SECTION A

Multiple choice questions

Choose the most appropriate answer by encircling it

1. A condition in which there is an abnormal, irreversible enlargement of air spaces distal

to terminal bronchioles due to destruction of alveolar walls, resulting in decreased elastic
recoil properties of lungs.
a. Bronchial carcinoma
b. Emphysema
c. Lung fibrosis
d. Pulmonary oedema
2. The presence of serous fluid in the pleural cavity is known as
a. Chylothorax
b. Haemothorax
c. Hydrothorax
d. Pyothorax

3. The following are causes of pleural effusion EXCEPT;

a. Acute pancreatitis
b. Meningitis
c. Pulmonary Tuberculosis
d. Systemic lupus erythematosus

4. The following are signs and symptoms of pleural effusion EXCEPT;

a. Chest pains
b. Fever
c. Haemoptysis
d. Shortness of breath

5. A condition in which there are multiple rib fractures, with or without fracture of sternum
is known as
a. Cardiac tamponade
b. Flail chest
c. Fractured ribs
d. Pulmonary injury
6. An injury to the lung tissue resulting in seepage of blood and / or fluids into the
interstitial space on the lung is called
a. Haemopneumothorax
b. Penetrating trauma
c. Pleural effusion
d. Pulmonary contusion

7. Which of the following surgical procedures are done in chest injuries

a. Lobectomy, Tracheostomy and Exploratory Thoracotomy

b. Pneumonectomy, exploratory lobectomy and tracheostomy
c. Tension Pneumonectomy, lobectomy and thoracotomy
d. Thoracotomy, haemopneumonectomy, and lobectomy
8. The following are General guidelines for nursing care of a patient with underwater seal
drainage EXCEPT;
a. Ensure the drainage bottles are kept at a lower level than the patient’s chest to
prevent fluid going back into the pleural cavity.
b. Ensure the tube coming from the chest is suspended above water in the
chamber and the one leading to the outlet should remain dipped in sterile
water.
c. Monitor patient’s clinical status, vital signs are taken frequently, lung
auscultation, and the chest wall observed for any abnormal chest movements.
d. Secure the drainage bottles to the drainage stand and tape the tubings to prevent
dislodgement of intercostal drain and entry of air into the pleural space.

9. The following are Indications for underwater seal drainage EXCEPT;

a. Atelectatasis
b. Chest surgery
c. Emphysema
d. Pleural effusion

10. Which of the following predisposes to the development of Deep vein thrombosis
a. Drugs such as aspirin
b. Increased activity
c. Increased fluid intake
d. Venous wall injury

11. The following are Complications of deep vein thrombosis EXCEPT;

 a. Blood dyscrasia
b. Engorged superficial veins
c. Valvular destruction
d. Venous stasis

12. A large haemothorax may be life threatening because of resultant

a. Collection of blood
b. Hypovolemia and tension
c. Severe pain
d. Sucking wound

13. The following are Complications of constrictive pericarditis EXCEPT;

a. Cardiac tampoande
b. Damage to the coronary arteries
c. Extended neck veins
d. Heart failure
14. The following are Complications of gangrene EXCEPT;
a. Delirium
b. Haematoma
c. Heart failure
d. Hip flexion Contracture

15. The following are Complications of varicose veins EXCEPT;

a. Development of carcinoma or sarcoma in longstanding venous ulcers.

b. Persistent inflammation of the vein
c. Skin ulcers especially near the ankle, usually referred to as venous ulcers
d. Venous obstruction leading to venous gangrene
16. The following are indications for cardiac surgery EXCEPT;

a. Cardiac Arrest
b. Mitral stenosis
c. Patent Ductus Arteriosus
d. Pulmonary regurgitation
17. The following are complications of cardiac surgery EXCEPT;
a. Angina pectoris
b. Cerebral injury
c. Low cardiac output
d. Renal failure

18. Which of the following is a type of pneumothorax

 a. Haemopneumothorax
b. Haemothorax
c. Pyopneumothorax
d. Simple pneumothorax
19. Chest tubes can be removed when

a. The tubes have been in situ for 12hours post operatively

b. There is fluctuation of fluid in the glass rod
c. There is persistent air space in the apex of the lungs
d. X-ray films confirm re expansion of the lungs
20. During the removal of the chest tubes, the patient is asked to
a. Exhale deeply and the tube is removed
b. Hold a breath as tube is being removed
c. Inhale deeply and the tube is removed
d. Swallow as the tube is being removed

21. Pulmonary resection is an indication in all of the following conditions EXCEPT;

a. Bronchiectasis
b. Bronchoadenoma
c. Pneumonia
d. Pulmonary tuberculosis

22. Subcutaneous Emphysema is a post-operative complication in all of the following

thoracic surgeries EXCEPT?

a. Injury to lungs during surgery

b. Injury to the esophagus during operation
c. Injury to the pericardium during operation
d. Injury to the trachea during operation
23. The rapid accumulation of fluid in the pericardial sac with compression of the heart
thereby preventing the diastolic filling is
a. Cardiac arrest
b. Cardiac tamponade
c. Col-pulmonary
d. Congestive cardiac failure

24. Which of the following would indicate an increased risk of deep vein thrombosis?
a. Anaemia
b. Hypertension
 c. Obesity
d. Vitamin K deficiency

25. The following clostridium genus does cause gas gangrene EXCEPT;
a. Clostridium Cl. Novyi
b. Clostridium Histolyticum
c. Clostridium Listeria
d. Clostridium Perfringes

26. The following are types of brain haematoma EXCEPT;

a. Epidural haematoma
b. Intracerebral haematoma
c. Meningeal Haematoma
d. Subdural haematoma

