NS 1 QUIZ 7

Situation: A 65-year old male named Tony was recently admitted to the hospital with the presence of
cough together with back and joint pains. He was diagnosed to have infective endocarditis.

1. Which of the following would be a risk factor in the development of Tony’s disease?

A. Old age
B. Having arthritis
C. Living in the city
D. His job as a farmer

ANSWER: A Risk factors of having infective endocarditis are the following: patients with cardiac
structural defects; older people; IV injection drug users; patients who undergo invasive procedure;
patients who have implants or invasive equipment; and patients who are receiving immunosuppressive
drugs or corticosteroids.

2. Upon assessment the nurse noticed small erythematous nodular lesions on the palms of the patient.
Tony has stated that these lesions are not painful. The nurse must document this as

A. Osler’s nodes
B. Splinter hemorrhages
C. Janeway lesions
D. Roth’s spots

ANSWER: C Classically, Osler's nodes are on the tip of the finger or toes and painful. Janeway lesions
occur on palm and soles and are non-painful. Osler's nodes are thought to be caused by localized
immunological-mediated response while Janeway lesions are thought to be caused by septic micro
emboli.

3. The nurse must know that the infection of Tony is found on the

A. Valves and endothelium

B. Myocardium
C. Pericardium
D. Epicardium

ANSWER: A There is a deformity of the valve and inflammation of the endothelium in this disease,
hence the term endocarditis.

4. Parenteral antibiotic therapy is done for Tony, the nurse must assess which of the following first prior
to administration of the drug?

A. Patient’s vital signs

B. Allergies to the antibiotic prescribed
C. Body temperature
D. Level of pain

ANSWER: B It is the task of the nurse to identify any allergies to any antibiotic drug prescribed in
order for the physician to order an alternative antibiotic.
5. Antibiotic therapy for patients with infective endocarditis usually takes how many weeks?

A. 2 weeks
B. 1 week
C. 4-6 weeks
D. 8-10 weeks

ANSWER: C Antibiotic therapy for infective endocarditis is done around 4-6 weeks via the parenteral
route.

6. Mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent infections.
The nurse responds based on the understanding of which of the following?

A. Little is known about iron-deficiency anemia and its relationship to infection in children.
B. Children with iron deficiency anemia are more susceptible to infection than are other children.
C. Children with iron-deficiency anemia are less susceptible to infection than are other children.
D. Children with iron-deficient anemia are equally as susceptible to infection as are other children.

ANSWER D. Children with iron-deficiency anemia are more susceptible to infection because of marked
decreases in bone marrow functioning with microcytosis

7. The clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors
related to pain crisis. Which of the following, if identified by the mother as a precipitating factor,
indicates the need for further instructions?

A. Infection
B. Trauma
C. Fluid overload
D. Stress

ANSWER C. Fluid overload. Pain crisis may be precipitated by infection, dehydration, hypoxia, trauma, or
physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake
of 1 1/2 to 2 times the daily requirement to prevent dehydration

8. When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the
following physiological functions?

A. Bleeding tendencies
B. Intake and output
C. Peripheral sensation
D. Bowel function

ANSWER A. Bleeding tendencies. Aplastic anemia decreases the bone marrow production of RBCs,
WBCs, and Platelets. The client is at risk for bruising and bleeding tendencies.

9. A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most
appropriate for the nurse to ask in determining the extent of the client's activity intolerance?
 A. "What activities were you able to do 6 months ago compared with present?"
B. "How long have you had this problem?"
C. "Have you been able to keep up with all your usual activities?"
D. "Are you more tired now than you used to be?"

ANSWER A. It is difficult to determine activity intolerance without objectively comparing activities from
one time frame to another. Because iron deficiency anemia can occur gradually and individual
endurance varies, the nurse can best assess the clients activity tolerance by asking the client to compare
activities 6 months ago and at the present

10. When discussing appropriate food choices with a patient who has iron-deficiency anemia and
follows a low-cholesterol diet, the nurse will encourage the patient to increase the dietary intake of

A. eggs and muscle meats.

B. nuts and cornmeal.
C. milk and milk products.
D. legumes and dried fruits

ANSWER D. Legumes and dried fruits are high in iron and low in fat and cholesterol.

