CEN Practice Test 4 with Rationale

CEN Practice Test 4 with Rationale

CEN Practice Questions often cover a wide range of emergency nursing topics.

BCEN Practice Test 4 with Rationale

Question 1.    
Which of the following is the most significant history to be obtained from a 25-year-old male who presents to the ER with a history of intermittent claudication in the arch of his left foot and left leg?
(a) Family history of diabetes.
(b) Smoking history.
(c) Drug history.
(d) Medical history.
Answer:
(b) Smoking history.

This patient most likely has Buerger’s disease, a peripheral arterial disease seen in young adults. It is commonly seen in tobacco smokers. Buerger’s disease is also called thromboangiitis obliterans.

Question 2.    
A 56-year-old obese female who presents to the ER with tenderness of the right calf, fever, and leg pain is currently being managed for deep vein thrombosis. Which of the following best explains the use of heparin over warfarin in the acute management of this patient?
(a) Wider therapeutic window.
(b) Availability of its antidote.
(c) Short onset of action.
(d) Less risk of hemorrhage.
Answer:
(c) Short onset of action.

Heparin is used in acute and emergency settings because of its short onset of action compared to warfarin. The therapeutic effect of warfarin starts about five days after the commencement of therapy. This patient’s treatment goal will include initial treatment with low molecular weight heparin, then long-term management with warfarin and other oral anticoagulants.

Question 3.    
A 45-year-old female who presents to the ER with a history of chest pain, dizziness, and severe hypotension is being managed for aortic disruption secondary to blunt trauma to the chest. Which of the following is not an expected finding on a chest X-ray?
(a) Widened mediastinum.
(b) Unfolding of the aorta.
(c) Obliterated aortic knob.
(d) Pleural cap.
Answer:
(b) Unfolding of the aorta.

The unfolding of the aorta is not a characteristic chest X-ray finding in aortic disruption. It is seen in hypertensive heart disease. Classic findings on chest X-ray are widened mediastinum, obliterated aortic knob, tracheal or esophageal deviation, apical or pleural cap, pneumothorax, pulmonary contusion hemothorax, and depressed bronchus.

Question 4.    
Which of the following interventions is paramount in a 35-year-old male who presents to the ER with Beck’s triad following penetrating trauma to the chest?
(a) Pericardiocentesis.
(b) Thoracotomy.
(c) Thoracocentesis.
(d) Tracheostomy.
Answer:
(a) Pericardiocentesis.

Emergency subxiphoid pericardiocentesis must be performed in patients with suspected cardiac tamponade secondary to trauma to the chest. During the procedure, the cardiac activity must be monitored with an ECG for ST elevation. Pericardiocentesis is therapeutic even when as little as 10 mL of blood is withdrawn. The definitive treatment is thoracotomy with pericardiotomy. This is done on patients with confirmed cardiac tamponade. It must be done by trained and qualified personnel.

Question 5. 
A 56-year-old female is being managed in the ER for heart failure due to severe mitral stenosis. The attending physician requests monitoring of the pulmonary artery pressure, including pulmonary capillary wedge pressure. Which of the following management areas is affected by the value of the pulmonary capillary wedge pressure?
(a) Fluid input.
(b) Dose of antihypertensive.
(c) Blood transfusion.
(d) Anticoagulant therapy.
Answer:
(a) Fluid input.

The pulmonary capillary wedge pressure provides an estimation of the pressure in the left atrium, rather than giving a direct measure of the end-diastolic pressure in the left ventricle. The high pressure causes a backflow of blood from the intravascular space into the tissue space. This causes pulmonary effusion and worsens the patient’s symptoms.

Question 6.    
A 65-year-old male presents to the ER with chest pain, cough, and hemoptysis. Blood pressure on admission is 170/100 mmHg. As part of the patient’s management, the attending physician orders the insertion of a Swan-Ganz catheter. Which of the following best describes the purpose of this catheter?
(a) Detection of occluded coronary arteries.
(b) Diagnosis of valvular insufficiency.
(c) Measurement of pulmonary wedge pressure.
(d) Measurement of left ventricular systolic pressure.
Answer:
(c) Measurement of pulmonary wedge pressure.

The Swan-Ganz catheter measures the pulmonary capillary wedge pressure, which indirectly estimates the left atrial pressure. It does not directly measure the wedge pressure of the left atrium. Unlike right cardiac catheterization, it does not diagnose occlusion of coronary arteries and valvular insufficiency. 

Question 7.    
You are preparing to discharge a patient who had an emergency CABG for STEMI. Which of the following discharge instructions is inappropriate?
(a) Avoid heavy lifting.
(b) Attend a cardiac rehabilitation program.
(c) Expect pedal edema.
(d) Expect low-grade fever one to two weeks after surgery.
Answer:
(d) Expect low-grade fever one to two weeks after surgery.

This statement is inappropriate because fever is a sign of ongoing infection. The patient should be instructed to check their temperature regularly and report any temperature spikes, bleeding from the wound site, erythema, or pus drainage.

Question 8.    
A 56-year-old male who presented to the ER with intermittent claudication and ulcers at the ankle had a femoropopliteal bypass for peripheral vascular disease. Which of the following parameters is most important to monitor for after the procedure?
(a) Capillary refill.
(b) Tenderness.
(c) Pulse rate.
(d) Paresthesia.
Answer:
(a) Capillary refill.

Capillary refill should be assessed on the nail beds of the toes to assess tissue perfusion of the lower limbs.

Question 9.    
Nurse M is to measure the pulmonary capillary wedge pressure in a 55-year-old male who presents to the ER with left ventricular heart failure. After measuring the pressure, Nurse M is expected to do which of the following?
(a) Ask the patient to lie in the semi-Fowler’s position.
(b) Deflate the balloon quickly.
(c) Flush the catheter with normal saline.
(d) Administer oral analgesia.
Answer:
(b) Deflate the balloon quickly.

To prevent obstruction of blood flow to the lung, the balloon must be quickly deflated as soon as the pulmonary capillary wedge pressure is obtained.

Question 10.
Which of the following treatment modalities is inappropriate in a 35-year-old male who presents to the ER with cardiogenic shock secondary to left ventricular failure?
(a) IV vasopressors.
(b) Liberal IV fluids.
(c) Emergency PCI.
(d) Balloon pump.
Answer:
(b) Liberal IV fluids.

In this patient, IV fluids must be used cautiously to avoid worsening pulmonary function. There is already increased hydrostatic pressure in the pulmonary bed, which leads to pulmonary edema and congestion. Liberal IV fluids can raise this pressure and further congest the lungs. Treatment modalities include IV vasopressors like dobutamine or dopamine, or a combination of both; balloon pumps for temporary support; and emergency angiography or coronary artery bypass grafting.

Question 11.
Which of the following best describes the mechanism of action of dobutamine given to a 67-year-old male being managed for cardiogenic shock secondary to myocardial infarction?
(a) Alpha and beta-agonist.
(b) Beta-agonist.
(c) Adrenergic receptor blocker.
(d) Calcium channel agonist.
Answer:
(b) Beta-agonist.

Dobutamine is a beta-agonist. It is an inotropic agent that stimulates the beta-i adrenergic receptors in the heart. This stimulation increases heart rate, cardiac output, and stroke volume. Dobutamine is given intravenously.

Question 12.
A 25-year-old male presented to the ER with blunt trauma to the chest wall. On examination, there was hypotension, muffled heart sounds, and increased jugular venous pressure. HR was 120 bpm, and RR was 40 breaths per minute. A differential diagnosis of cardiac tamponade was made. Which of the following is the most likely cause of shock in this patient?    
(a) Impaired ventricular filling.
(b) Myocardial hypertrophy.
(c) Impaired ventricular emptying.
(d) Abnormal cardiac rhythm.
Answer:
(a) Impaired ventricular filling.

This patient has obstructive shock caused by impaired ventricular filling. Accumulation of blood within the pericardial sac prevents expansion of the heart during diastole and sufficient ventricular filling. Treatment in this patient is the immediate removal of the accumulated blood via either a pericardiocentesis or pericardiotomy.

Question 13. 
Which of the following is not a cause of cardiogenic shock?
(a) Abnormal cardiac rhythm.
(b) Decreased intravascular volume.
(c) Impaired ventricular filling.
(d) Impaired cardiac contractility.
Answer:
(b) Decreased intravascular volume.

This is a cause of hypovolemic shock, not cardiogenic shock. Decreased intravascular volume leads to reduced preload, diminished ventricular filling, and reduced stroke volume. Causes of decreased intravascular volume include acute blood loss from accidents,  surgeries, upper or lower gastrointestinal bleeding, or other fluid losses like dehydration, severe burns, vomiting, and diarrhea.

Question 14. 
A 67-year-old female who presents to the ER with chest pain, diaphoresis, and headaches is being managed with procainamide for supraventricular tachycardia. The attending nurse must be aware of which of the following side effects?
(a) Tachycardia.
(b) Hypotension.
(c) Pruritus.
(d) Visual disturbances.
Answer:
(b) Hypotension.

Procainamide is a sodium channel blocker and a class 1 antiarrhythmic drug. Side effects include hypotension, bradycardia, and shock. High doses can cause a syndrome resembling lupus erythematosus that manifests as pleurisy, myalgia, and arthralgia. This syndrome can be associated with the acetylation status of the patient.

Question 15. 
Which of the following is not a clinical feature of cauda equina syndrome?
(a) Saddle anesthesia.
(b) Urinary retention.
(c) Urinary incontinence.
(d) Brisk deep tendon reflexes.
Answer:
(d) Brisk deep tendon reflexes.

The symptoms of cauda equina syndrome result from compression of a segment of the spinal cord’s lumbar section. Clinical features are paresis of the distal leg; saddle anesthesia (loss of sensation around the perineum); dysfunction of the bladder and bowel, which manifests as erectile dysfunction; urinary frequency and incontinence; urinary retention; an4 loss of anal wink reflexes and rectal tone. Deep tendon reflexes and muscle tone are decreased in the distal limbs.

Question 16. 
Which of the following is most appropriate in eliciting ankle clonus in a 35-year-old male who presents to the ER with a spinal cord injury secondary to a road traffic accident?
(a) Flicking the nail on the middle finger.
(b) Rapid dorsiflexion and plantar flexion of the ankle joint.
(c) Extension of the knee when the hip is flexed.
(d) Stroking the sole of the foot.
Answer:
(b) Rapid dorsiflexion and plantar flexion of the ankle joint.

Ankle clonus is elicited by rapid plantar flexing and dorsiflexing of the ankle joint. A positive reflex involves rapid and involuntary movement of the ankle. It is a sign of an upper motor neuron disease. Some causes are spinal cord injury, cerebral palsy, multiple sclerosis, epilepsy, stroke, and hepatic encephalopathy. Option A describes Hoffman’s reflex. Options C and D describe the Kernig sign and Babinski sign, respectively.

Question 17. 
Which of the following is not a clinical feature of transection of the spinal cord at C8?
(a) Flaccid paralysis.
(b) Horner’s syndrome.
(c) Respiratory failure.
(d) Absent deep tendon reflexes.
Answer:
(c) Respiratory failure.

Respiratory failure occurs in spinal cord transections at or above C5. This happens because there is a loss of innervation to the muscles that are involved in respiration. Transactions higher up at C3 cause dysfunction in the autonomic regulation of respiration and blood pressure. This leads to neurogenic shock.

Question 18. 
Which of the following is not a clinical feature of Brown-Sequard syndrome?
(a) Contralateral loss of pain.
(b) Contralateral loss of temperature sensation.
(c) Ipsilateral spastic paralysis.
(d) Preserved proprioception.
Answer:
(d) Preserved proprioception.

Brown-Sequard syndrome is caused by unilateral hemisection of the spinal cord. Clinical features include ipsilateral loss of proprioception and spastic paralysis below the lesion and contralateral loss of temperature and pain sensation below the lesion.

Question 19. 
A 35-year-old female is being managed in the ER for Horner’s syndrome due to a spinal cord injury. The lesion is most likely in which of the following nerve roots?
(a) Ti.
(b) C5.
(c) C7.
(d) L4.
Answer:
(a) Ti

Horner’s syndrome is caused by a transverse lesion of the C8 or Ti nerve roots. Clinical features include ptosis, miosis, anhidrosis, enophthalmos, and hyperemia. Transections at C5 cause respiratory failure and quadriplegia, transections at C7 cause quadriplegia, and transections at L4 cause cauda equina syndrome.

