1.

To evaluate the effectiveness of prescribed therapies for a patient with ventilatory

failure, which diagnostic test will be most useful to the nurse? *
1/1
a. Chest x-rays
b. Pulse oximetry
c. Arterial blood gas (ABG) analysis

d. Pulmonary artery pressure monitoring

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 *
1/1
a. increases the oxygen flow rate.

b. suction the patient's oropharynx.

c. assists the patient to cough and deep breathe.
d. helps the patient to sit in a more upright position.

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 *
1/1
a. administration of 100% oxygen by non-rebreather mask.
b. endotracheal intubation and positive pressure ventilation.

c. insertion of a mini-tracheostomy with frequent suctioning.

d. initiation of bilevel positive pressure ventilation (BiPAP).

4. When admitting a patient in possible respiratory failure with a high PaCO2, which
assessment information will be of most concern to the nurse? *
1/1
a. The patient is somnolent.

b. The patient's SpO2 is 90%.

c. The patient complains of weakness.
d. The patient's blood pressure is 162/94.
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? *
1/1
a. Assess the client’s lung sounds.
b. Notify the Rapid Response Team.

c. Provide reassurance to the client.

d. Take a full set of vital signs.

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? *
1/1
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.

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? *
1/1
a. Breathing so rapidly interferes with oxygenation.
b. Maybe the client has respiratory distress syndrome.
c. The blood clot interferes with perfusion in the lungs.

d. The client needs immediate intubation and mechanical ventilation.

8. A client appears dyspneic, but the oxygen saturation is 97%. What action by the
nurse is best? *
1/1
a. Assess for other manifestations of hypoxia.

b. Change the sensor on the pulse oximeter.

c. Obtain a new oximeter from central supply.
d. Tell the client to take slow, deep breaths.
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? *
1/1
a. Ensure the client has adequate sedation.
b. Find another provider to intubate.
c. Interrupt the procedure to give oxygen.

d. Monitor the client’s oxygen saturation.

10. An intubated clients oxygen saturation has dropped to 88%. What action by the
nurse takes priority? *
1/1
a. Determine if the tube is kinked.
b. Ensure all connections are patent.
c. Listen to the client’s lung sounds.

d. Suction the endotracheal tube.

11. The nurse must teach the patient not to do which of the following while
thoracentesis is being done upon him EXCEPT *
1/1
a. move
b. breathe deeply
c. cough
d. position patient in side-lying

12. The nurse has noted yellow exudate during the thoracentesis of the patient. Which
of the following conditions does the patient have? *
1/1
a. Hemothorax
b. Empyema

c. Pneumothorax
d. Hydrothorax
13. Which of the following medications if given in high doses can cause acute
respiratory failure in patients? *
1/1
a. antihistamines
b. antihypertensives
c. sedative-narcotics

d. anticonvulsants

14. Which of the following would be a first indication that the patient is already
suffering from hypoxia brought about by acute respiratory failure? *
1/1
a. restlessness

b. air hunger
c. dyspnea
d. lethargy

15. Preterm infants are prone to develop acute respiratory distress syndrome due to *
1/1
a. allergies
b. immature lungs
c. lack of lung surfactant

d. patent ductus arteriosus

1. While assisting a patient with intermittent asthma to identify specific triggers of

asthma, what should the nurse explain? *
1/1
A. Food and drug allergies do not manifest in respiratory symptoms.
B. Exercise-induced asthma is seen only in individuals with sensitivity to cold air.
C. Asthma attacks are psychogenic in origin and can be controlled with relaxation techniques.
D. Viral upper respiratory infections are a common precipitating factor in acute asthma attacks.

Feedback
Rationale: Respiratory infections are one of the most common precipitating factors of an acute
asthma attack. Sensitivity to food and drugs may also precipitate attacks and exercise induced
asthma occurs after exercise, especially in cold, dry air. Psychologic factors may interact with the
asthmatic response to worsen the disease but it is not a psychosomatic disease.

