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50 Item MS Practice Test With Answers and Rationale: B. O2 Therapy, Analgesia
50 Item MS Practice Test With Answers and Rationale: B. O2 Therapy, Analgesia
Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a typical description of pain
associated with an MI, and is now cold and clammy, pale and dyspneic. He has an IV of D5W running, and is complaining
of chest pain. Oxygen therapy has 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 in order to give Mr. Duffy the care he
needs. Which of the following nursing interventions will relieve his current myocardial ischemia?
2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the
following patterns of cardiac enzyme elevation are most common following an MI?
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 fibrillation
d. heart block
Ventricular irritability is common in the early post-MI period, which predisposes the client to ventricular arrhythmias. Heart
block and atrial arrhythmias may also be seen post-MI but ventricular arrhythmias are more common.
4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with him for his discharge should
educate him as to the purpose and actions of his new medication. What should she or he teach Mr. Duffy to do at home to
monitor his reaction to this medication?
You are speaking to an elderly group of diabetics in the OPD about eye health and the importance of visits to the
ophthalmologist.
5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from
their care provider?
a. fluorescein stain
b. 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 using snellen’s chart; D is used to focus
on layers of the cornea and lens looking for opacities and inflammation.
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 vision
c. Poor near vision
d. A gradual lessening of the power of accommodation
Option A defines astigmatism, B is myopia, and C is hyperopia
7. Some of the diabetic clients are interested in understanding what is visualized during funduscopic 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 the retina.
b. The area of central vision, seen on the temporal side of the optic disc, which is quite 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 the conjunctiva 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 option is not implicated?
a. glomerular disease
b. uncontrolled hypertension
c. 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 classical signs and symptoms did you
note?
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 be increased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is
essential.
c. Drug therapy is not usually affected by this diagnosis
d. Precautions should be taken with prescription drugs, but most OTC medications are safe for him to use.
Metabolic changes and alterations in excretion put the client with uremia at risk for development of toxicity to any drug.
Thus alteration in drug schedule and dosage is necessary for safe care.
You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin by reviewing assessment of the
cardiovascular system in your mind and asking yourself the following:
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 ventricular systole. It is generally located in the
5th left ICS, 7-9 cm from the MSL or at, or just medial to, the MCL.
13. During the physical examination of the well adult client, the health care provider auscultates the heart. When the
stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?
a. Tricuspid
b. Pulmonic
c. Aortic
d. Mitral
The sound created by closure of the tricuspid valve is heard at the 5th LICS at the LSB. Pulmonic closure is best heard at
the 2nd LICS, LSB. Aortic closure is best heard at the 2nd RICS, RSB. Mitral valve closure is best heard at the PMI landmark
(apex)
14. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?
a. S1
b. S2
c. S3
d. S4
S1 is caused by mitral and tricuspid valve closure, S2 is caused by the aortic and pulmonic valve closure; S3 and S4 are
generally considered abnormal heat sounds in adults and are best heard at the apex.
15. The coronary arteries furnish blood supply to the myocardium. Which of the following is a true statement relative to
the coronary circulation?
a. the right and left coronary arteries are the first of many branches off the ascending aorta
b. blood enters the right and left coronary arteries during systole only
c. the right coronary artery forms almost a complete circle around the heart, yet supplies only the right ventricle
d. the left coronary artery has two main branches, the left anterior descending and left circumflex: both
supply the left ventricle
The right and left coronary arteries are the only branches off the ascending aorta; blood enters these arteries mainly
during diastole; the right coronary artery also often supplies a small portion of the left ventricle.
Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis of mitral stenosis. She is
scheduled for surgery to repair her mitral valve.
16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints
of dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea have become unmanageable. These complaints are
probably due to:
17. On physical exam of Ms. Baker, several abnormal findings can be observed. Which of the following is not one of the
usual objective findings associated with mitral stenosis?
18. You are seeing more clients with diagnoses of mitral valve prolapse. You know those mitral valve prolapse is usually a
benign cardiac condition, but may be associated with atypical chest pain. This chest pain is probably caused by:
a. ventricular ischemia
b. dysfunction of the left ventricle
c. papillary muscle ischemia and dysfunction
d. cardiac arrythmias
Ventricular ischemia does not occur with prolapsed mitral valve; options B and D are not painful conditions in themselves.
Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup. His possible diagnosis is cancer
of the lung.
19. The most common lethal cancer in males between their fifth and seventh decades is:
20. Of the four basic cell types of lung cancer listed below, which is always associated with smoking?
a. adenocarcinoma
b. squamous cell carcinoma (epidermoid)
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma
Textbooks of medicine and nursing classify primary pulmonary carcinoma somewhat differently. However most agree that
sqaumous cell or epidermoid carcinoma is always associated with cigarette smoking.
21. Chemotherapy may be used in combination with surgery in the treatment of lung cancer. Special nursing
considerations with chemotherapy include all but which of the following?
a. Helping the client deal with depression secondary to the diagnosis and its treatment
b. Explaining that the reactions to chemotherapy are minimal
c. Careful observation of the IV site of the administration of the drugs
d. Careful attention to blood count results
There ar enumerous severe reactions to chemotherapy such as stomatitis, alopecia, bone marrow depression, nausea and
vomiting. Options A, B and D are important nursing considerations.
22. Which of the following operative procedures of the thorax is paired with the correct definition?
Mr. Liberatore, age 76, is admitted to your unit. He has a past medical history of hypertension, DM, hyperlipidemia.
Recently he has had several episodes where he stops talking in midsentence and stares into space. Today the episode
lasted for 15 minutes. The admission diagnosis is impending CVA.
23. The episodes Mr. Liberatore has been experiencing are probably:
24. Mr. Liberatore suffers a left sided CVA. He is right handed. The nurse should expect:
a. left-sided paralysis
b. visual loss
c. no alterations in speech
d. no impairment of bladder function
Visual field loss is a common side effect of CVA. In right-handed persons the speech center (Broca’s area) is most
commonly in the left brain; because of the crossover of the motor fibers, a CVA in the left brain will produce a right-sided
hemiplegia. Thus, Mr. Liberatore will probably have some speech disturbance and right-sided paralysis. Often bladder
control is diminished following CVA.
25. Upper motor neuron disease may be manifested in which of the following clinical signs?
a. spastic paralysis, hyperreflexia, presence of babinski reflex
b. flaccid paralysis, hyporeflexia
c. muscle atrophy, fasciculations
d. decreased or absent voluntary movement
Options B, C and D describe lower motor neuron disease.
Julie, an 18-year-old girl, is brought into the ER by her mother with the chief complaint of sudden visual disturbance that
began half an hour ago and was described as double vision and flashing lights.
26. During your assessment of Julie she tells you all visual symptoms are gone but that she now has a severe pounding
headache over her left eye. You suspect Julie may have:
a. a tension headache
b. the aura and headache of migraine
c. a brain tumor
d. a conversion reaction
The warning sign or aura is associated with migraine although not everyone with migrane has an aura. Migraine is usually
unilateral and described as pounding. Julie’s symptoms are most compatible with migraine.
27. You explain to Julie and her mother that migraine headaches are caused by:
28. A thorough history reveals that hormonal changes associated with menstruation may have triggered Julie’s migraine
attack. In investigating Julie’s history what factors would be least significant in migraine?
a. seasonal allergies
b. trigger foods such as alcohol, MSG, chocolate
c. family history of migraine
d. warning sign of onset, or aura
Sinus headache often accompanies seasonal allergies. Many factors may contribute to migraine. Usually the client comes
from a family that has migrated, which may have been called “sick headache” due to accompanying nausea and vomiting.
Often there is an aura. Stress, diet, hormonal changes, and fatigue may all be implicated in migraine.
29. A client with muscle contraction headache will exhibit a pattern different for Julie’s. Which of the following is more
compatible with tension headache?
Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is currently unknown. You begin to think
about the way brain tumors are classified.
30. Glioma is an intracranial tumor. Which of the following statements about gliomas do you know to be false?
31. Acoustic neuromas produce symptoms of progressive nerve deafness, tinnitus, and vertigo due to pressure and
eventual destruction of:
a. CN5
b. CN7
c. CN8
d. The ossicles
CN8, the acoustic nerve or vestibulocochlear nerve, is the most commonly affected CN in acoustic neuroma although as
the tumor progresses CN5 and CN7 can be affected.