11. A client is beginning a regimen of ferrous sulfate or iron. As you prepare to administer the
medication, it is important for you to advise the client that

A. Her urine will turn a dark orange

B. Her bowel movements will be dark and tarry
C. Her appetite will be diminished
D. Her vision will become slightly blurred

ANSWER B. Her bowel movements will be dark and tarry

12. A patient who is having a sickle cell crisis asks the nurse why the sickling causes such pain. The nurse
explains that the pain of sickling is caused by

A. Spasms of the blood cells as they change shape

B. Deposition of sickled red cells in the bone marrow
C. Tissue hypoxia caused by small blood vessel occlusion
D. Infectious processes in organs affected by the sickling

ANSWER C. The pain associated with sickle cell crisis is caused by ischemia as the sickled cells occlude
small blood vessels and capillaries.

13. A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are
performed. A nurse checks the lab results, knowing that which of the following would be increased in
this disease?

A. Platelet count
B. Hematocrit level
C. Reticulocyte count
D. Hemoglobin level
ANSWER C. Reticulocyte count. A diagnosis is established based on a complete blood count, examination
for sickled RBCs in the peripheral smear, and hemoglobin electrophoresis. Lab studies will show
decreased HGB and HCT levels and a decreased platelet count, and increased reticulocyte count, and the
presence of nucleated RBCS. Increased reticulocyte counts occur in children with sickle cell disease
because the life span of their sickled RBCS is shortened

14. The nurse is conducting a physical assessment on a client with anemia. Which of the following
clinical manifestations would be most indicative of the anemia?

A. BP 146/88
B. Respirations 28 shallow
C. Weight gain of 10 pounds in 6 months
D. Pink complexion

ANSWER B. When there are fewer red blood cells, there is less hemoglobin and less oxygen. Therefore,
the client is often short of breath. The client with anemia is often pale in color, has weight loss, and may
be hypotensive.

15. The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the
most important concept to teach for health maintenance?

A. Eat animal protein and dark leafy vegetables each day

B. Avoid exposure to others with acute infection
C. Practice yoga and meditation to decrease stress and anxiety
D. Get 8 hours of sleep at night and take naps during the day

ANSWER B. avoid exposure to infection. Clients with aplastic anemia are severely immunocompromised
and at risk for infection and possible death related to bone marrow suppression and pancytopenia. Strict
aseptic technique and reverse isolation are important measures to prevent infection

16. A vegetarian client was referred to a dietician for nutritional counseling for anemia. Which client
outcome indicates that the client does not understand nutritional counseling? The client:

A. Adds dried fruit to cereal and baked goods

B. Cooks tomato-based foods in iron pots
C. Drinks coffee or tea with meals
D. Adds vitamin C to all meal

ANSWER C. Coffee and tea increase GI mobility and inhibit the absorption of iron

17. The primary purpose of the Schilling test is to measure the client's ability to:

A. Store vitamin B12

B. Digest vitamin B12
C. Absorb vitamin B12
D. Produce vitamin B12

ANSWER C. Absorb vitamin B12 Pernicious anemia is caused by the body's inability to absorb vitamin
B12. This results in a lack of intrinsic factor in the gastric juices. Schilling's test helps diagnose pernicious
anemia by determining the ability to absorb vitamin B12.
18. A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess
before giving the injection?

A. Hematocrit
B. Partial thromboplastin time
C. Hemoglobin concentration
D. Prothrombin time

ANSWER A. Hematocrit. Epogen is a recombinant DNA form of erythropoietin, which stimulates the
production of RBCs and therefore causes the hematocrit to rise. The elevation in hematocrit causes an
elevation in blood pressure; therefore, the blood pressure is a vital sign that should be checked.
Erythropoietin can be used to correct anemia by stimulating red blood cell production in the bone
marrow in these conditions. The medication is known as epoetin alfa (Epogen, Procrit) or as
darbepoietin alfa (Arnesp). It can be given as an injection intravenously or subQ.

19. A mother asks the nurse if her child's iron deficiency anemia is related to the child's frequent
infections. The nurse responds based on the understanding of which of the following?

A. Little is known about iron-deficiency anemia and its relationship to infection in children.
B. Children with iron deficiency anemia are more susceptible to infection than are other children.
C. Children with iron-deficiency anemia are less susceptible to infection than are other children.
D. Children with iron-deficient anemia are equally as susceptible to infection as are other children.

ANSWER B. Children with iron-deficiency anemia are more susceptible to infection because of marked
decreases in bone marrow functioning with microcytosis.

20. Which of the following foods would the nurse encourage the mother to offer to her child with iron
deficiency anemia?

A. Rice cereal, whole milk, and yellow vegetables

B. Potato, peas, and chicken
C. Macaroni, cheese, and ham
D. Pudding, green vegetables, and rice

ANSWER B. Potato, peas, chicken, green vegetables, and rice cereal contain significant amounts of iron
and therefore would be recommended.

