1. Which of the following arteries primarily feeds the anterior wall of the heart? a. Circumflex artery b.

Internal mammary artery c. Left anterior descending artery d. Right coronary artery 2. When do coronary arteries primarily receive blood flow? a. During inspiration b. During diastole c. During expiration d. During systole 3. Which of the following illnesses is the leading cause of death in the US? a. Cancer b. Coronary artery disease c. Liver failure d. Renal failure 4. Which of the following conditions most commonly results in CAD? a. Atherosclerosis b. DM c. MI d. Renal failure 5. Atherosclerosis impedes coronary blood flow by which of the following mechanisms? a. Plaques obstruct the vein b. Plaques obstruct the artery c. Blood clots form outside the vessel wall d. Hardened vessels dilate to allow the blood to flow through 6. Which of the following risk factors for coronary artery disease cannot be corrected? a. Cigarette smoking b. DM c. Heredity d. HPN 7. Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease? a. 100 mg/dl b. 150 mg/dl c. 175 mg/dl d. 200 mg/dl 8. Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease? a. Decrease anxiety b. Enhance myocardial oxygenation c. Administer sublignual nitroglycerin d. Educate the client about his symptoms 9. Medical treatment of coronary artery disease includes which of the following procedures? a. Cardiac catheterization b. Coronary artery bypass surgery

c. Oral medication administration d. Percutaneous transluminal coronary angioplasty 10. Prolonged occlusion of the right coronary artery produces an infarction in which of he following areas of the heart? a. Anterior b. Apical c. Inferior d. Lateral 11. Which of the following is the most common symptom of myocardial infarction? a. Chest pain b. Dyspnea c. Edema d. Palpitations 12. Which of the following landmarks is the corect one for obtaining an apical pulse? a. Left intercostal space, midaxillary line b. Left fifth intercostal space, midclavicular line c. Left second intercostal space, midclavicular line d. Left seventh intercostal space, midclavicular line 13. Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration? a. Cardiac b. Gastrointestinal c. Musculoskeletal d. Pulmonary 14. A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this? a. Aortic b. Mitral c. Pulmonic d. Tricuspid 15. Which of the following blood tests is most indicative of cardiac damage? a. Lactate dehydrogenase b. Complete blood count c. Troponin I d. Creatine kinase 16. What is the primary reason for administering morphine to a client with myocardial infarction? a. To sedate the client b. To decrease the client’s pain c. To decrease the client’s anxiety d. To decrease oxygen demand on the client’s heart 17. Which of the followng conditions is most commonly responsible for myocardial infarction? a. Aneurysm b. Heart failure c. Coronary artery thrombosis d. Renal failure

18. What supplemental medication is most frequently ordered in conjuction withfurosemide (Lasix)? a. Chloride b. Digoxin c. Potassium d. Sodium 19. After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic changes are these? a. Electrophysiologic b. Hematologic c. Mechanical d. Metabolic 20. Which of the following complications is indicated by a third heart sound (S3)? a. Ventricular dilation b. Systemic hypertension c. Aortic valve malfunction d. Increased atrial contractions 21. After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs? a. Left-sided heart failure b. Pulmonic valve malfunction c. Right-sided heart failure d. Tricuspid valve malfunction 22. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? a. Cardiac catheterization b. Cardiac enzymes c. Echocardiogram d. Electrocardiogram 23. What is the first intervention for a client experiencing myocardial infarction? a. Administer morphine b. Administer oxygen c. Administer sublingual nitroglycerin d. Obtain an electrocardiogram 24. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying? a. “Tell me about your feeling right now.” b. “When the doctor arrives, everything will be fine.” c. “This is a bad situation, but you’ll feel better soon.” d. “Please be assured we’re doing everything we can to make you feel better.” 25. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? a. Beta-adrenergic blockers b. Calcium channel blockers c. Narcotics d. Nitrates 26. What is the most common complication of a myocardial infarction? a. Cardiogenic shock

Raised 30 degrees d. Which of the following symptoms might a client with right-sided heart failure exhibit? a. Pericarditis 27. Myocardial infarction d. Radial pulse d. Arrhythmias d. With which of the following disorders is jugular vein distention most prominent? a. Oliguria d. Hypotension 32. Calcium channel blockers c. Hepatic engorgement d. Supine position 29. Adequate urine output b. Apical pulse b. Abdominal aortic aneurysm b. Raised 10 degrees c. Right-sided heart failure 33. Polyuria c. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention? a. Furosemide c. Pulmonary emboli c. High-fowler’s b.b. DM b. Crackles b. Pneumothorax 28. Which of the following parameters should be checked before administering digoxin? a. Heart failure c. Diuretics . Respiratory rate 30. Heart failure c. Metoprolol d. In which of the following disorders would the nurse expect to assess sacral eddema in bedridden client? a. Enalapril 31. Toxicity from which of the following medications may cause a client to see a green halo around lights? a. Digoxin b. Polydipsia 34. Beta-adrenergic blockers b. Renal failure d. Which ofthe following symptoms is most commonly associated with left-sided heart failure? a. Arrhythmias c. Which of the following classes of medications maximizes cardiac performance in clients with heat failure by increasing ventricular contractility? a. Blood pressure c.

What is the definitive test used to diagnose an abdominal aortic aneurysm? a. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm? a. Inotropic agents 35. Syphilis 38. Proximal to the renal arteries 39. Arteriogram c. Headache d. DM c. Left-sided heart failure d. In which of the following areas is an abdominal aortic aneurysm most commonly located? a. Lower back pain 42. Gastritis 40. Upper back pain 41. Adjacent to the aortic branch d. Distal to the renal arteries c.d. Cardiomyopathy c. Abdominal X-ray b. Abdominal pain b. Diaphoresis c. Which of the following conditions is most closely associated with weight gain. Atherosclerosis b. What is the most common cause of abdominal aortic aneurysm? a. Hypotension d. Decreased myocardial contractility 36. Abdominal aortic aneurysm b. Angina pectoris b. Angina d. Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client? a. Abdominal pain b. HPN . Absent pedal pulses c. Ultrasound 43. What is the most common symptom in a client with abdominal aortic aneurysm? a. HPN d. Bradycardia b. and a decrease in urine output? a. Distal to the iliac arteries b. Stimulation of the sympathetic nervous system produces which of the following responses? a. Tachycardia c. nausea. Enlarged spleen c. Gastic distention d. A pulsating abdominal mass usually indicates which of the following conditions? a. CT scan d. Right-sided heart failure 37.

Friction rubs 48. Interna and Media 45. decreased BP.b. Lupus erythematosus c. decreased RBC. decreased RBC. decreased WBC d. which area of the abdomen is most commonly palpated? a. Syphilis 47. increased WBC 49. decreased RBC. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client? a. Hernia b. Right upper quadrant b. Retroperitoneal rupture at the repair site d. decreased BP. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm? a. decreased BP. Aortogram c. Lower back pain. increased WBC b. Stage 1 pressure ulcer c. PVD d. Surgical intervention . HPN c. Bruit b. Rapid expansion of the aneurysm 50. Marfan’s syndrome d. Which hereditary disease is most closely linked to aneurysm? a. Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms? a. Dullness d. Middle lower abdomen to the left of the midline d. decreased RBC. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area? a. Beta-adrenergic blocker administration d. Midline lower abdomen to the right of the midline 46. DM b. Severe lower back pain. Cardiac arrythmias d. Directly over the umbilicus c. Antihypertensive medication administration b. Intermittent lower back pain. Crackles c. When assessing a client for an abdominal aortic aneurysm. Cystic fibrosis b. increased BP. Which of the following treatments is the definitive one for a ruptured aneurysm? a. Interna c. Which of the following blood vessel layers may be damaged in a client with an aneurysm? a. Severe lower back pain. Aneurysm rupture c. Media d. Myocardial infarction 51. Externa b. Diminished pedal pulses 44. increased WBC c.

