Session 1

1.a nurse,what is the importance of a thorough preoperative assessment?

A.To identify and correct problems before surgery and
establish a baseline for postoperative comparison

2.Before administering preoperative medication to a client, nurse Jonalyn should plan to:
a. Verify the consent

3. A client with Cataract is about to undergo surgery. Nurse Princess is preparing plan of care.
Which of the following nursing diagnosis is most appropriate to address the long term need of
this type of patient?
B.Sensory perceptual alteration related to lens extraction and replacement

4. On the moming of Mrs. Sy's planned cholecystectomy, she awakens with a pain in her right
scapular area and thinks she slept in poor position. While doing the pre-op check list you note
that on her routine CB report her WBC is 15,000.
Your responsibility at this point is:
A.To notify the surgeon at once; this is an elevated WBC indicating an inflammatory reaction

5. Mrs. Sy is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM and
Demerol 50 mg IM one hour preoperatively. Which nursing actions follow the giving of the
pre-op medication?
b. Allow her family to be with her before the medication takes effect

6. A patient is admitted to the same day surgery unit for liver biopsy. Which of the following
laboratory tests assesses coagulation? SATA
A.Partial thromboplastin time.
B.Prothrombin time.
C.Platelet count.

7. A client with a perforated gastric ulcer is scheduled for emergency surgery. The client cannot
sign the operative consent form because he has been sedated with opioid analgesics. The
nurse should take which of the following actions in the care of this client?
A.Obtain a telephone consent from the family member witnessed by two persons.

8. A preoperative client expresses anxiety to the nurse about the upcoming surgery. Which of
the following responses by the nurse is most likely to stimulate further discussion between the
client and the nurse?
D."Can you share with me what you've been told about your surgery?"

9. A nurse is preparing the client for transfer to the operating room (OR). The nurse should take
which of the following actions in the care of this client at this time?
B. Ensure that the client has voided.
10. A nurse is reviewing the physician's order sheet for the preoperative client, which states that
the client must be on nothing per mouth (NPO) status after midnight. The nurse would clarify
whether which of the following medications should
be given to the client and not withheld?
B.Atenolol (Tenormin)

Session 2.

1. Nurse Jay is preparing to change a client's dressing. The statement that best explains the
basis of surgical asepsis that the nurse will perform in this procedure is:
A. Keep the area free from microorganisms

2. Function of a circulating nurse is:

A.Assists the scrub nurse and surgeon

3. Which among the following are not members of the sterile team in the operating room? Select
that all apply:
1. Surgeon
2. Anesthesiologist
3. Radiation technician
4. Scrub nurse
5. Circulating nurse
C. 2, 3, 5

4. What is the responsibility of the nurse regarding informed consent?

D.To witness a patient's signature

5. Which of the following is the primary responsibility of the nurse before surgical operation?
A.taking the vital signs

6. Mr. Alejandro is scheduled for a prostatectomy and the anesthesiologist plans to use a spinal
(subarachnoid) block during surgery. In the operating room, the nurse positions the client
according to the anesthesio logist's instructions. Why quire special positioning for this type of
anesthesia?
C.To prevent cerebrospinal fluid (CSF) leakage

7. What is the most important postoperative instruction nurse Nikki rust give to Mrs. Serrano
who has just returned fróm the operating room after receiving a subarachnoid block?
d. Remain supine for the time specified by the physician."

8. The common anesthesia used for appendectomy is?

A.spinal
9, The client returns from surgery with a blood pressure of 90/50, pulse 132, and respirations
30. Which action by Nurse Jo should receive priority?
A.continue to monitor vital signs

10. An additive given to potentiate and prolong the effects of regional anesthesia is
B. Epinephrine

Session 3

1. What does progression of patients through various phases of care in a post anesthesia care
unit (PACU) primarily depends on
a. Condition of patient

2. Priority Decision Upon admission of a patient to the PACU, the nurse's priority assessment is
C. respiratory adequacy

3. How is the initial information aiven to the PACU nurses about the surgical patient?
C.Averbal report from the anesthesia care provider (ACP)

4.To prevent agitation during the patient's recovery from anesthesia, when should
the nurse begin orientation explanation?
b. When the patient first arrives in the PACU

5, What is included in the routine assessment of the patient's cardiovascular function on

admission to the PACU?
b. Electrocardiographic (ECG) monitoring

6.With what are the postoperative respiratory complications of atelectasis and aspiration of
gastric contents associated?
a. Hypoxemia

7. To prevent airway obstruction in the postoperative patient who is unconscious or

semiconscious, what will the nurse do?
D.position the patient in a side -lying position

8. Priority Decision: To promote effective coughing, deep breathing, and ambulation in the
postoperative patient, what is most important for the nurse to do?
C.Provide adequate and regular pain medication

9. While assessing a patient in the PACU, the nurse finds that the patient's blood pressure is
below the preoperative baseline. The nurse determines that the patient has residual vasodilating
effects of anesthesia when what is assessed?
C. A normal pulse with warm, dry. pink skin
10. Priority Decision: A patient in the PACU has emergence delirium manifested by agitation and
thrashing. What should the nurse assess for first in the patient?
a. Hypoxemia

Session 4

1. The nurse is providing patient teaching to a young mother who has brought her 3-month-old
infant to the clinic for a well-baby checkup. What action should the nurse recommend to the
woman to prevent the transmission of organisms to her infant during the cold season?
d. Wash her hands frequently.