2. A patient is admitted to the emergency department with an acute asthma attack.

Which patient assessment is of greatest concern to the nurse? *
1/1
A. The presence of a pulsus paradoxus
B. Markedly diminished breath sounds with no wheezing

C. Use of accessory muscles of respiration and a feeling of suffocation

D. A respiratory rate of 34 and increased pulse and blood pressure
Feedback
Rationale: Diminished or absent breath sounds may indicate a significant decrease in air movement
resulting from exhaustion and an inability to generate enough muscle force to ventilate and is an
ominous sign. The other symptoms are expected in an asthma attack.

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? *
1/1
A. Prednisone orally
B. Ipratropium inhaler
C. Fluticasone inhaler
D. Albuterol nebulizer

Feedback
Rationale: The albuterol nebulizer will rapidly cause bronchodilation and be easier to use in an
emergency situation than an inhaler. It will be used every 20 minutes to 4 hours as needed. The
ipratropium inhaler could be used if the patient does not tolerate the short-acting β2-adrenergic
agonists (SABA) but its onset is slower than albuterol. Inhaled or oral corticosteroids will be used to
decrease the inflammation and provide better symptom control after the emergency situation is over.

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? *
1/1
A. “I do not need to use the spacer like I used to.”
B. “I will hold my breath for 10 seconds or longer if I can.”
C. “I will not shake this inhaler like I did with my old inhaler.”
D. “I will store it in the bathroom so I will be able to clean it when I need to.”
Feedback
Rationale: Storing the dry powder inhaler (DPI) in the bathroom will expose it to moisture, which
could cause clumping of the medication and an altered dose. The other statements show patient
understanding.

5. Which statements by a patient with moderate asthma inform the nurse that the
patient needs more teaching about medications (Select All That Apply)? *
1/1
A. “If I can’t afford all of my medicines, I will only use the salmeterol (Serevent).”

B. “I will stay inside if there is a high pollen count to prevent having an asthma attack.”
C. “I will rinse my mouth after using fluticasone (Flovent HFA) to prevent oral candidiasis.”
D. “I must have omalizumab (Xolair) injected every 2 to 4 weeks because inhalers don’t help my
asthma.”
E. “If I can’t afford all of my medicines, I will only use the salmeterol (Serevent).”

Feedback
Rationale: Salmeterol (Serevent) should not be taken without inhaled corticosteroids. Asthma
medications may make gastroesophageal reflux disease (GERD) symptoms worse and GERD
medications may make asthma symptoms worse. The rest of the statements show patient
understanding.

6. To decrease the patient’s sense of panic during an acute asthma attack, what is the
best action for the nurse to do? *
1/1
A. Leave the patient alone to rest in a quiet, calm environment.
B. Stay with the patient and encourage slow, pursed lip breathing.

C. Reassure the patient that the attack can be controlled with treatment.
D. Let the patient know that frequent monitoring is being done using measurement of vital signs
and SpO2.
Feedback
Rationale: The patient in an acute asthma attack is very anxious and fearful. It is important to stay
with the patient and interact in a calm, unhurried manner. Helping the patient to breathe with pursed
lips will facilitate expiration of trapped air and help the patient to gain control of breathing. Pursed lip
breathing also is used with COPD for this same reason.

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? *
1/1
A. Carry the flow meter with the patient at all times in case an asthma attack occurs
B. Use the flow meter to check the status of the patient’s asthma every time the patient takes
quick-relief medication
C. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow
rate is in the yellow zone

D. Use the flow meter by emptying the lungs, closing the mouth around the mouthpiece, and
inhaling through the meter as quickly as possible
Feedback
Rationale: A yellow zone reading with the PEFR indicates that the patient’s asthma is getting worse
and quick-relief medications should be used. The meter is routinely used only each morning before
taking medications and does not have to be on hand at all times. The meter measures the ability to
empty the lungs and involves blowing through the meter.