32. Whether Mr Snyder’s tumor is benign or malignant, it will eventually cause increased intracranial pressure. Signs and
symptoms of increasing intracranial pressure may include all of the following except:
33. Mr Snyder is scheduled for surgery in the morning, and you are surprised to find out that there is no order for an
enema. You assess the situation and conclude that the reason for this is:
a. Mr. Snyder has had some mental changes due to the tumor and would find an enema terribly traumatic
b. Straining to evacuate the enema might increase the intracranial pressure
c. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is not necessary
d. An oversight and you call the physician to obtain the order
Any activity that increases ICP could possibly cause brain herniation. Straining to expel an enema is one example of how
the increased ICP can be further aggravated.
34. Postoperatively Mr. Snyder needs vigilant nursing care including all of the following except:
35. Potential postintracranial surgery problems include all but which of the following?
a. increased ICP
b. extracranial hemorrhage
c. seizures
d. leakage of cerebrospinal fluid
Hemorrhage is predominantly intracranial, although there may be some bloody drainage on external dressings. Increased
ICP may result from hemorrhage or edema. CSF leakage may result in meningitis. Seizures are another postoperative
concern.
36. You are responsible for teaching Mrs. Hogan deep breathing and coughing exercises. Why are these exercises
especially important for Mrs. Hogan?
37. On the morning of Mrs. Hogan’s planned cholecystectomy she awakens with a pain in her right scapular area and
thinks she slept in poor position. While doing the preop check list you note that on her routine CB report her WBC is
15,000. Your responsibility at this point is:
a. to notify the surgeon at once; this is an elevated WBC indicating an inflammatory reaction
b. to record this finding in a prominent place on the preop checklist and in your preop notes
c. to call the laboratory for a STAT repeat WBC
d. none. This is not an unusual finding
A WBC count of 15,000 probably indicates acute cholecystitis, especially considering Mrs. Hogan’s new pain. The surgeon
should be called as he/she may treat the acute attack medically and delay the surgery for several days, weeks, or months.
38. Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM and Demerol 50 mg IM one
hour preoperatively. Which nursing actions follow the giving of the preop medication?
39. Mrs. Hogan is transported to the recovery room following her cholecystectomy. As you continue to check her vital signs
you note a continuing trend in Mrs. Hogan’s status: her BP is gradually dropping and her pulse rate is increasing. Your
most appropriate nursing action is to:
40. Mrs. Hogan returns to your clinical unit following discharge from the recovery room. Her vital signs are stable and her
family is with her. Postoperative leg exercises should be inititated:
a. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient.
b. Reduces the risk of aspiration of gastric contents.
c. Should be performed with the neck flexed forward making the chin touch the chest.
d. Should be performed after a patient is found to be not breathing and two breaths have been given but before checking
for a pulse.
Letter A is wrong because an attempt should not last no longer than 30 seconds. Unless injury is suspected the neck
should be slightly flexed and the head extended.. the ‘sniffing position’. After securing an airway and successfully
ventilating the patient with two breaths you should then check for a pulse. If there is no pulse begin chest compressions.
Intubation is part of the secondary survey ABC’s.
a. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured
b. Effective ventilations can always be given by one person.
c. Cricoid pressure may prevent gastric inflation during ventilations.
d. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations.
Cricoid pressure may prevent gastric inflation during ventilations and may also prevent regurgitation by compressing the
esophagus. Letter A may cause gastric insufflation thus increasing the risk for regurgitation and aspiration. With adults
breaths should be delivered slowly and steadily over 2 seconds. Effective ventilation using bag-valve mask usually requires
at least two well trained rescuers. A frequent problem with bag-valve mask ventilations is the inability to provide adequate
tidal volumes.
44. If breath sounds are only heard on the right side after intubation:
47. The most common lethal arrhythmia in the first hour of an MI is:
49. Atropine:
a. True
b. False
Asystole is not amenable to correction by defibrillation. But there is a school of thought that holds that asystole should be
treated like V-fib, i.e... defibrillate it. The thinking is that human error or equipment malfunction may result in
misidentifying V-fib as asystole. Missing V-fib can have deadly consequences for the patient because V-fib is highly
amenable to correction by defibrillation.