MEDICAL SURGICAL NURSIING

NCLEX CHAPTER QUESTIONS

Chapter 1
1. An example of a nursing activity that reflects the American Nurses Association’s definition of nursing is
♦ B. diagnosing that a patient with a feeding tube is at risk for aspiration
2. to obtain certification in a specialty area of nursing, a nurse must at least
♦ c. practice a specific period of time in the specialized area of nursing
3. in a responding to the Health People initiatives, the nursing profession is expected to
♦ c. teach people healthy self-care behaviors related to the major health problems of the country
4. when using evidence-based practice, the nurse,
♦ c. uses clinical decision making and judgment to determine what evidence is appropriate for a specific
clinical situation.
5. standardized nursing terminologies benefit patient care in that
♦ a. patient problems and nursing care are clearly defined
6. one advantage of the use of informatics in health care delivery is
♦ c. improved communication of the patient’s health status to the health care team.
7. when the nurse determines that the patient’s anxiety needs to be relieved before effective teaching can be
implemented, the phase of the nursing process being used is
♦ c. planning
8. an example of an independent nursing intervention is
♦ c. teaching a patient about the effects of prescribed drugs
9. the process of making a nursing diagnosis differs from a diagnostic process involves
♦ c. identifying factors related to the pathophysiology of a disease process
10. the nurse identifies the nursing diagnosis of risk for impaired skin integrity related to obesity and loss of
skin elasticity for a patient. The most appropriate expected patient outcome related to this nursing diagnosis
is that the
♦ b. patient achieves a normal weight for height
11. a patient has a nursing diagnosis of stress urinary incontinence related to overdistention between voidings.
An appropriate nursing intervention for this patient related to this nursing diagnosis is to
♦ a. provide privacy for toileting
12. linkages of NANDA nursing diagnoses, NOC patient outcomes, and NIC nursing interventions can be used
to
♦ b. provide guides for planning care
13. the primary purpose of the evaluation phase of the nursing process is to
♦ d. identify patient progress toward outcomes

Chapter 2

1. which of the following is the leading determinant of a patient’s health?

♦ A. behavior
2. in identifying patients at the greatest risk for health disparities, the nurse would note that
♦ b. cultural differences exist in the ability of patients to communicate with their health care provider
3. a 50 y/o Native American woman with type 2 diabetes mellitus living on a rural reservation has poor
glycemic control this situation may be related to all of the following factors except
♦ b. eating fresh foods rather than prepackaged foods
4. disparities in health are related to a number of factors including
♦ c. occupation: laborers are more vulnerable to job-related injuries than white collar workers
5. nurses play an important role in reducing health disparities. One important mechanism to do this is to
♦ d. engage in active listening and establish relationships with patients and families.
Chapter 3

1. forcing one’s own cultural beliefs and practices on another person is an example of
♦ cultural imposition
2. immigration may potentially affect an individual’s health in all of the following instances except
♦ d. immigrants are rarely affected by changes when they move to an area that has a different physical
environment
3. which of the following most accurately describes cultural factors that may affect health?
♦ A. diabetes and cancer rates differ by cultural/ethnic groups
4. when communicating with a patient who speaks a language that the nurse does not understand, it is
important to first attempt to
♦ b. use a trained medical interpreter
5. which of the following accurately reflects a physiologic aspect of culture/ethnicity to consider when
providing nursing care?
♦ D. Asians may require a lower dose of tricyclic antidepressants and antiphsychotics than whites
6. which of the following is the first step in developing cultural competence?
♦ B. examine one’s own cultural background, values, and beliefs about health and health care
7. as part of the nursing process, cultural assessment is best accomplished by
♦ b. using a cultural assessment guide as part of the nursing process

Chapter 4
1. the nursing history provides information to assist the nurse primarily in
♦ d. supporting identification of nursing diagnoses
2. the nurse would place information that the patient revealed about his concern that his illness is threatening
his job security in which of the following functional health patterns
♦ a. role-relationship
3. to examine the skin of a patient who has a full-thickness burn, the nurse primarily uses the technique of
♦ a. inspection
4. a focused examination is performed when
♦ c. a specific problem is identified during physical examination
5. after performing a screening history and physical, the first information the nurse records is the
♦ a. health history

Chapter 5
1. the nurse is teaching a middle-aged Hispanic woman in a clinic about various methods to relieve the
patient’s symptoms of menopause. The goal of this teaching would be to
♦ d. provide information for selection and use of treatment options
2. when planning teaching with consideration of adult learning principles, the nurse would
♦ c. provide opportunities for the patient to learn from other adults with similar experiences
3. a necessary skill of the nurse in the role of teacher is the ability to
♦ a. determine when patients are too distressed physically or psychologically to learn
4. when the nurse finds only a limited time available for patient teaching, a strategy that might be used is
♦ a. setting realistic goals that have high priority for the patient.
5. the nurse includes family members in patient teaching primarily because
♦ b. patients have been shown to have better outcomes when families are involved
6. when the nurse, the patient, and the patient’s family decide together what strategies would e best to meet the
learning objectives, the step of the teaching process that is involved is
♦ a. planning
7. a patient characteristic that enhances the teaching-learning process is
♦ b. high self-efficacy
8. which of the following is an example of a correctly written learning objective
♦ d. the patient’s spouse will demonstrate to the nurse how to correctly change a gastrostomy bag before
discharge
9. a patient tells the nurse that she enjoys talking with others and sharing experiences, but easily falls asleep
when reading. In planning teaching strategies with the patient, the nurse recognizes that the patient would
probably learn best with
♦ b. group teaching
10. short-term evaluation of teaching effectiveness includes
♦ a. observing the patient and asking direct questions

