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NEW QUESTION # 158
This medication is a calcium channel blocker indicated for the treatment of hypertension. Its onset is 2 minutes faster than nicardipine.
- A. Clonidine
- B. Amiodarone
- C. Procainamide
- D. Clevidipine
Answer: D
Explanation:
Correct answer: Clevidipine
Clevidipine is an IV calcium channel blocker that is also indicated for the treatment of hypertension.
While its onset is 2 minutes faster than nicardipine, its duration is shorter.
Clonidine is a central sympatholytic agent and is typically used orally in maintenance therapy of hypertension. Procainamide and amiodarone are antiarrhythmics.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 171-172.
NEW QUESTION # 159
Bivalirudin is indicated for use as an anticoagulant in patients with unstable angina undergoing coronary angioplasty when administered with which of the following?
- A. Aspirin
- B. Tirofiban (Aggrastat)
- C. Cilostazol (Pletal)
- D. Clopidogrel (Plavix)
Answer: A
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 # 160
Planning in the process of ethical analysis includes:
- A. Choosing a plan and acting
- B. Identification of what harm or good occurred as a result of the action
- C. Identification of the risks and benefits likely to arise from each action
- D. Anticipating objections
Answer: C
Explanation:
Correct answer: Identification of the risks and benefits likely to arise from each action Planning in the process of ethical analysis includes identification of the risks and benefits likely to arise from each action.
Choosing a plan and acting and anticipating objections are parts of implementation; identifying what occurred as a result of the action is part of evaluation.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 199.
NEW QUESTION # 161
The laparoscopic bariatric surgical procedure that results in restriction and malabsorption and also has a hormonal effect is:
- A. Roux-en-Y surgery
- B. Laparoscopic sleeve gastrectomy surgery
- C. Biliopancreatic diversion with duodenal switch surgery
- D. Laparoscopic adjustable gastric band surgery
Answer: A
Explanation:
Correct answer: Roux-en-Y surgery
In Roux-en-Y surgery, removal of the gastric fundus, which is the primary site of ghrelin production, enhances weight loss by reducing the appetite.
The gastric fundus, which is the primary site of ghrelin production, is not removed in biliopancreatic diversion with duodenal switch surgery, laparoscopic adjustable gastric band surgery, or laparoscopic sleeve gastrectomy surgery.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 360.
NEW QUESTION # 162
Which of the following is the most frequent trigger of COPD exacerbation?
- A. Pulmonary hypertension
- B. Heart disease
- C. Pulmonary embolus
- D. Respiratory infection
Answer: D
Explanation:
Correct answer: Respiratory infection
Individuals with COPD (chronic obstructive pulmonary disease) are at high risk for exacerbations.
Respiratory infection is the most common trigger of COPD exacerbation. Other common precipitating events include pulmonary embolus, pulmonary hypertension and patient factors, including heart disease and diabetes.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 258-259.
NEW QUESTION # 163
The diagnosis of acute pancreatitis is based on at least two of three criteri a. The three criteria include all of the following except:
- A. Serum lipase or amylase 2 to 4 times above the normal range
- B. Characteristic abdominal or epigastric pain that may radiate to the back
- C. Characteristic findings on imaging, most often ultrasound imaging
- D. Blood urea nitrogen greater than 25 mg/dL
Answer: D
Explanation:
Correct answer: Blood urea nitrogen greater than 25 mg/dL
Blood urea nitrogen (BUN) is not included in the diagnostic criteria for acute pancreatitis. It is, however, included in scoring systems to assess the severity of the disease.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 354.
NEW QUESTION # 164
Autonomic dysreflexia is a life-threatening complication that occurs in individuals with spinal cord injury at or above:
- A. L1
- B. L6
- C. T6
- D. C6
Answer: C
Explanation:
Correct answer: T6
Autonomic dysreflexia (also called autonomic hyperreflexia) occurs in individuals with spinal cord injury at or above T6 due to unopposed sympathetic response below the level of injury. It can occur any time after spinal shock has resolved and is a life-threatening complication.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 510.
NEW QUESTION # 165
A patient presented with hypertensive urgency. What is the best method of decreasing the blood pressure of the patient in this condition?
- A. Decreasing the blood pressure within a few days
- B. Decreasing the blood pressure within a few hours
- C. Immediate decreasing of blood
- D. Waiting for ECG changes to come
Answer: B
Explanation:
Explanation: The best way of decreasing blood pressure of a patient in hypertensive urgency is controlling it within a few hours because blood pressure is lowered more slowly to avoid hypotension, ischemia of vital organs, or failure of autoregulation.