Question 20.
Which of the following best describes neurogenic shock but not spinal shock?
(a) Bradycardia.
(b) Hypotension.
(c) Peripheral neuropathy.
(d) Autonomic neuropathy. 
Answer:
(d) Autonomic neuropathy.

Neurogenic shock is an autonomic neuropathy caused by a disruption of the sympathetic nervous system. It is caused by lesions around the C3-C5 spinal cord. Spinal shock is a temporary decrease or loss of reflexes following a spinal cord injury. It is temporal. Clinical features of neurogenic and spinal shock overlap. They are hypotension, bradycardia, flaccid paralysis, and absent bulbocavernosus reflex.

Question 21.
A patient with asthma is in the ER for acute exacerbation. The nurse administers nebulized salbutamol. Which of the following side effects should the nurse monitor post-administration?
(a) Bradycardia and hypotension.
(b) Tremors and tachycardia.
(c) Hyponatremia and confusion.
(d) Decreased bowel sounds and constipation.
Answer:
(b) Tremors and tachycardia.

Salbutamol primarily targets beta-2 receptors in the lungs and causes bronchodilation. However, it can also affect beta-i receptors, especially when given in high doses or to susceptible individuals. This can lead to side effects like tremors and tachycardia.

Question 22.
Which of the following modalities is contraindicated for acute treatment in a 55-year-old male being managed for left hemispheric ischemic stroke secondary to malignant hypertension?
(a) Anticoagulants.
(b) IV crystalloids.
(c) Diuretics.
(d) Antipyretics.
Answer:
(a) Anticoagulants.

Anticoagulants are generally not used in the acute treatment of ischemic stroke due to the risk of hemorrhagic transformation, which can worsen the patient’s outcome. This risk is higher in patients with large infarcts.

Question 23.
A 67-year-old patient with a history of congestive heart failure arrives at the ER with dyspnea and decreased breath sounds on the right side. The nurse suspects pleural effusion. Which of the following diagnostic tests is most appropriate to confirm this suspicion?
(a) Arterial blood gases (ABGs).
(b) Chest X-ray.
(c) Pulmonary function tests (PFTs).
(d) Electrocardiogram (ECG).
Answer:
(b) Chest X-ray.

A chest X-ray is the most common diagnostic test used to identify pleural effusion. It provides a visual representation of fluid accumulation in the pleural space.

Question 24.
A 50-year-old woman presents to the emergency department after a severe headache. On a non-contrast CT scan of the head, the radiologist identifies an area of increased brightness or whiteness in the cortex. What does this “cortical hyperdensity” most likely indicate?
(a) Acute ischemic stroke.
(b) Chronic infarction.
(c) Hemorrhagic stroke.
(d) Migraine. 
Answer:
(c) Hemorrhagic stroke.

On a non-contrast CT scan of the brain, hyperdensity (or increased brightness) often indicates acute bleeding. Thus, in the context of a patient with a severe headache and cortical hyperdensity on imaging, a hemorrhagic stroke (bleeding within the brain) is a primary concern. Acute ischemic strokes typically present as areas of hypodensity (or decreased brightness) on non-contrast CT scans. Chronic infarctions might also appear as areas of hypodensity. Although migraines can be severe and debilitating, they do not typically manifest with hyperdensities on CT scans.

Question 25.
A 57-year-old male presents to the ER with weaknesses on the left side of the body and an inability to form intelligible words. He is, however, able to understand words. A differential diagnosis of ischemic stroke is made. What type of speech disorder does this patient have?
(a) Wernicke’s aphasia.
(b) Motor aphasia.
(c) Global aphasia.
(d) Dysarthria.
Answer:
(b) Motor aphasia.

Also known as Broca’s Aphasia, motor aphasia occurs as a result of an infarct in the Broca’s area in the brain’s frontal lobe. In this condition, the patient is unable to form intelligible words. The person is, however, able to understand words. 

Question 26. 
A 56-year-old male who is being managed in the ER for an ischemic stroke is unable to form comprehensible sentences. He is, however, not aware of this and is upset that no one understands what he is saying. What form of speech disorder is this?
(a) Global aphasia.
(b) Dysarthria.
(c) Motor aphasia.
(d) Wernicke’s aphasia.
Answer:
(d) Wernicke’s Aphasia.

This speech disorder is caused by an infarct in the Wernicke area in the brain’s temporal lobe. Patients with this disorder can speak but cannot use comprehensible words. They also cannot understand others when they speak and do not seem to know that their listeners cannot comprehend their words.

Question 27.
Which of the following best describes a patient with dysarthria?
(a) Inability to use intelligible words.
(b) Inability to perform previously learned activities.
(c) Slurred speech.
(d) Inability to understand spoken words.
Answer:
(c) Slurred speech.

Dysarthria is also called slurred speech. It is a motor speech disorder characterized by paralysis of the muscles responsible for speech. The vocal cords can also be affected.

Question 28. 
Which of the following does not indicate the commencement of antihypertensives in a patient with ischemic stroke?
(a) MAP greater than 130 mmHg.
(b) Acute renal failure.
(c) UseoftPA.
(d) Hyperthermia.
Answer:
(d) Hyperthermia.

Reduction of blood pressure is usually not required in the acute management of ischemic stroke. However, some indications warrant the use of antihypertensives. Some of these are MAP greater than 130 mmHg, features of end-organ failure (e.g., acute renal failure, aortic dissection, pulmonary edema, and hypertensive encephalopathy), and the use of tPA, thrombolytics, or thrombectomy.

Question 29.
Which of the following drugs is unsuitable for monotherapy in controlling blood pressure in a patient with ischemic stroke?
(a) Labetalol.
(b) Nitroglycerin.
(c) Nicardipine.
(d) Hydralazine. 
Answer:
(b) Nitroglycerin.

Nitroglycerin is a potent vasodilator, useful in reducing both preload and afterload in patients with high blood pressure. It is a short-acting drug and unsuitable for monotherapy due to the risk of rebound hypertension.

Question 30.
A 66-year-old female with ischemic stroke is being managed with alteplase. Which of the following best describes this drug’s mechanism of action?
(a) Plasmin activator.
(b) Plasminogen antagonist.
(c) Plasminogen activator.
(d) Plasmin antagonist.
Answer:
(c) Plasminogen activator.

Alteplase is a thrombolytic that binds to fibrin and activates plasminogen. It cleaves plasminogen into plasmin. Plasmin is a fibrinolytic that breaks down fibrin polymers and dissolves blood clots.

Question 31.
Which of the following management options is not useful in a 35-year-old male being managed for a TIA secondary to cocaine abuse?
(a) Antipyretics.
(b) IV fluids.
(c) Enteral feeding.
(d) Anticoagulants.
Answer:
(c) Enteral feeding.

Patients with TIA have focal neurologic deficits that last less than an hour. Enteral feeding with a feeding tube is inappropriate since acute correction for hypoglycemia can be done with oral fluids. Treatment options in TIA are focused on eliminating risk factors to reduce the risk of reoccurrence.

Question 32.
Which of the following is an unusual cause of stroke in a young adult?
(a) Hypercoagulability.
(b) Hemoglobinopathy.
(c) Drug abuse.
(d) Hypertension.
Answer:
(d) Hypertension.

Hypertension is an unusual cause of stroke in a young adult. Common causes of stroke include hypercoagulability, hemoglobinopathy, drug abuse, heart disorders, vasculitis, cigarette smoking, and psychosocial stress. 

Question 33. 
A 65-year-old male patient arrives in the emergency department following a stroke. He has difficulty speaking and understanding spoken words. Which of the following types of aphasia is he most likely exhibiting?
(a) Wernicke’s Aphasia.
(b) Broca’s Aphasia.
(c) Conduction Aphasia.
(d) Global Aphasia.
Answer:
(b) Broca’s Aphasia.

Aphasia is a condition characterized by difficulty understanding or producing speech due to brain damage. Broca’s Aphasia, often referred to as “expressive aphasia,” is characterized by the ability to comprehend language but difficulty forming spoken words.
It is typically associated with damage to the frontal lobe, specifically Broca’s area. In contrast, Wernicke’s Aphasia involves fluent but nonsensical speech with poor comprehension. Conduction Aphasia is characterized by difficulty repeating sentences, while Global Aphasia involves severe impairment in both production and understanding of speech. Broca’s Aphasia is the most common type observed in stroke patients.

Question 34.
Which of the following treatment modalities is contraindicated in managing a 55-year-old male with hemorrhagic stroke?
(a) Dabigatran.
(b) IV labetalol.
(c) IV acetaminophen.
(d) IV diazepam. 
Answer:
(a) Dabigatran.

Anticoagulants should not be used in cases of hemorrhagic stroke because they increase the risk of bleeding, which can further harm the patient. If a patient was using antiplatelet medication before the onset of symptoms, treatments such as fresh frozen plasma, platelets, hemodialysis, vitamin K, or prothrombin complex concentrate may be administered as needed.

Question 35. 
A 56-year-old male admitted with ST elevated myocardial infarction was discharged with oral dabigatran. Which of the following best describes this drug’s mechanism of action?
(a) Inhibits platelet aggregation.
(b) Inhibits thrombin.
(c) Cleaves plasminogen.
(d) Inhibits vitamin K epoxide reductase.
Answer:
(b) Inhibits thrombin.

Dabigatran is an anticoagulant that directly inhibits the action of thrombin (factor Ila). In the clotting cascade, thrombin cleaves fibrinogen into fibrin. These fibrin fibers are added to the platelet plug to reinforce blood clots.

Question 36.
A 45-year-old male patient complains of vomiting bright red blood that looks like coffee grounds. The nurse recognizes this as:
(a) Melena.
(b) Hematochezia.
(c) Hematemesis.
(d) Hematuria.
Answer:
(c) Hematemesis.

Hematemesis refers to vomiting bright red blood resembling coffee grounds.

Question 37.
Which of the following IV fluids is most suitable in resuscitating a 45-year-old male who presents with a traumatic brain injury following a road traffic accident?
(a) Normal saline.
(b) Half-strength Darrow’s.    
(c) Mannitol.
(d) 4.3% dextrose saline.
Answer:
(a) Normal saline.

Normal saline is the fluid of choice in resuscitating a patient with a traumatic brain injury. It is an isotonic fluid; therefore, it stays largely in the extracellular compartment, including the intravascular space. It increases blood pressure and cerebral perfusion. Although mannitol treats cerebral edema, it is not used for resuscitation.

Question 38.
Which of the following is a complication of administering hypotonic fluid?
(a) Dehydration.
(b) Cell lysis.
(c) Oliguria.
(d) Hyperthermia.
Answer:
(b) Cell lysis.

Cellular edema and cell lysis are complications of using hypotonic fluids. Hypotonic fluids cause the movement of water from the intravascular space into the extracellular space. This is because the osmolality in the fluids is less than the osmolality in the cells. These fluids are used in patients with cellular dehydration (diabetic ketoacidosis and hyperglycemic hyperosmolar state). 

Question 39. 
A 56-year-old male who presents to the ER with malignant hypertension is managed with a hypertonic solution for cerebral edema. Which of the following should the nurse monitor the patient closely for?
(a) Dehydration.
(b) Pulmonary edema.
(c) Fever.
(d) Oliguria. 
Answer:
(b) Pulmonary edema.

Hypertonic solutions have a higher osmolality than those in the cells. As a result of this differential gradient, water moves from the cell into the intravascular space. Hypertonic solutions are useful for patients with cellular edema and increased intracranial pressure. However, these patients must be monitored for fluid overload (pulmonary edema). IV diuretics like furosemide are usually used along with hypertonic fluids.

Question 40. 
A 67-year-old male who presents to the ER with pedal and sacral edema is being managed with a solution that can cause water movement from the cellular to the extracellular space. What type of fluid is this?
(a) Hypertonic.
(b) Isotonic.
(c) Hypotonic.
(d) Crystalloids.
Answer:
(a) Hypertonic.