2. The nurse is explaining the safe and effective administration of nasal spray to a patient with
seasonal allergies. What information is most important to include in this teaching?
d. Overuse of nasal spray may cause rebound congestion.

3. A patient visiting the clinic is diagnosed with acute sinusitis. To promote sinus drainage, the
nurse should instruct the patient to perform which of the following?
d. Increase fluid intake.

4.The nurse is creating a plan of care for a patient diagnosed with acute laryngitis. What
intervention should be included in the patients plan of care?
c. Encourage the patient to limit speech whenever possible.

5.A patient comes to the ED and is admitted with epistaxis. Pressure has been applied to the
patient's midline septum for 10 minutes, but the bleeding continues. The nurse should anticipate
using what treatment to control the bleeding?
D.Silver nitrate application

6.The nurse is planning the care of a patient who is scheduled for a laryngectomy. The nurse
should assign the highest priority to which postoperative nursing diagnosis?
C.Ineffective airway clearance related to airway alterations

7.The home care nurse is assessing the home environment of a patient who wit be discharged
from the hospital shortly his laryngectomy. The nurse should inform the patient that he may
need to arrange for the installation of which system in his home?
A.A humidification system

8. The nurse is caning for a patent whose recent unexplained weight loss and history of
smoking have prompted diagnostic testing for cancer. What symptom is most closely associated
with the early stages of laryngeal cancer?
A.Hoarseness
9. The campus nurse at a university is assessing a 21year-old student who presents with a
severe nosebleed. The site of bleeding appears to be the anterior portion of the nasal septum.
The nurse instructs the student to tilt her head forwards and the nurse applies pressure to the
nose, but the student's nose continues to bleed Which intervention should the nurse next
implement ?
d. Insert a tampon in the affected nares

10. The nurse is conducting a presurgical interview for a patient with laryngeal cancer. The
patient states that he drinks approximately sir to eight shots of vodka per day. It is imperative
that nurse inform the surgical team so the patient can be assessed for what?
B.Delirium tremens

Session 5

1. While assisting a patient with intermittent asthma to identify specific triggers of asthma, what
should the nurse explain?
D. Viral upper respiratory infections are a common precipitating factor in acute asthma attacks.

2. A patient is admitted to the emergency department with an acute asthma attack. Which
patient assessment is of greatest concern to the nurse?
B. Markedly diminished breath sounds with no wheezing

3. Priority Decision: Which medication should the nurse anticipate being used first in the
emergency department for relief of severe respiratory distress related to asthma?
D. Albuterol nebulizer

4. When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder
inhaler (DPI), which statement by the patient shows the nurse that the patient needs more
teaching?
D.I Will store it the bathroom so I Will be able to clean it when I need to.

5. Which statements by a patient with moderate asthma inform the nurse that the patient needs
more teaching about medications (Select All That Apply)?
A "If I can't afford all of my medicines, I will only use the salmeterol (Serevent)."
E. "If I can't afford all of my medicines, I will only use the salmeterol (Serevent)."

6. To decrease the patient's sense of panic during an acute asthma attack, what is the best
action for the nurse to do?
B. Stay with the patient and encourage slow, pursed lip breathing

7. When teaching the patient with mild asthma about the use of the peak flow meter, what
should the nurse instruct the patient to do?
C. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow
rate is in the yellow zone
8. A patient is being discharged with plans for home 02 therapy provided by an 02 concentrator
with an 02-conserving portable unit. In preparing the patient to use the equipment, what should
the nurse teach the patient?
C. The unit concentrates 02 from the air, providing a continuous 02 supply

9. During an acute exacerbation of mild COPD, the patient is severely short of breath and the
nurse identifies a nursing diagnosis of ineffective breathing pattern related to obstruction of
airflow and anxiety. What is the best action by the nurse?
D.Position the patient upright with the elbows testing on the over the bed table

10.In planning care for the patient with bronchiectasis, with Nursing intervention should the
nurse include?
D.Promote drainage and removal of mucus.

Session 6
1. To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure,
which diagnostic test will be most useful to the nurse?
c. Arterial blood gas (ABG) analysis

2. While caring for a patient who has been admitted with a pulmonary embolism, the nurse
notes a change in the patient's oxygen saturation (SpO2) from 94% to 88%. The nurse will
a. increases the oxygen flow rate.
b. suction the patient's oropharynx.

3. A patient with respiratory failure has a respiratory rate of 8 and an SpO2 of 89%. The patient
is increasingly lethargic. The nurse will anticipate assisting with
b. endotracheal intubation and positive pressure ventilation.

4. When admitting a patient in possible respiratory failure with a high PaCo2, which assessment
information will be of most concern to the nurse?
a. The patient is somnolent.

5. A nurse answers a call light and finds a client anxious, short of breath, reporting chest pain,
and having a blood pressure of 88/52 mm Hg on the cardiac monitor. What action by the nurse
takes priority?
b. Notify the Rapid Response Team

6. A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and active
and has no known risk factors for PE. What action by the nurse is most appropriate?
a. Encourage the client to walk 5 minutes each hour.
b. Refer the client to smoking cessation classes.
c. Teach the client about factor V Leiden testing.
d. Tell the client that sometimes no cause for disease is found.
ANSWER:C

7. A client has a pulmonary embolism and is started on oxygen. The student nurse asks why the
clients oxygen saturation has not significantly improved. What response by the nurse is best?
c. The blood clot interferes with perfusion in the lungs.