NEW QUESTION # 166
A client comes to the emergency department complaining of severe pain in the left chest, radiating to the left arm. The client reported that the pain was not relieved after taking 3 doses nitroglycerin. The nurse prepares which equipment first?
- A. Artificial airway
- B. Oxygen
- C. IV catheter set
- D. ECG
Answer: B
Explanation:
Explanation: Administration of supplemental oxygen is the highest priority for the client. Angina is mainly caused by insufficient supply of oxygen to the heart muscles; therefore, delaying oxygen administration is not necessary. Options A and D may be ordered, but they are not the nurse's immediate action. There is no sign that the client needs an artificial airway.
NEW QUESTION # 167
A 38-year-old woman presented to accident and emergency department with short history of abdominal pain and distention, severe constipation, vomiting, dehydration and respiratory distress. On examination, she was having abdominal rigidity and no bowel sounds were audible. What is the most likely diagnosis based on this clinical scenario?
- A. Peritonitis
- B. Appendicitis
- C. Pancreatitis
- D. Bowel or intestinal obstruction
Answer: D
Explanation:
Explanation: The most likely diagnosis is bowel or intestinal obstruction because severe constipation, vomiting and resulting dehydration are features of this. Moreover, absent bowel sounds also indicate intestinal obstruction. The condition will be confirmed by doing abdominal x-rays.
NEW QUESTION # 168
Which of the following long-acting benzodiazepines is infrequently used for sedation in acute care except under special circumstances?
- A. Lorazepam
- B. Diazepam
- C. Ketamine
- D. Midazolam
Answer: B
Explanation:
Correct answer: Diazepam
Diazepam is a long-acting benzodiazepine; it is infrequently used for sedation in acute care except under special circumstances.
Diazepam is infrequently used in acute care; however, it may be selected as treatment of severe alcohol withdrawal. It may be given orally or as an IV bolus.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 156.
NEW QUESTION # 169
The most common cause of small bowel obstruction is:
- A. Hernias
- B. Adhesions due to previous surgery
- C. Inflammatory bowel disease
- D. Malignant tumors
Answer: B
Explanation:
Correct answer: Adhesions due to previous surgery
The most common cause of a small bowel obstruction (SBO) is adhesions due to previous surgery.
Hernias, malignant tumors (peritoneal implants), and inflammatory bowel disease are other causes of SBO. Malignant tumors are the second most common cause of small bowel obstructions.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 358.
NEW QUESTION # 170
An example of primary brain injury is:
- A. Hypocapnia
- B. Epidural hematoma
- C. Hypoxemia
- D. Increased intracranial pressure
Answer: B
Explanation:
Correct answer: Epidural hematoma
Primary brain injury can be described as focal (resulting in local damage at the site of damage) or diffuse (affecting the whole brain). Secondary brain injury is ongoing neuronal damage that occurs following the traumatic brain injury as the result of systemic and intracranial complications.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 500-502.
NEW QUESTION # 171
A known hypertensive man presented with severe headache, altered state of consciousness and a claim that this is the worst headache he has ever experienced. What is the cause?
- A. Stroke
- B. Subarachnoid headache
- C. All of the above
- D. Intracranial bleed
Answer: B
Explanation:
Explanation: Subarachnoid headache the cause in this case. A known hypertensive man who presents with severe headache, altered state of consciousness and claims that this is the worst headache ever, has the characteristics of a subarachnoid headache.
NEW QUESTION # 172
Which of the following causes are of stress related erosive syndrome?
- A. Multi-organ failure
- B. Severe burns
- C. All of the above
- D. Sepsis
Answer: C
Explanation:
Explanation: Stress related erosive syndrome occurs in the patients who are severely ill due to any trauma. All of the above are the predisposing factors to stress related erosive syndrome. Stress induces changes in the gastrointestinal mucosa.
NEW QUESTION # 173
If the patient is unable to furrow his forehead or smile and puff out his cheeks, then in which nerve is a lesion most commonly suspected?
- A. Occulomotor nerve
- B. Facial nerve
- C. Trigeminal nerve
- D. Abducens nerve
Answer: B
Explanation:
Explanation: If the patient is unable to furrow the forehead or smile and puff out the cheeks, then a lesion in the facial nerve is most commonly suspected, because the motor component of facial nerves is responsible for controlling all the muscles of the face.
