ANCC MEDSURG-BC Exam Questions

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21.

Which of the following transfusion reactions is most likely to occur with the administration of non-compatible blood?

  • Acute hemolytic

  • Febrile nonhemolytic

  • Allergic reaction

  • Transfusion-related acute lung injury (TRALI)

Correct answer: Acute hemolytic

Acute hemolytic reactions occur because of the administration of non-compatible blood types. 

Febrile nonhemolytic reactions occur because cytokines from leukocytes in the transfusion react with the recipient. Allergic reactions occur in response to allogeneic proteins in the donor's plasma. Transfusion-related acute lung injury occurs because of donor-recipient interactions of granulocyte antibodies that lead to pulmonary edema.

22.

Which of the following is the most common complication of peptic ulcer disease?

  • GI hemorrhage

  • Pyloric sphincter obstruction

  • Perforation

  • Barretts esophagus

Correct answer: GI hemorrhage

Gastrointestinal hemorrhage is the most common complication of peptic ulcer disease. While pyloric sphincter obstruction and perforation are potential serious complications of peptic ulcer disease, they are less common than GI hemorrhage. Barretts esophagus is not a complication of peptic ulcer disease.

23.

A nurse is participating in the development of a health promotion plan for a community with a high prevalence of obesity. Which strategy should be included to effectively address this issue?

  • Promote regular healthy eating habits

  • Recommend subsidizing an outdoor fitness station

  • Advocate for more exercise programs in schools

  • Suggest reducing salt intake

Correct answer: Promote regular healthy eating habits

Promoting regular healthy eating habits addresses a fundamental cause of obesity by encouraging balanced nutrition and sustainable dietary changes, which are crucial for long-term weight management.

While subsidizing an outdoor fitness station can encourage physical activity in the community, it does not directly address the dietary habits that contribute to obesity. Exercise programs in schools are beneficial for children, but a community-wide health promotion plan needs to encompass all age groups and address broader lifestyle factors.

Reducing salt intake is important for cardiovascular health but is not a comprehensive strategy for addressing obesity, which requires a focus on overall caloric intake and balanced nutrition.

24.

Which of the following best describes valvular insufficiency?

  • The valve does not close completely.

  • Lesions develop on the valve leaflets.

  • Blood flow through the valve is restricted.

  • The valve has a congenital malformation.

Correct answer: The valve does not close completely.

Valvular insufficiency, also called valvular regurgitation or valvular prolapse, is a condition in which the valve does not close completely, allowing blood to flow back and forth across the valve. Valvular insufficiency may be caused by lesions that develop on the valve leaflets or by a congenital malformation, but these do not correctly describe valvular insufficiency and may cause valvular stenosis as well. Blood flow through the valve being restricted describes valvular stenosis, not valvular insufficiency.

25.

What structure transports sperm to the urethra?

  • Vas deferens

  • Cowper's glands

  • Prostate gland

  • Mons pubis

Correct answer: Vas deferens

The vas deferens is a duct that transports sperm from the epididymis, the structure that curves over the testes, to the urethra.

The Cowper's glands, also called the bulbourethral glands, are located behind the urethra and secrete mucus into semen.

The prostate gland surrounds the neck of the bladder and urethra, functioning to add a fluid to semen that helps sperm survive in the female reproductive system.

The mons pubis is part of the female reproductive system.

26.

A nurse is assigned to a patient who is reluctant to participate in physical therapy after surgery. What is the best approach for the nurse to take?

  • Explore the patient’s concerns about physical therapy

  • Provide extra encouragement for the patient to attend physical therapy sessions

  • Recognize the patient’s right to choose whether to participate or not

  • Ask the physical therapist to speak with the patient

Correct answer: Explore the patient’s concerns about physical therapy

Exploring the patient’s concerns about physical therapy allows the nurse to understand any barriers or fears the patient may have and address them effectively. This approach can help the patient feel heard and supported, potentially increasing their willingness to participate.

Providing extra encouragement without understanding the patient’s concerns may not effectively address their reluctance and could lead to further resistance.

Recognizing the patient’s right to choose whether to participate without exploring their concerns does not help address any underlying issues that might be resolved.

Asking the physical therapist to speak with the patient can be helpful but should not replace the nurse’s role in initially exploring and addressing the patient’s concerns.

27.

A nurse is preparing to educate a patient with hypertension on lifestyle modifications. Which approach best incorporates evidence-based practice?

  • Providing guidance based on the latest hypertension management guidelines

  • Recommending individualized changes based on what best suits the patient’s lifestyle

  • Tailoring recommendations based on the patient’s financial resources

  • Advising the patient to implement slow, incremental changes

Correct answer: Providing guidance based on the latest hypertension management guidelines

Providing guidance based on the latest hypertension management guidelines ensures the patient receives recommendations supported by the most current and robust evidence, improving the likelihood of effective management. This approach ensures that lifestyle modifications are both scientifically valid and clinically effective.

While individualizing changes to suit the patient's lifestyle is important, they must be grounded in evidence-based recommendations to be truly effective.

