NCLEX Review Cardiovascular
Quiz
1. The nurse is caring for an adult who has a
clotting time of 20 minutes. What should the
nurse do because of the lab values?
1. Observe the client carefully for thrombus
formation.
2. Protect the client from sources of
infection.
3. Assure the client has adequate rest.
*4. Avoid giving the client injections.
2. A client who is receiving heparin asks the
nurse why it cannot be given by mouth. The
nurse’s reply is based on which knowledge?
Heparin is given parenterally because:
*1. It is destroyed by gastric secretions.
2. It irritates the gastric mucosa.
3. It irritates the intestinal lining.
4. Therapeutic levels can be achieved more
quickly.
3. An adult is admitted for a cardiac
catheterization. The client asks the nurse if
she will be asleep during the cardiac
catheterization. What is the best answer for
the nurse to give?
1. “You will be given a light general
anesthesia.”
*2. ” You will be sedated but not asleep.”
3. “The doctor will give you an anesthetic if
you are having too much pain.”
4. “Is it important for you to be asleep?”
4. An adult has just returned following a left
heart catheterization. What is it essential for
the nurse to do?
*1. Check her peripheral pulses.
2. Maintain her NPO.
3. Apply heat to the insertion site.
4. Start range of motion exercises
immediately.
5. The nurse is caring for an adult who is
admitted with a history of angina pectoris.
He calls the nurse and says he has just taken
a nitroglycerin tablet sublingually for
anginal pain. What action should the nurse
take next?
*1. Monitor ECG. If the pain does not
subside within five minutes, place a second
tablet under his tongue.
2. Assist him into bed and position him in
Trendelenburg position. Record vital signs
every five minutes.
3. Notify the physician immediately. Start an
IV so there will be a route for cardiac
medications.
4. Administer xylocaine (Lidocaine) IV.
Prepare for defibrillation.
6. A low sodium, low cholesterol weight
reducing diet is prescribed for an adult
client. The nurse knows the client
understands his diet when he chooses which
of the following meals?
*1. Baked chicken and mashed potatoes.
2. Stir-fried Chinese vegetables and rice.
3. Tuna fish salad with celery sticks.
4. Lean steak with carrots.
7. A 70-year-old is admitted to the intensive
care unit with cardiogenic shock. The nurse
prepares an infusion of dobutamine as
prescribed by the physician. The nurse
recognizes an essential safety measure to be
taken with this drug is to
1. Obtain a 12 lead electrocardiograph.
2. Assess electrolyte levels.
3. Administer the drug through a large vein.
4. Monitor for increase in temperature.
8. A client with atrial fibrillation is receiving
warfarin sodium (coumadin) daily. What is
the action of this drug?
1. Inactivates protamine sulfate.
2. Prevents new clots from forming.
3. Dissolves existing clots.
4. Slows the heart rate.
9. A client is receiving enalapril (Vasotec) 5
mg po daily for hypertension. Other
medications include estrogen, lithium
carbonate, and lorazepam. Which
complaints should alert the nurse that
medication interactions are present?
1. Recent memory loss, muscle weakness,
and hyperreflexia.
2. Blood pressure 140/90, reports of mood
swings, and restful night sleep.
3. Slight kyphosis, occasional hot flashes,
and menstrual cramps.
4. Feelings of panic and anxiety, retrograde
amnesia, and sleepiness.
10. A 68-year-old is admitted with a
diagnosis of right-sided congestive heart
failure. What assessment findings would the
nurse expect in this client?
1. Distended neck veins.
2. Slight ankle edema.
3. Hypotension.
4. Premature ventricular contractions.
11. Digoxin and Lasix (Furosemide) are
ordered for an adult client. Which of the
following would the nurse expect to be
ordered for this client?
1. Potassium.
2. Calcium.
3. Aspirin.
4. Warfarin.
12. An adult client is receiving digoxin. One
morning when the nurse goes to give the
client his digoxin he says, “I think I need to
see the eye doctor. Things seem to look
green today.” The nurse takes his vital signs
and finds them to be: B.P. 150/94; P 60; R.
28. What is the most appropriate initial
action for the nurse to take at this time?
1. Record the findings on the client’s chart.
2. Withhold the digoxin and report the
findings.
3. Request an appointment with the
ophthalmologist.
4. Reassure the client he is experiencing a
normal reaction to his medication.
13. The nurse is caring for an adult who
underwent a mitral valve replacement.
Following cardiac surgery, clients often
experience periods of disorientation. Which
of the following nursing actions may help
prevent this disorientation?
1. Keep the client heavily sedated.
2. Keep the ICU well lighted 24 hours a day.
3. Restrict visitors to 5 minutes at a time.
4. Position the cardiac monitor so that it is
out of the client’s view.
14. An adult had open heart surgery today
for a mitral valve replacement. He has a
central venous pressure catheter. The CVP is
recorded every 15 minutes. The nurse has
observed a marked increase in the CVP over
the last 2 hours. The latest reading is above
normal. Which nursing action would be
appropriate before the surgeon is called?
1. Increase the IV slightly to improve
cardiac output.
2. Elevate the client’s feet to increase
venous return.
3. Decrease the IV to a “keep open” rate.
4. Check the specific gravity of the urine.
15. For which of the following surgical
procedures is it essential for the nurse to
note the presence or absence of the dorsalis
pedis and posterior tibial pulses?
