University of Cebu

College of Nursing

MEDICAL SURGICAL NURSING (NCM 112)

PRELIM EXAMINATION

Name: _________________________________________ Year/Sec:_____ Date:______Score:_______

ANSWER BOX

1. 26.
2. 27.
3. 28.
4. 29.
5. 30.
6. 31.
7. 32.
8. 33.
9. 34.
10. 35.
11. 36.
12. 37.
13. 38.
14. 39.
15. 40.
16. 41.
17. 42.
18. 43.
19. 44.
20. 45.
21. 46.
22. 47.
23. 48.
24. 49.
25. 50.

TEST 2:

ASSESSMENT

NURSING DIAGNOSIS

GOAL

INTERVENTIONS

EVALUATION
 University of Cebu – Banilad
College of Nursing

NCM 112 PRELIM EXAMINATION

NAME: _______________________________________ YR & SEC: ___________ DATE: _____________

Instructions: Please read the questions carefully. Write the CAPITAL LETTER of the choice that corresponds to your
answer on the answer box provided. NO ERASURES, ALTERATIONS OR SUPERIMPOSITION allowed.

1. The heart is within the

A. thoracic cavity. C. abdominal cavity. E. mediastinum and abdominal cavity.
B. mediastinum. D. mediastinum and thoracic cavity.

2. Which of these statements concerning the form and location of the heart are correct?
A. The apex is the most superior part of the heart.
B. The apex is directed to the left, and deep to the fifth intercostal space.
C. The base of the heart is directed inferior and slightly posterior.
D. The most superior part of the heart is deep to the 12th intercostal space.
E. Both the apex is the most superior part of the heart and the base of the heart is directed inferior and slightly posterior are correct.

3. The pericardium, or pericardial sac

A. is a double-layered, closed structure. C. has a tough fibrous connective tissue outer layer. E. has all of these characteristics.
B. anchors the heart in the mediastinum. D. has an inner layer of squamous epithelial cells.

4. A large groove that runs around the heart, and separates the atria from the ventricles is the
A. anterior interventricular septum. C. coronary sinus. E. cardiac fissure.
B. posterior interventricular septum. D. coronary sulcus.

5. Which of these statements about the coronary arteries is true?

A. The left coronary artery supplies the anterior wall of the heart and most of the left ventricle.
B. The right coronary artery supplies most of the right ventricle.
C. Blood flow through the coronary arteries is greatest during ventricular diastole (relaxation).
D. A heart attack occurs if a coronary artery is blocked.
E. All of these are true.

6. Which of these valves is found between the right atrium and the right ventricle?
A. tricuspid valve C. aortic semilunar valve E. interventricular septum
B. bicuspid (mitral) valve D. pulmonary semilunar valve

7. Papillary muscles are attached to the cusps of valves by thin, strong connective tissue strings called
A. the chordae tendineae. C. the auricles. E. the coronary sinus.
B. the interventricular septa. D. the interventricular sulcus

8. In a normal heart, when the right ventricle contracts, it forces blood through the
A. tricuspid valve. C. aortic semilunar valve.
B. bicuspid valve. D. pulmonary semilunar valve.

9. In a normal electrocardiogram (ECG or EKG),

A. the P wave results from repolarization of the atria.
B. the QRS complex results from depolarization of the ventricles.
C. the T wave represents repolarization of the ventricles.
D. during the P-R interval, the ventricles contract.
E. Both the QRS complex results from depolarization of the ventricles and the T wave represents repolarization of the ventricles are
correct relationships.

10.Which of these statements concerning the functional characteristics of the heart chambers is NOT correct?
A. During ventricular diastole, blood collects in the right and left atria.
B. At the very beginning of ventricular diastole, blood flows directly from the atria into the relaxed ventricles.
C. 70% of ventricular filling occurs before the atria contract.
D. During ventricular systole, the atrioventricular valves close.
E. During ventricular diastole, the semilunar valves open.

11. The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has symptoms of infective
endocarditis (IE). Which question by the nurse is most appropriate?
A. "Do you have a history of a heart attack?" C. "Have you had any recent immunizations?"
B. "Is there a family history of endocarditis?" D. "Have you had dental work done recently?"

