MEDICAL SURGICAL NURSINGCARDIOVASCULAR DISORDERS EXAMINATION

ELENITA C. MANRIQUE, MD, RN

1. The nurse is monitoring a client post acute MI, the nurse notes eight (8) Premature Ventricular Contractions PVCs on cardiac monitor. The nurse first course of action should be

a. Administer antiarrhytmic drugsb. Notify the physician promptlyc. Increase oxygen concentrationd. Administer prescribed analgesic

2. Expected outcomes following administration of Furosemide ( Lasix ) includea. Increased urine output and blood pressureb. Increased urine output and cardiac contractilityc. Increased urine output and decreased PVCsd. Increased urine output and decreasing cardiac afterload

3. A client whose condition remains stable after a myocardial infarction is gradually allowed increased activity. Of the following criteria, the best one on which to judge whether activity is appropriate is to note the degree of

a. Edemab. Cyanosisc. Dyspnead. Weight loss

4. A basic principle of any rehabilitation, including cardiac rehabilitation is that rehabilitation begins ona. Discharge from the hospitalb. Discharge from the cardiac care unitc. Admission to the hospitald. Four weeks after the onset of illness

5. A client is discharged from the hospital following a myocardial infarction. The client is walking and is thought to continue walking gradually progressing distances. Which vital sign should the client be thought to monitor whether to increase or decrease progression

a. Pulse rateb. Blood pressurec. Body temperature d. Respiratory rate

6. If a client displays behavior detrimental to health such as smoking, eating a diet high in saturated fats, leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change behavior. The nurse can best reinforce the new adaptive behavior by

a. Explaining how the old behavior leads to poor healthb. Withholding praise until new behavior is well establishedc. Rewarding the client whether the acceptable behavior is performedd. Discussing the disadvantages of developing healthful behavior

7. A priority nursing assessment measure related to thrombolytic therapy following MI isa. Observe for rebound chest painb. Monitor for increase dysrhythmiasc. Monitor ECG every 4 hoursd. Observe signs of spontaneous bleeding

8. Crackles heard on lung auscultation indicatea. Pulmonary edemab. Bronchospasmc. Airway narrowingd. Fluid filled alveoli

9. The nurse can best evaluate the effectiveness of oxygen therapy to patients with congestive heart failure by observing the changes in client’s

a. ECGb. Arterial blood gassesc. Central venous pressured. Serum electrolyte values

10. Enalapril was given to a client with CHF. It is an angiotensin converting enzyme inhibitor that acts to improve cardiac output by

a. Reducing peripheral vascular resistance

b. Increasing peripheral vascular resistancec. Reducing fluid volumed. Improving myocardial contractility

11. A client with CHF will take oral furosemide at home. To help the client evaluate the effectiveness of therapy, the nurse should teach the client to

a. Take weight dailyb. Take daily blood pressurec. Take urine specimen to the laboratory for analysisd. Have a specimen for arterial blood gasses obtained each week for blood gas analysis

12. Clients with CHF are prone to atrial fibrillation. During the physical assessment, the nurse would suspect atrial fibrillation when palpation of the radial pulse revealed

a. Two regular beats followed by one irregular beatb. An irregular pulse rhythmc. Pulse rate below 60 perminuted. A weak thready pulse

13. Complications of atrial fibrillarion occur due toa. Stasis of blood in the atriab. Increase cardiac outputc. Decrease pulse rated. Elevated pulse pressure

14. The nurse should specifically alert for signs and symptoms of digitalis toxicity if laboratory findings indicate that the client has

a. Low sodiumb. High glucosec. High calciumd. Low potassium level

15. Which of the following best describe cardiogenic shock. The client experiences a. Decrease cardiac output due to hypovolemiab. Shock due to circulating blood volumec. Shock due to decreased cardiac contractilityd. Decrease cardiac output due to infection

16. The plan of care for a client with hypertension taking propranolol would includea. Instructing the client to discontinue the drug if nausea occurs and to monitor Blood Pressureb. Monitoring blood pressure every week and adjusting the medication dose accordinglyc. Measuring partial thromboplastin time weekly to evaluate blood clotting statusd. Instructing the client to notify the physician of irregular, slowed pulse

17. When teaching the client about Propranolol, the nurse should base the information on the knowledge that propranolol hydrochloride

a. Blocks beta adrenergic stimulation thus decreased heart rate and increased cardiac contractilityb. Blocks release of epinephrine thus decreased heart ratec. Blocks the acetycholine receptors in the smooth muscles of blood vesselsd. Blocks beta receptors thus decreasing myocardial contractility

18. A priority nursing doagnostic category for the client with hypertension would bea. Pain related to increased cerebral circulationb. Fluid volume deficit related to fluid loss secondary to intake of diureticsc. Impaired skin integrity related to increased pressure in the microcirculationd. Altered health maintenance related to unfamiliarity of the client to the aggressiveness of

the disease19. Which of the following are generally considered to be risk factors for the development of

atherosclerosis?a. Family history of MI, hypetension and anemiab. Diabetes, smoking and late onset of pubertyc. Male gender, total blood cholesterol above 150 mg/dl and low protein intaked. Physical inactivity, hypertension and diabetes

20. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.4 mg sublingually. The drug’s principal effects are produced by

a. Antispasmodic effect of myocardiumb. Stimulation of alpha an beta receptorsc. Vasodilation of peripheral vasculaturesd. Improved conductivity of the myocardium

21. The nurse teaches the client with angina about the common expected side effects of nitroglycerin including

a. Headache, hypotension and dizzinessb. Hypotension, flushing and dizzinessc. Hypotension, shock, shortness of breathd. Stomach cramps, flushing and dizziness

22. In explaining the procedure of coronary percutaneous transluminal coronary angioplasty (PTCA) to a client, the nurse should explain that the procedure involves

a. Opening of a stenosed artery with an inflatable balloon tipped catheterb. Increased blood clotting following proceduresc. Passing catheter through the coronary arteries to find blocked arteriesd. Inserting grafts to divert blood from blocked coronary arteries

23. The nurse identifies the commonality between a strain on the client’s heart with prolonged anemia or polycythemia to be

a. Pressureb. Temperaturec. Cardiac outputd. Surface tension

24. After a client has an endarterectomy, the nurse should plan to observe for a change ina. Appetiteb. Skin colorc. Bowel habitsd. Skin turgor

(Additional learning ) Thrombiangitis obliterans (Buerger’s Disease) is an occlusive vascular disease in which small and medium sized arteries become inflamed and spastic causing clots to form, idiopathic cause usually affecting legs and feet. The following questions refer to Thrombiangitis Obliterans

25. Which measure is most important for a client with thromboangitis obliterans?a. Protecting the extremities from traumab. Maintaining adequate hydrationc. Quitting smokingd. Protect the extremities from chilling and exposure

26. Intermittent claudication refers toa. Leg pain that occurs after exercise and relieved after restb. Non healing ulcers on the lower leg near the anklec. Pain in the calf or foot that occurs at restd. Burning or cold sensation that increases with exercise and is relieved by elevating the legs

27. Intermittent claudication is an indication of what condition?a. Phlebitisb. Arterial insufficiencyc. Venous insufficiencyd. Mitral regurgitation

28. While reading the patient’s chart, the nurse sees pedal pulses described as 4+ bilaterally. This indicates that this is

a. Thready and weakb. Slightly impairedc. Unequald. Normal

(Rationale : In the most widely used pulse scale, absent pulse is 0, markedly impaired 1+, moderately impaired 2+, slightly impaired3+, and normal 4+, With an abnormal pulse, the amplitude such as weak, thready or bounding also is described. The term bilateral means that pulses are equal)

29. With chronic occlusive arterial disease, the precipitating cause for ulceration and gangrenous lesion often is

a. Emotional stress which is short livedb. Poor hygiene and limited protein intakec. Stimulants such as coffee, tea, cola or drinksd. Trauma from mechanical, chemical or thermal sources

30. While auscultating a patient’s femoral area, the nurse notes a bruit. Bruits are caused bya. Turbulent blood flow through a stenotic vessel

b. Occluded blood vesselsc. Hypotension when the patient arisesd. Development of collateral circulation

You may continue answering general questions.

31. A 65 year old diabetic patient with arterial insufficiency in the legs complains that his feet are cold. Which nursing measure is contraindicated?

a. Applying heating pad to patient’s feetb. Applying warm socksc. Encouraging exercised. Increasing the room temperature slightly

32. Which of the following does not accurately describe Reynaud’s disease?a. It is characterized by episodic digital vasospasm associated with skin color changes?b. It is precipitated by exposure to cold or by emotional stressc. It is typically seen in fingers or toesd. It usually occurs in men ages 40 to 60

33. Which finding would the nurse expect when examining a patient with diagnosis of abdominal aortic aneurysm?

a. Tachycardiab. Pulsating abdominal massc. Paresis of legsd. Carotid bruits

34. A patient is scheduled for repair of abdominal aortic aneurysm. Which preoperative complications present the greatest threat to this patient?

a. Embolism in the foot b. Rupture of aneurysmc. Cerebrovascular accidentd. Myocardial infarction

Situation: Mrs. S, a 76 year old retired school teacher arrives at the Emergency department accompanied by her daughter. She complains that she has been experiencing “sinking spells” When asked for clarification, her daughter states that Mrs. S occasionally blacks out briefly during conversations and that she found her mother unconscious on the bathroom floor that morning. Questions 35 to 38 refers to this situation.

