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Nursing ANCC Adult Health Clinical Nurse Specialist Certification (ACNS) Sample Questions (Q136-Q141):

NEW QUESTION # 136
You are doing a neurological examination on a patient and find papilledem a. The ACNS understands that physical examination finding in papilledema include:

A. none of the above
B. arteriovenous nicking
C. hyperpigmentation of the macula
D. optic disk bulging

Answer: D

Explanation:
Papilledema, or optic disk bulging, is a critical finding during a neurological examination and can indicate serious underlying conditions. This condition appears as the swelling of the optic disc and is primarily caused by increased intracranial pressure (ICP). The optic disc is the point where the optic nerve enters the retina in the eye. Under normal circumstances, the optic disc has a distinct margin and is flat. However, in the presence of papilledema, this disc begins to protrude or bulge into the eye.
One of the hallmark signs of papilledema on funduscopic examination is the absence of venous pulsations. Normally, small venous pulsations can be seen on the optic disc due to the changes in venous pressure with cardiac cycles. However, when intracranial pressure is elevated, these pulsations are absent because the increased pressure is transmitted along the optic nerve to the eye, compressing the veins and preventing the pulsation.
Increased intracranial pressure leading to papilledema can be caused by a variety of conditions including, but not limited to, brain tumors, abscesses, hydrocephalus, or meningitis. In adults, meningitis is a common cause of increased ICP and subsequently papilledema. Meningitis involves inflammation of the protective membranes covering the brain and spinal cord, which can lead to increased fluid and pressure within the skull.
It is important to differentiate papilledema from other eye conditions that might mimic its appearance. For example, conditions like hypertensive retinopathy might also show signs such as arteriovenous nicking, and age-related macular degeneration might show hyperpigmentation of the macula. However, these conditions do not involve swelling of the optic disc and do not indicate raised intracranial pressure. Therefore, in a choice list that includes arteriovenous nicking, hyperpigmentation of the macula, or none of the above, the correct answer pointing towards an indication of increased ICP and papilledema is optic disk bulging.
Recognizing papilledema is crucial as it necessitates further investigation to identify and treat the underlying cause of increased intracranial pressure. Failure to address the root cause promptly can lead to serious outcomes, including permanent vision loss or other neurological impairments. Thus, the identification of optic disk bulging during a neurological examination is a key diagnostic indicator that should prompt immediate medical response.

NEW QUESTION # 137
You are treating your patient with a 5HT4 agonist for his gastrointestinal disorder. Of the following, which would you prescribe?

A. Alosetron.
B. Tegaserod.
C. Cisapride.
D. Senna.

Answer: B

Explanation:
To address the question of which medication to prescribe for a patient's gastrointestinal disorder using a 5HT4 agonist, it is essential to understand the pharmacological role of each option listed. Here is an expanded explanation of the drug choices provided:
Tegaserod: This medication is a 5HT4 agonist and is used specifically to treat certain gastrointestinal disorders, particularly those associated with symptoms of irritable bowel syndrome (IBS) predominantly featuring constipation. Tegaserod works by enhancing the release of neurotransmitters that increase the movement of the intestines, thereby promoting bowel movements and alleviating constipation. Due to its mechanism of action targeting the 5HT4 receptor, tegaserod is the correct choice when a 5HT4 agonist is indicated for gastrointestinal issues.
Senna: Senna is categorized as a stimulant laxative. It operates by stimulating the muscles in the intestines, which helps to facilitate the movement of stool through the bowel. Though effective for constipation, Senna does not function as a 5HT4 agonist and therefore does not fit the requirement for the medication needed in this scenario.
Cisapride: Previously used as a promotility agent, Cisapride enhances the release of acetylcholine at the myenteric plexus, which stimulates gastrointestinal motility and accelerates gastric emptying. It acts on serotonin receptors, but its primary action is not on the 5HT4 receptor. Furthermore, due to concerns about serious cardiac side effects, its availability is highly restricted in many countries.
Alosetron: This medication is a 5HT3 antagonist used primarily to manage severe diarrhea-predominant irritable bowel syndrome (IBS) in women. By blocking the 5HT3 receptors, alosetron slows the movement of stools through the intestines, which is the opposite effect of what is typically desired with a 5HT4 agonist. Therefore, alosetron is not suitable for the requirement of a 5HT4 agonist.
In conclusion, for a patient needing a 5HT4 agonist for treating a gastrointestinal disorder, Tegaserod is the appropriate prescription among the options listed. It directly targets the 5HT4 receptors and is effective in enhancing gut motility, specifically in cases related to constipation-predominant IBS. Other drugs listed either do not target the 5HT4 receptor or have different primary indications and mechanisms of action that do not align with the therapeutic needs specified.

