesterase inhibitor that prolongs the action of acetylcholine in the neuromuscular junction. Side effects are from stimulation of the muscarinic and nicotinic receptors in the parasympathetic nervous system. These side effects include bradycardia, hypermotility of the GI tract, hypertonia of the lower esophageal sphincter, nausea, vomiting, bronchoconstriction, diarrhea, abdominal cramps, low blood pressure, frequent urination, insomnia, headaches, and allergic reactions.

Question 18.    
Which of the following investigations is most appropriate in diagnosing multiple sclerosis?    
(a) Electromyography.
(b) MRI.
(c) CT scan.
(d) CSF analysis.
Answer:
(b) MRI.

Diagnostic investigations for multiple sclerosis include clinical evaluation, MRI, and analysis of CSF. However, the most sensitive test is an MRI, which can differentiate multiple sclerosis from other disorders that may mimic it. An MRI is also used to differentiate new plaques from old ones. 

Question 19.    
A 15-year-old male with multiple sclerosis is being managed in the ER with Baclofen. This drug provides relief from which of the following symptoms?
(a) Paresthesia.
(b) Confusion.
(c) Spasticity.
(d) Urinary incontinence.
Answer:
(c) Spasticity.

Baclofen is a GABA derivative used to treat spasticity in patients with multiple sclerosis. About 10 to 20 mg of oral Baclofen is given three to four times daily. Other treatment options for spasticity are gait training and physiotherapy.

Question 20.    
Which of the following is used in assessing the facial nerve in a 56-year-old male who presents to the ER with Bell’s palsy?
(a) Blowing of the cheeks.
(b) Raising of the shoulders.
(c) Jaw jerk.
(d) Grinding of the teeth.
Answer:
(a) Blowing of the cheeks.

Clinical examination of the facial nerve includes asking the patient to raise his eyebrows, close his eyes against resistance, show his teeth, or blow out his cheeks. The facial nerve innervates the muscles related to facial expressions. Option B is used to assess the trapezius muscle. Options C and D are used to assess the mandibular branch of the trigeminal nerve.

Question 21.    
A patient who presents to the ER with a cerebrovascular accident has a positive Romberg test. Which of the following is not assessed by a Romberg test?
(a) Proprioception.
(b) Coordination.
(c) Vestibular function.
(d) Attention.
Answer:
(d) Attention.

Attention, a cognition function, is tested with the mini-mental state exam. The Romberg test checks for proprioception, motor coordination, joint position, and vestibular function. It is also used to test the dorsal column of the spinal cord. In this test, patients are asked to stand straight with their eyes closed and feet together. Patients with a positive Romberg test cannot stand straight with closed eyes. Instead, they will sway. Examiners should stand at the back of patients to catch them if they fall.

Question 22.    
A 52-year-old patient presents to the emergency department with a sudden onset of flaccid paralysis of the lower limbs. Which of the following is a potential cause of flaccid paralysis?
(a) Multiple sclerosis.
(b) Guillain-Barre syndrome.
(c) Myasthenia gravis.
(d) Parkinson’s disease.
Answer:
(b) Guillain-Barre syndrome.

Flaccid paralysis is characterized by muscle weakness or paralysis with reduced muscle tone. Guillain-Barre syndrome (GBS) is an autoimmune disorder where the body’s immune system attacks the peripheral nerves. It often starts with weakness and tingling in the legs and can progress to muscle weakness or paralysis. Multiple sclerosis may lead to muscle stiffness and spasms rather than flaccid paralysis. Myasthenia leads to weakness but not necessarily flaccid paralysis. Parkinson’s disease does not cause flaccid paralysis.

Question 23.    
A five-year-old male presents to the ER with a history of salicylate poisoning. Which of the following actions will alkalinize the urine?
(a) Give 1 L of sodium chloride in 30 minutes.
(b) Give IV NaHC03 1-2 mEq/kg as a bolus injection.
(c) Give dextrose potassium insulin infusion.
(d) Give IV furosemide.
Answer:
(b) Give IV NaHC03 1-2 mEq/kg as a bolus injection.

In the treatment of salicylate poisoning, urine and plasma are ionized to increase the excretion of salicylic acid and reduce the risk of its absorption through the blood-brain barrier. Alkalizing the urine keeps the drug in its ionized form, making it easy for excretion by the renal tubules. The pH of the urine should be about 7.5 to 8.

Question 24.    
Which of the following is NOT a common cause of non-cardiogenic pulmonary edema?
(a) High altitude. 
(b) Opioid overdose.
(c) Near-drowning.
(d) Aortic stenosis.
Answer:
(d) Aortic stenosis.

While aortic stenosis can cause cardiogenic pulmonary edema due to left ventricular dysfunction, it does not cause non-cardiogenic pulmonary edema. Non-cardiogenic pulmonary edema can result from factors like high altitude, opioid overdose, or a near-drowning event directly affecting the lungs.

Question 25.    
Which of the following describes an inability to identify objects despite having normal sensory function?
(a) Agnosia.
(b) Apraxia.
(c) Aphasia.
(d) Akinesia. 
Answer:
(a) Agnosia.

Agnosia is an inability to identify objects despite having normal sensory function. Apraxia is an inability to perform certain motor skills that were previously learned while motor function is intact. Aphasia is an inability to use or understand words. Akinesia is an inability to move despite having a normal motor function.

Question 26.    
A nurse is educating the parent of a child diagnosed with chickenpox. Which of the following statements made by the parent indicates a need for further education?
(a) “I will give my child aspirin to reduce the fever.”
(b) “I will keep my child away from their newborn cousin.”
(c) “We should avoid scratching to prevent skin infections.”
(d) “I can use calamine lotion to help soothe the itching.”
Answer:
(a) “I will give my child aspirin to reduce the fever.”

Giving aspirin to children with chickenpox (or other viral infections) is contraindicated due to the risk of Reye’s syndrome, a rare but serious condition that causes swelling in the liver and brain. Acetaminophen or ibuprofen should be used instead to manage fever and pain in children with chickenpox.

Question 27.    
A 55-year-old female with Alzheimer’s disease is being managed in the ER with acute pyelonephritis. Part of her treatment plan includes donepezil. Which of the following best describes the mechanism of action of this drug?
(a) NMDA antagonist.
(b) Selective serotonin reuptake inhibitor.
(c) Acetylcholine receptor blocker.
(d) Cholinesterase inhibitor.
Answer:
(d) Cholinesterase inhibitor.

Donepezil is an acetylcholinesterase inhibitor that prolongs the action of acetylcholine. It is used to improve memory and cognition in; patients with Alzheimer’s disease. Other examples are tacrine, galantamine, and rivastigmine. Examples of NMDA antagonists are amantadine, memantine, and dextromethorphan. Selective serotonin receptor blockers include sertraline, escitalopram, fluoxetine, fluvoxamine, and citalopram. Examples of acetylcholine receptor blockers are atropine and scopolamine.

Question 28.    
A 65-year-old female who presents to the ER with Parkinson’s disease is managed with amantadine. Which of the following best describes this drug’s mechanism of action?
(a) Dopamine receptor agonist.
(b) Acetylcholinesterase inhibitor. 
(c) NMDA receptor antagonist.
(d) MAO-B inhibitor.
Answer:
(c) NMDA receptor antagonist.

Amantadine is an NMDA receptor antagonist used in treating dyskinesia and tremors in patients with Parkinson’s disease. It increases the action of both dopamine and . acetylcholine. It is not used as monotherapy. Examples of dopamine receptor antagonists are bromocriptine, pramipexole, rotigotine, and cabergoline. Examples of acetylcholinesterase inhibitors are physostigmine and neostigmine. Examples of MAO-B inhibitors are selegiline, rasagiline, and safinamide.

Question 29.    
Which of the following is not seen in acute appendicitis?
(a) Rebound tenderness.
(b) Rovsing’s sign.
(c) Cullen’s sign.
(d) Obturator sign.
Answer:
(c) Cullen’s sign.

Cullen’s sign is seen in acute pancreatitis. Signs seen in acute appendicitis are rebound tenderness, which can be elicited by palpating the McBurney’s point; Rovsing’s sign, which is tenderness at the right lower quadrant on palpation of the left lower quadrant; the psoas sign, which is tenderness caused by passive extension of the right hip; and the obturator sign, which is tenderness elicited when the thigh is flexed and passively rotated (internal rotation). 

Question 30.    
Which of the following is most necessary in diagnosing acute appendicitis?
(a) Abdominal ultrasound scan.
(b) Clinical evaluation.
(c) CT scan of the abdomen.
(d) Abdominal X-ray. 
Answer:
(b) Clinical evaluation.

Acute appendicitis is often diagnosed by clinical evaluation. In patients with classic features, delaying treatment for imaging tests can worsen the patient outcome and increase the risk of perforation. Radiological imaging is done with contrast-enhanced CT scan or ultrasonography in patients with unequivocal findings.

Question 31.    
A 48-year-old male presents to the ER following a marathon run. He complains of severe muscle pain and dark urine. Which of the following laboratory findings would best support a diagnosis of rhabdomyolysis?
(a) Elevated serum creatinine.
(b) Reduced serum myoglobin.
(c) Elevated serum myoglobin.
(d) Reduced serum creatine kinase.
Answer:
(c) Elevated serum myoglobin.

Rhabdomyolysis is characterized by the breakdown of damaged skeletal muscle tissue, which causes the release of a protein called myoglobin into the bloodstream. High amounts of myoglobin in the blood can cause kidney damage. Elevated serum myoglobin is one of the main findings in rhabdomyolysis and would best support the diagnosis in this situation.

Question 32.    
Which of the following is not a stigmata of chronic liver disease?
(a) Testicular atrophy.
(b) Finger clubbing.
(c) Lanugo hair.
(d) Acanthosis nigricans.
Answer:
(d) Acanthosis nigricans.

Acanthosis nigricans is a skin manifestation of diabetes mellitus and metabolic syndrome. The skin—particularly skin folds in the neck, groin, and axilla—are thickened and hyperpigmented. Stigmata of chronic liver disease include gynecomastia, testicular atrophy, spider nevus, ascites, finger clubbing, lanugo hair, paronychia, sweeping of the parotid gland, jaundice, and others.

Question 33.    
A 25-yeai;-old female who presents to the ER with abdominal pain, fever, chills, and vomiting derhonstrates a positive Murphy’s sign. Which of the following maneuvers best elicit this sign?
(a) Palpation of the epigastric region on deep inspiration.
(b) Palpation of the right hypochondrium on deep inspiration.
(c) Auscultation of the right hypochondrium.
(d) Percussion of the right hypochondrium.
Answer:
(b) Palpation of the right hypochondrium on deep inspiration.

To elicit Murphy’s sign, the patient is asked to take deep breaths while the right hypochondrium is palpated. The sign is positive when the patient halts during inspiration due to exacerbation of the pain.

Question 34.    
A patient with suspected rhabdomyolysis has been admitted to the emergency department. Which of the following interventions is the highest priority to initiate?'
(a) Administering intravenous corticosteroids.
(b) Implementing fluid resuscitation with isotonic saline.
(c) Starting a dopamine infusion.
(d) Monitoring for signs of hypocalcemia.
Answer:
(b) Implementing fluid resuscitation with isotonic saline.

In rhabdomyolysis, the release of myoglobin can lead to acute kidney injury. Fluid resuscitation with isotonic saline is a primary intervention that enhances renal perfusion and facilitates the excretion of myoglobin in the urine. Adequate hydration helps dilute the urine and prevent myoglobin from precipitating in the renal tubules. This reduces the risk of renal damage.

