CEN Practice Test 3 with Rationale

CEN Practice Test 3 with Rationale

The variety of CEN Practice Questions ensures you're prepared for any topic on the exam.

BCEN Practice Test 3 with Rationale

Question 1.    
Which of the following is the most common form of shoulder dislocation?
(a) Anterior.
(b) Posterior.
(c) Superior.
(d) Inferior.
Answer:
(a) Anterior.

More than 95 percent of shoulder dislocations are anterior. Inferior and posterior shoulder dislocations are rare. Superior shoulder dislocation is not a medical condition.

Question 2.    
Which of the following is not a complication of an anterior shoulder joint dislocation?
(a) Injury to the brachial plexus.
(b) Injury to the axillary nerve.
(c) Tear to the rotator cuff muscles.
(d) Injury to the serratus anterior muscle.
Answer:
(d) Injury to the serratus anterior muscle.

This statement is false because the anterior dislocation of the shoulder does not damage the serratus anterior. The serratus anterior muscle originates from the upper surface of the eighth and ninth ribs and inserts into the medial margins of the scapula. Anterior shoulder dislocation can cause injuries to the brachial plexus and rotator cuff muscles. It can also cause a fracture of the greater tuberosity.

Question 3.    
Which of the following structures will not be affected by an elbow dislocation?
(a) Latera pectoral nerve.
(b) Ulnar nerve.
(c) Median nerve.
(d) Radial nerve.
Answer:
(a) Latera pectoral nerve.

The lateral pectoral nerve innervates the pectoralis major muscle in the chest and has no anatomical relationship with the elbow. In contrast, the ulnar, median, and radial nerves are all near the elbow and can potentially be affected by an elbow dislocation.

Question 4.    
Which of the following age groups is most prone to radial head subluxation?
(a) Elderly.
(b) Toddlers.
(c) Neonates.    
(d) Teenagers.
Answer:
(b) Toddlers.

In toddlers, the width of the radial head is greater than the radial neck. This makes it easy for the radial head to slip through the ligaments in the elbow. Subluxation often occurs when the forearm is pulled upward, such as when the toddler is caught by the wrists to break a fall.

Question 5.    
Upon examination, a patient with a potential cauda equina injury fails to demonstrate an anal wink reflex. What could this suggest?
(a) The injury is above the T12 vertebra.
(b) There is no significant injury, as this reflex is not important.
(c) There may be a lesion or injury affecting the sacral nerve roots.
(d) The reflex test was conducted improperly.
Answer:
(c) There may be a lesion or injury affecting the sacral nerve roots.

The cauda equina is the bundle of spinal nerve roots located at the end of the spinal cord. It provides innervation to the lower limbs and pelvic organs. An absent anal wink reflex might suggest an injury or lesion affecting the sacral nerve roots, which are part of the cauda equina. If this reflex is absent or abnormal, it is essential to perform further evaluations because cauda equina syndrome is a surgical emergency.

Question 6.    
A male patient recently suffered an ischemic stroke. After performing some tests, the nurse notes that he has sudden neurological deterioration and increased swelling around the area of the original infarct. What does this suggest?
(a) Another ischemic stroke event.
(b) Hemorrhagic transformation.
(c) Hydrocephalus.
(d) Brain tumor development. 
Answer:
(b) Hemorrhagic transformation.

Hemorrhagic transformation refers to the development of a hemorrhage in a brain region previously affected by an ischemic stroke. This can lead to worsening neurological symptoms and increased swelling or edema in the affected area. Although ischemic strokes do not initially involve bleeding, the tissue damage they cause can make the area more susceptible to bleeding, especially if in conjunction with anticoagulant therapy. 

Question 7.
Which of the following principles of management is inappropriate for a female patient who has just had a tracheostomy?
(a) Place in the semi-Fowler’s position.
(b) Frequent suctioning of oral secretions.
(c) Provision of a bell and a writing pad.
(d) Vital sign monitoring.
Answer:
(b) Frequent suctioning of oral secretions.

This management modality is not only inappropriate but also harmful. Suctioning should be done only when secretions are copious. Placing the patient in the semi-Fowler’s position allows adequate lung expansion and improves respiration. A bell and a writing pad make communication easy. It alerts the managing team to the patient’s needs and removes strain on the vocal cords. Regular monitoring of vital signs assesses the patient’s respiratory function and alerts the nurse to conditions like distress, fever, pain, and others.

Question 8.    
Which of the following patients with ischemic stroke is at the highest risk of hemorrhagic transformation?
(a) A 40-year-old patient with a small cortical infarct.
(b) A 65-year-old patient who received a tPA (tissue plasminogen activator) within four and a half hours after the onset of symptoms.
(c) A 75-year-old patient with atrial fibrillation who has not been anticoagulated.
(d) A 50-year-old patient with a history of hypertension and controlled diabetes.
Answer:
(b) A 65-year-old patient who received a tPA (tissue plasminogen activator) within four and a half hours after the onset of symptoms.

Thrombolytic therapy, such as with tPA, dissolves the clot that causes an ischemic stroke. However, it also increases the risk of bleeding and puts these patients at a higher risk of experiencing hemorrhagic transformation than those who did not receive thrombolytic therapy.

Question 9.    
Which treatment modalities do not help reduce the risk of infections in a patient with a tracheostomy?
(a) Monitoring of temperature.
(b) Monitoring of white blood cell count.;
(c) Stoma care.
(d) Prophylactic antibiotics.
Answer:
(d) Prophylactic antibiotics.

Prophylactic antibiotics are not useful in preventing infection in a patient with a tracheostomy. Antibiotics should be used only when there is a suspected or confirmed infection. Prophylactic antibiotics increase the incidence of bacterial resistance to antibiotic therapy.

Question 10.    
The emergency nurse worries about the risk of shock in a 15-year-old male in the emergency room with a tension pneumothorax. Which of the following best describes the pathophysiology of this complication?
(a) Acute blood loss.
(b) Increased intrathoracic pressure.
(c) Decreased afterload.
(d) Impaired cardiac contractility.
Answer:
(b) Increased intrathoracic pressure.

In tension pneumothorax, there is a one-way movement of air into the pleural space,. Because of this, air accumulation in the lungs leads to mass mediastinal shift, compression of the contralateral lung, and increased intrathoracic pressure. This pressure reduces venous return and increases the risk of shock.

Question 11.    
Which of the following is not a complication of mumps?
(a) Orchitis.
(b) Conjunctivitis.
(c) Pancreatitis.
(d) Meningitis. 
Answer:
(b) Conjunctivitis.

Conjunctivitis is not a complication of mumps infection. Complications include orchitis, oophoritis, pancreatitis, meningitis, and encephalitis. Rare complications are hepatitis, polyarthritis, mastitis, and nephritis.

Question 12.    
A nurse is counseling the mother of a two-week-old infant with bronchopneumonia on the benefits of breast milk to prevent infections. Which of the following is not an antibacterial benefit?
(a) IgA transmission.
(b) Bifidus factor.
(c) Omega three fatty acids.
(d) Lactoferrin.
Answer:
(c) Omega three fatty acids.

Omega three fatty acids do not have an antibacterial effect. Breast milk is rich in omega three and omega six fatty acids that are useful in building the infant’s developing brain and improving cognition.

Question 13.    
Which foods may not be given to a five-year-old male managed for mumps?
(a) Semisolids.
(b) Citrus.
(c) Green vegetables.
(d) Mashed foods.
Answer:
(b) Citrus.

Acidic foods like citrus and vinegar can worsen pain in patients with swollen parotid glands. Patients should be fed semisolid or mashed foods to minimize the effort spent chewing and swallowing.

Question 14.    
Which patients are at least at risk of developing tetanus?
(a) A patient with third-degree burns.
(b) An IV drug abuser with infectious endocarditis.
(c) A patient with a gunshot injury.
(d) A patient with caustic poisoning.    
Answer:
(d) A patient with caustic poisoning.    

Caustic poisoning does not increase the risk of tetanus. The risk increases when the skin is broken (e.g., burns, gunshot injuries, lacerations, wounds, and IV drug abuse). The risk also increases in nonapparent wounds (e.g., postpartum and neonatal tetanus when the umbilical cord is involved).

Question 15.    
Which of the following is not a complication of meningococcal meningitis?
(a) SIADH.
(b) DIC.
(c) Gangrene. 
(d) Left ventricular heart failure.
Answer:
(d) Left ventricular heart failure.

Left ventricular heart failure is not a complication of meningococcal meningitis. Meningococcal meningitis is a form of acute bacterial meningitis with high morbidity and mortality rates' This disease is caused by the bacteria Neisseria meningitidis (gram¬negative diplococci). Complications include DIC, SLADH, tissue necrosis and gangrene, seizures, septic shock, multiple organ dysfunction, and cranial nerve deficits.

Question 16.    
Which of the following bacteria is least likely implicated in a two-week-old female with acute bacterial meningitis?
(a) E. coli.
(b) Listeria monocytogenes.
(c) Haemophilus influenzae.
(d) Streptococcus agalactiae.
Answer:
(c) Haemophilus influenzae.

Haemophilus influenzae is not likely to be implicated in a two-week-old’s acute bacterial meningitis. Implicated organisms in meningitis in neonates and infants are group B streptococcus (including Streptococcus agalactiae), Listeria monocytogenes, and E. coli. These organisms are often obtained via the birth canal. Implicated bacteria in older infants and young adults are Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Staphylococcus aureus. Implicated bacteria in older adults are Streptococcus pneumoniae, S. aureus, and N. meningitidis.

Question 17.    
Which of the following best describes Waterhouse-Friderichsen syndrome?
(a) Excess secretion of ADH.
(b) Insufficient plasma cortisol.
(c) Excess secretion of aldosterone.
(d) Insufficient plasma insulin. 
Answer:
(b) Insufficient plasma cortisol.

Waterhouse-Friderichsen syndrome is an adrenal insufficiency caused by overwhelming meningococcemia. The pathophysiology includes hemorrhage in the adrenal glands, which leads to insufficient secretion of adrenal hormones like plasma cortisol and aldosterone.

Question 18.    
A patient arrives at the emergency room with complaints of fatigue, constipation, and polyuria. The lab results indicate a calcium level of 12.6 mg/dL. Which of the following conditions is most likely responsible for these findings?
(a) Hypoparathyroidism.
(b) Chronic kidney disease.
(c) Primary hyperparathyroidism.
(d) Hypothyroidism.
Answer:
(c) Primary hyperparathyroidism.

Primary hyperparathyroidism is one of the most common causes of hypercalcemia. It is usually caused by a benign tumor of one of the parathyroid glands. As these glands secrete parathyroid hormone (PTH), which raises blood calcium levels, an overproduction of PTH can cause hypercalcemia. 

Question 19.    
A 67-year-old male presents in the emergency room with crushing chest pain, and an emergency ECG reveals ST elevation in leads II, III, and aVF. Which of the following arteries is most likely to be occluded?
(a) Right coronary artery.
(b) Left coronary artery.
(c) Right subclavian artery.
(d) Left subclavian artery.
Answer:
(a) Right coronary artery.

The right coronary artery is most likely occluded as it supplies the right ventricle and inferior and posterior walls of the left ventricle. In ECG, leads II, III, and aVF represent the inferior surface of the heart, while leads V1-V4 represent the anterior surface. Leads I, V5, V6, and aVL represent the lateral side of the heart.

Question 20.    
A 55-year-old male has an emergency ECG for crushing chest pain, nausea, and headaches. Which of the following statements is false about the P wave?
(a) It is usually less than 0.11 seconds.  
(b) It indicates atrial depolarization.
(c) It indicates electrical impulses from the AV node.
(d) It is upright in a normal sinus rhythm.
Answer:
(c) It indicates electrical impulses from the AV node.

This statement is false because the P wave indicates impulses from the SA node. The P wave indicates atrial depolarization and lasts less than 0.11 seconds. It is seen just before the QRS complex and is upright in a normal sinus rhythm.

Question 21.    
Which of the following is not a component of Beck’s triad seen in a 25-year-old male who presents to the emergency room with blunt trauma to the chest?
(a) Distended neck veins.
(b) Hypotension.
(c) Muffled heart sounds.
(d) Pulsus paradoxus.
Answer:
(d) Pulsus paradoxus.

Pulsus paradoxus, described as a decrease in systolic blood pressure (by more than 10 mm Hg) during inspiration, is also seen in cardiac tamponade. It is, however, not a component of Beck’s tria$. Beck’s triad is seen in cardiac tamponade. Clinical features are hypotension, increased venous pressure that presents as neck distention, and muffled heart sounds.

Question 22.    
A 55-year-old male managed for myocardial infarction has been stable for 48 hours. The patient is being worked up for discharge when the nurse notices on the monitor that the patient is in ventricular tachycardia. On examination, the patient is alert and conscious. There is no cyanosis. Which of the following interventions is most appropriate for this patient?
(a) IV epinephrine.
(b) IV procainamide. 
(c) Defibrillation.
(d) IV atropine. 
Answer:
(b) IV procainamide. 

Treatment of this patient involves the use of an antiarrhythmic drug, like procainamide, lidocaine, or digoxin. Epinephrine will increase this patient’s heart rate and is therefore contraindicated. Defibrillation is indicated for pulseless ventricular tachycardia. IV atropine is not useful in controlling an abnormal cardiac rhythm.

