CEN Practice Test 5 with Rationale

CEN Practice Test 5 with Rationale

CEN Review Questions are designed to mimic the format and difficulty of the actual exam.

BCEN Practice Test 5 with Rationale

Question 1.    
Which of the following best describes the primary composition of the tunica media in the arteries?
(a) Endothelial cells.
(b) Collagen and elastic fibers.
(c) Smooth muscle cells.
(d) Fibroblasts.
Answer:
(c) Smooth muscle cells.

The tunica media is the middle layer of the walls of arteries and veins. It is primarily composed of smooth muscle cells. This layer allows the blood vessel to constrict (vasoconstriction) or dilate (vasodilation) in response to various stimuli. Although the tunica media contains some elastic fibers, especially in large arteries, its primary component is smooth muscle. Endothelial cells line the innermost layer, called the tunica intima. Fibroblasts are associated with the outermost layer, the tunica externa, which consists of connective tissue. 

Question 2.
Which of the following statements is correct concerning chronic stable angina?
(a) Causes retrosternal chest pain at rest.
(b) Causes ST-segment elevation on leads II, III, and Avf.
(c) Causes retrosternal chest pain during activity.
(d) Causes chest pain that radiates to the back and is relieved by leaning forward.
Answer:
(c) Causes retrosternal chest pain during activity.

Chronic stable angina is typically predictable and is triggered by physical exertion, emotional stress, or other factors that increase the heart’s workload. The chest pain of chronic stable angina is usually relieved by rest, and this differentiates it from acute coronary syndrome, which comprises unstable angina, non-ST elevation myocardial infarction, and ST-elevation myocardial infarction. Acute coronary syndrome also occurs at rest, unlike chronic stable angina.

Question 3.
A 40-year-old man on follow-up for Prinzmetal angina comes in for his routine health maintenance visit. Which of the following statements is correct about Prinzmetal angina?
(a) Caused by coronaiy artery spasm.
(b) Causes persistent ST-segment elevation on leads II, III, and Avf.
(c) Causes retrosternal chest pain mainly during activity.
(d) Causes chest pain that radiates to the back and is relieved by leaning forward.
Answer:
(a) Caused by coronary artery spasm.

Prinzmetal angina, also known as variant angina, is a rare form of angina caused by temporary coronary artery spasms. The spasm in the coronary arteries reduces cardiac blood flow. It has angina symptoms, which include retrosternal chest pain in reaction to extreme weather or emotions. Prinzmetal angina differs from myocardial infarction, which causes chest pain at rest and is usually more severe and associated with increased cardiac enzymes and characteristic features on echocardiography.

Question 4.
A student nurse is asked to explain the pathophysiology of one of the ACS. She chooses myocardial infarction. Which of the following is not involved in the pathophysiology of myocardial infarction?
(a) There is a deposition of plaque in the arterial walls.
(b) Plaque rupture might occur in the pathogenesis.
(c) Plaque erosion might also occur.
(d) All of the above.
Answer:
(d) All of the above.

In the pathophysiology of myocardial infarction, there is plaque deposition on the arterial walls. The plaque might either rupture or erode in the process. This plaque or atheroma leads to impaired perfusion that causes myocardial infarction. When blood flow and perfusion are impaired, the myocytes experience myocardial ischemia and death.

Question 5.
A patient asks about the mechanism of action of levonorgestrel as an emergency contraceptive. How should the nurse explain its primary function?
(a) It causes the endometrium to shed, similar to a menstrual cycle.
(b) It primarily prevents ovulation and helps to avoid fertilization.
(c) It directly kills any sperm present in the reproductive tract.
(d) It ensures that a fertilized egg implants in the uterus.
Answer:
(b) It primarily prevents ovulation and helps to avoid fertilization.

Levonorgestrel works primarily by preventing or delaying ovulation. By preventing the release of an egg from the ovary, it reduces the chance of fertilization. It may also make it harder for a fertilized egg to become implanted in the uterus. However, levonorgestrel is not designed to cause an already-established pregnancy to terminate. It does not cause the endometrium to shed like a menstrual cycle or kill sperm.

Question 6.
Which of the following is not an associated risk factor or etiology of dissection?
(a) Severe atherosclerosis.
(b) Malignant hypertension.
(c) Inflammatory bowel disease.
(d) Marfan syndrome. 
Answer:
(c) Inflammatory bowel disease.

Inflammatory bowel disease is not an associated risk factor or etiology of aortic dissection. Aortic dissection is the passage of blood through a false pocket between the tunica intima and tunica media. Causes include atherosclerosis, malignant hypertension, acquired connective tissue disorders, hereditary connective tissue disorder, iatrogenic causes from aortic catheterization and aortic valve surgery, and trauma. Clinical features are tearing pain in the precordial area that can spread to the scapular, severe hypotension, syncope, arterial pulse deficits between the two limbs, and impaired perfusion (stroke, paraplegia, renal insufficiency, and myocardial and intestinal infarction). It is often fatal. Treatment requires rapid resuscitation with beta-blockers to control blood pressure and immediate surgery.

Question 7.
A student nurse in her emergency rotation interacts with a patient admitted for complications of an abdominal aortic aneurysm. The senior nurse asks her what the most severe complication of abdominal aortic aneurysm is. What should be her reply?
(a) Dissection.
(b) Rupture.
(c) Infection.
(d) Hypertension.
Answer:
(b) Rupture.

Rupture is the most severe complication of abdominal aortic aneurysm. An abdominal aortic aneurysm is a bulge or enlargement in the wall of the aorta, the main artery carrying blood from the heart to the abdomen and lower extremities. Causes include atherosclerosis, uncontrolled hypertension, older age, and, most significant of all, cigarette smoking. It is often asymptomatic.

Question 8.
Which of the following does not increase the risk of developing abdominal aortic aneurysm?
(a) 35-pack-year history of smoking.
(b) History of hypercholesterolemia.
(c) History of connective tissue disease.
(d) History of hypothyroidism.
Answer:
(d) History of hypothyroidism.

A history of hypothyroidism does not increase the risk of developing abdominal aortic aneurysm. An abdominal aortic aneurysm is a bulge or enlargement in the wall of the aorta, the main artery carrying blood from the heart to the abdomen and lower extremities. Causes include atherosclerosis, uncontrolled hypertension, and a family history of aneurysms. Clinical features are usually from compression of surrounding structures or rupture. Major complications are embolization, rupture, and DIC. Treatment options include the management of blood pressure and the cessation of smoking.

Question 9.
A 40-year-old man suddenly collapses as he enters the emergency room, and CPR is administered. Which of the following statements appropriately describes the technique of cardiopulmonary resuscitation?
(a) 120 chest compressions in 1 minute, with every 30 chest compressions followed by two rescue breaths.
(b) Two chest compressions per minute, with every 30 chest compressions followed by two rescue breaths.
(c) 120 chest compressions in 1 hour, with every 30 chest compressions followed by two rescue breaths.
(d) 120 chest compressions in 1 minute, with every 30 chest compressions followed by one rescue breath.
Answer:
(a) 120 chest compressions in 1 minute, with every 30 chest compressions followed by two rescue breaths.

One hundred and twenty chest compressions in one minute, with every thirty chest compressions followed by two rescue breaths, appropriately describes the technique of cardiopulmonary resuscitation (CPR). In standard adult CPR, rescuers perform chest compressions aiming for a rate of at least 100 to 120 compressions per minute. After every 30 compressions, two rescue breaths are given to provide oxygen to the patient. This cycle of compressions and rescue breaths is repeated until professional medical help arrives or the patient shows signs of recovery.

Question 10.
Which of the following best describes the primary symptom of a patient who presents with acute pulmonary edema?
(a) Hemoptysis.
(b) Bradypnea.
(c) Dyspnea at rest.
(d) Wheezing.
Answer:
(c) Dyspnea at rest.

Pulmonary edema is a condition where fluid accumulates in the alveoli and the parenchyma of the lungs. The most common and primary symptom of acute pulmonary edema is dyspnea or difficulty breathing, which can occur even at rest. As the fluid fills the lungs, the patient’s ability to exchange oxygen and carbon dioxide is compromised, which causes shortness of breath. Although wheezing, hemoptysis (coughing up blood), and changes in respiratory rate can also be associated with pulmonary conditions, dyspnea at rest is the primary sign of pulmonary edema.

Question 11.
Which of the following is a shockable heart rhythm?
(a) Ventricular fibrillation with evidence of cardiopulmonary compromise.
(b) Severe bradycardia with evidence of cardiopulmonary compromise.
(c) Asystole.
(d) Pulseless electrical activity.
Answer:
(a) Ventricular fibrillation with evidence of cardiopulmonary compromise.

Ventricular fibrillation is a potentially fatal arrhythmia in which the heart’s electrical activity becomes disordered and impairs blood pumping. Cardiopulmonary compromise and cardiac arrest may quickly result from this. The preferred treatment method for ventricular fibrillation is defibrillation, in which an electric shock is given to the heart to return it to a normal rhythm. Severe bradycardia and asystole require separate treatments because they are not shockable rhythms.

Question 12.
A 36-year-old woman with hyperthyroidism presents to the emergency room with recurrent syncope, chest palpitations, and fatigue. She regularly takes Methimazole and was feeling well on the medication until recently when she noticed her new symptoms. Her electrocardiogram shows an absence of P waves with irregular R-R intervals. What should be the emergency nurse’s diagnosis?
(a) Atrial fibrillation.
(b) Ventricular fibrillation.
(c) Atrial flutter.
(d) Ventricular tachycardia.
Answer:
(a) Atrial fibrillation.

The absence of P waves with irregular R-R intervals on the electrocardiogram indicates atrial fibrillation, a common arrhythmia associated with hyperthyroidism. In atrial fibrillation, the atria of the heart fibrillate or quiver instead of contracting effectively, which leads to an irregular and often rapid heart rate. Prompt medical evaluation and management are essential to address this condition and prevent potential complications.

Question 13.
What is the next thing to do for a 39-year-old patient with pulseless electrical activity from the AED?
(a) Continue CPR.
(b) Take a CBC.
(c) Defibrillate the patient.
(d) Do an LFT to rule out liver pathology.
Answer:
(a) Continue CPR.

Pulseless electrical activity is a non-shockable rhythm; hence, defibrillation cannot be used. Automated external defibrillators would already advise against releasing a shock. So, the best thing for the nurse to do is to continue CPR in that instant. Ventricular fibrillation and pulseless ventricular tachycardia are shockable and, therefore, amenable to defibrillation. Defibrillation treats life-threatening arrhythmias, specifically ventricular fibrillation and pulseless ventricular tachycardia. During defibrillation, pads are typically placed in the anterior-lateral position: one pad below the right clavicle and the other to the left of the apex of the heart, below the left breast. About 120 to 200 joules of energy are used, to a maximum of 360 joules. 

Question 14.
A 68-year-old woman comes to the emergency room because of worsening palpitations and syncope. She is found to have complete heart block after evaluation. Which of the following statements correctly describes complete heart block?
(a) Prolonged PR interval of more than 0.2 seconds.
(b) Progressive PR interval prolongation with skipped beats.
(c) Regular PR interval prolongation, leading to a skipped beat.
(d) Complete dissociation between the P waves and the QRS complexes.
Answer:
(d) Complete dissociation between the P waves and the QRS complexes.

Third-degree heart block is called complete heart block. There is a discontinuity between the P and QRS waves. The P-P intervals are usually regular, but they are not related to the QRS complexes. First-degree heart block is a sinus rhythm in which the PR interval lasts more than 0.2 seconds due to prolonged transmission from the atria to the ventricles. Second-degree AV heart block includes Mobitz Type I (Wenckebach) or Mobitz Type II. The PR interval lengthens progressively in the Mobitz Type I block until the QRS complex drops. In Mobitz Type II, an intermittent drop in the QRS complex is not typical of the Type I pattern. Also, in Mobitz Type II block, there is no rapid progression to complete heart block.

Question 15.
Which of the following is an increased risk for a patient with left-sided heart failure?
(a) Pleural effusion.
(b) Pulmonary edema.
(c) Pneumothorax.
(d) Pulmonary embolism.
Answer:
(b) Pulmonary edema.

Left-sided heart failure, specifically failure of the left ventricle, can result in the buildup of blood and increased pressure in the pulmonary veins. This leads to fluid leaking into the lungs’ air spaces, which causes pulmonary edema. Pleural effusion is a fluid buildup in the pleural space and can be caused by various conditions. Pneumothorax refers to air in the pleural space, which causes lung collapse. Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs, often due to blood clots.

Question 16.
A 35-year-old woman is being evaluated for infective endocarditis. Which of the following is not a risk factor for developing infective endocarditis?
(a) A damaged heart valve that will be treated with valve replacement surgery.
(b) Recent valve replacement surgery with an artificial valve.
(c) Recreational use of IV drugs.
(d) Poorly controlled chronic hypertension. 
Answer:
(d) Poorly controlled chronic hypertension.

Infective endocarditis is an infection of the heart’s inner surface, often on the heart valves. Risk factors for developing infective endocarditis include having a damaged heart valve or an artificial heart valve and intravenous drug use, which can provide sites or mechanisms for bacteria to adhere and grow. Poorly controlled chronic hypertension, while a cardiovascular risk, does not specifically increase the risk for infective endocarditis.

Question 17. 
A two-week-old infant is diagnosed with patent ductus arteriosus (PDA). Which medications might be administered to assist in closing the ductus arteriosus?
(a) Furosemide.
(b) Digoxin.
(c) Ibuprofen.
(d) Amoxicillin.
Answer:
(c) Ibuprofen.

Non-steroidal anti-inflammatory drugs (NSAIDs) like indomethacin and ibuprofen can be used in preterm and term infants to promote the closure of the ductus arteriosus. These medications inhibit the production of prostaglandins, which help keep the ductus arteriosus open. By reducing prostaglandins, the PDA may close.

Question 18.
A 35-year-old intravenous drug abuser is brought to the emergency room. He has had a fever, chills, chest pain, and night sweats for five days. Which investigation is not essential in the diagnosis of infective endocarditis?
(a) Echocardiography.
(b) Blood culture.
(c) Electrocardiography.
(d) All of the above.
Answer:
(c) Electrocardiography.

Electrocardiography is not typically used as an investigation in the diagnosis of infective endocarditis. The investigations used include blood culture and echocardiogram. Other serum biomarkers can also be used. Electrocardiography can be used in evaluating a patient for ischemic heart diseases, arrhythmias, and some cardiomyopathies. 

