FINAL COACHING

MEDICAL SURGICAL I
Prepared by: Dr. Elenita Arreglo
November 2023 Philippine Nurse Licensure Examination Review
NAME: DATE: SCORE: _____

“FIRST TAKER AKO, AT LAST TAKE KO NA ‘TO!

1. A client underwent total thyroidectomy. The nurse 8. A client who has had a long leg cast applied is to be
anticipates that the doctor will prescribed a lifetime supply of discharged. When discussing pain management, the nurse
1. Levothyroxine should advise the client to take the prescribed prn Tylenol with
2. Propylthiouracil codeine:
3. Calcium A. just as a last resort
4. Methimazole B. when the discomfort begins
5. Iodine C. before going to sleep
A. 1 and 2 D. as the pain becomes intense
B. 1 and 3 9. A physician orders 1000 mL of IV solution be administered
C. 1 and 4 over 8 hours. If the IV infusion set delivers 15 drops per mL,
D. 1 and 5 how many drops per minute should the nurse administer to the
E. 1 only patient?
2. A client with megaloblastic anemia and experiencing A. 15 drops/min
peripheral numbness and tingling sensation will be given B. 20 drops/min
A. Folic Acid C. 32 drops/min
B. Cyanocobalamine D. 64 drops/min
C. Ferrous sulphate 10. The nurse begins administering 500 mL of 5% dextrose
D. Erythropoietin and water solution at 01:00 to run over 4 hours. At 02:00, the
E. None of the above nurse administers 80 mg gentamicin in 50 cc normal saline to
3. A client with renal failure is receiving ferrous sulphate, infuse over 30 minutes. How many mL of fluid will the nurse
erythropoietin and calcium gluconate to administer to the patient between 02:00 and 03:00?
A. Treat anemia A. 175 ml
B. Relieve fatigue B. 150 ml
C. Supplement for loss C. 125 ml
D. None of the above D. 100 ml
4. Mr. James is a 56-year-old client with chronic renal failure. 11. The sterile nurse or sterile personnel touch only sterile
The nurse should recognize that this client will be at particular supplies and instruments. When there is a need for sterile
risk for which condition? supply which is not in the sterile field, who hands out these
A. Rapid development of drug toxicity items by opening its outer cover?
B. Development of allergic reaction to nephrotoxic A. Circulating nurse
drugs B. Anesthesiologist
C. Slow development of tolerance for drugs C. Surgeon
D. Need for increased doses of prescribed drugs D. Nursing aide
5. A client is receiving morphine for severe metastatic bone 12. The OR team performs distinct roles for one surgical
pain. To prevent complications from a side effect of morphine, procedure to be accomplished within a prescribed time frame
the nurse should: and deliver a standard patient outcome. While the surgeon
A. Monitor for diarrhea performs the surgical procedure, who monitors the status of
B. Wake the client every two hours the client like urine output, blood loss?
C. Observe for an opiate addiction A. Scrub nurse
D. Assess for altered breathing patterns B. Surgeon
6. A client with arthritis is taking ibuprofen, a non-steroidal C. Anesthesiologist
anti-inflammatory drug, and large doses of aspirin. The nurse, D. Circulating nurse
teaching about the symptoms of aspirin toxicity, advises the 13. Surgery schedules are communicated to the OR usually a
client to notify the physician if the client develops: day prior to the procedure by the nurse of the floor or ward
A. Feelings of drowsiness where the patient is confined. For orthopedic cases, what
B. Intermittent constipation department is usually informed to be present in the OR?
C. tinnitus A. Rehabilitation department
D. a metallic taste in the mouth B. Laboratory department
7. A client with arthritis asks the nurse if acetaminophen can be C. Maintenance department
substituted for the aspirin that causes stomach irritation. The D. Radiology department
nurse’s response should be based on the knowledge that 14. Troy is a one day post open reduction and internal fixation
acetaminophen: (ORIF) of the left hip and is in pain. Which of the following
A. lacks anticoagulant action observation would prompt you to call the doctor?
B. lacks an anti-inflammatory action A. Dressing is intact but partially soiled
C. has the same action as aspirin B. Left foot is cold to touch and pedal pulse is absent
D. has more severe side effects than aspirin C. Left leg in limited functional anatomic position

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 D. BP 114/78, pulse of 82 beats/minute bases an answer on the understanding that which nutrients are
15. There is an order of Demerol 50 mg I.M. now and every 6 essential for production of healthy red cells?
hours p r n. You injected Demerol at 5 pm. The next dose of A. Iron, folic acid, and vitamin B12
Demerol 50 mg I.M. is given: B. Vitamin C, vitamin D, and selenium
A. When the client asks for the next dose C. Vitamin A, calcium, and phosphorus
B. When the patient is in severe pain D. Aluminum, vitamin E, and beta carotene
C. At 11pm 27. A patient with iron-deficiency anemia has been taking oral
D. At 12pm iron supplements. Which test should the nurse review to
16. Which of the following should be given highest priority determine the effectiveness of this intervention?
when receiving patient in the OR? A. Hemoglobin
A. Assess level of consciousness B. Hematocrit
B. Verify patient identification and informed consent C. RBC count
C. Assess vital signs D. WBC count
D. Check for jewelry, gown, manicure and dentures 28. The nurse is assisting in the development of a care plan for
17. Surgeries like I and D (incision and drainage) and a patient with anemia. Which nursing diagnosis is most
debridement are relatively short procedures but considered common in a patient with anemia?
