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NEW QUESTION # 27
A patient has developed Acute Respiratory Acidosis, with a pH of 7.25 and a PaCO2 of 55. What is the underlying cause of Respiratory Acidosis?
- A. There are elevated levels of aldosterone present.
- B. There is an underlying gastric disorder.
- C. The lungs are not sufficiently ventilating.
- D. The lungs are working excessively resulting in "over breathing."
Answer: C
Explanation:
Explanation: The underlying cause of respiratory acidosis is that the lungs are not sufficiently ventilating.
Acute Respiratory Acidosis is a sudden collapse of the body's ventilation system often resulting from central nervous system disease, drugs or toxins or Chronic Obstructive Pulmonary Disease (COPD).
NEW QUESTION # 28
The ability to recognize needs and take action to influence the outcome of a conflict is called:
- A. Agency
- B. None of the above
- C. Moral agency
- D. Justice
Answer: C
Explanation:
Explanation: The ability to recognize needs and take action to influence the outcome of a conflict is called moral agency. In ACCN synergy model of Nurse Competency, Moral agency is the ability to recognize needs and take action to influence the outcome of a conflict .The other two are advocacy and agency.
NEW QUESTION # 29
Which of the following defines the purpose of professional codes?
- A. To define the criteria for the assessment and evaluation of the practice of the profession
- B. To delineate standards that govern the practice of the profession in various jurisdictions
- C. To impose regulations for licensure, regulate the practice of the profession, and evaluate and monitor the actions of those practicing in the profession
- D. To identify the moral requirements of a profession and the relationships in which those practicing the profession engage
Answer: D
Explanation:
Correct answer: To identify the moral requirements of a profession and the relationships in which those practicing the profession engage The Code of Ethics for Nurses was developed by the American Nurses Association and states the essential principles, values, and objectives that guide nursing actions. The provisions of the Code identify the ethical obligations of nurses and apply to nurses across all roles. Among the provisions in the Code are:
* The nurse's primary obligation to the patient
* The nurse's contribution to the work environment
* The nurse's role in patient advocacy
* The nurse's duty to self
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 193.
NEW QUESTION # 30
A patient who is scheduled for coronary angiography states, "I want to be asleep during my procedure. I can't stand any kind of pain." Of the following, the best response for the nurse to make to this patient is:
- A. "You will have to be awake during the procedure so you can control your breathing."
- B. "It sounds like you're feeling anxious. What has your doctor told you about your procedure?"
- C. "You have to stay awake, but the procedure is painless."
- D. "Don't worry. You will be given medicine to make you very sleepy and you won't remember anything."
Answer: B
Explanation:
Correct answer: "It sounds like you're feeling anxious. What has your doctor told you about your procedure?" It is most therapeutic to acknowledge the patient's feelings, find out what they have been told, and not to minimize fear. Typically, patients remain awake during the procedure, allowing them to facilitate the catheterization process by controlling respiratory patterns. An anxiolytic agent, such as diazepam, is frequently administered during the procedure to decrease anxiety.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 213-214.
NEW QUESTION # 31
To ensure consistency in QT-interval monitoring, a single method should be used by all practitioners who are responsible for cardiac monitoring. Each facility should have a protocol in place that defines this specific method of QT-interval monitoring and includes all of the following except:
- A. The formula for heart rate correction
- B. Criteria for lead selection
- C. The method for determining the end of the Q wave
- D. Defines the equipment to be used (manual or electronic)
Answer: C
Explanation:
Correct answer: The method for determining the end of the Q wave
The method for determined the end of the T wave, not the Q wave, needs to be consistent among all practitioners. Each facility should also require that whichever lead is chosen should be used for serial measurements in the same patient.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 443.
NEW QUESTION # 32
A Type II second-degree atrioventricular block:
- A. Is more common than a type I second-degree atrioventricular block and rarely requires treatment
- B. Occurs below the atrioventricular node in the bundle of His or bundle-branch system
- C. Is often referred to as a Wenckebach block
- D. Is also known as a complete block
Answer: B
Explanation:
Correct answer: Occurs below the atrioventricular node in the bundle of His or bundle-branch system A Type I, (not a Type II), second-degree block is often referred to as a Wenckebach block. Type II, second-degree AV block is less common than type I, and is a more serious form of atrioventricular block.
It is more dangerous than type I because of a higher incidence of associated symptoms and progression to complete AV block.
Complete failure of conduction of all atrial impulses to the ventricles is a third-degree atrioventricular block (complete block).
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 61-62.
NEW QUESTION # 33
In the pain scale, what does 3-5 indicates:
- A. Very severe pain
- B. Moderate pain
- C. Mild pain
- D. Severe pain
Answer: B
Explanation:
Explanation: On the pain scale, 3-5 refers to moderate pain. Pain is a subjective feeling and depends on individual's pain threshold plus pain tolerance. One should assess the pain with the help of information about onset, duration, and intensity.
