MEDICAL SURGICAL NURSING CARDIOVASCULAR DISORDERS EXAMINATION ELENITA C. MANRIQUE, MD, RN 1.

The nurse is monitoring a client post acute MI, the nurse notes eight (8) Premature Ventricular Contractions PVCs on cardiac monitor. The nurse first course of action should be a. Administer antiarrhytmic drugs b. Notify the physician promptly c. Increase oxygen concentration d. Administer prescribed analgesic 2. Expected outcomes following administration of Furosemide ( Lasix ) include a. Increased urine output and blood pressure b. Increased urine output and cardiac contractility c. Increased urine output and decreased PVCs d. Increased urine output and decreasing cardiac afterload 3. A client whose condition remains stable after a myocardial infarction is gradually allowed increased activity. Of the following criteria, the best one on which to judge whether activity is appropriate is to note the degree of a. Edema b. Cyanosis c. Dyspnea d. Weight loss 4. A basic principle of any rehabilitation, including cardiac rehabilitation is that rehabilitation begins on a. Discharge from the hospital b. Discharge from the cardiac care unit c. Admission to the hospital d. Four weeks after the onset of illness 5. A client is discharged from the hospital following a myocardial infarction. The client is walking and is thought to continue walking gradually progressing distances. Which vital sign should the client be thought to monitor whether to increase or decrease progression a. Pulse rate b. Blood pressure c. Body temperature d. Respiratory rate 6. If a client displays behavior detrimental to health such as smoking, eating a diet high in saturated fats, leading a sedentary lifestyle, techniques of behavior modification may be used to help the client change behavior. The nurse can best reinforce the new adaptive behavior by a. Explaining how the old behavior leads to poor health b. Withholding praise until new behavior is well established c. Rewarding the client whether the acceptable behavior is performed d. Discussing the disadvantages of developing healthful behavior 7. A priority nursing assessment measure related to thrombolytic therapy following MI is a. Observe for rebound chest pain b. Monitor for increase dysrhythmias c. Monitor ECG every 4 hours d. Observe signs of spontaneous bleeding 8. Crackles heard on lung auscultation indicate a. Pulmonary edema b. Bronchospasm c. Airway narrowing d. Fluid filled alveoli 9. The nurse can best evaluate the effectiveness of oxygen therapy to patients with congestive heart failure by observing the changes in clients a. ECG b. Arterial blood gasses c. Central venous pressure d. Serum electrolyte values 10. Enalapril was given to a client with CHF. It is an angiotensin converting enzyme inhibitor that acts to improve cardiac output by a. Reducing peripheral vascular resistance

b. Increasing peripheral vascular resistance c. Reducing fluid volume d. Improving myocardial contractility 11. A client with CHF will take oral furosemide at home. To help the client evaluate the effectiveness of therapy, the nurse should teach the client to a. Take weight daily b. Take daily blood pressure c. Take urine specimen to the laboratory for analysis d. Have a specimen for arterial blood gasses obtained each week for blood gas analysis 12. Clients with CHF are prone to atrial fibrillation. During the physical assessment, the nurse would suspect atrial fibrillation when palpation of the radial pulse revealed a. Two regular beats followed by one irregular beat b. An irregular pulse rhythm c. Pulse rate below 60 perminute d. A weak thready pulse 13. Complications of atrial fibrillarion occur due to a. Stasis of blood in the atria b. Increase cardiac output c. Decrease pulse rate d. Elevated pulse pressure 14. The nurse should specifically alert for signs and symptoms of digitalis toxicity if laboratory findings indicate that the client has a. Low sodium b. High glucose c. High calcium d. Low potassium level 15. Which of the following best describe cardiogenic shock. The client experiences a. Decrease cardiac output due to hypovolemia b. Shock due to circulating blood volume c. Shock due to decreased cardiac contractility d. Decrease cardiac output due to infection 16. The plan of care for a client with hypertension taking propranolol would include a. Instructing the client to discontinue the drug if nausea occurs and to monitor Blood Pressure b. Monitoring blood pressure every week and adjusting the medication dose accordingly c. Measuring partial thromboplastin time weekly to evaluate blood clotting status d. Instructing the client to notify the physician of irregular, slowed pulse 17. When teaching the client about Propranolol, the nurse should base the information on the knowledge that propranolol hydrochloride a. Blocks beta adrenergic stimulation thus decreased heart rate and increased cardiac contractility b. Blocks release of epinephrine thus decreased heart rate c. Blocks the acetycholine receptors in the smooth muscles of blood vessels d. Blocks beta receptors thus decreasing myocardial contractility 18. A priority nursing doagnostic category for the client with hypertension would be a. Pain related to increased cerebral circulation b. Fluid volume deficit related to fluid loss secondary to intake of diuretics c. Impaired skin integrity related to increased pressure in the microcirculation d. Altered health maintenance related to unfamiliarity of the client to the aggressiveness of the disease 19. Which of the following are generally considered to be risk factors for the development of atherosclerosis? a. Family history of MI, hypetension and anemia b. Diabetes, smoking and late onset of puberty c. Male gender, total blood cholesterol above 150 mg/dl and low protein intake d. Physical inactivity, hypertension and diabetes 20. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.4 mg sublingually. The drugs principal effects are produced by a. Antispasmodic effect of myocardium b. Stimulation of alpha an beta receptors c. Vasodilation of peripheral vasculatures d. Improved conductivity of the myocardium

21. The nurse teaches the client with angina about the common expected side effects of nitroglycerin including a. Headache, hypotension and dizziness b. Hypotension, flushing and dizziness c. Hypotension, shock, shortness of breath d. Stomach cramps, flushing and dizziness 22. In explaining the procedure of coronary percutaneous transluminal coronary angioplasty (PTCA) to a client, the nurse should explain that the procedure involves a. Opening of a stenosed artery with an inflatable balloon tipped catheter b. Increased blood clotting following procedures c. Passing catheter through the coronary arteries to find blocked arteries d. Inserting grafts to divert blood from blocked coronary arteries 23. The nurse identifies the commonality between a strain on the clients heart with prolonged anemia or polycythemia to be a. Pressure b. Temperature c. Cardiac output d. Surface tension 24. After a client has an endarterectomy, the nurse should plan to observe for a change in a. Appetite b. Skin color c. Bowel habits d. Skin turgor (Additional learning ) Thrombiangitis obliterans (Buergers Disease) is an occlusive vascular disease in which small and medium sized arteries become inflamed and spastic causing clots to form, idiopathic cause usually affecting legs and feet. The following questions refer to Thrombiangitis Obliterans 25. Which measure is most important for a client with thromboangitis obliterans? a. Protecting the extremities from trauma b. Maintaining adequate hydration c. Quitting smoking d. Protect the extremities from chilling and exposure 26. Intermittent claudication refers to a. Leg pain that occurs after exercise and relieved after rest b. Non healing ulcers on the lower leg near the ankle c. Pain in the calf or foot that occurs at rest d. Burning or cold sensation that increases with exercise and is relieved by elevating the legs 27. Intermittent claudication is an indication of what condition? a. Phlebitis b. Arterial insufficiency c. Venous insufficiency d. Mitral regurgitation 28. While reading the patients chart, the nurse sees pedal pulses described as 4+ bilaterally. This indicates that this is a. Thready and weak b. Slightly impaired c. Unequal d. Normal (Rationale : In the most widely used pulse scale, absent pulse is 0, markedly impaired 1+, moderately impaired 2+, slightly impaired3+, and normal 4+, With an abnormal pulse, the amplitude such as weak, thready or bounding also is described. The term bilateral means that pulses are equal) 29. With chronic occlusive arterial disease, the precipitating cause for ulceration and gangrenous lesion often is a. Emotional stress which is short lived b. Poor hygiene and limited protein intake c. Stimulants such as coffee, tea, cola or drinks d. Trauma from mechanical, chemical or thermal sources 30. While auscultating a patients femoral area, the nurse notes a bruit. Bruits are caused by a. Turbulent blood flow through a stenotic vessel

b. Occluded blood vessels c. Hypotension when the patient arises d. Development of collateral circulation You may continue answering general questions. 31. A 65 year old diabetic patient with arterial insufficiency in the legs complains that his feet are cold. Which nursing measure is contraindicated? a. Applying heating pad to patients feet b. Applying warm socks c. Encouraging exercise d. Increasing the room temperature slightly 32. Which of the following does not accurately describe Reynauds disease? a. It is characterized by episodic digital vasospasm associated with skin color changes? b. It is precipitated by exposure to cold or by emotional stress c. It is typically seen in fingers or toes d. It usually occurs in men ages 40 to 60 33. Which finding would the nurse expect when examining a patient with diagnosis of abdominal aortic aneurysm? a. Tachycardia b. Pulsating abdominal mass c. Paresis of legs d. Carotid bruits 34. A patient is scheduled for repair of abdominal aortic aneurysm. Which preoperative complications present the greatest threat to this patient? a. Embolism in the foot b. Rupture of aneurysm c. Cerebrovascular accident d. Myocardial infarction Situation: Mrs. S, a 76 year old retired school teacher arrives at the Emergency department accompanied by her daughter. She complains that she has been experiencing sinking spells When asked for clarification, her daughter states that Mrs. S occasionally blacks out briefly during conversations and that she found her mother unconscious on the bathroom floor that morning. Questions 35 to 38 refers to this situation. 35. The nurse connects Mrs. S to the cardiac monitor. Initially, her ECG strip shows a PR interval of 0.26 sec, atrial and ventricular rates of 54 beats per minute and one to three unifocal PVCs per minute with compensatory pauses following each one. These findings indicate a. Bradycardia with first degree atrioventricular block (AV block) b. Bradycardia with second degree AV block c. Complete heart block with ventricular escape beats d. Normal sinus rhythm with occasional PVCs 36. The physician places Mrs. S on Holter monitor on the medical unit and allows her to continue most of her normal activities. The nurse explains to her that monitoring a. Correlates activities and heart response by using a diary and a taped ECG b. Denotes an ischemic response with threadmill c. Indicates valvular outlines on the monitor and correlates them with heart sounds d. Highlight cold spots on the imaging screen 37. After analyzing Mrs. Ss holter monitor results, the physician diagnose sick sinus syndrome with stoke adams attacks and decides to insert a permanent ventricular pacemaker the next morning. The evening nurse explains to Mrs. S the changes she must make in her activities after receiving her pacemaker including a. No heavy lifting for 6 months b. Brisk exercise to improve collateral circulation c. Curtailment of the needlework and daily walk d. Some limitation of vigorous upper extremity movements 38. The nurse reviews discharge instructions with Mrs. S. Which statement indicates that Mrs. S may not completely understand her instructions? a. I will take my pulse every morning and write on this chart b. If I have a little bit of clear drainage from my wound for a few weeks, I shouldnt be alarmed about it

