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Medical-Surgical Nursing- 2018

1. The client is admitted to the telemetry unit diagnosed with acute exacerbation of CHF. Which signs and symptoms would
the nurse expect to find when assessing the client?
a. Apical pulse of 110 beats/ minute and 4+ pitting edema of the feet
b. Thick white sputum and crackles that clears with cough
c. The client is sleeping with one pillow and eupnea
d. Radial pulse of 90 and capillary refill time < 3 seconds
2. The nurse enters the room of the client diagnosed with congestive heart failure. The client is lying in bed gasping for
breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement first?
a. Sponge the clients forehead c. Take the client’s vital signs
b. Obtain a pulse oximetry reading d. Assist the client to a sitting position
3. The nurse is assessing the client diagnosed with CHF. Which signs and symptoms would indicate that the medical
treatment has been effective?
a. The client’s peripheral pitting edema has gone from 3+ to 4+
b. The client is able to take the radial pulse accurately
c. The client is able to perform activities of daily living without dyspnea
d. The client has minimal jugular vein distension
4. The physician has ordered an angiotensin converting-enzyme (ACE) inhibitor for the client diagnosed with CHF. Which
discharge instruction should the nurse include?
a. Instruct the client to take a cough suppressant if a cough develops
b. Teach the client to how to prevent orthostatic hypotension
c. Encourage the client to eat banana to increase potassium level
d. Explain the importance of taking medication with food
5. The client diagnosed with CHF is complaining of leg cramps at night. Which nursing interventions should be
a. Check the client for peripheral edema and make sure the client takes a diuretics early in the day
b. Monitor the client’s potassium level and assess the client’s intake of bananas and orange juice
c. Determine if the client has gain weight and instruct the client to keep the legs elevated
d. Instruct the client to ambulate frequently and perform calf-muscle stretching exercise daily
6. Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with myocardial infarction?
a. Creatine phosphokinase (CPK-MB) c. Troponin
b. Lactic dehydrogenase (LDH) d. White blood cell (WBC)
7. Along with persistent, crushing chest pain, which signs and symptoms would make the nurse suspect that the client is
experiencing a myocardial infarction?
a. Mid-epigastric pain and pyrosis c. Intermittent claudication and pallor
b. Diaphoresis and cool-clammy skin d. Jugular vein distention and dependent edema
8. The client is diagnosed with myocardial infarction is experiencing chest pain while walking in the bathroom. Which action
would the nurse implement first?
a. Administer sublingual nitroglycerin c. Have the client sit down immediately
b. Obtain a STAT ECG d. Assess the client’s vital sign
9. The client is one day postoperative CABG. The client complains of chest pain. Which intervention should the nurse
implement first?
a. Medicate the client with IV morphine c. Encourage the client to turn from side to side
b. Assess the client dressing and vital signs d. Check the client’s telemetry monitor
10. The client diagnosed with MI is six hours post- right femoral PTCA, also known as balloon surgery. Which assessment
data would require immediate intervention by the nurse?
a. The client is keeping the affected leg straight c. The client is complaining of numbness in the right
b. The pressure dressing to the right femoral area is foot
intact d. The client’s pedal pulse is 3+ and bounding
11. The nurse is administering a calcium channel blockers to the client diagnosed with myocardial infarction. Which
assessment would cause the nurse to question administering the medication?
a. The client’s apical pulse is 64 b. The client’s calcium level is elevated
c. The client’s telemetry shows occasional d. The clients blood pressure is 90/62
12. The client has just returned from the cardiac catheterization. Which assessment data would warrant immediate
intervention from the nurse?
a. The client’s BP is 110/70 and pulse is 90 c. The client refuses to keep the leg straight
b. The client groin dressing is dry and intact d. The client denies any numbness and tingling
13. The nurse is preparing to administer a beta blocker to the client diagnosed with CAD. Which assessment data would
cause the nurse to question administration of medication?
a. The client has BP of 110/70
b. The client has an apical pulse of 56
c. The client is complaining of headache
d. The client’s potassium is 4.5 mEq/L
14. Which intervention should the nurse implement when administering a loop diuretics to a client diagnosed with CAD?
a. Assess the client’s radial pulse c. Assess the client’s glucometer
b. Assess the client’s serum potassium level d. Assess the client’s pulse oximeter reading
15. When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI), the nurse explain to
him that the purpose of this drug is to:
a. Help him keep well hydrated c. Prevent kidney failure
b. Dissolve clots that he may have d. Treat potential cardiac arrhythmias
16. Aspirin is administered to the client experiencing a myocardial infarction (MI) because of its:
a. Antipyretic action c. Antiplatelet action
b. Antithrombolytic action d. Analgesic action
17. If a client who was admitted for myocardial infarction (MI) develops cardiogenic shock, which characteristic sign would
the nurse expect to observe?
a. Oliguria c. Elevated blood pressure
b. Bradycardia d. Fever
18. The physician orders continuous I.V nitroglycerin infusion for the client with myocardial infarction. Essential nursing
action includes which of the following:
a. Maintaining infusion pump for the medication c. Monitoring urine output hourly
b. Monitoring blood pressure every 4 hours d. Obtaining serum potassium levels daily
19. A patient with angina understands the nursing instructions when he states that nitrates should be:
a. Discarded when tingling sensation is present c. Kept for one year
b. Placed in a brown, dark bottle d. Taken 5 minutes after pain started
20. Aspirin is administered to the client experiencing an MI because of its antiplatelet action. Which of the following S/S
indicate that the patient is experiencing aspirin toxicity?
a. Ringing of the ears c. Gastritis
b. N/V d. Constipation
21. The nurse knows that following administration of nitroglycerin a patient’s angina will be relieved because the drug:
a. Constricts cardiac chambers to reduce workload
b. Stimulates the heart rate to increase blood supply to the myocardium
c. Increase myocardial contractility
d. Decrease workload of the heart through lowering the systemic blood pressure
22. Nursing care for the post-myocardial infarction patient is directed toward reducing the work of the heart and oxygen
consumption. Which nursing action best accomplishes this goal?
a. Position flat in bed with pillow under head. c. Assist patient in eating a regular diet.
b. If possible, allow use of bedside commode. d. Restrict all activity for 72 hours.
