AACN PCCN NOV 2023 Exam Hanbook version 1.1.1 Exam Questions

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21.

Which of the following statements related to dysarthria is TRUE?

  • Dysarthria is difficulty with speech production

  • The two primary categories of dysarthria are motor and sensory

  • The two primary categories of dysarthria are conduction and anomic

  • The two primary categories of dysarthria are comprehension and repetition

Correct answer: Dysarthria is difficulty with speech production

Dysarthria is difficulty with speech production due to weakness or lack of coordination of the muscles of speech. A patient with dysarthria has slurred speech and is difficult to understand, but the content of their speech is appropriate. Dysarthria often becomes apparent during the assessment of mental status.

Aphasia is difficulty with language. There are two major categories of aphasia: motor and sensory.

22.

A patient is tested for aphasia with the following results:

  • Naming: Unable
  • Fluency: Intact
  • Comprehension: Unable
  • Repetition: Unable

Which type of aphasia does this patient MOST likely have?

  • Wernicke's

  • Broca's

  • Global aphasia

  • Anomic aphasia

Correct answer: Wernicke's

Wernicke's aphasia is characterized by fluent speech but significant issues in comprehension, naming, and repetition. Patients often have difficulty understanding spoken language and may produce nonsensical or irrelevant words and sentences despite their fluency.

Broca's aphasia typically presents with non-fluent, labored speech but usually good comprehension. This does not match the patient's symptoms of intact fluency and poor comprehension.

Global aphasia involves severe impairments in all aspects of language function, including naming, fluency, comprehension, and repetition. This patient's intact fluency makes global aphasia less likely.

Anomic aphasia is marked primarily by difficulty in naming, with relatively preserved comprehension, fluency, and repetition. This does not align with the patient's inability to comprehend or repeat.

23.

You are caring for a 67-year-old male patient with a history of atrial fibrillation, who was admitted to the PCU following a diagnosis of Deep Vein Thrombosis (DVT). He was started on warfarin therapy three days ago. His baseline International Normalized Ratio (INR) was 1.0, and it has gradually increased to 1.8 over the past 48 hours. The healthcare team is closely monitoring his INR levels and adjusting his warfarin dose accordingly. Today, he received his scheduled dose of warfarin at 0800. The physician is discussing with you the timing of the next INR check. 

Given the typical pharmacokinetics of warfarin, when should you expect the peak depression of coagulation to occur following today's dose?

  • 36 hours

  • 12 hours

  • 24 hours

  • Eight hours

Correct answer: 36 hours

Warfarin is an oral anticoagulant that works by inhibiting the synthesis of vitamin K-dependent clotting factors. Following the administration of a dose of warfarin, the peak depression of coagulation typically occurs around 36 hours. This time frame reflects the time required for the existing clotting factors in circulation to be degraded and for the anticoagulant effect of warfarin to take full effect. The delayed onset is why warfarin therapy is often monitored with frequent INR checks, especially when initiating therapy or adjusting the dose.

At 12 hours, warfarin has not yet reached its maximum impact on the synthesis of clotting factors. While closer to the correct time frame, 24 hours is still slightly too early for the peak anticoagulant effect of warfarin, which typically occurs around 36 hours after administration. At eight hours, the anticoagulant effect of warfarin is minimal.

24.

A 55-year-old patient with a history of schizophrenia is admitted to the progressive care unit due to acute agitation and hallucinations. The healthcare team decides to administer haloperidol to manage the patient's symptoms. During the medication review, you educate the patient about haloperidol and its potential effects.

Which of the following statements about haloperidol is FALSE?

  • It is associated with the development of tolerance

  • It sedates without significant respiratory depression

  • Extrapyramidal reactions to haloperidol are possible

  • QTc interval monitoring is required when using haloperidol

Correct answer: It is associated with the development of tolerance

Haloperidol, an antipsychotic medication, does not typically lead to the development of tolerance. Patients generally do not require increasing doses to maintain its effectiveness for controlling symptoms of agitation, psychosis, or schizophrenia.

