MSNCB CMSRN Exam Questions

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81.

Which of the following is not a risk factor for a sickle cell crisis?

  • Iron deficiency

  • Dehydration

  • Infection

  • Pregnancy

Correct answer: Iron deficiency

Sickle cell crisis occurs when hemoglobin interacts with other hemoglobin in the red blood cells, forming long, rigid chains that cause the red blood cells to change into a crescent or sickle shape. Dehydration, infection, pregnancy, and other stresses on the body can increase the risk of a sickle cell crisis. Sickle cell disease may lead to iron deficiency as red blood cells are broken down but is not exacerbated by an iron deficiency.

82.

A patient with a fractured fibula is receiving skeletal traction and has external fixation in place. Which of the following do you instruct the nursing assistant to report immediately?

  • The traction weights are resting on the floor

  • The patient is complaining of pain and muscle spasm

  • The patient wants to change position in bed

  • There is a small amount of clear fluid on the skeletal pin sites

Correct answer: The traction weights are resting on the floor

Skeletal traction involves pulling force (weight may reach 10-40 pounds) applied directly to the bone, allowing traction to be tolerated for longer periods of time. 

When the traction weights are resting on the floor, they are not exerting pulling force to provide reduction and alignment, or to prevent muscle spasm. The weights should always hang freely. Attending to the weights may reduce the patient’s pain and spasm. 

With skeletal pins, a small amount of clear fluid drainage is expected. It is important to inspect the traction system after a patient changes position because position changes may alter the traction.

83.

When caring for a female patient who will be undergoing a total proctocolectomy with ileostomy for her Crohn's disease, which of these comments made before surgery would indicate that she has concerns about her body image?

  • "I need to go shopping for bigger, baggier clothing."

  • "I will have to discontinue my gym membership."

  • "I'm concerned that this may be only the first of many surgeries to come."

  • "I'm so afraid I may not survive the surgery."

Correct answer: "I need to go shopping for bigger, baggier clothing."

Psychosocial support is necessary as a part of your nursing interventions regarding body image concerns. Body image refers to a person's perception of self and determines how the person interacts with others. The patient does not need to buy special clothing after ileostomy surgery, although some minor adjustments may be needed for comfort, such as stretch underwear or pantyhose for support.

84.

Which of the following statements related to leiomyomas of the uterus is true?

  • They are tumors that develop from smooth muscle cells in the myometrium

  • They are more common in Caucasian women than in women of other races

  • These tumors become malignant, and treatment often includes cryosurgery

  • The incidence of these tumors increases after menopause

Correct answer: They are tumors that develop from smooth muscle cells in the myometrium

Leiomyomas are also called myomas, fibromyomas, or fibroids; they are benign tumors that develop from smooth muscle cells in the myometrium. Although they have an unknown etiology, their growth is related to estrogen.

They are more common in African-American women than in Caucasian women and are often untreated unless symptomatic. They often shrink and usually cease after menopause.

85.

The nurse is providing teaching to a patient who is being treated for incontinence. Which of the following statements by the patient requires further teaching?

  • This disease is normally curable.

  • There are many different types of incontinence.

  • Sometimes there is no obvious cause for this condition.

  • My incontinence might be due to medications I am using.

Correct answer: This disease is normally curable.

Incontinence is a symptom of other problems, not a disease itself. There are many different types of incontinence with varying causes. Incontinence may be due to medications or may be idopathic.

86.

Which of the following diagnostic studies is the most reliable tool for gastrointestinal disorders?

  • Endoscopy

  • Radiology

  • Angiography

  • Ultrasonography

Correct answer: Endoscopy

Endoscopy is one of the most reliable diagnostic tools for gastrointestinal disorders because it can pinpoint the area of concern. A flexible, lighted tube called an endoscope is inserted orally or rectally for direct visualization of the concerning area of the GI tract; usually, photographs can be obtained. Specific procedures include gastroscopy, duodenoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP).

87.

You are caring for a patient who presents with an area of edema on their lower left leg where the skin is warm to the touch, erythemic, and tender with palpation. Which of the following should you suspect is most likely the cause of the patient's symptoms?

  • Cellulitis

  • Right sided heart failure

  • Lymphedema

  • Venous insufficiency

Correct answer: Cellulitis

Right sided heart failure and venous insufficiency typically present with bilateral edema, not unilateral edema as described in this scenario. These conditions will also not typically cause erythema or warmth over the edematous area. While lymphedema can cause unilateral edema, this edema is also not typically associated with erythema or warmth. Both erythema and warmth are suggestive of an infectious etiology, which would be most consistent with cellulitis.

88.

The med/surg nurse is assessing a patient who was recently diagnosed with hyperthyroidism. Which of the following symptoms would the nurse not expect to see?

