ANCC Nursing Certification Exam — Questions and Answers

Question 1: A nurse leader implementing shared governance is most focused on which goal?

Empowering bedside nurses to participate in decision-making (Correct answer)
Reducing the number of nursing committees
Eliminating nurse manager roles
Centralizing all clinical decisions with nursing administration

Correct answer: Empowering bedside nurses to participate in decision-making

Shared governance distributes decision-making authority to frontline nurses, promoting autonomy and professional practice.

Question 2: Which sign/symptom differentiates pulmonary embolism (PE) from myocardial infarction (MI)?

Chest pain and shortness of breath
Sudden onset pleuritic chest pain and hemoptysis with normal cardiac enzymes (Correct answer)
Tachycardia and diaphoresis
Hypotension and syncope

Correct answer: Sudden onset pleuritic chest pain and hemoptysis with normal cardiac enzymes

Pleuritic chest pain (worsens with breathing), hemoptysis, and normal cardiac enzymes are characteristic of PE rather than MI.

Question 3: A patient with burns is placed on an air-fluidized bed to relieve pressure. It is especially important to carefully monitor this patient for:

Temperature
Fluid balance (Correct answer)
Pain level
Vital signs

Correct answer: Fluid balance

Explanation: When a patient, such as a burn patient, is placed on an air-fluidized bed, it is especially important to monitor fluid balance because he or she can easily become dehydrated. Air-fluidized beds contain a mass of fine ceramic microspheres through which warm air flows. The patient is placed on a special polyester filter sheet that allows air to pass through it. The warmth causes perspiration, which is quickly absorbed, so diaphoresis may not be evident.

Question 4: During a mental status exam, a patient demonstrates flight of ideas. This finding is most consistent with which condition?

Major depressive disorder
Manic episode (Correct answer)
Generalized anxiety disorder
Schizophrenia

Correct answer: Manic episode

Flight of ideas — rapidly shifting, loosely connected thoughts — is a hallmark feature of manic episodes.

Question 5: Which metric would best measure whether a newly implemented sepsis early warning algorithm in the EHR actually improves patient outcomes?

Rate at which nurses acknowledge alerts within the EHR
In-hospital mortality rate and time-to-antibiotics for patients with sepsis alerts (Correct answer)
Number of sepsis alerts fired per day
Alert firing sensitivity (percentage of true sepsis cases that generated an alert)

Correct answer: In-hospital mortality rate and time-to-antibiotics for patients with sepsis alerts

Clinical effectiveness of a sepsis alert system is best measured by patient outcome metrics — mortality rate and time-to-antibiotics. Alert firing rates and acknowledgment rates are process measures that do not directly confirm improved patient outcomes.

Question 6: A patient with borderline personality disorder is engaging in splitting behavior. How should the nursing staff respond?

Limit the patient's interactions with other patients
Allow staff the patient prefers to handle all care
Maintain consistent communication and unified team responses (Correct answer)
Assign only one nurse to avoid conflict

Correct answer: Maintain consistent communication and unified team responses

Consistent team communication prevents the patient from manipulating staff through idealization and devaluation dynamics.

Question 7: Which validated screening tool is most appropriate for assessing opioid use disorder risk before initiating chronic opioid therapy?

ORT (Opioid Risk Tool) or DIRE (Diagnosis, Intractability, Risk, Efficacy) score (Correct answer)
AUDIT-C (Alcohol Use Disorders Identification Test-Concise)
DAST-10 (Drug Abuse Screening Test)
CAGE questionnaire for alcohol screening

Correct answer: ORT (Opioid Risk Tool) or DIRE (Diagnosis, Intractability, Risk, Efficacy) score

The ORT and DIRE score are validated instruments specifically designed to predict opioid misuse risk in patients being considered for chronic opioid therapy.

Question 8: A 15-year-old girl weighing 54 kg (120 lb.) took ten 500-mg acetaminophen tablets in a suicide attempt 6 hours before discovery. The initial treatment should be:

GI decontamination with activated charcoal.
supportive therapy and psychiatric referral.
to initiate the 72-hour N-acetylcysteine protocol. (Correct answer)
gastric lavage.

Correct answer: to initiate the 72-hour N-acetylcysteine protocol.

Explanation: The 72-hour N-acetylcysteine protocol is recommended between 4- and 24 hours post-ingestion of intentional acetaminophen overdose. This can be initiated while awaiting results of blood work for acetaminophen levels. Only if the patient is exhibiting symptoms after the 24-hour mark may this protocol still be indicated at that time. Gl decontamination must be done within four hours of ingestion and gastric lavage within one hour of ingestion. Supportive therapy and psychiatric referral are also indicated for this patient, after initiating N-acetylcysteine administration.

Question 9: Because combining monoamine oxidase inhibitors (MAOls) with some foods may cause adverse reactions (hypertension, headache, diaphoresis, cardiac abnormalities, intracerebral hemorrhage), patients taking MAOls should be advised to avoid which of the following foods/beverages?

Milk products and vitamins, vitamins and minerals containing iron, and caffeine
Alcohol and grapefruit juice
Foods high in vitamin K (broccoli, spinach, Brussels sprouts, cauliflower, kale) and vitamin E supplements
Alcohol, products containing caffeine (tea, cola, chocolate coffee), and foods high in tyramine (organ meats, cured meats, cheese, raisins, avocados, and soy) (Correct answer)

Correct answer: Alcohol, products containing caffeine (tea, cola, chocolate coffee), and foods high in tyramine (organ meats, cured meats, cheese, raisins, avocados, and soy)

Explanation: Monoamine oxidase inhibitors (MAOls) should not be taken with alcohol and nonalcoholic substitutes for beer or wine, foods high in tyramine (organ meats, cured meats, caviar, cheese products, avocados, bananas, raisins, soy, and fava beans), and products containing caffeine (tea, cola, chocolate, and coffee). MAOls are older antidepressant medications that are used less frequently now that others are available because they have significant side effects and interactions with other medications, such as decongestants, opioids, and antidepressants.

Question 10: A 28-week gestation newborn in the NICU — which finding is most consistent with respiratory distress syndrome (RDS)?

Coarse crackles with productive cough and purulent secretions
Expiratory grunting, nasal flaring, subcostal retractions, and cyanosis on room air (Correct answer)
Unilateral absent breath sounds with mediastinal shift
Apnea episodes lasting 15 seconds with rapid spontaneous resolution

Correct answer: Expiratory grunting, nasal flaring, subcostal retractions, and cyanosis on room air

RDS in preterm neonates presents with expiratory grunting, nasal flaring, intercostal/subcostal retractions, and cyanosis — classic signs of surfactant deficiency.

Question 11: A 4-year-old child is brought in with a barky, seal-like cough that worsens at night. What is the most likely diagnosis?

Croup (laryngotracheobronchitis) (Correct answer)
Epiglottitis
Asthma
Bronchiolitis

Correct answer: Croup (laryngotracheobronchitis)

Croup presents with the classic seal-like barky cough and stridor, typically caused by parainfluenza virus.

Question 12: According to the ANCC Ambulatory Care Nursing scope and standards, telephone nursing practice (telehealth triage) requires the nurse to document which essential element?

The patient's insurance provider and policy number
The clinical decision-making process, advice given, and patient response (Correct answer)
The nurse's personal opinion about the patient's condition
Only the final disposition and next appointment date

Correct answer: The clinical decision-making process, advice given, and patient response

Thorough documentation of the clinical reasoning, instructions provided, and patient understanding is essential for legal accountability and continuity of care in telephone nursing.

Question 13: A patient with inferior STEMI has ST elevation in II, III, aVF; ST depression in V1-V2; and elevated JVP without pulmonary congestion. Which structure is most likely involved?

Left anterior descending artery infarction with cardiogenic shock
Left circumflex artery infarction with mitral regurgitation
Right ventricular infarction complicating inferior STEMI (Correct answer)
Posterior wall MI in isolation

Correct answer: Right ventricular infarction complicating inferior STEMI

Inferior STEMI with ST depression in V1-V2 (posterior involvement) and elevated JVP without pulmonary edema (right-sided heart failure) indicates right ventricular infarction. Confirm with right-sided leads (V4R ST elevation).

Question 14: A patient with SIADH has a serum sodium of 124 mEq/L and is asymptomatic. The appropriate initial treatment is:

Corticosteroid therapy
IV 3% hypertonic saline
Fluid restriction to 800–1000 mL/day (Correct answer)
Loop diuretics

Correct answer: Fluid restriction to 800–1000 mL/day

Fluid restriction is the first-line treatment for mild to moderate asymptomatic SIADH, addressing the underlying water excess.

Question 15: A patient with Type 2 diabetes has an HbA1c of 8.9%. According to ADA guidelines, the initial medication of choice is:

Glipizide
Metformin (Correct answer)
Insulin glargine
Empagliflozin

Correct answer: Metformin

Metformin remains the first-line pharmacologic treatment for Type 2 diabetes in most patients unless contraindicated.

Question 16: A patient develops ventricular fibrillation (VF) on a cardiac monitor and the nurse is alone at the bedside. What is the correct first action?

Confirm pulselessness, call for help and crash cart, then begin CPR immediately (Correct answer)
Administer amiodarone 300 mg IV push first
Apply synchronized cardioversion at 200 joules
Call rapid response team and wait for assistance

Correct answer: Confirm pulselessness, call for help and crash cart, then begin CPR immediately

For witnessed VF with confirmed pulselessness: call for help and crash cart, then immediately begin high-quality CPR. Every minute without defibrillation decreases survival by 7-10%.

Question 17: Which medication class is considered first-line pharmacotherapy for generalized anxiety disorder (GAD) in adults?

