NCM 112 LECTURE

MEDICAL AND SURGICAL NURSING

MIDTERM EXAMINATION

Name: ___________________________________________ Date: __________________

Section: ________
______________________________________________________________________________

Instructions:
- Choose the best answer among the options provided. Shade the circle that corresponds to
the letter of your choice on the answer sheet.
- Do not forget to write your name both on this questionnaire and the answer sheet.
- SUPERIMPOSITIONS AND ERASURES ARE NOT ALLOWED.

***GOODLUCK AND GOD BLESS***

1. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse

administers the medication, knowing that the primary action of this medication is to:

a. Promote expectoration.
b. Suppress the cough
c. Relax smooth muscles for bronchial airway
d. Prevent infection.

2. A client is receiving salbutamol via a nebulizer. The nurse monitors the client for which side
effect of this medication?

a. Constipation
b. Diarrhea
c. Bradycardia
d. Tachycardia

3. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client
indicated a need for further teaching?

a. Removes the cap and shakes the inhaler well before use.
b. Press the canister down with your finger as he breathes in.
c. Inhales the mist and quickly exhales.
d.  Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

4. A female client is scheduled to have a chest radiograph. Which of the following questions is
of most importance to the nurse assessing this client?

a.  “Is there any possibility that you could be pregnant?”

b. “Are you wearing any metal chains or jewelry?”
c.  “Can you hold your breath easily?”
d.  D. “Are you able to hold your arms above your head?”

5. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement
which of the following nursing interventions for this client?

a.  Encouraging additional fluids for the next 24 hours

 b. Ensuring the return of the gag reflex before offering foods or fluids
c. Administering atropine intravenously
d. Administering small doses of midazolam (Versed).

6. A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes
the:

a. Brachial and radial arteries, and then releases them and observes the circulation of the
hand.
b. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the
process with the other artery.
c. Radial artery and observes for color changes in the affected hand.
d. Ulnar artery and observes for color changes in the affected hand.

7. A nurse is assessing a client with chronic airflow limitation and notes that the client has a
“barrel chest.” The nurse interprets that this client has which of the following forms of chronic
airflow limitation?

a. Chronic obstructive bronchitis

b. Emphysema
c. Bronchial asthma
d. Bronchial asthma and bronchitis

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

a.  Maintain a fluid intake of 800 ml every 24 hours.

b.  Experience chills only once a day.
c.  Cough productively without chest discomfort.
d. Experience less nasal obstruction and discharge.

9. Which of the following individuals would the nurse consider to have the highest priority for
receiving an influenza vaccination?

a. A 60-year-old man with a hiatal hernia.

b. A 36-year-old woman with 3 children.
c. A 50-year-old woman caring for a spouse with cancer.
d. A 60-year-old woman with osteoarthritis.

10. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms.
Which of the following instructions would be appropriate for the nurse to give the client?

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

11. An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3
days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and
hears diffuse crackles. How would the nurse best interpret these assessment findings?

a.  It is likely that the client is developing a secondary bacterial pneumonia.

b. The assessment findings are consistent with influenza and are to be expected.
c. The client is getting dehydrated and needs to increase her fluid intake to decrease
secretions
d. The client has not been taking her decongestants and bronchodilators as prescribed.
12. A client with COPD reports steady weight loss and being “too tired from just breathing to
eat.” Which of the following nursing diagnoses would be most appropriate when planning
nutritional interventions for this client?

a. Altered nutrition: Less than body requirements related to fatigue.

b. Activity intolerance related to dyspnea.
c. Weight loss related to COPD.
d. Ineffective breathing pattern related to alveolar hypoventilation.

13. When developing a discharge plan to manage the care of a client with COPD, the nurse
should anticipate that the client will do which of the following?

a. Develop infections easily.

b. Maintain current status.
c.  Require less supplemental oxygen.
d. Show permanent improvement.

14. Which of the following outcomes would be appropriate for a client with COPD who has
been discharged to home? The client:

a. Promises to do pursed lip breathing at home.

b.  States actions to reduce pain.
c. States that he will use oxygen via a nasal cannula at 5 L/minute.
d. Agrees to call the physician if dyspnea on exertion increases.