Hypertonic solutions have a higher osmolality than that of the cells. As a result of this differential gradient, water moves from the cell into the intravascular space. Hypertonic solutions are useful for patients with cellular edema and increased intracranial pressure. Examples are 3% saline, 10% dextrose water, 5% dextrose in 0.9% saline, 5% dextrose in Ringer’s lactate, and 50% dextrose water.

Question 41. 
Which of the following cases is suitable for management with a hypotonic fluid?
(a) Cerebral edema.
(b) Diabetic ketoacidosis.
(c) Severe burns.
(d) Hypovolemic shock.
Answer:
(b) Diabefic ketoacidosis.

Hypotonic solutions are used to manage patients with cellular dehydration. They must be avoided in patients with cellular edema and intravascular hypovolemia.

Question 42.
Which of the following is not a hypertonic fluid initially in the bag?
(a) 5% dextrose water.
(b) 3% normal saline.
(c) 10% dextrose water.
(d) Full-strength Darrow’s.
Answer:
(a) 5% dextrose water.

Five percent dextrose water is initially isotonic in the bag, but when administered, the body rapidly metabolizes the dextrose, leaving behind free water that acts as a hypotonic fluid. It treats hypoglycemia and can be used as a maintenance fluid.

Question 43.
You are to administer 50% dextrose to a 56-year-old female patient through a central line. It is important to monitor the central line to prevent which of the following?
(a) Thrombosis.
(b) Phlebitis.
(c) Infiltration.
(d) Extravasation.
Answer:
(d) Extravasation.

Extravasation occurs when vesicant fluids or drugs infiltrate a line and cause tissue injury. Examples of vesicant drugs and fluids are 50% dextrose water, calcium gluconate, vancomycin, dopamine, phenytoin, promethazine, vasopressin, sodium bicarbonate, epinephrine, and dobutamine. These drugs must never be given IM or SC.

Question 44. 
Which of the following is not a short-term complication in a 56-year-old male receiving red blood cells for acute hemorrhagic shock?
(a) Febrile nonhemolytic reaction.
(b) Post-transfusion purpura.
(c) Fluid overload.
(d) Reduced oxygen affinity. 
Answer:
(b) Post-transfusion purpura.

This is a long-term (not short-term) complication that arises about 4 to 14 days after transfusion of red blood cells. It causes moderate to severe thrombocytopenia. At-risk groups are multiparous women who receive red blood cells during surgery.

Question 45. 
A patient with a history of chronic alcohol abuse presents with hematemesis. Which of the following is the most likely etiology of this patient’s symptoms?
(a) Peptic ulcer disease.
(b) Esophageal varices.
(c) Gastroenteritis.
(d) Diverticulitis.
Answer:
(b) Esophageal varices.

Patients with chronic alcohol abuse are at risk of developing cirrhosis of the liver. Cirrhosis can lead to portal hypertension, which may cause esophageal varices to develop. Esophageal varices are engorged blood vessels in the walls of the esophagus. These varices are fragile and can rupture easily, causing hematemesis.

Question 46. 
Which of the following drugs is most suitable for managing a 56-year-old female with primary pulmonary hypertension caused by increased vascular resistance?
(a) Sildenafil.
(b) Losartan.
(c) Amlodipine.
(d) Propranolol.
Answer:
(a) Sildenafil.

Patients with familial and idiopathic pulmonary arterial hypertension are managed with drugs like oral phosphodiesterase 5 inhibitors (sildenafil), prostacyclin analogs (epoprostenol), soluble guanylate cyclase inhibitors (riociguat), and endothelin receptor antagonists (bosentan).

Question 47.    
A patient diagnosed with pleural effusion is experiencing increasing dyspnea. Which of the following therapeutic interventions will most likely be performed to relieve the patient’s symptoms?
(a) Bronchoscopy.
(b) Thoracentesis.
(c) Percutaneous transluminal angioplasty (PTA).
(d) Endotracheal intubation.
Answer:
(b) Thoracentesis.

Thoracentesis is a procedure in which a needle is inserted into the pleural space to remove excess fluid, which can relieve dyspnea caused by a pleural effusion.

Question 48.
Which of the following investigations is unnecessary for confirming a pulmonary
embolism diagnosis?
(a) V/Q scan.
(b) D-dimer.
(c) CT angiography.
(d) Chest X-ray.
Answer:
(d) Chest X-ray.

Chest X-ray findings are nonspecific for pulmonary embolism. Relevant investigations include CT angiography, D-dimer, V/Q scanning, and duplex ultrasonography.

Question 49. 
A 56-year-old obese female who presents to the ER with chest pain, dyspnea, cough, and hemoptysis is suspected of having pulmonary fibrosis. Serum D-dimer is markedly elevated Which of the following statements is correct?
(a) Pulmonary embolism is confirmed.
(b) CT angiography should be done.
(c) V/Q scan is more sensitive than CT angiography.
(d) Duplex ultrasonography should be done to locate emboli in the lungs.
Answer:
(b) CT angiography should be done.

CT angiography is fast, highly specific, and sensitive to detecting pulmonary embolism. It can also assess the severity of the embolism. Option A is incorrect because elevated D- dimers do not confirm the diagnosis of pulmonary embolism. Pulmonary embolism is, however, excluded if D-dimer is normal. Option C is incorrect because CT angiography is more sensitive than VQ scanning. Option D is incorrect because duplex ultrasonography is used to detect thrombi in the upper and lower limbs.
 
Question 50.
A 76-year-old woman experiencing pulmonary embolism is being managed in the ER. For the initial anticoagulation, the attending physician decides to use IV unfractionated heparin over low-molecular-weight heparin. Which of the following best explains this decision?
(a) Decreased risk of bleeding.
(b) Short half-life.
(c) Improved bioavailability.
(d) Weight-based dosing.
Answer:
(b) Short half-life.

Although low-molecular-weight heparin has certain favorable characteristics (e.g., improved bioavailability, weight-based dosing, reduced risk of bleeding and thrombocytopenia, ease of administration, and others), unfractionated heparin has a short half-life and is readily reversible with protamine sulfate.

Question 51.
Which of the following is not a complication of pulmonary hypertension?
(a) Heart failure.
(b) Raynaud’s syndrome.
(c) Ortner’s syndrome.
(d) Bartter syndrome.
Answer:
(d) Bartter syndrome.

Bartter syndrome is a genetic renal disease characterized by potassium, sodium, and chloride loss via the urine, which leads to hyperaldosteronism and metabolic alkalosis. Right-sided heart failure is a common complication of chronic pulmonary hypertension. Raynaud’s syndrome is a rare complication seen primarily in women. Ortner’s syndrome is a rare complication characterized by hoarseness due to compression of the laryngeal nerve by an enlarged artery.

Question 52. 
A 25-year-old patient comes to the hospital after being involved in a motor vehicle accident. The patient complains of left upper quadrant pain and has signs of hypovolemic shock. The nurse suspects a splenic injury. Which of the following findings is least indicative of a splenic injury?    
(a) Kehr’s sign.
(b) Ecchymosis in the left flank area.
(c) Bradycardia.
(d) Abdominal tenderness.
Answer:
(c) Bradycardia.

Bradycardia (a slower-than-normal heart rate) is not typically indicative of splenic injury. Patients with splenic injury often manifest tachycardia due to hypovolemia.

Question 53. 
Which of the following best describes the primary pathophysiologic process of ARDS?
(a) Smooth muscle contraction, which leads to bronchoconstriction.
(b) Destruction of the alveoli due to chronic smoking.
(c) Diffuse alveolar damage, which leads to a fluid leak in the alveolar spaces.
(d) Chronic inflammation and thickening of the bronchial walls.
Answer:
(c) Diffuse alveolar damage, which leads to a fluid leak in the alveolar spaces.

ARDS is characterized by diffuse injury to the alveolar-capillary barrier, which results in increased permeability and the subsequent leakage of fluid into the alveolar spaces. This leads to decreased lung compliance, impaired gas exchange, and hypoxemia. While factors like bronchoconstriction and inflammation can be involved in other respiratory disorders, the hallmark of ARDS is the fluid-filled alveoli due to damage to the barrier.

Question 54.
A patient presents to the ER with dyspnea, cough, and anemia. On examination, the patient is pale, tachycardic, and tachypneic. An emergency chest X-ray reveals diffuse alveolar infiltrates in both lungs. Which of the following investigations is required in diagnosing diffuse alveolar hemorrhage?
(a) CT scan.
(b) Bronchoscopy.
(c) Spirometry.
(d) CT angiography. 
Answer:
(b) Bronchoscopy.

Bronchoscopy with bronchoalveolar lavage (BAL) is needed to diagnose diffuse alveolar hemorrhage.

Question 55. 
In which of the following conditions is the prone position for mechanical ventilation contraindicated?
(a) Pulmonary embolism.
(b) Raised intracranial pressure.
(c) Aspiration pneumonitis.
(d) Epiglottis.
Answer:
(b) Raised intracranial pressure.

In mechanical ventilation, prone positioning creates better oxygenation and ensures uniform ventilation of all lung fields. However, it is contraindicated in patients with spinal injury (to avoid damage to the cervical part of the spinal cord) and in patients with raised intracranial pressure. It is important to elevate the head of the bed to about 30° to increase venous return and reduce cerebral edema.

Question 56.
Which of the following principles is false when liberating a patient from mechanical ventilation?
(a) Daily breathing exercises should be done with a T piece.
(b) The patient is capable of spontaneous ventilation when breathing deeply and slowly without a ventilator.
(c) There should be a progressive withdrawal of sedatives.
(d) Chest physiotherapy should be commenced.
Answer:
(d) Chest physiotherapy should be commenced.

Chest physiotherapy is not a requirement for liberating a patient from mechanical ventilation. Indications for chest physiotherapy are orthostatic pneumonia, COPD, neuromuscular diseases affecting muscles of respiration, cystic fibrosis, and bronchiectasis. Chest physiotherapy improves mobilization and clearance of secretions in the airway.

Question 57. 
A patient With known spleen disease is at an increased risk for which of the following complications?
(a) Impaired clotting.
(b) Respiratory alkalosis.
(c) Overproduction of red blood cells.
(d) Susceptibility to certain bacterial infections.
Answer:
(d) Susceptibility to certain bacterial infections.

The spleen plays a significant role in filtering the blood and removing damaged blood cells and pathogens. Patients with spleen disease or those who have undergone a splenectomy are at an increased risk of susceptibility to certain bacterial infections, particularly encapsulated bacteria like Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. 

Question 58. 
Which of the following will not be assessed by a left heart catheterization?
(a) Aortic blood pressure.
(b) Aortic valve function.
(c) Anatomy of the coronary arteries.
(d) Pulmonary artery pressure.
Answer:
(d) Pulmonary artery pressure.

Left heart catheterization assesses the anatomy of the coronary arteries, systemic vascular resistance, mitral and aortic valve function, aortic blood pressure, and left ventricular pressure. Right heart catheterization assesses the pressure in the right atrium, right ventricle, and pulmonary artery.

Question 59.
A patient who presents to the ER with pre labor contractions is being managed with salbutamol. Which of the following best describes the function of this drug in this patient?
(a) Bronchodilation.
(b) Tocolytic.
(c) Cervical dilatation.
(d) Anxiolytic. 
Answer:
(b) Tocolytic.

Salbutamol is a beta-agonist. It is also a tocolytic given to patients with pre-labor contractions to stimulate the relaxation of uterine muscles.

Question 60.
Which of the following measures is not useful in reducing the reoccurrence risk of acute cystitis?
(a) Wiping from front to back.
(b) Consuming cranberry juice.
(c) Avoiding tampons.
(d) Using antiseptic soaps.
Answer:
(d) Using antiseptic soaps.

This measure will increase (not reduce) the risk of urinary tract infections. This is because antiseptic soaps kill normal bacteria flora in the skin and vagina, allowing the proliferation and unchecked growth of opportunistic bacteria and fungi.

Question 61. 
Which of the following is false about the measurement of fetal heart rate?
(a) The normal range is 120 to 160 bpm.
(b) The fetal heart rate is best heard at the fundus of the uterus.
(c) Continuous fetal heart rate monitoring is done via a cardiotocograph.
(d) A Pinard is less sensitive than a Sonicaid.
Answer:
(b) The fetal heart rate is best heard at the fundus of the uterus.