Myocarditis d. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy? a. Coronary artery disease c. and edema are classic signs and symptoms of which of the following conditions? a. Congestive b. Cardiomegaly b. What is the term used to describe an enlargement of the heart muscle? a. Myocarditis d. Dilated b. Pericarditis 57. Septal involvement occurs in which type of cardiomyopathy? a. Decreased myocardial contractility d. Restricitve 59. Which of the following cardiac conditions does a fourth heart sound (S4) indicate? a. Antihypertensive b. Nitrates . Calcium channel blockers d. Pericardial effusion 56. Which of the following types of cardiomyopathy can be associated with childbirth? a. cough. Pericarditis b. Normally functioning heart c. Cardiomyopathy c. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? a. Failure of the ventricle to eject all the blood during systole 60. Hypertension c. Hypertrophic d. Dilated aorta b. MI d. Dilated c. Cardiomyopathy b. Hypertrophic c. Dyspnea. weakness. Restrictive 54. expectoration. DM c. Heart failure b.52. Which of the following heart muscle diseases is unrelated to other cardiovascular disease? a. Pericardial Effusion 53. Beta-adrenergic blockers c. Restrictive 55. Myocardial infarction d. Obliterative d.

is the leading cause of CAD. Cholesterol levels above 200 mg/dl are considered excessive. B. A. therefore. C. Exercise also helps reduce cholesterollevels. the internal mammary artery supplies the mammary. but its administration isn’t the first priority. Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. The most common symptom of an MI is chest pain. C. Without adequate oxygen. 2. The right coronary artery supplies the right ventricle. most of the blood flow to coronary arteries is supplied during diastole. Oral medication administration is a noninvasive.1. or the apical portion (left ventricle) of the heart. 5. lateral portion (some of the left ventricle and the left atrium). D. medical treatment for coronary artery disease. producing arrhythmias. 4. Liver failure and renal failure account for less than 10% of all deaths in the US. Cardiac and GI pains don’t change with respiration. Although the coronary arteries may receive a minute portion of blood during systole. C. Pulmonary pain is generally described by these symptoms. it can’t be changed. A. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise. Altering one’s diet. . Dyspnea is the second most common symptom. Cigarettesmoking cessation is a lifestyle change that involves behavior modification. B. and the right coronary artery supplies the inferior wall of the heart. constrict blood flow. Hardened vessels can’t dilate properly and. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for CAD. 9. 7. and medication can correct hypertension. Edema is a later sign of heart failure. or the inferior portion of the heart. The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. nether are priorities when a client is compromised. surgical treatments. the myocardium suffers damage. DM is a risk factor for CAD but isn’t the most common cause. Breathing patterns are irrelevant to blood flow 3. resulting from deprivation of oxygen to the heart. supply the coronary arteries with oxygen and other nutrients. Normally. Musculoskeletal pain only increase with movement. Palpitations may result from reduced cardiac output. Sublingual nitorglycerin is administered to treat acute angina. B. Although educating the client and decreasing anxiety are important in care delivery. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive. C. D. They require dietary restriction and perhaps medication. 6. but the two conditions are related. to the right of the sternum. Atherosclerosis. not veins. The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. exercise. Myocardial infarction is commonly a result of CAD. 10. Aortic valve abnormalities are heard at the second intercostal space. heart sounds aren’t heard in the midaxillary line or the seventh intercostal space in the midclavicular line. prolonged occlusion could produce an infarction in that area. The circumflex artery supplies the lateral wall. Therefore. Diabetes mellitus is a risk factor that can be controlled with diet. This is the point of maximum impulse and the location of the left ventricular apex. 11. Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border. 14. 8. and medication. Atherosclerosis is a direct result of plaque formation in the artery. Coronary artery disease accounts for over 50% of all deaths in the US. C. 13. Arteries. exercise. or plaque formation. B. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. often seen after an MI. related to an increase in the metabolic needs of the body during an MI. The left anterior descending artery is the primary source of blood for the anterior wall of the heart. Cardiac catheterization isn’t a treatment but a diagnostic tool. Renal failure doesn’t cause CAD. Because “heredity” refers to our genetic makeup. The right coronary artery doesn’t supply the anterior portion (left ventricle). Cancer accounts for approximately 20%. 12. B.

Cardiac enzymes are used to diagnose MI but can’t determine the location. It gives the client a feeling of comfort and safety. resulting in left-sided heart failure. Increased atrial contraction or systemic hypertension can result is a fourth heart sound. cardiogenic shock. No one can determine if a client experiencing MI will feel or get better and therefore. 22. C. so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine will also decrease pain and anxiety while causing sedation. is defined as the end stage of left ventricular dysfunction. Rapid filling of the ventricles causes vasodilation that is auscultated as S3. A. B. C. Pulmonic and tricuspid valve malfunction causes right-sided heart failure. another complication of MI. They protect the myocardium. 17. Aortic valve malfunction is heard as a murmur. but the study may not be performed immediately. Morphine is administered because it decreases myocardial oxygen demand. and a complete chemistry is obtained to review electrolytes. and decreased anxiety. Validation of the client’s feelings is the most appropriate response. CK isoenzymes are required to detect cardiac injury. Because CK levles may rise with skeletal muscle injury. helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. and most widely used tool to determine the location of myocardial infarction. Lactate dehydrogenase is present in almost all body tissues and not specific to heart muscle. and electro physiologic changes affect conduction. Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. 23. Heart failure is usually the result of an MI. The myocardium is deprived of oxygen during an infarction. 19. A. LDH isoenzymes are useful in diagnosing cardiac injury. Because the pumping function of the heart is compromised . 20. Renal failure can be associated with MI but isn’t a direct cause. C. D. but isn’t primarily given for those reasons. The ECG is the quickest. Coronary artery thrombosis causes occlusion of the artery. 26. these responses are inappropriate. Arrhythmias. D. CBC is obtained to review blood counts. Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Narcotics reduce myocardial oxygen demand. D. Morphine and sublingual nitroglycerin are also used to treat MI. An ECG is the most common diagnostic tool used to evaluate MI. When the left ventricle doesn’t function properly. Administering supplemental oxygen to the client is the first priority of care. 16. Chloride and sodium aren’t loss during diuresis. Hematologic changes would affect the blood. A. Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage. Troponin I levels aren’t detectable in people without cardiac injury. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Beta-adrenergic blockers work by blocking beta receptors in the myocardium. 24. The condition occurs in approximately 15% of clients with MI. are the most common complication of an MI. An aneurysm is an outpouching of a vessel and doesn’t cause an MI. The left ventricle is responsible for the most of the cardiac output. but they’re more commonly administered after the oxygen. An anterior wall MI may result in a decrease in left ventricular function. leading to myocardial death. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Digoxin acts to increase contractility but isn’t given routinely with furosemide. Mechanical changes are those that affect the pumping action of the heart. A. promote vasodilation. 18. reducing the response to catecholamines and sympathetic nerve stimulation. most accurate. The other three responses give the client false hope. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload). 21. 25. caused by oxygen deprivation to the myocardium.15. C. Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic.

or dependent. Inclined pressure can’t be seen when the client is supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore. and a decrease in urine output are secondary effects of right-sided heart failure. unlike the proximal portion of the aorta. A. also decreasing the workload of the heart. . The radial pulse can be affected by cardiac and vascular disease and therefore. A. or a decrease in urine output. and renal disease aren’t directly linked to sacral edema. polyuria. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. none is a direct cause. There is no area adjacent to the aortic arch. The other symptoms listed are related to the parasympathetic nervous system. The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn’t surrounded by stable structures. in and of itself. The other medications aren’t associated with such an effect. Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. A. Digoxin has no effect on respiratory function. however. an MI doesn’t cause jugular vein distention. Distal to the iliac arteries. D. the veins would be barely discernible above the clavicle. 36. 35. which bends into the thoracic (descending) aorta. Angina pectoris doesn’t cause weight gain. Pericarditis most commonly results from a bacterial of viral infection but may occur after MI. Sacral. Jugular vein distention isn’t a symptom of abdominal aortic aneurysm or pneumothorax. in which case the nurse would withhold digoxin. making this an uncommon site for an aneurysm. 34. Crackles in the lungs are a classic sign of left-sided heart failure. which causes oliguria. 27. 31. and polydipsia aren’t associated with right-sided heart failure. C. 29. D. nausea. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention. Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume. can progress to heart failure. pulmonary emboli. B. heart failure is the second most common complication. if severe enough. 38. not visible). Weight gain. An MI. Plaques build up on the wall of the vessel and weaken it. exhibited as jugular vein distention. Although the other conditions are related to the development of an aneurysm. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. D. These sounds are caused by fluid backing up into the pulmonary system. B. thereby increasing ventricular contractility and ultimately increasing cardiac output. A. 37. In high Fowler’s position. Elevated venous pressure. Left-sided heart failure causes hypertension secondary to an increased workload on the system. B. Inotropic agents are administered to increase the force of the heart’s contractions. the vessel is again surrounded by stable vasculature. causing an aneurysm. Arrhythmias can be associated with both right and left-sided heart failure. Adequate urine output. Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. which is responsible for slowing the heart rate. The most accurate area on the body to assed dependent edema in a bedridden client is the sacral area. won’t always accurately depict the heart rate. An apical pulse is essential or accurately assessing the client’s heart rate before administering digoxin.by an MI. 33. Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. indicates a failure of the heart to pump. 30. Blood pressure is usually only affected if the heart rate is too low. The apical pulse is the most accurate point in the body. 28. edema is secondary to right-sided heart failure. Diabetes mellitus. nausea. 32. C.