‘dirty cases’. When are these; procedures best scheduled? A. Activity Intolerance related to tissue hypoxia
A. Last case B. Ineffective Airway Clearance related to dyspnea
B. In between cases C. Chronic Pain related to bone marrow dysfunction
C. According to availability of anesthesiologist D. Risk for Infection related to reduction in circulating
D. According to the surgeon’s preference WBCs
18. Another nursing check that should not be missed before 29. The nurse is preparing to give an injection of iron
the induction of general anesthesia is: (Imferon) to a patient with anemia. What is the rationale for
A. check for presence underwear using the Z-track method for injection?
B. check for presence dentures A. Prevent pain at the site
C. check patient’s blood studies B. Prevent tissue damage at the site
D. check baseline vital signs C. Promote absorption of the medication
19. Some different habits and hobbies affect postoperative D. Prevent discoloration of tissue at the site
respiratory function. If your client smokes 3 packs of cigarettes 30. A patient with thrombocytopenia is having pain. If each of
a day for the past 10 years, you will anticipate increased risk the following medications is ordered, which should the nurse
for: choose to administer?
A. perioperative anxiety and stress A. Morphine SQ
B. delayed coagulation time B. Meperidine (Demerol) IM
C. delayed wound healing C. Oxycodone with aspirin (Percodan) PO
D. postoperative respiratory dysfunction D. Acetaminophen with codeine (Tylenol No. 3) PO
20. Which of the following role would be the responsibility of 31. The nurse is caring for a patient with thrombocytopenia.
the scrub nurse? Which activity should be avoided?
A. Assess the readiness of the client prior to surgery A. Ambulation
B. Ensure that the airway is adequate B. Intramuscular injections
C. Account for the number of sponges, needles, C. Visits from family members
supplies, Used during the surgical procedure D. Eating fresh fruits and vegetables
D. Evaluate the type of anesthesia appropriate for the 32. A patient with aplastic anemia is to receive an injection of
surgical client erythropoietin (Epogen). The patient asks what the injection is
21. It is also the nurse’s function to determine when infection intended to do. Which should the nurse respond to the
is developing in the surgical incision. The perioperative nurse patient?
should observe for what signs of impending infection? A. It will increase production of RBC and other cells.
A. Localized heat and redness B. It works like a blood transfusion to give you extra
B. Serosanguinous exudates and skin blanching red blood cells.
C. Separation of the incision C. It will stimulate your body to produce more of its
D. Blood clots and scar tissue are visible own red blood cells.
22. You identified a potential risk of pre and postoperative D. It will increase your energy while your body is
clients. To reduce the risk of patient harm resulting from fall, recovering from the anemia.
you can implement the following EXCEPT: 33. A patient is admitted in sickle cell crisis with symptoms of
A. Assess potential risk of fail associated with the dyspnea and leg pain. The patients significant other asks, I
patient’s the following EXCEPT: medication regimen don’t really understand why he is hurting so badly. Which
B. Take action to address any identified risks through response by the nurse is best?
Incident Report (IR) A. The pain is due to a disturbance in cellular
C. Allow client to walk with relative to the OR metabolism.
D. Assess and periodically reassess individual client’s B. The bone marrow is expanding with the sickled
risk for falling cells and that causes pain.
23. The breakdown in teamwork is often times a failure in: C. Clumping of abnormal red blood cells blocks the
A. Electricity flow of blood through the capillaries.
B. Inadequate supply D. Bleeding in the joints occurs because red blood
C. Leg work cells are being rapidly destroyed by the bone marrow.
D. Communication 34. The nurse is caring for a patient in sickle cell crisis. What is
24. After an abdominal surgery, the circulating and scrub the rationale for providing warm compresses and blankets for
nurses have critical responsibility about sponge and Instrument this patient?
count. When is the first sponge/instrument count reported? A. Sickle cell crisis causes shivering and discomfort.
A. Before closing the subcutaneous layer B. Heat helps prevent the cells from becoming sickled.
B. Before peritoneum is closed C. Heat speeds production of new healthy RBCs.
C. Before closing the skin D. Heat prevents vasoconstriction and impaired
D. Before the fascia is sutured circulation.
25. Which of the following is true about wound evisceration? 35. A patient is admitted to the hospital with hypertension and