NEW QUESTION # 34
If the patient has temp >38 degree centigrade or subnormal rectal temperature < 36 degress centigrade, tachypnea or PaCO2 < 32 mm of Hg, what is the diagnosis?
- A. Systemic inflammatory response syndrome
- B. Neurogenic shock
- C. None of the above
- D. Septic shock
Answer: A
Explanation:
Explanation: The patient is suffering from systemic inflammatory response syndrome, because it is ageneralized inflammatory response of the body including many systems,in this temp > 38 degree centigrade or subnormal rectal temperature, moreover there is tachypnea, tachycardia. Its features also include leukocytosis or leucopenia.
NEW QUESTION # 35
A patient was suspected to be having disseminated intravascular coagulation (DIC). His D-dimers were carried out. What finding do you expect from a patient if he is really having DIC?
- A. All of the above
- B. Decreased
- C. No change
- D. Increased
Answer: D
Explanation:
Explanation: Increased findings are expected from a patient if he is really having DIC. Numbers of tests are included in the panel of disseminated intravascular coagulation. In these tests materials needed for clotting are decreased and those that measure clotting times are increased. D-dimers are increased in case of DIC. D-dimer is a specific polymer that results when fibrin breaks down, giving a marker to indicate the degree of fibrinolysis.
NEW QUESTION # 36
A diagnosed case of Infective Endocarditis is being managed in the hospital. Which of the following is the best mode of treatment in this case?
- A. Use of anti-microbials specifically against the culture's organisms for 4-6 weeks
- B. Use of anti-angina drugs
- C. Use of corticosteroids
- D. Use of anti-inflammatory drugs
Answer: A
Explanation:
Explanation: The best mode of treatment for a diagnosed case of Infective Endocarditis is anti-microbials specifically used against the organisms which are cultured, because when the infection is treated in time all the conditions are reversed.
NEW QUESTION # 37
Hyperphosphatemia is often associated with what other electrolyte imbalance?
- A. Hypocalcemia
- B. Hypermagnesemia
- C. Hypomagnesemia
- D. Hypercalcemia
Answer: A
Explanation:
Correct answer: Hypocalcemia
Hyperphosphatemia is an electrolyte imbalance in which there is an abnormally elevated level of phosphate in the blood. Often, calcium levels are lowered (hypocalcemia) due to precipitation of phosphate with the calcium in tissues.
Hypomagnesemia is a condition in which the amount of magnesium in the blood is lower than normal.
Hypercalcemia (the opposite of hypocalcemia) is a condition in which the calcium level in the blood is above normal. Hypermagnesemia is an electrolyte disturbance in which there is an abnormally elevated level of magnesium in the blood.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 379.
NEW QUESTION # 38
The nurse would expect to find the following test results in a patient just admitted with a diagnosis of heart failure:
- A. Brain natriuretic peptide: Elevated, Serum sodium: Elevated, Albumin: Decreased
- B. Brain natriuretic peptide: Elevated, Creatinine: Elevated, Serum sodium: Decreased
- C. Brain natriuretic peptide: Decreased, Serum sodium: Decreased, Serum potassium: Decreased
- D. Brain natriuretic peptide: Decreased, Serum potassium: Elevated, Complete Blood Count: Low RBC count
Answer: B
Explanation:
Correct answer: Brain natriuretic peptide: Elevated, Creatinine: Elevated, Serum sodium: Decreased Increased brain natriuretic peptide levels in the serum are used as markers of severity in heart failure.
Increases in arginine vasopressin availability lead to an inability to excrete free water and hypo- osmolarity. Decreased renal perfusion stimulates the renin-angiotensin-aldosterone system.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 229-230, 232.
NEW QUESTION # 39
Which of the following is not a risk factor for aspiration pneumonitis?
- A. Depression of gag or swallowing reflex
- B. Altered level of consciousness
- C. Parkinsonism or Alzheimer's disease
- D. Obstruction of respiratory tract
Answer: D
Explanation:
Explanation: Obstruction of respiratory tract is not a risk factor for aspiration pneumonitis. The main causing risk factor of aspiration pneumonitis is the altered level consciousness. All the factors are not the conscious factors means in which the person has not been aware of. Respiratory tract obstruction is unrelated to aspiration pneumonitis as in this condition patient can have a control over the disease and can sit erect.
NEW QUESTION # 40
The most common cause of tracheal deviation seen on chest x-ray is:
- A. Atelectasis
- B. Emphysema
- C. Pneumothorax
- D. Pleural effusion
Answer: C
Explanation:
Correct answer: Pneumothorax
On chest x-ray, the trachea should appear midline, with the carina seen at the level of the aortic knob or second intercostal space. Pneumothorax, which is the most common cause of tracheal deviation, causes a mediastinal and tracheal shift to the area away from the pneumothorax.
