" A 47-years-old women has had a gastric ulcer for years.

After she
started vomiting blood today, her neighbor drove her to the
emergency room". (Q 1-8):

1. Which of the following assessment findings indicates hypovolemic shock?

A. Pulse less than 60 bpm. B. Respiratory rate more than 20 b/m.
C. Pupils unequally dilated. D. Systolic blood pressure less than
90mmHg.

2. The underlying pathophysiologic alteration in all types of shock is:

A. Hemorrhage of blood or body fluids. B. Decreased cardiac output.
C. Inadequate tissue perfusion. D. Vasodilation of vascular beds.

3. In early stage of shock, the nurse would expect the result of (ABG) to
indicate:
A. Respiratory alkalosis. B. Respiratory acidosis.
C. Metabolic alkalosis. D. Metabolic acidosis.

4. If non of the following positions is contraindicated, which position would

be preferred for the client with hypovolemic shock?
A. Supine position . B. Semi-Flower's
position .
C. Supine with leg elevated 15 degrees. D. Head elevated 30 to 45
degrees.

5. Which of the following would be best indication that fluid replacement for
the client in hypovolemic shock is adequate?
A. Urine output greater than 30 ml/hr. B. Systolic BP above 110 mmHg.
C. Diastolic BP above 90 mmHg. D. Urine output of 20 to 30 ml/hr.

6. The client receives an intravenous infusion of packed red blood cells. A

priority for this client include assessing her for:
A. Hypovolemia . B. Anaphylactic reaction.
C. Pain. D. Altered level of
consciousness.

7. When assessing a client for early septic shock, the nurse should observe
for:
A. Cool, clammy skin. B. Warm, flushed skin.
C. Decrease systolic blood pressure. D. Hemorrhage.

8. Which of the following best describes cardiogenic shock? The client

experiences:
A. Decreased cardiac output due to hypovolemia.
B. Shock due to decreased circulating blood volume.
C. Shock due to decreased myocardial contractility.
D. Decreased cardiac output due to infarction.

" A 22-years-old man is brought to the emergency room with an

apparent head injury after being involved in a serious motor vehicle

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accident. He is unconscious on arrival and exhibit signs of increase
intracranial pressure". (Q 9-17 ):

9. When the client arrives in the emergency room, which of the following
considerations should receive the highest priority?
A. Establishing an airway. B. Determining whether he has a neck
fracture
C. Replacing blood losses. D. Stopping bleeding from open wounds.

10.The nurse assesses the client frequently for signs of increasing

intracranial pressure, including:
A. Tachycardia. B. Decrease systolic blood pressure.
C. Unequal pupil size. D. Decreasing body temperature.

11.Which of the following respiratory signs would indicate increasing

intracranial pressure in the brain stem?
A. Slow, irregular respirations. B. Rapid, shallow respirations.
C. Asymmetric chest excursion. D. Nasal flaring.

12.Which of the following clinical manifestation would be an early indicator

of a deterioration in the client's neurologic status?
A. Widening pulse pressure. B. Decrease in the pulse pressure.
C. Dilated, fixed pupil. D. Decrease in level of consciousness.

13.Which of the following positions would be most appropriate for a client

with a head injury?
A. Left Sim's position. B. Trendelenburg's position.
C. Head of the bed elevated 30 to 45 degrees. D. Head elevated on two
pillows.

14.Which of the following postoperative care measures would be

contraindicated for a client at risk for increased intracranial pressure?
A. Deep breathing. B. Coughing.
C. Turning. D. Passive range of motion
exercises.

15.Patient does not open his eyes to painful stimuli anymore, his speech is
inappropriate word and withdraws from pain , What is his Glasgow coma
score?
A. G.C.S.= 9. B. G.C.S.= 7.
C. G.C.S.= 10. D. G.C.S= 8.

16.The nurse assessing for signs of increase intracranial pressure, which

include:
A. Tachycardia, bradypnea, hypertension B. Bradycardia, bradypnea,
hypertension
C. Bradycardia, Tachypnea, hypotension D. Tachycardia, bradypnea,
hypotension

17.The nurse is caring for a client with a cerebral injury that impaired his
speech and hearing. Most likely, the client has experienced damage to:
A. Frontal lobe. B. Parietal lobe.
C. Occipital lobe. D. Temporal lobe.

