MEDICAL SURGICAL NURSING PRE TEST 1. A nurse administers an intravenous solution of D.45% sodium chloride.

With respect to human blood cells this solution is a. Isotonic c. Hypotonic b. Isometric d. Hypertonic 2. Two body systems that interact with the bicarbonate buffer system to preserve the normal body flu7id ph 7.4 are the a. Skeletal and nervous system c. Respiratory and urinary systems b. Circulatory and urinary systems d. Muscular and endocrine systems 3. a. b. c. d. The statement that correctly compares the blood plasma and interstitial fluid is: Bothe contain the same kind of ions Plasma exerts lower osmotic pressure than does interstitial Plasma conatains slightly more of each kind of ions than does interstitial cells The main cat ion in plasma is sodium , whereas the main cation in interstitial fluid is potassium 4. The nurse understands that a client with albuminuria has edema caused by? a. Fall in tissue hydrostatic pressure c. Fall in plasma colloid osmotic pressure b. Rise in plasma hydrostatic pressure d. Rise in tissue colloid osmotic pressure 5. During the acute phase of follwing myocardial infarction the nurse should make the client bed by? a. Changing the top linen and only necessary the bottom linen b. Changing the linen from top to bottom without lowering the head of the bed c. Lifting rather than rolling the client from side to side while changing the linen d. Sliding the client onto a stretcher , remaking the bed than sliding the client back to the bed 6 The client receiving digoxin (lanoxin) and will continue taking the drug after discharge the nurse should be primarily concerned with? a. Monitoring vital sign and encourage gradual increase in activities of daily living b. Taking the apical pulse before drug administration and teaching the client how to count the pulse rate. c. Observing the client for return of normal cardiac conduction pattern and for adverse effects of drugs d. Assessing the client for changes in cardiac rhythm and planning activity at home based tolerance 6. The nurse should realize that the client with right ventricular heart failure may develop ascites because of a. loss of cellular constituents of the blood b. Rapid osmosis from tissue spaces to cells

c. Increased pressure within the circulatory system d. Rapid diffusion of solutes and solvent into the plasma 7. The nurse can best assess the degree of edema in an extremity by? a. weighing the clients b. measuring the affected area c. Checking the pitting edema d. observing input and output 8. When assessing clients with the following medical problems the nurse would expect pulmonary edema to be associated with. a. Mitral stenosis b. pulmonary valve stenosis c. severe arteriosclerosis of the coronary arteries d. calcification and incomplete closure of the tricuspid valve 9. A client is admitted and the physician suspects atelectasis when assessing this individual the nurse would expect? a. Slow deep respirations b. Crackles on auscultation c. normal oral temp. d. Dimished breath sound 10. The nurse understands that in the absence of patholoyt, a clients respiratory center is stimulated by ? a. Oxygen b. Calcium ions c Lactic acid d. Carbon dioxide 11. A client is admitted with carbon monoxide poisoning. The nurse understands that the poisonous nature of carbon monoxide result from? a. Its tendency to block CO2 transport b. The inhibitory affect it has on with hemoglobin c. Its preferential combination with hemoglobin d. The bubbles it tends to from in blood plasma 12. Which of the following points should the nurse includes about sublingual nitroglycerin when instructing the client with angina? a. The drug will increase urine output b. Store tablets in a tight, light resistant container c. Use the tablets only pain is severe d. The shelf life of nitroglycerin is long, it keeps for up to 2yrs 13. A 54 yr old woman comes to the emergency department complaining of chest pain on exertion. The pain subsides with rest. A myocardial infarction (MI) is ruled out and the client is diagnosed with stable angina. The woman says, “ I really thought I was having a heart attack, How can you tell the difference which response by the nurse would provide the client with the most accurate information about the her condition, a. “ the pain associated with a heart attack is much more sever” b. “ the pain is associated with a heart attack radiate into the jaw and down the left arm” c. “ it is impossible to differentiate anignal pain from that of a heart attack without an ECG” d. “ the pain of angina is usually relieved by resting lying down”

