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Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a
typical description of pain associated with an MI, and is now cold and clammy, pale and
dyspneic. He has an IV of D5W running, and is complaining of chest pain. Oxygen therapy
has not been started, and he is not on the monitor. He is frightened.
1. The nurse is aware of several important tasks that should all be done immediately in
order to give Mr. Duffy the care he needs. Which of the following nursing interventions will
relieve his current myocardial ischemia?
2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood
tests are obtained. Which of the following patterns of cardiac enzyme elevation are most
common following an MI?
3. On his second day in CCU Mr. Duffy suffers a life-threatening cardiac arrhythmia.
Considering his diagnosis, which is the most probable arrhythmia?
a. atrial tachycardia
b. ventricular fibrillation
c. atrial fibrillation
d. heart block
4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with
him for his discharge should educate him as to the purpose and actions of his new
medication. What should she or he teach Mr. Duffy to do at home to monitor his reaction to
this medication?
You are speaking to an elderly group of diabetics in the OPD about eye health and the
importance of visits to the ophthalmologist.
5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should
these clients request from their care provider?
a. fluorescein stain
b. snellen’s test
c. tonometry
d. slit lamp
6. You also explain common eye changes associated with aging. One of these is presbyopia,
which is:
a. Refractive error that prevents light rays from coming to a single focus on the retina.
b. Poor distant vision
c. Poor near vision
d. A gradual lessening of the power of accommodation
7. Some of the diabetic clients are interested in understanding what is visualized during
funduscopic examination. During your discussion you describe the macular area as:
a. Head of the optic nerve, seen on the nasal side of the field, lighter in color than the
retina.
b. The area of central vision, seen on the temporal side of the optic disc, which is quite
avascular.
c. Area where the central retinal artery and vein appear on the retina.
d. Reddish orange in color, sometimes stippled.
8. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva.
You explain that this is called:
a. a pinguecula, which is normal slightly raised fatty structure under the conjunctiva that
may gradually increase with age.
b. Icterus, which may be due to liver disease.
c. A pterygium, which will interfere with vision.
d. Ciliary flush caused by congestion of the ciliary artery.
You are caring for Mr. Kaplan who has chronic renal failure (uremia)
9. You know that all but one of the following may eventually result in uremia. Which option
is not implicated?
a. glomerular disease
b. uncontrolled hypertension
c. renal disease secondary to drugs, toxins, infections, or radiations
d. all of the above
10. You did the initial assessment on Mr. Kaplan when he came to your unit. What classical
signs and symptoms did you note?
11. Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him.
Regarding his diagnosis and management of his drugs, you know that:
a. The half-life of many drugs is decreased in uremia; thus dosage may have to be
increased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy and often a
decrease in dose is essential.
c. Drug therapy is not usually affected by this diagnosis
d. Precautions should be taken with prescription drugs, but most OTC medications are safe
for him to use.
You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin by
reviewing assessment of the cardiovascular system in your mind and asking yourself the
following:
12. The point of maximum impulse (PMI) is an important landmark in the cardiac exam.
Which statement best describes the location of the PMI in the healthy adult?
a. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.
b. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
c. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
d. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
13. During the physical examination of the well adult client, the health care provider
auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the
left sternal border, which valve closure is best evaluated?
a. Tricuspid
b. Pulmonic
c. Aortic
d. Mitral
14. The pulmonic component of which heart sound is best heard at the 2nd LICS at the
LSB?
a. S1
b. S2
c. S3
d. S4
15. The coronary arteries furnish blood supply to the myocardium. Which of the following is
a true statement relative to the coronary circulation?
a. the right and left coronary arteries are the first of many branches off the ascending aorta
b. blood enters the right and left coronary arteries during systole only
c. the right coronary artery forms almost a complete circle around the heart, yet supplies
only the right ventricle
d. the left coronary artery has two main branches, the left anterior descending and left
circumflex: both supply the left ventricle
Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis
of mitral stenosis. She is scheduled for surgery to repair her mitral valve.
16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time
because her subjective complaints of dyspnea, hemoptysis, orthopnea, and paroxysmal
nocturnal dyspnea have become unmanageable. These complaints are probably due to:
17. On physical exam of Ms. Baker, several abnormal findings can be observed. Which of
the following is not one of the usual objective findings associated with mitral stenosis?
18. You are seeing more clients with diagnoses of mitral valve prolapse. You know those
mitral valve prolapse is usually a benign cardiac condition, but may be associated with
atypical chest pain. This chest pain is probably caused by:
a. ventricular ischemia
b. dysfunction of the left ventricle
c. papillary muscle ischemia and dysfunction
d. cardiac arrythmias
Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup.
His possible diagnosis is cancer of the lung.