1. Carotid endartarectomy.
2. Iliofemoral bypass.
3. Vein ligation.
4. Pacemaker implantation.
16. The nurse knows that the reason a client
who has had a myocardial infarction is
getting heparin is to:
1. Prevent extension of a thrombus.
2. Dissolve small thrombi that have lodged
in the coronary arteries.
3. Enhance the action of thrombin in the
bloodstream.
4. Decrease the amount of time it takes the
blood to clot.
17. The nurse is caring for a client receiving
heparin sodium. Which medication should
the nurse have readily available because the
client is receiving heparin?
1. Vitamin K.
2. Magnesium sulfate.
3. Warfarin sodium.
4. Protamine sulfate.
18. A 60-year-old client is admitted to the
hospital with peripheral vascular disease of
the lower extremities. He has had diabetes
mellitus for 22 years. He smokes two packs
of cigarettes per day and is employed in a
job where he must stand for 7 or more hours
each day. Which of the following would the
nurse expect to elicit when assessing this
client?
1. Diminished pedal pulses.
2. Warm tender calves.
3. Tremors of the feet bilaterally.
4. Difference in blood pressure when sitting
and standing.
19. A 60-year-old man has several ischemic
ulcers on each ankle and lower leg area.
Other parts of his skin are shiny and taut
with loss of hair. A primary nursing goal for
this client should be to
1. Increase activity tolerance.
2. Relieve anxiety.
3. Protect from injury.
4. Help build a positive body image.
20. A 48-year-old is found on a routine
physical examination to have a blood
pressure of 170/98. Follow up studies
confirm a diagnosis of hypertension. He is
prescribed hydrochlorothiazide. What
nursing instruction is it essential for him to
receive?
1. Use a calcium based salt substitute.
2. Avoid hard cheeses.
3. Drink orange juice or eat a banana daily.
4. Do not take aspirin.
21. A low sodium diet has been ordered for
an adult client. Which menu is the lowest in
sodium?
1. Tossed salad, carrot sticks, steak.
2. Baked chicken, mashed potatoes, green
beans.
3. Hot dog, roll, coleslaw.
4. Chicken noodle soup, applesauce, cottage
cheese.
22. An adult client was admitted to the
coronary care unit following a
subendocardial myocardial infarction. A
balloon-tipped pulmonary artery catheter
was inserted when the client began to
exhibit signs of cardiogenic shock. The
nurse measures the client’s pulmonary
capillary wedge pressure and finds it to be
27 mm Hg. The nurse knows that this
pressure is
1. Within normal limits.
2. Elevated above normal.
3. Less than normal.
4. Life threatening.
23. An elderly client with a long history of
heart disease was brought to the emergency
department of a local hospital following a 30
minute episode of chest pain unrelieved by
nitroglycerin. The client’s
electrocardiograph has an inverted T wave.
The nurse caring for the client knows this
finding indicates
1. First-degree heart block.
2. Second-degree heart block.
3. Atrial flutter.
4. Myocardial ischemia.
24. A client is admitted with
thrombophlebitis of the right leg. Which
findings would the nurse expect when
assessing this client?
1. Diminished pedal pulses.
2. Color changes in the extremities when
elevated.
3. Red, shiny skin.
4. Pain when the leg is elevated.
25. Heparin via IV infusion is ordered for a
client. Which of the following test results
should the nurse monitor frequently?
1. Hemoglobin and hematocrit.
2. Activated Partial Thromboplastin Time
(APTT)
3. Prothrombin time.
4. Platelet count.
NCLEX Review Cardiovascular
Quiz Answers and Rationales
1. (4) The normal clotting is 5 to 15 minutes.
A client with a clotting time of 20 minutes is
prone to bleeding and should not receive
injections. Choice #1 is appropriate for a
client who has a decreased clotting time.
Choice #2 is appropriate for a client with a
low white count and choice #3 is appropriate
for a client who has a low red count.
2. (1) Heparin is a protein and is destroyed
by gastric secretions. IV administration
achieves rapid levels of heparin. However
heparin cannot be given by mouth so this is
not the answer to the question.
3. (2) Persons undergoing cardiac
catheterization will receive a sedative but
are not put to sleep. Their cooperation is
needed during the procedure. A general
anesthesia is not used.
4. (3) Checking pulses is of highest priority.
The complications most likely to occur are
hemorrhage and obstruction of the vessel.
5. (1) Nitroglycerine can be given at 5
minute intervals for up to 3 doses if the pain
is not relieved. Monitor ECG is appropriate
for a hospitalized patient. Trendelenburg
position is contraindicated in someone who
has angina. It would increase cardiac work
load. There is no need to start an IV
immediately for angina. Most hospitalized
patients will have an IV access already in
place. There is no data to support
administering xylocaine. Defibrillation is for
cardiac arrest.
6. (1) Baked chicken is low in sodium.
Chinese food is high in sodium. Tuna fish is
high in sodium; so is celery. Steak is high in
sodium; so are carrots.
7. (3) Dobutamine is a vasoconstrictor and
must be administered through a large vein to
prevent extravasation. The nurse should also
assess the client’s vital signs, lung sounds,
urine output, and ECG. There is no need for
a 12 lead ECG. Electrolyte levels are not
related to dobutamine. Dobutamine does not
cause a change in temperature.