46. C. and the pain is referred to the lower back. Lupus erythematosus isn’t hereditary. Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. B. are associated with an aneurysm but isn’t life threatening. The expansion applies pressure in the abdominal cavity. The aorta lies directly left of the umbilicus. such as the liver. Diabetes mellitus doesn’t have direct link to aneurysm. 45. The finding. A hernia doesn’t cause vascular disturbances. Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. the vasculature is interrupted and blood volume is lost. . is a common symptom. can be normal on a thin person. Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. A. Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. the pain is constant because it can’t be alleviated until the aneurysm is repaired. 44. 40. therefore. suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs. Lower back pain results from expansion of the aneurysm. B. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension. the RBC count is decreased – not increase.39. C. A. a sign of poor circulation to the lower extremities. D. An aortogram is a diagnostic tool used to detect an aneurysm. Lower back pain. 51. usually signifying expansion and impending rupture of the aneurysm. 42. For the same reason. After the aneurysm ruptures. A bruit. This rupture is most commonly caused by leakage at the repair site. 50. Therefore. Marfan’s syndrome results in the degeneration of the elastic fibers of the aortic media. C. however. A. gastritis. The media has more smooth muscle and less elastic fibers. a vascular sound resembling heart murmur. Although cystic fibrosis is hereditary. but the link isn’t as strong as it is with hypertension. usually indicating an outpouching in a weakened vessel. any other region is inappropriate for palpation. so blood pressure wouldn’t increase. When the vessel ruptures. The presence of a pulsating mass in the abdomen is an abnormal finding. Myocardial infarction is neither hereditary nor a disease. Neither an enlarged spleen. it hasn’t been linked to aneurysms. 49. Only 1% of clients with syphilis experience an aneurysm. Cardiac arrhythmias aren’t directly linked to an aneurysm. Dullness is heard over solid organs. so it’s more capable of vasoconstriction and vasodilation. The factor common to all types of aneurysms is a damaged media. B. D. C. nor gastic distention cause pulsation. 43. The WBC count increases as cells migrate to the site of injury. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. a hematoma won’t form. 48. When rupture occurs. nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm. surgery is the only intervention that can repair it. therefore. it clearly delineates the vessels and any abnormalities. reducing the risk of rupture. CT scan and ultrasound don’t give a direct view of the vessels and don’t yield as accurate a diagnosis as the arteriogram. The interna and externa are generally no damaged in an aneurysm. as in abdominal aortic aneurysm. Friction rubs indicate inflammation of the peritoneal surface. 41. Diminished pedal pulses. clients with the syndrome are more likely to develop an aortic aneurysm. Abdominal pain is most common symptom resulting from impaired circulation. Blood pressure decreases due to the loss of blood. An abdominal aneurysm would only be visible on an X-ray if it were calcified. Headache and diaphoresis aren’t associated with abdominal aortic aneurysm. 47. Severe lower back pain indicates an aneurysm rupture. An arteriogram accurately and directly depicts the vasculature. Angina is associated with atherosclerosis of the coronary arteries. secondary to pressure being applied within the abdominal cavity. not upper. B.

Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Cardiomegaly denotes an enlarged heart muscle. Restrictive cardiomyopathy indicates constrictive pericarditis. Hypertension is usually exhibited by headaches. heart failure most commonly occurs in clients with cardiomyopathy. Dilated cardiomyopathy. B. a condition associated with pericarditis and advanced heart failure. however. which are primary goals in the treatment of cardiomyopathy. Myocarditis refers to inflammation of heart muscle. Myocardial infarction results from prolonged myocardial ischemia due to reduced blood flow through one of the coronary arteries. Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. These are the classic symptoms of heart failure. In hypertrophic cardiomyopathy. Myocardial infarction causes heart failure but isn’t related to these symptoms. B.52. Pericardial effusion is most predominant in clients with percarditis. Nitrates aren’t’ used because of their dilating effects. they aren’t as effective as betaadrenergic blockers and cause increase hypotension. Cardiomyopathy is a heart muscle disease of unknown origin. D. Antihypertensives aren’t usually indicated because they would decrease cardiac output in clients who are often already hypotensive. Because the structure and function of the heart muscle is affected. cardiac dilation and heart failure may develop during the last month of pregnancy of the first few months after birth. Diabetes mellitus is unrelated to cardiomyopathy. Cardiomyopathy isn’t usually related to an underlying heart disease such as atherosclerosis. though it does cause a murmur. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. An s4 isn’t heard in a normally functioning heart. A. Coronary artery disease and myocardial infarction are directly related to atherosclerosis. visual disturbances and a flushed face. By decreasing the heart rate and contractility. 55. 56. This abnormality isn’t seen in other types of cardiomyopathy. Myocarditis isn’t specifically associated with childbirth. Decreased myocardial contractility is heard as a third heart sound. C. the sac surrounding the heart. A. D. Although the cause isn’t entirely known. 60. hypertrophy of the ventricular septum – not the ventricle chambers – is apparent. The etiology in most cases is unknown. the underlying cause is usually myocardial. 53. 58. A. A dilated aorta doesn’t cause an extra heart sound. Pericarditis is an inflammation of the pericardium. Pericardial effusion is the escape of fluid into the pericardial sac. This increased resistance is related to decrease compliance of the ventricle. beta-adrenergic blockers improve myocardial filling and cardiac output. A. which would further compromise the myocardium. . and restrictive cardomyopathy all decrease cardiac output. 57. 54. An S4 occurs as a result of increased resistance to ventricular filling adterl atrial contraction. 59. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers.

to be covered with an anterior leg.m. a. 5. b. a. a. Avoid bathing the client with mild soap. d. A male client with psoriasis visits the dermatology clinic. d. b. When inspecting the affected areas. 2. left 18% 27% 30% 36% Which nursing intervention can help a client maintain healthy skin? Keep the client well hydrated. When planning care for a male client with burns on the upper torso. c. c.” A female client is brought to the emergency department with second. sit in the shade to prevent sunburn. c.BURNS 1. b. which nursing diagnosis should take the Ineffective airway clearance related to edema of the respiratory passages Impaired physical mobility related to the disease process Disturbed sleep pattern related to facility environment Risk for infection related to breaks in the skin In a female client with burns on the legs. when the sun is strongest. d. b. what is the total body surface area that has been burned? to see which type of secondary lesion? occlusive dressing. the nurse formulates the nursing diagnosis of Risk for injury. The nurse takes this opportunity to highest priority? discuss the importance of protecting the skin from the sun’s damaging rays. c. which nursing intervention helps prevent contractures? Applying knee splints Elevating the foot of the bed Hyperextending the client’s palms Performing shoulder range-of-motion exercises A male client comes to the physician’s office for treatment of severe sunburn.” “When at the beach. b. a.” “Apply sunscreen even on overcast days. c. “Minimize sun exposure from 1 to 4 p. a. d. Recommend wearing tight-fitting clothes in hot weather. 4. To address a potential client problem associated with this treatment. 3. Which instruction would best prevent skin damage? a. To complete the nursing diagnosis statement.” “Use a sunscreen with a sun protection factor of 6 or higher. Using the Rule of Nines. and anterior trunk. the nurse should add which “related-to” phrase? a. b. b. Remove adhesive tape quickly from the skin. 6. 7. c. d.and third-degree burns on the left arm. d. Related to potential interactions between the topical corticosteroid and other prescribed drugs Related to vasodilatory effects of the topical corticosteroid . the nurse expects Scale Crust Ulcer Scar A female adult client with atopic dermatitis is prescribed a potent topical corticosteroid.