Question 23.    
A nurse notices that her patient, being managed for STEMI, is in atrial fibrillation. She quickly proceeds to perform a carotid massage. Which of the following best describes the mechanism of action in this procedure?
(a) Vasovagal nerve stimulation.
(b) Baroreflex stimulation.
(c) Valsalva maneuver.
(d) Increases intrathoracic pressure.
Answer:
(b) Baroreflex stimulation.

Carotid massage stimulates the baroreceptors in the carotid sinus. Stimulation of the baroreceptors causes reflex bradycardia.

Question 24.    
A nurse monitors a patient brought into the emergency room with altered sensorium secondary to opioid overdose. They notice on the cardiac monitor that the patient is in ventricular fibrillation. Which of the following interventions is most appropriate?
(a) Defibrillation.
(b) Cardiac pacemaker.
(c) Endotracheal intubation.
(d) IV dobutamine.
Answer:
(a) Defibrillation.

Defibrillation must be urgently performed to restore normal heart rhythm. Fibrillation is a chaotic and disordered electrical activity of the heart, and defibrillation delivers a therapeutic dose of electric current to the heart to terminate this abnormal rhythm and allow the SA node to re-establish an effective rhythm.

Question 25.    
A 56-year-old male is managed for supraventricular tachycardia. The nurse teaches the patient how to perform the Valsalva maneuver when he anticipates an impending attack. Which best describes the correct way the patient should perform the Valsalva maneuver?
(a) Massage his sternal notch. 
(b) Hold his breath for 30 seconds.
(c) Inhale air, pinch the nose, close the mouth, and attempt to expel the air through the mouth.
(d) Pinch nose, close ears, and attempt to cough. 
Answer:
(c) Inhale air, pinch the nose, close the mouth, and attempt to expel the air through the mouth.

The Valsalva maneuver is used to restore normal heart rhythm from tachycardia. To do this maneuver, the patient inhales air, pinches his nose, closes his mouth, and attempts to expel the air through the mouth. The forceful expulsion stimulates the heart into a normal sinus rhythm. The Valsalva maneuver can also be used to unclog the ears.

Question 26.    
Which conditions are unlikely to cause a transudative pleural effusion?
(a) Left ventricular heart failure.
(b) Nephrotic syndrome.
(c) Liver cirrhosis.
(d) Pulmonary embolism.
Answer:
(d) Pulmonary embolism.

Pulmonary embolism is unlikely to cause a transudative pleural effusion. They are caused by increased hydrostatic pressure, a decrease in oncotic pressure, or both. Heart failure is the most common cause of transudative pleural effusion. Other causes are nephrotic syndrome and liver cirrhosis.

Question 27.    
Which of the following is a contraindication to cricothyrotomy?
(a) Severe facial edema.
(b) Failed orotracheal intubation.
(c) Toddlers.
(d) Obesity. 
Answer:
(c) Toddlers.

Cricothyrotomy is contraindicated in children under eight years of age. Relative contraindications are transection of the distal trachea, which can be partial or complete, and inability to identify landmarks because of injury to the cricoid, thyroid cartilage, and larynx. Cricothyrotomy is indicated when there are multiple failed attempts to perform orotracheal or nasotracheal intubation with an inability to use alternative methods and when there are contraindications to nasotracheal and orotracheal intubation (facial trauma, edema, hemorrhage, and other mass effects).

Question 28.    
An emergency cricothyrotomy is being performed on a 45-year-old female who presents in the emergency room with respiratory failure secondary to upper airway infection. Which of the following is not an acute complication of this procedure?
(a) Hemorrhage.
(b) Apnea.
(c) Subglottic stenosis.
(d) Vocal cord injury.
Answer:
(c) Subglottic stenosis.

This chronic (not acute) complication is seen weeks after the cricothyrotomy is performed. Acute complications of this procedure include hemorrhage, erroneous intubation of surrounding tissues in the neck and consequent apnea, and injury to the trachea, thyroid, vocal cords, and larynx. Late complications are airway obstruction caused by the formation of stoma granulation tissue, subglottic stenosis, wound infection, and voice changes.

Question 29.    
Which of the following is a contraindication to noninvasive positive pressure ventilation?
(a) Obstructive sleep apnea.
(b) Acute asthma.
(c) Pulmonary edema.
(d) Epiglottitis.
Answer:
(d) Epiglottitis.

Noninvasive positive pressure ventilation is contraindicated in patients with upper airway obstruction. Patients with epiglottitis should be rapidly intubated by qualified personnel in an operating room. Other contraindications to NIPPV are cardiopulmonary arrest, severe upper GI bleeding, unstable hemodynamic states, vomiting, copious oral secretions, loss of consciousness, and any condition that can impair gastric emptying (pregnancy, paralytic ileus, or bowel obstruction).

Question 30.    
Which of the following is not a clinical feature of Horner’s syndrome?
(a) Ptosis.
(b) Mydriasis.
(c) Anhidrosis. 
(d) Enophthalmos.
Answer:
(b) Mydriasis.

The disruption of the cervical sympathetic output causes Horner’s syndrome. This leads to unrestrained parasympathetic activity on the affected side. The classic signs of Horner’s syndrome are ptosis (drooping of the eyelid), miosis (constriction of the pupils), increased sweating, sinking of the eyeball (enophthalmos), and hyperemia, not mydriasis.

Question 31.    
Which of the following is a contraindication to testing the oculovestibular reflex?
(a) Cervical spine injury.
(b) Hemotympanum. 
(c) Vomiting.
(d) Raised ICP.
Answer:
(b) Hemotympanum. 

The oculovestibular reflex is tested to assess the function of the brain stem. This test is not performed on a patient with a ruptured tympanic membrane because water is poured into the ear during the test. Irrigation with water can dislodge blood clots from the ear and slow down the healing of the eardrum.

Question 32.    
Which of the following describes a positive Kernig sign?
(a) Flexion of the knee joint when the neck is passively rotated.
(b) Flexion of the knees when the neck is passively flexed.
(c) Inability to extend the knee when the hip and knees are both flexed at 90°.
(d) Inability to stand with the legs apart and the eyes closed.
Answer:
(c) Inability to extend the knee when the hip and knees are both flexed at 90°.

Kernig’s sign is used to examine meningeal irritation. The patient is placed in the supine position, and the hip and knee are flexed to 90° to test for Kernig’s sign. Pain or resistance upon knee extension indicates a positive Kernig’s sign.

Question 33.    
Which of the following is most critical before commencing a lumbar puncture in a patient with meningitis?
(a) Tonometry.
(b) Fundoscopy.
(c) Lumbar X-ray.
(d) Hematocrit. 
Answer:
(b) Fundoscopy.

A fundoscopy is required to rule out papilledema, a feature of raised intracranial pressure. Lumbar puncture must not be done on patients with increased intracranial pressure to prevent brain ^herniation and coning.

Question 34. 
A 25-year-old female managed for ectopic pregnancy will most likely have the embryo implanted in which of the following areas?
(a) Uterine cornua.
(b) Ovary.
(c) Fallopian tube.
(d) Cervix.
Answer:
(c) Fallopian tube.

The fallopian tube is the most likely site of ectopic implantation. Most ectopic pregnancies (around 95 percent occur in the fallopian tube, with the majority implanting in the ampulla. Non-tubal ectopic pregnancies account for about five percent and can implant in locations like the cervix, ovary, or intra-abdominally.

Question 35.    
A 68-year-old patient with a history of breast cancer arrives at the emergency room with altered mental status and abdominal discomfort. Lab findings indicate a serum calcium level of 13.8 mg/dL. Which of the following treatments is the most appropriate initial intervention?
(a) Give oral calcium supplements.
(b) Use normal saline IV hydration.
(c) Use intravenous bisphosphonates.
(d) Give oral phosphate supplements.
Answer:
(b) Use normal saline IV hydration.

One of the initial treatments for hypercalcemia, especially if the patient has signs of dehydration, is hydration with intravenous normal saline. This helps to dilute the serum calcium and increase its renal excretion. Bisphosphonates are effective in treating hypercalcemia but are usually used after initial hydration. Oral calcium exacerbates the problem, and oral phosphate supplements should not be used as the primary treatment for hypercalcemia in an emergency setting.

Question 36.    
Which of the following is the definitive treatment for a female patient who presents to the emergency room with a ruptured ectopic pregnancy?
(a) Methotrexate. 
(b) Salpingotomy.
(c) Salpingectomy.
(d) Bilateral tubal ligation.
Answer:
(c) Salpingectomy.

Salpingectomy, which involves excision of the ruptured fallopian tissue, is the definitive treatment for this patient. Salpingotomy is done to preserve the tube by extracting the products of conception. Methotrexate is used for unruptured ectopic pregnancies and is a more conservative approach. Indications for salpingectomy are ruptured ectopic pregnancy, persistent bleeding after salpingostomy, and ectopic pregnancy due to previous BTL. 

Question 37.    
Which of the following is not an absolute indication of a cesarean section? -
(a) Major degree placenta previa.
(b) Previous history of myomectomy.
(c) Two previous cesarean sections.
(d) Twin gestation. 
Answer:
(d) Twin gestation. 

Twin gestation is a relative (not absolute) indication of cesarean section. Vaginal delivery can be attempted if the leading twin has a normal presentation at term. Absolute indications for cesarean section are major degree placenta previa, two previous cesarean sections, previous history of myomectomy, major cephalopelvic disruption and obstructed labor, severe fetal distress in the first stage of labor, retroviral positive mother, bad obstetric history, and others.

Question 38.    
A nurse is about to discharge a patient who presented to the emergency room with a history of febrile seizures secondary to acute pharyngitis. Which of the following does not increase the child’s risk of developing a seizure disorder in the future?
(a) Complex febrile seizures.
(b) Delay of developmental milestones.
(c) History of seizures in siblings.
(d) Older children. 
Answer:
(d) Older children. 

The risk of seizure disorders increases in patients under one year old and patients with other risk factors, like a history of complex febrile seizures, delay of developmental milestones, and a history of febrile seizures in first-degree relatives.

Question 39. 
A patient has signs of hypovolemic shock after sustaining a traumatic injury. What is the most likely initial choice of fluid resuscitation for this patient?
(a) Dextrose 5% in water (D5W).
(b) Lactated Ringer’s solution.
(c) Normal saline (0.9% sodium chloride).
(d) Half-normal saline (0.45% sodium chloride).
Answer:
(c) Normal saline (0.9% sodium chloride).

Normal saline ?s isotonic, which means it has the same osmolarity as blood plasma. This makes it an initial fluid of choice for volume resuscitation when the patient is in hypovolemic shock, especially in trauma situations. The Lactated Ringer’s solution can also be used, but normal saline is more universally available. D5W and half-normal saline would not be the primary choices for immediate volume resuscitation for a patient in hypovolemic shock.

Question 40.    
Which of the following antipyretics is unsuitable for use in a five-year-old male being managed for varicella-zoster infection?
(a) Aspirin.
(b) Ibuprofen.
(c) Acetaminophen.
(d) Celecoxib.
Answer:
(a) Aspirin.

Salicylates like aspirin are contraindicated for use in children, especially children with varicella-zoster infection, due to the risk of developing Reye’s syndrome, a rare cause of hepatic encephalopathy.

Question 41.    
Which anti seizure drugs are unsuitable for use in a 35-year-old female with a BMI of 28 kg/m2? 
(a) Lamotrigine.
(b) Valproic acid.
(c) Ethosuximide.    
(d) Carbamazepine.
Answer:
(b) Valproic acid.

Weight gain is a known side effect of valproic acid. Its association with insulin secretion is not direct; instead, its mechanism for weight gain is multifactorial and not solely due to increased insulin secretion. Insulin is an anabolic hormone that increases appetite, food intake, energy conservation, and weight gain. This side effect is primarily seen in women.

Question 42.    
Which of the following antiseizure drugs is suitable in a 24-year-old G2 P 0+1 managed in the emergency room with generalized tonic-clonic seizures and is set for discharge?
(a) Ethosuximide. 
(b) Carbamazepine.
(c) Lamotrigine.
(d) Valproate.
Answer:
(c) Lamotrigine.

Older antiseizure drugs, like phenytoin, carbamazepine, valproate, and phenobarbital, are unsafe in pregnancy due to the high risk of congenital disabilities and neurologic conditions in the developing fetus. New-generation antiseizure drugs, like levetiracetam and lamotrigine, are widely prescribed for pregnant patients because of their safety profile. 

Question 43.    
Which of the following positions is most appropriate for a patient with a lumbar puncture for suspected meningitis?
(a) Fowler’s position.
(b) Semi-Fowler’s position.
(c) Supine position.
(d) Prone position. 
Answer:
(c) Supine position.

After a lumbar puncture, it is traditionally recommended for the patient to stay supine for several hours. This position is thought to reduce the chance of headache post-procedure, although recent evidence suggests that immediate mobilization might be just as effective in preventing post-lumbar puncture headaches. Standing or sitting can cause a quick redistribution of CSF and cause spinal headaches.

