Comprehensive Medical-Surgical Nursing Exam (500 questions) with Answers & Rationale, Exams of Nursing

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Comprehensive Medical-Surgical Nursing Exam (500 questions)

Topics  Almost all common board exam questions about Medical-Surgical Nursing Questions

1. According to Maslow, which of the following categories of needs represents the most basic? a) Physiologic needs Physiologic needs must be met before an individual is able to move toward psychological health and well-being. b) Self-actualization Self-actualization is the highest level of need c) Safety and security needs Safety and security needs, while lower level, are not essential to physiologic survival. d) Belongingness Belongingness and affection needs are not essential to physiologic survival.
2. Which of the following statements reflects the World Health Organization’s definition of health? a) A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. Such a definition, however, does not allow for any variations in the degrees of wellness or illness. b) A condition of homeostatis and adaptation. The WHO definition addresses physical, mental, and social dimensions of being. c) An individual’s location along a wellness–illness continuum. The concept of a health–illness continuum allows for a greater range in describing a person’s health than the definition provided by the WHO. d) A fluid, ever-changing balance reflected through physical, mental, and social behavior. The WHO definition does not allow for any variations in the degrees of wellness and illness.
3. Which of the following statements defines culture? a) The learned patterns of behavior, beliefs, and values that can be attributed to a particular group of people. Included among characteristics that distinguish cultural groups are manner of dress, values, artifacts, and health beliefs and practices. b) A group of people distinguished by genetically transmitted material. A group of people distinguished by genetically transmitted material describes the term race. c) The status of belonging to a particular region by origin, birth, or naturalization. The status of belonging to a particular region by origin, birth, or naturalization describes the term nationality.

d) The classification of a group based upon certain distinctive characteristics. The classification of a group based upon certain distinctive characteristics describes the term ethnicity.

4. The reason that case management has gained such prominence in health care can be traced to a) decreased cost of care associated with inpatient stay. The reasons case management has gained such prominence can be traced to the decreased cost of care associated with decreased length of hospital stay, coupled with rapid and frequent inter-unit transfers from specialty to standard care units. b) increased length of hospital stay. In general, length of hospital stay has decreased over the past 5 years. c) discharge from specialty care units to home. In general, patients are transferred from specialty care units to standard care units at least 24 hours prior to discharge. d) limited availability for inter-unit hospital transfers. In general, patients in acute care hospitals undergo frequent inter-unit transfers from specialty to standard care units.
5. A preferred provider organization is described as a a) business arrangement between hospitals and physicians. PPO’s usually contract to provide health care to subscribers, usually businesses, for a negotiated fee that often is discounted. b) prepaid group health practice system. A prepaid group health practice system is termed a health maintenance organization. c) limited insurance program. Insurance is a cost payment system of shared risk, not a health care delivery system. d) health care savings account program. A health care savings account program is an incentive program to consumers, not a health care delivery system.
6. Which of the following categories identifies the focus of community/public health nursing practice? a) Promoting and maintaining the health of populations and preventing and minimizing the progress of disease Although nursing interventions used by public health nurses might involve individuals, families, or small groups, the central focus remains promoting health and preventing disease in the entire community. b) Rehabilitation and restorative services Rehabilitation and restorative services are the focus of extended care facilities and home care nursing. c) Adaptation of hospital care to the home environment Adaptation of hospital care to the home environment is the focus of home nursing. d) Hospice care delivery Hospice care delivery refers to the delivery of services to the terminally ill.
7. A major goal for home care nurses is a) restoring maximum health function. Tertiary preventive nursing care, focusing on rehabilitation and restoring maximum health function, is a goal for home care nurses. b) promoting the health of populations. Promoting the health of populations is a focus of community/public health nursing. c) minimizing the progress of disease. Minimizing the progress of disease is a focus of community/public health nursing. d) maintaining the health of populations. Maintaining the health of populations is a focus of community/public health nursing.
8. In the United States, nurses performing invasive procedures need to be up-to-date with their immunizations, particularly a) hepatitis B. Hepatitis B is transmitted through contact with infected blood or plasma. b) hepatitis E. Hepatitis E is found mainly in underdeveloped countries with substandard sanitation and water quality. c) hepatitis A. hepatitis A is transmitted through the oral route from the feces and saliva of an infected person. d) hepatitis C. At present, immunization against hepatitis C is not available.
9. At what time during a patient’s hospital stay does discharge planning begin? a) Admission To prepare for early discharge and the possible need for follow-up in the home, discharge planning begins with the patient’s admission. b) Twenty-four hours prior to discharge

Discharge planning requires identification of patient needs and anticipatory guidance and is not relegated to a specific time for beginning. c) The shift prior to discharge Discharge planning requires communication with and cooperation of the patient, family, and health care team and is not relegated to a specific time for beginning. d) By the third hospital day Discharge planning may require involvement of personnel and agencies in the planning process and is not relegated to a specific day of hospital stay.

