50 ltem Medlcul-Surglcul Nurslng Pructlce Test

Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a typical description of pain
associated with an MI, and is now cold and clammy, pale and dyspneic. He has an IV of D5W running, and is complaining
of chest pain. Oxygen therapy has not been started, and he is not on the monitor. He is frightened.

1. The nurse is aware of several important tasks that should all be done immediately in order to give Mr. Duffy the care he
needs. Which of the following nursing interventions will relieve his current myocardial ischemia?

a. stool softeners, rest
b. O2 therapy, analgesia
c. Reassurance, cardiac monitoring
d. Adequate fluid intake, low-fat diet

2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the
following patterns of cardiac enzyme elevation are most common following an MI?

a. SGOT, CK, and LDH are all elevated immediately.
b. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
c. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
d. CK peaks first and remains elevated for 1 to 2 weeks.

3. On his second day in CCU Mr. Duffy suffers a life-threatening cardiac arrhythmia. Considering his diagnosis, which is the
most probable arrhythmia?

a. atrial tachycardia
b. ventricular fibrillation
c. atrial fibrillation
d. heart block

4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with him for his discharge should
educate him as to the purpose and actions of his new medication. What should she or he teach Mr. Duffy to do at home to
monitor his reaction to this medication?

a. take his blood pressure
b. take his radial pulse for one minute
c. check his serum potassium (K) level
d. weigh himself everyday

You are speaking to an elderly group of diabetics in the OPD about eye health and the importance of visits to the
ophthalmologist.

5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from
their care provider?

a. fluorescein stain
b. snellen¶s test
c. tonometry
d. slit lamp

6. You also explain common eye changes associated with aging. One of these is presbyopia, which is:

a. Refractive error that prevents light rays from coming to a single focus on the retina.
b. Poor distant vision
c. Poor near vision
d. A gradual lessening of the power of accommodation

7. Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. During
your discussion you describe the macular area as:

a. Head of the optic nerve, seen on the nasal side of the field, lighter in color than the retina.
b. The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
c. Area where the central retinal artery and vein appear on the retina.
d. Reddish orange in color, sometimes stippled.

8. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva. You explain that this is called:

a. a pinguecula, which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age.
b. Icterus, which may be due to liver disease.
c. A pterygium, which will interfere with vision.
d. Ciliary flush caused by congestion of the ciliary artery.

You are caring for Mr. Kaplan who has chronic renal failure (uremia)

9. You know that all but one of the following may eventually result in uremia. Which option is not implicated?

a. glomerular disease
b. uncontrolled hypertension
c. renal disease secondary to drugs, toxins, infections, or radiations
d. all of the above

10. You did the initial assessment on Mr. Kaplan when he came to your unit. What classical signs and symptoms did you
note?

a. fruity- smelling breath.
b. Weakness, anorexia, pruritus
c. Polyuria, polydipsia, polyphagia
d. Ruddy complexion

11. Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him. Regarding his diagnosis and
management of his drugs, you know that:

a. The half-life of many drugs is decreased in uremia; thus dosage may have to be increased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is essential.
c. Drug therapy is not usually affected by this diagnosis
d. Precautions should be taken with prescription drugs, but most OTC medications are safe for him to use.

You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin by reviewing assessment of the
cardiovascular system in your mind and asking yourself the following:

12. The point of maximum impulse (PMI) is an important landmark in the cardiac exam. Which statement best describes
the location of the PMI in the healthy adult?

a. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.
b. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
c. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
d. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.

13. During the physical examination of the well adult client, the health care provider auscultates the heart. When the
stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?

a. Tricuspid
b. Pulmonic
c. Aortic
d. Mitral

14. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?

a. S1
b. S2
c. S3
d. S4

15. The coronary arteries furnish blood supply to the myocardium. Which of the following is a true statement relative to
the coronary circulation?

a. the right and left coronary arteries are the first of many branches off the ascending aorta
b. blood enters the right and left coronary arteries during systole only
c. the right coronary artery forms almost a complete circle around the heart, yet supplies only the right ventricle
d. the left coronary artery has two main branches, the left anterior descending and left circumflex: both supply the left
ventricle

Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis of mitral stenosis. She is
scheduled for surgery to repair her mitral valve.

16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints
of dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea have become unmanageable. These complaints are
probably due to:

a. thickening of the pericardium
b. right heart failure
c. pulmonary hypertension
d. left ventricular hypertrophy

17. On physical exam of Ms. Baker, several abnormal findings can be observed. Which of the following is not one of the
usual objective findings associated with mitral stenosis?

a. low-pitched rumbling diastolic murmur, precordial thrill, and parasternal lift
b. small crepitant rales at the bases of the lungs
c. weak, irregular pulse, and peripheral and facial cyanosis in severe disease
d. chest x-ray shows left ventricular hypertrophy

18. You are seeing more clients with diagnoses of mitral valve prolapse. You know those mitral valve prolapse is usually a
benign cardiac condition, but may be associated with atypical chest pain. This chest pain is probably caused by:

a. ventricular ischemia
b. dysfunction of the left ventricle
c. papillary muscle ischemia and dysfunction
d. cardiac arrythmias

Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup. His possible diagnosis is cancer
of the lung.

19. The most common lethal cancer in males between their fifth and seventh decades is:

a. cancer of the prostate
b. cancer of the lung
c. cancer of the pancreas
d. cancer of the bowel

20. Of the four basic cell types of lung cancer listed below, which is always associated with smoking?

a. adenocarcinoma
b. squamous cell carcinoma (epidermoid)
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma

21. Chemotherapy may be used in combination with surgery in the treatment of lung cancer. Special nursing
considerations with chemotherapy include all but which of the following?

a. Helping the client deal with depression secondary to the diagnosis and its treatment
b. Explaining that the reactions to chemotherapy are minimal
c. Careful observation of the IV site of the administration of the drugs
d. Careful attention to blood count results

22. Which of the following operative procedures of the thorax is paired with the correct definition?

a. Pneumonectomy: removal of the entire lung
b. Wedge resection: removal of one or more lobes of a lung
c. Decortication: removal of the reibs or sections of ribs
d. Thoracoplasty: removal of fibrous membrane that develops over visceral pleura as a result of emphysema

Mr. Liberatore, age 76, is admitted to your unit. He has a past medical history of hypertension, DM, hyperlipidemia.
Recently he has had several episodes where he stops talking in midsentence and stares into space. Today the episode
lasted for 15 minutes. The admission diagnosis is impending CVA.

23. The episodes Mr. Liberatore has been experiencing are probably:

a. small cerebral hemorrhages
b. TIA¶s or transient ischemic attacks
c. Secondary to hypoglycemia
d. Secondary to hyperglycemia

24. Mr. Liberatore suffers a left sided CVA. He is right handed. The nurse should expect:

a. left-sided paralysis
b. visual loss
c. no alterations in speech
d. no impairment of bladder function

25. Upper motor neuron disease may be manifested in which of the following clinical signs?

a. spastic paralysis, hyperreflexia, presence of babinski reflex
b. flaccid paralysis, hyporeflexia
c. muscle atrophy, fasciculations
d. decreased or absent voluntary movement

Julie, an 18-year-old girl, is brought into the ER by her mother with the chief complaint of sudden visual disturbance that
began half an hour ago and was described as double vision and flashing lights.

26. During your assessment of Julie she tells you all visual symptoms are gone but that she now has a severe pounding
headache over her left eye. You suspect Julie may have:

a. a tension headache
b. the aura and headache of migraine
c. a brain tumor
d. a conversion reaction

27. You explain to Julie and her mother that migraine headaches are caused by:

a. an allergic response triggered by stress
b. dilation of cerebral arteries
c. persistent contraction of the muscles of the head, neck and face
d. increased intracranial pressure

28. A thorough history reveals that hormonal changes associated with menstruation may have triggered Julie¶s migraine
attack. In investigating Julie¶s history what factors would be least significant in migraine?

a. seasonal allergies
b. trigger foods such as alcohol, MSG, chocolate
c. family history of migraine
d. warning sign of onset, or aura

29. A client with muscle contraction headache will exhibit a pattern different for Julie¶s. Which of the following is more
compatible with tension headache?

a. severe aching pain behind both eyes
b. headache worse when bending over
c. a bandlike burning around the neck
d. feeling of tightness bitemporally, occipitally, or in the neck

Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is currently unknown. You begin to think
about the way brain tumors are classified.

30. Glioma is an intracranial tumor. Which of the following statements about gliomas do you know to be false?

a. 50% of all intracranial tumors are gliomas
b. gliomas are usually benign
c. they grow rapidly and often cannot be totally excised from the surrounding tissue
d. most glioma victims die within a year after diagnosis

31. Acoustic neuromas produce symptoms of progressive nerve deafness, tinnitus, and vertigo due to pressure and
eventual destruction of:

a. CN5
b. CN7
c. CN8
d. The ossicles

32. Whether Mr Snyder¶s tumor is benign or malignant, it will eventually cause increased intracranial pressure. Signs and
symptoms of increasing intracranial pressure may include all of the following except:

a. headache, nausea, and vomiting
b. papilledema, dizziness, mental status changes
c. obvious motor deficits
d. increased pulse rate, drop in blood pressure

33. Mr Snyder is scheduled for surgery in the morning, and you are surprised to find out that there is no order for an
enema. You assess the situation and conclude that the reason for this is:

a. Mr. Snyder has had some mental changes due to the tumor and would find an enema terribly traumatic
b. Straining to evacuate the enema might increase the intracranial pressure
c. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is not necessary
d. An oversight and you call the physician to obtain the order

34. Postoperatively Mr. Snyder needs vigilant nursing care including all of the following except:

a. Keeping his head flat
b. Assessments q ½ hour of LOC, VS, papillary responses, and mental status
c. Helping him avoid straining at stool, vomiting, or coughing
d. Providing a caring, supportive atmosphere for him and his family

35. Potential postintracranial surgery problems include all but which of the following?

a. increased ICP
b. extracranial hemorrhage
c. seizures
d. leakage of cerebrospinal fluid

Mrs. Hogan, a 43-year-old woman, is admitted to your unit for cholecystectomy.