Chapter 6
1. ageism is characterized by
♦ c. negative attitudes toward the elderly based on age
2. autoimmune diseases increase with aging. This is consistent with which of the following theories of aging
♦ a. immune theory of aging
3. an ethnic older adult may experience a loss of self-worth when the nurse
♦ d. emphasizes that a therapeutic diet does not allow ethnic foods
4. an important nursing action helpful to a chronically ill older adult is to
♦ c. treat the patient as a competent manager of the disease
5. when older adults become ill they are more likely than younger adults to
♦ d. alter their daily living activities to accommodate new symptoms
6. an important fact for the nurse to know about caregivers is that they
♦ a. may need nurses to assist them in reducing caregiver strain
7. an appropriate care choice for an older adult living with an employed daughter but who requires assistance
with activities of daily living is
♦ a. adult day care
8. a natural death act is an advance directive that
♦ c. allows a person to direct his or her health care in the event of terminal illness
9. nursing interventions directed at health promotion in the older adult are primarily focused on
♦ c. teaching positive health behaviors

Chapter 9
1. determination of whether an event is a stressor is based on a person’s
♦ b. perception
2. the nurse recognizes that a patient with newly diagnosed cancer of the breast is using an emotion-focused
coping process when she
♦ a. joins a support group for women with breast cancer
3. the nurse would expect which of the following findings in a patient as a result of the physiologic effect of
stress on the reticular formation
♦ c. inability to sleep the night before beginning to self-administer insulin injections
4. the nurse utilizes knowledge of the effects of stress on the immune system by encouraging patients to
♦ b. avoid exposure to upper respiratory infections
5. the nurse recognizes that a person who is subjected to chronic stress could be at higher risk for
 ♦ b. colds and flu
6. during a stressful circumstance that is uncontrollable, which type of coping strategy is the most effective
♦ c. emotion-focused coping
7. an appropriate nursing intervention for a hospitalized patient who has a nursing diagnosis of ineffective
coping related t inadequate psychologic resources is
♦ d. asking the patient to describe previous stressful situations and how she managed to resolve them

Chapter 10
1. pain is best described as
♦ b. an unpleasant, subjective experience
2. a neurotransmitter known for its involvement in pain modulation is
♦ d. norepinephrine
3. which of the following words is most likely to be used to describe neuropathic pain
♦ d. burning
4. unrelieved pain is
♦ c. dangerous and can lead to many physical and psychologic complications
5. a cancer patient who reports ongoing, constant moderate pain with short periods of severe pain during
dressing changes
♦ c. should be receiving both a long-acting and a short-acting opioid
6. an example of distraction to provide pain relief is
♦ b. music
7. an appropriate nonopioid analgesic for mild pain is
♦ b. ibuprofen (Advil)
8. an important nursing responsibility related to pain is to
♦ c. believe what the patient shays about the pain
9. providing opioids to a dying patient who is experiencing moderate to severe pain
♦ c. is an appropriate nursing action
10. a nurse believes that patients with the same type of tissue injury should have the same amount of pain. This
statement reflects
♦ d. the nurse’s lack of knowledge about pain mechanisms, which is likely to contribute to poor pain
management

Chapter 13
1. the role of the complement system in opsonization affects which response of the inflammatory process
♦ b. cellular
2. fever that accompanies inflammation is most likely caused by
♦ b. release of IL-1, IL-6, and TNF from monocytes
3. a patient has an open, infected surgical wound that is treated with irrigations and moist gauze dressings. The
nurse expects that this wound
♦ d. heals by the same processes as an uninfected deep wound
4. contractures frequently occur after burn healing because of
♦ d. excess fibrous tissue formation
5. rest and immobilization are important measures of acute care for wound healing because they
♦ a. decrease the inflammatory response
6. which one of the following orders should a nurse question as part of the plan of care for a patient with a
stage III pressure ulcer
♦ c. clean the ulcer every shift with Dakin’s solution
7. an 85 y/o patient is assessed to have a score of 15 on the Braden scale. This means that the patient
 ♦ b. is at risk for developing a pressure ulcer
8. a 65 y/o stroke patient who is confined to bed is assessed to be at risk for the development of a pressure
ulcer. Based on this information, the nurse should
♦ a. implement a 12hr turning schedule
9. an 82 y/o man is being cared for at home by his family. A pressure ulcer on his right buttock measures 1 cm
X 2 cm X 0.8 cm in depth, and pink tissue is completely visible on the wound bed. This pressure ulcer
should be documented as
♦ c. stage III