23. Cardiac enzyme studies are helpful in diagnosing a myocardial infarction. These studies are most indicative of:
a. Cardiac ischemia c. Cardiac necrosis
b. Location of the MI d. Size of the infarct
24. When teaching a client with myocardial infarction, the nurse explain that the pain associated with MI is caused by:
a. Left ventricular overload c. Extracellular electrolyte imbalance
b. Impending circulatory collapse d. Insufficient oxygen reaching the heart muscle
25. When teaching a client with myocardial infarction, the nurse explain that the pain associated with MI is caused by:
a. Left ventricular overload b. Impending circulatory collapse
c. Extracellular electrolyte imbalance d. Insufficient oxygen reaching the heart muscle
26. Which of the following controllable risk factors for coronary artery disease (CAD) appears most closely linked to the
development of the disease?
a. Age c. High cholesterol level
b. Medication usage d. Gender
27. When monitoring a client who is receiving Alteplase recombinant, or tissue plasminogen activator (t-PA), the nurse
understands it is important to monitor which vital signs and have resuscitation equipment available because reperfusion of
the cardiac tissue can result in which of the following:
a. Cardiac arrhythmias c. Seizure
b. Hypertension d. Hypothermia
28. Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6
hours after onset of myocardial infarction (MI) to:
a. Control chest pain c. Control arrhythmias associated with MI
b. Reduce coronary artery vasospasm d. Revascularized the blocked coronary artery
29. A client who experience angina has been told to follow a low-cholesterol diet. Which of the following meals should the
nurse tell the client would be best on her low-cholesterol diet?
a. Hamburger , salad, and milkshake c. Spaghetti with tomato sauce, salad, and coffee
b. Baked liver , green beans, and coffee d. Fried chicken, green beans, and skim milk
30. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that
this procedure is being used in this specific case to:
a. Open and dilate blocked coronary arteries d. Assess the functional adequacy of the valves and
b. Assess the extent of arterial blockage heart muscles
c. Bypass obstructed vessels
31. The client is schedule for PTCA to treat angina. Priority goals for the client immediately after PTCA should include:
a. Minimizing dyspnea c. Decreasing myocardial contractility
b. Maintaining adequate blood pressure control d. Preventing fluid volume deficit
32. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablet, 0.3 mg given sublingually.
This drug’s principal effects are produced by:
a. Antispasmodic effects on the pericardium c. Vasodilation of peripheral vasculature
b. Causing an increased myocardial oxygen demand d. Improve conductivity in the myocardium
33. Sublingual nitroglycerin tablets begin to works within 1 to 2 minutes. How should the nurse instruct the client to use the
drug when chest pain occurs?
a. Take one tablet every 2 to 5 minutes until the pain stops
b. Take one tablet and rest for 10 minutes. Call the physician if pain persists after 10 minutes
c. Take one tablet, the additional tablet every 5minutes for a total of three tablets. Call the physician if pain persists
after three tablets.
d. Take one tablet. If pain persists after 5 minutes, take 2 tablets. If pain still persists 5 minutes later, call the physician
34. A client with a history of heart failure has been taking several medications, including furosimide (Lasix), digoxin
(Lanoxin) and potassium chloride. The client complains of nausea, blurred vision, headache, and weakness. The nurse notes
that the client is confused. The telemetry strips shows first-degree AV block. The nurse should assess the client for signs of
which condition?
a. Hyperkalemia c. Fluid deficit
b. Digoxin toxicity d. Pulmonary edema
35. Which of the following sets of conditions is an indication that a client with a history of left-sided heart failure is
developing pulmonary edema?
a. Distended jugular veins and wheezing c. Coarsed crackles and tachycardia
b. Dependent edema and anorexia d. Hypotension and tachycardia
36. A 67-year-old woman is admitted for a treatment of pulmonary edema. During the admission interview, she states she
has a six-year history of congestive heart failure (CHF). The nurse performs an initial assessment. When the nurse
auscultates the breath sounds, the nurse should expect to hear
a. crackling c. whistling
b. wheezing d. absent breath sounds
37. A 69-year-old female has a history of heart failure. She is admitted to the emergency department with heart failure
complicated by pulmonary edema. On admission of this client, which of the following should the nurse assess first?
a. Blood pressure c. Serum potassium level
b. Skin breakdown d. Urine output
38. A patient diagnosed as having CHF (Congestive Heart Failure) is taking Furosemide (lasix). The best criteria for
evaluating the effectiveness of therapy is:
a. Abnominal girth c. A decreased in BP
b. Body weight is reduced d. Sodium and potassium levels in blood lowered
39. Which of the following choices best describes the signs and symptoms of left sided heart failure?
a. Rales, decreased pulmonary pressure, and c. Dyspnea, frothy sputum, and crackles
dyspnea d. Jaundice, pallor and jugular vein distention
b. Increased CVP, hepatomegaly and pitting edema
40. Digoxin is administered intravenously to a client with heart failure, primarily because the drug acts to:
a. Dilates the coronary arteries c. Decrease cardiac arrhythmias
b. Increase myocardial contractility d. Decrease electrical conductivity in the heart
41. Captopril (Capoten), an angiotensin-coverting enzyme (ACE) inhibitor, maybe administered to a client with heart failure
because it acts as a:
a. Vasopressor c. Vasodilator
b. Volume expander d. Potassium-sparing diuretics
42. Furosimide is administered intravenously to a client with heart failure. How soon after administration should the nurse
begin to see evidence of the drug’s desired effect?