27. Prognosis of head injury is best given by

a. APGAR chart
b. CT head
c. Glasgow coma scale
d. Sliding Scale

28. Which of the following brain tumours is highly vascular in nature such that it may
resemble an arteriovenous malformation?
a. C P angle epidermoid
b. Glioblastoma
c. Meningiomas
d. Pituitary Adenoma

29. Which of the following sites is most common in spinal injuries?

a. Lower cervical spine

b. Sacral spine
c. Thoraco-lumber segment
d. Upper cervical spine

30. The following statements are true about spinal injuries EXCEPT?
a. About 80% of spinal injuries result in neurological deficit
b. Any lesion to the spinal cord above T5 causes hypotension
 c. Cervical spine injury may result in Quadriplegia
d. Thoraco-lumbar spine injury may result in paraplegia

31. Which of the following type of spinal injury occurs most commonly due to seat belt while
driving a car?
a. Extension injury
b. Flexion injury
c. Flexion-distraction injury
d. Flexion-rotation injury

32. Which of the following type of spinal injury is associated with huge retroperitoneal
hematoma?
a. Direct injury
b. Flexion injury
c. Flexion-distraction injury
d. Violent muscle contraction

33. The following are possible complications of spinal tumors EXCEPT;

a. Amnesia
b. Incontinence
c. Loss of sensation
d. Paralysis

34. A small number of spinal tumors which occur in the nerves of the spinal cord itself are
called
a. Ependymomas
b. Leukemia
c. Lymphoma
d. Myeloma

35. A client comes to your health facility with complaints of back pain that gets worse over
time, its often in the middle or lower back, its usually severe and not relieved by pain
medicine, gets worse when lying down or straining (such as during a cough or sneeze) and
extends to the hips or legs. What appropriate provisional diagnosis would you give?
a. Brain injury
 b. Injury to the vertebrae
c. Pyelonephritis
d. Spinal tumor

36. The following are tests to confirm spinal tumors EXCEPT;

a. Cytology of cerebrospinal fluid
b. Spine Computed Tomography
c. Spine fasciculation
d. Spine X-ray
37. Which of the following is a symptom of spinal tumors?
a. Blood or clear fluid draining from the ears or nose
b. Loss of consciousness
c. Muscle weakness or loss of feeling in arms or legs
d. Weakness in one side or area of the body

38. The following are complications of pulmonary contusion EXCEPT;

a. Acute respiratory distress syndrome
b. Dyspnea
c. Pneumonia
d. Respiratory failure
39. The following are reasons for insertion of chest tubes EXCEPT;

a. Permit expansion of lungs

b. Restore normal intra-pleural pressure
c. To facilitate intra thoracic operations
d. To remove fluids from the pleural space and prevent its reflux
40. The following are causes of pleural effusion EXCEPT;
a. Cardiac failure
b. Lung abscess
c. Pneumonia
d. Respiratory failure

41. Which clinical manifestation is the main sign of lung disease?

a. Cough
b. Dyspnea
c. Hemoptysis
d. Hoarseness
42. While the nurse interviews a patient, he verbalizes that he has difficulty breathing during
sleep and uses three pillows for relief. The nurse notes that he may be experiencing

a. Claudication
b. Hyperventilation
c. Orthopnea
d. Paroxysmal nocturnal dyspnea
43. A 37-year-old patient is admitted to the Emergency Department with dyspnea, tachypnea
and pink frothy sputum. The nurse determines that the patient is experiencing:
a. Cor pulmonale
b. Lung abscess
c. Neck trauma
d. Pulmonary embolism

44. A post operative patient who had a bronchoscopy two hours ago is Nil per oral and states
that he is hungry. What should the nurse do?
a. Check for a gag reflex return
b. Inform patient to be nil per orally for the next four hours
c. Notify the physician
d. Order food since the patient is awake

45. A nurse is caring for a patient who had a thoracentesis eight hours ago. While assessing
the patient, the nurse observes that the patient has a rapid heart rate, rapid, shallow
respirations, and has absent breath sounds to the left upper lobe of the lung. The nurse
interprets this complication as:
a. Flail chest
b. Pneumothorax
c. Pulmonary embolism
d. Respiratory distress

46. A nurse is caring for a patient who had a surgical placement of a tracheostomy 48 hours
ago. What should the nurse's initial action be if tube dislodgement occurs?

a. Obtain the patient's vital signs

b. Place a 4x4 sterile gauze over the stoma to prevent infection
c. Re-insert the tube and notify the physician
d. Ventilate the patient using a manual resuscitation bag.
47. The nurse is suctioning a patient with an endotracheal tube. Which of the following is a
correct technique for this procedure?
a. Apply suction during insertion
b. Hyperoxygenate before and after suctioning
c. Suction for 5 seconds
d. Suction the mouth before suctioning the airway
48. All of the following are aspiration precaution measures that the nurse should implement
in a patient with a tracheostomy EXCEPT;

a. Deflate cuff during meals

b. Do not rush patient
c. Instruct patient to drink water, especially while chewing
d. Keep patient at low-Fowler's position
49. A nurse is providing discharge instructions for a tracheostomy patient. Which statement
indicates that the patient understands tracheostomy care?

a. "Before suctioning, I should wash my hands."

b. "I can no longer have showers anymore."
c. "I will increase the humidity in my home."
d. "If I stick a large cotton ball in the airway, I won't be able to breathe."
50. A nurse is monitoring a patient who has a chest tube drainage system and notices that
there is gentle bubbling in the suction control chamber. What is the appropriate nursing
action for this scenario?

a. Check for an air leak

b. Check to see if the chest tube is blocked or kinked
c. Document this finding.
d. Notify the physician immediately
51. While assessing a tracheostomy patient, the nurse notices that there is a crackling
sensation around the neck. The nurse suspects this complication as:
a. Pneumothorax
b. Subcutaneous emphysema
c. Trachea-innominate artery fistula
d. Tracheomalacia

52. The following are clinical signs of cardiac tamponade EXCEPT;

a. Bradycardia.
b. Distended neck veins.
c. Hypotension.
d. Kussmaul’s sign.