The fetal heart rate is typically best heard below the mother’s umbilicus in the midline, depending on the fetus’s position and the pregnancy stage.

Question 62. 
A patient being managed in the ER with premature rupture of membranes is noted to have a fetal heart rate of 110 bpm. Which of the following interventions is most appropriate?
(a) Give oral salbutamol.
(b) Increase the rate of IV drips.
(c) Encourage the patient to lie on their left side.
(d) Perform pulse oximetry.
Answer:
(c) Encourage the patient to lie on their left side.

This should be the first response. Next, the IV fluid transfusion rate is increased, and oxygen is administered. The physician must be promptly informed if the fetal heart rate decreases or does not improve.

Question 63. 
Which of the following patients will not benefit from Fowler’s position?
(a) A 56-year-old female with pulmonary edema.
(b) A 45-year-old male with a head injury.
(c) A 25-year-old male with GERD.
(d) A 55-year-old postop appendectomy patient.
Answer:
(d) A 55-year-old postop appendectomy patient.

In Fowler’s position, the patient’s head and chest are elevated. Patients with respiratory and cardiac conditions will benefit from high Fowler’s position (450) because they experience relief from long congestions. Patients with head injuries should be placed in the low Fowler’s position (about 30°) to improve brain venous drainage and reduce cerebral swelling.

Question 64.
Which of the following describes the purpose of the Trendelenburg position?
(a) Reduces cerebral swelling.
(b) Relieves pulmonary congestion.
(c) Increases venous return.
(d) Reduces pedal edema. 
Answer:
(c) Increases venous return.

In the Trendelenburg position, the patient’s head is tilted down until it is lower than the lower limbs. This position is used in patients with hypovolemic shock to improve venous return to the brain and heart.

Question 65. 
Which of the following best describes the cause of spinal headaches after a lumbar puncture?
(a) Irritation of the nerve plexus in the spinal canal.
(b) A side effect of the local anesthetic.
(c) A decrease in cerebrospinal fluid volume, which can lead to traction on pain-sensitive structures.
(d) Bleeding into the spinal canal.
Answer:
(c) A decrease in cerebrospinal fluid volume, which can lead to traction on pain-sensitive structures.

After a lumbar puncture, there is a decrease in cerebrospinal fluid volume, which can lead to traction on pain-sensitive structures, causing spinal headaches.

Question 66.
A 58-year-old male presents with ventricular tachycardia. The physician orders IV lidocaine for the patient. Which of the following is a common side effect of lidocaine?
(a) Hypertension.
(b) Bradycardia.
(c) Hyperkalemia.
(d) Hyperglycemia.
Answer:
(b) Bradycardia.

Lidocaine is an antiarrhythmic medication often used to treat ventricular arrhythmias. One of its potential side effects is bradycardia. Although lidocaine can affect cardiovascular and central nervous systems, it does not typically cause hypertension.

Question 67.
Which of the following drugs is unsuitable for inducing labor in a 35-year-old known asthmatic with preeclampsia at 36 weeks gestation?
(a) Misoprostol.
(b) Prostaglandin.
(c) Mifepristone.
(d) Oxytocin.
Answer:
(b) Prostaglandin.

Prostaglandin is contraindicated in patients with asthma due to an increased risk of bronchial constriction, mucus formation, and other hyperreactive airway reactions.

Question 68. 
A 26-year-old gravid patient at 18 weeks gestation is being managed for hyperemesis gravidarum. She is at risk for all of the following except:
(a) Wernicke encephalopathy.
(b) Mallory-Weiss tear.
(c) Liver disease.
(d) Gestational diabetes mellitus.
Answer:
(d) Gestational diabetes mellitus.

Hypoglycemia, not gestational diabetes mellitus, is a complication of this condition. Complications of hyperemesis gravidarum are dehydration, ketosis, hypoglycemia, and electrolyte disorders. Fatty liver disease, Wernicke encephalopathy, and Mallory-Weiss tears are more severe complications.

Question 69. 
Which of the following methods is most appropriate in stimulating a newborn with an Apgar score of six in the first minute of life?
(a) Suctioning.
(b) Sternal rub.
(c) Flicking the soles of the feet.
(d) Depressing the nail beds.
Answer:
(c) Flicking the soles of the feet.

This is the most appropriate method of stimulating a newborn with an Apgar score of six in the first minute of life. Another method is to rub the back when drying. Suctioning is recommended only for infants with airway obstruction. Prolonged suctioning can stimulate the vasovagal response and cause bradycardia. Sternal rubs and depressing the nail beds are unacceptable methods of stimulation.
 
Question 70. 
You are to commence chest compressions in a 34-week-old infant with an Apgar score of five in the fifth minute. Which of the following is the appropriate compression-to-ventilation ratio?
(a) 1:3.
(b) 1:4.
(c) 3:1.
(d) 4:1.
Answer:
(c) 3:1.

Chest compressions and ventilations are given in a 3:1 ratio for neonatal resuscitation. This means that in one cycle, which lasts two seconds, three compressions are followed by one ventilation. Over one minute, this translates to 90 compressions and 30 ventilations.

Question 71. 
You are anticipating resuscitating a fetus delivered at 30 weeks gestation. Which of the following is not an expected physical feature?
(a) Lanugo hair.
(b) Dry skin.
(c) Little body fat.
(d) Curly ears.
Answer:
(b) Dry skin.

Dry, scaly skin is seen in post-term infants. Preterm infants will likely present with shiny, pink, or translucent skin due to incomplete dermis development and insufficient adipose tissue deposition. Other features of prematurity include lanugo hair, curly ears, weight less than 2500 g, underdeveloped genitals, and poor cry and body tone. 

Question 72.
Which of the following is not a risk factor for placenta previa?
(a) Older maternal age.
(b) Prior cesarean section.
(c) Multiparity.
(d) Hypertension.
Answer:
(d) Hypertension.

Hypertension and other hypertensive diseases in pregnancy increase the risk of abruptio placentae, not placenta previa. Risk factors for placenta previa are prior cesarean section, prior induced abortion, myomectomy or fibroids, multiple gestation, older maternal age, smoking, and multiparity.

Question 73.
An ER nurse administers lidocaine with epinephrine for a laceration repair. The patient complains of dizziness and tinnitus soon after. This is a sign of:
(a) An expected response to epinephrine.
(b) Lidocaine toxicity.
(c) An allergic reaction to lidocaine.
(d) Inadequate dosing.
Answer:
(b) Lidocaine toxicity.

Symptoms of lidocaine toxicity can range from CNS effects, such as dizziness, tinnitus, and confusion, to more severe manifestations like seizures and cardiovascular collapse. Although epinephrine can cause some symptoms like palpitations or anxiety, the presentation of dizziness and tinnitus shortly after lidocaine administration strongly suggests lidocaine toxicity.

Question 74.
Which of the following is not a usual characteristic of antepartum hemorrhage secondary to placenta previa?
(a) Abdominal cramps.
(b) Scarlet blood.
(c) Normal fetal heart rate.
(d) Maternal tachycardia. 
Answer:
(a) Abdominal cramps.

The bleeding in the placenta previa is often painless. Blood loss is variable and bright red, unlike placenta abruption, which may present with abdominal cramps and passage of altered blood. The fetal heart rate in placenta previa is normal, but in abruptio placentae, the fetal heart rate reveals fetal distress. It is important to note that confirmation of diagnosis can be made only by a transvaginal ultrasound scan. Placenta previa must be ruled out or confirmed before a pelvic examination.

Question 75.
A 35-year-old lactating female presented to the ER with fever, redness, induration, and tenderness of her left breast. She is still in the puerperium. What is the most implicated bacteria?
(a) Streptococcus.
(b) Staphylococcus.
(c) Actinobacteria.
(d) Corynebacteria.
Answer:
(b) Staphylococcus.

Staphylococcus species are the most implicated bacteria in mastitis. Treatment includes drugs targeted at treating Staphylococcus aureus, such as cephalosporins and macrolides.

Question 76.
You are to discharge a lactating mother who was managed for mastitis. To reduce the risk of recurrence, you advise the mother to do which of the following?
(a) Wear a tight bra.
(b) Apply warm compression pads on the nipples daily.
(c) Break suction after each feed by placing a finger between the baby’s mouth and the nipple.
(d) Commence formula feeds.
Answer:
(c) Break suction after each feed by placing a finger between the baby’s mouth and the nipple.

This intervention will help reduce the risk of nipple soreness. The first option is incorrect because a tight bra is used to stop lactation. The second option is not useful in reducing the risk of mastitis, and the last option is not helpful to the infant.

Question 77.
A 30-year-old female patient with iron-deficiency anemia is advised to take oral iron supplements. Which of the following foods, when consumed with the iron supplement, would enhance iron absorption?    
(a) Dairy products.
(b) Tea.
(c) Whole grain cereals.
(d) Vitamin C-rich fruits.
Answer:
(d) Vitamin C-rich fruits.

Vitamin C (ascorbic acid) can enhance the absorption of non-heme iron from the digestive tract. Non-heme iron, found in plant-based foods and supplements, is not as readily absorbed as heme iron (found in animal products). Consuming vitamin C-rich foods like citrus fruits, strawberries, bell peppers, and tomatoes can promote better absorption of non-heme iron. On the other hand, certain substances in foods such as dairy products, tea, and whole grains can inhibit iron absorption.

Question 78.
A patient is being managed with magnesium sulfate for severe preeclampsia. Which of the following best describes the rationale behind using this drug?
(a) Tocolytic.
(b) Antihypertensive.
(c) Anticonvulsant.
(d) Anticoagulant.
Answer:
(c) Anticonvulsant.

Magnesium sulfate is used to treat seizures in preeclampsia and eclampsia. It reduces the risk of seizure by delaying calcium-dependent neurotransmission in the brain. Although magnesium sulfate is a tocolytic, it is not used for this effect in this patient because the goal of treatment is immediate delivery of the fetus.

Question 79.
Which of the following is an early sign of magnesium sulfate toxicity in a patient being managed for severe preeclampsia?
(a) Tinnitus.
(b) Hyporeflexia.
(c) Bradypnea.
(d) Oliguria.
Answer:
(b) Hyporeflexia.

Hyporeflexia, which manifests as an absent or slow patellar tendon reflex, is the first sign of magnesium sulfate toxicity. Respiratory failure occurs as magnesium sulfate accumulates in the blood. At higher doses, cardiac arrest occurs. To prevent these risks, urine output, deep tendon reflexes, respiratory rate, and serum concentrations of magnesium sulfate are monitored.

Question 80.
Which of the following complications is most commonly associated with long-term parenteral nutrition?
(a) Hyperglycemia.
(b) Hypertension.
(c) Vitamin D deficiency.
(d) Pulmonary edema.
Answer:
(a) Hyperglycemia.

Parenteral nutrition solutions are often high in glucose content. Hyperglycemia can be a side effect if the glucose is infused rapidly or the patient cannot adequately metabolize the glucose.

Question 81. 
Which of the following best describes the intramuscular regimen of giving a maintenance dose of magnesium sulfate in the Pritchard’s regimen?
(a) 10 g IM, 5 g every four hours.
(b) 10 g IV, 5 g every four hours.
(c) 10 g IM, 4 g every four hours.
(d) 10 mg IM, 4 g every four hours.
Answer:
(a) 10 g IM, 5 g every four hours.

The intramuscular regimen of a maintenance dose of magnesium sulfate is administering a stat dose of 10 g IM, then 5 g every four hours on alternating buttocks for 24 hours after delivery of the child or last seizure, whichever comes last.

Question 82. 
In a patient being managed with IV labetalol for severe preeclampsia, which of the following statements is false?
(a) 20 mg IV is given as a bolus.
(b) The maximum dose in 24 hours is 350 mg.
(c) The dose is increased sequentially to a maximum of 80 mg.
(d) Fatigue is a side effect of its administration.
Answer:
(b) The maximum dose in 24 hours is 350 mg.

This statement is false because the maximum dose in 24 hours is 220 mg. IV labetalol is the drug of choice in managing severe hypertension in pregnant patients. It is a nonselective beta-blocker. A loading dose of 20 mg IV is given. This dose is increased sequentially to a maximum of 220 mg after assessing the blood pressure 10 minutes after administration.

