MSNCB CMSRN Exam Questions

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1.

A patient with which of the following conditions would be most likely to be found sitting on the side of the bed, leaning forward, with an anxious expression?

  • Emphysema

  • Pleural effusion

  • Chronic bronchitis

  • Gastroesophageal reflux disease

Correct answer: Emphysema

The patient with emphysema is usually anxious due to dyspnea related to mild hypoxemia and leans forward to facilitate breathing with the use of accessory muscles. Very little sputum is produced in emphysema, and the patient appears thin due to difficulty eating and breathing at the same time. Enlarged alveoli lead to the classic "barrel chest" deformity.

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus production, and emphysema, which involves the destruction of the lungs over time.

2.

Which one laboratory test can be used to diagnose rheumatoid arthritis?

  • There is no single laboratory test that can be used to diagnose rheumatoid arthritis

  • Rheumatoid factor

  • Anti-citrullinated protein antibody

  • Erythrocyte sedimentation rate (ESR)

Correct answer: There is no single laboratory test that can be used to diagnose rheumatoid arthritis

Rheumatoid factor is found in 70-90% of patients with rheumatoid arthritis, but titers may be negative in the early stages of the disease. Anti-citrullinated protein antibodies are highly specific for rheumatoid arthritis, with over 80% of patients with rheumatoid arthritis being positive for them, but are not a definitive diagnosis. ESR can be used to indicate an inflammatory process, but is not specific for rheumatoid arthritis.

3.

The inability to reach the toilet on time due to environmental barriers or disorientation to place is known as:

  • Functional incontinence

  • Stress incontinence

  • Urge incontinence

  • Overflow incontinence

Correct answer: Functional incontinence

Urinary incontinence is defined as the involuntary loss of urine in sufficient amounts or frequency to constitutes a social and/or health problem. There are five types of incontinence: functional, stress, urge, overflow, and mixed incontinence. Functional incontinence is the inability to reach the toilet on time due to environmental barriers or disorientation to place. These patients are potentially continent individuals who cannot or will not reach the toilet in time. Treatment is aimed at establishing a toileting schedule, use of a bedside commode, provision of physical assistance, and staff training.

Stress incontinence is the leakage of urine with increased intra-abdominal pressure, often occurring with coughing, sneezing, or lifting. Urge incontinence is involuntary incontinence that occurs soon after a strong sense of urgency to void. Overflow incontinence results from impaired bladder neuromusculature and occurs when the bladder becomes overdistended. Mixed incontinence is a combination of stress and urge incontinence.

4.

When evaluating a patient for symptoms associated with acute pancreatitis, the nurse would observe for:

  • Turner's sign

  • Increased intracranial pressure (ICP)

  • Bradycardia

  • Hypertension

Correct answer: Turner's sign

Turner's sign is bruising of the lower abdomen and flank areas, indicative of a retroperitoneal bleed associated with acute pancreatitis.

ICP is not affected in a patient with pancreatitis. Tachycardia (not bradycardia) is usually associated with hypovolemic or pulmonary complications of pancreatitis. Hypotension (not hypertension) is associated with shock as seen in acute pancreatitis.

5.

Which of the following statements made by a patient with hepatitis C indicates the need for further teaching?

  • "I am at higher risk now for hepatitis B."

  • "Hepatitis C can be fatal."

  • "Hepatitis C is transmitted parenterally."

  • "My hepatitis C can be cured."

Correct answer: "I am at higher risk now for hepatitis B."

Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure, and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, hepatic cancer, and the need for liver transplantation. Antiviral therapy may be used for the treatment of chronic disease, and HCV is curable in up to 95% of cases.

Transmission of HCV is primarily through exposure to infected blood via needles, syringes, blood, and blood products (parenterally). HCV is responsible for as much as 70% of post-transfusion hepatitis and hepatitis in hemophiliacs. HCV has a slow onset, and while it does not increase the risk of hepatitis B virus (HBV), HCV-infected patients should also be tested for HBV and human immunodeficiency virus (HIV) given the common modes of transmission and the association of these coinfections with more rapid disease progression. There is no prophylaxis or vaccines available for immunity, and HCV can be fatal if left untreated.

6.

You are performing preoperative teaching with a patient who has ulcerative colitis (UC) and needs a total colectomy with an ileoanal reservoir. Which information do you include?

  • The surgery usually occurs in two stages

  • A reservoir is created that exits through the abdominal wall

  • A permanent ileostomy is created

  • Continence is not possible after this surgery

Correct answer: The surgery usually occurs in two stages

An ileoanal reservoir is usually created in two stages.

First, diseased intestines are removed, and a temporary loop ileostomy is created. Second, the loop ileostomy is closed, and stool goes to the reservoir and out through the anal sphincter, maintaining bowel control and eliminating the need for a permanent ileostomy.