53. The marked cerebral injury in which the brain is bruised with possible surface
haemorrhage is called …………………………..
a. Cerebral concussion
b. Cerebral contusion
c. Cerebral haematoma
d. Cerebral haemorrhage

54. A male client has undergone spinal surgery, the nurse should:
 a. Assess the client’s feet for sensation and circulation
b. Encourage client to drink plenty of fluids
c. Log-roll the client to prone position
d. Observe the client’s bowel movement and voiding patterns

55. Nurse Judith obtains a specimen of clear nasal drainage from a client with a head injury.
Which of the following tests differentiates mucus from cerebrospinal fluid (CSF)? 
a. Glucose
b. Microorganism
c. Protein
d. Specific gravity
56. What is the priority nursing assessment in the first 24 hours after admission of the client
with thrombotic Cerebral vascular accident.

a. Bowel sounds
b. Cholesterol level
c. Echocardiogram
d. Pupil size and papillary response
57. The nurse is aware that the early indicator of hypoxia in the unconscious client is:
a. Cyanosis
b. Hypertension
c. Increased respirations
d. Restlessness

58. Which of the following complications is associated with tracheostomy tube?

a. Acute respiratory distress syndrome (ARDS)
b. Damage to laryngeal nerves
c. Increased blood pressure
d. Increased cardiac output
59. A client has undergone laryngectomy. The immediate nursing priority would be:

a. Keep trachea free of secretions

b. Monitor for signs of infection
c. Promote means of communication
d. Provide emotional support

60. Nurse John assesses vital signs on a client who had undergone epidural anesthesia. Which
of the following would the nurse assess next? 

a. Ability to move legs

 b. Bladder distension
c. Dizziness
d. Headache

61. The following are signs and symptoms of pneumothorax EXCEPT;

a. Asymmetrical chest movement
b. Diminished or absent breath sounds
c. Sudden sharp pain on affected side
d. Tachycardia

62. Marco who was diagnosed with brain tumor was scheduled for craniotomy. In preventing
the development of cerebral edema after surgery, the nurse should expect the use of: 
a. Anticonvulsants
b. Antihypertensive
c. Diuretics
d. Steroids

63. A 37-year-old patient is admitted to the emergency department with dyspnea, tachypnea
and pink, frothy sputum. The nurse determines that the patient is experiencing:
a. Cor pulmonale
b. Lung abscess
c. Neck trauma
d. Pulmonary embolism

64. A nurse is caring for a patient who had a thoracentesis eight hours ago. While assessing
the patient, the nurse observes that the patient has a rapid heart rate, rapid, shallow
respirations, and has absent breath sounds to the left upper lobe of the lung. The nurse
interprets this complication as:
a. Flail chest
b. Pneumothorax
c. Pulmonary embolism
d. Respiratory distress

65. During thoracentesis, which of the following nursing intervention will be most crucial?
a. Advise patient to sit perfectly still during needle insertion until it has been
withdrawn from the chest
b. Apply pressure over the puncture site as soon as the needle is withdrawn
c. Maintain strict aseptic technique
d. Place patient in a quiet and cool room
66. To prevent leakage of fluid in the thoracic cavity, how will you position the client after
thoracentesis?
a. On bed rest
b. Place flat in bed
c.Turn on the affected side
d. Turn on the unaffected side

67. A client returns to the Cardiovascular Intensive Care Unit following a coronary artery
bypass graft In planning the client's care, the most important electrolyte to monitor is:
a. Bicarbonate.
b. Chloride.
c. Potassium.
d. Sodium.

68. A client is having a left pneumonectomy. In planning this client's postoperative care,
nursing interventions for a postoperative left pneumonectomy would include:
a. Monitoring the chest tubes.
b. Monitoring the right lung for an increase in rales.
c.Positioning the client in the semi-Fowler's position with a pillow under the shoulder
and back.
d. Positioning the client on the right side.
69. A female postoperative client has returned to the Unit following a pneumonectomy. In
assessing the client's incision, twenty-four hours postoperatively, the nurse notices fresh
blood on the dressing. The nurse should first:
a. Continue to monitor the dressing.
b. Note the time and amount of blood
c.Notify the physician.
d. Reinforce the dressing.

70. Which one is a critical feature of wet Gangrene

a. Its spread is rapid
b. The skin and superficial tissues become blistered
c. The skin is dark and dry
d. There is no pain

71. Gas Gangrene is caused by

a. Aerobic bacteria
b. Aerobic viruses
c. Anaerobic bacteria
d. Anaerobic viruses
72. An appropriate position for patient with pulmonary embolism is
a. Fowlers position
b. Lateral position
c. Recumbent position
d. Supine position

73.  Mr. Lucas, a 63 year old, went to the clinic complaining of hoarseness of voice and a
cough. His wife states that his voice has changed in the last few months. The nurse
interprets that Mr. Lucas symptoms are consistent with which of the following disorders:
a. Chronic sinusitis
b. Coronary artery disease
c. Gastro esophageal reflux disease.
d. laryngeal cancer
74. The nurse is teaching the client about behavioral changeswhich can affect development
of atherosclerosis. which of the following will she discuss as a non-modifiable risk factor
for atherosclerosis?