Situation : A 47-year old patient named Jack Wang was brought to the ER with complaints of chest pain
and dyspnea. Upon echocardiography the doctor has diagnosed myocarditis. Nurse Hope is tasked to
obtain the patient’s health history.

21. Which of the following statements from the patient would probably have led him to have
myocarditis?

A. “I have been taking corticosteroid therapy for several months now to treat my arthritis.”
B. “I have been experiencing hypertension every now and then.”
C. “I have been stressed a lot lately because of my work.”
D. “I am fond of eating salty foods.”
ANSWER A. Risk factors of myocarditis are the following: patients who have viral, bacterial, protozoan,
or parasitic infections; patients who are receiving immunosuppressive drugs or corticosteroids; and
patients who may develop sensitivity reaction to long-term drug therapy.

22. Which of the following drugs prescribed by the doctor is Nurse Hope going to question?

A. Penicillin-G
B. Ceftriaxone
C. Aspirin
D. Ampicillin

ANSWER C. Do not give NSAIDs to patients with cardiovascular diseases especially heart failure because
they may cause further myocardial damage.

23. One of the goals in the treatment of myocarditis is to prevent embolization. The nurse must
emphasize which of the following?

A. Application of elastic pressure stockings

B. ROM exercises
C. Taking anticoagulants
D. All of these

ANSWER D. All of these choices prevent embolization and the nurse must teach the patients properly
about doing these precautions.

24. Jack has suddenly developed shortness of breath, dyspnea, crackles, and a pink-frothy sputum. The
nurse must suspect for?

A. Right-sided heart failure

B. Left-sided heart failure
C. Cardiac tamponade
D. Pericardial friction rub

ANSWER B. Clinical manifestations of left-sided heart failure always has respiratory signs and symptoms.

25. The goal in the treatment of Scott’s myocarditis would be

A. Eliminating pain
B. Prevention of thrombus formation
C. Treatment of the underlying infection
D. Cardiac monitoring

ANSWER C. Since infection is the root of myocarditis, the best treatment of this is by giving the
appropriate drugs (e.g. bacterial myocarditis – antibiotics).

Situation : A 56-year old male client named Felix Bin is brought to the emergency department because
of severe chest pain not relieved by nitroglycerine. He has a history of angina pectoris. The attending
physician diagnosed him to have myocardial infarction. He is attended to by Nurse May.
26. The immediate nursing intervention in the diagnosis of myocardial infarction would be

A. Oxygen administration as ordered by the physician

B. Administration of morphine sulfate
C. Preparing for the immediate surgery of the patient
D. Administration of nitroglycerine

ANSWER A. The rationale behind oxygen therapy is to increase oxygen delivery to the ischemic
myocardium and thereby limit infarct size and subsequent complications.

27. During the diagnosis of myocardial infarction the doctor has noted that the endocardial muscles are
affected. The nurse must know that this classification of MI is

A. Transmural infarct
B. Subendocardial infarct
C. Intramural infarct
D. Intermural infarct

ANSWER B. A subendocardial infarct results in necrosis exclusively involving the innermost aspect of the
myocardium.

28. The client’s creatine-phosphokinase MB (CPK-MB) is monitored. The nurse must know that the peak
usually is achieved within how many hours after a myocardial infarction?

A. 3-6 hours
B. 12-18 hours
C. 3-4 days
D. 5-7 days

ANSWER B. CK-MB first appears 3-6 hours after symptom onset, peaks at 12-18 hours, and returns to
normal in 48- 72 hours. Its value in the early and late (>72 h) diagnosis of acute MI is limited. However,
its release kinetics can assist in diagnosing reinfarction if levels rise after initially declining following
acute MI.

29. In the ECG reading interpretation, the nurse has noted a T-wave depression. Nurse May must this as

A. Zone of ischemia
B. Zone of injury
C. Zone of infarction
D. Zone of occlusion

ANSWER A. T wave depression – ischemia, ST segment elevation – injury, pathologic Q wave – infarction.

30. Aside from relieving pain from MI, morphine sulfate is administered since it causes what to the
coronary arteries?

A. Vasodilation
B. Vasoconstriction
C. Vasospasms
 D. Thrombolytic

ANSWER A. Morphine sulfate is also a vasodilator and decreases the workload of the heart by reducing
preload and afterload.

31. Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline
blood pressure (BP) for a new patient?

A. Obtain a BP reading in each arm and average the results.

B. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.
C. Have the patient sit in a chair with the feet flat on the floor.
D. Assist the patient to the supine position for BP measurements.

ANSWER C. The patient should be seated with the feet flat on the floor. The BP is obtained in both arms,
but the results of the two arms are not averaged. The patient does not need to be in the supine position.
The cuff should be deflated at 2 to 3 mm Hg per second.

32. The nurse obtains this information from a patient with prehypertension. Which finding is most
important to address with the patient?

A. Low dietary fiber intake

B. No regular aerobic exercise
C. Weight 5 pounds above ideal weight
D. Drinks wine with dinner once a week

ANSWER B. The recommendations for preventing hypertension include exercising aerobically for 30
minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor
for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but
increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will
not increase the hypertension risk.

33. After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension,
which action should the nurse take?

A. Encourage oral fluids to prevent dry mouth or dehydration.

B. Instruct the patient to ask for help if heart palpitations occur.
C. Ask the patient to request assistance when getting out of bed.
D. Teach the patient that headaches may occur with this medication.

ANSWER C. Labetalol decreases sympathetic nervous system activity by blocking both α- and β-
adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe
orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible side effects of
other antihypertensives.

34. After the nurse teaches the patient with stage 1 hypertension about diet modifications that should
be implemented, which diet choice indicates that the teaching has been effective?

A. The patient avoids eating nuts or nut butters.

B. The patient restricts intake of dietary protein.
C. The patient has only one cup of coffee in the morning.
 D. The patient has a glass of low-fat milk with each meal.

ANSWER D. The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of
hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased
protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5
servings weekly are recommended in the DASH diet.

35. A patient has just been diagnosed with hypertension and has a new prescription for captopril
(Capoten). Which information is important to include when teaching the patient?

A. Check BP daily before taking the medication.

B. Increase fluid intake if dryness of the mouth is a problem.
C. Include high-potassium foods such as bananas in the diet.
D. Change position slowly to help prevent dizziness and falls.

ANSWER D. The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic

hypotension, and patients should be taught to change position slowly to allow the vascular system time
to compensate for the position change. Increasing fluid intake may counteract the effect of the
medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not
need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause
potassium retention, increased intake of high-potassium foods is inappropriate.

36. A 52-year-old patient who has no previous history of hypertension or other health problems
suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to
tell the patient that

A. a BP recheck should be scheduled in a few weeks.

B. the dietary sodium and fat content should be decreased.
C. there is an immediate danger of a stroke and hospitalization will be required.
D. more diagnostic testing may be needed to determine the cause of the hypertension.

ANSWER D. A sudden increase in BP in a patient over age 50 with no previous hypertension history or
risk factors indicates that the hypertension may be secondary to some other problem. The BP will need
rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the
immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this
sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to
an acceptable level.

37. Which action will be included in the plan of care when the nurse is caring for a patient who is
receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency?

A. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night.
B. Assist the patient up in the chair for meals to avoid complications associated with immobility.
C. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements.
D. Place the patient on NPO status to prevent aspiration caused by nausea and the associated
vomiting.

ANSWER C. Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV

antihypertensive medications. This can be most easily accomplished with an automated BP machine or
arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep
is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent
decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk
for aspiration, so an NPO status is unnecessary.

38. The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril
(Accupril). Which patient statement indicates that more teaching is needed?

A. "The medication may not work as well if I take any aspirin."

B. "The doctor may order a blood potassium level occasionally."
C. "I will call the doctor if I notice that I have a frequent cough."
D. "I won't worry if I have a little swelling around my lips and face."

ANSWER D. Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an

indication that the ACE inhibitor should be discontinued. The patient should be taught that if any
swelling of the face or oral mucosa occurs, the health care provider should be immediately notified
because this could be life threatening. The other patient statements indicate that the patient has an
accurate understanding of ACE inhibitor therapy.

39. Which information should the nurse include when teaching a patient with newly diagnosed
hypertension?

A. Dietary sodium restriction will control BP for most patients.

B. Most patients are able to control BP through lifestyle changes.
C. Hypertension is usually asymptomatic until significant organ damage occurs.
D. Annual BP checks are needed to monitor treatment effectiveness.

ANSWER C. Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle
changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most
patients. BP should be checked by the health care provider every 3 to 6 months.

40. The client diagnosed with a myocardial infarction asks the nurse, "why do I have to rest and take it
easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response?