36. You are responsible for teaching Mrs. Hogan deep breathing and coughing exercises. Why are these exercises
especially important for Mrs. Hogan?

a. they prevent postoperative atelectasis and pneumonia
b. the incision in gallbladder surgery is in the subcostal area, which makes the client reluctant to take a deep breath and
cough
c. because she is probably overweight and will be less willing to breathe, cough, and move postoperatively

37. On the morning of Mrs. Hogan¶s planned cholecystectomy she awakens with a pain in her right scapular area and
thinks she slept in poor position. While doing the preop check list you note that on her routine CB report her WBC is
15,000. Your responsibility at this point is:

a. to notify the surgeon at once; this is an elevated WBC indicating an inflammatory reaction
b. to record this finding in a prominent place on the preop checklist and in your preop notes
c. to call the laboratory for a STAT repeat WBC
d. none. This is not an unusual finding

38. Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM and Demerol 50 mg IM one
hour preoperatively. Which nursing actions follow the giving of the preop medication?

a. have her void soon after receiving the medication
b. allow her family to be with her before the medication takes effect
c. bring her valuables to the nursing station
d. reinforce preop teaching

39. Mrs. Hogan is transported to the recovery room following her cholecystectomy. As you continue to check her vital signs
you note a continuing trend in Mrs. Hogan¶s status: her BP is gradually dropping and her pulse rate is increasing. Your
most appropriate nursing action is to:

a. order whole blood for Mrs. Hogan from the lab
b. increase IV fluid rate of infusion and place in trendelenburg position
c. immediately report signs of shock to the head nurse and/or surgeon and monitor VS closely
d. place in lateral sims position to facilitate breathing

40. Mrs. Hogan returns to your clinical unit following discharge from the recovery room. Her vital signs are stable and her
family is with her. Postoperative leg exercises should be inititated:

a. after the physician writes the order
b. after the family leaves
c. if Mrs. Hogan will not be ambulated early
d. stat

41. An oropharyngeal airway may:

a. Not be used in a conscious patient.
b. Cause airway obstruction.
c. Prevent a patient from biting and occluding an ET tube.
d. Be inserted "upside down" into the mouth opening and then rotated into the proper orientation as it is advanced into the
mouth.
e. All of the above.

42. Endotracheal intubation:

a. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient.
b. Reduces the risk of aspiration of gastric contents.
c. Should be performed with the neck flexed forward making the chin touch the chest.
d. Should be performed after a patient is found to be not breathing and two breaths have been given but before checking
for a pulse.

43. When giving bag-valve mask ventilations:

a. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured
b. Effective ventilations can always be given by one person.
c. Cricoid pressure may prevent gastric inflation during ventilations.
d. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations.

44. If breath sounds are only heard on the right side after intubation:

a. Extubate, ventilate for 30 seconds then try again.
b. The patient probably only has one lung, the right.
c. You have intubated the stomach.
d. Pull the tube back and listen again.

45. An esophageal obturator airway (EOA):

a. Can be inserted by any person trained in ACLS.
b. Requires visualization of the trachea before insertion.
c. Never causes regurgitation.
d. Should not be used with a conscious person, pediatric patients, or patients who have swallowed caustic substances.

46. During an acute myocardial infarct (MI):

a. A patient may have a normal appearing ECG.
b. Chest pain will always be present.
c. A targeted history is rarely useful in making the diagnosis of MI.
d. The chest pain is rarely described as crushing, pressing, or heavy.

47. The most common lethal arrhythmia in the first hour of an MI is:

a. Pulseless Ventricular Tachycardia
b. Asystole
c. Ventricular fibrillation
d. First degree heart block.

48. Which of the following is true about verapamil?

a. It is used for wide-complex tachycardia.
b. It may cause a drop in blood pressure.
c. It is a first line drug for Pulseless Electrical Activity.
d. It is useful for treatment of severe hypotension.

49. Atropine:

a. Is always given for a heart rate less than 60 bpm.
b. Cannot be given via ET tube.
c. Has a maximum total dosage of 0.03-0.04 mg/kg IV in the setting of cardiac arrest.
d. When given IV, should always be given slowly.

50. Asystole should not be "defibrillated."

a. True
b. False
50 ltem MS pructlce test wlth Answers und Rutlonule
Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a
typical description of pain associated with an MI, and is now cold and clammy, pale and
dyspneic. He has an IV of D5W running, and is complaining of chest pain. Oxygen therapy
has not been started, and he is not on the monitor. He is frightened.

1. The nurse is aware of several important tasks that should all be done immediately in
order to give Mr. Duffy the care he needs. Which of the following nursing interventions will
relieve his current myocardial ischemia?

a. stool softeners, rest
b. O2 therapy, analgesia
c. Reassurance, cardiac monitoring
d. Adequate fluid intake, low-fat diet
All the nursing interventions listed are important in the care of Mr. Duffy. However relief of
his pain will be best achieved by increasing the O2 content of the blood to his heart, and
relieving the spasm of coronary vessels.

2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood
tests are obtained. Which of the following patterns of cardiac enzyme elevation are most
common following an MI?

a. SGOT, CK, and LDH are all elevated immediately.
b. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
c. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and
then the LDH (peaks 3-4 days).
d. CK peaks first and remains elevated for 1 to 2 weeks.
Although the timing of initial elevation, peak elevation, and duration of elevation vary with
sources, current literature favors option letter c.

3. On his second day in CCU Mr. Duffy suffers a life-threatening cardiac arrhythmia.
Considering his diagnosis, which is the most probable arrhythmia?

a. atrial tachycardia
b. ventricular fibrillation
c. atrial fibrillation
d. heart block
Ventricular irritability is common in the early post-MI period, which predisposes the client to
ventricular arrhythmias. Heart block and atrial arrhythmias may also be seen post-MI but
ventricular arrhythmias are more common.

4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with
him for his discharge should educate him as to the purpose and actions of his new
medication. What should she or he teach Mr. Duffy to do at home to monitor his reaction to
this medication?

a. take his blood pressure
b. take his radial pulse for one minute
c. check his serum potassium (K) level
d. weigh himself everyday
All options have some validity. However, option B relates best to the action of digitalis. If
the pulse rate drops below 60 or is markedly irregular, the digitalis should be held and the
physician consulted. Serum potassium levles should be monitored periodically in clients on
digitalis and diuretics, as potassium balance is essential for prevention of arrhythmias.
However the client cannot do this at home. Daily weights may make the client alert to fluid
accumulation, an early sign of CHF. Blood pressure measurement is also helpful; providing
the client has the right size cuff and he or she and/or significant other understand the
technique and can interpret the results meaningfully.

You are speaking to an elderly group of diabetics in the OPD about eye health and the
importance of visits to the ophthalmologist.

5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should
these clients request from their care provider?

a. fluorescein stain
b. snellen¶s test
c. tonometry
d. slit lamp
Option A is most often used to detect corneal lesions; B is a test for visual acuity using
snellen¶s chart; D is used to focus on layers of the cornea and lens looking for opacities and
inflammation.

6. You also explain common eye changes associated with aging. One of these is presbyopia,
which is:

a. Refractive error that prevents light rays from coming to a single focus on the retina.
b. Poor distant vision
c. Poor near vision
d. A gradual lessening of the power of accommodation
Option A defines astigmatism, B is myopia, and C is hyperopia

7. Some of the diabetic clients are interested in understanding what is visualized during
funduscopic examination. During your discussion you describe the macular area as:

a. Head of the optic nerve, seen on the nasal side of the field, lighter in color than the
retina.
b. The area of central vision, seen on the temporal side of the optic disc, which is
quite avascular.
c. Area where the central retinal artery and vein appear on the retina.
d. Reddish orange in color, sometimes stippled.
Options A and C refer to the optic disc, D describes the color of the retina.

8. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva.
You explain that this is called:

a. a pinguecula, which is normal slightly raised fatty structure under the
conjunctiva that may gradually increase with age.
b. Icterus, which may be due to liver disease.
c. A pterygium, which will interfere with vision.
d. Ciliary flush caused by congestion of the ciliary artery.
Correct by definition.

You are caring for Mr. Kaplan who has chronic renal failure (uremia)

9. You know that all but one of the following may eventually result in uremia. Which option
is not implicated?

a. glomerular disease
b. uncontrolled hypertension
c. renal disease secondary to drugs, toxins, infections, or radiations
d. all of the above
Options A, B and C are potential causes of renal damage and eventual renal failure.
Individuals can live very well with only one healthy kidney.

10. You did the initial assessment on Mr. Kaplan when he came to your unit. What classical
signs and symptoms did you note?

a. fruity- smelling breath.
b. Weakness, anorexia, pruritus
c. Polyuria, polydipsia, polyphagia
d. Ruddy complexion
Weakness and anorexia are due to progressive renal damage; pruritus is secondary to
presence of urea in the perspiration. Fruity smelling breath is found in diabetic ketoacidosis.
Polyuria, polydipsia, polyphagia are signs of DM and early diabetic ketoacidosis. Oliguria is
seen in chronic renal failure. The skin is more sallow or brown as renal failure continues.

11. Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him.
Regarding his diagnosis and management of his drugs, you know that:

a. The half-life of many drugs is decreased in uremia; thus dosage may have to be
increased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy and
often a decrease in dose is essential.
c. Drug therapy is not usually affected by this diagnosis
d. Precautions should be taken with prescription drugs, but most OTC medications are safe
for him to use.
Metabolic changes and alterations in excretion put the client with uremia at risk for
development of toxicity to any drug. Thus alteration in drug schedule and dosage is
necessary for safe care.

You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin by
reviewing assessment of the cardiovascular system in your mind and asking yourself the
following:

12. The point of maximum impulse (PMI) is an important landmark in the cardiac exam.
Which statement best describes the location of the PMI in the healthy adult?

a. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.
b. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
c. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
d. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
The PMI is the impulse at the apex of the heart caused by the beginning of ventricular
systole. It is generally located in the 5
th
left ICS, 7-9 cm from the MSL or at, or just medial
to, the MCL.

13. During the physical examination of the well adult client, the health care provider
auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the
left sternal border, which valve closure is best evaluated?

a. Tricuspid
b. Pulmonic
c. Aortic
d. Mitral
The sound created by closure of the tricuspid valve is heard at the 5
th
LICS at the LSB.
Pulmonic closure is best heard at the 2
nd
LICS, LSB. Aortic closure is best heard at the 2
nd

RICS, RSB. Mitral valve closure is best heard at the PMI landmark (apex)

14. The pulmonic component of which heart sound is best heard at the 2nd LICS at the
LSB?

a. S1
b. S2
c. S3
d. S4
S1 is caused by mitral and tricuspid valve closure, S2 is caused by the aortic and pulmonic
valve closure; S3 and S4 are generally considered abnormal heat sounds in adults and are
best heard at the apex.

15. The coronary arteries furnish blood supply to the myocardium. Which of the following is
a true statement relative to the coronary circulation?

a. the right and left coronary arteries are the first of many branches off the ascending aorta
b. blood enters the right and left coronary arteries during systole only
c. the right coronary artery forms almost a complete circle around the heart, yet supplies
only the right ventricle
d. the left coronary artery has two main branches, the left anterior descending and
left circumflex: both supply the left ventricle
The right and left coronary arteries are the only branches off the ascending aorta; blood
enters these arteries mainly during diastole; the right coronary artery also often supplies a
small portion of the left ventricle.

Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis
of mitral stenosis. She is scheduled for surgery to repair her mitral valve.

16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time
because her subjective complaints of dyspnea, hemoptysis, orthopnea, and paroxysmal
nocturnal dyspnea have become unmanageable. These complaints are probably due to:

a. thickening of the pericardium
b. right heart failure
c. pulmonary hypertension
d. left ventricular hypertrophy
Pulmonary congestion secondary to left atrial hypertrophy causes these symptoms. The left
ventricle does not hypertrophy in mitral stenosis; right heart failure would cause abdominal
discomfort and peripheral edema; pericardial thickening does not occur.


17. On physical exam of Ms. Baker, several abnormal findings can be observed. Which of
the following is not one of the usual objective findings associated with mitral stenosis?

a. low-pitched rumbling diastolic murmur, precordial thrill, and parasternal lift
b. small crepitant rales at the bases of the lungs
c. weak, irregular pulse, and peripheral and facial cyanosis in severe disease
d. chest x-ray shows left ventricular hypertrophy
Evidence of left atrial enlargement may be seen on chest x-ray and ECG. The other
objective findings may be seen in chronic mitral stenosis with episodes of atrial fibrillation
and right heart failure.

18. You are seeing more clients with diagnoses of mitral valve prolapse. You know those
mitral valve prolapse is usually a benign cardiac condition, but may be associated with
atypical chest pain. This chest pain is probably caused by:

a. ventricular ischemia
b. dysfunction of the left ventricle
c. papillary muscle ischemia and dysfunction
d. cardiac arrythmias
Ventricular ischemia does not occur with prolapsed mitral valve; options B and D are not
painful conditions in themselves.

Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup.
His possible diagnosis is cancer of the lung.

19. The most common lethal cancer in males between their fifth and seventh decades is:

a. cancer of the prostate
b. cancer of the lung
c. cancer of the pancreas
d. cancer of the bowel
The incidence of lung cancer is also rapidly rising in women.

20. Of the four basic cell types of lung cancer listed below, which is always associated with
smoking?

a. adenocarcinoma
b. squamous cell carcinoma (epidermoid)
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma
Textbooks of medicine and nursing classify primary pulmonary carcinoma somewhat
differently. However most agree that sqaumous cell or epidermoid carcinoma is always
associated with cigarette smoking.

21. Chemotherapy may be used in combination with surgery in the treatment of lung
cancer. Special nursing considerations with chemotherapy include all but which of the
following?

a. Helping the client deal with depression secondary to the diagnosis and its treatment
b. Explaining that the reactions to chemotherapy are minimal
c. Careful observation of the IV site of the administration of the drugs
d. Careful attention to blood count results
There ar enumerous severe reactions to chemotherapy such as stomatitis, alopecia, bone
marrow depression, nausea and vomiting. Options A, B and D are important nursing
considerations.

22. Which of the following operative procedures of the thorax is paired with the correct
definition?

a. Pneumonectomy: removal of the entire lung
b. Wedge resection: removal of one or more lobes of a lung
c. Decortication: removal of the reibs or sections of ribs
d. Thoracoplasty: removal of fibrous membrane that develops over visceral pleura as a
result of emphysema
Wedge resection is removal of part of a segment of the lung; decortication is the removal of
a fibrous membrane that develops over the visceral pleura; and thoracoplasty is the
removal of ribs or sections of ribs.

Mr. Liberatore, age 76, is admitted to your unit. He has a past medical history of
hypertension, DM, hyperlipidemia. Recently he has had several episodes where he stops
talking in midsentence and stares into space. Today the episode lasted for 15 minutes. The
admission diagnosis is impending CVA.

23. The episodes Mr. Liberatore has been experiencing are probably:

a. small cerebral hemorrhages
b. TIA¶s or transient ischemic attacks
c. Secondary to hypoglycemia
d. Secondary to hyperglycemia
A TIA is a temporary reduction in blood flow to the brain, manifesting itself in symptoms like
those Mr. Liberatore experiences. Although hypo- and hyperglycemia can cause some
drowsiness and/or disorientation, the episodes Mr. Liberatore experiences fit the pattern of
TIA because of his quick recovery with no sequelae and no treatment.

24. Mr. Liberatore suffers a left sided CVA. He is right handed. The nurse should expect:

a. left-sided paralysis
b. visual loss
c. no alterations in speech
d. no impairment of bladder function
Visual field loss is a common side effect of CVA. In right-handed persons the speech center
(Broca¶s area) is most commonly in the left brain; because of the crossover of the motor
fibers, a CVA in the left brain will produce a right-sided hemiplegia. Thus, Mr. Liberatore will
probably have some speech disturbance and right-sided paralysis. Often bladder control is
diminished following CVA.

25. Upper motor neuron disease may be manifested in which of the following clinical signs?

a. spastic paralysis, hyperreflexia, presence of babinski reflex
b. flaccid paralysis, hyporeflexia
c. muscle atrophy, fasciculations
d. decreased or absent voluntary movement
Options B, C and D describe lower motor neuron disease.

Julie, an 18-year-old girl, is brought into the ER by her mother with the chief complaint of
sudden visual disturbance that began half an hour ago and was described as double vision
and flashing lights.

26. During your assessment of Julie she tells you all visual symptoms are gone but that she
now has a severe pounding headache over her left eye. You suspect Julie may have:

a. a tension headache
b. the aura and headache of migraine
c. a brain tumor
d. a conversion reaction
The warning sign or aura is associated with migraine although not everyone with migrane
has an aura. Migraine is usually unilateral and described as pounding. Julie¶s symptoms are
most compatible with migraine.

27. You explain to Julie and her mother that migraine headaches are caused by:

a. an allergic response triggered by stress
b. dilation of cerebral arteries
c. persistent contraction of the muscles of the head, neck and face
d. increased intracranial pressure
The vascular theory best explains migraine and often diagnosis is confirmed through a trial
of ergotamine, which constricts the dilated, pulsating vesels.

28. A thorough history reveals that hormonal changes associated with menstruation may
have triggered Julie¶s migraine attack. In investigating Julie¶s history what factors would be
least significant in migraine?

a. seasonal allergies
b. trigger foods such as alcohol, MSG, chocolate
c. family history of migraine
d. warning sign of onset, or aura
Sinus headache often accompanies seasonal allergies. Many factors may contribute to
migraine. Usually the client comes from a family that has migrated, which may have been
called ³sick headache´ due to accompanying nausea and vomiting. Often there is an aura.
Stress, diet, hormonal changes, and fatigue may all be implicated in migraine.

29. A client with muscle contraction headache will exhibit a pattern different for Julie¶s.
Which of the following is more compatible with tension headache?

a. severe aching pain behind both eyes
b. headache worse when bending over
c. a bandlike burning around the neck
d. feeling of tightness bitemporally, occipitally, or in the neck
Options A and B describe sinus headache; option A may also be compatible with headache
secondary to eyestrain; option B is also compatible with migraine; option C would be correct
if stated a bandlike ³tightness´ around the head instead of ³burning´

Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is
currently unknown. You begin to think about the way brain tumors are classified.

30. Glioma is an intracranial tumor. Which of the following statements about gliomas do you
know to be false?

a. 50% of all intracranial tumors are gliomas
b. gliomas are usually benign
c. they grow rapidly and often cannot be totally excised from the surrounding tissue
d. most glioma victims die within a year after diagnosis
Gliomas are malignant tumors.

31. Acoustic neuromas produce symptoms of progressive nerve deafness, tinnitus, and
vertigo due to pressure and eventual destruction of:

a. CN5
b. CN7
c. CN8
d. The ossicles
CN8, the acoustic nerve or vestibulocochlear nerve, is the most commonly affected CN in
acoustic neuroma although as the tumor progresses CN5 and CN7 can be affected.