a. Cigarette smoking 
b. Female over 55 years of age
c. Hyperlipidemia
d. Sedentary lifestyle
75. John has just returned from the post anesthesia care unit from hemorrhidectomy. His
postoperative orders include sitz baths every morning. The nurse understands that sitz
bath is useful for:
a. Cause swelling
b. Lower body temperature
c. Promote healing
d. Relive tension

76.  A nurse is caring for a Lung cancer patient receiving subcutaneous morphine sulfate for
pain. Which of the following nursing actions is most important in the care of this patient?

a. Monitor heart rate

b. Monitor respiratory rate
c. Monitor temperature.
d. Monitor urine output.
77. A nurse is caring for a patient with peripheral vascular disease (PVD). The patient
complains of burning and tingling of the hands and feet and cannot tolerate touch of any
kind. Which of the following is the most likely explanation for these symptoms?
a. Fluid overload leading to compression of nerve tissue.
b. Inadequate tissue perfusion leading to nerve damage.
c. Inflammation of the skin on the hands and feet.
d. Sensation distortion due to psychiatric disturbance.
78. A patient in the cardiac unit is concerned about the risk factors associated with
atherosclerosis. Which of the following are hereditary risk factors for developing
atherosclerosis?
a. Age.
b. Family history of heart disease.
c. Overweight.
d. Smoking.

79. A nurse is providing discharge information to a patient with peripheral vascular disease.
Which of the following information should be included in instructions?

a. Avoid crossing the legs.

b. Use a heating pad to keep feet warm.
c. Use antibacterial ointment to treat skin lesions at risk of infection.
d. Walk barefoot whenever possible.

80. Thrombolytic therapy is frequently used in the treatment of suspected stroke. Which of
the following is a significant complication associated with thrombolytic therapy?

a. Air embolus.
b. Cerebral hemorrhage.
c. Expansion of the clot.
d. Resolution of the clot.
81. The surgical removal of an entire lung is termed as
a. Lobectomy
b. Pneumonectomy
c. Segmentectomy
d. Wedge resection.
82. The following is are  nursing interventions of a patient with water-seal chest drainage EXCEPT;
a. Encourage the patient to breathe deeply and cough at regular intervals
b. Ensure that the drainage system is kept at the chest level.
c. Ensure that the tube is not looping or interfering with the movements of the
patient
d. Make sure there is fluctuation of the fluid level in the water seal chamber.

83. The following are  post-operative complications following valve replacement EXCEPT;

a. Congestive heart failure
b. Hemolysis
c. Infection
d. Thromboembolism
84. When a clot develops in the veins as a result of stasis, but without inflammation, the process is
termed as :
a.  Burger's disease
b. Phlebothrombosis
c. Thrombophlebitis
d.  Varicose veins

85. The following are points are included in Patient education regarding care of the feet and legs for the
person with peripheral vascular problem EXCEPT;

a. Avoid circular compression around feet or knees, such as knee high stockings.

b. Encourage  sunburn
c. Wash feet daily with soap and luke warm water and dry thoroughly especially
between toes
d. Wear clean loose soft cotton socks to absorb moisture.

86. Collection of pus in the pleural cavity is known as
a. Empyema
b. Haemothorax
c. Pleural effusion
d. Pneumothorax

87. After  thoracentesis, the nurse should observe the client for

a.  Decreased respiratory rate
b.  Expectoration of blood
c. Increased breath sounds
d. Periods of confusion
88. If an open pneumothorax of the right lung occurred what would be the effect on the left
lung?

a. No anatomic change to the left lung would occur.

b. The left lung would collapse.
c. The left lung would develop atelectasis.
d. The left lung would expand into the right lung space.

89. Mrs Umina has just returned from a bronchoscopy. What nursing measure is the most
appropriate for a nurse to perform at this time?

a. Advise her to take nothing by mouth.

b. Encourage her to lie on her left side.
c. Observe for signs of an allergic reaction.
d. Provide postural drainage every two hours.
90. Thickening and hardening of the blood vessel walls due to fatty deposits is termed:
a. Arteriosclerosis;
b. Atherosclerosis;
c. Embolism;
d. Thrombosis.

91. Arterial ulcers may be distinguished from venous ulcers by the fact that arterial ulcers are
usually:

a. Appear on or between toes;

b. Produce minimum discomfort;
c. Quite shallow ulcers;
d. Reddish, uneven ulcer edges.
92. A post-cerebral vascular accident (CVA) patient who has weakness on the right side and
impaired reasoning has had the CVA in the:
a. Left cerebellum.
b. Left hemisphere of the cerebrum.
c. Right cerebellum.
d. Right hemisphere of the cerebrum.

93. The nurse updates the teaching plan for a post-Transient ischaemic attack patient to
include the provision for:
a. A daily aspirin dose.
b. High-carbohydrate diet.
c. Long rest periods daily.
d. Reduction of fluid intake to 800 mL/day.

94. The patient recovering from a cerebral vascular accident asks the purpose of
the warfarin. The best response by the nurse is that Warfarin:

a. Dilates the vessels to improve blood flow.

b. Dissolves the clot.
c. Prevents formation of new clots.
d. Suppresses the formation of platelets.