A. "Your heart is damaged and needs about 4 to 6 weeks to heal"

B. "There is necrotic myocardial tissue that puts you at risk for dysrhythmias"
C. "Your doctor has ordered bedrest. Therefore, you must stay in bed."
D. "Just because your chest doesn't hurt anymore doesn't mean you are out of danger"

ANSWER A. The heart tissue is dead, stress or activity may cause heart failure, and it does take about 6-8
weeks for scar tissue to form

41. A nursing student is asking her clinical instructor about the lifespan of red blood cells. The instructor
should know that the life of the erythrocytes is usually at around

A. 60 days
B. 100 days
C. 120 days
D. 180 days
ANSWER C. When matured, in a healthy individual these cells live in blood circulation for about 100 to
120 days (and 80 to 90 days in a full-term infant). At the end of their lifespan, they are removed from
circulation. In many chronic diseases,

the lifespan of the red blood cells is reduced.

42. When the patient has low hemoglobin and hematocrit, the nurse must suspect the patient to have

A. Anemia
B. Leukemia
C. Thrombocytopenia
D. Polycythemia

ANSWER A. Low Hgb/Hct leads to anemia. Anemia can be caused by blood loss, decreased blood cell
production, increased blood cell destruction, and hemodilution.

43. The blood cells that are high in the event that the patient is suffering from an allergic reaction would
be

A. Basophils
B. Eosinophils
C. Neutrophils
D. Both a and b

ANSWER D. It can be caused by infections, severe allergies, or an overactive thyroid gland.

44. A 7-year-old patient was admitted to the hospital for suspected dengue fever. The complete blood
count shows that the patient has a platelet count of 20,000 cells per mm3. The nurse interprets this as

A. Neutropenia
B. Thrombocytopenia
C. Leukopenia
D. Anemia

ANSWER B. Thrombocytopenia is a condition in which you have a low blood platelet count. Platelets
(thrombocytes) are colorless blood cells that help blood clot. Platelets stop bleeding by clumping and
forming plugs in blood vessel injuries. Normal value of thrombocytes is at 150,000-450,000 cells per
mm3

45. The nurse has observed that in the patient’s CBC, the white blood cells of the patient is at 13000
cells per mm3. The patient might be having a/an

A. Anemia
B. Infection
C. Dengue hemorrhagic fever
D. Blood dyscrasia
ANSWER B. A high white blood cell count may indicate that the immune system is working to destroy an
infection. It may also be a sign of physical or emotional stress.

46. Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect
that the client is experiencing a myocardial infarction?

A. Midepigastric pain and pyrosis

B. Diaphoresis and cool clammy skin
C. Intermittent claudication and paloor
D. Jugular vein distention and dependent edema

ANSWER B. Diaphoresis is a systemic reaction to the MI. The body vasoconstricts to shunt blood from
the periphery to the trunk of the body; this in turn, leads to cold, clammy skin

47. The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to
the bathroom. Which action should the nurse implement first?

A. Administer sublingual nitroglycerin

B. Obtain a stat 12 Lead ECG
C. Have the client sit down immediately
D. Assess the client's vital signs

ANSWER C. Stopping all activity will decrease the need of the myocardium for oxygen and may help
decrease the chest pain.

48. The client who has had a myocardial infarction is admitted to the telementry unit from intensive
care. Which referral would be most appropriate for the client?

A. Social worker
B. Physical therapy
C. Cardiac rehabilitation
D. Occupation therapy

ANSWER C. Cardiac rehabilitation is the most appropriate referral. The client can start rehabilitation in
the hospital and then attend an outpatient cardiac rehabilitation clinic, which includes progressive
exercises, diet teaching, and classes on modifying risk factors.

49. The client is one day postoperative coronary artery bypass surgery. The client complains of chest
pain. Which intervention should the nurse implement first?

A. Medicate the client with intravenous morphine

B. Assess the client's chest dressing and vital signs
C. Encourage the client to turn from side to side
D. Check the client's telemetry monitor

ANSWER B. The nurse must always assess the client to determine if the chest pain that is occurring is
expected post-operatively or if it is a complication of surgery.
50. The client diagnosed with a myocardial infarction is six hours post-right femoral percutaneous
transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data would
require immediate intervention by the nurse?