A urine output consistently above 100 ml/hour A weight gain of 4 lb (2 kg) in 24 hours Body temperature readings all within normal limits An electrocardiogram (ECG) showing no arrhythmias . d. b. to enhance absorption With an upward motion. c. fluid-filled vesicles that ulcerate and heal in 3 to 7 days Herpetic keratoconjunctivitis usually is bilateral and causes systemic symptoms. b. a. c. c. outward. 12. c.c. a. Related to percutaneous absorption of the topical corticosteroid Related to topical corticosteroid application to the face.” “Apply acyclovir ointment to the lesions every 3 hours.V. d.” Nurse Bea plans to administer dexamethasone cream to a client who has dermatitis over the anterior chest With a circular motion. The nurse should assess the client for which adverse reaction to this drug? How should the nurse apply this topical agent? area it’s meant to protect? phase of wound healing? body. b. b. c. d. b. herpes simplex infection may cause spontaneous abortion or premature delivery. Which observation shows that the fluid resuscitation is benefiting the client? a. c. The nurse identifies this as which Inflammatory Migratory Proliferative Maturation In an industrial accident. A client with genital herpes lesions can have sexual contact but must use a condom. b. d. 8. a. b. d. 14.” “Apply one applicator of tioconazole intravaginally at bedtime for 7 days. even. a male client that weighs 155 lb (70 kg) sustained full-thickness burns over 40% of his (Garamycin) by the I. Which statement about herpes simplex infection is true? During early pregnancy. He’s in the burn unit receiving fluid resuscitation. and upward strokes in the direction opposite hair growth Nurse Meredith is caring for a wheelchair-bound client. 13. a. and intertriginous sites A male client is diagnosed with herpes simplex. Which instruction should the nurse provide? “Apply one applicator of terconazole intravaginally at bedtime for 7 days. six times a day for 7 days. d. even. Genital herpes simplex lesions are painless. d. d. neck. a. outward. and downward strokes in the direction of hair growth In long. c. to increase blood supply to the affected area In long. Which piece of equipment impedes circulation to the Polyurethane foam mattress Ring or donut Gel flotation pad Water bed Nurse Rudolf documents the presence of a scab on a client’s deep wound. 9. 10. a. A female client with a severe staphylococcal infection is receiving the aminoglycoside gentamicin sulfate Aplastic anemia Ototoxicity Cardiac arrhythmias Seizures A male client is diagnosed with primary herpes genitalis.” “Apply sulconazole nitrate twice daily by massaging it gently into the lesions. 11. route.

she asks a staff nurse. b. During her visit to the clinic. every 4 hours while awake. 16. decrease circulation to the fingers. Later. A male client visits the physician’s office for treatment of a skin disorder.” “If someone develops symptoms. reduce the client’s fluid intake. b. a. d. a male client contracted scabies. the nurse should include which intervention in the plan of Placing mitts on the client’s hands Administering systemic antibiotics as prescribed Applying topical antibiotics as prescribed Continuing to administer antibiotics for 21 days as prescribed A female client with second. the nurse should: expects the physician to prescribe: The client is living at her daughter’s home. To help the turn him frequently. A female client sees a dermatologist for a skin problem.V.” “After you’re treated. palpitations. b. a. antibiotic. c. “What should my family do?” The most accurate response from the nurse is: a. 18. where six other persons are living. causing infection Inflammation of a hair follicle Irritation of opposing skin surfaces caused by friction A male client who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. c. dizziness.” “Just be careful not to share linens and towels with family members. d. 19. d. a.and third-degree burns on the arms receives autografts. the nurse dislodge the autografts. increase the amount of scarring. which is diagnosed the day after discharge. tell him to see a physician right away. metallic taste. b.O. perform passive range-of-motion (ROM) exercises. b. encourage the client to use a footboard. d. c. the nurse an I.V. 21. an oral antibiotic. 200 mg P. b. c. Two days later. This term refers to which condition? client avoid pressure ulcers. a. a. A female client with herpes zoster is prescribed acyclovir (Zovirax).” When caring for a male client with severe impetigo. diarrhea. d. the nurse reviews the client’s chart and notes Spontaneously occurring wheals A fungus that enters the skin’s surface. increase edema in the arms. “All family members will need to be treated. a. c. b. 17. corticosteroid. d. c. care? finds the client doing arm exercises. an I. d.15. a topical agent. The nurse should inform the client that this drug may cause: that the chief complaint was intertrigo. family members won’t be at risk for contracting scabies. The nurse knows that this client should avoid exercise because it may: . c. While in a skilled nursing facility. As a primary treatment. 20.

” “This prevents evaporation of water from the hydrated epidermis. and arms is seen in urgent care. c. A male client is diagnosed with gonorrhea. continue physical therapy. How should the nurse respond? client understands postoperative care of artificial skin when he states that during the first 7 days after the procedure. range of motion. infection. a female client is treated with artificial skin. It’s most important use cosmetic camouflage techniques. he will restrict: a. 25. isolate the client’s bed linens until the client is no longer infectious. body image. d. After administering medication for photochemotherapy. b.22. The nurse is providing home care instructions to a client who has recently had a skin graft. b. The nurse’s primary fluid resuscitation. c. The nurse teaches the concern should be: that the client remember to: include which instruction? intercourse. 24. b. d. protein intake. pain management. face.” client about the importance of protecting the skin from ultraviolet light before drug administration and for 8 hours afterward and stresses the need to protect the eyes.” “This prevents inflammation of the skin. Dr. going outdoors. tell sexual partners of your status and have them wash well after “If you don’t get treatment. 28. The client asks why the emollient “This makes the skin feel soft. Nurse Troy discovers scabies when assessing a client who has just been transferred to the medical-surgical wash hands. b. c. back. a. fluid ingestion. and remove any observable mites. apply a pediculicide to the client’s scalp.” “This minimizes cracking of the dermis. c. the nurse should: should be applied immediately after a bath or shower. place the client on enteric precautions. d. you may develop meningitis and suffer widespread central nervous system (CNS) A female client with atopic dermatitis is prescribed medication for photochemotherapy. a. notify the nurse in the day surgery unit of a potential scabies outbreak. a.” “If you have intercourse before treatment ends. protect the graft from direct sunlight. To prevent scabies infection in other clients. 26.” Following a full-thickness (third-degree) burn of his left arm.” damage. d. The unit from the day surgery unit.” “Wash your hands thoroughly to avoid transferring the infection to your eyes. c. d. the client must protect the eyes for: . b. When teaching the client about this disease. a. which takes 14 to 21 days. the nurse should “Avoid sexual intercourse until you’ve completed treatment. d. b. apply lubricating lotion to the graft site. a. 23. c. 27. Smith prescribes an emollient for a client with pruritus of recent onset. A male client with a solar burn of the chest.

Genital herpes simplex lesions typically are painful. b. c. and the anterior trunk accounts for 18%. 4. a. the arms account for 9% each.m. fluid-filled vesicles that ulcerate and heal within 1 to 2 weeks.m. 7. Option B isn’t appropriate because burns aren’t a disease.m. 2. 8 hours. Option C and D may be appropriate. According to the Rule of Nines. d. Answer A. causing the same adverse effects as systemic corticosteroids. Answer C. but don’t command a higher priority than option A because they don’t reflect immediately life-threatening problems. may cause spontaneous abortion or premature delivery. to 2 p.m.m. Therefore. The nurse should recommend wearing loose-fitting — not tight-fitting — clothes in hot weather to promote heat loss by evaporation. not vasodilation. d. the nurse should avoid strong or harsh detergents and should use mild soap. because the sun’s rays are as damaging then as on sunny days. Therefore.a. such as conjunctivitis. Sun exposure should be minimized during these hours. to 3 p. A female client with genital herpes simplex is being treated in the outpatient department. Answer D. when totaled. and scars also are secondary lesions in skin disorders. 30. Answer A. equal 100%. Answer A. Herpes simplex may be passed to the fetus transplacentally and. (11 a. d. and water can reflect more than half the sun’s rays onto the skin. 6. A potent topical corticosteroid rarely is prescribed for use on the face. b. or intertriginous sites because application on these areas may lead to increased adverse effects. 8. c. Keeping the client well hydrated helps prevent skin cracking and infection because intact healthy skin is the body’s first line of defense. Which of the following is the initial intervention for a male client with external bleeding? Elevation of the extremity Pressure point control Direct pressure Application of a tourniquet . cancer of the vagina. Sitting in the shade when at the beach doesn’t guarantee protection against sunburn because sand. Herpetic keratoconjunctivitis usually is unilateral and causes localized symptoms. Answer A. Hyperextending a body part for an extended time is inappropriate because it can cause contractures. ulcers. A potent topical corticosteroid may increase the client’s risk for injury because it may be absorbed percutaneously. daylight saving time) — not from 1 to 4 p. 4 hours. These preparations cause vasoconstriction. the nurse’s primary goal is to maintain respiratory integrity. The nurse teaches her about measures that may prevent herpes recurrences and emphasizes the need for prompt treatment if complications arise. 3. b. Applying knee splints prevents leg contractures by holding the joints in a position of function. 5. cancer of the uterus. Performing shoulder range-of-motion exercises can prevent contractures in the shoulders. The Rule of Nines divides body surface area into percentages that. The nurse shouldn’t remove adhesive tape quickly because this action can strip or scrape the skin. The sun is strongest from 10 a. option A should take the highest priority. concrete. A scale is the characteristic secondary lesion occurring in psoriasis. during early pregnancy. 48 hours. the anterior legs account for 9% each. neck. Topical corticosteroids aren’t involved in significant drug interactions. cancer of the cervix. Sunscreen should be applied even on overcast days. cancer of the ovaries. Answer C. c. 24 hours. When caring for a client with upper torso burns. Elevating the foot of the bed can’t prevent contractures because this action doesn’t hold the joints in a position of function. but not in the legs. Answer A. this client’s burns cover 36% of the body surface area. To help a client maintain healthy skin. Although crusts. they don’t accompany psoriasis. 29. A client with genital herpes lesions should avoid all sexual contact to prevent . Genital herpes simplex increases the risk of: a. The nurse should recommend sunscreen with a sun protection factor of at least 15.