  • Constipation

  • Tachycardia

  • Arrhythmias

  • Tremors

Correct answer: Constipation

Hyperthyroidism causes an increased metabolic rate that can lead to tachycardia, arrhythmias, tremors, and diarrhea. Constipation is very unlikely to occur with hyperthyroidism, and is more common with hypothyroidism.

89.

The nurse is caring for a patient with kidney stones. Of the following, which is the most important nursing action?

  • Strain the urine at each voiding

  • Record the patient’s blood pressure

  • Administer pain medication every 4 hours

  • Limit fluid intake at night

Correct answer: Strain the urine at each voiding

Urine is strained to determine whether any of the stone debris has been passed. All debris should be sent to the lab for analysis to determine stone content and effective treatment course.

Fluids should be encouraged (not limited) to dilute the urine and facilitate the passage of the stone. Blood pressure is not relevant to kidney stones. Administration of pain medication is an important nursing intervention but will be based on the physician’s order, and will typically be provided PRN, not on a schedule.

90.

Which of the following statements is true related to renal hormones?

  • Renin is released from the kidneys in response to hypoperfusion

  • Erythropoietin stimulates bone marrow production of ferritin

  • Vitamin D is necessary for absorption of phosphorus through the gastrointestinal tract

  • Prostaglandins are primarily produced in the renal cortex

Correct answer: Renin is released from the kidneys in response to hypoperfusion

Renin is released in response to hypoperfusion (due to trauma such as hemorrhage, acute heart failure, hypotension from postoperative complications).

Erythropoietin stimulates bone marrow to produce red blood cells, not ferritin. Vitamin D is necessary for absorption of calcium through the gastrointestinal tract, not phosphorus. The renal medulla (not renal cortex) is the major site of prostaglandin production.

91.

You are caring for a patient with type 1 diabetes mellitus who exhibits confusion, light-headedness, and impaired thought processes and has a bedside blood glucose level of 52. The patient is still conscious. You should first administer:

  • 15 grams of a fast-acting carbohydrate such as orange juice

  • IV bolus of dextrose 50%

  • IM or SQ glucagon

  • 10 units of fast-acting insulin

Correct answer: 15 grams of a fast-acting carbohydrate such as orange juice

The patient is having a hypoglycemic episode. Because the patient is still conscious with an intact swallowing response, the 15/15 rule is generally applied; administer 15 grams of a fast-acting carbohydrate and wait 15 minutes. Repeat as needed, until blood glucose levels are greater than 70 mg/dL.

In severe reactions, when the patient is unable to swallow or is unconscious, intramuscular or subcutaneous glucagon, or intravenous glucose (Dextrose 50%) should be administered. You should not administer insulin to a patient who is hypoglycemic; this action will further compromise the patient's condition.

92.

You are caring for a 42-year-old male who asks you about his risk for cancer. Which of the following statements is incorrect?

  • "Because you are male, you cannot get breast or cervical cancer."

  • "Smoking increases the risk of many types of cancers."

  • "You can reduce the risk of colon cancer by getting regular colonoscopies that can detect cancer early."

  • "Even people who live healthy lifestyles may develop cancer."

Correct answer: "Because you are male, you cannot get breast or cervical cancer."

While males cannot get cervical cancer, they may still develop breast cancer. Breast cancer primarily affects females, but it can occur in males. 

Smoking is a significant risk factor for many types of cancers. Regular colonoscopies are recommended to screen for colon cancer and reduce the risk of this type of cancer. Unfortunately, even those who live healthy lifestyles may develop cancer, and there is no way to completely eliminate this risk.

93.

All of the following statements related to rheumatoid arthritis (RA) are true except:

  • RA is the most common articular disease in adults

  • Isometric exercises are used in RA patients to preserve and improve muscle function

  • Disease-modifying anti-rheumatic drugs (DMARDs) should be initiated early in RA treatment

  • No single set of tests can confirm diagnosis of RA

Correct answer: RA is the most common articular disease in adults

Osteoarthritis (OA) is the most common form of articular (joint) disease and leading cause of progressive disability and pain in older adults.

Physical therapy for patients with RA focuses on range of motion, strengthening, and endurance, and may include isometric, isotonic (used with caution), and low-resistance exercise. DMARDs, such as methotrexate, should be initiated early in RA treatment to modify or slow disease process.

Diagnosis of RA is made through various laboratory tests, as well as synovial fluid analysis, arthroscopic examination, and radiologic studies (show characteristic changes); there is not one single set of tests that can confirm RA diagnosis.

94.