Benzodiazepines
Monoamine oxidase inhibitors
SSRIs/SNRIs (Correct answer)
Tricyclic antidepressants

Correct answer: SSRIs/SNRIs

SSRIs and SNRIs are first-line treatments for GAD due to their efficacy and more favorable safety profile compared to benzodiazepines.

Question 18: If a patient reports that injuries resulted from domestic violence, when documenting the abuse in the patient's health record, the NP should:

Record no information but fill out an incident report.
Indicate only that abuse occurred.
Use direct quotations to document the patient's statements. (Correct answer)
Summarize the patient's statements.

Correct answer: Use direct quotations to document the patient's statements.

Explanation: If a patient reports that injuries resulted from domestic violence, the NP should use direct quotations to document the patient's statements. The NP should make notes that are as detailed and accurate as possible, including descriptions of all injuries (size, location, extent) and any interventions because the health record may become part of a criminal proceeding.

Question 19: A patient is receiving a blood transfusion and develops fever, chills, and flank pain 15 minutes after starting. The nurse's priority action is:

Stop the transfusion, maintain IV access with NS, and notify the provider (Correct answer)
Increase the flow rate to complete the transfusion faster
Administer acetaminophen and diphenhydramine
Slow the infusion rate and monitor for improvement

Correct answer: Stop the transfusion, maintain IV access with NS, and notify the provider

These symptoms suggest an acute hemolytic transfusion reaction; stopping the transfusion immediately is the priority to prevent further harm.

Question 20: Which regulatory body most directly governs the accreditation standards applicable to ambulatory care organizations seeking to demonstrate quality and safety?

American Medical Association (AMA)
The Joint Commission (TJC) Ambulatory Care Program (Correct answer)
Centers for Medicare and Medicaid Services (CMS) only
State Board of Nursing exclusively

Correct answer: The Joint Commission (TJC) Ambulatory Care Program

The Joint Commission's Ambulatory Care accreditation program sets recognized national standards for quality and patient safety in outpatient settings.

Question 21: Which of the following antidysrhythmic drugs is most likely to result in bradycardia, hypotension, heart failure, PR prolongation, and/or constipation?

Amiodarone
Ibutilide
Diltiazem (Correct answer)
Lidocaine

Correct answer: Diltiazem

Explanation: Common adverse effects of calcium channel blockers, such as diltiazem or verapamil, include bradycardia, hypotension, heart failure, PR prolongation, and/or constipation. Bradycardia results from decreased sinoatrial (SA) nodal output and PR prolongations from delays in atrioventricular (AV) conduction. These drugs may cause marked hypotension and worsening of existing heart failure. Calcium channel blockers, used to treat tachycardia, block the influx of calcium ions across membranes of cardiac and arterial muscle cells, slowing the AV node conduction of impulses into the ventricles, thereby slowing the ventricular rate.

Question 22: A patient with chronic kidney disease has a potassium level of 6.3 mEq/L and peaked T-waves on ECG. Which intervention is most urgent?

Administer sodium polystyrene sulfonate (Kayexalate)
Schedule dialysis within 24 hours
Administer calcium gluconate IV to stabilize cardiac membranes (Correct answer)
Dietary potassium restriction counseling

Correct answer: Administer calcium gluconate IV to stabilize cardiac membranes

Calcium gluconate is the fastest intervention to stabilize cardiac membrane potential and prevent life-threatening arrhythmia from hyperkalemia.

Question 23: A patient taking lithium reports nausea, vomiting, coarse tremor, and confusion. What is the nurse's priority action?

Administer an antiemetic and monitor closely
Give the next lithium dose with food
Hold the lithium and notify the provider immediately (Correct answer)
Reassure the patient that these are expected side effects

Correct answer: Hold the lithium and notify the provider immediately

These symptoms indicate lithium toxicity, which requires immediate medication hold and provider notification to prevent serious harm.

Question 24: What is the primary purpose of milieu therapy in an inpatient psychiatric unit?

To provide structured one-on-one psychotherapy sessions
To use the therapeutic environment to promote healing and social skills (Correct answer)
To reduce the need for psychotropic medications
To isolate patients from environmental stressors

Correct answer: To use the therapeutic environment to promote healing and social skills

Milieu therapy uses the entire treatment environment — including peers, staff, and activities — as a therapeutic tool.

Question 25: According to the Surviving Sepsis Campaign, what is the recommended fluid resuscitation target within the first 3 hours of septic shock?

2 liters of normal saline regardless of weight
10 mL/kg colloid followed by reassessment
At least 20 mL/kg crystalloid
At least 30 mL/kg crystalloid (Correct answer)

Correct answer: At least 30 mL/kg crystalloid

The Surviving Sepsis Campaign recommends at least 30 mL/kg intravenous crystalloid fluid within the first 3 hours of sepsis-induced hypoperfusion or septic shock.

Question 26: Which principle of human factors engineering is most important when designing a medication reconciliation workflow in the EHR to prevent medication errors?

Allowing each unit to develop its own custom medication entry screens
Requiring nurses to memorize the medication reconciliation steps
Increasing the number of alert pop-ups to ensure every discrepancy is flagged
Designing systems that make it easy to do the right thing and difficult to make an error using forcing functions and error proofing (Correct answer)

Correct answer: Designing systems that make it easy to do the right thing and difficult to make an error using forcing functions and error proofing

Human factors engineering aims to design systems that align with human cognitive capabilities, use forcing functions to prevent errors, and reduce reliance on memory.

Question 27: Which combination of analgesic modalities best represents a multimodal analgesia approach for a post-surgical patient?

Maximizing opioid doses before adding non-opioid adjuvants
Two different opioids prescribed simultaneously for synergy
Morphine PCA alone titrated to pain level
Scheduled acetaminophen, scheduled NSAIDs (if not contraindicated), gabapentin, and opioids only as needed (Correct answer)

Correct answer: Scheduled acetaminophen, scheduled NSAIDs (if not contraindicated), gabapentin, and opioids only as needed

Multimodal analgesia combines analgesics and techniques with different mechanisms to provide superior pain relief at lower opioid doses, reducing opioid-related side effects.

Question 28: Which cancer screening test has the strongest evidence for reducing both incidence and mortality from colorectal cancer?

Fecal occult blood testing (FOBT) annually
Colonoscopy every 10 years (Correct answer)
Flexible sigmoidoscopy every 5 years
CT colonography every 5 years

Correct answer: Colonoscopy every 10 years

Colonoscopy every 10 years allows both detection and removal of precancerous polyps, reducing incidence and mortality.

Question 29: A patient receiving IV chemotherapy via a peripheral line reports burning pain at the site with surrounding erythema and blanching. This is most consistent with:

Phlebitis
Extravasation of a vesicant agent (Correct answer)
Allergic reaction to the drug
Thrombosis at the catheter site

Correct answer: Extravasation of a vesicant agent

Burning, erythema, and blanching at a chemotherapy infusion site indicate extravasation of a vesicant, which can cause tissue necrosis.

Question 30: An infant at a well-child visit is noted to have not regained birth weight by 2 weeks of age. What is the priority intervention?

Refer to endocrinology
Order thyroid function tests
Schedule a follow-up visit at 2 months
Evaluate feeding technique and frequency (Correct answer)

Correct answer: Evaluate feeding technique and frequency

Most newborn weight loss is due to inadequate intake; assessing feeding is the first step before pursuing diagnostic workup.

Question 31: When a nurse manager delegates a task to a nursing assistant, which task is outside the nursing assistant's scope of practice?

Taking and reporting vital signs
Performing initial nursing assessment after patient admission (Correct answer)
Ambulating a stable post-surgical patient
Assisting with bathing and oral hygiene

Correct answer: Performing initial nursing assessment after patient admission

Initial nursing assessment requires clinical judgment and is within the registered nurse's scope of practice only.

Question 32: What is the primary purpose of SNOMED CT in clinical documentation?

Billing and reimbursement coding for insurance claims
Standardized clinical terminology to enable consistent, computable clinical concepts across systems (Correct answer)
Drug formulary management and medication ordering
Laboratory reference ranges and normal values

Correct answer: Standardized clinical terminology to enable consistent, computable clinical concepts across systems

SNOMED CT is a comprehensive multilingual clinical terminology providing standardized, computable clinical concepts for documentation, semantic interoperability, and data analytics.

Question 33: Which intervention is most supported by evidence to prevent and treat ICU delirium?

Benzodiazepine administration to manage agitation
Continuous antipsychotic infusion as first-line treatment
Early mobilization, sleep protocol, and reorientation using the ABCDEF bundle (Correct answer)
Routine physical restraints to prevent falls during confusion

Correct answer: Early mobilization, sleep protocol, and reorientation using the ABCDEF bundle

The ABCDEF bundle (Assess, Both SAT/SBT, Choice of analgesia/sedation, Delirium assessment, Early mobility, Family engagement) is the evidence-based framework for preventing and treating ICU delirium.

Question 34: A patient is preparing for permanent pacemaker insertion. Which finding is most important to communicate to the proceduralist?

The patient took aspirin 81 mg this morning
Blood pressure is 138/82 mmHg
The left subclavian vein was used for a previous central line (Correct answer)
The patient reports mild anxiety about the procedure

Correct answer: The left subclavian vein was used for a previous central line

Previous subclavian vein use may have caused stenosis or occlusion, preventing pacemaker lead placement via that route. The proceduralist needs this information to plan venous access.

Question 35: A patient post-op for abdominal surgery develops a fever of 38.5°C on postoperative day 2. What is the most likely cause?

Deep vein thrombosis
Pulmonary atelectasis (Correct answer)
Surgical site infection
Urinary tract infection

Correct answer: Pulmonary atelectasis

Pulmonary atelectasis is the most common cause of fever in the first 48 hours after surgery due to hypoventilation.

Question 36: Which of the following best describes the primary focus of ambulatory care nursing practice?