14. In ARDS the pathogenesis involves? a. Alveolar capillary membrane injury b. Over activity of pneumocytes type 2 cells c. Over distention of the alveoli d. Inflamed and constricted bronchioles 15. Priority nursing diagnosis in the above patient would most likely be a. DOB b. Impaired gas exchange c. Fatigue related to use of accessory muscles d. Activity intolerance related to dyspnea 16. A client with an acute attack of asthma has 2 types of inhaler at hand, a bronchodilator and steroid, with his present condition, the best to give first is a. Reassurance b. Bronchodilator c. Steroid d. Relieve of anxiety 17. which of the following is NOT a prominent finding in the above patient a. under develop neck muscles b. intercostals retractions c. Cold clammy extremeties d. Cyanosis 18. The client has uncontrolled dyspnea and was bought to the ER He was started on Amonophylline drip, you know that one adverse affect of the drug is a. Depression b. Tachycardia c. Lethargy d. Cyanosis 19. The mechanism of action of aminophyllineis to a. CNS depression b. Bronchodilation c. Break down the mucus d. Increased heart rate 20. Chronic manifestation of the above client may lead to a. Chronic bronchitis b. Emphysema c. Bronchiectasis d. Atelectasis 21 To help alleviate the distress of a client with congestive heart failure and pulmonary edema the nurse should a. Elevate the lower extremities b. Encourage frequent coughing c, Prepare modified postural drainage d. Place the client in an orthopneic position 22. In general the higher the red blood cell count a. The higher the blood pH b. The lower the hematocrit

c. The greater the blood viscosity d. The less contributes to the immunity 23. The nurse notes several small bandages covering cuts on the client’s hands. The client says, “ I am so clumsy I always cutting myself, “ Which of the following responses of the nurse would be most appropriate: a. Don’t worry about it but keep your cuts clean and covered b. Even small cuts can be serious for people with diabetes and need special care c. Why don’t you think your injure yourself so frequently d. You really should have your doctor check all injuries even small ones 24. When taking a client’s apical pulse the nurse should place the stethoscope: a. Just to the left of the median point of the sternum b. In the fifth intercostals space at the left mid clavicular line c. Between the sixth and seventh ribs at the left midaxillary line d. between the third and fourth ribs and to the left of the sternum 25. A client with wpisodes of cardiac dysrhythmia is to war a Holter monitor for 24hr. When planning client teaching for this clien, the nurse is aware that the monitor: a. Can be taken off while bathing b. Can record acticvities and manifestations of responses c. Will assist in determining the size and contour of the heart d. Will record tracings of abnormal cardiac rhythms during activities of daily living 26. A client with angina pectoris is scheduled for an exercise electrocardiogram stress test. When explaining the value of this test, the nurse should include that exercise stress testing is a: a. Definitive method to diagnose the cause of chest pain b. Diagnostic modality of minimal value in planning treatment for angina c. Nonintrusive means of assessing cardiovascular conduction and function d. Minimally invasive manner of assessing a body’s reaction to increase in exercise 27. A client is admitted with chest pain unrelieved by nitroglycerin, an elevated temperature decreased blood pressure and diaphoresis. A myocardial infraction is diagnosed. The nurse understands that the most accurate explanation for one of theses presenting adaptations id: a. Parasympathetic reflexes from the infracted myocardium causes diaphoreseis b. Inflammation in the myocardium causes a rise in the systemic body temperature c. Catecholemines released at the site of the infarction causes intermittent localized pain d. Constriction of central and peripheral blood vessels cause a decrease in blood pressure 28. what is the method of oxygen administration that is lest likely to increase apprehension in client? a. Cannula b. catheter c. Ventur mask d. Rebreather mask 29. A client with pyrexia will most likely demonstrate: a. Dyspnea b. Precordial pain c. Increased pulse rate d. Elevated blood pressure

30. The nurse assess that a client’s pulse pressure is decreasing. This would be evaluated by calculating the: a. Force exerted against an arterial wall b. Difference between the apical and radial rates c. Difference between systolic and diastolic readings d. Degree of ventricular contraction in relation to output 31.After open heart surgery a client develops a temperature of 102F (38.8’) the nrse notifies the physician because elevated temperatures a. Increase the cardiac output b. May indicate cerebral edema c. May be a forenrunner of hemorrhage d. Are related to diaphoresis and possible chilling 32. The nurse should teach clients with peripheral vascular disease to stop smoking because nicotine a. Constricts the superficial vessels, dilating the deep vessels b. Constricts the peripheral vessels and increases the force of flow c. Dilates the superficial vessels but constricts the collateral circulation d. Dilates the peripheral vessels, causing a reflex constriction of visceral vessels 33. With chronic occlusive artrerial disease the precipitating cause for ulveration and gangrenous lesions often is: a. Emotional stress, which is short lived b. Poor hygiene and limited protein intake c. Stimulants such as coffee, Tea or cola drinks d. Trauma from mechanical chemical or thermal sources 34. Prolonged bed rest after surgery appears to promote hemostasis particularly in the deep veins of the calves. The most likely pathologic result of such hemostasis may be thrombus formation and a. Cerebral embolism b. coronary occlusion c. Pulmonary embolism d. Dry gangrene of a limb 35. To prevent a pulmonary embolus in a client on bed rest the nurse should: a. Limit the client’s fluid intake b. Encourage deep breathing and coughing c. Use the knee gatch when the client is in bed d. Teach the client to move the legs when in bed 36. In the postanesthesia care unit, while caring for a client who has received a general anestethic the nurse should sh9uld notify the physician if the: a. Client pushes the airway out b. Client has snoring respirations c. Respirations are regular but shallow d. Systolic blood pressure drops from 130 to 90 mm Hg 37. Postural changes immediately after spinal anesthesia may result in hypotension because there is: a. Dilation of blood vessels b. Decreased response of chemoreceptors