Question 19.
What clinical criteria are used to confirm the suspected diagnosis of infective endocarditis in a female patient?
(a) Jones criteria.
(b) Duke’s criteria.
(c) Rotterdam criteria.
(d) GOLD criteria.
Answer:
(b) Duke’s criteria.

Duke’s criteria confirm the diagnosis of a patient with suspected infective endocarditis. These criteria consider factors such as clinical manifestations, results of blood cultures, echocardiography findings, and the presence of predisposing heart conditions. Prompt and accurate diagnosis is essential as infective endocarditis can lead to serious complications and requires timely and appropriate management, which often involves prolonged antibiotic therapy and, in some cases, surgical intervention.

Question 20.
A 25-year-old man with a history of multiple admissions for drug intoxication and withdrawal syndromes is brought to the emergency room and presents with worsening fever, night sweats, and generalized weakness. Chest auscultation reveals a cardiac murmur not present at the patient’s last hospital visit. Echocardiography shows tricuspid regurgitation and vegetation on the tricuspid valve. Which of the following is the most likely diagnosis?
(a) Rheumatic heart disease.
(b) Infective endocarditis.
(c) Heart failure.
(d) Myocardial infarction.
Answer:
(b) Infective endocarditis.

The presence of tricuspid regurgitation and vegetation on the tricuspid valve seen on echocardiography indicate infective endocarditis. This condition involves the infection and inflammation of the endocardium, which often affects the heart valves. Risk factors like intravenous drug use can increase the likelihood of developing infective endocarditis. Prompt diagnosis and appropriate management, which includes antimicrobial therapy, are crucial to improve patient outcomes.

Question 21.
Which of the following is not a leading cause of heart failure?
(a) Arrhythmia.
(b) Valvular heart disease.
(c) Hypertensive heart disease.
(d) Diabetes. 
Answer:
(d) Diabetes.

Heart failure is the failure of the heart to pump blood to meet systemic demands at resting filling pressures. Heart failure may be classified as systolic or diastolic dysfunction. It is also classified as acute right ventricular or left ventricular failure. Right ventricular failure is usually from underlying left ventricular dysfunction, and isolated right ventricular dysfunction can arise from underlying pulmonary pathology. Isolated right ventricular dysfunction from pulmonary pathology is called cor pulmonale. Diabetes is not a leading cause of heart failure.

Question 22.
A nursing student is evaluating a 35-year-old woman with features of right ventricular failure (distended neck veins and pedal edema). Which of the following is the most common cause of right ventricular failure?
(a) Left ventricular failure.
(b) Chronic obstructive pulmonary disease.
(c) Arrhythmia.
(d) Myocardial infarction.
Answer:
(a) Left ventricular failure.

Left ventricular failure is the most common cause of right ventricular failure. Right ventricular heart failure causes an increase in systemic venous pressure due to the backflow of blood from the IVC and SVC. This increase causes the movement of fluid from the intravascular space into the tissue space. Affected patients present with pedal and sacral edema, distended neck veins, and ascites. Patients also have tender hepatomegaly, which may manifest with hyperbilirubinemia, elevated hepatic enzymes, and prolonged prothrombin time. Patients with chronic RVF have malabsorption syndromes.

Question 23.
A 48-year-old man managed for heart failure comes to the urgent care for a follow-up of his condition. What drug is not used to manage heart failure?
(a) Lisinopril.
(b) Furosemide.
(c) Digoxin.
(d) Verapamil.
Answer:
(d) Verapamil.

Verapamil is not typically used for the management of heart failure. It is a non-dihydropyridine calcium channel blocker that is used in the management of angina and atrial fibrillation. Drugs used in the management of heart failure include dihydropyridine 
calcium blockers such as amlodipine, angiotensin-converting enzyme inhibitors such as lisinopril, diuretics such as furosemide, and cardiac glycosides such as digoxin.

Question 24.
Which of the following drugs is an inotropic agent used in the management of heart failure with reduced ejection fraction?
(a) Lisinopril.
(b) Furosemide.
(c) Digoxin.
(d) Verapamil.
Answer:
(c) Digoxin.

An inotropic drug called digoxin is used to treat heart failure with a low ejection fraction. Digoxin is a cardiac glycoside that improves cardiac output in people with heart failure by increasing the force with which the heart muscle contracts. It can also reduce symptoms like weariness and shortness of breath by regulating the heart rate. While other drugs like lisinopril, furosemide, and verapamil can treat heart failure, they do not have the same inotropic effects as digoxin.

Question 25.
Which of the following medications is shown to improve the rate of survival in patients managed for congestive cardiac failure?
(a) Digoxin.
(b) Amiodarone.
(c) Verapamil.
(d) Spironolactone.
Answer:
(d) Spironolactone.

Spironolactone is a potassium-sparing diuretic, and studies have shown that it enhances the quality of life in patients managed for heart failure. Diuretics are a mainstay in the management of heart failure. These drugs reduce preload by reducing plasma volume. Examples of loop diuretics are furosemide and torsemide. Thiazide-type diuretics include hydrochlorothiazide, chlorothiazide, and indapamide. These diuretics are potassium-wasting and cause hypokalemia. Potassium-sparing diuretics include amiloride and spironolactone. Side effects of these drugs are hyperkalemia, gynecomastia (spironolactone), nausea, and GIT disturbances.

Question 26.
Beck’s triad is a group of clinical findings used to diagnose cardiac tamponade. Which of the following statements correctly describes Beck’s triad?
(a) Hypotension, bradypnea, and muffled heart sounds.
(b) Hypotension, distended neck veins, and muffled heart sounds.
(c) Hypertension, tachycardia, and muffled heart sounds
(d) Hypotension, tachycardia, and muffled heart sounds.
Answer:
(b) Hypotension, distended neck veins, and muffled heart sounds.

Cardiac tamponade is a cardiac emergency caused by an accumulation of blood in the pericardial sac. This sac constricts the heart and prevents it from relaxing during diastole. If left untreated, patients can die from obstructive shock. It is caused by either blunt or penetrating trauma to the chest. However, penetrating trauma is a more common cause. Clinical features include Beck’s triad of hypotension, distended neck veins, and muffled heart sounds. Other features are pulsus paradoxus and shock. Beck’s triad may not easily be confirmed in a noisy and busy emergency room.

Question 27.
Which of the following medications can be used in the treatment of uncomplicated acute pericarditis?
(a) Colchicine.
(b) Labetalol.
(c) Furosemide.
(d) Diltiazem. 
Answer:
(a) Colchicine.

Colchicine is used in the treatment of patients with uncomplicated acute pericarditis. Other drugs used include corticosteroids and NSAIDs. Other modalities include treatment of the underlying cause. Acute pericarditis is inflammation of the pericardium from infectious and non-infectious causes. It presents with tearing chest pain that radiates to the back and is relieved by leaning forward. It must be differentiated from other causes of chest pain, such as costochondritis, gastroesophageal reflux disease, and ischemic heart disease. 

Question 28.
A 35-year-old man comes to the emergency room with complaints of epigastric pain. What is not a possible cause of acute pericarditis?
(a) Viral infection.
(b) Radiation therapy.
(c) Uremia.
(d) Furosemide.
Answer:
(d) Furosemide.

Furosemide is not a possible cause of acute pericarditis. Acute pericarditis causes include infections (primarily viral), autoimmune diseases, inflammation, trauma, myocardial infarction (Dressler’s syndrome), radiation therapy, uremia, cancer, and drugs (such as isoniazid, hydralazine, phenytoin, anticoagulants, and procainamide). Subacute pericarditis has the same causes as acute pericarditis but lasts longer (from days to weeks). Causes of chronic pericardial effusion are hypothyroidism (myxedema) and metastases from breast and lung carcinomas, sarcoma, lymphoma, melanoma, and leukemia. Transient constrictive pericarditis may be idiopathic and is also caused by infection or inflammation post-pericardiotomy.

Question 29.
A 50-year-old man with end-stage renal disease secondary to diabetic nephropathy is brought to the clinic by his son. He presents with acute onset of chest pain that radiates to the back and is relieved by leaning forward. The patient has no history of angina pain, and cardiac enzymes are not elevated. Serum creatinine and blood urea nitrogen (BUN) are markedly elevated. What is the correct nursing diagnosis for this patient?
(a) Diabetic pericarditis.
(b) Uremic pericarditis.
(c) Myocardial infarction.
(d) Heart failure.
Answer:
(b) Uremic pericarditis.

The patient’s presentation of acute onset chest pain that radiates to the back, relieved by leaning forward, along with markedly elevated serum creatinine and blood urea nitrogen (BUN) levels, is suggestive of pericarditis associated with end-stage renal disease (ESRD) or uremia. Uremic pericarditis occurs due to inflammation of the pericardium caused by the accumulation of waste products in the blood, a common complication of advanced kidney disease. Prompt medical evaluation and management are essential to address this condition and alleviate symptoms.

Question 30.
Which treatment option is approved for the management of a patient with pericardial tamponade?
(a) NSAIDs.
(b) Colchicine.
(c) Chest tube insertion.
(d) Corticosteroids.
Answer:
(c) Chest tube insertion.

Chest tube insertion is used to manage severe pericardial effusion and tamponade.

Question 31.
Which statement correctly describes Raynaud’s syndrome?
(a) An arterial embolism that occludes the digital arteries, causing hand pain, cyanosis, and paresthesia.
(b) An arterial thrombosis that occludes the digital arteries, causing hand pain, cyanosis, and paresthesia.
(c) A venous thrombosis that occludes the digital veins, causing hand pain, cyanosis, and paresthesia.
(d) A vasospasm of the digital arteries that causes hand pain, cyanosis, and paresthesia.
Answer:
(d) A vasospasm of the digital arteries that causes hand pain, cyanosis, and paresthesia.

Raynaud’s syndrome is characterized by vasospasms of arteries in the hands due to cold or emotional stress. Clinical features are paresthesia in the affected hand, characterized by burning, tingling, or cold sensations and pain, and change in color, marked by pallor, cyanosis, or rubor. Secondary Raynaud’s syndrome can cause ulcerative changes. Treatment options include the avoidance of triggers, the use of relaxation techniques, the cessation of smoking, and the use of calcium channel blockers. In secondary causes, surgical debridement of the wound may be indicated. 

Question 32.
A 52-year-old woman comes to the urgent care clinic with complaints of intermittent leg claudication and paresthesia. She has no history of hypertension or diabetes. She is obese, and her fasting lipid profile, done a month ago, was abnormal. Which of the following statements is correct about peripheral arterial disease?
(a) It presents with limb edema and erythema.
(b) It presents with intermittent claudication worsened by activity.
(c) It presents with intermittent claudication relieved by activity.
(d) The pain is not related to being active. 
Answer:
(b) It presents with intermittent claudication worsened by activity.

Peripheral arterial disease is caused by atherosclerosis and occlusion of the vessels in the lower limbs. It may be asymptomatic in mild cases, but patients may also present with intermittent claudication. Clinical features include intermittent claudication, which patients describe as an aching, burning, or heavy sensation in their thighs, calves, hips, or buttocks. This pain is worsened by activity and relieved by rest. On examination, the affected limb shows dependent rubor and pale and atrophic hairless skin in chronic cases. The leg may be cyanotic and diaphoretic. In severe cases, patients present with peripheral arterial ulcers on the heel or toes. The ulcers are tender and have dry, black, and necrotic tissue.

Question 33.
A patient with symptoms in keeping with peripheral vascular disease wants to know the possible etiology of her condition. Which symptom is not a sign of Peripheral vascular disease?
(a) Claudication.
(b) Paresthesia.
(c) Ulcer.
(d) Edema.
Answer:
(d) Edema.

Edema is not typically a common sign of peripheral vascular disease. Clinical features include intermittent claudication, which patients describe as an aching, burning, or heavy sensation in th^ir thighs, calves, hips, or buttocks. This pain is worsened by activity and relieved by rest. Paresthesia is an abnormal tingling sensation the patient feels, usually on the upper and lower limbs. Ulcers result from delayed or poor wound healing, a common symptom in peripheral vascular disease.

Question 34.
What complication is the biggest concern for a nurse managing a patient with deep vein thrombosis (DVT)?
(a) Edema.
(b) Sepsis.
(c) Acute pulmonary embolism.
(d) Heart failure.
Answer:
(c) Acute pulmonary embolism.

Deep vein thrombosis is a primary cause of pulmonary embolism. It is characterized by the formation of blood clots in the deep veins of the lower limbs. Risk factors include obesity; age greater than 60 years; cigarette smoking; cancers; use of estrogen agonists like ' tamoxifen; heart failure; hypercoagulability disorders; immobilization, trauma to the limbs; the presence of a venous catheter; nephritic syndrome; use of oral contraceptives or estrogen replacement therapy; prior history of thromboembolism; pregnancy and myeloproliferative neoplasms like polycythemia, sickle cell anemia, and trauma. Clinical features are asymptomatic in small veins. In bigger veins, they may present as edema, tenderness, and erythema of the affected side. Patients may present with fever or features of pulmonary embolism and thromboembolism.

Question 35.
A 45-year-old man with a recent history of DVT is evaluated in the emergency room due to contraindications for anticoagulation therapy. Which intervention is most appropriate to prevent an acute pulmonary embolism in this patient?
(a) Administering a higher dose of anticoagulants.
(b) Insertion of an inferior vena cava filter.
(c) Performing a pulmonary angiography.
(d) Administering thrombolytic therapy.
Answer:
(b) Insertion of an inferior vena cava filter.

An inferior vena cava filter is a device placed to prevent emboli from traveling to the lungs, particularly from the legs, which could cause a pulmonary embolism. IVC filters are often considered in patients with contraindications to anticoagulants or those who develop recurrent pulmonary embolisms despite adequate anticoagulation. 

Question 36.
Which of the following is a management option for deep vein thrombosis?
(a) Superior vena cava filter.
(b) Anticoagulants.
(c) Antibiotics.
(d) Antihypertensive.
Answer:
(b) Anticoagulants.

Anticoagulants are a management option for deep vein thrombosis. Anticoagulants, also known as blood thinners, are commonly used to treat DVT by preventing the formation of new blood clots and reducing the risk of existing clots getting larger or breaking loose. This treatment helps to stabilize the clot and prevent complications like pulmonary embolism. Superior vena cava filters are used in specific cases but are not the primary management for DVT. Antibiotics are not used to treat DVT as it is not infectious. Antihypertensive medications are used to manage high blood pressure and unrelated to DVT.