Coordinating hospice care for terminally ill patients
Delivering health services to patients who are not admitted overnight (Correct answer)
Providing acute inpatient care to hospitalized patients
Managing long-term care for residents in skilled nursing facilities

Correct answer: Delivering health services to patients who are not admitted overnight

Ambulatory care nursing focuses on patients who receive health services without being admitted to an inpatient facility, including clinics, physician offices, and outpatient centers.

Question 37: Which developmental milestone should a child typically achieve by 12 months of age?

Speaking in 2-word phrases
Walking independently
Drawing a circle
Saying single meaningful words (Correct answer)

Correct answer: Saying single meaningful words

Most children say their first meaningful words (e.g., 'mama,' 'dada') by 12 months of age.

Question 38: A nurse is performing triage for an ambulatory care clinic. Which patient should be seen FIRST?

A 30-year-old with a mild sore throat for two days
A 25-year-old requesting a medication refill
A 45-year-old with a scheduled annual physical exam
A 60-year-old with sudden onset confusion and slurred speech (Correct answer)

Correct answer: A 60-year-old with sudden onset confusion and slurred speech

Sudden onset confusion and slurred speech are classic signs of a stroke (FAST criteria), representing an immediate life threat requiring urgent evaluation.

Question 39: According to USPSTF recommendations, which population should be screened for lung cancer with low-dose CT (LDCT)?

All smokers over age 40
Anyone with a first-degree relative with lung cancer
Adults 50–80 years with 20 pack-year history who currently smoke or quit within the past 15 years (Correct answer)
Adults over 65 with any smoking history

Correct answer: Adults 50–80 years with 20 pack-year history who currently smoke or quit within the past 15 years

USPSTF recommends annual LDCT for adults aged 50–80 with at least 20 pack-year smoking history who are current or recent quitters.

Question 40: Which chemotherapy agent is classified as an alkylating agent?

Vincristine
Methotrexate
Cyclophosphamide (Correct answer)
Doxorubicin

Correct answer: Cyclophosphamide

Cyclophosphamide is an alkylating agent that works by cross-linking DNA strands, preventing cancer cell replication.

Question 41: A 78-year-old has a pressure injury with full-thickness skin loss exposing subcutaneous tissue without exposed bone, tendon, or muscle. This is classified as:

Stage 4
Stage 2
Stage 1
Stage 3 (Correct answer)

Correct answer: Stage 3

Stage 3 pressure injuries involve full-thickness skin loss with visible subcutaneous tissue but no exposed bone, tendon, or muscle.

Question 42: What does CPOE stand for and what is its primary patient safety benefit?

Comprehensive Patient Outcome Evaluation — tracks outcomes data
Clinical Protocol Order Entry — standardizes care pathways
Computerized Physician Order Entry — eliminates handwriting-related errors and enables real-time CDS (Correct answer)
Central Pharmacy Order Execution — automates dispensing

Correct answer: Computerized Physician Order Entry — eliminates handwriting-related errors and enables real-time CDS

CPOE enables electronic medical orders, eliminating illegible handwriting and transcription errors, and enabling real-time CDS including drug interactions, allergy checks, and dosing alerts.

Question 43: Which finding on a throat culture indicates the need for antibiotic treatment in pharyngitis?

Elevated WBC on CBC
White exudates alone
Positive Group A Streptococcus culture (Correct answer)
Presence of normal oral flora

Correct answer: Positive Group A Streptococcus culture

A positive Group A Streptococcus culture confirms bacterial pharyngitis requiring antibiotic treatment to prevent complications.

Question 44: In ambulatory care nursing, which ethical principle is best demonstrated when a nurse ensures a patient understands their diagnosis and treatment options before signing a consent form?

Beneficence
Autonomy (Correct answer)
Justice
Nonmaleficence

Correct answer: Autonomy

Autonomy respects the patient's right to make informed decisions about their own health care, which is facilitated by ensuring they fully understand their situation.

Question 45: A 9-year-old with asthma exacerbation (RR 28, SpO2 92%, accessory muscle use) receives albuterol nebulizer treatment. Which finding indicates effectiveness?

Child becomes drowsy and respiratory rate decreases to 10
Wheezing decreases, respiratory rate normalizes to 22, and SpO2 improves to 97% (Correct answer)
PaCO2 rises from 38 to 50 mmHg on blood gas
Respiratory rate increases to 32 and SpO2 drops to 89%

Correct answer: Wheezing decreases, respiratory rate normalizes to 22, and SpO2 improves to 97%

Effective bronchodilator treatment is indicated by decreased wheezing, normalized respiratory rate, improved SpO2, and decreased work of breathing.

Question 46: When assessing pain in a non-verbal older adult with dementia, which scale is most appropriate?

Numeric Rating Scale (NRS 0–10)
Visual Analog Scale (VAS)
PAINAD Scale (Correct answer)
Wong-Baker FACES Scale

Correct answer: PAINAD Scale

The PAINAD (Pain Assessment in Advanced Dementia) scale uses behavioral indicators to assess pain in non-verbal patients.

Question 47: A breast cancer patient completes 5 years of tamoxifen therapy. What is the most serious long-term adverse effect the nurse should educate her about?

Osteoporosis and bone fractures
Endometrial cancer and thromboembolic events (Correct answer)
Permanent alopecia
Cardiomyopathy

Correct answer: Endometrial cancer and thromboembolic events

Tamoxifen's estrogenic activity in the uterus increases risk of endometrial cancer, and it also increases venous thromboembolism risk.

Question 48: A 75-year-old patient is prescribed a statin for hyperlipidemia. Which muscle-related adverse effect requires immediate follow-up?

Severe muscle pain with dark urine suggesting rhabdomyolysis (Correct answer)
Joint stiffness in the morning
Mild muscle aching that resolves with rest
Mild creatine kinase elevation only

Correct answer: Severe muscle pain with dark urine suggesting rhabdomyolysis

Rhabdomyolysis — characterized by severe myopathy and myoglobinuria (dark urine) — is a serious, potentially fatal statin complication.

Question 49: A patient with ARDS is on mechanical ventilation. Which ventilator strategy reduces ventilator-induced lung injury?

High PEEP with unrestricted FiO2
Pressure-controlled ventilation with high inspiratory pressures
Low tidal volume ventilation (6 mL/kg ideal body weight) (Correct answer)
High tidal volumes to maximize oxygenation

Correct answer: Low tidal volume ventilation (6 mL/kg ideal body weight)

Low tidal volume ventilation (6 mL/kg ideal body weight) is the evidence-based lung-protective strategy for ARDS. The ARDSNet trial demonstrated significant mortality reduction compared to 12 mL/kg tidal volumes.

Question 50: A patient with small cell lung cancer presents with facial edema, distended neck veins, and arm swelling. What is the suspected oncologic emergency?

Pericardial tamponade
Superior vena cava syndrome (Correct answer)
Tumor lysis syndrome
Hypercalcemia of malignancy

Correct answer: Superior vena cava syndrome

Superior vena cava syndrome is caused by tumor compression of the SVC, producing characteristic venous congestion in the upper body.

Question 51: A patient with complete heart block shows ventricular rate 32 bpm and hemodynamic instability. What is the immediate treatment?

Synchronized cardioversion at 120 joules
Transcutaneous pacing followed by transvenous pacing (Correct answer)
Amiodarone 150 mg IV bolus
Metoprolol IV to slow atrial rate

Correct answer: Transcutaneous pacing followed by transvenous pacing

Symptomatic third-degree AV block requires immediate transcutaneous pacing as a bridge to transvenous pacing. Amiodarone and beta-blockers are contraindicated as they worsen bradycardia.

Question 52: Which vaccine is recommended annually for all persons aged 6 months and older in the United States?

Tdap vaccine
Influenza vaccine (Correct answer)
Pneumococcal vaccine
Hepatitis B vaccine

Correct answer: Influenza vaccine

The CDC recommends annual influenza vaccination for all individuals 6 months and older.

Question 53: When counseling a patient about emergency contraception, the nurse practitioner should teach that Plan B (levonorgestrel) is most effective when taken within:

72 hours of unprotected intercourse (Correct answer)
24 hours of unprotected intercourse
12 hours of unprotected intercourse
120 hours of unprotected intercourse

Correct answer: 72 hours of unprotected intercourse

Plan B is most effective when taken within 72 hours of unprotected sex, though it has some efficacy up to 120 hours.

Question 54: Which oncologic emergency is characterized by hypercalcemia, hyperkalemia, hyperphosphatemia, and hyperuricemia after cancer treatment?

Spinal cord compression
Syndrome of inappropriate ADH (SIADH)
Tumor lysis syndrome (Correct answer)
Superior vena cava syndrome

Correct answer: Tumor lysis syndrome

Tumor lysis syndrome results from rapid destruction of cancer cells releasing intracellular contents into the bloodstream.

Question 55: A 45-year-old male presents with fatigue, cold intolerance, weight gain, and constipation. The most likely diagnosis is:

Diabetes mellitus type 2
Hypothyroidism (Correct answer)
Cushing syndrome
Hyperthyroidism

Correct answer: Hypothyroidism

The classic constellation of fatigue, cold intolerance, weight gain, and constipation is characteristic of hypothyroidism.

Question 56: In the ambulatory care setting, patient self-management education for a newly diagnosed type 2 diabetic should emphasize which concept?

Strict adherence to physician instructions without modification
Empowerment through health literacy and shared decision-making (Correct answer)
The patient's passive role in receiving care
Avoidance of all sugars, including fruit

Correct answer: Empowerment through health literacy and shared decision-making

Ambulatory care nursing promotes patient empowerment, health literacy, and shared decision-making to support chronic disease self-management.