Question 44. 
Which potential complications are most associated with the rapid infusion of a large volume of normal saline?
(a) Hyperkalemia.
(b) Hypernatremia.
(c) Hypokalemia.
(d) Hyponatremia.
Answer:
(b) Hypernatremia.

Normal saline contains sodium and chloride, so rapid and excessive infusion can lead to hypernatremia (elevated sodium levels in the blood). Healthcare providers must monitor serum electrolytes during rapid fluid resuscitation to prevent this and other potential complications. The alternatives listed can occur with various fluid and electrolyte imbalances, but they are not directly associated with the rapid infusion of normal saline.

Question 45.    
Which clinical findings differentiate tension pneumothorax from cardiac tamponade in a 25-year-old male who presents to the emergency room with tachypnea and distended neck veins secondary to blunt trauma to the chest?
(a) Muffled heart sounds.
(b) Hypotension.
(c) Hyperresonant hemithorax.
(d) Pulsus paradoxus.
Answer:
(c) Hyperresonant hemithorax.

Although the clinical features of cardiac tamponade and tension pneumothorax may overlap, characteristics that distinguish tension pneumothorax from cardiac tamponade are hyper resonance, and absent breath sounds on the affected hemithorax. Pulsus paradoxus is not usually seen in tension pneumothorax.

Question 46.    
A 58-year-old female presented to the emergency room with diaphoresis, shortness of breath, and crushing chest pain that radiates to the left shoulder. Blood pressure at presentation was 160/100 mmHg. A differential diagnosis of myocardial infarction was made, and the patient commenced aspirin; tablets and sublingual nitroglycerin. Which of the following is best to detect the location of the infarct quickly? 
(a) Angiography.
(b) Electrocardiogram.
(c) Echocardiogram.
(d) Cardiac enzymes.
Answer:
(b) Electrocardiogram.

An electrocardiogram is the quickest and least invasive method for assessing the location of the infarct. Although angiography detects the location of the infarct, it is invasive and not as fast as an ECG. An echocardiogram is used to assess the integrity of the cardiac wall after a myocardial infarction. In contrast, cardiac biomarkers confirm a diagnosis of myocardial infarction but do not show the location.

Question 47.    
A 56-year-old female presented to the emergency room with shortness of breath, cough, hemoptysis, and a blood pressure of 160/100 mmHg. Which of the following is most likely responsible for this patient’s high diastolic blood pressure?
(a) Cardiac output.
(b) Stroke volume.
(c) Vascular resistance.
(d) Baroreceptors.
Answer:
(c) Vascular resistance.

Vascular resistance refers to the resistance offered by the peripheral blood vessels against the flow of blood. It represents the opposition to flow. Vascular resistance determines diastolic blood pressure, while cardiac output influences systolic blood pressure.

Question 48.    
A patient presents to the emergency room with a sudden onset of sharp, localized chest pain and shortness of breath. A chest X-ray is ordered. Which of the following findings would be indicative of a Westermark sign?
(a) A focal area of hyper lucency in the lung without pulmonary vessels.
(b) A wedge-shaped opacity at the lung periphery.
(c) A horizontal fluid level in the pleural space.
(d) A widened mediastinum. 
Answer:
(a) A focal area of hyper lucency in the lung without pulmonary vessels.

The Westermark sign refers to an area of the lung on a chest radiograph that appears more radiolucent (darker) due to the decreased blood flow secondary to a pulmonary embolism. This absence or reduction of pulmonary vessels in a localized area can indicate the diagnosis of pulmonary embolism. 

Question 49.
Which component of arterial walls provides vessel elasticity and contractility and is at risk of damage in a patient with uncontrolled hypertension?
(a) Tunica intima.
(b) Tunica media.
(c) Tunica externa.
(d) Tunica adventitia.
Answer:
(b) Tunica media.

The tunica media is the middle layer of arterial walls, primarily composed of smooth muscle cells and some elastic fibers. It provides both elasticity and contractility to blood vessels. Prolonged hypertension exerts excess force on arterial walls, which can lead to structural and functional changes in the tunica media, which includes reduced elasticity. This can further exacerbate hypertension and increase the risk of complications such as aneurysms. The tunica intima is the innermost lining. The tunica externa (or adventitia) is the outermost layer, and neither primarily provides vessel elasticity.

Question 50.    
Which of the following is not a cause of compartment syndrome?
(a) Fracture.
(b) Snakebite.
(c) Crush injuries.
(d) Rhabdomyolysis.
Answer:
(d) Rhabdomyolysis.

Rhabdomyolysis is a complication of compartment syndrome, not a cause. The most common causes of compartment syndrome are fractures, reperfusion injuries, crush injuries, and contusions of the muscles. Less common causes are cocaine overdose, burns, snakebites, and the use of tight bandages and casts.

Question 51.    
A nurse expects the doctor to order a serum assay of which of the following enzymes in a patient with rhabdomyolysis?
(a) Myoglobin.
(b) Lactate dehydrogenase.
(c) Creatine kinase. 
(d) Pyruvate kinase.
Answer:
(c) Creatine kinase. 

Creatine kinase is elevated in patients with rhabdomyolysis due to its massive release from necrose muscles. A serum level greater than five times the upper limit of normal is diagnostic. Myoglobin is also measured in the urine.

Question 52.    
Which of the following is an immediate complication in a patient managed for rhabdomyolysis?
(a) Acute kidney injury. 
(b) Hypokalemia.
(c) Elevated liver enzymes.
(d) Hyperpyrexia.
Answer:
(a) Acute kidney injury. 

Acute kidney injury is the most common immediate complication of rhabdomyolysis. This is because the destruction of myocytes triggers the release of intracellular components, enzymes, inflammatory mediators, and potassium into the intravascular space. Dehydration, sepsis, acidosis, and hyperkalemia worsen the outcomes of patients.

Question 53.    
Which drugs are used in managing a patient with malignant hyperthermia?
(a) Flumazenil.
(b) Dantrolene.
(c) Baclofen.
(d) Lorazepam.
Answer:
(b) Dantrolene.

Dantrolene is a muscle relaxant used to treat muscle excitability in patients with malignant hyperthermia. It blocks the release of calcium ions from the sarcoplasmic reticulum. Flumazenil is an antidote to benzodiazepine poisoning. Baclofen is a muscle relaxant used for the relief of muscle spasticity. Lorazepam is a benzodiazepine.

Question 54.    
Which of the following questions is most suitable for clarifying a patient’s ethnicity?
(a) Are you an immigrant?
(b) What year did you come to America? 
(c) What is your ethnic group?
(d) What country do you come from? 
Answer:
(c) What is your ethnic group?

This is the most suitable question for clarifying a patient’s ethnicity. Option A is derogatory. Options B and D are presumptive. 

Question 55.
A patient comes into the emergency room with shortness of breath and chest pain. On the chest X-ray, the nurse notices a meniscus sign. What further intervention is likely needed?
(a) Chest tube placement.
(b) Administration of anticoagulants.
(c) Thoracentesis.
(d) Administration of bronchodilators.
Answer:
(c) Thoracentesis.

When a meniscus sign is observed on a chest X-ray, it suggests the presence of a pleural effusion. A thoracentesis may be performed to both diagnose the cause and relieve the symptoms. During this procedure, a needle is used to remove the excess fluid from the pleural space. The extracted fluid is typically sent to the laboratory for further analysis.

Question 56.    
A three-day-old neonate with feeding difficulty is brought to the emergency room. The neonate experiences increased work of breathing. Upon auscultation, the nurse identifies a continuous, machine-like murmur best heard at the left upper sternal border. This clinical presentation is most consistent with which of the following?
(a) Ventricular septal defect.
(b) Atrial septal defect.
(c) Patent ductus arteriosus (PDA).
(d) Tetralogy of Fallot.
Answer:
(c) Patent ductus arteriosus (PDA).

The continuous, machine-like murmur best heard at the left upper sternal border is a characteristic finding of patent ductus arteriosus (PDA). PDA is a congenital heart defect where the ductus arteriosus fails to close after birth. This can lead to an increased workload on the heart and symptoms such as difficulty feeding, increased work of breathing, and poor growth. The other options are other congenital heart diseases not typically associated with the described murmur.

Question 57.    
Which of the following is not a risk factor for candidal vaginitis?
(a) Diabetes mellitus. 
(b) Obesity.
(c) Contraceptive.
(d) Menopause.
Answer:
(d) Menopause.

Candidal vaginitis is rare in postmenopausal women. Atrophic vaginitis is more likely to be found in this group. Risk factors for candidal vaginitis include diabetes mellitus, obesity, intrauterine contraceptives, pregnancy, use of corticosteroids, immunosuppression, and tight and nonbreathable underwear.

Question 58.    
A patient presents to the emergency room with a sudden onset of severe chest pain.
The physician suspects an aortic dissection. Which imaging modality is the most appropriate to confirm the diagnosis?
(a) Standard chest X-ray.
(b) Echocardiogram.
(c) CT angiography.
(d) MRI of the chest.
Answer:
(c) CT angiography.

CT angiography is a powerful imaging modality to visualize blood vessels throughout the body. For suspected aortic dissection, a potentially life-threatening condition where Jthe layers of the aorta separate, a CT angiography is considered the gold standard for diagnosis due to its speed, accuracy, and ability to visualize the entire aorta and its branches.

Question 59.    
Which of the following clinical features is most important in differentiating a case of pulmonary edema from exacerbated COPD?
(a) Fever.
(b) Hemoptysis.
(c) Crepitations.
(d) High blood pressure.  
Answer:
(c) Crepitations.

Crepitations are usually heard in pulmonary edema. These sounds differentiate pulmonary edema from COPD. Crepitations are cracking sounds best heard at the base of the lungs. They are caused by the presence of excess fluid in the airways. It is important to note that a patient with pulmonary edema may have variable blood pressure. Therefore, Option D is false.

Question 60.    
A 56-year-old male managed for acute left ventricular heart failure is placed in the high Fowler’s position to relieve dyspnea. Which of the following best explains the function of this position?
(a) Decreased intrathoracic pressure.
(b) Decreased work of breathing.
(c) Decreased preload.
(d) Increased cerebral perfusion.
Answer:
(b) Decreased work of breathing.

In the high Fowler’s position, the diaphragm can move more freely, lung expansion is facilitated, and the work of breathing is decreased. This position can help improve ventilation in patients with conditions like pulmonary edema. 

Question 61.    
A patient presents to the emergency room with acute pulmonary edema secondary to congestive heart failure and is managed with supplemental oxygen, furosemide, and digoxin. Which of the following is essential to monitor to reduce the risk of shock?
(a) Fluid status.
(b) Serum potassium.
(c) Hematocrit.
(d) BUN. 
Answer:
(a) Fluid status.

This patient is on furosemide, which is a loop diuretic required to reduce the amount of fluid in the interstitial space. It is essential to monitor the fluid status of this patient (fluid input, output, and signs of dehydration) to reduce the risk of hypovolemic shock.

Question 62.    
A 28-year-old female arrives at the emergency room with vaginal bleeding and abdominal cramping. She mentioned that she recently underwent a suction curettage procedure. Which of the following is the most likely reason for this procedure?
(a) Diagnosis of endometrial cancer. 
(b) Management of a missed miscarriage.
(c) Removal of ovarian cysts.
(d) Treatment for ectopic pregnancy.
Answer:
(b) Management of a missed miscarriage.

Suction curettage, also known as vacuum aspiration, is a procedure often used to manage first-trimester miscarriages and missed miscarriages. In a missed miscarriage, the fetus has died, but the body has not expelled the pregnancy tissue. Suction curettage is employed to remove the fetal tissue.

Question 63.    
Which of the following is a cause of cor pulmonale?
(a) Ventricular septal defect.
(b) Chronic bronchitis.
(c) Congestive heart failure.
(d) Eisenmenger syndrome.
Answer:
(b) Chronic bronchitis.

Cor pulmonale is pulmonary hypertension caused by a primary pathology in the lungs. Pathophysiologic mechanisms include loss of pulmonary capillary beds, chronic vasoconstriction, increased alveolar pressure, and hypertrophy of pulmonary arterioles. Other causes of cor pulmonale include massive pulmonary embolism, ARDS, obesity, systemic sclerosis, and neuromuscular diseases.

Question 64.    
Which of the following is most appropriate in excluding an ectopic pregnancy from a ruptured ovarian cyst?
(a) Hematocrit.
(b) B-HCG.
(c) Abdominopelvic ultrasound.
(d) Speculum examination. 
Answer:
(b) B-HCG.

B-HCG is elevated in ectopic pregnancy and normal in a ruptured ovarian cyst. Since the clinical presentation of the two conditions overlaps, it is important to rule out/confirm pregnancy by analyzing serum B-HCG levels.

Question 65.    
What is a patient with a history of uncontrolled hypertension most at risk of developing?
(a) Pulmonary embolism.
(b) Right ventricular failure.
(c) Left ventricular hypertrophy.
(d) Pericarditis.
Answer:
(c) Left ventricular hypertrophy.

Left ventricular hypertrophy (LVH) refers to the thickening of the muscular walls of the left ventricle. Chronic hypertension places an increased workload on the left ventricle, which causes enlargement and thickening over time. As the ventricular walls thicken, they may not supply adequate oxygen to the myocardium, which can lead to chest pain or heart failure. LVH also increases the risk of arrhythmias and sudden cardiac death.