Question 83.
When administering parenteral nutrition, which vascular access is preferred for long-term therapy?
(a) Peripheral IV catheter.
(b) Central venous catheter (CVC).
(c) Peripherally inserted central catheter (PICC).
(d) Arterial line.
Answer:
(b) Central venous catheter (CVC).

A central venous catheter (CVC) is usually preferred for long-term parenteral nutrition therapy because it provides a high flow rate. This reduces the risk of vein irritation from hypertonic solutions. It also allows for secure and stable access over an extended period. Although PICCs can also be used, CVCs are typically more durable for long-term needs. 

Question 84.
A patient at 33 weeks gestation is being prepped for an emergency cesarean section due to a prelabour rupture of membranes and chorioamnionitis. To improve the respiratory function of the fetus, the woman is given which of the following?
(a) Surfactant.
(b) Naltrexone.
(c) Magnesium sulfate.
(d) Dexamethasone. 
Answer:
(d) Dexamethasone.

Dexamethasone is a corticosteroid given to hasten the maturity of the fetal lungs and reduce the risk of acute respiratory distress syndrome. It is indicated for use in the delivery of preterm babies who are less than 34 weeks. Surfactant is given to infants with ARDS, while naltrexone is given to infants with respiratory failure due to opioid intoxication from their mothers. Magnesium sulfate is given to reduce the risk of neurologic dysfunction in fetuses under 32 weeks old.

Question 85.
Which of the following aspects of an examination is used to differentiate threatened abortion from inevitable abortion?
(a) Bimanual examination.
(b) Cervical motion tenderness.
(c) Fetal heart rate.
(d) Cervical os.
Answer:
(d) Cervical os.

To differentiate between the two, the cervical os is examined with a cervical speculum. In inevitable abortion, the cervical os is opened.

Question 86.
A patient who presents to the ER with inevitable abortion is being managed with methotrexate. Which of the following describes this drug’s mechanism of action?
(a) Cervical dilatation.
(b) Induction of labor.
(c) Contraction of the uterus.
(d) Cytotoxic.
Answer:
(d) Cytotoxic.

Methotrexate is a cytotoxic used in induced abortion and gestational trophoblastic disease. It is a cytotoxic that destroys trophoblastic tissue. Methotrexate is often used with misoprostol to induce an abortion on pregnancies of less than eight weeks.

Question 87.
A patient comes to the ER with severe epigastric pain that improves with meals but worsens a few hours after eating. This presentation is most consistent with which type of peptic ulcer?
(a) Gastric ulcer.
(b) Duodenal ulcer.
(c) Esophageal ulcer.
(d) Meckel’s diverticulum ulcer.
Answer:
(b) Duodenal ulcer.

Duodenal ulcers often cause pain that is relieved by eating but returns a few hours after a meal, especially during the night. This pattern differs from gastric ulcers, which can cause pain immediately after eating.

Question 88. 
Which of the following is not a clinical presentation of a hydatidiform mole?
(a) Doughy uterus.
(b) Uterine bleeding.
(c) Severe vomiting.
(d) Jaundice.
Answer:
(d) Jaundice.

This is not a clinical presentation of trophoblastic disease. Clinical features include severe vomiting, uterine bleeding with passage of grape-like vesicles, and a doughy uterus bigger than the gestational age. In choriocarcinoma, patients may present with jaundice if the disease is advanced.

Question 89.
Which medication is frequently used for pain relief and can exacerbate peptic ulcer disease when used chronically?
(a) Ibuprofen.
(b) Acetaminophen.
(c) Morphine.
(d) Metoclopramide. 
Answer:
(a) Ibuprofen.

Ibuprofen can irritate the stomach lining and exacerbate peptic ulcer disease. Chronic use can increase the risk of developing ulcers or worsen existing ones.

Question 90.
A 36-year-old patient with a history of kidney transplantation arrives at the ER with complaints of fever and malaise. Which of the following is the most important consideration for the nurse when assessing this patient?
(a) The patient’s recent travel history.
(b) Potential side effects of immunosuppressive medications.
(c) The patient’s daily water intake.
(d) Time since the last kidney function test.
Answer:
(b) Potential side effects of immunosuppressive medications.

Patients on immunosuppressive medications after organ transplantation are at an increased risk for infections due to suppressed immune response. It is crucial for the nurse to consider potential infections in these patients, even with mild symptoms, as they may present atypically and can progress rapidly. 

Question 91.
In managing abrasions, it is important that the wounds be prevented from drying out because dryness interferes with which of the following?
(a) Clotting.
(b) Re-epithelization.
(c) Debridement.
(d) Asepsis.
Answer:
(b) Re-epithelization.

Abrasions are covered with commercial wound dressings to prevent the wounds from drying out. Drying interferes with the re-epithelization of the wound.

Question 92.
Which of the following is not an intervention in managing abrasions?
(a) Irrigation.
(b) Suturing.
(c) Antibiotics.
(d) Dressing.
Answer:
(b) Suturing.

Abrasions are not sutured because the wounds are scrapes that involve the epidermis. Suturing is unnecessary because the wounds do not extend deep into the tissues. Healing occurs by secondary intention.

Question 93.
Which of the following sutures is unsuitable for the repair of the epidermis?
(a) Nylon.
(b) Silk.
(c) Polyester.
(d) Polyglycolic acid.
Answer:
(d) Polyglycolic acid.

Nonabsorbable sutures are used to repair cutaneous wounds. Because they can be removed, they reduce the risk of tissue reactivity. Polyglycolic acid is an absorbable suture and is therefore used for dermal repairs.

Question 94.
Which of the following is a disadvantage of nylon sutures?
(a) Risk of infection.
(b) Tissue reactivity.
(c) High memory.
(d) High tensility.
Answer:
(c) High memory.

Nylon sutures have high memory (i.e., a tendency to coil back to their packaged shape). Because of this, there is a considerable risk of slippage of knots. To avoid this, the knots must be secured properly. Option A is incorrect because nylon sutures are monofilaments and, therefore, have a lower risk of infection. Option D is incorrect because the high tensile strength of nylon is an advantage in securing wounds.

Question 95. 
Which of the following patients is most likely to be on long-term immunosuppressive therapy?
(a) A 45-year-old male with hypertension.
(b) A 32-year-old female with Hashimoto’s thyroiditis.
(c) A 28-year-old male with a bone marrow transplant.
(d) A 50-year-old female with osteoporosis.
Answer:
(c) A 28-year-old male with a bone marrow transplant.

Bone marrow transplant recipients require long-term immunosuppressive therapy to prevent graft-versus-host disease (GVHD), wherein the transplanted bone marrow attacks the recipient’s body. Immunosuppression helps to prevent this complication and ensures the success of the transplant.

Question 96.
Which of the following dressings is unsuitable for a wound created by a pressure ulcer?
(a) Transparent films.
(b) Gauze.
(c) Hydrocolloids.
(d) Foam dressings.
Answer:
(b) Gauze.

Gauze dressings are dry-woven or nonwoven dressings. They are unsuitable for the primary dressing of moist wounds like pressure ulcers because they can stick to the base of the ulcer and interfere with re-epithelization.

Question 97. 
A 58-year-old male presents to the emergency department with chest pain and is diagnosed with a non-ST elevation myocardial infarction (NSTEMI). Which of the following interventions should be immediately implemented?
(a) Administer a nitroglycerin sublingual tablet.
(b) Start a heparin infusion.
(c) Perform an immediate coronary angiography.
(d) Administer aspirin.
Answer:
(d) Administer aspirin.

Aspirin acts as an antiplatelet agent, preventing further clot formation and propagation in NSTEMI. It is one of the immediate and first-line treatments given to reduce further cardiac injury. Although the other options are also treatments for NSTEMI, aspirin is typically administered first upon diagnosis. 

Question 98.
Which of 1jhe following is a disadvantage of using a hydrocolloid dressing?
(a) Desiccation.
(b) Adheres to the wound.
(c) Leaves residue on the wound bed.
(d) Requires frequent changing.
Answer:
(c) Leaves residue on the wound bed.

Hydrocolloid dressings contain methylcellulose, pectin, or gelatin, which absorbs water from the wound. They are good adhesives, waterproof, and encourage autolytic debridement. However, they can leave residue on the wound bed that can be mistaken for infection. Also, since they tend to spill into areas prone to friction, they can worsen existing pressure ulcers.

Question 99.
Which of the following is not a function of a sitz bath in a patient who had an episiotomy?
(a) Increases blood flow.
(b) Reduces edema.
(c) Cleans the perineum.
(d) Antiseptic properties.
Answer:
(d) Antiseptic properties.

A sitz bath does not have antiseptic properties. However, it increases blood flow to the perineum, reduces edema, relieves pain, and cleans the perineum.

Question 100.    
A 75-year-old woman is brought to the emergency department by her daughter due to increasing forgetfulness and confusion over the past six months. Which of the following is a primary distinguishing characteristic of dementia?
(a) Rapid onset and fluctuating course of cognitive decline.
(b) Symptoms are mostly present during the night and resolve during the day.
(c) Chronic and progressive decline in cognitive function while conscious.
(d) Presence of hallucinations as the first and most significant symptom. 
Answer:
(c) Chronic and progressive decline in cognitive function while conscious.

Dementia is characterized by a chronic and progressive decline in cognitive function that affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Consciousness is not affected. The distinguishing feature of dementia is that it is not a normal part of aging and is different from the occasional memory lapses people may experience as they age.

Question 101.
Which laboratory finding is most specific to diagnosing a non-ST elevation myocardial infarction (NSTEMI) in a patient presenting with chest pain?
(a) Elevated C-reactive protein.
(b) Elevated B-type natriuretic peptide (BNP).
(c) Elevated troponin levels.
(d) Reduced RBC count.
Answer:
(c) Elevated troponin levels.

Troponin is a cardiac-specific protein that is released in the bloodstream when there is damage to the heart muscles. Elevated troponin levels indicate myocardial injury and are specific for diagnosing myocardial infarction, including NSTEMI.

Question 102.    
In managing a patient with pressure ulcers, the wound should be cleaned with which of the following?
(a) Povidone-iodine.
(b) Normal saline.
(c) Hydrogen peroxide.
(d) Chlorhexidine.
Answer:
(b) Normal saline.

Cleaning should be done with normal saline during each dressing. Antiseptics can cause sloughing of granulation tissue and delay healing. Normal saline can be applied with squeeze bottles or commercial syringes.

Question 103. 
Which of the following is an example of mechanical wound debridement?
(a) Wet-to-dry dressings.
(b) Sterile scalpel.
(c) Hydrocolloid dressings.
(d) Use of sterile maggots.
Answer:
(a) Wet-to-dry dressings.

Wet-to-dry dressings are examples of mechanical wound debridement. In this method, a wet dressing is applied and removed when dry to strip off the necrotic tissue. This dressing is used for crusted and thickened wounds. 

Question 104.    
Which of the following is an example of autolytic wound debridement?
(a) Transparent films.
(b) Sterile maggots.
(c) Use of collagenase.
(d) Wet-to-dry dressings.
Answer:
(a) Transparent films.

In autolytic wound debridement, hydrocolloid dressings or transparent film dressings are applied to wounds to facilitate digestion of the wound by the body’s enzymes. Option B is a form of biological debridement, and option C is a form of enzymatic debridement, and option D is a form of mechanical debridement.

Question 105.    
Which of the following is not a factor contributing to pressure ulcers?
(a) Shearing.
(b) Pressure.
(c) Heat.
(d) Friction.
Answer:
(c) Heat.

Heat is not a factor contributing to pressure ulcers. Shearing forces, pressure, moisture, and friction contribute to the formation of pressure ulcers. These factors cause skin dehiscence, occlusion of microvessels, and maceration.

Question 106.    
A 6-year-old boy presents to the emergency department with a sore throat, difficulty swallowing, and fever. His tonsils are swollen with white patches. Which of the following is the most common bacterial cause of pharyngitis in children?
(a) Staphylococcus aureus.
(b) Streptococcus pneumoniae.
(c) Streptococcus pyogenes (Group A Streptococcus).
(d) Escherichia coli. 
Answer:
(c) Streptococcus pyogenes (Group A Streptococcus).