35. The nurse connects Mrs. S to the cardiac monitor. Initially, her ECG strip shows a PR interval of 0.26 sec, atrial and ventricular rates of 54 beats per minute and one to three unifocal PVCs per minute with compensatory pauses following each one. These findings indicate

a. Bradycardia with first degree atrioventricular block (AV block)b. Bradycardia with second degree AV blockc. Complete heart block with ventricular escape beatsd. Normal sinus rhythm with occasional PVCs

36. The physician places Mrs. S on Holter monitor on the medical unit and allows her to continue most of her normal activities. The nurse explains to her that monitoring

a. Correlates activities and heart response by using a diary and a taped ECGb. Denotes an ischemic response with threadmillc. Indicates valvular outlines on the monitor and correlates them with heart soundsd. Highlight “cold” spots on the imaging screen

37. After analyzing Mrs. S’s holter monitor results, the physician diagnose sick sinus syndrome with stoke – adams attacks and decides to insert a permanent ventricular pacemaker the next morning. The evening nurse explains to Mrs. S the changes she must make in her activities after receiving her pacemaker including

a. No heavy lifting for 6 monthsb. Brisk exercise to improve collateral circulationc. Curtailment of the needlework and daily walkd. Some limitation of vigorous upper extremity movements

38. The nurse reviews discharge instructions with Mrs. S. Which statement indicates that Mrs. S may not completely understand her instructions?

a. “I will take my pulse every morning and write on this chart”b. “If I have a little bit of clear drainage from my wound for a few weeks, I shouldn’t be

alarmed about it

c. “I’ve ordered a medical alert bracelet with my pacemaker information on it”d. “My daughter is buying me a new microwave oven – mine is one of those models that might not

be safe” (Additional learning) Sick sinus syndrome – results from sinus node disease or dysfunction that causes problems with impulse transmission and conduction. Common in older adults. The slow escape rhythm significantly affects cardiac output causing manifestations such as syncope (known as Stokes Adams attack), dizziness, fatigue, exercise intolerance and heart failure.

Answer the following questions on ECG

39. Which of the following findings needs further assessment?a. PR interval of 0.16 secb. RR interval of 0.16 secc. QRS interval of 0.16 secd. None of the above

40. ECG changes in hypercalcemia excepta. Shortened QT intervalb. Depressed ST segmentc. Widened T waved. Tachycardia

41. An ECG to evaluate the effects of hypocalcemia on the heart such asa. Prolonged ST segmentb. Inverted T wavec. Shortened RR intervald. All of the above

42. P wave representsa. Atrial depolarizationb. Rapid influx of sodium into the cellc. Membrane potential becoming more positive than restingd. All of the above

43. An early sign of ischemia in the ECGa. Inverted T waveb. Prominent Qc. ST segment elevationd. All of the above

44. QRS representsa. Impulse conduction in the atriab. Impulse conduction in the ventriclesc. Impulse conduction from atrial to purkinje fibersd. Impulse conduction resting

45. A “u” wave was identified by the nurse in the ECG and the nurse interprets this finding asa. Hyperkalemiab. Hypokalemiac. Hypercalcemiad. Hypocalcemia

46. T wave representsa. Ventricular relaxationb. Ventricular repolarizationc. Bothd. Neither

47. An absence P wave was seen on ECG, the nurse knows that such finding meansa. No impulse being initiated on the SA nodeb. No impulse being initiated by the AV nodec. No impulse transmission at all branchesd. A and B

48. Five (5) small squares in the ECG paper vertically placed is equal toa. 1 mmb. 0.5 mmc. 5 mmd. 10 mm

49. Hyperkalemia may manifest the following ECG changes, excepta. Tall T waveb. ST segment elevationc. Presence of U waved. No exception

50. ECG finding of client who had cadiac arrest?a. ST segment elevationb. Hold medicationc. Asystoled. Dysrythmias

51. The nurse assists the physician in treating a client in shock. One modality of treatment that employs the physical law explaining the increased venous return accompanying mild vasoconstriction underlies the use of

a. Adrenalin in treating shockb. Digoxin to increase cardiac outputc. Sympathectomy in treating hypertensiond. Rotating tourniquet in pulmonary edema

Rationale: Tourniquets constrict veins of the extremities and reduce venous return, digoxin does not cause vasoconstriction

52. A client is to have a pacemaker inserted. The explains that the catheter will be inserted into the subclavian vein and advanced to allow the electrode to be positioned in the

a. SA nodeb. Left atriumc. Right ventricled. Superior vena cava

Rationale : The pace maker electrode is inserted via the venous system into the right ventricle where PM generated impulses can directly stimulate the ventricles

53. A client will undergo treadmill test. Appropriate nursing care include the following excepta. Tell the client to avoid smoking a week prior to the testb. Avoid food and fluids 2 – 3 hours before the testc. Tell the client to wear comfortable shoesd. No exception

54. An echocardiogram was requested for cardiac patient. Pre procedure care includea. Assess medications being taken especially those that may affect BPb. Assess for allergy to iodinec. Assess for any metallic implantsd. No special preparation is needed

(Additional learning) Cardiac catheterization – maybe performed to identify CAD or cardiac valvular disease, to determine pulmonary artery or heart chamber pressures, to obtain myocardial biopsy, to evaluate artificial valves or to perform angioplasty or stent an area of CAD

55. A client will undergo cardiac catheterization to identify coronary artery disease. Pre procedure nursing care include the following, but

a. Assess for use of Aspirinb. Establish baseline of peripheral pulsesc. Discontinue oral anticoagulantd. Encourage oral fluids unless contraindicated

Rationale: Pre procedure, the client should be put on NPO 6 – 8 hours to prevent aspiration56. After cardiac catheterization, the nurse assesses the following, except

a. Cardiac rate and rhythmb. Catheter insertion site for bleeding and hematomac. Administer pain medications as prescribedd. No exception

57. When caring for a client after cardiac catheterization, it is most important that the nursea. Provide for restb. Administer oxygenc. Check ECG for 30 minutesd. Check pulses distal to the insertion site

58. During cardiac catheterization, blood sample from the right atrium, right ventricle and pulmonary artery are analyzed for their oxygen content. Normally,

a. All contain less CO2 than does pulmonary veinb. All contain more oxygen than does pulmonary vein bloodc. The samples all contain about the same amount of oxygend. Pulmonary artery blood contains more oxygen than the other examples

(Additional learning) Pericardiocentesis – The procedure is performed to remove fluid from the pericardial sac for diagnostic or therapeutic purposes. It may also be done as an emergency measure for the client with cardiac tamponade. A large gauge 16 to 18 needle is inserted to the left of the xiphoid process into the pericardial sac and excess fluid is withdrawn. The needle is attached to the ECG lead to help determine if the needleis touching the epicardial sac thus preventing piercing of the myocardium

59. Pericardiocentesis is being done to a client with cardiac tamponade. The nurse notes PVCs on ECG during the procedure, the nurse knows that this PVCs indicate that

a. The needle is touching the myocardium and should be withdrawn slightlyb. Normal findings during pericardiocentesisc. Arryhtmias from the diseases cardiac cellsd. All of the above

60. When auscultating the heart sound, Where should S1 (First heart sound) be heard most loudly?a. Over the claviclesb. At the apex of the heartc. Carotid areasd. Base of the heart

61. A client with pericardial effusion develop cardiac tamponade, assessment of the problem include a. Hypotension, jugular vein distention and pounding heart beatb. Rising venous pressure, increased cardiac output and muffled heart soundc. Chest pain, altered level of consciousness and hypertensiond. Hypotension, muffled heart sound and jugular vein distention

62. The nurse was giving health teaching to a client about nitroglycerine. Which of the following responses made by the client shows the need for further teaching?

a. “If the first dose does not relieve my pain in 5 minutes, I will take the 2nd dose”b. “I will not drink, eat or smoking until the tablet is completely dissolved in my mouth”c. “I should protect my tablets from heat, light and moisture and replace every 6 months”d. “If I develop headache, I must discontinue the drug and see my physician at once”

( Additional learning ) Acute Coronary Syndrome is a condition of unstable cardiac ischemia. ACS includes unstable angina and acute myocardial ischemia with or without significant injury of myocardial tissue

63. The nurse caring for a client with acute coronary syndrome identified which of the following Nursing Diagnosis to be highest priority

a. Anxiety related to unknown outcome of disorderb. Ineffective health maintenance related to lack of knowledge about CADc. Decreased cardiac output related to myocardial ischemiad. Ineffective tissue perfusion (Cardiopulmonary) related to underlying coronary artery

disease 64. The parents of young athlete who collapsed and died due to hypertrophic cardiomyopathy ask the nurse

how It is possible that their son had no symptoms of this disorder before experiencing sudden cardiac death. The nurse responds

a. “Exercise causes the heart to contract more forcefully and can lead to changes in the heart’s rhythm or outflow of blood from the heart in people with hypertrophic cardiomyopathy”

b. “It is likely your son had symptoms of the disorder before he died, but he may not have thought them important enough to tell someone about”

c. “ In this type of cardiomyopathy, the ventricle does not fill normally. During exercise, the heart may not be able to meet the body’s needs for blood and oxygen”

d. “Cardiomyopathy results in destruction and scarring of cardiac muscles, as a result, the ventricle may rupture during strenuous exercise, leading to sudden death”

65. A client comes to the emergency department with chest pain, dyspnea, and an irregular heartbeat. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia) with frequent premature ventricular contractions. Shortly after admission, the client has ventricular tachycardia and becomes

unresponsive. After successful resuscitation, the client is taken to the intensive care unit (ICU). Which nursing diagnosis is appropriate at this time?

a. Deficient knowledge related to interventions used to treat acute illnessb. Impaired physical mobility related to complete bed rest c. Social isolation related to restricted visiting hours in the ICU d. Anxiety related to the threat of death

66. A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. This client should avoid which of the following a. High volumes of fluid intake b. Aerobic exercise programs c. Caffeine-containing products d. Foods rich in protein

