Competency Appraisal 504n

Proficiency Test – Answer key

Situation: The Philippines is composed of a majority of young population. An increase of the

incidence of communicable disease is commonly observed among countries with young
population. Communicable disease prevention program is an important function of the public
health nurse in improving the quality of life.
1. When providing nursing intervention for preventing injury when a rabid patient is in convulsion, you tell
the family or watcher to:
a. Call you when patient is in convulsion
b. Give sedatives so patient can sleep
c. Stay with patient all the time
d. Restraint the patient and ring the bell
Answer: C

2. Jabog was bitten by a dog. You interviewed Jabog and his father to take the history before seeing a doc-
tor. You told Jabog’s father not to kill the dog because the dog will be:
a. Given a vaccine
b. Confined
c. Observed for 10 days
d. Be examined
Answer: C

3. Malaria can be prevented by the following except:

a. Avoiding outdoor night time activities
b. Use of mosquito repellants
c. Planting of herbal plants which can be mosquito repellants
d. Spending leisure time in the forest
Answer: D

4. Which of the following is the diagnostic test for H-fever?

a. Rumple leads test
b. Malarial smear
c. Immunochromatographic test
d. Nocturnal blood exam

5. In doing a tourniquet test, how would petechiae be considered positive

a. 10 b. 20 c. 30 d. 5
Answer: B

6. In a patient with dengue fever, which f the following will you give the patient as part of the nursing in-
tervention?
a. Water and salt solution
b. Oresol
c. Saline solution
d. IV fluids
Answer: B

7. Tina, 3 year old came to the RHU due to unresponsiveness to antibiotics. She showed her strawberry
tongue. Which among the following syndrome is her diagnosis?
a. Nagasaki fever
b. Typhoid fever
c. Kawasaki fever
d. H-fever
Answer: C

8. Treatment of leptospirosis is symptomatic but this drug is prescribed at 200mg orally once a week for
prevention. What is the drug of choice?
a. Doxycycline c. Chloramphenicol
b. Rifampicin d. Ziduvodin
Answer: A

9. What is the mode of transmission of leptospirosis?

 a. Open skin contact
b. Sexually transmitted
c. Contaminated food
d. Droplet
Answer: A

10. The drug of choice or the treatment of Anthrax is:

a. Aspirin c. Dilantin
b. Penicillin d. Accutane
Answer: B

11. In the critical stage of anthrax, what is the most appropriate nursing intervention?
a. Infuse IV fluids
b. Bring the patients to the hospital
c. Institute isolation technique
d. Use respiratory precautions
Answer: C

12. Leprosy has been a public health problem in the Philippines. The following are early signs and symptoms
except:
1. Change of skin color
2. Loss of sensation on skin lesion
3. Loss of eyebrow
4. Ulcers that do not heal
a. 1, 2 c. 4
b. 3 d. 2, 4
Answer: B

13. The recent incident of SARS is classified as:

a. Endemic c. Epidemic
b. Pandemic d. Sporadic
Answer: A

14. The occurrence of a particular disease beyond the immunizable population is:
a. Endemic c. Sporadic
b. Epidemic d. Pandemic
Answer: B

Situation: TB has been declared emergency in 1993 by the WHO.

15. DOTS is a comprehensive strategy to detect and cure TB. The primary element of DOTS is?
a. Health workers counsel and observes their patients swallow each anti-TB medication and monitor
progress until cures
b. Regular drug supply
c. Political will in terms of manpower and funding
d. Sputum microscopy services
Answer: A

16. In TB control program DOH has specific objectives, one on prevention programs, which is focused on
children. Which one below is this program?
a. Sputum collection and examination
b. Tuberculin skin testing
c. EPI for BCG vaccine
d. Maternal and child health nursing
Answer: C

17. The source of infection in PTB is through which of the following?

a. Contamination of potable water
b. Direct contact with infected person
c. Crowded living patterns
d. Sexual intercourse
Answer: B

