1. The term “pink puffer” refers to the client with which of the following symptoms?

a. ARDS

b. Asthma

c. Chronic obstructive bronchitis

d. Emphysema.

ANSWER: D. Emphysema

Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic.
They’re pink and usually breathe through pursed lips, hence the term “puffer”.

2. The underlying pathophysiology of COPD is:

a. inflamed airways that obstruct airflow.

b. mucus secretions that block airways

c. overinflated alveoli that impair gas exchange.

d. characterized by variations of all of the above.

ANSWER: D. Characterized by variations in all of the above.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes
obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum)
production and wheezing.

3. The abnormal inflammatory response in the lungs occurs primarily in the:

a. airways.

b. parenchyma.

c. pulmonary vasculature.

d. areas identified in all of the above.

ANSWER: D. Areas identified in all of the above.

An inflammatory response occurs throughout the proximal and peripheral airways, lung parenchyma,
and pulmonary vasculature.

4. Two diseases common to the etiology of COPD are:

a. asthma and atelectasis.

b. chronic bronchitis and emphysema.

c. pneumonia and pleurisy.

d. tuberculosis and pleural effusions.

ANSWER: B. Chronic bronchitis and Emphysema

Chronic obstructive pulmonary disease, commonly referred to as COPD, is a group of progressive

lung diseases. The most common of these diseases are emphysema and chronic bronchitis.

5. The term “blue bloater” refers to which of the following conditions?

a. adult respiratory distress syndrome

b. asthma

c. chronic obstructive bronchitis

d. emphysema

ANSWER: C. Chronic obstructive bronchitis

Clients with chronic obstructive bronchitis appear bloated; they have large barrel chest and peripheral
edema, cyanotic nail beds, and at times, circumoral cyanosis.

6. The most important environmental risk factor for emphysema is:

a. air pollution.

b. allergens.

c. infectious agents.

d. cigarette smoking.

ANSWER: D. Cigarette Smoking

Smoking is the biggest risk factor for chronic obstructive pulmonary disease (COPD), which includes
chronic bronchitis and emphysema.

7. A 66-year-old client has marked dyspnea at rest, is thin and uses accessory muscles to breathe. He is
tachypneic, with a prolonged expiration phase. He has no cough. He leans forward with his arms braced
on his knees to support his chest and shoulder for breathing. This client has symptoms of which of the
following respiratory disorder?

a. ARDS

b. Asthma
c. Chronic obstructive bronchitis

d. Emphysema.

ANSWER: D. Emphysema

These are classic signs and symptoms of emphysema.

8. Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons
explains why?

a. reducing fluid volume reduces oxygen demand

b. reducing fluid volume improves clients’ morbidity

c. restricting fluid volume reduces sputum production

d. reducing fluid volume improves respiratory function

ANSWER: A. Reducing fluid volume reduces oxygen demand

Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn,
reduces the respiratory rate.

9. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the
following topics?

a. How to have his wife learn to listen to his lungs with a stethoscope

b. How to increase his oxygen therapy

c. How to treat respiratory infections without going to the physician

d. How to recognize the signs of impending respiratory infection.

ANSWER: D. How to recognize the signs of impending respiratory infection

Respiratory infection in clients with a respiratory disorder can be fatal. It's important that the client
understands how to recognize the signs and symptoms of an impending respiratory infection.

10. A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is
most likely to experience what type of acid- base imbalance.

a. respiratory acidosis
b. respiratory alkalosis

c. metabolic acidosis

d. metabolic alkalosis

ANSWER: A. Respiratory Acidosis

Respiratory acidosis is most often due to hypoventilation. Chronic respiratory acidosis is most commonly
caused by chronic obstructive pulmonary disease. In end-stage disease, pathological changes lead to
airway collapse, air trapping, and disturbance of ventilation-perfusion relationships.

1. A nurse is caring for several clients. Which of the following clients are at risk for having a pulmonary
embolism? (Select all that apply.)

A. A client who has a BMI of 30

B. A female client who is postmenopausal

C. A client who has a fractured femur

D. A client who is a marathon runner

E. A client who has chronic atrial fibrillation

ANSWER: ACE

RATIO: Obesity, a long bone fracture, and turbulent blood flow in the heart increase the risk for a
blood clot.

2. A nurse is reviewing prescriptions for a client who has acute dyspnea and diaphoresis. The client states
that she is anxious because she feels that she cannot get enough air. Vital signs are: heart rate 117/min,
respiratory rate 38/min, temperature 38.4° C (101.2° F), and blood pressure 100/54 mm Hg. Which of
the following actions is the priority action at this time?

A. Notify the provider.

B. Administer heparin via IV infusion.

C. Administer oxygen therapy.

D. Obtain a spiral CT scan.

ANSWER: C

RATIO: Meeting the oxygenation needs first is the priority action according to ABCs.

3. A male patient’s X-ray result reveals bilateral white- outs indicating adult respiratory distress syndrome
(ARDS). This syndrome results from;
A. Cardiogenic pulmonary edema

B. Respiratory alkalosis

C. Increased pulmonary capillary permeability.

D. Renal failure

ANSWER: C

RATIO: ARDS results from increased pulmonary capillary permeability, which leads to noncardiogenic
pulmonary edema. In cardiogenic pulmonary edema, pulmonary congestion occurs secondary to heart
failure. In the initial stage of ARDS, respiratory alkalosis may arise secondary to hyperventilation;
however, it does not cause ARDS. Renal failure does not cause ARDS, either.

4. A nurse is caring for a male client with acute respiratory distress syndrome. Which of the following
would the nurse expect to note in the client?

A. Pallor

B. Low arterial PaO2

C. Elevated arterial PaO2

D. Decreased respiratory rate.

ANSWER: B

RATIO: The earliest clinical sign of acute respiratory distress syndrome is an increased respiratory rate.
Breathing becomes labored, and the client may exhibit air hunger, retractions, and cyanosis. Arterial
blood gas analysis reveals increasing hypoxemia, with a PaO2 lower than 60 mmHg.

5. A nurse is assessing a client who has a pulmonary embolism. Which of the clinical manifestations
should the nurse expect to find? (Select all that apply.)

A. Bradypnea

B. Pleural friction rub

C. Hypertension

D. Petechiae

E. Tachycardia

ANSWER: BDE

RATIO: Options B, D, and E are clinical manifestations of pulmonary embolism.

6. You’re providing care to a patient who is being treated for aspiration pneumonia. The patient is on a
100% non-rebreather mask. Which finding below is a HALLMARK sign and symptom that the patient is
developing acute respiratory distress syndrome (ARDS)?

A. The patient is experiencing bradypnea.

B. The patient is tired and confused.

C. The patient’s PaO2 remains at 45 mmHg.

D. The patient’s blood pressure is 180/96.

ANSWER: C

RATIO: A hallmark sign and symptom found in ARDS is refractory hypoxemia. This is where that
although the patient is receiving a high amount of oxygen (here a 100% non-rebreather mask) the
patient is STILL hypoxic. Option C is the answer because it states the patient's arterial oxygen level is
remaining at 45 mmHg (a normal is 80 mmHg but when treating patients with ARDS a goal is at least
60 mmHg). Yes, the patient can be tired and confused from a low oxygen level BUT this question wants
to know the HALLMARK sign and symptom.

7. A male adult patient hospitalized for treatment of a pulmonary embolism develops respiratory
alkalosis. Which clinical findings commonly accompany respiratory alkalosis?

A. Nausea and vomiting

B. Abdominal pain or diarrhea

C. Hallucination or tinnitus

D. Lightheadedness and paresthesia

ANSWER: D

RATIO: The patient with respiratory alkalosis may complain of lightheadedness or paresthesia
(numbness and tingling in the arms and legs). Nausea, vomiting, abdominal pain, and diarrhea may
accompany respiratory acidosis. Hallucinations and tinnitus rare are associated with respiratory
alkalosis or any other acid-base imbalance.

8. A client is suspected of having pulmonary embolism. A nurse assesses the client, knowing that which
of the following a common clinical manifestation of pulmonary embolism?

A. Dyspnea

B. Bradypnea

C. Bradycardia

D. Decrease respiration
ANSWER: A

RATIO: Dyspnea is the most frequent symptom; the duration and intensity of the dyspnea depend on
the extent of embolization.

9. A patient has been hospitalized in the ICU for a near drowning event. The patient’s respiratory
function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress
syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS?

A. infiltrates only on the upper lobes

B. enlargement of the heart with bilateral lower lobe infiltrates

C. white-out infiltrates bilaterally

D. normal chest x-ray

ANSWER: C

RATIO: This is a finding found on the chest x-ray of ARDS.

10. Which patient below is at MOST risk for developing ARDS and has the worst prognosis?

A. A 52-year-old male patient with a pneumothorax.

B. A 48-year-old male being treated for diabetic ketoacidosis.

C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection.

D. A 30-year-old female with cystic fibrosis.

ANSWER: C

RATIO: Sepsis is the MOST common cause of ARDS because of systemic inflammation experienced.
This is also true if the cause of the sepsis is a gram-negative bacterium (this also makes the infection
harder to treat…hence poor prognosis). With sepsis, the immune cells that are present with the
inflammation travel to the lungs and damage the alveolar capillary membrane leading to fluid to leak
in the alveolar sacs.

11. The nurse assesses a patient for possible pulmonary embolism. The nurse looks for the most
frequent sign of:

A. Cough

B. Hemoptysis

C. Syncope

D. Tachypnea
ANSWER: D

RATIO: The most frequent sign of pulmonary embolism is tachypnea.