67. The nurse observes a client’s cardiac monitor and identifies asystole. This dysrhythmia requires nursing attention because the heart is

a. Not beatingb. Beating slowlyc. Beating irregularlyd. Beating very rapidly

68. A client with Congestive Heart Failure Class II, the client manifesta. Symptoms at restb. No symptom with regular physical activityc. Marked limitation of activities of daily livingd. Slight limitation of activities of daily living

69. To determine the effectiveness of Diuretic therapy in management of patient with Congestive heart failure, the nurse assesses the following except

a. Breath soundsb. Repeat Chest X rayc. Bipedal edemad. ABG

70. All of the following are possible nursing diagnosis for a client with Congestive heart failure, excepta. Risk of activity intolerance related to decreased cardiac output secondary to cardiac dysfunctionb. Risk for impaired skin integrity related to decreased tissue perfusion secondary to valvular effectc. Fluid volume excess related to decreased cardiac output secondary to myocardial

infarctiond. No exception

71. Health teaching in a client receiving digitalis include the following buta. Notify your physician if you develop double visionb. You may take antacid to enhance absorption of digoxinc. Incorporate potassium rich food in the dietd. No exception

72. Your client has a very low hemoglobin amount. What chief complaint would you expect during the heath history?

a. Sore throatb. Chest painc. Nausead. Fatigue

73. The nurse following a client post gastrectomy observes carefully for maturation failure anemia related to malabsorption, including

a. Numbness and tingling of extremities b. Steatorrheac. Dark yellow and bronze skind. Bone pain

74. Which of the following nursing diagnoses would be of highest priority for the client hospitalized for bone marrow transplant to treat relapse of acute myeloytic leukemia?

a. Disturbed body image related to bruising and hematoma formationb. Ineffective protection related to decreased phagocytesc. Anxiety related to fear of unknownd. Imbalance nutrition less than body requirements related to malabsorption of needed nutrients

75. A client with multiple myeloma calls the home health nurse complaining of severe back pain of new onset. The appropriate response by the nurse is

a. Reassure the client is bone pain is expected in this diseaseb. Inquire about the client’s use of NSAIDs and analgesic to mange painc. Suggest use of a back brace to reduce paind. Notify the physician of the onset of new pain

76. A client whose husband has hemophilia asks if her newborn baby girl could have the disease. The nurse response is based on the knowledge that

a. The most common forms of hemophilia are transmitted as sex linked recessive disorder, her daughter is at risk for carrying the defective gene

b. Because hemophilia is a sex linked recessive disorder carried by the Y chromosomes, her daughter has no risk of carrying the disease

c. Hemophilia is an autosomal dominant disorder, therefore her daughter has 50% chance of getting the disease

d. Although hemophilia is genetically transmitted its pattern of inheritance is unknown and her daughter will need to be tested for the defective gene

(Additional learning) Hodgkin’s disease – is a lymphatic cancer

77. With hodgkin’s disease the lymph nodes usually affected first are thea. Axillaryb. Inguinalc. Cervicald. Mediastinal

78. The highest incidence of Hodgkin’s disease is ina. Childrenb. Young adultsc. Elderly personsd. Middle aged persons

Rationale – common among 15 – 30 years of age79. A client is to have whole body radiation for Hodgkin’s disease. The nurse’s teaching plan should center

around the likely increased:a. Blood viscosityb. Susceptibility to infectionc. Red blood cell productiond. Tendency for pathologic fracture

80. A client with Hodgkin’s disease tells the nurse “ I might as well give up on dating, No woman would want me now” What is the most appropriate response?

a. “Its sounds you are concerned about the effects of this disease and the proposed treatment plan”

b. “Don’t worry. Malignant lymphomas are very treatable when caught in an early stage of the disease”

c. “Well, you never be able to have children all right but there are other ways to have satisfying relationship with women”

d. “Lots of women find bald man attractive, besides your hair may grow back soft and curly”81. Vitamin K is essential for normal blood clotting because it promotes

a. Platelet aggregationb. Fibrinogen formation by the liverc. Activation of clotting factor Xd. Formation of clotting factor VII

82. A client has anaphylactic reaction within the first half after an infusion containing Ampicillin is started. The nurse understands that the symptoms occurring during an anaphylactic reaction are the result of

a. Respiratory depression and cardiac standstillb. Constriction of capillaries and decreased cardiac outputc. Bronchial constriction and decreased peripheral resistanced. Decreased cardiac output and dilation of major blood vessels

83. Occurrence of a anaphylactic reaction after receiving Peniccilin indicates that the client hasa. An acquired atopic sensitizationb. Passive immunity to the penicillin allergenc. Developed potent bivalent antibodies when the IV administration was startedd. Antibodies to penicillin acquired after prior use of the drug

84. Which of the following results indicate moderate anemia?a. Hematocrit of 45%

b. Pulse rate of 140 per minutec. WBC of 14, 000d. Complaints shortness of breath with exercise

85. What method should be used to assess carotid arteries?a. Inspect for absence of movementb. Auscultate with the bell of stethoscopec. Palpate with firm pressured. Percuss lightly over each artery

86. Swelling of the body part as a result of lymphatic obstruction is labeleda. Lymphedemab. Lymphadenopathyc. Lymphangitisd. Central cyanosis

87. A 16 year old male sustained an open fracture in the right arm. Priority nursing diagnosis isRisk for infectionAcute PainImpaired mobilitySelf care deficit

88. Pathogenesis involvesa. Occurrence of signs and symptomsb. Studying etiologic factorsc. Disease progression leading to morphological and functional changesd. All of the above

89. A 5 year old boy bumped his head on the floor sustaining a small laceration on the forehead. Priority nursing diagnosis is

a. Impaired skin integrityb. Risk for infectionc. Anxietyd. Risk for bleeding

90. An 80 year old female with osteoporosis is hospitalized because of Pneumonia. She is diabetic and hypertensive. She is very active in the church activities. What is the most significant risk factor that predispose her to pneumonia

a. Activity in the churchb. Diabetes mellitusc. Osteoporosisd. Age

91. Which of the following laboratory findings need further evaluationa. WBC = 9500 /cu mmb. Hemoglobin = 13 g/Lc. Urine protein = 100mg/dayd. Specific gravity of urine = 1.040

92. The following are signs of systemic inflammation, excepta. Leukocytosisb. Feverc. Paind. No exception

93. A client with elephantiasis affecting the lower extremities would have the following nursing diagnoses, except

a. Fluid volume excessb. Disturbed body imagec. Risk for infectiond. Impaired skin integrity

94. Blister formation in deep partial thickness burn is caused bya. Increased blood flow to areasb. Increased capillary permeabilityc. Activation of WBCd. Vasodilation

95. A client with burn injury, deep partial thickness on the forearm less than 25% TBSA will have the priority nursing diagnosis

a. Fluid volume deficit

b. Risk for infectionc. Acute paind. Impaired skin integrity

96. Proteinuria may lead toa. Increase hydrostatic pressureb. Decreased oncotic pressurec. Bothd. Neither

97. Which of the following laboratory findings need further evaluation by the nursea. Thrombocytes of 600,000/cummb. Erythrocytes of 4.5 M/cummc. WBC of 5.0 T/cummd. Hemoglobin 10 g/L

98. A nurse is assessing a client with HIV, what is the most important laboratory finding the nurse must note that may induce symptoms of AIDS in this client?

a. Decreasing Neutrophilsb. Decreasing T lymphocytesc. Decreasing B lymphocytesd. Decreasing Eosinophils

99. The most priority nursing management for anemiaa. Help the client in activities of daily livingb. Manage fatigue, provide periods of restc. Prevent infection by aseptic techniqued. Administer ferrous sulfate as ordered

100. The nurse understands that Pernicious anemia resulted froma. Deficiency of vitamin B12b. Deficiency of Ironc. Deficiency of Folic acidd. All of the above

101. The priority nursing diagnosis for Pernicious anemia isa. Ineffective tissue perfusionb. Risk for hemorrhagec. Imbalance nutrition less than body requirementsd. Risk for anemia

102. A client is to be admitted with painful sickle cell crisis, the admitting nurse anticipates that the primary intervention for such client is

a. O2 administrationb. Hydrationc. Manage fatigued. Prevent infection

103. The client tells the nurse “I am not sure of this but the doctor says my problem is in the hemoglobin of my RBC, is that true?” The nurse would best respond

a. “Yes, that is true. The hemoglobin structure is abnormal”b. “Yes, that is true. The iron is lacking in the hemoglobin”c. “Yes, that is true. The amount of hemoglobin in the RBC is lacking”d. “Yes, that is true. All your hemoglobin must be replaced”

104. A child is suffering from Dengue hemorrhagic fever, the mother asks the nurse why such rashes are appearing in her child’s skin; The nurse responds based in the knowledge that

a. The virus attacks the plateletsb. The virus impedes platelet plug formation in small vesselsc. The virus stops clot formation thus leading to bleeding under the skind. The virus destroys the small vessels leading to its rupture

105. Expected patient outcomes for anemic patient with Imbalance nutrition less than body requirements, except

a. Prioritizes activitiesb. Eats a healthy dietc. Maintains adequate amount of iron, vitamin B12 and folic acidd. No exception

106. Patients with Polycythemia may manifest pruritus. Priority nursing management include the following except

a. Bathing in tepid cool water and vigorous toweling off after bathingb. Use of bicarbonate dissolved in bath waterc. Application of cocoa butter or oat meal based lotion and bath productsd. No exception

107. A client visited the clinic for routine check up. BP was 200/110. The nurse asks the client for any symptoms wherein the client responds negatively. The priority nursing diagnosis is

a. Knowledge deficit related to absence of symptomsb. Ineffective health maintenance related to uncontrolled high blood pressurec. Imbalance nutrition more than body requirements as evidence by obesityd. Risk for complications ( Cardiovascular ) related to elevated blood pressure