c. Ive ordered a medical alert bracelet with my pacemaker information on it d. My daughter is buying me a new microwave oven mine is one of those models that might not be safe (Additional learning) Sick sinus syndrome results from sinus node disease or dysfunction that causes problems with impulse transmission and conduction. Common in older adults. The slow escape rhythm significantly affects cardiac output causing manifestations such as syncope (known as Stokes Adams attack), dizziness, fatigue, exercise intolerance and heart failure. Answer the following questions on ECG 39. Which of the following findings needs further assessment? a. PR interval of 0.16 sec b. RR interval of 0.16 sec c. QRS interval of 0.16 sec d. None of the above 40. ECG changes in hypercalcemia except a. Shortened QT interval b. Depressed ST segment c. Widened T wave d. Tachycardia 41. An ECG to evaluate the effects of hypocalcemia on the heart such as a. Prolonged ST segment b. Inverted T wave c. Shortened RR interval d. All of the above 42. P wave represents a. Atrial depolarization b. Rapid influx of sodium into the cell c. Membrane potential becoming more positive than resting d. All of the above 43. An early sign of ischemia in the ECG a. Inverted T wave b. Prominent Q c. ST segment elevation d. All of the above 44. QRS represents a. Impulse conduction in the atria b. Impulse conduction in the ventricles c. Impulse conduction from atrial to purkinje fibers d. Impulse conduction resting 45. A u wave was identified by the nurse in the ECG and the nurse interprets this finding as a. Hyperkalemia b. Hypokalemia c. Hypercalcemia d. Hypocalcemia 46. T wave represents a. Ventricular relaxation b. Ventricular repolarization c. Both d. Neither 47. An absence P wave was seen on ECG, the nurse knows that such finding means a. No impulse being initiated on the SA node b. No impulse being initiated by the AV node c. No impulse transmission at all branches d. A and B 48. Five (5) small squares in the ECG paper vertically placed is equal to a. 1 mm b. 0.5 mm c. 5 mm d. 10 mm

49. Hyperkalemia may manifest the following ECG changes, except a. Tall T wave b. ST segment elevation c. Presence of U wave d. No exception 50. ECG finding of client who had cadiac arrest? a. ST segment elevation b. Hold medication c. Asystole d. Dysrythmias 51. The nurse assists the physician in treating a client in shock. One modality of treatment that employs the physical law explaining the increased venous return accompanying mild vasoconstriction underlies the use of a. Adrenalin in treating shock b. Digoxin to increase cardiac output c. Sympathectomy in treating hypertension d. Rotating tourniquet in pulmonary edema Rationale: Tourniquets constrict veins of the extremities and reduce venous return, digoxin does not cause vasoconstriction 52. A client is to have a pacemaker inserted. The explains that the catheter will be inserted into the subclavian vein and advanced to allow the electrode to be positioned in the a. SA node b. Left atrium c. Right ventricle d. Superior vena cava Rationale : The pace maker electrode is inserted via the venous system into the right ventricle where PM generated impulses can directly stimulate the ventricles 53. A client will undergo treadmill test. Appropriate nursing care include the following except a. Tell the client to avoid smoking a week prior to the test b. Avoid food and fluids 2 3 hours before the test c. Tell the client to wear comfortable shoes d. No exception 54. An echocardiogram was requested for cardiac patient. Pre procedure care include a. Assess medications being taken especially those that may affect BP b. Assess for allergy to iodine c. Assess for any metallic implants d. No special preparation is needed (Additional learning) Cardiac catheterization maybe performed to identify CAD or cardiac valvular disease, to determine pulmonary artery or heart chamber pressures, to obtain myocardial biopsy, to evaluate artificial valves or to perform angioplasty or stent an area of CAD 55. A client will undergo cardiac catheterization to identify coronary artery disease. Pre procedure nursing care include the following, but a. Assess for use of Aspirin b. Establish baseline of peripheral pulses c. Discontinue oral anticoagulant d. Encourage oral fluids unless contraindicated Rationale: Pre procedure, the client should be put on NPO 6 8 hours to prevent aspiration 56. After cardiac catheterization, the nurse assesses the following, except a. Cardiac rate and rhythm b. Catheter insertion site for bleeding and hematoma c. Administer pain medications as prescribed d. No exception 57. When caring for a client after cardiac catheterization, it is most important that the nurse a. Provide for rest b. Administer oxygen c. Check ECG for 30 minutes d. Check pulses distal to the insertion site

58. During cardiac catheterization, blood sample from the right atrium, right ventricle and pulmonary artery are analyzed for their oxygen content. Normally, a. All contain less CO2 than does pulmonary vein b. All contain more oxygen than does pulmonary vein blood c. The samples all contain about the same amount of oxygen d. Pulmonary artery blood contains more oxygen than the other examples (Additional learning) Pericardiocentesis The procedure is performed to remove fluid from the pericardial sac for diagnostic or therapeutic purposes. It may also be done as an emergency measure for the client with cardiac tamponade. A large gauge 16 to 18 needle is inserted to the left of the xiphoid process into the pericardial sac and excess fluid is withdrawn. The needle is attached to the ECG lead to help determine if the needleis touching the epicardial sac thus preventing piercing of the myocardium 59. Pericardiocentesis is being done to a client with cardiac tamponade. The nurse notes PVCs on ECG during the procedure, the nurse knows that this PVCs indicate that a. The needle is touching the myocardium and should be withdrawn slightly b. Normal findings during pericardiocentesis c. Arryhtmias from the diseases cardiac cells d. All of the above 60. When auscultating the heart sound, Where should S1 (First heart sound) be heard most loudly? a. Over the clavicles b. At the apex of the heart c. Carotid areas d. Base of the heart 61. A client with pericardial effusion develop cardiac tamponade, assessment of the problem include a. Hypotension, jugular vein distention and pounding heart beat b. Rising venous pressure, increased cardiac output and muffled heart sound c. Chest pain, altered level of consciousness and hypertension d. Hypotension, muffled heart sound and jugular vein distention 62. The nurse was giving health teaching to a client about nitroglycerine. Which of the following responses made by the client shows the need for further teaching? a. If the first dose does not relieve my pain in 5 minutes, I will take the 2nd dose b. I will not drink, eat or smoking until the tablet is completely dissolved in my mouth c. I should protect my tablets from heat, light and moisture and replace every 6 months d. If I develop headache, I must discontinue the drug and see my physician at once ( Additional learning ) Acute Coronary Syndrome is a condition of unstable cardiac ischemia. ACS includes unstable angina and acute myocardial ischemia with or without significant injury of myocardial tissue 63. The nurse caring for a client with acute coronary syndrome identified which of the following Nursing Diagnosis to be highest priority a. Anxiety related to unknown outcome of disorder b. Ineffective health maintenance related to lack of knowledge about CAD c. Decreased cardiac output related to myocardial ischemia d. Ineffective tissue perfusion (Cardiopulmonary) related to underlying coronary artery disease 64. The parents of young athlete who collapsed and died due to hypertrophic cardiomyopathy ask the nurse how It is possible that their son had no symptoms of this disorder before experiencing sudden cardiac death. The nurse responds a. Exercise causes the heart to contract more forcefully and can lead to changes in the hearts rhythm or outflow of blood from the heart in people with hypertrophic cardiomyopathy b. It is likely your son had symptoms of the disorder before he died, but he may not have thought them important enough to tell someone about c. In this type of cardiomyopathy, the ventricle does not fill normally. During exercise, the heart may not be able to meet the bodys needs for blood and oxygen d. Cardiomyopathy results in destruction and scarring of cardiac muscles, as a result, the ventricle may rupture during strenuous exercise, leading to sudden death 65. A client comes to the emergency department with chest pain, dyspnea, and an irregular heartbeat. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia) with frequent premature ventricular contractions. Shortly after admission, the client has ventricular tachycardia and becomes