12. A patient has severe aortic stenosis. When assessing the patient, which of these findings would be expected?
A. Hypertension C. Narrowed pulse pressure
B. Bounding pulses D. Diastolic murmur

13. A patient who had a mitral valve replacement with a prosthetic mechanical valve and is ready for discharge home. Which
information should the healthcare provider include in the discharge teaching for this patient? Select all that apply.
A. "Your valve will need to be replaced after 10 years."
B. "If you plan to become pregnant, be sure to consult your healthcare provider."
C. "You may need to take an antibiotic before certain medical or dental procedures."
D. “You will need to come in regularly for coagulation studies."
E. "Call our office immediately if you experience an infection of any kind."
14. A patient has a vegetative growth on the mitral valve which has caused the valve to become stenotic. This increases the risk of
which of the following problems? Select all that apply.
A. Atrial fibrillation C. Decreased peripheral pulses E. Pulmonary embolism
B. Orthopnea D. Stroke

15. A 75-year-old patient will be undergoing a mitral valve replacement for severe mitral stenosis. When reviewing the patient's chart,
which of these infectious diseases would likely be present in this patient's history?
A. Meningitis C. Rheumatic fever
C. Varicella (chicken pox) D. Haemophilus influenzae

16. A patient has been diagnosed with chronic mitral regurgitation. When interviewing the patient, which of these should the healthcare
provider expect the patient to report? Please choose from one of the following options.
A. Frequent dyspnea C. Occasional syncope
B. Swelling of the feet D. Insomnia 3 nights/week

17. Which of the following symptoms might a client with right-sided heart failure exhibit?
A. Adequate urine output C. Polyuria
B. Oliguria D. Polydipsia

18. A patient with longstanding valve disease requires a valve replacement. When discussing the differences between biological and
mechanical valves, what information should the healthcare provider include? Select all that apply.

A. Patients using mechanical valves experience less hemolysis of their red blood cells.
B. Biologic valves are commonly used for older patients because these valves are less durable.
C. Patients who have a biologic valve are at increased risk for thromboembolism.
D. Mechanical valves do not last as long as biologic valves.
E. Patients who have mechanical valves require long-term anticoagulant therapy.
F. The hemodynamics produced by biologic valves is superior to mechanical valves.

19. In a client with mitral regurgitation the nurse would expect to see which of the following signs and symptoms?
A. Crushing chest pain C. Exertional dyspnea
B. Elevated white blood cell count D. Low red blood cell count

20. Fluid retention and diminished heart function cause exertional dyspnea in clients with mitral regurgitation as heart failure worsens.
This is due to a rise in left atrial pressure and subsequent pulmonary and venous congestion.
Clients with mitral stenosis would likely manifest symptoms associated with congestion in the?
A. Pulmonary circulation C. Descending aorta
B. Bundle of His D. Superior vena cava

21. A 68 year-old client is admitted for mitral valve replacement surgery. The client has a history of mitral valve regurgitation and mitral
stenosis since her teenage years. During the admission assessment, the nurse should ask the client if as a child she had?
A. Encephalitis C. Hay fever
B. Measles D. Rheumatic fever

22. Clients that present with mitral stenosis have a history of rheumatic fever or bacterial endocarditis.
Plans for nursing interventions for a client in the acute stage of bacterial endocarditis should include which of the following
interventions?
A. Aggressive physical therapy C. Strict fluid restriction
B. Daily ECGs D. Administration of analgesics as needed

23. The patient had a history of rheumatic fever and has been diagnosed with mitral valve stenosis. The patient is planning to have a
biologic valve replacement. What protective mechanisms should the nurse teach the patient about using after the valve replacement?
A. Long-term anticoagulation therapy C. Antibiotic prophylaxis for dental care
B. Exercise plan to increase cardiac tolerance D. Take β-adrenergic blockers to control palpitations.

24. An 80-year-old patient with uncontrolled type 1 diabetes mellitus is diagnosed with aortic stenosis. When conservative therapy is no
longer effective, the nurse knows that the patient will need to do or have what done?
A. Aortic valve replacement C. Take nitroglycerin for chest pain.
B. Open commissurotomy (valvulotomy) procedure D. Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

25. A patient is diagnosed with mitral stenosis and new onset atrial fibrillation. which interventions could the nurse delegate to
unlicensed assistive personnel? (select all that apply)
A. obtain and record daily weight C. obtain and record vital signs, including pulse ox
B. determine apical-radial pulse rate D. observe for overt signs of bleeding

26. A patient with a history of coronary artery disease is being treated for a myocardial infarction (MI). During treatment, acute mitral
valve regurgitation occurs. What is the most likely cause of the acute mitral valve dysfunction?
A. Ventricular fibrillation C. Infective endocarditis
B. Rupture of the chordae tendineae D. Atherosclerosis

27. The healthcare provider is caring for a patient with a systolic heart murmur. Which of these valve disorders are associated with a
systolic murmur?
A. Aortic and tricuspid stenosis C. Pulmonic regurgitation and tricuspid stenosis
B. Aortic stenosis and mitral regurgitation D. Pulmonic and mitral regurgitation