108. The client complains to the nurse, “Every time I am taking this antihypertensive medication, I would develop this throbbing headache, I do not like this anymore” the nurse responds best by

a. “ We will replace your medication as ordered”b. “I will inform your doctor about your headache”c. “That is normal adverse effect, you must bear it if you want to get well”d. “ I am very sorry for that but we have to continue your medications as prescribed”

109. The client asks the nurse, “ What is the difference between Clonidine (Catapress) and Nifedipine(Calcibloc)? Why do they need to replace the calcibloc?” The nurse responds based on the knowledge that

a. Catapress is a centrally acting drug that suppresses the sympathetic nervous systemb. Catapress is also a calcium channel blocker that is long actingc. Catapress is better drug that calcibloc in the treatment of hypertensiond. Catapress is another brand name for Nifedipine

110. A client suffers an acute chest pain that lasted for 5 minutes, it was so severe that the client thought he is going to die. The pain was relieved by Nitroglycerine and rest. The priority nursing diagnosis is

a. Ineffective myocardial tissue perfusion related to ischemia to cardiac cells as evidenced by pain

b. Acute pain related to ischemia and necrosis of cardiac cellsc. Knowledge deficit related to wrong notion of dying due to severe chest paind. Anxiety related to unknown cause

111. The nurse knows that Nitroglycerine is relieving the chest pain bya. Increasing O2 supply to the heart muscles by causing vasodilationb. Decreasing cardiac workload of the client by causing bradycardiac. Improving blood supply to cardiac cells by dilating atherosclerotic coronary vesselsd. Decreasing cardiac workload by increasing the volume of blood going back to the heart

112. The client asks the nurse, “How will I know if it Heart attack already?” The nurse responds bya. “ If the chest pain is longer than 5 minutes”b. “If you are not relieved by nitroglycerine”c. “If the pain is not relieved by positioning alone”d. “ If your ECG shows that it is heart attack”

113. Possible laboratory test findings in a client with Angina pectoris isa. Elevated homocysteine levelsb. Elevated CK MB isoenzymec. Elevated myoglobind. All of the above

114. A client is suffering from myocardial infarction. He is in the Coronary care unit. The CCU nurse noted appearance of six PVCs in this client per minute. The nurse knows that PVCs are occurring due to

a. Ischemia to cardiac cellsb. Possible re entry of impulses due to necrosisc. Unknown reasonsd. Arrythmias as complication of MI

115. The priority nursing diagnosis for the client above isa. Anxiety related to unknown causeb. Risk for cardiac arrestc. Decreased cardiac outputd. Acute pain related to ischemia and necrosis of cardiac cells

116. The most common cause of immediate death of clients with myocardial infarction isa. Dysrryhthmiasb. Cardiac arrest

c. Impaired gas exchanged. Airway obstruction

117. The client with cardiac arrest was started on Epinephrine IV during resuscitation. Epinephrine effects on this client include the following except

a. Improve cardiac contractionb. Vasoconstrictionc. Bronchodilationd. No exception

118. The client with Dilated Cardiomyopathy develops Heart failure Class 1. The priority nursing diagnosis is

a. Risk for ineffective tissue perfusionb. Risk for activity intolerancec. Risk for decreased cardiac outputd. Risk for infection

119. A client suffering from left sided heart failure due to MI was admitted in the emergency department due to acute pulmonary edema. The nurse would put the client into

a. High fowler’s positionb. Semi fowler’s positionc. Low fowler’s positiond. Position of comfort

120. Furosemide and digoxin were ordered for the client. The nurse assessed what laboratory finding prior to giving these medications?

a. Complete blood countb. Electrolytes levelc. Enzyme elevationd. All of the above

121. The nurse assessed the ECG and found that the client is having “U wave” in the ECG. The nurse knows that such finding indicate

a. Hypophosphatemiab. Hypokalemiac. Hypocalcemiad. Hyponatremia

122. A client was receiving Digoxin for three days following an acute attack of Congestive heart failure. The nurse best evaluates the effectiveness of Digoxin by

a. Monitoring heart rateb. Assess for disappearance of signs and symptomsc. Monitor cardiac outputd. All of the above

123. Priority nursing management for Pericarditisa. Monitor for signs of tissue perfusionb. Position the patientc. Administer NSAIDs as orderedd. Let the patient verbalize his feelings

124. Triggering factors for the most common type of asthma attacka. Exposure to pollensb. Infectionsc. Exercised. All of the above

125. All of the following is increased in a client with Bronchial asthma, excepta. Residual volumeb. Total lung capacityc. Expiratory reserve volumed. Vital capacity

126. The best method of monitoring routinely hypoxemia in client with an acute attack of asthma a. Arterial blood gassesb. Peak flow meterc. Pulse oximetryd. Assess cyanosis

127. The client with bronchial asthma was given Ipratropium ( Atrovent ) nebulization. The nurse knows that this drug is classified as

a. Xanthine bronchodilatorb. Sympathomimetic bronchidilatorc. Anticholinergic bronchodilator d. Steroid containing bronchodilator

128. Adverse effect of bronchodilator includea. Increase mucus secretionb. Increase O2 demand by cardiac cellsc. Hypotensiond. Bradycardia

129. Oxygen dissociation from hemoglobin and therefore oxygen delivery to the tissues are accelerated by

a. A decreasing oxygen pressure in the bloodb. An increasing carbon dioxide pressure in the bloodc. A decreasing oxygen pressure and /or an increasing carbon dioxide pressure in the bloodd. An increasing oxygen pressure and/or a deceasing car bon dioxide pressure in the blood

130. A client is admitted with carbon monoxide poisoning. The nurse understands that the poisoning. The nurse understands that the poisonous nature of carbon monoxide results from

a. Its tendency to block CO2 transportb. The inhibitory effect on vasodilationc. Its preferential combination with hemoglobind. The bubbles it tends to form in blood plasma

131. Cutting the left phrenic nerve results ina. Collapse of the right lungb. Paralysis of the left side of the diaphragmc. Relief of pain in the left side of the chestd. Paralysis of the diaphragm on the opposite side

132. A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that tidal volume is the amount of air

a. Exhaled forcible after a normal expirationb. Exhaled normally after a normal inspirationc. Trapped n the alveoli that cannot be exhaledd. Forcibly inspired over and above a normal inspiration

133. To facilitate maximum air exchange, the client should be placed in thea. Supine positionb. Orthopneic positionc. High fowler’s positiond. Semi fowler’s position

134. When spontaneous pneumothorax is suspected in a client with a history of emphysema, the nurse should call the physician and

a. Administer 60% O2 via venture maskb. Place the client on the unaffected sidec. Give O2 2L per minute via canulad. Prepare for IV administration of elecrolytes

135. When assessing an individual with a spontaneous pneumothorax, the nurse sould expect dyspnea and

a. Hematemesisb. Unilateral chest painc. Increased chest motiond. Mediastinal shift toward the involved side

136. A client has bronchoscopy in ambulatory surgery. To prevent laryngeal edema, the nurse shoulda. Place ice chips in the client’s mouthb. Offer the client liberal amounts of fluidc. Keep the client in the semi fowler’s positiond. Tell the client to suck on medicated lozenges

137. After a bronchoscopy because of suspected cancer of a lung, a client develops pleural effusion. This is most likely the result of

a. Extension of cancerous lesionsb. Excessive fluid intakec. Inadequate chest expansiond. Irritation from the bronchoscopy

138. Which of the following nursing diagnoses does the nurse identify as of highest priority for a client with tension pneumothorax?

a. Decreased cardiac outputb. Ineffective breathing patternc. Acute paind. Risk for aspiration

139. Structural changes in the respiratory system include the following, excepta. Decreased cough and gag reflexb. Decreased size of airwayc. Increased airway resistanced. Decreased dead space

140. The single most important contributor to lung diseasea. Family historyb. Smokingc. Allergensd. Recreational and occupational exposure

141. Decreased or absent breath sounds are seen in the following conditions, excepta. Pleural effusionb. Atelectasisc. Pnemothoraxd. Pneumonia

142. All of the following nursing diagnoses are appropriate for a client with an acute asthma attack. Which is of highest priority?

a. Anxiety related to difficulty of breathingb. Ineffective airway Clearance related to bronchoconstriction and increased mucus secretionc. Ineffective breathing pattern related to wheezing secondary to bronchial asthmad. Ineffective health maintenance related to lack of knowledge about attack triggers and appropriate

use of medication143. The nurse caring for a client with asthma notices that the client’s respirations have slowed and he

is no longer coughing. Breath sounds are diminished throughout his lung fields and absent in the bases. The nurse should

a. Notify the physicianb. Allow the client to rest undisturbedc. Obtain a chest x rayd. Ask family members to leave

144. Which of the following would be an expected finding in a client admitted with chronic obstructive airway disease?

a. AP chest diameter equal to a greater than lateral chest diameterb. Mental confusion and lethargyc. 3+ pitting edema of ankles and lower legsd. Oxygen saturation readings of 85% or less

145. An appropriate goal for a client admitted with an acute exacerbation of COPD would bea. Will verbalize self care measures to regain lost lung functionb. Arterial blood gas will be within normal limits by dischargec. Will maintain O2 saturation of 90% or higherd. Will identify strategies to help reduce number of cigarettes smoked per day

146. A client with skeletal traction suddenly develops right sided chest pain and shortness of breath. The nurse should

a. Check for Homan’s signb. Start oxygen per nasal canulac. Administer the prescribed analgesicd. Elevate the head of the bed 45 degrees

147. The nurse caring for a client with COPD recognizes which of the following as an early sign of possible respiratory failure?

a. Restlessness and tachypneab. Deep comac. Hypotension and tachycardiad. Decreased urine output

148. The nurse caring for a client undergoing mechanical ventilation for acute respiratory failure plans and implements which of the following measures to help maintain effective alveolar ventilation?

a. Keeps the client in supine positionb. Increases the tidal volume on the ventilatorc. Maintains ordered oxygen concentrationd. Performs endotracheal suctioning as indicated

SITUATION: Ms. Lola, age 79 is admitted to the hospital with a diagnosis of bacterial pneumonia. She has a temperature of 38 C, a productive cough and is experiencing difficulty in breathing.

