Question 1: A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient?

• The patient is allergic to shellfish
• The patient has a pacemaker (Correct answer)
• The patient suffers from claustrophobia
• The patient takes anti-psychotic medication

Correct answer: The patient has a pacemaker

A pacemaker is an absolute contraindication for a magnetic resonance imaging (MRI) scan due to the powerful magnetic fields and radiofrequency pulses used during the procedure. These forces can interfere with the pacemaker's function, cause it to malfunction, or even dislodge it, posing a significant safety risk to the patient. Patients with pacemakers require alternative imaging methods.

Question 2: A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?

• A patient admitted for myocardial infarction without cardiac muscle damage.
• A post-operative coronary bypass patient, recovering on schedule.
• A patient with a history of ventricular tachycardia and syncopal episodes. (Correct answer)
• A patient with a history of atrial tachycardia and fatigue.

Correct answer: A patient with a history of ventricular tachycardia and syncopal episodes.

An automatic internal cardioverter-defibrillator (AICD) is implanted in patients at high risk for life-threatening ventricular arrhythmias, such as ventricular tachycardia (VT) or ventricular fibrillation (VF). A patient with a history of ventricular tachycardia and syncopal episodes indicates a significant risk of sudden cardiac death, making them an ideal candidate for an AICD to detect and terminate these dangerous rhythms.

Question 3: A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern?

• Bulging anterior fontanel
• Repeated vomiting (Correct answer)
• Signs of sleepiness at 10 PM.
• Inability to read short words from a distance of 18 inches

Correct answer: Repeated vomiting

Repeated vomiting in a child after head trauma is a significant and concerning sign of increased intracranial pressure (ICP). This symptom indicates that the brain may be swelling or bleeding, putting pressure on vital structures. While other signs exist, repeated vomiting warrants immediate medical attention to prevent further neurological damage.

Question 4: An adolescent brings a physician’s note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?

• The condition was caused by the student’s competitive swimming schedule.
• The student will most likely require surgical intervention.
• The student experiences pain in the inferior aspect of the knee. (Correct answer)
• The student is trying to avoid participation in physical education.

Correct answer: The student experiences pain in the inferior aspect of the knee.

Osgood-Schlatter disease is a common cause of knee pain in growing adolescents, particularly those involved in sports. It is characterized by inflammation of the patellar ligament at its insertion point on the tibial tuberosity, which is located just below the kneecap (inferior aspect of the knee). The pain is typically exacerbated by activity and relieved by rest.

Question 5: A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient’s lab results would expect which of the following changes in laboratory findings?

• Elevated serum calcium. (Correct answer)
• Low serum parathyroid hormone (PTH).
• Elevated serum vitamin D.
• Low urine calcium.

Correct answer: Elevated serum calcium.

Primary hyperparathyroidism is characterized by the excessive secretion of parathyroid hormone (PTH), which plays a crucial role in calcium regulation. Elevated PTH levels lead to increased calcium reabsorption from bones, increased calcium absorption in the intestines, and increased renal reabsorption of calcium. Consequently, the most expected laboratory finding is elevated serum calcium (hypercalcemia).

Question 6: A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?

• Slow, deep respirations
• Stridor
• Bradycardia
• Air hunger (Correct answer)

Correct answer: Air hunger

Severe pulmonary edema, often a complication of myocardial infarction, causes fluid to accumulate in the lungs, significantly impairing gas exchange. This leads to profound hypoxemia and dyspnea, which the patient experiences as an overwhelming sensation of 'air hunger'—a desperate need to breathe. The body's compensatory mechanisms will increase respiratory rate and effort, not slow them.

Question 7: A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?

• The child has a poor chance of recovery without joint deformity.
• Most children progress to adult rheumatoid arthritis.
• Nonsteroidal anti-inflammatory drugs are the first choice in treatment. (Correct answer)
• Physical activity should be minimized.

Correct answer: Nonsteroidal anti-inflammatory drugs are the first choice in treatment.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically the first-line treatment for juvenile idiopathic arthritis (JIA) to manage pain and inflammation. If NSAIDs are insufficient, other medications like disease-modifying antirheumatic drugs (DMARDs) or biologics may be added. While JIA can be chronic, many children achieve remission, and physical activity is encouraged to maintain joint function, not minimized.

Question 8: A patient is admitted to the same day surgery unit for liver biopsy. Which of the following laboratory tests assesses coagulation? (Select all that apply)

• Partial thromboplastin time (Correct answer)
• Prothrombin time (Correct answer)
• Platelet count (Correct answer)
• Hemoglobin

Correct answer: Partial thromboplastin time

Partial thromboplastin time (PTT), Prothrombin time (PT), and Platelet count are all essential laboratory tests for assessing coagulation, especially before a procedure like a liver biopsy. PTT evaluates the intrinsic and common coagulation pathways, while PT assesses the extrinsic and common pathways. The platelet count measures the number of platelets, which are crucial for primary hemostasis. Together, these tests provide a comprehensive picture of a patient's clotting ability and risk of bleeding.