Tailoring recommendations based on financial resources is necessary for responsible use of resources, but should not compromise adherence to evidence-based guidelines.

Incremental changes can be helpful in some situations, but may delay necessary changes and must be informed by evidence-based guidelines to ensure they are appropriate and effective.

28.

Electrical activity of the heart is facilitated by the transmembranal exchange of all of the following ions except:

  • Phosphorous

  • Sodium

  • Potassium

  • Calcium

Correct answer: Phosphorous

Excitability of the heart is affected by the ionic exchange across cell membranes. Ions which facilitate electrical activity in the heart include sodium, potassium, calcium, and magnesium.

29.

A low thyroid-stimulating hormone (TSH) level with elevated triiodothyronine (T3) and thyroxine (T4) levels indicates:

  • Primary hyperthyroidism

  • Secondary hyperthyroidism

  • Primary hyperparathyroidism

  • Secondary hypothyroidism

Correct answer: Primary hyperthyroidism

Primary hyperthyroidism results from hypersecretion of thyroid hormones and is evidenced by increased serum T3 and T4, and decreased serum TSH.

In rare cases of secondary hyperthyroidism (excess secretion of TSH), the TSH level will be increased. Primary hyperparathyroidism is characterized by a state of hypersecretion of one or more of the parathyroid glands, which is usually due to benign adenoma or hyperplasia.

In rare cases of secondary hypothyroidism (decreased secretion of TSH), the TSH level will be decreased, as well as T3 and T4.

30.

A patient with congestive heart failure is experiencing medication side effects that impact their quality of life. Who is best for the nurse to collaborate with to address this issue?

  • Pharmacist

  • Cardiologist

  • Physical therapist

  • Social worker

Correct answer: Pharmacist

To address medication side effects in a patient with congestive heart failure, the nurse should collaborate with a pharmacist. Pharmacists specialize in medications and can provide critical insights into adjusting the regimen to mitigate side effects and enhance the patient's quality of life.

Collaborating with a cardiologist, while important for overall heart failure management, might not address specific medication side effects. A physical therapist's focus on rehabilitation does not extend to managing medications. Social workers, although vital for support, lack the expertise to make necessary adjustments to the medication regimen.

31.

Which of the following is NOT a type of burn?

  • Convection burns

  • Chemical burns

  • Electrical burns

  • Radiation burns

Correct answer: Convection burns

Thermal burns are burns that are caused by hot temperatures. Burns that occur from fire or heat are due to the thermal component, and heat may be transferred by convection, causing a burn. While convection may transfer heat, the method by which the heat is transferred is not a type of burn, and these burns would be considered thermal burns. Convection burns are not recognized as a type of burn.

Chemical burns, electrical burns, and radiation burns are all types of burns.

32.

A nurse is providing care to a patient who prefers to communicate through written notes due to a speech impairment. How should the nurse respond?

  • Accept the patient communicating exclusively through written communication

  • Ask the patient to try to speak to facilitate easier communication

  • Ask the patient to communicate using sign language

  • Use a communication technique that minimizes the need for the patient to respond

Correct answer: Accept the patient communicating exclusively through written communication

Accepting the patient communicating exclusively through written communication respects their preferred method of communication and ensures the patient can express themselves effectively. This approach accommodates the patient’s needs and facilitates clear communication.

Asking the patient to try to speak may cause unnecessary stress and discomfort, especially if they have a speech impairment. Asking the patient to communicate using sign language is not appropriate unless the patient is already proficient in sign language and has indicated a preference for using it. Using a communication technique that minimizes the need for the patient to respond does not encourage effective communication and may leave the patient feeling unheard.

33.

Which of the following statements is false regarding living wills and health care proxies?

  • A living will is the equivalent of a Do Not Resuscitate (DNR) order

  • They can be revoked or changed by the patient at any time

  • A witness is required when signing a living will or health care proxy document

  • These documents can be obtained from many sources

Correct answer: A living will is the equivalent of a Do Not Resuscitate (DNR) order 

An advance directive may include a living will or health care proxy and is based on the belief that patients have a right to make their own treatment decisions. These documents can be obtained from various sources, including the internet, hospitals, physicians, or clinics. A living will allows individuals to specify whether they would accept or refuse particular life-sustaining interventions such as dialysis, mechanical ventilation, CPR, tube feeding, IV hydration, and blood transfusions. This is NOT the equivalent of a DNR order, which states life-sustaining efforts should be limited at the request of the patient. A health care proxy sets apart a specific individual who can make medical decisions on behalf of the patient once the patient is unable to make decisions independently. 

These documents are fluid, and can be changed easily or revoked (by the patient). The time, date, and who requested the changes should be noted, and the information should be witnessed.

34.

Which action by a nurse MOST demonstrates a breach of patient confidentiality?

  • Sharing patient details with a colleague who is not involved in the care, but is a hospital employee with access to the information

  • Discussing patient information with another colleague involved in their care in a private setting

  • Discussing the patient with the nurse’s family using information that would not identify the patient

  • Reporting patient information to the hospital’s security team during a security incident involving the patient

Correct answer: Sharing patient details with a colleague who is not involved in the care, but is a hospital employee with access to the information

Sharing patient details with a colleague not involved in the care is a breach of confidentiality. Access to patient information should be restricted to healthcare providers directly involved in the patient's care to protect privacy.