A. Occurs 6-8 hours post op vertigo related to polycythemia vera (PV). For which treatment
B. Occurs as a consequence of anesthesia should the nurse prepare the patient?
C. Has increased risk of infection [Link]
D. Can be prevented by abdominal exercises [Link]
26. A patient is diagnosed with anemia and asks the nurse [Link] phlebotomy
what nutrients are important for RBC formation. The nurse [Link] of colony-stimulating factors

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36. The nurse is caring for a patient with PV. Which laboratory 46. A patient who has Disseminated Intravascular coagulation
study should the nurse monitor to help evaluate the (DIC) is administered heparin sodium. Which of the following
effectiveness of treatment for this patient? responses, if identified with the patient would indicate that
A. Hematocrit heparin is effective:
B. Total protein A. breath sound clear to auscultation
C. Blood urea nitrogen (BUN) B. stool negative to occult blood
D. WBC differential C. pupils equal and reactive to light
37. The nurse is planning discharge teaching for a patient with D. oral mucosa pink and moist
polycythemia. Which nursing intervention should the nurse 47. To which of the following nursing diagnosis would the
consider to help prevent complications in this patient? nurse give priority in the care of a patient whose blood test
A. Monitor intake and output. reveals RBC count of 3.0 M/mm3:
B. Avoid use of injections for pain. A. risk for activity intolerance
C. Maintain bedrest during treatment. B. risk for fluid volume deficit
D. Encourage 3 L of water intake daily. C. risk for impaired skin integrity
38. The nurse is caring for a patient with a clotting disorder. D. risk for infection
Which blood product should the nurse anticipate being 48. Which of the following observations of a patient who has
prescribed? pernicious anemia would indicate that the goal of the care has
A. Albumin been achieve:
B. Normal saline A. the patient’s skin has no petechiae
C. Fresh frozen plasma B. the patient has no paresthesia
D. Packed WBCs C. the patient has no dependent edema
39. The nurse is reviewing the care plan for a patient with D. the patient has good appetite
disseminated intravascular coagulation. Which nursing 49. A client was diagnosed with Polycythemia. Hematocrit is
intervention is most likely to cause an acute complication in 60%. This condition is common among
this patient? A. Children
A. Placing the patient on strict bedrest B. Women
B. Providing a diet that is high in fat and sodium C. 60 years old and above
C. Administering intramuscular meperidine (Demerol) D. Reproductive years
for pain 50. Which of the following is an assessment finding in a client
D. Allowing a family member with a respiratory with Erythrocytosis?
infection to visit A. Flushing, headache, claudication, epistaxis
40. A nurse is assisting with data collection on a newly B. Headache, hypertension, chest pain
admitted patient with a history of hemophilia. Which C. Stasis, hypercoagulability, endothelial injury, fever
assessment finding indicates that the patient has experienced D. Hypotension, thrombus formation, dizziness
some severe episodes of bleeding in the past? 51. Phlebotomy is ordered for a client with Polycythemia, the
A. Joint deformities nurse knows that such procedure will
B. Distended abdomen A. Remove excess plasma in the blood
C. Ecchymoses on the extremities B. Increases viscosity of the blood
D. Elevated WBC count C. Deplete iron stores
41. A patient is being prepared for splenectomy. What is the D. All of the above
purpose of the order for a vitamin K injection? 52. A client who underwent Bariatric surgery is at most risk for
A. It corrects a dietary deficiency. developing which type of anemia?
B. It helps correct underlying anemia. A. Iron deficiency anemia
C. It corrects clotting factor deficiencies. B. Pernicious anemia
D. It replaces vitamin K lost during night sweats. C. Folic acid deficiency
42. The nurse suspects a patient has polycythemia. Which D. Hemolytic anemia
hematocrit value is causing the nurse to have this concern? 53. A 28 year old female client is experiencing heavy menstrual
A. 38% flow with dysmenorrhea for more than 7 days. She feels listless
B. 45% and tires all the time. The nurse knows that the cause of the
C. 47% client’s symptoms is
D. 55% A. The pain does not allow her to rest so she feels
43. The nurse is providing education to an individual with tires all the time
sickle cell anemia. Which activities should the nurse instruct B. The problem has decreased her hemoglobin levels
the patient to avoid? C. The symptoms are not related to heavy menstrual
1. Scuba diving flow
2. Contact sports D. The symptoms must have been there before heavy
3. Sexual activity menstrual flow occur
4. Long-distance driving 54. Which of the following interventions will prevent sickle cell
5. Skiing in the mountains crisis?
6. Standing for long periods A. Restrict fluid and sodium
A. 1,2 B. Encourage flu vaccines
B. 1.3 C. Administer prophylactic antibiotic
C. 1,4 D. Administer analgesic as ordered
D. 1,5 55. Which of the following evaluation outcome tells the nurse
E. 1,6 that the interventions to a client with COPD are effective?
44. Nursing care for a patient who has polycythemia vera A. The client has RR 32 cpm
would focus in preventing: B. The client has crackles
A. dysrhythmias C. The client exhibits intolerance to activity
B. hypotension D. The client is maintained on low flow oxygen
C. thrombosis 56. A client with COPD has a history of smoking 2 packs of
D. decubitus ulcers cigarettes for 15 years. Compute for the pack years the patient
had smoked
45. Which of the following is not expected in Polycythemia A. 30 pack years
vera? B. 15 pack years
A. Flushing of face C. 40 pack years
B. Erythromelalgia D. 600 pack years
C. Elevated platelets 57. Which of the following conditions in a client with
D. Elevated erythropoeitin Emphysema needs further assessment?
E. None of the above A. Pulse oximeter reading is 93%

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 B. The clients arterial blood gas is 75 D. Sudden onset of chest pain and dyspnea
C. The client has dyspnea in walking to the kitchen 69. When assessing a client with chest trauma. Which of the
D. The client has fever following indicates a possible pneumothorax?
58. A client with chronic bronchitis comes to the emergency A. Adventitious sound and dyspnea
room in acute exacerbation. The nurse knows that the one B. Tracheal deviation and absent breath sounds
prominent clinical manifestation of this condition C. Frothy bloody sputum and consolidation.