NEW QUESTION # 138
Which of the following examples would be representative of an occurrence that would put the Adult Clinical Nurse Specialist's license in jeopardy?

A. The CNS appropriately delegates the right medication dose and administration to a registered nurse who administers the wrong dose that is fatal to the patient.
B. The CNS delegates a patient assessment task to a licensed practical nurse who has been sent to the outpatient clinic to fill in for a nurse that is sick.
C. The CNS provides healthcare services consistent with established standards of practice in the jurisdiction.
D. A medical assistant in the clinic exceeds the scope of her authority, but the CNS takes prompt action to correct the problem.

Answer: B

Explanation:
When considering which actions could potentially jeopardize the license of an Adult Clinical Nurse Specialist (CNS), it is essential to understand the regulatory and scope-of-practice frameworks that guide nursing roles. In the given scenario where a CNS delegates a patient assessment task to a Licensed Practical Nurse (LPN) who is temporarily filling in at an outpatient clinic, several factors need to be examined.
Typically, a CNS is an advanced practice nurse who has both the educational background and the clinical expertise to manage complex patient situations and lead nursing practices. In contrast, LPNs generally have a more limited scope of practice, which focuses largely on providing basic nursing care under the supervision of registered nurses (RNs) or advanced practice nurses like CNSs.
Patient assessment involves collecting and interpreting various pieces of health information to make clinical decisions. This process requires a higher level of clinical judgment and expertise, typically expected from RNs or advanced practice nurses. In many jurisdictions, LPNs are not authorized to perform comprehensive patient assessments independently. They are trained to assist with data collection but not to synthesize this data for more complex clinical decision-making.
Therefore, if a CNS delegates an assessment task to an LPN, especially in a setting where the LPN is unfamiliar or temporarily assigned, there could be significant risks involved. This includes the possibility of incomplete or inaccurate assessment, which can lead to inappropriate treatment decisions and jeopardize patient safety.
From a legal and regulatory standpoint, the CNS could be held responsible for any adverse outcomes resulting from inappropriate delegation. This is because delegating beyond an individual's scope of practice can be seen as a failure to adhere to established standards of nursing care, thus putting the CNS's license at risk.
In this scenario, the CNS should have assessed the LPN's competencies and the specific requirements of the task before delegation. If the task was beyond the LPN's scope of practice, the CNS should have either performed the assessment themselves or delegated it to another appropriately qualified professional, such as an RN.
In conclusion, while delegation is a critical skill in nursing management and care coordination, it must be executed with careful consideration of the delegatee's qualifications and the nature of the task. The CNS in the given example could potentially jeopardize their license by delegating a complex patient assessment task to an LPN without verifying that the LPN is capable of performing this task within the legal scope of their practice and their competency level.

NEW QUESTION # 139
Of the following, what is expected of a patient undergoing conscious sedation?