32. Whether Mr Snyder¶s tumor is benign or malignant, it will eventually cause increased
intracranial pressure. Signs and symptoms of increasing intracranial pressure may include
all of the following except:

a. headache, nausea, and vomiting
b. papilledema, dizziness, mental status changes
c. obvious motor deficits
d. increased pulse rate, drop in blood pressure
As ICP increases, the pulse rate decreases and the BP rise. However, as ICP continues to
rise, vital signs may vary considerably.

33. Mr Snyder is scheduled for surgery in the morning, and you are surprised to find out
that there is no order for an enema. You assess the situation and conclude that the reason
for this is:

a. Mr. Snyder has had some mental changes due to the tumor and would find an enema
terribly traumatic
b. Straining to evacuate the enema might increase the intracranial pressure
c. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is
not necessary
d. An oversight and you call the physician to obtain the order
Any activity that increases ICP could possibly cause brain herniation. Straining to expel an
enema is one example of how the increased ICP can be further aggravated.

34. Postoperatively Mr. Snyder needs vigilant nursing care including all of the following
except:

a. Keeping his head flat
b. Assessments q ½ hour of LOC, VS, papillary responses, and mental status
c. Helping him avoid straining at stool, vomiting, or coughing
d. Providing a caring, supportive atmosphere for him and his family
Postoperatively clients who have undergone craniotomy usually have their heads elevated to
decrease local edema and also decrease ICP.

35. Potential postintracranial surgery problems include all but which of the following?

a. increased ICP
b. extracranial hemorrhage
c. seizures
d. leakage of cerebrospinal fluid
Hemorrhage is predominantly intracranial, although there may be some bloody drainage on
external dressings. Increased ICP may result from hemorrhage or edema. CSF leakage may
result in meningitis. Seizures are another postoperative concern.

Mrs. Hogan, a 43-year-old woman, is admitted to your unit for cholecystectomy.

36. You are responsible for teaching Mrs. Hogan deep breathing and coughing exercises.
Why are these exercises especially important for Mrs. Hogan?

a. they prevent postoperative atelectasis and pneumonia
b. the incision in gallbladder surgery is in the subcostal area, which makes the
client reluctant to take a deep breath and cough
c. because she is probably overweight and will be less willing to breathe, cough, and move
postoperatively
Option A is true: the rationale for deep breathing and coughing is to prevent postoperative
pulmonary complications such as pneumonia and atelectasis. However, the risk of
pulmonary problems is somewhat increased in clients with biliary tract surgery because of
their high abdominal incisions. Option C assumes the stereotype of the person with
gallbladder disease ± fair, fat and fory ± which is not necessarily the case. Splinting the
incision with the hands or a pillow is very helpful in controlling the pain during coughing.

37. On the morning of Mrs. Hogan¶s planned cholecystectomy she awakens with a pain in
her right scapular area and thinks she slept in poor position. While doing the preop check
list you note that on her routine CB report her WBC is 15,000. Your responsibility at this
point is:

a. to notify the surgeon at once; this is an elevated WBC indicating an
inflammatory reaction
b. to record this finding in a prominent place on the preop checklist and in your preop notes
c. to call the laboratory for a STAT repeat WBC
d. none. This is not an unusual finding
A WBC count of 15,000 probably indicates acute cholecystitis, especially considering Mrs.
Hogan¶s new pain. The surgeon should be called as he/she may treat the acute attack
medically and delay the surgery for several days, weeks, or months.

38. Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM
and Demerol 50 mg IM one hour preoperatively. Which nursing actions follow the giving of
the preop medication?

a. have her void soon after receiving the medication
b. allow her family to be with her before the medication takes effect
c. bring her valuables to the nursing station
d. reinforce preop teaching
Options A, C and D should all take place prior to administration of the drugs. The family
may also be involved earlier but certainly should have that time immediately after the
medication is given and before it takes full effect to be with their loved ones. Good planning
of nursing care can facilitate this.

39. Mrs. Hogan is transported to the recovery room following her cholecystectomy. As you
continue to check her vital signs you note a continuing trend in Mrs. Hogan¶s status: her BP
is gradually dropping and her pulse rate is increasing. Your most appropriate nursing action
is to:

a. order whole blood for Mrs. Hogan from the lab
b. increase IV fluid rate of infusion and place in trendelenburg position
c. immediately report signs of shock to the head nurse and/or surgeon and
monitor VS closely
d. place in lateral sims position to facilitate breathing
These are signs of impending shock, which may be true shock or a reaction to anesthesia.
Your most appropriate action is to report your findings quickly and accurately and to
continue to monitor Mrs. Hogan carefully.

40. Mrs. Hogan returns to your clinical unit following discharge from the recovery room. Her
vital signs are stable and her family is with her. Postoperative leg exercises should be
inititated:

a. after the physician writes the order
b. after the family leaves
c. if Mrs. Hogan will not be ambulated early
d. stat
Leg exercises, deep breathing and coughing, moving, and turning should begin as soon as
the client¶s condition is stable. The family can be extremely helpful in encouraging the client
to do them, in supporting the incision, etc. a doctor¶s oreder is not necessary ± this is a
nursing responsibility.

41. An oropharyngeal airway may:

a. Not be used in a conscious patient.
b. Cause airway obstruction.
c. Prevent a patient from biting and occluding an ET tube.
d. Be inserted "upside down" into the mouth opening and then rotated into the proper
orientation as it is advanced into the mouth.
e. All of the above.
An oropharyngeal airway should be used in an unconscious patient. In a conscious or
semiconscious patient its use may cause laryngospasm or vomiting. An oropharyngeal
airway that is too long may push the epiglottis into a position that obstructs the airway. It is
often use with an ETT to prevent biting and occlusion. It is usually inserted upside down and
then rotated into the correct orientation as it approaches full insertion.

42. Endotracheal intubation:

a. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient.
b. Reduces the risk of aspiration of gastric contents.
c. Should be performed with the neck flexed forward making the chin touch the chest.
d. Should be performed after a patient is found to be not breathing and two breaths have
been given but before checking for a pulse.
Letter A is wrong because an attempt should not last no longer than 30 seconds. Unless
injury is suspected the neck should be slightly flexed and the head extended.. the µsniffing
position¶. After securing an airway and successfully ventilating the patient with two breaths
you should then check for a pulse. If there is no pulse begin chest compressions. Intubation
is part of the secondary survey ABC¶s.

43. When giving bag-valve mask ventilations:

a. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured
b. Effective ventilations can always be given by one person.
c. Cricoid pressure may prevent gastric inflation during ventilations.
d. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations.
Cricoid pressure may prevent gastric inflation during ventilations and may also prevent
regurgitation by compressing the esophagus. Letter A may cause gastric insufflation thus
increasing the risk for regurgitation and aspiration. With adults breaths should be delivered
slowly and steadily over 2 seconds. Effective ventilation using bag-valve mask usually
requires at least two well trained rescuers. A frequent problem with bag-valve mask
ventilations is the inability to provide adequate tidal volumes.

44. If breath sounds are only heard on the right side after intubation:

a. Extubate, ventilate for 30 seconds then try again.
b. The patient probably only has one lung, the right.
c. You have intubated the stomach.
d. Pull the tube back and listen again.
Most likely you have a right main stem bronchus intubation. Pulling the tube back a few
centimeters may be all you need to do.

45. An esophageal obturator airway (EOA):

a. Can be inserted by any person trained in ACLS.
b. Requires visualization of the trachea before insertion.
c. Never causes regurgitation.
d. Should not be used with a conscious person, pediatric patients, or patients who
have swallowed caustic substances.
EOA insertion should only be attempted by persons highly proficient in their use. Moreover,
since visualization is not required the EOA may be very useful in patient¶s when intubation is
contraindicated or not possible. Vomiting and aspiration are possible complications of
insertion and removal of an EOA.

46. During an acute myocardial infarct (MI):

a. A patient may have a normal appearing ECG.
b. Chest pain will always be present.
c. A targeted history is rarely useful in making the diagnosis of MI.
d. The chest pain is rarely described as crushing, pressing, or heavy.
Which is why a normal ECG alone cannot be relied upon to rule out an MI. Chest pain does
not always accompany an MI. This is especially true of patients with diabetes. A targeted
history is often crucial in making the diagnosis of acute MI. The chest pain associated with
an acute MI is often described as heavy, crushing pressure, 'like an elephant sitting on my
chest.'

47. The most common lethal arrhythmia in the first hour of an MI is:

a. Pulseless Ventricular Tachycardia
b. Asystole
c. Ventricular fibrillation
d. First degree heart block.
Moreover, ventricular fibrillation is 15 times more likely to occur during the first hour of an
acute MI than the following twelve hours which is why it is vital to decrease the delay
between onset of chest pain and arrival at a medical facility. First degree heart block is not
a lethal arrhythmia.

48. Which of the following is true about verapamil?

a. It is used for wide-complex tachycardia.
b. It may cause a drop in blood pressure.
c. It is a first line drug for Pulseless Electrical Activity.
d. It is useful for treatment of severe hypotension.
Verapamil usually decreases blood pressure, which is why it is sometimes used as an
antihypertensive agent. Verapamil may be lethal if given to a patient with V-tach, therefore
it should not be given to a tachycardic patient with a wide complex QRS. Verapamil is a
calcium channel blocker and may actually cause PEA if given too fast intravenously or if
given in excessive amounts. The specific antidote for overdose from verapamil, or any other
calcium channel blocker, is calcium. Verapamil may cause hypotension.