15. Which of the following physical assessment findings would the nurse expect to find in a
client with advanced COPD?

a.  Increased anteroposterior chest diameter.

b. Underdeveloped neck muscles.
c. Collapsed neck veins.
d. Increased chest excursions with respiration.

16. Which of the following is the primary reason to teach pursed-lip breathing to clients with
emphysema?

a. To promote oxygen intake.

b. To strengthen the diaphragm.
c.  To strengthen the intercostal muscles.
d.  To promote carbon dioxide elimination.
17. Which of the following is a priority goal for the client with COPD?

a. Maintaining functional ability.

b. Minimizing chest pain.
c. Increasing carbon dioxide levels in the blood.
d.  Treating infectious agents.

18. When teaching a client with COPD to conserve energy, the nurse should teach the client to
lift objects:

a.  While inhaling through an open mouth.

b.  While exhaling through pursed lips.
c. After exhaling but before inhaling.
d. While taking a deep breath and holding it.
19. The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of
the following s/s would be included in the teaching plan?

a. Clubbing of nail beds

b. Hypertension
c. Peripheral edema
d. Increased appetite

20. Which of the following ABG abnormalities should the nurse anticipate in a client with
advanced COPD?

a.  Increased PaCO2
b.  Increased PaO2
c. Increased pH
d.  Increased oxygen saturation

21. Which of the following diets would be most appropriate for a client with COPD?

a.  Low fat, low cholesterol

b.  Bland, soft diet
c.  Low-Sodium diet
d. High calorie, high-protein diet

22. The nurse is planning to teach a client with COPD how to cough effectively. Which of the
following instructions should be included?

a. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.
b.  Lie flat on back, splint the thorax, take two deep breaths and cough.
c.  Take several rapid, shallow breaths and then cough forcefully.
d. Assume a side-lying position, extend the arm over the head, and alternate deep breathing
with coughing.

23. A 34-year-old woman with a history of asthma is admitted to the emergency department.
The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal
flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished
breath sounds. Based on these findings, what action should the nurse take to initiate care of
the client?

a.  Initiate oxygen therapy and reassess the client in 10 minutes.

b.  Draw blood for an ABG analysis and send the client for a chest x-ray.
c.  Draw blood for an ABG analysis.
d. Administer bronchodilators.

24. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the
rationale for the use of steroids in clients with asthma?

a. Corticosteroids promote bronchodilation.

b. Corticosteroids act as an expectorant.
c. Corticosteroids have an anti-inflammatory effect.
d. Corticosteroids prevent development of respiratory infections.

25. Which of the following health promotion activities should the nurse include in the discharge
teaching plan for a client with asthma?
a. Incorporate physical exercise as tolerated into the treatment plan.
b. Monitor peak flow numbers after meals and at bedtime.
 c.  Eliminate stressors in the work and home environment.
d. Use sedatives to ensure uninterrupted sleep at night.

26. The client with asthma should be taught which of the following is one of the most common
precipitating factors of an acute asthma attack?

a. Occupational exposure to toxins.

b. Viral respiratory infections.
c. Exposure to cigarette smoke.
d. Exercising in cold temperatures.

27. A female client comes into the emergency room complaining of SOB and pain in the lung
area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her
VS are: 140/80, P 110, R 40. The physician orders ABG’s, results are as follows: pH: 7.50; PaCO2
29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; SaO2 86%. Considering these results,
the first intervention is to:
a. Begin mechanical ventilation.
b. Place the client on oxygen.
c. Give the client sodium bicarbonate.
d. Monitor for pulmonary embolism.
28. A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen,
the first nursing action would be to:

a.  Wait until the client’s lab work is done.

b. Not administer oxygen unless ordered by the physician.
c. Administer oxygen at 2 L flow per minute.
d. Administer oxygen at 10 L flow per minute and check the client’s nail beds.