95. Immediately after a cerebral vascular accident, a major nursing priority is ensuring:

a. Adequate hydration.
b. Airway maintenance.
c. Control of elimination.
d. Preservation of motor function.
96. The nurse recognizes that the acute phase of a cerebral vascular accident has ended when:
 a. 48 hours has passed from onset.
b. The blood pressure drops.
c. The patient begins to respond verbally.
d. Vital signs and neurologic signs stabilize.
97. The nurse explains that a lumbar puncture is most helpful as a diagnostic tool for a new
stroke patient, because it can help determine if the stroke:

a. Is complete or in evolution.
b. Is hemorrhagic or embolic.
c. Is lacunar.
d. Will result in paralysis.
98. During the acute cerebral vascular accident phase, there is a risk for falls related to
paralysis. The intervention that best protects the patient from injury is:
a. Keep on doing vital signs till stable
b. Keep the bed in a high position for ease of nursing care.
c. Keep the patient restrained with ropes
d. Keep the side rails up, according to agency policy.
99. The nurse assesses that the cerebral vascular accident patient is in transition to the
rehabilitation phase when:
a. The blood pressure has been within normal limits for 24 hours.
b. The patient makes positive statements about his condition.
c. There are no further neurologic deficits observed.
d. There are successful attempts at independent function.

100. A female patient is diagnosed with deep-vein thrombosis. Which nursing

diagnosis should she receive highest priority at this time?
a. Altered peripheral tissue perfusion related to venous congestion
b.  Fluid volume excess related to peripheral vascular disease
c. Impaired gas exchanges related to increased blood flow 
d. Risk for injury related to edema

101. A male client is admitted to the hospital with blunt chest trauma after a motor

vehicle accident. The first nursing priority for this client would be to:
a. Assess the client’s airway 
b. Encourage deep breathing and coughing
c.  Provide pain relief 
d.  Splint the chest wall with a pillow

102. Which of the following listed assessment finding is typical of cardiac tamponade?

a. A pulse pressure of 18/82 mmHg

b. A pulse rate of 60 per minute
c. Flat neck veins
d. Muffed or distant heart sounds
103. The following signs cause the nurse to suspect cardiac tamponade after a client
has cardiac surgery EXCEPT;
a. Hypertension
b. Increased urine output
c. Jugular vein distention
d. Tachycardia

104. Atherosclerosis impedes coronary blood flow by which of the following

mechanisms?
a. Blood clots form outside the vessel wall
b. Hardened vessels dilate to allow blood to flow through
c. Plaques obstruct the artery
d. Plaques obstruct the vein
105. The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-
Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide
information about:
a. Cardiac output
b. Left ventricular functioning
c. Stroke volume
d. Venous pressure

106. A male patient has a sucking stab wound to the chest. Which action should the
nurse take first?

a. Applying a dressing over the wound and taping it on three sides

b. Drawing blood for a hematocrit and hemoglobin level
c. Preparing a chest tube insertion tray
d. Preparing to start an I.V. line

107. An emergency room nurse is assessing a male 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. A sucking sound at the site of injury
c. Diminished breath sounds
 d. The presence of a barrel chest
108. After undergoing a left pneumonectomy, a female patient has a chest tube in place
for drainage. When caring for this patient, the nurse must:

a. Clamp the chest tube once every shift

b. Encourage coughing and deep breathing
c. Milk the chest tube every 2 hours
d. Monitor fluctuations in the water-seal chamber
109. Nurse Oliver is caring for a client immediately after removal of the endotracheal
tube. The nurse reports which of the following signs immediately if experienced by the
client?

a. A few basilar lung crackles on the right

b. Occasional pink-tinged sputum
c. Respiratory rate 24 breaths/min
d. Stridor
110. A nurse is assisting a physician with the removal of a chest tube. The nurse should
instruct the client to:

a. Exhale slowly
b. Inhale and exhale quickly
c. Perform the Valsalva maneuver
d. Stay very still

111. Which respiratory disorder is most common in the first 24 to 48 hours after
surgery?
a. Atelectasis
b. Bronchitis
c. Pneumonia
d. Pneumothorax
112. A 60-year-old male patient is suspected of having coronary artery disease. Which
noninvasive diagnostic method would the nurse expect to be ordered to evaluate cardiac
changes?
a. Cardiac biopsy
b. Cardiac catheterization
c. Magnetic reasonance imaging
d. Pericardiocentesis

113. When caring for a patient with arterial occlusive disease, which of the following
home health care instructions is most appropriate for the nurse to give to the patient?

a. “It’s best to sit and rest for several hours a day.”

b. “It’s best to wear tight socks instead of no socks.”
c. “Make sure the head of your bed is slightly elevated when sleeping.”
d. “You should massage your legs to relieve pain.”
114. On the first day after thoracotomy, the nurse’s assessment of the patient reveals a
temperature of 37.8° C, a heart rate of 96 beats/minute, blood pressure of 136/86 mm
Hg, and shallow respirations of 24 breaths/minute, with rhonchi heard at the lung bases.
The patient complains of incisional pain. Which nursing action takes priority?
a. Administering ibuprofen (Motrin) as ordered to reduce fever
b. Encouraging the patient to cough and deep-breathe
c. Helping the patient out of bed
d. Medicating the patient for pain

115. Which intervention is most important to include in a nursing care plan for a
patient with atelectasis?
a. Get the patient out of bed to a chair every day.
b. Give oxygen continuously at 3 L/minute.
c. Have the patient cough and deep-breathe every 4 hours.
d. Have the patient use an incentive spirometer every hour.

116. When assessing the patient with an acute dissecting thoracic aortic aneurysm, the
nurse should expect which finding?
a. Decreased hemoglobin level and hematocrit
b. Hypertension
c. Severe chest pain
d. Slow respiratory rate

117. A patient, aged 72, has vascular disease. Which nursing intervention would be
appropriate?

a. Advise him to wear knee-length stockings.

b. Caution him not to exercise daily
c. Encourage him to avoid caffeine and nicotine.
d. Instruct him to soak both feet in cool water.
118. A patient with a head injury and reduced Level of Consciousness is placed on a
hypothermia blanket and given antipyretic medication. Which statement best describes
the therapeutic value of these interventions?

a. They prevent hypoxia associated with diaphoresis.

b. They promote equalization of osmotic pressures.
c. They promote the integrity of intracerebral neurons.
d. They reduce brain metabolism and limit hypoxia.