The most important intervention to prevent pressure ulcers is frequent position changes. Gel pads redistribute with the client’s weight. Answer C. even. Answer A. Rings or donuts aren’t to be used because they restrict circulation. Topical antibiotics are less effective than systemic antibiotics in treating impetigo. proteinuria. they will produce an acceptable urine output of at least 0. and hearing loss) and nephrotoxicity (indicated by urinary cells or casts.5 ml/kg/hour. To prevent the spread of scabies in other hospitalized clients. 10. In the inflammatory phase. In fact. Answer C. Thus. 11. Terconazole and tioconazole are used to treat vulvovaginal candidiasis. 16. 17. Gentamicin isn’t associated with aplastic anemia. epidermis thickens. Answer B. A fungus that enters the skin surface and causes infection is a dermatophyte. the actions of the migratory phase continue and intensify. When someone in a group of persons sharing a home contracts scabies. the nurse should begin at the midline and use long. and an inflammatory reaction occurs in the subcutaneous tissue. 18. or seizures. a dangerous complication. Spontaneously occurring wheals occur in hives. and downward strokes in the direction of hair growth. the nurse moves each joint through its range of movement. and a urine output consistently above 100 ml/hour is more than adequate. Intertrigo refers to irritation of opposing skin surfaces caused by friction. and granulation tissue fills the wound. the nurse should isolate the client’s bed linens until the client is no longer infectious — usually 24 hours after treatment begins. dizziness. Weight gain from fluid resuscitation isn’t a goal. Answer B.V. These adverse reactions are most common in elderly and dehydrated clients. If the kidneys are adequately perfused. the goal of fluid resuscitation is to maintain a mean arterial blood pressure that provides adequate perfusion of vital structures. During the proliferative phase. Because exercising the autograft sites may dislodge the grafted tissue. This application pattern reduces the risk of follicle irritation and skin inflammation. oliguria. each individual in the home needs prompt treatment whether he’s symptomatic or not. Other required precautions include using good hand-washing technique and wearing gloves when applying the pediculicide and during all contact with the client. It is accompanied by migration of epithelial cells. Oral acyclovir may cause such adverse GI effects as diarrhea. and those receiving concomitant therapy with another potentially ototoxic or nephrotoxic drug. a scabies epidemic is unlikely because scabies is spread through skin or sexual contact. The client’s nails should be kept trimmed to avoid scratching. and vomiting. however. those with renal impairment. During passive ROM exercises. In a client with burns. the physician typically prescribes systemic antibiotics for 7 to 10 days to prevent glomerulonephritis. None of the other options results from exercise 22. Impetigo is a contagious. Answer A. When applying a topical agent. Answer A. mitts aren’t necessary. cardiac arrhythmias. which relieve pressure on the skin and underlying tissues. Body temperature readings and ECG interpretations may demonstrate secondary benefits of fluid resuscitation but aren’t primary indicators. The water bed also distributes pressure over the entire surface. A footboard prevents plantar flexion and footdrop by maintaining the foot in a dorsiflexed position. and reduced creatinine clearance). Inflammation of a hair follicle is called folliculitis. Scabies can be transmitted from one person to another before symptoms develop. The most significant adverse reactions to gentamicin and other aminoglycosides are ototoxicity (indicated by vertigo. Adequate hydration is necessary to maintain healthy skin and ensure tissue repair. 20. a blood clot forms. 19. Although many drugs are used to treat skin disorders.spreading the disease. or a metallic taste. Answer A. A client with primary herpes genitalis should apply topical acyclovir ointment in sufficient quantities to cover the lesions every 3 hours. or oral agents — are the mainstay of treatment. It isn’t associated with palpitations. Answer B. topical agents — not I. Answer D. The scab formation is found in the migratory phase. 14. Towels and linens should be washed in hot water. the nurse should advise the client to keep the grafted extremity in a neutral position. Answer B. Answer D. If pressure isn’t relieved. nausea. Answer C. 21. outward. Answer B. 15. the expected urine output of a 155-lb client is 35 ml/hour. reducing circulation and oxygenation of the tissues and resulting in cell death and ulcer formation. 13. 9. This client doesn’t . Foam mattresses evenly distribute pressure. Although the nurse should notify the nurse in the day surgery unit of the client’s condition. superficial skin infection caused by beta-hemolytic streptococci. capillaries become occluded. If the condition is severe. In the maturation phase. a 4-lb weight gain in 24 hours suggests third spacing. cells and vessels return to normal and the scab sloughs off. 12. six times a day for 7 days. which improves joint mobility and circulation to the affected area but doesn’t prevent pressure ulcers. and development of new cells that grow across the wound. synthesis of scar tissue by fibroblasts. tinnitus. Sulconazole nitrate is used to treat tinea versicolor.

When grading arterial pulses. Subcutaneous emphysema. Fluid resuscitation and infection become concerns if the burn extends to the dermal and subcutaneous skin layers. d. Murmurs that indicate heart disease are often accompanied by other symptoms such as: a. 3. Answer A. Answer C. the skin’s upper layer. To avoid burning and sloughing. 1. 30. but direct pressure is the first step. c. uterus. Protein intake and fluid intake are important for healing and regeneration and shouldn’t be restricted. Periorbital edema. Answer C. For severe or arterial bleeding. carotid. not the dermis (the layer beneath the epidermis). c. Protecting the eyes for a shorter period increases the risk of eye injury. d. Answer D. The client should avoid sexual intercourse until treatment is completed. A client who doesn’t refrain from intercourse before treatment is completed should use a condom in addition to informing sex partners of the client’s health status and instructing them to wash well after intercourse. Applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis. 23. brachial. An emollient doesn’t prevent skin inflammation. this effect occurs whether or not the client has just bathed or showered. which usually takes 4 to 7 days. Body image disturbance is a concern that has lower priority than pain management. The nurse is performing her admission assessment of a patient. 29. Absent perfusion. the nurse’s main concern is pain management. To prevent eye discomfort. Decrease heart rate Decreased cardiac output Increased plasma volume Increased blood pressure greatest risk of developing severe cardiac problems? . A tourniquet may further damage the injured extremity and should be avoided unless all other measures have failed. 25. Above normal perfusion. Diminished perfusion. To prevent disruption of the artificial skin’s adherence to the wound bed. 28. Normal perfusion. 27.require enteric precautions because the mites aren’t found on feces. The other three interventions are helpful to the client and his recovery but are less important. With a superficial partial thickness burn such as a solar burn (sunburn). Dyspnea on exertion. not gonorrhea. Applying direct pressure to an injury is the initial step in controlling bleeding. or vagina. Going outdoors is acceptable as long as the left arm is protected from direct sunlight. indicates: 2. and a follow-up culture confirms that the infection has been eradicated. c. b. the client must protect the graft from direct sunlight. and temporal artery sites. a 1+ pulse a. Answer B. Pressure points are those areas where large blood vessels can be compressed against bone: femoral. An emollient minimizes cracking of the epidermis. Genital herpes simplex isn’t a risk factor for cancer of the ovaries. A female client with genital herpes simplex is at increased risk for cervical cancer. Adults and children with gonorrhea may develop gonococcal conjunctivitis by touching the eyes with contaminated hands. Thoracic petechiae. Answer B. Although emollients make the skin feel soft. Which pregnancy-related physiologic change would place the patient with a history of cardiac disease at the a. 26. Meningitis and widespread CNS damage are potential complications of untreated syphilis. b. the client must protect the eyes for 48 hours after taking medication for photochemotherapy. d. Answer B. b. Answer D. pressure point control can be used. Elevation reduces the force of flow. the client should restrict range of motion of the involved limb. facial. 24.