Question 35.    
A 16-year-old female being managed for severe acute asthma has worsened symptoms despite management with supplemental oxygen, IV epinephrine, corticosteroids, and nebulized albuterol. Arterial blood gases show PaCo2 62 mmHg. Which of the following interventions is most appropriate?
(a) IV theophylline.
(b) NIPPV.
(c) Mechanical ventilation.
(d) IV diazepam.    
Answer:
(c) Mechanical ventilation.
This patient requires immediate mechanical support to prevent cardiopulmonary failure. Indications for mechanical ventilation in a patient with severe asthma are PaCo2 greater than 60 mmHg, excessive production of respiratory secretions, decreased consciousness, and facial abnormalities that will prevent proper NIPPY. 

Question 36.    
Which of the following treatments is inappropriate for a five-year-old asthmatic male who presents to the ER with coughing, wheezing, breathlessness, and chest pain?
(a) Nebulized albuterol.
(b) Subcutaneous epinephrine.
(c) IV hydrocortisone.
(d) IV amoxicillin that is administered intravenously.
Answer:
(d) IV amoxicillin that is administered intravenously.

Amoxicillin is typically administered orally. IV antibiotics could be considered, but amoxicillin is not commonly administered intravenously.

Question 37.    
A 60-year-old male patient presents to the ER complaining of chest pain. An electrocardiogram (ECG) is promptly performed. Which of the following ECG findings is most indicative of an acute myocardial infarction?
(a) Peaked T-waves.
(b) ST-segment elevation.
(c) Prolonged PR interval.
(d) Widened QRS complex.
Answer:
(b) ST-segment elevation.

ST-segment elevation is a main sign of an acute myocardial infarction (AMI), especially when seen in more than one contiguous lead and accompanied by clinical symptoms of chest pain. Although the other options, such as peaked T-waves, might indicate hyperkalemia, prolonged PR interval can suggest first-degree heart block and a widened QRS complex can indicate bundle branch block or hyperkalemia. Therefore, ST-segment elevation is most indicative of AMI in this situation.

Question 38.    
A 70-year-old patient presents to the ER after falling at home. The nurse assesses the patient’s respirations and finds a respiratory rate of 8 breaths per minute. The patient is alert and oriented but reports feeling slightly drowsy. What is the most appropriate initial nursing intervention for this patient’s condition?
(a) Administer supplemental oxygen via a nasal cannula.     
(b) Initiate chest compressions immediately.
(c) Increase the patient’s fluid intake.
(d) Re-position the patient in a high Fowler’s position.
Answer:
(a) Administer supplemental oxygen via a nasal cannula.     

Bradypnea refers to an abnormally slow breathing rate, but the specific rate that defines bradypnea can vary; some sources define it as fewer than 12 breaths per minute for adults, while others may use a different cutoff. In this scenario, the patient’s respiratory rate is eight breaths per minute, which indicates bradypnea. Even though the patient is alert and oriented, drowsiness can be an early sign of hypoxia. The most appropriate immediate action would be to provide supplemental oxygen to ensure adequate oxygenation.

Question 39.    
Which of the following histories is most important to obtain from a 45-year-old female who presents to the ER with a history of chronic productive cough of three months duration, pedal edema, and hypertension?
(a) Family history of hypertension.
(b) Contact with someone with a recent cough.
(c) Cigarette smoking.
(d) IV drug abuse.
Answer:
(c) Cigarette smoking.

From the symptoms, this patient has a differential diagnosis of COPD. Cigarette smoking is a primary risk factor for COPD. A history of 40 pack-years is predictive of COPD. Other risk factors are exposure to passive smoking, smoke from indoor cooking, underlying airway disease, occupational hazards (dust), and air pollution.

Question 40.    
Which drug should be administered first to a patient who presents to the ER with diarrhea, wheezing, shortness of breath, and hypotension following ingestion of seafood?
(a) Diphenhydramine.
(b) Epinephrine.
(c) Albuterol. 
(d) Hydrocortisone. 
Answer:
(b) Epinephrine.

Epinephrine is the treatment of choice in anaphylaxis and must be given immediately for relief from all symptoms and clinical signs of anaphylaxis. It can be given subcutaneously or as an intramuscular dose of 0.3 to 0.5 mL. Other treatment includes acute resuscitation with IV fluids, oxygen, and vasopressors when indicated. Oral antihistamines are given for pruritus, and nebulized beta-agonists are given for respiratory symptoms.

Question 41.    
Which of the following features is most appropriate in distinguishing diverticulitis from appendicitis?
(a) Right suprapubic pain.
(b) Rebound tenderness.
(c) Vomiting.
(d) Palpable sigmoid.
Answer:
(d) Palpable sigmoid.

Patients with diverticulitis often present with tenderness in the left lower abdominal quadrant. The pain can also be felt in the suprapubic area. However, the sigmoid is often palpable at the left iliac fossa, differentiating it from appendicitis. 

Question 42.    
A 46-year-old male being managed for renal calculi is treated with hydrochlorothiazide. Which of the following best explains this drug’s mechanism of action in this patient’s condition?
(a) Dissolution of calculi.
(b) Alkalinization of urine.
(c) Lowers excretion of calcium.
(d) Muscle relaxant.
Answer:
(c) Lowers excretion of calcium.

Hydrochlorothiazide is a thiazide diuretic given to patients with calcium oxalate calculi. This drug reduces calcium excretion in the urine by increasing its reabsorption in the distal convoluted tubule.

Question 43. 
A 35-year-old male who presents to the ER with upper GI bleeding secondary to GERD is set to be discharged to his primary care physician. Part of his discharge requirements include aluminum hydroxide. The patient should be warned of which of the following potential side effects?
(a) Diarrhea.    
(b) Constipation.
(c) Drowsiness.
(d) Rashes.
Answer:
(b) Constipation.

Aluminum hydroxide is an antacid used in treating GERD. Aluminum hydroxide reacts with HC1 and reduces the acidity of the stomach. A side effect of aluminum hydroxide is constipation because aluminum ions prevent contraction of the smooth muscle in the gut, prevent peristalsis, and increase stool transit time.

Question 44.    
Which of the following best describes Barrett’s esophagus?
(a) Hypertrophy of the esophageal mucosa.
(b) Atrophy of the esophageal mucosa.
(c) Metaplasia of the esophageal mucosa.
(d) Atrophy of the gastric mucosa.
Answer:
(c) Metaplasia of the esophageal mucosa.

Barrett’s esophagus is a complication of chronic GERD. Regurgitation of acid from the stomach into the lower esophagus causes metaplasia of the esophageal mucosa from stratified squanjous cells into simple columnar cells. Barrett’s esophagus is a premalignant condition that increases the risk for adenocarcinoma of the esophagus.

Question 45.    
A nurse in the ER is assessing a patient who was involved in a motor vehicle accident. The patient has a suspected head injury and exhibits bradypnea with a respiratory rate of 10 breaths per minute. What could be the potential cause of bradypnea in this patient?
(a) Cerebral hypoxia.
(b) Increased intracranial pressure.
(c) Stimulation of the sympathetic nervous system.
(d) Hyperventilation syndrome.
Answer:
(b) Increased intracranial pressure.

Bradypnea, or a decreased respiratory rate, can be caused by various factors. There is a suspected head injury after a motor vehicle accident in this scenario. The increased intracranial pressure (ICP) could be causing pressure on the brainstem, which would cause bradypnea.

Question 46.    
A nurse monitors the vital signs of a gravid patient being managed with magnesium sulfate for severe eclampsia. The patient’s patellar reflex is 2+. Which of the following best describes this grade?
(a) Diminished reflex.
(b) Normal reflex.
(c) Brisk reflex.
(d) Hyperactive reflex.
Answer:
(b) Normal reflex.

o - Absent reflex 1+ - Diminished reflex 2+ - Normal reflex 3+ - A brisk reflex that is more active than normal 4+ - Very brisk and hyperactive reflex.

Question 47.    
Which of the following is not an expected presentation in a 55-year-old male who is being managed for aortic dissection?
(a) Chest pain.
(b) Syncope.
(c) Heart murmurs.
(d) Collapsing pulse.
Answer:
(d) Collapsing pulse.

Typical presentations in a patient with aortic dissection are precordial pain, which is described as tearing or ripping. The pain can also be interscapular. Patients can also present with syncope and features of hypotension. Patients can present with symptoms of end-organ malperfusion. In about 20 percent of patients, there are deficits of arterial pulses in major blood vessels. This can present as a difference in blood pressure between two limbs if more than 30 mmHg. Murmurs of regurgitation can also be heard on auscultation. A collapsing pulse (or “water-hammer” pulse) is associated with aortic regurgitation, not necessarily aortic dissection.

Question 48.    
Which of the following drugs is the first-line treatment of hypertension in a 56-year-old male who presents to the ER with tearing chest pain, hypertension, and aortic regurgitation and is being managed for aortic dissection?
(a) Beta-blockers.
(b) Calcium channel blockers.
(c) ACEI inhibitors.
(d) Nitrates.
Answer:
(a) Beta-blockers.

Beta-blockers are first-line antihypertensive drugs in patients with aortic dissection. 5 mg IV metoprolol is given for up to four doses at about 15-minute intervals. Second-line drugs are calcium channel blockers like verapamil or diltiazem. An IV nitroprusside infusion is given if the systolic blood pressure is persistently above 110 mmHg. Please note that nitroprusside must not be used as monotherapy. It must be given either with a beta-blocker or a calcium channel blocker to prevent reflex activation of the sympathetic system.

Question 49.    
A nurse in the ER is preparing to assess a pediatric patient’s pain level. The child is four years old and has difficulty verbally expressing the extent of his pain. What would be the most appropriate method for the nurse to gauge the child’s pain accurately?
(a) Ask the child to rate the pain on a scale from 1 to 10.
(b) Use the graphic pain scale and ask the child to point to the face that best describes their pain.
(c) Rely on the child’s vital signs to determine the pain level.
(d) Ask the parents to estimate the pain level on behalf of the child.
Answer:
(b) Use the graphic pain scale and ask the child to point to the face that best describes their pain.

The graphic pain scale, often referred to as the Faces Pain Scale, is specifically designed for children who'might have difficulty understanding or using numerical pain scales. It uses a series of faces ranging from happy (no pain) to sad/crying (worst pain) to represent different pain levels visually.

Question 50.    
You are to commence CPR on a 45-year-old female being managed for an opioid overdose. Which of the following is most useful in signaling an appropriate positioning of the patient’s airway?
(a) External auditory meatus aligned with the sternal notch.
(b) Head flat on the stretcher.     
(c) Head tilt position.
(d) The rami of the mandible pointing downward. 
Answer:
(a) External auditory meatus aligned with the sternal notch.

To open the airway using the “sniffing position,” the external auditory meatus should be aligned with the sternal notch. In this position, the patient’s face is inclined upwards. Position the mandible upward by lifting the lower jaw or pushing the ramus of the mandible upward (jaw lift). The head should not be kept flat unless contraindicated,

Question 51.    
A patient managed for trichomoniasis is about to be discharged on oral metronidazole. Which of the following statements is accurate when educating the patient on medication use?
(a) It should be taken with orange juice to increase absorption.
(b) It should not be taken with alcohol.
(c) It should be taken on an empty stomach.
(d) It should be taken with fatty foods.
Answer:
(b) It should not be taken with alcohol.

When taken with alcohol, metronidazole triggers a disulfiram-like reaction. Symptoms include nausea, vomiting, palpitations, shortness of breath, flushing, and hypotension. To reduce the risk of this occurrence, patients are counseled to avoid alcohol throughout metronidazole therapy and for at least two days after completion.

Question 52.    
A patient with cystic fibrosis is treated in the ER with nebulized hypertonic saline. Which of the following best describes the rationale behind this treatment?
(a) Bronchodilation.
(b) Mucus thinner.
(c) Cough suppressant.
(d) Vasodilation.
Answer:
(b) Mucus thinner.