8. A patient is being discharged with plans for home O2 therapy provided by an O2

concentrator with an O2-conserving portable unit. In preparing the patient to use the
equipment, what should the nurse teach the patient? *
1/1
A. The portable unit will last about 6 to 8 hours.
B. The unit is strictly for portable and emergency use.
C. The unit concentrates O2 from the air, providing a continuous O2 supply.

D. Weekly delivery of one large cylinder of O2 will be necessary for a 7- to 10-day supply of O2.
Feedback
Rationale: Oxygen concentrators or extractors continuously supply O2 concentrated from the air. O2-
conserving units will last for up to 20 hours. Portable liquid O2 units will hold about 6 to 8 hours of
O2 but because of the expense they are only used for portable and emergency use. Compressed O2
comes in various tank sizes but generally it requires weekly deliveries of four to five large tanks to
meet a 7- to 10-day 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? *
1/1
A. Prepare and administer routine bronchodilator medications.
B. Perform chest physiotherapy to promote removal of secretions.
C. Administer oxygen at 5 L/min until the shortness of breath is relieved.
D. Position the patient upright with the elbows resting on the over-the-bed table.
Feedback
Rationale: The tripod position with an elevated backrest and supported upper extremities to fix the
shoulder girdle maximizes respiratory excursion and an effective breathing pattern. Staying with the
patient and encouraging pursed lip breathing also helps. Bronchodilators may help but can also
increase nervousness and anxiety; rescue inhalers would be used before routine bronchodilators.
Postural drainage is not tolerated by a patient in acute respiratory distress and oxygen is titrated to
an effective rate based on ABGs because of the possibility of carbon dioxide narcosis.

10. In planning care for the patient with bronchiectasis, which nursing intervention
should the nurse include? *
1/1
A. Relieve or reduce pain
B. Prevent paroxysmal coughing
C. Prevent spread of the disease to others
D. Promote drainage and removal of mucus

Feedback
Rationale: Mucus production is increased in bronchiectasis and collects in the dilated, pouched
bronchi. A major goal of treatment is to promote drainage and removal of the mucus, primarily
through deep breathing, coughing, and postural drainage.

1. In formulating a nursing diagnosis of risk for infection for a client with chronic
lymphoid leukemia (CLL), nursing measures should include: (Select all that apply.) *
1/1
A. Maintaining a clean technique for all invasive procedures.
B. Placing the client in protective isolation.

C. Limiting visitors who have colds and infections.

D. Ensuring meticulous handwashing by all persons coming in contact with the client.

2. The client diagnosed with leukemia has central nervous system involvement. Which
instructions should the nurse teach? *
1/1
A. Sleep with the head of the bed elevated to prevent increased intracranial pressure.
B. Take an analgesic medication for pain only when the pain becomes severe.
C. Explain that radiation therapy to the head may result in permanent hair loss.
D. Discuss end-of-life decisions prior to cognitive deterioration
Feedback
Rationale: Radiation therapy to the head and scalp area is the treatment of choice for central
nervous system involvement of any cancer. If the radiation therapy destroys the hair follicle, the hair
will not grow back.

3. A client with acute leukemia is admitted to the oncology unit. Which of the following
would be most important for the nurse to inquire? *
1/1
A. ""Have you noticed a change in sleeping habits recently?""
B. ""Have you had a respiratory infection in the last 6 months?"

C ""Have you lost weight recently?"

D. ""Have you noticed changes in your alertness?"
Feedback
Rationale: The client with leukemia is at risk for infection and has often had recurrent respiratory
infections during the previous 6 months. Insomnolence, weight loss, and a decrease in alertness
also occur in leukemia, but

4. What nursing diagnosis is seen with acute lymphocytic leukemia and

thrombocytopenia? *
1/1
A. potential for injury

B. self-care deficit
C. potential for self harm
D. alteration in comfort
Feedback
Rationale: Low platelet increases risk of bleeding from even minor injuries. Safety measures: shave
with an electric razor, use soft tooth brush, avoid SQ or IM meds and invasive procedures (urinary
drainage catheter or a nasogastric tube), side-rails up, remove sharp objects, frequently assess for
signs of bleeding, bruising, hemorrhage.