Question 57: A nurse uses the EHR to access medication history, allergy list, and recent labs from the patient's previous hospitalization at an affiliated facility. This is an example of:

Telemedicine consultation between facilities
Clinical decision support at point of care
Internal auditing and compliance monitoring
Health Information Exchange (HIE) supporting longitudinal patient record access (Correct answer)

Correct answer: Health Information Exchange (HIE) supporting longitudinal patient record access

Health Information Exchange (HIE) enables authorized clinicians to electronically access and share patient clinical information across different healthcare organizations.

Question 58: A patient is in narrow complex tachycardia at 180 bpm, regular rhythm, hemodynamically stable. Which is the first-line treatment per ACLS?

Metoprolol 5 mg IV bolus
Synchronized cardioversion at 100 joules
Vagal maneuvers followed by adenosine 6 mg rapid IV push (Correct answer)
Amiodarone 150 mg IV over 10 minutes

Correct answer: Vagal maneuvers followed by adenosine 6 mg rapid IV push

Stable narrow complex regular tachycardia (likely AVNRT or AVRT) is treated first with vagal maneuvers. If unsuccessful, adenosine 6 mg rapid IV push is the first-line pharmacologic treatment.

Question 59: A post-PCI patient on DAPT (clopidogrel and aspirin) needs emergency appendectomy. Which antiplatelet management is most appropriate?

Continue both antiplatelet agents through surgery to prevent stent thrombosis
Consult cardiology; if within 30 days of BMS or 12 months of DES, delay surgery if possible (Correct answer)
Stop both agents 7-10 days before surgery with no bridge therapy
Replace clopidogrel with warfarin as a bridge

Correct answer: Consult cardiology; if within 30 days of BMS or 12 months of DES, delay surgery if possible

Premature DAPT discontinuation within 30 days of BMS or 6-12 months of DES carries high stent thrombosis risk. Emergency surgery requires cardiology consultation to weigh bleeding versus stent thrombosis risk.

Question 60: A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, and blood glucose of 480 mg/dL. This presentation is consistent with:

Hyperosmolar hyperglycemic state (HHS)
Severe hypoglycemia
Diabetic ketoacidosis (DKA) (Correct answer)
Lactic acidosis

Correct answer: Diabetic ketoacidosis (DKA)

DKA presents with Kussmaul respirations (compensatory for metabolic acidosis), fruity breath from ketones, and high glucose.

Question 61: When implementing a quality improvement initiative in an ambulatory care clinic, the PDSA (Plan-Do-Study-Act) cycle is used primarily to:

Evaluate individual nurse performance annually
Create new policies without staff input
Eliminate the need for data collection
Test changes on a small scale before widespread implementation (Correct answer)

Correct answer: Test changes on a small scale before widespread implementation

The PDSA cycle is a rapid-cycle improvement model that tests interventions on a small scale to gather data before broader implementation.

Question 62: Which ethical principle is most relevant when a nurse manager allocates scarce staffing resources during a surge?

Justice (Correct answer)
Autonomy
Beneficence
Nonmaleficence

Correct answer: Justice

Justice requires fair and equitable distribution of resources, which is the guiding ethical principle in resource allocation decisions.

Question 63: A patient with a chest tube develops subcutaneous emphysema around the insertion site. What does this indicate?

The water seal chamber is malfunctioning
Air is leaking into the subcutaneous tissue, possibly indicating tube displacement (Correct answer)
This is a normal finding post-thoracostomy
The chest tube is functioning correctly

Correct answer: Air is leaking into the subcutaneous tissue, possibly indicating tube displacement

Subcutaneous emphysema (crepitus around the insertion site) suggests the chest tube has become dislodged or there is an air leak.

Question 64: A patient on clopidogrel and aspirin for unstable angina — which factor most significantly reduces clopidogrel effectiveness?

CYP2C19 poor metabolizer genetic variant (Correct answer)
Taking clopidogrel with food
History of peptic ulcer treated with ranitidine
Concurrent use of atorvastatin

Correct answer: CYP2C19 poor metabolizer genetic variant

Clopidogrel is a prodrug requiring activation by CYP2C19. Poor metabolizers with loss-of-function alleles have significantly reduced active metabolite levels and diminished platelet inhibition.

Question 65: A nurse practitioner identifies a grade III/VI systolic murmur in a 7-year-old that radiates to the carotid arteries. The next step is:

Reassure the parent it is an innocent murmur
Obtain a chest X-ray only
Refer to pediatric cardiology (Correct answer)
Prescribe prophylactic antibiotics

Correct answer: Refer to pediatric cardiology

A loud murmur (grade III+) with radiation to carotids suggests a pathologic etiology requiring cardiologic evaluation.

Question 66: A patient undergoing chemotherapy develops an absolute neutrophil count (ANC) of 450 cells/mcL. Which precaution is most important?

Neutropenic precautions to prevent infection (Correct answer)
Contact precautions for MRSA
Reverse isolation with positive pressure room
Droplet precautions for influenza

Correct answer: Neutropenic precautions to prevent infection

An ANC below 500 cells/mcL indicates severe neutropenia (nadir), requiring protective neutropenic precautions to reduce infection risk.

Question 67: A patient with acute pancreatitis is NPO and requesting pain relief. Which analgesic is preferred?

Meperidine (Demerol) IV
Hydromorphone IV (Correct answer)
Ketorolac IM
Morphine sulfate IV

Correct answer: Hydromorphone IV

Hydromorphone is preferred for pancreatitis pain; meperidine is avoided due to toxic normeperidine metabolites, and morphine may cause sphincter of Oddi spasm.

Question 68: Which nursing diagnosis is most appropriate for a patient with cancer experiencing cancer-related fatigue?

Impaired physical mobility related to skeletal metastases
Ineffective breathing pattern related to dyspnea
Activity intolerance related to disease process and treatment effects (Correct answer)
Risk for injury related to fall risk

Correct answer: Activity intolerance related to disease process and treatment effects

Activity intolerance accurately captures cancer-related fatigue's impact on the patient's ability to sustain physical activity.

Question 69: Which change in sleep architecture is expected with normal aging?

Increased deep (slow-wave) sleep
Decreased REM sleep and increased nighttime awakenings (Correct answer)
Increased total sleep time
Earlier sleep onset without any fragmentation

Correct answer: Decreased REM sleep and increased nighttime awakenings

Normal aging is associated with reduced REM sleep, decreased sleep efficiency, and increased nighttime awakenings.

Question 70: A nurse is educating an older adult about prevention of osteoporosis. Which recommendation is most appropriate?

Avoid all weight-bearing exercise to prevent fractures
Avoid dairy products due to lactose intolerance risk
Take calcium supplements alone without exercise
Engage in weight-bearing and resistance exercise, ensure adequate calcium and vitamin D (Correct answer)

Correct answer: Engage in weight-bearing and resistance exercise, ensure adequate calcium and vitamin D

Weight-bearing and resistance exercises stimulate bone formation, and adequate calcium and vitamin D are essential for bone health.

Question 71: The nurse is caring for a patient with cancer who reports severe, uncontrolled pain rated 9/10. According to the WHO analgesic ladder, which step of therapy is indicated?

Step 3: Strong opioids with or without non-opioids (Correct answer)
Step 2: Weak opioids with or without non-opioids
Step 1: Non-opioid analgesics alone
Step 4: Interventional procedures only

Correct answer: Step 3: Strong opioids with or without non-opioids

Severe pain (7–10) corresponds to Step 3 of the WHO analgesic ladder, requiring strong opioids such as morphine or oxycodone.

Question 72: A patient has serum sodium of 118 mEq/L and is symptomatic with seizures. Which IV solution is indicated?

D5W (5% dextrose in water)
3% Hypertonic saline (Correct answer)
0.45% Half-normal saline
0.9% Normal saline

Correct answer: 3% Hypertonic saline

Severe symptomatic hyponatremia with seizures requires hypertonic (3%) saline to rapidly correct sodium and resolve neurologic symptoms.

Question 73: In ambulatory care, the concept of 'care transitions' is MOST relevant to which nursing intervention?

Scheduling back-to-back appointments for efficiency
Transitioning nursing staff between shifts
Transferring a patient from one exam room to another within the clinic
Coordinating a patient's handoff from the hospital to outpatient follow-up to reduce readmission (Correct answer)

Correct answer: Coordinating a patient's handoff from the hospital to outpatient follow-up to reduce readmission

Care transitions in ambulatory nursing refer to coordinating the movement of patients between care settings (hospital to home/outpatient) to ensure safety and continuity.

Question 74: A patient with sickle cell disease in vaso-occlusive crisis reports 9/10 pain after two doses of IV hydromorphone with minimal relief. Which intervention is most appropriate to advocate for next?

Advocate for increased opioid dosing, shorter dosing intervals, or patient-controlled analgesia (PCA) (Correct answer)
Administer ketorolac as the sole treatment to avoid opioid escalation
Suggest non-pharmacological interventions only and avoid further opioids
Reassure the patient that the pain will self-resolve and encourage discharge planning

Correct answer: Advocate for increased opioid dosing, shorter dosing intervals, or patient-controlled analgesia (PCA)

Sickle cell vaso-occlusive crisis involves severe ischemic pain requiring aggressive, patient-tailored opioid management. When standard doses are inadequate, escalation to higher doses, shorter intervals, or PCA is evidence-based.

Question 75: A patient with neuropathic pain from diabetic peripheral neuropathy needs medication. Which first-line agent is most evidence-supported?

Duloxetine (Cymbalta) or pregabalin (Lyrica) (Correct answer)
Tramadol 50 mg every 6 hours as needed
Ibuprofen 600 mg every 8 hours
Oxycodone extended release 10 mg every 12 hours

Correct answer: Duloxetine (Cymbalta) or pregabalin (Lyrica)

First-line treatments for diabetic peripheral neuropathy per ADA, AAN, and NeuPSIG guidelines are duloxetine (SNRI), pregabalin (alpha-2-delta ligand), or gabapentin.