12. The following are nursing intervention to assist in the prevention of pulmonary embolism in a
hospitalized patient include all except:

A. A liberal fluid intake

B. Assisting the patient to do leg elevation above the level of the heart.

C. Encouraging the patient to dangle his or her legs over the side of the bed for 30 minutes, four times a
day.

D. The use of elastic stocking, especially when decreased mobility would promote venous stasis.

ANSWER: C

RATIO: Dangling could get the emboli stuck and may impede blood flow.

13. You are caring for a patient with acute respiratory distress syndrome. As the nurse you know that
prone positioning can be beneficial for some patients with this condition. Which findings below indicate
this type of positioning was beneficial for your patient with ARDS?

A. Improvement in lung sounds

B. Development of a V/Q mismatch

C. PaO2 increased from 59 mmHg to 82 mmHg

D. PEEP needs to be titrated to 15 mmHg of water

ANSWER: AC

RATIO: Prone positioning helps improve PaO2 (82 mmHg is a good finding) without actually giving the
patient high concentrations of oxygen. It helps improves perfusion and ventilation (hence correcting
the V/Q mismatch). In this position, the heart is no longer laying against the posterior part of the lungs
(improves air flow...hence improvement of lung sounds) and it helps move secretions from other areas
that were fluid filled and couldn’t move in the supine position, hence helping improve atelectasis.

14. A patient is experiencing respiratory failure due to pulmonary edema. The physician suspects ARDS
but wants to rule out a cardiac cause. A pulmonary artery wedge pressure is obtained. As the nurse you
know that what measurement reading obtained indicates that this type of respiratory failure is NOT
cardiac related?
A. >25 mmHg

B. <10 mmHg

C. >50 mmHg

D. <18 mmHg

ANSWER: D

RATIO: A pulmonary artery wedge pressure measures the left atrial pressure. A pulmonary catheter is
"wedged" with a balloon in the pulmonary arterial branch to measure the pressure. If the reading is
less than 18 mmHg it indicates this is NOT a cardiac issue but most likely ARDS. Therefore, the
pulmonary edema is due to damage to the alveolar capillary membrane leaking fluid into the alveolar
sac and NOT a heart problem such as heart failure.

15. Which of the following is a type of embolism?

A. Travelling emboli

B. Fat emboli

C. Burn emboli

D. Diabetic emboli

ANSWER: B

RATIO: Most commonly, pulmonary embolism is due to a blood clot or thrombus, but there are other
types of emboli: fat, air, amniotic fluid, and septic.

1. The nurse is presenting a class on chest tubes. Which statement describes a tension pneumothorax?

A. A tension pneumothorax develops when an air-filled bleb on the surface of the lung ruptures.

B. When a tension pneumothorax occurs, the air moves freely between the pleural space and the
atmosphere.

C. The injury allows air into the pleural space but prevents it from escaping from the pleural space.

D. A tension pneumothorax results from a puncture of the pleura during a central line placement.

ANSWER: C

RATIO: This describes a tension pneumothorax. It is a medical emergency requiring immediate

intervention to preserve life.
2. The nurse is caring for a client with a right-sided chest tube secondary to a pneumothorax. Which
interventions should the nurse implement when caring for this client? Select all that apply.

A. Place the client in a low-Fowler's position.

B. Assess chest tube drainage system frequently.

C. Maintain strict bed rest for the client.

D. Secure a loop of drainage tubing to the sheet.

E. Observe the site for subcutaneous emphysema.

ANSWER: B, D, E

RATIO: The system must be patent and intact to function properly. Looping the tubing prevents direct
pressure on the chest tube itself and keeps tubing off the floor, addressing both a safety and an
infection control issue. Subcutaneous emphysema is air under the skin, which is a common occurrence
at the chest tube insertion site.

3. The initial characteristics symptoms of a simple pneumothorax is.

A. ARDS

B. Severe respiratory distress

C. Sudden chest pain

D. Tachypnea and chest discomfort

ANSWER: D

RATIO: The patient experiences chest discomfort and tachypnea initially.

4. Clinical manifestation of related to pneumothorax includes the following except for:

A. Pleuritic pain

B. Respiratory distress

C. Acrocyanosis

D. Tachypnea

ANSWER: C

RATIO: Acrocyanosis is not a sign of pneumothorax.

5. Which of the following should the nurse assess in patient with pneumothorax?
A. Tracheal alignment

B. Expansion of the chest

C. Breath sounds

D. All of the above

ANSWER: D

RATIO: All of the options listed should be assessed by the nurse in a patient with pneumothorax.

6. The pressure required in the pleural space to keep the lungs inflated is:

A. Positive

B. Negative

C. Atmospheric

D. All of the above

ANSWER: B

RATIO: The negative intrapleural pressure by holding the lungs to the thoracic cage, which lungs have
the tendency to recoil, allows only the contraction of the lungs that expels air out of the lungs,
without the lungs collapsing under the weight of the low pressure created within the lungs.

7. The following are types of pneumothorax except:

A. Trauma

B. Simple

C. Tension

D. Direct

ANSWER: D

RATIO: There is no direct type of pneumothorax.

8. On auscultation, which of the following suggest a right pneumothorax?

A. Bilateral inspiratory and expiratory crackles.

B. Absence of breath sounds in the right thorax.

C. Inspiratory wheezes in the right thorax.

D. Bilateral pleural friction rub.

ANSWER: B

RATIO: In pneumothorax, the alveoli are deflated and no air exchange occurs in the lungs. Therefore,
breath sounds in the affected lung field are absent. None of the other options are associated with
pneumothorax. Bilateral crackles may result from pulmonary congestion, inspiratory wheezes may
signal asthma, and a pleural friction rub may indicate pleural inflammation.

9. Nurse Lei is caring for a client with pneumothorax and who has had a chest tube inserted notes
continues gentle bubbling in the suction control chamber. Which action is appropriate?

A. Do nothing, because this is an expected finding.

B. Immediately clamp the chest tube and notify the physician.

C. Check for an air leak because the bubbling should be intermittent.

D. Increase the suction pressure so that the bubbling becomes vigorous.

ANSWER: A

RATIO: Continuous gentle bubbling should be noted in the suction control chamber. Bubbling should
be continuous in the suction control chamber and not intermittent. Increasing the suction pressure
only increases the rate of evaporation of water in the drainage system; in addition, increasing the
suction can be harmful and is not done without a specific prescription to do so. Chest tubes should
only be clamped to check for an air leak or when changing drainage devices (according to agency
policy).

10. An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest
wall. Which of the signs would indicate the presence of pneumothorax in this client?

A. A low respiratory rate

B. Diminished breath sounds

C. The presence of barrel chest

D. A sucking sound at the site of injury.

ANSWER: B

RATIO: This client has sustained a blunt or a closed chest injury.

-Basic symptoms of a closed pneumothorax are shortness of breath and chest pain.

-A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous
emphysema.

-Hyperresonance also may occur on the affected side.

-A sucking sound at the site of injury would be noted with an open chest injury.

1. The physician diagnosed the patient with Class III Primary Pulmonary Hypertension. The nurse is
aware that the characteristic of this condition is:

A. No manifestation at rest and mild to moderate physical activity induces dyspnea, fatigue, chest pain,
or lightheadedness.

B. No or slight manifestation at rest and mild (less than ordinary) activity induces dyspnea, fatigue, chest
pain or lightheadedness.

C. Dyspnea and fatigue is present at rest, unable to carry out any level of physical activity without
manifestations, and manifestations of right sided heart failure apparent (engorged neck veins,
dependent edema and enlarged liver).

D. Pulmonary hypertension diagnosed by pulmonary function test and right sided cardiac
catheterization, no limitation of physical activity, and moderate physical activity does not include
dyspnea, fatigue, chest pain or light headedness.

ANSWER: B

RATIO: Class III - patients with pulmonary hypertension resulting in limitation of physical activity:
comfortable at rest ; less than ordinary activity causes undue dyspnea or fatigue, chest pain, or near
syncope. LETTER D IS CLASS I, LETTER A IS CLASS II, LETTER B IS CLASS III AND LETTER C IS CLASS IV.

2. The morning weight for a client with emphysema indicates that the client has gained 5 pounds in less
than a week, even though his oral intake has been modest. The client's weight gain may reflect which
associated complication of COPD?

A. Polycythemia

B. Cor Pulmonale

C. Left Ventricular failure

D. Compensated acidosis

ANSWER: B

RATIO: Answer B is correct. Answers A and D do not cause weight gain, so they’re incorrect. And
answer C would be reflected in pulmonary edema, so it’s incorrect.

3. Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension
often goes undetected until symptoms of other system failures occur. This may occur in the form of:
A. Cerebrovascular accident

B. Liver disease

C. Myocardial infarction

D. Pulmonary disease

ANSWER: A

RATIO: HTN is referred to as the silent killer for adults, because until the adult has significant damage
to other systems, the HTN may go undetected. CVA's can be related to long-term HTN. Myocardial
infarction is generally related to coronary artery disease

4. A client is receiving spironolactone to treat hypertension. Which of the following instructions should
the nurse provide?

A. Eat foods high in potassium

B. Take daily potassium supplements

C. Discontinue sodium restriction

D. Avoid salt substitute

ANSWER: D

RATIO: Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes
because of their high potassium content. The client should also avoid potassium-rich foods and
potassium supplements. To reduce fluid-volume overload, sodium restrictions should continue.