29. Immediately following a thoracentesis, which clinical manifestations indicate that a

complication has occurred and the physician should be notified?
a.  Serosanguineous drainage from the puncture site.
b.  Increased temperature and blood pressure.
c. Increased pulse and pallor.
d. Hypotension and hypothermia.
30. If a client continues to hypoventilate, the nurse will continually assess for a complication of:
a.  Respiratory acidosis
b. Respiratory alkalosis
c.  Metabolic acidosis
d. Metabolic alkalosis
31. Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing
intervention is to:
a. Repeat auscultation after asking the client to deep breath and cough.
b.  Instruct the client to limit fluid intake to less than 2000 ml/day.
c. Inspect the client’s ankles and sacrum for the presence of edema.
d.  Place the client on bedrest in a semi-Fowler's position.
32. The most reliable index to determine the respiratory status of a client is to:
a. Observe the chest rising and falling.
b. Observe the skin and mucous membrane color.
c. Listen and feel the air movement.
d. Determine the presence of a femoral pulse.
33. The physician has scheduled a client for a left pneumonectomy. The position that
will most likely be ordered postoperatively for his is the:
a.  Nonoperative side or back
b.  Operative side or back
c. Back only
d.  Back or either side.

34. Assessing a client who has developed atelectasis postoperatively, the nurse will most likely
find:
a. A flushed face.
b. Dyspnea and pain.
c. Decreased temperature.
d.  Severe cough and no pain.
35. An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the
tissues, is caused by:
a.  A decreasing oxygen pressure in the blood.
b.  An increasing carbon dioxide pressure in the blood.
c. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the
blood.
d.  An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the
blood.
36. The best method of oxygen administration for client with COPD uses:
a. Cannula
b. Simple Face mask
c.  Non-rebreather mask
d. Venturi mask

37. The most important action the nurse should do before and after suctioning a client is:
a. Placing the client in a supine position
b. Making sure that suctioning takes only 10-15 seconds
c. Evaluating for clear breath sounds
d. Hyperventilating the client with 100% oxygen

38. The position of a conscious client during suctioning is:

a. Fowler's
b. Supine position
c. Side-lying
d. Prone

39. Presence of overdistended and non-functional alveoli is a condition called:

a. Bronchitis
b. Emphysema
c. Empyema
d. Atelectasis

40. The accumulation of fluids in the pleural space is called:

a. Pleural effusion
b. Hemothorax
c. Hydrothorax
d. Pyothorax

41. Nurse Kim is caring for a client with a pneumothorax and who has had a chest tube inserted
notes continuous gentle bubbling in the suction control chamber. What action is appropriate?
a. Do nothing, because this is an expected finding.
b. Immediately clamp the chest tube and notify the physician.
c. Check for an air leak because the bubbling should be intermittent.
d. Increase the suction pressure so that bubbling becomes vigorous.

42. The nurse caring for a male client with a chest tube turns the client to the side, and the
chest tube accidentally disconnects. The initial nursing action is to:
a. Call the physician.
b. Place the tube in a bottle of sterile water
c.  Immediately replace the chest tube system.
d. Place the sterile dressing over the disconnection site.

43. A nurse is caring for a male client immediately after removal of the endotracheal tube. The
nurse reports which of the following signs immediately if experienced by the client?
a. Stridor
b. Occasional pink-tinged sputum
c. A few basilar lung crackles on the right
d. Respiratory rate of 24 breaths/min

44. The nurse is reviewing data collected during the assessment of a client with tuberculosis.
Which nursing diagnosis should the nurse select for this client? (Select all that apply.)
a. Infection, Risk for
b. Health: Community, Deficient
c. Resilience, Impaired
d.  Fatigue
e. All are correct

45. The nurse is assessing a client with tuberculosis. Which should the nurse focus on during
this assessment? (Select all that apply.)
a. Presence of cough
b. Difficulty breathing
c. Skin color
d. all are correct

46. The right forearm of a client who had a purified protein derivative (PPD) test for
tuberculosis is reddened and raised about 3mm where the test was given. This PPD would be
read as having which of the following results?
a. Indeterminate
b. Needs to be redone
c. Negative
d. Positive
47. A client with primary TB infection can expect to develop which of the following conditions?

a. Active TB within 2 weeks

b. Active TB within 1 month
c. A fever that requires hospitalization
d. A positive skin test
48. A client has active TB. Which of the following symptoms will he exhibit?

a. Chest and lower back pain

b. Chills, fever, night sweats, and hemoptysis
c. Fever of more than 104*F and nausea
d. Headache and photophobia

49. Which of the following diagnostic tests is definitive for TB?

a. Chest x-ray
b. Mantoux test
c. Sputum culture
d. Tuberculin test

50. A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the
following reasons is this done?

a. To confirm the diagnosis

b. To determine if a repeat skin test is needed
c. To determine the extent of the lesions
d. To determine if this is a primary or secondary infection

51. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse
sees no electrocardiographic complexes on the screen. Which is the priority action of the
nurse?
a. Call a code.
b. Call the health care provider.
c. Check the client's status and lead placement.
d. Press the recorder button on the electrocardiogram console.