Streptococcus pyogenes, also known as Group A Streptococcus (GAS), is the most common bacterial cause of acute pharyngitis in children. It is responsible for “strep throat,” and its clinical presentation often includes a sore throat, fever, swollen tonsils with white patches (exudate), and tender cervical lymph nodes. Rapid diagnosis and antibiotic treatment are essential to reduce complications, such as rheumatic fever and post-streptococcal glomerulonephritis.

Question 107. 
Which of the following interventions is most appropriate in treating cutaneous abscesses?
(a) Warm compresses.
(b) IV antibiotics.
(c) Incision and drainage.
(d) Topical antibiotics.
Answer:
(c) Incision and drainage.

All abscesses must be incised and drained of the exudative material. Warm compresses make the abscess come to a point and drain. However, this intervention is not appropriate for patients who present to the ER. Oral antibiotics are given after the abscess is incised and drained. Topical antibiotics are not useful in this case.

Question 108.    
Which of the following clinical features helps to differentiate cellulitis from deep vein thrombosis?
(a) Peau d’orange.
(b) Tenderness.
(c) Edema.
(d) Ulcer.
Answer:
(a) Peau d’orange.

Cellulitis often presents with a peau d’orange surface, while the surface of deep vein thrombosis is smooth. Also, the affected area of cellulitis is red and hot, while that of deep vein thrombosis is cool with normal skin color or cyanosis. Lymphangitis is also present in cellulitis and absent in deep vein thrombosis.

Question 109.    
Which of the following groups is most at risk for scalded skin syndrome?
(a) Infants.
(b) Elderly.
(c) Males.    
(d) Females.
Answer:
(a) Infants.

Scalded skin syndrome mainly affects infants. It is rarely seen in older patients. Epidemics among infants are typically seen in nurseries. The umbilical stump is the primary site of infection in the first few days of life. This syndrome is caused by group A coagulase-positive staphylococcus aureus. 

Question 110.    
Which of the following interventions is most appropriate for impetigo?
(a) Wet-on-dry dressing.
(b) Incision and drainage.
(c) Warm compress.
(d) Topical antibiotics.
Answer:
(d) Topical antibiotics.

This intervention is the most appropriate for impetigo, a nonulcerative and superficial bacterial infection of the skin. The affected area is irrigated with water to remove the crusts, and topical mupirocin, ozenoxacin, fusidic acid, or retapamulin is applied.

Question 111.    
Which of the following substances is least likely to cause physical dependence?
(a) Nicotine.
(b) Alcohol.
(c) Heroine.
(d) Cannabis.
Answer:
(d) Cannabis.

Cannabis is least likely to cause physical dependence because withdrawal symptoms are not as intense as with the other listed substances. Physical dependence develops due to chronic use of drugs that induce tolerance.

Question 112.    
A patient with alcohol withdrawal symptoms will be managed with which of the following?
(a) Disulfiram.
(b) Bupropion.
(c) Naloxone.
(d) Diazepam. 
Answer:
(d) Diazepam.

Patients with withdrawal symptoms will be managed with benzodiazepines and thiamin. Diazepam can be given either intravenously or orally until the patient is sedated. Benzodiazepines are also given as prophylaxis for seizures. Disulfiram is used to encourage abstinence in motivated patients with alcoholism. Bupropion is used to blunt withdrawal symptoms in patients with nicotine addiction. Naloxone is used to treat opioid overdose.

Question 113. 
Which of the following is not a chronic complication of alcohol abuse?
(a) Delirium tremens.
(b) Wernicke encephalopathy.
(c) Korsakoff psychosis.
(d) Enlarged parotid glands.
Answer:
(a) Delirium tremens.

Delirium tremens is an acute condition caused by withdrawal from alcohol. It begins two to three days after alcohol withdrawal. Features are anxiety, insomnia with nocturnal illusions and nightmares, diaphoresis, depression, and restlessness. Clinical features can progress to include disorientation, delirium, and visual and auditory hallucinations.

Question 114.
A false positive result can be obtained for all of the following substances except:
(a) Heroin.
(b) Amphetamine.
(c) Marijuana.
(d) Cocaine.
Answer:
(d) Cocaine.

False-positive results can be seen in drug testing. For example, poppy seeds can produce false positives for opioids, Ibuprofen can produce false positives for marijuana, and tricyclic antidepressants can produce false positives for amphetamines. However, testing for cocaine includes testing for its metabolite, benzoylecgonine. Other substances cannot create this metabolite, so there is no risk of false-positive results.

Question 115.
A patient who presents to the ER with acute lead poisoning will be managed with any of these chelating agents except:
(a) Succimef.
(b) Dimercaprol.
(c) BAL.
(d) Deferoxamine.
Answer:
(d) Deferoxamine.

Deferoxamine is a chelating agent used to manage acute iron poisoning, not lead poisoning. Chelating drugs for lead poisoning include succimer, calcium disodium ethylenediaminetetraacetic acid, and dimercaprol/BAL (British antilewisite). 

Question 116.
A patient who presents to the ER with acute aspirin poisoning is managed with IV sodium bicarbonate. Which of the following justifies the use of this drug?
(a) Inhibits absorption of aspirin.
(b) Inhibits metabolism of aspirin.
(c) Increases excretion of aspirin.
(d) Stimulates enterohepatic circulation.
Answer:
(c) Increases excretion of aspirin.

Sodium bicarbonate is given to increase the urine pH and stimulate the excretion of the metabolites via alkaline diuresis. Potassium is also given because hypokalemia can inhibit alkaline diuresis.

Question 117.    
A patient who presents to the ER with acute acetaminophen poisoning is managed with Mucomyst. This drug is most effective within how many hours of acetaminophen ingestion?
(a) 6.
(b) 8.
(c) 4.
(d) 2. 
Answer:
(b) 8.

Mucomyst (N-acetylcysteine) is used to treat acute acetaminophen poisoning. It is effective if it is given within eight hours of acetaminophen ingestion. The efficacy of the drug is uncertain after 24 hours of acetaminophen ingestion. However, it is still given.

Question 118. 
Which of the following is the most likely complication of gastric lavage on a four-year-old male who presents to the ER with acute poisoning?
(a) Prolonged vomiting.
(b) Abdominal distension.
(c) Aspiration.
(d) Hematemesis.
Answer:
(c) Aspiration.

Gastric lavage is used to empty the stomach of its contents. In this procedure, water is pushed into the stomach via an NGT and then aspirated with a syringe. This procedure is not routinely done for poisons due to the risk of aspiration. Other complications of this procedure are epistaxis and injury to the esophagus or oropharynx.

Question 119.    
A patient who presents to the ER with heavy metal poisoning is managed with polyethylene glycol via an NGT. Which of the following best describes the action of this drug?
(a) Saline laxative.
(b) Cathartic.
(c) Emollient.
(d) Osmotic laxative.
Answer:
(d) Osmotic laxative.

Polyethylene glycol is a nonabsorbable compound that exerts osmotic pressure in the lumen of the gut. It pulls water into the colon and stimulates peristalsis. Polyethylene glycol is also used to prepare the colon for abdominal surgeries.

Question 120.    
The relatives of a patient with third-degree burns present to the ward with flowers. Which of the following responses is most appropriate?
(a) Accept the flowers and place them on the patient’s bedside table.
(b) Accept the flowers and place them at the reception.
(c) Inform the attending physician.
(d) Ask the caregivers to take the flowers away.
Answer:
(d) Ask the caregivers to take the flowers away.

Flowers and potted plants should not be near a patient with severe burns. This precaution reduces the risk of infections and sepsis. Flowers and potted plants should also be kept away from patients with severe immunodeficiency.

Question 121.
Which of the following medications is a mast cell stabilizer commonly used for prophylaxis against asthma symptoms?
(a) Montelukast.
(b) Cetirizine.
(c) Cromolyn sodium.
(d) Albuterol.
Answer:
(c) Cromolyn sodium.

Cromolyn sodium is a mast cell stabilizer that prevents the release of mediators from mast cells, thereby preventing the onset of asthma symptoms. It is used as a prophylactic treatment for asthma. Although montelukast is used in asthma treatment, it is a leukotriene receptor antagonist. Cetirizine is an antihistamine and albuterol is a bronchodilator.

Question 122.    
Which of the following interventions is inappropriate in a patient who presents to the ER with second-degree burns on their lower extremities?
(a) IV analgesia.
(b) Assess airway.
(c) Insert a line with a size 18G cannula.
(d) Place the patient in a supine position. 
Answer:
(d) Place the patient in a supine position.

Burned extremities must be elevated to improve venous return and reduce edema. 

Question 123. 
Which of the following best describes the use of the Parkland formula in burn management?
(a) Determines total surface area with burns.
(b) Determines fluid management in the first 24 hours of the burn.
(c) Determines the degree of burns.
(d) Determines the amount of analgesic to be given.
Answer:
(b) Determines fluid management in the first 24 hours of the burn.

The Parkland formula determines fluid volume in the first 24 hours of the burn injury. It is calculated as (4 mL/kg) x %TBSA burned. It is used for second-degree and third-degree burns. Half the estimated fluid is given in the first eight hours of management, while the remainder is given over 16 hours.

Question 124.    
A patient with third-degree burns will be managed with which of the following fluids?
(a) IV normal saline.
(b) IV dextrose saline.
(c) IV dextrose water.
(d) IV Ringer’s lactate.
Answer:
(d) IV Ringer’s lactate.

Ringer’s lactate is the fluid of choice in the management of burns. IV dextrose water is unsuitable because it is not an isotonic fluid. Although normal saline is isotonic, large volumes of this fluid can tip this patient into hyperchloremic acidosis.

Question 125.
Which of the following is not a characteristic of a first-degree burn?
(a) May present as vesicles.
(b) Blanches easily.
(c) Intact pain sensation.
(d) Appears red.
Answer:
(a) May present as vesicles.

First-degree burns are erythematous and very tender, and they blanch under pressure. They do not cause vesicles or bullae. Second-degree burns (or superficial partial-thickness burns) may present with vesicle formation.

Question 126.
Which of the following animals is most implicated in the transmission of rabies in the United States?
(a) Bats.
(b) Dogs.
(c) Raccoons.
(d) Skunks.
Answer:
(a) Bats.

In the United States, vaccination of dogs has reduced the incidence of rabies. Rabies is typically transmitted via the bite of bats. Other implicated animals are raccoons, foxes, and skunks.

Question 127.    
A patient with exercise-induced bronchoconstriction is seeking medication to prevent symptoms when exercising. Which mast cell stabilizer might be recommended for this use?
(a) Prednisone.
(b) Diphenhydramine.
(c) Ipratropium bromide.
(d) Nedocromil.
Answer:
(d) Nedocromil.

Nedocromil is a mast cell stabilizer that can be used as a prophylactic treatment for exercise-induced bronchoconstriction. It helps prevent the release of inflammatory mediators that can lead to bronchoconstriction. Prednisone is a corticosteroid, diphenhydramine is an antihistamine, and ipratropium bromide is an anticholinergic bronchodilator.

Question 128.
Which of the following is not a clinical feature of heat exhaustion?
(a) Dizziness.
(b) Nausea.
(c) Tachycardia.
(d) Delirium. 
Answer:
(d) Delirium.

In heat exhaustion, there are no neurologic symptoms. The presence of confusion, delirium, and ataxia indicate heatstroke, which is a severe form of heat illness. Features of heat exhaustion include weakness, headaches, dizziness, malaise, tachycardia, hyperthermia, diaphoresis, and orthostatic hypotension.

Question 129. 
Which population is most at risk of severe complications from the cytomegalovirus (CMV) infection?
(a) Healthy adolescents.
(b) Pregnant women in their third trimester.
(c) Immunocompromised patients.
(d) Infants aged 1-2 years.
Answer:
(c) Immunocompromised patients.

Cytomegalovirus (CMV) can cause severe complications in individuals with weakened immune systems, such as transplant recipients, people with HIV/AIDS, or those receiving chemotherapy. Although CMV can affect people of all ages, healthy individuals typically experience mild or no symptoms. Pregnant women, especially in the first half of pregnancy, are at risk of transmitting the virus to the fetus, which can lead to congenital CMV. Infants 1-2 years old are not at a higher risk than other age groups.

