MedCa Certification Practice Patient Care Section Q & A w/ Rationales

MedCa Certification Practice Patient Care Section Q & A w/ Rationales 2024

• A 65-year-old male patient with a history of chronic obstructive pulmonary

disease (COPD) is admitted to the hospital with an acute exacerbation of dyspnea and cough. The nurse assesses his vital signs and oxygen saturation. Which of the following findings would indicate a need for immediate intervention?

a) Heart rate of 90 beats per minute

b) Respiratory rate of 24 breaths per minute

c) Blood pressure of 150/90 mmHg

d) Oxygen saturation of 88% on room air*

Rationale: The normal range for oxygen saturation is 95-100%. A value below 90%

indicates hypoxemia, which can lead to tissue hypoxia and organ damage. The patient with COPD may have a lower baseline oxygen saturation, but any drop below 90% should be reported and treated promptly.

• A 45-year-old female patient with type 2 diabetes mellitus is scheduled for a

colonoscopy. She asks the nurse how to manage her diabetes medications before the procedure. What is the best response by the nurse?

• "You should take your usual dose of oral antidiabetic agents the night before and

skip them on the day of the procedure."*

• "You should stop taking your oral antidiabetic agents three days before the

procedure and monitor your blood glucose closely."

• "You should take half of your usual dose of oral antidiabetic agents the night

before and the morning of the procedure."

• "You should continue taking your oral antidiabetic agents as prescribed until the

day of the procedure and then resume them after the procedure." Rationale: The patient should take her usual dose of oral antidiabetic agents the night before and skip them on the day of the procedure to avoid hypoglycemia during fasting. She should also check her blood glucose before and after the procedure and resume her medications as instructed by the provider.

• A 32-year-old male patient with a history of schizophrenia is brought to the

emergency department by his family. He has been non-compliant with his antipsychotic medication for several weeks and is experiencing auditory hallucinations, paranoia, and agitation. The nurse administers a dose of haloperidol intramuscularly as ordered by the provider. What is the most important nursing action after giving the medication?

a) Monitor the patient's vital signs and level of consciousness

b) Assess the patient for extrapyramidal side effects*

c) Educate the patient about the benefits of medication adherence

d) Reassure the patient that the hallucinations will subside soon

Rationale: Haloperidol is a typical antipsychotic that can cause extrapyramidal side effects such as dystonia, akathisia, parkinsonism, and tardive dyskinesia. The nurse should assess the patient for these side effects after giving the medication and report any abnormal findings to the provider. The nurse should also monitor vital signs and level of consciousness, educate the patient about medication adherence, and reassure the patient, but these are not as urgent as assessing for extrapyramidal side effects.

• A 28-year-old female patient with a history of asthma is admitted to the hospital

with an acute asthma attack. She reports using her albuterol inhaler several times a day for the past week, but without much relief. The nurse auscultates her lungs and hears wheezes throughout both lung fields. Which of the following interventions would be most appropriate for this patient?

a) Administer oxygen via nasal cannula

b) Administer corticosteroids intravenously*

c) Administer antihistamines orally

d) Administer bronchodilators via nebulizer

Rationale: Corticosteroids are anti-inflammatory agents that reduce airway

inflammation and mucus production in asthma. They are indicated for patients with severe or persistent asthma who do not respond well to bronchodilators alone.Corticosteroids are given intravenously in acute asthma attacks to achieve rapid effects. Oxygen, bronchodilators, and antihistamines may also be used in asthma management, but they are not as effective as corticosteroids in this case.

• A 50-year-old male patient with a history of hypertension and coronary artery

disease is admitted to the hospital with chest pain that radiates to his left arm and jaw. He rates his pain as 8 out of 10 on a numeric scale. The nurse administers nitroglycerin sublingually as ordered by the provider. What is the expected outcome of this medication?

a) It will decrease the heart rate and blood pressure

b) It will dilate the coronary arteries and increase blood flow to the heart*

c) It will reduce the oxygen demand and workload of the heart

d) It will prevent platelet aggregation and thrombus formation

Rationale: Nitroglycerin is a vasodilator that dilates the coronary arteries and increases blood flow to the heart. This relieves ischemia and reduces chest pain in patients with angina or myocardial infarction. Nitroglycerin may also decrease the blood pressure and preload, which reduces the oxygen demand and workload of the heart, but this is not its primary effect. Nitroglycerin does not affect the heart rate or platelet aggregation.

• A 60-year-old female patient with a history of osteoporosis is admitted to the

hospital with a hip fracture after a fall. She undergoes surgery to repair the fracture and is transferred to the orthopedic unit. The nurse plans to implement measures to prevent complications of immobility in this patient. Which of the following interventions would be most effective for this purpose?

a) Encourage the patient to perform active range of motion exercises of the

unaffected extremities*

b) Apply sequential compression devices to the lower extremities

c) Elevate the head of the bed to 45 degrees

d) Encourage the patient to drink at least 2 liters of fluid per day

Rationale: Active range of motion exercises of the unaffected extremities promote circulation, muscle strength, joint mobility, and venous return. They also prevent contractures, atrophy, and thromboembolism in immobilized patients. Sequential compression devices, elevation of the head of the bed, and fluid intake may also be beneficial, but they are not as effective as active range of motion exercises.

• A 40-year-old male patient with a history of alcohol abuse is admitted to the

hospital with signs and symptoms of liver cirrhosis. He has ascites, jaundice, spider angiomas, and hepatic encephalopathy. The nurse monitors his laboratory values and notes that his serum ammonia level is elevated. What is the most likely cause of this finding?

a) Impaired liver function and decreased metabolism of ammonia*

b) Increased protein intake and increased production of ammonia

c) Decreased renal function and decreased excretion of ammonia

d) Increased bacterial infection and increased breakdown of urea

Rationale: Ammonia is a toxic by-product of protein metabolism that is normally

converted to urea by the liver and excreted by the kidneys. In liver cirrhosis, the liver function is impaired and the metabolism of ammonia is decreased. This leads to increased serum ammonia levels and hepatic encephalopathy, which is a neurological complication characterized by confusion, lethargy, asterixis, and