10. The leading health problems of elementary school children include a) cancer. The leading health problems of elementary school children are injuries, infections, malnutrition, dental disease, and cancer. b) alcohol and drug abuse. Alcohol and drug abuse are leading health problems for high school students. c) mental and emotional problems. Mental and emotional problems are leading health problems for high school students. d) homicide. Homicide is a leading health problem for high school children.
11. Which skill needed by the nurse to think critically involves identification of patient problemsindicated by data? a) Analysis Analysis is used to identify patient problems indicated by data. b) Interpretation Interpretation is used to determine the significance of data that is gathered. c) Inferencing Inferences are used by the nurse to draw conclusions. d) Explanation Explanation is the justification of actions or interventions used to address patient problemsand to help a patient move toward desired outcomes.
12. The ethics theory that focuses on ends or consequences of actions is the a) utilitarian theory. Utilitarian theory is based on the concept of the greatest good for the greatest number. b) formalist theory. Formalist theory argues that moral standards exist independently of the ends or consequences. c) deontological theory. Deontological theory argues that moral standards exist independently of the ends or consequences. d) adaptation theory. Adaptation theory is not an ethics theory.
13. Which of the following ethical principles refers to the duty to do good? a) Beneficence Beneficence is the duty to do good and the active promotion of benevolent acts. b) Fidelity Fidelity refers to the duty to be faithful to one’s commitments. c) Veracity Veracity is the obligation to tell the truth. d) Nonmaleficence Nonmaleficence is the duty not to inflict, as well as to prevent and remove, harm; it is more binding than beneficence.
14. During which step of the nursing process does the nurse analyze data related to the patient’s health status? a) Assessment Analysis of data is included as part of the assessment. b) Implementation Implementation is the actualization of the plan of care through nursing interventions. c) Diagnosis Diagnosis is the identification of patient problems. d) Evaluation Evaluation is the determination of the patient’s responses to the nursing interventions and the extent to which the outcomes have been achieved.
15. The basic difference between nursing diagnoses and collaborative problems is that a) nurses manage collaborative problems using physician-prescribed interventions. Collaborative problems are physiologic complications that nurses monitor to detect onset or changes and manage through the use of

physician-prescribed and nursing-prescribedinterventions to minimize the complications of events. b) collaborative problems can be managed by independent nursing interventions. Collaborative problems require both nursing and physician-prescribed interventions. c) nursing diagnoses incorporate physician-prescribed interventions. Nursing diagnoses can be managed by independent nursing interventions. d) nursing diagnoses incorporate physiologic complications that nurses monitor to detect change in status. Nursing diagnoses refer to actual or potential health problems that can be managed by independent nursing interventions.

16. Health education of the patient by the nurse a) is an independent function of nursing practice. Health education is an independent function of nursing practice and is included in all state nurse practice acts. b) requires a physician’s order. Teaching, as a function of nursing, is included in all state nurse practice acts. c) must be approved by the physician. Health education is a primary responsibility of the nursing profession. d) must focus on wellness issues. Health education by the nurse focuses on promoting, maintaining, and restoring health; preventing illness; and assisting people to adapt to the residual effects of illness.
17. Nonadherence to therapeutic regimens is a significant problem for which of the following age groups? a) Adults 65 and over Elderly people frequently have one or more chronic illnesses that are managed with numerous medications and complicated by periodic acute episodes, making adherence difficult. b) Teenagers Problems of teenagers, generally, are time limited and specific, and require promoting adherence to treatment to return to health. c) Children In general, the compliance of children depends on the compliance of their parents. d) Middle-aged adults Middle-aged adults, in general, have fewer health problems, thus promoting adherence.
18. Experiential readiness to learn refers to the patient’s a) past history with education and life experience. Experiential readiness refers to past experiences that influence a person’s ability to learn. b) emotional status. Emotional readiness refers to the patient’s acceptance of an existing illness or the threat of an illness and its influence on the ability to learn. c) acceptance of an existing illness. Emotional readiness refers to the patient’s acceptance of an existing illness or the threat of an illness and its influence on the ability to learn. d) ability to focus attention. Physical readiness refers to the patient’s ability to cope with physical problems and focus attention upon learning.
19. Asking the patient questions to determine if the person understands the health teaching provided would be included during which step of the nursing process? a) Evaluation Evaluation includes observing the person, asking questions, and comparing the patient’s behavioral responses with the expected outcomes. b) Assessment Assessment includes determining the patient’s readiness regarding learning. c) Planning and goals Planning includes identification of teaching strategies and writing the teaching plan. d) Implementation Implementation is the step during which the teaching plan is put into action.
20. Which of the following items is considered the single most important factor in assisting the health professional in arriving at a diagnosis or determining the person’s needs? a) History of present illness The history of the present illness is the single most important factor in assisting the health professional in arriving at a diagnosis or determining the person’s needs. b) Physical examination The physical examination is helpful but often only validates the information obtained from the history. c) Diagnostic test results Diagnostic test results can be helpful, but they often only verify rather than establish the diagnosis.

d) Biographical data Biographical information puts the health history in context but does not focus the diagnosis.