A. Dyspnea D. Flat sound on percussion, absent breath sound and
[Link] dyspnea
C. Fever 70. Flail chest develop in a client after trauma will show the
D. Rusty sputum following assessment finding except?
59. The nurse diagnosed a client with COPD with impaired gas A. Paradoxical breathing
exchange. Which of the following outcome is appropriate for B. A symmetrical chest expansion
the diagnosis? C. Pain on expiration
A. The client drinks 2 – 3 liters of fluid per day D. No exception
B. The client demonstrates the correct way to purse – 71. Management of flail chest include the following except
lip breathe A. Narcotics as ordered
C. The client is able to ambulate to the bathroom B. Mechanical ventilation
without dyspnea C. Support lung function
D. The client is able to identify early symptoms of D. No exception
exacerbation 72. The nurse is monitoring a client who has a right sided
60. The nurse is assessing a client recently diagnosed with chest tube inserted two hours ago. Which of the following
chronic bronchitis. Which of the following findings is not should be implemented if the nurse notices that the water seal
expected? chamber has no fluctuation?
A. Clubbing of the client’s fingers. A. Assess for leakage
B. Frequent respiratory infections. B. Increase the amount of wall suction.
C. Productive cough C. Check the tubing for kinks or clots.
D. Hacking cough. D. Monitor the client’s pulse oximeter reading.
61. The nurse is assessing a client with acute attack of 73. A client who has left sided chest tube refuses to do deep
bronchial asthma. Which of the following symptoms would the breathing exercises due to pain. Which of the following should
nurse expect to find? be done by the nurse?
A. Fever A. Administer pain medication prior to deep breathing
B. Rales exercises.
C. Wheezing B. Encourage the client to take shallow breaths to
D. Barrel chest help with the pain.
62. The nurse knows that an attack of asthma is becoming C. Explain that deep breaths do not have to be taken
severe if which of the following occurs? at this time.
A. Louder wheezing D. Tell the client that if he doesn’t take deep breaths,
B. Severe intercostal retraction he could die
C. Respiratory rate of 25 74. The nurse is discussing pneumothorax to a group of
D. Diminished breath sounds nursing. Which statement is correct about tension
63. A client with mild intermittent asthma will receive pneumothorax?
A. Inhaled steroids A. A tension pneumothorax develops when an
B. Oral steroids air-filled bleb on the surface of the lung ruptures.
C. Bronchodilator & steroids inhaler B. When a tension pneumothorax occurs, the air
D. Leukotriene agonists moves freely between the pleural space and the
64. Which of the following statements is correct about mast atmosphere.
cell stabilizers? C. The injury allows air into the pleural space but
A. “I should take two (2) puffs when I begin to have prevents it from escaping from the pleural space
an asthma attack.” D. A tension pneumothorax results from a puncture
B. “I must taper off the medications and not stop of the pleura during a central line placement.
taking them abruptly.” 75. The nurse receives an order that the chest tubes will be
C. “These drugs will be most effective if taken at removed in 30 minutes. Which of the following should be done
bedtime.” first?
D. “These drugs are not good at the time of an A. Prepare the needed equipment
attack.” B. Administer analgesic as ordered
65. The nurse is checking the spirometry results of a client C. Inform the X ray department
with acute exacerbation of bronchial asthma. Which of the D. Position the client
following is unexpected finding in this client? 76. Which expected outcome should be given priority in the