Chapter 14
1. if a person is heterozygous for a given gene, it means that the person
♦ d. has two different alleles for the gene
2. a father who has a sex-linked recessive disorder and a wife with a normal genotype will
♦ c. pass the carrier state to his female children
3. the function of monocytes in immunity is related to their ability to
♦ d. capture antigens by phagocytosis and present them to lymphocytes
4. one function of cell-mediated immunity is
♦ c. surveillance for malignant cell changes
5. the reason newborns are protected for the first 6 months of life from bacterial infections is because of the
maternal transmission of
♦ a. IgG
6. in a type I hypersensitivity reaction, the primary immunologic disorder appears to be
♦ d. release of chemical mediators of IgE-bound mast cells and basophils
7. the nurse is alerted to possible anaphylactic shock immediately after a patient has received intramuscular
penicillin by the development of
♦ a. edema and itching at the injection site
8. the nurse advises a friend who asks him to administer his allergy shots that
♦ d. immunotherapy should only be administered in a setting where emergency equipment and drugs are
available
9. association between HLA antigens and disease is most commonly found in what disease conditions
♦ d. autoimmune disorders
10. a patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains
that plasmapheresis is used in her treatment to
♦ c. exchange her plasma that contains antinuclear antibodies with a substitute fluid
11. the most common cause of secondary immunodeficiencies is
♦ a. drugs
12. which of the following accurately describes rejection following transplantation
♦ d. hyperacute reaction can usually be avoided if crossmatching is done prior to the transplantation
13. if a person is having an acute rejection of a transplanted organ, which of the following drugs would most
likely be used
♦ b. daclizumab

Chapter 15
1. sources of emerging infections include all of the following except
♦ a. plants
2. which of the following antibiotic-resistant organisms cannot be killed by normal hand soap
♦ a. vancomycin-resistant enterococci
3. transmission of HIV from an infected individual to another occurs
 ♦ a. most commonly as a result of sexual contact
4. following infection with HIV
♦ c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T
cells
5. which of the following statements is false
♦ d. opportunistic diseases occur more often
6. a diagnosis of AIDS is made when an HIV-infected patient has
♦ a. a CD4+ T cell count below 200 μl
7. screening for HIV infection generally involves
♦ b. electrophoretic analysis for HIV antigen in plasma
8. antiretroviral drugs are used to
♦ c. treat opportunistic diseases
9. opportunistic diseases in HIV infection
♦ c. occur in the presence of immunosupporesion
10. which of the following statements about metabolic side effects of ART is false
♦ a. theses are an annoying set of symptoms that are ultimately harmless
11. which of the following eliminates the risk of transmission of HIV
♦ a. using sterile equipment to inject drugs
12. of the following, which is the most appropriate nursing intervention to help an HIV-infected patient adhere
to a treatment regiment
♦ d. assess the patient’s routines and find adherence cues that fit into the patient’s life circumstances

Chapter 16
1. trends in the incidence and death rates of cancer include the fact that
♦ d. African Americans have a higher death rate from cancer than whites
2. cancer is a name for a large group of diseases, all of which are characterized by
♦ d. cell growth that escapes normal control
3. a characteristic of the stage of progression in the development of cancer is
♦ d. proliferation of cancer cells in spite of host control mechanisms
4. the primary protective role of the immune system related to malignant cells is
♦ a. surveillance for cells with tumor-associated antigens
5. the primary difference between benign and malignant neoplasms is the
♦ d. characteristic of tissue invasiveness
6. important nursing roles related to prevention and detection of cancer include
♦ b. instructing persons on ways to increase capacity to cope with stress
7. the goals of cancer treatment are based on the principle that
♦ c. a combination of treatment modalities is effective or controlling many cancers
8. the most effective method of administering a chemotherapeutic agent that is a vesicant is to
♦ d. use a central venous access device
9. the nurse explains to a patient undergoing brachytherapy of the cervix that she
♦ b. requires the use of radioactive precautions during nursing care
10. stomatitis, a common side effect of chemotherapeutic agents, occurs because the
♦ d. rapidly dividing cells of the mucous membranes of the mouth are being destroyed
11. the nurse teaches the patient receiving IL-2 about the drug based on the knowledge that this agent is
administered primarily for the purpose of
♦ a. stimulating the immune system
12. the nurse counsels the patient receiving radiation therapy or chemotherapy that
♦ c. following successful treatment, a return to the person’s previous functional level can be expected
13. an inappropriate nursing intervention to promote nutrition in the patient with cancer is
 ♦ a. providing bland, pureed food because the person’s taste sensation is altered
14. syndrome of inappropriate ADH secretion (SIADH) that occurs in certain types of cancer is primarily due to
♦ ectopic hormonal production
15. a patient has recently been diagnosed with early stages of breast cancer. Which of the following is most
appropriate for the nurse to focus on
♦ a. maintaining patient’s hope