21. Of the following areas for assessing the patient profile, which should be addressed after the others? a) Body image The patient is often less anxious when the interview progresses from information that is less personal to information that is more personal. b) Education Educational level is relatively impersonal and readily revealed by the patient. c) Occupation Occupation is relatively impersonal and readily revealed by the patient. d) Environment Housing, religion, and language are relatively impersonal and readily revealed by the patient.
22. Which of the following methods of physical examination refers to the translation of physical force into sound? a) Percussion Percussion translates the application of physical force into sound. b) Palpation Palpation refers to examination by non-forceful touching. c) Auscultation Auscultation refers to the skill of listening to sounds produced within the body created by movement of air or fluid. d) Manipulation Manipulation refers to the use of the hands to determine motion of a body part.
23. In which range of body mass index (BMI) are patients considered to have increased risk for problems associated with poor nutritional status? a) Below 24 Additionally, higher mortality rates in hospitalized patients and community-dwelling elderly are associated with individuals who have low BMI. b) 25- 29 Those who have a BMI of 25 to 29 are considered overweight. c) 30 to 39 Those who have BMI of 30-39 are considered obese. d) Over 40 Those who have BMI over 40 are considered extremely obese.
24. To calculate the ideal body weight for a woman, the nurse allows a) 100 pounds for 5 feet of height. To calculate the ideal body weight of a woman, the nurse allows 100 pounds for 5 feet of height and adds 5 pounds for each additional inch over 5 feet b) 106 pounds for 5 feet of height. The nurse allows 106 pounds for 5 feet of height in calculating the ideal body weight for a man. c) 6 pounds for each additional inch over 5 feet. The nurse adds 6 pounds for each additional inch over 5 feet in calculating the ideal body weight for a man. d) 80 pounds for 5 feet of height. Eighty pounds for 5 feet of height is too little.
25. A steady state within the body is termed a) homeostasis. When a change occurs that causes a body function to deviate from its stable range, processes are initiated to restore and maintain the steady state or homeostasis. b) constancy. Constancy refers to the balanced internal state of the human body maintained by physiologic and biochemical processes. c) adaptation. Adaptation refers to a constant, ongoing process that requires change in structure, function, or behavior so that the person is better suited to the environment. d) stress. Stress refers to a state produced by a change in the environment that is perceived as challenging, threatening, or damaging to the person’s dynamic balance or equilibrium.
26. Which of the following terms, according to Lazarus, refers to the process through which an event is evaluated with respect to what is at stake and what might and can be done? a) Cognitive appraisal The outcome of cognitive appraisal is identification of the situation as either stressful or non-stressful.

b) Coping Coping consists of both cognitive and behavioral efforts made to manage the specific external or internal demand that taxes a person’s resources. c) Hardiness Hardiness is a personality characteristic that is composed of control, commitment, and challenge. d) Adaptation Lazarus believed adaptation was affected by emotion that subsumed stress and coping.

27. An increase in the number of new cells in an organ or tissue that is reversible when the stimulus for production of new cells is removed is termed a) hyperplasia. Hyperplasia occurs as cells multiply and are subjected to increased stimulation resulting in tissue mass enlargement. b) hypertrophy. Hypertrophy is an increase in size and bulk of tissue that does not result from an increased number of cells. c) atrophy. Atrophy refers to reduction in size of a structure after having come to full maturity. d) neoplasia. With neoplasia, the increase in the number of new cells in an organ or tissue continues after the stimulus is removed.
28. Which of the following types of cells have a latent ability to regenerate? a) Stable Stable cells have a latent ability to regenerate if they are damaged or destroyed and are found in the kidney, liver, and pancreas, among other body organs. b) Labile Labile cells multiply constantly to replace cells worn out by normal physiologic processes. c) Permanent Permanent cells include neurons — the nerve cell bodies, not their axons. Destruction of a neuron causes permanent loss, but axons may regenerate. d) Epithelial Epithelial cells are a type of labile cell that multiply constantly to replace cells worn out by normal physiologic processes.
29. The relaxation techniques of progressive muscle relaxation, relaxation with guided imagery, and the Benson Relaxation Response share which of the following elements? a) A mental device (something on which to focus the attention) Similar elements also include a quiet environment, a comfortable position, and a passive attitude. b) Nutritional foundation Relaxation techniques do not encompass specific nutritional guidelines. c) Analgesic preparation Relaxation techniques are used to reduce one’s response to stress and do not require analgesia prior to practicing the techniques. d) Physician’s order A physician’s order is not required to assist an individual to learn techniques to reduce one’s response to stress.
30. Which of the following terms has been defined by the American Psychiatric Association as a group of behavioral or psychological symptoms or a pattern that manifests itself in significant distress, impaired functioning, or accentuated risk of enduring severe suffering or possible death? a) Mental disorder The definition was adopted by the American Psychiatric Association in 1994. b) Emotional disorder There is no universally accepted definition of what constitutes an emotional disorder. c) Anxiety Anxiety is defined as fear of the unknown. d) Schizophrenia Schizophrenia is a specific disorder characterized by psychosis.
31. Establishing financial security has been identified as a developmental task of which of the following groups? a) Middle adult The middle adult’s tasks also include launching children, and refocusing on one’s marital relationship. b) Older adult The older adult’s tasks include adapting to retirement and declining physical stamina. c) Young adult The young adult’s tasks include establishing a lifestyle and independence. d) Teenager The teenager’s primary developmental tasks include developing an identity and intimacy.