Question 37.
Which of the following is not a risk factor for the development of disseminated intravascular coagulopathy?
(a) Eclampsia.
(b) Abruptio placenta.
(c) Septicemia.
(d) Shock. 
Answer:
(d) Shock.

Shock is not a risk factor for the development of disseminated intravascular coagulopathy. DIC involves a complex disruption in the body’s clotting mechanisms, which leads to both excessive clotting and bleeding rather than specifically leading to embolism. When the clotting factors are exhausted, bleeding ensues. Causes are obstetric complications (abruptio placentae, eclampsia, severe preeclampsia or embolism of amniotic fluid, a retained product of conception, and severe maternal sepsis); septicemia caused by gram-negative microorganisms; adenocarcinomas of the pancreas and prostate; shock; snake envenomation; intravascular hemolysis; tissue damage from burns or frostbite, and complications of prostate surgery.

Question 38.
Which of the following does not cause obstructive shock (failure of cardiac filling or emptying)?
(a) Cardiac tamponade.
(b) Tension pneumothorax.
(c) Acute pulmonary embolism.
(d) Severe hypertension.
Answer:
(d) Severe hypertension.

Severe hypertension is not a cause of obstructive shock. Obstructive shock is caused by extrinsic factors that impair the filling or emptying of the heart. The mechanism includes mechanical obstruction to ventricular filling, cardiac tamponade, clot or tumor in the atria, tension pneumothorax, and compression of the IVC or SVC. It is also caused by mechanical obstruction to ventricular emptying (pulmonary embolism).

Question 39.
Which of the following is not a possible cause of cardiogenic shock?
(a) Myocardial infarction.
(b) Severe valvular heart disease.
(c) Cardiac tamponade.
(d) Malignant hypertension.
Answer:
(d) Malignant hypertension.

Malignant hypertension is not a possible cause of cardiogenic shock. Cardiogenic shock is caused by a severe impairment of the heart’s pumping ability, leading to inadequate blood flow to meet the body’s needs. Possible causes of cardiogenic shock include myocardial infarction, severe valvular heart disease, and cardiac tamponade. Malignant hypertension, a severe and sudden increase in blood pressure, can lead to hypertensive emergency but is not a typical cause of cardiogenic shock.

Question 40.
Which of the following is a result of acute pulmonary embolism?
(a) Cardiogenic shock.
(b) Obstructive shock.
(c) Septic shock.
(d) Anaphylactic shock.
Answer:
(b) Obstructive shock.

Acute pulmonary embolism causes obstructive shock. It occurs when a blood clot (usually from deep vein thrombosis) travels to the lungs and obstructs blood flow in the pulmonary arteries. This obstruction impedes the heart’s ability to pump blood effectively, which results in obstructive shock. Cardiogenic shock is caused by severe heart pump failure, septic shock is due to a severe infection, and anaphylactic shock is an extreme allergic reaction.

Question 41.
A 40-year-old chronic alcoholic presents with recurrent bloody emesis for the past two hours. The patient had attended a party where he was said to have ingested several bottles of vodka. His breath smells of alcohol. While in the ER, he has another episode. The emergency team places an endotracheal tube. What is the reason for placing the tube?
(a) To stop the vomiting.
(b) To protect the airway against aspiration.
(c) To prevent shock.
(d) To reduce blood loss.
Answer:
(b) To protect the airway against aspiration.

In a patient with recurrent bloody emesis with risks for aspiration, placing an endotracheal tube helps to protect the airway against aspiration. Aspiration and its complications increase the risk of morbidity and mortality in patients with upper gastrointestinal bleeding with severe hematemesis. By inserting an ETT, the patient’s airway is secured, and any future vomiting is prevented from entering the lungs, which reduces the risk of aspiration and provides a clear route for ventilation.

Question 42.
Which of the following drugs is useful in the treatment of lung abscess secondary to aspiration and bacterial pneumonia?
(a) Clindamycin and amoxicillin.
(b) Metronidazole.
(c) Fluconazole.
(d) Doxycycline. 
Answer:
(a) Clindanjycin and amoxicillin.

Clindamycin and amoxicillin or clindamycin and ceftriaxone are effective in the treatment of patients with lung abscesses. Clindamycin covers anaerobic organisms, while ceftriaxone covers gram-negative infections. Amoxicillin covers gram-positive infections. Metronidazole is effective for the treatment of anaerobic infections below the diaphragm. Doxycycline is useful in the treatment of sexually transmitted bacteria. Fluconazole is an antifungal that is effective against several fungal infections, including the treatment of candidiasis.

Question 43.
A 68-year-old woman with delirium is brought to the emergency room with aspiration syndrome. What is the best approach for an emergency nurse to manage an unconscious patient with confirmed aspiration pneumonia?
(a) Oxygen therapy and antibiotics.
(b) Bronchoscopy
(c) Analgesics only.
(d) Observation and follow-up only.
Answer:
(a) Oxygen therapy and antibiotics.

Oxygen therapy to prevent respiratory failure and antibiotics to treat the underlying cause are the approach of choice for the treatment of bacterial pneumonia. Other ancillary management options include analgesics and fluid rehydration. Oxygen therapy ensures adequate oxygenation, while antibiotics help to treat the underlying bacterial infection responsible for aspiration pneumonia. These interventions aim to stabilize the patient’s condition and prevent further complications.

Question 44.
Which of the following correctly describes bronchial asthma?
(a) An autoimmune disorder of the airways.
(b) A degenerative disorder of the airways.
(c) A hypersensitivity disorder of the airways.
(d) An acute inflammatory disorder of the airways.
Answer:
(c) A hypersensitivity disorder of the airways.

Bronchial asthma is a type 1 hypersensitivity reaction of the airways, which presents with airway hyperresponsiveness, wheezing, cough, and dyspnea. Patients with mild to moderate cases experience chest tightness, breathlessness, wheezing, and cough. Symptoms are often worse during sleep. On presentation, signs include wheezing, tachypnea, pulsus paradoxus, tachycardia, and breathlessness, evidenced by the use of the accessory muscles of respiration. Patients with severe exacerbations present with altered consciousness, cyanosis, and a silent chest. In chronic cases, patients have barrel-shaped chests and hyperinflated lungs.

Question 45.
A 15-year-old boy with asthma is brought to the emergency room following a recent severe exacerbation. Which sign can be helpful to an emergency nurse in diagnosing acute severe asthma?
(a) Pulsus alternans.
(b) Pulsus parvus.
(c) Irregular pulse.
(d) Pulsus paradoxus.
Answer:
(d) Pulsus paradoxus.

Pulsus paradoxus is an important clinical sign that can help diagnose acute severe asthma. Pulsus paradoxus manifests as an excessive decrease in the amplitude of the pulse during inspiration. In severe asthma exacerbations, there is a decrease in the intrathoracic pressure during inspiration, which leads to decreased venous return and left ventricular filling. The process causes a significant reduction in blood pressure during inspiration, a clinical sign known as pulsus paradoxus. Pulsus parvus is seen in aortic stenosis, and irregular respirations may occur in some arrhythmia.

Question 46.
A patient be assessed for which of the following before undergoing CT angiography?
(a) Recent consumption of food.
(b) Allergy to iodinated contrast agents.
(c) Prior history of hypertension.
(d) Level of consciousness.
Answer:
(b) Allergy to iodinated contrast agents.

Before undergoing CT angiography, it is crucial to assess whether the patient is allergic to iodinated contrast agents, as these are commonly used in the procedure. An allergic reaction can lead to serious complications, including anaphylaxis.

Question 47.
A 65-year-old chronic smoker presents to the emergency room with progressive breathlessness and is diagnosed with chronic obstructive pulmonary disease. Which conditions are a pathological variant of chronic obstructive pulmonary disease?
(a) Chronic asthma.
(b) Eosinophilic asthma.
(c) Emphysema.
(d) Bronchopneumonia. 
Answer:
(c) Emphysema.    

Emphysema is characterized by progressive destruction of the lung parenchyma with loss of elastic recoil, radial airway traction, and alveoli septa. Patients with emphysema are typically referred to as pink puffers, with cachectic appearance, pursed-lip breathing, dome-shaped chest, and use of accessory muscles of respiration.

Question 48.
A senior emergency nurse asks a nurse intern to describe chronic bronchitis. Which of the following is a correct description?
(a) A chronic obstructive pulmonary disease characterized by chest pain and dizziness.
(b) A chronic obstructive pulmonary disease characterized by a persistent cough lasting three months for two consecutive years.
(c) A chronic obstructive pulmonary disease characterized by the destruction of the alveolar walls.
(d) A chronic obstructive pulmonary disease characterized by hypersensitivity to allergens.
Answer:
(b) Chronic bronchitis is a chronic obstructive pulmonary disease characterized by persistent cough lasting three months for two consecutive years.

Chronic bronchitis is characterized by a chronic productive cough that lasts for at least three months in two consecutive years. Smoking is the predominant risk factor for chronic bronchitis. Patients with chronic bronchitis are referred to as blue bloaters, with characteristic cyanosis, edema, chronic productive cough, leg swelling, and pulmonary hypertension.

Question 49.
A patient who recently had a suction curettage procedure presents to the emergency room with signs of sepsis. Which complication from the procedure could be a potential cause for her current condition?
(a) Gas embolism.
(b) Infection.
(c) Hemorrhage.
(d) Ovarian torsion.
Answer:
(b) Infection.

Although suction curettage is generally a safe procedure, it has risks. One of the potential complications is an infection, which can occur if any pregnancy tissue is left behind or bacteria enter the uterus during the procedure. This can subsequently lead to sepsis if not treated promptly.

Question 50.
Which of the following describes empyema thoracis?
(a) Pneumonia contracted in a hospital setting after 48 to 72 hours of admission.
(b) Pneumonia contracted outside of the hospital setting.
(c) Pneumonia contracted by prolonged endotracheal intubation.
(d) Collection of pus within the pleural space.
Answer:
(d) Collection of pus within the pleural space.

Empyema thoracis refers to a condition characterized by the collection of pus within the pleural space. It is frequently a complication of pneumonia. It presents with an accumulation of abscesses in the pleural cavity. It occurs due to the spread of infection from the lung parenchyma to the pleural space. The remaining options refer to nosocomial and community-acquired pneumonia, which are different types of pneumonia. Empyema thoracis, however, is a complication, not a type of pneumonia.

Question 51.
A 10-year-old boy is brought to the emergency room with a superficial burn injury' covering less than five percent of the body surface area. He is lethargic and has no other complaints apart from slight dyspnea. Physical examination shows black soot in the nostrils. How should the emergency nurse manage the patient?
(a) On an outpatient basis.
(b) On an inpatient basis.
(c) Surgery.
(d) In the ICU.
Answer:
(b) On an inpatient basis.

The presence of black soot in the nostrils indicates possible inhalation injury, which can be serious and may lead to respiratory complications. Additionally, his lethargy and dyspnea raise concerns about potential airway compromise and systemic effects of smoke inhalation. The patient should be admitted for close monitoring, observation, and appropriate treatment to address any respiratory issues or systemic complications that may arise.

Question 52.
Which of the following actions by the nurse is not the correct management of inhalation injury following burns?
(a) Removal from injury exposure.
(b) Oxygen therapy.
(c) Chest tube passage.
(d) Intubation. 
Answer:
(c) Chest tube passage.

Chest tube passage is not a management action in the immediate treatment of inhalation injury following burns. A patient with inhalation injury following burns is first removed from the injury contact. The patient is evaluated via a focused history and examination and then resuscitated via the ABCs. When inhalational injury is suspected, irrespective of the burn surface area or depth of injury, the patient should be admitted and managed on an inpatient basis.

Question 53.
Which clinical findings should alert the emergency nurse to the possibility of inhalational injury in a 12-year-old burn victim?
(a) Loss of nasal hairs and presence of soot.
(b) Nasal discharge.
(c) Bibasal crackles.
(d) Presence of burnt clothes.
Answer:
(a) Loss of nasal hairs and presence of soot.

Loss of nasal hairs and soot in the nasal passages are clinical findings that should alert the emergency nurse to the possibility of inhalation injury in a burn victim.

Question 54.
Which of the following is not a disease that causes obstructive patterns of pulmonary disease?
(a) Chronic asthma.
(b) Chronic bronchitis.
(c) Emphysema.
(d) Pulmonary fibrosis.
Answer:
(d) Pulmonary fibrosis.

Unlike chronic obstructive pulmonary disease, which causes an obstructive pattern of pulmonary disease, pulmonary fibrosis causes a restrictive pattern. Pulmonary fibrosis can be idiopathic or secondary to an underlying pathology. Causes of pulmonary fibrosis include idiopathic pulmonary fibrosis and other secondary causes, such as inflammatory conditions and diffuse infiltrating disorders. 

Question 55.
A nursing patient reads about the beneficial effects of long-term oxygen therapy. She learns that long-term oxygen therapy has been shown to improve survival in some patients with a particular disease. Which of the following conditions, in its most severe form, may require long-term oxygen therapy at home?
(a) Bronchial asthma.
(b) Cardiac asthma.
(c) Chronic obstructive pulmonary disease.
(d) Acute heart failure.
Answer:
(c) Chronic obstructive pulmonary disease.

Chronic obstructive disease in the severe state requires home-based oxygen therapy. COPD includes chronic bronchitis and emphysema. Patients with persistent hypoxia are treated with low-dose oxygen therapy at home. Oxygen therapy improves survival in COPD patients.

Question 56.
A 45-year-old man with lung cancer comes to the emergency room. Which of the following is a definitive treatment for pleural effusion?
(a) Needle thoracotomy.
(b) Chest tube.
(c) Analgesics.
(d) Bronchodilators.
Answer:
(b) Chest tube.

Pleural effusion is an accumulation of fluid within the pleural space. Causes are varied and classified as either transudates or exudates. Diagnosis is clinical and confirmed by chest X-ray. However, thoracocentesis and analysis of the pleural fluid are needed to diagnose the cause. Treatment modalities include thoracocentesis, pleurectomy, and chest tube drainage.

Question 57.
A 65-year-old man with a 30-pack-year history of smoking presents to the emergency room with chronic cough, weight loss, and dyspnea. A chest X-ray shows a mass in the superior portion of the lung, blunting of the costophrenic angles, and homogenous opacity at the base of the lung. Which of the following clinical findings can be deduced from the chest X-ray?
(a) Pleural effusion.
(b) Mesothelioma.
(c) Pulmonary fibrosis.
(d) Pericardial effusion.
Answer:
(a) Pleural effusion.