c. Decreased strength of cardiac contractions d. Interruption of cardiac accelerator pathways 38. After abdominal surgery a cli8ent suddenly complains of numbness in the right leg and a funny feeling in the toes. The nurse should first: a. Elevate the legs and tell the client to stay in bed b. Tell the client to remain in bed and notify the physician c. Rub the client’s legs to start circulation and cover the client with a warm blanket d. Tell the client about the dangers of staying in bed too much and encourage ambulation 39. After a bilateral lumbar sympathectomy a client has sudden drop in blood pressure but the evidence of bleeding. The nurse recognizes that this is most likely caused by: a. An inadequat6e fluid intake b. The aftereffects of anesthesia c. A reallocation of the blood supply d. An increased level of epinephrine 40. While convalescing from abdominal surgery a client develops thrombophlebitis. The sign that would indicate this complication the nurse would be: a. Intermittent claudication b. Pitting edema of the lower extremities c. Severe pain on extension of an extremities d. Localized warmth and tenderness of the leg 41. A client is being instructed on the use of antiembolism stockings. The nurse should teach the client that the stockings should be; a. Alternately kept on 2hrs and off 2 hrs b. Worn only at night when activity islessened c. Put on before getting out of bed in the morning d. Left in place until the physician advises otherwise 42. The nurse should be aware that arteriosclerosis of blood vessels leading to the brain may not become evident ( until there is an extremely severe blockage or until a brain attack occurs) because of collateral blood circulation supplied through the; a. Circle of willis b. Jugular vessels c. The bicarotid trunk d. Hypothalamic hypophyseal portal system 43. when teaching a client about orthostatic hypotension the nurse shluld explain that it can be modified by: a. wearing support hose continuously b. Lying down for 30 mins after taking medication c. Avoiding tasks that require high energy expenditure d.sitting on the edge of the bed a short time before arising 44. To assess the effectiveness of a vasodilator administered to lower hypertension the nurse should take the client’s pulse and blood pressure: a. Prior to administering the drug b. 30 mins after giving the drug c. Immediately after client gets out of bed d. After a position is maintained for 5 mins

45. The nurse should teach clients with peripheral vascular disease to stop smoking because nicotinic a. Constricts the superficial vessels dilating deep vessels b. Constricts the peripheral vessels and increases the force of flow c. Dilates the superficial vessels but constricts the collateral circulation d. Dilates the peripheral vessels causing a reflex constriction of visceral vessels 46. With chronic occlusive arterial desease, the precipitating cause for ulceration ang gangrenous lesions often is: a. Emotional stress, which is short lived b. Poor hypeiene and limited protein intake c. Stimulants such as coffee, tea or cola drinks d. Trauma from mechanical, chemical, or thermal sources 47. Prolonged bed rest after surgery appears to promote hemostasis, particularly in the deep veins of the calves. The most likely pathologic result of such hemostasis may be thrombus formation and: a. Cerebral embolism b. Coronary occlusion C. Pulmonary embolism d. Dry gangrene of a limb 48. To prevent a pulmonary embolus in a client on bed rest, the nurse should: a. Limit the client’s fluid intake b. Encourage deep breathing and coughing c. Use the knee gatch when the client is in bed d. Teach the client to move the legs when in bed 49. Tin the postanesthesia care unit, while caring for a client who has reveived a general anesthetic the nurse should notify the physician if the: a. Client pushes the airway out b. Client has snoring respirations c. Respirations are regular but shallow d. Systolic blood pressure drops from 130-90mm Hg 50. Postural changes immediately after spinal anesthesia may result in hypontension because there is a. Dilation of blood vessels b. Decreased response of chemoreceptors c. Decreased strength of cardiac contractions d. Interruptions of cardiac accelerator pathways 51. Cholesterol frequently discussed in relation to atherosclerosis is a substance that: a. May be controlled by eliminating food sources b. Is found in many foods, both plant and animal sources c. All persons would be better off without because it causes the disease process d. Circulates in the blood the level of which usually decreases when unsaturated fats are substituted for saturated fats 52 when cardiovascular disease is a concern, reduction of saturated fat in the diet may be desired and substitutes of polyunsaturated fat may be revommended when teaching about this diet the nurse should instruct the client to avoid a. Fish

