CMSRN Trivia 4 — Questions and Answers
Question 1: A patient is receiving total parenteral nutrition (TPN). Which complication should the nurse monitor for most closely during the first hour of administration?
- Hyperglycemia (Correct answer)
- Air embolism
- Fluid overload
- Catheter occlusion
Correct answer: Hyperglycemia
Hyperglycemia is the most common metabolic complication of TPN and requires close blood glucose monitoring, especially during initiation.
Question 2: Which sign is a late indicator of increased intracranial pressure?
- Headache
- Projectile vomiting
- Cushing's triad (hypertension, bradycardia, irregular respirations) (Correct answer)
- Pupillary changes
Correct answer: Cushing's triad (hypertension, bradycardia, irregular respirations)
Cushing's triad is an ominous late sign of severely elevated ICP indicating brainstem herniation is imminent.
Question 3: A nurse is caring for a patient post-thyroidectomy. Which assessment finding requires the most immediate intervention?
- Serum calcium of 8.8 mg/dL
- Positive Chvostek's sign (Correct answer)
- Hoarse voice
- Temperature of 37.5°C
Correct answer: Positive Chvostek's sign
A positive Chvostek's sign (facial muscle twitching when tapping the facial nerve) indicates hypocalcemia from accidental parathyroid removal, risking tetany.
Question 4: Which type of isolation precaution is required for a patient with active pulmonary tuberculosis?
- Contact precautions
- Droplet precautions
- Airborne precautions (Correct answer)
- Reverse isolation
Correct answer: Airborne precautions
Tuberculosis is transmitted via airborne particles and requires a negative pressure room, N95 respirator, and airborne precautions.
Question 5: A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, and blood glucose of 480 mg/dL. Which condition does the nurse suspect?
- Hyperosmolar hyperglycemic state
- Diabetic ketoacidosis (Correct answer)
- Hypoglycemic unawareness
- Lactic acidosis
Correct answer: Diabetic ketoacidosis
Kussmaul respirations and fruity breath are classic signs of DKA, caused by ketone accumulation in type 1 diabetes.
Question 6: Which assessment technique is used to detect ascites in a patient with liver failure?
- Rebound tenderness
- Shifting dullness on percussion (Correct answer)
- Auscultation for bruit
- Palpation for splenomegaly
Correct answer: Shifting dullness on percussion
Shifting dullness on percussion detects ascites because fluid shifts to dependent areas when the patient changes position.
Question 7: A patient's arterial blood gas shows: pH 7.28, PaCO2 28 mmHg, HCO3 13 mEq/L. How should the nurse interpret this result?
- Respiratory acidosis with compensation
- Metabolic acidosis with respiratory compensation (Correct answer)
- Respiratory alkalosis with compensation
- Mixed metabolic and respiratory alkalosis
Correct answer: Metabolic acidosis with respiratory compensation
A low pH with low HCO3 indicates metabolic acidosis; the low PaCO2 reflects respiratory compensation by hyperventilation.
CMSRN Trivia 4
A patient is receiving total parenteral nutrition (TPN).
Which complication should the nurse monitor for most closely during the first hour of administration?