Question 130.    
A patient presents to the ER with third-degree burns secondary to a fire incident. During the examination, the nurse notices that the patient’s mucous membranes are cherry red Which of the following should the nurse suspect?
(a) Inhalational injury.
(b) Carbon monoxide poisoning.
(c) Cyanosis.
(d) Shock.
Answer:
(b) Carbon monoxide poisoning.

Oversaturation of hemoglobin in the red blood cells with carbon monoxide and dilatation of capillaries causes a cherry color of mucous membranes. This is a sign of carbon monoxide poisoning.

Question 131.
Which of the following interventions is a suitable assignment for an LPN in the management of a patient with pulmonary embolism?
(a) Serving the patient small, semisolid food.
(b) Facilitating auscultation of the lungs.
(c) Administering IV morphine.
(d) Assessing blood gases.
Answer:
(b) Facilitating auscultation of the lungs.

This is the most appropriate intervention to be assigned based on the scope of practice of the LPN. Option A is best suited for a nursing assistant. Options C and D are to be done by a registered nurse.

Question 132.    
You are to discharge a patient who was admitted with abdominal bloating, flatulence, and dyspepsia. As you educate the patient on food choices, you encourage them to eat only small amounts of:
(a) Yogurt.
(b) Cabbage.
(c) Corn.
(d) Radishes.
Answer:
(b) Cabbage.

Cabbage can cause bloating and flatulence because it is a gas-releasing food. This patient should be encouraged to eat only small amounts or avoid it altogether.

Question 133.    
Which of the following is not a right ensured by EMTALA?
(a) Right to medical screening.
(b) Right to resuscitation and stabilization.
(c) Right to transfer.
(d) Right to health insurance. 
Answer:
(d) Right to health insurance.

EMTALA does not ensure this right. EMTALA requires that all patients who present to the ER—regardless of race, sex, ethnicity, religion, and socioeconomic status—be given medical screening, resuscitation, and stabilization. It also requires that all patients who present to the ER be transferred to the appropriate level of healthcare after stabilization.

Question 134. 
Which of the following is a significant consequence of EMTALA on healthcare organizations?
(a) Increased working hours.
(b) Uncompensated care.
(c) Sepsis.
(d) Misdiagnosis.
Answer:
(b) Uncompensated care.

Because EMTALA demands that all patients who present to the ER be treated regardless of their health insurance, health workers and health organizations may not always receive compensation for the care they provide. While EMTALA can lead to uncompensated care, it is not the sole reason for the closure of some health organizations in America.

Question 135.    
The privacy rule is enforced by which of the following bodies?
(a) State nursing board.
(b) State law.
(c) Joint commission.
(d) Federal law.
Answer:
(d) Federal law.

The privacy rule is a federal law granting rights to patients regarding how their health information is used, stored, and transferred. This rule covers all forms of health information, whether oral, written, or electronic. 

Question 136.    
Which of the following bodies is not required to follow HIPAA regulations?
(a) Healthcare providers.
(b) Churches.
(c) Employers.
(d) Health insurance companies.
Answer:
(c) Employers.

Employers are examples of bodies not required to follow the privacy and security rules. Other bodies include child protective agencies, law enforcement agencies, schools, municipal offices, and life insurers. Bodies expected to follow the regulations are healthcare providers, healthcare plans, health insurance companies, and healthcare clearinghouses.

Question 137.    
Which of the following is not protected health information?
(a) Billing address.
(b) Radiologic reports.
(c) Prescription forms.
(d) Educational data.
Answer:
(d) Educational data.

Educational data is held by non-covered entities and is not protected health information. Protected health information includes all forms of health information that is held by specific entities, which are covered by HIPAA. Some of these covered entities are healthcare providers and health insurance plans. Other examples of nonprotected health information are employment records.

Question 138.    
HIPAA gives patients the right to do all of the following except:
(a) Request a copy of their health records.
(b) Request corrections to their health records.
(c) Refuse treatment for their medical conditions.
(d) Refuse permission to use their health information.
Answer:
(c) Refuse treatment for their medical conditions.

HIPAA does not give patients the right to refuse treatment. HIPAA gives patients the right to decide how their health information is used, stored, and transmitted.

Question 139.    
Which of the following is not a requirement for informed consent?
(a) Competence.
(b) Voluntariness.
(c) Patient education.
(d) Financial ability.
Answer:
(d) Financial ability.

Financial ability is not a requirement for informed consent. Before patients give informed consent, they must understand what it means to give consent. Also, patients must be appropriately educated to make an informed decision. Consent must also be given voluntarily and not under duress or compulsion.

Question 140.    
A patient is diagnosed with exercise-induced bronchoconstriction (EIB). Which of the following is a main treatment option that can be prescribed to prevent EIB?
(a) Oral corticosteroids.
(b) Short-acting beta-agonists (SABA).
(c) Anticholinergic inhalers.
(d) Mucolytic agents.
Answer:
(b) Short-acting beta-agonists (SABA)

Exercise-induced bronchoconstriction (EIB) is bronchoconstriction that occurs during or after exercise. Short-acting beta-agonists (SABA) are commonly prescribed to prevent EIB when taken fifteen to twenty minutes before exercise. They work by relaxing the bronchial smooth muscle and prevent bronchoconstriction.

Question 141.
You are preparing to examine a Muslim woman who presents to the ER with symptoms of acute PID In the examining room, which of the following is most appropriate?
(a) Ask the patient to remove her hijab and clothes and drape herself with a sheet.
(b) Ask the patient to remove all her clothes and keep her hijab on.
(c) Ask the patient to remove her hijab but keep her clothes on.
(d) Expose only the parts that need to be examined.
Answer:
(d) Expose only the parts that need to be examined.

In this case, the patient only needs to be exposed from the xiphisternum to the suprapubic line for an abdominal examination. To examine the cervix, the patient’s abdomen is covered, and she is positioned in the lithotomy position with a drape over her lower limbs. 

Question 142.    
Bronchoconstriction in asthma is mainly caused by which of the following mechanisms?
(a) Relaxation of the bronchial smooth muscle.
(b) Inflammation and swelling of the bronchial lining.
(c) Excessive production of pulmonary surfactant.
(d) Increased bronchial mucus production due to bacterial infection.
Answer:
(d) Inflammation and swelling of the bronchial lining.

Asthma is a chronic inflammatory disease of the airways. The inflammation leads to swelling of the bronchial lining, which narrows the airway lumen and contributes to bronchoconstriction.

Question 143.    
A nurse has just withdrawn a sample from a venipuncture. To reduce the risk of
needle injuries, they are expected to do which of the following?
(a) Separate the needle from the syringe before discarding it.
(b) Cap the needle after withdrawing the sample.
(c) Disinfect their hands with hand sanitizer.
(d) Dispose of the syringe with the needle.
Answer:
(d) Dispose of the syringe with the needle.

The syringe, with the needle, should be disposed of immediately in the biohazard box. Separating the needle, trying to manipulate it by bending it, or attempting to cap it can increase the risk of puncture injuries. Disinfecting hands after the procedure does not reduce the risk of needle prick injuries but reduces the risk of infection transmission.

Question 144.    
To reduce the risk of wound contamination while attending to a patient from a road traffic accident, a nurse is expected to do which of the following?
(a) Use sterile gloves.
(b) Wear a drape.
(c) Work from uncontaminated to contaminated areas.
(d) Dress wounds with isopropyl alcohol. 
Answer:
(c) Work from uncontaminated to contaminated areas.

Option A is incorrect because the wounds are already contaminated, and sterile gloves will confer no projection. Option B is incorrect because a drape does not reduce the risk of wound contamination. Option D is incorrect because the wound must be thoroughly irrigated and debrided before being dressed with antiseptics. Using isopropyl alcohol directly on a wound can cause pain and may not be the best choice for wound care.

Question 145. 
A nurse has just had an accidental needle-prick injury. Which of the following should be their first action?
(a) Dab the site with povidone-iodine.
(b) Run the affected site under tap water.
(c) Suck the puncture site.
(d) Commence HIV PEP.
Answer:
(b) Run the affected site under tap water.

The first response is to run the puncture site under tap water. After that, the nurse should make an incident report to appropriate management.

Question 146.    
You are attending to a patient with meningococcal meningitis. Which of the following precautions should you employ?
(a) Contact precautions.
(b) Airborne precautions.
(c) Droplet precautions.
(d) Bloodborne precautions.
Answer:
(c) Droplet precautions.

Meningococcal meningitis is transmitted via infected droplets from the nose and throat. Droplet precautions include using face masks, isolation, and observation of cough etiquette.

Question 147.    
A patient who presents to the ER with a fracture of the wrist with no other injuries will be triaged as: ’
(a) Urgent.
(b) Delayed.
(c) Expectant.
(d) Immediate.
Answer:
(b) Delayed.
The five classifications of triage are:

  • Immediate: Color red. These patients require urgent treatment for life-threatening injuries. These patients have a good chance of survival if promptly treated.
  • Urgent: Color yellow. Treatment can be delayed for a short period due to no impending life-threatening risk.
  • Delayed: Color green. These patients do not require urgent treatment and are not at risk of mortality.
  • Expectant: Color blue. These patients require extensive treatment that exceeds available resources, or their conditions will not improve with life support. 
  • Dead: Color black. These patients are in cardiac arrest and will not respond to resuscitation.

Question 148.
A patient who presents to the ER with Beck’s triad following blunt trauma to the chest will be triaged as:
(a) Delayed.
(b) Urgent.
(c) Immediate.
(d) Expectant.
Answer:
(c) Immediate.

Blunt trauma to the chest can lead to death in a short period. Therefore, the patient has to be administered immediately.

Question 149.    
The emergency physician requests that the START protocol be used to attend to the mass casualty patients in the ER. A nurse will assess patients with which of the following?
(a) Chest auscultation and GCS.
(b) Respiration, pulse, and mental status.
(c) GCS, respiration, and blood pressure.
(d) Mental status, respiration, and blood pressure. 
Answer:
(b) Respiration, pulse, and mental status.

The START protocol means simple triage and rapid treatment. It is a protocol used to rapidly assess and attend to mass casualty victims. After assessment, patients are triaged according to five colors. Assessment includes respiration, pulse rate, and mental status.

Question 150.
What is another name for the decontamination corridor?
(a) Hot zone.
(b) Cold zone.
(c) Warm zone.
(d) Neutral zone.
Answer:
(c) Warm zone.

The warm zone is another name for the decontamination corridor. In this zone, patients and exposed people are decontaminated. Emergency personnel must attend to exposed people with appropriate PPE. The cold zone describes the clean zone and involves emergency rooms. The hot zone describes the primary site of exposure.

Question 151.
A 45-year-old homeless patient is being managed for Wernicke encephalopathy. This patient will need management with which of the following micronutrients?
(a) Thiamine.
(b) Folic acid.
(c) Cobalamin.
(d) Ascorbic acid.
Answer:
(a) Thiamine.

Wernicke encephalopathy is caused by thiamine deficiency. It is triggered in patients with chronic alcoholism, which impairs the absorption and storage of thiamine. Treatment includes IV or IM administration of 100 mg thiamine.

Question 152.
Which of the following is not a clinical feature of generalized anxiety disorder?
(a) Shortness of breath.
(b) Dizziness.
(c) Urinary frequency.
(d) Constipation.
Answer:
(d) Constipation.

The clinical features of generalized anxiety disorder are excessive anxiety and worry, difficulty concentrating, diaphoresis, shortness of breath, palpitations, diarrhea, nausea, vomiting, irritability, fatigue, restlessness, headaches, and sleep disturbances.

Question 153.    
A patient with generalized anxiety disorder is being treated with citalopram. Which of the following describes this drug’s mechanism of action?
(a) Norepinephrine reuptake inhibitor.
(b) Serotonin reuptake inhibitor.
(c) Serotonin receptor antagonist.
(d) Norepinephrine receptor antagonist.
Answer:
(b) Serotonin reuptake inhibitor.

Citalopram is a selective serotonin reuptake inhibitor used in treating patients with major depression, anxiety disorders, obsessive-compulsive disorder, eating disorders, and post-traumatic stress disorder. Apart from citalopram, other drugs include sertraline, escitalopram, fluoxetine, fluvoxamine, and paroxetine.