18. Category I of the TB treatment regimen is prescribed to the following but:

a. New pulmonary TB patient sputum positive
b. Seriously ill patient with form of smear-negative TB with extensive parenchyma involvement
 c. Seriously ill patient with form of extra pulmonary TB
d. Previously treated patient classified as relapse and failure
Answer: B

19. Which of the following statements primary preventive measure for PTB?
a. Provide public health nursing outreach services
b. BCG vaccination of newborn and in grade 1 school entrants
c. Make available medical lab and x-ray facilities
d. Educate the public in mode of spread and methods of control
Answer: A

20. TB ranks fifth in the leading cause of morbidity and mortality recognizes that the most hazardous form
for development of critical diseases is:
a. 1 year c. 3 months
b. 2 ½ years d. 6-12 months
Answer: D

21. Incubation period of SARS

a. 2-8 days c. 1-10 days
b. 5-11 days d. 1-5 days
Answer: A

22. The following countries where SARS originated includes the following except:
a. China c. Philippines
b. Canada d. Australia
Answer: C

23. What is the causative agent of SARS?

a. Corona virus c. Rhabdo virus
b. Retro virus d. Influenza virus
Answer: A

24. This is the study of distribution of disease or physiologic condition among the population and the factors
affecting such distribution?
a. Epidemic c. Epidemiology
b. Pandemic d. Endemic
Answer: C

25. The following are epidemiological triad except for:

a. Environment c. Host
b. People d. Agent
Answer: B

The following questions pertain to the concept in the Disturbances in Perception and Coordination.
(For Items No. 26-50)

26. The relay center for sensory impulses is the

a. Thalamus c. Hypothalamus
b. Cerebellum d. Medulla oblongata

27. An indication of parasympathetic dominance in a client under stress would be:

a. Constipation
b. Goose pimples
c. Excess epinephrine secretions
d. Increased gastrointestinal secretion

28. The nurse understands that hemiplegia involves:

a. Paresis of both extremities
b. Paralysis of one side of the body
c. Paralysis of both lower extremities
d. Paralysis of both upper and lower extremities
29. An over exercised muscle that has an insufficient oxygen supply may become sore from a
build-up of:
a. Acetone c. Butyric acid
b. Lactic acid d. Acetoacetic acid

30. Stimulation of the vagus nerve result in:

a. Tachycardia
b. Slowing of the heart
c. Dilation of the bronchioles
d. Coronary artery vasodilation

31. A feeling of pleasantness or unpleasantness, varying in degree from mild to intense, occurs
when sensory impulses reach the:
a. Thalamus c. Hypothalamus
b. Basal ganglia d. Cerebral cortex

32. A client has dilated right pupil. The nurse understands that this adaptation is related to the:
a. Second cranial nerve
b. Third cranial nerve
c. Fourth cranial nerve
d. Seventh cranial nerve

33. The mouth of a client sustained trauma to the face, is drawn over the left. This suggests injury
to the:
a. Left facial nerve
b. Right facial nerve
c. Left abducent nerve
d. Right trigeminal nerve

34. A physician performs a lumbar puncture. To do this procedure, the physician m ust insert a
needle into the:
a. Pia matter c. Aqueduct of sylvius
b. Foramen ovale d. Subarachnoid space

35. After a brain attack a client remains unresponsive to sensory stimulation the lobe of the
cerebral cortex that registers general sensations such as heat, cold, pain, and touch is:
a. Frontal lobe c. Occipital lobe
b. Parietal lobe d. Temporal lobe

36. Cold applications for short periods of time produce:

a. Local anesthesia
b. Peripheral vasodilation
c. Depression of vital signs
d. Constriction of pupils

37. A procedure done to relieve intractable pain in the upper torso is a:

a. Rhizotomy c. Cordotomy
b. Rhinotomy d. Chondrectomy

38. After abdominal surgery a client complaints of pain. The first action by the nurse should be to:
a. Reposition the patient
b. Monitor the vital signs
c. Administer the ordered analgesic
d. Determine the characteristics of pain

39. The nurse assists the physician in performing a lumbar puncture. When pressure is placed on
the jugular vein during a lumbar puncture, there is normally a rise in the spinal fluid pressure. This
is referred to as:
a. Homan’s sign c. Chvostek’s sign
 b. Romberg’s sign d. Queckenstedt’s sign

40. The nurse would recognize that further teaching is need when a client with glaucoma states, “It
would be dangerous for me to:
a. Use any sedatives.”
b. Become constipated.”
c. Lift any heavy objects.”
d. Use atropine in any form.”