32. When up to a 6-month period elapses between the experience of trauma and the onset of symptoms of posttraumatic stress disorder (PTSD), the episode is termed a) delayed. In the case of delayed PTSD, there may be up to a 6-month period of time that elapses between the trauma and the manifestation of symptoms. b) acute. Acute PTSD is defined as the experience of symptoms for less than a 3-month period. c) chronic. Chronic PTSD is defined as the experience of symptoms lasting longer than 3 months. d) primary. The concept of primary disease is not used in relation to PTSD.
33. Which of the following statements accurately describes a risk factor for depression? a) History of physical or sexual abuse History of physical or sexual abuse and current substance abuse are risk factors for depression. b) Male gender A risk factor for depression is female gender. c) Age over 50 years A risk factor for depression is onset before 40 years. d) Negative family history of depression Family history of depression is a risk factor.
34. Of the following stages of grieving as described by Kubler-Ross, which is the initial? a) Denial The stages include: denial, anger, bargaining, depression, and acceptance. b) Anger Anger is the second stage of the process. c) Bargaining Bargaining is the third stage of the process. d) Depression Depression is the fourth stage of the process.
35. Which of the following terms refers to Leininger’s description of the learned and transmitted knowledge about values, beliefs, rules of behavior, and lifestyle practices that guide a designated group in their thinking and actions in patterned ways? a) Culture Leininger was the founder of the specialty called transcultural nursing and advocated culturally competent nursing care. b) Minority Minority refers to a group of people whose physical or cultural characteristics differ from the majority of people in a society. c) Race Race refers to a group of people distinguished by genetically transmitted characteristics. d) Subculture Subculture refers to a group that functions within a culture.
36. The inability of a person to recognize his or her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies is termed a) cultural blindness. Cultural blindness results in bias and stereotyping. b) acculturation. Acculturation is the process by which members of a culture adapt or learn how to take on the behaviors of another group. c) cultural imposition. Cultural imposition is the tendency to impose one’s cultural beliefs, values, and patterns of behavior on a person from a different culture. d) cultural taboo. Cultural taboos are those activities governed by rules of behavior that are avoided, forbidden, or prohibited by a particular cultural group.
37. Which of the following groups of individuals may stare at the floor during conversations as a sign of respect? a) Native Americans Some Native Americans stare at the floor during conversations, conveying respect and indicating that the listener is paying close attention to the speaker. b) Indo-Chinese The Indo-Chinese may consider direct eye contact impolite or aggressive. c) Arabs Arabs may consider direct eye contact impolite or aggressive.

d) Asians Asians may consider direct eye contact impolite or aggressive.

38. For which of the following religious groups is all meat prohibited? a) Hinduism Hinduism prohibits consumption of all meats and animal shortening. b) Seventh-Day Adventism Seventh-Day Adventism prohibits consumption of pork. c) Judaism Judaism prohibits consumption of pork. d) Islam Islam prohibits the consumption of pork and animal shortening.
39. The paradigm that explains the cause of illness as an imbalance in the forces of nature is the a) holistic perspective. The naturalist or holistic perspective believes that health exists when all aspects of a persona are in perfect balance or harmony. b) magico-religious view. The magico-religious view holds that illness is caused by forces of evil. c) biomedical view. The biomedical view holds life events as cause and effect and incorporates the bacterial or viral explanation of communicable disease. d) scientific view. The scientific view holds life events as cause and effect and incorporates the bacterial or viral explanation of communicable disease.
40. The aim of genomic medicine is a) improving predictions about individuals’ susceptibility to diseases Predictions regarding the time of their onset, their extent and eventual severity as well as which treatments or medications are likely to be most effective or harmful are the focus of genomic medicine. b) reproduction The focus of genomic medicine is broader than the reproduction of cells. c) cure of disease The focus of genomic medicine is broader than the cure of disease. d) cloning Genomic medicine is gene-based health care.
41. Nondisjunction of a chromosome results in which of the following diagnoses? a) Down Syndrome When a pair of chromosomes fails to separate completely and creates a sperm or oocyte that contains two copies of a particular chromosome (nondisjunction) Down syndrome results from three number 21 chromosomes. b) Huntingon Disease Huntington disease is one example of a germ-line mutation. c) Duchenne Muscular Dystrophy Duchenne muscular dystrophy, an inherited form of muscular dystrophy, is an example of a genetic caused by structural gene mutations. d) Marphan Syndrome Marphan Syndrome is a genetic condition that may occur in a single family member as a result of spontaneous mutation.
42. Which type of Mendelian inherited condition results in both genders being affected equally in a vertical pattern? a) Automosomal dominant inheritance An individual who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome of a pair. b) Automosomal recessive inheritance The pattern of inheritance in autosomal recessive inherited conditions is different from that of autosomal dominant inherited conditions in that it is more horizontal than vertical, with relatives of a single generation tending to have the condition. c) X-linked inheritance X-linked conditions may be inherited in families in recessive or dominant patterns. In both, the gene mutation is located on the X- chromosome. All males inherit an X chromosome from their mother with no counterpart; hence, all males express the gene mutation. d) Multifactorial genetic inheritance Neural tube defects, such as spina bifida and anencephaly, are examples of multifactorial genetic conditions. The majority of neural tube defects are caused by both genetic and environmental influences that combine during early embryonic development leading to incomplete closure of the neural tube.
43. A specific BRCA1 cancer-predisposing gene mutation seems to occur more frequently among women of which descent? a) Ashkanazi Jewish Expression of the BRCA1 gene is an example of inheritance in the development of breast cancer. b) Mediterranean