5. The nurse is caring for a client diagnosed with acute myeloid leukemia. Which
assessment data warrant immediate intervention? *
1/1
A. T 99, P 102, R 22, and BP 132/68.
B. Hyperplasia of the gums.
C. Weakness and fatigue.
D. Pain in the left upper quadrant

Feedback
Rationale: Pain is expected, but it is a priority, and pain control measures should be implemented.

6. Which medication is contraindicated for a client diagnosed with leukemia? *

1/1
A. Bactrim, a sulfa antibiotic
B. Morphine, a narcotic analgesic
C. Epogen, a biologic response modifier

D. Gleevec, a genetic blocking agent

Feedback
Rationale: Epogen is a biologic response modifier that stimulates the bone marrow to produce RBCs.
The bone marrow is the area of malignancy in leukemia. Stimulating the bone marrow would be
generally ineffective for the desired results and would have the potential to stimulate malignant
growth.

7. A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic

leukemia. She is admitted to the hospital for treatment. The nurse should assign the
patient: *
1/1
A. To a private room so she will not infect other patients and healthcare workers
B. To a private room so she will not be infected by other patients and healthcare workers

C. To a semiprivate room so she will have stimulation during her hospitalization

D. To a semiprivate room so she will have the opportunity to express her feelings about her
illness"
Feedback
Rationale: To a private room so she will not be infected by other patients and health care workers —
CORRECT: protects patient from exogenous bacteria, risk for developing infection from others due to
depressed WBC count, alters ability to fight infection

8. A 33-year-old male is being evaluated for possible acute leukemia. Which of the
following would the nurse inquire about as a part of the assessment? *
1/1
A. The client collects stamps as a hobby.
B. The client recently lost his job as a postal worker.
C. The client had radiation for treatment of Hodgkin's disease as a teenager.
D. The client's brother had leukemia as a child.
Feedback
Rationale: Radiation treatment for other types of cancer can result in leukemia. Some hobbies and
occupations involving chemicals are linked to leukemia, but not the ones in these answers; therefore,
answers A and B are incorrect. Answer D is incorrect because the incidence of leukemia is higher in
twins than in siblings.

9. The most common signs and symptoms of leukemia related to bone marrow
involvement are which of the following? *
1/1
A. Petechiae, fever, fatigue

B. Headache, papilledema, irritability

C. Muscle wasting, weight loss, fatigue
D. Decreased intracranial pressure, psychosis, confusion
Feedback
Rationale: Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever
related to infection from the depressed number of effective leukocytes, and fatigue from the anemia.

Situation: the following questions pertains to the clinical decision making skills and
knowledge of a registered nurse caring for various patients with cervical cancer 1. A
33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which
statement by the nurse best explains the diagnosis? *
1/1
a. "The cancer is found at the point of origin only."
b. "Tumor cells have been identified in the cervical region."
c. "The cancer has been identified in the cervix and the liver."
d. "Your cancer was identified in the cervix and has limited local spread."

Feedback
Answer: d. "Your cancer was identified in the cervix and has limited local spread."
Rationale: Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or
at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor
growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as
to the liver.
2. The patient is told that her adenoma tumor is not encapsulated but has normally
differentiated cells and surgery will be needed. The patient asks the nurse what this
means. What should the nurse tell the patient? *
1/1
a. It will recur.
b. It has metastasized.
c. It is probably benign.

d. It is probably malignant.
Feedback
Answer: c. It is probably benign.
Rationale: Benign tumors are usually encapsulated, have normally differentiated cells, and do not
metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are
capable of metastasis.

3. Which statement by the nurse most facilitates patient cancer prevention during the
promotion stage of cancer development? *
1/1
a. "Exercise every day for 30 minutes."
b. "Follow smoking cessation recommendations."

c. "Following a vitamin regime is highly recommended."

d. "I recommend excision of the cancer as soon as possible."
Feedback
Answer: b. "Follow smoking cessation recommendations."
Rationale: The promotion stage of cancer is characterized by the reversible proliferation of the
altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking,
and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a
promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer.
Surgery at this stage may not be possible without a critical mass of cells, and this advice would not
be consistent with the nurse's role.