41. A client with glaucoma should be advised to:

a. Take laxatives daily
b. Use eyewashes on a regular basis
c. Keep an extra supply of eye medication on hand
d. Have corrective lens prescriptions checked every 3 months

42. When caring for a client with primary closed-angle glaucoma, the nurse should understand that
the goal of the therapy is:
a. Dilating the pupil
b. Resting the eye muscles
c. Controlling intraocular pressure
d. Preventing secondary infections

43. The first symptom of a client with open-angle glaucoma is most likely to exhibit is:
a. Constant blurred vision
b. Sudden attacks of acute pain
c. Impairment of peripheral vision
d. A sudden, complete loss of vision

44. A cataract is:

a. An opacity of the lens
b. A thin film over the cornea
c. A crystallization of the pupil
d. An increase in the density of the conjunctiva

45. After a client has cataract surgery, the nurse should:

a. Instruct the client to avoid driving for 2 weeks
b. Teach the client coughing and deep-breathing exercises
c. Encourage eye exercises to strengthen the ocular musculature
d. Advise the client to refrain from vigorous brushing of teeth and hair

46. When a client with detached retina asks about the condition, the nurse should explain that
retinal detachment is a:
a. Consequence of optic-retinal atrophy
b. Degeneration of the choroid and optic chiasm
c. Division between the photoreceptor and neural layers of the retina
d. Separation between the sensory portion of the retina and the pigment layer

47. The goal of surgery for the treatment of detached retina is to:
a. Promote growth of new retinal cells
b. Adhere the sclera of the choroid layer
c. Graft a healthy piece of retina to place
d. Create a scar that aids in healing retinal holes

48. The earbones that transmit vibrations to the oval window of the cochlea are found in the:
a. Utricle c. Middle ear
b. Cochlea d. Eustachian tube

49. Otosclerosis is a common cause of conductive hearing loss. With such a partial hearing loss:
a. Stapedectomy is the procedure of choice
 b. Hearing aids usually restore some hearing
c. The client is usually unable to hear bass bones
d. Air conduction is more effective than bone conduction

50. A client who complaints of tinnitus is describing a symptom that is:

a. Objective c. Functional
b. Subjective d. Prodromal

The following questions pertain to the concept in the Disturbances in Cellular Functioning. (For
Items No. 51-75)

51. Which of the following instructions should be included in the teaching for the client with rheumatoid
arthritis?
A. Avoid exercise because it fatigues the joints
B. Take prescribed anti-inflammatory medications with meals
C. Alternate hot and cold packs to affected joints
D. Avoid weight-bearing activity

52. Damage to the VII cranial nerve results in:

A. Facial pain
B. Absence of ability to smell
C. Absence of eye movement
D. Tinnitus

53. Acticoat (silver nitrate) dressings are applied to the legs of a client with deep partial thickness
burns. The nurse should:
A. Change the dressings once per shift
B. Moisten the dressing with sterile water
C. Change the dressings only when they become soiled
D. Moisten the dressing with normal saline

54. A client has been receiving Rheumatrex (methotrexate) for severe rheumatoid arthritis. The nurse
should tell the client to avoid taking:
A. Aspirin
B. Multivitamins
C. Omega 3 fish oils
D. Acetaminophen

55. A diagnosis of multiple sclerosis is often delayed because of the varied symptoms experienced by
those affected with the disease. Which symptom is most common in those with multiple sclerosis?
A. Resting tremors
B. Double vision
C. Flaccid paralysis
D. “Pill-rolling” tremors