Nebulized hypertonic saline is used as a mucus thinner in patients with exacerbated symptoms of cystic fibrosis. The salt molecules in the hypertonic saline are deposited in the respiratory airway and exert an osmotic pressure on the mucosa, absorbing water and thinning out the mucus plugs. This makes the mucus easier to expectorate. 

Question 53.    
A 52-year-old male patient arrives at the ER complaining of abdominal pain, blood in
stools, and unintended weight loss over the past few months. The patient was recently diagnosed with stage III colorectal cancer. Which of the following manifestations should be anticipated?
(a) A tumor that is confined only to the mucosal lining of the colon. 
(b) A cancer that has spread to nearby lymph nodes but not to distant organs.
(c) Metastasis to the liver and the lungs.
(d) A tumor is present but has not breached the colon wall.
Answer:
(b) A cancer that has spread to nearby lymph nodes but not to distant organs.

Stage III colorectal cancer is characterized by the tumor entering through the muscularis propria and into the subserosa. It also invades other organs and regional lymph nodes.

Question 54.    
Which of the following is not an immediate concern in a patient who presents to the ER with full-thickness burns secondary to a fire incident?
(a) Dehydration.
(b) Eschar.
(c) Contractures.
(d) Hypothermia.
Answer:
(c) Contractures.

Contractures and the formation of keloids are late complications of burns. They form during healing and fibrosis. Contractures often form at the joints in the feet and hands. They can also form at the perineum.

Question 55.    
IV cimetidine is Part of the initial management of a patient with third-degree burns. This drug is useful in preventing which of the following?
(a) Nausea.
(b) Stress ulcers.
(c) Diarrhea.
(d) Anxiety.    
Answer:
(b) Stress ulcers.

Cimetidine is an H2 receptor blocker. It inhibits the secretion of hydrochloric acid and will be useful in this patient for preventing stress ulcers.

Question 56.    
Which of the following is not a clinical feature of organophosphate poisoning?
(a) Lacrimation.
(b) Diarrhea.
(c) Mydriasis.
(d) Urinary frequency.
Answer:
(c) Mydriasis.

In organophosphate poisoning, there is an inhibition of acetylcholinesterase, which leads to stimulation of parasympathetic activity. Clinical features include lacrimation, diarrhea, frequency, miosis (not mydriasis), bradycardia, vomiting, salivation, and fasciculations.

Question 57.    
A patient with organophosphate poisoning is being managed with IV pralidoxime. Which of the following symptoms is best treated with pralidoxime?
(a) Seizures.
(b) Muscle fasciculations.
(c) Nausea.
(d) Lacrimation.
Answer:
(b) Muscle fasciculations.

Pralidoxime treats neuromuscular symptoms such as muscle fasciculations in patients with organophosphate poisoning. Secretory features (lacrimation, diarrhea, salivation, frequency, and vomiting) are treated with atropine. Benzodiazepines are used to treat seizures.

Question 58.    
A 35-year-old construction worker is brought into the emergency department after experiencing anelectrical injury. Which of the following complications is not typically associated with electrical injuries?
(a) Hemolysis.
(b) Parkinson’s disease.
(c) Rhabdomyolysis. 
(d) Cardiac arrhythmias.
Answer:
(b) Parkinson’s disease.

Electrical injuries can have a wide range of complications, from superficial burns to systemic and internal injuries. Regarding hemolysis, electric current can cause direct damage to red blood cells, which in turn can lead to hemolysis. Electrical injuries can lead to muscle damage, resulting in rhabdomyolysis, a condition where damaged skeletal muscle breaks down rapidly and releases myoglobin into the bloodstream. In cardiac arrhythmias, the electrical current can disrupt the heart’s normal rhythm, leading to various cardiac arrhythmias. Parkinson’s disease is a progressive nervous system disorder that affects movement. It is not a direct complication of electrical injuries.

Question 59.    
Which of the following is not a component of critical incident stress management?
(a) Defusing.
(b) Debriefing. 
(c) Psychoanalysis.
(d) Follow-up.
Answer:
(c) Psychoanalysis.

Critical incident stress management components include defusing, debriefing, and follow up (in that order). 

Question 60.    
Which of the following is not a purpose of critical incident stress management?
(a) Helping patients cope with depressive disorders.
(b) Reducing the risk of post-traumatic stress disorder.
(c) Offering psychological first aid.
(d) Helping patients cope with trauma.
Answer:
(a) Helping patients cope with depressive disorders.

This is not the purpose of critical incident stress management. CISM is not an alternative treatment for patients with psychiatric disorders. It is a form of psychological first aid used to reduce the risk of post-traumatic stress disorder in trauma patients. This therapy helps patients identify the emotions surrounding the trauma and encourages them to talk about their perceptions without fear of judgment or condemnation.

Question 61.    
Which of the following is not an example of a critical incident?
(a) Work-related death.
(b) Suicide of a coworker.
(c) Assault.
(d) Stage IV colorectal cancer. 
Answer:
(d) Stage IV colorectal cancer. 

Stage IV colorectal cancer is not an example of a critical incident. Critical incidents are stressful events that can cause psychological reactions in the people who witness the events. They are sudden and can overwhelm the witnesses’ ability to cope. Critical incidents are often work-related. Examples include the death of a coworker, terrorist attack, natural disaster, workplace assault, workplace injury, war, state of emergency, vehicular accident, and others.

Question 62.    
A patient presents with symptoms of fatigue, shortness of breath, and pallor. A blood test reveals a low hemoglobin level. Which of the following conditions is primarily associated with decreased red blood cells (RBCs)?
(a) Polycythemia vera.
(b) Thalassemia.
(c) Hemophilia.
(d) Immune thrombocytopenic purpura (ITP).
Answer:
(b) Thalassemia.

Thalassemia is a group of inherited blood disorders characterized by decreased hemoglobin production, leading to a reduced number of red blood cells, which can result in anemia. Polycythemia vera is associated with an increased number of RBCs: Hemophilia deals with clotting disorders, and ITP is related to a low platelet count.

Question 63.    
Which of the following principles of ethics supports A patient’s right to refuse treatment?
(a) Beneficence.
(b) Veracity.
(c) Autonomy.
(d) Privacy.
Answer:
(c) Autonomy.

Autonomy means that the patient has the final say in their health decision-making. This ethical principle gives the patient the right to accept or refuse treatment after thorough education and counseling.

Question 64.    
Which of the following is necessary for confirming a diagnosis of variant angina in a 45-year-old female with a history of nocturnal chest pain?
(a) Exercise test.
(b) Provocative test. 
(c) Chest X-ray.
(d) Echocardiography.
Answer:
(b) Provocative test. 

Provocative testing with acetylcholine or ergonovine is used to confirm a coronary artery spasm diagnosis, which can cause variant angina. This test is done during angiography in a cardiac catheterization lab. The test is positive when ST-segment elevation is observed on ECG or when a coronary artery spasm is observed on cardiac catheterization.

Question 65.    
A 56-year-old female who presents with diaphoresis, crushing chest pain, and breathlessness was given sublingual nitroglycerin for acute myocardial infarction. Which of the following is not a mechanism of action of nitroglycerin in this patient?
(a) Reduces preload.
(b) Reduces afterload.
(c) Arterial dilatation.
(d) Reduces heart rate.
Answer:
(d) Reduces heart rate.

Nitroglycerin is a short-acting and potent vasodilator. It dilates arteries, veins, and arterioles, reducing left ventricular preload and afterload. It reduces cardiac ischemia because it reduces the oxygen demand of the cardiac muscle. It does not reduce heart rate. Beta-blockers mediate this function. 

Question 66.    
Which of the following is an immediate concern for a 56-year-old male patient currently being managed for an abdominal aortic aneurysm?
(a) Hypovolemic shock.
(b) Disseminated intravascular coagulation.
(c) Acute peripheral arterial occlusion.
(d) Pulmonary embolism.
Answer:
(a) Hypovolemic shock.

Hypovolemic shock is a critical condition that occurs due to a severe loss of blood or fluids, resulting in inadequate perfusion of organs and tissues. The rupture or significant leakage of the aneurysm can lead to massive internal bleeding and cause hypovolemic shock. This is an immediate concern because it can be life-threatening, and rapid intervention is required to control the bleeding, replace lost fluids, and stabilize the patient.

Question 67. 
Which of the following treatment modalities would likely be recommended for a patient with stage III colorectal cancer?
(a) Surgical resection only.
(b) Chemotherapy combined with radiation.
(c) Targeted drug therapy that is focused on liver lesions.
(d) Wait and watch approach.
Answer:
(b) Chemotherapy combined with radiation.

For stage III colorectal cancer, the tumor is first surgically removed. Then, adjuvant chemotherapy is often recommended to eliminate any remaining cancer cells and reduce the risk of recurrence. Chemotherapy is sometimes combined with radiation.

Question 68.    
Which of the following is a 65-year-old male most at risk of having in the early postoperative phase of an emergency repair of an abdominal aortic aneurysm?
(a) Hemorrhagic shock.
(b) Myocardial infarction.
(c) Acute kidney injury.
(d) Erectile dysfunction.
Answer:
(b) Myocardial infarction.

Acute myocardial infarction is the most common cause of early postoperative death for patients who undergo surgery for an abdominal aortic aneurysm. Kidney injury is the most common cause of late postoperative death.

Question 69.    
A patient on; heparin therapy for a deep vein thrombosis (DVT) has a PTT drawn. The normal range for PTT is 25-35 seconds. If the patient’s PTT result is 70 seconds, the nurse should:
(a) Prepare to administer more heparin as the level is subtherapeutic.
(b) Maintain the current heparin dosage as the level is therapeutic.
(c) Prepare to decrease the heparin dose or administer protamine sulfate due to a risk of bleeding.
(d) Discontinue heparin and start warfarin immediately.
Answer:
(c) Prepare to decrease the heparin dose or administer protamine sulfate due to a risk of bleeding.

A PTT of 70 seconds is prolonged, indicating the patient is at an increased risk of bleeding. The nurse should anticipate an order to reduce the heparin dose or administer the heparin antidote, protamine sulfate, to reverse its effects. While switching to warfarin might be a consideration in certain situations, it is not the immediate concern with an elevated PTT.

Question 70.    
Which of the following is an indication of gastric lavage?
(a) Ingested hydrocarbons.
(b) Drugs that are absorbed by activated charcoal.
(c) Heavy metal poisoning.
(d) Short duration of ingestion of toxic material.
Answer:
(d) Short duration of ingestion of toxic material.

Gastric lavage is not routine management of poisoning due to numerous risks (aspiration, perforation, esophageal injury, and epistaxis). The only indication of gastric lavage is a short duration between ingesting the material and the onset of symptoms (usually less than one hour). This is not usually the case for most patients. Gastric lavage is contraindicated in patients with hydrocarbon poisoning due to the high risk of aspiration pneumonia. Drugs absorbed by activated charcoal do not need to be eliminated via gastric lavage. Treatment for heavy metal poisoning includes using the appropriate chelating agent.

Question 71.    
A 25-year-old patient presents to the ER with a penetrating eye injury. The physician orders a cycloplegic agent. What is the primary therapeutic purpose of administering a cycloplegic agent in this scenario?
(a) To reduce intraocular pressure.
(b) To promote constriction of the pupil.
(c) To provide anesthesia to the eye.
(d) To paralyze the ciliary muscle and relieve pain.
Answer:
(d) To paralyze the ciliary muscle and relieve pain.

Cycloplegics are medications used to paralyze the eye’s ciliary muscle. In cases of eye injuries or inflammation, the paralysis of the ciliary muscle can help alleviate pain. This is especially true in conditions where eye movement causes pain.