28. The healthcare provider is monitoring the pulmonary capillary wedge pressures (PCWP) of a patient with severe mitral stenosis and
regurgitation. What information will the pulmonary capillary wedge pressures provide?
A. Peripheral arterial pressure C. Arterial oxygen pressure
B. Right ventricular function D. left atrial pressure
29. A patient who has a diagnosis of mitral valve stenosis is admitted to the hospital. Which of these findings indicate the patient is
experiencing a serious complication from this valve disorder?
A. Left hemiparesis and visual changes C. Hypotension and syncope
B. Intermittent claudication D. Sudden onset of dyspnea

30. When caring for a patient with mitral insufficiency, which of these sounds would the healthcare provider expect to auscultate? Select
all that apply.
A. Transient pericardial friction rub C. Thrill over the second to third intercostal spaces
B. Murmur at the fifth intercostal space at the midclavicular line D. Holostystolic (pansystolic) murmur
E. Musical crescendo-decrescendo murmur

31. A patient is hospitalized with infective endocarditis and develops sharp left flank pain and hematuria. The nurse notifies the
physician, recognizing that these symptoms may indicate:
A. Vegetative embolization to the kidneys.
B. Colonization of microorganization in the kidneys.
C. Septicemia resulting in decreased urine output.
D. Hemolysis of red blood cells by microorganisms.
E Vegetative embolization to the kidneys.

32. The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis. A
significant finding that constitutes a risk factor for infective endocarditis in this patient is a history of a recent
A. myocardial infarction. C. professional teeth cleaning.
B. streptococcal pharyngitis. D. viral upper respiratory infection.

33. The physician writes the following admitting orders for a patient with suspected infective endocarditis who has fever and chills:
ceftriaxone (Rocephin) 1.0 g IVPB q12hr, ASA for temperature above 102° F (38.9° C), and blood cultures x 3, CBC, SMAC, and ECG.
When admitting the patient, the nurse gives the highest priority to
A. scheduling the ECG. C. obtaining the blood cultures.
B initiating the IV antibiotic. D. administering the antipyretic agent.

34. During the assessment of a patient with systemic infection resulting to infective endocarditis, the nurse would expect to find
A. a new regurgitant murmur. C. dyspnea and a dry, hacking cough.
B. splinter hemorrhages of the lips. D. substernal chest pain and pressure.

35. A patient hospitalized with infective endocarditis develops sharp left flank pain and hematuria. The nurse notifies the physician,
recognizing that these symptoms may indicate
A. bacterial colonization in the kidneys. C. septicemia resulting in decreased glomerular blood flow.
B. vegetative embolization to the kidneys. D. hemolysis of red blood cells by hemolytic microorganisms.

36. A patient is admitted to the hospital with possible acute pericarditis. The nurse explains to the patient that to confirm a diagnosis of
acute pericarditis, the physician will most likely use
A. multiple ECGs. C. cardiac catheterization.
B. daily blood cultures. D. fluid obtained by pericardiocentesis.

37. The nurse suspects the development of cardiac tamponade in a patient with acute pericarditis upon finding
A. increased systolic BP. C. a pulsus paradoxus of 8 mm Hg.
B. jugular vein distention. D. increased systolic blood pressure with widening pulse pressure.

38. Cardiac tamponade is suspected in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse
should
A. subtract one-third of the diastolic blood pressure from the systolic blood pressure.
B. auscultate for a pericardial friction rub that increases in volume during inspiration.
C. evaluate the rhythm of the pulse in relation to the patient's inspiration and expiration.
D. note the first Korotkoff sound occurring during both inspiration and expiration, while deflating the blood pressure cuff.

39. The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. The
most appropriate intervention by the nurse for this problem is to
A. force fluids to 3000 ml/day to decrease fever and inflammation.
B. teach the patient to take deep, slow respirations to control the pain.
C. position the patient in Fowler's position, leaning forward on a padded overbed table.
D. consult with the physician to provide patient-controlled analgesia (PCA) with a narcotic analgesic.

40. The nurse establishes the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge
concerning long-term management of rheumatic fever when a patient recovering from rheumatic endocarditis says
A. "I will have to take prophylactic antibiotics for years, perhaps indefinitely."
B. "I know I should see my physician if I develop excessive fatigue or difficulty breathing."
C. "I should avoid contact with school-aged children and persons with upper respiratory infections."
D. "My monthly antibiotic injection will protect me during any invasive procedures I need to have performed."