Chapter 17
1. during the postoperative care of a 76 y/o patient, the nurse monitors the patient’s intake and output
carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because
♦ d. small losses of fluid are more significant because body fluids account for only about 50% of body
weight in older adults
2. if the blood plasma has a higher osmolality than the fluid within a red blood cell, the mechanism involved in
equalizing the fluid concentration is
♦ a. osmosis
3. an elderly woman was admitted to the medical unit with dehydration. A clinical indication of this problem
is
♦ a. weight loss
4. implementation of nursing care for the patient with hyponatremia includes
♦ a. fluid restriction
5. a patient is receiving a loop diuretic. The nurse should be alert for which symptoms
♦ c. weak, irregular pulse, and poor muscle tone
6. which patient would be at greatest risk for the potential development of hypermagnesemia
♦ c. 42 y/o woman with systemic lupus erythematosus and renal failure
7. it is especially important for the nurse to assess for which clinical manifestation(s) in a patient who has just
undergone a total thyroidectomy
♦ c. positive chvostek sign
8. the nurse anticipates that the patient with hyperphosphatemia secondary to renal failure will require
♦ a. calcium supplements
9. the lungs act as an acid-base buffer by
♦ a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load
10. a patient has the following arterial blood gas results: pH 7.52; PaCO2 30mm hG; hco3- 24 mEq/L. the nurse
determines that the results indicate
♦ d. respiratory alkalosis
11. the typical fluid replacement for the patient with an ICF fluid volume deficit is
♦ b. hypotonic

Chapter 21
1. in a patient who has a hemorrhage in the vitreous cavity of the eye, the nurse knows that blood is
accumulating
♦ b. between the lense and the retina
2. increased intraocular pressure may occur as a result of
♦ d. increased production of aqueous humor by the ciliary process
3. the nurse should specifically question patients using eyedrops to treat glaucoma about
♦ c. a history of heart or lung disease
4. the nurse should always assess the patient with an ophthalmic problem for
♦ a. visual acuity
5. during assessment of hearing, the nurse would expect to find
 ♦ b. pearl-gray tympanic membrane
6. arcus senilis is due to
♦ d. cholesterol deposits in the cornea
7. before injection fluorescein for angiography, it is important to
♦ a. obtain an emisis basin

Chapter 22
1. presbyopia occurs in older individuals because
♦ b. the lens becomes inflexible
2. the most important nursing intervention in patients with epidemic keratoconjunctivitis is
♦ d. teaching patient and family members good hygiene techniques
3. patients with eye inflammation or an eye infection should be taught
♦ c. to apply a cold washcloth with pressure to the inflamed area frequently
4. rubella can cause hearing problems if
♦ b. exposure is before 16 weeks of gestation
5. in preparing patients for retinal detachment surgery, the nurse should
♦ d. assess the patient’s level of knowledge about retinal detachment and provide information appropriate
to the situation
6. the nurse is teaching an adult patient how to administer antibiotic eardrops. Instruction should include
which of the following
♦ b. be careful to avoid touching the tip of the dropper bottle to the ear
7. the nurse would suspect otosclerosis from assessment findings of hearing loss in
♦ a. a 26 y/o woman who has three biologic children under 5 years of age
8. the patient who has a sensorineural hearing loss
♦ a. has difficulty understanding speech
9. the nurse teaches the patient with extended-wear contact lenses that
♦ b. the lenses may be worn for up to 1 week without removal
10. the nurse is teaching a patient with a moderate hearing impairment in preparation for hospital discharge. To
facilitate communication, the nurse should
♦ a. use simple sentences
11. patients with permanent visual impairment
♦ d. may experience the same grieving process that is associated with other losses

Chapter 23
1. the primary function of the skin is
♦ b. protection
2. age-related changes in the skin include
♦ b. a loss of collagen
3. when assessing the sleep-rest pattern in relation to the skin, the nurse questions the patient regarding
♦ d. the presence of dark circles under the eyes
4. during the physical examination of a patient’s skin, the nurse would
♦ c. pinch up a fold of skin to assess for turgor
5. skin lesions found by the nurse and described as circumscribed, superficial, elevated, solid, and greater than
1 cm in diameter are called
♦ a. plaques
6. to assess the skin for temperature and moisture, the most appropriate technique is
♦ a. palpation
7. individuals with dark skin are more likely to develop
 ♦ a. keloids
8. on inspection of the patient’s skin, the nurse notes the complete absence of melanin pigment in patchy areas
on the patient’s hands. This condition is called
♦ a. vitiligo
9. diagnostic testing is recommended for skin lesions when
♦ b. a more definitive diagnosis is needed