Question 72.    
A six-year-old male who presents to the ER with cough, wheezing, and chest tightness is being managed for an acute asthmatic attack. Which of the following clinical signs will alert the attending nurse to worsening symptoms?
(a) Crackles.
(b) Silent chest.
(c) Tachypnea.
(d) Fever.
Answer:
(b) Silent chest.

A silent chest is a sign of severe exacerbation of symptoms. In this case, the patient stops coughing and wheezing due to worsening respiratory function. Immediate assisted ventilation is needed to prevent cardiopulmonary failure.

Question 73.    
A 56-year-old female who presents to the ER with severe anemia is being managed for atrophic gastritis. Her management plan will include foods rich in which of the following?
(a) Legumes.
(b) Cabbage.
(c) Red meat.
(d) Fat.
Answer:
(c) Red meat.

In atrophic gastritis, there is autoimmune destruction of parietal cells, including the proton pump and intensive factor necessary in producing gastric acid and aiding vitamin B12 absorption. Patients with this disease have megaloblastic anemia from cobalamin deficiency. The treatment plan will include supplementation with vitamin B12 and increased intake of foods rich in vitamin B12. Sources of vitamin B12 are meat, especially red meat from beef, pork, and offal. Other sources are poultry, dairy, and seafood like salmon, mackerel, oysters, and clams.

Question 74.    
A 15-year-old male who presents to the ER with a sickle cell crisis is managed with hydroxyurea. Which of the following best explains this drug’s mechanism of action?
(a) Stimulates vasodilation
(b) Controls pain. 
(c) Increases HbF.
(d) Increases oxidation.
Answer:
(c) Increases HbF.

Hydroxyurea is a myelosuppressive drug used in treating myelosuppressive diseases like leukemia, ovarian cancer, and melanoma. In sickle cell anemia, it increases HbF and the total hemoglobin level. Since HbF is less prone to sickling in stressful conditions, it reduces the frequency of sickle cell crises by almost 50 percent.

Question 75.    
A mother brings her 6-year-old son to the emergency department after he complains of blurred vision after an eye examination. The boy’s pediatrician had used a cycloplegic agent for a retinoscopy earlier in the day. Which of the following is a common side effect of cycloplegic agents?
(a) Miosis (constricted pupils).
(b) Hyperlacrimation (increased tearing).
(c) Blurred near vision.
(d) Decreased intraocular pressure.
Answer:
(c) Blurred near vision.

Cycloplegic agents paralyze the ciliary muscle, which causes an inability to accommodate or focus on near objects. This results in blurred near vision. This is a temporary side effect, but it can be disturbing, especially for those not expecting it.

Question 76.    
A 68-year-old male presents with widespread petechiae rashes and decompensated liver failure. Which of the following is not a pathophysiology of this patient’s bleeding condition?
(a) Vitamin K deficiency.
(b) Thrombocytopenia.
(c) Elevated liver enzymes. 
(d) Hypofibrinogenemia. 
Answer:
(c) Elevated liver enzymes. 

Elevated liver enzymes are not responsible for this patient’s coagulopathy. In liver disease, coagulopathy is caused by vitamin K deficiency, which affects the function of vitamin In-dependent clotting factors and the clotting cascade. This leads to hypofibrinogenemia.
Also, diminished secretion of thrombopoietin causes thrombocytopenia. Elevated liver enzymes are seen in liver disease and point to existing liver pathology.

Question 77. 
A patient with DIC is managed with cryoprecipitate. Which of the following substrates is provided by cryoprecipitate?
(a) Fibrinogen.
(b) Thrombin.
(c) Plasminogen.
(d) Platelets.
Answer:
(a) Fibrinogen.

Cryoprecipitate provides concentrated fibrinogen, clotting Factor I. In the coagulation cascade, fibrinogen is converted to fibrin. Fibrin molecules polymerize into a mesh that reinforces the blood clot. Cryoprecipitate is made from fresh frozen plasma that is frozen and thawed repeatedly in the laboratory. 

Question 78.    
Which of the following is responsible for initiating the clotting cascade in DIC?
(a) Thrombin.
(b) Tissue factor.
(c) Calcium.
(d) Vitamin K.
Answer:
(b) Tissue factor.

The tissue factor, also known as Factor III, initiates the extrinsic pathway of the clotting cascade in DIC. The tissue factor activates Factor VII, which plays a role in converting prothrombin to thrombin. Thrombin activates the conversion of fibrinogen to fibrin.

Question 79.    
A five-year-old male who presents to the ER with an acute exacerbation of asthma is managed with nebulized ipratropium. Which of the following best describes this drug’s mechanism of action?
(a) Muscarinic receptor blocker.
(b) Nicotinic receptor blocker.
(c) Beta receptor agonist.     
(d) Beta receptor blocker.
Answer:
(a) Muscarinic receptor blocker.

Ipratropium bromide is a muscarinic receptor blocker. It is a broncholytic drug that relieves symptoms in COPD and asthma patients. It reduces bronchoconstriction and mucus plug formation in the respiratory tree.

Question 80.    
Which of the following is not a pathophysiologic process involved in Alzheimer’s disease?
(a) Short-term memory loss.     
(b) Visuospatial dysfunction.
(c) Impaired consciousness.
(d) Poor judgment.
Answer:
(c) Impaired consciousness.

The level of consciousness in patients with Alzheimer’s is usually intact until delirium sets in. The manifestation of Alzheimer’s includes short-term memory loss, cognitive dysfunction that manifests as impaired judgment, impaired reasoning, and the inability to perform complete tasks. Dysfunction in language manifests as difficulty in speaking and difficulty recalling words. Visuospatial dysfunction manifests as an inability to recognize familiar faces.

Question 81.    
Which of the following drugs is not useful in managing trigeminal neuralgia?
(a) Carbamazepine.
(b) Gabapentin.
(c) Baclofen.
(d) Acetaminophen. 
Answer:
(d) Acetaminophen. 

Acetaminophen is not used in treating trigeminal neuralgia. Carbamazepine is the drug of choice. If there are contraindications to using this drug in the patient, other anticonvulsants like gabapentin, lamotrigine, and phenytoin are used. Apart from anticonvulsants, baclofen and amitriptyline are used in place of carbamazepine.

Question 82.    
Which of the following treatments is contraindicated in a patient with a traumatic eardrum rupture?
(a) Aural irrigation.
(b) Oral antibiotics.
(c) Topical antibiotics.
(d) Oral analgesia.
Answer:
(a) Aural irrigation.

This treatment is contraindicated in this patient. The appropriate treatment aims to. keep the ear canal moist to encourage hemostasis and clot formation and reduce the risk of infections. Irrigation of the ear canal can dislodge clots, prevent hemostasis, and encourage infection. Perforations that last for more than eight weeks are surgically closed. Antibiotic therapy is indicated for a dirty or infected ear canal.

Question 83.    
Which of the following is not a clinical feature of Ludwig’s angina?
(a) Tenderness.
(b) Abscess.
(c) Induration.
(d) Drooling.
Answer:
(b) Abscess.

Ludwig’s angina describes cellulitis of the submandibular region of the jaw. It is not a true abscess; however, clinical treatment includes incision and drainage. Cellulitis also involves the suprahyoid soft tissues and the submaxillary and sublingual spaces. 

Question 84.    
A patient with Meniere’s disease will benefit from a diet low in which of the following?
(a) Sodium.
(b) Potassium.
(c) Protein.
(d) Calcium.
Answer:
(a) Sodium.

Patients with Meniere’s disease will benefit from a low-salt diet to reduce the buildup of endolymphatic fluid in the inner ear. Other measures include a restriction on alcohol and caffeine intake and the use of diuretics like acetazolamide and hydrochlorothiazide.

Question 85.    
Which of the following is not a clinical feature of Meniere’s disease?
(a) Tinnitus.
(b) Vertigo.
(c) Sensorineural deafness.
(d) Nystagmus.
Answer:
(d) Nystagmus.

The cardinal symptoms of Meniere’s disease are tinnitus, vertigo, and sensorineural deafness. Vertigo is often associated with nausea, vomiting, diarrhea, diaphoresis, and unsteady gait.

Question 86.    
Which of the following drugs is not implicated in ototoxicity?
(a) Gentamicin.
(b) Furosemide.
(c) Vancomycin.
(d) Tetracycline.
Answer:
(d) Tetracycline.

Tetracycline is not implicated in ototoxicity. A significant side effect of tetracycline is staining and permanent discoloration of the enamel of the teeth. Aminoglycosides, antineoplastic drugs, quinine, salicylates, and diuretics like furosemide are implicated in ototoxicity.

Question 87.    
The pain in trigeminal neuralgia is often described as:
(a) Persistent.
(b) Paroxysmal.
(c) Nocturnal.
(d) Throbbing.
Answer:
(b) Paroxysmal.

The pain in trigeminal neuralgia is described as paroxysmal attacks of excruciating and unilateral pain triggered by stimulation of facial points.

Question 88.    
A patient who has just had a reduction of their dislocated mandible will be counseled on doing which of the following?
(a) Avoiding hot foods.
(b) Eating only semisolids for three weeks.
(c) Cutting food into smaller pieces before chewing.
(d) Gargling with warm saline water.
Answer:
(c) Cutting food into smaller pieces before chewing.

After reducing the dislocated mandible, the mandible is supported with Barton’s bandage. The patient is counseled not to open his or her mouth wide for at least six weeks, to'cut food into smaller pieces before eating, and to use a fist to support the jaw when yawning.

Question 89.    
Which of the following measures is not useful in managing myoglobinuria in a patient with electrical injuries?
(a) Alkalinization of urine.
(b) Surgical debridement.
(c) IV fluids.
(d) Allopurinol.
Answer:
(d) Allopurinol.

Myoglobinuria is managed with IV fluids to facilitate excretion, alkalinization of urine with sodium bicarbonate, and rapid debridement of necrosed muscle. Allopurinol is used to reduce serum concentrations of uric acid. It is not used in the management of myoglobinuria.

Question 90.    
Which of the following first aid interventions is inappropriate for a patient suffering from a snakebite?
(a) Establishing IV access.
(b) Securing the airway.     
(c) Applying a tourniquet. 
(d) Reassuring the patient.
Answer:
(c) Applying a tourniquet. 

This intervention is not encouraged in managing snake bites because it can worsen perfusion and increase the risk of tissue necrosis. Other unacceptable first-aid interventions are suctioning the wound, incising the wound, and using cauterization, cryotherapy, or electric shock. 

Question 91.    
A 16-year-old boy is struck in the eye with a baseball. Blood is pooling in the anterior chamber of the affected eye. This condition is known as:
(a) Retinal detachment.
(b) Subconjunctival hemorrhage.
(c) Corneal abrasion.
(d) Hyphema.
Answer:
(d) Hyphema.

Hyphema refers to blood in the anterior chamber of the eye, which is often caused by trauma. Recognizing and appropriately managing hyphema is important because complications can lead to diminished vision or blindness.

Question 92.    
Which of the following measures is inappropriate in providing a safe and secure environment for a patient with Alzheimer’s disease?
(a) A bright, familiar environment.
(b) Overstimulation.
(c) Regular exercise.
(d) Frequent orientation. 
Answer:
(b) Overstimulation.

For patients with Alzheimer’s disease, structured and appropriate new stimulation or activities can be beneficial. Overstimulation should be avoided to reduce the patient’s risk of feeling out of control, restless, anxious, or agitated. Avoiding Overstimulation reduces the incidence of behavioral disorders.

Question 93. 
Which of the following is not a feature of myasthenic crisis?
(a) Lacrimation.
(b) Tachypnea.
(c) Muscle weakness.
(d) Diplopia.
Answer:
(a) Lacrimation.