a. 5 to 10 minutes c. 2 to 4 hours
b. 30 to 60 minutes d. 6 to 8 hours
43. The nurse teaches the client with heart failure to take the oral furosimide in the morning. The primary reason for this is
to help:
a. Prevent electrolyte imbalance c. Excrete excessive fluids accumulated during the
b. Retard rapid drug absorption night
d. Prevent sleep disturbance during the night
44. As part of discharge planning in client for with heart failure, The nurse should teach the client that signs of digitalis
toxicity includes which of the following:
a. Rash over the chest and back c. Visual disturbances such as seeing yellow spots
b. Increase appetite d. Elevated blood pressure
45. When teaching a client propranolol hydrochloride, the nurse should base the i formation on the knowledge that
a. Blocks beta-adrenergic stimulation and thus causing decrease heart rate, myocardial contractility, and conduction
b. Increase norepinephrine secretion and thus decreases blood pressure and heart rate
c. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure
d. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of
angiotensin I to angiotensin II
46. Hypertension is a known killer. This phrase is associated with the fact that hypertension often goes undetected until
sign and symptoms of other system failure occur such signs and symptoms in the form of:
a. Cerebrovascular accident (CVAs) c. Myocardial infarction
b. Liver disease d. Pulmonary disease
47. The client receives epinephrine during resuscitation in the emergency department. The drug administered primarily
because of its ability to:
a. Dilates bronchioles c. Free glycogen in the liver
b. Constricts arterioles d. Enhance myocardial contractility
48. When performing external chest compression on an adult during cardiopulmonary resuscitation (CPR), the rescuer
should depress the sternum:
a. 0.5 to 1 inch c. 1.5 to 2 inches
b. 1 to 5 inches d. 2 to 2.5 inches
49. If the client’s chest wall fails to rise with each inflation when rescue breathing is administered during CPR, the most
likely reason is that the:
a. Airway is not clear
b. Victims is beyond resuscitation
c. Inflation is being given at too rapid a rate
d. Rescuer is using inadequate force for cardiac compression
50. Pentoxifylline (Trental) is a drug used to decrease platelet aggregation and blood viscosity. The nurse should anticipate
that pentoxifylline would be useful in the treatment of clients with which of the following conditions?
a. Angina c. Intermittent claudication
b. Gastric reflux d. Transient ischemic attack
51. A man is brought to the ER for treatment of chest pain, shortness of breath and restlessness. Which of the diagnostic
finding indicates that the client had a Myocardial Infarction?
A. Total CK (creatine kinase) of 173 units/L C. CK-MB isoenzyme level of 6%
B. Myoglobin level of 58 ug/ml D. Troponin T level of 0.1 ng/ml
52. The nurse is caring for a client following Myocardial Infarction. Which of the following nursing diagnosis should be the
nurse’s top priority?
A. Anxiety related to fear of death
B. Risk for Fluid volume excess related to decreased organ perfusion
C. Potential Altered peripheral tissue perfusion related to decreased cardiac output
D. Activity intolerance related to imbalance between myocardial oxygen supply and demand
53. When assessing a client with Angina who is presently taking Nitroglycerin, the nurse will prioritize which of the
following side effects?
A. Hypertension C. Flushing and dizziness
B. Orthostatic Hypotension and Headache D. Tachycardia
54. Which of the following ECG findings describes a Ventricular Tachycardia?
A. Repetitive firing of an irritable ventricular ectopic focus at a rate of 140 to 250 beats/min or more
B. Multiple rapid impulses from many foci depolarize in the atria in a totally disorganized manner at a rate of 350 to
600 times/min
C. Atrial and ventricular rates are 100 to 180 beats/min
D. Atrial and ventricular rates are 60 to 100 beats/min
55. A 35 year old client has been diagnosed with Infective Endocarditis. All of the following is included in the assessment of
endocarditis except..
A. Nontender hemorrhagic lesions on the fingers, and toes
B. Hemorrhages with pale centers that may be seen in the fundi of the eyes
C. Kussmaul’s sign
D. Roth’s spot
56. The nurse is discharging a client to home following Cardiac Surgery. Which of the following statement by the client
needs follow up by the nurse?
A. “ I should avoid crossing my legs” C. “ I will progressively sweep the floor in my
B. “ I must limit pushing my lawn mower for 6 house”
weeks” D. “ I know that my incision heals in about 3 to 4
57. The following are assessments of a right-sided heart failure, except:
A. Enlargement of the liver C. Confusion and restlessness
B. Anorexia and nausea D. Distended jugular veins
58. Digoxin is administered intravenously to a client with heart failure. The nurse determines that the initial sign of digoxin
toxicity is:
A. Nausea and Vomiting C. Green halo around objects
B. Anorexia D. Bradycardia
59. A client receiving Metoprolol (Neobloc) asked the nurse about the purpose of the medication. The nurses’ answer
would be:
A. “It increases your cardiac output” C. “It increases the workload of your heart”
B. “It decreases your heart rate and increases your D. “It decreases the oxygen demand of your heart”
blood pressure”
60. The nurse understands that a priority nursing diagnosis for the client with hypertension would be:
A. Pain C. Ineffective health maintenance
B. Impaired skin integrity D. Deficient fluid volume
61. A 30 year old client is complaining of chest pain and discomfort that remains constant and worsens with deep
inspiration, coughing and when lying down. The nurse knows that the most characteristic sign of these manifestations is:
A. Valvular regurgitation C. Muffled heart sound
B. Friction rub D. Pulsus paradoxus
62. A female client is scheduled for an Exercise Stress test, which is a cardiac stress test procedure. Which is a correct
teaching made by the nurse?
