MED SURGE 2 MIDTERM PRACTICE QUESTIONS
119. You are providing care to a patient with COPD who is receiving medical treatment for exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on the arms and legs. Which medication ordered for this patient can cause hyperglycemia and bruising?* A. Prednisone B. Atrovent C. Flagyl D. Levaquin
A
120. A patient is post-opt from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?* A. Respiratory acidosis B. Respiratory alkalosis C. Hypokalemia D. Metabolic acidosis
A
125. A patient on mechanical ventilation has the following blood gases: PaCO2 29, pH 7.56, HCO3 23. Which of the following conditions is the patient experiencing?* A. Respiratory alkalosis not compensated B. Respiratory alkalosis partially compensated C. Respiratory alkalosis fully compensated D. Respiratory acidosis partially compensated
A
126. A patient is experiencing respiratory acidosis due to brain trauma. Which of the following lab values correlates with this acid imbalance?* A. Potassium level of 6.0 B. Potassium level of 2.5 C. Potassium level of 5.0 D. Potassium level of 3.5
A
130. Diabetic ketoacidosis, aspirin toxicity, and renal failure are examples of the causes of ___________________.* A. High anion gap metabolic acidosis B. Normal anion gap metabolic acidosis C. Low anion gap metabolic acidosis D. Normal anion gap respiratory acidosis
A
131. In metabolic alkalosis, the blood pH level:* A. Increases B. Decreases C. Stays the same
A
135. A patient states they have been vomiting for the last 4 days. The patient is irritable, weak, and reporting muscle cramping and weakness. On assessment, the patient is experiencing bradypnea with a respiratory rate of 10. The patient has the following ABGs result: HCO3 36, pH 7.52, PaCO2 48. Which condition below is presenting?* A. Metabolic alkalosis partially compensated B. Metabolic alkalosis fully compensated C. Metabolic acidosis partially compensated D. Metabolic acidosis not compensated
A
137. A patient reports taking Diamox and has been reporting confusion, fatigue, and headaches. On assessment, you note the patient is exhibiting deep and rapid respirations. Which arterial blood gas finding below confirms the acid-base imbalance for this patient given their symptoms and medication usage?* A. HCO3 12, pH 7.19, PaCO2 29 B. HCO3 23, pH 7.36, PaCO2 36 C. HCO3 10, pH 7.65, PaCO2 47 D. PaCO2 49, pH 7.55, HCO3 21
A
138. A patient is in high anion gap metabolic acidosis due to diabetic ketoacidosis. Which of the following signs and symptoms would you expect to see in this patient?* A. Kussmaul's respirations B. Glucose 110 C. Hypoventilation D. Neuronal-excitability
A
15. A 30 year old female is being treated for infective endocarditis with IV antibiotics. At the beginning of the hospitalization, the patient's symptoms were severe and sudden with a high fever but are now controlled. She has no significant health history other than 2 cesarean sections in the past. She is being prepped for a central line placement so she can be discharged home with home health to continue the 4 week antibiotic regime. What is type of infective endocarditis this classified as based on the information listed?* A. Acute Infective Endocarditis B. Subacute Infective Endocarditis C. Non-infective Endocarditis D. Pericarditis
A
2. What area of the heart is responsible for the delay of conduction between the atria and ventricles? A. AV node B. Bundle of His C. Bachmann's Bundle D. Right bundle branch
A
32. You're caring for a patient with pneumonia. The patient has just started treatment for pneumonia and is still experiencing hypoxemia. You know that respiratory acidosis is very common with patients with pneumonia. Which arterial blood gas readings below represent respiratory acidosis that is NOT compensated?* A. pH 7.29, PaCO2 55, HCO3 23, PO2 85 B. pH 7.48, PaCO2 35, HCO3 22, PO2 85 C. pH 7.20, PaCO2 20, HCO3 28, PO2 85 D. pH 7.55, PaCO 63, HCO3 19, PO2 85
A
37. A patient is admitted with pneumonia. Sputum cultures show that the patient is infected with a gram positive bacterium. The patient is allergic to Penicillin. Which medication would the patient most likely be prescribed?* A. Macrolide B. Cephalosporins C. Penicillin G D. Tamiflu
A
38. A 25 year-old female patient with pneumonia is prescribed Doxycycline. What question is important to ask the patient prior to administration of this medication?* A. "Do you take birth control pills?" B. "Are you allergic to Penicillin?" C. "Are you allergic to eggs?" D. "Do you have a history of diabetes?"