4. The laboratory reports that the cells from the patient's tumor biopsy are grade II.
What should the nurse know about this histologic grading? *
1/1
a. Cells are abnormal and moderately differentiated.

b. Cells are very abnormal and poorly differentiated.

c. Cells are immature, primitive, and undifferentiated.
d. Cells differ slightly from normal cells and are well-differentiated
Feedback
Answer: a. Cells are abnormal and moderately differentiated.
Rationale: Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells
differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and
poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is
difficult to determine.

5. Patients may reduce the risk of developing cancer using health promotion
strategies.Identify strategies which can reduce the risk of developing cancer (select all
that apply.). *
1/1
a. Control weight

b. Genetic testing

c. Immunizations

d. Use sunscreen

e. Stop smoking

f. Limit alcohol intake

6. The patient and his family are upset that the patient is going through procedures to
diagnose cancer. What nursing actions should the nurse use first to facilitate their
coping with this situation (select all that apply.)? *
1/1
a. Maintain hope

b. Exhibit a caring attitude

c. Plan realistic long-term goals

d. Give them anti-anxiety medications
e. Be available to listen to fears and concerns

f. Teach them about the different types of cancer that could be diagnosed
Feedback
Rationale: Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears
and concerns would be the first nursing interventions to use as well as assessing factors affecting
coping during the diagnostic period. Providing relief from distressing symptoms for the patient and
teaching them about the diagnostic procedures would also be important. Realistic long-term goals
and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the
family antianxiety medications would not be appropriate.

7. The patient is receiving an IV vesicant chemotherapy drug. The nurse notices

swelling and redness at the site. What should the nurse do first? *
1/1
a. Ask the patient if the site hurts.
b. Turn off the chemotherapy infusion.

c. Call the ordering health care provider.

d. Administer sterile saline to the reddened area.
Feedback
Rationale: Because extravasation of vesicants may cause severe local tissue breakdown and
necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for
the drug-specific extravasation procedures should be followed to minimize further tissue damage.
The site of extravasation usually hurts, but it may not. It is more important to stop the infusion
immediately. The health care provider may be notified by another nurse while the patient's nurse
starts the drug-specific extravasation procedures, which may or may not include sterile saline.

8. When caring for the patient with cancer, what does the nurse understand as the
response of the immune system to antigens of the malignant cells? *
1/1
a. Metastasis
b. Tumor angiogenesis
c. Immunologic escape
d. Immunologic surveillance

Feedback
Rationale: Immunologic surveillance is the process in which lymphocytes check cell surface antigens
and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells
from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor,
increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer
development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself.
Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer
cells to reproduce.
9. The patient is being treated with brachytherapy for cervical cancer. What factors
must the nurse be aware of to protect herself when caring for this patient? *
1/1
a. The medications the patient is taking
b. The nutritional supplements that will help the patient
c. How much time is needed to provide the patient's care
d. The time the nurse spends at what distance from the patient

Feedback
Rationale: The principles of ALARA (as low as reasonably achievable) and time, distance, and
shielding are essential to maintain the nurse's safety when the patient is a source of internal
radiation. The patient's medications, nutritional supplements, and time needed to complete care will
not protect the nurse caring for a patient with brachytherapy for cervical cancer.

10. A client, age 41, visits the gynecologist. After examining her, the physician
suspects cervical cancer. The nurse reviews the client’s history for risk factors for this
disease. Which history finding is a risk factor for cervical cancer? *
1/1
a. Onset of sporadic sexual activity at age 17
b. Spontaneous abortion at age 19
c. Pregnancy complicated with eclampsia at age 27
d. Human papillomavirus infection at age 32

Feedback
Rationale: Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for
cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16,
multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated
by eclampsia aren’t risk factors for cervical cancer.