A. Increased residual volume nursing care plan for a patient with adult respiratory distress
B. Decreased expiratory reserve volume syndrome:
C. Increased tidal volume A. systolic BP blood pressure greater than 90 mmHg
D. Increased functional residual capacity B. oxygen saturation greater than 95%
66. Which of the following assessment finding would indicate a C. respiration rate lees than 20/min
possible bronchial asthma? D. heart rate lees than 100/min
A. Low O2 saturtion 77. The nurse is caring for a patient who has just had an
B. Swelling caused by histamine release endotracheal tube inserted. Which of the following actions
C. Wheezing on inspiration would the nurse take first:
D. Wheezing on expiration A. inflate the cuff with appropriate volume
E. All of the above B. auscultate for bilateral breath sound
67. The nurse knows that bronchodilators act by C. tape the tube securely in place
A. Relaxing the smooth muscles of the bronchioles D. suction the pulmonary secretion
B. Loosens phlegm 78. The client diagnosed with ARDS is transferred to the
C. Decreasing edema of the bronchi intensive care department and placed on a ventilator. Which
D. Prevent histamine release intervention should the nurse implement first?
68. Which of the following is the most common clinical A. Confirm that the ventilator settings are correct.
manifestations of pulmonary embolism? B. Verify that the ventilator alarms are functioning
A. Positive Homan’s sign properly.
B. Crushing chest pain and diaphoresis C. Assess the respiratory status and pulse oximeter
C. Bilateral crackles and cough reading.

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 D. Monitor the client’s arterial blood gas results. A. Increased dead space volume means the air that is
79. Which of the following assessment date would make the left in the lung after forceful expiration is increased
nurse suspect of developing ARDS? B. Increased dead space volume means there is
A. Low arterial oxygen when administering high increased volume of air that does not participate in
concentration of oxygen. gas exchange
B. The client is in severe respiratory distress C. Increased dead space volume means that there is
C. Breath sounds are clear but pulse oximeter reading increased amount of air that is normally inhaled or
is low exhaled.
D. The client has distended neck veins and cough D. Increased dead space volume means there is
80. A client with ARDS is hooked to a mechanical ventilator, increased volume of air that the lungs can hold
which assessment finding would the nurse suspect that the 89. Functional residual capacity is increased as well in the
client develops complication secondary to ventilator? patient. The student nurse learns that this is
A. Urine output is 100 ml in 2 hours A. Volume of air that is left in the lungs after normal
B. The cardiac monitor is showing sinus tachycardia expiration
C. Diminished breath sound on one lung B. Volume of air that can still be inhaled after normal
D. Pulse oximeter greater than 95% inspiration
81. The STAT ABG in a client with ARDS were as follows pH C. Volume of air that does not participate in gas
7.38, PaO2 92, PaCO2 38, HCO3 24. What is the priority action exchange
by the nurse? D. Volume of air that actually participate in gas
A. Continue to monitor the client without taking any exchange
action. 90. Vital capacity is decreased in elderly. This is the
B. Encourage the client to take deep breaths and A. Total volume of air that goes in and out of the
cough. lungs in normal respiration
C. Administer one (1) amp of sodium bicarbonate IVP. B. Total volume of air maximally inhaled and exhaled
D. Notify the respiratory therapist of the ABG results. C. Total volume of air the lungs can hold
82. A client is diagnosed to have ARDS. The nurse knows that D. Total volume of air left in the lungs after forceful
ARDS is expiration
A. Caused by an acute lung injury 91. The student nurse is learning about the possible risk
B. Causing sudden pulmonary edema factors for the development of emphysema which include
C. Manifesting poor lung compliance A. Smoking, family history, allergy,
D. All of the above B. Chronic asthma, family history, allergy, stress
E. Caused by acute lung injury and sudden pulmonary C. Male patient, asthma, hypertension and smoking
edema D. Family history, chronic asthma, smoking
83. Which statement by the nurse with sleep apnea is correct? 92. A client with pneumothorax is being assessed. The nurse
A. Even if I lose weight and stop smoking cigarettes I anticipates that percussion of the unaffected lung is
may still need treatment for sleep apnea.” A. Resonant
B. “The continuous positive airway pressure (CPAP) B. Hyperresonant
holds my airway open with pressure.” C. Flat
C. “The CPAP will not help me stay awake during the D. Dull
day while I am at work.” 93. A client is admitted to the hospital due to overdose of
D. “It is not right to have a couple of beers at night barbiturates. Which of the following assessments would the
because I have this CPAP machine.” nurse not encounter?
84. The nurse is preparing a plan to a client post pleurodesis. A. Respiratory depression
Which of the following is a collaborative intervention for this B. Bradypnea
patient? C. Respiratory alkalosis
A. Monitor the amount of the drainage D. Decreasing O2 saturation
B. Perform complete respiratory assessment every 2 94. Which of the following is a complication of pulmonary
hours embolism?
C. Administer Morphine sulfate IV A. Pulmonary hypertension
D. Monitor vital signs B. Left sided heart failure
85. Pleurodesis is done to C. Heart attack
A. Decrease rate of fluid accumulation D. Pneumonia
B. Separate pleural membranes Situation: A 23 year old nursing student complains of
C. Prevent another thoracentesis palpitation, chest pain and easy fatigability. After a thorough
D. All of the above work up, she is diagnosed to have Mitral valve prolapse.
86. The nurse is assessing a client with chronic bronchitis for Answer the following questions
recurrent pneumonia. The client is at risk for developing
bronchiectasis. The nurse anticipate that the doctor will order 95. This client should avoid which of the following?
for which of the following? A. high volumes of fluid intake
A. Intravenous antibiotic for 7 to 10 days B. aerobic exercise programs
B. Provide low calorie and low sodium diet C. caffeine-containing products
C. Start TPN D. foods rich in protein
D. Encourage the client to turn, cough and deep 96. Upon assessment, which finding is expected of this client
breathe frequently condition?