52. The home care nurse is providing instructions to a client with an arterial ischemic leg ulcer
about home care management and self-care management. Which statement, if made by the
client, indicates a need for further instruction?
a. "I need to be sure not to go barefoot around the house."
b. "If I cut my toenails, I need to be sure that I cut them straight across."
c. "It is all right to apply lanolin to my feet, but I shouldn't place it between my toes."
d. ."I need to be sure that I elevate my leg above my heart level for at least an hour every day."

53. The nurse is providing instructions to a client with a diagnosis of hypertension regarding
high-sodium items to be avoided. The nurse instructs the client to avoid consuming which item?

a. Bananas
 b. Broccoli
c. Pork
d. Cantaloupe

54. The nurse in the medical unit is reviewing the laboratory test results for a client who has
been transferred from the intensive care unit. The nurse notes that a cardiac troponin T level
assay was performed while the client was in the intensive care unit. The nurse determines that
this test was performed to assist in diagnosing which condition?

a. Heart failure
b. Atrial fibrillation
c. Myocardial infarction
d. Ventricular tachycardia

55. The nurse is performing an assessment on a client with a diagnosis of left-sided heart
failure. Which assessment component would elicit specific information regarding the client's
left-sided heart function?

a. Listening to lung sounds

b. Monitoring for organomegaly
c. Assessing for jugular vein distention
d. Assessing for peripheral and sacral edema

56. The nurse in the medical unit is assigned to provide discharge teaching to a client with a
diagnosis of angina pectoris. The nurse is discussing lifestyle changes that are needed to
minimize the effects of the disease process. The client continually changes the subject during
the teaching session. The nurse interprets that this client's behavior is most likely related to
which problem?

a. Anxiety related to the need to make lifestyle changes

b. Boredom resulting from having already learned the material
c. An attempt to ignore or deny the need to make lifestyle changes
d. Lack of understanding of the material provided at the teaching session and embarrassment
about asking questions

57. The nurse is caring for a client who has been hospitalized with a diagnosis of angina
pectoris. The client is receiving oxygen via nasal cannula at 2 L/min. The client asks why the
oxygen is necessary. The nurse should provide which information to the client?

a. Oxygen has a calming effect.

b. Oxygen will prevent the development of any thrombus.
c. Oxygen dilates the blood vessels so that they can supply more nutrients to the heart muscle.
d. The pain of angina pectoris occurs because of a decreased oxygen supply to heart cells.

58. A client with a diagnosis of angina pectoris is hospitalized for an angioplasty. The client
returns to the nursing unit after the procedure, and the nurse provides instructions to the client
regarding home care measures. Which statement, if made by the client, indicates an
understanding of the instructions?

a. "I need to cut down on cigarette smoking."

b. "I am so relieved that my heart is repaired."
c. "I need to adhere to my dietary restrictions."
d. "I am so relieved that I can eat anything I want to now."

59. The nurse is caring for a client with a diagnosis of myocardial infarction (MI) and is assisting
the client in completing the diet menu. Which beverage should the nurse instruct the client to
select from the menu?

a. Tea
b. Cola
c. Coffee
d. Raspberry juice

60. The nurse is performing an admission assessment on a client with a diagnosis of angina
pectoris who takes nitroglycerin for chest pain at home. During the assessment the client
complains of chest pain. The nurse should immediately ask the client which question?

a. "Where is the pain located?"

b. "Are you having any nausea?"
c. "Are you allergic to any medications?"
d. "Do you have your nitroglycerin with you?"

61. The nurse has provided dietary instructions to a client with coronary artery disease. Which
statement by the client indicates an understanding of the dietary instructions?

a. "I'll need to become a strict vegetarian."

b. "I should use polyunsaturated oils in my diet."
c. "I need to substitute eggs and whole milk for meat."
d. "I should eliminate all cholesterol and fat from my diet."