A
41. A patient is being discharged home on Doxycycline for treatment of pneumonia. Which statement by the patient indicates they understood your education material?* A. "I will wear sunscreen when outdoors." B. "I will avoid green leafy vegetables while taking this medication." C. "I will monitor my blood glucose regularly due to the side effects of hypoglycemia." D. "I will take this medication with a full glass of milk."
A
44. A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications?* A. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone. B. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol. C. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone. D. The patient inhales the Fluticasone and immediately inhales the Salmeterol.
A
54. Your patient with asthma is taking Theophylline. Which product below should the patient avoid consuming?* A. Caffeine B. Dairy C. Wheat D. Shellfish
A
58. A nurse in an urgent care center is caring for a client who is having an acute asthma exacerbation. What is the nurse's highest priority? A. Administering a nebulizer beta-adrenergic. B. Allow the patient to rest. C. Position the patient in high-fowler's. D. Give the patient oxygen.
A
7. What part of the heart's electrical system is known as the "gatekeeper"? A. AV node B. Gap Junction C. Tetany D. SA node
A
9. What area of the heart forms the QRS part on an EKG? A. Purkinje fibers B. Left and right bundles C. AV node D. SA node
A
91. 24-36 hours after a myocardial infarction _____________ congregate at the site during the inflammation phase.* A. Neutrophils B. Eosinophils C. Platelets D. Macrophages
A
94. A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time?* A. Troponin result and when the next troponin level is due to be collected B. Diet status C. Last consumption of caffeine D. CK result and when the next CK level is due to be collected
A
31. Which of the following patients are MOST at risk for developing pneumonia? Select-all-that-apply:* A. A 53 year old female recovering from abdominal surgery. B. A 69 year old patient who recently received the pneumococcal conjugate vaccine. C. A 42 year old male with COPD and is on continuous oxygen via nasal cannula. D. A 8 month old with RSV (respiratory syncytial virus) infection.
A,C,D
96. A patient is complaining of chest pain. On the bedside cardiac monitor you observe pronounced T-wave inversion. You obtain the patient's vital signs and find the following: Blood pressure 190/98, HR 110, oxygen saturation 96% on room air, and respiratory rate 20. Select-all-that-apply in regards to the MOST IMPORTANT nursing interventions you will provide based on the patient's current status:* A. Obtain a 12-lead EKG B. Place the patient in supine position C. Assess urinary output D. Administer Nitroglycerin sublingual as ordered per protocol E. Collect cardiac enzymes as ordered per protocol F. Encourage patient to cough and deep breath G. Administer Morphine IV as ordered per protocol H. Place patient on oxygen via nasal cannula
A,D,E,G,H
50. Select all the correct options that represent the pathophysiology of an asthma attack.* A. The smooth muscle surrounding the alveoli constricts, limiting oxygenation. B. The mucosa lining experiences severe inflammation. C. The goblet cells within the mucosa lining produce excessive amounts of mucous. D. Too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis.
B,C
73. Select all the correct statements about educating the patient with heart failure:* A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.