149. When the nurse obtain the history, she learns that the patient has longstanding osteoarthritis, follows vegetarian diet, has never been seriously ill, and is very concerned with cleanliness. The patient says “I hope I can take a bath each day. I feel so dirty if I don’t bathe everyday”. Which of the following factors adds MOST to the danger of her illness?

a. The patient’s ageb. The history of osteoarthritis c. Following vegetarian diet d. Taking a bath everyday

150. The patient appears slightly cyanotic on admission. The cyanotic that accompanies bacterial pneumonia is primarily due to:a. Severe infection b. Iron deficiency anemia c. Inadequate circulationd. Poor oxygen of blood

151. Aspirin is administered to the patient because of its antipyretic anda. Analgesic effectsb. Antibiotic effectsc. Synergistic effectsd. Antihistamine effects

152. Age related changes in the client’s respiratory system contributes to the development of her condition

a. Decreased protection against foreign particlesb. Decrease number of cilia and mucusc. Increased infection rated. All of the above

SITUATION : Mr. Peter Whitney age 65 is admitted to the hospital with an acute exacerbation of long stand COPD brought on by upper respiratory infection. He is tachpyneic and acutely short of breath. Both Mr. Whitney and his wife are extremely anxious.

153. Which of the following physical assessment findings is typical in a patient with advanced obstructive pulmonary disease?

a. Increased anterior posterior chest diameter b. Under developed neck musclesc. Collapsed neck veins d. Increased chest excursions with respiration

154. The primary purpose of pursed lip breathing is to help a. Promote oxygen intake b. Strengthen diaphragm c. Strengthen the intercostals muscled. Promote carbon dioxide elimination

155. Arterial blood gases are drawn while the patient is breathing room air. The results are pH 7.32, PO2 mmHg. PCO2 80 mmHg. What conclusion can the nurse safely make from these findings?

a. The patient is in metabolic acidosisb. The patient is in respiratory acidosisc. The patient is in metabolic alkalosis d. The patient is in respiratory alkalosis

SITUATION: After a serious automobile accident, Mr. Taylor age 74 transported by ambulance to the emergency department. He complains of severe pain in his right chest where the struck the steering wheel. He also experienced a compound fracture of his right tibia and fibula and multiple lacerations and contusions.

156. Which of the following findings would confirm the presence of a right pneumothrax?a. Pronounced ralesb. Inspiratory wheezesc. Dullness to percussiond. Absence of breath sounds

SITUATION: Manny was admitted to the hospital with a diagnosis of hypertension157. At the time of Manny’s physical examination, which finding was indicative of hypertension?

a. Pupil changes on opthalmoscopic examb. Presence of a second heart soundc. Sinus rhythm on auscultationd. Cardiac enlargement on percussion

158. Which test should be ordered for Manny before treatment is indicated?a. Creatinine clearancesb. Serum uric acidc. Serum lipid profiled. CBC

159. When teaching Manny precautions to take while on hypertensive medication, the nurse should advise him to

a. Avoid standing for long periods of time b. Observe for black and blue marksc. Learn to take his BP TIDd. Take at least one hot bath daily

SITUATION: Mr. E. is a clerk in a grocery store. During a hold up, he was shot in the right chest. A thick dressing was applied to the wound. He was immediately taken to the emergency room of the local hospital, where emergency medical technician noted that there was a sucking noise form the wound.

160. Mr. E’s BP dropped to 100/60. His pulse rate is 96 and weak. His respiratory rate is 40. The most appropriate immediate care by the nurse should include positioning Esteban in

a. An upright position and removing the dressing to inspect the wound b. A semi fowler’s position and administering oxygen c. Trendelenburg’s position and drawing blood for type and cross matchd. Trendelenburg’s position and administering oxygen

161. Mr. E is found to have pneumothorax. Immediate priority planning for his care should include readying equipment for which procedure?

a. Suctionb. Insertion of chest tube c. Insertion of tracheostomy tubed. Decompression of the pericardial sac

162. Mr. E’s lungs are fully expanded and the chest tube is scheduled to be removed. During the removal procedure he should be instructed to

a. Hold his breathb. Breath normallyc. Forcibly exhale while bearing downd. Take several rapid swallow breaths

SITUATION: Mr. Sison is a 65 year old man who has been admitted to the hospital with advanced cirrhosis of the liver. He lives with his daughter, Lisa and her husband David.

163. On assessing Mr. Sison upon admission, the nurse notes that the client has ascites. The nurse should recognize that this is a result of

a. Portal hypertension, decreased colloidal osmotic pressure and decreased serum albuminb. Increased capillary permeability, increased albumin-globulin ration and obstruction of the

hepatic ductc. Portal hypertension, decreased capillary permeability and increased destruction of the

aldosteroned. Increased venous pressure, excretion of sodium and obstruction of lymphatic channels

164. While reviewing the patient’s chart, the nurse notes that he is anemic. The nurse should recognize that this is because of a/an

a. Lack of intrisic factor in the congested stomach wallsb. Failure of the hepatic cells to manufacture hematopoietin

c. Decreased production of prothrombin and fibrinogend. Increased destruction of RBC by the enlarge spleens not been proven

SITUATION : Mrs. Bomar age 69 has a history of congestive heart failure. Her physician recently increased her daily lanoxin dose as her condition was deteriorating. Ten days ago Mrs. Bomar stopped taking all her medications, which she blamed for her frequent headache. She is admitted now to the ER with congestive heart failure complicated by pulmonary edema. She is edematous and cyanotic in acute respiratory distress, extremely anxious and complaining of nausea.

165. When auscultating the patient’s lungs, the type of sounds the nurse will most likely hear area. Wheezing soundsb. Ralesc. Metallic tingling soundsd. Louder inspiratory that expiratory sounds

166. In which of the following position in bed is the patient likely to be most comfortablea. Low Fowler’s position b. Sim’s position right c. High Fowler’s positiond. Trendelenburg position

167. Digoxin is administered to the patient primarily because the drug helpsa. Dilate coronary arteries b. Strengthen heart beatc. Decrease cardiac dysrhthmiasd. Decrease the electrical activity of the myocardium

168. The nurse knows that Digoxin slows down heart rate bya. Slows down SA node from transmitting impulsesb. Slows down opening of Sodium channel in the cell membranec. Slows down entry of calcium d. Slows down the release of potassium out of the cell

169. The doctor orders Nifedipine 10 mg TID to this client. The nurse woulda. Administer drug as ordered because Nifedipine enhances the effect of Digoxinb. Question the drug ordered because Nifedipine increases toxic effects of Digoxinc. Clarify the route of drug administration before giving the drugd. Ask the head nurse first before giving the drug

170. The following are contraindication to Digoxin therapy, excepta. Amiodarone with Digoxin induce arythmiasb. Hypertrophic cardiomyopathyc. Chronic Glomerulonephritisd. Pulmonary edema

171. A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of

a. Lipids and fibrous tissueb. WBCsc. Lipoproteinsd. High density cholesterol

172. The coronary arteries are susceptible to development of arteriosclerosis because coronary areteries:

a. Are smaller in diameterb. Accumulate more Low density Lipoproteinc. Have numerous twist and turnsd. Have decreased pulse pressure

173. The nurse is teaching a 45 year old patient about ways to lower cholesterol levels as they are elevated. One method is exercise, which

a. Increases HDL and decreases triglyceridesb. Increases LDL and decreases triglyceridesc. Decreases HDL and increases LDLd. Decreases both HDL and LDL

174. When discussing angina pectoris secondary to atherosclerotic disease with a patient, the patient asks why he or she experiences chest pan with exertion. The nurse informs the patient exertion

a. Increases the heart’s oxygen demandsb. Causes vasoconstriction of the heart

c. Increases blood flow to the mesenteric aread. Reduces effectiveness of medication

175. Which abnormal laboratory value is most indicative of aplastic anemia?a. a decrease hemoglobinb. an elevated white blood cellc. an elevated red blood cell countd. a decreased erythrocyte sedimentation rate

176. After confirming the diagnosis of iron-deficiency anemia through laboratory values, the next essential test is:

a. Stool guaiacb. Liver function.c. Lipid profile.d. Endoscopy.

177. If none of the following bed positions is contraindicated, which position would be preferred for the client with hypovolemic shock?

a. Supine.b. Semi-fowler’s.c. Supine with the legs elevated 15 degrees.d. Trendelenburg’s.

178. Which of the following points should the nurse include about sublingual nitroglycerin when instructing the client with angina?

a. the drug will increase urine outputb. store tablets in a tight, light resistant containerc. use the tablets only pain is severed. the shelf life of nitroglycerin is long, it keeps for up to 2 year

179. A middle-aged woman with malignant growth on the larynx is admitted to the hospital for a laryngectomy. The client would most likely state that the earliest symptom of her health problem was:

a. a sore throatb. chronic hoarsenessc. pain radiating to the eard. difficulty swallowing

180. While a client with hypertension is being assessed, he says to the nurse, “I really don’t know why I’m here. I feel and haven’t had any symptoms. “The nurse would explain to the client that symptoms of hypertension:

a. are often not often b. signify a high risk of strokec. occur only with malignant hypertensiond. appear after irreversible kidney damage has occurred

181. A 54 year old woman comes to the emergency department complaining of chest pain on exertion. The pain subsides with rest. A myocardial infarction (MI) is ruled out and the client is diagnosed with stable angina. The woman says, “I really thought I was having a heart attack. How can you tell the difference?” Which response by the nurse would provide the client with the most accurate information about the:

a. “The pain associated with a heart attack is much more severe”b. “The pain is associated with a heart attack radiates into the jaw and down the left arm”c. “It is impossible to differentiate anginal pain from that of a heart attack without an ECG”d. “The pain of angina is usually relieved by resting or lying down”

182. Non-pharmacological approaches to hypertension control that the nurse may be involved in teaching the client with hypertension include:

a. proper administer of anti hypertensive agentsb. activity restrictionsc. low potassium therapyd. a regular exercise program

183. The client is taking triamcinolone acetonide (Azmacort) inhalant to treat her bronchial asthma. Which of the following conditions is the client at increased risk for developing while taking this medication?

a. oral candidiasisb. hyperglycemiac. gastric ulcerd. fluid retention

184. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will

a. Maintain a fluid intake of 800 mL every 24 hours.b. Experience chills only once a day.c. Cough productively without chest discomfort.d. Experience less nasal obstruction and discharge.