5. The most important long-term goal for a client with hypertension would be to:

A. Learn how to avoid stress

B. Explore a job change or early retirement

C. Make a commitment to long term therapy

D. Control high blood pressure

ANSWER: C

RATIO: Compliance is the most critical element of hypertensive therapy. In most cases, hypertensive
clients require lifelong treatment and their hypertension cannot be managed successfully without
drug therapy. Stress management and weight management are important components of
hypertension therapy, but the priority goal is related to compliance.
6. A nurse in the emergency department is assessing a client who was in a motor vehicle crash. Findings
include absent breath sounds in the left lower lobe with dyspnea, blood pressure 118/68 mm Hg, heart
rate 124/min, respiratory rate 38/min, temperature 38.6° C (101.4° F), and SaO2 92% on room air. Which
of the following actions should the nurse take first?

A. Obtain a chest x-ray.

B. Prepare for chest tube insertion.

C. Administer oxygen via a high-flow mask.

D. Initiate IV access.

ANSWER: C

RATIO: According to the airway, breathing, and circulation to client care, the nurse should

place the priority on administering oxygen via high-flow mask to provide the client oxygen to

restore optimal breathing.

7. Which of the following regarding pulmonary hypertension is false:

A. PH has many underlying etiologies

B. The disease affects the left side of the heart

C. The hemodynamic definition of PH is a mean pulmonary arterial pressure (PAP) greater than 25
mmHg.

D. Pulmonary arterial hypertension is a subset of pulmonary hypertension.

ANSWER: B

RATIO: Recall that the right ventricle pumps blood through the pulmonary arteries. These arteries
carry deoxygenated blood to the lungs. In PH, the pulmonary arteries are constricted, leading to the
right side of the heart having to pump harder to eject blood to the lungs. This can ultimately lead to
right-sided heart failure. It must be noted that left-sided heart failure is an etiology of PH.

8. Which of the following statement is not correct regarding pulmonary hypertension.

A. The disease affects men more than women.

B. Non- specific symptom such as fatigue and edema are present clinically.

C. Catheterization is required when PH is suspected.

D. Underlying causes are evaluated.

ANSWER: A
RATIO: Although the incidence of PAH is higher in women than in men, the estimated 5-year survival
rate from diagnosis

9. Which of the following statement about pulmonary arterial hypertension is incorrect.

A. Vasoconstriction is an issue

B. Vascular wall re-modelling is an issue

C. There is a cure for pulmonary arterial hypertension.

D. The balance of vasoconstriction and vasodilatation may indicate PAH.

ANSWER: C

RATIO: Pulmonary hypertension cannot be cured, but treatments can reduce your symptoms and help
you manage your condition. If the cause is identified and treated early, it may be possible to prevent
permanent damage to your pulmonary arteries, which are the blood vessels that supply your lungs.

10. All of the following are true regarding calcium channel blockers in pulmonary arterial hypertension.

A. Calcium channel blockers have a selective effect on vascular smooth muscles.

B. Normal physiologic doses are sufficient for treatment purposes.

C. Adverse effect must be considered.

D. Long -term clinical response is less than 10%.

ANSWER: A

RATIO: The calcium channel blockers act by blocking the influx of calcium ions into vascular smooth
muscle and cardiac muscle cells during membrane depolarization. Because muscle contraction is
largely dependent upon influx of calcium, its inhibition causes relaxation, particularly in arterial beds.
Thus, the major effects of the calcium channel blockers are relaxation of vascular and arterial smooth
muscle cells resulting in arterial vasodilation.

1. An initial characteristic symptom of a simple pneumothorax is:

A. ARDS

B. Severe onset of chest pain

C. Severe respiratory distress

D. Tachypnea and chest discomfort.

ANSWER: D
RATIO: The patient experiences chest discomfort and tachypnea initially.

2. Clinical manifestations related to pneumothorax include the following except for:

A. Pleuritic pain

B. Respiratory distress

C. Acrocyanosis

D. Tachypnea

ANSWER: C

RATIO: Acrocyanosis is not a sign of pneumothorax.

3. Which of the following the nurse assesses in patient with pneumothorax?

A. Tracheal alignment

B. Expansion of the chest

C. Breath sounds

D. All of the above

ANSWER: D

RATIO: All of the options listed should be assessed by the nurse in a patient with pneumothorax.

4. The pressure required in the pleural space to keep the lungs inflated is:

A. Positive

B. Negative

C. Atmospheric

D. All of the above

ANSWER: B

RATIO: The pressure in the pleural space is normally negative to maintain lung inflation.

5. The following are types of pneumothorax except:

A. Trauma

B. Simple

C. Tension

D. Direct

ANSWER: D

RATIO: There is no direct type of pneumothorax.

6. The healthcare provider is assisting during the insertion of a pulmonary artery catheter. Which of
these, if assessed in the patient, would indicate the patient is experiencing a complication from the
catheter insertion?

A. Inspiration phase is greater than expiration

B. Diaphragmatic excursion of 3 cm

C. Tracheal deviation from normal

D. Vesicular breath sounds noted on auscultation

ANSWER: C.

RATIO: Vesicular breath sounds and diaphragmatic excursion of 3cm are normal findings.

Inspiration phase is normally greater than expiration, but it may also be noted in pneumothorax.
Tracheal deviation from midline is associated with a tension pneumothorax, which is a potential
complication associated with central line insertion.

7. During the assessment of a 60-year-old female patient, you note the following signs: dyspnea,
hypotension, reduced chest expansion on the left side, hyperresonant percussion note and tactile
fremitus on the left side, absent breath sounds on the left side, and a tracheal shift to the right. These
findings suggest which of the following?

A. A pleural effusion on the left side

B. A pneumothorax on the left side

C. Atelectasis on the left side

D. Consolidation on the left side

ANSWER: B
RATIO: The patient has reduced chest expansion, a hyperresonant percussion note, absent breath
sounds, and tactile fremitus all on the left side. That to go along with a tracheal shift to the right. This
indicates that the patient has a pneumothorax on the left side. Remember that, when a
pneumothorax is present, the trachea will shift away from the affected side. That means you can rule
out left-sided atelectasis because the trachea would shift to that side. A pleural effusion and
consolidation would cause a dull percussion note, not a hyperresonant note, so we can rule out those
two as well.

8. A 50-year-old male patient is intubated with a size 8 endotracheal tube and is receiving volume-
controlled A/C ventilation. Upon assessment, you note that the patient’s cuff pressure is measured at 38
cm H2O. Which of the following would you recommend?

A. Withdraw the tube 1-2 cm and reassess the patient’s breath sounds

B. Recommend reintubation with a smaller endotracheal tube

C. Lower the cuff pressure to < 30 cm H2O

D. Recommend ventilation via a tracheostomy instead

ANSWER: C

RATIO: First action should be to lower the cuff pressure to < 30 cm H2O and then check to make sure
that there are not any leaks.

9. An adult patient who is receiving mechanical ventilation suddenly started showing signs of tachypnea.
Upon assessment, you note tracheal deviation to the right and decreased breath sounds and
hyperresonance on the left. Which of the following would you recommend?

A. The patient needs suctioning

B. The patient needs a bronchoscopy

C. The insertion of a chest tube

D. The patient needs a thoracentesis

ANSWER: C

RATIO: Patients with a pneumothorax will typically show tracheal deviation away from the affected
side. They will also show decreased breath sounds and hyperresonance on the affected side as well. So
in order to treat a pneumothorax, the patient requires immediate insertion of a chest tube on the
affected side.
10. During the assessment of a 52-year-old female patient that is receiving oxygen via nasal cannula at 4
L/min, you hear the bubble humidifier making a whistling noise. Which of the following is the most likely
cause of this finding?

A. There is an obstruction in the delivery tube

B. The patient’s ventilation has increased

C. There is a clogged system diffuser

D. The flowmeter pressure is set too high

ANSWER: A

RATIO: The relief valve of a bubble humidifier sounds when the pressure in the reservoir container
exceeds the valve’s threshold pressure. The most common reason for this to occur is when there is a
downstream obstruction to outflow.

1. A 60-year-old male client comes into the emergency department with complaints of crushing chest
pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction.
Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2
mg of morphine given intravenously. The nurse should first:

A. Administer morphine

B. Obtain 12 leads ECG

C. Obtain laboratory work

D. Order chest X-ray

ANSWER: A

RATIO: Although obtaining the ECG, CXR and blood work are all important, the nurses priority action
would be to relieve the crushing chest pain.

2. Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes. How should the nurse instruct the
client to use the drug when chest pain occurs?

A. Take one tablet every 2-5 minutes until pain stops.

B. Take one tablet and rest for 10 minutes. Call the physician if pain persist after 10 minutes.

C. Take one tablet, then an additional tablet every 5 minutes for a total of 3 tablets. Call the physician if
pain persist

after 3 tablets.

D. Take one tablet. If pain persist, after 5 minutes, take two tablets. If pain still persist 5 minutes later, call
the
physician.

ANSWER: C

RATIO: Teach pt that any pain unrelieved within 15 minutes by the usual methods, including
nitroglycerin, should be treated at the closest emergency center.

3. A nurse is preparing for the admission of a client with heart failure who is being sent directly to the
hospital from the physician’s office. The nurse would plan on having which of the following medications
readily available for use?

A. Diltiazem (Cardizem)

B. Digoxin (Lanoxin)

C. Propranolol (Inderal)

D. Metoprolol (Lopressor)

ANSWER: B

RATIO: Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a
variety of mechanisms. Choice A, C and D have a negative inotropic effect and would worsen the
failing heart.