B,C,D
105. Which of the following EKG changes are abnormal findings that may indicate ischemia or injury to the cardiac muscle found on a 12-lead EKG? SELECT-ALL-THAT-APPLY:* A. Lengthening p-waves B. ST-segment elevation C. T-wave inversion D. Tall t-waves E. QT interval narrowing F. ST-segment depression
B,C,D,F
33. Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:* A. Stridor B. Coarse crackles C. Oxygen saturation less than 90% D. Non-productive, nagging cough E. Elevated white blood cells F. Low PCO2 of less than 35 G. Tachypnea
B,C,E,G
23. Select-all-that-apply: Which of the following are NOT typical signs and symptoms of pericarditis?* A. Fever B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pain
B,C,F
55. A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise. Select all that apply:* A. Avoid warming up before exercise. B. Administer a short-acting beta agonist before exercise. C. Administer a short-acting beta agonist after exercise. D. Avoid exercising when experiencing a respiratory illness.
B,D
79. Select all the correct statements about the pharmacodynamics of Beta-blockers for the treatment of heart failure:* A. These drugs produce a negative inotropic effect on the heart by increasing myocardial contraction. B. A side effect of these drugs include bradycardia. C. These drugs are most commonly prescribed for patients with heart failure who have COPD. D. Beta-blockers are prescribed with ACE or ARBs to treat heart failure.
B,D
35. A 72 year-old male patient who is diagnosed with bilateral lower lobe pneumonia is admitted to your unit. The patient has a history of systolic heart failure and arthritis. On assessment, you note the patient has a respiratory rate of 21, oxygen saturation 93% on 2L nasal cannula, is alert & oriented, and has a productive cough with green/yellowish sputum. Which of the following nursing interventions will you provide to this patient based on your assessment findings and the patient's diagnosis? Select-all-that-apply:* A. Keep head-of-the-bed less than 30 degrees at all times. B. Collect sputum cultures. C. Encourage 3L of fluids a day to keep secretions thin. D. Encourage incentive spirometer usage E. Provide education about receiving the Pneumovax vaccine every 5 years.
B,D,E
63. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply:* A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea
B,D,F
115. A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication?* A. The patient should use the medications every 2 hours for acute episodes of shortness of breath. B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort. C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later. D. The patient should use the medications at the same exact time, regardless of the order.
B
116. In regards to question 115, which action by the patient demonstrates they know how to properly use this medication?* A. The patient rinses their mouth after using the Spiriva inhaler. B. The patient rinses their mouth after using the Pulmicort inhaler. C. The patient dispenses of the inhalers. D. The patient coughs 2 times after using the Pulmicort inhaler.
B
123. A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition?* A. Bradypnea B. Tachypnea C. Bradycardia D. None of the options are correct
B
124. A patient has the following blood gases: PaCO2 25, pH 7.50, HCO3 19. Which of the following could NOT be the cause of this condition?* A. Anxiety attack B. Chronic obstructive pulmonary disease (COPD) C. Fever D. Aspirin toxicity
B
127. Which patient is experiencing partially compensated respiratory acidosis?* A. PaCO2 30, pH 7.35, HCO3 26 B. PaCO2 53, pH 7.23, HCO3 28 C. PaCO2 45, pH 7.49, HCO3 21 D. PaCO2 50, pH 7.30, HCO3 23
B
129. A patient with COPD has the following blood gases: PCO2 59, pH 7.26, HCO3 42. Which of the following conditions is presenting?* A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis
B
133. A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2 50. Which of the following signs may this patient exhibit as a compensatory mechanism?* A. Hyperventilation (tachypnea) B. Hypoventilation (bradypnea) C. Increased potassium level (hyperkalemia) D. Constipation
B
134. What of the following is NOT a cause of metabolic alkalosis?* A. Hyperaldosteronism B. Usage of Diamox C. Nasogastric suctioning D. Diuretic therapy
B
139. A patient has the following arterial blood gases: PaCO2 33, HCO3 15, pH 7.23. Which condition below is presenting? A. Metabolic alkalosis partially compensated B. Metabolic acidosis partially compensated C. Respiratory alkalosis not compensated D. Metabolic acidosis fully compensated
B
36. You're providing discharge teaching to a patient who was admitted for pneumonia. You are discussing measures the patient can take to prevent pneumonia. Which of the following statements by the patient indicates they did NOT understand your education material?* A. "I'll use hand sanitizer regularly while I'm out in public." B. "It is important I don't receive the Pneumovax vaccine since I'm already immune to pneumonia." C. "I will try to avoid large crowds of people during the peak of flu season." D. "It is important I try to quit smoking."