185. The nurse teaches 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 instill.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.186. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which

of the following instructions would be appropriate for the nurse to give the client?a. “Use your nasal decongestant spray regularly to help clear your nasal passages.”b. “Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.”c. “It is important to increase your activity. A daily brisk walk will help promote drainage.”d. “Keep a diary of when your symptoms occur. This can help you identify what precipitates

your attacks.” 187. Which of the following measures should the nurse perform in relation to suctioning a

tracheostomy tube?a. Apply suction while inserting the suction catheter into the tubeb. Change the tracheostomy tube after suctioning the clientc. Select a suction catheter that approximates the diameter of the tracheostomy tube d. Administer high concentrations of oxygen before and after suctioning the client

188. The nurse is evaluating a client’s lung sounds. Which of the following breath sounds indicate adequate ventilation when auscultated over the lung fields?

a. Vesicularb. Bronchialc. Bronchovesiculard. Adventitious

189. A client is scheduled for radical neck surgery and a total laryngectomy. During the preoperative teaching, the nurse should prepare the client for which of the following postoperative possibilities?

a. endotracheal intubationb. insertion of a laryngectomy tubec. immediate speech therapyd. gastrostomy tube

190. As part of the client’s diagnostic work-up, she is to have a bronchoscopy under local anesthesia. Her preoperative medication will be atropine sulfate, 0.4 mg, and meperidine HCl, 100 mg IM. Which of the following interventions should the nurse perform after the test?

a. Irrigate the NGT with 30mL of normal saline every 2 hoursb. Offer 200mL of oral fluids every hour to liquefy lung secretionsc. Observe the abdomen for signs of distention and broad-like rigidityd. Position the client on her side and keep her NPO for several hours

191. Which of the following symptoms is not typically associated with peripheral arterial disease?a. ankle edemab. intermittent claudicationc. decreased or absent pulsesd. cool skin

192. The nurse is preparing the client with heart failure to go home. The nurse would instruct the client to:

a. monitor urine output dailyb. maintain bed rest for at least 1 weekc. monitor daily potassium intaked. weigh daily

193. A patient receives morphine sulfate post-operatively for complaints of pain. Since the patient is receiving morphine, which of the following medications would be MOST important for the nurse to have available?

a. Naloxone (Narcan)

b. Disulfiram (Antabuse)c. Dolophine (Methadone)d. Epinephrine (Adrenalie)

194. A client scheduled for a cardiac catheterization says to the nurse “I know you were in here when the doctor had me sign the consent form for the test. I thought I understood everything, but now I’m not so sure”. Which of the following responses by the nurse is BEST?

a. “Why didn’t you listen more closely?”b. “You sound as if you would like to ask more questions”c. “I’ll get you a pamphlet about cardiac catheterization”d. “That often happens when this procedure is explained to clients”

195. After suctioning a client’s tracheostomy tube, the nurse waits a few minutes before suctioning again. The nurse would use intermittent suction primarily to prevent:

a. stimulating the client’s gag reflexb. depriving the client of sufficient oxygen supplyc. dislodging the tracheostomy tubed. obstructing the suctioning catheter with secretions

196. Which of the following activities would the nurse likely to choose to implement in response to a nursing diagnosis of Activity Intolerance related to lack of energy conservation?

a. encourage the client to perform all tasks early in the dayb. encourage the client to alternate periods of rest and activity throughout the dayc. administer narcotics to promote pain relief and restd. instruct the client to perform daily hygienic care until activity tolerance improves

Situation: The community health nurse is making her first home visit to Mr. Juan Dela Cruz, a 60-year –old with emphysema.

197. The tissue change most characteristics of emphysema isa. accumulation of mucus in the pleural space b. constriction of capillaries by fibrous tissuec. filling of the air space by inflammatory coagulationd. overdistention , inelasticity ,and rupture of the alveoli

198. The primary goal of Mr. dela Cruz’s medical and nursing rehabilitation program should be to help him achieve

a. decreased physiologic dependence upon others b. increased understanding of infectious disease control c. decreased awareness of subjective symptomsd. increased capacity for physical exertion

199. Mr. dela Cruz is to be instructed on the use of aerosol therapy. The physician has

ordered treatment with Salbutamol (Ventolin) three times daily a. eliminate bronchial infection b. improve pulmonary ventilationc. decrease bronchial irritationd. increase pulmonary circulation

200. The desired pharmacologic effect of Salbutamol for Mr. deal Cruz is that ofa. bronchodilatorb. antibioticc. detergent d. demulcent

201. In teaching Mr. dela Cruz the technique of diaphragmatic breathing , which of the following steps is correct?

a. Place both hands on his chest b. Breath in through the mouth while tightening the abdominal musclesc. Breath out slowly through the nosed. Breath out through pursed lips while contracting the abdominal muscles

202. Cor pulmonale is a complication that can develop in a patient with emphysema. Symptoms that are most indicative of this condition are

a. dyspnea, persistent cough, distended neck veinsb. anorexia, dyspnea, weight lossc. jaundice, orthopnea, ankle edemad. persisitent cough, anorexia, orthopnea

203. The heart’s pacemaker or sinoauricular node is locateda. at the base of the right atrial septumb. in the upper part of the right atriumc. at the entrance of the right ventricled. in the anterior left atrium

204. Hypertension is defined as persistently elevated systolic and diastolic pressure abovea. 200/80b. 170/90c. 140/90d. 170/100

205. The clinical nurse reviews the laboratory reports of a hypertensive patient whose therapeutic regimen is being re-evaluated. Which laboratory test results indicate need for adjustment

a. Urine protein 250 mg/24 hrb. Urine specific gravity 1.030c. Venous blood ph 7.38d. Serum sodium 140 mEq/L

Situation: Mrs. Pauline Garcia, a 55-years-old attorney with a history of hypertension, is admitted to the coronary care unit with tentative diagnosis of myocardial infarction. She complains of severe chest pain and is dyspneic.

206. The most important priority in caring for Mrs. Garcia isa. improving her electrolyte balanceb. improving her oxygenationc. lowering her blood pressured. increasing her urinary output

207. Mrs. Garcia is placed on a cardiac monitor. For which life-threatening arrhythmia does she need to be observed?

a. sinus tachycardiab. Sinus bradycardiac. Premature atrial contractionsd. Consecutive premature ventricular contractions

208. The physician orders oxygen by nasal cannula for Mrs. Garcia. The nurse knows that a humidifier is used when administering oxygen primarily because

a. oxygen is drying to the mucous membraneb. moisture will loosen secretionsc. oxygen diffuses more readily through waterd. humidified oxygen is more rapidly absorbed

209. A sign of developing pulmonary edema in a patient with chronic heart disease is a. cyanosisb. increased coughingc. depressed respiratory rated. weight loss

210. Before adiministration of Morphine, the nurse must get the respiratory rate becausea. Morphine causes Cheyne- stokes breathingb. Morphine may cause respiratory depression

c. Morphine may not relieved the pain if RR is more than 20/mind. Morphine causes hypotension

211. Aminophyline is often administered to the patient in pulmonary edema toa. increase pulmonary arterial pressureb. decrease bronchospasmc. increase peripheral vascular pressured. decrease cardiac irritability

212. Mr. Juan Reyes, 75 years old, is brought to the emergency room in an unconscious state. A stat blood gas analysis reveals a plasma pH of 7.25 and Pco2 of 70 mmHg. Mr. Reyes’s blood gases indicate that he is in a state of

a. respiratory acidosisb. metabolic anhydremiac. respiratory alkalosisd. metabolic acidosis

213. Before initiating oxygen therapy the nurses should know if the patient a. is hypertensiveb. is taking diureticsc. has a history of diabetesd. has s history of chronic pulmonary disease

214. What is the rationale for maintaining maximum respiratory function for a patient with CVA (cerebral vascular accident)?

a. More oxygen is needed to meet increased metabolic needsb. Oxygen deprivation may result in cerebral damagec. Blood volume is increased by an adequate oxygen supplyd. Cerebral anoxia can precipitate acute renal failure

215. If a patient goes into respiratory failure the most immediate priority is to a. obtain blood gases for analysisb. initiate assisted ventilation c. administer sodium bicarbonate IVd. determine patency of the airway

Situation: Mrs. Diaz, a 69-year-old woman, has been found to have pernicious anemia

216. Which of the following is a common early symptom due to her anemia?a. Dysuriab. Depressionc. Tingling of handsd. Dyspnea

217. It is essential that Mrs. Diaz’s family understands that a. blood transfusions will be necessary on a regular basisb. vitamin B12 must be continued for her lifetimec. behavioral disturbances are to be accepted as normal d. the condition can be controlled with a well-balanced diet

218. The pathophysiology of pernicious anemia results from a. total vitamin B deficiencyb. a deficiency of a extrinsic factorsc. severe iron deficiencyd. a deficiency of intrinsic factor