A. The client is keeping the affected extremity straight

B. The pressure dressing to the right femoral area is intact
C. The client is complaining of numbness in the right foot
D. The client's right pedal pulse is +3 and bounding

ANSWER C. Any neurovascular assessment data that is abnormal requires intervention by the nurse;
numbness may indicate decreased blood flow to the right foot

51. The intensive care department nurse is assessing the client who is 12 hours post-myocardial
infarction. The nurse assesses an S3 heart sound. Which intervention should the nurse implement?

A. Notify the health-care provider immediately

B. Elevate the head of the client's bed
C. Document this as a normal and expected finding
D. Administer morphine intravenously

ANSWER A. An S3 indicates left ventricular failure and should be reported to the healthcare provider. It
is a potentially life threatening complication of a myocardial infarction

52. The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial
infarction. Which assessment data would cause the nurse to question administering this medication?

A. The client's apical pulse is 64

B. The client's calcium level is elevated
C. The client's telemetry shows occasional PVCs
D. The client's blood pressure is 90/62

ANSWER D. The client's blood pressure is low, and a calcium channel blocker could cause the blood
pressure to bottom out.

53. In Schilling test, this is done by

A. Letting the patient take radioactive iodine

B. Letting the patient take radioactive vitamin B12
C. Letting the patient take radioactive folic acid
D. Letting the patient take radioactive intrinsic factor

ANSWER B. This test is divided into 2 main stages. The patient is given radiolabeled vitamin B12 orally,
following an intramuscular (IM) dose of unlabeled vitamin B12 one hour later. The injection is given to
ensure that none of the radioactive B12 binds to any vitamin B12 depleted tissues, for example, the
liver.

54. Under production of the intrinsic factor can cause malabsorption of which of the following?

A. Vitamin B6
 B. Vitamin B1
C. Vitamin B12
D. Vitamin B2

ANSWER C. Intrinsic factor is a glycoprotein secreted by parietal (humans) or chief (rodents) cells of the
gastric mucosa. In humans, it has an important role in the absorption of vitamin B12 (cobalamin) in the
intestine, and failure to produce or utilize intrinsic factor results in the condition pernicious anemia.

55. The administration of folic acid for megaloblastic anemia would be

A. 1 gram daily
B. 10 mg daily
C. 100 mg daily
D. 1 mg daily

ANSWER D. Folate deficiency is treated by increasing the amount of folic acid in the diet and
administering 1 mg of folic acid daily.

56. For vegetarians suffering from megaloblastic anemia the nurse must teach the patient to take

A. Vitamin B12 supplements

B. Iron supplements
C. Vitamin C supplements
D. Taking intrinsic factor through IV

ANSWER A. Vegetarians can prevent or treat deficiency with oral supplements through vitamins or
fortified soy milk.

57. Patients with megaloblastic anemia may have difficulty maintaining which of the following

A. Speech
B. Hearing
C. Balance
D. Erection

ANSWER C. The nurse needs to pay particular attention to ambulation and should assess the patient’s
gait and stability as well as the need for assistive devices (eg, canes, walkers) and for assistance in
managing daily activities.

58. Which individuals would the nurse identify as having the highest risk for CAD?

A. A 45-year-old depressed male with a high-stress job

B. A 60-year-old male with below normal homocysteine levels
C. A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels
D. A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2

ANSWER A. The 45-year-old depressed male with a high-stress job is at the highest risk for CAD. Studies
demonstrate that depression and stressful states can contribute to the development of CAD. Elevated
HDL levels and low homocysteine levels actually help to prevent CAD. Although a sedentary lifestyle is a
risk factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient with two risk factors is at
greatest risk for developing CAD.

59. When providing nutritional counseling for patients at risk for CAD, which foods would the nurse
encourage patients to include in their diet (select all that apply)?

A. Tofu
B. Walnuts
C. Tuna fish
D. All of the above

ANSWER D. Tuna fish, tofu, and walnuts are all rich in omega-3 fatty acids, which have been shown to
reduce the risks associated with CAD when consumed regularly.

60. When planning emergent care for a patient with a suspected MI, what should the nurse anticipate
administrating?

A. Oxygen, nitroglycerin, aspirin, and morphine

B. Oxygen, furosemide (Lasix), nitroglycerin, and meperidine
C. Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen
D. Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)

ANSWER A. Oxygen, nitroglycerin, aspirin, and morphine. The American Heart Association's guidelines
for emergency care of the patient with chest pain include the administration of oxygen, nitroglycerin,
aspirin, and morphine. These interventions serve to relieve chest pain, improve oxygenation, decrease
myocardial workload, and prevent further platelet aggregation. The other medications may be used
later in the patient's treatment.