A. Client is instructed to fast for 4 hours before the C. Avoid wearing of bra during the procedure
test D. Client can drink soda before the procedure
B. Client can wear slippers during the procedure
63. The nurse is caring for a client with Mitral Regurgitation. Which of these situations will the nurse expect in the history of
the client?
A. Atherosclerosis C. Streptococci infection
B. Elevated cholesterol level D. Excessive smoking
64. The nurse is preparing the client for the removal of a Multilumen Pulmonary Artery Catheter. In what position should
the nurse place the client?
A. Semi-fowler’s position C. Lateral position
B. High-fowler’s position D. Supine position
65. A client with heart failure is about to be administered with digoxin (Lanoxin). The nurse knows that it is a standard
nursing practice to assess:
A. Potassium level C. Urinary output
B. Apical heart rate D. Blood pressure
66. The following are nursing diagnosis for a client with mitral valve disease. Which of these should be given priority in the
client’s care plan?
A. Knowledge deficit regarding disease C. Decreased cardiac output
B. Impaired Gas exchange D. Activity intolerance
67. The nurse is assessing a client with Raynaud’s disease. Which of the following is a manifestation of the disease?
A. Intermittent claudication C. Constant digital rest pain
B. Pallor of the fingertips D. Absent pedal pulse
68. In preparing for cardioversion, which of the following actions is most appropriate?
a. Keep the client awake.
b. Keep the side rails up for client safety.
c. Set the machine on SYNC and charge at 200 watts.
d. Set the machine on DEFIB and charge at 400 watts.
69. Which of the following condition causes heart failure after a myocardial infarction (MI)?
a. Increase workload of the heart
b. Increased oxygen demands of the heart
c. Inability of the heart chambers to adequately fill
d. Impairment of contractile function of the damaged myocardium
70. In hypertension, nursing approaches is geared towards lowering the blood pressure and involves dietary modification.
The DASH diet for hypertension may include which of the following except
a. Plenty of fruits and vegetables c. Lots of water
b. Serving of fish d. Ready to cook food
71. The first line of treatment in lowering the blood pressure of hypertensive patients is
a. Diuretics c. Beta blockers
b. ACE inhibitors d. Calcium channel blockers
72. A major consideration in the management of the older adult with hypertension is to
a. Prevent pseudohypertension from converting to true hypertension
b. Obese person should attain normal weight to lower blood pressure
c. Lifestyle modification is indicated to all with elevated blood pressure
d. Ensure medication intake to control the blood pressure
73. A patient with a tricuspid valve disorder will have impaired blood flow between
a. Right ventricle and pulmonary artery c. Lft atrium and and left ventricle
b. Vena cava and right atrium d. Right atrium and right ventricle
74. An important nursing responsibility in a patient recovering from a cardiac catheterization is
a. Assisting the patient to ambulate
b. Informing patient that general anesthesia is given
c. Telling to increase oral fluids to remove injected dye
d. Checking the site and placing on bed rest
75. When taking the admission history of a patient, what clinical indicators might be expected in a right ventricular failure?
a. Dyspnea, edema c. Tachycardia, neck vein distention
b. Ascites, cough d. Vertigo, Palpitations
Respiratory System
1. A 50 year old factory worker with emphysema presents to the ER department with difficulty of breathing. For a client
with impaired gas exchange, which position is best?
A. Lateral position
B. High fowler’s position, leaning forward
C. Supine position
D. Semi-fowler’s position, leaning forward
2. The nurse is caring for a client diagnosed with asthma. Which of the following drugs should the nurse administer?
A. theophylline (Theo-dur)
B. prednisone (Sterapred)
C. metoprolol (Lopressor)
D. alfuzosin (Uroxatral)
3. The nurse is caring for a client with bronchospasm. Which nursing diagnosis takes highest priority?
A. Anxiety
B. Activity intolerance due to fatigue
C. Ineffective breathing pattern
D. Ineffective cardiopulmonary tissue perfusion
4. For a client with advanced chronic obstructive pulmonary disease, which nursing action best promotes adequate gas
A. Encouraging the client to drink three glasses of fluid daily
B. Keeping the client in semi-fowler’s position
C. Using a venture mask to deliver oxygen as prescribed
D. Administering a sedative as prescribed
5. The nurse is caring for a client who had undergone bronchoscopy. The following nursing interventions should be
performed, except:
A. Assess the results of coagulation studies
B. Assess for confusion and lethargy
C. Monitor respiratory status
D. May offer ice chips once patient demonstrate a cough reflex
6. A nurse is caring for a client with pneumothorax and who has a chest tube inserted. Which of the following indicates a
normal assessment of the chest tube system?
A. Placid bubbling in the suction control chamber
B. Presence of bubbling in the dry suction system
C. Excessive bubbling in the water seal chamber
D. The tip of the tube of the water seal chamber is above water level
7. An emergency room nurse is assessing a client who has sustained a blunt injury to the chest wall. Which of these signs
would indicate the presence of a pneumothorax in this client?
A. A low respiratory rate
B. Diminished breath sounds
C. A sucking sound at the site of injury
D. The presence of barrel chest
8. The nurse is caring for a client with an oxygen mask that delivers oxygen concentrations of 40% to 60% for short-term
oxygen therapy. Which of the following masks is the client using?
A. Partial rebreather mask
B. Nonrebreather mask
C. Simple face mask
D. Venture mask
9. A client is about to undergo a pulmonary angiography. Which of the following statement by the client needs follow up
by the nurse?