Myasthenic crisis is characterized by severe respiration muscle weakness (manifesting as tachypnea, cyanosis, and other signs of respiratory distress/failure) or severe quadriparesis. it is seen in 15 to 20 percent of patients. It is caused by infectious states that stimulate the immune system and drive autoimmune responses against acetylcholine receptors. Lacrimation is a side effect seen in a cholinergic crisis (caused by high doses of anticholinesterase drugs).

Question 94.    
Which of the following is the most common cause of cholecystitis?
(a) Septicemia.
(b) Cholelithiasis.
(c) Drugs.
(d) Liver flukes.
Answer:
(b) Cholelithiasis.

About 95 percent of patients with cholecystitis have cholelithiasis. Impaction of a gallstone in the gallbladder causes chronic obstruction and status of bile. This leads to an inflammatory cascade initiated by inflammatory mediators like phospholipase A and „ prostaglandins. There may be a supervening bacterial infection. Causes of acalculous cholecystitis include total parenteral nutrition, prolonged fasting, critical illness, vasculitis, and immune deficiency. This form of cholecystitis is thought to be caused by bile stasis, infection, and ischemia.

Question 95.    
Which of the following is a recommended treatment strategy for hyphema?
(a) Applying warm compresses every hour.
(b) Lying iflat without head elevation.
(c) Using cycloplegic agents to reduce pain.
(d) Prescribing systemic anticoagulants.
Answer:
(c) Using cycloplegic agents to reduce pain.

In treating hyphema, cycloplegic agents can paralyze the ciliary muscle. This provides pain relief from recurring spasms.

Question 96.    
Which of the following treatment modalities is contraindicated in a patient with hepatic encephalopathy?
(a) Low-protein diet.
(b) Motility agents.
(c) Sedatives.
(d) Antibiotics.
Answer:
(c) Sedatives.

Sedatives are contraindicated in patients with hepatic encephalopathy because they can worsen outcomes by pushing patients farther into a coma. A low-protein diet with protein sourced from plants is more beneficial than a diet that completely excludes protein. 

Question 97.    
A 56-year-old male with upper GI bleeding secondary to ruptured esophageal varices is administered octreotide. Which of the following best describes this drug’s mechanism of action?
(a) Inhibition of glucagon.
(b) Vasoconstriction.
(c) Platelet aggregation.
(d) Antimotility agent. 
Answer:
(a) Inhibition of glucagon.

Octreotide increases splanchnic vasoconstriction by inhibiting the release of vasodilating hormones like glucagon and vasoactive intestinal peptides. Octreotide is a derivative of somatostatin and is preferred over vasopressin.

Question 98.    
Which of the following procedures is most suitable for a 56-year-old male with ruptured esophageal varices and persistent upper GI bleeding despite interventions with IV octreotide and endoscopic banding?
(a) Liver transplantation.
(b) TIPS procedure.
(c) Sengstaken-Blakemore tube.
(d) IV vasopressin.
Answer:
(b) TIPS procedure.

Transjugular intrahepatic portosystemic shunt (TIPS) is a life-saving procedure for patients with upper GI bleeding. This procedure creates a bypass between the hepatic and portal venous circulation. TIPS is an emergency procedure with a lower morbidity profile than the Sengstaken-Blakemore tube (increased risk of perforation and aspiration). IV octreotide has a better therapeutic effect compared to IV vasopressin.

Question 99.    
A patient is being managed for acute watery diarrhea secondary to norovirus infection. Which of the following measures is not useful in reducing the risk of spread?
(a) Handwashing.
(b) Sterile gloves.
(c) Isolation.
(d) Disinfection of surfaces.
Answer:
(b) Sterile gloves.

Noroviruses are spread by direct and indirect contact with patients and their surroundings. Viruses in the patient’s stool can infect others via fecal-oral routes. Contact precautions include handwashing, isolation of the patient, disinfection of the patient’s surroundings, and use of gowns and gloves. However, these gloves are not necessarily sterile since contact is not made with an exposed mucosa or broken skin.

Question 100.    
Telling patients they cannot return if they are discharged against medical advice demonstrates which of the following?
(a) Fraud.
(b) Battery. 
(c) Malpractice.
(d) False imprisonment.
Answer:
(d) False imprisonment.

In false imprisonment, patients are held against their wishes. Restraints can be chemical, physical, or psychological. In this case, psychological restraint has been used. The nurse has lied to the patient to dissuade them from leaving.

Question 101.    
Which of the following is not a component of malpractice?
(a) Breach of duty. 
(b) Effect.
(c) Causation.
(d) Damages.     
Answer:
(b) Effect.

The effect is not a component of malpractice. The components are:

• Duty - The nurse must have a professional relationship with the patient that requires the provision of nursing care.
• Breach of duty - The nurse does not provide the required standard of care.
• Foreseeability - An unfavorable effect of the nurse’s inability to provide care.
• Causation - An ability to draw a link between the nurse’s action and the harm done. Harm/injury - Injury suffered as a result of the nurse’s actions.
• Damages - The nurse is accountable for the harm and must compensate for it.

Question 102.    
Which of the following is not a characteristic of a qualitative research method?
(a) Use of open-ended questions.
(b) Use of structured questionnaires.
(c) Aims to describe data.
(d) Use of a small sample size. 
Answer:
(b) Use of structured questionnaires.

This is a characteristic of a quantitative research method. Qualitative research aims to describe data and understand a phenomenon. Sample sizes are often small, and open-ended questions are used semi-formally or informally. The researcher is often involved in the research. Therefore, the data obtained is subjective and may be biased.

Question 103. 
Which of the following is not an objective of quantitative research?
(a) Testing cause and effect.
(b) Testing a hypothesis.
(c) Interpreting social interactions.
(d) Explaining a phenomenon.
Answer:
(c) Interpreting social interactions.

This is an objective of qualitative research. Quantitative research is done to explain a phenomenon, test a hypothesis, establish a correlation between variables, and use this correlation to predict outcomes in the future.

Question 104.    
A patient presents with complaints of fever, cough, and sudden onset of chest pain. A chest X-ray reveals an air-fluid level in the right lung field. This finding is most suggestive of which of the following conditions?
(a) Pneumothorax.
(b) Atelectasis.
(c) Pulmonary edema.
(d) Lung abscess.
Answer:
(d) Lung abscess.

An air-fluid level seen on a chest X-ray within the lung typically suggests a lung abscess, which is a necrotic cavity filled with pus. Pneumothorax, atelectasis, and pulmonary edema do not characteristically present with an air-fluid level.

Question 105.    
A four-year-old male with prolonged bleeding secondary to hemophilia will be managed with which of the following blood products?
(a) Red blood cells.
(b) Platelets.
(c) Fresh frozen plasma.
(d) Whole blood.
Answer:
(c) Fresh frozen plasma.

Fresh frozen plasma contains Factors VIII and IX and is useful in providing urgent treatment until the necessary clotting factor is transfused. Red blood cells are not necessary unless the patient is in hemorrhagic shock. Platelets are not useful since hemorrhage is from deficient clotting factors,-' not platelets. Whole blood is not useful in treating this patient.

Question 106.    
A patient is being managed with heparin. The nurse has the antidote, protamine sulfate, in the drug tray in case of emergencies. Which of the following best describes this drug’s mechanism of action?
(a) Receptor blocker.
(b) Heparin degradation.
(c) Heparin binder. 
(d) Heparin excretion.
Answer:
(c) Heparin binder. 

Protamine sulfate binds to heparin and forms a stable complex with no anticoagulant function. The reticuloendothelial system readily breaks down this complex. This antidote readily reverses the action of heparin in five minutes. About 1 to 1.5 mg of protamine is given per 100 IU of circulating heparin.

Question 107.    
A 56-year-old female with atrial fibrillation is being managed with warfarin. Her INR is 4.5. Which of the following responses is most appropriate?
(a) Withhold the next dose of warfarin.
(b) Reduce the next dose of warfarin by half.
(c) Continue with the next dose of warfarin.
(d) Give protamine sulfate. 
Answer:
(a) Withhold the next dose of warfarin.

INR that is less than or equal to 1 is considered normal. A range from 2 to 3 is considered therapeutic in patients on anticoagulant therapy. A value of 4.5 is considered critical and puts the patient at increased risk of bleeding. The most appropriate response is to withhold the next warfarin dose, assess the patient’s vital signs, and assess for bleeding. The attending physician must also be informed. The antidote for warfarin is vitamin K and fresh frozen plasma. Protamine sulfate is used to reverse the effects of heparin.

Question 108.    
Which of the following methods is most effective in controlling posterior epistaxis?
(a) Nasal balloons.
(b) Pinching the alae of the nose together.
(c) Electrocauterization.
(d) Topical lidocaine.
Answer:
(a) Nasal balloons.

Posterior bleeds are controlled by inserting nasal balloons for tamponade. Anterior bleeds are more common than posterior bleeds and are often easier to control. This is because anterior bleeds occur in the Kiesselbach’s area, while posterior bleeds occur deeper in the nasal cavity and are more serious. Another method for controlling bleeding is the use of a posterior gauze pack. Other measures for severe cases are ligation of the internal maxillary artery or angiographic embolization.

Question 109.    
A patient with trigeminal neuralgia is unlikely to experience increased pain when performing which of the following activities?
(a) Chewing.
(b) Brushing teeth.
(c) Smiling.
(d) Swallowing.
Answer:
(d) Swallowing.

Trigeminal neuralgia is caused by compression of the fifth cranial nerve by an intracranial artery, a vein, multiple sclerosis plaques, or a tumor. Clinical features are excruciating and paroxysmal facial pain triggered by brushing the teeth, chewing, smiling, or sleeping on the affected side of the face. Swallowing is unlikely to cause increased pain.

Question 110.    
Which of the following is an expected side effect of Fab antivenom?
(a) Anorexiai
(b) Serum sickness.
(c) Redman syndrome.
(d) Postural hypotension.
Answer:
(b) Serum sickness.

Serum sickness is a type III hypersensitivity reaction against antivenoms obtained from animal sources. Fab antivenom comes from sheep antibodies. Clinical features of serum sickness are gashes, fever, pruritus, hypotension, hematuria, splenomegaly, arthralgia, malaise, glomerulonephritis, lymphadenopathy, and shock. A loading dose of the antivenom is administered slowly, and the patient is observed for adverse reactions to reduce the risk of serum sickness.

Question 111.    
When applying povidone-iodine as an antiseptic on a wounded forearm, which of the following precautions should be considered?
(a) Ensure that the patient is fasting.
(b) Allow the solution to dry for at least 30 minutes.
(c) Apply a thick layer and then scrub vigorously. 
(d) Ask the patient if they are allergic to iodine.
Answer:
(d) Ask the patient if they are allergic to iodine.

Povidone-iodine is an iodine-containing antiseptic. Before using it on a patient, asking about any known allergies or sensitivities to iodine or shellfish is important.

Question 112.    
Which of the following treatment modalities is not useful in managing acute food poisoning caused by Clostridium perfringens?
(a) IV fluids.
(b) Antiemetics.
(c) Oral metronidazole.
(d) Bed rest.
Answer:
(c) Oral metronidazole.

Clostridium perfringens food poisoning is usually a self-limiting condition that does not require antibiotics. Treatment primarily focuses on supportive care, such as IV fluids to prevent dehydration and antiemetics to manage nausea and vomiting. Bed rest may be recommended as part of supportive care, but oral metronidazole is typically not needed for managing this type of food poisoning.

Question 113.    
A patient with intense pruritus secondary to obstructive jaundice is managed with cholestyramine. Which of the following best explains the mechanism of action of this drug?
(a) Histamine receptor blocker.
(b) Relaxation of the neck of the gallbladder.
(c) Bile acid sequestrant.
(d) HMG CoA reductase inhibitor. 
Answer:
(c) Bile acid sequestrant.