Glucose-6-phosphate dehydrogenase deficiency (G6PD) is a common enzyme abnormality that affects millions of people throughout the world, especially those of Mediterranean, South East Asian, African, Middle Eastern, and Near Eastern origin. c) African American Sickle cell anemia is associated with the African-American population. d) Chinese and Japanese Individuals of Chinese and Japanese descent who are rapid metabolizers of the enzyme N-acetyltransferase and who are prescribed the drug isoniazid (as part of treatment for tuberculosis) are at significantly increased risk for developing isoniazid-induced hepatitis.

44. Which of the following statements describes accurate information related to chronic illness? a) Most people with chronic conditions do not consider themselves sick or ill. Although some people take on a sick role identity, most people with chronic conditions do not consider themselves sick or ill and try to live as normal a life as is possible. b) Most people with chronic conditions take on a sick role identity. Research has demonstrated that some people with chronic conditions may take on a sick role identity, but they are not the majority. c) Chronic conditions do not result from injury. Chronic conditions may be due to illness, genetic factors, or injury d) Most chronic conditions are easily controlled. Many chronic conditions require therapeutic regimens to keep them under control.
45. In which phase of the trajectory model of chronic illness are the symptoms under control and managed? a) Stable The stable phase indicates that the symptoms and disability are under control or managed. b) Acute The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. c) Comeback The comeback phase is the period in the trajectory marked by recovery after an acute period. d) Downward The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.
46. Which phase of the trajectory model of chronic illness is characterized by reactivation of the illness? a) Unstable The unstable phase is characterized by development of complications or reactivation of the illness. b) Stable The stable phase indicates that the symptoms and disability are under control or managed. c) Acute The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. d) Comeback The comeback phase is the period in the trajectory marked by recovery after an acute period.
47. Which phase of the trajectory model of chronic illness is characterized by the gradual or rapid decline in the trajectory despite efforts to halt the disorder? a) Dying The dying phase is characterized by stoppage of life-maintaining functions. b) Unstable The unstable phase is characterized by development of complications or reactivation of the illness. c) Acute The acute phase is characterized by sudden onset of severe or unrelieved symptoms or complications that may necessitate hospitalization for their management. d) Downward The downward phase occurs when symptoms worsen or the disability progresses despite attempts to control the course through proper management.
48. In order to help prevent the development of an external rotation deformity of the hip in a patient who must remain in bed for any period of time, the most appropriate nursing action would be to use a) a trochanter roll extending from the crest of the ilium to the midthigh. A trochanter roll, properly placed, provides resistance to the external rotation of the hip. b) pillows under the lower legs. Pillows under the legs will not prevent the hips from rotating externally. c) a hip-abductor pillow. A hip-abductor pillow is used for the patient after total hip replacement surgery. d) a footboard.

A footboard will not prevent the hips from rotating externally.