62. A client is admitted to the visiting nurse service for assessment and follow-up after being
discharged from the hospital with new-onset heart failure (HF). The nurse teaches the client
about the dietary restrictions required with HF. Which statement by the client indicates that
further teaching is needed?

a. "I'm not supposed to eat cold cuts."

b. "I can have most fresh fruits and vegetables."
c. "I'm going to weigh myself daily to be sure I don't gain too much fluid."
d. "I'm going to have a ham and cheese sandwich and potato chips for lunch."

63. The nurse is performing a health screening on a 54-year-old client. The client has a blood
pressure of 118/78 mm Hg, total cholesterol level of 190 mg/dL, and fasting blood glucose level
of 184 mg/dL. The nurse interprets this to mean that the client has which modifiable risk factor
for coronary artery disease (CAD)?

a. Age
b. Hypertension
c. Hyperlipidemia
d. Glucose intolerance

64. The nurse is trying to determine the ability of the client with myocardial infarction (MI) to
manage independently at home after discharge. Which statement by the client is the strongest
indicator of the potential for difficulty after discharge?
a. "I need to start exercising more to improve my health."
b. "I will be sure to keep my appointment with the cardiologist."
c. "I don't have anyone to help me with doing heavy housework at home."
d. “I think I have a good understanding of what all my medications are for."

65. The home care nurse has taught a client with a problem of inadequate cardiac output about
helpful lifestyle adaptations to promote health. Which statement by the client best
demonstrates an understanding of the information provided?

a. "I will eat enough daily fiber to prevent straining at stool."

b. "I will try to exercise vigorously to strengthen my heart muscle."
c. "I will drink 3000 to 3500 mL of fluid daily to promote good kidney function."
d. "Drinking 2 to 3 oz of liquor each night will promote blood flow by enlarging blood vessels."

66. A client has been experiencing difficulty with completion of daily activities because of
underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood
pressure. Which observation by the nurse best indicates client progress in meeting goals for this
problem?

a. Ambulates 10 feet farther each day

b. Verbalizes the benefits of increasing activity
c. Chooses a healthy diet that meets caloric needs
d. Sleeps without awakening throughout the night

67. The health care provider has written a prescription for a client to have an echocardiogram.
Which action should the nurse take to prepare the client for the procedure?

a. Questions the client about allergies to iodine or shellfish

b. Has the client sign an informed consent form for an invasive procedure
c. Tells the client that the procedure is painless and takes 20 to 30 minutes
d. Keeps the client on nothing-by-mouth (NPO) status for 2 hours before the procedure

68. A client with coronary artery disease is scheduled to have a diagnostic exercise stress test.
Which instruction should the nurse plan to provide to the client about this procedure?

a. Eat breakfast just before the procedure.

b. Wear firm, rigid shoes, such as work boots.
c. Wear loose clothing with a shirt that buttons in front and remind NPO status.
d. Avoid cigarettes for 30 minutes before the procedure.

69. A client is scheduled for a cardiac catheterization to diagnose the extent of coronary artery
disease. The nurse places highest priority on telling the client to report which sensation during
the procedure?

a. Chest pain
b. Urge to cough
c. Warm, flushed feeling
d. Pressure at the insertion site

70. A client recovering from pulmonary edema is preparing for discharge. What should the
nurse plan to teach the client to do to manage or prevent recurrent symptoms after discharge?

a. Sleep with the head of bed flat.

b. Weigh himself or herself on a daily basis.
c. Take a double dose of the diuretic if peripheral edema is noted.
d. Withhold prescribed digoxin (Lanoxin) if slight respiratory distress occurs.
71. Which of the following are most likely to be early signs of cardiac problems in older
persons? (Select all that apply.)

a. Mental status changes

b. Agitation
c. Frequent falls
d. All are correct

72. A patient has been diagnosed with Right-Sided Congestive Heart Failure, and is confused
about return of deoxygenated blood from the tissue. To clarify the confusion, which chamber of
the heart receives blood from systemic circulation?

a. Left atrium
b. Right atrium
c. Right ventricle
d. Left ventricle

73. It is important that the nurse be knowledgeable about cardiac output in order to:

a. Evaluate blood flow to peripheral tissues.

b. Determine the electrical activity of the myocardium.
c. Provide information on the immediate need for oxygen.
d. Implement nutritional changes.