8. (2) Clients with atrial fibrillation are
subject to clot formation. Warfarin sodium
(Coumadin) is given to prevent new clots
from forming and existing clots from
enlarging. Coumadin interrupts clotting by
depressing hepatic synthesis of vitamin K
dependent coagulation factor. Thrombolytic
agents such as streptokinase or tPA dissolve
existing clots. Protamine sulfate is the
antidote for heparin. Warfarin does not slow
the heart rate.
9. (1) Recent memory loss, muscle
weakness, and hyperreflexia are adverse side
effects associated with lithium carbonate
toxicity. Enalapril (Vasotec), an
antihypertensive drug, increases lithium
levels when they are taken together. The
other symptoms do not indicate medication
interaction.
10. (1) Right sided heart failure is
characterized by venous symptoms such as
distended neck veins, hepatomegaly and
pitting peripheral edema. Slight ankle edema
might be seen with left sided heart failure.
Blood pressure usually rises with heart
failure. Premature ventricular contractions
are not a major symptom with right sided
heart failure.
11. (1) Lasix is a potassium depleting
diuretic. Digoxin toxicity occurs more
quickly in the presence of a low serum
potassium.
12. (2) Disturbance in green and yellow
vision is a sign of digitalis toxicity. A pulse
of 62 is borderline for toxicity.
13. (4) Positioning the cardiac monitor so it
is out of the client’s view will make the ICU
less machine oriented and more people
oriented. It may be anxiety producing for the
client. The other choices are clearly
incorrect since none of them will prevent
disorientation. Sedation may cause
disorientation. Keeping the room well
lighted 24 hours a day causes abnormal
sleep and waking patterns. Sleep deprivation
may cause disorientation. Restricting
visitors limits the emotional support a
potentially disoriented person may need
from significant others in his life.
14. (3) High CVP is indicative of circulatory
overload. The IV should be decreased not
increased. Elevation of the client’s feet
would increase circulating volume. Check
specific gravity of urine would be
appropriate if the CVP were low and the
nurse was concerned about dehydration.
Note that choice #1 and #3 are opposites.
15. (2) Palpable pulses in the feet indicate
that the bypass is patent. Following a carotid
endartarectomy the carotid and temporal
pulse s are most essential. A vein ligation
would not compromise arterial circulation in
the feet. Apical pulse is appropriate after
pacemaker insertion.
16. (1) Heparin prevents formation of new
thrombi. It does not dissolve those already
present. Heparin blocks the action of
thrombin. It does not enhance it. Heparin
makes it take longer for blood to clot.
17. (4) Protamine sulfate is the antidote for
heparin. Vitamin K is the antidote for
warfarin sodium (Coumadin). Magnesium
sulfate is a central nervous system
depressant given to treat preeclampsia.
18. (1) Arterial disease will cause decreased
pulses in the lower extremities. Warm tender
calves are typical with thrombophlebitis.
19. (3) He has decreased arterial circulation
and will not heal well if injured. Important
physical and safety needs take precedence
over emotional needs.
20. (3) Hydrochlorothiazide is a potassium
depleting diuretic. Orange juice and bananas
are good sources of potassium. The person
who is taking a potassium depleting diuretic
should take a potassium based salt substitute
if he is to take one. Hard cheeses should be
avoided by persons taking the powerful
monamine oxidase inhibitor antidepressants.
Aspirin has an anticoagulant effect and is
not contraindicated when taking a thiazide
diuretic.
21. (2) Chicken is low in sodium, as are
mashed potatoes and green beans. Carrot
sticks, steak, hot dog, soup and cottage
cheese are all high in sodium.
22. (4) The normal pulmonary capillary
wedge pressure (PCWP) is 5 to 12 mm Hg.
The higher the pressure, the more severe the
heart failure. Pressures that exceed 25 to 30
mm Hg can be associated with pulmonary
edema, which is life threatening.
23. (4) An inverted T wave is characteristic
of myocardial ischemia.
24. (3) Red, shiny skin suggests
inflammation. Diminished pedal pulses
suggest arterial insufficiency. Color changes
when the extremities are elevated would
suggest arterial insufficiency or varicose
veins. Thrombophlebitis should not cause
pain when the leg is elevated.
25. (2) APTT is the blood test used to
monitor the effectiveness of heparin.
Prothrombin time is used to monitor
coumadin therapy.
NCLEX Review Quiz: Endocrine
1.         The client is admitted with a
tentative diagnosis of diabetes insipidus.
What should the nurse assess for while
taking a nursing history?
1.         An increased appetite.
2.         Excessive urine output.
3.         Recent rapid weight gain.
4.         Gynecomastia.
2.         A client has a transphenoidal
hypophysectomy for a pituitary tumor.
When he returns to the nursing unit
following surgery the head of his bed is
elevated 300.  The primary purpose for this
position is to:
1.         Promote respiratory effort and
prevent atelectasis.
2.         Reduce pressure on the sella turcica
and reduce headache.
3.         Prevent acidosis and development of
cerebral edema.
4.         Promote oxygenation and prevent
cerebral ischemia.