A. He is not arousable and may require assistance maintaining an airway. Cardiovascular function may be affected.
B. He is not easily aroused but may be able to respond to painful stimulation. May require intervention to maintain airway. Cardiovascular function is still in tact.
C. He is able to normally respond to verbal commands.Ventilatory and cardiovascular functions are normal, however, he may be somewhat impaired cognitively.
D. He is able to respond to verbal commands with or without physical stimuli. Not necessary to intervene in order to maintain the patient's airway.

Answer: D

Explanation:
Conscious sedation, also known as moderate sedation or procedural sedation, is a medically controlled state of depressed consciousness used often in minor surgeries or during diagnostic procedures. While under conscious sedation, patients remain awake enough to follow simple instructions and respond to verbal cues, yet they are relaxed and may not remember the procedure afterward.
The correct answer to the question regarding the expected state of a patient under conscious sedation is: "He is able to respond to verbal commands with or without physical stimuli. Not necessary to intervene in order to maintain the patient's airway." This statement accurately describes the typical responsiveness and airway control expected in a patient undergoing conscious sedation.
During conscious sedation, the patient can communicate discomfort and cooperate with instructions, which helps the medical team adjust the level of sedation as needed. It is crucial in conscious sedation that the patient's airway remains unobstructed and functions independently. Generally, the patient does not require assistance for breathing, unlike deeper levels of sedation or anesthesia where mechanical ventilation might be necessary.
Contrasting other sedation levels helps clarify this point: - Minimal sedation: This is a lighter sedation where the patient is fully awake and able to respond normally to verbal commands. Cognitive function and coordination may be mildly impaired, but ventilatory and cardiovascular functions are unaffected. - Deep sedation: In this state, the patient is not easily aroused but can respond purposefully following repeated or painful stimulation. The patient might require assistance in maintaining an open airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. - General anesthesia: The patient is not arousable, even by painful stimulation. The patient often requires assistance in maintaining an airway, and positive pressure ventilation may be necessary because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
Thus, understanding these distinctions is critical for medical professionals to manage the level of sedation appropriately and ensure patient safety during medical procedures. The ability to respond to verbal commands with or without physical stimuli and maintaining airway independence without intervention distinctly characterizes the state of conscious sedation.

NEW QUESTION # 140
Which of the following is NOT an appropriate serving size of fruit for a person on the ADA diet?

A. 2 plums.
B. 1 c apple juice.
C. ½ c unsweetened canned fruit.
D. 2 Tbsp raisins.

Answer: B

Explanation:
The question is asking which fruit serving size is not appropriate for someone following the American Diabetes Association (ADA) diet. The correct answer is "1 cup of apple juice." The ADA diet is tailored to help individuals manage their blood sugar levels, and thus, portion control is a critical aspect of this diet. It's important to understand that different forms of fruits have different impacts on blood sugar levels. Whole fruits contain fiber, which helps slow down the digestion process and the release of sugar into the bloodstream, making them a healthier choice in appropriate portions.
In contrast, fruit juices, such as apple juice, lack fiber and are more concentrated sources of sugar and calories. Consequently, they can lead to quicker and higher spikes in blood sugar levels. According to ADA guidelines, if fruit juice is consumed, it should be limited to a smaller serving size because of its higher sugar content and lack of fiber. Specifically, the ADA recommends that servings of juice should not exceed 1/2 cup. This is because a full cup of fruit juice can contain the sugar equivalent of several pieces of whole fruit, without the beneficial fiber.
The other options provided - "2 plums," "½ cup unsweetened canned fruit," and "2 tablespoons of raisins" - are generally considered appropriate serving sizes for someone on the ADA diet. These options contain fiber (to varying extents), are more filling, and have a slower impact on blood sugar levels compared to a full cup of fruit juice.
Thus, "1 cup apple juice" is the correct answer as it is not an appropriate serving size for someone managing their diet according to ADA guidelines. To adhere to the ADA diet, it's recommended to consume whole fruits in appropriate portions and limit the intake of fruit juices, especially in larger quantities like a full cup.

NEW QUESTION # 141
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