unresponsive. After successful resuscitation, the client is taken to the intensive care unit (ICU). Which nursing diagnosis is appropriate at this time? a. Deficient knowledge related to interventions used to treat acute illness b. Impaired physical mobility related to complete bed rest c. Social isolation related to restricted visiting hours in the ICU d. Anxiety related to the threat of death 66. A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. This client should avoid which of the following a. High volumes of fluid intake b. Aerobic exercise programs c. Caffeine-containing products d. Foods rich in protein 67. The nurse observes a clients cardiac monitor and identifies asystole. This dysrhythmia requires nursing attention because the heart is a. Not beating b. Beating slowly c. Beating irregularly d. Beating very rapidly 68. A client with Congestive Heart Failure Class II, the client manifest a. Symptoms at rest b. No symptom with regular physical activity c. Marked limitation of activities of daily living d. Slight limitation of activities of daily living 69. To determine the effectiveness of Diuretic therapy in management of patient with Congestive heart failure, the nurse assesses the following except a. Breath sounds b. Repeat Chest X ray c. Bipedal edema d. ABG 70. All of the following are possible nursing diagnosis for a client with Congestive heart failure, except a. Risk of activity intolerance related to decreased cardiac output secondary to cardiac dysfunction b. Risk for impaired skin integrity related to decreased tissue perfusion secondary to valvular effect c. Fluid volume excess related to decreased cardiac output secondary to myocardial infarction d. No exception 71. Health teaching in a client receiving digitalis include the following but a. Notify your physician if you develop double vision b. You may take antacid to enhance absorption of digoxin c. Incorporate potassium rich food in the diet d. No exception 72. Your client has a very low hemoglobin amount. What chief complaint would you expect during the heath history? a. Sore throat b. Chest pain c. Nausea d. Fatigue 73. The nurse following a client post gastrectomy observes carefully for maturation failure anemia related to malabsorption, including a. Numbness and tingling of extremities b. Steatorrhea c. Dark yellow and bronze skin d. Bone pain 74. Which of the following nursing diagnoses would be of highest priority for the client hospitalized for bone marrow transplant to treat relapse of acute myeloytic leukemia? a. Disturbed body image related to bruising and hematoma formation b. Ineffective protection related to decreased phagocytes c. Anxiety related to fear of unknown d. Imbalance nutrition less than body requirements related to malabsorption of needed nutrients 75. A client with multiple myeloma calls the home health nurse complaining of severe back pain of new onset. The appropriate response by the nurse is

a. Reassure the client is bone pain is expected in this disease b. Inquire about the clients use of NSAIDs and analgesic to mange pain c. Suggest use of a back brace to reduce pain d. Notify the physician of the onset of new pain 76. A client whose husband has hemophilia asks if her newborn baby girl could have the disease. The nurse response is based on the knowledge that a. The most common forms of hemophilia are transmitted as sex linked recessive disorder, her daughter is at risk for carrying the defective gene b. Because hemophilia is a sex linked recessive disorder carried by the Y chromosomes, her daughter has no risk of carrying the disease c. Hemophilia is an autosomal dominant disorder, therefore her daughter has 50% chance of getting the disease d. Although hemophilia is genetically transmitted its pattern of inheritance is unknown and her daughter will need to be tested for the defective gene (Additional learning) Hodgkins disease is a lymphatic cancer 77. With hodgkins disease the lymph nodes usually affected first are the a. Axillary b. Inguinal c. Cervical d. Mediastinal 78. The highest incidence of Hodgkins disease is in a. Children b. Young adults c. Elderly persons d. Middle aged persons Rationale common among 15 30 years of age 79. A client is to have whole body radiation for Hodgkins disease. The nurses teaching plan should center around the likely increased: a. Blood viscosity b. Susceptibility to infection c. Red blood cell production d. Tendency for pathologic fracture 80. A client with Hodgkins disease tells the nurse I might as well give up on dating, No woman would want me now What is the most appropriate response? a. Its sounds you are concerned about the effects of this disease and the proposed treatment plan b. Dont worry. Malignant lymphomas are very treatable when caught in an early stage of the disease c. Well, you never be able to have children all right but there are other ways to have satisfying relationship with women d. Lots of women find bald man attractive, besides your hair may grow back soft and curly 81. Vitamin K is essential for normal blood clotting because it promotes a. Platelet aggregation b. Fibrinogen formation by the liver c. Activation of clotting factor X d. Formation of clotting factor VII 82. A client has anaphylactic reaction within the first half after an infusion containing Ampicillin is started. The nurse understands that the symptoms occurring during an anaphylactic reaction are the result of a. Respiratory depression and cardiac standstill b. Constriction of capillaries and decreased cardiac output c. Bronchial constriction and decreased peripheral resistance d. Decreased cardiac output and dilation of major blood vessels 83. Occurrence of a anaphylactic reaction after receiving Peniccilin indicates that the client has a. An acquired atopic sensitization b. Passive immunity to the penicillin allergen c. Developed potent bivalent antibodies when the IV administration was started d. Antibodies to penicillin acquired after prior use of the drug 84. Which of the following results indicate moderate anemia? a. Hematocrit of 45%

b. Pulse rate of 140 per minute c. WBC of 14, 000 d. Complaints shortness of breath with exercise 85. What method should be used to assess carotid arteries? a. Inspect for absence of movement b. Auscultate with the bell of stethoscope c. Palpate with firm pressure d. Percuss lightly over each artery 86. Swelling of the body part as a result of lymphatic obstruction is labeled a. Lymphedema b. Lymphadenopathy c. Lymphangitis d. Central cyanosis 87. A 16 year old male sustained an open fracture in the right arm. Priority nursing diagnosis is Risk for infection Acute Pain Impaired mobility Self care deficit 88. Pathogenesis involves a. Occurrence of signs and symptoms b. Studying etiologic factors c. Disease progression leading to morphological and functional changes d. All of the above 89. A 5 year old boy bumped his head on the floor sustaining a small laceration on the forehead. Priority nursing diagnosis is a. Impaired skin integrity b. Risk for infection c. Anxiety d. Risk for bleeding 90. An 80 year old female with osteoporosis is hospitalized because of Pneumonia. She is diabetic and hypertensive. She is very active in the church activities. What is the most significant risk factor that predispose her to pneumonia a. Activity in the church b. Diabetes mellitus c. Osteoporosis d. Age 91. Which of the following laboratory findings need further evaluation a. WBC = 9500 /cu mm b. Hemoglobin = 13 g/L c. Urine protein = 100mg/day d. Specific gravity of urine = 1.040 92. The following are signs of systemic inflammation, except a. Leukocytosis b. Fever c. Pain d. No exception 93. A client with elephantiasis affecting the lower extremities would have the following nursing diagnoses, except a. Fluid volume excess b. Disturbed body image c. Risk for infection d. Impaired skin integrity 94. Blister formation in deep partial thickness burn is caused by a. Increased blood flow to areas b. Increased capillary permeability c. Activation of WBC d. Vasodilation 95. A client with burn injury, deep partial thickness on the forearm less than 25% TBSA will have the priority nursing diagnosis a. Fluid volume deficit

b. Risk for infection c. Acute pain d. Impaired skin integrity 96. Proteinuria may lead to a. Increase hydrostatic pressure b. Decreased oncotic pressure c. Both d. Neither 97. Which of the following laboratory findings need further evaluation by the nurse a. Thrombocytes of 600,000/cumm b. Erythrocytes of 4.5 M/cumm c. WBC of 5.0 T/cumm d. Hemoglobin 10 g/L 98. A nurse is assessing a client with HIV, what is the most important laboratory finding the nurse must note that may induce symptoms of AIDS in this client? a. Decreasing Neutrophils b. Decreasing T lymphocytes c. Decreasing B lymphocytes d. Decreasing Eosinophils 99. The most priority nursing management for anemia a. Help the client in activities of daily living b. Manage fatigue, provide periods of rest c. Prevent infection by aseptic technique d. Administer ferrous sulfate as ordered 100. The nurse understands that Pernicious anemia resulted from a. Deficiency of vitamin B12 b. Deficiency of Iron c. Deficiency of Folic acid d. All of the above 101. The priority nursing diagnosis for Pernicious anemia is a. Ineffective tissue perfusion b. Risk for hemorrhage c. Imbalance nutrition less than body requirements d. Risk for anemia 102. A client is to be admitted with painful sickle cell crisis, the admitting nurse anticipates that the primary intervention for such client is a. O2 administration b. Hydration c. Manage fatigue d. Prevent infection 103. The client tells the nurse I am not sure of this but the doctor says my problem is in the hemoglobin of my RBC, is that true? The nurse would best respond a. Yes, that is true. The hemoglobin structure is abnormal b. Yes, that is true. The iron is lacking in the hemoglobin c. Yes, that is true. The amount of hemoglobin in the RBC is lacking d. Yes, that is true. All your hemoglobin must be replaced 104. A child is suffering from Dengue hemorrhagic fever, the mother asks the nurse why such rashes are appearing in her childs skin; The nurse responds based in the knowledge that a. The virus attacks the platelets b. The virus impedes platelet plug formation in small vessels c. The virus stops clot formation thus leading to bleeding under the skin d. The virus destroys the small vessels leading to its rupture 105. Expected patient outcomes for anemic patient with Imbalance nutrition less than body requirements, except a. Prioritizes activities b. Eats a healthy diet c. Maintains adequate amount of iron, vitamin B12 and folic acid d. No exception 106. Patients with Polycythemia may manifest pruritus. Priority nursing management include the following except

