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50 Item MS Practice Test With Answers and Rationale

50 Item MS Practice Test With Answers and Rationale

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Published by: mervilyn on Aug 16, 2010
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10/25/2012

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50 item MS practice test with Answers and Rationale
Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with atypical description of pain associated with an MI, and is now cold and clammy, pale anddyspneic. He has an IV of D5W running, and is complaining of chest pain. Oxygen therapyhas not been started, and he is not on the monitor. He is frightened.1. The nurse is aware of several important tasks that should all be done immediately inorder to give Mr. Duffy the care he needs. Which of the following nursing interventions willrelieve his current myocardial ischemia?a. stool softeners, rest
b. O2 therapy, analgesia
 c. Reassurance, cardiac monitoringd. Adequate fluid intake, low-fat diet
 
All the nursing interventions listed are important in the care of Mr. Duffy. However relief of his pain will be best achieved by increasing the O2 content of the blood to his heart, andrelieving the spasm of coronary vessels.2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic bloodtests are obtained. Which of the following patterns of cardiac enzyme elevation are mostcommon following an MI?a. SGOT, CK, and LDH are all elevated immediately.b. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
c. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) andthen the LDH (peaks 3-4 days).
d. CK peaks first and remains elevated for 1 to 2 weeks.
 
Although the timing of initial elevation, peak elevation, and duration of elevation vary withsources, current literature favors option letter c.3. On his second day in CCU Mr. Duffy suffers a life-threatening cardiac arrhythmia.Considering his diagnosis, which is the most probable arrhythmia?a. atrial tachycardia
b. ventricular fibrillation
 c. atrial fibrillationd. heart block
 
Ventricular irritability is common in the early post-MI period, which predisposes the client toventricular arrhythmias. Heart block and atrial arrhythmias may also be seen post-MI butventricular arrhythmias are more common.4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning withhim for his discharge should educate him as to the purpose and actions of his newmedication. What should she or he teach Mr. Duffy to do at home to monitor his reaction tothis medication?a. take his blood pressure
b. take his radial pulse for one minute
c. check his serum potassium (K) leveld. weigh himself everyday
 
All options have some validity. However, option B relates best to the action of digitalis. If the pulse rate drops below 60 or is markedly irregular, the digitalis should be held and thephysician consulted. Serum potassium levles should be monitored periodically in clients on
 
digitalis and diuretics, as potassium balance is essential for prevention of arrhythmias.However the client cannot do this at home. Daily weights may make the client alert to fluidaccumulation, an early sign of CHF. Blood pressure measurement is also helpful; providingthe client has the right size cuff and he or she and/or significant other understand thetechnique and can interpret the results meaningfully.You are speaking to an elderly group of diabetics in the OPD about eye health and theimportance of visits to the ophthalmologist.5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests shouldthese clients request from their care provider?a. fluorescein stainb. snellen’s test
c. tonometry
 d. slit lamp
 
Option A is most often used to detect corneal lesions; B is a test for visual acuity usingsnellen’s chart; D is used to focus on layers of the cornea and lens looking for opacities andinflammation.
 
6. You also explain common eye changes associated with aging. One of these is presbyopia,which is:a. Refractive error that prevents light rays from coming to a single focus on the retina.b. Poor distant visionc. Poor near vision
d. A gradual lessening of the power of accommodation
 
Option A defines astigmatism, B is myopia, and C is hyperopia7. Some of the diabetic clients are interested in understanding what is visualized duringfunduscopic examination. During your discussion you describe the macular area as:a. Head of the optic nerve, seen on the nasal side of the field, lighter in color than theretina.
b. The area of central vision, seen on the temporal side of the optic disc, which isquite avascular.
c. Area where the central retinal artery and vein appear on the retina.d. Reddish orange in color, sometimes stippled.
 
Options A and C refer to the optic disc, D describes the color of the retina.8. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva.You explain that this is called:
a. a pinguecula, which is normal slightly raised fatty structure under theconjunctiva that may gradually increase with age.
b. Icterus, which may be due to liver disease.c. A pterygium, which will interfere with vision.d. Ciliary flush caused by congestion of the ciliary artery.
 
Correct by definition.
 
You are caring for Mr. Kaplan who has chronic renal failure (uremia)
 
9. You know that all but one of the following may eventually result in uremia. Which optionis not implicated?a. glomerular diseaseb. uncontrolled hypertensionc. renal disease secondary to drugs, toxins, infections, or radiations
d. all of the above
 
Options A, B and C are potential causes of renal damage and eventual renal failure.Individuals can live very well with only one healthy kidney.10. You did the initial assessment on Mr. Kaplan when he came to your unit. What classicalsigns and symptoms did you note?a. fruity- smelling breath.
b. Weakness, anorexia, pruritus
c. Polyuria, polydipsia, polyphagiad. Ruddy complexion
 
Weakness and anorexia are due to progressive renal damage; pruritus is secondary topresence of urea in the perspiration. Fruity smelling breath is found in diabetic ketoacidosis.Polyuria, polydipsia, polyphagia are signs of DM and early diabetic ketoacidosis. Oliguria isseen in chronic renal failure. The skin is more sallow or brown as renal failure continues.
 
11. Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him.Regarding his diagnosis and management of his drugs, you know that:a. The half-life of many drugs is decreased in uremia; thus dosage may have to beincreased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy andoften a decrease in dose is essential.
c. Drug therapy is not usually affected by this diagnosisd. Precautions should be taken with prescription drugs, but most OTC medications are safefor him to use.
 
Metabolic changes and alterations in excretion put the client with uremia at risk fordevelopment of toxicity to any drug. Thus alteration in drug schedule and dosage isnecessary for safe care.
 
You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin byreviewing assessment of the cardiovascular system in your mind and asking yourself thefollowing:12. The point of maximum impulse (PMI) is an important landmark in the cardiac exam.Which statement best describes the location of the PMI in the healthy adult?a. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.b. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
c. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
d. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
 
The PMI is the impulse at the apex of the heart caused by the beginning of ventricularsystole. It is generally located in the 5
th
left ICS, 7-9 cm from the MSL or at, or just medialto, the MCL.
 

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