The chest X-ray findings described, including blunting of the costophrenic angles and homogenous opacity at the base of the lung, indicate pleural effusion. Pleural effusion is fluid accumulation in the pleural space, seen as a homogenous opacity on a chest X-ray. Mesothelioma, pulmonary fibrosis, and pericardial effusion do not exhibit the same X-ray findings as described.

Question 58.
Which of the following is the emergency treatment modality for tension pneumothorax?
(a) Needle thoracocentesis.
(b) Chest tube drainage.
(c) Thoracotomy.
(d) Pleurectomy.
Answer:
(a) Needle thoracocentesis.

Tension pneumothorax is the accumulation of air in the pleural space with cardiopulmonary compromise. It is an emergency and is treated with an immediate needle thoracocentesis. Primary pneumothorax occurs in young men with a tall and thin habitus. There is typically no underlying lung disease. Secondary spontaneous pneumothorax occurs in patients with underlying pulmonary pathology. Traumatic pneumothorax occurs due to blunt or penetrating trauma to the chest wall. Iatrogenic pneumothorax occurs due to surgical interventions like thoracocentesis, transthoracic needle aspiration, mechanical ventilation, and others.

Question 59.
Which of the following findings on an ECG suggests left ventricular hypertrophy?
(a) A tall R wave in V1 and a deep S wave in V5 or V6.
(b) Prolonged PR interval.
(c) ST-segment depression and T wave inversion in leads II, III, and aVF.
(d) A presence of Q wave in lead III.
Answer:
(a) A tall R wave in V1 and a deep S wave in V5 or V6.

One electrocardiographic criterion for diagnosing left ventricular hypertrophy is the presence of a tall R wave in Vi combined with a deep S wave in V5 or V6. The sum of the amplitudes of the R wave in V1 and the S wave in V5 or V6 exceeding 35 mm is one of the criteria suggestive of LVH. The other options are not specific criteria for LVH. 

Question 60.
A 38-year-old male presents to the emergency room with severe dyspnea and decreased breath sounds on the left side. He was recently involved in a motorcycle accident. The trachea is deviated to the right. What is the most immediate and appropriate intervention for this patient?
(a) Chest X-ray.
(b) High-flow oxygen.
(c) Needle thoracocentesis.
(d) Broad-spectrum antibiotics.
Answer:
(c) Needle thoracocentesis.

Tension pneumothorax is a life-threatening condition characterized by the progressive buildup of air within the pleural space, which leads to lung collapse and mediastinal shift. Immediate decompression via needle thoracocentesis is essential to relieve the pressure and prevent cardiovascular collapse. While imaging studies can help confirm the diagnosis, they should not delay immediate intervention in a clinically apparent tension pneumothorax.

Question 61.
Which of the following investigations is the most appropriate initial tool for assessing a patient brought into the emergency room with features suggestive of pneumothorax?
(a) Echocardiogram.
(b) Electrocardiograph.
(c) Abdominal ultrasound scan.
(d) Chest X-ray.
Answer:
(d) Chest X-ray.

The most appropriate initial tool for assessing a patient with features suggestive of pneumothorax is a chest X-ray. Features suggestive of pneumothorax on chest X-ray include hyperinflated lung, hyperlucent lung shadows, and features suggestive of mediastinal shift in cases of tension pneumothorax. In summary, a chest X-ray can help confirm the presence of pneumothorax by showing characteristic findings, such as the absence of lung markings beyond the edge and potential mediastinal shift.

Question 62.
Which of the following features on chest examination suggest pneumothorax?
(a) Stony, dull percussion notes.
(b) Increased breath sounds.
(c) Hyperresonant percussion notes.
(d) Silent chest. 
Answer:
(c) Hyperresonant percussion notes.

The characteristic chest examination finding of pneumothorax on percussion is* hyperresonant percussion notes. Normally, a chest examination is resonant, barring cardiac and hepatic dullness. However, hyperresonant percussion notes on chest examination are suggestive of pneumothorax. Percussion notes are stony, dull in pleural effusion, and dull in pneumonia.

Question 63.
Which of the following investigations is most reliable in the definitive diagnosis of asthma?
(a) Chest X-ray.
(b) Chest CT scan.
(c) Chest MRI.
(d) Spirometry.
Answer:
(d) Spirometry.

Spirometry is an investigation used to measure pulmonary function. Asthma is a type 1 hypersensitivity disorder characterized by airway hyperresponsiveness, which leads to airway obstruction, chest tightness, and wheezing. Spirometry is the most reliable investigation in the definitive diagnosis of asthma. The lung function test assesses the volume and degree of breathing dynamics. It can aid in the diagnosis of asthma and assess its severity.

Question 64.
Which of the following is correct about acute pulmonary edema?
(a) Noncardiogenic pulmonary edema can be caused by left ventricular failure.
(b) Noncardiogenic pulmonary edema can be caused by acute respiratory distress syndrome (ARDS).
(c) Noncardiogenic pulmonary edema can be caused by myocardial infarction.
(d) Cardiogenic pulmonary edema can be caused by drowning.
Answer:
(b) Noncardiogenic pulmonary edema can be caused by acute respiratory distress syndrome (ARDS).

ARDS is a type of noncardiogenic pulmonary edema that can be caused by various factors, which include severe infections, trauma, aspiration, or inhalation injury. Noncardiogenic causes include fluid overload, drowning, aspiration pneumonitis, respiratory distress syndrome, allergic reactions, and acute kidney injury. Clinical features include chest tightness, difficulty breathing, pain, worsening cyanosis, diaphoresis, and anxiety. Patients with cardiogenic causes present with cardiovascular symptoms like murmurs, distended neck veins, hypertension, and hepatomegaly.

Question 65.
Which of the following is a clinical sign in support of acute pulmonary edema?
(a) A fourth heart sound was detected on examination.
(b) Bibasal crackles on cardiac auscultation.
(c) Hyperresonant chest percussion notes.
(d) Increased breathing sounds.
Answer:
(b) Bibasal crackles on cardiac auscultation.

Acute pulmonary edema is characterized by bibasal crackles on lung auscultation. These bibasal crackles result from the accumulation of fluid in the alveoli, which results in impairment of gas exchange and the resultant characteristic crackle sounds during breathing. Acute pulmonary edema can be classified into cardiogenic and noncardiogenic.

Question 66.
A patient presents with features suggestive of acute cardiogenic pulmonary edema. Which of the following is not an appropriate initial management action by the emergency nurse?
(a) Place the patient in the cardiac position.
(b) Administer intranasal oxygen.
(c) Administer diuretics.
(d) Administer intravenous fluids.
Answer:
(d) Administering intravenous fluids.

Intravenous fluids should be withheld or used with caution in patients with acute pulmonary edema. The approved treatment actions include intranasal oxygen and diuretics. Intravenous fluids may exacerbate fluid overload and worsen the condition.

Question 67.
Which medications can provide symptomatic relief in patients with acute cardiogenic pulmonary edema?
(a) Furosemide.
(b) Verapamil.
(c) Thiazides.
(d) Procainamide.
Answer:
(a) Furosemide.

Furosemide is a popular loop diuretic commonly used to relieve pulmonary congestion in patients with acute cardiogenic pulmonary edema. It helps with diuresis and withdrawal of fluids in the pulmonary interstitium. This reduces pulmonary congestion. Furosemide also helps reduce preload and pulmonary congestion.

Question 68.
Which of the following is a strong risk factor for acute pulmonary embolism?
(a) Deep vein thrombosis.
(b) Heart failure.
(c) Asthma.
(d) Chronic obstructive pulmonary disease. 
Answer:
(a) Deep vein thrombosis.

Deep vein thrombosis is a primary cause of pulmonary embolism.

Question 69. 
A 50-year-old long-distance driver develops a sudden onset of dyspnea and chest pain. The patient is also noticed to have DVT on examination. Cardiac enzymes are normal. What is the most likely diagnosis?
(a) Acute pulmonary embolism.
(b) Acute respiratory distress syndrome.
(c) Acute severe asthma.
(d) COPD.
Answer:
(a) Acute pulmonary embolism.

Acute pulmonary embolism occurs when a blood clot (usually from deep vein thrombosis) travels to the lungs and obstructs blood flow in the pulmonary arteries. This obstruction impedes the heart’s ability to pump blood effectively, resulting in obstructive shock.

Question 70.
A patient presents to the emergency room with features of non-severe ARDS. What should the emergency nurse recommend for airway management?
(a) Intranasal oxygen by face mask.
(b) Intranasal oxygen by nasal cannula.
(c) Mechanical ventilation.
(d) Continuous positive airway pressure.
Answer:
(d) Continuous positive airway pressure.

In patients with acute respiratory distress syndrome (ARDS), the main goal is to maintain adequate oxygenation while preventing further lung injury. CPAP provides constant positive pressure throughout the respiratory cycle, which can help improve oxygenation and recruit collapsed alveoli. Mechanical ventilation might be used in severe cases of ARDS when non-invasive ventilation methods fail or if there are other indications. However, the preference is to avoid intubation if possible due to associated risks. Intranasal oxygen by face mask or nasal cannula might not provide sufficient support for someone in ARDS. It is  
worth noting that the exact approach might vary based on the patient’s individual condition and clinical guidelines.

Question 71.
Which of the following describes flail chest?
(a) Fracture of one rib.
(b) Fracture of three or more adjacent ribs on the same side.
(c) Fracture of the sternum.
(d) Fracture of the clavicle.
Answer:
(b) Fracture of three or more adjacent ribs on the same side.

Flail chest is caused by the fracture of more than three adjacent ribs from blunt or penetrating trauma. The broken ribs move paradoxically during breathing (i.e., inward during inspiration and outward during expiration). Treatment includes acute resuscitation and stabilization for patients with multiple injuries. Supportive management of symptoms includes IV analgesia for pain relief, supplemental oxygen, and mechanical ventilation where indicated. IV fluids and surgery may be required for specific patients.

Question 72.
A patient presents to the emergency room after sustaining an injury to the ribs. Paradoxical breathing is seen in which of the following conditions?
(a) Flail ribs.
(b) Flail chest.
(c) Flail sternum.
(d) Unstable ribs.
Answer:
(b) Flail chest.

Flail chest is caused by the fracture of more than three adjacent ribs from blunt or penetrating trauma.

Question 73.
Which of the following correctly describes hemothorax?
(a) Accumulation of blood within the pericardial space due to trauma.
(b) Accumulation of blood within the pleural space due to trauma.
(c) Accumulation of chyle within the pericardial space due to trauma.
(d) All of the above.
Answer:
(b) Accumulation of blood within the pleural space due to trauma.

Hemothorax is the accumulation of blood within the pleural space due to penetrating injuries that lacerate the lung, internal mammary artery, or intercostal vessels. Clinical features include difficulty breathing. On examination, the affected side has decreased percussion notes and breath sounds. These may not be easily elicited in patients with multiple injuries. Patients may also present with hypovolemic shock. Treatment is acute resuscitation with oxygen, mechanical ventilation, IV fluids, vasopressors, and blood - products where indicated, chest tube thoracostomy, and thoracotomy in select cases.

Question 74.
A 36-year-old woman is involved in a road traffic accident. The patient has some chest bruises and is in distress. Further evaluation reveals massive hemothorax. Which of the following is the treatment of choice for massive hemothorax?
(a) Pleurectomy.
(b) Pleurodesis.
(c) Chest tube passage.
(d) Surgery. 
Answer:
(c) Chest tube passage.

Chest tube insertion is used in the management of massive hemothorax.

Question 75. 
A patient presents to the emergency room with yellowing of the skin and sclera. What is this clinical manifestation?
(a) Cyanosis.
(b) Erythema.
(c) Pallor.
(d) Jaundice.
Answer:
(d) Jaundice.

Jaundice is a yellow discoloration of the skin, mucous membranes, and sclera of the eyes. It is caused by an accumulation of bilirubin in the bloodstream and tissue. Bilirubin is a yellow compound produced when red blood cells break down. Elevated levels of bilirubin can result from liver disease, hemolysis, or other conditions affecting bilirubin metabolism or excretion. 

Question 76.
A patient diagnosed with hypertriglyceridemia is being educated about lifestyle modifications in the emergency room. Which is the most appropriate recommendation for managing this condition?
(a) Increased intake of trans fats.
(b) Regular aerobic exercise
(c) Regularly consume large amounts of alcohol.
(d) Limit fluid intake to one liter per day.
Answer:
(b) Regular aerobic exercise.

Regular aerobic exercise can help lower triglyceride levels and is often recommended for patients with hypertriglyceridemia. Aerobic activities include walking, jogging, swimming, and cycling.

Question 77.
Which is the management of severe flail chest that is not amenable to medical therapy?
(a) Counseling.
(b) Observation and follow-up.
(c) Surgery.
(d) Continued medical therapy.
Answer:
(c) Surgery.

Flail chest is caused by the fracture of more than three adjacent ribs from blunt or penetrating trauma. Surgery may be required for specific patients.

Question 78.
A 35-year-old driver presents in the emergency room with chest trauma after a road traffic accident. Which is the likely complication of pulmonary contusion?
(a) ARDS.
(b) Asthma.
(c) Cardiac asthma.
(d) Mesothelioma.
Answer:
(a) ARDS.

Acute respiratory distress syndrome can complicate pulmonary contusion.

Question 79.
Which of the following conditions can cause pulmonary hypertension?
(a) Malignant hypertension.
(b) Laryngomalacia.
(c) Tonsillitis.
(d) Acute pulmonary embolism.
Answer:
(d) Acute pulmonary embolism.

Pulmonary hypertension can be caused by acute pulmonary embolism.

Question 80.
A 50-year-old patient with emphysema presents to the emergency room for evaluation of right ventricular failure. What is the underlying pulmonary disease that can cause right ventricular failure?
(a) Cardiac asthma.
(b) Right ventricular infarction.
(c) Cor pulmonale.
(d) Right atrial enlargement. 
Answer:
(c) Cor pulmonale.

Right ventricular failure due to underlying pulmonary disease is referred to as cor pulmonale.

Question 81.
A 40-year-old woman with ataxia, gait abnormalities, and paresthesia is brought to the clinic for evaluation. The patient is diagnosed with multiple sclerosis. What is multiple sclerosis?
(a) Autoimmune disorder.
(b) Allergic disorder.
(c) Infectious disorder.
(d) Acute inflammatory disorder.
Answer:
(a) Autoimmune disorder.