Question 154.
In which of the following disorders is a patient likely to have a fictitious illness for personal gain?
(a) Conversion disorder.
(b) Munchausen’s.
(c) Malingering.
(d) Hypochondriasis. 
Answer:
(c) Malingering.

Patients with a malingering disorder fake an illness for personal gain. This personal gain may be relief from work or monetary gain from concerned individuals or organizations. In Munchausen’s, the patient fakes a disease but not for personal or economic gain. Patients with hypochondriasis believe they have an illness even though they do not.

Question 155.
A female patient being managed for schizophrenia attempts to converse with the nurse attending to her. Her speech is rambling, although fluent. Which of the following terms describes this phenomenon?
(a) Glossolalia.
(b) Logorrhea.
(c) Aphasia.
(d) Apraxia.
Answer:
(b) Logorrhea.

This is a communication disorder characterized by the use of incoherent, repetitive words. It is often seen in psychiatric disorders and with brain injury. Aphasia is an inability to speak or use previously learned words. Apraxia is difficulty in executing previously learned tasks.

Question 156.
A 15-year-old female who presents to the ER with major depressive disorder is placed on an SSRI. Which of the following is the patient most at risk of developing?
(a) Hallucination.
(b) Obesity.
(c) Suicidal ideation.
(d) Anorexia nervosa.
Answer:
(c) Suicidal ideation.

Suicidal ideation is a potential risk for teenagers commenced on antidepressants. The patients and their caregivers must be counseled on this risk. Caregivers must also be counseled to monitor their wards for signs of increased agitation and restlessness while using antidepressants.

Question 157.
Which of the following drugs is unlikely to cause neuroleptic malignant syndrome?
(a) Haloperidol.
(b) Olanzapine.
(c) Droperidol.
(d) Citalopram.
Answer:
(d) Citalopram.

Citalopram is not associated with neuroleptic malignant syndrome. Neuroleptic malignant syndrome is primarily associated with antipsychotic medications.

Question 158.
To reduce the risk of hypertensive crises in a patient placed on phenelzine, the patient must be counseled on the effects of consuming certain foods with the drug. Which of the following foods is not implicated? 
(a) Cheese.
(b) Grapes.
(c) Cured meat.
(d) Raisins.
Answer:
(b) Grapes.

The risk of hypertensive crisis increases when patients on monoamine oxidase inhibitors take foods rich in tyramine or dopamine. These foods include pickled, cured, and fermented foods like yogurt, cheese, red wine, canned figs, raisins, caviar, banana peels, raisins, yeast extracts, soy sauce, sour cream, and tenderized meats.

Question 159.
A 29-year-old woman presents to the emergency department with agitation, tremors, and profuse sweating. She reports starting a new antidepressant medication a week ago and accidentally took a higher dose this morning. Which of the following sets of symptoms is most indicative of serotonin syndrome?
(a) Bradycardia, hypothermia, and hypotension.
(b) Hyperthermia, clonus, and dilated pupils.
(c) Dry mouth, urinary retention, and blurred vision.
(d) Ataxia, dysphagia, and ptosis.
Answer:
(b) Hyperthermia, clonus, and dilated pupils.

Serotonin syndrome is a potentially life-threatening condition resulting from increased serotonin activity in the central nervous system. It often manifests with a combination of cognitive, autonomic, and somatic symptoms. Common symptoms include hyperthermia, clonus (especially inducible or spontaneous ocular clonus), dilated pupils, increased bowel sounds, and agitation. Prompt recognition and withdrawal of the offending agent are crucial.

Question 160. 
A 27-year-old female who presents to the ER says people can hear her thoughts. Which of the following best describes this phenomenon?
(a) Thought insertion.
(b) Delusion of persecution.
(c) Thought broadcasting.
(d) Delusion of grandeur.
Answer:
(c) Thought broadcasting.

In thought broadcasting, patients believe that everyone can hear their thoughts. It is a positive symptom of schizophrenia. In delusions of persecution, patients believe that people are out to get them. In thought insertion, patients believe that their thoughts are not theirs but are manipulated and controlled by someone else. In delusions of grandeur, patients elevate themselves to a higher status of importance.

Question 161.
A patient treated with buspirone is likely to have which of the following?
(a) Schizophrenia.
(b) Alcohol dependence.
(c) Generalized anxiety disorder.
(d) Bipolar disorder.
Answer:
(c) Generalized anxiety disorder.

Buspirone is a serotonin receptor agonist used to treat patients with generalized anxiety disorder. It is not used to treat psychosis or alcohol, barbiturate, or benzodiazepine withdrawal.

Question 162.
A patient being managed with olanzapine will likely complain of reduced libido due to the drug’s antagonistic effect on which of the following?
(a) Norepinephrine.
(b) Dopamine.
(c) Serotonin.
(d) Acetylcholine.
Answer:
(b) Dopamine.

Erectile dysfunction, reduced libido, and infertility are side effects of antipsychotics because of their antagonistic effects on dopamine and increased prolactin secretion. Antagonistic effects on acetylcholine receptors cause constipation, blurred vision, dry mouth, and extrapyramidal effects. 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 163.
A patient who presents to the ER with agitation and psychosis is given haloperidol. Sedation is a side effect of this drug because of its action on which of the following receptors?
(a) Serotonin.
(b) Dopamine.
(c) Histamine.
(d) Acetylcholine.
Answer:
(c) Histamine.    

Sedation is a side effect of most antipsychotics due to their antagonistic action on histamine. Other antagonistic effects of histamine include drowsiness and dry mouth. Antagonistic effects on acetylcholine receptors cause constipation, blurred vision, dry mouth, and extrapyramidal effects. Antagonistic effects on dopamine cause reduced libido and gynecomastia. 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 164.
A 54-year-old woman who presents to the ER with insomnia and anxiety says she sees images of snakes on her bed as soon as she wakes up. What form of hallucination is this?
(a) Hypnopompic.
(b) Hypnagogic.
(c) Gustatory.
(d) Tactile. 
Answer:
(a) Hypnopompic.

Hypnopompic hallucinations are visual hallucinations that the patient sees when they wake up. Hypnagogic hallucinations are seen before the patient goes to sleep.

Question 165.
A patient who presents to the ER is noticed to imitate the speech of the attending nurse. Which of the following best describes this occurrence?
(a) Echopraxia.
(b) Apraxia.
(c) Echolalia.
(d) Aphasia.
Answer:
(c) Echolalia.

Echolalia is the involuntary repetition of another person’s speech or vocalizations. Echopraxia is the involuntary repetition of another person’s actions. Apraxia is a difficulty in performing previously learned tasks. Aphasia is an inability to use previously learned words. 

Question 166.

A client is being managed with warfarin for transient ischemic attacks. Which of the following is required to evaluate the therapeutic level of warfarin?
(a) Platelet count.
(b) Partial thromboplastin time.
(c) Bleeding time.
(d) Prothrombin time.
Answer:
(d) Prothrombin time.

Prothrombin time is used to assess the extrinsic and common pathway of coagulation. It is used with the international normalized and prothrombin ratios to measure clotting tendencies in conditions like warfarin therapy, liver disease, and vitamin K deficiency.

Question 167.
A toddler who presents to the ER has just been diagnosed with shaken child syndrome from child abuse. Which of the following signs most supports this diagnosis?
(a) Fracture of the clavicle.
(b) Dislocation of the wrist.
(c) Retinal hemorrhage.
(d) Battle’s sign.
Answer:
(c) Retinal hemorrhage.

In shaken child syndrome, the child is shaken violently. Usually, this happens because the child will not stop crying. As the child is shaken, the head moves back and forth, creating a risk for internal head injuries and intracerebral hemorrhage. Retinal hemorrhage is the most specific sign of internal head injuries.

Question 168.
Which of the following is the most common cause of postpartum hemorrhage?
(a) Cervical laceration.
(b) DIC.
(c) Uterine atony.
(d) Retained placenta.
Answer:
(c) Uterine atony.

The most common cause of postpartum hemorrhage is uterine atony. Risk factors for uterine atony pre-grand multiparity, multiple gestations, polyhydramnios, fetal macrosomia, congenital anomalies, precipitate labor, anesthesia, and chorioamnionitis. Other causes of hemorrhage are uterine rupture, retained products of conception, cervical tears, episiotomies, inversion of the uterus, bleeding disorders and coagulopathies, uterine fibroids, and involution of the placenta.

Question 169.
Which of the following is the primary cause of anemia in a patient with end-stage renal disease?
(a) Increased lysis of the red blood cells.
(b) Erythropoietin deficiency.
(c) Poor iron absorption.
(d) Hyperplasia of the bone marrow. 
Answer:
(b) Erythropoietin deficiency.

Erythropoietin is a hormone that stimulates the production of red blood cells in the marrow. It is mainly produced in the kidneys, with small amounts from the liver. In end-stage renal disease, there is cellular death of the kidneys and fibrosis. This leads to - erythropoietin deficiency.

Question 170.
Which of the following recommendations should a nurse provide to a patient who has undergone a kidney transplant about preventing CMV infection?
(a) Take oseltamivir daily.
(b) Avoid close contact with young children who attend daycare.
(c) Consume undercooked meat.
(d) Consume undercooked eggs.
Answer:
(b) Avoid close contact with young children who attend daycare.

Children, especially those in daycare, can shed CMV in their urine or saliva for months after becoming infected. Transplant recipients are often on immunosuppressive medications and are more likely to be infected with CMV. Therefore, avoiding close contact with young children who might be shedding the virus is advised. Oseltamivir is an antiviral drug for influenza, not CMV. Consuming undercooked meat and eggs can expose an individual to various pathogens, but this is not specifically a CMV recommendation.

Question 171.
A patient who is being managed for hyperemesis gravidarum is at risk of all these except:
(a) Dehydration.
(b) Wernicke encephalopathy.
(c) Liver failure.
(d) HELLP.
Answer:
(d) HELLP.

A patient being managed for hyperemesis gravidarum is not at risk for HELLP. In hyperemesis gravidarum, severe vomiting causes dehydration, electrolyte derangement, ketosis, and weight loss. Patients present with features of hypovolemic shock. Complications are fatty degenerative changes in the liver, Wernicke encephalopathy, and Mallory-Weiss tears.

Question 172.
A patient who presents to the ER with antepartum hemorrhage at 34 weeks is being worked up for emergency CS. For prophylaxis of Rh sensitization, she is to receive RhoGAM at which of the following times?
(a) Within one week of delivery.
(b) Within 72 hours of delivery.
(c) Within one month of delivery.
(d) Within 48 hours of delivery.
Answer:
(b) Within 72 hours of delivery.

To reduce maternal sensitization and production of antibodies in subsequent pregnancies, the Rh-negative mother must be given Rhod immune globulin within 72 hours of delivery or termination of pregnancy, at 28 weeks gestation, after an episode of vaginal bleeding, and after amniocentesis.

Question 173.    
A woman who presents to the ER with hyperemesis gravidarum at 34 weeks has just had an amniotomy for augmentation of labor. Which of the following actions must be prioritized by the nurse?
(a) Assess cervical dilatation.
(b) Assess fetal heart rate.
(c) Assess maternal pulse.
(d) Assess contractions.
Answer:
(b) Assess fetal heart rate.

Fetal distress is a complication of amniotomy. Therefore, fetal heart rate is measured before and after amniotomy to assess the hemodynamic status of the fetus.

Question 174.
A 67-year-old female is being managed for a fracture of the neck of the femur secondary to osteoporosis. Which of the following is the most common risk factor of osteoporosis in women?
(a) Insufficient calcium intake.
(b) Estrogen depletion.
(c) Hypertension.
(d) Genetics.
Answer:
(b) Estrogen depletion.

Estrogen depletion is the most common cause of osteoporosis in women. Depletion of estrogen leads to increased resorption of bone and decreased bone density.

Question 175.
Which of the following is correct about the blood group AB?
(a) It is a universal donor.
(b) It has both A and B antibodies.
(c) It has no A or B antigens.
(d) It has both A and B antigens.
Answer:
(d) It has both A and B antigens.

The AB blood group has both A and B antigens in the red blood cells but no A or B antibodies in the plasma. This quality makes it a universal recipient of blood. However, because of the A and B antigens in the red blood cell, it can donate blood only to recipients with the AB blood group.

Practice Tests:

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