49. Atropine:

a. Is always given for a heart rate less than 60 bpm.
b. Cannot be given via ET tube.
c. Has a maximum total dosage of 0.03-0.04 mg/kg IV in the setting of cardiac
arrest.
d. When given IV, should always be given slowly.
Only give atropine for symptomatic bradycardias. Many physically fit people have resting
heart rates less than 60 bpm. Atropine may be given via an endotracheal tube.
Administering atropine slowly may cause paradoxical bradycardia.

50. Asystole should not be "defibrillated."

a. True
b. False
Asystole is not amenable to correction by defibrillation. But there is a school of thought that
holds that asystole should be treated like V-fib, i.e... defibrillate it. The thinking is that
human error or equipment malfunction may result in misidentifying V-fib as asystole.
Missing V-fib can have deadly consequences for the patient because V-fib is highly
amenable to correction by defibrillation.

Aortic d. 7-9 cm to the left of the midsternal line. blood enters the right and left coronary arteries during systole only c. Drug toxicity is a major concern in uremia. 7-9 cm to the left of the midsternal line. The half-life of many drugs is decreased in uremia.c. 7th intercostal space. which will interfere with vision. d. Weakness. Polyuria. pruritus c. anorexia. d. 16. infections. Base of the heart. intercostal space. You know that all but one of the following may eventually result in uremia. the health care provider auscultates the heart. b. glomerular disease b. She is scheduled for surgery to repair her mitral valve. fruity. the right and left coronary arteries are the first of many branches off the ascending aorta b. thus dosage may have to be increased to be effective. 5th intercostal space. yet supplies only the right ventricle d. the left anterior descending and left circumflex: both supply the left ventricle Sally Baker. Regarding his diagnosis and management of his drugs. Ms. 13. Mitral 14. individualization of therapy and often a decrease in dose is essential. or radiations d. orthopnea. but most OTC medications are safe for him to use. c. Apex of the heart. hemoptysis. you know that: a. The point of maximum impulse (PMI) is an important landmark in the cardiac exam. polydipsia. Drug therapy is not usually affected by this diagnosis d. polyphagia d. You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. thickening of the pericardium . the left coronary artery has two main branches. toxins. S1 b. Ciliary flush caused by congestion of the ciliary artery. the right coronary artery forms almost a complete circle around the heart. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB? a. intercostal space. What classical signs and symptoms did you note? a. Tricuspid b. renal disease secondary to drugs. During the physical examination of the well adult client. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints of dyspnea. You begin by reviewing assessment of the cardiovascular system in your mind and asking yourself the following: 12. Ruddy complexion 11. b. a 40-year-old woman. 7-9 cm to the left of the midsternal line. uncontrolled hypertension c. These complaints are probably due to: a. Base of the heart. all of the above 10. S4 15. and paroxysmal nocturnal dyspnea have become unmanageable. Kaplan when he came to your unit. Kaplan in an attempt to stabilize him. Numerous drugs have been used on Mr. c. A pterygium. is admitted to the hospital with an established diagnosis of mitral stenosis. which valve closure is best evaluated? a.smelling breath. You did the initial assessment on Mr. 7-9 cm to the left of the midsternal line. Apex of the heart. You are caring for Mr. Which of the following is a true statement relative to the coronary circulation? a. When the stethoscope is placed on the 5th intercostal space along the left sternal border. Pulmonic c. The coronary arteries furnish blood supply to the myocardium. b. S2 c. Kaplan who has chronic renal failure (uremia) 9. Which statement best describes the location of the PMI in the healthy adult? a. S3 d. Precautions should be taken with prescription drugs. Which option is not implicated? a.

no alterations in speech d. On physical exam of Ms. Upper motor neuron disease may be manifested in which of the following clinical signs? . and peripheral and facial cyanosis in severe disease d. cancer of the prostate b. He has a past medical history of hypertension. His possible diagnosis is cancer of the lung. ventricular ischemia b. dysfunction of the left ventricle c. Recently he has had several episodes where he stops talking in midsentence and stares into space. a long term heavy smoker. The most common lethal cancer in males between their fifth and seventh decades is: a.b. Which of the following operative procedures of the thorax is paired with the correct definition? a. bronchoalveolar carcinoma 21. Helping the client deal with depression secondary to the diagnosis and its treatment b. He is right handed. Pneumonectomy: removal of the entire lung b. Oliver. is admitted to the hospital for a diagnostic workup. left ventricular hypertrophy 17. Of the four basic cell types of lung cancer listed below. You are seeing more clients with diagnoses of mitral valve prolapse. Explaining that the reactions to chemotherapy are minimal c. This chest pain is probably caused by: a. no impairment of bladder function 25. right heart failure c. but may be associated with atypical chest pain. chest x-ray shows left ventricular hypertrophy 18. Careful observation of the IV site of the administration of the drugs d. cardiac arrythmias Mr. low-pitched rumbling diastolic murmur. Liberatore suffers a left sided CVA. and parasternal lift b. The nurse should expect: a. Liberatore has been experiencing are probably: a. Mr. You know those mitral valve prolapse is usually a benign cardiac condition. Special nursing considerations with chemotherapy include all but which of the following? a. hyperlipidemia. small crepitant rales at the bases of the lungs c. Liberatore. visual loss c. Baker. Careful attention to blood count results 22. Decortication: removal of the reibs or sections of ribs d. Secondary to hypoglycemia d. Secondary to hyperglycemia 24. papillary muscle ischemia and dysfunction d. is admitted to your unit. several abnormal findings can be observed. undifferenciated carcinoma d. 19. squamous cell carcinoma (epidermoid) c. TIA¶s or transient ischemic attacks c. Chemotherapy may be used in combination with surgery in the treatment of lung cancer. DM. The admission diagnosis is impending CVA. age 76. Which of the following is not one of the usual objective findings associated with mitral stenosis? a. irregular pulse. small cerebral hemorrhages b. cancer of the pancreas d. left-sided paralysis b. weak. cancer of the lung c. pulmonary hypertension d. which is always associated with smoking? a. 23. cancer of the bowel 20. Wedge resection: removal of one or more lobes of a lung c. precordial thrill. adenocarcinoma b. The episodes Mr. Thoracoplasty: removal of fibrous membrane that develops over visceral pleura as a result of emphysema Mr. Today the episode lasted for 15 minutes.

increased pulse rate. flaccid paralysis. hyporeflexia c. persistent contraction of the muscles of the head. papilledema. A thorough history reveals that hormonal changes associated with menstruation may have triggered Julie¶s migraine attack. headache worse when bending over c. a bandlike burning around the neck d. and vertigo due to pressure and eventual destruction of: a. The type of tumor he has is currently unknown. chocolate c. hyperreflexia. fasciculations d. MSG. You begin to think about the way brain tumors are classified. spastic paralysis. mental status changes c. dilation of cerebral arteries c. Which of the following statements about gliomas do you know to be false? a. Snyder is admitted to your unit with a brain tumor. obvious motor deficits d. is brought into the ER by her mother with the chief complaint of sudden visual disturbance that began half an hour ago and was described as double vision and flashing lights. or aura 29. 30. an allergic response triggered by stress b. trigger foods such as alcohol. You assess the situation and conclude that the reason for this is: a. In investigating Julie¶s history what factors would be least significant in migraine? a. Snyder has had some mental changes due to the tumor and would find an enema terribly traumatic b. Straining to evacuate the enema might increase the intracranial pressure . they grow rapidly and often cannot be totally excised from the surrounding tissue d. tinnitus.a. You explain to Julie and her mother that migraine headaches are caused by: a. and vomiting b. it will eventually cause increased intracranial pressure. muscle atrophy. most glioma victims die within a year after diagnosis 31. severe aching pain behind both eyes b. feeling of tightness bitemporally. 26. Which of the following is more compatible with tension headache? a. You suspect Julie may have: a. occipitally. CN5 b. warning sign of onset. a tension headache b. and you are surprised to find out that there is no order for an enema. The ossicles 32. dizziness. a conversion reaction 27. Mr Snyder is scheduled for surgery in the morning. CN8 d. Glioma is an intracranial tumor. a brain tumor d. During your assessment of Julie she tells you all visual symptoms are gone but that she now has a severe pounding headache over her left eye. neck and face d. decreased or absent voluntary movement Julie. drop in blood pressure 33. headache. Acoustic neuromas produce symptoms of progressive nerve deafness. nausea. CN7 c. the aura and headache of migraine c. 50% of all intracranial tumors are gliomas b. family history of migraine d. Mr. increased intracranial pressure 28. an 18-year-old girl. or in the neck Mr. seasonal allergies b. gliomas are usually benign c. Whether Mr Snyder¶s tumor is benign or malignant. A client with muscle contraction headache will exhibit a pattern different for Julie¶s. Signs and symptoms of increasing intracranial pressure may include all of the following except: a. presence of babinski reflex b.