Multiple sclerosis is an autoimmune disorder that affects the central nervous system.' Paresthesia is the most common early feature of multiple sclerosis. It can affect the upper and lower extremities, the trunk, or part of the face. Paresthesia is associated with muscle weakness. Visual disturbances are also early signs. They include optic neuritis, scotomas, and internuclear ophthalmoplegia. Other clinical features are vertigo, disturbance of gait, bladder dysfunction characterized by hesitancy, frequency, urgency, retention or incontinence, and disturbances of cognition and mood.

Question 82.
A 42-year-old woman is being evaluated for multiple sclerosis. She had an episode of sudden loss of vision a month ago. She has tingling and painful sensations in her limbs, unsteady gait and balance. Multiple sclerosis primarily affects people from which demographic?
(a) Males.
(b) Elderly.
(c) Females.
(d) Neonate.
Answer:
(c) Females.

MS affects individuals of various origins and characteristics, but it is more common in females. Treatment includes corticosteroids and immunomodulators to slow the immune response, baclofen to treat muscle spasticity, analgesia with Gabapentin or tricyclic antidepressants, and symptomatic management. 

Question 83.
Which of the following is correct about multiple sclerosis?
(a) It is an upper motor neuron disorder.
(b) It is a lower motor neuron disorder.
(c) It is a peripheral neuropathy.
(d) It is a vasculopathy.
Answer:
(a) It is an upper motor neuron disorder.

Multiple sclerosis is an upper motor neuron disorder. The damage to the myelin sheath in the CNS affects the upper motor neurons responsible for transmitting nerve signals from the brain to the spinal cord and peripheral nerves. The disrupted signals lead to impaired motor function, sensory disturbances, and other neurological deficits.

Question 84.
A 38-year-old woman is being managed for acute exacerbation of multiple sclerosis. She feels much better compared to a week ago. The muscle spasticity and pain have reduced. Which of the following is not a clinical manifestation of multiple sclerosis?
(a) Paresthesia.
(b) Vertigo.
(c) Optic neuritis.
(d) Fasciculations.
Answer:
(d) Fasciculations.

Involuntary muscle twitches or contractions called fasciculations are not typical clinical manifestations of multiple sclerosis. Paresthesia is the most common early feature.

Question 85.
A patient on follow-up for multiple sclerosis worries about her worsening muscle spasticity. Which of the following agents can be used to treat this?
(a) Baclofen.
(b) Corticosteroids.
(c) Antibiotics.
(d) Lidocaine. 
Answer:
(a) Baclofen.

Treatment of multiple sclerosis includes corticosteroids and immunomodulators to slow down the immune response, baclofen to treat muscle spasticity, analgesia with Gabapentin or tricyclic antidepressants, and symptomatic management.

Question 86.
A 45-year-old woman presents to the emergency room with progressive paresthesia, gait ataxia, and hypertonia. She was diagnosed with multiple sclerosis. Which drug is used in the management of multiple sclerosis?
(a) Antibiotics.
(b) Antifungals.
(c) Anesthetic agents.
(d) Corticosteroids.
Answer:
(d) Corticosteroids.

Multiple sclerosis primarily presents with upper motor neuron symptoms. The upper motor neuron symptoms include hypertonia and hyperreflexia. Multiple sclerosis is caused by inflammation and damage in the white matter of the brain. The white matter is made up of nerve fibers covered by a myelin sheath. Multiple sclerosis is an autoimmune disorder characterized by autoantibodies in the neurons in the CNS. The autoimmune reaction disrupts nerve signaling. This causes a wide range of neurological symptoms. The treatment is carried out with immunomodulators and steroids.

Question 87.
A 25-year-old woman with myasthenia gravis is admitted to the emergency room for treatment after developing progressive weakness unamenable to her usual medications. Which of the following does Myasthenia gravis primarily affect?
(a) Brain and spinal cord.
(b) Peripheral nerves and muscles.
(c) Neuromuscular junction.
(d) Muscles only.
Answer:
(c) Neuromuscular junction.

Myasthenia gravis is an autoimmune disorder that involves the neuromuscular junction.

Question 88.
A senior nurse teaches the nursing students about myasthenia gravis. How is Myasthenia gravis best described?
(a) Autoimmune disorder.
(b) Allergic disorder.
(c) Infectious disorder.
(d) Acute inflammatory disorder.
Answer:
(a) Autoimmune disorder.

Myasthenia gravis is caused by the autoimmune destruction of acetylcholine receptors. An autoimmune disorder occurs when the body starts attacking and destroying its own tissues It differs from an allergic disorder in which an external or foreign antigen causes an excessive or exaggerated immune response. It is not an infectious disorder, as it cannot be spread from person to person, nor is it an acute inflammatory disorder. 

Question 89.
A 44-year-old woman presents to the emergency room with worsening limb weakness. The patient is being treated for myasthenia gravis and is on medications. Which of the following is a clinical manifestation of myasthenia gravis?
(a) Ptosis.
(b) Proptosis.
(c) Hypertonia.
(d) Seizures.
Answer:
(a) Ptosis.

Myasthenia gravis is a neuromuscular disorder caused by autoimmune destruction of acetylcholine receptors. The most common symptoms are ptosis, double vision, and muscle weakness that worsens as the day progresses. Some patients may experience bulbar symptoms like dysphagia, choking, and regurgitation. In severe cases, patients experience myasthenic crises characterized by quadriparesis and respiratory distress that require urgent mechanical ventilation. Treatment involves the use of anticholinesterase drugs, corticosteroids, plasma exchange, IV immune globulin, and thymectomy.

Question 90.
Which statement correctly describes the muscle weakness associated with myasthenia gravis?
(a) Worsens with activity and improves with rest.
(b) Improves as the day progresses.
(c) Unrelated to activity.
(d) Affects only limb muscles. 
Answer:
(a) Worsens with activity and improves with rest.

The most common symptoms of myasthenia gravis are ptosis, double vision, and muscle weakness that worsens during activity and improves with rest. This pattern is due to acetylcholine having fewer receptors to bind to during activity because they have been destroyed. Patients usually become symptomatic when more than two-thirds of the receptors have been destroyed. The muscles affected in myasthenia gravis are typically the extraocular muscles, bulbar, and proximal limb muscles. The muscle weakness is specific and not generalized.

Question 91.
Which of the following describes myasthenia crisis?
(a) Severe exacerbation of myasthenia gravis symptoms, often involving weakness in the respiratory muscles.
(b) Myasthenia gravis symptoms involving the brain.
(c) Myasthenia gravis symptoms involving the spinal cord.
(d) Myasthenia gravis symptoms involving the eyeball.
Answer:
(a) Severe exacerbation of myasthenia gravis symptoms often involving weakness in the respiratory muscles.

A myasthenic crisis is a severe exacerbation of myasthenia gravis symptoms, which can include profound weakness in the respiratory muscles. This can lead to respiratory failure, requiring urgent medical intervention and possibly mechanical ventilation to assist with breathing.

Question 92.
Which surgery is effective in the treatment of myasthenia gravis?
(a) Thymectomy.
(b) Myomectomy.
(c) Appendectomy.
(d) Thyroidectomy.
Answer:
(a) Thymectomy.

Thymectomy, the surgery performed to remove the thymus gland, is an important option for treatment in patients with myasthenia gravis, especially in patients with a thymoma (thymus gland tumor). Other treatment options involve the use of anticholinesterase drugs, corticosteroids, plasma exchange, and IV immune globulin.

Question 93.
Which condition is also known as acute inflammatory demyelinating polyneuropathy?
(a) Myasthenia gravis.
(b) Multiple sclerosis.
(c) Guillain-Barre syndrome.
(d) Measles.
Answer:
(c) Guillain-Barre syndrome.

Guillain-Barre syndrome has several subtypes, with acute inflammatory demyelinating polyneuropathy being the most common in the US. It is a medical emergency that requires prompt support of respiration and treatment in the ICU with plasmapheresis or IV immune globulin. 

Question 94.
Which monitoring action by an emergency nurse is of the best prognostic importance in a 45-year-old man managed for Guillain-Barre syndrome?
(a) Pulse rate.
(b) Respiratory rate.
(c) Blood pressure.
(d) Temperature.
Answer:
(b) Respiratory rate.

In Guillain-Barre syndrome, the progressive muscle weakness can extend to the respiratory muscles, potentially causing respiratory failure. Therefore, monitoring the patient’s respiratory rate is of utmost importance.

Question 95.
Where are patients with myasthenia gravis involving respiratory muscles best managed?
(a) Stroke unit.
(b) Emergency unit.
(c) Intensive care unit.
(d) Special care baby unit.
Answer:
(b) Respiratoiy rate.

In Guillain-Barre syndrome, the progressive muscle weakness can extend to the respiratory muscles, potentially causing respiratory failure. Therefore, monitoring the patient’s respiratory rate is of utmost importance.

Question 96.
Which of the following infections is associated with Guillain-Barre syndrome?
(a) Staphylococcus.
(b) Candida.
(c) Campylobacter.
(d) Diphtheria. 
Answer:
(c) Campylobacter.

Campylobacter jejuni infection is one of the commonly associated infections with GuillainBarre syndrome. This is an acute polyneuropathy disease characterized by muscle paresis and loss of sensation in distal extremities. It is an autoimmune disease often triggered by infections of herpes viruses, Campylobacter jejuni, mycoplasma species, and enteric
viruses.

Question 97. 
A 35-year-old man presents to the emergency room after four days of ascending paralysis, which started in his lower legs and has since moved up the body. The patient is weak, breathless, and can barely talk. Which of the following complications of Guillain-Barre syndrome does the patient have?
(a) Respiratory failure.
(b) Idiopathic pulmonary fibrosis.
(c) Aspiration.
(d) Asthma.
Answer:
(a) Respiratory failure.

Considering the clinical presentation of patient-ascending paralysis and respiratory distress, respiratory failure is the most likely complication of the patient’s Guillain-Barre syndrome.

Question 98.
Which of the following is a complication of acute inflammatory demyelinating polyneuropathy?
(a) Respiratory failure.
(b) Idiopathic pulmonary fibrosis.
(c) Aspiration.
(d) Asthma.
Answer:
(a) Respiratory failure.

Respiratory failure is a complication of acute inflammatory demyelinating polyneuropathy, particularly in severe cases of Guillain-Barre syndrome.

Question 99.    
Which of the following statements about a 28-year-old woman with migraine headaches is correct?
(a) Migraines are primary-type headaches.
(b) Migraines are secondary-type headaches.
(c) Migraines usually occur for less than one minute.
(d) Migraines are not associated with vomiting.
Answer:
(a) Migraines are primary-type headaches.

Migraine headaches are a type of primary headache disorder. Underlying medical conditions or other external factors do not cause primary headaches. Migraines are characterized by recurrent episodes of severe throbbing head pain, often accompanied by other symptoms such as nausea, sensitivity to light and sound, and visual disturbances.

Question 100.
Which of the following statements about a 40-year-old man with cluster headaches is correct?
(a) Cluster headaches are primary-type headaches.
(b) Cluster headaches are secondary-type headaches.
(c) Cluster headaches occur for less than one minute
(d) Cluster headaches are associated with meningeal signs.
Answer:
(a) Cluster headaches are primary-type headaches.

Cluster headaches, together with migraine and tension headaches, are primary headaches. Headaches are classified as primary or secondary headaches. Cluster headaches are characterized by recurrent episodes of excruciatingly severe, one-sided head pain that occurs in clusters or groups. The pain is often centered around one eye and can be accompanied by symptoms such as eye redness, tearing, and nasal congestion. Migraines cause unilateral pain that is throbbing, associated with phonophobia and photophobia.

Question 101.    
A 30-year-old man is admitted to the emergency room with a unilateral severe headache in the frontal area associated with lacrimation, ptosis, and rhinorrhea. The patient is diagnosed with cluster headaches. Which of the following interventions is most effective in aborting the episode?
(a) Intravenous fluids.
(b) Antibiotics.
(c) Oxygen therapy.
(d) Anesthetics. 
Answer:
(c) Oxygen therapy.

Oxygen therapy is a proven and highly effective intervention for aborting an acute cluster headache episode. When administered as high-flow oxygen through a mask at a rate of 100% oxygen, it helps to abort acute attacks.

Question 102.
Which of the following causes a secondary-type headache?
(a) Migraine.
(b) Tension headache.
(c) Cluster headache.
(d) Giant cell temporal arteritis.
Answer:
(d) Giant cell temporal arteritis.

Giant cell arteritis, or temporal arteritis, is a medium-sized vasculitis that can present with secondary headache. Diagnosis of giant cell arteritis can be made by temporal artery biopsy and elevated ESR. Treatment options include glucocorticoids.

Question 103.
A 40-year-old woman comes to the urgent care clinic with complaints of headaches for the past weeks. She also has blurring vision. Which of the following causes of headaches is also known as pseudotumor cerebri?
(a) Idiopathic intracranial hypertension.
(b) Meningitis.
(c) Giant cell temporal arteritis.
(d) Encephalitis.
Answer:
(a) Idiopathic intracranial hypertension.

Pseudotumor cerebri, or idiopathic intracranial hypertension, is so named because it causes raised intracranial pressure despite no brain mass or tumor. It is common in middle-aged women and can present with clinical signs and symptoms of raised intracranial pressure, such as severe headaches, vision changes, and nausea. Treatment may involve reducing intracranial pressure through medications or surgical procedures.

Question 104.
What is the most common type of primary headache?
(a) Tension.
(b) Migraine.
(c) Cluster.
(d) Tremor.
Answer:
(a) Tension.

Of all the primary headaches, tension headaches are the most common. They are typically characterized by mild to moderate, non-localized, non-throbbing pain that feels like a tight band around the head. There is usually no associated neck stiffness, phonophobia, or photophobia. The headache is related to anxiety and stress.

Question 105.
A 45-year-old woman admitted to the emergency room is found to have raised intracranial pressure. Which of the following nursing actions will be most beneficial?
(a) Elevating the foot of the bed.
(b) Elevating the head of the bed.
(c) Placing her in the left lateral position.
(d) Placing her in the knee-chest position.
Answer:
(b) Elevating the head of the bed.

Raising the head of the bed at a 30 to 45-degree angle helps to promote venous drainage and reduce intracranial pressure. Improved drainage improves cerebral perfusion and halts the risk of further long-term neurologic deficits.