1. What are manifestations of acute coronary syndrome (ACS) (select all that apply)? *
1/1
a. Dysrhythmia
b. Stable angina
c. Unstable angina

d. ST-segment-elevation myocardial infarction (STEMI)

e. Non-ST-segment-elevation myocardial infarction (NSTEMI)

2. Myocardial ischemia occurs as a result of increased oxygen demand and decreased

oxygen supply. What factors anddisorders result in increased oxygen demand (select
all that apply)? *
1/1
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

3. What causes the pain that occurs with myocardial ischemia? *

1/1
a. Death of myocardial tissue
b. Dysrythmias caused by cellular irritability
c. Lactic acid accumulation during anaerobic metabolism

d. Elevated pressure in the ventricles and pulmonary vessels

4. When a patient reports chest pain, why must unstable angina be identified and
rapidly treated? *
1/1
a. The pain may be severe and disabling.
b. ECG changes and dysrhythmias may occur during an attack
c. Atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen

d. Spasm of a major coronary artery may cause total occlusion of the vessel with progression to
MI
5. The nurse suspects stable angina rather than MI pain in the patient who reports that
his chest pain *
1/1
a. is relieved by nitroglycerin.

b. is a sensation of tightness or squeezing.

c. does not radiate to the neck, back, or arms.
d. is precipitated by physical or emotional exertion.

6. A patient admitted to the hospital for evaluation of chest pain has no abnormal
serum cardiac markers 4 hours afterthe onset of pain. What noninvasive diagnostic
test can be used to differentiate angina from other types of chest pain? *
1/1
a. 12-lead ECG
b. Exercise stress test

c. Coronary angiogram
d. Transesophageal echocardiogram

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? *
1/1
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

8. At what point in the healing process of the myocardium following an infarct does
early scar tissue result in an unstable heart wall? *
1/1
a. 2 to 3 days after MI
b. 4 to 10 days after MI
c. 10 to 14 days after MI

d. 6 weeks after MI
9. To detect and treat the most common complication of MI, what should the nurse
do? *
1/1
a. Measure hourly urine output.
b. Auscultate the chest for crackles.
c. Use continuous cardiac monitoring.

d. Take vital signs every 2 hours for the first 8 hours.

10. Which treatment is used first for the patient with a confirmed MI to open the
blocked artery within 90 minutes ofarrival to the facility? *
1/1
a. Stent placement
b. Coronary artery bypass graft (CABG)
c. Percutaneous coronary intervention (PCI)

d. Transmyocardial laser revascularization (TMR)

1. What are non-modifiable risk factors for primary hypertension (select all that
apply)? *
1/1
a. Age

b. Obesity
c. Gender

d. Ethnicity

e. Genetic link

2. How is secondary hypertension differentiated from primary hypertension? *

1/1
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

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

1/1
a. No symptoms

b. Cardiac palpitations
c. Dyspnea on exertion
d. Dizziness and vertigo

4. Priority Decision: 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 thepatient to
do? *
1/1
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

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 beentaking
his medication regularly. What is the nurse’s best response to this patient? *
0/1
a. "Try always to take your medication when you carry out another daily routine so you do not
forget to take it."
b. "You probably would not need to take medications for hypertension if you would exercise more
and stop smoking."
c. "The drugs you are taking cause sexual dysfunction in many patients. Are you experiencing
any problems in this area?"

d. "You need to remember that hypertension can be only controlled with medication, not cured,
and you must always take your medication."

Correct answer
d. "You need to remember that hypertension can be only controlled with medication, not cured,
and you must always take your medication."

6. A 78-year-old patient is admitted with a BP of 180/98 mm Hg. Which age-related

physical changes may contributeto this patient’s hypertension (select all that apply)? *
1/1
a. Decreased renal function d. Increased adrenergic receptor sensitivity

b. Increased baroreceptor reflexes e. Increased collagen and stiffness of the myocardium

c. Increased peripheral vascular resistance f. Loss of elasticity in large arteries from
arteriosclerosis

7. What should the nurse emphasize when teaching a patient who is newly prescribed
clonidine (Catapres)? *
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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.