Gross, painless hematuria is commonly the first symptom of:

  • Bladder cancer

  • Nephrotic syndrome

  • Polycystic kidney disease (PKD)

  • Kidney stones

Correct answer: Bladder cancer

In cancer of the bladder, tumors begin in the transitional cell layer lining the bladder, and this abnormal cell growth and configuration is called dysplasia. This type of cancer may be asymptomatic, but gross, painless hematuria is the first symptom 85% of the time. Pelvic pain and frequent urination occur with advanced bladder cancers.

Nephrotic syndrome typically manifests with proteinuria, hyperlipidemia, and edema. Dull, aching lumbar or flank pain is most commonly experienced with polycystic kidney disease, along with proteinuria, hematuria, pyuria, calculi, kidney masses, polyuria, and nocturia; symptoms are widely diverse among these patients. Kidney stones often present with severe pain and fever/chills.

95.

Which of the following dietary considerations is true for a patient who is diagnosed with a volvulus?

  • The patient should be made NPO

  • The patient should follow a high-fiber, high-protein diet

  • The patient can only have clear fluids

  • The patient may have a full fluid diet except for milk

Correct answer: The patient should be made NPO

A volvulus is twisting of the intestines and may require surgery. A patient with a volvulus should not have anything to eat or drink until the volvulus is resolved, both because food will not be able to pass through the intestines and because surgery is possible.

96.

The patient you are caring for has a diagnosis of acute renal failure (ARF), and the doctor has ordered daily weights to closely assess fluid status. You know that 1 pound of weight is equivalent to approximately how many mL (cc's)?

  • 500 cc

  • 750 cc

  • 1000 cc

  • 1250 cc

Correct answer: 500 cc

Genitourinary nursing assessment and interventions for the patient with ARF include:

  • Assessing and recording accurate intake and output; careful monitoring of fluid balance indicators is crucial
  • Anticipating fluid restrictions (generally intake exceeds output by no more than 500 cc/24 hours)
  • Weighing daily to assess fluid status: 500 cc = 1 pound
  • Anticipating adjusted doses of medication excreted via renal system, due to damaged kidneys
  • Support with hemodialysis if uremia present
  • 24-hour urine collection as indicated

97.

Which of the following would the nurse not expect to see in a patient with chronic renal failure?

  • Hyperproteinemia

  • Hypokalemia

  • Hypercholersteremia

  • Hypermanesemia

Correct answer: Hyperproteinemia

Hypoproteinemia, not hyperproteinemia, is normally present in patients who are in chronic renal failure due to proteinuria and decreased protein synthesis. Hypokalemia or hyperkalemia may be present in chronic renal failure; either one is not unexpected depending on the patient's underlying condition. Hypercholersteremia is typically present due to altered lipid metabolism. Hypermanesemia is often present due to decreased excretion of magnesium.

98.

You are caring for a patient who is in acute renal failure (ARF) who asks about his continuing treatment and prognosis. Which of the following statements to the patient is correct?

  • "Acute renal failure is often reversible."

  • "You will need a intravenous pyelogram to evaluate the blood flow in your kidneys."

  • "Everyone who has acute renal failure needs to be on dialysis until it resolves."

  • "You will need a medication called Lasix during the oliguric phase of acute renal failure."

Correct answer: "Acute renal failure is often reversible."

Acute renal failure is often reversible and can be recovered from without long-term kidney damage in many situations. 

Intravenous pyelograms are typically avoided in patients with ARF, as this can worsen damage to the kidneys. Dialysis may be necessary is severe cases, but most people in ARF do not require dialysis unless their condition becomes critical. Lasix will not help ARF in the oliguric phase or other phases.

99.

What is the most common complication of insulin treatment?

  • Hypoglycemia

  • Hypokalemia

  • Diabetic ketoacidosis

  • Hyperglycemia

Correct answer: Hypoglycemia

Insulin treatment reduces blood sugar levels. Complications associated with high blood glucose levels, such as diabetic ketoacidosis and hyperglycemia, are not complications from using insulin, rather they are complications from failing to use insulin. Insulin treatments can cause both hypokalemia and hypoglycemia; however, hypoglycemia is far more common a complication.

100.

Which of the following patients would be most likely to be developing acute glomerulonephritis if they present with symptoms that were suspicious for this diagnosis?

  • A patient who had a streptococcal infection seven days previously

  • A patient has an active streptococcal infection

  • A patient who had a staphylococcus infection 14 days previously

  • A patient has an active staphylococcus infection

Correct answer: A patient who had a streptococcal infection seven days previously

Glomerulonephritis is characterized by bilateral inflammation of the glomeruli because of an immunological reaction. It most commonly occurs 7–10 days following a streptococcal infection. Glomerulonephritis caused secondary to an infection is unlikely to occur during the infection itself or more than 10 days after the infection.