Exam (elaborations)
BMTCN PRACTICE TEST B WITH 100% CORRECT ANSWERS.
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- Oxford University (OX)
BMTCN PRACTICE TEST B WITH 100% CORRECT ANSWERS.
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PCCN QUESTIONS WITH VERIFIEDCORRECT ANSWERS
Two days following a near-drowning accident, a pt is dyspneic, using accessory muscles,
expectorating large amounts of secretions and reporting feeling of impending death. Changes to
the assessment data include
RR- 24 TO 36
CXR clear to bilateral diffuse infiltrates
ABG 40% face mask or 100% non-rebreather mask
pO2 120 mm Hg to 56 mm Hg
pCO2 33 mmHg to 56 mmHg
pH 7.42 to 7.35
HCO3 24 meq/L to 27 mEq/L
Which of the ff do these changes most likely represent
A. aspiration pneumonia
B. pulmonary em - answer D. The onset of symptoms occured within 48 hours of the incident.
THe bilateral diffuse infiltrates and ABG results indicating hypoxemia and CO2 retention are all
consistent with ARDS.
Aspiration pneumonia should include hypoxxemia, respiratory alkalosis. The CXR results would
reveal an area of opacity with aspiration pneumonia rather than diffuse infiltrates.
Interstitial lung disease invlolves an inflammation of supportive tissue between the air sacs
rather than inflammation in the air sacs themselves. Symptoms would be SOB and a dry cough.
A pt reports chest pain that is sharp, constant, worse when lying down and alleviated with
sitting up and leaning forward. The most likely cause of these findings is
A. ACS
B. pericarditis
C. PE
,D. AAA - answer B Pericarditis is inflammation of the pericardial sac. The damaged epicardium
becomes rough and inflamed and irritates the pericardium lying adjacent to it, precipitating
pericarditis. Pain is the most common symptom of pericarditis. THe pain is sharp, constant and
is alleviated when sitting up and leaning forward.
A pt tells a nurse, "I don't know how I'm going to pay for this hospitalization." The nurse should
A. arrange a meeting with hospital social services staff
B. Notify the business office so a payment plan can be designed
C. redirect the pt toward meeting psychologic needs
D. give the pt applications for public assistance medical coverage - answer A. Collaboration with
a social worker is indicated in this case the social worker can assist the pt in identifying ways to
address the financial implications of this hospitalization and help identify methods of payments.
A cardiac pt with with DNR status is being managed medically. The nurse notes a new cough,
thick yellow sputum and a temperature of 101.4 (38.4) Coarse crackles are present in the right
upper field. The nurse should most immediately anticipate
A. blood and sputum cultures followed by a broad spectrum abx
B. mucolytics and judicious IV fluid administration
C. an antyipyretic and conservative management
D. NPO status and encouragement of frequent activity - answer A. This pt symptoms are
consistent with pneumonia. Management should include abx therapy, oxygen therapy for
hypoxemia, mechanical ventilation if acute respiratory failure develops, fluid management for
hydration, nutritional support, and treatment of associated medical problems and
complications.
Which of the ff findings is most indicative of a ruptured aortic aneurysm
A. Back pain
B. bounding peripheral pulses
C. intermittent claudication
D. warm, flushed skin - answer A. An aneurysm is the localized dilation of an artery. Should an
aneurysm rupture, blood will build up under pressure in the tissues surrounding the aorta,
,which can result in acute pain and tenderness in theses areas. This is particularly the case if the
aneurysm leaks from the back of the aorta. Ruptured AAA presents with a classic triad of pain in
the flank or back, hypotension and a pulsatile abdominal mass; however, only about half of the
full triad. The pt will complain of the pain and may feel cold, sweaty and faint on standing. The
pt may also report abdominal pain. A small percentage may have vomiting
According to recommendations based on research findings, pain assessment should occur
A. based on changes in vital signs
B. only when the pt movements indicate the pt is seeking attention
C. routinely, regardless of physical findings
D. only when the presence of pain can be validated - answer C. Pain is considered the fifth vital
sign and must be assessed regularly. Presence of physical findings may be part of the
comprehensive assessment of pain. However, physical findings may not be present in all
patients with pain
A pt with a tracheostomy requires frequent suctioning for thick sputum, A nurse finds a
colleague instilling saline in the endotracheal tube prior to suctioning. The most appropriate
response by the nurse would be to
A. report the colleague to the charge nurse or manager
B. noted the practice on the pt chart to ensure consistency of suctioning techniques
C. ask the attending physician to review the suctioning policy.
D. collaborate with the colleague to review the evidence about this practice. - answer D. In
addition to an unappreciable increase in sputum recovery, use of NS adversely affects arterial
and global tissue oxygenation and dislodges bacterial colonies, thus contributing to lower
airway contamination. Other harmful pt outcomes have been reported in the nursing literature,
including delays in return to baseline vital signs, Spo2 and intracranial pressure. Because no
solid scientifically based benefits for routine use of normal saline have been shown, it is highly
recommended that this potentially harmful practice be abandoned. Instead, treatment
considerations should center on ways to prevent the development of thick tenacious secretions.
A review of these data should take place with the colleague to help mitigate continuation of this
dangerous practice
, Upon admission to the PCU, you screen a pt to determine whether to administer an influenza
vaccine. Which of the following is a contraindication to the vaccine?
A. Guillian-Barre syndrome
B. chronic renal failure
C. COPD
D. cirrhosis - answer A. Persons who developed Guillain-Barre syndrome after receiving an
influenza vaccine should not receive the influenza vaccine without checking with their provider
Emergency treatment of ventricular dysrhythmias for the pt who has an ICD pacemaker includes
which of the following
A. If a pt develops vfib, the nurse should not defibrillate with external paddles
B. if the ICD is firing correctly and the pt does not have pulse, CPR is not indicated
C. when preparing for external defibrillation, avoid placing the paddle directly over the ICD
pulse generator
D. when you need to turn off all functions of the ICD or pacemaker, apply a magnet - answer C.
Defibrillation has been known to cause malfunction of an ICD or pacemaker. Care should be
taken to ensure the defibrillation paddle/ pads are applied at least 4-finger breaths away from
the device. The anterior-lateral and anterior-posterior positions for paddle/pad placement are
acceptable in a pt with a permanent ICD or pacemaker. The pads may also be placed safely away
from the ICD with 1 pad at the apex left mid-axillary, 5th ICS., and the other pad right of the
sternum just below the clavicle.
Based on the device implanted and the manufacturer, application of a magnet may turn device
off or reset to the default settings.
A pt is admitted following mitral valve replacement. Which of the following should most likely
be included in the patent's plan of care
A. positive inotropic agent
B. anticoagulant
C. prophylactic antibiotic
D. ACE inhibitor - answer B. Anticoagulatn therapy recommendations are based on the valve
apparatus and the pt risk factors (afib, LV dyfunction, previous thromboembolism, and
hypercoagulable condition). Mechanical valve replacement require lifelong anticoagulant
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