B
40. A patient is admitted with rupture of the Achilles tendon. The patient was recently treated with antibiotics for pneumonia. Which of the following medications below can cause this adverse effect?* A. Penicillin B. Fluroquinolones C. Tetracyclines D. Macrolides
B
48. Your patient's asthma is poorly controlled. The patient reports using their rescue inhaler 4 times a week. In addition, the patient's asthma is not responding to other treatments. The physician orders the patient to take a medication that works by blocking the role of the immunoglobulin IgE. This describes which medication below?* A. Montelukast B. Omalizumab C. Cromolyn D. Salmeterol
B
57. A patient received a nebulizer of Albuterol. What is a side effect of this medication?* A. Bradycardia B. Tachycardia C. Drowsiness D. Feeling cold
B
59. A nurse is auscultating breath sounds of a patient who had asthma. When the patient exhales, the nurse hears continuous high pitched squeaking sounds. What is this finding called? A. Ronchi B. Wheezes C. Normal breath sounds D. Crackles
B
67. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?* A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis.
B
68. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure?* A. K+ 5.6 B. BNP 820 C. BUN 9 D. Troponin <0.02
B
8. What area of the heart forms the PR segment on the EKG? A. Purkinje fibers B. AV node and Right and Left Bundles C. Apex of heart D. Bundle of His
B
80. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?* A. Measure and record the urine voided. B. Assist the patient up slowly and gradually. C. Place the call light in the patient's reach while in the bathroom. D. Provide privacy for the patient.
B
82. Which of the following is a common side effect of Spironolactone?* A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough
B
85. A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? a. High-potassium foods b. Drugs to treat erectile dysfunction c. Nonsteroidal antiinflammatory drugs d. Over-the-counter H2 -receptor blockers
B
87. You're educating a patient about the causes of a myocardial infarction. Which statement by the patient indicates they misunderstood your teaching and requires you to re-educate them?* A. Coronary artery dissection can happen spontaneously and occurs more in women. B. The most common cause of a myocardial infarction is a coronary spasm from illicit drug use or hypertension. C. Patients who have coronary artery disease are at high risk for developing a myocardial infarction. D. Both A and B are incorrect.
B
88. You note in the patient's chart that the patient recently had a myocardial infarction due to a blockage in the left coronary artery. You know that which of the following is true about this type of blockage?* A. A blockage in the left coronary artery causes the least amount of damage to the heart muscle. B. Left coronary artery blockages can cause anterior wall death which affects the left ventricle. C. Left coronary artery blockage can cause posterior wall death which affects the right ventricle. D. The left anterior descending artery is least likely to be affected by coronary artery disease.
B
18. You're providing discharge teaching to a patient being treated for endocarditis. Which statement by the patient demonstrated they understood your teaching about this condition?* A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic resistance." B. "I will only wash my hands with soap and water." C. "I will inform my dentist about my history of endocarditis prior to any invasive procedures." D. "I will avoid eating fish and organ meats."
C
20. A patient with endocarditis has listed in their medical history "Roth Spots". You know that this is a complication of infective endocarditis and presents as?* A. Non-tender spots found on the feet and hands B. Red and tender lesions found in the eyes C. Retinal hemorrhages with white centers D. Purplish spots found on the forearms and groin
C
22. A patient is hospitalized with chronic pericarditis. On assessment, you note the patient has pitting edema in lower extremities, crackles in lungs, and dyspnea on excretion. The patient's echocardiogram shows thickening of the pericardium. This is known as what type of pericarditis?* A. Pericardial effusion B. Acute pericarditis C. Constrictive pericarditis D. Effusion-Constrictive pericarditis
C
24. You are providing care to a patient with pericarditis. Which of the following is NOT a proper nursing intervention for this patient?* A. Monitor the patient for complications of cardiac tamponade. B. Administer Ibuprofen as scheduled. C. Place the patient in supine position to relieve pain. D. Monitor the patient for pulsus paradoxus and muffled heart sounds.