Bathing in tepid cool water and vigorous toweling off after bathing Use of bicarbonate dissolved in bath water Application of cocoa butter or oat meal based lotion and bath products No exception 107. A client visited the clinic for routine check up. BP was 200/110. The nurse asks the client for any symptoms wherein the client responds negatively. The priority nursing diagnosis is a. Knowledge deficit related to absence of symptoms b. Ineffective health maintenance related to uncontrolled high blood pressure c. Imbalance nutrition more than body requirements as evidence by obesity d. Risk for complications ( Cardiovascular ) related to elevated blood pressure 108. The client complains to the nurse, Every time I am taking this antihypertensive medication, I would develop this throbbing headache, I do not like this anymore the nurse responds best by a. We will replace your medication as ordered b. I will inform your doctor about your headache c. That is normal adverse effect, you must bear it if you want to get well d. I am very sorry for that but we have to continue your medications as prescribed 109. The client asks the nurse, What is the difference between Clonidine (Catapress) and Nifedipine(Calcibloc)? Why do they need to replace the calcibloc? The nurse responds based on the knowledge that a. Catapress is a centrally acting drug that suppresses the sympathetic nervous system b. Catapress is also a calcium channel blocker that is long acting c. Catapress is better drug that calcibloc in the treatment of hypertension d. Catapress is another brand name for Nifedipine 110. A client suffers an acute chest pain that lasted for 5 minutes, it was so severe that the client thought he is going to die. The pain was relieved by Nitroglycerine and rest. The priority nursing diagnosis is a. Ineffective myocardial tissue perfusion related to ischemia to cardiac cells as evidenced by pain b. Acute pain related to ischemia and necrosis of cardiac cells c. Knowledge deficit related to wrong notion of dying due to severe chest pain d. Anxiety related to unknown cause 111. The nurse knows that Nitroglycerine is relieving the chest pain by a. Increasing O2 supply to the heart muscles by causing vasodilation b. Decreasing cardiac workload of the client by causing bradycardia c. Improving blood supply to cardiac cells by dilating atherosclerotic coronary vessels d. Decreasing cardiac workload by increasing the volume of blood going back to the heart 112. The client asks the nurse, How will I know if it Heart attack already? The nurse responds by a. If the chest pain is longer than 5 minutes b. If you are not relieved by nitroglycerine c. If the pain is not relieved by positioning alone d. If your ECG shows that it is heart attack 113. Possible laboratory test findings in a client with Angina pectoris is a. Elevated homocysteine levels b. Elevated CK MB isoenzyme c. Elevated myoglobin d. All of the above 114. A client is suffering from myocardial infarction. He is in the Coronary care unit. The CCU nurse noted appearance of six PVCs in this client per minute. The nurse knows that PVCs are occurring due to a. Ischemia to cardiac cells b. Possible re entry of impulses due to necrosis c. Unknown reasons d. Arrythmias as complication of MI 115. The priority nursing diagnosis for the client above is a. Anxiety related to unknown cause b. Risk for cardiac arrest c. Decreased cardiac output d. Acute pain related to ischemia and necrosis of cardiac cells 116. The most common cause of immediate death of clients with myocardial infarction is a. Dysrryhthmias b. Cardiac arrest

a. b. c. d.

c. Impaired gas exchange d. Airway obstruction 117. The client with cardiac arrest was started on Epinephrine IV during resuscitation. Epinephrine effects on this client include the following except a. Improve cardiac contraction b. Vasoconstriction c. Bronchodilation d. No exception 118. The client with Dilated Cardiomyopathy develops Heart failure Class 1. The priority nursing diagnosis is a. Risk for ineffective tissue perfusion b. Risk for activity intolerance c. Risk for decreased cardiac output d. Risk for infection 119. A client suffering from left sided heart failure due to MI was admitted in the emergency department due to acute pulmonary edema. The nurse would put the client into a. High fowlers position b. Semi fowlers position c. Low fowlers position d. Position of comfort 120. Furosemide and digoxin were ordered for the client. The nurse assessed what laboratory finding prior to giving these medications? a. Complete blood count b. Electrolytes level c. Enzyme elevation d. All of the above 121. The nurse assessed the ECG and found that the client is having U wave in the ECG. The nurse knows that such finding indicate a. Hypophosphatemia b. Hypokalemia c. Hypocalcemia d. Hyponatremia 122. A client was receiving Digoxin for three days following an acute attack of Congestive heart failure. The nurse best evaluates the effectiveness of Digoxin by a. Monitoring heart rate b. Assess for disappearance of signs and symptoms c. Monitor cardiac output d. All of the above 123. Priority nursing management for Pericarditis a. Monitor for signs of tissue perfusion b. Position the patient c. Administer NSAIDs as ordered d. Let the patient verbalize his feelings 124. Triggering factors for the most common type of asthma attack a. Exposure to pollens b. Infections c. Exercise d. All of the above 125. All of the following is increased in a client with Bronchial asthma, except a. Residual volume b. Total lung capacity c. Expiratory reserve volume d. Vital capacity 126. The best method of monitoring routinely hypoxemia in client with an acute attack of asthma a. Arterial blood gasses b. Peak flow meter c. Pulse oximetry d. Assess cyanosis 127. The client with bronchial asthma was given Ipratropium ( Atrovent ) nebulization. The nurse knows that this drug is classified as

Xanthine bronchodilator Sympathomimetic bronchidilator Anticholinergic bronchodilator Steroid containing bronchodilator 128. Adverse effect of bronchodilator include a. Increase mucus secretion b. Increase O2 demand by cardiac cells c. Hypotension d. Bradycardia 129. Oxygen dissociation from hemoglobin and therefore oxygen delivery to the tissues are accelerated by a. A decreasing oxygen pressure in the blood b. An increasing carbon dioxide pressure in the blood c. A decreasing oxygen pressure and /or an increasing carbon dioxide pressure in the blood d. An increasing oxygen pressure and/or a deceasing car bon dioxide pressure in the blood 130. A client is admitted with carbon monoxide poisoning. The nurse understands that the poisoning. The nurse understands that the poisonous nature of carbon monoxide results from a. Its tendency to block CO2 transport b. The inhibitory effect on vasodilation c. Its preferential combination with hemoglobin d. The bubbles it tends to form in blood plasma 131. Cutting the left phrenic nerve results in a. Collapse of the right lung b. Paralysis of the left side of the diaphragm c. Relief of pain in the left side of the chest d. Paralysis of the diaphragm on the opposite side 132. A client states that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that tidal volume is the amount of air a. Exhaled forcible after a normal expiration b. Exhaled normally after a normal inspiration c. Trapped n the alveoli that cannot be exhaled d. Forcibly inspired over and above a normal inspiration 133. To facilitate maximum air exchange, the client should be placed in the a. Supine position b. Orthopneic position c. High fowlers position d. Semi fowlers position 134. When spontaneous pneumothorax is suspected in a client with a history of emphysema, the nurse should call the physician and a. Administer 60% O2 via venture mask b. Place the client on the unaffected side c. Give O2 2L per minute via canula d. Prepare for IV administration of elecrolytes 135. When assessing an individual with a spontaneous pneumothorax, the nurse sould expect dyspnea and a. Hematemesis b. Unilateral chest pain c. Increased chest motion d. Mediastinal shift toward the involved side 136. A client has bronchoscopy in ambulatory surgery. To prevent laryngeal edema, the nurse should a. Place ice chips in the clients mouth b. Offer the client liberal amounts of fluid c. Keep the client in the semi fowlers position d. Tell the client to suck on medicated lozenges 137. After a bronchoscopy because of suspected cancer of a lung, a client develops pleural effusion. This is most likely the result of a. Extension of cancerous lesions b. Excessive fluid intake c. Inadequate chest expansion d. Irritation from the bronchoscopy

a. b. c. d.

138. Which of the following nursing diagnoses does the nurse identify as of highest priority for a client with tension pneumothorax? a. Decreased cardiac output b. Ineffective breathing pattern c. Acute pain d. Risk for aspiration 139. Structural changes in the respiratory system include the following, except a. Decreased cough and gag reflex b. Decreased size of airway c. Increased airway resistance d. Decreased dead space 140. The single most important contributor to lung disease a. Family history b. Smoking c. Allergens d. Recreational and occupational exposure 141. Decreased or absent breath sounds are seen in the following conditions, except a. Pleural effusion b. Atelectasis c. Pnemothorax d. Pneumonia 142. All of the following nursing diagnoses are appropriate for a client with an acute asthma attack. Which is of highest priority? a. Anxiety related to difficulty of breathing b. Ineffective airway Clearance related to bronchoconstriction and increased mucus secretion c. Ineffective breathing pattern related to wheezing secondary to bronchial asthma d. Ineffective health maintenance related to lack of knowledge about attack triggers and appropriate use of medication 143. The nurse caring for a client with asthma notices that the clients respirations have slowed and he is no longer coughing. Breath sounds are diminished throughout his lung fields and absent in the bases. The nurse should a. Notify the physician b. Allow the client to rest undisturbed c. Obtain a chest x ray d. Ask family members to leave 144. Which of the following would be an expected finding in a client admitted with chronic obstructive airway disease? a. AP chest diameter equal to a greater than lateral chest diameter b. Mental confusion and lethargy c. 3+ pitting edema of ankles and lower legs d. Oxygen saturation readings of 85% or less 145. An appropriate goal for a client admitted with an acute exacerbation of COPD would be a. Will verbalize self care measures to regain lost lung function b. Arterial blood gas will be within normal limits by discharge c. Will maintain O2 saturation of 90% or higher d. Will identify strategies to help reduce number of cigarettes smoked per day 146. A client with skeletal traction suddenly develops right sided chest pain and shortness of breath. The nurse should a. Check for Homans sign b. Start oxygen per nasal canula c. Administer the prescribed analgesic d. Elevate the head of the bed 45 degrees 147. The nurse caring for a client with COPD recognizes which of the following as an early sign of possible respiratory failure? a. Restlessness and tachypnea b. Deep coma c. Hypotension and tachycardia d. Decreased urine output 148. The nurse caring for a client undergoing mechanical ventilation for acute respiratory failure plans and implements which of the following measures to help maintain effective alveolar ventilation?

a. b. c. d.