4. A nurse is conducting a health history with a client with a primary diagnosis of heart failure. Which of
the following disorders reported by the client is unlikely to play a role in exacerbating the heart failure?

A. Recent URI

B. Nutritional anemia

C. Peptic ulcer disease

D. A-fib

ANSWER: C

RATIO: HF is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections,

anemia, thyroid disorder, pregnancy Paget’s disease, nutritional deficiencies (thiamine, alcoholism),
pulmonary disease and hypervolemia

5. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no
electrocardiogram complexes on the screen. The first action of the nurse is to:

A. Check the client status and lead placement.

B. Press the recorder button on the electrocardiogram console.

C. Call the physician.

D. Call a code blue

ANSWER: A

RATIO: Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly

electrode displacement. Accurate assessment of the client and equipment is necessary to determine
the cause and identify the appropriate intervention. The remaining options are secondary to client
assessment

6. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?

A. Heart failure

B. Diabetes

C. MI

D. Pericardial effusion

ANSWER: A

RATIO: Because the structure and function of the heart muscle is affected, heart failure most
commonly occurs in clients with cardiomyopathy.

7. When interpreting an ECG, the nurse would keep in mind which of the following about the P wave?
Select all that apply.

A. Reflects electrical impulse beginning at the SA node

B. Indicated electrical impulse beginning at the AV node.

C. Reflects atrial muscle depolarization

D. Identifies ventricular muscle depolarization

E. Has duration normally of 0.11 seconds or less.

ANSWER: A C E

RATIO: In a client who has had an ECG, the P wave represents the activation of the electrical impulse in
the SA node, which is then transmitted to the AV node. In addition, the P wave represents atrial
muscle depolarization, not ventricular depolarization. The normal duration of the P wave is 0.11
seconds or less in duration and 2.5 mm or more in height.

8. Which of the following arteries primarily feeds the anterior wall of the heart?
A. Circumflex artery

B. Internal mammary artery

C. Left anterior descending artery

D. Right coronary artery

ANSWER: C

RATIO: The left anterior descending artery is the primary source of blood for the anterior wall of the
heart.

9. With which of the following disorders is jugular vein distention most prominent?

A. Abdominal aortic aneurysm

B. Heart failure

C. MI

D. Pneumothorax

ANSWER: B

RATIO: The most common risk factor for JVD is heart failure. Your risk of heart failure is increased if
you have chronic high blood pressure or coronary artery disease (CAD).

10. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the
following conditions?

A. Pericarditis

B. Hypertension

C. MI

D. Heart Failure

ANSWER: D

RATIO: These are the classic signs of Heart Failure

11. Which of the following factors can cause blood pressure to drop to normal levels?

A. Kidney’s excretion of sodium only

B. Kidney’s retention of sodium and water

C. Kidney’s excretion of sodium and water

D. Kidney’s retention of sodium and excretion of water.

ANSWER: C

RATIO: Blood pressure decreases with decreased cardiac output, peripheral vascular resistance,
volume of blood, viscosity of blood and elasticity of vessel walls.

12. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains
to the client that this procedure is being used in this specific case to:

A. Open and dilate the blocked coronary arteries.

B. Assess the extent of arterial blockage

C. Bypass obstructed vessels

D. Assess the functional adequacy of the valves and heart muscles.

ANSWER: B

RATIO: cardiac catheterization is being used in this specific case to assess the extent of arterial
blockage

13. As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg
given sublingually. This drug’s principal effects are produced by:

A. Antispasmodic effect on the pericardium

B. Causing an increased myocardial oxygen demand

C. Vasodilation of peripheral vasculature

D. Improved conducting in the myocardium.

ANSWER: C

RATIO: Nitroglycerin opens up (dilates) the arteries in the heart (coronary arteries), which improves
symptoms and reduces how hard the heart has to work.

14. Furosemide is administered intravenously to a client with HF. How soon after administration should
the nurse begin to see evidence of the drugs desired effect?

A. 5 to 10 minutes

B. 30 to 60 minutes

C. 2-4 hours

D. 6-8 hours
ANSWER: A

RATIO: After IV injection of furosemide, diuresis normally begins in about 5 mins and reaches its peak
within about 30 mins. Medication effects last 2-4 hrs. When furosemide is given IM or orally, drug
action begins more slowly and lasts longer than when it is given IV.

15. Which of the following symptoms is most commonly associated with left-sided heart failure?

A. Crackles

B. Arrhythmias

C. Hepatic engorgement

D. Hypotension

ANSWER: A

RATIO: Symptoms for left-sided heart failure include fatigue, weakness, and shortness of breath. Left-
sided heart failure is the most common form of heart failure. During left-sided heart failure, fluid
accumulates in the lungs.

1. A patient is being treated for cardiogenic shock. Which statement below best describes this condition?
Select all that apply:

A. “The patient will experience an increase in cardiac output due to an increase in preload and
afterload.”

B. “A patient with this condition will experience decreased cardiac output and decreased tissue
perfusion.”

C. “This condition occurs because the heart has an inadequate blood volume to pump.”

D. “Cardiogenic shock leads to pulmonary edema.”

ANSWER: B D

RATIO: Cardiogenic shock occurs when the heart can NOT pump enough blood to meet the perfusion
needs of the body. The cardiac output will be DECREASED, which will DECREASE tissue perfusion and
cause cell injury to organs/tissues. In this condition, the heart is WEAK and can't pump blood out of
the heart. This can be due to either a systolic (contraction) or diastolic (filling) issue along with a
structural or dysrhythmia issue. In cardiogenic shock, there is NOT an issue with blood volume, but
there is a problem with the heart itself
2. Cardiac output is very important for determining if a patient is in cardiogenic shock. What is a normal
cardiac output in an adult?

A. 2-5 liters/minute

B. 1-3 liters/minute

C. 4-8 liters/minute

D. 8-10 liters/minute

ANSWER: C

RATIO: Cardiac output is the amount of blood the heart pumps per minute. The heart’s cardiac output
should be anywhere from 4-8 liters of blood per minute.

3. Which patient below is at MOST risk for developing cardiogenic shock?

A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish.

B. A 25-year-old female who has experienced an upper thoracic spinal cord injury.

C. A 72-year-old male who is post-op from a liver transplant.

D. A 49-year-old female who is experiencing an acute myocardial infarction.

ANSWER: D

RATIO: An acute MI (heart attack) is the main cause of cardiogenic shock. It happens because a
coronary artery has become blocked. Coronary arteries supply the heart muscle’s cells with
oxygenated blood. If they don’t receive this oxygenated blood they will die, which causes the heart
muscle to quit working (hence pumping efficiently). When the heart muscle fails to pump efficiently,
cardiac output fails and cardiogenic shock occur.

4. You’re caring for a patient with cardiogenic shock. Which finding below suggests the patient’s
condition is worsening? Select all that apply:

A. Blood pressure 95/68

B. Urinary output 20 mL/hr

C. Cardiac Index 3.2 L/min/m2

D. Pulmonary artery wedge pressure 30 mmHg

ANSWER: B D

RATIO: When answering this question look for values that are abnormal and that point to worsening
tissue perfusion (urinary output should be 30 mL/hr or greater….if it’s lower than this it show the
kidneys are not being perfused) and worsening cardiac output (the blood pressure and cardiac index
are within normal limits BUT pulmonary artery wedge pressure is NOT). A pulmonary artery wedge
pressure (also called pulmonary capillary wedge pressure) is the pressure reading of the filling
pressure in the left atrium. A normal PAWP is 4-12 mmHg and if it’s >18 mmHg this indicates
cardiogenic shock. If it reads high, that means there is back-flowing of blood into the heart and lungs
(hence the left ventricle is failing to pump efficiently and increasing the pressure in the left atrium).

5. You’re precepting a new nurse. You ask the new nurse to list the purpose of why a patient with
cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the
new nurse understands the purpose of an intra-aortic balloon pump? Select all that apply:

A. “This device increases the cardiac afterload, which will increase cardiac output.”

B. “This device will help increase blood flow to the coronary arteries.”

C. “The balloon pump will help remove extra fluid from the heart and lungs.”

D. “The balloon pump will help increase cardiac output.”

ANSWER: B D

RATIO: An intra-aortic balloon pump increases coronary artery blood flow and cardiac output.

6. A patient is receiving treatment for an acute myocardial infarction. The nurse is closely monitoring the
patient for signs and symptoms associated with cardiogenic shock. Which value below is associated with
cardiogenic shock?

A. Cardiac index 1.5 L/min/m2

B. Pulmonary capillary wedge pressure (PCWP) 10 mmHg

C. Central venous pressure (CVP) 4 mmHg

D. Troponin <0.01 ng/mL

ANSWER: A

RATIO: A patient who has experienced an acute myocardial infarction is at risk for cardiogenic shock. A
normal cardiac index should be 2.5-4 L/min/m2. Cardiac index is the specific cardiac output based on
the patient’s size. Any number less than 2.2 L/min/m2 can be associated with cardiogenic shock. All
the other values are within normal limits. PCWP would be >18 mmHg in cardiogenic shock, and CVP
would be high.

7. A patient who has cardiogenic shock is experiencing labored breathing and low oxygen levels. A STAT
chest x-ray is ordered. The x-ray results show pulmonary edema. The physician orders Furosemide IV.
What finding would require immediate nursing action?

A. Blood pressure 98/54

B. Urinary output 45 mL/hr

C. Potassium 1.8 mEq/L

D. Heart rate 110 bpm

ANSWER: C

RATIO: Furosemide (Lasix) is a diuretic which wastes potassium. The nurse would want to ensure the
potassium level is normal (3.5 to 5 mEq/L) before administering IV Furosemide. The nurse would need
to notify the physician of the potassium level so supplementation can be provided.