219. The client has experienced chest pain at 9 am, he was rushed to the hospital after an hour. Laboratory tests were ordered stat, The nurse anticipates that blood tests would reveal

a. Cardiac enzyme elevationb. Cardiac enzyme depression

c. Cardiac enzyme normald. Elevated homocysteine level

220. The following conditions may manifest hemolysis in patients, exceptA. Sickle cell anemiaB. Pernicious anemiaC. Hereditary spherocytosisD. G6PD deficiency

221. A test for ABO and Rh incompatibility that identifies antigen and antibody in the RBC and the plasmaA. Schilling’s testB. CBCC. Coomb’s testD. Bone marrow aspiration

222. Sickle cell crisis is most commonly caused byA. InfectionB. DehydrationC. RBC sequestrationsD. All of the above

223. Schilling’s test is a test forA. Absorption of vitamin B12B. Presence of intrinsic factorsC. Deficiency of Folic acidD. All of the above

224. Objective assessment in patients with anemia include all of the following butA. Pale conjunctivaB. RBC of 3,000,000C. Easy fatigabilityD. No exception

225. In client with Iron deficiency anemia, priority dependent nursing intervention would beA. Provide periods of restB. Administer ferrous sulfate as orderedC. Small frequent mealsD. All of the above226. The following antihypertensive drugs may cause vasodilation to decrease blood pressure, exceptA. Alpha 1 antagonistB. Calcium channel blockersC. Ace inhibitorsD. No exception227. One of the most significant concerns for medical and nursing management of hypertension isA. Complications from medicationsB. Insufficient informationC. Non compliance with recommended therapyD. Uncontrolled dietary management228. After bronchoscopyA. Client maybe given ice chips and fluids after he demonstrates that he can perform the gag reflexB. Should immediately be given a house to alleviate the hunger resulting from the requested fastC. Should initially be given ice ginger ale to prevent vomiting and possible aspiration of stomach contentsD. Will need to remain NPO for 6 hours to prevent pharyngeal irritation229. Neuromuscuar blockers are given to patients with Acute Respiratory Failure who are on

ventilator assistance to accomplish all of the following, exceptA. Maintain Positive end expiratory PressureB. Maintain better ventilationC. Increased respiratory rateD. Keep the patient from fighting the ventilator230. Clinical manifestations directly related to cor pulmonale include all of the following, exceptA. Dyspnea and coughB. Diminished peripheral pulsesC. Distended neck veinsD. Edema of the feet and legs231. For a patient with chronic bronchitis, the nurse expects to see the major clinical symptoms of

A. Chest pain during respirationsB. Sputum and productive coughC. Fever, chills and diaphoresisD. Tachypnea and tachycardia232. Obstruction of the airway in the patient with asthma is caused by all of the following, exceptA. Thick mucusB. Swelling of bronchial membranesC. Destruction of alveolar wallD. Contraction of muscles surrounding the bronchi233. Respiratory difficulty and paralysis of al four extremities occur with spinal cord injury located

a. Above C4b. At C6c. At C7d. Around C8

234. Because infection is the leading cause of mortality in the oncology population, the nurse preoperatively notes the significance of

a. basophil of 1.3 %b. An eosinophil count of 4.5 %c. A lymphocyte count of 23%d. A neutrophil count of 20%

235. Albert is admitted with a radiation induce thrombocytopenia. As a nurse you should observe the following symptoms

a. Petecchiae, ecchymosis, epistaxisb. Weakness, easy fatigability and pallorc. Headache, dizziness, blurred visiond. Severe sore throat, bacteremia, hepatomegaly

236. Plasma leakage produces edema which increasesa. Circulating blood volumeb. Hematocrit levelc. Systolic blood pressured. All of the above

237. Early indicators of late stage septic shock include all of the following, excepta. Decreased pulse pressureb. Full bounding pulsec. Pale cool skind. Renal failure

238. The primary goal in treating cardiogenic shock isa. Improve the heart’s pumping abilityb. Limit further myocardial damagec. Preserve healthy myocardiumd. Treat oxygenation needs of the heart muscle

239. A client who has pneumonectomy is in the post anesthesia care unit. The nurse’s primary concern at this time would be to maintain:

a. Blood replacementb. Ventilatory exchangec. Closed chest drainaged. Supplementary oxygenation

240. When assessing the breath sounds of a client with COPD, the nurse hears rhonchi. Rhonchi can best describe as:

a. Snorting during inspiratory phaseb. Moist rumbling sound that clears after coughingc. Musical sound more pronounced during expirationd. Crackling inspiratory sounds unchanged with coughing

241. The best method to assess for stridor in immediate postop period after a radical neck dissection is to

a. Listen with stethoscope over the tracheab. Assess the client’s ability to cough and deep breathec. Determine the client’s ability to do neck exercisesd. Listen with stethoscope over the base of the lungs

242. The nurse’s physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. The nurse should:

a. Initiate O2 therapyb. Assess a pleural friction rubc. Obtain a chest X ray film immediatelyd. Position the client in Fowler’s position

243. When discussing breathing exercises with a post op client, the nurse should include teaching the client to:

a. Take short frequent breathsb. Exhale with open mouth openc. Plan to do exercise twice a dayd. Place the hand on the abdomen and feel it rise

244. A 21 year old aspiring actress is admitted for rhinoplasty to improve her appearance and facilitate her breathing. When monitoring for hemorrhage after the surgery, the nurse should assess specifically for the presence of

a. Facial edemab. Excessive swallowingc. Pressure around eyesd. Serosanguinous drainage on dressing

245. A client with emphysema is short of breath and using accessory muscles of respiration. The nurse recognizes that the client’s dyspnea is caused by

a. Spasms of the bronchi that traps the airb. An increase in the vital capacity if the lungsc. A too rapid expulsion of air from the alveolid. Difficulty in expelling the air trapped in the alveoli

246. A client with a 10 year history of emphysema is admitted in acute respiratory distress. The nurse’s assessment of this client will include observing for:

a. Pursed lip breathingb. Use of accessory muscles for respirationc. Signs and symptoms of respiratory alkalosisd. Prolonged inspiration with considerable effort

247. A client with a history of Emphysema is in acute respiratory failure with respiratory acidosis. Low level oxygen is administered by a nasal cannula. Four hours later, the nurse identifies that the client has increased restlessness and confusion followed by a decreased respiratory rate and lethargy. The nurse could:

a. Increase oxygen by 2% incrementsb. Question the client about confusionc. Percuss and vibrate chest wallsd. Discontinue or decreased oxygen flow rate

248. The nurse is teaching the client diaphragmatic breathing. The client should be advised to:a. Take rapid deep breathsb. Breath with hands on the hipsc. Expand abdomen on inhalationd. Perform exercises in the orthopneic position

249. A 21 year old client comes to the emergency department with the chief complaint of left sided chest pain following a racquetball game. A chest x ray reveals a left pneumothorax. When assessing the left side of the client chest, the nurse would expect to find

a. A resonant sound on percussionb. Vocal fremitus on palpationc. Rales and rhonchi on auscultationd. An absence of breath sounds on auscultation

250. A client with pneumothorax asks, “Why did they put tubes on my chest?” The nurse should explain that the purpose of the chest tube is to

a. Check the bleeding in the lungb. Monitor the function of the lungc. Drain fluid from the pleural spaced. Remove air from the pleural space

251. When inspecting a dressing following a partial pneumonectomy for cancer of the lung, the nurse observes some puffiness of the tissue around the area. When the area is palpated, the tissue feels spongy and crackles. When charting, the nurse should describe this as

a. Stridorb. Crepitusc. Pitting edemad. Chest distention

252. When turning a client following right pneumonectomy, the nurse should plan to place the client in either the:

a. Right or left side lying positionb. High fowler’s or supine positionc. Supine or right side lying positiond. Left side lying position or low fowler’s position

253. After thoracentesis for pleural effusion, a client returns to the physician’s office for a follow up visit. The nurse would suspect a recurrence of pleural effusion when the client says:

a. “Lately I can only breathe well when I sit up”b. “During the night I sometimes have fever and chills”c. “I get a sharp stabbing pain when I take deep breath”d. I am coughing up larger amounts of thicker mucus for the last two days

254. During the immediate post op period after laryngectomy, a nursing priority for the client should be to

a. Provide emotional supportb. Observe for signs of infectionc. Keep the trachea free of secretionsd. Promote a means of communication

255. Chronic Bronchial asthma will result toa. Respiratory alkalosisb. Respiratory acidosisc. Metabolic acidosisd. Metabolic Alkalosis

256. After surgery, the physician orders an incentive spirometer for a client. The nurse would know that the client was using the spirometer correctly when observing that the client

a. Uses the incentive spirometer for 10 consecutive breaths an hourb. Coughs twice before inhaling deeply through the mouth piecec. Inhales deeply, seals the lips around the mouthpiece and exhalesd. Inhales deeply through the mouthpiece hold breath for 2seconds then exhales

257. A 60 year old male is returned to the surgical unit after laryngoscopy. The nurse reminds the client not to take anything by mouth until instructed to do so. This nursing intervention generally would be considered:

a. Appropriate because these clients usually experience painful swallowing for several daysb. Appropriate because early drinking or eating after the client’s laryngoscopy may result in

aspirationc. Inappropriate because the client is not unconscious and maybe thirsty after being NPOd. Inappropriate because the client is likely to be anxious and probably will not be aware of feeling

thirsty 258. A total laryngectomy and radical neck dissection is scheduled for client with cancer of the

larynx. When reinforcing the physician’s statements to the client, the nurse should review what the surgery entails and what abilities will be lost. The discussion also should focus on what abilities will be retained, such as the ability to:

a. Blow the noseb. Sip through the strawc. Chew and swallow foodd. Smell and differentiate odors