3.         The nurse is discussing discharge
plans with a client who had a transphenoidal
hypophysectomy. Which statement made by
the client indicates a need for more
teaching?
1.         I won’t brush my teeth until the
doctor removes the stitches.
2.         I will wear loafers instead of tie
shoes.
3.         Where can I get a Medic Alert
bracelet?
4.         I will take all these new medicines
until I feel better.
4.         The nurse is caring for a client who
had a total thyroidectomy. Postoperative
nursing care after his return to the nursing
care unit should include observing for
1.         Hoarseness.
2.         Signs of hypercalcemia.
3.         Loss of reflexes
4.         Mental confusion
5.         The nurse is teaching a client who
had a total thyroidectomy in preparation for
discharge. Which is of highest priority in the
teaching plan?
1.         “Report any signs of inflammation at
the incision site.”
2.         “Take your thyroid medication every
day.”
3.         “Continue with coughing and deep
breathing exercises.”
4.         “Maintain strict bedrest for the first
week at home.”
6.         Which of the following is most likely
to develop if hyperthyroidism remains
untreated?
1.         Pulmonary embolism.
2.         Respiratory acidosis.
3.         Cerebral vascular accident.
4.         Heart failure
7.         A diagnosis of toxic hyperthyroidism
is made in the client. Propylthiouracil 100
mg po tid is         ordered.  Which of the
following is the expected effect of this drug?
1.         Increased perspiration and decreased
appetite.
2.         Increased basal metabolic rate.
3.         Increase in protein bound iodine.
4.         Weight gain and reduced pulse.
8.         A client, who has just had a
thyroidectomy, returns to the unit in stable
condition. What equipment is it essential for
the nurse to have readily available?
1.         Tracheostomy set.
2.         Thoracotomy tray.
3.         Sphygmomanometer.
4.         Ice collar.
9.         The client develops
hypoparathyroidism after a total
thyroidectomy. What treatment should the
nurse anticipate?
1.         Emergency tracheostomy.
2.         Administration of calcium.
3.         Oxygen administration.
4.         IV potassium.
10.       Which of the following diets would
most likely be ordered for the client with
hypothyroidism?
1.         High protein, high calorie.
2.         Restricted fluids, low protein.
3.         High roughage, low calorie.
4.         High carbohydrate, low roughage.
11.       A woman with myxedema is started
on thyroid replacement therapy and
discharged. She returns to clinic one week
later.  Which statement she makes is most
indicative of an adverse reaction to the
medication?
1.         “My chest hurt when I was sweeping
the floor this morning.”
2.         “I had severe cramps last night.”
3.         “I am loosing weight.”
4.         “My pulse rate has been more rapid
lately.”
12.       A client with Cushing’s syndrome is
on a low sodium, high potassium diet for
which of the following reasons?
1.         Shock can occur in clients who have
decreased amounts of adrenocortical
steroids.
2.         Increased aldosterone levels cause
sodium retention and potassium excretion in
the kidneys.
3.         Excessive cortisone production
causes hypertension.
4.         Decreased amounts of
corticosteroids cause electrolyte imbalances.
13.       The nurse is caring for a client who
is on a low sodium, high potassium diet.
Which foods, if selected by the client,
indicate an understanding of the prescribed
diet?
1.         Baked macaroni and cheese, carrot
and raisin salad, and chocolate layer cake.
2.         Shrimp salad, spinach salad, and
strawberries.
3.         Cheese omelet, buttermilk biscuits
and chocolate pudding.
4.         Fresh asparagus spears, broiled
chicken breast, and lettuce and tomato salad.
14.       Diagnostic tests indicate that a 54-
year-old woman has bilateral adrenal
hyperplasia.  She undergoes a bilateral
adrenalectomy. The postoperative nursing
care plan states to observe for adrenal crisis.  2.         Take the medication on an empty
Which of the following symptoms, if
observed, would be most critical and need to
be reported immediately?
1.         Pitting edema of the ankles.
2.         Lowering of the blood pressure.
3.         Oliguria.
4.         Glucosuria.
15.       Fludrocortisone acetate (Florinef) 0.1
mg daily po has been ordered for a client
following bilateral adrenalectomy for which
of the following purposes?
1.         To restore sodium and potassium
balance.
2.         To prevent hypertension.
3.         To stimulate protein catabolism.
4.         To replace deficient adrenocortical
androgens.
16.       The nurse is doing discharge
teaching with a client who has had a
bilateral adrenalectomy. What should be
included in the teaching plan?
1.         Telling her that after 1-2 years she
will likely not need to take medication.
2.         Explaining that she will need to take
corticosteroids for the rest of her life.
3.         Reinforcing that steroids should be
slowly tapered if she decides to stop taking
them.
4.         Teaching her urine and blood testing
to help in the regulation of steroid dosages.
17.       A client who has had an
adrenalectomy is being discharged on
Florinef 0.1 mg daily and prednisone 7.5 mg
daily. What instruction must be given to the
client?
1.         Increase salt intake to prevent salt
deprivation.
stomach to aid in absorption.
3.         Expect a 3 to 5 pound weight
increase for about 6 weeks.
4.         Avoid exposure to infection, because
she is susceptible.
18.       A woman with a tumor of the
adrenal cortex says to the nurse, “Will I
always look this ugly?  I hate having a
beard.” What is the best response for the
nurse to make?