Question 66.    
A 45-year-old male presents to the emergency room with severe abdominal pain, nausea, and vomiting. Lab results indicate a triglyceride level of 1,200 mg/dL. Which conditions is he at risk for due to his elevated triglyceride level?
(a) Pneumonia.
(b) Acute pancreatitis.
(c) Aortic dissection.
(d) Pulmonary embolism.
Answer:
(b) Acute pancreatitis.

Elevated triglyceride levels, especially above 1,000 mg/dL, can lead to acute pancreatitis. Pancreatitis is an inflammation of the pancreas, and one of the less common causes is hypertriglyceridemia. 

Question 67.    
Which of the following is the most likely cause of jaundice in a three-day-old newborn?
(a) Hepatitis C infection.
(b) Gallstones.
(c) Physiological jaundice. 
(d) Cirrhosis. 
Answer:
(c) Physiological jaundice. 

Physiological jaundice is common in newborns and typically appears on the second or third day after birth. The newborn’s liver is momentarily unable to process the extra bilirubin, which is caused by the breakdown of fetal red blood cells. This type of jaundice usually resolves independently as the infant’s liver matures. Other options listed are more common causes of jaundice in adults and older children but are very unlikely in a three- day-old newborn.

Question 68.    
After hemodynamic control, which interventions must be prioritized in a 25-year-old patient who presents to the emergency room with vaginal bleeding at 26 weeks gestation?
(a) Pelvic examination.
(b) Pelvic ultrasound.
(c) Partial thromboplastin time.
(d) Complete blood count.
Answer:
(b) Pelvic ultrasound.

An ultrasound scan must be done to rule out placenta previa. This must be done before pelvic examination because of the increased risk of bleeding in placenta previa. Please note that ultrasound scan findings do not exclude abruptio placentae. Diagnosis of abruptio placentae requires clinical evaluation and confirmation through laboratory and ultrasound scan findings.

Question 69.    
Which of the following is not a complication of abruptio placentae?
(a) DIC.
(b) Rh sensitization.
(c) Eclampsia.
(d) Birth asphyxia.
Answer:
(c) Eclampsia.

Eclampsia is an obstetric emergency characterized by seizures in a woman with preeclampsia, diagnosed by hypertension and proteinuria. Complications of abruptio placentae include hemodynamic instability, DIC, Rh sensitization, fetal distress, birth asphyxia, and fetal demise.

Question 70.    
Which of the following is not a risk factor for placental abruption?
(a) Hypertension.
(b) Previous cesarean section.
(c) Polyhydramnios.
(d) Abdominal trauma. 
Answer:
(b) Previous cesarean section.

This is not a risk factor for placental abruption but for placenta previa. Risk factors for placental abruption are hypertension, polyhydramnios, abdominal trauma, older maternal age, chorioamnionitis, vasculitis, previous history of abruption, and drug and tobacco abuse.

Question 71.    
Which of the following is not a disease-modifying antirheumatic drug?
(a) Methotrexate.
(b) Diclofenac.
(c) Leflunomide.
(d) Hydroxychloroquine.
Answer:
(b) Diclofenac.

NSAIDs are not disease-modifying rheumatic drugs (DMARDs) because they do not slow down the progression of disease. They provide relief from joint pain in patients with rheumatoid arthritis. Examples of DMARDs are leflunomide, methotrexate, sulfasalazine, and hydroxychloroquine.

Question 72.    
In which of the following conditions is osteomyelitis secondary to salmonella infection most likely?
(a) Hemodialysis.
(b) Diabetes mellitus.
(c) Pressure ulcers.
(d) Sickle cell anemia.
Answer:
(d) Sickle cell anemia.

Patients with sickle cell anemia have a higher likelihood of immunodeficiency and liver disease, which makes them more susceptible to bone infections caused by salmonella. Patients who are elderly, bedridden, or receiving hemodialysis will likely have osteomyelitis caused by Staphylococcus aureus. 

Question 73.    
Which of the following is the initial management of a patient who presents to the emergency room with neck pain after a fall?
(a) Analgesia.
(b) Cervical collar.
(c) Physiotherapy.     
(d) Cervical spine X-ray.
Answer:
(b) Cervical collar.

The neck must first be stabilized to prevent further injury to the cervical spine. For all patients with neck pain following trauma, an injury to the cervical spine must be suspected and ruled out only after a radiologic investigation.

Question 74.    
A patient was found in a snowbank and brought to the emergency room. He was in the snowbank for an unknown amount of time. The patient’s core temperature is 3i°C (87.8°F). Which of the following clinical manifestations is most consistent with this ' temperature reading?
(a) Hot, flushed skin.
(b) Rapid heart rate.
(c) Muscle rigidity.
(d) Profuse sweating.
Answer:
(c) Muscle rigidity.

At a core temperature of 31°C (87.8°F), the patient is experiencing moderate hypothermia. One of the clinical manifestations of moderate hypothermia is muscle rigidity or stiffness.

Question 75.    
Which of the following clinical findings is correct concerning opioid overdose?
(a) Pinpoint pupils.
(b) Tachycardia.
(c) Aggression.
(d) Auditory hallucinations. 
Answer:
(a) Pinpoint pupils.

Opioids are one of the most commonly abused medications. Opioids are medications generally used for pain relief (in severe or moderate cases) and for treating other indications. Opioid analgesics include drugs like morphine, oxycodone, and fentanyl. Pentazocine is a mixed agonist-antagonist opioid. Clinical features include respiratory depression, apnea, miosis (pinpoint pupils), hypotension, delirium, bradycardia, hypothermia, and urinary retention. Treatment options include acute resuscitation, mechanical ventilation, and intravenous naloxone.

Question 76.    
Which of the following is not a function of heat therapy in pain relief?
(a) Decreases blood flow.
(b) Reduces tissue edema.
(c) Decreases muscle spasm.
(d) Increases muscle extensibility.
Answer:
(a) Decreases blood flow.

Heat therapy increases blood flow, which can help decrease pain, joint stiffness, and muscle spasms. It also enhances the extensibility of collagen tissues and muscles.

Question 77.    
Which of the following interventions is unnecessary in a patient with an ankle sprain?
(a) Elevation.
(b) Compression.
(c) Rest.
(d) Heat therapy.
Answer:
(d) Heat therapy.

This intervention is unnecessary for this patient. Interventions include rest, elevation, compression, joint protection, and ice application. Immobilization is used for severe cases.

Question 78.    
During the assessment of circulation in a trauma patient, which of the following is correct?
(a) Capillary refill is the best assessment for circulation.
(b) Cyanosis is best appreciated in the nail bed.
(c) Cold, clammy extremities are signs of shock.
(d) Hyperpyrexia increases pulse rate, respiratory rate, and blood pressure.
Answer:
(c) Cold, clammy extremities are signs of shock.

In shock, vasodilation of peripheral blood vessels causes the dissipation of heat. The upper and lower limbs are cool and clammy to the touch. Option A is incorrect because circulation is assessed with pulse rate, blood pressure, and capillary refill. Option B is incorrect because cyanosis is assessed in the buccal mucosa, lips, and nail beds. Option D is incorrect because hyperpyrexia increases heart and respiratory rates but not blood pressure. 

Question 79.    
A patient had an emergency exploratory laparotomy for peritonitis and was placed on oral Oxycodone. Which of the following side effects is most unlikely to occur?
(a) Nausea.
(b) Constipation.
(c) Dizziness.
(d) Anorexia.
Answer:
(d) Anorexia.

Oxycodone is an opioid used in pain management. Common side effects are constipation, nausea, vomiting, dizziness, hypersomnolence, pruritus, and xerostomia. Infrequent side effects are diarrhea, anorexia, urine retention, difficulty breathing, and hiccups.

Question 80.    
A 20-year-old female presents to the emergency room and says a vampire has been stalking her. She clicks her fingers and grimaces constantly. Which of the following diagnoses is most appropriate?
(a) Catatonic schizophrenia.
(b) Major depression.
(c) Mania.
(d) Bipolar disorder. 
Answer:
(a) Catatonic schizophrenia.

This disorder is characterized by delusions, disorganized speech, hallucinations, and repetitive, inappropriate, and bizarre motor movements. Patients with major depression present with suicidal ideation, fatigue, psychomotor agitation, insomnia or hypersomnia, inability to concentrate, and weight gain or weight loss. Patients with mania present with grandiosity, flight of ideas, the pressure of speech, distractibility, increased busyness, and engagement in high-risk behaviors

Question 81.    
A 35-year-old woman with a known history of cannabis abuse presents to the emergency room and states that Michael Jackson is forcing her to marry him. Which of the following diagnoses is most appropriate?
(a) Voyeurism.
(b) Delusion of grandeur.
(c) Delusion of persecution.
(d) Erotomania.
Answer:
(d) Erotomania.

In erotomania, patients believe that someone of a higher status (a celebrity most times) is in love with them. Voyeurism is a paraphilic disorder in which sexual arousal and satisfaction are obtained by watching people disrobe, bathe, or engage in sexual activities. In delusions of grandeur, patients believe they are important or of a higher status than they are. In delusions of persecution, patients believe that people are out to get them.

Question 82.    
Which of the following medications is most commonly associated with the development of agranulocytosis?
(a) Metoprolol.
(b) Furosemide.
(c) Clozapine.
(d) Atorvastatin.
Answer:
(c) Clozapine.

Clozapine is an antipsychotic medication known to have the potential side effect of agranulocytosis. Regular monitoring of white blood cell counts is recommended to detect the condition early and manage it appropriately.

Question 83.    
Which of the following is a feature of acrocyanosis in a 35-year-old female who presents to the emergency room with bluish discoloration of her fingers, a burning sensation, and paresthesia?
(a) Trophic changes. 
(b) Persistent cyanosis.
(c) Tenderness of the fingers.
(d) Absent pulses.
Answer:
(b) Persistent cyanosis.

In acrocyanosis, there is a persistent bluish discoloration of the fingers even after the fingers are warmed. Unlike Raynaud’s syndrome, there are no trophic changes, ulcers, or tenderness. Pulses are also present.

Question 84.    
A 72-year-old male patient with a history of hypertension and on medication presents to the emergency room feeling light-headed whenever he stands up from a seated position. What would be the most likely diagnosis for this patient?
(a) Orthostatic hypertension.
(b) Atrial fibrillation.
(c) Postural hypotension.
(d) Myocardial ischemia.
Answer:
(c) Postural hypotension.

Postural hypotension (orthostatic hypotension) is a sudden decrease in blood pressure when a person stands up from a lying or sitting position. The common symptoms include dizziness or light headedness, and can be more common in older adults, especially those on medications for hypertension.

Question 85.    
Which of the following is not a skin manifestation of peripheral arterial disease?
(a) Necrosis.
(b) Dependent rubor.
(c) Skin atrophy.
(d) Lichenification. 
Answer:
(d) Lichenification. 

This is a skin manifestation of peripheral venous (not arterial) disease. Chronic venous insufficiency causes stasis dermatitis, characterized by hyperpigmentation, induration, and shallow ulcers often located around the medial malleolus. These ulcers are usually moist and do not penetrate the deep fascia. The ulcers in peripheral arterial disease present as black necrotic tissue, which may be wet due to bacterial infection. Also, these ulcers tend to extend into the deep fascia and expose the tendon and bone.

Question 86.    
A 25-year-old patient comes to the emergency room after being bitten by a stray dog. The dog ran away and could not be observed or tested. The patient has never received a rabies vaccine in the past. Which is the most appropriate management intervention regarding rabies prophylaxis for this patient?
(a) Use a rabies vaccine only.
(b) Use rabies immune globulin (RIG) only.
(c) Use a rabies vaccine and RIG.
(d) No intervention is needed as the risk is low.
Answer:
(c) Use a rabies vaccine and RIG.

Rabies prophylaxis must be considered if a patient is bitten by an animal unavailable for observation or testing, especially a high-risk species like a stray dog. For a patient who has never been vaccinated against rabies, the appropriate management intervention is to administer both the rabies vaccine and rabies immune globulin (RIG). The vaccine stimulates the patient’s immune system to produce antibodies against the virus, while RIG provides immediate and passive immunity.

Question 87.    
Which of the following neurotransmitters is mainly affected by myasthenia gravis?
(a) Epinephrine.
(b) Norepinephrine.
(c) Histamine.
(d) Acetylcholine.
Answer:
(d) Acetylcholine.

In myasthenia gravis, there is an autoimmune attack on the receptors for acetylcholine, which results in fewer receptors for the neurotransmitter.

Question 88.    
The nursing assistant informs the nurse that the patient on IV fluids complains of swelling and tenderness of the cannulated arm. Which of the following interventions is most appropriate?
(a) Ask the nursing assistant to check the patient’s pulse rate.
(b) Ask the nursing assistant to administer IV acetaminophen. 
(c) Inspect and remove the infiltrated line.
(d) Wait for the infusion to be over.
Answer:
(c) Inspect and remove the infiltrated line.

This is the most appropriate response. Checking the pulse rate does not offer relief to the patient’s discomfort. Administration of IV drugs is not the duty of the nursing assistant; moreover, it will only worsen the patient’s condition. Option D will worsen the patient’s condition.