56. The physician has ordered a low purine diet for a client with gout. Which protein source is high in
purine?
A. Dried beans
B. Nuts
C. Cheese
D. Eggs
57. A client with myasthenia gravis is admitted in a cholinergic crisis. Signs of cholinergic crisis include:
A. Decreased blood pressure and constricted pupils
B. Increased heart rate and increased respirations
C. Increased respirations and increased blood pressure
D. Anoxia and absence of the cough reflex

58. A client has a tentative diagnosis of myasthenia gravis. The nurse recognizes that myasthenia
gravis involves:
A. Loss the myelin sheath in portions of the brain and spinal cord
B. An interruption in the transmission of impulses from nerve endings to muscles
C. Progressive weakness and loss of sensation that begins in the lower extremities
 D. Loss of coordination and stiff “cogwheel” rigidity

59. The physician has ordered a lumbar puncture for a client with suspected Guillain-Barre syndrome.
The spinal fluid of a client with Guillian-Barre syndrome typically shows:
A. Decreased protein concentration with a normal cell count
B. Increased protein concentration with a normal cell count
C. Increased protein concentration with an abnormal cell count
D. Decreased protein concentration with an abnormal cell count

60. The nurse is formulating a plan of care for a client with a goiter. The priority nursing diagnosis for
the client with a goiter is:
A. Body image disturbance related to enlargement of the neck
B. Activity intolerance related to fatigue
C. Nutrition imbalance, less than body requirements , related to increased metabolism
D. Risk for ineffective airway clearance related to pressure of goiter on the trachea

61. The nurse is caring for a client with rheumatoid arthritis. The nurse knows that the client’s
symptoms will be most improved by:
A. Taking a warm shower upon awakening
B. Applying ice packs to the joints
C. Taking two aspirin before going to bed
D. Going for an early morning walk

62. The nurse is caring for a client with Guillain-Barre Syndrome. Which of the following
would indicate the client’s condition is deteriorating?
A. Weakness and Paresthesia
B. Pain and Muscle aches
C. Urinary Retention
D. Respiratory Infection

63. A nurse is receiving a client in transfer from the emergency room who has a diagnosis of
Guillain-Barre syndrome. The client’s chief complaint is an ascending paralysis that has
reached the level of the waist. The nurse plans to have which item available for emergency
use?
A. Cardiac monitor and intubation tray
B. Blood pressure cuff and flashlight
C. Nebulizer and pulse oximeter
D. Flashlight and incentive spirometer

64. What does the nurse understand that clients with myasthenia gravis, Guillain-Barre syn-
drome, and amyotrophic lateral sclerosis share in common?
A. Progressive deterioration until death
B. Deficiencies of essential neurotransmitters
C. Increased risk for respiratory complications
D. Involuntary twitching of small muscle groups

65. What nursing intervention is anticipated for a client in the plateau phase of Guillain
Barre syndrome?
A. Providing a straw to stimulate the facial muscles
B. Inserting an indwelling catheter to monitor urinary output
C. Encouraging aerobic exercises to avoid muscle atrophy
D. Administering antibiotic medication to prevent pneumonia
66. The client comes to the emergency department with weakness that has been progress-
ing upward in both legs for two days. The nurse, suspecting Guillain-Barré syndrome, be-
gins care by doing which of the following? Select all that apply.
1. Taking medical history, noting recent viral influenza
2. Giving the client orange juice for fatigue and low blood glucose
3. Assessing neurological and respiratory function
4. Evaluating for petit malseizures
5. Assessing vital signs
A. 1,3,5 C. 1,2,4
B. 2,3,4 D. 3,4,5
67. The nurse implements which of the following interventions in the plan of care for a client
with hypothyroidism?
A. Applying lotion for skin care
B. Providing a cool temperature in the room
C. Scheduling periods of test
D. Administering p.r.n. medication for diarrhea

68. The nurse is caring for a client with myxedema. Which of the following would indicate to
the nurse that the client’s condition is deteriorating?
A. An increase in pulse rate and respirations
B. Cold skin and episodes of chills
C. Difficulty in arousing the client for medications
D. Client complaints of palpitations