NEW QUESTION # 174
Which of the following drugs are used for treatment of Crohn's disease as immunomodulatory agents?
- A. Both a and b
- B. Methotrexate
- C. Cyclosporine
- D. None of the above
Answer: A
Explanation:
Explanation: Cyclosporine and Methotrexate are used for treatment of Crohn's disease. Crohn's disease (also known as granulomatous, and colitis) is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms.
NEW QUESTION # 175
All of the following statements regarding the QT interval on an electrocardiogram are true except:
- A. A prolonged QTc (corrected QT interval) is associated with torsades de pointes and sudden cardiac death
- B. The most commonly used method of correcting the measured QT interval for heart rate is the Bazett formula
- C. A shortened corrected QTc (corrected QT interval) indicates abnormally prolonged ventricular repolarization
- D. A normal corrected QT interval (QTc) is < 0.46 second in women and < 0.45 second in men
Answer: C
Explanation:
Correct answer: A shortened corrected QTc (corrected QT interval) indicates abnormally prolonged ventricular repolarization A prolonged QTc indicates abnormally prolonged ventricular repolarization and is associated with torsades de pointes and sudden cardiac death. To determined the corrected QT interval, the measured QT interval is divided by the square root of the preceding R-R interval (all measurements are in seconds); this is known as the Bazett formula and is the most commonly used method of correcting the measured QT interval for heart rate.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 443.
NEW QUESTION # 176
Acute kidney injury (AKI) is characterized by three clinical phases, seen primarily due to intrarenal injury.
The first phase of AKI is characterized by:
- A. A significant rise in BUN and creatinine levels; common complications include fluid overload and acute hyperkalemia
- B. A significant rise in BUN and creatinine levels along with acute hypokalemia
- C. An increase in urine output
- D. A drop in BUN and creatinine levels
Answer: A
Explanation:
Correct answer: A significant rise in BUN and creatinine levels; common complications include fluid overload and acute hyperkalemia In the first phase of acute kidney injury (AKI), the oliguric phase, the BUN and creatinine levels rise significantly. Common complications include fluid overload and acute hyperkalemia.
An increase in urine output occurs in the diuretic phase, which follows the oliguric phase. Hyperkalemia, rather than hypokalemia, is a common complication of the first phase of AKI. BUN and creatinine levels significantly rise, rather than drop, in the first phase of AKI.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 373.
NEW QUESTION # 177
Which of the following terms refers to the use of one's own skills and knowledge to promote the interests of another?
- A. Advocacy
- B. Fidelity
- C. Paternalism
- D. Nonmaleficence
Answer: A
Explanation:
Correct answer: Advocacy
Patient advocacy is an essential role of the nurse. The nurse is able to understand the impact of disease and interpret health care information in a unique way, then acts as a patient advocate by applying this understanding to ensure the patient's values and beliefs guide the plan of care.
Paternalism refers to circumstances in which the principle of doing good (beneficence) overrides that of autonomy. Nonmaleficence is the principle that imposes the duty to do no harm. Fidelity describes the obligation to be faithful to promises and commitments.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 198.
NEW QUESTION # 178
Which of the following statements regarding chest x-rays is true?
- A. Patients with chronic obstructive pulmonary disease most likely present with narrowing of the intercostal spaces on chest x-ray
- B. The angle of the ribs to the spine is normally 90 degrees
- C. Costophrenic angles are more distinct in women than in men on chest x-ray
- D. Identification of a pleural space on a chest x-ray is an abnormal finding
Answer: D
Explanation:
Correct answer: Identification of a pleural space on a chest x-ray is an abnormal finding The pleural space is not visible on a chest x-ray unless fluid (pleural effusion) or air (pneumothorax) is present within the space.
Costophrenic angles, which can normally be seen on chest x-ray where the tapered edges of the diaphragm and the chest wall meet, are more distinct in men than in women, as breast tissue can obscure these angles. Patients with chronic obstructive pulmonary disease (COPD) most likely present with widening, rather than narrowing, of the intercostal spaces on chest x-ray. Also in COPD, the angle of the ribs to the spine increases from the normal 45 degrees to 90 degrees. These changes occur because of hyperinflation.
Reference:
Burns, Suzanne
M. AACN Essentials of Progressive Care Nursing, Fourth Edition. Pg 247.
NEW QUESTION # 179
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