Hogan is transported to the recovery room following her cholecystectomy. e. cough. so an enema is not necessary d.000. Snyder needs vigilant nursing care including all of the following except: a. stat 41. vomiting. the incision in gallbladder surgery is in the subcostal area. bring her valuables to the nursing station d. Assessments q ½ hour of LOC. after the family leaves c. have her void soon after receiving the medication b. after the physician writes the order b. An oversight and you call the physician to obtain the order 34. Hogan deep breathing and coughing exercises. Her vital signs are stable and her family is with her. Mr. because she is probably overweight and will be less willing to breathe. Postoperative leg exercises should be inititated: a. a 43-year-old woman. papillary responses. An oropharyngeal airway may: a. While doing the preop check list you note that on her routine CB report her WBC is 15. Not be used in a conscious patient. is admitted to your unit for cholecystectomy. 36. d. Keeping his head flat b. Hogan. to call the laboratory for a STAT repeat WBC d. Hogan¶s status: her BP is gradually dropping and her pulse rate is increasing. Hogan is scheduled for surgery 2 days later and is to be given atropine 0. and mental status c. immediately report signs of shock to the head nurse and/or surgeon and monitor VS closely d. this is an elevated WBC indicating an inflammatory reaction b. Postoperatively Mr. Mrs. c. You are responsible for teaching Mrs. and move postoperatively 37. As you continue to check her vital signs you note a continuing trend in Mrs. VS. Hogan from the lab b. Cause airway obstruction. leakage of cerebrospinal fluid Mrs. reinforce preop teaching 39. place in lateral sims position to facilitate breathing 40. Hogan returns to your clinical unit following discharge from the recovery room. Your responsibility at this point is: a. Why are these exercises especially important for Mrs. they prevent postoperative atelectasis and pneumonia b. Prevent a patient from biting and occluding an ET tube. if Mrs.c. This is not an unusual finding 38. to record this finding in a prominent place on the preop checklist and in your preop notes c. Your most appropriate nursing action is to: a. 42. Be inserted "upside down" into the mouth opening and then rotated into the proper orientation as it is advanced into the mouth. Hogan¶s planned cholecystectomy she awakens with a pain in her right scapular area and thinks she slept in poor position. On the morning of Mrs. Mrs. Hogan? a. All of the above. seizures d. supportive atmosphere for him and his family 35. Hogan will not be ambulated early d.3 mg IM and Demerol 50 mg IM one hour preoperatively. Providing a caring. Snyder had been on clear liquids and then was NPO for several days. Which nursing actions follow the giving of the preop medication? a. Helping him avoid straining at stool. Mrs. order whole blood for Mrs. b. increased ICP b. increase IV fluid rate of infusion and place in trendelenburg position c. extracranial hemorrhage c. Endotracheal intubation: . which makes the client reluctant to take a deep breath and cough c. to notify the surgeon at once. or coughing d. none. Potential postintracranial surgery problems include all but which of the following? a. allow her family to be with her before the medication takes effect c.

Should be performed after a patient is found to be not breathing and two breaths have been given but before checking for a pulse. The chest pain is rarely described as crushing. b. the right. When given IV. He presented in the ER with a typical description of pain associated with an MI. d. True b. .04 mg/kg IV in the setting of cardiac arrest. d. ventilate for 30 seconds then try again. should always be given slowly. 43. When giving bag-valve mask ventilations: a. Effective ventilations can always be given by one person. Oxygen therapy has not been started. d. Asystole c. You have intubated the stomach. pale and dyspneic. 46." a. and is complaining of chest pain. pressing. Duffy is admitted to the CCU with a diagnosis of R/O MI. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient. c. d.03-0. Pulseless Ventricular Tachycardia b. If breath sounds are only heard on the right side after intubation: a. 49. A targeted history is rarely useful in making the diagnosis of MI. It may cause a drop in blood pressure. c. First degree heart block.a. or patients who have swallowed caustic substances. c. Asystole should not be "defibrillated. It is used for wide-complex tachycardia. b. A patient may have a normal appearing ECG. He is frightened. b. c. b. Pull the tube back and listen again. 44. Chest pain will always be present. During an acute myocardial infarct (MI): a. Which of the following is true about verapamil? a. d. Reduces the risk of aspiration of gastric contents. pediatric patients. It is useful for treatment of severe hypotension. Is always given for a heart rate less than 60 bpm. Cricoid pressure may prevent gastric inflation during ventilations. c. 48. b. c. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured b. Ventricular fibrillation d. Has a maximum total dosage of 0. It is a first line drug for Pulseless Electrical Activity. 45. 47. Cannot be given via ET tube. and is now cold and clammy. b. and he is not on the monitor. Can be inserted by any person trained in ACLS. False LWHP06SUDFWLFHWHVWZLWK$QVZHUVDQG5DWLRQDOH Mr. The most common lethal arrhythmia in the first hour of an MI is: a. Atropine: a. The patient probably only has one lung. c. or heavy. Should not be used with a conscious person. d. Requires visualization of the trachea before insertion. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations. An esophageal obturator airway (EOA): a. He has an IV of D5W running. d. Should be performed with the neck flexed forward making the chin touch the chest. Extubate. Never causes regurgitation. 50.

d. CK peaks first (12-24 hours). What should she or he teach Mr. During the first three days that Mr. ventricular fibrillation c. 3. and duration of elevation vary with sources. If the pulse rate drops below 60 or is markedly irregular. heart block Ventricular irritability is common in the early post-MI period. as potassium balance is essential for prevention of arrhythmias. Mr. However relief of his pain will be best achieved by increasing the O2 content of the blood to his heart. Considering his diagnosis. atrial tachycardia b. Daily weights may make the client alert to fluid accumulation. Duffy. take his radial pulse for one minute c. weigh himself everyday All options have some validity. Which of the following nursing interventions will relieve his current myocardial ischemia? a. Which of the following patterns of cardiac enzyme elevation are most common following an MI? a. O2 therapy. an early sign of CHF. 4. b. take his blood pressure b. low-fat diet All the nursing interventions listed are important in the care of Mr. and relieving the spasm of coronary vessels. which is the most probable arrhythmia? a. Although the timing of initial elevation. On his second day in CCU Mr. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later. Duffy the care he needs. the digitalis should be held and the physician consulted. Heart block and atrial arrhythmias may also be seen post-MI but ventricular arrhythmias are more common. However the client cannot do this at home. SGOT. 2. However. Duffy to do at home to monitor his reaction to this medication? a. Reassurance. Duffy suffers a life-threatening cardiac arrhythmia. and LDH are all elevated immediately. analgesia c. Duffy is placed on digitalis on discharge from the hospital. cardiac monitoring d. which predisposes the client to ventricular arrhythmias. Serum potassium levles should be monitored periodically in clients on digitalis and diuretics. Duffy is in the CCU. followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days). The nurse is aware of several important tasks that should all be done immediately in order to give Mr. The nurse planning with him for his discharge should educate him as to the purpose and actions of his new medication. c. rest b.1. peak elevation. check his serum potassium (K) level d. providing . CK peaks first and remains elevated for 1 to 2 weeks. a number of diagnostic blood tests are obtained. CK. stool softeners. option B relates best to the action of digitalis. Adequate fluid intake. Blood pressure measurement is also helpful. atrial fibrillation d. current literature favors option letter c.

which will interfere with vision. which is: a. b. Poor distant vision c. Kaplan who has chronic renal failure (uremia) . The area of central vision. Head of the optic nerve. d. You are speaking to an elderly group of diabetics in the OPD about eye health and the importance of visits to the ophthalmologist. Poor near vision d. A pterygium. Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. seen on the temporal side of the optic disc. c. d. You decide to discuss glaucoma prevention. c. B is myopia. 5. 8. which may be due to liver disease.the client has the right size cuff and he or she and/or significant other understand the technique and can interpret the results meaningfully. Area where the central retinal artery and vein appear on the retina. fluorescein stain snellen¶s test tonometry slit lamp Option A is most often used to detect corneal lesions. which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age. b. and C is hyperopia 7. c. a pinguecula. D describes the color of the retina. lighter in color than the retina. sometimes stippled. Correct by definition. seen on the nasal side of the field. During your discussion you describe the macular area as: a. b. A gradual lessening of the power of accommodation Option A defines astigmatism. Ciliary flush caused by congestion of the ciliary artery. B is a test for visual acuity using snellen¶s chart. b. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva. which is quite avascular. Refractive error that prevents light rays from coming to a single focus on the retina. d. Which of the following diagnostic tests should these clients request from their care provider? a. D is used to focus on layers of the cornea and lens looking for opacities and inflammation. Options A and C refer to the optic disc. You explain that this is called: a. One of these is presbyopia. You also explain common eye changes associated with aging. Reddish orange in color. You are caring for Mr. Icterus. 6.

You know that all but one of the following may eventually result in uremia. 7-9 cm to the left of the midsternal line. uncontrolled hypertension c. anorexia. d. 7-9 cm to the left of the midsternal line. Drug therapy is not usually affected by this diagnosis d. intercostal space. pruritus c. Thus alteration in drug schedule and dosage is necessary for safe care. Which statement best describes the location of the PMI in the healthy adult? a. Regarding his diagnosis and management of his drugs. 10. 7th intercostal space. toxins. b. B and C are potential causes of renal damage and eventual renal failure. Numerous drugs have been used on Mr. . You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. Apex of the heart. all of the above Options A. Polyuria. Which option is not implicated? a.smelling breath. Kaplan when he came to your unit. Ruddy complexion Weakness and anorexia are due to progressive renal damage. pruritus is secondary to presence of urea in the perspiration. Kaplan in an attempt to stabilize him. b. The half-life of many drugs is decreased in uremia. Apex of the heart. You did the initial assessment on Mr. polyphagia d. infections. The skin is more sallow or brown as renal failure continues. Weakness. Base of the heart. Fruity smelling breath is found in diabetic ketoacidosis. you know that: a. glomerular disease b. 7-9 cm to the left of the midsternal line. renal disease secondary to drugs. c.9. The point of maximum impulse (PMI) is an important landmark in the cardiac exam. Drug toxicity is a major concern in uremia. Individuals can live very well with only one healthy kidney. You begin by reviewing assessment of the cardiovascular system in your mind and asking yourself the following: 12. fruity. What classical signs and symptoms did you note? a. Oliguria is seen in chronic renal failure. polyphagia are signs of DM and early diabetic ketoacidosis. intercostal space. c. Precautions should be taken with prescription drugs. or radiations d. Polyuria. Metabolic changes and alterations in excretion put the client with uremia at risk for development of toxicity to any drug. polydipsia. b. 5th intercostal space. 7-9 cm to the left of the midsternal line. but most OTC medications are safe for him to use. 11. polydipsia. Base of the heart. individualization of therapy and often a decrease in dose is essential. thus dosage may have to be increased to be effective.