87. Which of the following assessment data indicate that the A. Murmur
client is having Pleural effusion on the right side? B. Systolic click over the apex
A. Crackles and diminished breath sound on the right C. Mitral click on the 4th ICS left parasternal area
side D. Atrial gallop
B. Vesicular breath sounds on the left and resonant 97. The most definitive diagnostic test for patients with mitral
on percussion valve prolapse is
C. Absent breath sound and flat on percussion on the A. ECG
right side B. 2D echocardiography
D. Pain on the left side on deep inspiration and C. Chest X ray
difficulty of breathing D. Brain natriuretic peptide
88. The client is undergoing spirometry to assess pulmonary 98. Complications of mitral valve prolapse may include
function. The student nurse asks the staff nurse, what does it A. Mitral regurgitation
mean when they say that the dead space volume is increased, B. Dysrhythmias
the staff nurse is correct by saying C. Both
D. Neither

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Situation: A client with Valvular Heart Disease B. Septicemia
C. Stasis of blood
99. A client is being seen in the clinic with mitral valve D. All of the above
stenosis. Which of the following assessment data indicate an 111. Which of the following procedures/ treatment will not
early complication? require prophylactic antibiotic?
A. The client complains of shortness of breath when A. Dental extraction
walking. B. Normal Spontaneous Delivery
B. The client has jugular vein distention and bipedal C. Cardiac catheterization
edema. D. None of the above
C. The client complains of chest pain after eating a 112. Which of the following is a priority independent nursing
large meal. intervention is the most important to a patient with bacterial
D. Murmur is heard over the apical area. endocarditis with mitral regurgitation?
100. Which of the following assessment is indicative of A. Manage fever with antipyretic drug
tricuspid regurgitation B. Assess for changes in murmur
A. Murmur in the 4th ICS left parasternal C. Assess for microthrombi
B. Murmur in the apical area D. Assess for signs of ecchymoses
C. Murmur in the 2nd ICS right parasternal area E. All of the above
D. Murmur in the 4th ICS right parasternal area SITUATION: A 40 year old male has hypertension and
101. The definitive management for severe valvular defects? diabetes. He smokes two packs of cigarettes a day. His current
A. Valvular replacement concern is calf pain during minimal exercise which decreases
B. Valvuloplasty with rest.
C. Angioplasty
D. Bypass surgery 113. The nurse assesses patient’s symptoms as being
102. Valvular heart disease maybe caused by associated with peripheral arterial occlusive disease. The
A. Rheumatic disease nursing diagnosis is probably:
B. Congenital A. Ineffective peripheral tissue perfusion
C. Infection B. Dysfunctional use of extremities related to muscle
D. All of the above spasms
Situation: A client with Pericarditis C. Impaired mobility related to stress associated with
pain
103. Which of the following is the most prominent clinical D. Impairment in muscle use associated with pain
manifestation of pericarditis? 114. The nurse knows that the hallmark symptom of peripheral
A. Pulsus paradoxus. arterial occlusion disease is
B. Complaints of fatigue and arthralgias. A. Intermittent claudication
C. Petechiae and splinter hemorrhages. B. edema
D. Increased chest pain with inspiration. C. hairless dark skin
104. The client is diagnosed with acute pericarditis. Which D. inflammation
sign/symptom warrants immediate attention by the nurse? 115. The most important health teaching for this client is
A. Muffled third heart sounds A. Elevate legs after work
B. Flat jugular veins. B. Stop smoking
C. Bounding peripheral pulses. C. Pain reliever as ordered
D. Altered consciousness D. Avoid trauma
105. The client is admitted due to pericarditis and in pain. It is 116. Management in this client include the following, except
most important for the nurse to do which of the following in A. Elevate the legs
the emergency room. B. Analgesic for pain
A. Place the client in orthopneic position C. Avoid trauma
B. Monitor for friction rub D. No exception
C. Monitor vital signs 117. The most common sign of abdominal aortic aneurysm is
D. Assess for signs of cardiac tamponade A. Chest pain
106. Which of the following signs would indicate that the client B. Abdominal bruit.
with pericarditis is experiencing cardiac tamponade? C. Abdominal pain.
A. Hypotension, flat neck veins, muffled heart sounds D. Difficulty of breathing.
B. Hypotension, bounding pulses 118. The client is admitted for surgical repair of an 8-cm
C. Distant heart sounds, friction rub abdominal aortic aneurysm. Which sign/symptom would make
D. Decreasing BP, inaudible heart sounds the nurse suspect the client has an expanding Abdominal
107. The client has just had a pericardiocentesis. Which Aortic Aneurysm?
interventions should the nurse implement? A. Complaints of low back pain.
A. Monitor vital signs every 15 minutes for the first B. Weakened radial pulses.
hour. C. Decreased urine output.
B. Assess the client’s heart and lung sounds. D. Increased abdominal girth.
C. Record the amount of fluid removed as output. 119. Which of the following is not true of type A dissecting
D. All of the above aneurysm?
Situation: A client with infective endocarditis A. It is located in the ascending aorta
B. It is primarily treater with surgery
108. The client with infective endocarditis is admitted to the C. It is mostly congenital in nature
medical department. Which of the following order should be D. None of the above
implemented first? 120. Which of the following statements made by the client
A. Administer intravenous antibiotic. diagnosed with chronic venous insufficiency is correct?
B. Obtain blood cultures. A. “I shouldn’t cross my legs for more than 15
C. Schedule an echocardiogram. minutes.”
D. Encourage bed rest with bathroom privileges. B. “I need to elevate the foot of my bed while
109. The following are important risk factors for development sleeping.”
of infective endocarditis, except C. “I should take a baby aspirin every day with food.”