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

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

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

emergency? *
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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

10. During treatment of a patient with a BP of 222/148 mm Hg and confusion, nausea,
and vomiting, the nurse initiallytitrates the medications to achieve which goal? *
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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

1. A patient was brought into the emergency department since a concrete wall fell on a
patient during a recent earthquake. The nurse on duty has assessed bruises on the
patient's chest. She suspects blunt trauma. Which of the following types of blunt
trauma has occurred? *
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A. Acceleration
B. Deceleration
C. Shearing
D. Compression

2. During the initial assessment, the doctor has observed for signs of hemothorax on
the left side of the chest of the patient due to blunt chest trauma. The nurse must
watch out for which of the following cardiac complications on the patient? *
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A. Heart failure
B. Cardiac tamponade

C. Myocardial infarction
D. Arrythmias

3. A patient who just had a motor vehicular accident was brought in to the ER with
massive blood loss from the chest. Nurse Leo must know that the cardinal signs of
hypovolemic shock associated with blood loss would be which of the following? Select
all that apply *
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A. Hypotension

B. Pulmonary edema
C. Tachycardia

D. Restlessness
E. Tachypnea

4. A patient who was hit by a car is suspected to have rib fracture. Nurse Diana who
was at the ER has observed crunching sounds on the patients ribcage upon
auscultation. She must note this as *
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A. Crepitus

B. Pleural friction rub

C. Pulmonary edema
D. Ronchi

5. A male patient was brought into the ER due to blunt trauma to the chest. Upon
assessment, Nurse Jenny has observed for bruises on the patient's chest and a harsh
sound heard during inspiration. She must note this as *
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A. Wheezing
B. Crepitus
C. Stridor

D. Ronchi

6. Fracture to the 5th-9th rib is usually associated with injury to which of the following
organs? Select all that apply *
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A. Small intestines
B. Liver
C. Spleen

D. Pancreas
E. Gallbladder

7. The nurse is reviewing the doctor's medication orders for the patient who just had a
blunt chest trauma. Which of the following medications should the nurse question from
the physician? *
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A. Lidocaine
B. Tramadol
C. Meperidine

D. Prednisone

8. Which of the following is NOT true regarding flail chest? *

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A. There is a loose segment of the chest wall.
B. Fracture to several portion of the ribs occur.
C. The loose chest wall moves outward during inspiration.

D. The loose chest wall moves outward during expiration.

9. Which of the following is a major complication of pulmonary contusion? *

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A. Pulmonary edema
B. Acute respiratory distress syndrome

C. Heart failure
D. Flail chest

10. A patient is suffering from massive blood loss due to a gunshot wound to the
chest. The doctor has ordered to start blood transfusion (BT). Which of the following
tests must be done prior to BT? *
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A. Prothrombin time
B. Partial thromboplastin time
C. Complete blood count
D. Crossmatching

11. This is a condition where air is present inside the patient's thoracic cavity due to an
open chest injury *
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A. Pneumothorax

B. Hydrothorax
C. Hemothorax
D. None of the above

12. This is a type of pneumothorax where air is sucked into the thoracic cavity through
a small opening from a chest injury and the air is remained trapped inside *
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A. Open pneumothorax
B. Tension pneumothorax

C. Simple pneumothorax
D. Traumatic pneumothorax

13. The nurse must place a patient who had a chest trauma in which of the following
positions? *
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A. High-Fowler's position

B. Supine position
C. Semi-Fowler's position
D. Prone position

14. Why are narcotic analgesics carefully administered to patient's who have chest
injury? *
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A. They can cause hypotension
B. They might induce arrythmias
C. They can promote hypertensive crisis
D. They can depress respirations
15. When administering narcotic analgesics to patients who have chest trauma, the
nurse must always prepare this medication alongside narcotics at the patient's
bedside *
1/1
A. Oxycodone
B. Acetylcysteine
C. Naloxone

D. Protamine sulfate