119. A patient, age 41, undergoes a right upper lobectomy. Postoperatively, he has a
chest tube connected to an underwater seal with suction. One day after surgery, the nurse
detects no bubbling in the suction compartment. What would be the best nursing action at
this time?
a. Add more sterile water to the suction compartment.
b. Check the practitioner’s order for amount of suction, and increase pressure
until gentle bubbling occurs.
c. Check the practitioner’s order for amount of suction, and increase the water seal
by 3.9”(10 cm)
d. Milk the chest tube, using slow, even strokes.

120. Which measure can reduce or prevent the incidence of atelectasis in a

postoperative patient?

a. Chest physiotherapy
b. Incentive spirometry
c. Mechanical ventilation
d. Reducing oxygen requirements
121. A patient with a C6 spinal injury would most likely have which sign or symptom?

a. Aphasia
b. Hemiparesis
c. Paraplegia
d. Quadriplegia

122. A patient with cancer develops pleural effusion. During chest auscultation, which
breath sounds should the nurse expect to hear?
a. Crackles
b. Diminished breath sounds
c. Rhonchi
d. Wheezes
123. Which of the following treatments would be most appropriate to relieve the pain
of a patient admitted with deep vein thrombosis.

a.Applying heat
b.Bed rest
c.Exercise
d.Leg elevation
124. Which physiologic effects of a pulmonary embolism would initially affect
oxygenation?
a. A blood clot blocks perfusion and ventilation, producing profound hypoxia.
b. A blood clot blocks perfusion, producing hypoxia despite normal or
supernormal ventilation
c. A blood clot blocks ventilation, but perfusion is unaffected.
d. A blood clot blocks ventilation, producing hypoxia despite normal perfusion.

125. A patient with a pulmonary embolism may have an umbrella filter placed in the
vena cava for which reason?

a. To break up clots into insignificantly small pieces

b. To collect clots so that they do not reach the lungs
c. To prevent further clot formation
d. To slowly release an anticoagulant that dissolves any clots
126. The nurse is caring for a patient with a pleural effusion. The patient asks, “What
is a pleural effusion?” Which of the following responses would be appropriate for the
nurse to make?

a. “It is the accumulation of fluid in the pleural space.”

b. “It is the collapse of a bronchiole.”
c. “It is the collapse of alveoli.”
d. “It is the fluid in the alveolar space.”

127. Which type of shock should the nurse expect to observe in a patient experiencing
cardiac tamponade?

a. Anaphylactic
b. Cardiogenic
c. Hypovolemic
d. Septic
128. A patient with a spinal cord injury says he has difficulty recognizing the signs and
symptoms of urinary tract infection (UTI) before it becomes too late. Which of the
following is an early indication of UTI?
a. Burning on urination
b. Fever and change in the clarity of urine
c. Frequency of urination
d. Lower back pain
129. The following are Investigations for brain tumors EXCEPT;
a. Angiogram
b. CT scan
c. Intra venous Pyelogram
d. MRI

130. The priority in preparing the room for a client with a C7 spinal cord injury is
having:
a. A catheterization tray
b. A ventilator on stand by
c. The halo brace device 
d. The spinal kinetic bed

131. 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?
a. Bulging anterior fontanel.
b. Inability to read short words from a distance of 18 inches.
c. Repeated vomiting.
d. Signs of sleepiness at 10 PM.

132. The following are signs and symptoms of pericarditis EXCEPT

a. Angina pain
b. Dyspnea
c. Hypertension
d. Hypotension

133. Pericardiocentesis is indicated when there are signs and symptoms of …

a. Angina pectoris
b. Cardiac tampoande
c. Constrictive pericarditis
d. Heart failure
134. You are a nurse in a surgical ward and you are planning to discharge a stroke
patient. What instruction will you include on discharge

a. To do active exercise like running every 2 hours

b. To be chewing a gum to retain muscle tone
c. To go to physiotherapy if he feel like
d. To maintain strict bed rest at home
135. The nurse is caring for a patient with a C7 spinal cord injury who develops
bradycardia, hypertension, and sweating. Which intervention should the nurse perform
first?
a. Covering the patient with a blanket
b. Lying the patient flat in bed
c. Palpating the patient’s bladder
d. Performing a rectal examination

136. The nurse is caring for a comatose patient who has suffered a closed head injury.
Which intervention should the nurse implement to prevent increases in intracranial
pressure.
a. Elevating the head of the bed 30 to 45 degrees
b. Maintaining a well-lit room
c. Suctioning the airway every hour and as needed
d. Turning the patient and changing his position every 2 hours

137. Which condition places a patient at risk for an embolic stroke?

a. A history of Myocardial Infarction
b. Atrial fibrillation
c. Bradycardia
d. Deep vein thrombosis

138. After a patient experiences a brain stem infarction, the nurse should observe for
which condition?

a. Aphasia
b. Bradypnea
c. Contralateral hemiplegia
d. Numbness and tingling to the face or arm

139. A patient with a subdural hematoma becomes restless and confused, with dilation
of the ipsilateral pupil. The physician orders mannitol for which reason?

a. To draw water into the vascular system to increase blood pressure

b. To prevent acute tubular necrosis
c. To promote osmotic diuresis to decrease intracranial pressure
d. To reduce intraocular pressure
 140. The nurse is administering preoperative medication to a patient going to the
operating room for an aorto bifemoral bypass. After administering preoperative
medication to the patient, the nurse should:
a. Allow him to walk to the bathroom unassisted.
b. Place the bed in low position with the side rails up.
c. Take his vital signs
d. Tell him that he’ll be asleep before he leaves for surgery.