Chapter 24
1. the nurse advises a patient with photosensitivity to use a sunscreen that contains
♦ c. benzophenones
2. in teaching a patient who is using topical corticosteroids to treat an acute dermatitis, the nurse should tell the
patient that
♦ b. topical corticosteroids usually do not cause systemic side effects
3. a patient with psoriasis tells the nurse that she has quit her job as a receptionist because she feels her
appearance is disgusting to customers. The nursing diagnosis that best describes this patient response is
♦ d. social isolation related to decreased activities secondary to fear of rejection
4. in teaching a patient with malignant melanoma about this disorder, the nurse recognizes that the prognosis
of the patient is most dependent on
♦ a. the thickness of the lesion
5. the nurse identifies that a patient with a diagnosis of which of the following disorders is most at risk for
spreading the disease
♦ b. impetigo on the face
6. a mother and her two children have been diagnosed with pediculosis corporis at a health center. An
appropriate measure in treating this condition is
♦ a. applying pyrethrins to the body
7. a common site for the lesions associated with childhood atopic dermatitis is the
♦ c. antecubital space
8. during assessment of a patient the nurse notes an area of red, sharply defined plaques covered with silvery
scales that are mildly itchy on the patient’s knees and elbows. The nurse recognizes this finding as
♦ b. psoriasis
9. a dermatologic manifestation of Cushing syndrome would include
♦ a. telangiectasia
10. important patient teaching after a chemical peel includes
♦ a. avoidance of sun exposure

Chapter 25
1. in presenting a program on fire and burn prevention for families, the nurse focuses on the most common
cause of household fires as
♦ c. carelessness with cigarettes
2. the injury that is least likely to result in a full-thickness burn is
♦ a. sunburn
3. when assessing a patient with a partial-thickness burn, the nurse would expect to find
♦ c. red, shiny, wet appearance
4. the extent of burns is assessed by
♦ d. using guides to indicate burn location relative to total body surface
5. an 82 kg patient has a 45% TBSA burn. Using 4 ml/kg/% TBSA burn during the first 24 hours after a burn
injury, the nurse would anticipate a fluid replacement of
♦ c. 9225 ml
6. fluid and electrolyte shifts that occur during the early emergent phase include
♦ c. sequestering of sodium and water in interstitial fluid
7. to maintain a positive nitrogen balance in a major burn, the patient must
♦ b. increase normal adult caloric intake by about 3 times
8. pain management for the burn patient is most effective when
♦ b. the patient has as much control over the management of the pain as possible
9. a therapeutic measure used to prevent hypertrophic scarring during the rehabilitative phase of burn recovery
is
♦ a. applying pressure garments
10. it is important for the burn patient and family to
♦ b. talk frequently with the nurse about the patient’s progress
11. discharge planning for the burn patient begins
♦ b. on admission

Chapter 26
1. the mechanism that stimulates the release the release of surfactant is
♦ c. alveolar stretch from deep breathing
2. during inspiration, air enters the thoracic cavity as a result of
♦ d. decreased intrathoracic pressure relative to pressure at the airway
3. the ability of the lungs to adequately oxygenate the arterial blood is best determined by examination of the
♦ c. arterial oxygen tension
4. the most important respiratory defense mechanism distal to the respiratory bronchioles is the
♦ a. alveolar macrophage
5. a rightward shift of the oxygen-hemoglobin dissociation curve
♦ c. facilitates release of oxygen at the tissue level
6. very early signs or symptoms of inadequate oxygenation include
♦ b. apprehension and restlessness
7. during the respiratory assessment of the older adult, the nurse would expect to find
♦ c. increased anterior-posterior chest diameter
8. when assessing activity-exercise patterns related to respiratory health, the nurse inquires about
♦ a. dyspnea during rest or exercise
9. when auscultating the chest of an elderly patient in respiratory distress, it is best to
♦ b. begin listening at the lung bases
10. which of the following is an abnormal assessment finding of the respiratory system
♦ d. bronchial breath sounds in the lower lung fields
11. a diagnostic procedure done to remove pleural fluid for analysis is
♦ a. thoracentesis

Chapter 27
1. a patient was seen in the clinic for an episode of epistaxis, which was controlled by placement of anterior
nasal packing. During discharge teaching, the nurse instructs the patient to
♦ d. avoid vigorous nose blowing and strenuous activity
2. a patient with allergic rhinitis reports severe nasal congestion, sneezing, and watery, itchy eyes and nose at
various times of the year. To teach the patient to control these symptoms, the nurse advises the patient to
♦ d. keep a diary of when the allergic reaction occurs and what precipitates it
3. a patient with sleep apnea would like to avoid using a nasal CPAP devise, if possible. To help reach this
goal, the nurse suggests that he
♦ a. lose excess weight
4. a type of tracheostomy tube that prevents speech is
♦ c. a tube with an inflated foam cuff
5. to prevent excessive pressure on tracheal capillaries, pressure in the cuff on a tracheostomy tube should be
♦ b.less than 20 mm Hg or 25 cm H2O
6. which of the following is a lte symptom of head and neck cancer
♦ d. decreased mobility of the tongue
7. while in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with
some clots. Which of the following nursing interventions would apply
♦ d. continue your assessment of the patient, including oxygen saturation, respiratory rate, and breath
sounds
8. when using a voice prosthesis, the patient
♦ d. blocks the stoma entrance with a finger