Pleural effusion and atelectasis can also cause tracheal deviation from midline; however, pneumothorax is the most common cause. Emphysema does not typically cause tracheal deviation. More common chest x-ray findings in emphysema include hyperinflated lungs, flattened diaphragm, and widened intercostal spaces.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 247-248.
NEW QUESTION # 41
Extrinsic causes of hemolysis include all of the following except:
- A. Sickle cell anemia
- B. A transfusion reaction
- C. Damage from cardiopulmonary bypass
- D. Splenic disorders
Answer: A
Explanation:
Correct answer: Sickle cell anemia
Sickle cell anemia is an example of an abnormality intrinsic to the red blood cell.
Extrinsic causes of hemolysis include immune destruction from a transfusion reaction, damage by artificial heart valves, splenic disorders, use of an intra-aortic balloon pump, or cardiopulmonary bypass.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 327.
NEW QUESTION # 42
The 6-minute-walk test is used in the diagnosis of:
- A. Pulmonary arterial hypertension
- B. Chronic obstructive lung disease
- C. Asthma
- D. Interstitial lung disease
Answer: A
Explanation:
Correct answer: Pulmonary arterial hypertension
The 6-minute-walk test is a measurement of distance used to monitor exercise tolerance, response to therapy and disease progression in pulmonary arterial hypertension.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 266.
NEW QUESTION # 43
Patient and family education in the progressive care setting most often occurs:
- A. Informally
- B. In a classroom setting
- C. On the first day of the patient's admission
- D. At the nurses' station
Answer: A
Explanation:
Correct answer: Informally
Education in the progressive care setting most often occurs informally and can often be subtle, occurring with each interaction between the patient, family, and members of the health care team.
Some patients may be able to tolerate limited sessions in a classroom setting, but this is not typical, and on the first day of admission, very few patients or their families demonstrate readiness to learn.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 27.
NEW QUESTION # 44
A 49 year old male patient has experienced a myocardial infarction with an approximate 55% damage to his ventricle. What interventions would most likely NOT be performed for this patient to avoid the complication of cardiogenic shock?
- A. Intraaortic balloon pump
- B. Angioplasty
- C. Chest tube insertion
- D. Bypass surgery
Answer: C
Explanation:
Explanation: The interventions that would most likely NOT be performed for this patient is insertion of a chest tube. All treatments are aimed with the goal of restoring blood flow and oxygenation early and quickly to avoid organ damage.
NEW QUESTION # 45
A 60 years old known diabetic for last 15 years presented in medical OPD with weight loss, muscle cramping, headaches and general malaise. He also had anemia which was not responding to typical anti anemic. His BUN and creatinine was also raised when investigated. What is he suffering from most likely?
- A. Nephritic syndrome
- B. Acute renal failure
- C. Nephritic syndrome
- D. End Stage Renal disease
Answer: D
Explanation:
Explanation: The patient is suffering from end stage renal disease as diabetes is one of the commonest causes of end stage renal disease. Moreover high BUN and creatinine are confirming the damage to the kidneys. Anemia is also there due to decreased erythropoietin production from damaged kidneys.
NEW QUESTION # 46
All of the following statements are true regarding the atrioventricular (AV) node except:
- A. Its rate of automaticity is 40 to 60 beats per minute and it can function as a backup pacemaker if the sinus node fails
- B. It functions to slow conduction of the impulse from the atria to the ventricles to allow time for the atria to contract and empty their blood into the ventricles
- C. It screens out rapid atrial impulses to protect the ventricles from dangerously rapid rates when the atrial rate is very fast
- D. It is a small group of cells located in the upper right atrium
Answer: D
Explanation:
Correct answer: It is a small group of cells located in the upper right atrium The atrioventricular node is a small group of cells in the lower right atrium, not the upper right atrium..
The sinus node is located in the upper right atrium.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 37-38.
NEW QUESTION # 47
Bivalirudin is indicated for use as an anticoagulant in patients with unstable angina undergoing coronary angioplasty when administered with which of the following?
- A. Tirofiban (Aggrastat)
- B. Aspirin
- C. Clopidogrel (Plavix)
- D. Cilostazol (Pletal)
Answer: B
Explanation:
Correct answer: Aspirin
When administered with aspirin, bivalirudin is indicated as a blood thinner in patients with unstable angina who are undergoing coronary angioplasty. It is an anticoagulant with direct thrombin inhibitor properties.
Bivalirudin has been used as a substitute for unfractionated heparin. Potential advantages over unfractionated heparin include no inhibition by components of the platelet release reaction, it provides more predictable anticoagulation, and its activity against clot-bound thrombin.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 185.
NEW QUESTION # 48
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