69. The nurse instructs a client who has been prescribed Lugol’s solution to notify the physi-
cian if which of the following occurs?
A. Blurred Vision
B. Weight Gain
C. Increased Urinary Output
D. Brassy taste in mouth

70. Oral levothyroxine (synthroid) daily is prescribed for a client with hypothyroidism. The
nurse provides medication instructions to the client and tells the client to take the medica-
tion:
A. Just after breakfast
B. With a snack at 3:00pm
C. In the morning on an empty stomach
D. With food

71. The nurse is assessing a client with a diagnosis of hypothyroidism. Which adaptation
should the nurse expect this client to exhibit?
A. Dry skin C. Resting tremors
B. Weight loss D. Heat intolerance

Situation: To gain insight into immunologic disorders the nurse needs a sound knowledge to
assess and care for clients with dysfunction in immune system.
72. The administration of weak or attenuated microorganisms to stimulate the production of antibodies
without causing a full-blown disease is referred to as:
A. active naturally acquired immunity
B. active artificially acquired immunity
C. passive natural immunity
D. passive artificial immunity

73. The nurse demonstrates understanding of natural immunity when he makes which of the following
statements?
A. “Breastfeeding is the best way to enhance the infant’s immunity.”
B. “Timely vaccination could easily provide protection from hepatitis.”
C. “The skin provides the first line of defense in warding off disease.”
D. “Administration of human immune globulins boosts the immunity.”

74. Before administering antibodies against tetanus, which of the following patient statements would
indicate a need for further nursing assessment?
A. “I have reactions to horse serum.”
B. “I cannot have any seafood.”
C. “I have lactose intolerance.”
D. “I do not like eggs.”

75. The patient is newly diagnosed with an autoimmune thyroid disease. When the nurse discusses the
patient’s asks, “What did the physician mean by autoimmune disease?” The nurse appropriately re-
sponds:
A. “The body’s immune defenses fail to respond to the pathogenic agents.”
B. “Immune defenses are attacking the normal body cells.”
C. “There is a break in the body’s defenses.”
 D. “The physician was able to identify the underlying cause of the disorder.”

The following questions pertain to the concept in the Disturbances in Acute Biologic Crisis & Emergency & Disaster
Nursing. (For Items No. 76-100)

76. Mr. A. is admitted into the emergency department with diaphoresis, pale, clammy skin, and BP of 120/80. Thirty
minutes later the client’s B/P is 90/70. Which intervention should the nurse implement first?
a. Start an IV with an 18-gauge catheter.
b. Administer dopamine intravenous infusion.
c. Obtain arterial blood gases (ABGs).
d. Insert an indwelling urinary catheter

77. Which assessment data would warrant immediate intervention for the client diagnosed with septic shock?
e. Vital signs T 100.4°F, P 104, R 26, and BP 102/60.
f. A white blood cell count of 18,000 mm.
g. A urinary output of 90 mL in the last four (4) hours.
h. The client complains of being thirsty

78. Mr. B. diagnosed with septicemia has the following orders. Which order has the highest priority?
i. Provide clear liquid diet.
j. Initiate IV antibiotic therapy.
k. Obtain a STAT chest x-ray.
l. Perform hourly blood sugar checks.

79. Mrs. C. is diagnosed with neurogenic shock. Which signs/symptoms would the nurse assess in this client?
m. Cool moist skin c. Wheezing.
n. Bradycardia d. Decreased bowel sounds.

80. The nurse in the emergency department administered an intramuscular antibiotic in the left gluteal muscle to the
client with pneumonia who is being discharged home. Which intervention should the nurse implement?
o. Ask the client about drug allergies.
p. Obtain a sterile sputum specimen.
q. Have the client wait for 30 minutes.
r. Place a warm washcloth on the client’s left hip.

81. The nurse caring for a client with sepsis writes the client diagnosis of “alteration in comfort R/T chills and fever.”
Which intervention should be included in the plan of care?
s. Ambulate the client in the hallway every shift.
t. Monitor urinalysis, creatinine level, and BUN levels.
u. Apply sequential compression devices to the lower extremities.
v. Administer an antipyretic medication every four (4) hours PRN.