Chapter 28
1. in assessing a patient with pneumococcal pneumonia, the nurse recognizes that clinical manifestations of
this condition include
♦ a. fever, chills, and a productive cough with rust-colored sputum
2. an appropriate nursing intervention for a patient with pneumonia with the nursing diagnosis of ineffective
airway clearance related to thick secretions and fatigue would be to
♦ d. teach the patient how to cough effectively to bring secretions to the mouth
3. a patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room.
The patient is taught all the following to prevent spread of the disease except
♦ a. expect routine TST to evaluate infection
4. a patient has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment
secondary to a traumatic injury and infection. The nurse plans care for the patient knowing that the patient
is most susceptible to
♦ a. candidiasis
5. which of the following statements best describes the treatment of lung abscess
♦ b. antibiotics given for a prolonged period are the usual treatment of choice
6. a common complication of may types of environmental lung diseases is
♦ a. pulmonary fibrosis
7. the patient with lung cancer needs to receive influenza vaccine and pneuomococcal vaccines. The nurse
will
♦ b. administer both vaccines at the saem time in different arms
8. the nurse identifies a flail chest in a trauma patient when
♦ c. paradoxic chest movement occurs during respiration
9. the nurse notes tidaling of the water level in the tube submerged in the water-seal chamber in a patient with
closed chest tube drainage. The nurse should
♦ a. continue to monitor this normal finding
10. a nursing measure that should be instituted after a pneumonectomy is
♦ c. range-of-motion exercises on the affected upper extremity
11. guillain-barre syndrome causes respiratory problems primarily by
♦ d. interrupting nerve transmission to respiratory muscles
12. a patient is on a continuous epoprostenil infusion pump. The alarm goes off indicating an obstruction in the
intravenous line downstream. The nurse should
♦ c. assess the central line immediately for any obstruction or accidental clamping of tubing
13. which of the following statements does not describe the follow-up management of lung transplantation
♦ b.high doses of oxygen are administered around the clock
Chapter 29
1. asthma is best characterized as
♦ a. an inflammatory disease
2. in evaluating the asthmatic patient’s knowledge of self-care, the nurse recognizes that additional instruction
is needed when the patient says
♦ a. “I use my corticosteroid inhaler when I feel short of breath.”
3. A plan of care for the patient with COPD could include
♦ A. exercise such as walking
4. The effects of cigarette smoking on the respiratory system include
♦ D. hyperplasia of goblet cells and increased production of mucus
5. The major advantage of a Venturi mask is that it can
♦ C. deliver a precise concentraton of O2
6. One of the most important things that a nurse can teach a patient with COPD is to
♦ D. know the early signs/symptoms of COPD exacerbation
7. Diagnostic studies that the nurse would expect to be abnormal in a person with CF are
♦ D. pulmonary function test and sweat test
8. A primary goal for the patient with bronchiectasis is that the patient will
♦ C. maintain removal of bronchial secretions

Chapter 30
1. An individual who lives at a high altitude may normally have an increased RBC count because
♦ B. hypoxia caused by decreased atmospheric oxygen stimulates erythropoiesis
2. Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of
causing
♦ D. decreased phagocytosis of bacteria
3. An anticoagulant such as warfarin (Coumadin) that interferes with the production of prothrombin will alter
the clotting mechanism during
♦ B. activation of thrombin
4. When reviewing laboratory results of an 83 y/o patient with an infection, the nurse would expect to find
♦ A. minimal leukocytosis
5. Significant information obtained from the patient’s health history that relates to the hematologic system
includes
♦ A. jaundice
6. While assessing the lymph nodes, the nurse
♦ C. lightly palpates superficial lymph nodes with the pads of the fingers
7. If a lymph node is palpated, which of the following is a normal finding
♦ B. firm, mobile nodes
8. Immediately following a bone marrow biopsy and aspiration, the nurse should instruct the patient to
♦ B. lie still with a sterile pressure dressing intact

Chapter 31
1. In a severly anemic patient, the nurse would expect to find
♦ A. dyspnea and tachycardia
2. When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would
question the patient about
♦ B. dietary intake of iron
3. A nursing intervention for a patient with severe anemia of chronic kidney disease includes
 ♦ D. teaching self-injection of erythropoietin
4. The nursing management of a patient in sickle cell crisis includes
♦ C. aggressive analgesic and oxygen therapy
5. A complication of the hyperviscosity of polycythemia is
♦ A. thrombosis
6. When providing care for a patient with thrombocytopenia, the nurse instructs the patient to
♦ A. dab his or her nose instead of blowing
7. The nurse would anticipate that a patient with von Willebrand’s disease undergoing surgery would be
treated with administration of vWF and
♦ D. factor VIII
8. DIC is a disorder in which
♦ C. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of
clotting factors, leading to diffuse clotting and hemorrhage
9. Appropriate nursing actions when caring for a hospitalized patient with severe neutropenia include
♦ D. strict hand washing and frequent vital sign assessment
10. Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow,
laboratory results the nurse would expect to find include
♦ D. a deficiency of all cellular blood components
11. The most common type of leukemia in older adults is
♦ C. chronic lymphocytic leukemia
12. Multiple drugs are often used in combinations to treat leukemia and lymphoma because
♦ C. the drugs are more effective without causing side effects
13. The nurse is aware that a major difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma is
that
♦ B. hodgkin’s lymphoma is considered potentially curable
14. A patient with multiple myeloma becomes confused and lethargic. The nurse would expect tat these clinical
manifestations may be explained by diagnostic results that indicate
♦ C. hypercalcemia
15. When reviewing the patient’s hematologic laboratory values after a splenectomy, the nurse would expect to
find
♦ D. increased platelet count
16. Complications of transfusions that can be decreased by the use of leukocyte reduction filters for red blood
cells and platelets are
♦ D. transmission of cytomegalovirus and alloimmunization