Cholestyramine is a bile acid sequestrant. It binds to intestinal bile acids, preventing their absorption into the bloodstream. The bile acid/cholestyramine complexes are then excreted in the stool.

Question 114. 
Which of the following treatment modalities is unnecessary in a patient being managed for acute hepatitis A infection?
(a) Ribavirin.
(b) IV fluids.
(c) Cholestyramine.
(d) Antipyretics.
Answer:
(a) Ribavirin.

Ribavirin is an antiviral drug used in treating infections with hepatitis C, RSV, and viruses responsible for some viral hemorrhagic fevers. Acute hepatitis A is a self-limiting infection requiring no specific antiviral medication treatment. Treatment is mainly supportive to address nausea, vomiting, fever, abdominal pain, and pruritus.

Question 115.    
Which of the following microorganisms is implicated in hemolytic uremic syndrome?
(a) Campylobacter jejuni.
(b) Vibrio cholerae.
(c) Escherichia coli.
(d) Entamoeba histolytica.
Answer:
(c) Escherichia coli.

Hemolytic uremic syndrome is an acute and rapidly progressive disease characterized by acute kidney injury, hemolytic anemia, and thrombocytopenia. It commonly affects children infected by Escherichia coli Oi57:H7, which releases Shiga toxin. It can also affect adults.

Question 116.    
Which of the following treatment modalities is contraindicated in managing a 15- 15-month-old fe^nale who presents with acute watery diarrhea secondary to rotavirus infection? 
(a) IV crystalloids.
(b) Loperamide.
(c) Ondansetron.     
(d) Zinc.
Answer:
(b) Loperamide.

Loperamide is an antidiarrheal drug. It is not used in managing acute watery diarrhea in children less than two years of age. IV crystalloids are used in managing patients with moderate to severe dehydration, while ondansetron is safe for children with severe and persistent vomiting. Oral zinc is effective in bulking up the stools and reducing the frequency of stealing.

Question 117.    
Which of the following statements about a direct inguinal hernia is false?
(a) It does not pass through the inguinal canal.
(b) It is more likely to herniate into the scrotum. 
(c) It can be manually reduced.
(d) It can be elicited by a cough impulse.
Answer:
(b) It is more likely to herniate into the scrotum. 

This statement is false. Since direct hernias do not transverse through the inguinal canal, they are less likely to be found in the scrotum. Indirect hernias pass through the inguinal canal and are likely found in the scrotum. Inguinal hernias seen in the scrotum are always indirect. Direct hernias herniate obliquely and appear as a circular sweeping at the external ring.

Question 118.    
A patient presents with a chemical burn to the eye. While considering the use of povidone-iodine for ocular irrigation, it is important to understand that:
(a) Povidone-iodine is the preferred solution for ocular chemical burns.
(b) A1% povidone-iodine solution can be used for ocular antisepsis before surgery.
(c) Povidone-iodine should be used at full concentration for all eye injuries.
(d) Povidone-iodine is contraindicated for use in ocular injuries. 
Answer:
(b) A1% povidone-iodine solution can be used for ocular antisepsis before surgery.

Povidone-iodine is used in a diluted form (1% solution) for ocular antisepsis before surgery due to its broad-spectrum antimicrobial properties. It is important to use the correct concentration to prevent complications.

Question 119.
When examining a chest X-ray, an air-fluid level without a parenchymal lung disease typically indicates which of the following?
(a) A large pneumothorax.
(b) Pleural effusion.
(c) A hiatal hernia.
(d) Emphysema.
Answer:
(c) A hiatal hernia.

When an air-fluid level is observed without a parenchymal lung disease on a chest X-ray, it can indicate a hiatal hernia. This is when a portion of the stomach herniates through the diaphragm into the thoracic cavity. Although pneumothorax, pleural effusion, and emphysema are all conditions associated with the thorax, they do not typically present with an air-fluid level in the absence of a lung disease. 

Question 120.    
Which of the following is not a route of giardiasis transmission?
(a) Waterborne.
(b) Sexual contact.
(c) Foodborne.
(d) Respiratory droplet.
Answer:
(d) Respiratory droplet.

Giardiasis is a parasitic infection of the bowel. It is not spread by respiratory droplets or oral secretions. It is spread by fecal-oral routes via contaminated food and water. Transmission can also occur by coming into contact with feces during sex, by ingesting contaminated water in swimming pools, when changing diapers of infected children, and through poor handwashing hygiene.

Question 121.    
Which of the following is used in measuring the appropriate length of tubing to insert a nasopharyngeal airway in a 45-year-old being managed for ventilatory failure?
(a) Distance from the tip of the nose to the tragus of the ear.
(b) Distance from the tip of the nose to the ramus of the mandible.
(c) Distance from the tip of the nose to the sternal notch.
(d) Distance from the tip of the nose to the xiphisternum.
Answer:
(a) Distance from the tip of the nose to the tragus of the ear.

The appropriate measurement before inserting a nasopharyngeal airway is the distance from the tip of the nose to the tragus of the ear. The distance for an oropharyngeal airway is measured from the angle of the mouth to the angle of the ramus of the mandible.

Question 122.    
Which of the following steps is incorrect when inserting an oropharyngeal airway in a conscious 19-year-old male?
(a) Clearing the oropharynx of secretions and vomitus.
(b) Collecting the appropriate measurement of the tube. 
(c) Inserting the airway with its tip pointing to the floor of the mouth.
(d) Turning the airway about 180 degrees as you approach the posterior oropharynx.
Answer:
(c) Inserting the airway with its tip pointing to the floor of the mouth.

This step is incorrect because the airway must be inserted with its tip pointing toward the roof of the riiouth (concave up). If a tongue depressor is used, its tip should be pointed toward the floor of the mouth (concave down).

Question 123.    
Which of the following is an absolute contraindication to the Heimlich maneuver?
(a) Infants.
(b) Obesity.
(c) Pregnancy.
(d) Cyanosis. 
Answer:
(a) Infants.

The Heimlich maneuver should not be performed on infants under one year old. Infants are resuscitated by back blows. In this maneuver, the infant is held in a prone position with the head down. The head of the infant is supported with the rescuer’s nondominant hand while the dominant hand delivers five back blows. After this, the infant is placed on the rescuer’s thigh in a supine, head-down position, and five chest thrusts are given. A. sequence of back blows and chest thrusts are given until the airway is cleared.

Question 124. 
Which of the following statements is incorrect when commencing a bag valve mask ventilation in a conscious 27-year-old male with apnea.?
(a) You should insert an oropharyngeal airway.
(b) You should use your hand to hold the mask over the patient’s mouth, with your thumb and index finger anchoring the connector stem of the mask.
(c) You should avoid covering the patient’s eyes.
(d) To achieve a proper seal, you should ensure the mask covers the bridge of the nose, mandibular alveolar ridge, and malar eminences.
Answer:
(a) You should insert an oropharyngeal airway.

This statement is incorrect because oropharyngeal airways are contraindicated in conscious patients with an intact gag reflex. A nasopharyngeal airway should be used in this patient.

Question 125.
A 47-year-old female presents to the ER with palpitations, dizziness, and dyspnea in exertion. Emergency ECG reveals a sawtooth pattern in leads II, III, and aVF. Which of the following diagnoses is most appropriate?
(a) Atrial fibrillation.
(b) Atrial flutter.
(c) Ventricular tachycardia.
(d) Ventricular fibrillation.
Answer:
(b) Atrial flutter.

Atrial flutter on an ECG is characterized by the following features: a narrow complex tachycardia, sawtooth-like flutter waves seen in leads II, III, and aVF, consistent atrial activity, and no flat or isoelectric baseline. 

Question 126.    
Which of the following drugs is not a scabicide?
(a) Permethrin. 
(b) Lindane.
(c) Benzyl benzoate.
(d) Praziquantel.
Answer:
(d) Praziquantel.

Praziquantel is not a scabicide. It is the drug of choice for fluke infestation. Scabicides used to treat scabies infestation are permethrin, lindane, ivermectin, sulfur mixed with petroleum jelly, and crotamiton lotion.

Question 127.    
The primary reason for administering a 5% dextrose saline intravenous solution would be to:
(a) Rapidly expand the intravascular volume.
(b) Replace electrolyte imbalances.
(c) Provide the patient with both hydration and a source of glucose.
(d) Correct metabolic acidosis.
Answer:
(c) Provide the patient with both hydration and a source of glucose.

5% dextrose saline contains 5% dextrose in normal saline (0.9% NaCl). It is designed to provide patients with hydration (from the saline component) and calories (from the dextrose component).

Question 128.    
Which of the following cells is most susceptible to radiation?
(a) Bone cells.
(b) Hepatic cells.
(c) Lymphoid cells.
(d) Brain cells. 
Answer:
(c) Lymphoid cells.

Undifferentiated cells with high mitotic rates are the most vulnerable to radiation. Examples of such cells include cancerous cells and stem cells like lymphoid cells. Differentiated cells in the brain, muscle, and spinal cord are the least susceptible to radiation.

Question 129.    
A health worker is expected to divulge all the information necessary to help a patient make an informed decision, even if such information can affect the patient’s coping mechanisms. This is in accordance with which healthcare principle?
(a) Beneficence.
(b) Veracity.
(c) Fidelity.
(d) Autonomy.
Answer:
(b) Veracity.

The ethical principle of veracity requires all health workers to be truthful and honest in their dealings with their patients, even if such honesty can affect the patient’s coping mechanisms. The ethical principle of veracity supports a patient’s right to know.

Question 130.    
You are attending to a 17-year-old female who presents to the ER with acute PID. You suspect that she has an STI. She is unwilling to divulge this information to her parents, who are also present in the ER. The results of the STI screening reveal that the patient has a chlamydial infection. Which of the following responses is most appropriate?
(a) Discuss the results of the test with the parents first.
(b) Obtain permission from your patient to discuss the results with her parents.
(c) Send a consult to the psychologist.
(d) Discuss the results of the test with your patient first.
Answer:
(d) Discuss the results of the test with your patient first.

This is the most appropriate response because the patient has a right to autonomy and' protection of her health information. Other options listed are inappropriate.

Question 131.    
Which of the following is the most appropriate way to obtain a sexual history from a patient who presents to the ER with foul-smelling vaginal discharge and fever?
(a) Are you married?  
(b) Do you have a boyfriend?
(c) When was the last time you had sex?
(d) Are you sexually active?
Answer:
(d) Are you sexually active?

This is the most appropriate method of obtaining a sexual history from this patient. Options A and B are judgmental, while Option C is presumptive.

Question 132.    
Which of the following is an example of battery?
(a) Use of physical restraints on a patient with psychosis.
(b) Attempting a venipuncture without permission.
(c) Forgetting to take off a tourniquet after venipuncture.
(d) Punching a patient in the face.
Answer:
(b) Attempting a venipuncture without permission.

Battery is unauthorized and intentional touching or handling of a patient. This act may or may not be harmful. Battery is classified under civil law.

Question 133.    
Which of the following is an example of negligence?
(a) Giving a vesicant drug intramuscularly.
(b) Attempting a venipuncture without permission.
(c) Applying physical restraints on a patient with delirium.
(d) Refusing flowers for a patient with third-degree burns. 
Answer:
(a) Giving a vesicant drug intramuscularly.

Vesicant drugs are not given intramuscularly because they cause tissue necrosis. These drugs are given intravenously in the correct dilutions. The route of administration of vesicant drugs is clearly stated. Using an inappropriate method of administration is a form of negligence.

Question 134. 
Which of the following statements about a laryngeal mask airway is false?
(a) It reduces the risk of jaw and tongue displacement.
(b) It reduces the risk of gastric inflation.
(c) It can be used as a bridging device.
(d) It reduces the risk of regurgitation in conscious patients.
Answer:
(d) It reduces the risk of regurgitation in conscious patients.