74. Nurses can best help older clients prevent hypertension by teaching:

a. Low-fat, low-cholesterol diets.

b. The importance of exercise.
c. How to handle stressful situations.
d. How to maintain a normal blood pressure.

75. Modification of lifestyle behaviors to help manage hypertension does not include which of
the following?

a. Weight loss of even 10 pounds

b. The DASH diet
c. Fruits, vegetables, and whole grains
d. Alcohol intake with meals

76. Older clients experiencing anginal pain with complaints of fatigue or weakness usually are
medicated with which of the following types of medication?

a. Sublingual nitroglycerin
b. Cardiac glycosides
c. HMG-CoA reductase inhibitors
d. Morphine sulfate

77. Which of the following diagnostic studies most likely would confirm a myocardial infarction?

a. Serum myoglobin level

b. Creatinine kinase (CK)
c. White blood cell count (WBC)
d. Troponin T levels

78. Which of the following diagnostic tests is preferred for evaluating heart valve function?

a. Chest x-ray
b. Duplex Doppler
c. Echocardiogram
d. Electrocardiogram

79. A client is scheduled for a cardiac catheterization using a radiopaque dye. Which of the
following assessments is most critical before the procedure?

a. Intake and output

b. Baseline peripheral pulse rates
c. Height and weight
d. Allergy to iodine or shellfish

80. A client with no history of cardiovascular disease comes into the ambulatory clinic with
flulike symptoms. The client suddenly complains of chest pain. Which of the following questions
would best help a nurse to discriminate pain caused by a non-cardiac problem?

a. "Have you ever had this pain before?"

b. "Can you describe the pain to me?"
c. "Does the pain get worse when you breathe in?"
d. "Can you rate the pain on a scale of 1-10, with 10 being the worst?"

81. A nurse is assessing the blood pressure of a client diagnosed with primary hypertension. The
nurse ensures accurate measurement by avoiding which of the following?

a. Seating the client with arm bared, supported, and at heart level.
b. Measuring the blood pressure after the client has been seated quietly for 5 minutes.
c. Using a cuff with a rubber bladder that encircles at least 80% of the limb.
d. Taking a blood pressure within 15 minutes after nicotine or caffeine ingestion.

82. IV heparin therapy is ordered for a client. While implementing this order, a nurse ensures
that which of the following medications is available on the nursing unit?

a. Vitamin K
b. Aminocaporic acid
c. Potassium chloride
d. Protamine sulfate

83. When administered a thrombolytic drug to the client experiencing an MI, the nurse explains
to him that the purpose of this drug is to:

a. Help keep him well hydrated

b. Dissolve clots he may have
c. Prevent kidney failure
d. Treat potential cardiac arrhythmias.

84. A client has driven himself to the ER. He is 50 years old, has a history of hypertension, and
informs the nurse that his father died of a heart attack at 60 years of age. The client is presently
complaining of indigestion. The nurse connects him to an ECG monitor and begins
administering oxygen at 2 L/minute per NC. The nurse's next action would be to:

a. Call for the doctor

b. Start an intravenous line
c. Obtain a portable chest radiograph
d. Draw blood for laboratory studies

85. The nurse receives emergency laboratory results for a client with chest pain and
immediately informs the physician. An increased myoglobin level suggests which of the
following?
a. Cancer
b. Hypertension
c. Liver disease
d. Myocardial infarction

86. The most important long-term goal for a client with hypertension would be to:

a. Learn how to avoid stress

b. Explore a job change or early retirement
c. Make a commitment to long-term therapy
d. Control high blood pressure

87. Hypertension is known as the silent killer. This phrase is associated with the fact that
hypertension often goes undetected until symptoms of other system failures occur. This may
occur in the form of:

a. Cerebrovascular accident
b. Liver disease
c. Myocardial infarction
d. Pulmonary disease