Chapter 32
1. A patient with a triscuspid valve disorder will have impaired blood flow between the
♦ C. right atrium and right ventricle
2. A patient with an MI of the anterior wall of the left ventricle most likely has an occlusion of the
♦ D. left anterior descending artery
3. If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the
♦ C. ventricles
4. The portion of the vascular system responsible for hemostatis is the
♦ B. endothelial layer of the arteries
5. When a person’s blood pressure rises, the homeostatic mechanism to compensate for an elevation involves
stimulation of
♦ A. baroreceptors that inhibit the sympathetic nervous system, causing vasodilatation
6. A P wave on an ECG represents an impulse
♦ B. arising at the SA node and depolarizing the atria
7. When checking the capillary filling time of a patient, the color returns in 5 seconds. The nurse recognizes
this finding as indicative of
♦ D. impaired arterial flow to the extremities
8. The ausculatory area in the left midclavicular line at the level of the fifth ICS is the
♦ B. mitral area
9. When assessing the patient, the nurse notes a palpable precordial thrill. This finding may be caused by
♦ A. heart murmurs
10. When assessing the cardiovascular system of a 79 y/o patient, the nurse expects to find
♦ C. difficulty in isolating the apical pulse
11. An important nursing responsibility for a patient recovering from a cardiac catheterizations
♦ A. checking the percutaneous site and distal pulses

Chapter 34
1. If a patient has decreased cardiac output caused by fluid volume deficit and marked vasodilation, the
regulatory mechanism that will increase the blood pressure by improving both of these is
♦ D. activation of the rennin-angiotensin-aldosterone system
2. While obtaining subjective assessment data from a patient with hypertension, the nurse recognizes that a
modifiable risk factor for the development of hypertension is
♦ B. excessive alcohol consumption
3. Target organ damage that can occur from hypertension includes
♦ D. renal dysfunction and left ventricular hypertrophy
4. A high-risk population that should be targeted in the primary prevention of hypertension is
♦ B. African American
5. In teaching a patient with hypertension about controlling the condition, the nurse recognizes that
♦ D. lifestyle modifications are indicated ro all persons with elevated BP
6. A major consideration in the management of the older adult with hypertension is to
♦ D. use careful technique in assessing the BP of the patient because of he possible presence of an
auscultatory gap
7. A patient with newly diagnosed hypertension has a blood pressure of 158/98 after 12 months of exercise and
diet modifications. The nurse advises the patient that
♦ A. medication may be require because the BP is still not at goal.
8. A patient is admitted to the hospital in hypertensive crisis. The nurse recognizes that hypertensive
emergency in that
♦ D. hypertensive emergencies are associated with evidence of target organ damage

Chapter 34
1. In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this
disorder involve
♦ C. accumulation of lipid and fibrous tissue within the coronary arteries
2. After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction
is needed when the patient says
♦ A. “I would like to add weight lifting to my exercise program.”
3. A hospitalized patient with angina tells the nurse that she is having chest pain. The nurse bases her actions
on the knowledge that ischemia
♦ B. will be relieved by rest, nitroglycerin, or both
4. The clinical spectrum of acute coronary syndrome includes
♦ D. unstable angina, STEMI, and NSTEMI
5. In planning activity for the patient recovering from an MI, the nurse recognizes that the healing heart wall is
most vulnerable to stress
♦ C. 10 to 13 days after the infarction
6. A patient I s admitted to the CCU with chest pain of 24 hours duration, ECG findings consistent with an
acute MI, and rare ventricular dysrhythmias. The nurse plans care for the patient based on the expectation
that the patient will be managed with
♦ C. intravenous nitroglycerin
7. Three days after MI, a patient states that he does not understand what the alarm is about because his
problem was just a case of “bad indigestion”. His reaction is an example of
♦ B. denial
8. The most common pathologic finding in individuals at risk for sudden cardiac death is
♦ D. atheroscleoritc heart disease

Chapter 35
1. The nurse recognizes that primary manifestations of systolic failure include
♦ B.  ejection fraction and  PAWP
2. A compensatory mechanism involved in HF that leads to inappropriate fluid retention and additional
workload of the heart is
♦ C. neurohormonal response
3. A drug used in the management of a patient with ADHF and pulmonary edema that will decrease both
preload and afterload and provide relief of anxiety is
♦ D. morphine sulfate
4. A patient with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To
prevent possible complications of this combination of drugs, the nurse needs to
♦ A. monitor serum potassium levels
5. The primary causes of death in patient with heart transplants in the first year include
♦ C. infection and acute rejection