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" Fatma J. is a 53 years old admitted for complaint of chest pain
diagnosed as stable angina pectoris. The frequency and intensity of
her angina attack have increased since her husband's sudden death
4 month ago. Following coronary angiography, she is diagnosed with
coronary artery disease." (Q18-23):

18.She is admitted to the ICU. Which nursing goal would have the highest
priority in planning the patient’s care?
A. Maintain normal fluid and electrolyte balance. B. Maintain adequate
nutrition.
C. Provide physical and psychological rest. D. Prevent invasive
infections.

19.Which of the following statements by Fatma in her health history would

not correlate with a diagnosis of stable angina pectoris?
A. "The nitroglycerin tablets takes the pain away in a few minutes"
B. "I feel pressure in my chest and the pain radiated to neck and jaw"
C. "The pain comes on even when I'm lying still and resting"
D. "I sweat a lot during an attack, and my hands get all clammy"

20.The pain associated with Myocardial Infarction (MI), is due to?

A. Impending circulatory collapse. B. Extracellular electrolyte imbalance.
C. Left ventricular overload. D. Insufficient oxygen reaching the heart
muscles

21.Which of the following finding is indicative of MI?

A. Elevated serum cholesterol value. B. Elevated creatinine phosphokinase
(CPK).
C. Elevated white blood cell count. D. Below normal erythrocyte sedimentation
rate.

22.All of the following may induce angina pectoris Except:

A. Light meal. B. Exposed for cold.
C. Stress or emotion upset. D. Physical exercise.

23.Evaluation of the effectiveness of cardiac nitrates is based on:

A. Relief of angina pain. B. Decrease in blood pressure.
C. Improved cardiac output D. Dilation of superficial blood vessels.

24.Which of the following is a false statement in relation to ECG?

A. The P wave is represents depolarization of the atrium.
B. The QRS wave is represents relaxation of the atrium.
C. The T wave follows the S wave and represents ventricular relaxation.
D. The U wave represents repolarization of purkinje fibers.

25.Where is the correct placement for lead V4 when doing an ECG?

A. 4th ICS, right sternal border B. 5th ICS, mid axillary line
C. 4th ICS, left sternal border D. 5th ICS, mid-clavicular line

26.The nurse has noticed that a patients ECG pattern has changed. The
appearance of the P waves is similar to Saw toothed shape "series of
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identical P waves". What does this changes in pattern indicated?
 B. Atrial flutter. B. Ventricular fibrillation.
C. Atrial fibrillation. D. Premature Atrial Complexes.

27.A rhythm strip from a patient's ECG shows the following pattern:

How should the nurse interpret this pattern?

A. Normal sinus rhythm. B. Sinus bradycardia.
C. Sinus tachycardia. D. Ventricular tachycardia.

28.Estimate the heart rate for this Figure:

A. H.R.= 50 - 60 bpm. B. H.R.= 90 – 100 bpm.
C. H.R. = 70 – 80 bpm. D.H.R. = 120 – 130 bpm.
29.A rhythm strip from a patient's ECG shows the following pattern:

How should the nurse interpret this pattern?

B. Ventricular trigeming. B. Ventricular bigeming.
C. Ventricular fibrillation. D. Ventricular tachycardia.

30.Which of the following symptoms are mainly frequent in pericarditis?

A. Chest pain which respond to nitroglycerine.
B. Chest pain which continues consecutively for one hour.
C. Chest pain which increases with deep breathing and change position.
D. Chest pain which increases when the patient sits up.

31.The symptoms of the right side heart failure are?

A. Edema, swelling, weight gain. B. Weakness, palpitation, nausea
C. Fatigue, vertigo, headache D. A feeling distress when breathing

32.The major goal of therapy for the client with heart failure would be to:
A. Increaes cardiac output. B. Improve respiratory status.
C. Decrease peripheral edema. D. Enhance comfort.

33.The nurse expects that a client with mitral stenosis would likely
demonstrate symptoms associated with congestion in the:
A. Aorta. B. Right atrium.
C. Pulmonary circulation. D. Superior vena cava.
34.Dopamine is useful in treating:
A. Hypotension resulting from decreased cardiac output B. Postural
hypotension.
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C. Hypotension secondary D. Hypotension secondary to
anesthesia.
35.Which of the following statements is correct regarding CVP line:
A. A CVP line is a potential source of septicemia.
B. A CVP used for insertion of a pacing wire.
C. Traumatic pneumothorax or hemothorax is a potential complication.
 D. All of the above.