Haloperidol is known for its sedative effects, which can help manage agitation and psychosis in patients. Unlike some other sedatives, haloperidol does not significantly depress respiratory function, making it safer when respiratory depression is a concern.

Extrapyramidal side effects are a well-known risk with haloperidol. These can include dystonia (muscle contractions causing twisting and repetitive movements), akathisia (a sense of inner restlessness and inability to stay still), and Parkinsonism (symptoms similar to Parkinson's disease, such as tremors, slow movement, and rigidity). These side effects occur due to the blockage of dopamine receptors in the brain.

Haloperidol has been associated with prolongation of the QTc interval on Electrocardiogram (ECG), which can increase the risk of a potentially life-threatening arrhythmia called torsades de pointes. Therefore, it is essential to monitor the QTc interval in patients receiving haloperidol, especially at higher doses or when other risk factors for QT prolongation are present.

25.

This medication is commonly given to manage an acute hypertensive episode. It is a beta-receptor agonist (beta-blocker) particularly indicated in patients with suspected myocardial infarction or angina. To administer, a 5-mg bolus is given over five minutes and repeated three times. An IV drip may then be started. 

What is the medication?

  • Labetalol

  • Nicardipine

  • Enalapril

  • Nitroprusside

Correct answer: Labetalol

Labetalol is commonly used to manage acute hypertensive episodes. It is a beta-blocker that has both alpha- and beta-adrenergic blocking activity. The dosing regimen described fits with the typical administration protocol for labetalol in acute settings. Following the boluses, an IV drip may be started.

Nicardipine is a calcium channel blocker, not a beta-blocker. It is also used to manage hypertensive crises but is not specifically indicated for use in patients with suspected myocardial infarction or angina in the same way as labetalol.

Enalapril is an Angiotensin-Converting Enzyme (ACE) inhibitor, not a beta-blocker. It is used to manage hypertension and heart failure but not typically in the acute management of hypertensive crises.

Nitroprusside is a vasodilator, not a beta-blocker. It is used for immediate blood pressure reduction in hypertensive crises but works through direct vasodilation rather than beta-receptor blockade.

26.

A 44-year-old male patient with sepsis is receiving aggressive fluid resuscitation. His initial blood pressure was 85/45 mmHg, and after 2 liters of normal saline, his blood pressure is 80/42 mmHg. Which of the following is the MOST likely reason for the persistent hypotension?

  • Septic shock

  • Inadequate fluid resuscitation

  • Cardiac tamponade

  • Myocardial depression

Correct answer: Septic shock

Septic shock is characterized by persistent hypotension despite adequate fluid resuscitation due to profound vasodilation and myocardial dysfunction caused by sepsis. This patient’s lack of response to fluids indicates that the shock is not purely due to hypovolemia but also involves the severe systemic effects of sepsis.

Inadequate fluid resuscitation might initially explain hypotension, but after administering 2 liters of fluid, you should consider a more complex cause, like septic shock. Cardiac tamponade could cause hypotension, but the scenario lacks typical signs, such as jugular venous distension or muffled heart sounds. Myocardial depression can contribute to hypotension in septic shock but is usually part of the broader shock state rather than the primary cause of unresponsive hypotension.

27.

Which of the following statements about hypertension is FALSE? 

  • Consistent therapy in Stage 1 hypertension is rarely necessary

  • Hypertension in Stage I is characterized by 130–139 mmHg systolic or 80–89 mmHg diastolic pressure in adults

  • Current guidelines define a normal blood pressure as < 120 mmHg systolic and < 80 mmHg diastolic pressure in adults

  • Stage 2 hypertension is defined as > 140 mmHg systolic or > 90 mmHg diastolic pressure in an adult

Correct answer: Consistent therapy in Stage 1 hypertension is rarely necessary

Consistent therapy in Stage 1 hypertension is often necessary and recommended. Current guidelines by the American College of Cardiology (ACC) and the American Heart Association (AHA) define Stage 1 hypertension as 130–139 mmHg systolic or 80–89 mmHg diastolic pressure. They recommend treatment with lifestyle modifications and, in some cases, antihypertensive medication if they have a history of cardiovascular disease, diabetes, or a high ten-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score.