Chapter 36
1. A patient admitted with ACS has continuous ECG monitoring. An examination of the rhythm strip reveals
the following characteristics: atrial rate – 74 and regular; ventricular rate – 62 and irregular; P wave –
normal shape; PR interval – lengthens progressively until a P wave is not conducted; QRS – normal shape.
Nursing management would involve
♦ D. careful observation for symptoms of hypotension or angina
2. The nurse is monitoring the ECG of a patient admitted with ACS. Which of the following ECG
characteristics would be most suggestive of ischemia
♦ C. sinus rhythm with depressed ST segment
3. The ECG monitor of a patient in the cardiac care unit following an MI indicates ventricular bigeminy. The
nurse anticipates
♦ D. assessing the patient’s response to the dysrhythmia
4. The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from
defibrillation in that
♦ D. cardioversion may be done on a nonemergency basis with sedation of the patient
5. When providing discharge instructions to a patient with a new permanent pacemaker, the nurse teaches the
patient to
♦ A. take and record a daily pulse rate
6. the nurse plans care for the patient with an implantable cardoverterdefibrillator based on the knowledge that
♦ b. all members of the patient’s family should learn CPR
7. important teaching for the patient scheduled for a diagnostic electrophysiologic study includes explaining
that
♦ a. ventricular tachycardia may be induced and treated during the procedure

Chapter 37
1. a patient with a history of IV cocaine use has acute infective endocarditis. The nurse assesses the patient for
♦ b. a new murmur
2. nursing assessment findings for acute pericarditis include
♦ c. chest pain, dyspnea, and pericardial friction rub
3. prophylactic antibiotics are indicated to prevent infective endocarditits for at-risk individuals who are
♦ a. undergoing any dental procedure
4. the most common underlying cause of myocarditis is
♦ b. a viral infection
5. teaching the patient with rheumatic fever about the disease, the nurse explains that rheumatic fever is
♦ c. a sequel of group A streptococcal infection
6. a patient with rheumatic fever should be taught about the need for
♦ b. antibiotic therapy
7. a common cause of aortic valve stenosis in older adults is
♦ a. rheumatic fever
8. which of the following findings is indicative of left ventricular overload in a patient with chronic aortic
regurgitation
♦ c. exertional dyspnea and a diastolic high-pitched murmur
9. a patient hospitalized with aortic stenosis has a nursing diagnosis of activity intolerance related to
insufficient oxygen secondary to decreased cardiac output. And appropriate nursing intervention for this
patient is to
♦ c. progressively increase activity to increase cardiac tolerance
10. the nurse caring for a patient scheduled for a mitral valve replacement with a mechanical valve understands
that this procedure
♦ b. requires long-term anticoagulation therapy
11. which of the following assessment findings would the nurse expect in a patient with dilated cardiomyopathy
♦ a. dyspnea and fatigue
12. the nurse plans care for the patient with dilated cardiomyopathy based on the knowledge that
♦ c. the prognosis of the patient is poor, and emotional support is a high priority of care

Chapter 38
1. A patient diagnosed with peripheral arterial disease is most likely to also have
♦ A. coronary artery disease
2. A 62 y/o woman weights 92 kg and has a history of daily alcohol intake, smoking, high blood pressure, high
sodium intake, and sedentary lifestyle. The nurse identifies the risk factors most highly related to peripheral
arterial disease in this patient as
♦ C. cigarette smoking and hypertension
3. A patient is scheduled for an abdominal aortic aneurysm repair. The nurse suspects rupture of the aneurysm
when
♦ B. the patient complains of sudden, severe back pain
4. Important nursing measures after an abdominal aortic aneurysm repair are to
♦ D. monitor urine output, BUN, and creatinine
5. Specific symptoms of aortic dissection vary depending on
♦ C. the aortic branches affected in the descent of the dissection
6. Rest pain is a manifestation of peripheral arterial disease that occurs as a result of
♦ B. inadequate blood flow to the nerves of the feed
7. A patient with infective endocarditis develops sudden left leg pain with pallor, paresthesia, and a loss of
peripheral pulses. The nurse’s initial action should be to
♦ A. notify the physician
8. The usual medical treatment of Raynaud’s phenomenon involves
♦ D. administration of calcium channel blockers
9. The patient who is most likely to have the highest risk for deep vein thrombosis is a
♦ D. 72 y/o man who had a suprapubic prostatectomy for cancer of the prostate
10. The nurse suspects the presence of a deep vein thrombosis based on the findings of
♦ C. generalized edema of the involved extremity
11. A priority nursing intervention in the plan of care for the patient with acute lower extremity deep vein
thrombosis would include
♦ B. administering anticoagulants as ordered
12. The nurse instructs the patient discharged on anticoagulant therapy to
♦ D. be aware of and report signs or symptoms of bleeding
13. In planning care and patient teaching for the patient with venous leg ulcers, the nurse recognizes that the
most important intervention in healing and control of this condition is
♦ C. elevation of the extremities to increase venous return