Keeps the client in supine position Increases the tidal volume on the ventilator Maintains ordered oxygen concentration Performs endotracheal suctioning as indicated

SITUATION: Ms. Lola, age 79 is admitted to the hospital with a diagnosis of bacterial pneumonia. She has a temperature of 38 C, a productive cough and is experiencing difficulty in breathing. 149. When the nurse obtain the history, she learns that the patient has longstanding osteoarthritis, follows vegetarian diet, has never been seriously ill, and is very concerned with cleanliness. The patient says I hope I can take a bath each day. I feel so dirty if I dont bathe everyday. Which of the following factors adds MOST to the danger of her illness? a. The patients age b. The history of osteoarthritis c. Following vegetarian diet d. Taking a bath everyday 150. The patient appears slightly cyanotic on admission. The cyanotic that accompanies bacterial pneumonia is primarily due to: a. Severe infection b. Iron deficiency anemia c. Inadequate circulation d. Poor oxygen of blood 151. Aspirin is administered to the patient because of its antipyretic and a. Analgesic effects b. Antibiotic effects c. Synergistic effects d. Antihistamine effects 152. Age related changes in the clients respiratory system contributes to the development of her condition a. Decreased protection against foreign particles b. Decrease number of cilia and mucus c. Increased infection rate d. All of the above SITUATION : Mr. Peter Whitney age 65 is admitted to the hospital with an acute exacerbation of long stand COPD brought on by upper respiratory infection. He is tachpyneic and acutely short of breath. Both Mr. Whitney and his wife are extremely anxious. 153. Which of the following physical assessment findings is typical in a patient with advanced obstructive pulmonary disease? a. Increased anterior posterior chest diameter b. Under developed neck muscles c. Collapsed neck veins d. Increased chest excursions with respiration 154. The primary purpose of pursed lip breathing is to help a. Promote oxygen intake b. Strengthen diaphragm c. Strengthen the intercostals muscle d. Promote carbon dioxide elimination 155. Arterial blood gases are drawn while the patient is breathing room air. The results are pH 7.32, PO2 mmHg. PCO2 80 mmHg. What conclusion can the nurse safely make from these findings? a. The patient is in metabolic acidosis b. The patient is in respiratory acidosis c. The patient is in metabolic alkalosis d. The patient is in respiratory alkalosis SITUATION: After a serious automobile accident, Mr. Taylor age 74 transported by ambulance to the emergency department. He complains of severe pain in his right chest where the struck the steering wheel. He also experienced a compound fracture of his right tibia and fibula and multiple lacerations and contusions.

Which of the following findings would confirm the presence of a right pneumothrax? a. Pronounced rales b. Inspiratory wheezes c. Dullness to percussion d. Absence of breath sounds SITUATION: Manny was admitted to the hospital with a diagnosis of hypertension 157. At the time of Mannys physical examination, which finding was indicative of hypertension? a. Pupil changes on opthalmoscopic exam b. Presence of a second heart sound c. Sinus rhythm on auscultation d. Cardiac enlargement on percussion 158. Which test should be ordered for Manny before treatment is indicated? a. Creatinine clearances b. Serum uric acid c. Serum lipid profile d. CBC 159. When teaching Manny precautions to take while on hypertensive medication, the nurse should advise him to a. Avoid standing for long periods of time b. Observe for black and blue marks c. Learn to take his BP TID d. Take at least one hot bath daily SITUATION: Mr. E. is a clerk in a grocery store. During a hold up, he was shot in the right chest. A thick dressing was applied to the wound. He was immediately taken to the emergency room of the local hospital, where emergency medical technician noted that there was a sucking noise form the wound. 160. Mr. Es BP dropped to 100/60. His pulse rate is 96 and weak. His respiratory rate is 40. The most appropriate immediate care by the nurse should include positioning Esteban in a. An upright position and removing the dressing to inspect the wound b. A semi fowlers position and administering oxygen c. Trendelenburgs position and drawing blood for type and cross match d. Trendelenburgs position and administering oxygen 161. Mr. E is found to have pneumothorax. Immediate priority planning for his care should include readying equipment for which procedure? a. Suction b. Insertion of chest tube c. Insertion of tracheostomy tube d. Decompression of the pericardial sac 162. Mr. Es lungs are fully expanded and the chest tube is scheduled to be removed. During the removal procedure he should be instructed to a. Hold his breath b. Breath normally c. Forcibly exhale while bearing down d. Take several rapid swallow breaths SITUATION: Mr. Sison is a 65 year old man who has been admitted to the hospital with advanced cirrhosis of the liver. He lives with his daughter, Lisa and her husband David. 163. On assessing Mr. Sison upon admission, the nurse notes that the client has ascites. The nurse should recognize that this is a result of a. Portal hypertension, decreased colloidal osmotic pressure and decreased serum albumin b. Increased capillary permeability, increased albumin-globulin ration and obstruction of the hepatic duct c. Portal hypertension, decreased capillary permeability and increased destruction of the aldosterone d. Increased venous pressure, excretion of sodium and obstruction of lymphatic channels 164. While reviewing the patients chart, the nurse notes that he is anemic. The nurse should recognize that this is because of a/an a. Lack of intrisic factor in the congested stomach walls b. Failure of the hepatic cells to manufacture hematopoietin

156.

c. Decreased production of prothrombin and fibrinogen d. Increased destruction of RBC by the enlarge spleens not been proven SITUATION : Mrs. Bomar age 69 has a history of congestive heart failure. Her physician recently increased her daily lanoxin dose as her condition was deteriorating. Ten days ago Mrs. Bomar stopped taking all her medications, which she blamed for her frequent headache. She is admitted now to the ER with congestive heart failure complicated by pulmonary edema. She is edematous and cyanotic in acute respiratory distress, extremely anxious and complaining of nausea. 165. When auscultating the patients lungs, the type of sounds the nurse will most likely hear are a. Wheezing sounds b. Rales c. Metallic tingling sounds d. Louder inspiratory that expiratory sounds 166. In which of the following position in bed is the patient likely to be most comfortable a. Low Fowlers position b. Sims position right c. High Fowlers position d. Trendelenburg position 167. Digoxin is administered to the patient primarily because the drug helps a. Dilate coronary arteries b. Strengthen heart beat c. Decrease cardiac dysrhthmias d. Decrease the electrical activity of the myocardium 168. The nurse knows that Digoxin slows down heart rate by a. Slows down SA node from transmitting impulses b. Slows down opening of Sodium channel in the cell membrane c. Slows down entry of calcium d. Slows down the release of potassium out of the cell 169. The doctor orders Nifedipine 10 mg TID to this client. The nurse would a. Administer drug as ordered because Nifedipine enhances the effect of Digoxin b. Question the drug ordered because Nifedipine increases toxic effects of Digoxin c. Clarify the route of drug administration before giving the drug d. Ask the head nurse first before giving the drug 170. The following are contraindication to Digoxin therapy, except a. Amiodarone with Digoxin induce arythmias b. Hypertrophic cardiomyopathy c. Chronic Glomerulonephritis d. Pulmonary edema 171. A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries is composed chiefly of a. Lipids and fibrous tissue b. WBCs c. Lipoproteins d. High density cholesterol 172. The coronary arteries are susceptible to development of arteriosclerosis because coronary areteries: a. Are smaller in diameter b. Accumulate more Low density Lipoprotein c. Have numerous twist and turns d. Have decreased pulse pressure 173. The nurse is teaching a 45 year old patient about ways to lower cholesterol levels as they are elevated. One method is exercise, which a. Increases HDL and decreases triglycerides b. Increases LDL and decreases triglycerides c. Decreases HDL and increases LDL d. Decreases both HDL and LDL 174. When discussing angina pectoris secondary to atherosclerotic disease with a patient, the patient asks why he or she experiences chest pan with exertion. The nurse informs the patient exertion a. Increases the hearts oxygen demands b. Causes vasoconstriction of the heart

c. Increases blood flow to the mesenteric area d. Reduces effectiveness of medication 175. Which abnormal laboratory value is most indicative of aplastic anemia? a. a decrease hemoglobin b. an elevated white blood cell c. an elevated red blood cell count d. a decreased erythrocyte sedimentation rate 176. After confirming the diagnosis of iron-deficiency anemia through laboratory values, the next essential test is: a. Stool guaiac b. Liver function. c. Lipid profile. d. Endoscopy. 177. If none of the following bed positions is contraindicated, which position would be preferred for the client with hypovolemic shock? a. Supine. b. Semi-fowlers. c. Supine with the legs elevated 15 degrees. d. Trendelenburgs. 178. Which of the following points should the nurse include about sublingual nitroglycerin when instructing the client with angina? a. the drug will increase urine output b. store tablets in a tight, light resistant container c. use the tablets only pain is severe d. the shelf life of nitroglycerin is long, it keeps for up to 2 year 179. A middle-aged woman with malignant growth on the larynx is admitted to the hospital for a laryngectomy. The client would most likely state that the earliest symptom of her health problem was: a. a sore throat b. chronic hoarseness c. pain radiating to the ear d. difficulty swallowing 180. While a client with hypertension is being assessed, he says to the nurse, I really dont know why Im here. I feel and havent had any symptoms. The nurse would explain to the client that symptoms of hypertension: a. are often not often b. signify a high risk of stroke c. occur only with malignant hypertension d. appear after irreversible kidney damage has occurred 181. A 54 year old woman comes to the emergency department complaining of chest pain on exertion. The pain subsides with rest. A myocardial infarction (MI) is ruled out and the client is diagnosed with stable angina. The woman says, I really thought I was having a heart attack. How can you tell the difference? Which response by the nurse would provide the client with the most accurate information about the: a. The pain associated with a heart attack is much more severe b. The pain is associated with a heart attack radiates into the jaw and down the left arm c. It is impossible to differentiate anginal pain from that of a heart attack without an ECG d. The pain of angina is usually relieved by resting or lying down 182. Non-pharmacological approaches to hypertension control that the nurse may be involved in teaching the client with hypertension include: a. proper administer of anti hypertensive agents b. activity restrictions c. low potassium therapy d. a regular exercise program 183. The client is taking triamcinolone acetonide (Azmacort) inhalant to treat her bronchial asthma. Which of the following conditions is the client at increased risk for developing while taking this medication? a. oral candidiasis b. hyperglycemia c. gastric ulcer d. fluid retention

184. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will a. Maintain a fluid intake of 800 mL every 24 hours. b. Experience chills only once a day. c. Cough productively without chest discomfort. d. Experience less nasal obstruction and discharge. 185. The nurse teaches the client how to instill nasal drops. Which of the following techniques is correct? a. The client uses sterile technique when handling the dropper. b. The client blows the nose gently before instill. c. The client uses a new dropper for each installation. d. The client sits in a semi-Fowlers position with the head tilted forward after administration of the drops. 186. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? a. Use your nasal decongestant spray regularly to help clear your nasal passages. b. Ask the doctor for antibiotics. Antibiotics will help decrease the secretion. c. It is important to increase your activity. A daily brisk walk will help promote drainage. d. Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks. 187. Which of the following measures should the nurse perform in relation to suctioning a tracheostomy tube? a. Apply suction while inserting the suction catheter into the tube b. Change the tracheostomy tube after suctioning the client c. Select a suction catheter that approximates the diameter of the tracheostomy tube d. Administer high concentrations of oxygen before and after suctioning the client 188. The nurse is evaluating a clients lung sounds. Which of the following breath sounds indicate adequate ventilation when auscultated over the lung fields? a. Vesicular b. Bronchial c. Bronchovesicular d. Adventitious 189. A client is scheduled for radical neck surgery and a total laryngectomy. During the preoperative teaching, the nurse should prepare the client for which of the following postoperative possibilities? a. endotracheal intubation b. insertion of a laryngectomy tube c. immediate speech therapy d. gastrostomy tube 190. As part of the clients diagnostic work-up, she is to have a bronchoscopy under local anesthesia. Her preoperative medication will be atropine sulfate, 0.4 mg, and meperidine HCl, 100 mg IM. Which of the following interventions should the nurse perform after the test? a. Irrigate the NGT with 30mL of normal saline every 2 hours b. Offer 200mL of oral fluids every hour to liquefy lung secretions c. Observe the abdomen for signs of distention and broad-like rigidity d. Position the client on her side and keep her NPO for several hours 191. Which of the following symptoms is not typically associated with peripheral arterial disease? a. ankle edema b. intermittent claudication c. decreased or absent pulses d. cool skin 192. The nurse is preparing the client with heart failure to go home. The nurse would instruct the client to: a. monitor urine output daily b. maintain bed rest for at least 1 week c. monitor daily potassium intake d. weigh daily 193. A patient receives morphine sulfate post-operatively for complaints of pain. Since the patient is receiving morphine, which of the following medications would be MOST important for the nurse to have available? a. Naloxone (Narcan)

b. Disulfiram (Antabuse) c. Dolophine (Methadone) d. Epinephrine (Adrenalie) 194. A client scheduled for a cardiac catheterization says to the nurse I know you were in here when the doctor had me sign the consent form for the test. I thought I understood everything, but now Im not so sure. Which of the following responses by the nurse is BEST? a. Why didnt you listen more closely? b. You sound as if you would like to ask more questions c. Ill get you a pamphlet about cardiac catheterization d. That often happens when this procedure is explained to clients 195. After suctioning a clients tracheostomy tube, the nurse waits a few minutes before suctioning again. The nurse would use intermittent suction primarily to prevent: a. stimulating the clients gag reflex b. depriving the client of sufficient oxygen supply c. dislodging the tracheostomy tube d. obstructing the suctioning catheter with secretions 196. Which of the following activities would the nurse likely to choose to implement in response to a nursing diagnosis of Activity Intolerance related to lack of energy conservation? a. encourage the client to perform all tasks early in the day b. encourage the client to alternate periods of rest and activity throughout the day c. administer narcotics to promote pain relief and rest d. instruct the client to perform daily hygienic care until activity tolerance improves Situation: 197. a. b. c. d. The community health nurse is making her first home visit to Mr. Juan Dela Cruz, a 60-year old with emphysema. The tissue change most characteristics of emphysema is accumulation of mucus in the pleural space constriction of capillaries by fibrous tissue filling of the air space by inflammatory coagulation overdistention , inelasticity ,and rupture of the alveoli

198. The primary goal of Mr. dela Cruzs medical and nursing rehabilitation program should be to help him achieve a. decreased physiologic dependence upon others b. increased understanding of infectious disease control c. decreased awareness of subjective symptoms d. increased capacity for physical exertion 199. Mr. dela Cruz is to be instructed on the use of aerosol therapy. The physician has ordered treatment with Salbutamol (Ventolin) three times daily a. eliminate bronchial infection b. improve pulmonary ventilation c. decrease bronchial irritation d. increase pulmonary circulation 200. a. b. c. d. The desired pharmacologic effect of Salbutamol for Mr. deal Cruz is that of bronchodilator antibiotic detergent demulcent

201. In teaching Mr. dela Cruz the technique of diaphragmatic breathing , which of the following steps is correct? a. Place both hands on his chest b. Breath in through the mouth while tightening the abdominal muscles c. Breath out slowly through the nose d. Breath out through pursed lips while contracting the abdominal muscles

202. Cor pulmonale is a complication that can develop in a patient with emphysema. Symptoms that are most indicative of this condition are a. dyspnea, persistent cough, distended neck veins b. anorexia, dyspnea, weight loss c. jaundice, orthopnea, ankle edema d. persisitent cough, anorexia, orthopnea 203. a. b. c. d. 204. a. b. c. d. The hearts pacemaker or sinoauricular node is located at the base of the right atrial septum in the upper part of the right atrium at the entrance of the right ventricle in the anterior left atrium

Hypertension is defined as persistently elevated systolic and diastolic pressure above 200/80 170/90 140/90 170/100 205. The clinical nurse reviews the laboratory reports of a hypertensive patient whose therapeutic regimen is being re-evaluated. Which laboratory test results indicate need for adjustment a. Urine protein 250 mg/24 hr b. Urine specific gravity 1.030 c. Venous blood ph 7.38 d. Serum sodium 140 mEq/L Situation: Mrs. Pauline Garcia, a 55-years-old attorney with a history of hypertension, is admitted to the coronary care unit with tentative diagnosis of myocardial infarction. She complains of severe chest pain and is dyspneic. 206. a. b. c. d. The most important priority in caring for Mrs. Garcia is improving her electrolyte balance improving her oxygenation lowering her blood pressure increasing her urinary output

207. Mrs. Garcia is placed on a cardiac monitor. For which life-threatening arrhythmia does she need to be observed? a. sinus tachycardia b. Sinus bradycardia c. Premature atrial contractions d. Consecutive premature ventricular contractions 208. The physician orders oxygen by nasal cannula for Mrs. Garcia. The nurse knows that a humidifier is used when administering oxygen primarily because a. oxygen is drying to the mucous membrane b. moisture will loosen secretions c. oxygen diffuses more readily through water d. humidified oxygen is more rapidly absorbed 209. A sign of developing pulmonary edema in a patient with chronic heart disease is a. cyanosis b. increased coughing c. depressed respiratory rate d. weight loss 210. Before adiministration of Morphine, the nurse must get the respiratory rate because a. Morphine causes Cheyne- stokes breathing b. Morphine may cause respiratory depression

c. Morphine may not relieved the pain if RR is more than 20/min d. Morphine causes hypotension 211. a. b. c. d. Aminophyline is often administered to the patient in pulmonary edema to increase pulmonary arterial pressure decrease bronchospasm increase peripheral vascular pressure decrease cardiac irritability

212. Mr. Juan Reyes, 75 years old, is brought to the emergency room in an unconscious state. A stat blood gas analysis reveals a plasma pH of 7.25 and Pco2 of 70 mmHg. Mr. Reyess blood gases indicate that he is in a state of a. respiratory acidosis b. metabolic anhydremia c. respiratory alkalosis d. metabolic acidosis 213. a. b. c. d. Before initiating oxygen therapy the nurses should know if the patient is hypertensive is taking diuretics has a history of diabetes has s history of chronic pulmonary disease

214. What is the rationale for maintaining maximum respiratory function for a patient with CVA (cerebral vascular accident)? a. More oxygen is needed to meet increased metabolic needs b. Oxygen deprivation may result in cerebral damage c. Blood volume is increased by an adequate oxygen supply d. Cerebral anoxia can precipitate acute renal failure 215. a. b. c. d. If a patient goes into respiratory failure the most immediate priority is to obtain blood gases for analysis initiate assisted ventilation administer sodium bicarbonate IV determine patency of the airway

Situation: Mrs. Diaz, a 69-year-old woman, has been found to have pernicious anemia 216. a. b. c. d. 217. a. b. c. d. Which of the following is a common early symptom due to her anemia? Dysuria Depression Tingling of hands Dyspnea