8. A client appears dyspneic, but the oxygen saturation is 97%. What action by the nurse is
best?
a. Assess for other manifestations of hypoxia.

9. A nurse is assisting the health care provider who is intubating a client. The provider has been
attempting to intubate for 40 seconds. What action by the nurse takes priority?
c. Interrupt the procedure to give oxygen.

10. An intubated clients oxygen saturation has dropped to 88%. What action by the nurse takes
priority?
c. Listen to the client's lung sounds.

Session 7
1. In a severely anemic patient, you expect to find
A dyspnea and tachycardia.
B. cyanosis and pulmonary edema,
C. cardiomegaly and pulmonary fibrosis.
D. ventricular dysrhythmias and wheezing.
ANSWER: А

2. You are caring for a patient with a diagnosis of iron-deficiency anemia. Which clinical
manifestations are you most likely to observe when assessing this patient?
B. Brittle nails; smooth, shiny tongue, and cheilosis

3.When providing teaching for the patient with iron-deficiency anemia who has been prescribed
iron supplements, you should include taking the iron with which beverage?
A Milk
B. Ginger ale
C. Orange juice
D. Water
ANSWER: C
4. The primary pathophysiology underlying thalassemia is
A. erythropoietin deficiency.
B. abnormal hemoglobin synthesis.
C. autoimmunity
D. S-shaped hemoglobin
ANSWER:B
5. Which individual is at high risk for a cobalamin (vitamin B12) deficiency anemia?
A .A 47-year-old man who had a gastrectomy (removal of the stomach)
B. A 54-year-old man with a history of irritable bowel disease and ulcerative colitis
C. A 26-year-old woman who complains of heavy menstrual periods
D. A 15-year-old girl who is a vegetarian
ANSWER:_A

6. You encourage the patient with cobalamin deficiency to seek treatment because untreated
pernicious anemia may result in
A death
B. liver failure
C. heart failure.
D. gastrectomy
ANSWER: А

7. The Schilling test for pernicious anemia involves

A administration of radioactive cobalamin and measuring its excretion in the urine.
B. blood cultures for organism identification
C. the measurement of serum iron.
D. the administration of iron and blood assessment of total iron binding in 24 hours
ANSWER: A

8. Which finding allows you to identify the patient's anemia as folic acid deficiency rather than
cobalamin deficiency?
A Loss of appetite
B. Lack of neuromuscular symptoms
C. Red tongue
D. Change in nail shape
ANSWER: B

9. Which foods should you encourage patients with folic acid deficiency to include in their daily
food intake (select all that apply)?
A Ready-to-eat cereal
B. Wheat tortillas
C. Lentils
D. Strawberries
E. Potatoes
ANSWER: A Band C

10. You are evaluating the laboratory data of the patient with suspected aplastic anemia. Which
findings support this
diagnosis?
A. Reduced RBCs, reduced white blood cells (WBCs), and reduced platelets
B. Reduced RBCs, normal WBCs, and normal platelets
C. Normal RBCs, reduced WBCs, and reduced platelets
D. Elevated RBCs, increased WBCs, and increased platelets
ANSWER: A

Session 8
1. What are non-modifiable risk factors for primary hypertension (select all that apply)?
a. Age
b. Obesity
c. Gender
d. Ethnicity
e. Genetic link
ANSWER: A. C,D and E

2. How is secondary hypertension differentiated from primary hypertension?

a. Has a more gradual onset than primary hypertension
b. Does not cause the target organ damage that occurs with primary hypertension
c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery
d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of
age
ANSWER:C

3. What is the patient with primary hypertension likely to report?

a. No symptoms
b. Cardiac palpitations
c. Dyspnea on exertion
d. Dizziness and vertigo
ANSWER: A

4. A patient with stage 2 hypertension who is taking hydrochlorothiazide (Hydrodiuril) and

lisinopril (Prinivil) has prazosin (Minipress) added to the medication regimen. What is most
important for the nurse to teach the patient to do?
a. Weigh every morning to monitor for fluid retention
b. Change position slowly and avoid prolonged standing
c. Use sugarless gum or candy to help relieve dry mouth
d. Take the pulse daily to note any slowing of the heart rate
ANSWER: B

5. A 38-year-old man is treated for hypertension with triamterene and hydrochlorothiazide

(Maxzide) and metoprolol(Lopressor). Four months after his last clinic visit, his BP returns to
pretreatment levels and he admits he has not been taking his medication regularly. What is the
nurse's best response to this patient?
Answer: C.”The drugs you are taking cause sexual dysfunction in many patients. Are you
experiencing any problem?in this area?
6. A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related physical
changes may contribute to this patient's hypertension? (Select All That Apply)
a. Decreased renal function
c. Increased peripheral vascular resistance
e. Increased collagen and stiffness of the myocardium
f. Loss of elasticity in large arteries from arteriosclerosis
ANSWER: A, C,E and F

7. What should the nurse emphasize when teaching a patient who is newly prescribed clonidine
(Catapres)?
a. The drug should never be stopped abruptly.
b. The drug should be taken early in the day to prevent nocturia.
c. The first dose should be taken when the patient is in bed for the night.
d. Because aspirin will decrease the drug's effectiveness, Tylenol should be used instead.
ANSWER: A