8. They physician orders a Dobutamine IV drip on a patient in cardiogenic shock. After starting the IV
drip, the nurse would make it priority to monitor for?

A. Rebound hypertension

B. Ringing in the ears

C. Worsening hypotension

D. severe headache

ANSWER: C

RATIO: Dobutamine increases contractility and cardiac output, BUT causes vasodilation due to the way
it acts on receptors and this may make hypotension worse. The patient may be started on
norepinephrine or dopamine if worsening of hypotension occurs.

9. Which medications below are used in cardiogenic shock that provide a positive inotropic effect on the
heart? Select all that apply:

A. Nitroglycerin

B. Sodium Nitroprusside

C. Dobutamine

D. Norepinephrine

E. Dopamine

ANSWER: C E

RATIO: Dobutamine and Dopamine are vasopressors that have a POSITIVE inotropic effect on the
heart. This means these medications increase the strength of the heart’s contractions (increases
contractility), which increases stroke volume.
10. A patient with cardiogenic shock has an intra-aortic balloon pump. As the nurse you know that
during ________ the balloon deflates and during _____ the balloon inflates in a section of the aorta.

A. systole, diastole

B. diastole, systole

C. inspiration, expiration

D. expiration, inspiration

ANSWER: A

RATIO: An intra-aortic balloon pump is a balloon attached to the catheter inside a section of the aorta.
It will inflate and deflate during systole (contraction) and diastole (relaxation). When the balloon
deflates during systole it creates a suction-like pressure that will draw blood out of the weak heart and
into the coronary arteries and systemic circulation (hence increasing cardiac output and blood supply
to the heart muscle). When the balloon inflates during diastole it will create pressure that will push
blood into the coronary arteries (hence further increasing blood supply to the heart muscle).

1. The client is admitted to the hospital with a hypertensive crisis. Diazoxide (Hyperstat) is ordered.
During administration the nurse should:

A. Utilize an infusion pump

B. Check the blood glucose level

C. Place the patient in Trendelenburg position

D. Cover the solution with foil

ANSWER: B

RATIO: Hyperstat is given IV push for hypertensive crises. but it often causes hyperglycemia. The
glucose level will drop rapidly when stopped. Answer A is incorrect because the hyperstat is given by
IV push. The client should be placed in dorsal recumbent position. not a Trendelenburg position. as
stated in answer C. Answer D is incorrect because the medication does not have to be covered with
foil.

2. A 52-year-old patient who has no previous history of hypertension or other health problems suddenly
develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the
patient that

A. BP recheck should be scheduled in a few weeks.

B. the dietary sodium and fat content should be decreased.

C. there is an immediate danger of a stroke and hospitalization will be required.

D. More diagnostic testing may be needed to determine the cause of the hypertension.

ANSWER: D

RATIO: A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk
factors indicates that the hypertension may be secondary to some other problem. The BP will need
rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the
immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to
this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this
BP to an acceptable level.

3. Which action will be included in the plan of care when the nurse is caring for a patient who is receiving
sodium nitroprusside (Nipride) to treat a hypertensive emergency?

A. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night.

B. Assist the patient up in the chair for meals to avoid complications associated with immobility.

C. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements.

Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

ANSWER: C

RATIO: Use an automated noninvasive blood pressure machine to obtain frequent BP measurements.
Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive
medications.

4. The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril
(Accupril). Which patient statement indicates that more teaching is needed?

A. "The medication may not work as well if I take any aspirin."

B. "The doctor may order a blood potassium level occasionally."

C. "I will call the doctor if I notice that I have a frequent cough."

D. "I won't worry if I have a little swelling around my lips and face."

ANSWER: D

RATIO: Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an

indication that the ACE inhibitor should be discontinued.

5. During change-of-shift report, the nurse obtains this information about a hypertensive patient
who received the first dose of propranolol (Inderal) during the previous shift. Which information
indicates that the patient needs immediate intervention?
 A. The patient's most recent BP reading is 156/94 mm Hg.

B. The patient's pulse has dropped from 64 to 58 beats/minute.

C. The patient has developed wheezes throughout the lung fields.

D. The patient complains that the fingers and toes feel quite cold.

ANSWER: C

RATIO: The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a
common adverse effect of the noncardioselective -blockers) is occurring.

6. Which action will the nurse in the hypertension clinic take in order to obtain an accurate
baseline blood pressure (BP) for a new patient?

A. Obtain a BP reading in each arm and average the results.

B. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second.

C. Have the patient sit in a chair with the feet flat on the floor.

D. Assist the patient to the supine position for BP measurements.

ANSWER: C

RATIO: The patient should be seated with the feet flat on the floor. when obtaining baseline blood
pressure.

7. The nurse obtains this information from a patient with prehypertension. Which finding is most
important to address with the patient?

A. Low dietary fiber intake

B. No regular aerobic exercise

C. Weight 5 pounds above ideal weight

D. Drinks wine with dinner once a week

ANSWER: B

RATIO: The recommendations for preventing hypertension include exercising aerobically for 30
minutes most days of the week.

8. Your patient's blood pressure is 172/98. Is this a hypertensive emergency?

A. Yes -it this

 B. No - it would be considered Stage 2 Hypertension

C. No - this is considered pre-hypertension

D. No - it would be considered Stage 1 Hypertension

ANSWER: B

RATIO: Normal blood pressure is under 120/80. From 120/80 to 139/89 is pre-hypertension. The
threshold for high blood pressure is 140/90, while anything over 180/110 is hypertensive crisis – an
emergency.

9. Why is HTN considered a silent killer?

A. Because symptoms don't usually present until end organ damage occurs

B. It is not; myocardial infarctions are considered the silent killer

C. Because at no point in the disease progression does symptoms ever present

D. Because it never progresses slowly, it occurs suddenly and immediately

ANSWER: A

RATIO: Hypertension is known as the "silent killer" because many it can be symptom free. Many
people that have it don't know they do.

10. You are taking care of a patient in the hospital and the CNA reports to you that their blood pressure
is 198/101. They have been running 140's/80's throughout their stay. What will you do first?

A. Check the cuff size to make sure it’s appropriate and recheck blood pressure

B. STAT page the physician

C. Ensure the recording has been appropriately documented and continue to monitor them with
their next BP reading in 4 hours

D. Check the chart, obtain any PRN antihypertensives and immediately administer them

ANSWER: A

RATIO: It is important to verify first sudden changes in vital signs before reporting.

1. Which of the following heart muscle diseases is unrelated to other cardiovascular diseases?

A. Cardiomyopathy

B. Coronary artery disease

C. Myocardial infarction

D. Pericardial effusion

ANSWER: A

RATIO: Cardiomyopathy isn't usually related to an underlying heart disease such as atherosclerosis.
The etiology in most cases is unknown. CAD & MI are directly related to atherosclerosis. Pericardial
effusion is the escape of fluid into the pericardial sac, a condition associated w/ Pericarditis &
advanced heart failure.

2. Which of the following types of cardiomyopathy can be associated with childbirth?

A. Dilated

B. Hypertrophic

C. Myocarditis

D. Restrictive

ANSWER: A

RATIO: Although the cause isn't entirely known, cardiac dilation & heart failure may develop during
the last month of pregnancy or the first few months after birth. The condition may result from a
preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an
abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency.
Myocarditis isn't specifically associated w/ childbirth. Restrictive cardiomyopathy indicates
constrictive pericarditis; the underlying cause is usually myocardial.

3. Septal involvement occurs in which type of cardiomyopathy?

A. Congestive

B. Dilated

C. Hypertrophic

D. Restrictive

ANSWER: C

RATIO: In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum—not the ventricle

chambers—is apparent. This abnormality isn't seen in other types of cardiomyopathy.

4 Which of the following recurring conditions most commonly occurs in clients with
cardiomyopathy?

A. Heart failure
B. DM

C. MI

D. Pericardial effusion

ANSWER: A

RATIO: Because the structure & function of the heart muscle is affected, heart failure most commonly
occurs in pts w/ cardiomyopathy. MI results from prolonged myocardial ischemia due to reduced
blood flow through one of the coronary arteries. Pericardial effusion is most predominant in pts w/
pericarditis.

5 What is the term used to describe an enlargement of the heart muscle?

A. Cardiomegaly

B. Cardiomyopathy

C. Myocarditis

D. Pericarditis

ANSWER: A

RATIO: An enlarged heart is medically known as cardiomegaly. Cardiomegaly can be caused by a

number of different conditions, including diseases of the heart muscle or heart valves, high blood
pressure, arrhythmias, and pulmonary hypertension.

6. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which
of the following conditions?

A. Pericarditis

B. Hypertension

C. obliterative

D. restricted

ANSWER: D

RATIO: These are the classic signs of failure. Pericarditis is exhibited by a feeling of fullness in the chest
& auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual
disturbances, & a flushed face. MI causes heart failure but isn't related to these symptoms.

7. Which of the following types of cardiomyopathy does not affect cardiac output?

A. Dilated
B. Hypertrophic

C. Restrictive

D. Obliterative

ANSWER: B

RATIO: Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle
remains relatively unchanged. All of the rest decrease cardiac output.

8. Which of the following cardiac conditions does a fourth heart sound (S4) indicate?

A. Dilated aorta

B. Normally functioning heart

C. Decreased myocardial contractility

D. Failure of the ventricle to eject all the blood during systole

ANSWER: D

RATIO: An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. The
increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause
an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as a
third heart sound. An S4 isn't heard in a normally functioning heart

9. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?