49. To prevent footdrop, the patient is positioned in: a) Order to keep the feet at right angles to the leg When the patient is supine in bed, padded splints or protective boots are used. b) A semi-sitting position in bed Semi-fowlers positioning is used to decrease the pressure of abdominal contents on the diaphragm. c) A sitting position with legs hanging off the side of the bed In order to prevent footdrop, the feet must be supported. d) A side-lying position Side-lying positions do not provide support to prevent footdrop.
50. Through which of the following activities does the patient learn to consciously contract excretory sphincters and control voiding cues? a) Biofeedback Cognitively intact patients who have stress or urge incontinence may gain bladder control through biofeedback. b) Kegel exercises Kegel exercises are pelvic floor exercises that strengthen the pubococcygeus muscle. c) Habit training Habit training is used to try to keep the patient dry by strictly adhering to a toileting schedule and may be successful with stress, urge, or functional incontinence. d) Bladder training Habit training is a type of bladder training.
51. During which stage of pressure ulcer development does the ulcer extend into the subcutaneous tissue? a) Stage III Clinically, a deep crater with or without undermining of adjacent tissues is noted. b) Stage IV A stage IV pressure ulcer extends into the underlying structure, including the muscle and possibly the bone. c) Stage II A stage II ulcer exhibits a break in the skin through the epidermis or dermis. d) Stage I A stage I pressure ulcer is an area of nonblanchable erythema, tissue swelling, and congestion, and the patient complains of discomfort.
52. During which stage of pressure ulcer development does the ulcer extend into the underlying structures, including the muscle and possibly the bone? a) Stage IV A stage IV pressure ulcer extends into the underlying structure, including the muscle and possibly the bone. b) Stage III A stage III ulcer extends into the subcutaneous tissue. c) Stage II A stage II ulcer exhibits a break in the skin through the epidermis or dermis. d) Stage I A stage I pressure ulcer is an area of nonblanchable erythema, tissue swelling, and congestion, and the patient complains of discomfort.
53. Which type of incontinence is associated with weakened perineal muscles that permit leakage of urine when intra- abdominal pressure is increased? a) Stress incontinence Stress incontinence may occur with coughing or sneezing. b) Urge incontinence Urge incontinence is involuntary elimination of urine associated with a strong perceived need to void. c) Reflex (neurogenic) incontinence Neurogenic incontinence is associated with a spinal cord lesion. d) Functional incontinence Functional incontinence refers to incontinence in patients with intact urinary physiology who experience mobility impairment, environmental barriers, or cognitive problems.
54. Ageism refers to a) Bias against older people based solely on chronological age Individuals demonstrating ageism base their beliefs and attitudes about older people based upon chronological age without consideration of functional capacity. b) fear of old age. Fear of aging and the inability of many to confront their own aging process may trigger ageist beliefs. c) loss of memory.

Age-related loss of memory occurs more with short-term and recent memory. d) benign senescent forgetfulness. Benign senescent forgetfulness refers to the age-related loss of memory in the absence of a pathologic process.

55. When assessing the older adult, the nurse anticipates increase in which of the follow components of respiratory status? a) Residual lung volume As a result, patient experience fatigue and breathlessness with sustained activity. b) Vital capacity The nurse anticipates decreased vital capacity. c) Gas exchange and diffusing capacity The nurse anticipates decreased gas exchange and diffusing capacity resulting in impaired healing of tissues due to decreased oxygenation. d) Cough efficiency The nurse anticipates difficulty coughing up secretions due to decreased cough efficiency.
56. According to the classification of hypertension diagnosed in the older adult, hypertension that can be attributed to an underlying cause is termed a) secondary. Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromacytoma). b) primary. Primary hypertension has no known underlying cause. c) essential. Essential hypertension has no known underlying cause. d) isolated systolic. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).
57. Which of the following terms refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? a) Presbyopia Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. b) Presbycusis Presbycusis refers to age-related hearing loss. c) Cataract Cataract is the development of opacity of the lens of the eye. d) Glaucoma Glaucoma is a disease characterized by increased intraocular pressure.
58. Which of the following states is characterized by a decline in intellectual functioning? a) Dementia Dementia is an acquired syndrome in which progressive deterioration in global intellectual abilities is of such severity that it interferes with the person’s customary occupational and social performance. b) Depression Depression is a mood disorder that disrupts quality of life. c) Delirium Delirium is often called acute confusional state. d) Delusion Delusion is a symptom of psychoses.
59. When a person who has been taking opioids becomes less sensitive to their analgesic properties, that person is said to have developed a (an) a) tolerance. Tolerance is characterized by the need for increasing dose requirements to maintain the same level of pain relief. b) addiction. Addiction refers to a behavioral pattern of substance use characterized by a compulsion to take the drug primarily to experience its psychic effects. c) dependence. Dependence occurs when a patient who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued. d) balanced analgesia. Balanced analgesia occurs when the patient is using more than one form of analgesia concurrently to obtain more pain relief with fewer side effects.
60. Prostaglandins are chemical substances thought to a) increase sensitivity of pain receptors. Prostaglandins are believed to increase sensitivity to pain receptors by enhancing the pain-provoking effect of bradykinin.

b) reduce the perception of pain. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. c) inhibit the transmission of pain. Endorphins and enkephalins reduce or inhibit transmission or perception of pain. d) inhibit the transmission of noxious stimuli. Morphine and other opioid medications inhibit the transmission of noxious stimuli by mimicking enkephalin and endorphin.