S2 is caused by the aortic and pulmonic valve closure. LSB. The coronary arteries furnish blood supply to the myocardium. the left anterior descending and left circumflex: both supply the left ventricle The right and left coronary arteries are the only branches off the ascending aorta. 13. or just medial to. blood enters the right and left coronary arteries during systole only c. thickening of the pericardium b. is admitted to the hospital with an established diagnosis of mitral stenosis. S3 d. S3 and S4 are generally considered abnormal heat sounds in adults and are best heard at the apex. Sally Baker. Tricuspid b. S1 b. Mitral valve closure is best heard at the PMI landmark (apex) 14. the MCL.The PMI is the impulse at the apex of the heart caused by the beginning of ventricular systole. RSB. the health care provider auscultates the heart. S4 S1 is caused by mitral and tricuspid valve closure. right heart failure . the right coronary artery also often supplies a small portion of the left ventricle. 16. When the stethoscope is placed on the 5th intercostal space along the left sternal border. During the physical examination of the well adult client. Mitral The sound created by closure of the tricuspid valve is heard at the 5th LICS at the LSB. hemoptysis. Pulmonic closure is best heard at the 2nd LICS. blood enters these arteries mainly during diastole. Ms. It is generally located in the 5th left ICS. the right coronary artery forms almost a complete circle around the heart. orthopnea. yet supplies only the right ventricle d. the left coronary artery has two main branches. Pulmonic c. S2 c. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB? a. Aortic d. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints of dyspnea. Which of the following is a true statement relative to the coronary circulation? a. 15. which valve closure is best evaluated? a. These complaints are probably due to: a. the right and left coronary arteries are the first of many branches off the ascending aorta b. She is scheduled for surgery to repair her mitral valve. and paroxysmal nocturnal dyspnea have become unmanageable. Aortic closure is best heard at the 2nd RICS. 7-9 cm from the MSL or at. a 40-year-old woman.

Which of the following is not one of the usual objective findings associated with mitral stenosis? a. Mr. undifferenciated carcinoma d. 18. chest x-ray shows left ventricular hypertrophy Evidence of left atrial enlargement may be seen on chest x-ray and ECG. irregular pulse. cancer of the prostate b. The other objective findings may be seen in chronic mitral stenosis with episodes of atrial fibrillation and right heart failure. precordial thrill. d. This chest pain is probably caused by: a. cancer of the bowel The incidence of lung cancer is also rapidly rising in women. Oliver. small crepitant rales at the bases of the lungs c. 19. His possible diagnosis is cancer of the lung. and peripheral and facial cyanosis in severe disease d. pulmonary hypertension d. cancer of the lung c. options B and D are not painful conditions in themselves. The left ventricle does not hypertrophy in mitral stenosis. weak. b. squamous cell carcinoma (epidermoid) c. On physical exam of Ms. Of the four basic cell types of lung cancer listed below. low-pitched rumbling diastolic murmur. left ventricular hypertrophy Pulmonary congestion secondary to left atrial hypertrophy causes these symptoms. cancer of the pancreas d. You know those mitral valve prolapse is usually a benign cardiac condition. The most common lethal cancer in males between their fifth and seventh decades is: a. c. 17. Baker. 20. bronchoalveolar carcinoma . and parasternal lift b.c. several abnormal findings can be observed. pericardial thickening does not occur. but may be associated with atypical chest pain. is admitted to the hospital for a diagnostic workup. right heart failure would cause abdominal discomfort and peripheral edema. ventricular ischemia dysfunction of the left ventricle papillary muscle ischemia and dysfunction cardiac arrythmias Ventricular ischemia does not occur with prolapsed mitral valve. which is always associated with smoking? a. You are seeing more clients with diagnoses of mitral valve prolapse. adenocarcinoma b. a long term heavy smoker.

B and D are important nursing considerations. 22. He is right handed. Although hypo. Careful attention to blood count results There ar enumerous severe reactions to chemotherapy such as stomatitis. manifesting itself in symptoms like those Mr. Mr. The episodes Mr. Liberatore suffers a left sided CVA. hyperlipidemia. Today the episode lasted for 15 minutes. Liberatore experiences fit the pattern of TIA because of his quick recovery with no sequelae and no treatment. 23. is admitted to your unit. Secondary to hypoglycemia d. Mr. Special nursing considerations with chemotherapy include all but which of the following? a. Secondary to hyperglycemia A TIA is a temporary reduction in blood flow to the brain. 24. Explaining that the reactions to chemotherapy are minimal c. 21. alopecia. The admission diagnosis is impending CVA. Careful observation of the IV site of the administration of the drugs d. Recently he has had several episodes where he stops talking in midsentence and stares into space. Helping the client deal with depression secondary to the diagnosis and its treatment b. Liberatore. small cerebral hemorrhages b. age 76. the episodes Mr. visual loss . Which of the following operative procedures of the thorax is paired with the correct definition? a. Decortication: removal of the reibs or sections of ribs d. The nurse should expect: a. left-sided paralysis b. and thoracoplasty is the removal of ribs or sections of ribs. Liberatore has been experiencing are probably: a. Pneumonectomy: removal of the entire lung b. TIA¶s or transient ischemic attacks c.Textbooks of medicine and nursing classify primary pulmonary carcinoma somewhat differently. However most agree that sqaumous cell or epidermoid carcinoma is always associated with cigarette smoking. DM. Wedge resection: removal of one or more lobes of a lung c. decortication is the removal of a fibrous membrane that develops over the visceral pleura. bone marrow depression. Thoracoplasty: removal of fibrous membrane that develops over visceral pleura as a result of emphysema Wedge resection is removal of part of a segment of the lung. Options A. Liberatore experiences. nausea and vomiting.and hyperglycemia can cause some drowsiness and/or disorientation. Chemotherapy may be used in combination with surgery in the treatment of lung cancer. He has a past medical history of hypertension.

because of the crossover of the motor fibers. no alterations in speech d. A thorough history reveals that hormonal changes associated with menstruation may have triggered Julie¶s migraine attack. warning sign of onset. You suspect Julie may have: a. neck and face d. an 18-year-old girl. spastic paralysis. pulsating vesels. Thus. an allergic response triggered by stress b. 26. presence of babinski reflex b. C and D describe lower motor neuron disease. fasciculations d. or aura Sinus headache often accompanies seasonal allergies. You explain to Julie and her mother that migraine headaches are caused by: a. seasonal allergies b. increased intracranial pressure The vascular theory best explains migraine and often diagnosis is confirmed through a trial of ergotamine. chocolate c. persistent contraction of the muscles of the head. Many factors may contribute to migraine. Mr. is brought into the ER by her mother with the chief complaint of sudden visual disturbance that began half an hour ago and was described as double vision and flashing lights.c. 25. In right-handed persons the speech center (Broca¶s area) is most commonly in the left brain. Julie. which constricts the dilated. dilation of cerebral arteries c. flaccid paralysis. muscle atrophy. Upper motor neuron disease may be manifested in which of the following clinical signs? a. a CVA in the left brain will produce a right-sided hemiplegia. Julie¶s symptoms are most compatible with migraine. During your assessment of Julie she tells you all visual symptoms are gone but that she now has a severe pounding headache over her left eye. Migraine is usually unilateral and described as pounding. hyperreflexia. 27. no impairment of bladder function Visual field loss is a common side effect of CVA. MSG. hyporeflexia c. decreased or absent voluntary movement Options B. a brain tumor d. which may have been . a tension headache b. the aura and headache of migraine c. In investigating Julie¶s history what factors would be least significant in migraine? a. Often bladder control is diminished following CVA. a conversion reaction The warning sign or aura is associated with migraine although not everyone with migrane has an aura. Usually the client comes from a family that has migrated. family history of migraine d. Liberatore will probably have some speech disturbance and right-sided paralysis. trigger foods such as alcohol. 28.

CN5 CN7 CN8 The ossicles CN8. hormonal changes. The type of tumor he has is currently unknown. a bandlike burning around the neck d. 30. Snyder is admitted to your unit with a brain tumor. headache. mental status changes c. c. vital signs may vary considerably. severe aching pain behind both eyes b. You assess the situation and conclude that the reason for this is: . d. gliomas are usually benign c. diet. drop in blood pressure As ICP increases. Signs and symptoms of increasing intracranial pressure may include all of the following except: a. dizziness. occipitally. feeling of tightness bitemporally. obvious motor deficits d. the acoustic nerve or vestibulocochlear nerve. 29. option B is also compatible with migraine. 50% of all intracranial tumors are gliomas b. option C would be correct if stated a bandlike ³tightness´ around the head instead of ³burning´ Mr. is the most commonly affected CN in acoustic neuroma although as the tumor progresses CN5 and CN7 can be affected. as ICP continues to rise. they grow rapidly and often cannot be totally excised from the surrounding tissue d. and fatigue may all be implicated in migraine. A client with muscle contraction headache will exhibit a pattern different for Julie¶s. However. headache worse when bending over c. Whether Mr Snyder¶s tumor is benign or malignant. 33. Mr Snyder is scheduled for surgery in the morning. option A may also be compatible with headache secondary to eyestrain. Acoustic neuromas produce symptoms of progressive nerve deafness. 31. Which of the following is more compatible with tension headache? a. and vertigo due to pressure and eventual destruction of: a. and you are surprised to find out that there is no order for an enema. or in the neck Options A and B describe sinus headache. Stress. nausea. You begin to think about the way brain tumors are classified. b. most glioma victims die within a year after diagnosis Gliomas are malignant tumors. Glioma is an intracranial tumor. papilledema. tinnitus. Which of the following statements about gliomas do you know to be false? a. 32. it will eventually cause increased intracranial pressure. and vomiting b. the pulse rate decreases and the BP rise. Often there is an aura.called ³sick headache´ due to accompanying nausea and vomiting. increased pulse rate.