82. The nurse and an unlicensed nursing assistant are caring for a group of clients on a medical floor. Which action
by the assistant would warrant immediate intervention by the nurse?
w. The assistant places a urine specimen in a biohazard bag in the hallway.
x. The assistant uses the alcohol foam hand cleanser after removing gloves.
y. The assistant puts soiled linen in a plastic bag in the client’s room.
z. The assistant obtains a stethoscope for a client in an isolation room.

83. The elderly female client with vertebral fractures who has been self-medicating with ibuprofen, a nonsteroidal anti-
inflammatory drug (NSAID), presents to the emergency department complaining of abdominal pain; is pale, clammy,
and has a P 110 and a BP of 92/60. Which type of shock would the nurse suspect?
aa.Cardiogenic shock c. Neurogenic shock.
bb.Hypovolemic shock d. Septic shock.

84. The client has recently experienced a myocardial infarction. Which action by the nurse would help prevent
cardiogenic shock?
cc. Monitor the client’s telemetry.
dd.Turn the client every two (2) hours.
ee.Administer oxygen via nasal cannula.
ff. Place the client in the Trendelenburg position.

85. The client diagnosed with septicemia is receiving a broad-spectrum antibiotic. Which laboratory data require the
nurse to notify the physician?
gg.The client’s potassium level is 3.8 mEq/L.
 hh.The urine culture indicates high sensitivity to the antibiotic.
ii. The client’s pulse oximeter reading is 94%.
jj. The culture and sensitivity is resistant to the client’s antibiotic.

SITUATION: Kendall is a teacher, was rushed to the hospital due to burns sustained from a
burning building.
86. Ms. Kylie, the ER nurse attended to the client. The initial nursing management is to:
a. Administer oxygen inhalation
b. Apply furacin ointment over the burned surface
c. Check the vital signs
d. Assess airway, breathing and circulation

86. Applying the “rule of nine’s” which part has the largest percentage of burns?
a. Upper trunk
b. Left thigh and face
c. Right upper arms and neck
d. Face and neck

87. Looking at her client, Ms. Judy was able to identify fluid deficit: nursing assessment indicating fluid
deficit are the following except:
a. Oliguria c. Cystitis
b. Hypovolemic shock d. Cardiogenic shock

88. Kendall’s condition was referred to the attending physician, IV fluids were ordered. The purpose of
fluids requirements is to prevent:
a. Oliguria c. Cystitis
b. Hypovolemic shock d. Cardiogenic shock

89. The primary purpose for the insertion of Foley bag catheter to Kendall is to:
a. Prevent bladder distention
b. Determine accurate workout of the kidney
c. Obtain urine specimen
d. Assure accurate urinary output measurements

90. A patient is hemorrhaging from multiple trauma sites. The nurse expects that compensatory mechanisms
associated with hypovolemia would cause all of the following symptoms EXCEPT

A. hypertension
B. oliguria
C. tachycardia
D. tachypnea

Answer: (A) hypertension

in hypovolemia, one of the compensatory mechanisms is activation of the sympathetic nervous system that
increases the RR & PR and helps restore the BP to maintain tissue perfusion but not cause a hypertension.
The SNS stimulation constricts renal arterioles that increases release of aldosterone, decreases glomerular
filtration and increases sodium & water reabsorption that leads to oliguria.

91. A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The
nurse assesses that the client has entered the second phase of acute renal failure. Nursing actions throughout
this phase include observation for signs and symptoms of

A. Hypervolemia, hypokalemia, and hypernatremia.

B. Hypervolemia, hyperkalemia, and hypernatremia.
C. Hypovolemia, wide fluctuations in serum sodium and potassium levels.
D. Hypovolemia, no fluctuation in serum sodium and potassium levels.