It is essential that Mrs. Diazs family understands that blood transfusions will be necessary on a regular basis vitamin B12 must be continued for her lifetime behavioral disturbances are to be accepted as normal the condition can be controlled with a well-balanced diet 218. The pathophysiology of pernicious anemia results from a. total vitamin B deficiency b. a deficiency of a extrinsic factors c. severe iron deficiency d. a deficiency of intrinsic factor 219. The client has experienced chest pain at 9 am, he was rushed to the hospital after an hour. Laboratory tests were ordered stat, The nurse anticipates that blood tests would reveal a. Cardiac enzyme elevation b. Cardiac enzyme depression

c. Cardiac enzyme normal d. Elevated homocysteine level 220. The following conditions may manifest hemolysis in patients, except A. Sickle cell anemia B. Pernicious anemia C. Hereditary spherocytosis D. G6PD deficiency 221. A test for ABO and Rh incompatibility that identifies antigen and antibody in the RBC and the plasma A. Schillings test B. CBC C. Coombs test D. Bone marrow aspiration 222. Sickle cell crisis is most commonly caused by A. Infection B. Dehydration C. RBC sequestrations D. All of the above 223. Schillings test is a test for A. Absorption of vitamin B12 B. Presence of intrinsic factors C. Deficiency of Folic acid D. All of the above 224. Objective assessment in patients with anemia include all of the following but A. Pale conjunctiva B. RBC of 3,000,000 C. Easy fatigability D. No exception 225. In client with Iron deficiency anemia, priority dependent nursing intervention would be A. Provide periods of rest B. Administer ferrous sulfate as ordered C. Small frequent meals D. All of the above 226. The following antihypertensive drugs may cause vasodilation to decrease blood pressure, except A. Alpha 1 antagonist B. Calcium channel blockers C. Ace inhibitors D. No exception 227. One of the most significant concerns for medical and nursing management of hypertension is A. Complications from medications B. Insufficient information C. Non compliance with recommended therapy D. Uncontrolled dietary management 228. After bronchoscopy A. Client maybe given ice chips and fluids after he demonstrates that he can perform the gag reflex B. Should immediately be given a house to alleviate the hunger resulting from the requested fast C. Should initially be given ice ginger ale to prevent vomiting and possible aspiration of stomach contents D. Will need to remain NPO for 6 hours to prevent pharyngeal irritation 229. Neuromuscuar blockers are given to patients with Acute Respiratory Failure who are on ventilator assistance to accomplish all of the following, except A. Maintain Positive end expiratory Pressure B. Maintain better ventilation C. Increased respiratory rate D. Keep the patient from fighting the ventilator 230. Clinical manifestations directly related to cor pulmonale include all of the following, except A. Dyspnea and cough B. Diminished peripheral pulses C. Distended neck veins D. Edema of the feet and legs 231. For a patient with chronic bronchitis, the nurse expects to see the major clinical symptoms of

A. Chest pain during respirations B. Sputum and productive cough C. Fever, chills and diaphoresis D. Tachypnea and tachycardia 232. Obstruction of the airway in the patient with asthma is caused by all of the following, except A. Thick mucus B. Swelling of bronchial membranes C. Destruction of alveolar wall D. Contraction of muscles surrounding the bronchi 233. Respiratory difficulty and paralysis of al four extremities occur with spinal cord injury located a. Above C4 b. At C6 c. At C7 d. Around C8 234. Because infection is the leading cause of mortality in the oncology population, the nurse preoperatively notes the significance of a. basophil of 1.3 % b. An eosinophil count of 4.5 % c. A lymphocyte count of 23% d. A neutrophil count of 20% 235. Albert is admitted with a radiation induce thrombocytopenia. As a nurse you should observe the following symptoms a. Petecchiae, ecchymosis, epistaxis b. Weakness, easy fatigability and pallor c. Headache, dizziness, blurred vision d. Severe sore throat, bacteremia, hepatomegaly 236. Plasma leakage produces edema which increases a. Circulating blood volume b. Hematocrit level c. Systolic blood pressure d. All of the above 237. Early indicators of late stage septic shock include all of the following, except a. Decreased pulse pressure b. Full bounding pulse c. Pale cool skin d. Renal failure 238. The primary goal in treating cardiogenic shock is a. Improve the hearts pumping ability b. Limit further myocardial damage c. Preserve healthy myocardium d. Treat oxygenation needs of the heart muscle 239. A client who has pneumonectomy is in the post anesthesia care unit. The nurses primary concern at this time would be to maintain: a. Blood replacement b. Ventilatory exchange c. Closed chest drainage d. Supplementary oxygenation 240. When assessing the breath sounds of a client with COPD, the nurse hears rhonchi. Rhonchi can best describe as: a. Snorting during inspiratory phase b. Moist rumbling sound that clears after coughing c. Musical sound more pronounced during expiration d. Crackling inspiratory sounds unchanged with coughing 241. The best method to assess for stridor in immediate postop period after a radical neck dissection is to a. Listen with stethoscope over the trachea b. Assess the clients ability to cough and deep breathe c. Determine the clients ability to do neck exercises d. Listen with stethoscope over the base of the lungs

242. The nurses physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. The nurse should: a. Initiate O2 therapy b. Assess a pleural friction rub c. Obtain a chest X ray film immediately d. Position the client in Fowlers position 243. When discussing breathing exercises with a post op client, the nurse should include teaching the client to: a. Take short frequent breaths b. Exhale with open mouth open c. Plan to do exercise twice a day d. Place the hand on the abdomen and feel it rise 244. A 21 year old aspiring actress is admitted for rhinoplasty to improve her appearance and facilitate her breathing. When monitoring for hemorrhage after the surgery, the nurse should assess specifically for the presence of a. Facial edema b. Excessive swallowing c. Pressure around eyes d. Serosanguinous drainage on dressing 245. A client with emphysema is short of breath and using accessory muscles of respiration. The nurse recognizes that the clients dyspnea is caused by a. Spasms of the bronchi that traps the air b. An increase in the vital capacity if the lungs c. A too rapid expulsion of air from the alveoli d. Difficulty in expelling the air trapped in the alveoli 246. A client with a 10 year history of emphysema is admitted in acute respiratory distress. The nurses assessment of this client will include observing for: a. Pursed lip breathing b. Use of accessory muscles for respiration c. Signs and symptoms of respiratory alkalosis d. Prolonged inspiration with considerable effort 247. A client with a history of Emphysema is in acute respiratory failure with respiratory acidosis. Low level oxygen is administered by a nasal cannula. Four hours later, the nurse identifies that the client has increased restlessness and confusion followed by a decreased respiratory rate and lethargy. The nurse could: a. Increase oxygen by 2% increments b. Question the client about confusion c. Percuss and vibrate chest walls d. Discontinue or decreased oxygen flow rate 248. The nurse is teaching the client diaphragmatic breathing. The client should be advised to: a. Take rapid deep breaths b. Breath with hands on the hips c. Expand abdomen on inhalation d. Perform exercises in the orthopneic position 249. A 21 year old client comes to the emergency department with the chief complaint of left sided chest pain following a racquetball game. A chest x ray reveals a left pneumothorax. When assessing the left side of the client chest, the nurse would expect to find a. A resonant sound on percussion b. Vocal fremitus on palpation c. Rales and rhonchi on auscultation d. An absence of breath sounds on auscultation 250. A client with pneumothorax asks, Why did they put tubes on my chest? The nurse should explain that the purpose of the chest tube is to a. Check the bleeding in the lung b. Monitor the function of the lung c. Drain fluid from the pleural space d. Remove air from the pleural space 251. When inspecting a dressing following a partial pneumonectomy for cancer of the lung, the nurse observes some puffiness of the tissue around the area. When the area is palpated, the tissue feels spongy and crackles. When charting, the nurse should describe this as

Stridor Crepitus Pitting edema Chest distention 252. When turning a client following right pneumonectomy, the nurse should plan to place the client in either the: a. Right or left side lying position b. High fowlers or supine position c. Supine or right side lying position d. Left side lying position or low fowlers position 253. After thoracentesis for pleural effusion, a client returns to the physicians office for a follow up visit. The nurse would suspect a recurrence of pleural effusion when the client says: a. Lately I can only breathe well when I sit up b. During the night I sometimes have fever and chills c. I get a sharp stabbing pain when I take deep breath d. I am coughing up larger amounts of thicker mucus for the last two days 254. During the immediate post op period after laryngectomy, a nursing priority for the client should be to a. Provide emotional support b. Observe for signs of infection c. Keep the trachea free of secretions d. Promote a means of communication 255. Chronic Bronchial asthma will result to a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic acidosis d. Metabolic Alkalosis 256. After surgery, the physician orders an incentive spirometer for a client. The nurse would know that the client was using the spirometer correctly when observing that the client a. Uses the incentive spirometer for 10 consecutive breaths an hour b. Coughs twice before inhaling deeply through the mouth piece c. Inhales deeply, seals the lips around the mouthpiece and exhales d. Inhales deeply through the mouthpiece hold breath for 2seconds then exhales 257. A 60 year old male is returned to the surgical unit after laryngoscopy. The nurse reminds the client not to take anything by mouth until instructed to do so. This nursing intervention generally would be considered: a. Appropriate because these clients usually experience painful swallowing for several days b. Appropriate because early drinking or eating after the clients laryngoscopy may result in aspiration c. Inappropriate because the client is not unconscious and maybe thirsty after being NPO d. Inappropriate because the client is likely to be anxious and probably will not be aware of feeling thirsty 258. A total laryngectomy and radical neck dissection is scheduled for client with cancer of the larynx. When reinforcing the physicians statements to the client, the nurse should review what the surgery entails and what abilities will be lost. The discussion also should focus on what abilities will be retained, such as the ability to: a. Blow the nose b. Sip through the straw c. Chew and swallow food d. Smell and differentiate odors 259. A client is receiving an antihypertensive drug IV for control of severe hypertension. The clients BP is unstable and at 160/94 before the infusion. Fifteen minutes after the infusion is started the blood pressure rises to 180/100. The response to the drug would be describe as a. Allergic response b. Synergistic response c. Paradoxical response d. Individual hypersusceptibility 260. Evaluation of effectiveness of Nitroglycerine SL is based on a. Relief of anginal pain b. Improve cardiac output

a. b. c. d.