Question 89.    
A 56-year-old female patient comes to the emergency room with complaints of nausea, headache, and muscle cramps. Her serum sodium level is 125 mEq/L. Which of the following is the most appropriate initial intervention for this patient?
(a) Administer hypertonic saline (3% NaCl) rapidly.
(b) Restrict all fluid intake immediately.
(c) Provide normal saline intravenously at a moderate rate.
(d) Encourage intake of salt-rich foods.
Answer:
(c) Provide normal saline intravenously at a moderate rate.

In mild to moderate symptomatic hyponatremia, an initial approach often involves the infusion of normal saline (0.9% NaCl) to correct the sodium imbalance. Hypertonic saline (3% NaCl) is typically reserved for severe, symptomatic hyponatremia (e.g., seizures or altered mental status). Restricting fluid intake is more appropriate for chronic or asymptomatic hyponatremia, especially due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Encouraging salt-rich foods alone would not provide a rapid enough correction in an emergency setting.

Question 90.    
A patient with peripheral arterial disease is managed with clopidogrel, an antiplatelet drug. Which of the following best describes the mechanism of action of this drug?
(a) Glycoprotein Ilb/IIIa inhibitor.
(b) Cyclooxygenase inhibitor.
(c) ADP inhibitor.
(d) Leukotriene receptor blocker. 
Answer:
(c) ADP inhibitor.

Clopidogrel is metabolized into an active metabolite that inhibits an ADP receptor responsible for activating platelet aggregation. A loading dose of 300 to 600 mg of clopidogrel is given as an oral tablet of 75 mg daily. Examples of glycoprotein Ilb/IIIa inhibitors are abciximab (ReoPro), tirofiban (Aggrastat), and eptifibatide (Integrilin). Aspirin is a cyclooxygenase inhibitor. All these drugs, except leukotriene receptor antagonists, are examples of antiplatelet drugs.

Question 91.    
Which of the following is not a risk factor for venous insufficiency of the lower limbs?
(a) Obesity.
(b) Dyslipidemia.
(c) Pregnancy.
(d) Old age.
Answer:
(b) Dyslipidemia.

Dyslipidemia is a risk factor for peripheral arterial disease, not venous insufficiency. Risk factors of venous insufficiency are deep venous thrombosis (the most common risk factor), obesity, trauma, elderly age, pregnancy, and standing or sitting for long periods.

Question 92.    
A patient who presents with a chronic venous ulcer will benefit from which of the following interventions?
(a) Antiplatelet drugs.
(b) Venous ligation.
(c) Compression stockings.
(d) Skin grafting.
Answer:
(c) Compression stockings.

The underlying pathophysiology of venous ulcers is the pooling of blood in the peripheral venous due to impaired efficiency of the valves in the veins. Compression stockings improve peripheral circulation by increasing pressure, which improves ulcers and edema. The use of driigs like antiplatelets, anticoagulants, and antidiuretic drugs does not produce significant effects in the treatment of venous ulcers. Surgical interventions like venous ligation and valve reconstruction also are not effective. Skin grafting has no effect if the underlying pathophysiology is not corrected.

Question 93.    
A patient was admitted to the emergency room with agitation, psychosis, and violent behavior and Was given IM diazepam and haloperidol. A nurse noticed later that the patient was unable to move. Which of the following interventions is most appropriate?
(a) Flumazenil.
(b) Baclofen.
(c) Benztropine. 
(d) Naltrexone.
Answer:
(c) Benztropine. 

First-generation antipsychotics like haloperidol antagonize D2 dopamine receptors, which cause extrapyramidal motor effects like dystonia, akathisia, tremor, bradykinesia, and tardive dyskinesia. Benztropine is an antimuscarinic agent used in treating these extrapyramidal effects. It inhibits cholinergic neurons in the basal ganglia. This prevents dopamine reuptake and increases dopaminergic activity.

Question 94.    
Which of the following is a characteristic symptom of schizophrenia?
(a) Low mood.
(b) Loss of appetite. 
(c) Auditory hallucinations.
(d) All of the above.
Answer:
(c) Auditory hallucinations.

Auditory hallucination is considered a significant symptom of a psychiatric illness. First-person auditory hallucination is part of the major criteria for the diagnosis of schizophrenia. Hallucinations are also a sign of several other psychotic disorders. Delusions refer to unusual beliefs, and they are seen in delusional and mood disorders.

Question 95.    
Which of the following is not a contraindication of ECT?
(a) Pneumonia.
(b) Recent STEMI.
(c) Goiter.
(d) Arrhythmia.
Answer:
(c) Goiter.

A goiter is not a contraindication of ECT. Increased intracranial pressure from edema, tumors, and other causes of pressure effect and respiratory and cardiac disorders are contraindicated. Other contraindications are severe liver disease, unstable dentition, retinal detachment, and pheochromocytoma. 

Question 96.    
Which of the following conditions is treated with ECT?
(a) General anxiety disorder.
(b) Major depressive disorder.
(c) Psychosis. 
(d) Dissociative disorder. 
Answer:
(b) Major depressive disorder.

Electroconvulsive therapy treats patients with major depressive disorder and bipolar disorder that is refractory to pharmacotherapy.

Question 97.
A 45-year-old male presents to the emergency room with increased anxiety and panic attacks. He states hesitancy about taking medications and wishes to seek other therapeutic interventions. Which non-pharmacologic treatments have been effective for many patients with similar symptoms?
(a) Aromatherapy.
(b) Deep tissue massage.
(c) Cognitive Behavioral Therapy (CBT).
(d) Acupuncture.
Answer:
(c) Cognitive Behavioral Therapy (CBT).

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is particularly effective in the treatment of various mental health disorders, such as anxiety disorders and panic attacks. CBT aims to identify and change negative thought patterns and behaviors that contribute to the symptoms. It provides patients with tools to manage and reduce their symptoms effectively.

Question 98. 
Dryness of the mucosa of the mouth and blurred vision are side effects of antipsychotics due to blockage of which of the following receptors?
(a) Histamine.
(b) Dopamine.
(c) Acetylcholine.
(d) Norepinephrine.
Answer:
(c) Acetylcholine.

Antagonistic effects on acetylcholine receptors cause constipation, blurred vision, dry mouth, and extrapyramidal effects. Antagonistic effects on dopamine cause reduced libido and gynecomania. Antagonistic effects on histamine cause sedation, drowsiness, and dry mouth. Antiadrenergic effects cause postural hypotension. Hematologic side effects include agranulocytosis and thrombocytopenia. Endocrine changes include weight gain, type 2 diabetes mellitus, and metabolic syndrome. Cardiovascular changes include arrhythmia and stroke.

Question 99.
A 35-year-old male presents to the emergency room and is managed with a tricyclic antidepressant for depression. Which of the following is not an example of this class of drugs? 
(a) Amitriptyline.     
(b) Clomipramine.
(c) Doxepin.
(d) Fluoxetine.
Answer:
(d) Fluoxetine.

Fluoxetine is a selective serotonin reuptake inhibitor. Tricyclic antidepressants are serotonin and norepinephrine reuptake inhibitors, which increase the synaptic „ concentrations of these neurotransmitters. Examples are amitriptyline, clomipramine, imipramine, doxepin, lofepramine, iprindole, and desipramine.

Question 100.    
The mother of a five-year-old female with chickenpox wants to know if her daughter can be reinfected. Which of the following makes this unlikely?
(a) Active natural immunity.
(b) Passive natural immunity.
(c) Active artificial immunity.
(d) Passive artificial immunity.
Answer:
(a) Active natural immunity.

Due to active natural immunity, this patient is unlikely to be reinfected with chickenpox. In this case, memory cells are exposed to the chickenpox antigen and produce antibodies that can fight off infections in the future.

Question 101.    
A patient with tetanus infection is managed with tetanus immune globulin. Which of the following best describes the purpose of this drug?
(a) Active immunity.
(b) Neutralization of circulating toxins.
(c) Prevention of the further release of toxins.
(d) Sedation.
Answer:
(b) Neutralization of circulating toxins.

Tetanus immune globulin is given to neutralize the unbound circulating toxin. Active immunity is conferred via tetanus antitoxin. Further release of toxins is done by rapid debridement of the wound and commencement of antibiotics. Benzodiazepines are used as sedatives.

Question 102.    
Which of the following is not an intervention in a patient with tetanus?
(a) Frequent turning.
(b) Hyperalimentation.
(c) Treatment in a bright room.
(d) Mechanical ventilation.
Answer:
(c) Treatment in a bright room.

Patients with tetanus should be treated in a quiet, dark room to prevent unnecessary nervous system stimulation. Frequent turning prevents bedsores. IV hyperalimentation helps to avoid aspiration from parenteral feeding. Mechanical ventilation is for cases of severe respiratory failure.

Question 103.    
Which of the following is a risk factor for the herpes zoster infection?
(a) HIV.
(b) Pregnancy.
(c) Diabetes mellitus.
(d) Sickle cell anemia.
Answer:
(a) HIV.

The risk of herpes zoster infection increases in older patients with HIV infection and patients with severe immunosuppression (e.g., leukemia or SCID treatments).

Question 104.    
Which of the following strains of the human papillomavirus is implicated in cervical cancer?
(a) HPV 6. 
(b) HPV 8. 
(c) HPV 18.
(d) HPV 11.    
Answer:
(c) HPV 18.

Carcinogenic strains of HPV implicated in cervical cancer are HPV 16 and HPV 18. These strains are also implicated in cancers that affect the oral cavity, penis, anus, vulva and vagina.

Question 105.    
A child presents to the emergency room with infectious mononucleosis and is at risk of developing which of the following cancers?
(a) Acute lymphoblastic leukemia.
(b) Acute lymphocytic leukemia.
(c) Non-Hodgkin’s lymphoma.
(d) Burkitt’s lymphoma.
Answer:
(d) Burkitt’s lymphoma.

The Epstein-Barr virus causes infectious mononucleosis. This virus has been associated with an increased risk of developing Burkitt’s lymphoma, B cell tumors, gastric cancer, nasopharyngeal carcinoma, and some forms of Hodgkin’s lymphoma.

Question 106.    
A 56-year-old female is treated with IV tranexamic acid for chronic anemia and vaginal bleeding secondary to uterine bleeding. Which of the following best describes the mechanism of action of this drug?
(a) GnRH agonist.
(b) Androgen receptor agonist.
(c) Estrogen receptor modulator.
(d) Antifibrinolytic. 
Answer:
(d) Antifibrinolytic. 

Tranexamic acid is a synthetic derivative of lysine. It is an antifibrinolytic that binds to lysine receptors and inhibits the conversion of plasminogen to plasmin and consequently prevents the breakdown of fibrin molecules. This effect reduces vaginal bleeding in ~ patients with symptomatic uterine fibroids.

Question 107.
Which of the following interventions is contraindicated in a 78-year-old female who presents to the emergency room with severe vaginal bleeding secondary to cervical cancer?
(a) Blood transfusion.
(b) Vasopressors.
(c) Speculum examination.
(d) Vaginal packing.
Answer:
(c) Speculum examination.

Speculum examination is contraindicated in this patient due to the risk of increased bleeding. In cervical cancer, contact bleeding occurs due to the friability of tissues and mucosa. These tissues can bleed on contact. Treatment modalities in this patient include acute resuscitation with IV fluids, blood products, and vasopressors. Also, the vagina should be packed to stimulate clotting.

Question 108.    
A 38-year-old female presents to the emergency room with vaginal bleeding and is being worked up for a myomectomy. Part of her pretreatment includes leuprolide. Which best describes the rationale behind the use of the drug?
(a) Shrinks fibroids.
(b) Antifibrinolytic.
(c) Estrogen receptor blocker.
(d) Androgen receptor agonist.
Answer:
(a) Shrinks fibroids.

Leuprolide is a GnRH agonist that reduces the size of uterine fibroids and uterine bleeding. It does this by reducing the secretion of estrogen. These drugs are given preoperatively to reduce the risk of hemorrhage during surgery. Also, they reduce the size of the uterus and the fibroids. They are not used for long-term management. 

Question 109.    
Which of the following is not a cause of menorrhagia?
(a) Family history.
(b) Hyperthyroidism.
(c) Infection. 
(d) Anorexia nervosa.
Answer:
(d) Anorexia nervosa.

Anorexia nervosa is not a cause of menorrhagia. It is an eating disorder characterized by fear of weight gain, food restriction, calorie intake restriction, and malnutrition. Amenorrhea and oligomenorrhea are complications of malnutrition. Other causes of menorrhagia are the use of nonhormonal IUDs, fibroids, adenomyosis, endometriosis, thyroid disorders, hormonal imbalance, cancers, anticoagulants, and inherited bleeding disorders.

Question 110.    
Which of the following is not useful to reduce the incidence of MRSA in hospital settings?
(a) Handwashing. 
(b) Isolation procedures.
(c) Empirical therapy.
(d) Sensitivity studies.
Answer:
(c) Empirical therapy.

Empirical use of antibiotics does not reduce the incidence of MRS A in hospital settings. Empirical therapy helps in providing prompt intervention and treatment in patients. However, it may increase the risk of antibiotic resistance.