A blood pressure below 120/80 mmHg is considered normal according to the ACC/AHA guidelines. The latest guidelines for diagnosing and classifying hypertension define Stage 2 hypertension as > 140 mmHg systolic or > 90 mmHg diastolic pressure in an adult.

28.

Goals in patient management of acute Heart Failure (HF) revolve around four general principles. Which of the following is one of these principles?

  • Improve ventricular function

  • Increase preload and decrease afterload

  • Micromanage hemodynamic parameters

  • Manage fluid volume deficits

Correct answer: Improve ventricular function

One of the primary goals in managing acute heart failure is to improve ventricular function, which can help alleviate symptoms, enhance cardiac output, and improve overall patient outcomes.

While managing preload and afterload is important in heart failure, the goal is typically to decrease preload to reduce congestion and to decrease afterload to reduce the workload on the heart rather than increasing preload.

Monitoring hemodynamic parameters is important, but the goal is not micromanagement. It is to maintain overall stability and address the underlying issues.

In acute heart failure, the primary concern is often managing fluid overload rather than deficits. Managing fluid volume typically involves diuretics and fluid restrictions to prevent congestion and edema.

29.

A 58-year-old female patient with type 2 diabetes mellitus was treated for Hyperosmolar Hyperglycemic State (HHS) and is now stable. During discharge planning, what intervention is MOST likely to prevent recurrence of HHS?

  • Educating the patient about regular blood glucose monitoring

  • Prescribing a higher dose of insulin

  • Scheduling weekly follow-up appointments

  •   Recommending a high-protein diet

Correct answer: Educating the patient about regular blood glucose monitoring

Educating the patient about monitoring her blood glucose regularly is the most effective intervention to prevent recurrence of HHS, as it enables early detection and management of hyperglycemia.

Prescribing a higher dose of insulin may not be necessary. The dosage should be tailored to the patient's needs rather than a blanket recommendation.

Scheduling weekly follow-up appointments can help with ongoing management but is not as immediately effective as self-monitoring.

Recommending a high-protein diet is not directly related to preventing HHS recurrence and does not address blood glucose control.

30.

Hydroxyurea is a medication sometimes prescribed to help prevent complications due to what condition?

  • Sickle cell disease

  • Acute renal failure

  • Myasthenia gravis

  • Chronic renal failure

Correct answer: Sickle cell disease

Hydroxyurea increases the production of fetal hemoglobin (HbF), which helps to reduce the frequency of sickle cell crises, pain episodes, and the need for blood transfusions. It can also help decrease the risk of acute chest syndrome and other severe complications associated with sickle cell disease.

Hydroxyurea is not indicated in the treatment of Acute Renal Failure (ARF), myasthenia gravis, or chronic renal failure.

31.

A 46-year-old female patient has been on heparin therapy for five days, and her platelet count has decreased significantly. Which of the following BEST explains the mechanism behind Heparin-Induced Thrombocytopenia (HIT)?

  • Heparin binds to platelet factor 4, forming a complex that triggers an immune response

  • Heparin directly destroys platelets in the bloodstream

  • Heparin increases platelet production in the bone marrow, leading to their early destruction

  • Heparin activates the coagulation cascade, consuming platelets in the process

Correct answer: Heparin binds to platelet factor 4, forming a complex that triggers an immune response

HIT occurs when heparin forms a complex with platelet factor 4, which then triggers an immune response leading to platelet activation, aggregation, and subsequent thrombocytopenia.

Heparin does not directly destroy platelets; the destruction occurs secondary to the immune response. The statement that heparin increases platelet production, leading to their early destruction, is incorrect and does not reflect the pathophysiology of HIT. While heparin does have effects on the coagulation cascade, it does not cause thrombocytopenia by consuming platelets in this manner.

32.

Which of the following is the BEST method of evaluating aspiration risk for patients who are receiving enteral feedings?