8. What is included in the correct technique for BP measurements?

a. Always take the BP in both arms.
b. Position the patient supine for all readings
c. Place the cuff loosely around the upper arm
d. Take readings at least two times at least 1 minute apart.
ANSWER:D

9. Which manifestation is an indication that a patient is having a hypertensive emergency?

a. Symptoms of a stroke with an elevated BP
b. A systolic BP >200 mm Hg and a diastolic BP >120 mm Hg
c. A sudden rise in BP accompanied by neurologic impairment
d. A severe elevation of BP that occurs over several days or weeks
ANSWER: C

10. During treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea and
vomiting, the nurse initially titrates the medications to achieve which goal?
a. Decrease the mean arterial pressure (MAP) to 129 mm Hg
b. Lower the BP to the patient's normal within the second to third hour
c. Decrease the SBP to 160 mm Hg and the DBP to between 100- and 110-mm Hg as quickly
as possible
d. Reduce the systolic BP (SBP) to 158 mm Hg and the diastolic BP (DBP) to 111 mm Hg within
the first 2 hours
ANSWER:A

Session 9

1. Which patient is most likely to be in the fibrous stage of development of coronary artery
disease (CAD)?
a. Age 40, thrombus adhered to the coronary artery wall
b. Age 50, rapid onset of disease with hypercholesterolemia
c. Age 32, thickened coronary arterial walls with narrowed vessel lumen
d. Age 19, elevated low-density lipoprotein (LDL) cholesterol, lipid-filled smooth muscle cells
ANSWER: c

2. What accurately describes the pathophysiology of CAD?

a. Partial or total occlusion of the coronary artery occurs during the stage of raised fibrous
plaque
b. Endothelial alteration may be caused by chemical irritants such as hyperlipidemia or by
tobacco use
c. Collateral circulation in the coronary circulation is more likely to be present in the young
patient with CAD
d. The leading theory of atherogenesis proposes that infection and fatty dietary intake are the
basic underlying causes of
atherosclerosis
ANSWER: B

3. While obtaining patient histories, which patient does the nurse identify as having the highest
risk for CAD?
a. A white man age 54, who is a smoker and has a stressful lifestyle
b. A white woman, age 68, with a BP of 172/100 mm Hg and who is physically inactive
c. An Asian woman age 45, with a cholesterol level of 240 mg/dL and a BP of 130/74 mm Hg
d. An obese African American man, age 65, with a cholesterol level of 195 mg/dL and a BP of
128/76 mm Hg
ANSWER: B

4. Priority Decision: While teaching women about the risks and incidence of CAD, what does the
nurse emphasize?
a. Smoking is not as significant a risk factor for CAD in women as it is in men.
b. Women seek treatment sooner than men when they have symptoms of CAD.
c. Estrogen replacement therapy in postmenopausal women decreases the risk for CAD.
d. CAD is the leading cause of death in women with a higher mortality rate after Ml than in men.
ANSWER: D

5. Which characteristics are associated with LDLs (select all that apply)?
a. Increases with exercise
b. Contains the most cholesterol
c. Has an affinity for arterial walls
d. Carries lipids away from arteries to liver
e. High levels correlate most closely with CAD
ANSWER: B.C and E
,
6. Which serum lipid elevation, along with elevated LDL, is strongly associated with CAD?
a. Apolipoproteins
b. Fasting triglycerides
c. Total serum cholesterol
d. High-density lipoprotein (HDL)
ANSWER: B

7. Myocardial ischemia occurs as a result of increased oxygen demand and decreased oxygen
supply, What factors and disorders result in increased oxygen demand (select all that apply)?
a. Hypovolemia or anemia
b. Increased cardiac workload with aortic stenosis
c. Narrowed coronary arteries from atherosclerosis
d. Angina in the patient with atherosclerotic coronary arteries
e. Left ventricular hypertrophy caused by chronic hypertension
f. Sympathetic nervous system stimulation by drugs, emotions, or exertion
ANSWER: B,D E F

8. What causes the pain that occurs with myocardial ischemia?

a. Death of myocardial tissue
b. Dysrhythmias caused by cellular irritability
c. Lactic acid accumulation during anaerobic metabolism
d. Elevated pressure in the ventricles and pulmonary vessels
ANSWER:C

9. What types of angina can occur in the absence of CAD (select all that apply)?
C.Prinzmetal’s angina
D.microvascular angina

10.which characteristic describes unstable angina (select all that apply)?

B.Unpredictable and unrelieved by rest
C. Characterized by progressive severity

Session 10
1.which of the following is the most common symptoms of myocardial( MI) ?
A.chest pain

2.An intravenous analgesic frequently administered to relieve chest pain associated with MI is:
C.Morphine sulfate

3. The classic ECG changes that occur with an Ml include all of the following except:
a. An absent P wave
b. An abnormal Q wave
c. T-wave inversion
d. ST segment elevation
ANSWER: A

4. Which of the following statements about myocardial infarction pain is incorrect?

a. It is relieved by rest and inactivity.
b. It is substernal in location.
c. It is sudden in onset and prolonged in duration
d. It is viselike and radiates to the shoulders and arms.
ANSWER: A