C
25. You are providing discharge teaching to a patient being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicates the patient did NOT understand the education you provided?* A. "I can take this medication with or without food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take all my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout."
C
27. You are providing care to a patient experiencing chest pain when coughing or breathing in. The patient has pericarditis. The physician has ordered the patient to take Ibuprofen for treatment. How will you administer this medication?* A. strictly without food B. with a full glass of juice C. with a full glass of water D. with or without food
C
29. A patient is presenting with mild symptoms of pneumonia. The doctor diagnoses the patient with "walking pneumonia". From your nursing knowledge, you know this type of pneumonia is caused by what type of infectious agent?* A. Fungi B. Streptococcus pneumoniae C. Mycoplasma pneumoniae D. Influenza
C
30. A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia?* A. Aspiration pneumonia B. Ventilator acquired pneumonia C. Hospital-acquired pneumonia D. Community-acquired pneumonia
C
34. You're educating a patient with pneumonia on how to deep breathe by using an incentive spirometer. Which of the following is the correct way to use this device?* A. Encourage the patient to use it twice a day. B. The patient exhales into the device rapidly and then coughs. C. The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and exhales. D. The patient rapidly inhales 10 times from the device and then exhales for 6 seconds.
C
43. A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of secretions? A. Encourage the client to ambulate B. Encourage coughing and breathing exercises C. Encourage the client to increase fluid intake D. Encourage regular use of the incentive spirometer
C
45. You're assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient's lung fields and note expiratory wheezes. The patient's peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack?* A. Theophylline B. Tiotropium C. Albuterol D. Cromolyn
C
46. You assist your patient with using their inhaler. The inhaler contains the medication Budesonide. Before administering the inhaler, you will want to connect what device to the inhaler to help decrease the patient from developing ________?* A. Peak flow meter; pneumonia B. Incentive spirometer; thrush C. Spacer; thrush D. Peak flow meter; mouth sores
C
5. The SA node fires at a rate of? A. 80-90 bpm B. 40-60 bpm C. 60-100 bpm D. 60-80 bpm
C
51. You're educating a patient how to use a peak flow meter to help monitor the status of their asthma. Which statement by the patient demonstrates they understand how to use the device?* A. "This device will help keep my lungs strong so I don't have another asthma attack." B. "I will inhale as hard as I can while using the device." C. "I will use this device at the same time, either in the morning or before bedtime, and compare the readings with my personal best reading." D. "I will notify the doctor if my peak flow rating is 90% or more than my personal best peak flow."
C
60. A nurse is assessing a client for hypoxemia during an asthma attack. Which one of the following manifestations should the nurse expect? A. Nausea B. Dysphagia C. Agitation D. Hypotension
C
71. A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?* A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.
C
74. A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?* A. Narcan B. Aminophylline C. Digibind No medication because this is a normal Digoxin level.
C
77. A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings?* A. Na+ 135 B. BNP 560 C. K+ 8.0 D. K+ 1.5
C
81. A patient is taking Digoxin. Prior to administration you check the patient's apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action?* A. Hold this dose and administer the second dose at 1800. B. Administer the dose as ordered. C. Hold the dose and notify the physician of the digoxin level. D. Hold this dose until the patient's potassium level is normal.