1.         “After surgery you will not develop
any more symptoms, but the changes you
now have will linger.”
2.         “That varies from person to person. 
You should ask your physician.”
3.         “After surgery your appearance
should gradually return to normal.”
4.         “Electrolysis and plastic surgery
should make your appearance normal.”
19.       The client is ready for discharge
following a unilateral adrenalectomy. Which
statement she          makes indicates the best
understanding of her condition?
1.         “I will continue on a low sodium,
low potassium diet.”
2.         “My husband has arranged for a
marriage counselor because of our fights.”
3.         “I will stay out of the sun so I will
not turn splotchy brown.”
4.         “I will take all of those pills every
day.”
20.       The nurse’s next door neighbor
calls.  He says he cannot awaken his 21-
year-old wife.  The nurse notes that the
client is unconscious and is having deep
respirations.  Her breath has a fruity smell to
it.  The husband says that his wife has been
eating and drinking a lot and that last night
she vomited before lying down.  Which of
the following is the most appropriate initial
action for the nurse to take?
1.         Start cardiopulmonary resuscitation.
2.         Get her to a hospital immediately.
3.         Try to rouse her by giving her coffee.
4.         Give her sweetened orange juice.
21.       An adolescent with newly diagnosed
IDDM asks the nurse if he can continue to
play football. What is the best answer for the
nurse to give?
1.         “Now that you have diabetes, you
should not play football as you may get a cut
which will not heal.”
2.         “If you work with your physician to
regulate the insulin dosage and your diet you
should be able to play football.”
3.         “It would be better for you to work
as equipment manager so you will not be
under as much stress.  Stress can aggravate
diabetes.”
4.         “You can probably continue to play
football if you can regulate it so that you
have the same amount of exercise each day.”
22.       An adolescent with IDDM is
learning about a diabetic diet. He asks the
nurse if he will ever be able to go out to eat
with his friends again. What is the best
response for the nurse to make?
1.         “You can go out with them but you
should take your own snack.”
2.         “Yes.  You will learn to use the
exchange lists so you can eat with your
friends.”
3.         “When you get food out in a
restaurant be sure to order diet soft drinks.”
4.         “Eating out will not be possible on a
diabetic diet.  Why don’t you plan to invite
your friends to your house?”
23.       One morning at 10 a.m. a client with
IDDM becomes very irritable and starts to
yell at the nurse. Which initial nursing
assessment should take priority?
1.         Blood pressure and pulse.
2.         Color and temperature of skin.
3.         Reflexes and muscle tone.
4.         Serum electrolytes.
24.       An elderly client has been recently
diagnosed as having non-insulin dependent
diabetes mellitus (NIDDM). Which of the
following complaints she has is most likely
to be related to the diagnosis of diabetes
mellitus?
1.         Pruritus vulvae.
2.         Cough.
3.         Eructation.
4.         Singultus.
25.       An elderly client with NIDDM
develops an ingrown toenail. What is the
best action for the nurse to take?
1.         Put cotton under the nail and clip the
nail straight across.
2.         Elevate the foot immediately.
3.         Apply warm, moist soaks.
4.         Notify the physician.
Answers and Rationales of NCLEX
Review – Endocrine:
1.         (2)        Excessive urine output is
characteristic of diabetes insipidus, which is
caused by decreased ADH (antidiuretic
hormone).  Increased appetite might be seen
in diabetes mellitus.   Gynecomastia is seen
in Cushing’s syndrome.
2.         (2)        Slight head elevation will
reduce pressure and edema formation.  This
position may help promote respiratory
effort.  However, that is not the primary
reason in this client.
3.         (4)        He will need to take
medications for the rest of life not just until
he feels better. All of the other actions are
appropriate.  He should not bend over to tie
shoes as this increases intracranial pressure.  will increase the heart rate and the heart will
#1.  Remember he had a transphenoidal
procedure.
4.         (1)        The nurse should have him
state his name every hour.  Hoarseness
indicates damage to the laryngeal nerve.  It
is usually temporary.  The nurse should
observe for signs of hypocalcemia such as
hyperreflexia.
5.         (2)        After a total thyroidectomy is
performed it is essential to take thyroid
replacement daily.  Reporting inflammation
of the incision site is not of highest priority.  high in sodium – macaroni and cheese,
After discharge he will not need to do
breathing exercises or maintain strict bed
rest.
6.         (4)        Hyperthyroidism causes
tachycardia, which can be severe enough to
cause the heart to wear out.
7.         (4) Propylthiouracil causes the
thyroid gland to become less vascular and to
shrink. Decreased thyroid activity will slow
down the metabolic rate resulting in weight
gain and reduced pulse and respirations.
8.         (1)        Swelling in the operative site
could cause airway obstruction.  The nurse
should have a tracheostomy set and oxygen
at the bedside for 48 hours after
thyroidectomy.
9.         (2)        Hypoparathyroidism causes a
decrease in calcium.
10.       (3)        Hypothyroidism causes
constipation and obesity.
11.       (1)        Chest pain on exertion
suggests angina.  In addition to a slow heart
rate the client with hypothyroidism
frequently has atherosclerosis.  Thyroxin
require more oxygen.   Angina is a likely
and serious complication that can occur. 