5. Myocardial cell damage can be reflected by high levels of cardiac enzymes. The
cardiac-specific isoenzyme is:
a. Alkaline phosphatase
b. Creatine kinase (CK-MB)
c. Myoglobin
d. Troponin
ANSWER:B

6. A patient admitted to the hospital for evaluation of chest pain has no abnormal serum cardiac
markers 4 hours after the onset of pain. What noninvasive diagnostic test can be used to
differentiate angina from other types of chest pain?
a. 12-lead ECG
b. Exercise stress test
c. Coronary angiogram
d. Transesophageal echocardiogram
ANSWER: B

7. A 52-year-old man is admitted to the emergency department with severe chest pain. On what
basis would the nurse
suspect an MI?
a. He has pale, cool, clammy skin.
b. He reports nausea and vomited once at home.
c. He says he is anxious and has a feeling of impending doom.
d. He reports he has had no relief of the pain with rest or position change.
ANSWER: D

8. At what point in the healing process of the myocardium following an infarct does early scar
tissue result in an unstable heart wall?
C.10 to 14 days after MI

9.To detect and treat the most common complication of MI, what should the nurse do?
C.Use continuous cardiac Monitoring

10.Which treatment is used first for the patient with a confirmed MI to open the blocked artery
within 90 minutes of arrival to the facility?
C.Percutaneous coronary intervention (PCI)

Session 11
1.Which statement accurately describe heart failure(select all that apply)?
A.A common cause of diastolic failure is left ventricular hypertrophy
B. A primary risk factor for heart failure is coronary artery disease (CAD)

2. What describe the action of the natriuretic peptides and nitric oxide in their counter regulatory
processes in response to heart failure (HF)?
C.Vasodilation and decrease blood pressure

3. The acronym FACES is used to help educate patients to identify symptoms of heart failure.
What does this acronym mean?
a. Frequent activity leads to cough in the elderly and swelling
b. Factors of risk activity, cough, emotional upsets, salt intake
c. Follow activity plan, continue exercise, and know signs of problems
d. Fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath
ANSWER: D

4. What is the pathophysiologic mechanism that results in the pulmonary edema of left-sided
heart failure?
a. Increased right ventricular preload
b. Increased pulmonary hydrostatic pressure
c. Impaired alveolar oxygen and carbon dioxide exchange
d. Increased lymphatic flow of pulmonary extravascular fluid
ANSWER:B

5. Which initial physical assessment finding would the nurse expect to be present in a patient
with acute left-sided heart failure?
a. Bubbling crackles and tachycardia
b. Hepatosplenomegaly and tachypnea
c. Peripheral edema and cool, diaphoretic skin
d. Frothy blood-tinged sputum and distended jugular veins
ANSWER: A

6. A patient with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction
(LVEF) of 18%. To decrease the risk of complications from these conditions, what drug does the
nurse anticipate giving?
a. Diuretics
b. Anticoagulants
c. B-Adrenergic blockers
d. Potassium supplements
ANSWER:B
7. Which diagnostic test is most useful in differentiating dyspnea related to pulmonary effects of
heart failure from dyspnea related to pulmonary disease?
a. Exercise stress testing
b. Cardiac catheterization
c. B-type natriuretic peptide (BNP) levels
d. Determination of blood urea nitrogen (BUN)
ANSWER: C

8. Which medication is currently approved only for use with African American patients for
hypertension and angina?
a. Captopril (Capoten)
b. Nitroglycerin (Nitro-Bid)
c. Spironolactone (Aldactone)
d. Isosorbide dinitrate and hydralazine (BiDil)
ANSWER: D

9. A patient is admitted to the emergency department with acute decompensated heart failure
(ADHF). Which IV medication would the nurse expect to administer first?
a. Digoxin (Lanoxin)
b. Morphine sulfate
c. Nesiritide (Natrecor)
d. Bumetanide (Bumex)
ANSWER:C

10. The patient with chronic heart failure is being discharged with a diuretic, a
renin-angiotensin-aldosterone system
(RAAS) inhibitor and a ß-adrenergic blocker. When received from the pharmacy, which
medication should not be included for this patient?
a. Losartan (Cozaar)
b. Carvedilol (Coreg)
c. Dopamine (Intropin)
d. Hydrochlorothiazide (HCTZ)
Answer:C

Session 12
1.When obtaining a health history from a 72 year old man with peripheral arterial disease (PAD)
of the lower extremities, the nurse asks about a history of related condition,including
D.coronary artery disease (CAD)

2. Following teaching about medications for PAD, the nurse determines that additional
instruction is necessary when the patient makes which statement?
a. "I should take one aspirin a day to prevent clotting in my legs."
b. "The lisinoprill use for my blood pressure may help me walk further without pain.
c. "I will need to have frequent blood tests to evaluate the effect of the Coumadin I will be
taking."
d. "Pletal should help me increase my walking distance and help prevent clots from forming in
my legs."
ANSWER:C

3. A patient with PAD has a nursing diagnosis of ineffective peripheral tissue perfusion .What
should be included in the teaching plan for this patient (select all that apply)?
a. Keep legs and feet warm
b. Apply cold compresses when the legs become swollen.
c. Walk at least 30 minutes per day to the point of discomfort.
d. Use nicotine replacement therapy as a substitute for smoking.
e. Inspect lower extremities for pulses, temperature, and any injury.
ANSWER: A.C E