C
90. After a myocardial infarction, at what time (approximately) do the macrophages present at the site of injury to perform granulation of the tissue?* A. 24 hours B. 2 days C. 10 days D. 6 hours
C
93. On an EKG, the lateral view of the heart is represented with leads?* A. V1, V2, V3 B. II, II, AVF C. I, AVL, V5, V6 D. V1, V2, V6
C
98. A patient recovering from a myocardial infarction is complaining of the taste of blood in their mouth. On assessment, you note there is bleeding on the anterior gums. Which medication can cause this?* A. Coreg B. Cardizem C. Lovenox D. Lipitor
C
1. What area of the heart's electrical conduction is known as the "pacemaker" of the heart? A. SA node B. AV node C. Purkinje Fibers D. Bundle of His
A
100. A patient is experiencing Heparin-Induced Thrombocytopenia from Heparin therapy. The doctor orders Heparin to be discontinued. The patient will most likely be placed on what other medication?* A. Argatroban B. Lovenox C. Levophed D. Tridil
A
104. A patient's morning lab work shows a potassium level of 6.3. The patient's potassium level yesterday was 4.0 The patient was recently started on new medications for treatment of myocardial infarction. What medication below can cause an increased potassium level?* A. Losartan B. Norvasc C. Aspirin D. Cardizem
A
11. What is the correct sequence of electrical conduction of the heart? A. SA node, internodal pathways, AV node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers B. AV node, internodal pathways, SA node, Bundle of His, Right and Left Bundle Branch, Purkinje fibers C. SA node, internodal pathways, AV node, Purkinje Fibers, Right and Left Bundle Branch, Bundle of His D. None of the options are correct
A
111. An alarm beeps notifying you that one of your patient's oxygen saturation is reading 89%. You arrive to the patient's room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be:* A. Continue to monitor the patient B. Increase the patient's oxygen level to 3 L C. Notify the doctor for further orders D. Turn off the alarm settings
A
118. A patient is ordered at 1400 to take Theophylline. You're assessing the patient's morning lab results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You're next nursing action is to?* A. Administer the dose at 1400 as ordered B. Notify the physician for further orders C. Hold the 1400 dose D. Collect another blood sample to confirm the level
A
6. On an EKG the P-wave represents what area of the heart? A. Left bundle branch B. AV node C. Bachmann's Bundle D. SA node
D
19. A patient being treated for infective endocarditis is complaining of very sharp radiating abdominal pain that goes to the left shoulder and back. As the nurse familiar with complications of infective endocarditis, what do you suspect is the cause of this patient finding?* A. Renal embolic event B. Pulmonary embolic event C. Central nervous system embolic event D. Splenic embolic event
D
26. A patient with severe pericarditis has developed a large pericardial effusion. The patient is symptomatic. The physician orders what type of procedure to help treat this condition?* A. Pericardiectomy B. Heart catheterization C. Thoracotomy D. Pericardiocentesis
D
28. On physical assessment of a patient with pericarditis, you may hear what type of heart sound?* A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub
D
42. You are about to hang a bag of intravenous Vancomycin for a patient who has severe pneumonia. Which statement by the patient causes you to hold the bag of Vancomycin and notify the doctor immediately?* A. "I'm seeing yellow halos around the light." B. "My mouth tastes like metal." C. "My head hurts." D. "I have this constant ringing in my ears."
D
47. A patient with asthma is receiving a nebulizer of Cromolyn. The patient reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will?* A. Immediately stop the nebulizer B. Re-adjust the nebulizer C. Call a rapid response because the patient is having a potential anaphylactic reaction to the medication. D. Reassure the patient this is a temporary side effect of this medication.
D
55. Which medication below blocks the function of Leukotriene for the treatment of asthma?* A. Salmeterol B. Theophylline C. Tiotropium D. Montelukast
D
56. The physician orders the patient to start taking Omalizumab. How will you administer this medication as the nurse?* A. Intravenous B. Intramuscular C. Orally D. Subcutaneously
D
97. In regards to the patient in the previous question, after administering the first dose of Nitroglycerin sublingual the patient's blood pressure is now 68/48. The patient is still having chest pain and T-wave inversion on the cardiac monitor. What is your next nursing intervention?* A. Hold further doses of Nitroglycerin and notify the doctor immediately for further orders. B. Administer Morphine IV and place the patient in reverse Trendelenburg position. C. Administer Nitroglycerin and monitor the patient's blood pressure. D. All the options are incorrect.