Question 9: The mother of a 2-month-old infant brings the child to the clinic for a well-baby check. She is concerned because she feels only one testis in the scrotal sac. Which of the following statements about the undescended testis is the most accurate?

• Normally, the testes are descended by birth
• The infant will likely require surgical intervention
• The infant probably has with only one testis
• Normally, the testes descend by one year of age (Correct answer)

Correct answer: Normally, the testes descend by one year of age

Undescended testes (cryptorchidism) are common in newborn infants, especially premature ones. However, in most cases, the testes will spontaneously descend into the scrotal sac by the age of one year. If descent has not occurred by this time, surgical intervention (orchidopexy) is typically recommended to prevent potential complications such as infertility and an increased risk of testicular cancer.

Question 10: Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided?

• Metabolic Acidosis
• Metabolic Alkalosis
• Respiratory Acidosis (Correct answer)
• Respiratory Alkalosis

Correct answer: Respiratory Acidosis

Anne's depressed ventilation, characterized by shallow and slow respirations, leads to inadequate exhalation of carbon dioxide (CO2). When CO2 is retained in the body, it combines with water to form carbonic acid, increasing the blood's acidity. This elevation in carbonic acid and subsequent decrease in pH results in respiratory acidosis, which can be exacerbated by her head injury and alcohol consumption.

Question 11: A mother is admitted in the emergency department following complaints of fever and chills. The nurse on duty took her vital signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?

• Hyperthermia (Correct answer)
• Hyperthermia and Respiratory Alkalosis
• Hypothermia
• Hypothermia and Respiratory Alkalosis

Correct answer: Hyperthermia

The patient's temperature of 100°F (37.8°C) is elevated above the normal body temperature range, which typically falls between 97.8°F and 99°F (36.5°C to 37.2°C). This indicates the presence of hyperthermia or fever. The arterial blood gas values (pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L) are all within normal physiological limits, indicating no acid-base imbalance.

Question 12: Acids have no hydrogen ions and are able to bind in a solution.

• True
• False
• Acid is a substance that is not capable of donating hydrogen ions.
• Acids and bases have nothing to do with hydrogen ions.

The statement 'Acids have no hydrogen ions and are able to bind in a solution' is false. By definition, an acid is a substance that donates hydrogen ions (protons) when dissolved in a solution. The concentration of hydrogen ions is a key determinant of a solution's acidity or pH.

Question 13: Match the acid-base status of the following blood samples to the disorders in the drop down list. (PaCO2 values are in mm Hg and bicarbonate values in mmol/l). pH 7.57, PaCO2 22, HCO3- 17

• Respiratory Acidosis, Partially Compensated
• Respiratory Alkalosis, Uncompensated
• Metabolic Acidosis, Partially Compensated
• Respiratory Alkalosis, Partially Compensated (Correct answer)

Correct answer: Respiratory Alkalosis, Partially Compensated

The pH of 7.57 is alkalotic, and the low PaCO2 of 22 mmHg indicates a respiratory cause for the alkalosis. The HCO3- of 17 mmol/L is low, signifying that the kidneys are attempting to compensate for the alkalosis by excreting bicarbonate. Since the pH is still outside the normal range, the compensation is partial, making it respiratory alkalosis, partially compensated.

Question 14: pH 7.39, PaCO2 44, HCO3- 26

• Respiratory Acidosis
• Metabolic Acidosis
• Respiratory Alkalosis
• Normal (Correct answer)

Correct answer: Normal

All the provided arterial blood gas values fall within their normal physiological ranges. A pH of 7.39 is within the normal range of 7.35-7.45, PaCO2 of 44 mmHg is within 35-45 mmHg, and HCO3- of 26 mmol/L is within 22-26 mmol/L. Therefore, the patient's acid-base status is normal.

Question 15: pH 7.55, PaCO2 25, HCO3- 22

• Respiratory Acidosis, Partially Compensated
• Respiratory Alkalosis, Uncompensated (Correct answer)
• Metabolic Alkalosis, Partially Compensated
• Metabolic Acidosis, Uncompensated

Correct answer: Respiratory Alkalosis, Uncompensated

The pH of 7.55 is elevated, indicating alkalosis. The PaCO2 of 25 mmHg is low, which is the primary cause of the alkalosis, classifying it as respiratory alkalosis. The bicarbonate (HCO3-) level of 22 mmol/L is within the normal range, indicating that the kidneys have not yet initiated compensation for the respiratory disturbance, making it uncompensated.

Question 16: pH 7.17, PaCO2 48, HCO3- 36

• Respiratory Acidosis, Uncompensated
• Metabolic Acidosis, Partially Compensated
• Respiratory Alkalosis, Partially Compensated
• Respiratory Acidosis, Partially Compensated (Correct answer)

Correct answer: Respiratory Acidosis, Partially Compensated

The pH of 7.17 is low, indicating acidosis. The elevated PaCO2 of 48 mmHg points to a respiratory cause for the acidosis. The HCO3- of 36 mmol/L is high, showing that the kidneys are attempting to compensate for the acidosis by retaining bicarbonate. Since the pH remains outside the normal range, the compensation is partial, resulting in respiratory acidosis, partially compensated.