This statement is false because a laryngeal mask airway (LMA) does not reduce the risk of regurgitation in conscious patients. LMAs are associated with a risk of regurgitation and aspiration, especially in patients who are not fasted or have other risk factors. To reduce the risk of regurgitation and aspiration, it is essential to ensure the patient is appropriately fasted and to use the LMA correctly.

Question 135.    
Which of the following positions is unsuitable for use in an unconscious 17-year-old who presents with a road traffic accident and suspected cervical spine injury?
(a) Sniff position.
(b) Jaw thrust.
(c) Chin lift.
(d) Supine position.
Answer:
(a) Sniff position.

In the sniff position, the patient’s head is elevated so the external auditory meatus and sternum are on the same plane. This position is contraindicated in patients with a suspected cervical spine injury. Therefore, the neck of such patients must not be handled or maneuvered- Acceptable positions are chin lift, jaw thrust, and supine position.

Question 136.    
A patient being managed with digoxin for arrhythmia presents with palpitations and dizziness. Emergency ECG reveals irregular and rapid QRS complexes that twist around the baseline. Which of the following treatment modalities is most appropriate?
(a) Amiodarone.
(b) Procainamide.
(c) Magnesium sulfate.     
(d) Calcium gluconate.
Answer:
(c) Magnesium sulfate.     

Magnesium sulfate is effective in treating Torsades de Pointes because it helps correct the underlying electrolyte imbalance, particularly hypomagnesemia, which can contribute to the development of this arrhythmia. By increasing magnesium levels, it stabilizes the cardiac cell membrane and reduces the risk of ventricular arrhythmias. Amiodarone and procainamide are antiarrhythmic drugs but are not the first-line choices for managing Torsades de Pointes. Calcium gluconate is used for the treatment of calcium channel blocker toxicity and is not appropriate for this arrhythmia.

Question 137.    
Which of the following arrhythmias is amenable to direct-current defibrillation?
(a) Pulseless ventricular tachycardia.
(b) Supraventricular tachycardia.     
(c) Atrial fibrillation.
(d) Atrial flutter.
Answer:
(a) Pulseless ventricular tachycardia.

Pulseless ventricular tachycardia and ventricular fibrillation are the two arrhythmias amenable to direct-current defibrillation.

Question 138.    
Which of the following electrolytes must be monitored in a 58-year-old male managed with digoxin and verapamil for congestive heart failure?
(a) Potassium.
(b) Bicarbonate.
(c) Sodium.
(d) Calcium. 
Answer:
(a) Potassium.

This patient is at risk of digoxin toxicity. The risk for toxicity increases when there is hypokalemia. It is important to monitor his serum potassium to reduce this risk.

Question 139. 
A patient with a history of chronic hyponatremia is brought to the emergency room. Rapidly correcting the hyponatremia with hypertonic solutions like 5% dextrose saline can potentially cause:
(a) Re-feeding syndrome.
(b) Hypokalemic metabolic alkalosis.
(c) Central pontine myelinolysis.
(d) Diabetic ketoacidosis.
Answer:
(c) Central pontine myelinolysis.

Central pontine myelinolysis (CPM) is a neurological disorder that can occur when chronic hyponatremia is corrected too rapidly. It involves the destruction of the myelin sheath of nerve cells in the brainstem, which can lead to severe neurological symptoms. 

Question 140.    
Blue bloater describes a patient with which of the following diseases?
(a) Emphysema.
(b) Asthma.
(c) Chronic bronchitis.
(d) Cystic fibrosis.
Answer:
(c) Chronic bronchitis.

Blue bloater is used to describe a patient with chronic bronchitis. This patient presents with central cyanosis, pedal edema, pulmonary hypertension, and chronic cough. These patients are usually overweight.

Question 141.    
A patient with severe anemia is being evaluated with the Schilling test. The patient is likely to have any of the following diseases except:
(a) Atrophic gastritis.
(b) Gastric bypass surgery.
(c) Inflammatory bowel disease.     
(d) Hemorrhoids.
Answer:
(d) Hemorrhoids.

The Schilling test is used to assess cobalamin deficiency, not hemorrhoids. Causes of cobalamin deficiency include decreased intake (malnutrition and vegan diet) and decreased absorption (atrophic gastritis, gastric bypass surgery, inflammatory bowel disease, Celiac disease, peptic ulcer disease, and fish tapeworm infestation). Anemia from chronic bleeding (seen in hemorrhoids) causes iron deficiency anemia.

Question 142.    
Which of the following methods is not useful in correcting hyperkalemia?
(a) Polystyrene sulfate.
(b) Salbutamol. 
(c) Calcium gluconate.
(d) Dextrose insulin infusion.
Answer:
(c) Calcium gluconate.

Calcium gluconate is given to patients with severe hyperkalemia to stabilize the cardiac membrane and reduce the risk of arrhythmia. It does not correct hyperkalemia. Treatment options for correcting hyperkalemia are polystyrene sulfate, salbutamol, dextrose insulin infusion, and dialysis in severe hyperkalemia.

Question 143.    
Which of the following is not suitable for assessing the hydration status of a four-year-old male who presents with acute watery diarrhea?
(a) Conjunctiva.
(b) Buccal mucosa.
(c) Capillary refill.
(d) Skin turgidity.
Answer:
(a) Conjunctiva.

Conjunctiva is used to assess pallor. It is not suitable for assessing hydration status. To assess this child’s hydration status, the buccal mucosa, capillary refill, skin turgidity, blood pressure, heart rate, urine color and output, weight, consciousness, and respiratory rate are observed.

Question 144.     
Which of the following drugs is unlikely to cause hypokalemia?
(a) Furosemide.
(b) Amiloride.
(c) Hydrochlorothiazide.
(d) Albuterol. 
Answer:
(b) Amiloride.

Amiloride is a potassium-sparing diuretic. Hyperkalemia (not hypokalemia) is a side effect of this drug. Another example of a potassium-sparing diuretic is spironolactone. Potassium-wasting drugs include diuretics like furosemide and thiazides, insulin, salbutamol, albuterol, enemas, laxatives, and antipsychotics.

Question 145.
Which of the following is required in eliciting the Chvostek sign?
(a) Inflating the midarm with the cuff of a sphygmomanometer.
(b) Tapping the skin that is 2 cm anterior to the tragus of the ear.
(c) Asking the patient to blow out their cheeks.
(d) Tapping the patient’s chin while the patient holds their mouth open.
Answer:
(b) Tapping the skin that is 2 cm anterior to the tragus of the ear.

The Chvostek sign is seen in hypocalcemia. To elicit this sign, the facial nerve is stimulated by tapping the skin 2 cm anterior to the tragus of the ear. There is an ipsilateral contraction of the face due to facial nerve stimulation. This sign confirms muscle tetany. The facial nerve is not anterior to the zygomatic arch nerve, but the stimulation is anterior to the tragus. Option A is used to elicit Trousseau’s sign (for hypocalcemia). Option C is used to assess the motor function of the facial nerve. Option D is used to elicit the jaw jerk reflex. 

Question 146.    
A 48-year-old patient with a severe urinary tract infection is prescribed gentamicin. Which of the following adverse effects should they be monitored for?
(a) Hyperkalemia.
(b) Ototoxicity.
(c) Hyperglycemia.
(d) Hypothyroidism.
Answer:
(b) Ototoxicity.

Gentamicin is an aminoglycoside antibiotic that is effective against various bacterial infections. However, one of its primary side effects is ototoxicity, which can manifest as hearing loss, vertigo, and tinnitus.

Question 147.    
Which of the following is not a clinical presentation of diabetes insipidus?
(a) Polyuria.
(b) Polydipsia.
(c) Hyponatremia.
(d) Dehydration.     
Answer:
(c) Hyponatremia.

Diabetes insipidus is a cause of hypernatremia (not hyponatremia). In this disease, there is insufficient secretion of antidiuretic hormone. This leads to the excretion of diluted urine and polyuria. The thirst center is triggered to compensate for the increased serum osmolality, which leads to polydipsia.

Question 148.    
Before administering gentamicin to a patient with sepsis, which of the following lab values should be reviewed?
(a) Liver enzymes (AST & ALT).
(b) Blood glucose levels.
(c) Serum creatinine and BUN.
(d) Coagulation profile (PT, INR).
Answer:
(c) Serum creatinine and BUN.

Gentamicin can be nephrotoxic, which means it has the potential to cause kidney damage. Before administration, it is important to assess kidney function, typically by reviewing serum creatinine and BUN (Blood Urea Nitrogen) levels. These values can give insight into how well the kidneys filter waste products from the blood. If these values are elevated, it might indicate reduced kidney function, and gentamicin could exacerbate this.

Question 149.    
A 56-year-old female admitted with chronic cough, pedal edema, and hypertension is prepared to be discharged to the clinic on a long-acting beta-agonist. Which of the following is appropriate?
(a) Salbutamol.
(b) Albuterol.
(c) Salmeterol.
(d) Ipratropium. 
Answer:
(c) Salmeterol.

Salmeterol is a long-acting beta-agonist used to manage nocturnal chest symptoms in patients with COPD. Other examples of long-acting beta-agonists are olodaterol, vilanterol, formoterol, and arformoterol.

Question 150.    
A patient presents. Which nerve is most commonly associated with a mid-shaft fracture of the humerus?
(a) Ulnar nerve.
(b) Median nerve.
(c) Radial nerve.
(d) Sciatic nerve.
Answer:
(c) Radial nerve.

The radial nerve runs posteriorly in the arm and is closely associated with the shaft of the humerus. It is vulnerable to injury, especially with mid-shaft humerus fractures. Damage to the radial nerve can lead to what is known as “wrist drop,” where the patient has difficulty extending the wrist and fingers.

Question 151.    
A 56-year-old male presents to the ER with difficulty breathing, cachexia, and restlessness. A differential diagnosis of chronic obstructive disease is made after obtaining a significant cigarette smoking history of 45 pack years. The patient is counseled to practice pursed-lip breathing. Which of the following best explains the purpose of this method?
(a) Increased oxygenation.
(b) Increased lung expansion.
(c) Increased carbon dioxide excretion.
(d) Strengthening of accessory muscles.
Answer:
(c) Increased carbon dioxide excretion.

Pursed-lip breathing increases the exhalation and excretion of carbon dioxide. This method helps the patient control the depth of expiration, thereby reducing the risk of trapped air in the alveoli and improving hypercapnia.

Question 152.    
A patient who sustained a trauma injury to the arm cannot extend her wrist and
fingers and has decreased sensation on the back of her hand. An injury to which of the following nerves is likely?    ;
(a) Axillary nerve. 
(b) Radial nerve.
(c) Median nerve.
(d) Ulnar nerve.
Answer:
(b) Radial nerve.

The symptoms described are consistent with a radial nerve injury. The radial nerve innervates the extensor muscles of the wrist and fingers and provides sensation to the back of the hand. Damage to the radial nerve can lead to an inability to extend the wrist and fingers.

Question 153.    
Which of the following treatments is definitive in managing Guillain-Barre syndrome?
(a) IV corticosteroid.
(b) Plasma exchange.
(c) Heat therapy.
(d) Baclofen.
Answer:
(b) Plasma exchange.

Plasma exchange removes circulating plasma components (cryoglobulins and antibodies) responsible for the autoimmune response in Guillain-Barre. This procedure is useful in patients who fail to respond to IV immunoglobulin. Heat therapy is a supportive measure used to relieve pain in elderly patients. Other supportive measures include physiotherapy and anticoagulation therapy with LMWH to reduce the risk of deep vein thrombosis. Baclofen is not used because the paralysis seen in Guillain-Barre syndrome is flaccid.