88. During the previous few months, a 56-year-old woman felt brief twinges of chest pain while
working in her garden and has had frequent episodes of indigestion. She comes to the hospital
after experiencing severe anterior chest pain while raking leaves. Her evaluation confirms a
diagnosis of stable angina pectoris. After stabilization and treatment, the client is discharged
from the hospital. At her follow-up appointment, she is discouraged because she is
experiencing pain with increasing frequency. She states that she is visiting an invalid friend
twice a week and now cannot walk up the second flight of steps to the friend's apartment
without pain. Which of the following measures that the nurse could suggest would most likely
help the client deal with this problem?

a. Visit her friend earlier in the day.

b. Rest for at least an hour before climbing the stairs.
c. Take a nitroglycerin tablet before climbing the stairs.
d. Lie down once she reaches the friend's apartment.

89. Which of the following symptoms should the nurse teach the client with unstable angina to
report immediately to her physician?

a. A change in the pattern of her pain

b. Pain during sex
c. Pain during an argument with her husband
d. Pain during or after an activity such as lawnmowing

90. The physician refers the client with unstable angina for a cardiac catheterization. The nurse
explains to the client that this procedure is being used in this specific case to:

a. Open and dilate the blocked coronary arteries

b. Assess the extent of arterial blockage
c. Bypass obstructed vessels
d. Assess the functional adequacy of the valves and heart muscle.

91. As an initial step in treating a client with angina, the physician prescribes nitroglycerin
tablets, 0.3mg given sublingually. This drug's principle effects are produced by:

a. Antispasmotic effect on the pericardium

b. Causing an increased mycocardial oxygen demand
c. Vasodilation of peripheral vasculature
d. Improved conductivity in the myocardium

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

a. Headache
b. High blood pressure
c. Shortness of breath
d. Stomach cramps

93. Which of the following blood tests is most indicative of cardiac damage?

a. Lactate dehydrogenase
b. Complete blood count (CBC)
c. Troponin I
d. Creatine kinase (CK)

94. Which of the following diagnostic tools is most commonly used to determine the location of
myocardial damage?

a. Cardiac catherization
b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram (ECG)

95. One hour after administering IV furosemide (Lasix) to a client with heart failure, a short
burst of ventricular tachycardia appears on the cardiac monitor. Which of the following
electrolyte imbalances should the nurse suspect?

a. Hypocalcemia
b. Hypermagnesemia
c. Hypokalemia
d. Hypernatremia

96. Following a treadmill test and cardiac catheterization, the client is found to have coronary
artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his
first visit to the unit he says that he doesn't understand why he needs to be there because
there is nothing that can be done to make him better. The best nursing response is:

a. "Cardiac rehabilitation is not a cure but can help restore you to many of your former
activities."
b. "Here we teach you to gradually change your lifestyle to accommodate your heart disease."
c. "You are probably right but we can gradually increase your activities so that you can live a
more active life."
d. "Do you feel that you will have to make some changes in your life now?"

97. A client enters the ER complaining of severe chest pain. A myocardial infarction is
suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing
until cardiac enzyme studies are returned. All of the following will be included in the nursing
care plan. Which activity has the highest priority?

a. Monitoring vital signs

b. Completing a physical assessment
c. Maintaining cardiac monitoring
d. Maintaining at least one IV access site
98. A client enters the ER complaining of chest pressure and severe epigastric distress. His VS
are 158/90, 94, 24, and 99*F. The doctor orders cardiac enzymes. If the client were diagnosed
with an MI, the nurse would expect which cardiac enzyme to rise within the next 3 to 8 hours?

a. Creatine kinase (CK or CPK)

b. Lactic dehydrogenase (LDH)
c. LDH-1
d. LDH-2

99. When checking the capillary filling time of a patient, the color returns in 10 seconds. The
nurse recognizes this finding as indicative of

a. a normal response.
b. thrombus formation in the veins.
c. lymphatic obstruction of venous return.
d. impaired arterial flow to the extremities.

100. When assessing the cardiovascular system of a 79-year-old patient, the nurse expects to
find

a.. a narrowed pulse pressure.

b. diminished carotid artery pulses.
c. difficulty in isolating the apical pulse.
d. an increased heart rate in response to stress.

=END=

Prepared by:

BILLY RAY A. MARCELO, RN, MAN

Lecturer – NCM 112