A
13. Which of the following patients are MOST at risk for developing endocarditis? Select-all-that-apply:* A. A 25 year old male who reports using intravenous drugs on a daily basis. B. A 55 year old male who is post-opt from aortic valve replacement. C. A 63 year old female who is newly diagnosed with hyperparathyroidism and is taking Aspirin. D. A 66 year old female who recently had an invasive dental procedure performed 1 month ago and is having a fever.
A, B, D
61. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:* A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
A, C, E
17. Select-all-that-apply: What are the typical signs and symptoms of infective endocarditis?* A. Hyperthermia B. S4 gallop C. Enlarged Spleen D. Hyperkalemia E. Substernal pain that radiates to the back F. Heart failure G. Cardiac Murmur
A, C, F, G
39. Select all the medications used to treat pneumonia that are narrow-spectrum?* A. Macrolides B. Tamiflu C. Fluroquinolones D. Penicillins
A, D
52. Select all the following that can trigger an asthma attack:* A. Sulfites B. Smoke C. Caffeine D. GERD E. Cold, windy weather F. Beta agonist G. Cockroaches
A,B,D,E,G
49. You're providing discharge teaching to a patient who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient:* A. Easily fatigued with physical activity B. Reduced peak flow meter reading C. Chest retractions D. Cyanosis E. Wheezing with activity F. Nighttime coughing G. No relief with short-acting bronchodilator inhaler
A,B,E,F
114. Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply:* A. "It is best to eat three large meals a day that are relatively low in calories." B. "Avoid going outside during extremely hot or cold days." C. "It is important to receive the Pneumovax vaccine annually." D. "Smoking cessation can help improve your symptoms."
A,C
103. A patient is complaining of a nagging cough that is continuous. Which medication below can cause this side effect?* A. Losartan B. Lisinopril C. Cardizem D. Lipitor
B
110. A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition?* A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.
B
102. A patient is being discharged home after receiving treatment for a myocardial infarction. The patient will be taking Coreg. What statement by the patient demonstrates they understood your education material about this drug?* A. "I will take this medication at night." B. "I will take this medication as needed." C. "I will monitor my heart rate and blood pressure while taking this medication." D. "I will take this medication in the morning with grapefruit juice."
C
107. A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD?* A. Emphysema B. Pneumonia C. Chronic bronchitis D. Pneumothorax
C
108. A patient with emphysema may present with all of the following symptoms EXCEPT?* A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia
C
109. The term" blue bloaters" is used to describe patients with?* A. Pulmonary hypertension B. Left-sided heart failure C. Chronic Bronchitis D. Emphysema
C
117. A patient with COPD is reporting depression and thoughts of suicide. The patient states, "I just feel like ending it all." You assess the patient's health history and note that the patient was recently started on which medication that could cause this side effect:* A. Atrovent B. Prednisone C. Roflumilast D. Theophylline
C
121. A patient attempted to commit suicide by ingesting a bottle of Aspirin. Which of the following conditions is this patient at risk for?* A. Hyperkalemia B. Hypercalcemia C. Respiratory alkalosis D. Respiratory acidosis
C
122. Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition?* A. Calcium and sodium levels B. Potassium and sodium levels C. Calcium and potassium levels D. Potassium and phosphate levels
C
136. Which of the following is NOT a cause of metabolic acidosis?* A. Aspirin toxicity B. Ileostomy C. Hyperaldosteronism D. Carbonic anhydrase inhibitors
C
14. A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as?* A. Janeway Lesions B. Roth Spots C. Osler's Nodes D. Trousseau's Sign
C
16. A patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a mitral murmur which the patient states they've never had before, and dark, small lines on the patient's fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis?* A. Abdominal ultrasound B. Heart catheterization C. Transesophageal echocardiogram D. White blood cell count
C
101. A patient taking Lovenox is having a severe reaction. What is the antidote for this medication?* A. Activated Charcoal B. Acetylcysteine C. Narcan D. Protamine sulfate
D
112. You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following:* A. Increase the breathing rate to prevent hypoxemia B. Decrease the use of the abdominal muscles C. Encourages the use of accessory muscles to help with breathing D. Strengthen the diaphragm
D
113. A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation?* A. Spiriva B. Salmeterol C. Symbicort D. Albuterol
D
128. Which of the following is not a cause of respiratory acidosis?* A. Pulmonary emboli B. Asthma C. Chronic obstructive pulmonary disease (COPD) D. Hyperventilation
D
132. A patient is in metabolic alkalosis due to diuretic therapy. How do you expect the potassium level and bicarbonate level to be affected?* A. Increased potassium level and increased bicarb level B. Decreased potassium level and decreased bicarb level C. Increased potassium level and decreased bicarb level D.Decreased potassium level and increase bicarb level
D
140. Which of the following conditions are not thought to cause atrial fibrillation? A. Mitral stenosis B. Mitral regurgitation C. Tricuspid regurgitation D. Peripheral vascular disease
D
62. A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition?* A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema."