A. “ I will lie still during the procedure”
B. “I will not drink or eat for 5 hours before the procedure”
C. “ It is necessary that I sign the consent form”
D. “ I understand that I will be sedated before the procedure”
10. A client with chest injury has suffered rib fracture. A nurse assesses the client for which most distinctive sign of rib
A. Shallow respirations
B. Client splints on chest
C. Dyspnea
D. Pain at the injury site that increases with inspiration
11. A client was admitted to the ER department with multiple abrasions, complaining of shortness of breath. X-ray reveals a
right pneumothorax, the nurse should first?
A. Administer a sedative
B. Prepare a chest drainage system
C. Help the patient turn, cough and deep breathe
D. Prepare the client for a CT scan of the chest
12. A client undergoes a right pneumonectomy for lung cancer. Which of the following positions shouldn’t be used when
repositioning the client immediately following the procedure?
A. Semi-fowler’s position
B. Left side lying position
C. Right side lying position
D. High fowler’s position
13. Which of the following indicates that a client’s chest tube should be removed?
A. Lung reexpansion on chest x-ray
B. Cessation of pain and dyspnea
C. 120 ml of chest tube drainage in 24 hours
D. Absence of fluid fluctuation in the water seal chamber
14. A client becomes increasingly irritable and is short of breath. A chest x-ray shows 30% of his right lung collapsed. The
nurse should assess for which early sign of hypoxia?
A. Bradycardia
B. Restlessness
C. Hypotension
D. Glycosuria
15. A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following
statements would demonstrate to the nurse that the client understands the instructions?
a. “I should limit the use of the inhaler to early morning and bedtime use.”
b. “It is important to not shake the canister because that can damage the spray device.”
c. “I should hold one nostril closed while I insert the spray into the other nostril.”
d. “The inhaler tip is inserted into the nostril and pointed toward the inside nostril wall.”
16. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection?
a. The client maintains a fluid intake of 800mL every 24 hours.
b. The client experiences chill only once a day.
c. The client coughs productively without chest discomfort.
d. The client experiences less nasal obstruction and discharge.
17. The nurses teach the client how to instill nasal drops. Which of the following techniques is correct?
a. The client uses sterile technique when handling the dropper.
b. The client blows the nose gently before instilling drops.
c. The client uses a new dropper for each installation.
d. The client sits in a semi-fowler’s position with the head tilted forward after administration of the drops.
18. A client with acute sinusitis is examined in an ambulatory clinic. The nurse can anticipate the use of which of the
following medications in the client’s treatment plan?
a. antibiotics
b. antihistamine
c. bronchodilators
d. oral corticosteroids
19. Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza
a. A 60-year-old man with a hiatal hernia
b. A 36-year-old woman with three children
c. A 50-year-old woman caring for a spouse with cancer
d. A 60-year-old woman with osteoarthritis
20. The nurse is suctioning a client who had a laryngectomy. What is the maximum amount of time the nurse should
suction the client?
a. 10 seconds
b. 15 seconds
c, 25 seconds
d. 30 seconds
21. Which of the following signs and symptoms would the nurse include in a teaching plan as an early warning sign of
laryngeal cancer?
a. Dysphagia
b. Hoarseness
c. Airway obstruction
d. Stomatitis
22. A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the
client’s health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned
with cleanliness. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia?
a. Age
b. Osteoarthritis
c. Vegetarian diet
d. Daily bathing

23. A client with bacterial pneumonia is to be started on intravenous antibiotics. Which of the following diagnostic tests
must be completed before antibiotic therapy begins?
a. urinalysis
b. sputum culture
c. chest radiograph
d. red blood cell count
24. A client with pneumonia has a temperature of 39.2°C, is diaphoretic, and has a productive cough. The nurse should
include which of the following measures in the plan of care?
a. Position changes every 4 hours.
b. Nasotracheal suctioning to clear secretions
c. Frequent linen changes.
d. Frequent offering of a bedpa
25. Bed rest is prescribed for a client with pneumonia during the acute phase of the illness. Bed rest serves which of the
following purposes?
a. It reduces the cellular demand for oxygen.
b. It decreases the episodes of coughing.
c. It promotes safety.
d. It promotes clearance of secretions.
26. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
a. Decreased cardiac output.
b. Pleural effusion.
c. Inadequate peripheral circulation.
d. Decreased oxygenation of the blood
27. Aspirin is administered to clients with pneumonia because of its antipyretic and:
a. analgesic effects.
b. anticoagulant effects.
c. adrenergic effects.
d. antihistamine effects.
28. Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
a. Coma
b. Apathy
c. Irritability
c. Depression
29. Which of the following antituberculosis drugs can cause damage to the eight cranial nerve?
a. Streptomycin
b. Isoniazid (INH)
c. Para-aminosalicylic acid (PAS)
d. Ethambutol hydrochloride (Myambutol)
30. Which of the following techniques for administering the Mantoux test is correct?
a. Hold the needle and syringe almost parallel to the client’s skin.
b. Pinch the skin when inserting the needle.
c. Aspirate before injecting the medication.
d. Massage the site after injecting the medication.
31. The nurse should caution sexually active female clients taking INH that the drug has which of the following effects?
a. Increases the risk of vaginal infection.
b. Has mutagenic effects on ova.
c. Decreases the effectiveness of oral contraceptives.
d. Inhibits ovulation.
32. Clients who have had active tuberculosis are at risk for recurrence. Which of the following conditions increases that
a. Cool and damp weather.
b. Active exercise and exertion.
c. Physical and emotional stress.
d. Rest and inactivity
33. When instructing clients on how to decrease the risk of COPD, the nurse should emphasize which of the following
a. Participate regularly in aerobic exercises.
b. Maintain a high-protein diet.
c. Avoid exposure to people with known respiratory infections.
d. Abstain from cigarette smoking.