A. Antihypertensive

B. Beta-adrenergic blockers

C. Calcium channel blockers

D. Nitrates

ANSWER: B

RATIO: By decreasing the heart rate & contractility, beta-blockers improve myocardial filling & cardiac
output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually
indicated because they would decrease cardiac output in pts who are already hypotensive. Calcium
channel blockers are sometimes used for the same reasons as beta-blockers; however, they aren't as
effective as beta-blockers & cause increased hypotension. Nitrates aren't used because of their dilating
effects, which would further compromise the myocardium

10. Which of the following blood tests is most indicative of cardiac damage?

A. Lactic dehydrogenase
B. Complete blood count

C. Troponin I

D. Creatine kinase

ANSWER: C

RATIO: Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I
levels aren't detectable in people without cardiac injury. Option A: Lactate dehydrogenase (LDH) is
present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in
diagnosing a cardiac injury. Option B: CBC is obtained to review blood counts, and a complete
chemistry is obtained to review electrolytes. Option D: Because CK levels may rise with a skeletal
muscle injury, CK isoenzymes are required to detect cardiac injury.

1. A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform carotid
massage. The nurse responds that this procedure may stimulate the:

A. Vagus nerve to slow the heart rate

B. Vagus nerve to increase the heart rate; overdriving the rhythm

C. Diaphragmatic nerve to slow the heart rate

D. Diaphragmatic nerve to overdrive the rhythm

ANSWER: A

RATIO: Carotid sinus massage is one of the maneuvers used for vagal stimulation to decrease a rapid
heart rate and possibly terminate a tachydysrhythmia. The others include inducing the gag reflex and
asking the client to strain or bear down. Medication therapy often is needed as an adjunct to keep the
rate down or maintain the normal rhythm.

2. A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There
are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse
determines that the client is experiencing:

A. Premature ventricular contractions

B. Ventricular tachycardia

C. Ventricular fibrillation

D. Sinus tachycardia

ANSWER: B
RATIO: Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes
(usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm
is usually regular.

3. A nurse notices frequent artifact on the ECG monitor for a client whose leads are connected by
cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the
following items is unlikely to be responsible for the artifact?

A. Frequent movement of the client

B. Tightly secured cable connections

C. Leads applied over hairy areas

D. Leads applied to the limbs

ANSWER: B

RATIO: Motion artifact, or "noise," can be caused by frequent client movement, electrode placement
on limbs, and insufficient adhesion to the skin, such as placing electrodes over hairy areas of the skin.
Electrode placement over bony prominence's also should be avoided. Signal interference can also
occur with electrode removal and cable disconnection.

4 A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the client
to do which of the following, if prescribed, during an episode of ventricular tachycardia?

A. Breathe deeply, regularly, and easily

B. Inhale deeply and cough forcefully every 1 to 3 seconds

C. Lie down flat in bed

D. Remove any metal jewelry

ANSWER: B

RATIO: Cough cardiopulmonary resuscitation (CPR) sometimes is used in the client with unstable
ventricular tachycardia. The nurse tells the client to use cough CPR, if prescribed, by inhaling deeply
and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the
cerebral and coronary circulation for a short time until other measures can be implemented.

5 When ventricular fibrillation occurs in a CCU, the first person reaching the client should:

A. Administer oxygen

B. Defibrillate the client

C. Initiate CPR
D. Administer sodium bicarbonate intravenously

ANSWER: B

RATIO: Ventricular fibrillation is a death-producing dysrhythmia and, once identified, must be

terminated immediately by precordial shock (defibrillation). This is usually a standing physician's order
in a CCU.

6. A nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There are no P
waves; instead there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular,
with a rate of 120 beats a minute. The nurse interprets this rhythm as:

A. Sinus tachycardia

B. Atrial fibrillation

C. Ventricular tachycardia

D. Ventricular fibrillation

ANSWER: B

RATIO: Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small
fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just
fibrillating. Sinus tachycardia is a sinus rate above 100 beats/minute with normal P waves. Ventricular
fibrillation is seen on the ECG without a visible P wave; an unmeasurable heart rate, PR or QRS; and
the rhythm is irregular and chaotic. Ventricular tachycardia is seen as three or more premature
ventricular contractions (PVCs) that have distorted QRS complexes with regular or irregular rhythm,
and the P wave is usually buried in the QRS complex without a measurable PR interval.

7. A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls
on the T wave of the preceding beat. The client’s rhythm suddenly changes to one with no P waves or
definable QRS complexes. Instead there are coarse wavy lines of varying amplitude. The nurse assesses
this rhythm to be:

A. Ventricular tachycardia

B. Ventricular fibrillation

C. Atrial fibrillation

D. Asystole

ANSWER: B

RATIO: Ventricular fibrillation is characterized by irregular, chaotic undulations of varying amplitudes.

Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results
from electrical chaos in the ventricles.
8. When auscultating the apical pulse of a client who has atrial fibrillation, the nurse would expect
to hear a rhythm that is characterized by:

A. The presence of occasional coupled beats

B. Long pauses in otherwise regular rhythm

C. A continuous and totally unpredictable irregularity

D. Slow but strong and regular beats

ANSWER: C

RATIO: In atrial fibrillation, multiple ectopic foci stimulate the atria to contract. The AV node is unable
to transmit all of these impulses to the ventricles, resulting in a pattern of highly irregular ventricular
contractions.

9. A client is having frequent premature ventricular contractions. A nurse would place priority on
assessment of which of the following items?

A. Blood pressure and peripheral perfusion

B. Sensation of palpitation

C. Causative factor such as caffeine

D. Precipitating factors such as infections

ANSWER: A

RATIO: Premature ventricular contractions can cause hemodynamic compromise. The shortened
ventricular filling time with the ectopic beats leads to decreased stroke volume and, if frequent
enough, to decreased cardiac output. The client may be asymptomatic or may feel palpations. PVCs
can be caused by cardiac disorders or by any number of physiological stressors, such as infection,
illness, surgery, or trauma, and by the intake of caffeine, alcohol, or nicotine.

10. A client with a bundle branch block is on a cardiac monitor. The nurse should expect to observe:

A. Sagging ST segment

B. Absence of P wave configurations

C. Inverted T waves following each QRS complex

D. Widening of QRS complexes to 0.12 seconds or greater

ANSWER: D
RATIO: Bundle branch block interferes with the conduction of impulses from the AV node to the
ventricle supplied by the affected bundle. Conduction through the ventricles is delayed, as evidenced
by a widened QRS complex.

1. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for
this client during the first 24 hours after admission?

A. Nothing by mouth

B. Regular diet

C. Clear liquids

D. Skim milk

ANSWER: A

RATIO: Shock and bleeding must be controlled before oral intake, so the client should receive nothing
by mouth. A regular diet is incorrect. When the bleeding is controlled, the diet is gradually increased,
starting with ice chips and then clear liquids. Skim milk shouldn't be given because it increases gastric
acid production, which could prolong bleeding. A liquid diet is the first diet offered after bleeding and
shock are controlled.

2. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?

A. His gastric bleeding occurred 2 hours earlier

B. He has fresh, active upper GI bleeding

C. He needs transfusion of packed RBC

D. He needs immediate saline gastric lavage

ANSWER: A

RATIO: Upper GI Bleeding: Hematemesis is vomiting of red-colored blood and indicates upper GI
bleeding, usually from an arterial source or varix. It is considered a medical emergency, and the most
vital distinction is whether there is blood loss sufficient to cause shock. The bleeding is similar to dark
brown emesis, with granular material that resembles coffee grounds. This results from upper GI
bleeding that has slowed or stopped, with conversion of red hemoglobin to brown hematin by gastric
acid.3

3. Which diagnostic tests would be used first to evaluate a client with upper GI bleeding?

A. Upper GI series

B. Arteriography
C. Endoscopy

D. Hemoglobin level and hematocrit

ANSWER: C

RATIO: In most circumstances, the standard of care for the initial diagnostic evaluation of suspected
acute GI bleeding is urgent upper endoscopy and/or colonoscopy, as recommended by guidelines from
the American College of Gastroenterology and the 2010 International Consensus Recommendations.

4. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to
the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear
is suspected, and the nurse begins taking a client history from the client’s wife. The question by the
nurse that demonstrates her understanding of Mallory- Weiss tearing is:

A. “Tell me about your husband’s alcohol usage”

B. Has your husband recently fallen or injured his chest?”

C. “Is your husband being treated with tuberculosis?”

D. “Describe spices and condiments your husband uses on food.”

ANSWER: A

RATIO: A Mallory-Weiss tear is associated with massive bleeding after a tear occurs in the mucous
membrane at the junction of the esophagus and stomach. There is a strong relationship between
ethanol usage, resultant vomiting, and a Mallory-Weiss tear. The bleeding is coming from the stomach,
not from the lungs as would be true in some cases of tuberculosis. A Mallory-Weiss tear doesn't occur
from chest injuries or falls and isn't associated with eating spicy foods.

5. A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding
duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric area along with a rigid,
board-like abdomen. These clinical manifestations most likely indicate which of the following?

A. The esophagus has become inflamed

B. Additional ulcers have developed

C. An intestinal obstruction has developed

D. The ulcers have perforated

ANSWER: D

RATIO: The body reacts to perforation of an ulcer by immobilizing the area as much as possible. This
results in board-like muscle rigidity, usually with extreme pain. Perforation is a medical emergency
requiring immediate surgical intervention because peritonitis develops quickly after perforation. An
intestinal obstruction would not cause mid-epigastric pain. Esophageal inflammation or the
development of additional ulcers would not cause a rigid, board-like abdomen.