Question 111.    
In the Mantoux test, protein-derived tuberculin is administered to trigger which of the following hypersensitivity reactions?
(a) Type I.
(b) Type II.
(c) Type III.
(d) Type IV. 
Answer:
(d) Type IV. 

Type IV hypersensitivity reaction is also called delayed cell-mediated hypersensitivity reaction. In this case, T cells, macrophages, and monocytes are released to contain the offending antigen. This reaction takes days to develop.

Question 112.    
Which of the following is a management for a patient who presents to the emergency room with symptoms of withdrawal from valium?
(a) Gabapentin.
(b) Benzodiazepines.
(c) Naltrexone.
(d) Bupropion.
Answer:
(b) Benzodiazepines.

Patients with acute withdrawal symptoms from sedatives will be managed with IV benzodiazepines.

Question 113.    
Which of the following samples is most appropriate for collection in a two-year-old female with suspected tuberculosis?
(a) Sputum.
(b) Stool.
(c) Gastric acid.
(d) Saliva.
Answer:
(c) Gastric acid.

Sputum may not be easily obtained in young children who do not know how to expectorate. Because of this, gastric aspirate is obtained by gastric lavage. These samples are typically collected in the morning, just before eating.

Question 114.    
Which of tie following is not a symptom of withdrawal from opioids?
(a) Lacrimation.
(b) Rhinorrhea.
(c) Diarrhea. 
(d) Increased appetite.
Answer:
(d) Increased appetite.

This is not a symptom of withdrawal from opioids. Symptoms are anxiety, yawning, diaphoresis, lacrimation, mydriasis, rhinorrhea, tachycardia, hypertension, chills, anorexia, diarrhea, and fever. These symptoms are caused by stimulation of the central nervous system. Increased appetite is an effect of cannabis.

Question 115.    
A patient presents to the emergency room with symptoms of withdrawal from opioid abuse, and is managed with methadone. What is the mechanism of action of this drug?
(a) Opioid receptor antagonist.
(b) Opioid receptor agonist.
(c) Dopamine receptor agonist.
(d) Dopamine reuptake inhibitor.
Answer:
(b) Opioid receptor agonist.

Methadone is an opioid receptor agonist. It is used in treating patients with opioid withdrawal symptoms. It is also used for opioid detoxification as it has a long half-life and fewer euphoric and sedative effects. 

Question 116.    
A 52-year-old woman presents to the emergency room five days post total abdominal hysterectomy with complaints of increased abdominal pain, fever, and malodorous vaginal discharge. Which of the following complications should the nurse suspect?
(a) Urinary tract infection.
(b) Wound dehiscence.
(c) Surgical site infection.
(d) Ovarian cyst rupture. 
Answer:
(c) Surgical site infection.

Following a total abdominal hysterectomy, the symptoms of increased abdominal pain, fever, and malodorous vaginal discharge suggest a surgical site infection (SSI). SSIs can occur at the incision site or deeper within the surgical site and are a significant concern after surgeries.

Question 117.
Which of the following is not a goal of treatment in the management of a rape victim?
(a) HIV PEEP.
(b) Emergency contraceptives.
(c) Psychological evaluation.
(d) Religious counseling.
Answer:
(d) Religious counseling.

This is not a goal in the treatment of rape victims. However, religious counseling can be offered if the patient requests it. The treatment goals of rape victims include medical evaluation and rapid management of injuries, pregnancies, and sexually transmitted infections. Psychological evaluation and support, evidence collection, and crisis intervention (with the expressed consent of the victim) are also objectives.

Question 118.    
Which of the following is not a clinical feature of a manic episode of bipolar disorder?
(a) Grandiosity.
(b) Hypersomnia.
(c) Distractibility.
(d) Talkativeness.
Answer:
(b) Hypersomnia.

This is not a clinical feature of a manic episode of bipolar disorder. In the manic phase of bipolar disorder, affected patients experience insomnia. For a diagnosis of mania, the patient must exhibit at least three of these symptoms for over a week: grandiosity, insomnia, talkativeness, excessive involvement in activities that may be high risk (gambling, drinking, sexual activities), distractibility, and racing of ideas.

Question 119.    
A 73-year-old man presents to the emergency room with a history of multiple minor strokes over the past year. He now exhibits a stepwise deterioration in cognitive function with episodes bf confusion. He has a history of hypertension and hyperlipidemia. What is the most likely diagnosis?
(a) Alzheimer’s disease.
(b) Frontotemporal dementia.
(c) Vascular dementia. 
(d) Lewy body dementia.
Answer:
(c) Vascular dementia. 

Vascular dementia results from impaired blood flow to parts of the brain, often due to a series of minor or one major stroke. It can manifest as a stepwise decline in cognitive abilities. This differs from the gradual and continuous decline often seen in diseases like Alzheimer’s. Risk factors such as hypertension and hyperlipidemia can contribute to its development.

Question 120.    
A 35-year-old woman comes to the emergency room with complaints of muscle weakness, especially toward the end of the day, and occasional double vision. She states that these symptoms worsen after periods of activity and improve with rest. Based on her presentation, which of the following conditions should the nurse consider as a potential diagnosis?
(a) Guillain-Barre Syndrome.
(b) Myasthenia gravis.
(c) Multiple sclerosis.
(d) Amyotrophic lateral sclerosis (ALS).
Answer:
(b) Myasthenia gravis.

Myasthenia gravis is an autoimmune disorder that affects the communication between nerves and muscles. The hallmark of this disease is muscle weakness that worsens after periods of activity and improves after periods of rest. Common symptoms include eye muscle weakness, which results in drooping of the eyelids (ptosis) and double vision. The presentation described aligns with the typical manifestations of myasthenia gravis.

Question 121.    
A 23-year-old woman presents to the emergency room in distress. She complains that her right arm is rotten and smelly, although this is not the case. Which of the following drugs is most appropriate for use in this patient?
(a) Citalopram.
(b) Risperidone.
(c) Lithium.    
(d) Amitriptyline. 
Answer:
(b) Risperidone.

This patient has visual and olfactory hallucinations, which are clinical features of psychosis. An antipsychotic drug such as Risperidone is needed to treat her condition. Citalopram is a selective serotonin reuptake inhibitor used to treat depression and anxiety 
disorders. Lithium is a mood stabilizer used in the treatment of bipolar disorders. Amitriptyline is a tricyclic antidepressant used to treat depression and anxiety disorders.

Question 122.    
A 35-year-old female presents to the emergency room with psychosis and agitation managed with olanzapine. Which of the following best describes the mechanism of action of this drug?
(a) Dopamine receptor agonist.
(b) Serotonin receptor agonist.
(c) Norepinephrine receptor antagonist.
(d) Dopamine receptor antagonist.
Answer:
(d) Dopamine receptor antagonist.

Olanzapine is an atypical antipsychotic. It is a dopamine receptor antagonist, serotonin receptor antagonist, and serotonin receptor inverse agonist. It is used to treat psychotic symptoms in schizophrenia.

Question 123.    
Which of the following is not a side effect of antipsychotics?
(a) Dry mouth.
(b) Tardive dyskinesia.
(c) Blurred vision.
(d) Diarrhea.
Answer:
(d) Diarrhea.

Constipation, not diarrhea, is a side effect of antipsychotics. The side effects of antipsychotics arise from their antagonistic effects on dopamine, serotonin, and acetylcholine receptors. Antagonistic effects on acetylcholine receptors cause constipation, blurred vision, dry mouth, and extrapyramidal effects. Antagonistic effects on dopamine cause reduced libido and gynecomastia. Antagonistic effects on histamine cause sedation, drowsiness, anti dry mouth. Anti-adrenergics cause postural hypotension. Hematologic side effects include agranulocytosis and thrombocytopenia; endocrine changes include weight gain, type 2 diabetes mellitus, and metabolic syndrome. Cardiovascular changes include arrhythmia and stroke.

Question 124.
A 65-year-old male patient presents to the emergency room with chest pain radiating to the left arm. Which medication, commonly administered in an emergency setting, helps dilate the coronary arteries, thereby improving blood flow to the myocardium?
(a) Aspirin.
(b) Nitroglycerin. 
(c) Metoprolol.
(d) Morphine.
Answer:
(b) Nitroglycerin. 

Nitroglycerin is a vasodilator that primarily works by relaxing and dilating the coronary arteries, which can increase blood flow to the heart muscle (myocardium). This can help alleviate the chest pain associated with angina or a heart attack. Although aspirin acts as an antiplatelet agent to prevent clotting, Metoprolol is a beta-blocker that slows down the heart rate and decreases the workload on the heart. Morphine is an analgesic that can help manage pain and anxiety.

Question 125.    
Which of the following is not useful in reducing the risk of deep vein thrombosis in an obese patient who presents to the emergency room with STEMI? 
(a) Early ambulation.
(b) Subcutaneous heparin.
(c) Compression stocking.     
(d) Physiotherapy.
Answer:
(d) Physiotherapy.

Physiotherapy is not a useful intervention in this patient, who is not bedridden. The patient must be ambulated as soon as possible to reduce the risk of DVT. To do so, the nurse should encourage the patient to take small walks with walking aids. Prophylactic anticoagulants, such as oral aspirin, oral clopidogrel, oral warfarin, or subcut heparin must be given. Compression stockings can also be applied as soon as the patient wakes up in the morning to inverse venous pressure and improve venous return.

Question 126.    
Unfractionated heparin is more suitable for use than lower-weight molecular heparin in which of the following conditions?
(a) Liver failure.
(b) Renal failure.
(c) Myocardial infarction.
(d) Stroke. 
Answer:
(b) Renal failure.

Unfractionated heparin is more suitable for use than LMWH in patients with renal failure. This is because the kidneys primarily excrete LMWH, and its use in patients with renal failure may lead to accumulation and an increased risk of bleeding. Unfractionated heparin is metabolized and eliminated by multiple pathways, not solely through renal excretion.

Question 127.
Which of the following surgeries has the least risk of DVT?
(a) Hip arthroplasty.
(b) Knee arthroplasty.
(c) Elective neurosurgery.
(d) Appendectomy
Answer:
(d) Appendectomy

Surgeries of the hip, pelvis, and lower limbs have the highest risks of deep vein thrombosis, followed by CNS and spinal cord surgeries and major surgeries requiring general anesthesia.

Question 128.    
A patient presents to the emergency room with peripheral arterial disease managed with cholestyramine for atherosclerosis. Which of the following best describes the mechanism of action of this drug?
(a) Increases serum HDL.
(b) Inhibits absorption of cholesterol in the intestine.
(c) Inhibits absorption of bile acids.
(d) Inhibits the production of cholesterol.
Answer:
(c) Inhibits absorption of bile acids.

Cholestyramine is a bile acid sequestrant that binds to bile acids and inhibits their absorption. This increases the uptake of LDL used in making bile acids. As more bile acids are synthesized from LDL, it is excreted. This mechanism reduces serum LDL in the long run. The use of this drug is, however, limited due to its gastrointestinal symptoms like bloating, flatulence, diarrhea, and nausea. This drug reduces the absorption of thyroxine, digoxin, and warfarin.

Question 129.    
Which of, the following is not a purpose of therapeutic communication techniques?
(a) To ease a patient’s anxiety.
(b) To give moral advice.
(c) To educate the patient.
(d) To form a nurse-patient relationship.    
Answer:
(b) To give moral advice.

This is not the purpose of therapeutic communication in a health setting. A health worker is not responsible for giving patients moral advice. They do provide patients With health education, healthcare, and health advocacy. Forming a healthy patient-nurse relationship can help fulfill this goal.

Question 130.    
Which of the following is not a therapeutic communication technique?
(a) Use of open-ended questions.
(b) Use of silence.
(c) Active listening.    
(d) Probing.
Answer:
(d) Probing.

Probing hinders therapeutic communication. Probing patients for answers to questions that are not necessary for their healthcare and its management is not only uncomfortable but offensive. Patients may react to this technique by being defensive, suspicious, and uncooperative with future healthcare plans.

Question 131.    
A patient presented to the emergency room and had just been diagnosed with pancreatic cancer. This patient, however, refused to accept this diagnosis and told his visiting friends that he had stomach flu. Which of the following defense mechanisms is being demonstrated?
(a) Suppression.
(b) Denial.
(c) Regression.
(d) Sublimation. 
Answer:
(b) Denial.

Denial is a defense mechanism in which the person refuses to admit reality.

Question 132.    
A patient who has just received a diagnosis of advanced lung cancer has become aggressive and impatient toward his wife. Which of the following defense mechanisms is being demonstrated?
(a) Denial.
(b) Regression.
(c) Displacement.
(d) Reaction formation.
Answer:
(c) Displacement.

In displacement, the patient redirects anger or feelings of frustration to a substitute that is not responsible for the condition/response.

Question 133.    
A patient presents with a sudden onset of fever, sore throat, and fatigue. What is a potential cause to consider based on these symptoms?
(a) Agranulocytosis.
(b) Myocardial infarction.
(c) Asthma exacerbation.
(d) Deep vein thrombosis.
Answer:
(a) Agranulocytosis.

Agranulocytosis is a severe reduction in granulocytes, a type of white blood cell. This leads to increased susceptibility to bacterial and fungal infections. Common symptoms include sudden onset fever, sore throat, fatigue, and other signs of infection. It can be induced by certain medications or have an idiopathic origin.