34. When performing postural drainage, which of the following factors promotes the movement of secretions from the
lower to the upper respiratory tract?
a. Friction between the cilia.
b. Force of gravity.
c. Sweeping motion of cilia.
d. Involuntary muscle contractions.
35. The nurse teaches a client with COPD to assess for signs and symptoms of right-sided heart failure. Which of the
following signs and symptoms should be included in the teaching plan?
a. clubbing nail beds
b. hypertension
c. peripheral edema
d. increased appetite
36. A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the
client is dyspneic, with a respiratory rate of 35 breaths / minute, nasal flaring, and use of accessory muscles. Auscultation of
the lung fields reveals greatly diminished breath sounds. Based on these findings, which of the following doctor’s order
should the nurse take to initiate care of the client?
a. Initiate oxygen therapy and reassess the client in 10 minutes.
b. Draw blood for an arterial blood gas analysis and send the client for a chest x-ray.
c. Encourage the client to relax and breathe slowly through the mouth.
d. Administer bronchodilators.
37. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids
in clients with asthma?
a. Corticosteroids promote bronchodilation.
b. Corticosteroids act as an expectorant
c. Corticosteroids have an anti-inflammatory effect
d. Corticosteroids prevent development of respiratory infections
38. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate
obtaining the specimen?
a. limiting fluids
b. having the client take three deep breaths
c. asking the client to spit into the collection container
d. asking the client to obtain the specimen after eating
39. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should
be reported immediately to the physician?
a. blood-streaked sputum
b. dry cough
c. hematuria
d. stridor
40. A nurse is suctioning a client through an endotracheal tube. During the suctioning procedure the nurse notices that the
client is restless. Which of the following is the most appropriate nursing intervention?
a. Continue to suction
b. Ensure that the suction is limited to 15 seconds
c. Stop the procedure and reoxygenate the client
d. Notify the physician immediately
41. A nurse is suctioning a client through an endotracheal tube. During the suctioning procedure the nurse notices that the
client is restless. Which of the following is the most appropriate nursing intervention?
a. Continue to suction
b. Ensure that the suction is limited to 15 seconds
c. Stop the procedure and reoxygenate the client
d. Notify the physician immediately
42. A nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD).
Which of the following would the nurse expect to note in evaluating this client?
a. Increased oxygen saturation with exercise
b. Hypocapnia
c. A hyperinflated chest on x-ray
d. A widened diaphragm noted on chest x-ray
43. A nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the
effectiveness of breathing during dyspneic periods. Which of the following positions will the nurse instruct the client to
a. Side-lying in bed
b. Sitting in a recliner chair
c. Sitting up in bed
d. Sitting on the side of the bed and leaning on an overbed table
44. A community nurse is conducting an educational session with community members regarding tuberculosis (TB). The
nurse tells the group that the first symptom associated with TB is:
a. bloody, productive cough
b. a morning cough with the expectoration of mucoid sputum
c. chest pain
d. dyspnea
45. A Client is suspected of having a pulmonary embolism. A nurse assesses the client, knowing that which of the following
is common clinical manifestation of pulmonary embolism ?
a. Decrease respiration
b. Bradypnea
c. Dyspnea
d. Bradycardia
46. A nurse instructs a client to use the pursed-lip method of breathing. The client asks the nurse about the purpose of this
type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to:
a. promote oxygen intake
b. strengthen the diaphragm
c. strengthen the intercostal muscles
d. promote carbon dioxide elimination
47. Isoniazid (INH) and rifampicin (Rifadin) have been prescribed for a client with tuberculosis. A nurse reviews the medical
record of the client. Which of the following, if noted in the client’s history, would require physician notification?
a. heart disease
b. allergy to penicillin
c. hepatitis B
d. rheumatic fever
48. A client is suspected of having a pulmonary embolus (PE). A nurse assesses the client, knowing that which of the
following is not a common clinical manifestation of PE?

a. decreased respirations
b. tachypnea
c. dyspnea
d. chest pain
49. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following
nursing interventions for this client?
a. forcing fluids for the next 24 hours
b. ensuring the return of the gag reflex before offering food or fluids
c. administering atropine intravenously
d. administering small doses of midazolam (Versed)
50. A client has an order to have radial arterial blood gases drawn. Prior to drawing the sample, a nurse occludes the:
a. Brachial and radial arteries, and then releases them and observes the circulation to the hand.
b. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other
c. Radial artery and observes for color changes in the affected hand
d. Ulnar artery and observes for color changes in the affected hand
51. A nurse is caring for a client diagnosed with tuberculosis (TB). Which assessment, if made by the nurse, would not be
consistent with the usual clinical presentation of tuberculosis?
a. Nonproductive or productive cough
b. Anorexia and weight loss
c. Chills and night sweats
d. High-grade fever
52. A nurse is caring for a client diagnosed with tuberculosis. Which assessment, if made by the nurse, would not be
consistent with the usual clinical presentation of tuberculosis and may indicate the development of a concurrent problem?
a. Nonproductive or productive cough
b. Anorexia and weight loss
c. Chills and night sweats
d. High grade fever
53. A nurse is preparing to give a bed bath to an immobilized client with tuberculosis (TB). The nurse should plan to wear
which of the following items when performing this care?