and move postoperatively Option A is true: the rationale for deep breathing and coughing is to prevent postoperative pulmonary complications such as pneumonia and atelectasis. extracranial hemorrhage c. Straining to evacuate the enema might increase the intracranial pressure c. Snyder needs vigilant nursing care including all of the following except: a. vomiting. Assessments q ½ hour of LOC. Hogan¶s planned cholecystectomy she awakens with a pain in . or coughing d. Providing a caring. Snyder had been on clear liquids and then was NPO for several days. supportive atmosphere for him and his family Postoperatively clients who have undergone craniotomy usually have their heads elevated to decrease local edema and also decrease ICP. Increased ICP may result from hemorrhage or edema. VS.a. You are responsible for teaching Mrs. Mrs. Hogan. Keeping his head flat b. On the morning of Mrs. Helping him avoid straining at stool. However. a 43-year-old woman. 35. they prevent postoperative atelectasis and pneumonia b. 37. seizures d. because she is probably overweight and will be less willing to breathe. 34. and mental status c. Hogan deep breathing and coughing exercises. Why are these exercises especially important for Mrs. the risk of pulmonary problems is somewhat increased in clients with biliary tract surgery because of their high abdominal incisions. Postoperatively Mr. which makes the client reluctant to take a deep breath and cough c. CSF leakage may result in meningitis. fat and fory ± which is not necessarily the case. is admitted to your unit for cholecystectomy. although there may be some bloody drainage on external dressings. Snyder has had some mental changes due to the tumor and would find an enema terribly traumatic b. 36. increased ICP b. Hogan? a. Splinting the incision with the hands or a pillow is very helpful in controlling the pain during coughing. Seizures are another postoperative concern. Option C assumes the stereotype of the person with gallbladder disease ± fair. Potential postintracranial surgery problems include all but which of the following? a. the incision in gallbladder surgery is in the subcostal area. leakage of cerebrospinal fluid Hemorrhage is predominantly intracranial. An oversight and you call the physician to obtain the order Any activity that increases ICP could possibly cause brain herniation. Mr. so an enema is not necessary d. cough. Mr. papillary responses. Straining to expel an enema is one example of how the increased ICP can be further aggravated.

her right scapular area and thinks she slept in poor position. The family may also be involved earlier but certainly should have that time immediately after the medication is given and before it takes full effect to be with their loved ones. Hogan¶s new pain. Hogan is transported to the recovery room following her cholecystectomy. Her vital signs are stable and her family is with her. 38. As you continue to check her vital signs you note a continuing trend in Mrs. The surgeon should be called as he/she may treat the acute attack medically and delay the surgery for several days. to notify the surgeon at once. reinforce preop teaching Options A. 39. Mrs. 40. Which nursing actions follow the giving of the preop medication? a. after the physician writes the order b.000. increase IV fluid rate of infusion and place in trendelenburg position c. Hogan returns to your clinical unit following discharge from the recovery room. this is an elevated WBC indicating an inflammatory reaction b. Postoperative leg exercises should be inititated: a. to record this finding in a prominent place on the preop checklist and in your preop notes c. place in lateral sims position to facilitate breathing These are signs of impending shock. Your most appropriate nursing action is to: a. to call the laboratory for a STAT repeat WBC d. especially considering Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0. Mrs. bring her valuables to the nursing station d. or months. While doing the preop check list you note that on her routine CB report her WBC is 15. Your most appropriate action is to report your findings quickly and accurately and to continue to monitor Mrs. order whole blood for Mrs. This is not an unusual finding A WBC count of 15. none. Hogan will not be ambulated early d. Hogan¶s status: her BP is gradually dropping and her pulse rate is increasing. Hogan from the lab b. allow her family to be with her before the medication takes effect c. weeks. Your responsibility at this point is: a. C and D should all take place prior to administration of the drugs. if Mrs. Good planning of nursing care can facilitate this.000 probably indicates acute cholecystitis. have her void soon after receiving the medication b. Mrs.3 mg IM and Demerol 50 mg IM one hour preoperatively. after the family leaves c. stat . immediately report signs of shock to the head nurse and/or surgeon and monitor VS closely d. which may be true shock or a reaction to anesthesia. Hogan carefully.

ventilate for 30 seconds then try again. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient. Should be performed with the neck flexed forward making the chin touch the chest. Intubation is part of the secondary survey ABC¶s. An oropharyngeal airway may: a. e. 44. 42. Be inserted "upside down" into the mouth opening and then rotated into the proper orientation as it is advanced into the mouth. b. Extubate. Cause airway obstruction. in supporting the incision. etc. An oropharyngeal airway that is too long may push the epiglottis into a position that obstructs the airway. It is usually inserted upside down and then rotated into the correct orientation as it approaches full insertion. Effective ventilation using bag-valve mask usually requires at least two well trained rescuers. the right. Letter A is wrong because an attempt should not last no longer than 30 seconds. Reduces the risk of aspiration of gastric contents. Unless injury is suspected the neck should be slightly flexed and the head extended.. b. Endotracheal intubation: a. If breath sounds are only heard on the right side after intubation: a. deep breathing and coughing. Letter A may cause gastric insufflation thus increasing the risk for regurgitation and aspiration. b. If there is no pulse begin chest compressions. Not be used in a conscious patient. Cricoid pressure may prevent gastric inflation during ventilations and may also prevent regurgitation by compressing the esophagus. The family can be extremely helpful in encouraging the client to do them. d. moving. and turning should begin as soon as the client¶s condition is stable. Prevent a patient from biting and occluding an ET tube. a doctor¶s oreder is not necessary ± this is a nursing responsibility.Leg exercises. In a conscious or semiconscious patient its use may cause laryngospasm or vomiting. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations. An oropharyngeal airway should be used in an unconscious patient. It is often use with an ETT to prevent biting and occlusion. All of the above. c. When giving bag-valve mask ventilations: a. b. After securing an airway and successfully ventilating the patient with two breaths you should then check for a pulse. d. Should be performed after a patient is found to be not breathing and two breaths have been given but before checking for a pulse. The patient probably only has one lung. 43. Cricoid pressure may prevent gastric inflation during ventilations. With adults breaths should be delivered slowly and steadily over 2 seconds. the µsniffing position¶. c. . c. d. A frequent problem with bag-valve mask ventilations is the inability to provide adequate tidal volumes. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured Effective ventilations can always be given by one person. 41.

A targeted history is often crucial in making the diagnosis of acute MI. 45. b. Should not be used with a conscious person. First degree heart block is not a lethal arrhythmia. d. Pulseless Ventricular Tachycardia Asystole Ventricular fibrillation First degree heart block. d. since visualization is not required the EOA may be very useful in patient¶s when intubation is contraindicated or not possible. The chest pain is rarely described as crushing. 48. crushing pressure. Can be inserted by any person trained in ACLS. Which is why a normal ECG alone cannot be relied upon to rule out an MI. The chest pain associated with an acute MI is often described as heavy. An esophageal obturator airway (EOA): a. d. Vomiting and aspiration are possible complications of insertion and removal of an EOA. A targeted history is rarely useful in making the diagnosis of MI. It is useful for treatment of severe hypotension. c. or patients who have swallowed caustic substances. b. or heavy. c. Most likely you have a right main stem bronchus intubation. b. . pediatric patients. Chest pain does not always accompany an MI. c. 'like an elephant sitting on my chest. ventricular fibrillation is 15 times more likely to occur during the first hour of an acute MI than the following twelve hours which is why it is vital to decrease the delay between onset of chest pain and arrival at a medical facility. Never causes regurgitation. It is a first line drug for Pulseless Electrical Activity. d. d. This is especially true of patients with diabetes. 46. Moreover. The most common lethal arrhythmia in the first hour of an MI is: a. Requires visualization of the trachea before insertion. It is used for wide-complex tachycardia. Moreover. pressing. Pull the tube back and listen again. You have intubated the stomach. Which of the following is true about verapamil? a. EOA insertion should only be attempted by persons highly proficient in their use. A patient may have a normal appearing ECG. It may cause a drop in blood pressure.' 47. c. Pulling the tube back a few centimeters may be all you need to do. Chest pain will always be present.c. During an acute myocardial infarct (MI): a. b.

" a. The thinking is that human error or equipment malfunction may result in misidentifying V-fib as asystole.. . Missing V-fib can have deadly consequences for the patient because V-fib is highly amenable to correction by defibrillation. defibrillate it. False Asystole is not amenable to correction by defibrillation. The specific antidote for overdose from verapamil. Verapamil is a calcium channel blocker and may actually cause PEA if given too fast intravenously or if given in excessive amounts. Many physically fit people have resting heart rates less than 60 bpm. Is always given for a heart rate less than 60 bpm. should always be given slowly.Verapamil usually decreases blood pressure. which is why it is sometimes used as an antihypertensive agent. Atropine: a. But there is a school of thought that holds that asystole should be treated like V-fib. or any other calcium channel blocker. d. c. Verapamil may be lethal if given to a patient with V-tach. 50.e.04 mg/kg IV in the setting of cardiac arrest. Only give atropine for symptomatic bradycardias. b. i. Administering atropine slowly may cause paradoxical bradycardia. Has a maximum total dosage of 0. When given IV.03-0. True b. 49. Asystole should not be "defibrillated.. Cannot be given via ET tube. therefore it should not be given to a tachycardic patient with a wide complex QRS. Verapamil may cause hypotension. is calcium. Atropine may be given via an endotracheal tube.