4. When teaching the patient with PAD about modifying risk factors associated with the
condition, what should the nurse emphasize?
a. Amputation is the ultimate outcome if the patient does not alter lifestyle behaviors.
b. Modifications will reduce the risk of other atherosclerotic conditions such as stroke.
c. Risk-reducing behaviors initiated after angioplasty can stop the progression of the disease.
d. Maintenance of normal body weight is the most important factor in controlling arterial disease.
ANSWER:B

5. During care of the patient following femoral bypass graft surgery, the nurse immediately
notifies the health care provider if the patient experiences
a. fever and redness at the incision site.
b. 2+ edema of the extremity and pain at the incision site.
c. a loss of palpable pulses and numbness and tingling of the feet.
d. increasing ankle-brachial indices and serous drainage from the incision
ANSWER:C

6. What are characteristics of arteriospastic disease (Raynaud's phenomenon) (select all that
apply)?
a. Predominant in young females
b. May be associated with autoimmune disorders
c. Precipitated by exposure to cold, caffeine, and tobacco
d. Involves small cutaneous arteries of the fingers and toes
e. Inflammation of small and medium-sized arteries and veins
f. Episodes involve white, blue, and red color changes of fingertips
ANSWER: A B C D F

7. Which aneurysm is uniform in shape and a circumferential dilation of the artery?

a. False aneurysm
b. Pseudoaneurysm
c. Saccular aneurysm
d. Fusiform aneurysm
ANSWER: D

8. A surgical repair is planned for a patient who has a 5.5-cm abdominal aortic aneurysm (AAA).
On physical assessment of the patient, what should the nurse expect to find?
a. Hoarseness and dysphagia
b. Severe back pain with flank ecchymosis
c. Presence of a bruit in the periumbilical area
d. Weakness in the lower extremities progressing to paraplegia
ANSWER:C

9. A thoracic aortic aneurysm is found when a patient has a routine chest x-ray. The nurse
anticipates that additional diagnostic testing to determine the size and structure of the aneurysm
will include which test?
a. Angiography
b. Ultrasonography
c. Echocardiography
d. Computed tomography (CT) scan
ANSWER: D

10. A patient with a small AAA is not a good surgical candidate. What should the nurse teach
the patient is one of the best ways to prevent expansion of the lesion?
a. Avoid strenuous physical exertion.
b. Control hypertension with prescribed therapy.
c. Comply with prescribed anticoagulant therapy.
d. Maintain a low-calcium diet to prevent calcification of the vessel.
ANSWER: B

Session13

1.A 20 year old patient has acute infective endocarditis. Whole obtaining a Nursing history,
what should be nurse ask the patient about(select all that apply)
A.Renal dialysis
B.IV drug abuse
C.Recent dental work
D. Cardiac catheterization
E. Recent urinary tract infection
Answer:A B CD E

2. A patient has an admitting diagnosis of acute left-sided infective endocarditis. What is the
best test to confirm this diagnosis?
a. Blood cultures
b. Complete blood count
c. Cardiac catheterization
d. Transesophageal echocardiogram
ANSWER: A

3. Which manifestation of infective endocarditis is a result of fragmentation and

microembolization of vegetative lesions?
a. Petechiae
b. Roth's spots
c. Osler's nodes
d. Splinter hemorrhages
ANSWER: _A

4. What describes Janeway's lesions that are manifestations of infective endocarditis?

a. Hemorrhagic retinal lesions
b. Black longitudinal streaks in nail beds
c. Painful red or purple lesions on fingers or toes
d. Flat, red, painless spots on the palms of hands and soles of feet
ANSWER:D

5. The patient with acute pericarditis is having a pericardiocentesis. Postoperatively what

complication should the nurse monitor the patient for?
a. Pneumonia
b. Pneumothorax
c. Myocardial infarction (MI)
d. Cerebrovascular accident (CVA)
ANSWER: B

6. Priority Decision: A patient with acute pericarditis has a nursing diagnosis of pain related to
pericardial inflammation What is the best nursing intervention for the patient?
a. Administer opioids as prescribed on an around-the-clock schedule.
b. Promote progressive relaxation exercises with the use of deep, slow breathing.
c. Position the patient on the right side with the head of the bed elevated 15 degrees
d. Position the patient in Fowler's position with a padded over-the-bed table for the patient to
lean on.
ANSWER:D

7. When obtaining a nursing history for a patient with myocarditis, what should the nurse
specifically question the patient about?
a. Prior use of digoxin for treatment of cardiac problems
b. Recent symptoms of a viral illness, such as fever and malaise
c. A history of coronary artery disease (CAD) with or without an MI
d. A recent streptococcal infection requiring treatment with penicillin
ANSWER:_B
8. Priority Decision: What is the most important role of the nurse in preventing rheumatic fever?
a. Teach patients with infective endocarditis to adhere to antibiotic prophylaxis
b. Identify patients with valvular heart disease who are at risk for theumatic fever.
c. Encourage the use of antibiotics for treatment of all infections involving a sore throat.
d. Promote the garly diagnosis and immediate treatment of group A streptococcal pharyngitis.
ANSWER:D

9. What manifestations most strongly support a diagnosis of acute rheumatic fever?

a. Carditis, polyarthritis, and erythema marginatum
b. Polyarthritis, chorea, and decreased anti-streptolysin Otter
c. Organic heart murmurs, fever, and elevated erythrocyte sedimentation rate (ESR)
d. Positive C-reactive protein, elevated white blood cells (WBCs), and subcutaneous nodules
ANSWER: A