Question 76: Post-op day 1 after a right hemicolectomy, a patient's ostomy stoma appears pale and dusky. What is the correct interpretation?

Stoma is adequately perfused
Stoma requires more frequent irrigation
Possible stoma ischemia requiring immediate provider notification (Correct answer)
Normal appearance for the first 24 hours

Correct answer: Possible stoma ischemia requiring immediate provider notification

A healthy stoma should be beefy red; a pale or dusky stoma suggests ischemia or necrosis requiring urgent assessment.

Question 77: A cancer patient expresses that they want to stop curative treatment and focus on comfort. The nurse's most appropriate response is:

Contact the family to discuss overriding the patient's decision
Encourage the patient to continue treatment to maximize survival
Document refusal of treatment and take no further action
Acknowledge the patient's wishes and facilitate a palliative/goals-of-care discussion with the team (Correct answer)

Correct answer: Acknowledge the patient's wishes and facilitate a palliative/goals-of-care discussion with the team

Respecting patient autonomy requires acknowledging their wishes and ensuring they receive appropriate palliative care planning.

Question 78: Which laboratory finding is most consistent with dehydration in an older adult?

BUN:creatinine ratio greater than 20:1 (Correct answer)
Low serum sodium (hyponatremia)
Low hematocrit
BUN:creatinine ratio less than 10:1

Correct answer: BUN:creatinine ratio greater than 20:1

A BUN:creatinine ratio >20:1 indicates prerenal azotemia, commonly caused by dehydration in older adults.

Question 79: Which usability testing method involves observing nurses performing real tasks in the EHR and measuring time-on-task, errors, and satisfaction?

Expert heuristic evaluation
Summative usability testing with task-based performance metrics (Correct answer)
Formative usability testing with think-aloud protocol
Cognitive walkthrough by the design team

Correct answer: Summative usability testing with task-based performance metrics

Summative usability testing measures actual performance outcomes (task completion rates, time-on-task, error rates, satisfaction scores) with representative users performing realistic tasks. It quantifies usability for go/no-go decisions.

Question 80: A 30-year-old woman presents with painful, grouped vesicles on her labia. Which test would confirm the diagnosis?

Culture for gonorrhea
KOH preparation
RPR for syphilis
Tzanck smear or PCR for HSV (Correct answer)

Correct answer: Tzanck smear or PCR for HSV

Grouped painful vesicles are characteristic of herpes simplex virus (HSV), confirmed by PCR or Tzanck smear.

Question 81: A patient diagnosed with schizophrenia is experiencing command hallucinations. Which nursing intervention is the priority?

Administer an antipsychotic medication immediately
Assess whether the patient intends to act on the commands (Correct answer)
Document the hallucinations without intervening
Place the patient in a quiet room alone

Correct answer: Assess whether the patient intends to act on the commands

Assessing the patient's intent to act on command hallucinations is the priority because it determines the immediate safety risk.

Question 82: A patient develops acute respiratory distress with absent breath sounds on the left side after central line placement. What is the priority intervention?

Administer supplemental oxygen and monitor
Reposition the patient to the right lateral decubitus position
Obtain a STAT chest X-ray before intervening
Prepare for immediate needle decompression or chest tube insertion (Correct answer)

Correct answer: Prepare for immediate needle decompression or chest tube insertion

Absent breath sounds after central line placement indicate tension pneumothorax, requiring immediate decompression.

Question 83: Which patient receiving chemotherapy is at highest risk for developing chemotherapy-induced peripheral neuropathy (CIPN)?

A patient receiving cyclophosphamide
A patient receiving paclitaxel or vincristine (Correct answer)
A patient receiving carboplatin alone
A patient receiving doxorubicin

Correct answer: A patient receiving paclitaxel or vincristine

Taxanes (paclitaxel) and vinca alkaloids (vincristine) are the agents most associated with dose-limiting peripheral neuropathy.

Question 84: What is the most common cause of dementia in the United States?

Vascular dementia
Alzheimer's disease (Correct answer)
Lewy body dementia
Frontotemporal dementia

Correct answer: Alzheimer's disease

Alzheimer's disease accounts for approximately 60–80% of all dementia cases in the United States.

Question 85: A nurse working in an ambulatory infusion center notes that a patient's IV site is red, warm, and swollen. This finding is MOST consistent with:

Infiltration
Speed shock
Phlebitis (Correct answer)
Air embolism

Correct answer: Phlebitis

Redness, warmth, and swelling at an IV site are classic signs of phlebitis, indicating inflammation of the vein.

Question 86: A 67-year-old woman with osteoporosis has a T-score of -2.8. First-line pharmacological treatment includes:

Bisphosphonates (e.g., alendronate) (Correct answer)
Calcium supplementation only
Teriparatide injection
Calcitonin nasal spray

Correct answer: Bisphosphonates (e.g., alendronate)

Bisphosphonates are first-line pharmacotherapy for osteoporosis due to evidence reducing vertebral and hip fracture risk.

Question 87: A nurse is reviewing a patient's medication list and identifies a potential drug-drug interaction. The MOST appropriate next step is to:

Withhold all medications until the physician returns
Administer the medications as prescribed and monitor the patient
Instruct the patient not to take the medications at home
Contact the prescribing provider to clarify the order before administration (Correct answer)

Correct answer: Contact the prescribing provider to clarify the order before administration

The nurse has a professional and legal responsibility to clarify orders with the prescriber before administering medications involved in a potentially harmful drug interaction.

Question 88: Which BRCA1/BRCA2 gene mutation counseling point is most critical for a nurse to communicate?

Carriers have significantly increased lifetime risk for breast and ovarian cancers and can pass the mutation to children (Correct answer)
BRCA mutations guarantee cancer development
Male BRCA carriers are not at increased cancer risk
Only women with a BRCA mutation develop cancer

Correct answer: Carriers have significantly increased lifetime risk for breast and ovarian cancers and can pass the mutation to children

BRCA1/BRCA2 mutations substantially increase breast and ovarian cancer risk and are inherited in an autosomal dominant pattern.

Question 89: An ambulatory care nurse is developing a population health initiative to reduce cardiovascular disease risk in the clinic's patient panel. Which intervention addresses the BROADEST population-level impact?

Sending reminder letters to patients with known hypertension
Offering a one-time community health fair
Implementing a standing order protocol for routine blood pressure screening and follow-up for all patients (Correct answer)
Providing individualized counseling for each patient during annual exams

Correct answer: Implementing a standing order protocol for routine blood pressure screening and follow-up for all patients

A standing order protocol for systematic blood pressure screening and follow-up creates a sustainable, population-wide process that reaches all patients, not just those with known diagnoses.

Question 90: Which theory of depression focuses on negative cognitive triad (negative views of self, world, and future)?

Cognitive-behavioral theory (Beck) (Correct answer)
Biopsychosocial model
Psychoanalytic theory
Interpersonal theory

Correct answer: Cognitive-behavioral theory (Beck)

Aaron Beck's cognitive theory identifies the negative cognitive triad as a core feature maintaining depression.

Question 91: Which tool is widely used to assess delirium in older hospitalized patients?

Montreal Cognitive Assessment (MoCA)
Mini-Mental State Examination (MMSE)
Confusion Assessment Method (CAM) (Correct answer)
Geriatric Depression Scale (GDS)

Correct answer: Confusion Assessment Method (CAM)

The Confusion Assessment Method (CAM) is the gold standard tool for identifying delirium in clinical settings.

Question 92: For patients with diabetes mellitus, the first indication of diabetic nephropathy is usually:

Increased creatinine
Microalbuminuria (Correct answer)
Increased blood urea nitrogen (BUN)
Macroalbuminuria

Correct answer: Microalbuminuria

Explanation: For patients with diabetes mellitus, the first indication of diabetic nephropathy, the most common cause of end-stage renal disease, is usually microalbuminuria. Microalbuminuria is usually detectable before a decrease in the glomerular filtration rate (GFR) and occurs 10-15 years after the onset of diabetes. With the onset of microalbuminuria, the patient should be maintained on strict glycemic control and treatment of hypertension to slow the progression. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin I| receptor blockers (ARBs) have been shown to slow progression by reducing pressure within the glomeruli.

Question 93: A patient with COPD is receiving supplemental oxygen at 2 L/min via nasal cannula. The nurse notes the patient's respiratory rate has decreased to 8/min and SpO2 is 99%. What is the concern?

The patient may rely on hypoxic drive, and high oxygen may suppress respiratory effort (Correct answer)
The oxygen should be switched to a face mask for better delivery
This is the expected therapeutic response to oxygen therapy
The oxygen rate is too low and should be increased

Correct answer: The patient may rely on hypoxic drive, and high oxygen may suppress respiratory effort

Some patients with COPD depend on hypoxic drive to breathe; excessive supplemental oxygen can suppress this and cause respiratory depression.

Question 94: A 3-year-old presents with suspected epiglottitis. Which nursing action is the absolute priority?

Avoid any agitation; keep child calm with parent; do NOT examine the throat (Correct answer)
Place child supine and prepare for bag-mask ventilation
Obtain a throat culture to identify the causative organism
Administer ibuprofen to reduce fever immediately

Correct answer: Avoid any agitation; keep child calm with parent; do NOT examine the throat

Epiglottitis is a life-threatening emergency. Throat examination or any agitation can precipitate complete airway obstruction. The child must be kept calm with the parent while an emergent airway team is assembled.

Question 95: Which ECG finding is consistent with left ventricular hypertrophy (LVH)?