Discussing patient information with a colleague involved in care in a private setting is necessary for coordinated care and does not breach confidentiality.

Discussing the patient with family, even without identifiable information, breaches confidentiality, but not to the same extent as sharing details with someone unauthorized to have detailed information.

Reporting information to the hospital’s security team during an incident is appropriate and necessary for safety.

35.

A nurse is collaborating with an occupational therapist to develop a care plan for a patient with a recent stroke. Which action by the nurse best supports effective collaboration?

  • Discussing the patient's functional limitations and goals

  • Informing the therapist about the patient’s speech therapy progress to date

  • Asking the therapist to ensure that the patient’s therapy does not conflict with nursing care

  • Providing the therapist with the patient's diagnosis

Correct answer: Discussing the patient's functional limitations and goals

Discussing the patient's functional limitations and goals ensures the occupational therapist is fully aware of the patient's needs and can tailor therapy to meet the patient’s specific functional goals, thus facilitating effective collaboration.

Informing the therapist about the patient’s speech therapy progress to date is more relevant to a speech therapist and does not directly aid in the occupational therapist's planning for functional rehabilitation.

Asking the therapist to ensure the patient’s therapy does not conflict with nursing care does not contribute to collaborative goal-setting or address the patient’s functional needs comprehensively.

Providing the therapist with the patient's diagnosis is not as effective as discussing the patient's specific functional limitations and goals in facilitating effective collaboration for care planning.

36.

A patient prescribed levothyroxine for hypothyroidism should be instructed to avoid which of the following to prevent decreased absorption of the medication?

  • Calcium supplements

  • Vitamin C supplements

  • Potassium supplements

  • Magnesium supplements

Correct answer: Calcium supplements

Calcium supplements can interfere with the absorption of levothyroxine, leading to reduced efficacy of the medication. Patients should avoid taking calcium supplements within a few hours of their levothyroxine dose.

Vitamin C supplements do not interfere with levothyroxine absorption and are not a concern for patients taking this medication. Potassium supplements do not affect the absorption of levothyroxine and are not relevant to this medication. Magnesium supplements, although they can interfere with absorption, are not as important to avoid with levothyroxine when compared to calcium.

37.

When human immunodeficiency virus (HIV) initially attaches to a host cell, what genetic material is released into the cell’s cytoplasm?

  • RNA

  • DNA

  • Chromosome

  • Ribosome

Correct answer: RNA

Human immunodeficiency virus (HIV) is a small particle of genetic material surrounded by a protein shell and is an RNA-containing virus. Upon entering the bloodstream, HIV attaches to the surface of a white blood cell, called a CD4 lymphocyte (also known as a T helper cell or T4 cell). The viral membrane and CD4 cell fuse and the HIV particle release its RNA into the CD4 cell. Reverse transcriptase enzyme then orchestrates the conversion of the HIV single-stranded RNA to double-stranded DNA, which then enters the nucleus of the infected CD4 cell and becomes a part of the cell's DNA.

A chromosome is a large DNA molecule found in cells and is not normally present in viruses. Ribosomes are proteins in the cell that may contain RNA but do not store genetic information.

38.

Which of the following patients most likely to develop polycystic kidney disease?

  • A 55-year-old male whose mother had polycystic kidney disease

  • A 61-year-old female who has used alcohol heavily for 12 years

  • A 35-year-old male who had a ruptured kidney in a car accident that occurred three years previously

  • A 45-year-old female with type one diabetes mellitus

Correct answer: A 55-year-old male whose mother had polycystic kidney disease

Polycystic kidney disease is an inherited disorder, and the patients who would be most likely to develop this condition would be those with a family history of the disease. Heavy alcohol use, kidney trauma, and diabetes do not cause polycystic kidney disease.

39.

Which of the following is least likely to increase the risk of Gastroesophageal Reflux Disease (GERD)?

  • Dumping syndrome

  • Pregnancy

  • Smoking

  • Hiatal hernia

Correct answer: Dumping syndrome

Dumping syndrome occurs when gastric emptying occurs too rapidly. Delayed gastric emptying, not rapid gastric emptying, is associated with an increased risk of GERD. Pregnancy, smoking, and the presence of a hiatal hernia all increase the risk of GERD.

40.

A nurse is caring for a patient who tells them, "You have to treat me extra nice because my dad is the CEO here." Which of the following ethical principles should guide how the nurse provides care?

  • Justice

  • Privacy

  • Beneficence 

  • Respect

Correct answer: Justice

Justice is the ethical principle of fairness and involves not treating people differently based on who they are or allocating resources in an unfair way. Justice should guide the nurse to treat the patient the same as they would treat any other patient in a similar situation. Privacy is the ethical principle of protecting patient information and keeping it private. Respect is the ethical principle of recognizing the inherent worth and human rights of each individual. Beneficence is the ethical principle of doing or promoting good.