d. a. d. c. These are two classic signs of which of the following disorders? a. Bruce Owen. The priority nursing diagnosis for the patient with cardiomyopathy is: a. Which of the following would she cite as an early sign of increased ICP? 9. 6. d. d. b. d. c. Cerebrovascular accident (CVA) . Which step in the nursing process is described above? a. Which intervention is the most important for this patient? 10. Decreased cardiac output related to reduced myocardial contractility. Administer antibiotics to reduce the risk of infection 11. c. Planning Implementation Analysis Evaluation An elderly patient may have sustained a basilar skull fracture after slipping and falling on an icy sidewalk. Which of the following types of drugs might be given to control increased intracranial pressure (ICP)? a. The nurse is teaching family members of a patient with a concussion about the early signs of increased a. b.4. Anxiety related to risk of declining health status. c. b. Jessie James is diagnosed with retinal detachment. Patch the affected eye and call the ophthalmologist. Barbiturates Carbonic anhydrase inhibitors Anticholinergics Histamine receptor blockers The nurse knows that basilar skull factures: 7. c. Dr. b. May have cause cerebrospinal fluid (CSF) leaks from the nose or ears. then irrigate the eye with saline solution. a chemist. d. sustained a chemical burn to one eye. 8. Her pedal pulse is palpable and there is no edema present. Her affected leg appears pink and warm. b. Have no characteristic findings. A patient with thrombophlebitis reached her expected outcomes of care. Administer a cycloplegic agent to reduce ciliary spasm. Are always surgically repaired. c. Immediately instill a tropical anesthetic. Decreased systolic blood pressure Headache and vomiting Inability to wake the patient with noxious stimuli Dilated pupils that don’t react to light Admitting him to the hospital on strict bed rest Patching both of his eyes Referring him to an ophthalmologist Preparing him for surgery intracranial pressure (ICP). b. d. b. c. Are the least significant type of skull fracture. The nurse is assessing a patient and notes a Brudzinski’s sign and Kernig’s sign. Which intervention takes priority for a patient with a chemical burn of the eye? a. a. 5. Ineffective individual coping related to fear of debilitating illness Fluid volume excess related to altered compensatory mechanisms.

Priestly has a spinal cord injury. . b. Citrus fruits. Hemangioblastoma. d. A patient is admitted to the hospital for a brain biopsy. d. c. Angioma. Kelly Smith complains that her headaches are occurring more frequently despite medications. Gary Jordan suffered a cerebrovascular accident that left her unable to comprehend speech and unable to speak. The nurse knows that the most common type of primary brain tumor is: a. Immediately following cerebral aneurysm rupture. The nurse should instruct the patient with Parkinson’s disease to avoid which of the following? 14. b. b. c. c. d. Freshly prepared meats.b. b. a. c. Skim milk Chocolate Photophobia Explosive headache Seizures Hemiparesis Persistent hypertension Subarachnoid hemorrhage Atrial fibrillation Skull fracture 16. Although Ms. d. b. 12. b. She must remove indwelling urinary catheter prior to intercourse. c. Receptive aphasia Expressive aphasia Global aphasia Conduction aphasia 15. d. Patients with a history of headaches should be taught to avoid: a. Meningitis Seizure disorder Parkinson’s disease c. c. a. c. d. Discharge teaching should make her aware that: a. Meningioma. She can still get pregnant. she can still have sexual intercourse. d. a. This type of aphasia is known as: a. Which of the following is a cause of embolic brain injury? 18. b. Positioning may be awkward. Walking in an indoor shopping mall Sitting on the deck on a cool summer evening Walking to the car on a cold winter day Sitting on the beach in the sun on a summer day 13. the patient usually complains of: 17. d. She can no longer achieve orgasm. Glioma.

b. Remove the brace so that the patient can shower. Explain that she should take her medication with breakfast. Tell her to buy an alarm watch to remind her. As a result. suffered a cervical fracture requiring immobilization with halo traction. When caring for the patient in halo traction. When caring for a patient with esophageal varices. b. Encourage the patient to use a pillow under the ring. Esophageal perforation Pulmonary hypertension “I’m so depressed because I can’t have any visitors for a week. age 36. d. b.19. The teaching plan for a man with a spinal cord injury should include sexually concerns. Instruct her to take her medication after one of her favorite television shows. the nurse must: a. What response by the patient indicates that he understands the precautions necessary with this diagnosis? a. b.” “The doctor is a good friend of mine and won’t keep me in isolation. Which of the following injuries would most likely prevent erection and ejaculation? a. c. C5 C7 T4 S4 22.” “The nurse told me that my urine and stool are also sources of meningitis bacteria. a. “Nimodipine replaces calcium. Keep a wrench taped to the halo vest for quick removal if cardiopulmonary resuscitation is Remove the brace once a day to allow the patient to rest. d. c.” “Thank goodness. b. Cathy Bates. The nurse asks a patient’s husband if he understands why his wife is receiving nimodipine (Nimotop). c. b. 20. c. Richard Barnes was diagnosed with pneumococcal meningitis.” Fatigue while talking Change in mental status Numbness of the hands and feet Spontaneous fractures 24.” “Nimodipine promotes growth of blood vessels in the brain.” 21. How can the nurse best help the patient remember to take her medication? a. Ivy Hopkins. Many men who suffer spinal injuries continue to be sexually active. age 25. d. d. d. necessary. since she suffered a cerebral aneurysm rupture. b. the nurse knows that bleeding in this disorder usually . c. is a homemaker who frequently forgets to take her carbamazepine (Tegretol).” “Nimodipine reduces the brain’s demand for oxygen. c. Tell her take her medication at bedtime. 23. stems from: a. An early symptom associated with amyotrophic lateral sclerosis (ALS) includes: 25. I’ll only be in isolation for 24 hours.” “Nimodipine reduces vasospasm in the brain. d. Which response by the husband indicates that he understands the drug’s use? a. she has been experiencing seizures.

Obtain an order to irrigate the stoma. 27. Portal hypertension Peptic ulcers 26. Which assessment finding indicates dehydration? . The nurse explains to the patient who has an abdominal perineal resection that an indwelling urinary catheter must be kept in place for several days afterward because: a. b. b. The first day after. Discharge instructions for a patient who has been operated on for colorectal cancer include irrigating the colostomy. If a patient’s GI tract is functioning but he’s unable to take foods by mouth. What special precautions should the nurse take when caring for this patient? a. Wear gloves and a gown when removing the patient’s bedpan. the preferred method of feeding 31. b. d. 30. b. d. Place the patient on bed rest and call the doctor. Which type of solution causes water to shift from the cells into the plasma? 32. Total parenteral nutrition Peripheral parenteral nutrition Enteral nutrition Oral liquid supplements Hypertonic Hypotonic Isotonic Alkaline Active transport Osmosis Diffusion Filtration Call the doctor immediately. a. b. What is the most appropriate nursing intervention? a.c. b. d. Prevent the droplet spread of the organism. d. Tiffany Black is diagnosed with type A hepatitis. d. It prevents urinary tract infection following surgery It prevents urine retention and resulting pressure on the perineal wound It minimizes the risk of wound contamination by the urine It determines whether the surgery caused bladder trauma 29. is: a. c. Continue the current plan of care. He experiences abdominal cramping while the irrigant is infusing He has difficulty inserting the irrigation tube into the stoma He expels flatus while the return is running out He’s unable to complete the procedure in 1 hour 28. c. c. c. d. Particles move from an area of greater osmelarity to one of lesser osmolarity through: 33. d. The nurse knows her teaching is effective when the patient states he’ll contact the doctor if: a. c. c. surgery the nurse finds no measurable fecal drainage from a patient’s colostomy stoma. b. c. a. d. Put on a mask and gown before entering the patient’s room. Use caution when bringing food to the patient.

Tenting of chest skin when pinched Rapid filling of hand veins A pulse that isn’t easily obliterated Neck vein distention Performing nasogastric tube irrigation with normal saline solution Weighing the patient daily Administering tap water enema until the return is clear Encouraging the patient with excessive perspiration to dink broth Bradycardia A central venous pressure of 6 mm Hg Pitting edema An orthostatic blood pressure change 34. A patient with metabolic acidosis has a preexisting problem with the kidneys. c. a. Aspirate urine from the tubing port using a sterile syringe and needle Disconnect the catheter from the tubing and obtain urine Open the drainage bag and pour out some urine Wear sterile gloves when obtaining urine 39. diaphoretic. c. Liver Pancreas Lungs heart Voids during the nighttime hours Has a urine output of less than 100 ml in 24 hours Has a urine output of at least 100 ml in 2 hours Has pain and burning on urination 37. b. b. 38. a patient is retuned to the room with continuous bladder irrigation in place. d. After undergoing a transurethral resection of the prostate to treat benign prostatic hypertrophy. b. flow rate Notify the doctor immediately Assess the irrigation catheter for patency and drainage Administer meperidine (Demerol) as prescribed 40. b. d. The nurse considers the patient anuric if the patient. The doctor tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays.a. d. d. a. Which assessment finding would indicate an extracellular fluid volume deficit? 36. Which nursing intervention would most likely lead to a hypo-osmolar state? 35. c. d. b. Renal calculi can form anywhere in the urinary tract. c. a. c. Increase the I. c.V. What is their most common formation site? . c. b. severe pain originating in the lumbar region and radiating around the side and toward the bladder. d. What should the nurse do first? a. Which nursing action is appropriate to prevent infection when obtaining a sterile urine specimen from an indwelling urinary catheter? a. One day later. the patient reports bladder pain. A patient comes to the hospital complaining of sudden onset of sharp. d. Which other organ helps regulate blood pH? a. The patient also reports nausea and vomiting and appears pale. and anxious. b.