b. Corn oil c. Whole milk d. Soft margarine 53. When ateaching a client with a cardiac problem, who is on a high unsaturated fatty acid diet the nurse stress the importance of increasing the intake of: a. Enciched whole mil b. Red meats such as beef c. Vegetables and whole grains d. Liver and other glandular organ meats 54. When anticipating the possible health problems encountered in a health clinic in an African American community the nurse needs to focus on assessing for signs and symptoms of: a. Osteoporosis b. Hypertension c. Uterine cancer d. Thyroid disorders 55. A 2 gram sodium diet is prescribed for a client with severe hypertension. The client does not like the diet and the nurse hears the request that the spouse “ Bring in some good home cooked food” It would be most effective for the nurse to plan to: a. Call in the dietititian for client teaching. b. Wait for the clients family and discuss the diet with the client and family c. Tell the client that the use of salt is forbidden because it will raise the blood pressure d. Catch the family members before they go into the client’s room and tell them about the diet 56. A client asks what the coronary arteries have to do with angina. When determining the answer the nurse should take into consideration that the coronary arteries carry: a. Blood to the endocardium b. Blood from the aorta to the myocardium c. Rduced oxygen content blood to the lungs d. d. High oxygen content blood from the lungs toward the heart 57.The nurse realizes that the pains associated with a coronary occlusion is cused primarily by: a. Arterial spasm b. Ischemia of the heart muscle c. Blocking of the coronary veins d. Irritation of nerve endings in the cardiac plexus 58. Nitroglycerin SL is prescribed for anginal pain when teaching how to use nitroglycerin the nurse tells the client to place 1 tablet under thetounge when pain occurs and to repeat the dose in 5 mins if pain persists. The nurse should also tell the client to: a. Place 2 tablets under the tongue when intense pain occurs b. Swallow 1 tablet and place 1 tablet under the tongue when pain is intense c. Place 1 tablet under the tongue 3 min before activity and repeat the doses in 5 minsa if pain occurs d. Place 1 tablet under the tongue when pain occurs and use an additional tablet after the attack to prevent recurrence

59. When caring for a client after cardiac catheterization it is most important that the nurse: a. Provide for rest b. Administer oxygen c. Check the ECG every 30 mins d. Check a pulse distal to the insertion site 60. During a cardiac catheterization blood samples from the right atrium, right ventricle and pulmonary artery are analyzed for their oxygen content normally a. All contain less Co2 than does pulmonary vein blood b.All contain more oxyegen that does pulmonary vein blood c. The samples of blood all contain about the same amount oxygen d. Pulmonary artery blood contains more oxygen than the other samples 61. The nurse in the coronary care unit should observe for one of the more common complications of myocardial infarction which is: a. Hypokalemia b. Anaphylactic shock c. Cardiac Dysrhythmia d. Cardiac enlargement 62. The nurse prepares a client for insetion of a nurse pulmonary artery catheter (g.g Swan Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: a. Stroke volume b. Cardiac output c. Venous pressure d. Left ventricular functioning 63. A 72 yr old client is admitted with cerebral arteriosclerosis, complicated by polycythemia vera. Heparin q6h is prescribed. If the inticoagulant therapy is effective the nurse would expect: a. An APPT twice the normal value b. An absence of ecchymotic areas c. A decreased viscosity of the blood d. A reduction of confusion and weakness 64. When a client is receiving anticoagulants the nursing care should include observations for: a. Nausea b. Epistaxis c. Headache d. Chest pain 65. A client is receiving coumadin. The test that would be most specific for calculating the daily dosage of this anticoagulant is the a. INR 2. Clotting time c. Bleeding time d. Sedimentation rate