41. The nurse establishes a nursing diagnosis of pain related to decreased coronary blood flow while caring for a patient with aortic
stenosis. An appropriate intervention by the nurse is to
A. promote rest to decrease myocardial oxygen demand.
B. consult with the physician about the use of nitroglycerine.
C. monitor peripheral pulses to detect peripheral embolization.
D. elevate the head of the bed 40 degrees to decrease venous return.

42. During postoperative teaching with a patient who has had a mitral valve replacement with a mechanical valve, the nurse instructs
the patient regarding
A. the need to avoid high-voltage electrical fields.
B. the need for anticoagulation therapy for the duration of the valve.
C. the probability that the valve will need to be replaced in 7 to 10 years.
D. the need to check the pulse daily to determine the functioning of the valve.
43. A client with mitral stenosis presents to the clinic for a follow-up visit. What clinical manifestation alerts you to the possibility that the
client may be experiencing a worsening of this condition?
A. The client's oxygen saturation is 92%. C. The client has a systolic crescendo-decrescendo murmur .
B. The client has an irregular heart rate and rhythm. D. The client experiences a loss of strength in the upper extremities.

44. A client has been diagnosed with aortic stenosis. What alteration in the client's vital signs would you expect to find upon
assessment?
A. A bounding arterial pulse C. A narrowed pulse pressure
B. A slow, faint arterial pulse D. An elevated systolic and diastolic pressure

45. The client who has had a valve replacement asks you why he must take anticoagulants for the rest of his life. What is your best
response?
A. "You are now at greater risk for a heart attack, and the anticoagulants can reduce that risk."
B. "Blood clots form more easily on replacement valves and areas inside the heart where stitches have been placed."
C. "The vein taken from your leg reduces circulation in the leg, making blood return to the heart much slower."
D. "The surgery left a lot of small clots in your heart and lungs; the anticoagulants will slowly dissolve these unnecessary clots."

Situation: Caoimhe a normally fit Irish girl, aged 10 years, presented to her community clinic with a 1-week history of fever, worsening
breathlessness and nausea leading to loss of appetite. She had upper respiratory infection with a sore throat about 3 weeks ago. On
clinical examination, she was sweating, tachycardic and a murmur of grade 3/6 was noted. She also stated she had a sore throat 3
months previously, which was dismissed as trivial due to its intermittent nature. Her mother highlighted a rash on the upper aspects of
both thighs and she had intermittent hip and knee pain for the 12 months, sometimes resulting in limping and reduced mobility. She was
referred to a regional adult cardiologist 3 days after his presentation to the local clinic. The cardiology team performed ECG that
detected sinus tachycardia (128 bpm) and left atrial (LA) and left ventricular (LV) hypertrophy. Transthoracic echocardiography (TTE)
revealed severe mitral-aortic disease with predominant mitral incompetence and pulmonary arterial hypertension. There was evidence
of LA and LV dilation

46. Further assessment indicated Caoimhe has subcutaneous nodules, erythema marginatum, and polyarthritis of multiple joints.
An appropriate nursing diagnosis based on these findings is:
A. Activity intolerance related to arthralgia
B. Risk for infection related to open skin lesions.
C Risk for impaired skin integrity related to pruritus and scratching.
D. Risk for impaired physical mobility related to permanent joint fixation.

47. Which of the following nursing assessment would indicate that Caoimhe already has valvular damage?
A. Brisk, hammering pulses C. Systolic clicks
B. Pericardial friction rub D. Murmurs

47. The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective
endocarditis based on the assessment finding of
A. Fever, chills, and diaphoresis C. Petechiae of the buccal mucosa and conjunctiva.
B. Capillary refill time of 5 seconds. D. An increase in pulse rate of 20 with activity

49. The nurse recognizes that the most significant information related by Caoimhe relating to her medical diagnosis is? :
A. she had intermittent hip and knee pain for the 12 months
B. a rash on the upper aspects of both thighs.
C. she was sweating, tachycardic
D. She had upper respiratory infection with a sore throat about 3 weeks ago.

50. The community health nurse involved in programs to prevent rheumatic fever knows that the most important intervention to
decrease the incidence of the disease includes
A. immunizing susceptible groups of people with streptococcal vaccine.
B. providing prophylactic antibiotics to people with a family history of rheumatic fever.
C. teaching people to seek medical diagnosis and treatment for streptococcal pharyngitis.
D. promoting hygienic measures to prevent the transmission of streptococcal infections.

TEST 2: NURSING CARE PLAN (10 POINTS)

Referring to the case of Caoimhe, create a nursing care plan by identifying 2 relevant assessments leading to 1 nursing diagnosis.
From that nursing diagnosis, create 1 short term or long-term goal, enumerate your relevant interventions (as many as you can as
applicable, whether independent, dependent or collaborative nursing interventions), and make your evaluation statement.