d. c. A urinary tract infection Renal calculi An enlarged kidney A distended bladder 46. c. A patient comes to the hospital complaining of severe pain in the right flank. b. Kidney Ureter Bladder Urethra 41. increased reabsorption of sodium and water Increased urine output. The symptoms have been present for several weeks after a viral illness. and vomiting. The nurse suspects: a. increased reabsorption of sodium and water Decreased urine output. age 75. c. b. A patient with suspected renal insufficiency is scheduled for a comprehensive diagnostic work-up. c. the nurse should assign highest priority to which nursing diagnosis? a. c. c. is admitted to the medical-surgical floor with weakness and left-sided chest pain. d. d. the nurse notes a firm mass extending above the symphysis pubis. d. b.002 Urine pH of 3 Absence of protein Absence of glucose 43. the patient asks which part of the kidney “does the work. b.” Which answer is correct? a. Gregg Lohan. Specific gravity of 1. Pain Risk of infection Altered urinary elimination Altered nutrition: less than body requirements 42. the renin-angiotensin-aldosterone system exerts which of the following effects on renal 45. b. decreased reabsorption of sodium and water The glomerulus Bowman’s capsule The nephron The tubular system 44. nausea. Decreased urine output. b. decreased reabsorption of sodium and water Increased urine output. b. The nurse is reviewing the report of a patient’s routine urinalysis.a. d. After the nurse explains the diagnostic tests. d. While assessing a patient who complained of lower abdominal pressure. When planning this patient’s care. The doctor tentatively diagnoses right ureter-olithiasis (renal calculi). During a shock state. Which of the following values should the nurse consider abnormal? a. Which assessment finding is most symptomatic of pericarditis? a. Pericardial friction rub Bilateral crackles auscultated at the lung bases Pain unrelieved by a change in position Third heart sound (S3) . d. function? a. c.

b. Lying on his back with the head of the bed elevated 30 to 45 degrees. and 0 is absent perfusion. These changes may cause cardiac stress. Pituitary gland and pancreas Liver and gallbladder. and chest pain. a 2+ is normal perfusion. 1. When assessing a patient for fluid and electrolyte balance. When assessing him for jugular vein distention. Lying on his side with the head of the bed flat. and perior-bital edema aren’t associated with murmurs and heart disease. He admits to smoking a pack of cigarettes per day. the nurse is aware that the organs most important in maintaining this balance are the: a. c. 2. James King is admitted to the hospital with right-side-heart failure. b. What is the ratio of chest compressions to ventilations when one rescuer performs cardiopulmonary resuscitation (CPR) on an adult? a. Other indicators are tachycardia. Subcutaneous emphysema. 4. syncope. Answer: D Decreased cardiac output related to reduced myocardial contractility is the greatest threat to the survival of a patient with cardiomyopathy. Lungs and kidneys. Sitting upright.47. 3. b. Weight reduction Decreasing salt intake Smoking cessation Decreasing caffeine intake 49. 15:1 15:2 12:1 12:2 50. Flat on his back. A 4+ is bounding perfusion. Brain stem and heart. possibly increasing both the heart rate and cardiac output. Answer: C Pregnancy increase plasma volume and expands the uterine vascular bed. Answer: A A murmur that indicates heart disease is often accompanied by dyspnea on exertion. c. When developing a teaching plan. b. The nurse is interviewing a slightly overweight 43-year-old man with mild emphysema and borderline hypertension. The other options can be addressed once cardiac output and myocardial contractility have been restored. the nurse should position him: a. . d. d. which of the following should receive highest priority to help decrease respiratory complications? a. Blood pressure during early pregnancy may decrease. d. Answer: D A 1+ pulse indicates weak pulses and is associated with diminished perfusion. thoracic petechiae. especially during the second trimester. a 3+ is increased perfusion. which is a hallmark of heart failure. but it gradually returns to prepregnancy levels. c. 48. c. d.

decreases cerebral edema. Planning refers to designing a plan of action that will help the nurse deliver quality patient care. Meningiomas are the second most common. Retinal reattachment can be accomplished by surgery only.0): Double eversion of the eyelids should be performed to look for and remove ciliary spasm. Irrigation should be continued until the pH of the eye is restored to neutral (pH 7. Anticholinergics have many uses including reducing GI spasms. and reduces the brain’s need for glucose and oxygen. Analysis is the process of identifying the patient’s nursing problems. If the macula is detached or threatened. Classic findings in this type of fracture may include otorrhea. 12. and then the pH of the eye should be checked. Expressive aphasia. and raccoon eyes. or Parkinson’s disease. surgery is urgent. Answer: C Global aphasia occurs when all language functions are affected. 7. Answer: A Immediate bed rest is necessary to prevent further injury. Then the eye should be patched. Angiomas and hemangioblastomas are types of cerebral vascular tumors that account for 3% of brain tumors. Answer: D Evaluation assesses the effectiveness of the treatment plan by determining if the patient has met the expected treatment outcome. and VIII.5. with 15%. Answer: B A positive response to one or both tests indicates meningeal irritation that is present with meningitis. Irrigation should be done for 5 to 10 minutes. which increases the risk of hyperthermia. 8. affects the ability to comprehend written or spoken words. 14. Receptive aphasia. 13. 6. Brudzinski’s and Kernig’s signs don’t occur in CVA. Answer: C A chemical burn to the eye requires immediate instillation of a topical anesthetic followed by irrigation with copious amounts of saline solution. and an antibiotic ointment can be administered to reduce the risk of infection. Carbonic anhydrase inhibitors are used to decrease ocular pressure or to decrease the serum pH in a patient with metabolic alkalosis. 11. Parenteral narcotic analgesia is often required for pain relief. This decreases cortical activity and cerebral metabolism. II. 10. Battle’s signs. also known as Broca’s . Surgical treatment isn’t always required. Answer: B A basilar skull fracture carries the risk of complications of dural tear. rhinorrhea. Implementation refers to all of the nursing interventions directed toward solving the patient’s nursing problems. causing CSF leakage and damage to cranial nerves I. Answer: B Headache and projectile vomiting are early signs of increased ICP. and dilated pupils that don’t reac to light are considered late signs. prolonged detachment of the macula results in permanent loss of central vision. Answer: A Barbiturates may be used to induce a coma in a patient with increased ICP. also known as Wernicke’s aphasia. Histamine receptor blockers are used to decrease stomach acidity. Answer: D Gliomas account for approximately 45% of all brain tumors. unconsciousness. and he should be instructed to avoid sun exposure during hot weather. Both eyes should be patched to avoid consensual eye movement and the patient should receive early referral to an ophthalmologist should treat the condition immediately. seizure disorder. An ophthalmologist should also be consulted. 9. Answer: D The patient with Parkinson’s disease may be hypersensitive to heat. reduces cerebral blood volume. Decreased systolic blood pressure. VII.

Conduction aphasia refers to abnormalities in speech repetition.aphasia. leading to rupture and bleeding into the lower esophagus. processed meats. and chocolate and caffeine-containing products. Answer: D Women with spinal cord injuries who were sexually active may continue having sexual intercourse and must be reminded that they can still become pregnant. affected the patient’s ability to form language and express thoughts. Typical headache triggers include alcohol. seizures. Answer: D Men with spinal cord injury should be taught that the higher the level of the lesion. which should help compliance. Taking it at meals will also establish a regular routine. dysphagia. pulmonary hypertension. 22. 17. 16. especially migraines. 20. 21. Placing a pillow under the patient’s head may alter the stability of the brace. ALS doesn’t cause a change in mental status. should be taught to keep a food diary to identify potential food triggers. Answer: B An explosive headache or “the worst headache I’ve ever had” is typically the first presenting symptom of a bleeding cerebral aneurysm. 18. aged cheeses. 24. An indwelling urinary catheter may be left in place during sexual intercourse. 19. Persistent hypertension may place the patient at risk for a thrombotic injury to the brain. Bleeding associated with esophageal varices doesn’t stem from esophageal perforation. Answer: C Increased pressure within the portal veins causes them to bulge. Answer: D Nimodipine is a calcium channel blocker that acts on cerebral blood vessels to reduce vasospasm. Answer: C Tegretol should be taken with food to minimize GI distress. Answer: A The nurse must have a wrench taped on the vest at all times for quick halo removal in emergent situations. The sacral region is the lowest area on the spinal column and injury to this area will cause more erectile dysfunction. or peptic ulcers. 25. Photophobia. and hemiparesis may occur later. The drug doesn’t increase the amount of calcium. Answer: B Patient with pneumococcal meningitis require respiratory isolation for the first 24 hours after treatment is initiated. Positioning will need to be adjusted to fit the patient’s needs. caused by a traveling clot. Answer: C An embolic injury. . 23. affect cerebral vasculature growth. paresthesia. 15. or fractures. Blood may pool in the fibrillating atrium and be released to travel up the cerebral artery to the brain. may result from atrial fibrillation. Answer: D Patients with a history of headaches. Subarachnoid hemorrhage and skull fractures aren’t associated with emboli. the better their sexual function will be. She may be fully capable of achieving orgasm. or reduce cerebral oxygen demand. Answer: A Early symptoms of ALS include fatigue while talking. and weakness of the hands and arms. The brace isn’t to be removed for any other reason until the cervical fracture is healed.