D
64. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition?* A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure.
D
69. Which of the following tests/procedures are NOT used to diagnose heart failure?* A. Echocardiogram B. Brain natriuretic peptide blood test C. Nuclear stress test D. Holter monitoring
D
70. What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath.* A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction
D
72. You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?* A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."
D
75. Which of the following is a late sign of heart failure?* A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum
D
76. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?* A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors
D
78. During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue?* A. Lisinopril B. Losartan C. Lasix D. Digoxin
D
83. The physician's order says to administer Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?* A. Administer the Lasix as ordered B. Notify the physician of the BNP level C. Assess the patient for edema D. Hold the dose and notify the physician about the potassium level
D
84. The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? a. Muscle aches b. Constipation c. Pounding headache d. Anorexia and nausea
D
86. A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first? a. Urine output b. Heart rhythm c. Breath sounds d. Blood pressure
D
89. A patient is 36 hours status post a myocardial infarction. The patient is starting to complain of chest pain when they lay flat or cough. You note on auscultation of the heart a grating, harsh sound. What complication is this patient mostly likely suffering from?* A. Cardiac dissection B. Ventricular septum rupture C. Mitral valve prolapse D. Pericarditis
D
92. A patient is complaining of chest pain. You obtain a 12-lead EKG and see ST elevation in leads II, III, AVF. What area of the heart does this represent?* A. Lateral B. Septal C. Anterior D. Inferior
D
95. A doctor has ordered cardiac enzymes on a patient being admitted with chest pain. You know that _____________ levels elevate 2-4 hours after injury to the heart and is the most regarded marker by providers.* A. Myoglobin B. CK-MB C. CK D. Troponin
D
99. A patient is on a Heparin drip post myocardial infarction. The patient has been on the drip for 4 days. You are assessing the patient's morning lab work. Which of the following findings in the patient's lab work is a potential life-threatening complication of Heparin therapy and requires intervention?* A. K+ 3.7 B. PTT 65 seconds C. Hgb 14.5 D. Platelets 135,000
D
66. A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?* A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct. F. Options A, B, and C are all correct.
E
10. True or False: The SA node is located in the Left atrium. False True
False
106. True or False: COPD is reversible and tends to happen gradually.* True False
False
12. True or False: Endocarditis only affects the atrioventricular and semilunar valves in the heart.* True False
False
141. Atrial fibrillation is characetized by random p-waves on the EKG. True False
False
142. The R waves in atrial fibrillation are regular. True False
False
21. True or False: The pericardium layer consists of a fibrous layer that is made up of two layers called the parietal and visceral layers.* True False
False
143. The hallmark of atrial flutter are "saw-tooth" waves, sometimes called F-waves. True False
True
144. P-waves are absent in atrial flutter. True False
True
3. True or False: Bachmann's bundle is located in the left atrium. True False
True
4. True or False: Depolarization of the heart muscle is when the muscle contracts and repolarization is when the heart muscle rests. True False
True
65. True or False: Patients with left-sided diastolic dysfunction heart failure usually have a normal ejection fraction.* True False
True