66. When preparing a client for discharge after surgery for coronary artery bypass graft the nurse should teach that there will be: a. No further drainage from the incision after hospitalization b. A mild fever and extreme fatigue for several week after surgery c. Little incisional pain and tenderness after 3 to 4 weeks after surgery d. Some increase in edema in the leg used for the donor graft when activity increases 67. The nurse finds a injured person sitting in a chair obviously in shock. The n urse should: a. Keep the head elevated give a stimulant to small sips b. apply tourniquets to three extremities rotating one every 15 mins c. Surround the body with a warm blanket or chemical heating pads if a vailable d. Place the person in the supine position prevent chilling and give fluids if possible 68. The adaptations of a client with complete heart block would most likely include: a. Nausea/ vertigo b. Flushing and slurred speech c. Cephalalgia and blurred vision d. syncope and low ventricular rate 69. The nurse should prioritize care and provide treatment first for a client with a. head inuries b. A fractured femus c. Ventricular fibrillation d. A penetrating abdominal wound 70. While a pacemaker catheter is being inserted the client’s heart rate drops to 38. The drug the nurse should expect the physician to order is a. Atropine sulfate b. Digozxin (lanoxin) c. Lidocaine (xylocaine) d. Procainamide ( Prnestyl) 71. A client with a bunle branch block is on a cardiac monitor. The nurse should expect to observe a. Sagging ST segments b. Absence of P wave configurations c. Inverted T waves following each QRS complex d. Widening of QRS complexes to 0.12 sec or greater 72 The nurse realizes that a pacemaker is used in some clients to serve the function normally performed by the: a. AV node B. SA node c. Bundle of His d. Accelerator nerves to the heart 73. The cardioversion is a procedure used to convert certain dysrhythmias to normal rhythm. I addition to atrial fibrillation, cardioversion is most affective when the client demonstrates ventricular: a. Standstill b. Fibrillation c. Tachycardia

d.Premature complexes 74. The nurse observes the following dysrhythmia on a client’s cardiac monitor. The nurse determines that the client is exhibiting: a. ATrial flutter b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia 75. The physician has inserted a permanent fixed (asynchronous) pacemaker in a clientl When teaching the nurse should: a. Instruct the client to sleep on two pillows b. Encourage the client to reduce the former level of activity c. Instruct the client to take the pulse daily and keep accurate records d. Inform the client that the pacemaker will function when the heart rate drops below a preset rate 76. To evaluate the effectiveness of a client’s pacemaker that provides on demand pacing the nurse ensures that the pulse remains atleast: a. In a regular rhythm b. Above the demand rate c. Equal to the pacemaker d. Palpable at all pulse sites 77. When ventricular fibrillation accurs in a coronary care unit the first person raching the client should: a. Administer oxygen b. Defibrillate the client c. Initiate cardiopulmonary resusciatation d. Administer sodium bicarbonate intravenously 78. A client who has a myocardial infarction is in the coronary care on cardiac monitor. The nurse observes ventricular irritability on the screen. The nurse should preapere to administer a. Digoxin ( lanoxin) b. Furosemide ( lasix) c,. Lidocaine ( xylocaine) d. Levarterenol bitartrate ( levophed) 79. During a cardiac arrest the nurse and the arrest team must keep in mind the : a. Age of the client b. Time the client was anoxic c. Emergency medications available d. Heart rate of the client before the arrest 80. A client is found unconscious and unresponsive. The nurse should first a. Initiate a code b. Check for a radial pulse c. Give four full lung inflations d. Compress the lower sternum 15times 81. When performing external cardiac compression, the nurse should exert downward vertical pressure on the lower sternum by placing:

a. The fleshy part of a clenched list on the lower sternum b. The heels of each hand side by side extending the fingers over the chest c. The fingers of one hand on the sternum and the fingers of the other hand on top of them d. The heel of one hand on the sternum and the heel of the other on top of it, interlocking the fingers 82. A client has edema in the lower extremities during the day which disappears at night, The nurse should suspect: a. lung disease b. Pulmonary edema c. Myocardial infarction d. Right ventricular heart failure 83. A client is admitted to the hospital and has edematous ankles. To best limit edema of the feet the nurse should prepare to: a. Restrict fluids b. elevate the legs c. Apply elastic bandages d. Do ROM exercise 84. When taking an admission history of a client with right ventricular heart failure the nurse would expect the client to complain of: a. Dyspnea, edema, fatigue b. Fatigue, vertigo, headache c. weakness, palpitations nausea d. a feeling of distress when breathing 85. when assessing the lower extremeties of a client with right ventricular heart failure the nurse expects pitting edema because of the a. Increase in the tissue hydrostatic pressure b. Increase in tissue colloid osmotic pressure c. elevation in the plasma hydrostatic pressure d. Decrease in the plasma colloid osmotic pressure

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