  • Assess cough reflex

  • Assess gag reflex

  • Routinely measure gastric residual volume

  • Test tracheal secretions for the presence of glucose

Correct answer: Assess cough reflex

The cough and swallow reflexes are important to airway protection and are the best method of evaluating aspiration risk for patients receiving enteral feedings. The least reliable protective reflex in assessing aspiration risk is the gag reflex. 

The idea that Gastric Residual Volume (GRV) is a valid measure of enteral nutrition tolerance and the link between the amount of GRV and the risk of aspiration pneumonia events have not been proven. Furthermore, GRV measurement is poorly standardized and should not be routinely incorporated into practice.

Testing tracheal secretions for the presence of glucose can indicate aspiration if enteral feeding contents enter the airway, but it is more of a diagnostic tool after aspiration has occurred rather than a preventive measure.

33.

A 49-year-old male patient with a known spinal cord injury at the T8 level presents with new onset of urinary incontinence and muscle weakness in the lower extremities. He also complains of back pain that radiates down both legs. 

Which of the following actions is the MOST appropriate next step?

  • Obtain an urgent Magnetic Resonance Imaging (MRI) scan

  • Administer pain medication

  • Consult physical therapy for gait training

  • Monitor the patient’s symptoms closely

Correct answer: Obtain an urgent Magnetic Resonance Imaging (MRI) scan

In a patient with a history of spinal cord injury presenting with new urinary incontinence, muscle weakness, and radicular back pain, it is critical to rule out spinal cord compression or other significant pathology. An urgent MRI is the most appropriate next step to identify any new lesions, hematomas, or other causes of compression that could require immediate intervention.

Pain medication may provide symptom relief but does not address the underlying cause of these new symptoms. Consulting physical therapy for gait training would be premature without first understanding the cause of the new weakness. Monitoring the patient’s symptoms closely is important but would delay potentially life-saving treatment if there is a serious underlying cause.

34.

A 67-year-old female patient is admitted for a COPD exacerbation. She is receiving oxygen therapy via nasal cannula at 4 L/min, but her oxygen saturation remains at 88%. 

What is the MOST likely next step in management?

  • Administer a bronchodilator

  • Increase oxygen flow to 6 L/min

  • Initiate Noninvasive Positive Pressure Ventilation (NIPPV)

  • Switch to a Venturi mask

Correct answer: Administer a bronchodilator

Administering a bronchodilator helps open the airways and improve oxygen exchange. This intervention should be performed before further escalating oxygen therapy. Increasing the oxygen flow alone may not improve oxygenation significantly if the patient has significant airway obstruction.

NIPPV may be used if bronchodilators fail, but it is not the first-line treatment. A Venturi mask may be considered, but the patient likely needs bronchodilator therapy to relieve airway obstruction first.

35.

What is the MOST common cause of hemorrhagic stroke?

  • Hypertension

  • Aneurysm rupture 

  • Arteriovenous Malformation (AVM)

  • Head trauma

Correct answer: Hypertension

Hypertension, or high blood pressure, is the most common cause of hemorrhagic stroke. Chronic hypertension can weaken blood vessel walls, leading to a rupture and subsequent bleeding in the brain. Managing blood pressure is crucial to preventing hemorrhagic strokes.

While an aneurysm rupture is a significant cause of hemorrhagic stroke, it is not as common as hypertension. An aneurysm is a weakened area in a blood vessel wall that can burst, causing bleeding.

An AVM is a tangle of abnormal blood vessels connecting arteries and veins in the brain. Although AVMs can lead to hemorrhagic strokes, they are a less common cause than hypertension.

Head trauma can cause a hemorrhagic stroke, particularly in cases of severe injury. However, it is not as common a cause as hypertension.

36.

A 30-year-old female patient with type 1 diabetes mellitus is admitted to the progressive care unit with symptoms of nausea, vomiting, and abdominal pain. She reports not taking her insulin for the past two days due to a lack of appetite and has noticed a fruity odor on her breath. Her blood glucose level is 450 mg/dL, and her blood pH is 7.25. The healthcare team suspects Diabetic Ketoacidosis (DKA) and prepares to initiate treatment.