6. Patient admitted to ER has profuse bright-red hematemesis. During initial care of the patient, the
nurse's first priority is to:

A. perform a nursing assessment of patient's status

B. establish 2 IV sites

C. obtain a thorough health history

D. perform a gastric lavage with cool tap water in prep for endoscopic exam

ANSWER: A

RATIO: Although all of the interventions may be indicated when a patient has upper GI bleeding, the
first nursing priority with bright-red (arterial) blood is to perform a focused assessment of the
patient's condition, with emphasis on blood pressure (BP), pulse, and peripheral perfusion to
determine the presence of hypovolemic shock.

7. You promote hemodynamic stability in a patient with upper GI bleeding by:

A. Encouraging oral fluid intake.

B. Monitoring central venous pressure

C. Monitoring laboratory test results and vital signs

D. Giving blood, electrolyte and fluid replacement

ANSWER: D

RATIO: Patients with hemodynamic instability and/or suspected ongoing bleeding should receive
intravenous fluid resuscitation with the goal of normalization of blood pressure and heart rate prior to
endoscopic evaluation/intervention (strong recommendation, very low- quality evidence).

8. Your patient has a GI tract that is functioning, but has the inability to swallow foods. Which is the
preferred method of feeding for your patient?

A. TPN

B. PPN

C. NG feeding

D. Oral liquid supplement

ANSWER: C
RATIO: Because the GI tract is functioning, feeding methods involve the enteral route which bypasses
the mouth but allows for a major portion of the GI tract to be used.

9. A 24-year-old man undergoes a laparotomy after a gunshot wound to the abdomen. The patient has
multiple injuries including significant liver laceration, colon injuries, multiple small bowels and an injury
to the intrahepatic vena cava. The patient receives 34 units of packed red blood cells, 15 liters of
crystalloid, 11 units of FFP, and 12 pack of platelets. The patient’s abdomen is packed close and he is
taken to the intensive care unit for further resuscitation. Which of the following is sequela of abdominal
compartment syndrome?

A. Decreased systemic vascular resistance

B. Increased intracranial pressure

C. Decreased plasma renin and aldosterone

D. Decreased peak airway pressure

ANSWER: B

RATIO: The intracranial pressure increases and cerebral perfusion pressure decreases because of
decrease venous return. Compartment syndrome also results in increased peak airway pressures,
decreased venous return and decreased cardiac output, increased systemic vascular resistance,
decreased renal blood flow and glomerular filtration rate, and decreased portal venous flow with
decreased liver function.

10. The patient is at risk for developing intra-abdominal hypertension (IAH) after surgery to correct
abdominal trauma. In which way will the nurse measure the progress of this complication?

A. Monitoring the amount of respiratory distress exhibited by the patient

B. Monitoring the amount of gastrointestinal tube drainage

C. Measurement of abdominal distention

D. Monitoring transurethral bladder pressure

ANSWER: D

RATIO: Bladder pressure method is the most reliable measurement via indirect means

11. A patient has severe abdominal compartment syndrome and will undergo surgical decompression.
The nurse will expect to administer which drugs before this surgery to help reduce unstable cardiac
dysrhythmias? Select all that apply

A. Furosemide
B. Vasopressin

C. Sodium Bicarbonate

D. Epinephrine

E. Mannitol

ANSWER: C/E

RATIO: Furosemide is a potassium wasting diuretic, Vasopressin (ADH), Epinephrine stimulates

sympathetic nervous system. Resuscitation with fluids containing sodium bicarbonate immediately
before and during decompression surgery may prevent unstable dysrhythmias. Resuscitation with
fluids containing mannitol immediately before and during decompression surgery may prevent
unstable dysrhythmias.

12. A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with
ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic
therapy, which nursing action would be most effective in ensuring safe care?

A. Measuring serum potassium for hyperkalemia

B. Assessing the client for hypovolemia

C. Measuring the client’s weight daily

D. Documenting precise intake and output.

ANSWER: D

RATIO: For the client with ascites receiving diuretic therapy, careful intake and output measurement is
essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and
documented, could place the client at risk for serious fluid and electrolyte imbalances.

13. A client with suspected gastric cancer undergoes an endoscopy of the stomach. Which of the
following assessments made after the procedure would indicate the development of a potential
complication?

A. The client displays signs of sedation

B. The client demonstrates lack of appetite

C. The client complaints of a sore throat

D. The client experiences a sudden increase in temperature.

ANSWER: D
RATIO: The most likely complication of an endoscopic procedure is perforation. a sudden temp spike
with 1 to 2 hours after the procedure is indicative of a perforation and should be reported immedialty
to the physician.

14. Thrombus formation is a danger for all postoperative clients. The nurse should act independently to
prevent this complication by:

A. Encouraging adequate fluids

B. Performing active -assistive leg exercise

C. Massaging gently the legs with lotion

D. Applying elastic stocking

ANSWER: B

RATIO: Inactivity causes venous stasis, hypercoagulability, and external pressure against the veins, all
of which lead to thrombus formation. Early ambulation or exercise of the lower extremities reduces
the occurrence of this phenomenon.

15. Oxygen 3L/min by nasal cannula is prescribed for Joey who is admitted to the hospital for chest pain.
The nurse institutes safety precautions in the room because oxygen:

A. Supports combustion

B. Converts to an alternate form of matter

C. Has unstable properties

D. Is inflammable

ANSWER: A

RATIO: The nurse should know that Oxygen is necessary to produce fire, thus precautionary measures
are important regarding its use.

1. A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulted to
ascites. The nurse should be aware that the ascites is most likely the result of increased.

A. Pressure in the portal vein

B. Production of serum albumin

C. Secretion of bile salt

D. Interstitial osmotic pressure

ANSWER: A

RATIONALE:
Enlarged cirrhotic liver impinges the portal system causing increased hydrostatic pressure resulting to
ascites. Portal venous pressure is the blood pressure in the hepatic portal vein, and is
normally between 5-10 mmHg. Raised portal venous pressure is termed portal hypertension, and has
numerous sequelae such as ascites and hepatic encephalopathy.

2. Which diagnostic test is best to evaluate liver enlargement and ascites?

A. Ultrasound

B. X-ray

C. CT Scan

D. Nuclear medicine

ANSWER: B

RATIONALE: An abdominal X-ray may be helpful in the diagnosis of ascites. Findings on an abdominal
X-ray suggestive of ascites include increased density in abdomen diffusely, lack of shadow
differentiation between different soft tissues in abdomen, displacement of intestines and viscera
medially, and flank bulging.

3. Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver:
Which laboratory test indicates liver cirrhosis?

A. Decreased red blood cell count

B. Decreased serum acid phosphatase

C. Elevated white blood cell count

D. Elevated serum aminotransferase

ANSWER: D

RATIONALE: Hepatic cell death causes release of liver enzymes alanine aminotransferase(ALT),
aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) into the circulation. Liver cirrhosis
is a chronic and irreversible disease of the liver characterized by generalized inflammation and fibrosis
of the liver tissues.

4. A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient’s
blood pressure because of which change that is associated with the liver failure?

A. Hypoalbuminemia
B. Increased capillary permeability

C. Abnormal peripheral vasodilation

D. Excess renin release of the kidney

ANSWER: A

RATIONALE: Blood pressure decreases as the body is unable to maintain normal oncotic pressure with
liver failure, so patients with liver failure require close blood pressure monitoring. Increased capillary
permeability, abnormal peripheral vasodilation, and excess rennin released from the kidney's aren't
direct ramifications of liver failure.

5. You’re caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires
paracentesis. Relief of which symptom indicated that the paracentesis was effective?

A. Pruritus

B. Dyspnea

C. Jaundice

D. Peripheral neuropathy

ANSWER: B

RATIO: Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing
pressure on the diaphragm. The goal is to improve the patient's breathing. The others are signs of
cirrhosis that aren't relieved by paracentesis.

6. You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to
suspect hepatic encephalopathy in her?

A. Asterixis

B. Chvostek sign

C. Trousseau’s sign

D. Hepatojugular reflex

ANSWER: A

RATIO: Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to
hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.

7. Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following
points do you include?
A. “You’ll need to lie on your stomach during the test”

B. “you’ll need to lie on your right side after the test.”

C. “During the biopsy you’ll be asked to exhale deeply and hold it.”

D. “The biopsy is performed under general anesthesia.”

ANSWER: B

RATIONALE: After a liver biopsy, the patient is placed on the right side to compress the liver and to
reduce the risk of bleeding or bile leakage.

8. The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which
foods in the patient’s diet?

A. Meats and beans

B. Butter and gravies

C. Potatoes and pasta

D. Cakes and pastries

ANSWER: A

RATIONALE: Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize
protein adequately, causing protein by-products to build up in the body rather than be excreted.

9. When teaching a client about pancreatic function, the nurse understands that pancreatic lipase
performs which function?

A. Transport fatty acids into the brush border

B. Breaks down fat into fatty acids and glycerol

C. Triggers cholecystokinin to contract the gallbladder

D. Breaks down protein into dipeptides and amino acid

ANSWER: B

RATIONALE: Breaks down fat into fatty acids and glycerol. Lipase hydrolyses or breaks down fat into
fatty acids and glycerol. Lipase is not involved with the transport of fatty acids into the brush border.
Fat itself triggers cholecystokinin release. Protein breakdown into dipeptides and amino acids is the
function of trypsin, not lipase.