61. Which of the following principles or guidelines accurately informs the nurse regarding placebos? a) Placebos should never be used to test the person’s truthfulness about pain. Perception of pain is highly individualized. b) A placebo effect is an indication that the person does not have pain. A placebo effect is a true physiologic response. c) A placebo should be used as the first line of treatment for the patient. A placebo should never be used as a first line of treatment. d) A positive response to a placebo indicates that the person’s pain is not real. Reduction in pain as a response to placebo should never be interpreted as an indication that the person’s pain is not real.
62. Regarding tolerance and addiction, the nurse understands that a) although patients may need increasing levels of opioids, they are not addicted. Physical tolerance usually occurs in the absence of addiction. b) tolerance to opioids is uncommon. Tolerance to opioids is common. c) addiction to opioids commonly develops. Addiction to opioids is rare. d) the nurse must be primarily concerned about development of addiction by the patient in pain. Addiction is rare and should never be the primary concern for a patient in pain.
63. The preferred route of administration of medication in the most acute care situations is which of the following routes? a) Intravenous The IV route is the preferred parenteral route in most acute care situations because it is much more comfortable for the patient, and peak serum levels and pain relief occur more rapidly and reliably. b) Epidural Epidural administration is used to control postoperative and chronic pain. c) Subcutaneous Subcutaneous administration results in slow absorption of medication. d) Intramuscular Intramuscular administration of medication is absorbed more slowly than intravenously administered medication.
64. Mu opioids have which of the following effects on respiratory rate: a) Stimulation, then depression Mu opioids also cause bradycardia, hypothermia, and constipation. b) No change Kappa opioids result in no change in respiratory rate. c) Stimulation, only Delta opioids result in stimulation of respiratory rate. d) Depression, only Neither mu, nor kappa, nor delta opoids depress respiratory rate as its only effect upon respiratory rate.
65. Which of the following electrolytes is a major cation in body fluid? a) Potassium Potassium is a major cation that affects cardiac muscle functioning. b) Chloride Chloride is an anion. c) Bicarbonate Bicarbonate is an anion. d) Phosphate Phosphate is an anion.
66. Which of the following electrolytes is a major anion in body fluid? a) Chloride Chloride is a major anion found in extracellular fluid. b) Potassium Potassium is a cation.

c) Sodium

Sodium is a cation. d) Calcium Calcium is a cation.

67. Oncotic pressure refers to a) the osmotic pressure exerted by proteins. Oncotic pressure is a pulling pressure exerted by proteins, such as albumin. b) the number of dissolved particles contained in a unit of fluid. Osmolality refers to the number of dissolved particles contained in a unit of fluid. c) the excretion of substances such as glucose through increased urine output. Osmotic diuresis occurs when the urine output increases due to excretion of substances such as glucose. d) the amount of pressure needed to stop flow of water by osmosis. Osmotic pressure is the amount of pressure needed to stop the flow of water by osmosis.
68. Which of the following solutions is hypotonic? a) 0.45% NaCl. Half-strength saline is hypotonic b) Lactated Ringer’s solution. Lactated Ringer’s is isotonic. c) 0.9% NaCl. Normal saline (0.9% NaCl) is isotonic. d) 5% NaCl. A solution that is 5% NaCl is hypertonic.
69. The normal serum value for potassium is a) 3.5-5.5 mEq/L. Serum potassium must be within normal limits to prevent cardiac dysrhythmias. b) 135-145 mEq/L. Normal serum sodium is 135-145 mEq/L. c) 96-106 mEq/L. Normal serum chloride is 96-106 mEq/L. d) 8.5-10.5 mg/dL. Normal total serum calcium is 8.5- 10. 5 mg/dL.
70. In which type of shock does the patient experiences a mismatch of blood flow to the cells? a) Distributive Distributive or vasogenic shock results from displacement of blood volume, creating a relative hypovolemia. b) Cardiogenic Cardiogenic shock results from the failure of a heart as a pump. c) Hypovolemic In hypovolemic shock, there is a decrease in the intravascular volume. d) Septic In septic shock, overwhelming infection results in a relative hypovolemia.
71. Which stage of shock is best described as that stage when the mechanisms that regulateblood pressure fail to sustain a systolic pressure above 90 mm Hg? a) Progressive In the progressive stage of shock, the mechanisms that regulate blood pressure can no longer compensate, and the mean arterial pressure falls below normal limits. b) Refractory The refractory or irreversible stage of shock represents the point at which organ damage is so severe that the patient does not respond to treatment and cannot survive. c) Compensatory In the compensatory state, the patient’s blood pressure remains within normal limits due to vasoconstriction, increased heart rate, and increased contractility of the heart. d) Irreversible The refractory or irreversible stage of shock represents the point at which organ damage is so severe that the patient does not respond to treatment and cannot survive.
72. When the nurse observes that the patient’s systolic blood pressure is less than 80–90 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and urine output is less than 30 cc per hour, the nurse recognizes that the patient is demonstrating which stage of shock? a) Compensatory In compensatory shock, the patient’s blood pressure is normal, respirations are above 20, and heart rate is above 100 but below 150.

b) Progressive In progressive shock, the patient’s skin appears mottled and mentation demonstrates lethargy. c) Refractory In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support. d) Irreversible In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.