ST elevation in leads II, III, and aVF
Delta wave and shortened PR interval
Sawtooth baseline at 300 bpm in leads II, III, aVF
S wave in V1 + R wave in V5 or V6 at or above 35 mm (Sokolow-Lyon criteria) (Correct answer)

Correct answer: S wave in V1 + R wave in V5 or V6 at or above 35 mm (Sokolow-Lyon criteria)

The Sokolow-Lyon criteria for LVH: S wave depth in V1 plus the tallest R wave in V5 or V6 at or above 35 mm. LVH reflects increased myocardial mass from hypertension or aortic stenosis.

Question 96: A stable patient with new-onset atrial flutter (rate 150 bpm) has estimated onset greater than 48 hours ago. What is the priority before electrical cardioversion?

Adenosine 6 mg IV push to terminate the flutter
Amiodarone IV infusion for rhythm conversion
Immediate synchronized cardioversion at 50 joules
Rate control followed by anticoagulation for at least 3 weeks before cardioversion (Correct answer)

Correct answer: Rate control followed by anticoagulation for at least 3 weeks before cardioversion

For AF/flutter with onset greater than 48 hours or unknown duration in a stable patient, at least 3 weeks of therapeutic anticoagulation is required before cardioversion, or a TEE must rule out left atrial thrombus.

Question 97: A patient has a mechanical mitral valve replacement and is prescribed warfarin. What is the correct target INR range?

2.0-3.0
3.0-4.0
1.5-2.0
2.5-3.5 (Correct answer)

Correct answer: 2.5-3.5

Mechanical mitral valves carry higher thromboembolic risk and require a target INR of 2.5-3.5. Mechanical aortic valves in normal sinus rhythm with low thrombogenic features may have a target of 2.0-3.0.

Question 98: Which antipsychotic medication requires mandatory REMS (Risk Evaluation and Mitigation Strategy) enrollment due to risk of agranulocytosis?

Clozapine (Correct answer)
Haloperidol
Quetiapine
Risperidone

Correct answer: Clozapine

Clozapine requires REMS enrollment with mandatory absolute neutrophil count monitoring due to its risk of life-threatening agranulocytosis.

Question 99: A child presents with a strawberry tongue, sandpaper-like rash, and positive rapid strep test. Which treatment is indicated?

Azithromycin for 5 days
Amoxicillin for 10 days (Correct answer)
Topical corticosteroids
Watchful waiting

Correct answer: Amoxicillin for 10 days

Scarlet fever (Group A Streptococcus) is treated with amoxicillin for 10 days to prevent rheumatic fever.

Question 100: A patient with a history of atrial fibrillation is anticoagulated. The nurse assesses sudden onset of severe right leg pain, pallor, and pulselessness. What is the priority action?

Reassess in 1 hour for spontaneous improvement
Elevate the affected leg and apply warm compresses
Apply compression stockings to the affected leg
Notify the provider immediately for suspected acute arterial occlusion (Correct answer)

Correct answer: Notify the provider immediately for suspected acute arterial occlusion

The 6 Ps of arterial occlusion (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) require immediate provider notification and intervention.

Question 101: When teaching a patient with heart failure about fluid restriction, the nurse explains that daily weights should be taken:

Each morning after voiding and before eating (Correct answer)
Once weekly at the same time
Before and after exercise
After each meal and before bedtime

Correct answer: Each morning after voiding and before eating

Daily weights taken under standardized conditions (morning, after voiding, before eating) provide accurate fluid status monitoring.

Question 102: Which developmental milestone is expected in a 4-month-old infant?

Holds head steady when sitting, follows objects past midline, social smile (Correct answer)
Pulls self to standing position
Saying 2-3 words with meaning
Walking with support

Correct answer: Holds head steady when sitting, follows objects past midline, social smile

At 4 months, expected milestones include head control when supported sitting, tracking objects past midline, cooing, and a well-established social smile.

Question 103: A nurse is using motivational interviewing with a patient who abuses alcohol. Which statement best reflects the 'rolling with resistance' technique?

'Here is a list of AA meetings in your area.'
'You must stop drinking or your liver will fail.'
'It sounds like you're not ready to make changes yet, and that's okay.' (Correct answer)
'Tell me about the times alcohol has caused problems for you.'

Correct answer: 'It sounds like you're not ready to make changes yet, and that's okay.'

Rolling with resistance means acknowledging ambivalence without confrontation, validating the patient's current position.

Question 104: Which nursing theory is most associated with nursing as a 'caring science' and the human-to-human relationship?

Betty Neuman's Systems Model
Dorothea Orem's Self-Care Deficit Theory
Jean Watson's Theory of Human Caring (Correct answer)
Virginia Henderson's Need Theory

Correct answer: Jean Watson's Theory of Human Caring

Jean Watson's Theory of Human Caring positions caring as a moral ideal and the essence of nursing practice.

Question 105: A patient underwent PCI via the right radial artery. Which complication should the nurse assess for first post-procedure?

Retroperitoneal hemorrhage
Venous thromboembolism at the access site
Contrast-induced nephropathy only after 72 hours
Radial artery occlusion and hand ischemia (Correct answer)

Correct answer: Radial artery occlusion and hand ischemia

Radial artery occlusion is the most common complication of transradial PCI, occurring in 1-10% of cases. Assessment of radial pulse, capillary refill, and hand perfusion is the priority.

Question 106: A patient with asthma visits the ambulatory clinic for a routine follow-up. Which finding would indicate POOR asthma control requiring escalation of therapy?

Nighttime awakenings due to asthma symptoms more than twice per month (Correct answer)
Peak flow readings consistently above 80% of personal best
No limitation of normal activities in the past four weeks
Using a rescue inhaler fewer than two days per week

Correct answer: Nighttime awakenings due to asthma symptoms more than twice per month

Nighttime awakenings more than twice per month is a key indicator of poorly controlled asthma per GINA guidelines and warrants a step-up in therapy.

Question 107: A 7-year-old with DKA is receiving IV rehydration. Which finding is an early warning sign of cerebral edema?

Headache, sudden decrease in LOC, or change in neurological status during treatment (Correct answer)
Blood glucose decreasing from 450 to 250 mg/dL over 4 hours
Increasing serum sodium during rehydration
Persistent ketonuria 6 hours into treatment

Correct answer: Headache, sudden decrease in LOC, or change in neurological status during treatment

Cerebral edema in pediatric DKA presents with headache, behavioral changes, decreased LOC, or focal neurological deficits during rehydration. Any neurological deterioration must be treated as cerebral edema until proven otherwise.

Question 108: A patient with HFrEF (EF 30%) is being discharged. Which medication combination has the strongest evidence for reducing mortality?

Digoxin and furosemide
Nitrate monotherapy and aspirin
Calcium channel blocker and loop diuretic
ACE inhibitor or ARNI, beta-blocker, aldosterone antagonist, and SGLT2 inhibitor (Correct answer)

Correct answer: ACE inhibitor or ARNI, beta-blocker, aldosterone antagonist, and SGLT2 inhibitor

The four pillars of HFrEF therapy with mortality benefit are: ACE inhibitor or ARNI (sacubitril/valsartan), beta-blocker, aldosterone antagonist, and SGLT2 inhibitor.

Question 109: To evaluate whether a new EHR fall risk assessment tool improves patient outcomes, which study design provides the strongest evidence?

Before-after observational study without a control group
Expert consensus opinion survey of clinical staff
Randomized controlled trial comparing units using the tool versus standard care (Correct answer)
Retrospective chart review of falls in the previous year

Correct answer: Randomized controlled trial comparing units using the tool versus standard care

A randomized controlled trial (RCT) provides the highest level of evidence by controlling for confounding variables through random assignment, allowing causal inference.

Question 110: A hospice patient with terminal cancer is actively dying, unconscious, and unable to swallow. Which analgesic route is most appropriate?

Administer oral morphine despite inability to swallow
Hold all opioids until the patient regains consciousness to provide consent
Use subcutaneous, IV, or transdermal routes for around-the-clock opioid coverage (Correct answer)
Dose down opioids as death approaches to prevent addiction

Correct answer: Use subcutaneous, IV, or transdermal routes for around-the-clock opioid coverage

When oral administration is no longer possible, subcutaneous (most common in hospice), IV, or transdermal fentanyl routes maintain analgesic coverage. Opioid dosing is never reduced or withheld based on addiction concerns at end of life.

Question 111: A nurse executive is developing a staffing plan using the patient classification system. What is the primary purpose of this system?

To schedule physician rounding times
To measure patient acuity and quantify nursing care requirements (Correct answer)
To track nursing overtime hours
To determine patient room assignments

Correct answer: To measure patient acuity and quantify nursing care requirements

Patient classification systems measure acuity to objectively determine the nursing hours required per patient per shift.

Question 112: A clinic nurse is assessing a patient's pain on a 0-10 numeric rating scale. The patient rates pain as 7/10. Which intervention is MOST appropriate?

Administer the maximum dose of all available analgesics immediately
Reassure the patient that a score of 7 is manageable and advise rest
Assess the quality, location, and duration of pain, then collaborate with the provider for a treatment plan (Correct answer)
Document the score and reassess at the next scheduled visit

Correct answer: Assess the quality, location, and duration of pain, then collaborate with the provider for a treatment plan

A comprehensive pain assessment (PQRST) must precede any intervention, and collaboration with the provider ensures an appropriate, individualized treatment plan.

Question 113: Which screening tool is most commonly recommended in ambulatory care for universal depression screening in adults?

Beck Anxiety Inventory (BAI)
Mini-Mental State Examination (MMSE)
Montreal Cognitive Assessment (MoCA)
Patient Health Questionnaire-9 (PHQ-9) (Correct answer)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a validated, widely used tool endorsed by the USPSTF for universal depression screening in primary care and ambulatory settings.