A. Immunocompromised patient D. “I should increase my fluid intake to 3000 mL a
B. Invasive procedure day.”
C. Existing valvular disease 121. Which of the following assessment is expected in a client
D. No exception with chronic venous insufficiency?
110. Embolization can complicate infective endocarditis due to A. Absent pedal pulses
A. Dislodgment of microthrombi B. Cool skin temperature.

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 C. Intermittent claudication. A. The client’s peripheral pitting edema has gone from
D. Pigmented skin. 3+ to 1+.
[Link] most prominent symptom of Buerger’s disease is B. The client’s BP is 110/80 from 150/100.
A. Numbness and tingling sensation C. The client is able to walk around the room without
B. Pain in the upper extremities dyspnea.
C. Pain in the lower extremities D. The client is using accessory muscles for breathing.
D. All of the above 133. The nurse is assessing the client diagnosed with
123. Which of the following is incorrect about cardiomyopathy congestive heart failure. Which laboratory data would indicate
A. Mostly hereditary that the client is in severe congestive heart failure?
B. No cure A. Pulmonary edema on Chest X ray and
C. Patients develop heart failure cardiomegaly
D. All are correct B. An elevated creatine kinase (CK-MB).
124. A client with hypertrophic cardiomyopathy was admitted C. Cardiac catheterization
due to heart failure, which of the following Doctor’s order D. Decreased albumin in the blood
would the nurse question? 134. The nurse is caring for a client with congestive heart
A. Chest X ray failure class II. It is most important for the nurse to
B. 2 D echocardiography A. Plan all activities throughout the day
C. Furosemide B. Put the client on complete bed rest
D. Digoxin C. Monitor VS every 15 minutes
Situation: A client with Acute Coronary Syndrome D. Place oxygen on bedside
135. Which of the following drugs is not cardiotonic?
125. Which specific cardiac enzyme would the nurse expect to A. Digoxin
elevate in a client diagnosed with a myocardial infarction? B. Dobutamine
A. Creatine phosphokinase (CPK). C. Milrinone
B. Troponin D. None of the above
C. Myoglobin SHOCK
D. CK MB isoenzyme 136. A patient involved in a motor vehicle accident has pale
126. Which of the following is characteristics of MI pain? mucous membranes, diaphoresis, confusion, blood pressure
A. Mid-epigastric pain and pyrosis. 88/48 mm Hg, irregular heart rhythm, and metabolic acidosis.
B. Constant and severe lasting more than 30 Which finding should the nurse recognize as the likely cause of
minutes acidosis?
C. Radiating to the left arm and face. A. Hyperventilation
D. Excruciating with feeling of impending doom and B. Aerobic metabolism
facial grimace C. Inadequate ventilation
127. The nurse is caring for a client post acute MI who D. Anaerobic metabolism
develops an audible S3. Which of the following should be done 137. A patient with progressive shock is diaphoretic and
by the nurse first? confused. The most recent blood pressure measurement was
A. Monitor vital signs. 82/40 mm Hg and a urinary catheter output was 10 mL for 1
B. Elevate the head of the client’s bed. hour. Intravenous (IV) fluids are infusing at 150 mL/hr. Which
C. Document this as a normal and expected finding. action should the nurse take related to the urine output?
D. Administer morphine intravenously. A. Encourage oral fluids.
128. The most common complication of Myocardial infacrction B. Irrigate urinary catheter.
A. Cardiac arrest C. Increase IV fluid infusion rate.
B. Premature ventricular complex D. Check urinary catheter for kinking.
C. Ventricular tachycardia 138. After an episode of shock, a patient’s laboratory results
D. Atrial fibrillation reveal elevated serum levels of ammonia and bilirubin and
129. Priority nursing management in acute myocardial decreased plasma proteins and clotting factors. Which organ
infarction is should the nurse recognize as being damaged from the shock?
A. Oxygenation A. Heart
B. Morphine as ordered B. Liver
C. Percutaneous coronary intervention C. Kidneys
D. All of the above D. Intestines
130. An elderly is admitted due to confusion, Acute coronary 139. A patient is receiving a dopamine infusion for cardiogenic
syndrome is considered, the nurse understands that acute shock. What should the nurse expect to assess in the patient
coronary syndrome is because of this medication?