Ketones accumulate in the blood when which type of molecule is broken down faster than it can be metabolized?

  • Fat

  • Protein

  • Carbohydrate

  • Glucose

Correct answer: Fat

In conditions like DKA, the lack of insulin prevents glucose from entering cells, leading the body to break down fats for energy. This rapid breakdown of fats results in the production of ketones, which accumulate in the blood, causing ketosis and acidosis.

Proteins are broken down into amino acids, which can be used for gluconeogenesis or other metabolic processes, but they do not produce ketones as fats do.

Carbohydrates are typically broken down into glucose, which is used for energy. In the presence of adequate insulin, carbohydrates do not lead to the production of ketones.

Glucose itself does not lead to the production of ketones. It is the primary energy source for cells when insulin is present and functioning correctly. The problem in DKA is the lack of insulin, which forces the body to use fats for energy, leading to ketone production.

37.

A 34-year-old female patient is diagnosed with Disseminated Intravascular Coagulation (DIC) following placental abruption. Which laboratory value is MOST likely to be elevated in a patient with DIC?

  • Fibrin Degradation Products (FDPs)

  • Platelet count

  • Prothrombin Time (PT)

  • Fibrinogen level

Correct answer: Fibrin Degradation Products (FDPs)

FDPs are elevated due to the widespread fibrinolysis occurring in DIC, in which fibrin is broken down, releasing degradation products into circulation.

Platelet count is typically decreased in DIC due to the consumption of platelets during the formation of clots. PT is prolonged, but the elevation of FDPs is more specific to fibrinolysis. Fibrinogen levels are decreased in DIC because fibrinogen is consumed during clot formation.

38.

Which of the following statements is FALSE about the safe and effective use of Intermittent Pneumatic Compression Devices (IPCs)?

  • The use of these devices is contraindicated in ambulatory patients

  • Assessment for correct fit needs to be ongoing as changes in weight and fluid shifts occur

  • The devices need to be closely monitored to make sure they are being worn and are correctly placed

  • Ensure the devices do not impede the patient's ambulation

Correct answer: The use of these devices is contraindicated in ambulatory patients

IPCs are not contraindicated in ambulatory patients, and care should be taken to ensure the devices do not impede the patient's ambulation.

IPC devices help to prevent DVT and pulmonary embolism. Follow the manufacturer's recommendations for the correct fit, including patient measurement. Assessment for correct fit needs to be ongoing as changes in weight and fluid shifts occur. The devices need to be closely monitored to make sure they are being worn and are correctly placed.

39.

A 54-year-old male patient is intubated for severe pneumonia and is receiving mechanical ventilation. His vital signs include BP 120/75 mmHg, HR 90 bpm, and SpO2 94% on 40% FiO2. You notice that the endotracheal tube has moved outward by 2 cm. 

What is the MOST appropriate immediate action?

  • Assess breath sounds and secure the tube

  • Increase the oxygen concentration to 60%

  • Notify the physician and await further orders

  • Administer a sedative to prevent further movement

Correct answer: Assess breath sounds and secure the tube

When an endotracheal tube has moved, it is crucial to first assess breath sounds to ensure that the tube is still properly positioned in the trachea. If the tube is out of position, ventilation might be compromised. After placement has been confirmed, the tube should be secured to prevent further movement.

Increasing the oxygen concentration might be necessary if oxygenation is compromised, and notifying the physician is important but these actions are of lower priority than assessment and securing of the tube. Administering a sedative to prevent movement is not appropriate as the first response to a displaced tube.

40.

You are assessing a patient who has been admitted with Ogilvie syndrome. This condition PRIMARILY affects which of the following? 

  • The colon

  • The lower extremities

  • The pancreas

  • The kidneys

Correct answer: The colon

Ogilvie syndrome, also known as acute colonic pseudo-obstruction, primarily affects the colon. It is characterized by a massive dilation of the colon without any mechanical obstruction. This condition typically occurs in hospitalized or immobilized patients and, if not managed promptly, can lead to complications including perforation and ischemia.