Question 114: A patient on warfarin has an INR of 4.8 with no bleeding. The most appropriate next step is:

Administer fresh frozen plasma
Administer vitamin K 10 mg IV immediately
Continue warfarin and recheck in 1 week
Hold warfarin dose and recheck INR in 1–2 days (Correct answer)

Correct answer: Hold warfarin dose and recheck INR in 1–2 days

For supratherapeutic INR without bleeding, holding warfarin and rechecking INR within 1–2 days is the appropriate management.

Question 115: A telemetry strip shows a regular atrial rate near 300 bpm with sawtooth deflections and variable ventricular response. Which rhythm does this describe?

Sinus tachycardia with frequent PACs
Atrial flutter with variable block (Correct answer)
Atrial fibrillation with rapid ventricular response
Multifocal atrial tachycardia

Correct answer: Atrial flutter with variable block

Atrial flutter shows regular sawtooth flutter waves at 250-350 bpm (classically 300 bpm) with variable AV block (2:1, 3:1, 4:1), creating a regularly irregular ventricular response.

Question 116: A nurse manager notices that turnover on the unit is 34% annually. Which retention strategy is most evidence-based?

Increasing base salary for all nurses immediately
Mandating overtime to fill vacancies
Implementing shared governance and improving nurse participation in decision-making (Correct answer)
Reducing patient-to-nurse ratios through agency staffing only

Correct answer: Implementing shared governance and improving nurse participation in decision-making

Shared governance and professional practice models are evidence-based strategies that improve nurse satisfaction and reduce turnover.

Question 117: A nurse in an outpatient oncology infusion clinic is preparing to administer a vesicant chemotherapy agent. Which action is the HIGHEST priority before starting the infusion?

Ensure the patient has eaten a full meal within the last 30 minutes
Confirm the patient's insurance authorization is current
Check if the patient has a preference for IV arm
Verify IV site patency and assess for signs of extravasation risk (Correct answer)

Correct answer: Verify IV site patency and assess for signs of extravasation risk

Vesicant chemotherapy can cause severe tissue damage if extravasation occurs, making IV site patency verification the highest priority patient safety action before administration.

Question 118: A FLACC assessment shows grimacing (face 2), legs drawn up (legs 2), rigid body (activity 2), crying continuously (cry 2), and inconsolable (consolability 2). Total score and clinical meaning?

Total score 6: mild-to-moderate pain
Total score 10: sedation-related symptoms, not pain
Total score 8: moderate pain
Total score 10: severe pain requiring immediate intervention (Correct answer)

Correct answer: Total score 10: severe pain requiring immediate intervention

FLACC scores each of 5 categories 0-2 with maximum total = 10. A score of 10 (2+2+2+2+2) indicates severe pain requiring immediate pharmacological and non-pharmacological intervention.

Question 119: Which action BEST demonstrates cultural competence in an ambulatory care nursing encounter?

Asking the patient about their health beliefs and preferred language before teaching (Correct answer)
Assuming all patients from the same country share identical beliefs
Using family members as interpreters to save time
Providing education only in English to promote consistency

Correct answer: Asking the patient about their health beliefs and preferred language before teaching

Cultural competence requires assessing individual patient beliefs, values, and language preferences to provide respectful and effective care.

Question 120: After removal of a chest tube, a 48-year-old patient complains of retrosternal and neck pain, is dyspneic, and has slight neck edema. Hamman's sign is positive (precordial systolic crepitus). The probable diagnosis is:

Pneumomediastinum (Correct answer)
Pneumopericardium
Pneumothorax
Cardiac tamponade

Correct answer: Pneumomediastinum

Explanation: Retrosternal and neck pain, dyspnea, and slight neck edema indicate pneumomediastinum. Hamman's sign —a precordial rasping sound heard on auscultation during heartbeat as the heart moves against tissues filled with air-is an indication of both pneumomediastinum and pneumopericardium but is not generally present with pneumothorax or cardiac tamponade. However, neck edema can occur with pneumomediastinum. Air leaks can occur from damage to the pleura during surgery or (less commonly) from obstructed chest tubes. Air leaks usually resolve within a few days but may require the reinsertion of a chest tube.

Question 121: A 55-year-old patient has a BP reading of 148/94 mmHg on two separate visits. According to JNC guidelines, this is classified as:

Stage 2 hypertension
Normal blood pressure
Stage 1 hypertension (Correct answer)
Elevated blood pressure

Correct answer: Stage 1 hypertension

Stage 1 hypertension is defined as systolic 130–139 mmHg or diastolic 80–89 mmHg; 148/94 meets Stage 2 criteria (≥140/90).

Question 122: A patient develops petechiae, oozing from IV sites, and a prolonged PT/PTT post-surgery. These findings are most consistent with:

Vitamin K deficiency
Disseminated intravascular coagulation (DIC) (Correct answer)
Heparin-induced thrombocytopenia (HIT)
Immune thrombocytopenic purpura (ITP)

Correct answer: Disseminated intravascular coagulation (DIC)

DIC is characterized by simultaneous clotting and bleeding, with petechiae, coagulation factor consumption, and prolonged PT/PTT.

Question 123: Which approach is MOST consistent with evidence-based practice in ambulatory care nursing?

Integrating current best research evidence with clinical expertise and patient preferences (Correct answer)
Implementing the newest interventions immediately upon publication without review
Relying solely on physician orders for all clinical decisions
Following traditional routines that have been used for many years regardless of research

Correct answer: Integrating current best research evidence with clinical expertise and patient preferences

Evidence-based practice integrates best available research, clinical expertise, and patient values/preferences to guide clinical decision-making.

Question 124: Which preoperative nursing intervention most reduces the risk of surgical site infection (SSI)?

Applying povidone-iodine scrub the morning of surgery
Administering prophylactic antibiotics within 60 minutes before incision (Correct answer)
Keeping the patient NPO for 12 hours before surgery
Shaving the operative site the night before surgery

Correct answer: Administering prophylactic antibiotics within 60 minutes before incision

Evidence-based SSI prevention bundles include prophylactic antibiotics given within 60 minutes before surgical incision.

Question 125: Which grading scale is most commonly used to classify chemotherapy-related adverse effects in oncology clinical practice?

NCI Common Terminology Criteria for Adverse Events (CTCAE) (Correct answer)
TNM Staging System
ECOG Performance Status Scale
Karnofsky Performance Scale

Correct answer: NCI Common Terminology Criteria for Adverse Events (CTCAE)

The NCI CTCAE is the standardized system for grading the severity of adverse events in oncology clinical trials and practice.

Question 126: A nurse manager uses the Plan-Do-Study-Act (PDSA) cycle for a quality improvement project. In which phase would outcomes data be analyzed?

Do
Plan
Study (Correct answer)
Act

Correct answer: Study

The Study phase of the PDSA cycle involves analyzing data collected during the 'Do' phase to determine if the change achieved the intended improvement.

Question 127: An intubated ICU patient has partial facial tightening (face 2), fully bent upper limbs with finger flexion (upper limbs 3), and is tolerating the ventilator (compliance 1). What is the BPS total score and what does it indicate?

Score 3: minimal discomfort within acceptable range
Score 7: extreme pain requiring immediate opioid escalation
Score 5: adequate sedation confirmed
Score 6: clinically significant pain requiring intervention (Correct answer)

Correct answer: Score 6: clinically significant pain requiring intervention

BPS total: face 2 + upper limbs 3 + ventilator compliance 1 = 6. BPS scores at or above 5 indicate significant pain requiring intervention.

Question 128: Which of the following best describes interoperability in health information technology?

The process of converting paper records to electronic format
Security encryption used to protect patient data
The ability of a hospital EHR to generate billing reports
The ability of different health information systems to exchange and use clinical data seamlessly (Correct answer)

Correct answer: The ability of different health information systems to exchange and use clinical data seamlessly

Interoperability refers to the ability of different health information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner.

Question 129: Which of the following is the most common cause of community-acquired pneumonia in otherwise healthy adults?

Streptococcus pneumoniae (Correct answer)
Haemophilus influenzae
Mycoplasma pneumoniae
Staphylococcus aureus

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae (pneumococcus) is the leading bacterial cause of community-acquired pneumonia in adults.

Question 130: Which electrolyte imbalance is most commonly associated with prolonged nasogastric suctioning?

Hyperkalemia
Hypernatremia
Hypermagnesemia
Hypokalemia and metabolic alkalosis (Correct answer)

Correct answer: Hypokalemia and metabolic alkalosis

NG suctioning causes loss of HCl and K+, resulting in hypokalemia and metabolic alkalosis.

Question 131: According to Piaget's Theory of Cognitive Development, at which of the following ages does a child begin to act with intention and may first attempt to climb over obstacles, such as crib side rails?

4 to 8 months.
13 to 18 months.
9 to 12 months. (Correct answer)
18 to 24 months.

Correct answer: 9 to 12 months.

Explanation: According to Piaget's Theory of Cognitive Development, at age 9 to 12 months, a child begins to act with intention and may first attempt to climb over obstacles, such as crib side rails. This is a transitional stage for the children during which intellectual development progresses and the child begins to understand that hidden objects are not permanently gone. They also begin to associate words and symbols (such as "bye-bye") with events, such as the parent leaving.

Question 132: A post-surgical patient develops fever, rigors, and hypotension 48 hours after central venous catheter insertion. Blood cultures are drawn. Which action should be taken first?

Administer acetaminophen and reassess in 2 hours
Begin empiric broad-spectrum antibiotics after cultures are drawn, before results return (Correct answer)
Wait for culture results before initiating antibiotics
Remove the central line immediately and culture the catheter tip

Correct answer: Begin empiric broad-spectrum antibiotics after cultures are drawn, before results return

In suspected CLABSI with signs of sepsis, empiric broad-spectrum antibiotics must be initiated promptly after blood cultures are drawn. Delaying treatment for culture results increases mortality.