Question 106.
A patient’s CT scan showed the presence of cerebral edema. Intracranial pressure was also subsequently raised. Which of the following agents can be used to manage increased intracranial pressure?
(a) Mannitol.
(b) Labetalol.
(c) Intravenous fluids.
(d) Thiazides.
Answer:
(a) Mannitol.

In addition to the initial resuscitation and raising the head of the bed, osmotic agents such as mannitol are commonly used to manage of raised intracranial pressure. As an osmotic diuretic, mannitol draws fluid out of brain tissue and into the bloodstream, thereby treating cerebral edema and reducing intracranial pressure. Mannitol is administered intravenously and closely monitored to prevent side effects.

Question 107.
What clinical feature is associated with Cushing’s triad?
(a) Raised intracranial pressure.
(b) Diabetes.
(c) Hypoglycemia.
(d) Cardiac tamponade. 
Answer:
(a) Raised intracranial pressure.

Cushing’s triad refers to a triad of clinical signs seen in patients with raised intracranial pressure. It includes hypertension (elevated blood pressure), bradycardia (slower than normal heart rate), and irregular or abnormal breathing patterns. The triad is mainly seen in severely raised ICP and warrants immediate evaluation and urgent treatment. Diabetes, hypoglycemia, and cardiac tamponade are unrelated to Cushing’s triad.

Question 108.
A 17-day-old neonate is brought to the neonatal unit for evaluation for irritability and poor suck. Which of the following investigations is best for evaluating a patient with possible meningitis?
(a) Blood culture.
(b) Complete blood count.
(c) Peripheral blood smear.
(d) CSF analysis.
Answer:
(d) CSF analysis.

Analysis of the cerebrospinal fluid is a first-line investigation modality in the management of patients with meningitis. In this procedure, known as a lumbar puncture, a needle is inserted into the patient’s subarachnoid space at the L4 or L5 spinal vertebrae, level, and cerebrospinal fluid is withdrawn for chemical and microbiological analyses. This is the investigation of choice for confirming meningitis. Typically, observations in the CSF include the appearance, which can be clear (normal), yellow, or turbid if there is a bacterial infection (e.g., meningitis), and the presence of white blood cells, proteins, and glucose relative to the level of glucose in the body.

Question 109.
Which of the following is a common cause of meningitis in the adult population?
(a) Group B Streptococcus.
(b) E. coli.
(c) HIV.
(d) Streptococcus pneumonia.
Answer:
(d) Streptococcus pneumonia.

Streptococcus pneumonia and Neisseria meningitides are the leading causes of bacterial meningitis in the adult population, whereas E. coli and group B Streptococcus are common causes of bacterial meningitis in neonates. Strep. Pneumonia is a gram-positive bacterium that can cause severe infections, including meningitis. In addition to Strep pneumonia and N. meningitidis, Haemophilus influenzae type B (prior to widespread vaccination) was a common cause of meningitis in children.

Question 110.
Which of the following statements correctly describes meningitis?
(a) Inflammation of the brain parenchyma.
(b) Inflammation of the coverings of the brain.
(c) Inflammation of the spinal cord.
(d) Inflammation of the eyes.
Answer:
(b) Inflammation of the coverings of the brain.

Meningitis is the inflammation of the meninges, which are the protective coverings of the brain and spinal cord. Meningitis’s etiology includes various agents, including bacteria, viruses, fungi, and parasites. It results when any of these agents gain access to the central nervous system via the blood (hematogenous route), move retrograde via nerves (e.g., olfactory nerves), or by direct spread from contact (e.g., otitis media). For bacterial meningitis, specific bacteria are known to attack specific age groups.

The classical presenting triad of meningitis is fever, headaches, and neck stiffness. A lumbar puncture is done to identify the causal agent, and treatment is given appropriately. It can cause severe complications, such as neurological deficits, seizures, and even death if not promptly diagnosed and treated.

Question 111.
Febrile seizures are common in which demographic of patients?
(a) Adults.
(b) Children.
(c) Elderly.
(d) Middle-aged.
Answer:
(b) Children.

Seizures refer to spontaneous uncoordinated electrical misfiring in the neurons of the brain. Seizures are common both in adults and children. However, some seizures are more common in specific age groups. Febrile seizures occur in children under five years of age and are triggered by febrile illnesses, such as ear infections, malaria, respiratory tract infections, and urinary tract infections. Usually, these seizures do not result from a neurologic deficit or condition. Therefore, the prognosis of febrile convulsions is very good in children. Treatment options for seizures include anticonvulsants.

Question 112.
Absence seizures are common in which demographic of patients?
(a) Neonates.
(b) Elderly.
(c) School-age.
(d) Middle-aged.
Answer:
(c) School-age.

Absence seizures are most common in school-age children. They are generalized seizures, which cause the affected child to stare into space with a loss of awareness for a few seconds. In this type of seizure, the child is usually unaware of what happened over the time of the seizure and also has no memory of the seizures. They might have behavioral problems, deteriorating school performance, or generalized tonic-clonic seizures.

Question 113.    
Which of the following is not a type of focal seizure?
(a) Focal aware seizure.
(b) Focal impaired consciousness seizures.
(c) Absence seizures.
(d) Focal onset aware seizures. 
Answer:
(c) Absence seizures.

Absence seizures are generalized seizures.

Question 114.
Which of the following is the most common type of stroke?
(a) Ischemic.
(b) Hemorrhagic.
(c) Subarachnoid hemorrhage.
(d) All of the above.
Answer:
(a) Ischemic.

Ischemic strokes account for about 87 percent of all stroke cases. They are sometimes preceded by transient ischemic attacks, which result in short, temporary neurologic deficits followed by full recovery within 24 hours. In ischemic stroke, a thrombus or embolus blocks blood flow to the brain. Brain cells are suseptable to the absence of oxygen and, when deprived, begin to die in a few minutes. Hence, ischemic stroke is a medical emergency and requires prompt intervention for a better prognosis. Patients might present with weakness on the affected side of the body, slurred speech, facial deviation, headaches, and altered mental status. Anticoagulants are the mainstay of treatment in ischemic stroke, although they are more effective when administered within three and a half hours of the stroke. 

Question 115.
In which of the following types of stroke are anticoagulants contraindicated?
(a) Embolic.
(b) Thrombotic.
(c) Ischemic.
(d) Intracerebral hemorrhage.
Answer:
(d) Intracerebral hemorrhage.

Unlike ischemic stroke, hemorrhagic strokes worsen with anticoagulants and are contraindicated. This is because using anticoagulants increases the tendency of bleeding, which worsens the stroke. The most common etiology of hemorrhagic stroke is hypertension. Patients might present with seizures, headache, altered mental status, and weakness of the side controlled by the affected brain region. Management of hemorrhagic stroke can involve abortion of seizures, blood pressure control, control of intracranial pressure, and surgical evacuation.

Question 116.
Which of the following is not a risk factor for the development of stroke?
(a) Hypertension.
(b) Diabetes.
(c) Dyslipidmia.
(d) Meningitis.
Answer:
(d) Meningitis.

Of all the options mentioned, meningitis is not a risk factor for developing stroke. The leading risk factors for stroke include diabetes, hypertension, and dyslipidemia.

Question 117.    
Which of the following is not a possible complication of stroke?
(a) Raised intracranial pressure.
(b) Cerebral edema.
(c) Neurologic deficits.
(d) Diabetes.
Answer:
(d) Diabetes.

Diabetes is a risk factor, not a complication of stroke. The leading risk factors for stroke include diabetes, hypertension, and dyslipidemia. Diabetes refers to elevated blood sugar above the normal limits. There are two types; Type I, which is due to the presence of a deficiency in the production of insulin, and Type II, which is a result of the inability of the body to utilize the insulin produced, usually due to defective receptors and other factors.

Question 118.    
A 58-year-old known hypertensive patient presents with slurring of speech, facial deviation, and weakness of the left side of the body. Which of the following investigations helps make a diagnosis?
(a) Head ultrasound.
(b) Head computed tomography.
(c) Head X-ray.
(d) Liver function test.
Answer:
(b) Head computed tomography.

Computed tomography of the head is the first-line investigation in the evaluation of a ' stroke patient. It helps to rule out hemorrhagic stroke (which is indicated by hyper-dense lesions in the brain). Patients in which hemorrhage has been ruled out can then be managed as ischemic stroke with reperfusion therapy and anticoagulants. Head ultrasound cannot be used to diagnose stroke. Head X-rays cannot be used to diagnose stroke, as X-rays primarily show bones and not detailed soft tissue structures like the brain. Magnetic resonance imaging can also be used, but it takes more time.

Question 119.    
Which is true concerning the primary goal of treatment following a transient ischemic attack?
(a) Secondary prevention for stroke.
(b) Chronic fibrinolytic.
(c) Immediate surgery.
(d) Prevention of intracranial infection. 
Answer:
(a) Secondary prevention for stroke.

The main goal of treatment following a transient ischemic attack (TIA) is secondary prevention for stroke. Ischemic strokes are sometimes preceded by transient ischemic attacks, which result in short, temporary neurologic deficits followed by full recovery within 24 hours. TIA is a warning sign for stroke. Therefore, patients are started on secondary prophylaxis for stroke, such as anticoagulants and preventive evaluations. 

Question 120.
Which of the following scales can measure the depth of a head injury in the brain?
(a) ATLS scale.
(b) Glasgow Coma Scale.
(c) Jones scale.
(d) Duke’s scale.
Answer:
(b) Glasgow Coma Scale.

The Glasgow Coma Scale is used to assess and quantify the depth and duration of impaired consciousness in patients with traumatic brain injury. It evaluates three criteria: eye, verbal, and motor responses. The lowest possible score is three (deep coma or death), while the highest is 15 (fully awake and oriented person). The ATLS (Advanced Trauma Life Support) is a training program for medical providers to manage acute trauma cases, but it’s not a scale. Jones and Duke’s scales are not standard scales used to measure the depth of injury in traumatic brain injury.

Question 121.
A 20-year-old woman is rushed to the emergency room after the development of sudden-onset severe abdominal pain and fever. She also has anorexia and vomiting. Which of the following is not true about acute appendicitis?
(a) It is caused by obstruction of the appendix by fecaliths.
(b) Abdominal examination demonstrates tenderness in the right iliac fossa.
(c) It is associated with right iliac fossa pain, fever, anorexia, nausea, and vomiting.
(d) The treatment for acute appendicitis is cholecystectomy.
Answer:
(d) The treatment for acute appendicitis is cholecystectomy.

Appendicitis is treated through an appendectomy. If it is not treated early, appendicitis can lead to perforation and generalized peritonitis. Cholecystectomy is performed to remove the gallbladder.

Question 122.
A senior nurse asks a nursing student how to pick up generalized peritonitis on examination. Which statement is true regarding symptoms of acute generalized peritonitis?
(a) Generalized lymphadenopathy.
(b) Clinical jaundice.
(c) Clinical pallor.
(d) Rebound abdominal tenderness with guarding.
Answer:
(d) Rebound abdominal tenderness with guarding.

Patients with acute generalized peritonitis often exhibit rebound abdominal tenderness with guarding on examination. This clinical sign connotes widespread peritonitis (inflammation of the peritoneum, the thin membrane lining of the abdominal cavity). The other listed options, such as generalized lymphadenopathy, clinical jaundice, and clinical pallor, are not clinical signs seen in generalized peritonitis.

Question 123.
Which of the following is a possible complication of acute appendicitis?
(a) Perforation.
(b) Hepatitis.
(c) Cholecystitis.
(d) Malignant transformation.
Answer:
(a) Perforation.

If not treated early, appendicitis can lead to perforation and generalized peritonitis.

Question 124.
What is not a cause of upper gastrointestinal bleeding?
(a) Gastric ulcer.
(b) Duodenal ulcer.
(c) Esophageal varices.
(d) Esophageal webs.
Answer:
(d) Esophageal webs.

Esophageal webs are not a common cause of upper gastrointestinal bleeding. Upper gastrointestinal bleeding refers to bleeding above the ligament of Treitz and includes bleeding from the esophagus, stomach, and duodenum. Causes of upper gastrointestinal bleeding include esophagitis, esophageal rupture, esophageal varices, gastric and duodenal ulcers, and Meckel’s diverticulum. Upper gastrointestinal bleeding often presents with melena (dark stool for denatured blood) and hematemesis (vomiting blood).

Question 125.
A 53-year-old man comes to the urgent care clinic with complaints of rectal bleeding after stooling. He undergoes a lower GI endoscopy for evaluation. Which of the following is a common cause of lower gastrointestinal bleeding?
(a) Gastric ulcer.
(b) Duodenal ulcer.
(c) Esophageal varices.
(d) Diverticulitis. 
Answer:
(d) Diverticulitis.

Diverticulitis is a common cause of lower gastrointestinal bleeding. Lower gastrointestinal bleeding refers to bleeding below the ligament of Treitz and includes bleeding from the colon to the rectum. Causes of lower gastrointestinal bleeding include diverticulitis, tumors, hemorrhoids, and inflammatory bowel diseases. Lower gastrointestinal bleeding often presents with hematochezia (fresh stool mixed with stool). Gastric ulcers, duodenal ulcers, and esophageal varices are causes of upper gastrointestinal bleeding, not lower gastrointestinal bleeding.

Question 126.
A patient presents to the emergency room with complaints of abdominal discomfort. Upon examination, the nurse noted liver and spleen enlargement. What is this condition best termed?
(a) Hepatomegaly.
(b) Splenomegaly.
(c) Hepatosplenomegaly.
(d) Ascites.
Answer:
(c) Hepatosplenomegaly.

Hepatosplenomegaly is the simultaneous enlargement of the liver (hepatomegaly) and the spleen (splenomegaly). It can result from various conditions, including infections, blood disorders, or liver diseases.

Question 127.
Which of the following is a congenital gastrointestinal anomaly that may present with gastrointestinal bleeding, especially in pediatric patients?
(a) Sigmoid diverticulitis.
(b) Crohn’s disease.
(c) Peptic ulcer disease.
(d) Meckel’s diverticulum.
Answer:
(d) Meckel’s diverticulum.

Meckel’s diverticulum is a congenital outpouching of the small intestine that is present at birth. It is a common cause of gastrointestinal bleeding in pediatric patients and may result in symptoms such as painless rectal bleeding, abdominal pain, or other complications. Unlike other options listed, Meckel’s diverticulum is a specific congenital anomaly that can lead to gastrointestinal bleeding in younger individuals.