10. A patient with rheumatic heart disease with Earditis asks the nurse how long his activity will
be restricted. What is the best answer by the nurse?
a. "Full activity will be allowed as soon as acute symptoms have subsided."
b. "Bed rest will be continued until symptoms of heart failure are controlled."
c. "Nonstrenuous activities can be performed as soon as antibiotics are started."
d. "Bed rest must be maintained until anti-inflammatory therapy has been discontinued."
ANSWER: B
11. The patient is admitted post-radiation therapy with symptoms of cardiomyopathy (CMP).
Which type of CMP should the nurse suspect that the patient is experiencing?
a. Dilated
b. Restrictive
c. Takotsubo
d. Hypertrophic
ANSWER:B
12. What accurately describes dilated CMP (select all that apply)?
a. Characterized by ventricular stiffness
b. The least common type of cardiomyopathy
c. The hyperdynamic systolic function creates a diastolic failure
d. Echocardiogram reveals cardiomegaly with thin ventricular walls
e. Often follows an infective myocarditis
or exposure to toxins or drugs
f. Differs from chronic heart failure in that there is no ventricular hypertrophy
ANSWER: D E F

13. When planning care for the patient with hypertrophic CMP, what should the nurse include?
a. Ventricular pacing
c. Teach the patient to avoid strenuous activity and dehydration
d. Surgery for cardiac transplantation will need to be done soon
ANSWER: C
14. When performing discharge teaching for a patient with any type of CMP, what should the
nurse instruct the patient to do (select all that apply)?
a. Eat a low-sodium diet.
b. Go to the gym every day
c. Engage in stress reduction activities.
d. Abstain from alcohol and caffeine intake.
e. Avoid strenuous activity and allow for periods of rest.
f. Suggest that caregivers learn cardiopulmonary resuscitation (CPR).
ANSWER: A C D E F

15. A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy.
Which information will the nurse plan to teach the patient about managing this disorder?
a. A heart transplant should be scheduled as soon as possible,
b. Elevating the legs above the heart will help relieve dyspnea,
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the doctor about any symptoms of heart failure such as shortness of breath
ANSWER:D

session 14

1.When a burn damages cells, you would expect the cells to release the major electrolyte:
A.potassium

2. Diuretics affect the kidneys by altering the reabsorption and excretion of:
A.water only
B. electrolytes only
C. water and electrolytes.
D. Other drugs.
Answer: C

3. The main extracellular cation is:

A calcium
B. potassium
C. bicarbonate
D. sodium
ANSWER: D

4. Patient X is diagnosed with constipation. As a knowledgeable nurse, which nursing

intervention is appropriate for maintaining normal bowel function?
A.Assessing dietary intake
B. Decreasing fluid intake
C. Providing limited physical activity
D. Turning, coughing, and deep breathing
ANSWER: A
5. A 12-year-old boy was admitted in the hospital two days ago due to hyperthermia. His
attending nurse, Dennis, is quite
unsure about his plan of care. Which of the following nursing intervention should be included in
the care of plan for the client?
A. Room temperature reduction
B. Fluid restriction of 2,000 ml/day
C. Axillary temperature measurements every 4 hours
D. Antiemetic agent administration
ANSWER: A

6. A 36-year-old male client is about to be discharged from the hospital after 5 days due to
surgery. Which intervention should be included in the home health care nurse's instructions
about measures to prevent constipation?
A. Discouraging the client from eating large amounts of roughage-containing foods in the diet.
B. Encouraging the client to use laxatives routinely to ensure adequate bowel elimination
C. Instructing the client to establish a bowel evacuation schedule that changes every day.
D. Instructing the client to fill a 2-L bottle with water every night and drink it the next day.
ANSWER:D

7. Mrs. Dela Riva is in her first trimester of pregnancy. She has been lying all day because her
OB-GYN requested her to have a complete bed rest. Which nursing intervention is appropriate
when addressing the client's need to maintain skin integrity?
A. Monitoring intake and output accurately
B. Instructing the client to cough and deep-breathe every 2 hours
C. Keeping the linens dry and wrinkle free
D. Using a foot board to maintain correct anatomic position
ANSWER:C

8. A patient with tented skin turgor, dry mucous membranes, and decreased urinary output is
under nurse Mark's care. Which nursing intervention should be included the care plan of Mark
for his patient?
A. Administering 1.V. and oral fluids
B. Clustering necessary activities throughout the day
C. Assessing color, odor, and amount of sputum
D. Monitoring serum albumin and total protein levels
ANSWER:A

9. A client with very dry mouth, skin and mucous membranes is diagnosed of having
dehydration. Which intervention should the nurse perform when caring for a client diagnosed
with fluid volume deficit?
A.Assessing urinary intake and output
B. Obtaining the client's weight weekly at different times of the day
C. Monitoring arterial blood gas (ABG) results
D. Maintaining I.V. therapy at the keep-vein-open rate
ANSWER: A

10. Which electrolyte would the nurse identify as the major electrolyte responsible for
determining the concentration of the extracellular fluid?
A Potassium
B. Phosphate
C. Chloride
D. Sodium
ANSWER:D

Session 15

1. Orly Khan is suffering from fluid volume deficit (FVD), which of the following symptoms would
the nurse expect to assess in the patient?
C.tachycardia