7.

Which of the following disorders results from a deficiency of factor VIII?

  • Hemophilia

  • Sickle cell disease

  • Christmas disease

  • Disseminated intravascular coagulation (DIC)

Correct answer: Hemophilia

Hemophilia results from a deficiency of or absent factor VIII (antihemophilic).

Sickle cell disease is caused by a defective hemoglobin molecule. Christmas disease results in a factor IX deficiency (plasma thromboplastin). There are several potential factor deficiencies in DIC, including factor I (fibrinogen), factor II (prothrombin), factor V (proaccelerin), factor VIII, and factor XIII (fibrin-stabilizing).

8.

A patient was admitted to the medical-surgical unit complaining of difficulty holding objects. He states that his condition has progressively worsened. Based on the initial examination, the physician suspects Amyotrophic Lateral Sclerosis (ALS). The nurse is aware that characteristics of ALS include all of the following except:

  • Memory loss

  • Outbursts of uncontrolled crying

  • Dysphagia

  • Fasciculation of involved muscles

Correct answer: Memory loss

ALS is a progressive, degenerative disease involving the destruction of the motor neurons of the anterior horn cells (in the spinal cord), brainstem (especially cranial motor nerves), and cerebral cortex. It results in progressive muscle weakness and wasting of affected muscles; it involves both upper and lower motor neurons, and eventually causes death (within 5-10 years) due to respiratory muscle weakness. Cognitive problems such as memory loss are not present in ALS.

Emotional lability, dysphagia, and fasciculations (muscle twitches) are manifestations of ALS.

9.

Which of the following is an early sign of systemic lupus erythematosus (SLE)?

  • Joint pain

  • Restrictive lung disease

  • Kidney failure

  • Cardiac dysrhythmias

Correct answer: Joint pain

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder. Joint pain is often one of the first signs of SLE and occurs early in the disease process. 

Cardiopulmonary involvement, including restrictive lung disease and cardiac dysrhythmias, are often seen later in the course of the disease. Kidney failure also occurs late in the disease process.

10.

You are caring for Mr. H., who was admitted for an exacerbation of ulcerative colitis (UC). You gather the following data during your admission assessment:

  • Objective: Temperature: 101 degrees F, pulse 108, blood pressure: 101/55, respiratory rate: 20, O2 saturation: 98% room air
  • Subjective: frequent bloody stools, increased abdominal pain, decreased appetite with a 6-pound unexpected weight loss. noncompliance with pharmaceutical treatment plan due to financial restraints.

You anticipate that all of the following diagnostics and labs will be ordered on this patient except:

  • Serum amylase

  • Complete metabolic panel (CMP)

  • Complete blood count (CBC)

  • Stool samples

Correct answer: Serum amylase

The physician will likely order a CMP to assess electrolyte imbalance(s), a CBC to evaluate infection and inflammation, and stool samples will need to be obtained for assessment of infectious organisms such as C. diff. Coagulation studies may also be necessary, depending on the amount of bleeding the patient is experiencing.

Serum amylase studies are not indicated for ulcerative colitis exacerbation, but rather in the diagnosis of pancreatitis. Amylase is an enzyme that helps digest carbohydrates and is made primarily in the pancreas and the glands that make saliva. When the pancreas is diseased or inflamed, amylase releases into the blood and increased levels can be detected.

11.

Assessing for distention of the neck veins can best be completed:

  • With the patient's head elevated 30-45 degrees

  • With the patient in Trendelenburg position

  • With the patient lying prone in bed

  • With the patient sitting up at a 90-degree angle

Correct answer: With the patient's head elevated 30-45 degrees

Physical assessment of the cardiopulmonary system includes inspection, palpation, percussion, and auscultation of the patient. During inspection, observing for neck vein distention (a sign of peripheral vascular disease) can best be visualized with the patient's head elevated at 30-45 degrees. In addition, observe for aortic pulsations, skin color, hair distribution, edema, varicose veins, lesions such as ulcers, and capillary refill in extremities.

12.

This renal hormone stimulates bone marrow production of red blood cells (RBCs):

  • Erythropoietin

  • Renin

  • Prostaglandins

  • Vitamin D

Correct answer: Erythropoietin

Erythropoietin is a renal hormone that stimulates bone marrow production of RBCs.

Vitamin D, renin, and prostaglandins are other renal hormones.

13.

Which of the following is least likely to increase the risk of cardiomyopathy?

  • Pregnancy

  • Alcohol abuse

  • Sedentary lifestyle

  • Viral infection

Correct answer: Pregnancy

There are multiple factors that can increase the risk of cardiomyopathy, including alcohol abuse, smoking, substance abuse, infections, hypertension, and obesity. A sedentary lifestyle promotes obesity and hypertension. Pregnancy itself is not a significant risk factor for cardiomyopathy, although some complications of pregnancy may increase the risk of cardiomyopathy. 