10. For Rico who has chronic pancreatitis, which nursing intervention would be most helpful?
A. Allowing liberalized fluid intake

B. Counseling to stop alcohol consumption

C. Encouraging daily exercise

D. Modifying dietary protein

ANSWER: B

RATIONALE: Chronic pancreatitis typically results from repeated episodes of acute pancreatitis. More
than half of chronic pancreatitis cases are associated with alcoholism. Counseling to stop alcohol
consumption would be the most helpful for the client.

11. A clinical manifestation of acute pancreatitis is epigastric pain. Your nursing intervention to facilitate
relief of pain would place the patient in a:

A. Knee chest position

B. Semi-Fowler’s position

C. Recumbent position

D. Low-Fowlers position

ANSWER: A

RATIONALE: Flexion of the trunk lessens the pain and decreases restlessness.

12. What assessment finding of a patient with acute pancreatitis would indicate a bluish discoloration
around the umbilicus?

A. Grey-Turner’s sign

B. Homan’s sign

C. Rovsing’s sign

D. Cullen’s sign

ANSWER: D

RATIO: Cullen's sign is associated with pancreatitis when a hemorrhage is suspected.

13. Pancreatitis is commonly characterized by:

A. Edema and inflammation

B. Pleural effusion
C. Sepsis

D. Disseminated intravascular coagulation

ANSWER: A

RATIONALE: Choice A is correct, Sepsis is one of the cause of this disease, Pleural effusion and DIC are
the complications of Pancreatitis.

14. A major symptom of pancreatitis that brings the patient to medical care is:

A. Severe abdominal pain

B. Fever

C. Jaundice

D. Mental agitation

ANSWER: A

RATIONALE: Abdominal pain is the major symptom of pancreatitis that causes the patient to seek
medical care and this results from irritation and edema of the inflamed pancreas. Boardlike abdomen.
A rigid or boardlike abdomen may develop and cause abdominal guarding.

15. The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged
and elevated level of:

A. Serum calcium

B. Serum lipase

C. Serum bilirubin

D. Serum amylase

ANSWER: B

RATIONALE: Serum amylase and lipase levels are elevated within 24 hours of the onset of symptoms.
Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain
elevated days longer than amylase.

1. A client is in DKA, secondary to infection. As the condition progresses, which of the following
symptoms might the nurse see?

A. Kussmaul’s respirations and a fruity odor on the breath

B. Shallow respirations and severe abdominal pain

C. Decreased respirations and increased urine output.

D. Cheyne-stokes respirations and foul-smelling urine

ANSWER: A

RATIONALE: DKA patient has Kussmaul’s respiration and fruity odor on the breath because of the
presence of metabolic acidosis.

2. When a client is in diabetic ketoacidosis, the insulin that would be administered is:

A. Human NPH insulin

B. Human regular insulin

C. Insulin lispro injection

D. Insulin glargine injection

ANSWER: B

RATIONALE: Regular insulin, also known as neutral insulin and soluble insulin is a type of short-
acting insulin. It is used to treat type 1 diabetes, type 2 diabetes, gestational diabetes, and
complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.

Neutral Protamine Hagedorn insulin, also known as isophane insulin, is an intermediate-acting insulin
given to help control blood sugar levels in people with diabetes.

Lispro insulin is a rapid-acting human insulin analog used to lower blood glucose

Insulin glargine is a long acting human insulin and it works by replacing the insulin that is normally
produced by the body and by helping move sugar from the blood into other body tissues where it is
used for energy. It also stops the liver from producing more sugar.

3. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would
a nurse expect to note as confirming this diagnosis?

A. Elevated blood glucose level and a low plasma bicarbonate

B. Decreased urine output

C. Increased respirations and an increase in pH

D. Comatose state

ANSWER: A

RATIONALE: In the client with DKA, the nurse should expect to note blood glucose levels between 350
and 1500 mg/dL, ketonuria, serum pH less than 7.35, and serum bicarbonate less than 15 mEq/dL.
4. Which of the following methods of insulin administration would be used in the initial treatment of
hyperglycemia in a client with diabetic ketoacidosis?

A. Subcutaneous

B. Intramuscular

C. IV bolus only

D. IV bolus, followed by continuous infusion.

ANSWER: D

RATIONALE: IV bolus, followed by continuous infusion until SQ administration is resumed

5. A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing
action is to prepare to:

A. Administer regular insulin intravenously

B. Administer 5% dextrose intravenously

C. Correct the acidosis

D. Apply an electrocardiogram monitor.

ANSWER: A

RATIONALE: Lack (absolute or relative) of insulin is the primary cause of DK1. Treatment consists of
insulin administration (regular insulin), IV fluid administration (normal saline initially), and potassium
replacement, followed by correcting acidosis. Applying an electrocardiogram monitor is not a priority
action.

6. During the admission of a client with diabetic ketoacidosis, Nurse Kendra will anticipate the physician
ordering which of the following types of intravenous solution if the client cannot take fluids orally?

A. Lactated Ringer’s solution

B. 0.9 normal saline solution

C. 5% dextrose in water (D5W)

D. 0.45% normal saline solution

ANSWER: D

RATIONALE: 0.9% normal saline solution is an isotonic solution and is administered at a high rate to
replace fluid losses. 0.45% normal saline is a hypotonic solution which dilutes cell and decrease
osmolality resulting into cell swelling aiding the dehydration status of the patient and may be used for
hypertension or hypernatremia and for those at risk for heart failure.
7. Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to
exhibit? Select all that apply:

A. Sweating

B. Low PCO2

C. Retinopathy

D. Acetone breath

E. Elevated serum bicarbonate

ANSWER: B C D

RATIONALE: Metabolic acidosis initiates respiratory compensation in the form of Kussmaul's

respirations to counteract the effects of ketone buildup, resulting in a lowered PCO2. A fruity odor to
the breath (acetone breath) occurs when the ketone level is elevated in ketoacidosis. Microvascular
changes consistent with diabetic retinopathy have been reported prior to and after treatment of
diabetic ketoacidosis.

8. Which of the following chronic complications is associated with diabetes?

A. Dizziness, dyspnea on exertion, and coronary artery disease.

B. Retinopathy, neuropathy, and coronary artery disease

C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts

D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s

ANSWER: B

RATIONALE: Over time, the surge and crash of dissolved glucose and insulin that occurs in diabetes can
end up causing irreparable damage to many body organs and systems. Doctors refer to this as "end-
organ damage" because it can effect nearly every organ system in the body: Eye; Kidney; Nerve; Joint
and foot problems; Skin infection and Cognitive Issues.

9. Which of the following if stated by the nurse is correct about Hyperglycemic Hyperosmolar Nonketotic
Syndrome (HHNS)?

A. This syndrome occurs mainly in people with Type I Diabetes

B. It has a higher mortality rate than Diabetic Ketoacidosis

C. The client with HHNS is in a state of over hydration

D. This condition develops very rapidly

ANSWER: B

RATIONALE: HHNS can occur in people who have not yet been diagnosed with diabetes making it
dangerous than DKA.

10. Blood sugar is well controlled when Hemoglobin A1C is:

A. Below 5.7%

B. Between 12%-15%

C. Less than 180 mg/dL

D. Between 90 and 130 mg/dL

ANSWER: A

RATIONALE: For people without diabetes, the normal range for the hemoglobin A1c level is between
4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have prediabetes and a higher
chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes

11. The client’s blood gases reflect diabetic acidosis. The nurse should expect:

A. Increased pH

B. Decreased PO2

C. Increased PCO2

D. Decreased HCO3

ANSWER: D

RATIONALE: Bicarbonate is an essential component of the physiological pH buffering system in the

human body. Up to ¾ of the carbon dioxide in the human body is converted to carbonic acid which is
quickly turned to bicarbonate. Bicarbonate is an alkali so helps to keep the acid-base balance of the
body stable

12. Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of diabetes mellitus type 2. As
a nurse, you know that the primary purpose of sulfonylureas, such as long-acting glyburide (Micronase),
is to:

A. Induce hypoglycemia by decreasing insulin sensitivity.

B. Improve insulin sensitivity and decrease hyperglycemia.

C. Stimulate the beta cells of the pancreas to secrete insulin.

D. Decrease insulin sensitivity by enhancing glucose uptake.

ANSWER: C

RATIONALE: Sulfonylureas such as glyburide are used only with patients who have some remaining
pancreatic-beta cell function. These drugs stimulate insulin secretion, which reduces liver glucose
output and increases cell uptake of glucose, enhancing the number of and sensitivity of cell receptor
sites for interaction with insulin.

13. When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the
nurse’s priority is to provide:

A. Oxygen

B. Carbohydrates

C. Fluid replacement

D. Dietary instruction

ANSWER: C

RATIONALE: As a result of osmotic pressures created by increased serum glucose. the cells become
dehydrated; the client must receive fluid and then insulin

14. A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood
glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which
finding would be of most concern of the nurse?

A. Pulse

B. BP

C. Respiration

D. Temperature

ANSWER: D

RATIONALE: Glucose level is normal; pulse rate is normal; respiratory rate is normal; BP is slightly
normal for patient with type 2 DM because mostly patient with this disease is hypotensive. High body
temperature indicates infection.

15. The principal goals of therapy for older patients who have poor glycemic control are:

A. Enhancing quality of life.

B. Decreasing the chance of complications.

C. Improving self-care through education.

D. All of the above.

ANSWER: D

RATIONALE: All statements are true