2. John Reid is admitted in the hospital and is currently receiving hypertonic fluids. Nursing
management for the client includes monitoring for all of the following potential complications
except:
A water intoxication
B fluid volume excess (FVE)
C. cellular dehydration
D.cell shrinkage
ANSWER:A
3. Mr. Wenceslao is scheduled to receive an isotonic solution; which one of the following is an
example of such solution?
AD10% W
B. 0.45% saline
C. 0.9% saline
D. 3% normal saline
ANSWER:C
4. Which of the following statements provides the rationale for using a hypotonic solution for a
patient with FVD?
A. A hypotonic solution provides free water to help the kidneys eliminate the solute.
B. A hypotonic solution supplies an excess of sodium and chloride ions.
C. Excessive volumes are recommended in the early postoperative period.
D. A hypotonic solution is used to treat hyponatremia
ANSWER: A

5. The process of endocrine regulation of electrolytes involves:

A. sodium reabsorption and chloride excretion
B. chloride reabsorption and sodium excretion
C. potassium reabsorption and sodium excretion
D. sodium reabsorption and potassium excretion
ANSWER:D

6. Maria, an 85-year-old patient with a feeding tube, has been experiencing severe watery stool.
The patient is lethargic and has poor skin turgor, a pulse of 120, and hyperactive reflexes.
Nursing interventions would include:
A. measuring and recording intake and output and daily weights
B. administering salt tablets and monitoring hypertonic parenteral solutions
C. administering sedatives
D. applying wrist restraints to avoid displacement of the feeding tube
ANSWER: _A

7.Disease of which of the following structures is most likely to affect electrolyte reabsorption?
A. glomerulus
B. renal tubules
C. bladder
D. renal pelvis
ANSWER: B

8. Daniel who is a marathon runner is at high risk for fluid volume deficit. Which one of the
following is a related factor?
A. decreased diuresis
B. disease-related process
C. decreased breathing and perspiration
D. increased breathing and perspiration
ANSWER: D

9. Jomarick is diagnosed with FVD; which of the following nursing diagnoses might apply to his
condition?
A. altered urinary elimination
B. decreased cardiac output
C. increased cardiac output
D. vomiting
ANSWER: B

10. Body fluids perform which of the following functions?

A. transport nutrients
B. transport electrical charges
C. cushion the organs
D. facilitate fat metabolism
ANSWER:A

Session 16
1. A client's kidneys are retaining increased amounts of sodium. The nurse plans care,
anticipating that the kidneys also are retaining greater amounts of which substances?
A Calcium and Chloride
B Chloride and bicarbonate
C. Potassium and Phosphates
D. Aluminum and magnesium
ANSWER: B

2. The nurse is preparing to care for a client with a potassium deficit. The nurse reviews the
client's record and determines that the client was at risk for developing the potassium deficit
because of which situation?
A Sustained tissue damage
B. Requires Nasogastric suction
C. Has a history of Addison's disease
D. Is taking a potassium-retaining diuretic
Answer: B

3. A nurse is planning care for a client with hypokalemia. Which interventions should be
included in the plan of care? Select all that apply.
A. Ensure adequate fluid intake.
B. Implement safety measures to prevent falls
C. Encourage low fiber foods to prevent diarrhea
D. Instruct the client about foods that contain potassium
E. Encourage the client to obtain assistance to ambulate.
ANSWER: A.B.D E

4. The nurse is caring for a client with heart failure who is receiving high doses of a diuretic. On
assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness,
and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs
would the nurse expect to note in a client with hyponatremia?
A Muscle twitches
B. Decreased Urinary output
C. Hyperactive bowel sounds
D. Increased specific gravity of the urine
ANSWER: C

5. A patient prescribed spironolactone is demonstrating ECG changes & complaining of muscle

weakness. The nurse realizes this patient is exhibiting signs of which of the following.
A. hyperkalemia
B. hypokalemia
C. hypercalcemia
D. hypocalcemia
Answer:A
6. The nurse is planning care for a patient with fluid volume overload & hyponatremia. Which of
the following should be included in this patient's plan of care?
A. Restrict fluids
B. Administer intravenous fluids,
C. Provide Kayexalate.
D. Administer intravenous normal saline with furosemide
ANSWER:A

7.A patient is prescribed 20 mEq of potassium chloride. The nurse realizes that the reason the
patient is receiving this replacement is
A. to sustain respiratory function
B. to help regulate acid-base balance.
C. to keep a vein open.
D. to encourage urine output.
ANSWER: B

8. A patient with fluid retention related to renal problems is admitted to the hospital. The nurse
realizes that this patientcould possibly have which of the following electrolyte imbalances?
A.hypokalemia
B. hypernatremia
C. carbon dioxide
D.magnesium
ANSWER:B

9. An elderly patient comes into the clinic with the complaint of watery diarrhea for several days
with abdominal &muscle cramping. The nurse realizes that this pt is demonstrating which of the
following?
A. hypernatremia
B. hyponatremia
C. fluid volume excess
D. hyperkalemia
ANSWER:B

10. A patient is admitted with hypernatremia caused by being stranded on a boat in the Atlantic
Ocean for five days without a fresh water source. Which of the following is this patient at risk for
developing?
A. pulmonary edema
B. atrial dysrhythmias
C. cerebral bleeding
D. stress fractures
ANSWER: C