19. The most common lethal cancer in males between their fifth and seventh decades is:
20. Of the four basic cell types of lung cancer listed below, which is always associated with
smoking?
a. adenocarcinoma
b. squamous cell carcinoma (epidermoid)
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma
21. Chemotherapy may be used in combination with surgery in the treatment of lung
cancer. Special nursing considerations with chemotherapy include all but which of the
following?
a. Helping the client deal with depression secondary to the diagnosis and its treatment
b. Explaining that the reactions to chemotherapy are minimal
c. Careful observation of the IV site of the administration of the drugs
d. Careful attention to blood count results
22. Which of the following operative procedures of the thorax is paired with the correct
definition?
Mr. Liberatore, age 76, is admitted to your unit. He has a past medical history of
hypertension, DM, hyperlipidemia. Recently he has had several episodes where he stops
talking in midsentence and stares into space. Today the episode lasted for 15 minutes. The
admission diagnosis is impending CVA.
23. The episodes Mr. Liberatore has been experiencing are probably:
24. Mr. Liberatore suffers a left sided CVA. He is right handed. The nurse should expect:
a. left-sided paralysis
b. visual loss
c. no alterations in speech
d. no impairment of bladder function
25. Upper motor neuron disease may be manifested in which of the following clinical signs?
a. spastic paralysis, hyperreflexia, presence of babinski reflex
b. flaccid paralysis, hyporeflexia
c. muscle atrophy, fasciculations
d. decreased or absent voluntary movement
Julie, an 18-year-old girl, is brought into the ER by her mother with the chief complaint of
sudden visual disturbance that began half an hour ago and was described as double vision
and flashing lights.
26. During your assessment of Julie she tells you all visual symptoms are gone but that she
now has a severe pounding headache over her left eye. You suspect Julie may have:
a. a tension headache
b. the aura and headache of migraine
c. a brain tumor
d. a conversion reaction
27. You explain to Julie and her mother that migraine headaches are caused by:
28. A thorough history reveals that hormonal changes associated with menstruation may
have triggered Julie’s migraine attack. In investigating Julie’s history what factors would be
least significant in migraine?
a. seasonal allergies
b. trigger foods such as alcohol, MSG, chocolate
c. family history of migraine
d. warning sign of onset, or aura
29. A client with muscle contraction headache will exhibit a pattern different for Julie’s.
Which of the following is more compatible with tension headache?
Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is
currently unknown. You begin to think about the way brain tumors are classified.
30. Glioma is an intracranial tumor. Which of the following statements about gliomas do you
know to be false?
31. Acoustic neuromas produce symptoms of progressive nerve deafness, tinnitus, and
vertigo due to pressure and eventual destruction of:
a. CN5
b. CN7
c. CN8
d. The ossicles
32. Whether Mr Snyder’s tumor is benign or malignant, it will eventually cause increased
intracranial pressure. Signs and symptoms of increasing intracranial pressure may include
all of the following except:
33. Mr Snyder is scheduled for surgery in the morning, and you are surprised to find out
that there is no order for an enema. You assess the situation and conclude that the reason
for this is:
a. Mr. Snyder has had some mental changes due to the tumor and would find an enema
terribly traumatic
b. Straining to evacuate the enema might increase the intracranial pressure
c. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is
not necessary
d. An oversight and you call the physician to obtain the order
34. Postoperatively Mr. Snyder needs vigilant nursing care including all of the following
except:
35. Potential postintracranial surgery problems include all but which of the following?
a. increased ICP
b. extracranial hemorrhage
c. seizures
d. leakage of cerebrospinal fluid
36. You are responsible for teaching Mrs. Hogan deep breathing and coughing exercises.
Why are these exercises especially important for Mrs. Hogan?
37. On the morning of Mrs. Hogan’s planned cholecystectomy she awakens with a pain in
her right scapular area and thinks she slept in poor position. While doing the preop check
list you note that on her routine CB report her WBC is 15,000. Your responsibility at this
point is:
38. Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM
and Demerol 50 mg IM one hour preoperatively. Which nursing actions follow the giving of
the preop medication?
39. Mrs. Hogan is transported to the recovery room following her cholecystectomy. As you
continue to check her vital signs you note a continuing trend in Mrs. Hogan’s status: her BP
is gradually dropping and her pulse rate is increasing. Your most appropriate nursing action
is to:
40. Mrs. Hogan returns to your clinical unit following discharge from the recovery room. Her
vital signs are stable and her family is with her. Postoperative leg exercises should be
inititated:
a. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient.
b. Reduces the risk of aspiration of gastric contents.
c. Should be performed with the neck flexed forward making the chin touch the chest.
d. Should be performed after a patient is found to be not breathing and two breaths have
been given but before checking for a pulse.
a. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured
b. Effective ventilations can always be given by one person.
c. Cricoid pressure may prevent gastric inflation during ventilations.
d. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations.
44. If breath sounds are only heard on the right side after intubation:
47. The most common lethal arrhythmia in the first hour of an MI is:
49. Atropine:
a. True
b. False