Question 134.    
Which of the following is not a typical intervention for a patient diagnosed with postural hypotension?
(a) Increased fluid intake.
(b) Use of support when standing.
(c) To Lie down with feet elevated.
(d) Encouragement of rapid changes in position.
Answer:
(d) Encouragement of rapid changes in position.

For patients with postural hypotension, rapid changes in position should be avoided, as it can exacerbate the symptoms. Recommended interventions include slow and deliberate movements, the use of supports when standing, and increased fluid intake to maintain blood volume.

Question 135.    
A 19-year-old female who presents to the emergency room with fever, malaise, and polyarthritis is managed for acute rheumatic fever. Which of the following is not a component of the major criteria according to the modified Jones criteria?
(a) Pancarditis.
(b) Sydenham chorea.
(c) Hyperpyrexia.
(d) Subcutaneous nodules.
Answer:
(c) Hyperpyrexia.

According to the modified Jones criteria, the major criteria are pancarditis, Sydenham chorea, erythema marginatum, polyarthritis, and subcutaneous nodules. Minor criteria are polyarthralgia, hyperpyrexia, prolonged PR interval, elevated ESR, and elevated C reactive protein.

Question 136.    
Which of the following is an unlikely cause of rheumatic fever in a 17-year-old female who presents to the emergency room with fever, polyarthritis, and difficulty breathing?
(a) Overcrowding.
(b) Malnutrition.
(c) Incomplete vaccination.
(d) Poor personal hygiene. 
Answer:
(c) Incomplete vaccination.

Incomplete vaccination is an unlikely cause because rheumatic fever is caused by group A beta-hemolytic streptococci. Protection from this bacterium is not conferred by immunization. The risk factors for infection include overcrowding, malnutrition, low socioeconomic status, poor perineal hygiene (which includes poor respiratory hygiene), and insufficient handwashing.

Question 137.
Which of the following is not a principle of management in a 17-year-old female managed for acute rheumatic fever?
(a) Eradication of existing pathogen with penicillin G.
(b) Inhibition of platelet aggregation with aspirin.
(c) Immunosuppression with prednisolone.
(d) Antibiotic prophylaxis till age 40.
Answer:
(b) Inhibition of platelet aggregation with aspirin.

In this context, aspirin is not used primarily for its platelet aggregation inhibition properties. In rheumatic fever, aspirin is used for quick and symptomatic relief of fever, polyarthritis, and polyarthralgia. About 5 to 20 mg/kg of oral aspirin is given to patients for two to four weeks.

Question 138.    
A 25-year-old female presented to the emergency room with a history of burning sensation, paresthesia, and pallor of her fingers. On examination, both hands had pallor and cyanosis of the ring, middle, and little fingers. A diagnosis of Raynaud’s syndrome was made. Which of the following drugs is unsuitable for the management of this patient?
(a) Prazosin.
(b) Nitroglycerin.
(c) Atenolol.
(d) Nifedipine.
Answer:
(c) Atenolol.

Atenolol is unsuitable in the management of this patient. Vasodilators are used for symptomatic relief. These drugs include calcium channel blockers like nifedipine, felodipine, amlodipine, or isradipine; adrenergic blockers like prazosin; and nitrates like nitroglycerin applied topically on the fingers. Vasoconstrictors like beta-blockers, ergot derivatives, and clonidine are contraindicated. 

Question 139.    
A 25-year-old male is managed in the emergency room for hemothorax secondary to a road traffic accident. The patient was in shock on admission, and two units of packed cells were transfused. However, the patient remained in a hemodynamically unstable state. Which of the following treatment modalities is required for this patient?  
(a) Thoracocentesis.
(b) Tube thoracostomy.
(c) Thoracotomy.
(d) Pericardiocentesis.
Answer:
(c) Thoracotomy.

Urgent thoracotomy is required in patients with massive bleeding (greater than 1500 mL initially) or blood loss of more than 200 ml/hr for two to four hours. It is also required in patients who need repeated transfusions of blood. For hemodynamically stable patients, fluid resuscitation and insertion of a chest tube are required.

Question 140.    
Which of the following is not a pathophysiologic process in a patient being managed in the emergency room for respiratory acidosis secondary to emphysema?
(a) Loss of elastic recoil.
(b) Airway remodeling.
(c) Loss of alveolar septa.
(d) Compression of the lung parenchyma.
Answer:
(d) Compression of the lung parenchyma.

The pathophysiologic processes in COPD are airway remodeling and narrowing caused by bronchospasm, mucus production and mucus plug, mucosal edema, and fibrosis. Also, there is a loss of elastic recoil and alveoli septa with enlargement of the alveolar spaces, which may coalesce into bullae. There is increased airway resistance, which causes hyperinflated lungs and increases energy spent on breathing.

Question 141.    
A 56-year-old female managed for pulmonary edema secondary to left ventricular heart failure was given IV morphine. Which of the following is not an important effect of morphine for this patient?
(a) Reduces anxiety.
(b) Vasodilation.     
(c) Reduces work of breathing.
(d) Increases heart rate. 
Answer:
(d) Increases heart rate. 

Morphine is an opioid used in the acute management of pulmonary edema caused by left ventricular heart failure. It acts as an anxiolytic and relieves the restlessness and anxiousness seen in patients with pulmonary edema. It is a vasodilator, which reduces preload and afterload. It also improves respiratory function by reducing the work of breathing. It is not given to increase heart rate.

Question 142.    
A 45-year-old female presents to the emergency room with anxiousness, cyanosis, difficulty breathing, cough, and diaphoresis. On examination, BP is 100/60 mmHg, and PR is 120 bpm. On auscultation, bilateral crepitations are heard. A differential diagnosis of pulmonary edema is made. Which of the following is an expected finding on a chest X-ray to confirm this diagnosis?
(a) Kerley B lines.
(b) Meniscus sign.
(c) Unfolding of the aorta.
(d) Ground glass appearance.
Answer:
(a) Kerley B lines.

Kerley B lines are also known as septal lines. They are seen when the interlobular septa in the pulmonary tissue become prominent. Kerley B lines are a sign of interstitial edema in the lungs. Other features of pulmonary interstitial edema are the thickening of the interlobar fissures, perihilar haze, and peribronchial cuffing.

Question 143.    
Which of the following is used in the management of severe depression?
(a) Risperidone.
(b) Reserpine.
(c) Haloperidol.
(d) Electroconvulsive therapy.
Answer:
(d) Electroconvulsive therapy.

Electroconvulsive therapy is used to manage severe depression, depression with suicidal ideation, or psychotic symptoms.

Question 144.    
Which of the following is not a clinical feature of shunt obstruction in a 13-year-old female managed for hydrocephalus secondary to meningitis?
(a) Personality problems.     
(b) Projectile vomiting. 
(c) Head enlargement.
(d) Headaches.
Answer:
(c) Head enlargement.

Head enlargement is not a presentation of hydrocephalus in teenagers and adults. This is because the sutures of the skull are rigid and do not allow expansion, even in the face of increased intracranial pressure. In infants and toddlers, these sutures are pliable, which allows the head to increase in size. 

Question 145.    
A 16-year-old female presents to the emergency room with a history of fever, vomiting, headaches, and loss of consciousness for three days. Six weeks ago, she had a ventricular shunt procedure for hydrocephalus secondary to acute bacterial meningitis. Which of the following organisms is most likely to cause an infection in her shunt?
(a) Staphylococcus aureus.
(b) Staphylococcus epidermidis.
(c) Streptococcus agalactiae.
(d) Candida albicans. 
Answer:
(b) Staphylococcus epidermidis.

About five to ten percent of shunts tend to become infected within a month of insertion. This occurs more in children and young adults. The most implicated organism is the commensal Staphylococcus epidermidis (about 60 percent of cases), followed by Staphylococcus aureus (about 30 percent of cases.)

Question 146.    
A four-year-old presents to the emergency room with a history of vomiting, headaches, and irritability. The child had a VP shunt inserted six months ago for hydrocephalus. On examination, the child is afebrile, with elevated blood pressure and heart rate. The shunt track is also swollen. Which of the following dysfunctions is most likely?
(a) Infection.
(b) Obstruction.
(c) Overdrainage.
(d) Subdural hematoma.
Answer:
(b) Obstruction.

Obstruction is a common malfunction of a shunt. Blockage can come from blood cells, tissue debris, or microorganisms. Blockage of the distal end of the shunt is common in adults. In this case, a ventricular tap is not useful. Symptoms of obstruction in children are headaches, vomiting, nausea, restlessness, and irritability. Fever is usually absent unless there is a superseding infection. The shunt track is often swollen.

Question 147.    
Which of the following is not a complication of overdrainage of ventriculoperitoneal shunts?
(a) Chiari malformation.
(b) Slit-like ventricles.
(c) Subdural hematoma.
(d) Ascites.
Answer:
(d) Ascites.

Ascites is not a Complication of over drainage of ventriculoperitoneal shunts. Complications are slit-like ventricles, which occur when the brain and surrounding meninges pull away from the skull. This is seen in adults who have had a shunt since they were children. Another complication is Chiari I malformation, characterized by crowding of the posterior fossa and tonsillar herniation. Subdural hematoma also occurs when there is trauma to the subdural meninges and surrounding tissue.

Question 148.    
Which of the following is not a side effect of lithium use?
(a) Polyuria.
(b) Polydipsia.     
(c) Weight loss.
(d) Tremors.
Answer:
(c) Weight loss.

Weight gain (not loss) is a side effect of lithium use. Other side effects are polyuria, „ polydipsia, fine tremors, edema, and fasciculation. These effects are transient and usually resolve when the dose is slightly reduced.

Question 149.    
A 54-year-old female presents to the emergency room with a history of nausea and a metallic taste in her mouth. She was recently placed on a drug for bipolar disorder. Which drug is most likely the cause of her symptoms?
(a) Sodium valproate.
(b) Lithium.
(c) Olanzapine.
(d) Lamotrigine.
Answer:
(b) Lithium.

Lithium is a mood stabilizer used for managing patients with bipolar disorder. Nausea and metallic taste are side effects of its use. Other side effects are weight gain, polyuria, polydipsia, tremors, fasciculations, neutropenia, and hypothyroidism.

Question 150.    
A seven-year-old boy presents to the emergency room with complaints of bloody diarrhea, fever, and abdominal cramps. He recently consumed undercooked hamburger meat during a family barbecue. Which of the following diagnostic tests would be most appropriate to determine the presence of Shiga toxin-producing bacteria?
(a) Complete blood count.
(b) Stool culture for Escherichia coli Oi57:H7.
(c) Fecal occult blood test.
(d) Abdominal ultrasonography. 
Answer:
(b) Stool culture for Escherichia coli Oi57:H7.

Shiga toxin-producing Escherichia coli (often E. coli 0157:H7) is a common cause of bloody diarrhea, especially if the patient has consumed contaminated food. The most definitive method to identify these bacteria is a stool test that is culture-specific to this strain. 

Question 151.    
A 35-year-old patient presents to the emergency room with depression and is placed on tricyclic antidepressants. Which of the following best describes the mechanism of action of this drug?
(a) Dopamine reuptake inhibitor.
(b) Dopamine receptor antagonist.
(c) Serotonin receptor agonist.
(d) Serotonin reuptake inhibitor.
Answer:
(d) Serotonin reuptake inhibitor.

Tricyclic antidepressants are serotonin and norepinephrine reuptake inhibitors. They block the transportation of serotonin and norepinephrine and thereby increase the concentrations of these neurotransmitters in the synapses. They do not inhibit the reuptake of dopamine. Some of these TCAs also antagonize serotonin, adrenergic, and NMDA receptors.

Question 152.    
Which of the following is not a side effect of ECT?
(a) Memory loss.
(b) Confusion.
(c) Vomiting.
(d) Hallucinations.
Answer:
(d) Hallucinations.

Hallucinations are not a side effect of electroconvulsive therapy (ECT). ECT is used to treat patients with depression that is unresponsive to drugs. Common side effects are retrograde and anterograde amnesia, headaches, confusion, nausea and vomiting, arrhythmia, and muscle soreness.

Question 153.    
A patient presents to the emergency room and is being managed with probenecid for gout. Which of the following best describes the mechanism of action of this drug?
(a) Analgesia.
(b) Immunomodulator.
(c) Inhibits the production of uric acid.  
(d) Increases excretion of uric acid.
Answer:
(d) Increases excretion of uric acid.

Probenecid is a uricosuric drug that increases the excretion of uric acid. Another example of a uricosuric drug is lesinurad. NSAIDs are given for analgesia, while colchicine is provided as an immunomodulator. Allopurinol and febuxostat inhibit the production of uric acid.

Question 154.    
A patient is being managed for acute gouty attacks. Which food is not necessary to avoid?
(a) Offal. 
(b) Beer.
(c) Seafood.
(d) Skim milk.
Answer:
(d) Skim milk.

The goal of a diet plan in patients with gout is to reduce foods high in purines (precursors of uric acid). These foods include red meat, offal, seafood, alcohol made from grain, and foods high in fructose (fruit juices, candy, ice cream, and confectionery products). Suitable foods include skim milk, low-fat yogurt, complex carbohydrates, nuts, and citruses.