141. When assessing a patient with a head injury which order should the assessment
take:-
a. Airway , Breathing , Circulaton, Deficit
b. Airway Breathing, Deficit, Circulation
c. Airway, Deficit, Breathing, Circulation
d. Deficit (neuro) Airway, Breathing Circulation
142. Which of the following is risk factors of cancer of the lung?
a. Living in the city
b. Sedentary life style
c. Working in a farm
d. Working with petroleum products
143. Neoplasm of the lungs can be classified as either benign or malignant. The
following are characteristics of malignant tumor apart from:

a. Encapsulated
b. Infiltrates surrounding tissues
c. Metastasis
d. Poorly differentiated cells

INDICATE TRUE OR FALSE ON THE FOLLOWING STATEMENTS

1. Venous Thrombosis is classified either as superficial vein Thrombosis or Deep vein

thrombosis
a. True
b. False
2. Peripheral vascular disease does not lead to stenosis, embolism or thrombus formation
a. True
 b. False
3. Constrictive pericarditis is not one of the complications of Tuberculosis of the heart
a. True
b. False
4. Peripheral artery occlusive disease is also called Peripheral vascular disease
a. True
b. False
5. varicose veins are painless, especially when standing or walking
a. True
b. False
6. A patient with Peripheral vascular disease can present with Diminished hair and nail
growth on affected limb and digits.
a. True
b. False
7. Dyslipidemia is believed to be associated with the development of Peripheral vascular
disease.
a. True
b. False
8. Varicose veins can be prevented by avoiding wearing of elastic stockings especially
knee-high stockings to ensure complete emptying of the leg veins.
a. True
b. False
9. Following Post Sclerotherapy, the nurse should not apply elastic compression bandages
on the patients’ legs
a. True
b. False
10. Varicose veins are defined as any dilated, elongated and tortuous vein irrespective of
size.
a. True
b. False
11. Peripheral vascular disease includes all diseases caused by the obstruction of large
arteries in the arms and legs.
a. True
b. False
12. Bacterial infections are the only cause of gangrene.
a. True
b. False
13. Varicose veins cannot be prevented by elevating the legs when they are tired.
a. True
b. False
14. During postoperative care for cardiovascular surgical patients, it is cardinal to take note
of the respiratory character as well as the respiratory rate.
a. True
b. False
15. Appropriate Treatment can reverse the damage caused by gangrene.
a. True
b. False
16. Aspiration is one of the complications of chest injuries.
a. True
b. False
17. Lobectomy is the surgical treatment of choice for small cell lung cancer.
a. True
b. False
18. Changes in the endothelial blood vessel lining predisposes to deep vein thrombosis
a. True
b. False
19. People with diabetes can reduce their risk of developing gangrene by checking their
body regularly for injuries.
a. True
b. False
20. Emphysema, along with chronic empyema, together are referred to as Chronic
Obstructive Lung Disease
a. True
b. False
21. Aging can bring about Emphysema
a. True
b. False
22. Gangrene can only affects the tissues outside the body.
a. True
b. False
23. Acquired brain injury occurs when an object such as a bullet or knife fractures the skull,
enters the brain and injures the brain tissue in the process.
a. True
b. False
24. A severe brain injury occurs when the brain receives a neurological injury which results
in physiologic changes to a person’s brain.
a. True
b. False
25. Closed head injuries occur when the brain tissue strikes the inside of the skull.
a. True
b. False
26. A high Glasgow Coma Scale grade at the time of the initial medical intervention indicates
severe brain injury.
a. True
b. False
27. The Glasgow Outcome Scale is used at various points after brain injury to determine the
prognosis, or likelihood, of the person regaining independence.
a. True
b. False
28. Hormonal contraceptives does not predispose to deep vein thrombosis.
a. True
b. False
29. A high-level injury, such as a cervical injury, will more likely result in quadriplegia
a. True
b. False
30. Damage to the vertebrae may have occurred at the same time as the spinal cord injury
a. True
b. False
31. The patient with head injury with a Glasgow coma of 15/15 is unconscious
a. True
b. False
32. Manitol is a diuretic of choice in head injury
a. True
b. False
33. In head injury concussion is when the brain is bruised and has a tear
a. True
b. False
34. Burr holes are indicated in all head injuries
a. True
b. False
35. Meningitis could be a complication of head injury
a. True
b. False
36. Ottorrhea may be a significant sign and symptom of RTA victims having head injury
a. True
b. False
37. Cervical collar is contra indicated in all spinal injury patients
a. True
b. False
38. A brain tumor is a localized intracranial lesion which occupies space in the skull and
tends to cause a rise in intracranial pressure.
a. True
 b. False
39. A brain abscess is a collection of infectious material within the tissue of the brain.
a. True
b. False
40. An abscess can result from intracranial surgery, penetrating head injury, or tongue
piercing
a. True
b. False
41. To prevent brain abscess, otitis media, mastoiditis, rhinosinusitis, dental infections, and
systemic infections should be treated promptly.
a. True
b. False
42. Tumors of the pituitary and pineal glands and of cerebral blood vessels are NOT types of
brain tumors.
a. True
b. False
43. Accumulation of lipid or fatty substances and fibrous tissue in the vessel wall is known as
Atherosclerosis
a. True
b. False
44. Cigarette smoking, tobacco use does not predispose to atherosclerosis
a. True
b. False
45. Control of Hypertension and diabetes mellitus prevents the development of
atherosclerosis
a. True
b. False
46. Mitral stenosis is the progressive thickening and contracture of the mitral valve leaflets
and chordae tendineae that causes narrowing of the orifice and progressive obstruction to
blood flow from the left atrium into the left ventricle.
a. True
b. False
47. Mitral valve prolapse is a dysfunction of the mitral valve leaflets that prevents the mitral
valve from closing completely during systole
a. True
b. False
48. In Mitral Valve prolapse blood does not regurgitate from the left ventricle back into the
left atrium.
a. True
b. False
49. Percutaneous trans luminal valvuloplasty or mitral valve replacement may be performed
in mitral valve stenosis
a. True
b. False.
50. In Coronary Artery Disease, plaques partially or totally occlude the coronary artery
vasculature
a. True
b. False
51. Complete spinal cord injury or lesion causes loss of voluntary motor function, all
sensations, and proprioception below the level of the lesion
a. True
b. False
52. Flaccid paralysis is the loss of voluntary movement caused by damage to the lower motor
neurons reflexes, but deep tendon reflexes are retained.
a. True
b. False
53. Injury to the cord at the C1 to C4 level causes quadriplegia and loss of respiratory
function
a. True
b. False