Question 128.
Which of the following organisms is implicated in the pathophysiology of peptic ulcer disease?
(a) E. coli.
(b) H. pylori.
(c) K. pneumonia.
(d) N. meningitides.
Answer:
(b) H. pylori.

Helicobacter pylori (H. pylori) is fundamental in the pathophysiology of peptic ulcer disease. Up to 90 percent of duodenal ulcers are associated with H. pylori. H. pylori is a gram-negative bacteria that infects the lining of the stomach and duodenum, which leads to inflammation and the formation of ulcers.

Question 129.
A 52-year-old woman presents to the emergency room with complaints of severe colicky right hypochondrial pain. The patient has no history suggestive of acute hepatitis. Abdominal ultrasound reveals acute cholecystitis. Which of the following is true about cholecystitis?
(a) It causes severe right iliac fossa pain.
(b) It causes severe right upper quadrant pain.
(c) It causes severe umbilical pain.
(d) It is painless.
Answer:
(b) It causes severe right upper quadrant pain.

Cholecystitis is gallbladder inflammation and presents with severe colicky right upper quadrant pain. It is frequently caused by infections, stones, and parasitic worms. This leads to the buildup of bile and pressure in the gallbladder, causing pain, tenderness, and sometimes fever. The treatment is completed through cholecystectomy.

Question 130.
Which of the following is true concerning liver cirrhosis?
(a) It is a form of acute liver disease.
(b) It is a form of chronic liver disease.
(c) It can be cured with antibiotics.
(d) It cannot be caused by infections. 
Answer:
(b) It is a form of chronic liver disease.

Liver cirrhosis is a form of chronic liver disease characterized by the irreversible scarring of the liver tissue. It develops from chronic hepatic inflammation caused by chronic hepatitis, autoimmune hepatitis, and metabolic liver diseases. This leads to the formation of regenerative liver nodules and progressive loss of liver secretory and metabolic functions. Clinical manifestations of liver cirrhosis include jaundice, xanthomas, spider nevi, gynecomastia, palmar erythema, Dupuytren’s contracture, testicular atrophy, and parotid gland enlargement. The disease is not acute, and while some causes of cirrhosis, such as certain infections, might be treated with antibiotics, cirrhosis itself cannot be cured.

Question 131.
A 35-year-old man with a 10-year history of chronic alcoholism develops alcoholic cirrhosis. Which of the following is not a manifestation of liver cirrhosis?
(a) Obesity.
(b) Jaundice.
(c) Testicular atrophy.
(d) Gynecomastia.
Answer:
(a) Obesity.

Obesity is not a manifestation of liver cirrhosis.

Question 132.
Which underlying condition is not typically associated with hepatosplenomegaly?
(a) Chronic alcoholism.
(b) Infectious mononucleosis.
(c) Sickle cell disease.
(d) Asthma.
Answer:
(d) Asthma.

Hepatosplenomegaly can be seen in various conditions, such as chronic alcoholism, which can lead to cirrhosis and liver enlargement; infectious mononucleosis, which can cause the spleen and liver to enlarge due to the infection; and sickle cell disease, where the abnormal sickle cells can clog the spleen and liver, leading to enlargement. Asthma is a respiratory condition that does not directly impact the liver or spleen and is not associated with hepatosplenomegaly.

Question 133.
A 45-year-old man with a history of multiple sexual partners develops liver cirrhosis secondary to chronic hepatitis B infection. The patient is decompensated, in distress, and has the facies of chronic liver disease. What is the definitive treatment for liver cirrhosis in this patient?
(a) Liver transplant.
(b) Antiviral agents.
(c) Immunomodulators.
(d) Steroids.
Answer:
(a) Liver transplant.

The definitive treatment of liver cirrhosis is through a liver transplant.

Question 134.
Which of the following viruses can be contracted by sexual intercourse?
(a) Hepatitis A virus.
(b) Hepatitis B virus.
(c) Hepatitis E virus.
(d) Coxsackievirus.
Answer:
(b) Hepatitis B virus.

Hepatitis B virus is a communicable disease. It can be contracted through sexual intercourse, blood transfusion, and sharing of sharps. Another route of spread is maternal-to-child vertical transmission during childbirth. Hepatitis A virus and hepatitis E virus are primarily transmitted through contaminated food or water and are not typically contracted through sexual intercourse.

Question 135.
Which virus depends on the hepatitis B virus to infect humans?
(a) Hepatitis A virus.
(b) Hepatitis D virus.
(c) Hepatitis E virus.
(d) Coxsackievirus.
Answer:
(b) Hepatitis D virus.

The Hepatitis D virus belongs to a group of viruses called Delta viruses. It lacks the envelope antigen and thus depends on the Hepatitis B virus to replicate and multiply within the host. It can cause co-infection, a situation where Hepatitis D and Hepatitis B viruses infect the host at the same time, or super-infection, where the Hepatitis D virus infects a person with an underlying Hepatitis B infection.

Question 136.
Which of the following is true about acute viral hepatitis?
(a) It lingers for over six months.
(b) It usually presents with fever, pruritus, right hypochondrial pain, and fatigue.
(c) It usually presents with weight loss.
(d) It usually presents with acute abdomen. 
Answer:
(b) It usually presents with fever, pruritus, right hypochondrial pain, and fatigue.

Acute viral hepatitis is an inflammatory liver condition caused by infection with one of the hepatitis viruses. The severity and duration of symptoms can vary depending on the specific virus and individual factors. Acute viral hepatitis is usually a self-limiting condition, which means that it resolves spontaneously, without specific treatment in most cases. However, in some cases, especially with hepatitis B and C, the infection may become chronic and lead to long-term liver damage.

Question 137.
A four-year-old boy presents to the emergency room with complaints of irritability and excessive crying. The patient has also been passing bloody stool. Abdominal examination reveals a sausage-shaped mass, and intussusception is diagnosed. Which of the following statements is true about intussusception?
(a) A portion of the bowel telescopes into an adjacent bowel segment.
(b) Common in teenagers.
(c) Only treated with surgery.
(d) Always idiopathic.
Answer:
(a) A portion of the bowel telescopes into an adjacent bowel segment.

Intussusception is the invagination or telescoping of a portion of the bowel into an adjacent bowel segment. This can cause a blockage in the intestinal tract, which leads to clinical features of intestinal obstruction such as progressive abdominal distension, vomiting, and change in bowel habits (inability to pass stool). This condition occurs more frequently in infants and young children and is considered a medical emergency that requires prompt treatment.

Question 138.
Which of the following is not a recognized treatment option for intussusception?
(a) Hydrotherapy.
(b) Air enema.
(c) Surgery.
(d) Radiation therapy.
Answer:
(d) Radiation therapy.

Radiation therapy is not standard medical management for intussusception.

Question 139.
Intussusception is common in which demographic of patients?
(a) Elderly.
(b) Adults.
(c) Children.    
(d) Females.    
Answer:
(c) Children.

Intussusception is more commonly seen in infants and younger children. It is frequently diagnosed in children between six months and two years, but it can also occur in older children and adults, although less frequently. Treatment can be by medical management (air enema and hydrotherapy) or surgical management.

Question 140.
A 45-year-old man presents to the emergency department with features suggestive of intestinal obstruction. Which instructions should the emergency nurse give the patient?
(a) Take nothing by mouth.
(b) Avoid using the toilet.
(c) Do not strain during urination.
(d) Adhere to antihypertensives.
Answer:
(a) Take nothing by mouth.

Generally, patients with intestinal obstruction are placed on nil per oris (nothing by mouth) and nasogastric tube decompression. Eating anything by mouth would further complicate the condition.

Question 141.
Which is a common cause of intestinal obstruction following abdominal surgery?
(a) Ileus.
(b) Malignancy.
(c) Inflammation.
(d) Diabetes.
Answer:
(a) Ileus.

Ileus is the reduction in the intestinal contractile force due to infection, surgery, or electrolyte abnormalities. Postoperative ileus occurs in surgical patients, and such patients are placed on nil per oris for a few hours or days, depending on the extent of the surgery. If patients are not placed on nil per oris and eat, they may experience intestinal obstruction. Regular feeding by mouth should commenced only when bowel movements have resumed, which can be heard by auscultation or observation of bowel movements from flatulence or stooling. 

Question 142.
While presenting during grand rounds, a senior emergency nurse explains that intestinal obstruction can be mechanical (dynamic) or adynamic. Which causes mechanical intestinal obstruction?
(a) Hypokalemia.
(b) Sepsis.
(c) Diabetes.
(d) Adhesions. 
Answer:
(d) Adhesions.

Adhesions occur when organs or tissues stick to surfaces as the body attempts to heal after a surgery or invasive procedure. Adhesions are very common after abdominal surgeries or explorations. Intestinal obstruction refers to an obstruction in the movement of digested food products through the intestinal lumen. It can result from mechanical obstruction (such as tumors and adhesions) or functional obstruction, such as the ileus.

Question 143.
A 58-year-old male patient presents with sudden severe lower abdominal pain, blood in his stools, and a history of chronic constipation. From what emergency condition related to the colon might the patient be suffering?
(a) Diverticulitis.
(b) Colonic polyps.
(c) Ulcerative colitis.
(d) Intussusception.
Answer:
(a) Diverticulitis.

Diverticulitis is an inflammation or infection of small pouches called diverticula that can form in the walls of the colon. Common symptoms include sudden pain (usually on the left side of the lower abdomen), fever, and sometimes, blood in the stools. Chronic constipation can increase the chances of developing diverticulitis due to increased pressure on the colon walls.

Question 144.
Which of the following is not correct about the management of acute pancreatitis?
(a) Place the patient on nil per oris.
(b) Give intravenous fluids.
(c) Administer analgesics.
(d) Ensure graded oral intake.
Answer:
(d) Ensure graded oral intake.

Graded oral intake is not an appropriate initial management modality for acute pancreatitis. The correct management of acute pancreatitis includes placing the patient on nil per oris and intravenous fluids to maintain hydration and electrolyte balance. Analgesics are used for pain relief, as acute pancreatitis can be very painful.

Question 145.
A 35-year-old man with morbid obesity presents to the emergency room with sudden-onset abdominal pain, which is epigastric, severe, and associated with fever and vomiting. The patient is diagnosed with acute pancreatitis after laboratory assays and imaging. 
Which is a leading cause of acute pancreatitis?
(a) Fever.
(b) Obesity.
(c) Malnutrition.
(d) Alcoholism.
Answer:
(d) Alcoholism.

Alcoholism is a leading cause of acute pancreatitis. Acute pancreatitis is an inflammation of the pancreas. The inflammation leads to leakage of proteolytic enzymes, which causes autodigestion of the pancreas and worsening pancreatitis. Pancreatitis causes epigastric pain that radiates to the back. Leading risk factors include chronic alcoholism, gallstones, and infections. Treatment involves placing the patient on nil per oris, intravenous fluids, and antibiotics.

Question 146.
Which of the following is not a risk factor/etiology of acute pancreatitis?
(a) Mumps infection.
(b) Hypertriglyceridemia.
(c) Chronic alcoholism.
(d) Gallstones.
Answer:
(a) Mumps infection.

Mump is not a risk factor/etiology of acute pancreatitis.

Question 147.
Which of the following signs is associated with acute pancreatitis?
(a) Rovsing’s sign.
(b) Psoas sign.
(c) Obturator sign.
(d) Cullen sign.
Answer:
(d) Cullen sign.

Cullen's sign is associated with acute pancreatitis. It refers to the appearance of periumbilical bruising, which can result from bleeding into the abdominal wall due to inflammation of the pancreas. 

Question 148.
A patient presents to the emergency room with complaints of continuous diarrhea, weight loss, and abdominal pain. He mentions a family history of gastrointestinal diseases. Which chronic inflammatory bowel disease is limited to the colon?
(a) Crohn’s disease.
(b) Irritable bowel syndrome (IBS).
(c) Celiac disease.
(d) Ulcerative colitis. 
Answer:
(d) Ulcerative colitis.

Ulcerative colitis is a chronic inflammatory bowel disease that affects only the innermost lining of the large intestine (colon) and rectum. Symptoms include continuous diarrhea (often with blood), abdominal pain, and weight loss. Unlike Crohn’s disease, which can affect any part of the digestive tract, ulcerative colitis only affects the colon.

Question 149.
Which investigation is appropriate in the evaluation of a 37-year-old patient with abdominal trauma following a road traffic accident?
(a) Abdominal X-ray.
(b) Chest X-ray.
(c) Abdominal ultrasound.
(d) EKG.
Answer:
(c) Abdominal ultrasound.

Abdominal ultrasound is fast, noninvasive, and provides quick information about the intra-abdominal organs. It helps diagnose hemoperitoneum and intra-abdominal injury.

Question 150.
A 45-year-old patient presents with a painful, swollen, red, and warm area on his leg. He recently had a minor cut at that site. The wound culture reveals a bacterial infection. Which bacterium is a common cause of skin infections following minor cuts or abrasions?
(a) Escherichia coli.
(b) Streptococcus pneumoniae.
(c) Staphylococcus aureus.
(d) Pseudomonas aeruginosa.
Answer:
(c) Staphylococcus aureus.

Staphylococcus aureus is a common bacterium found on the skin and in the nasal passages of many people. It can cause skin infections when there is a break in the skin, such as a cut or abrasion. The symptoms described (painful, red, swollen, and warm area) are consistent with a staphylococcal skin infection.

Question 151.
A 25-year-old man comes to the emergency room because of testicular pain. He mentions that he has had multiple sexual partners recently. He is diagnosed with epididymitis after evaluation. What is the most common cause of epididymitis in people of reproductive age?
(a) Chlamydia and Neisseria.
(b) Staphylococcus.
(c) E. coli.
(d) Klebsiella.
Answer:
(a) Chlamydia and Neisseria.    

Epididymitis, an infection of the epididymis, is most commonly caused by sexually transmitted microorganisms such as Chlamydia trachomatis and Neisseria gonorrhea in people of reproductive age. These organisms infect the genital tract and ascend through the urethra to infect the epididymis. This leads to pain and swelling of the scrotum.

Question 152.
Which of the following is a cause of testicular pain?
(a) Testicular torsion.
(b) Orchitis.
(c) Both A and B.
(d) Azoospermia.
Answer:
(c) Both A and B.