She will also probably loose weight and
have an increased pulse. These are expected
when taking thyroxin.
12.       (2)        Cushing’s syndrome is
hyperfunction of the adrenal cortex. 
Increased aldosterone causes the kidneys to
retain sodium and fluid and excrete
potassium.
13.       (4)        All the other selections are
carrots, cake, shrimp, spinach, cheese
omelet, biscuits, pudding.
14.       (2)        Hypotension is indicative of
adrenal crisis.  Adrenal crisis is an
emergency and can be fatal if not detected
and treated immediately.  Hypotension,
oliguria and glucosuria are not seen in
adrenal crisis.
15.       (1)        Florinef is a
mineralocorticoid that is given to permit
absorption of sodium and excretion of
potassium by the renal tubules.
16.       (2)        After a bilateral
adrenalectomy she will have to take steroids
– cortisone and Florinef for the remainder of
her life.
17.       (4)        She is more susceptible to
infection.  Salt intake needs to be restricted
because Florinef causes sodium retention. 
The medications are ulcerogenic and should
be taken with food.  A weight increase
indicates fluid retention and the physician
should be notified.
18.       (3)        A gradual return to normal
will occur after adrenalectomy when there
are no longer abnormal amounts of steroids
being produced.
19.       (4)        She must take steroid
replacement every day for the rest of her
life.  #1 is not an appropriate diet.  The
fights should decrease as her mood swings
decrease after surgery.
20.       (4)         Her symptoms suggest
ketoacidosis.  She must receive medical
treatment at once.
21.       (2)        Diabetes is not a
contraindication for sports.  Changes in
activity level will alter the utilization of
glucose so he will need to work closely with
his physician to regulate exercise, insulin
and diet control.
22.       (2)        Eating out with friends is
very important to an adolescent.  Snacks will
be allowed on his diet.  He should be taught
how to use the exchange lists in managing
his diet.
23.       (2)        The nurse can immediately
assess the skin.  Behavior change and
irritability suggest hypoglycemia.  If he is
hypoglycemic he will have pale, cold,
clammy skin and needs treatment (ingestion
of a rapid acting carbohydrate) at once.
24.       (1)        Pruritus vulvae (itching of
the vulva) frequently accompanies diabetes.  seal drainage is to
Monilial infections are common due to the
change in pH.  Eructation is belching or
burping and singultus is hiccups.  Neither of
these is particularly related to diabetes.
25.       (4)        An ingrown toenail may
cause infection, which can be very serious
for the diabetic client.  The physician should
be notified.  It is not appropriate for the
nurse to initiate treatment.
NCLEX Review Respiratory
Questions
1. An adult client is admitted for diagnosis
and treatment of a left lung lesion. A
bronchoscopy was performed under local
anesthesia. What nursing action is of highest
priority when he returns following the
bronchoscopy?
1. Collect all sputum for examination.
2. Assess level of consciousness frequently.
3. Withhold food and fluids until gag reflex
has returned.
4. Monitor blood pressure and pulse at 10
minute intervals.
2. A lower left lobectomy was performed on
an adult client. He was returned to his room
following an uneventful stay in the recovery
room. It is most important for the nurse to
1. Encourage him to perform deep breathing
and coughing exercises.
2. Assist him with arm exercises to prevent
shoulder ankylosis.
3. Help him perform leg exercises to prevent
thrombophlebitis.
4. Position him in semi-Fowler’s position on
his left side.
3. A client who has had a lobectomy returns
to the nursing unit. He has a chest tube
attached to portable water seal drainage
system and oxygen per nasal cannula. The
first nursing measure concerning the water
1. Milk the tubing to prevent accumulation
of fibrin and clots.
2. Raise the drainage apparatus to bed height
to accurately assess the meniscus level.
3. Attach the chest tubes to the bed linen to
assure that airflow and drainage are
unhindered by kinks.
4. Mark the time and level of drainage in the
collection chamber.
4. An adult client had a left thoracotomy. He
has portable water seal chest drainage. On
the first postoperative day the fluid in the
water seal chamber stops fluctuating. What
does this most likely indicate?
1. The chest tube is clogged by fibrin or a
clot.
2. There is an air leak in the system.
3. Pulmonary edema has occurred due to
increased blood volumes in remaining lung
tissue.
4. The client’s left lung has reexpanded.
5. An adult client had a left lower
lobectomy. Passive exercises are started on
his left arm after surgery. The exercises are
designed to prevent
1. Hyperflexion of the wrist.
2. Ankylosis of the shoulder.
3. Flexion contractures of the elbow.
4. Spasticity of the intercostal muscle
6. An adult client is admitted to the acute
care hospital with bacterial pneumonia. On
admission she was pale to dusky in color.
Her respirations were 32, temperature 1030F
and pulse 110. Auscultation revealed
decreased or absent lung sounds in both
bases and rhonchi in both upper lung fields.
She was oriented to person, time and place,
but her responses were brief. Oxygen per
nasal cannula is started at 7 l / minute. IV
antibiotics were started. While checking the
client one hour after admission the nurse
notes that she is less responsive, answering
only yes or no questions. Her respirations
are somewhat more shallow and have
decreased to 27 per minute. What is the best
INITIAL action for the nurse to take?
1. Increase the IV infusion rate to increase
the amount of circulating antibiotics.