54. Central venous catheters or Dialysis access catheters predisposes to deep vein thrombosis
a. True
b. False
55. Heparin is an example of an anticoagulant drug given to delay the clotting time of blood
and prevent the formation of a thrombus.
a. True
b. False
56. Compression stockings are recommended in patients with deep vein thrombosis to
decrease venous blood flow
a. True
b. False
57. Use of thrombolysis could make the patient susceptible to bleeding.
a. True
b. False
58. Pulmonary contusion usually resolves itself without causing permanent complications
a. True
b. False
59. All the different types of gangrene require immediate medical attention.
a. True
b. False
 60. Any condition that affects blood flow decreases the risk of gangrene
a. True
b. False

CROSS MATCH

Cross match the conditions in column I with the appropriate predisposing factors in
column II. Responses in column II should be used only once.

COLUMN I COLUMN II
…B….Gangrene A Air pollution long term exposure
2 …D….Deep vein thrombosis B Atherosclerosis

3 A…. Emphysema C Obstruction of thoracic duct

4 C….Pleural effusion D Hypercoagulability
5 G….Lung cancer E Pneumothorax
F Chronic phlebitis
G Radon gas exposure

Answers to Cross Match

1. B
2. D
3. A
4. C
5. G

Cross match the conditions in column I with the appropriate complications in column II.
Responses in column II should be used only once.

COLUMN I COLUMN II

6. …E………Open Pneumothorax A. Pulmonary edema

 7. …D……….Flail chest B. Pleural effusion
8. …G……….Deep vein thrombosis C. Blood poisoning
9. …A………..Constrictive pericarditis D. Pulmonary contusion
10. …B………..Lung cancer E. Mediastinal shift
F. Chronic Phlebitis
G. varicose veins

Answers to cross match

1. E
2. D
3. G
4. A
5. B

Cross match the conditions in column I with the appropriate clinical manifestations in
column II. Responses in column II should be used only once.

COLUMN I COLUMN II

6. …E………Constrictive pericarditis A. Pain or tenderness in the calf or

thigh
7. …D………Peripheral vascular disease B. shoulder pain that travels down
the outside of the arm
8. …A………Deep vein thrombosis C. Wheezing- due to passage of air
through narrowed
bronchioles.
9. …B………Cancer of the lungs D. Claudication- pain, weakness, or
cramping muscles due to
decreased blood flow
10. …C……..emphysema E. Long-term swelling (edema) of
the legs and ankles

F. The affected area becomes cold,

numb, may turn brown to purplish-
blue to black in color

G. Painful veins especially when

standing or walking

Answers to Cross Match

 11. E
12. D
13. A
14. B
15. C

Cross match the surgical procedures in column I with the appropriate conditions in column
II. Responses in column II should be used only once.

COLUMN I COLUMN II

16. …B……Bullectomy A. Gangrene

17. …E……Vein stripping B. Emphysema
18. …D……Angioplasty C. Deep vein thrombosis
19. …F……Lymphadenectomy D. Peripheral vascular disease
20. …A……Skin graft E. Varicose veins
F. Lung cancer
G. Pleural effusion

Answers to cross match

11. B
12. E
13. D
14. F
15. A

Cross match the conditions in column I with the appropriate predisposing factors in
column II. Responses in column II should be used only once.

COLUMN I COLUMN II

16. …C…..Constrictive pericarditis A. Diabetes Mellitus

17. …D….Deep vein thrombosis
18. …F…Pulmonary contusion
19. …B….Varicose veins
20. …A…Gangrene
B. Congenital defective valves
C. Tuberculosis of the heart
D. Polycythaermia rubra
E. Empyema
G. Pleural effusion
 F. Explosions

Answers to cross Match

21. C
22. D
23. F
24. B
25. A

CROSS MATCH THE TERMINOLOGIES IN COLUMN I WITH THE APPROPRIATE

MEANING IN COLUMN II. RESPONSES IN COLUMN II SHOULD BE USED ONLY
ONCE.

COLUMN I COLUMN II
26. …E…Linear skull fractures A Tumors between the meninges and bones of the spine
27. …D……Epidural hematoma B. tumors that develop in the spinal cord arachnoid
membrane (meningiomas) in the nerve roots that extend
out from the
spinal cord
28. …B..Intradural C. There is a break in the bone at the base of the skull
extramedullary tumors
29. …G…………Spinal tumor D Occur when a blood clot forms underneath the skull, but
on top of the dura, the tough covering that surrounds the
brain
30. …A………..Extradural tumors E. There is a break in the bone, but it does not move the bone.
F . occur when a blood clot forms underneath the skull and
underneath the dura, but outside of the brain
G growth developing within or near the spinal cord

Answers to cross match

21. E
22. D
23. B
24. G
25. A