Question 154.    
Which of the following treatment modalities is contraindicated in the management of Guillain-Barre?
(a) IV immunoglobulin.
(b) Heat therapy.
(c) IV corticosteroids.
(d) Low-weight molecular heparin. 
Answer:
(c) IV corticosteroids.

Corticosteroids may worsen outcomes in a patient with Guillain-Barre. Therefore, their use is contraindicated. IV immunoglobulin is the treatment of choice in this case. Heat therapy is useful in providing analgesia, while low-weight molecular heparin is used for anticoagulation prophylaxis.

Question 155.
Which of the following initial interventions is most appropriate in a 56-year-old female who presents to the ER with weakness of the left arm and aphasia?
(a) Emergency CT of the brain.
(b) IVrt-PA.
(c) Oral aspirin.
(d) Sublingual nitroglycerin.
Answer:
(a) Emergency CT of the brain.

This is the most appropriate initial response because a CT scan of the brain will reveal the underlying pathology, like tumors, ischemia, bleeding, or other causes. The treatment options depend on the cause of the disease. For example, thrombolytics, like IV rt-PA, are contraindicated in patients with hemorrhagic stroke due to the risk of bleeding.

Question 156.    
Which of the following complications is most likely to increase morbidity in a patient with Parkinsonian crisis?
(a) Hyperthermia.
(b) Acute urinary retention.
(c) Delirium.
(d) Spastic paralysis.
Answer:
(a) Hyperthermia.

Parkinsonian crisis is a rare complication of Parkinson’s disease caused by exacerbation of motor symptoms. Hyperthermia is a poor prognostic factor of recovery. Clinical, manifestations of Parkinsonian crisis include severe akinesia, dysphagia, hyperthermia, diaphoresis, and elevated muscle enzymes. Risk factors are infections and changes in medication.

Question 157.    
A 68-year-old woman comes to the ER after a fall on an outstretched hand. She complains of pain and limited movement in her shoulder. X-rays confirm that there is a fracture of the proximal humerus. What complication should the nurse be most concerned about in the initial assessment?
(a) Avascular necrosis.     
(b) Rotator cuff tear.
(c) Radial nerve injury.
(d) Carpal tunnel syndrome.
Answer:
(a) Avascular necrosis.     

Avascular necrosis (AVN) is a significant concern with proximal humerus fractures, especially in older adults. The blood supply to the humeral head can be compromised with fractures, which can cause bone cell death (necrosis). 

Question 158.    
Which of the following medications is unsuitable for use in a 35-year-old known depressive disorder patient recently diagnosed with GERD?
(a) Omeprazole.
(b) Cimetidine. 
(c) Aluminum hydroxide.
(d) Magnesium hydroxide.
Answer:
(b) Cimetidine. 

Cimetidine is an H2 receptor blocker used in treating stomach hyperacidity. However, it is a nonselective antagonist of cytochrome P450 enzymes. It interacts with many drugs, like selective serotonin reuptake inhibitors and tricyclic antidepressants. It inhibits metabolism and increases serum levels to toxic states.

Question 159.     
Which of the following is not a clinical feature of hepatocellular jaundice?
(a) Jaundice.
(b) Pruritus.
(c) Pale stools.
(d) Dark-colored urine. 
Answer:
(c) Pale stools.

Pale stools are not a clinical feature seen in hepatocellular jaundice. Pale stools are seen in obstructive jaundice. In obstructive jaundice, conjugated bilirubin cannot enter the intestines, which leads to pale stools. However, there is an excretion of conjugated bilirubin in the urine, and any excess conjugated bilirubin manifests as jaundice and pruritus.

Question 160.    
A patient is managed with aminocaproic acid for DIC secondary to a snakebite. Which of the following best describes this drug’s mechanism of action?
(a) Converts plasminogen to plasmin.
(b) Inhibits formation of thrombin.
(c) Inhibits formation of plasmin.
(d) Converts fibrinogen to fibrin.
Answer:
(c) Inhibits formation of plasmin.

Aminocaproic acid and tranexamic acid are antifibrinolytic drugs that inhibit plasmin formation. They do so by binding to plasminogen and inhibiting its conversion to plasmin.

Question 161.    
A truck driver arrives at the hospital with a proximal humerus fracture after they are involved in a motor vehicle accident. Swelling, deformity, and ecchymosis around the shoulder area are observed. Which of the following assessments should be prioritized?
(a) Checking the patient’s grip strength.
(b) Assessing the distal pulses.
(c) Palpating the clavicle for tenderness.
(d) Evaluating the elbow’s range of motion.
Answer:
(b) Assessing the distal pulses.

While all options are relevant in a comprehensive assessment, vascular integrity should be prioritized. Proximal humerus fractures, particularly those with a significant displacement, may impinge or damage the axillary artery or its branches. Assessing the distal pulses ensures the fracture has not compromised the vascular supply to the distal extremity.

Question 162.    
Which of th’e following is the most common form of temporomandibular joint dislocation?
(a) Anterior.
(b) Posterior.     
(c) Medial.
(d) Lateral.
Answer:
(a) Anterior.

Anterior dislocation of the mandibular condyle is the most common direction of dislocation.

Question 163.    
A patient with GERD is being discharged from the ER on antacids containing calcium hydroxide. The patient is most likely to experience which of the following?  
(a) Tetany.
(b) Paresthesia.
(c) Flatulence. 
(d) Constipation. 
Answer:
(d) Constipation. 

Constipation is a common side effect of antacids containing calcium hydroxide, calcium carbonate, and aluminum carbonate. The formation of kidney stones is another side effect of calcium-containing antacids.

Question 164.    
Which of the following drug supplements should not be taken with oral warfarin?
(a) Ginkgo biloba.
(b) Vitamin E.
(c) Ginseng.
(d) Cod liver oil. 
Answer:
(d) Cod liver oil. 

Cod liver oil is an excellent source of vitamins A and D, but not vitamin K. Patients on anticoagulants such as warfarin must maintain a consistent vitamin K, intake, as significant fluctuations can affect the medication’s efficacy. So cod liver oil will not help, since it is not a source of vitamin K. Warfarin is an oral anticoagulant. It interacts with a wide range of orthodox and complementary therapies. Implicated complementary drugs include ginkgo biloba, vitamin E, garlic, ginseng, green tea, and St John’s wort. Common drugs include aspirin, salicylates, acetaminophen, antacids, NSAIDs, and many antibiotics.

Question 165.    
An elderly patient who presents to the ER with hemorrhagic stroke has hyperpyrexia. Which of the following best describes the mechanism of this pathophysiology?
(a) Microbial infection.
(b) Hyperventilation.
(c) Damage to the hypothalamus.
(d) DIC.
Answer:
(c) Damage to the hypothalamus.

The hypothalamus regulates temperature changes. Any damage to the hypothalamus affects the autoregulation of temperature.

Question 166.    
A patient with a tracheostomy suddenly becomes anxious and has difficulty breathing. The nurse notices decreased breath sounds on auscultation. What action should be taken first?
(a) Administer supplemental oxygen.
(b) Attempt to pass a suction catheter.
(c) Call for respiratory therapy.
(d) Re-position the patient to a high Fowler’s position.
 Answer:
(b) Attempt to pass a suction catheter.

When a tracheostomy patient presents with sudden respiratory distress, the priority is to ensure patency of the tracheostomy tube. Mucus plugs or secretions can obstruct the tube. The nurse should first attempt to pass a suction catheter to clear any obstruction.

Question 167.    
Which of the following is not a pathophysiologic process of drowning?
(a) Hypoxia.
(b) Aspiration.
(c) Hypothermia.     
(d) Hyperventilation.
Answer:
(d) Hyperventilation.

The pathophysiology of drowning includes tissue hypoxia, which triggers respiratory and cardiac arrest; metabolic acidosis; cerebral edema and brain death; hypothermia due to submersion in cold water; and fluid aspiration, which causes pneumonitis and pulmonary edema.

Question 168.    
Which of the following is not a factor contributing to the risk of hypothermia in the elderly?
(a) Diminished subcutaneous fat. 
(b) Diminished sensation of temperature.
(c) High surface area/mass ratio.
(d) Impaired mobility.
Answer:
(c) High surface area/mass ratio.

This factor contributes to the risk of hypothermia in children, not the elderly. Factors contributing to the risk of hypothermia in elderly patients are diminished sensation to temperature, diminished subcutaneous fat, neglect, and impaired communication, mobility, and cognition.

Question 169.    
Which of the following is unlikely to be seen in a patient with hypothermia following a near-drowning accident?
(a) Hypotension.
(b) Lethargy.
(c) Tachypnea.
(d) Bradycardia. 
Answer:
(c) Tachypnea.

Tachypnea is unlikely to be seen in a patient who presents to the ER with hypothermia following a near-drowning accident. Hypothermia slows down all physiologic functions of the respiratory, cardiac, and nervous systems. It also slows down metabolism, nerve conduction, and mental acuity. Clinical features of hypothermia are lethargy, bradycardia, bradypnea, chills, hallucinations, and coma.

Question 170.    
Which of the following is a typical rash seen in an infection with Borrelia? Assume it is a red rash with a central clearing that resembles a “bull’s eye.”
(a) Erythema migrans.
(b) Erythema nodosum.
(c) Erythema marginatum.
(d) Erythema capsulatum.
Answer:
(a) Erythema migrans.

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected black-legged ticks. Erythema migrans is the typical dermatologic finding in this disease. It often presents as a red rash with a central clearing that resembles a “bull’s eye.” It can also present as a reddish macule encircled by a pale ring. It is seen about 3 to 32 days after the tick bite. 

Question 171.    
What is the drug of choice for a patient with Rocky Mountain spotted fever?
(a) Vancomycin.
(b) Doxycycline.
(c) Penicillin G.
(d) Ceftriaxone.
Answer:
(b) Doxycycline.

The primary drug of choice for Rocky Mountain spotted fever is doxycycline. Therapy is done for about 5 to 10 days. Early commencement of antibiotics drastically reduces mortality.

Question 172.    
Which of the following is not a data collection method for qualitative research?
(a) Interviews.
(b) Focus groups.
(c) Surveys.
(d) Probability sampling.
Answer:
(d) Probability sampling.

Probability sampling is a method of selecting a sample from a population in which each member has a known, non-zero chance of being selected. It is not a form of data collection but rather a sampling technique. Data collection methods for qualitative research include focus groups, interviews, and direct observation.

Question 173.    
Which of the following is not a model of quantitative research?
(a) Experimental studies.
(b) Correlational studies.
(c) Ethnographic studies.
(d) Survey studies.
Answer:
(c) Ethnographic studies.

In ethnographic studies, the researcher observes the variable in its natural setting. This research aim§ to observe the variable’s environment, culture, and unique challenges. This research method is time-consuming, cost-intensive, and requires skill in observing and inferring data.

Question 174.    
Which of the following is a nominal variable?
(a) Hair color.
(b) Age.
(c) Blood pressure.
(d) Height.
Answer:
(a) Hair color.

A categorical variable is also called a nominal variable. It is a variable that cannot be intrinsically arranged or ordered. Age, blood pressure, and height can be arranged in ascending or descending order. Hair color can be categorized but not ordered.

Question 175.    
Which of the following is an example of an interval variable?
(a) Temperature.
(b) Age.
(c) Weight.
(d) Eye color.
Answer:
(a) Temperature.

An interval variable describes data that can be arranged on a scale but does not have a true zero point. It is distinct from an ordinal variable, which denotes data that can be ranked, but the distances between ranks may not be consistent. Internal variables have values that are arranged equidistant from each other on the scale. Examples of such data include temperature measured in Fahrenheit or Celsius.

Practice Tests:

• CEN Practice Test 2
• CEN Practice Test 3
• CEN Practice Test 4
• CEN Practice Test 5