In the diagnosis of acute scrotal pain, testicular torsion and orchitis must be differentiated. Testicular torsion is caused by spermatic cord twists that cut off blood flow to the testicle, while orchitis is the inflammation of the testicle, often due to infection. Testicular pain from torsion is not relieved by lifting the scrotum, unlike orchitis, which is relieved by scrotal lifting.

Question 153.
A 35-year-old man with chronic hypercalcemia develops colicky right lumbar pain. Which of the following is a risk factor for the development of kidney stones?
(a) Hypercalcemia.
(b) Obesity.
(c) Diabetes.
(d) Hypertension. 
Answer:
(a) Hypercalcemia.

Hypercalcemia, an abnormally high level of calcium in the blood, is a risk factor for the development of kidney stones. Elevated levels of calcium can lead to the formation of calcium-based stones in the kidneys. Kidney stones cause recurrent colicky lumbar pain and vomiting. There is associated dysuria and hematuria. Treatment can be medical or surgical. 

Question 154. 
Which sign indicates a bladder injury in a patient who has experienced trauma?
(a) Hematuria.
(b) Epigastric tenderness.
(c) Right iliac fossa tenderness.
(d) Vomiting.
Answer:
(a) Hematuria.

Hematuria, the appearance of blood in the urine, is a common presentation of bladder disease. Hematuria with a bladder origin can be due to bladder cancer or bladder trauma. Bladder cancer primarily causes painless hematuria, while trauma can cause painful hematuria.

Question 155.
Urinary retention is a common complaint in elderly males. Which is not a risk factor for urinary retention?
(a) Benign prostatic hyperplasia.
(b) Urethral stricture.
(c) Prostatic adenocarcinoma.
(d) Urinary tract infection.
Answer:
(d) Urinary tract infection.

Urinary tract infection is a complication, not an etiology for urinary retention. Urinary retention is the bladder’s inability to fully empty urine, which causes residual urine buildup. The residual urine buildup causes fluid retention and pain. The pain is typically suprapubic and is moderate to severe. The buildup of residual urine can be a nidus for infection and lead to recurrent urinary tract infections.

Question 156.
Which of the following is true about dysfunctional uterine bleeding?
(a) It refers to any bleeding from the uterus during menstruation.
(b) It refers to uterine bleeding outside of the normal menstrual period.
(c) It is a physiological phenomenon.
(d) It does not need further evaluation and treatment.
Answer:
(b) It refers to uterine bleeding outside of the normal menstrual period.

Dysfunctional uterine bleeding is any bleeding that is different from normal menstrual bleeding. It can be in terms of volume or frequency of bleeding. Dysfunctional uterine bleeding is often caused by anovulation. Other conditions, like endometriosis and polycystic ovarian syndrome, can cause abnormal uterine bleeding. Still, they are not necessarily linked to anovulation or ovulatory disorders in the context of dysfunctional bleeding.

Question 157.
A 24-year-old woman arrives at the emergency room with sudden, severe abdominal pain. Which of the following is a potential diagnosis when considering gynecological causes for this acute abdominal presentation?
(a) Ovarian torsion.
(b) Pelvic inflammatory disease.
(c) Cystitis.
(d) Cervicitis.
Answer:
(a) Ovarian torsion.

This condition is an emergency. It is also called adnexal torsion and occurs when an ovary becomes curled around the surrounding tissues. In other cases, the fallopian tube can be curled as well. The patient will be in severe pain because there will be no blood supply to these organs during ovarian torsion.

Question 158.
Which of the following is the most common cause of postpartum hemorrhage?
(a) Uterine atony.
(b) Placenta previa.
(c) Placental abruption.
(d) Preeclampsia.
Answer:
(a) Uterine atony.

The most common cause of postpartum hemorrhage is uterine atony. Risk factors for uterine atony are 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 159.
A 24-year-old woman who recently had a miscarriage comes to the follow-up clinic. Which is the most common cause of spontaneous miscarriage in the first trimester?
(a) Infections.
(b) Uterine anomalies.
(c) Chromosomal abnormalities.
(d) IUFD.
Answer:
(c) Chromosomal abnormalities.

The most common cause of first-trimester miscarriage is chromosomal abnormalities. Other causes of miscarriage (in all trimesters) include viral infections (e.g., cytomegalovirus, rubella virus, parvovirus, and herpes virus), uterine anomalies, and major trauma to the uterus. Risk factors include older maternal age, substance abuse disorders, cigarette smoking, poorly controlled diabetes mellitus or hypertension, and thyroid disorders.

Question 160.
A researcher evaluates the relationship between some antepartum events and the development of maternal chorioamnionitis. Which of the following increases the risk of a patient developing chorioamnionitis?
(a) Prelabor rupture of membranes.
(b) Multiple gestations.
(c) Multiparity.
(d) Preeclampsia.
Answer:
(a) Prelabor rupture of membranes.

Prelabor rupture of membranes (PROM) is a rupture of membranes before the onset of labor. PROM can occur before term or at term. Irrespective of when it occurs, PROM poses a risk of obstetric infections and the development of chorioamnionitis. The risk of developing chorioamnionitis should always be balanced with the potential benefits of prolonging the pregnancy.

Question 161.
Which is not appropriate for the management of a patient brought to the mental health department with violent and aggressive behaviors?
(a) Chemical restraints.
(b) Therapeutic communication.
(c) Putting the patient in a separate room.
(d) Examination under anesthesia.
Answer:
(d) Examination under anesthesia.

The risk of violence is higher in patients with psychiatric conditions. Patients with psychiatric conditions who are violent should be handled with caution and ethically. The patient should be nursed alone in a room devoid of material that the patient can use to cause deliberate self-harm. The patients can also be restrained pharmacologically. However, examination under anesthesia is not a psychiatric procedure.

Question 162.
Which of the following anxiety disorders is most common in toddlers?
(a) Social anxiety disorder.
(b) Generalized anxiety disorder.
(c) Separation anxiety disorder.
(d) Panic disorders.
Answer:
(c) Separation anxiety disorder.

Individuals affected with separation anxiety disorder fear being separated from the people they are attached to. This often occurs in young children but can also be seen in adults. Affected individuals may experience nightmares of separation from their attachment figures. They may also experience physical symptoms when separated or when anticipating a separation.

Question 163.
What is the diagnosis for individuals who worry excessively that their actions at social gatherings can be negatively interpreted by others and, therefore, avoid them?
(a) Panic disorder.
(b) Generalized anxiety disorder.
(c) Social phobia.
(d) Separation anxiety disorder.
Answer:
(c) Social phobia.

Social anxiety disorder is also known as social phobia. Affected individuals have a deep fear of social situations. They worry that others may negatively interpret their actions. This leads to embarrassment, worry, and avoidance of social gatherings. 

Question 164.
Which of the following is used in the treatment of specific phobias?
(a) Systematic desensitization.
(b) Pharmacotherapy.
(c) Surgery.
(d) All of the above.
Answer:
(a) Systematic desensitization.

Specific phobias refer to fear of particular objects or specific situations. Treatment of specific phobias is completed through systematic desensitization. Systematic desensitization includes graded exposure of the patient to the specific situation and training the patient to control their anxiety in such situations.

Question 165.
What is an excessive worry about different domains of life lasting for more than six months?
(a) Social anxiety disorder.
(b) Generalized anxiety disorder.
(c) Social phobia.
(d) Panic disorder. 
Answer:
(b) Generalized anxiety disorder.

Generalized anxiety disorder refers to a condition where patients have excessive worry or anxiety that lasts for days for a minimum of six months. Sources of anxiety are health, social interactions, work, and other life activities. Symptoms include restlessness, agitation, fatigue, lack of concentration, insomnia, muscle tension, and others.

Question 166.
A 35-year-old man presents to the emergency room because of an episode of violent behavior. He is said to have assaulted a young man because, according to him, “The young man was very disrespectful. He passed by my house without greeting me!” He is also said to have been gambling frequently and sees himself as the smartest gambler in the world despite losing all his stakes. What is the most likely diagnosis?
(a) Depression.
(b) Anxiety.
(c) Manic episode.
(d) Post-traumatic stress disorder.
Answer:
(c) Manic episode.

This patient most likely is having a manic episode. Mania is a mood disorder characterized by an elated mood, increased energy, and feelings of self-importance, also known as delusions of grandeur. Patients believe they have special abilities or hold special positions, and they also have a decreased need for sleep.

Question 167.
A patient with a recent history of surgery presents with fever, hypotension, and a rash resembling sunburn. Blood cultures are drawn. The emergency nurse recognizes these symptoms as indicative of which life-threatening condition associated with Staphylococcus aureus?
(a) Toxic shock syndrome (TSS).
(b) Bacterial endocarditis.
(c) Staphylococcal scalded skin syndrome.
(d) Meningitis.
Answer:
(a) Toxic shock syndrome (TSS).

Toxic shock syndrome (TSS) is a rare but severe condition caused by toxins produced by Staphylococcus aureus. Symptoms include fever, rash, hypotension, and multi-organ dysfunction. Historically, it has been linked to tampon use. TSS can result from surgical wounds, burns, or other sites of infection where the bacteria can enter the bloodstream.

Question 168.
Which of the following drugs is used in treating depression?
(a) Valproate.
(b) Lidocaine.
(c) Diazepam.
(d) Fluoxetine.
Answer:
(d) Fluoxetine.

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). SSRIs are the first line for the management of depression. They are also used for treating other psychiatric disorders. Apart from pharmacotherapy, other options for the management of depression include psychotherapy. Electroconvulsive therapy is used in the management of severe depression, depression with suicidal ideation, or psychotic symptoms.

Question 169.
A male patient with a history of angina experiences chest pain. Which of the following medications would be contraindicated if the patient has recently taken medications for erectile dysfunction?
(a) Adenosine.
(b) Nitroglycerin.
(c) Atropine.
(d) Epinephrine.
Answer:
(b) Nitroglycerin.

Patients who have recently taken medications for erectile dysfunction, such as sildenafil (Viagra) or tadalafil (Cialis), should not be given Nitroglycerin due to the risk of severe hypotension (very low blood pressure). Both classes of medications have vasodilatory effects, and their combined use can lead to a synergistic and potentially dangerous drop in blood pressure. Adenosine is an antiarrhythmic, Atropine is used for bradycardia, and Epinephrine is used in life-threatening situations like anaphylaxis and cardiac arrest.

Question 170.
A 23-year-old female presents with a six-month history of decreased social interactions, poor self-care, and consistent reports of hearing voices. The voices are perceived as coming from outside and often converse about her. Which best represents her auditory experiences?
(a) Second-person auditory hallucination.
(b) Third-person auditory hallucination.
(c) First-person auditory hallucination.
(d) Delusional misinterpretation. 
Answer:
(b) Third-person auditory hallucination.

Auditory hallucinations, in which voices speak about the patient in the third person, particularly commenting on the patient’s actions, are a major criteria for the diagnosis of schizophrenia. First-person auditory hallucinations would involve the voices speaking from the “I” or “me” perspective. In this case, the patient’s experience of voices conversing about her and commenting on her actions fits the description of third-person auditory hallucinations.

Question 171.
A patient with chronic heart failure comes to the hospital in a lethargic state. Lab results show a sodium level of no mEq/L. Which condition most likely contributed to the patient’s hyponatremia?
(a) Dehydration due to reduced fluid intake.
(b) Overuse of diuretics, which caused a loss of sodium.
(c) Excessive salt intake.
(d) Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Answer:
(b) Overuse of diuretics, which caused a loss of sodium.

Patients with chronic heart failure often use diuretics to manage fluid overload. An adverse effect of diuretics is the excessive loss of sodium in urine, which can lead to hyponatremia. Although dehydration, SIADH, and excessive salt intake can also impact sodium levels, given the patient’s background of heart failure and the very low sodium level, diuretic overuse is a more likely contributor in this scenario.

Question 172.
Which of the following is an indication for admission to the psychiatric unit?
(a) Low mood.
(b) Insomnia.
(c) Risk of harm to self and others.
(d) Weight loss.
Answer:
(c) Risk of harm to self and others.

Homicidal or suicidal ideation is an indication for admission in a psychiatric patient. Homicidal ideation refers to the contemplation of homicide. Risk factors are personality disorders, psychosis, delirium, and substance-induced disorders. Homicidal ideation also occurs in patients with no psychiatric disorder. Suicidal ideation includes completed suicide and attempted suicide. Completed suicide is a suicidal act that results in death. Attempted suicide is a nonfatal but injurious act that is self-directed and intended to result in death. It may or may not cause injury. Non-suicidal self-injury (NSSI) is a self-inflicted injurious act that is not intended to cause death. The causes of suicidal behavior include depression.

Question 173.
Which is a complication of acetaminophen overdose?
(a) Liver failure.
(b) Liver cirrhosis.
(c) Heart failure.
(d) Idiopathic pulmonary fibrosis.
Answer:
(a) Liver failure.

Acetaminophen poisoning causes hepatic injury in overdose. The metabolites of acetaminophen metabolism are poisonous to the liver, which causes acute liver failure. The patient develops jaundice, raised liver enzymes, and right upper quadrant pain. In severe cases of liver failure, the patients can develop hepatic encephalopathy and may need a liver transplant.

Question 174.
A patient comes to the hospital after being scratched by a raccoon. He mentions he received a rabies vaccine after being exposed to a bat three years ago. What is the recommended course of action for postexposure prophylaxis in this scenario?
(a) Give four doses of rabies vaccine.
(b) Give two doses of rabies vaccine.
(c) Use rabies immune globulin (RIG) only.
(d) No intervention since the patient was previously vaccinated.
Answer:
(b) Give two doses of rabies vaccine.

For individuals previously vaccinated for rabies, the recommended postexposure prophylaxis after a subsequent potential rabies exposure is two doses of the rabies vaccine. The first dose should be administered as soon as possible after exposure, and the second dose should be given three days later. Rabies immune globulin (RIG) is not recommended for previously vaccinated individuals.

Question 175.    
An elderly female comes to the hospital with confusion and a core body temperature of 35°C (95°F). She was found in her home with no heat during a cold spell. Which intervention is the most appropriate initial step in rewarming the patient?
(a) Immersion in a hot water bath.
(b) Administration of warm IV fluids.
(c) Passive external rewarming with blankets.
(d) Active internal re-warming with peritoneal lavage.
Answer:
(c) Passive external rewarming with blankets.

A patient with a core temperature of 35°C (95°F) has mild hypothermia. The initial step for a patient with mild hypothermia is passive external rewarming, which involves insulating the patient from the cold environment and allowing the body to rewarm itself using its metabolic processes.

Practice Tests:

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