2. Notify the physician of the client’s
changed mental status and await further
orders.
3. Increase the oxygen flow rate to 10 liters /
minute.
4. Continue to stimulate her until she
responds appropriately.
7. A tracheostomy tube is inserted in a
patient who is in respiratory distress as a
result of pneumonia. The family asks why
the tube is inserted. What should the nurse
include when explaining to the patient and
family? The purpose of a tracheostomy tube
is to
1. Decrease the client’s anxiety by
increasing the size of the airway.
2. Provide increased cerebral oxygenation
thereby preventing further respiratory
depression.
3. Facilitate nursing care since tracheal tubes
have fewer side effects than nasotracheal
tubes.
4. Provide more controlled ventilation and
ease removal of secretions the client is
unable to handle.
8. An adult is about to have a tracheostomy
performed. Which action is of highest
priority for the nurse before the procedure is
done?
1. Establishing means of postoperative
communication.
2. Drawing blood for serum electrolytes and
blood gases.
3. Inserting an indwelling catheter and
attaching it to dependent drainage.
4. Doing a surgical prep of the neck and
upper chest wall.
9. The nurse is performing tracheal
suctioning. Which action is essential to
prevent hypoxemia during suctioning?
1. Removal of oral and nasal secretions.
2. Encouraging the client to deep breathe
and cough.
3. Administer 100% oxygen before
suctioning.
4. Auscultate the lungs.
10. An adult is admitted to the hospital with
progressive dyspnea on exertion, which has
become increasingly severe during the last
six months. Physical examination reveals
crackles at the base of the lung and clubbing
of fingers. The client has asbestosis that has
caused fibrosis in the alveoli. Soon after
admission, the nurse helps the client to the
bathroom. Before he returns to bed, he is
very short of breath. Considering the
severity of his symptoms, it is essential for
the nurse to include which of the following
in the plan of care.
1. Give continuous oxygen via nasal
catheter.
2. Allow the client to move at his own pace.
3. Give bronchodilators to increase his
ability to breathe.
4. Keep the client in bed to prevent further
episodes of dyspnea.
11. An order is written for oxygen by nasal
cannula at 2 liters per minute. In assessing
the adequacy of the oxygen therapy, which
of the following is most effective?
1. Checking the respiratory rate.
2. Checking the color of mucous
membranes.
3. Measurement of pulmonary functions.
4. Measurement of arterial blood gasses.
12. A client with asbestosis must see his
doctor regularly for a check up. What is the
primary reason for him to have frequent
checkups?
1. Patients with asbestosis are at high risk
for developing bronchogenic cancer.
2. His doctor is monitoring him closely to
look for signs of improvement.
3. Patients who use low flow oxygen for
long periods are at high risk for developing
neurological symptoms.
4. Periodic sputum samples are needed to
follow the progress of the disease.
13. An adult male has had a hacking cough
and shortness of breath for several months.
He now has chest pain. His family has
pressured him into seeking medical
consultation. He continues to say, “It is just
a smoker’s cough.” The physician examines
the client and arranges for hospital
admission for a diagnostic work-up. The
nurse is explaining several types of tests that
are ordered. Which of these tests is most
definitive in the process of ruling out a
malignancy?
1. Needle biopsy.
2. Thoracentesis.
3. Bronchogram.
4. Sputum analysis.
14. Preoperative teaching for the client who
is to have a pneumonectomy should include
all of the following. Which is of highest
priority?
1. Management of postoperative pain.
2. Turning, coughing and deep breathing
exercises.
3. How to move with the least pain.
4. Leg exercises.
15. An adult client has just arrived in the
recovery room following a pneumonectomy.
What is the most appropriate initial action
for the nurse?
1. Take his vital signs for baseline data.
2. Check the IV solution for rate and correct
solution.
3. Administer oxygen through an
appropriate device.
4. Auscultate for the presence of breath
sounds.
16. What action is essential because the
client had a pneumonectomy?
1. Observe the tracheal position.
2. Auscultate bilateral breath sounds.
3. Assess for hypertension.
4. Assess for blood streaked sputum.
17. The nurse is positioning an adult who
has just returned to the surgical nursing care
unit following a pneumonectomy. What is
the most appropriate position in which to
place the client?
1. Semi-Fowler’s on the unaffected side.
2. Semi-Fowler’s on the affected side.
3. Sims position on the unaffected side.
4. Semi-Fowler’s on his back.
18. Which of the following nursing
interventions should be instituted the day
after surgery for the client who has had a
pneumonectomy?
1. Provide range of motion exercises to
affected arm.
2. Strip chest tubes every hour.
3. Force fluids to 3500 cc / day.
4. Monitor intermittent positive pressure
breathing therapy.
19. An adult has been diagnosed as having
pulmonary tuberculosis. Which test(s)
would the nurse expect to be ordered before
the client is started on Isoniazid (INH)
therapy?
1. LDH, SGOT (AST)
2. BUN, serum creatinine
3. Skin test for allergy
4. Chest X-ray
20. A patient is admitted with
histoplasmosis. Which item in the patient’s
history is most likely related to the onset of
the disease?
1. He works in a factory.
2. He likes to explore caves.
3. He has three cats.
4. He smokes four packs of cigarettes a
week.