259. A client is receiving an antihypertensive drug IV for control of severe hypertension. The client’s BP is unstable and at 160/94 before the infusion. Fifteen minutes after the infusion is started the blood pressure rises to 180/100. The response to the drug would be describe as

a. Allergic responseb. Synergistic responsec. Paradoxical responsed. Individual hypersusceptibility

260. Evaluation of effectiveness of Nitroglycerine SL is based ona. Relief of anginal painb. Improve cardiac output

c. A decreased in blood pressured. Dilation of superficial vessel

261. A client is receiving an anticoagulant for pulmonary embolism. The drug that is contraindicated for clients receiving anticoagulant is

a. Chloral hydrateb. Acetylsalicylic acidc. Isoxsuprine ( Vasodilan )d. Chlorpromazine (Thorazine )

262. Early symptoms of Morphine overdose includea. Slow pulse, slow respiration and sedationb. Slow respirations, dilated pupils and deep sleepc. Profuse sweating, pinpoint pupils and deep sleepd. Slow respiration, constricted pupils and deep sleep

263. A nurse is taking care of the elderly with COPD in the home care. To prevent occurrence of pneumonia, the nurse would include which of the following in her plan of care?

a. Instruct and observe the patient of thorough hand washingb. Administering vaccines as orderedc. Prevent patients to talk with one another for more than an hourd. All of the above

264. The most definitive diagnostic test for Iron deficiency anemia isa. CBCb. Bone marrow aspirationc. Schilling’s testd. Hematocrit

265. A client who is suffering from Parkinson’s disease developed Congestive heat failure secondary to myocardial infarction. Dopamine drip was ordered. The nurse knows that such medication

a. Will increase release of calcium from cardiac cellsb. Prolong cardiac repolarizationc. Will replace lost dopamine in the braind. All of the above

266. Elderly people have a high incidence of hip fracture because ofa. Carelessnessb. Fragility of the bonesc. Sedentary existenced. Rheumatoid diseases

267. The nurse would expect an elderly client with hearing loss caused by aging to havea. Copious, moist cerumenb. Tears in the tympanic membranec. Difficulty hearing women’s voicesd. Overgrowth of the epithelial auditory lining

268. The test that should be included in the yearly physical examination of men during the late middle and older adult year is

a. PSAb. ELISA for HIVc. Triglyceridesd. Rheumatoid factor

269. A client with a history of hypertension is hospitalized with a Transient Ischemic Attacks (TIA). The client has been told to stop smoking. The nurse discovers a pack of cigarettes in the client’s bathrobe. The best course of action to take at this time is to:

a. Let the client know where they foundb. Discard them without making a commentc. Report the situation to the head nursed. Call the physician and request directions

270. A client with a terminal illness reaches the stage of acceptance. The nurse can best help during this stage by

a. Allowing the client to cryb. Allowing unrestricted visitingc. Explaining all that is being doned. Being around though not necessarily speaking

271. When creating a therapeutic environment for a client who has just had a myocardial infarction, the nurse should provide for

a. Daily newspapers in the morningb. Telephone communicationc. Television for short periodsd. Short family visits

272. A nurse administers an intravenous solution of 0.45% sodium chloride. With respect to human blood cells, this solution is

a. Isotonicb. Isomericc. Hypotonicd. Hypertonic

273. The statement that correctly compares the blood plasma & interstitial fluid is:a. Both contain the same kind of ionsb. Plasma exerts lower osmotic pressure than does interstitialc. Plasma contains slightly more of each kind of ions than does interstitial cellsd. The main cation in plasma is sodium, whereas the main cation in interstitial fluid is potassium

274. Ammonia is excreted by the kidney to help maintain:a. Osmotic pressure of the bloodb. Acid- Base balance of the bodyc. Low bacterial levels in the urined. Normal red blood cell production

275. The nurse understands that a client with albuminuria has edema caused bya. Fall in tissue hydrostatic pressureb. Rise in plasma hydrostatic pressurec. Fall in plasma colloid osmotic pressured. Rise in tissue colloid osmotic pressure

276. The percentage of water in the average adult human body isa. 80%b. 60%c. 40%d. 20%

277. The nurse administers serum albumin to client to assist in:a. Clotting of bloodb. Formation of RBCc. Activation of WBCd. Development of oncotic pressure

278. Which assessment finding is most likely in a patient with Myasthenia gravis?a. Restlessness, decrease level of consciousness and history of extreme muscle weakness in the

morningb. Unequal papillary response, diplopia and inability to hold her mouth closedc. Frequent changes in facial expression, exophthalmos and low pitched voiced. Ptosis, dysphagia and nasal voice

279. A patient was diagnosed to have acute closed angle glaucoma. Which statement about its clinical manifestation is not correct?

a. Nausea & vomiting may occurb. The patient commonly sees rainbows around lightsc. Ocular pain results from increased intraocular pressured. The patient’s vision becomes cloudy & blurred

280. The patient above was scheduled for peripheral iridectomy. The primary purpose of this procedure is to

a. Prevent blood from entering the anterior chamber of the eyeb. Decrease the production of aqueous humorc. Enhance drainage of aqueous humord. Permit papillary dilation

281. A 25-year-old male suffered a spinal cord injury from playing basketball resulting in paraplegia. The nurse finds the patient conscious, breathing satisfactorily and lying on his back complain of pain and an inability to move his legs. The nurse should first

a. Gently lift the patient onto a flat piece of lumber and using any available transportation rush him to the medical institution

b. Roll the patient onto his abdomen, place a pad under his head and cover him with material available

c. Gently raise the patient to a sitting position to see if the pain either diminishes or increase in intensity

d. Leave the patient lying on his back with instructions not to move then go and seek for additional help

282. Once admitted, the physician indicates the patient is paraplegic. The family asks the nurse what this means. The nurse explains that

a. Upper extremities are paralyzedb. Lower extremities are paralyzedc. One side of the body is paralyzedd. Both upper and lower extremities are paralyzed

283. The nurse recognizes that one major early problem of the patient isa. Hyper reflexiab. Muscle spasmc. Hypotensiond. Autonomic dysreflexia

284. The patient was diagnosed to have hyperopia. You expect that the patient’s condition is due toa. A long eyeballb. A short eyeballc. Abnormal curvature of the cornead. Inability of the lens to accommodate

285. The above condition can be treated witha. Concave lensb. Convex lensc. Cylindrical lensd. Double vision lens

286. The patient was diagnosed to have Huntington’s disease. Her daughter is asking you if she would get the same disease later in her life. Knowing the transmission of the disease, your best response would be

a. You better ask your doctorb. You don’t need to worry because you may not carry the genec. You have 25% chance of getting the diseased. You have 50% chance of getting the disease

287. Manifestations of Huntington’s, include the following, excepta. Movement problemb. Intellectual dysfunctionc. Emotional disturbancesd. Rigidity and tremor

288. Cataract results froma. Destruction of the lensb. Drying up of the lens fiber & crystallizationc. Corneal and scleral damaged. Retinal detachment

289. On a visit to a clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would the nurse most likely assess?

a. Early morning stiffnessb. Limited motion of jointsc. Deformed motion of jointsd. Rheumatoid nodules

290. The patient with renal failure will manifest all of the following, excepta. Anemiab. Hypertensionc. Hypokalemiad. No exception

291. Cushing’s disease resulted from high levels of glucocorticoids due toa. Hyperfunctioning of the adrenal glandsb. Hypersecretion of the pituitary gland or a tumor of ACTH

c. Overdose of exogenous steroidsd. Maybe all of the above

292. The patient is admitted with a diagnosis of Grave’s disease. You know that this patient would most likely manifest which of the following signs?

a. Toxic goiter and increased TSHb. Thyrotoxicosis & enlarged thyroid glandc. Exopthalmos & cold intoleranced. Elevated T3, T4 and calcitonin

293. The patient underwent thyroidectomy for thyroid cancer, you are aware of possible complications, which of the following is not a complication of thyroidectomy

a. Difficulty of breathingb. Hoarsenessc. Hypoparathyroidismd. Hypocalcemia & paralysis

294. The patient is undergoing hemodialysis because of chronic renal failure. You are asked by the relative on the chances of recovery for this patient, based on your knowledge, your best response would be

a. The patient has few months to liveb. He has to be maintained on hemodialysis or else he will diec. He has to undergo hemodialysis to excrete his waste because the kidneys are not functioningd. A kidney transplant can improve his condition

295. Upper urinary tract infection would most likely manifests the following signs & symptoms, except

a. Flank painb. Fever & chillsc. Hematuriad. Dysuria

296. The initial manifestation of renal failure isa. Hypovolemiab. Oliguriac. Nocturiad. Polyuria

297. A client is admitted after vomiting fresh blood. He is diagnosed to have duodenal ulcer. The client develops sudden, sharp pain in the mid epigastric region along with a rigid boardlike abdomen. These clinical manifestations most likely indicate which of the following?

a. An intestinal obstruction has developedb. Additional ulcers developc. The esophagus has inflamedd. The ulcer has perforated

298. A client with PUD tells the nurse that he has black stool which he has not reported to his physician, Based on this information, Which nursing diagnosis would be appropriate for this client?

a. Ineffective coping related to fear of diagnosis of chronic illnessb. Deficient knowledge related to unfamiliarity of significant signs & symptomsc. Constipation related to decreased gastric mobilityd. Imbalanced nutrition less than body requirements

299. A client is taking an antacid for treatment of PUD, Which of the following statements indicate that the client understands how to correctly take the antacid?

a. I should take the antacid before my other medicationsb. I need to decrease my intake of fluid so that I don’t dilute effects of my antacidsc. My antacid will be most effective if I take it whenever I have paind. It is best for me to take antacid 1 – 3 hours after meals

300. Patient was diagnosed to have hiatal hernia. What is the problem in herniation?a. Protrusion of a part due to muscle weaknessb. Reflux esophagitisc. Small meal is advised. All of the above