Answer: (C) Hypovolemia, wide fluctuations in serum sodium and potassium levels.
The second phase of ARF is the diuretic phase or high output phase. The diuresis can result in an output of
up to 10L/day of dilute urine. Loss of fluids and electrolytes occur.
92. Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft.
When she arrives in the RR she is still in shock. The nurse’s priority should be:

A. placing her in a trendeleburg position

B. putting several warm blankets on her
C. monitoring her hourly urine output
D. assessing her VS especially her RR

Answer: (D) assessing her VS especially her RR

Shock is characterized by reduced tissue and organ perfusion and eventual organ dysfunction and failure.
Checking on the VS especially the RR, which detects need for oxygenation, is a priority to help detect its
progress and provide for prompt management before the occurrence of complications.

93. A major goal for the client during the first 48 hours after a severe bum is to prevent hypovolemic shock.
The best indicator of adequate fluid balance during this period is

A. Elevated hematocrit levels.

B. Urine output of 30 to 50 ml/hr.
C. Change in level of consciousness.
D. Estimate of fluid loss through the burn eschar.

Answer: (B) Urine output of 30 to 50 ml/hr.

Hypovolemia is a decreased in circulatory volume. This causes a decrease in tissue perfusion to the different
organs of the body. Measuring the hourly urine output is the most quantifiable way of measuring tissue
perfusion to the organs. Normal renal perfusion should produce 1ml/kg of BW/min. An output of 30-50
ml/hr is considered adequate and indicates good fluid balance.

94. Which is irrelevant in the pharmacologic management of a client with CVA?

A. Osmotic diuretics and corticosteroids are given to decrease cerebral edema

B. Anticonvulsants are given to prevent seizures
C. Thrombolytics are most useful within three hours of an occlusive CVA
D. Aspirin is used in the acute management of a completed stroke.

Answer: (D) Aspirin is used in the acute management of a completed stroke.

The primary goal in the management of CVA is to improve cerebral tissue perfusion. Aspirin is a platelet
deaggregator used in the prevention of recurrent or embolic stroke but is not used in the acute management
of a completed stroke as it may lead to bleeding.

95. Which of the following is the most common symptom of myocardial infarction (MI)?

1. Chest pain
2. Dyspnea
3. Edema
4. Palpitations

Answer: 1. The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the
heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the
body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result
from reduced cardiac output, producing arrhythmias.

96. Which of the following symptoms is the most likely origin of pain the client described as knifelike
chest pain that increases in intensity with inspiration?
1. Cardiac
2. Gastrointestinal
3. Musculoskeletal
4. Pulmonary

Answer: 4. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases
with movement. Cardiac and GI pains don’t change with respiration.

97. Which of the following complications is indicated by a third heart sound (S3)?

1. Ventricular dilation
2. Systemic hypertension
3. Aortic valve malfunction
4. Increased atrial contractions

Answer: 1. Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial
contraction or systemic hypertension can result in a fourth heart sound. Aortic valve malfunction is heard as
a murmur.

98. After an anterior wall myocardial infarction, which of the following problems is indicated by
auscultation of crackles in the lungs?

1. Left-sided heart failure

2. Pulmonic valve malfunction
3. Right-sided heart failure
4. Tricupsid valve malfunction

Answer: 1. the left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in
a decrease in left ventricular function. When the left ventricle doesn’t function properly, resulting in left-
sided heart failure, fluid accumulates in the interstitial and alveolar spaces in the lungs and causes crackles.
Pulmonic and tricuspid valve malfunction causes right sided heart failure.

99. What is the first intervention for a client experiencing MI?

1. Administer morphine
2. Administer oxygen
3. Administer sublingual nitroglycerin
4. Obtain an ECG

Answer: 2. Administering supplemental oxygen to the client is the first priority of care. The myocardium is
deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and
prevent further damage. Morphine and nitro are also used to treat MI, but they’re more commonly
administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.

100. Which of the following classes of medications protects the ischemic myocardium by blocking
catecholamines and sympathetic nerve stimulation?

1. Beta-adrenergic blockers
2. Calcium channel blockers
3. Narcotics
4. Nitrates
Answer: 1. Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the
response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to
reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers
reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand,
promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing
left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).