Respiratory Questions Answers and
Rationale
1. (3) Food and fluids should be
withheld to prevent aspiration. The
client will have received a local
anesthetic to block the gag reflex during
the bronchoscopy. The nurse should
observe sputum for color but it is not
necessary to collect it. Bronchoscopy is
usually done under a local anesthetic so
level of consciousness is not a priority.
Vital signs may be monitored but
preventing aspiration is of highest
priority.
2. (1) Deep breathing and coughing
assume highest priority after a
thoracotomy. Arm and leg exercises
are also important. He would be
positioned in semi-Fowler’s position on
his right side (nonoperative).
3. (4) It is important to monitor the
amount of chest drainage. Chest tubes
are milked only if there is an
obstruction in the tubing and only with
a physician’s order. The chest
drainage system should not be raised
above chest level. It should remain low.
Chest tubes should not be attached to
the linens.
4. (1) Fibrin and clots will obstruct the
outflow of air from the patient’s
thoracic cavity. It is too soon for the
lung to have reexpanded. An air leak in
the system would cause an absence of
 bubbling in the suction control chamber
not the water seal chamber.
5. (2) The muscles have been cut
during surgery. Range of motion
exercises will help to prevent ankylosis
of the shoulder or frozen shoulder.
Patients also tend to splint incisional
discomfort by limiting movement on
the affected side.
6. (2) Changes in mental status are
always significant. Since her
respirations are decreasing it is doubtful
if oxygen would be effective.
7. (4) This is the purpose of a
tracheostomy. The client may become
less anxious when she is no longer
hypoxic. However, relief of anxiety is
not the purpose of a tracheostomy
tube.
8. (1) A tracheostomy makes a client
unable to speak. Other means of
communication will be necessary.
9. (3) 100% oxygen is given before
and after suctioning to prevent hypoxemia.
10. (2) The client is best able to
evaluate his symptom of dyspnea.
When he wants to rest, he should be
allowed to rest. #1 is not correct.
Oxygen may be ordered, but is often
ordered PRN. A nasal cannula is usually
ordered. #3 is not an independent
nursing action. #4 is not correct. The
client will be allowed to do as much as
he is able to prevent complications of
bedrest. The day should be planned so
that periods of exertion are followed by
periods of rest.
11. (4) Arterial blood gasses give the
most specific information of the
adequacy of the oxygen therapy. #1.
The respiratory rate is a good measure
but is not the best measure. #2. Color
changes in the mucous membranes are
a late sign of hypoxemia. #3.
Pulmonary function tests are used to
evaluate pulmonary function.
12. (1) This is true. The doctor is
looking for a change in cough,
hemoptysis, weight loss, etc. #2. The
asbestos fibers in the lungs cannot be
removed and the fibrosis is not
reversible. Improvement is not
expected. #3. is not correct. #4,
sputum production is not a
characteristic of this disorder. Also,
sputum does not give information
about the progress of the fibrosis.
13. (1) Needle biopsy of the lungs
detects peripherally located tumors. It
 provides a firm diagnosis in 80% of
cases.
14. (2) Turning coughing and deep
breathing help to prevent the most
frequent, most life threatening
complication likely to occur after
thoracic surgery. The others are
important and should be done.
15. (3) An oxygen source is of highest
priority as the client is likely to be
hypoventilating due to the effects of
anesthesia. Oxygen will prevent
hypoxia. After starting oxygen the
nurse will make all of the other
assessments.
16. (1) Tracheal shift can occur
following pneumonectomy. Tracheal
shift would compromise the client’s
unaffected lung. There will be no
breath sounds on the operative sounds.
He has only one lung after a
pneumonectomy. Hypotension, not
hypertension, is a major sign of
hemorrhage. The sputum will probably
not be bloody, as the remaining lung
was not operated on. A small amount
of blood streaked sputum could be the
result of intubation during surgery.
17. (4) Semi-Fowler’s on the back will
neither cause mediastinal shift nor
cause hemorrhage at the pulmonary
artery stump site. Positioning the client
on his affected side could cause
hemorrhage at the pulmonary artery
stump site. Positioning the client on his
unaffected side could cause mediastinal
shift.
18. (1) Range of motion exercises should be
started within 4 hours of surgery to
prevent adhesion formation.
Intermittent positive pressure breathing
therapy will not be used as the pressure
could interrupt the suture line. Most
physicians do not insert chest tubes in
these clients, as the fluid is allowed to
accumulate and eventually consolidate
in the space. An increased fluid load
could lead to respiratory compromise.
19. (1) Liver function tests, SGOT (AST)
and LDH would be performed to serve
as baseline. Liver toxicity can occur
with INH. Renal function tests, BUN
and serum creatinine are essential in
persons who are receiving streptomycin
therapy. There is not a skin test for
allergy to INH. A chest X-ray will have
been done as part of the diagnostic
process but is not necessary again
before starting INH therapy.
20. (2) Histoplasmosis is caused by a
fungus that grows in chicken and bat
manure. Bats live in caves. Exploring
caves is a likely source of exposure to
the fungus. Choice 1, working in a
factory, might be related to COPD if the
factory had emissions. Choice 3 would
be a possible source of toxoplasmosis,
not histoplasmosis. Choice 4 is not
related to histoplasmosis although it
could be related to other respiratory
diseases.