Question 133: A patient with non-Hodgkin lymphoma is prescribed rituximab. The nurse monitors for which infusion-related reaction most commonly occurring during the first infusion?

Hypertension and tachycardia only
Severe peripheral neuropathy
Anaphylaxis with urticaria and angioedema
Fever, chills, rigors, hypotension, and bronchospasm (Correct answer)

Correct answer: Fever, chills, rigors, hypotension, and bronchospasm

Rituximab commonly causes infusion reactions including fever, chills, rigors, hypotension, and bronchospasm, especially during the first infusion.

Question 134: Which federal law established the legal framework for protecting electronic health information privacy and security in the United States?

The Affordable Care Act (ACA)
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 with HITECH amendments (Correct answer)
The Joint Commission accreditation standards
The American Recovery and Reinvestment Act (ARRA) alone

Correct answer: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 with HITECH amendments

HIPAA (1996) established the foundational privacy and security framework for PHI. The HITECH Act (2009) significantly strengthened HIPAA by extending requirements to business associates and establishing the Breach Notification Rule.

Question 135: Which finding is most indicative of increased intracranial pressure (ICP) in a patient with a traumatic brain injury?

Temperature of 38.1°C
Heart rate of 110 bpm with normal BP
Cushing's triad: hypertension, bradycardia, and irregular respirations (Correct answer)
Mild confusion without vital sign changes

Correct answer: Cushing's triad: hypertension, bradycardia, and irregular respirations

Cushing's triad (hypertension, bradycardia, irregular respirations) is a late, ominous sign of severely elevated ICP.

Question 136: A patient calls the ambulatory care clinic reporting chest pain and shortness of breath. The nurse's FIRST priority action should be:

Notify the physician and document the call in the patient's chart
Advise the patient to take an antacid and call back if symptoms worsen
Schedule an appointment for the next available opening
Instruct the patient to activate emergency medical services (911) immediately (Correct answer)

Correct answer: Instruct the patient to activate emergency medical services (911) immediately

Chest pain with shortness of breath may indicate a life-threatening emergency such as myocardial infarction, requiring immediate activation of emergency services.

Question 137: When screening for colorectal cancer, at what age should average-risk patients begin colonoscopy screening?

55 years
45 years (Correct answer)
40 years
50 years

Correct answer: 45 years

The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults.

Question 138: A patient with chronic heart failure develops acute pulmonary edema with SpO2 84%, severe dyspnea, and pink frothy sputum. Which initial intervention has highest priority?

Position upright (high Fowler's), apply high-flow oxygen or NIV, and prepare IV furosemide (Correct answer)
Obtain 12-lead ECG to identify precipitating arrhythmia
Administer oral furosemide and reassess in 30 minutes
Start IV fluid bolus to increase preload and improve cardiac output

Correct answer: Position upright (high Fowler's), apply high-flow oxygen or NIV, and prepare IV furosemide

Acute pulmonary edema is a respiratory emergency. Immediate priorities: upright positioning (reduces preload), high-flow O2 or NIV (improves oxygenation), and IV furosemide (rapid diuresis). These occur simultaneously.

Question 139: In ambulatory care, which federal law primarily governs the privacy and security of patient health information?

Emergency Medical Treatment and Labor Act (EMTALA)
Health Insurance Portability and Accountability Act (HIPAA) (Correct answer)
Occupational Safety and Health Act (OSHA)
Americans with Disabilities Act (ADA)

Correct answer: Health Insurance Portability and Accountability Act (HIPAA)

HIPAA establishes national standards for protecting the privacy and security of individually identifiable health information (PHI) in all health care settings.

Question 140: Under the Health Insurance Portability and Accountability Act (HIPAA), which action by a nurse violates patient privacy?

Sharing patient information with direct care providers on a need-to-know basis
Discussing patient information with a colleague in a public elevator within earshot of others (Correct answer)
Documenting in the medical record under the nurse's own login
Providing the patient's spouse with discharge instructions at the patient's request

Correct answer: Discussing patient information with a colleague in a public elevator within earshot of others

Discussing patient information in public areas where unauthorized persons may overhear constitutes a HIPAA privacy violation.

Question 141: Which physical exam finding is most associated with appendicitis?

Murphy's sign
Rovsing's sign positivity
McBurney's point tenderness
Both B and C (Correct answer)

Correct answer: Both B and C

Both McBurney's point tenderness and a positive Rovsing's sign are classic physical exam findings in appendicitis.

Question 142: Which leadership style is most appropriate when managing a highly experienced and motivated nursing team?

Transactional leadership
Autocratic leadership
Delegative (laissez-faire) leadership (Correct answer)
Bureaucratic leadership

Correct answer: Delegative (laissez-faire) leadership

Delegative leadership is most effective with expert, self-motivated teams who require minimal direction but maximum autonomy.

Question 143: A patient takes oxycodone 30 mg orally every 12 hours and is switching to IV morphine. What IV morphine dose per 24 hours is approximately equivalent?

30 mg IV morphine per 24 hours
60 mg IV morphine per 24 hours
10 mg IV morphine per 24 hours
20 mg IV morphine per 24 hours (Correct answer)

Correct answer: 20 mg IV morphine per 24 hours

Total daily oral oxycodone = 60 mg. Converting to OME: 60 mg x 1.5 = 90 mg oral morphine/24hr. Converting oral to IV (3:1): 90/3 = 30 mg IV morphine/24hr. After 25-30% dose reduction for incomplete cross-tolerance: approximately 20-22 mg IV morphine/24hr.

Question 144: Which of the following circumstances is likely to be the greatest barrier to a child's access to medical care?

Being homeless (Correct answer)
Living in a rural area
Lacking an extended family
Having a single parent

Correct answer: Being homeless

Explanation: The circumstance that is likely to be the greatest barrier to a child's access to medical care is being homeless. People who are homeless often move from shelter to shelter or other temporary living situations, and their medical care is often provided through emergency departments or free clinics, so there is little consistency in care or follow-up. Children who are homeless are often exposed to others who are ill and may not have facilities for adequate hygiene.

Question 145: Fifteen hours after a patient was involved in an accident that resulted in a comminuted fracture of the femur, the patient exhibits increasing dyspnea and tachypnea as well as confusion, difficulty speaking, and a petechial rash in the mouth and upper body. The most likely cause of this triad of symptoms is:

Pulmonary embolism
Pneumonia
Fat embolism syndrome (Correct answer)
Stroke

Correct answer: Fat embolism syndrome

Explanation: The most likely cause of this triad of symptoms is fat embolism syndrome. Fat emboli enter the bloodstream and lodge in the lungs where platelets, red blood cells, and fibrin adhere to them, leading to respiratory distress syndrome. They can migrate to the skin (causing petechiae) and to the brain (causing central nervous system [CNS] problems).

Question 146: Under the Fair Labor Standards Act (FLSA), registered nurses classified as exempt employees are generally:

Paid at state minimum wage rates only
Required to receive compensatory time instead of overtime pay
Not entitled to mandatory overtime compensation if salaried above the threshold (Correct answer)
Entitled to overtime pay at 1.5× their hourly rate

Correct answer: Not entitled to mandatory overtime compensation if salaried above the threshold

Salaried employees meeting professional exemption criteria under FLSA are exempt from overtime requirements.

Question 147: For a patient on IABP for cardiogenic shock, what is the primary mechanism by which IABP improves myocardial oxygen supply?

Inflation during systole increases cardiac output directly
Balloon deflation during systole causes afterload reduction only
Continuous forward flow augments LV output by reducing SVR
Inflation during diastole increases coronary artery perfusion pressure (Correct answer)

Correct answer: Inflation during diastole increases coronary artery perfusion pressure

IABP counterpulsation inflates during diastole (triggered by the dicrotic notch), augmenting diastolic pressure and improving coronary perfusion pressure — called diastolic augmentation.

Question 148: Which blood test is the primary tumor marker used to monitor treatment response in prostate cancer?

PSA (prostate-specific antigen) (Correct answer)
CEA (carcinoembryonic antigen)
AFP (alpha-fetoprotein)
CA-125

Correct answer: PSA (prostate-specific antigen)

PSA is the primary serum biomarker for prostate cancer diagnosis, staging, and monitoring treatment response.

Question 149: A patient with cancer is receiving opioids for chronic pain and reports new-onset constipation. The first-line intervention is:

Administer an opioid antagonist
Stop the opioid medication immediately
Restrict dietary fiber intake
Initiate a bowel regimen with a stimulant laxative when starting opioid therapy (Correct answer)

Correct answer: Initiate a bowel regimen with a stimulant laxative when starting opioid therapy

Opioid-induced constipation is an expected side effect; a stimulant laxative bowel regimen should be initiated prophylactically at opioid start.

Question 150: A nurse in an ambulatory surgery center is providing preoperative teaching to a patient scheduled for a same-day procedure. Which instruction is MOST important to reinforce?

The patient may eat a light breakfast on the morning of surgery
The patient should stop all prescription medications one week before surgery
The patient can shower with regular soap immediately after the procedure
The patient must arrange for a responsible adult to drive them home after discharge (Correct answer)

Correct answer: The patient must arrange for a responsible adult to drive them home after discharge

Patients receiving anesthesia or sedation must have a responsible adult driver arranged for discharge, as they cannot safely drive themselves due to residual effects.

ANCC Nursing Certification Exam

The ANCC (American Nurses Credentialing Center) administers specialty nursing certification exams that validate clinical expertise across specialties including ambulatory care, cardiac vascular, medical-surgical, oncology nursing, and advanced practice nurse practitioner roles.

150

Questions

180 min

Time Limit

70%

To Pass

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