a. Particulate respirator, gown, and gloves
b. Particulate respirator and protective eyewear
c. Surgical mask and gloves
d. Surgical mask, gown, and protective eyewear
54. The arterial blood gases of a client with COPD deteriorate, and respiratory failure is impending. The nurse should first
assess the client for:
a. cyanosis
b. bradycardia
c. mental confusion
d. distended neck veins
55. After a brochoscopy the nurse should assess the client for the return of the gag reflex by:
a. Touching the pharynx with the tongue depressor
b. Observing for when the client spits the airway out
c. Giving a small amount of water using a syringe
d. Instructing the client to breathe deeply and cough gently
56. A client has been admitted to the emergency department with multiple injuries including fracture ribs. Because of the
client’s fractured ribs, the nurse should assess for signs of:
a. Pneumonitis
b. Hematemesis
c. Pulmonary edema
d. Respiratory acidosis
57. A client with pneumothorax asks. “Why did they put this tube into my chest?” The nurse would explain that the purpose
of this tube is to:
a. Check for bleeding in the lungs
b. Monitor the function of the lungs
c. Drain fluid from the pleural space
d. Remove air from the pleural space
58. What is the rationale that supports multidrug treatment for clients with tuberculosis?
a. Multiple drugs potentiate the drugs’ actions
b. Multiple drugs reduce undesirable drug side effects
c. Multiple drugs allow reduced drug dosages to be given
d. Multiple drugs reduce development of resistant strains of the bacteria
59. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should
be reported immediately to the physician?
a. blood-streaked sputum
b. dry cough
c. hematuria
d. stridor
60. A client with an acute emphysemic episode is dyspneic and anxious. To decrease the dyspnea, the nurse's first action
should be to:
a. Increase the oxygen at 6 L/min
b. Encourage rhythmic breathing
c. Check vital signs including the BP
d. Have the client breath into a brown bag
61. A client with a 10-year history of emphysema is admitted in acute respiratory distress. The nurse’s assessment to the
client will include observing for:
a. pursed-lip breathing
b. Use of accessory muscles of respiration
c. Signs and symptoms of respiratory alkalosis
d. Prolonged inspiration with considerable effort
62. When auscultating the chest of a client with COPD, the nurse should usually expect to hear:
a. Diminished sound
b. Crackles and gurgles
c. Expiratory wheezing
d. A pleural friction rub
63. When assessing a client with pleural effusion, the nurse should expect to find:
a. Moist crackles at the posterior of the lungs
b. Reduced or absent breath sounds at the base of the lung
c. Deviation of the trachea the involved side
d. Increased resonance with percussion of the involved area
64. A nurse is preparing to give a bed bath to an immobilized client with tuberculosis (TB). The nurse should plan to wear
which of the following items when performing this care?
a. Particulate respirator, gown, and gloves
b. Particulate respirator and protective eyewear
c. Surgical mask and gloves
d. Surgical mask, gown, and protective eyewear
65. A nurse is performing respiratory assessment on a client being treated for an asthmatic attack. The nurse determines
that the client’s respiratory status is worsening if which of the following occurs?
a. Loud wheezing
b. Wheezing during inspiration and expiration
c. Wheezing on expiration
d. Noticeably diminished breath sounds
66. Home care nurse assesses a client with COPD who is complaining of increased dyspnea. The client is on home oxygen
via a concentrator at 2 liters per minute, and the client’s respiratory rate of 22 breaths per minute. The appropriate nursing
action is:
a. Determine the need to increase the oxygen
b. Conduct further assessment of the client’s respiratory status
c. Call emergency services to take the client to the emergency room
d. Reassure client that there is nothing to worry
67. A nurse evaluates a client following treatment for carbon monoxide poisoning. The nurse would document that the
treatment was effective when the:
a. Client is awake and talking
b. Carboxyhemoglobin are less than 5%
c. Heart monitor shows sinus tachycardia
d. Client is sleeping soundly
68. The nurse instructs a preoperative client in the proper use of an incentive spirometer. Postoperative assessment of the
effectiveness of its use is determined if the client exhibits:
a. Coughing
b. Shallow breaths
c. Wheezing in one lung field
d. Unilateral chest expansion
69. The nurse has an order to administer Amphotericin B (Fungizone) intravenously to the client with histoplasmosis. The
nurse plan to do which of the following during administration of the medication?
a. Monitor for hypothermia
b. Administer a concurrent fluid challenge
c. Assess the intravenous infusion site
d. Monitor for an excessive urine output
70. A hospitalized client is dyspneic and has been diagnosed with left pneumothorax by chest x-ray. Which of the following
observed by the nurse indicates that the pneumothorax is rapidly worsening?
a. Pain with respiration
b. Hypertension
c. Tracheal deviation to the right
d. Tracheal deviation to the left
71. A client who experiences repeated pleural effusion from inoperable lung cancer is to undergo pleurodesis. The nurse
plan to assist with which of the following after the physician injects sclerosing agent through the chest tube?
a. Clamp the chest tube
b. Ambulate the client
c. Ask the client to cough and deep breath
d. Ask the client to remain in one position only
72. A client with significant flail chest has the arterial blood gas (ABGs) that reveal a PaO2 of 68 and a PaCO2 of 51. two
hours ago the PaO2 was 82 and the PaCO2 was 44. Based on these changes, the nurse obtains which of the following
a. Injectable Lidocaine (Xylocaine)
b. Portable X-ray machine
c. Intubation tray
d. Chest tube insertion set.
73. A client with empyema is to have thoracentesis performed at the bedside. The nurse plans to have which of the
following available in the event that the procedure is not effective?
a. Code cart
b. Chest tube and drainage system
c. Extra-large drainage
d. A small-borne needle
74. A patient has been diagnosed to have Chronic Obstructive Pulmonary Disease (COPD). Which is an expected laboratory
a. pH 7.58
b. HCO3 24 mEQ/L
c. pO2 95 mm Hg
d. pCO2 55 mm Hg
75. A nurse is caring for a client with a tracheostomy. To provide safe care, the nurse must be sure to
a. Use gloves when rendering care.
b. Assure that ties are secure but not restrictive.
c. Clean ties daily with peroxide.
d. Suction the client every 2 hours.