The procedure will often take an hour to complete. 32. Osmosis is the movement of a pure solvent through a semipermeable membrane from an area of greater osmolarity to one of lesser osmolarity until equalization occurs. It may also occur in blood. most accurate method to determine fluid changes. Therefore. Type A hepatitis isn’t transmitted through the air by way of droplets. not dehydration. Hand veins fill slowly with dehydration. small molecules pass through. An isotonic solution. not rapidly. Answer: A A hypertonic solution causes water to shift from the cells into the plasma because the hypertonic solution has a greater osmotic pressure than the cells. 30. An indwelling urinary catheter may be a source of postoperative urinary tract infection. enteral nutrition via a feeding tube is the preferred method. Answer: A Tenting of chest skin when pinched indicates decreased skin elasticity due to dehydration. but disposable utensils should be used. A hypotonic solution has a lower osmotic pressure than that of the cells. Active transport is the movement of particles though energy expenditure from other sources such as enzymes.26. the normal plan of care can be followed. not its osmotic effect. Answer: B The nurse should wear gloves and a gown when removing the patient’s bedpan because the type A hepatitis virus occurs in stools. 29. It causes fluid to shift into the cells. . the doctor doesn’t have to be notified and the stoma shouldn’t be irrigated at this time. it would be absorbed by the body. Weighing the patient is the easiest. which has the same osmotic pressure as the cells. 34. 27. Because tap water is hypotonic. wouldn’t cause any shift. Answer: D The colostomy may not function for 2 days or more (48 to 72 hours) after surgery. oral liquid supplements are contraindicated. Answer: B An indwelling urinary catheter is kept in place several days after this surgery to prevent urine retention that could place pressure on the perineal wound. Special precautions aren’t needed when feeding the patient. nasotracheal secretions. possibly resulting in rupture. 28. Filtration is the process by which fluid is forced through a membrane by a difference in pressure. Since no fecal drainage is expected for 48 to 72 hours after a colostomy (only mucous and serosanguineous). 31. A pulse that isn’t easily obliterated and neck vein distention indicate fluid overload. The membrane is impermeable to the solute but permeable to the solvent. Urine won’t contaminate the wound. Answer: C If the patient’s GI tract is functioning. diluting the body fluid concentration and lowering osmolarity. Peripheral and total parenteral nutrition places the patient at risk for infection. and urine. Answer: C Administering a tap water enema until return is clear would most likely contribute to a hypo-osmolar state. Answer: B The patient should notify the doctor if he has difficulty inserting the irrigation tube into the stoma. A solution’s alkalinity is related to the hydrogen ion concentration. Answer: C Particles move from an area of greater osmolarity to one of lesser osmolarity through diffusion. An indwelling urinary catheter won’t necessarily show bladder trauma. 33. If the patient is unable to consume foods by mouth. Abdominal cramping and expulsion of flatus may normally occur with irrigation. Difficulty with insertion may indicate stenosis of the bowel. but large ones don’t.

37. or crystals. Answer: D An orthostatic blood pressure indicates an extracellular fluid volume deficit. such as an obstructed irrigation catheter. making the patient’s value normal. not bradycardia or orthostatic blood pressure change. Answer: A Renal calculi most commonly from in the kidney. Urine specific gravity normally ranges from 1. The liver. phenylketonuria. Answer: A To obtain urine properly. Answer: C The nephron is the kidney’s functioning unit. (The extracellular compartment consists of both the intravascular compartment and interstitial space. ketones. Altered nutrition: less than body requirements isn’t appropriate at this time. the nurse should ensure that other factors.Therefore. Voiding at night is called nocturia. bladder. Answer: C The respiratory and renal systems act as compensatory mechanisms to counteract-base imbalances. 39. 41. The lungs alter the carbon dioxide levels in the blood by increasing or decreasing the rate and depth of respirations. Nasogastric tube irrigation with normal saline solution wouldn’t cause a shift in fluid balance. They may remain there or become lodged anywhere along the urinary tract. bacteria.V. and heart play no part in compensating for acid-base imbalances. flow rate may worse the pain. 35. sterile gloves aren’t necessary. severe pain that the patient can’t rest and becomes increasingly anxious. Opening a closed urine drainage system increases the risk of urinary tract infection. 43. and urethra are less common sites of renal calculi formation.) A fluid volume deficit within the intravascular compartment would cause tachycardia. however. it helps identify rather than contribute to fluid imbalance. the nurse should aspirate it from a port. A central venous pressure of 6 mm Hg is in the high normal range. 40.032. 42. Pitting edema indicates fluid volume overload. Standard precautions specify the use of gloves during contract with body fluids. The baseline for urine output and renal function is 30 ml of urine per hour. a urine pH of 3 is abnormal and may indicate such conditions as renal tuberculosis. Therefore. using a sterile syringe after cleaning the port. Answer: B Normal urine pH is 4. thereby increasing or decreasing carbon dioxide elimination. urine contains no protein. Answer: C Although postoperative pain is expected. Normally. 36. Answer: B Anuria refers to a urine output of less than 100 ml in 24 hours. . Answer: A Ureterolithiasis typically causes such acute. The glomerulus. indicating adequate hydration. the nursing diagnosis of pain takes highest priority. alkaptonuria. Notifying the doctor isn’t necessary unless the pain is severe or unrelieved by the prescribed medication. A urine output of at least 100 ml in 2 hours is within normal limits. After assessing catheter patency. and acidosis.002 to 1. The ureter. Risk for infection and altered urinary elimination are appropriate once the patient’s pain is controlled. bilirubin. and tubular system are components of the nephron. glucose. the nurse should administer an analgesic such as meperidine as prescribed. therefore. Drinking broth wouldn’t contribute to a hypo-osmolar state because it doesn’t replace sodium and water lost through excessive perspiration. Bowman’s capsule. 38. Pain and burning on urination is called dysuria. aren’t the cause of the pain. Increasing the I. casts.5 to 8. pancreas. pyrexia.

The lungs are typically clear when auscultated. If the patient lies flat. The feeling of pressure is usually relieved with urination. Answer: D The lungs and kidneys are the body’s regulators of homeostasis. 45. Answer: D The bladder isn’t usually palpable unless it is distended. Sitting up and leaning forward often relieves pericarditis pain. A urinary tract infection and renal calculi aren’t palpable. Answer: B The correct ratio of compressions to ventilations when one rescuer performs CPR is 15:2 50. 47. Losing weight and decreasing salt and caffeine intake can help to decrease risk factors for hypertension. . Answer: D Assessing jugular vein distention should be done when the patient is in semi-Fowler’s position (head of the bed elevated 30 to 45 degrees). 46. An S3 indicates left-sided heart failure and isn’t usually present with pericarditis. if he sits upright. Answer: A A pericardial friction rub may be present with the pericardial effusion of pericarditis. Reduced renal perfusion stimulates the reninangiotensin-aldosterone system in an effort to conserve circulating volume. the kidneys maintain a balance of fluid and electrolytes. Answer: A As a response to shock. The lungs are responsible for removing fluid and carbon dioxide. 49. the renin-angiotensin-aldosterone system alters renal function by decreasing urine output and increasing reabsorption of sodium and water. The other organs play secondary roles in maintaining homeostasis.44. the veins will be flat. 48. the veins will be more distended. The kidneys aren’t palpable above the symphysis pubis. Answer: C Smoking should receive highest priority when trying to reduce risk factors for with respiratory complications. Reduced bladder tone due to general anesthesia is a common postoperative complication that causes difficulty in voiding.