Question 155.    
A five-year-old male managed for infectious mononucleosis is most at risk of which of the following complications?
(a) Splenic rupture.
(b) Heart failure.
(c) Glomerulonephritis.
(d) Meningitis. 
Answer:
(a) Splenic rupture.

Splenomegaly is a complication of infectious mononucleosis due to mass aggregation and release of lymphocytes. Splenic rupture can cause massive hypotension and increase morbidity. Patients are advised to avoid contact sports and lifting heavy objects for one month to reduce the risk of rupture after discharge.

Question 156.    
What counsel will a patient managed in the emergency room for a severe scabies infestation receive?
(a) Sun-dry and store all clothes in airtight bags.
(b) Contact tracing.
(c) Avoid sharing bedsheets and towels.
(d) Avoid sharing utensils.
Answer:
(d) Avoid sharing utensils.

The patient will not be counseled to avoid sharing utensils because scabies is not spread via the fecal-oral route. It is spread by prolonged direct contact (hugging, sex, sleeping on the same bed) and indirectly via fomites (clothes, bedsheets, towels, underwear). All close contacts of the patient must be traced and treated, and all of the patient’s clothes and personal materials must be washed, sun- or air-dried, ironed, and stored in air-tight bags for at least three days. This must also be done to the personal items of clothing of close contacts.

Question 157.    
Which of the following conditions should not be treated with vancomycin to reduce the incidence of resistance?
(a) MRSA-mediated endocarditis.
(b) Clostridium difficile-induced diarrhea.
(c) Multidrug-resistant Streptococcus pneumoniae.
(d) Pulmonary tuberculosis.
Answer:
(d) Pulmonary tuberculosis.

Vancomycin is used neither as a first-line nor a second-line treatment of pulmonary tuberculosis. It treats MRSA-mediated endocarditis, Clostridium difficile-induced diarrhea, multidrug-resistant Streptococcus pneumoniae, beta-lactam-resistant enterococci, Viridans streptococci, and Corynebacteria.

Question 158.    
A 32-year-old woman presents to the emergency room with a rash, shortness of breath, and facial swelling shortly after starting a new medication for a suspected bacterial infection. She states she has no known allergies. The nurse should suspect a hypersensitivity reaction to which of the following types of antibiotics, given the presentation?    
(a) Aminoglycosides.    
(b) Tetracyclines.
(c) Macrolides.
(d) Beta-lactam antibiotics.
Answer:
(d) Beta-lactam antibiotics.

Beta-lactam antibiotics, which include penicillin and cephalosporin, are among the most common causes of drug allergies. Symptoms can range from mild rashes to severe anaphylactic reactions, as described in the patient’s presentation.

Question 159.    
A 45-year-old male arrives at the emergency room with a suspected vascular malformation. Which of the following diagnostic tests would be appropriate to confirm the presence of a smooth muscle cell-specific mutation associated with this condition?
(a) ELISA.
(b) SMMHC assay.
(c) Polymerase chain reaction (PCR).
(d) Hemoglobin electrophoresis. 
Answer:
(b) SMMHC assay.

The SMMHC assay is utilized to identify mutations in the smooth muscle myosin heavy chain gene, which are linked to certain vascular malformations. A mutation in this gene indicates the presence of smooth muscle cells that are specific to certain types of vascular malformations.

Question 160.    
A 60-year-old woman presents with a noticeable personality change over the last six months. Her family reports increased impulsivity and socially inappropriate behavior. She has been losing weight and neglecting personal hygiene. Neurological examination is largely unremarkable. Which of the following conditions is most consistent with her presentation?
(a) Alzheimer’s disease.
(b) Frontotemporal dementia.
(c) Vascular dementia.
(d) Lewy body dementia.
Answer:
(b) Frontotemporal dementia.

Frontotemporal dementia (FTD) is a group of disorders characterized by the degeneration of nerve cells, especially those in the frontal and temporal lobes. Unlike other forms of dementia, where memory issues are usually the primary symptom, FTD often begins with behavioral or language problems. Changes in personality, neglect of personal hygiene, and socially inappropriate behavior are characteristic presentations of FTD.

Question 161.    
Which of the following approaches most effectively reduces patient boarding in emergency rooms?
(a) Employing more emergency nurses.
(b) Providing more primary care providers.
(c) Providing more beds in emergency rooms.
(d) Creating more emergency rooms.
Answer:
(b) Providing more primary care providers.

A primary cause of patient boarding in the emergency room is the presentation of nonemergency cases because primary care physicians and providers are overwhelmed. If more primary care providers are employed, patients are more likely to present to them before their condition deteriorates or they become anxious.

Question 162.    
Which of the following is not an effect of patient boarding?
(a) Increased turnover of radiological reports.
(b) Assault on staff.     
(c) Medication errors.
(d) Sepsis.
Answer:
(a) Increased turnover of radiological reports.

This statement is false because patient boarding decreases the turnover time for emergency radiologic reports like X-rays, CT scans, and ultrasound scans. 

Question 163.    
During a 12-lead ECG, where is lead Vi placed?     
(a) In the fourth intercostal space at the right sternal border.
(b) At the apex of the heart.
(c) In the fourth intercostal space at the left sternal border.
(d) In the fifth intercostal space at the midclavicular line.
Answer:
(a) In the fourth intercostal space at the right sternal border.

When placing chest leads for a 12-lead ECG, Vi is positioned in the fourth intercostal space at the right sternal border. This is crucial as accurate placement ensures the correct interpretation of the heart’s electrical activity. The other options are placements for other leads; for instance, the fifth intercostal space, midclavicular line, is the placement for lead V4.

Question 164.    
A 32-year-old woman presents to the emergency room with palpitations. Her ECG reveals a prolonged QT interval. Which medications might be a potential cause for this ECG finding?
(a) Amiodarone.
(b) Digoxin.
(c) Lisinopril.
(d) Metformin.
Answer:
(a) Amiodarone.

Amiodarone is an antiarrhythmic drug. It can potentially prolong the QT interval and thus predispose the patient to torsades de pointes, a specific type of ventricular tachycardia. Reasons for prolonged QT interval can include medications, electrolyte imbalances, and genetic factors. Amiodarone is the most likely culprit for a drug-induced prolonged QT interval. Digoxin primarily affects the atrial rate and can lead to various arrhythmias but does not typically cause QT prolongation. Lisinopril is an ACE inhibitor, and Metformin is an antidiabetic agent. Neither drug is associated with QT prolongation.

Question 165.    
Which of the following is a contraindication to vaginal birth after cesarean section?
(a) One previous history of vertical uterine incision.
(b) The fetus has a cephalic presentation at term.
(c) The fetus weighs 3.5 kg.
(d) The fetus has a heart rate of 135 bpm in the first stage of labor.
Answer:
(a) One previous history of vertical uterine incision.

In VBAC, a trial of labor is not done on women with a previous history of vertical uterine incision. Other contraindications to VBAC are a prior history of uterine rupture and persisting conditions to vaginal delivery.

Question 166.    
Which of the following is not useful for inducing labor in a 35-year-old female with moderate preeclampsia at 34 weeks gestation?
(a) Misoprostol.
(b) Mifepristone.
(c) Ergometrine.
(d) Foley’s catheter.
Answer:
(c) Ergometrine.

Ergometrine is an oxytocic used in stimulating contractions. However, the contractions produced by ergometrine are frequent and sustained. This characteristic makes it unsuitable for inducing labor. Ergometrine is used only after delivery of the fetus and for controlling postpartum hemorrhage. It is not used in patients with hypertension and other cardiovascular disorders.

Question 167.    
A 45-year-old male presents to the emergency room after a syncopal episode. His ECG reveals rapid QRS complexes without a preceding P wave. This presentation is most consistent with which of the following arrhythmias?
(a) Ventricular Tachycardia (VT).
(b) Atrial Flutter.
(c) Sinus Tachycardia.     
(d) Second-degree heart block.
Answer:
(a) Ventricular Tachycardia (VT).

Ventricular Tachycardia (VT) is characterized by rapid QRS complexes (typically greater than 100 bpm) without a discernible P wave before each QRS complex. This indicates that the rhythm originates from the ventricles, not the atria. Atrial Flutter typically has a “sawtooth” pattern of atrial activity with a regular ventricular response. Sinus Tachycardia will have a P wave before each QRS complex. Second-degree heart block involves irregular dropped beats and does not typically present as rapid QRS complexes without preceding P waves. 

Question 168.    
Which of the following is not a component of the active management of the third stage of labor?
(a) Controlled cord traction. 
(b) IV oxytocin.
(c) Uterine massage.
(d) Episiotomy.
Answer:
(d) Episiotomy.

Episiotomy is not a component of the active management of the third stage of labor, which involves measures to expedite the delivery of the placenta and reduce the risk of postpartum hemorrhage. Components of the active management of the third stage of labor include controlled cord traction in delivering the placenta, fundal massage to encourage contractions, and administering IV oxytocin as soon as the fetal shoulder is delivered.

Question 169.    
A 45-year-old G6 P5+1 who presents to the emergency room with a pre-labor rupture of membrane at 35 weeks gestation has been induced into labor with IV oxytocin. Which of the following elevates the patient’s risk of postpartum hemorrhage?
(a) Infections.
(b) Atony.
(c) Retention of placenta.
(d) Bleeding disorder. 
Answer:
(b) Atony.

Uterine atony elevates the risk of postpartum hemorrhage in this patient, who is a grand multipara (with five or more viable pregnancies). Chorioamnionitis also puts her at risk of uterine atony. The principles of the active management of labor must be strictly followed to reduce this risk.

Question 170.    
A 25-year-old patient presents to the emergency room in acute respiratory distress. The nurse suspects bronchospasm and prepares to administer nebulized salbutamol. Which of the following expected outcomes indicates the effectiveness of the treatment?
(a) A decreased respiratory rate and improved oxygen saturation.
(b) An increased blood pressure and heart rate.
(c) A decreased urine output and dry mucous membranes.
(d) A prolonged QT interval on the ECG.
Answer:
(a) A decreased respiratory rate and improved oxygen saturation.

Salbutamol, a beta-2 agonist, relaxes the smooth muscles of the airways, which leads to bronchodilation. This should help alleviate the patient’s respiratory distress, which would mean a decreased respiratory rate and improved oxygen saturation.

Question 171.    
A 15-year-old presents to the emergency room with a history of weakness and syncope. On examination, the patient is markedly wasted, with lanugo hair. A differential diagnosis of anorexia nervosa is made. According to ICD-10, what is the criterion for diagnosing this patient according to her body weight?
(a) Below 10 percent
(b) Below 15 percent
(c) Below 5 percent
(d) Below 25 percent
Answer:
(b) Below 15 percent

According to the International Classification of Diseases, the criterion for diagnosing this patient is having a body weight below 15 percent of the expected body weight.

Question 172.
A 15-year-old female managed in the emergency room for anorexia nervosa is most likely to have which of the following abnormal blood biochemistries?
(a) Hypermagnesemia.     
(b) Hyponatremia.
(c) Hypokalemia.
(d) Hypercholesterolemia.
Answer:
(c) Hypokalemia.

Hypokalemia is a common biochemical finding in patients with anorexia nervosa. This is a common cause of presentation in the ER. Other abnormal biochemical results are hypoglycemia, hypoalbuminemia, and hypomagnesemia.

Question 173.    
A patient who presents to the emergency room is noticed to initiate and involuntarily repeat the attending nurse’s actions. What is the name of this abnormality?
(a) Apraxia.
(b) Echopraxia.
(c) Dysdiadochokinesia.
(d) Tardive dyskinesia.
Answer:
(b) Echopraxia.

Echopraxia, also known as echokinesis, is the involuntary imitation and repetition of the actions of another person. It is often seen in Tourette’s syndrome, schizophrenia, and autism spectrum disorders. Apraxia is a difficulty in performing previously acquired skills. Dysdiadochokinesia is the inability to perform rapidly alternating movements, while tardive dyskinesia is an extrapyramidal symptom characterized by involuntary movement of the tongue, face, lips, trunk, and extremities. 

Question 174.    
Which of the following is not a priority in a female patient who presents to the emergency room with seizures and altered consciousness secondary to anorexia nervosa?
(a) Provision of warmth.
(b) Enteral feeding.
(c) Monitoring of serum biochemistry.
(d) ECG monitoring.    
Answer:
(b) Enteral feeding.

This is not a priority for this patient because she requires acute resuscitation with IV fluids and glucose. Also, serum biochemistry and cardiac function must be monitored. It should be noted that this patient is at risk of refeeding syndrome.

Question 175.
An 80-year-old woman comes to the emergency room with progressive cognitive decline, visual hallucinations, and parkinsonism symptoms. Which of the following conditions is most consistent with her presentation?
(a) Alzheimer’s disease
(b) Vascular dementia.
(c) Frontotemporal dementia.
(d) Lewy body dementia.
Answer:
(d) Lewy body dementia.

Lewy body dementia is the third most common cause of dementia after Alzheimer’s disease and vascular dementia. It is characterized by a progressive cognitive decline combined with visual hallucinations, parkinsonism (motor symptoms similar to Parkinson’s disease), and fluctuations in attention and alertness.

Practice Tests:

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