1. The laboratory findings of a client reveals Hemoglobin 14g/L, Hematocrit 58%, RBC 5 Million, WBC 6 Thousand,
Platelets 150,000. It would be appropriate for the nurse to interpret this finding as
a. Normal
b. Erythrocytosis
c. Leukopenia
d. Fluid deficit
2. A client who had undergone Billroth II procedure asks the nurse “Why Am I being given Vitamin B12 injection?” The
nurse responds correctly by stating that
a. “ Vitamin B 12 is needed for absorption of Intrinsic factor that you are not producing since you lost your stomach in
the procedure”
b. “ Vitamin B12 is needed for maturation of RBC”
c. “Since you lost your stomach in the procedure, you cannot absorb Vitamin B12, a supplement is needed for neural
and hematologic functions
d. “ Vitamin B 12 injection is needed to supplement your oral vitamin B 12”
3. A 25 year old female complaints of prolong menstrual bleeding, weakness, pallor and easy fatigability, priority
intervention for this client include
a. Provide periods of rest
b. Administer ferrous sulfate
c. Referral to an OB GYNE consultant
d. Provide small frequent meals
4. Laboratory results show microcytic hypochromic peripheral smear, the nurse knows that such finding may indicate
a. Folic acid deficiency anemia
b. Iron deficiency anemia
c. Sickle cell anemia
d. All of the above
5. Thalassemias are inherited disorders characterized as
a. Lack of Iron in the hemoglobin
b. Lack of chains of amino acids in the hemoglobin
c. Lack of oxygen carrying capacity
d. Lack of red blood cells
6. Which of the following symptoms are classic for thrombocytopenia?
a. Weakness and fatigue
b. Dizziness and vomiting
c. Bruising and petechiae
d. Light-Headedness and nausea
7. Which of the following statements indicates that a client with thrombocytopenia understands the function of platelets
in her body?
a. “Platelets regulate acid-base balance”
b. “Platelets regulate the immune response”
c. “Platelets protect the body from infection”
d. “Platelets stop the bleeding when arteries and veins are injured”
8. A home care nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a
liquid oral iron supplement. The nurse tells the mother to:
a. Administer the iron through a straw
b. Administer the iron at meal time
c. Add the iron to the formula for easy administration
d. Mix the iron with cereal to administer
9. Which is a correct statement regarding a client with sickle cell trait?
a. The client has a chronic form of sickle cell anemia
b. The client has the most lethal form of the disease
c. The client will transmit the disease to all children
d. The client has some normal and some abnormal hemoglobin cells
10. The nurse writes a nursing diagnosis of altered tissue perfusion for a client diagnosed with anemia. Which interventions
should be included in the plan of care? Select all that apply
a. monitor Hgb and Hct
b. move the client to a room near the nurse’s desk
c. limit the client’s dietary intake of green leafy vegetable
d. assess the client for numbness and tingling
e. allow for rest periods during the day
11. The mother of a child with sickle cell anemia tells the nurse that she learned that sickled blood don not have a long life
expectancy as normal red cells. Which answer would be correct for the nurse to tell the mother regarding how long a
sickled blood cell survive?
a. 5 days c. 30 days
b. 15 days d. 60 days
12. How would the nurse best evaluate whether the parents are giving their child with iron deficiency anemia iron as
a. Parents state they offer orange juice when they give the medication
b. Parents state the child has greenish black stools
c. Parents state the child experience nausea with iron preparation
d. Parents state they are giving iron as prescribed
13. Which situation might cause the nurse to think that the client has von Willebrand’s disease?
a. The client has had unexplained episodes of hematemesis
b. The client has microscopic blood in his urine
c. The client ha prolonged bleeding following surgery
d. the female client has developed abruption placenta
14. The client with Hemophilia A is experiencing hemarthrosis. Which intervention would the nurse recommend to the
a. Alternate aspirin and acetaminophen to help with the pain
b. Apply cold packs for 24-48 hours to the affected areas
c. Perform active range of motion exercises
d. Put the extremity in the dependent position
15. The nurse is caring for the following clients. Which client would the nurse assess first?
a. The client whose partial thromboplastin time (PTT) is 38 seconds
b. The client whose hemoglobin is 14 gm/dl and hematocrit of 48%
c. The client whose platelet count is 75,000/ml of blood
d. The client whose RBC of 48/106 mm
16. An eleven-month-old infant is brought to the pediatric clinic. The nurse suspects that the child has iron deficiency
anemia. Because iron deficiency anemia is suspected, which of the following is the most important information to obtain
from the infant’s parents?
a. normal dietary intake
b. relevant sociocultural, economic, and educational background of the family
c. any evidence of blood in the stools
d. a history of maternal anemia during pregnancy
17. Which of the following symptom is expected with a hemoglobin level of 5-7 g/dl?
a. None c. Palpitations
b. Pallor d. Shortness of breath
18. Recommended diet for client diagnosed with anemia
a. lean meat and poultry d. milk and cheese
b. green and leafy vegetable
c. grains
19. A 22 year-old client ids admitted in the emergency room to rule out anemia. What confirmatory test for pernicious
a. CBC c.hemoglobin electrophoresis
b. Schilling”s test d. WBC
20The clients haemoglobin level id 10.5 mg/dl . What is the nursing management for client with Anemia?

a. Use a soft bristled toothbrush

b. frequent rest periods
c. void IM injections
d. reverse isolation