36.The symptoms of decrease CVP are:

A. Tachycardia, hypertension, oliguria. B. Ascities, hepatomegaly,
anuria.
C. Tachycardia, hypotension, anuria. D. Bradycardia, dyspnea,
ascites.

37.Which of the following is a false diagnosis when the CVP increased:

A. Heart failure. B. Cardiac tamponade.
C. Hypervolemia. D. Hypovolemia.
38.The most common immediate complication for central venous line
insertion is:
A. Infection. B. Pneumothorax.
C. Cardiac tamponade. D. Thrombosis.
39.Which of the following is a disadvantage for insertion a femoral line:
A. Infection. B. Pneumothorax.
C. Difficult dressing. D. Uncomfortable for patient.
40.Bleeding between dura and inner surface of the skull , called :
A. Subdural hematoma B. Intracerebral hematoma
C. Epidural hematoma D. Intraventricularr
hemorrhage
41.A patient is admitted to the ICU with a diagnosis of acute upper GI
bleeding. Which nursing diagnosis would have the highest priority?
A. Deficient fluid volume related to bleeding
B. Impaired tissue integrity related to mucosal damage
C. Disturbed sensory perception (visual) related to increased blood ammonia
levels
D. Anxiety related to critical illness
42.All of the following is considered as a clinical manifestation of
hypovolemia, Except:
A. Decrease skin turgor. B. Hypotension
C. Oliquria. D. Strong, rapid pulse.

43.The physician has ordered for a patient with congestive heart failure
(80mg of lasix) IV twice a day. The nurse notes the K level is 3.0 mEq/L,
the nurse should:
A. Administer the lasix 80 mg IV as ordered.
B. Administer half of the dose of lasix (40 mg) IV.
C. Offer the patient potassium rich food and fluid after administering lasix 80 mg
IV.
D. Withhold the drug and notify the physician of the serum K level.
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44.A 38-year-old man is admitted to the ICU with a diagnosis of acute
pancreatitis. When assessing his condition, the nurse notes that he has a
positive Trousseau’s sign. This sign is associated with what condition?
A. Hyperkalemia B. Hypokalemia
C. Hypocalcemia D. Hypercalcemia

45.Your patient’s ECG shows wide flat P wave, wide QRS and Tall T waves.
You realize that this indicates:
 A. Hypercalcemia B. Hypokalemia
C. Hyperklemia D. Hyperphosphatemia
46.Which of the following is correct regarding hypovolemia:
A. Increased HCT B. Decreased Creatinine
C. Decreased specific gravity D. Decreased BUN

47.All of the following is used to manage a cases of hypocalcemia, Except:

A. Calcium chlorid B. Decrease magnesium level
C. Calcium gluconate D. Decrease phosphorous level

48.Which of the following isotonic solution used to treatment of a cases

with hypernatremia:
A. Lactated Ringer's B. Normal saline (0.9% NaCl)
C. Half saline (0.45% NaCl) D. Dextrose in water (D5W)

49.Which if the following is/are complication of fluid therapy:

A. Sepsis B. Circulatory overload
C. Allergic reaction D. All of the above

50.All of the following is considered as a causes for hypokalemia, Except:

A. Diarrhea and vomiting B. Tissue trauma
C. Diuretics D. Excessive renal excretion of K

I. True and False Questions

1- ( F ) When a P.V.C. becomes coupled with a normal beat, this is called
ventricular
trigeming.
2- ( T ) Cerebral blood flow are affected by carbon dioxide tension and oxygen
tension.
3- ( T ) A fixed, unilaterally dilated pupil indicates herniation of the brain.
4- ( F ) Hyperventilation is used for a long period of time by maintaining PaCo2
(35-45 mmHg) to reduce ICP.
5- ( T ) If the CVP measure is less than 5 cm water that mean hypovolemia.
6- ( T ) The most common complication for insertion subcalvian line is bleeding.
7- ( F ) The arterial line is used for injection of medication when the peripheral
access
is difficult.
8- ( F ) P-R interval is shorter than other in a case of atrial fibrillation.
9- ( F ) A third degree AV block is present when it takes 3 atrial impulses to
stimulate
the ventricular response.
10- ( T ) Left side heart failure causes mostly pulmonary symptoms.
11- ( T ) CK is the most sensitive and reliable indicator in case of MI.

II. Answer 3 of the following questions (10 marks):

1- List five purposes of the central venous pressure line.

2- Discuss the stages of shock.

3- Nursing management for head trauma.

4- How do you assess clinically the state of hydration?

5- Nursing care principle for IHD (angina and MI).

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