c. A decreased in blood pressure d. Dilation of superficial vessel 261. A client is receiving an anticoagulant for pulmonary embolism. The drug that is contraindicated for clients receiving anticoagulant is a. Chloral hydrate b. Acetylsalicylic acid c. Isoxsuprine ( Vasodilan ) d. Chlorpromazine (Thorazine ) 262. Early symptoms of Morphine overdose include a. Slow pulse, slow respiration and sedation b. Slow respirations, dilated pupils and deep sleep c. Profuse sweating, pinpoint pupils and deep sleep d. Slow respiration, constricted pupils and deep sleep 263. A nurse is taking care of the elderly with COPD in the home care. To prevent occurrence of pneumonia, the nurse would include which of the following in her plan of care? a. Instruct and observe the patient of thorough hand washing b. Administering vaccines as ordered c. Prevent patients to talk with one another for more than an hour d. All of the above 264. The most definitive diagnostic test for Iron deficiency anemia is a. CBC b. Bone marrow aspiration c. Schillings test d. Hematocrit 265. A client who is suffering from Parkinsons disease developed Congestive heat failure secondary to myocardial infarction. Dopamine drip was ordered. The nurse knows that such medication a. Will increase release of calcium from cardiac cells b. Prolong cardiac repolarization c. Will replace lost dopamine in the brain d. All of the above 266. Elderly people have a high incidence of hip fracture because of a. Carelessness b. Fragility of the bones c. Sedentary existence d. Rheumatoid diseases 267. The nurse would expect an elderly client with hearing loss caused by aging to have a. Copious, moist cerumen b. Tears in the tympanic membrane c. Difficulty hearing womens voices d. Overgrowth of the epithelial auditory lining 268. The test that should be included in the yearly physical examination of men during the late middle and older adult year is a. PSA b. ELISA for HIV c. Triglycerides d. Rheumatoid factor 269. A client with a history of hypertension is hospitalized with a Transient Ischemic Attacks (TIA). The client has been told to stop smoking. The nurse discovers a pack of cigarettes in the clients bathrobe. The best course of action to take at this time is to: a. Let the client know where they found b. Discard them without making a comment c. Report the situation to the head nurse d. Call the physician and request directions 270. A client with a terminal illness reaches the stage of acceptance. The nurse can best help during this stage by a. Allowing the client to cry b. Allowing unrestricted visiting c. Explaining all that is being done d. Being around though not necessarily speaking

271. When creating a therapeutic environment for a client who has just had a myocardial infarction, the nurse should provide for a. Daily newspapers in the morning b. Telephone communication c. Television for short periods d. Short family visits 272. A nurse administers an intravenous solution of 0.45% sodium chloride. With respect to human blood cells, this solution is a. Isotonic b. Isomeric c. Hypotonic d. Hypertonic 273. The statement that correctly compares the blood plasma & interstitial fluid is: a. Both contain the same kind of ions b. Plasma exerts lower osmotic pressure than does interstitial c. Plasma contains slightly more of each kind of ions than does interstitial cells d. The main cation in plasma is sodium, whereas the main cation in interstitial fluid is potassium 274. Ammonia is excreted by the kidney to help maintain: a. Osmotic pressure of the blood b. Acid- Base balance of the body c. Low bacterial levels in the urine d. Normal red blood cell production 275. The nurse understands that a client with albuminuria has edema caused by a. Fall in tissue hydrostatic pressure b. Rise in plasma hydrostatic pressure c. Fall in plasma colloid osmotic pressure d. Rise in tissue colloid osmotic pressure 276. The percentage of water in the average adult human body is a. 80% b. 60% c. 40% d. 20% 277. The nurse administers serum albumin to client to assist in: a. Clotting of blood b. Formation of RBC c. Activation of WBC d. Development of oncotic pressure 278. Which assessment finding is most likely in a patient with Myasthenia gravis? a. Restlessness, decrease level of consciousness and history of extreme muscle weakness in the morning b. Unequal papillary response, diplopia and inability to hold her mouth closed c. Frequent changes in facial expression, exophthalmos and low pitched voice d. Ptosis, dysphagia and nasal voice 279. A patient was diagnosed to have acute closed angle glaucoma. Which statement about its clinical manifestation is not correct? a. Nausea & vomiting may occur b. The patient commonly sees rainbows around lights c. Ocular pain results from increased intraocular pressure d. The patients vision becomes cloudy & blurred 280. The patient above was scheduled for peripheral iridectomy. The primary purpose of this procedure is to a. Prevent blood from entering the anterior chamber of the eye b. Decrease the production of aqueous humor c. Enhance drainage of aqueous humor d. Permit papillary dilation 281. A 25-year-old male suffered a spinal cord injury from playing basketball resulting in paraplegia. The nurse finds the patient conscious, breathing satisfactorily and lying on his back complain of pain and an inability to move his legs. The nurse should first

a. Gently lift the patient onto a flat piece of lumber and using any available transportation rush him to the medical institution b. Roll the patient onto his abdomen, place a pad under his head and cover him with material available c. Gently raise the patient to a sitting position to see if the pain either diminishes or increase in intensity d. Leave the patient lying on his back with instructions not to move then go and seek for additional help 282. Once admitted, the physician indicates the patient is paraplegic. The family asks the nurse what this means. The nurse explains that a. Upper extremities are paralyzed b. Lower extremities are paralyzed c. One side of the body is paralyzed d. Both upper and lower extremities are paralyzed 283. The nurse recognizes that one major early problem of the patient is a. Hyper reflexia b. Muscle spasm c. Hypotension d. Autonomic dysreflexia 284. The patient was diagnosed to have hyperopia. You expect that the patients condition is due to a. A long eyeball b. A short eyeball c. Abnormal curvature of the cornea d. Inability of the lens to accommodate 285. The above condition can be treated with a. Concave lens b. Convex lens c. Cylindrical lens d. Double vision lens 286. The patient was diagnosed to have Huntingtons disease. Her daughter is asking you if she would get the same disease later in her life. Knowing the transmission of the disease, your best response would be a. You better ask your doctor b. You dont need to worry because you may not carry the gene c. You have 25% chance of getting the disease d. You have 50% chance of getting the disease 287. Manifestations of Huntingtons, include the following, except a. Movement problem b. Intellectual dysfunction c. Emotional disturbances d. Rigidity and tremor 288. Cataract results from a. Destruction of the lens b. Drying up of the lens fiber & crystallization c. Corneal and scleral damage d. Retinal detachment 289. On a visit to a clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would the nurse most likely assess? a. Early morning stiffness b. Limited motion of joints c. Deformed motion of joints d. Rheumatoid nodules 290. The patient with renal failure will manifest all of the following, except a. Anemia b. Hypertension c. Hypokalemia d. No exception 291. Cushings disease resulted from high levels of glucocorticoids due to a. Hyperfunctioning of the adrenal glands b. Hypersecretion of the pituitary gland or a tumor of ACTH

c. Overdose of exogenous steroids d. Maybe all of the above 292. The patient is admitted with a diagnosis of Graves disease. You know that this patient would most likely manifest which of the following signs? a. Toxic goiter and increased TSH b. Thyrotoxicosis & enlarged thyroid gland c. Exopthalmos & cold intolerance d. Elevated T3, T4 and calcitonin 293. The patient underwent thyroidectomy for thyroid cancer, you are aware of possible complications, which of the following is not a complication of thyroidectomy a. Difficulty of breathing b. Hoarseness c. Hypoparathyroidism d. Hypocalcemia & paralysis 294. The patient is undergoing hemodialysis because of chronic renal failure. You are asked by the relative on the chances of recovery for this patient, based on your knowledge, your best response would be a. The patient has few months to live b. He has to be maintained on hemodialysis or else he will die c. He has to undergo hemodialysis to excrete his waste because the kidneys are not functioning d. A kidney transplant can improve his condition 295. Upper urinary tract infection would most likely manifests the following signs & symptoms, except a. Flank pain b. Fever & chills c. Hematuria d. Dysuria 296. The initial manifestation of renal failure is a. Hypovolemia b. Oliguria c. Nocturia d. Polyuria 297. A client is admitted after vomiting fresh blood. He is diagnosed to have duodenal ulcer. The client develops sudden, sharp pain in the mid epigastric region along with a rigid boardlike abdomen. These clinical manifestations most likely indicate which of the following? a. An intestinal obstruction has developed b. Additional ulcers develop c. The esophagus has inflamed d. The ulcer has perforated 298. A client with PUD tells the nurse that he has black stool which he has not reported to his physician, Based on this information, Which nursing diagnosis would be appropriate for this client? a. Ineffective coping related to fear of diagnosis of chronic illness b. Deficient knowledge related to unfamiliarity of significant signs & symptoms c. Constipation related to decreased gastric mobility d. Imbalanced nutrition less than body requirements 299. A client is taking an antacid for treatment of PUD, Which of the following statements indicate that the client understands how to correctly take the antacid? a. I should take the antacid before my other medications b. I need to decrease my intake of fluid so that I dont dilute effects of my antacids c. My antacid will be most effective if I take it whenever I have pain d. It is best for me to take antacid 1 3 hours after meals 300. Patient was diagnosed to have hiatal hernia. What is the problem in herniation? a. Protrusion of a part due to muscle weakness b. Reflux esophagitis c. Small meal is advise d. All of the above