14.

One of the responsibilities of a nurse in a fertility clinic is to provide health teaching to the patient in relation to the timing of intercourse. Patient instructions should include the information that the best time to achieve pregnancy is:

  • Fourteen days before the next period is expected

  • Immediately after menses ends

  • Fourteen days after the beginning of last period

  • Midway between periods

Correct answer: Fourteen days before the next period is expected

Ovulation generally occurs 14 days before the onset of menses. 

Immediately after menses ends means that ovulation would occur on approximately day 5 of the menstrual cycle, which is incorrect (generally occurs midway through the menstrual cycle). 

Variations in the cycle occur in the preovulation period. Therefore, midway between periods is inaccurate information. 

Fourteen days after the beginning of last period would be correct only if the patient's cycle is 28 days long; if her cycle is shorter or longer, this information is incorrect.

15.

A patient admitted to the medical-surgical floor with pneumonia is receiving supplemental oxygen at 2 L/minute via nasal cannula. The patient’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). Because of these history findings, the nurse closely monitors the oxygen flow and the patient’s respiratory status.

Which of the following complications may arise if the patient receives a high oxygen concentration?

  • Apnea

  • Anginal pain

  • Respiratory alkalosis

  • Metabolic acidosis

Correct answer: Apnea

Hypoxia is the main breathing stimulus for a client with COPD. Supplemental oxygen is used for individuals with severe or progressive hypoxemia. Oxygen use is progressive (during exacerbations only, intermittently, at night, or continuously). Excessive oxygen administration may lead to apnea by removing that stimulus.

Anginal pain results from a reduced myocardial oxygen supply. A patient with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a patient with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations do not cause metabolic acidosis.

16.

Which of the following is least likely to be a cause or predisposing factor of delirium?

  • Parkinson's disease

  • Anemia

  • Pain

  • Electrolyte disturbances

Correct answer: Parkinson's disease

Parkinson's disease is a potential cause of dementia, but not delirium. Parkinson's disease treatments can, however, cause delirium. Anemia, pain, and electrolyte disturbances are all potential causes or predisposing factors of delirium.

17.

Which of the following is the most common cause of upper Gastrointestinal (GI) bleeding?

  • Ulcer disease

  • Erosive disorders

  • Esophageal varices

  • Mallory-Weiss tears

Correct answer: Ulcer disease

Ulcer disease is the most common cause of upper GI bleeding, accounting for 40–48% of these cases. Erosive disorders account for 22% of upper GI bleeds, while esophageal varices are the cause of 12% and Mallory-Weiss tears of the gastroesophageal junction cause about 8% of upper GI bleeds.

18.

Which of the following is least important when planning rehabilitation after a Myocardial Infarction (MI)?

  • Improving coping mechanisms

  • Risk factor modification

  • Regular physical examinations

  • Education related to complications of an MI

Correct answer: Improving coping mechanisms

Improving coping mechanisms is normally a component of psychiatric rehabilitation, not cardiac rehab. Risk factor modification, regular physical examinations, and education related to complications of an MI are all important components of planning cardiac rehab.

19.

Which of the following is least likely to be a cause of rhabdomyolysis?

  • Glomerulonephritis

  • Malignant hyperthermia

  • Chest trauma

  • Use of simvastatin (Zocor)

Correct answer: Glomerulonephritis

Rhabdomyolysis is the breakdown of muscle tissue and can lead to kidney failure if not treated. While rhabdomyolysis can cause kidney damage, glomerulonephritis is not a cause of rhabdomyolysis. 

Chest trauma can lead to muscle breakdown that causes rhabdomyolysis. Malignant hyperthermia is a rare complication of anesthesia use that can lead to metabolic changes that cause rhabdomyolysis. Use of statin drugs such as simvastatin is a known risk factor for rhabdomyolysis.

20.

Regulatory centers in the brain respond to stimulation from sensory receptors. All of the following statements related to sensory receptors are true except:

  • As pH rises, a patient is triggered to breathe more rapidly

  • Stretch receptors prevent excessive distension of the lung

  • When PCO2 increases, a patient is triggered to breathe more rapidly

  • Chemoreceptors respond to changes in pH, PaO2, and PaCO2

Correct answer: As pH rises, a patient is triggered to breathe more rapidly

As pH rises, due to decreased PCO2, the patient is triggered to breathe more slowly, not more rapidly.

When PCO2 increases and pH falls, the patient is triggered to breathe more rapidly. Stretch receptors prevent excessive distension of the lung, and chemoreceptors respond to changes in pH, PaO2, and PaCO2.