A. Is a collection of signs and symptoms referring to A. Pain relief
myocardial infarction B. Decreased heart rate
B. Is a collection of signs and symptoms referring to C. Increased blood pressure
unstable angina D. Increased respiratory rate
C. Is a collection of signs and symptoms referring to 140. A client with constrictive pericarditis is develop shock, it is
unstable angina, STEMI or NSTEMI most important for the nurse to
D. None of the above A. Position the client modified Trendelenburg
B. Refer to the physician
Situation: A client with Congestive heart failure C. Auscultate heart sounds
D. Check the BP every 15 minutes
131. The nurse is developing a discharge-teaching plan for the 141. As part of ongoing data collection and care of a patient in
client diagnosed with congestive heart failure and will take shock, the nurse notes a slowing heart rate, systolic blood
digoxin at home. Which intervention should be priority? pressure less than 60 mm Hg, a decreasing temperature,
A. Notify health-care provider of a weight gain of decreasing respiration rate, and scant urine output. These
more than one (1) pound in a week. signs and symptoms should indicate to the nurse that the
B. Teach client how to count the radial pulse when patient is in which stage of shock?
taking digoxin. A. Compensatory
C. Instruct client to remove the saltshaker from the B. Progressive
dinner table. C. Irreversible
D. Encourage client to monitor ECG D. none of the above
132. After rendering nursing interventions to a client with 142. Which is an early sign of shock
congestive heart failure. Which assessment indicates A. Hypotension
ineffectiveness of nursing plan? B. Narrowing of pulse pressure
C. Bradycardia

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 D. All of the above 155. In the ECG strip, you identify that rhythm is regular, the
143. Characteristics of compensatory shock except atrial rate is 310 beats per minute, ventricular rate is 80 beats
A. Tachycardia per minute, the p wave consists of saw – toothed waves, the
B. Decreasing urine output PR interval is unmeasurable, the QRS complex is 0.08 second,
C. Hypotension the T wave is unidentifiable, the QT is unmeasurable. You
D. No exception would identify the strip as
144. Neurogenic shock will show the following manifestations A. Atrial tachycardia
except B. Atrial fibrillation
A. Hypotension C. Atrial flutter
B. Bradycardia D. None of the above
C. Loss of reflexes 156. In controlled atrial fibrillation. The ventricular response
D. Sudden jerky movement rate is
A. Less than 60 beats per minute
ECG QUESTIONS B. Less than or equal to 100 beats per minute
145. Atrial rhythm can be determined by examining what C. Greater than 100 beats per minute
interval on the ECG strip? D. Greater than 120 beats per minute
A. PP interval 157. The ECG strip show irregular ventricular rhythm,
B. QT interval ventricular rate is 130 beats per minute, the P wave is absent,
C. RR interval the PR interval and the QT interval are not measurable, QRS
D. TP interval complex is wide and bizarre with varying duration and the T
146. First degree AV block is characterized by: wave is opposite the QRS complex. You would interpret the
A. A variable heart rate usually slower than 60 bpm rhythm as
B. An irregular rhythm A. Ventricular fibrillation
C. Delayed conduction producing a prolonged PR B. Ventricular tachycardia
interval C. Idioventricular rhythm
D. P waves hidden with the QRS D. Torsades de pointes
147. The client’s ECG reading shows a P-wave before each QRS 158. In type I second degree block, the PR interval
complex and the rate is 70. P – R interval is 0.16 sec and A. Varies according to the ventricular response
consistent in all waves. Which action should the nurse B. Progressively lengthens until QRS complex is
implement? dropped
A. Document this as normal sinus rhythm. C. Remains constant despite an irregular ventricular
B. Call a code rhythm
C. Prepare to administer digoxin per orem. D. Is unmeasurable
D. Assess the client’s cardiac enzymes. 159. Which of the following is the ECG finding in hypokalemia?
148. ECG shows ventricular rate greater than 300 per minute, A. Presence of U wave
extremely irregular without specific pattern, QRS is irregular, B. Peak T wave
undulating waves without recognizable QRS complex. C. Prolonged QT
Interpretation of this reading is: D. Shortening of the QT
A. Atrial fibrillation 160. Which of the following ECF finding is characteristic of
B. Atrial flutter Hypocalcemia.
C. Ventricular fibrillation A. Shortening of QT
D. Ventricular flutter B. Prolonged QT
149. This is the most common type of dysrhythmia. Majority of C. Presence of U wave
patients are asymptomatic. Atrial rate is very fast and the P D. Tall T wave
wave is not recognizable. The nurse knows this as
A. Atrial fibrillation
B. Atrial flutter
C. Ventricular tachycardia
D. Ventricular fibrillation
150. T wave represents
A. Atrial repolarization
B. Atrial depolarization
C. Ventricular depolarization
D. Ventricular repolarization
151. The normal duration of QRS is
A. 0.10 second
B. 0.12 to 0.20 second
C. 0.24second
D. 0.36 to 0.44 second
152. To gather information about impulse conduction from the
atria to the ventricle, study the
A. P wave
B. PR interval
C. ST segment
D. T wave
153. Atrial and ventricular rates can be determined by counting
the small boxes between
A. The end of P and the beginning of another
B. Two consecutive P or R waves
C. The middle of two consecutive T waves
D. The beginning of P and the end of T wave
154. A monitor shows an irregular rhythm and a rate that
increases and decreases in consistent cycles. The rhythm most
likely represents
A. Sinus arrest
B. Sinus bradycardia
C. Normal sinus rhythm
D. Sinus arrhythmia

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