73. Which of the following vasoactive drugs used in treating shock results in reduced preload and afterload, reducing oxygen demand of the heart? a) Nitroprusside (Nipride) A disadvantage of nitroprusside is that it causes hypotension. b) Dopamine (Intropin) Dopamine improves contractility, increases stroke volume, and increases cardiac output. c) Epinephrine (adrenaline) Epinephrine improves contractility, increases stroke volume, and increases cardiac output. d) Methoxamine (Vasoxyl) Methoxamine increases blood pressure by vasoconstriction.
74. The nurse anticipates that the immunosuppressed patient is at greatest risk for which type of shock? a) Septic Septic shock is associated with immunosuppression, extremes of age, malnourishment, chronic illness, and invasive procedures. b) Neurogenic Neurogenic shock is associated with spinal cord injury and anesthesia. c) Cardiogenic Cardiogenic shock is associated with disease of the heart. d) Anaphylactic Anaphylactic shock is associated with hypersensitivity reactions.
75. Which of the following colloids is expensive but rapidly expands plasma volume? a) Albumin Albumin is a colloid that requires human donors, is limited in supply, and can cause congestive heart failure. b) Dextran Dextran is a colloid, synthetic plasma expander that interferes with platelet aggregation and is not recommended for hemorrhagic shock. c) Lactated Ringers Lactated ringers is a crystalloid, not a colloid. d) Hypertonic Saline Hypertonic saline is a crystalloid, not a colloid.
76. Which of the following terms refers to cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin? a) Anaplasia Usually, anaplastic cells are malignant. b) Neoplasia Neoplasia refers to uncontrolled cell growth that follows no physiologic demand. c) Dysplasia Dysplasia refers to bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue. d) Hyperplasia Hyperplasia refers to an increase in the number of cells of a tissue, most often associated with a period of rapid body growth.
77. Palliation refers to a) relief of symptoms associated with cancer. Palliation is the goal for care in terminal cancer patients. b) hair loss. Alopecia is the term that refers to hair loss. c) the spread of cancer cells from the primary tumor to distant sites. Metastasis is the term that refers to the spread of cancer cells from the primary tumor to distant sites. d) the lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow. Nadir is the term that refers to the lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow.
78. During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? a) Progression During this third step, cells show a propensity to invade adjacent tissues and metastasize. b) Promotion During promotion, repeated exposure to promoting agents causes the expression of abnormal genetic information even after long latency

periods. c) Initiation During this first step, initiators such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA. d) Prolongation No stage of cellular carcinogenesis is termed prolongation.

79. The drug, Interleukin-2, is an example of which type of biologic response modifier? a) Cytokine Other cytokines include interferon alfa and filgrastim. b) Monoclonal antibodies Monoclonal antibodies include rituximab, trastuzumab, and gemtuzumab. c) Retinoids Retinoic acid is an example of a retinoid. d) Antimetabolites Antimetabolites are cell cycle-specific antineoplastic agents.
80. Of the following terms, which is used to refer to the period of time during which mourning a loss takes place? a) Bereavement Bereavement is the period of time during which mourning a loss takes place. b) Grief Grief is the personal feelings that accompany an anticipated or actual loss c) Mourning Mourning is the individual, family, group and cultural expressions of grief and associated behaviors d) Hospice Hospice is a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill patients and their families.
81. Which of the following “awareness contexts” is characterized by the patient, the family, and the health care professionals being aware that the patient is dying but all pretend otherwise? a) Mutual pretense awareness In mutual pretense awareness, the patient, the family and the health care professionals are aware that the patient is dying but all pretend otherwise. b) Closed awareness In closed awareness, the patient is unaware of his terminality in a context where others are aware. c) Suspected awareness In suspected awareness, the patient suspects what others know and attempts to find it out. d) Open awareness In open awareness, all are aware that the patient is dying and are able to openly acknowledge that reality.
82. For individuals known to be dying by virtue of age and/or diagnoses, which of the following signs indicate approaching death: a) Increased restlessness As the oxygen supply to the brain decreases, the patient may become restless. b) Increased wakefulness As the body weakens, the patient will sleep more and begin to detach from the environment. c) Increased eating For many patients, refusal of food is an indication that they are ready to die. d) Increased urinary output Based upon decreased intake, urinary output generally decreases in amount and frequency.
83. Which of the following terms best describes a living will? a) Medical directive The living will is a type of advance medical directive in which the individual of sound mind documents treatment preferences. b) Proxy directive A proxy directive is the appointment and authorization of another individual to make medical decisions on behalf of the person who created an advance directive when he/she is no loner able to speak for him/herself. c) Health care power of attorney Health care power of attorney is a legal document that enables the signer to designate another individual to make health care decisions on his/her behalf when he/she is unable to do so. d) Durable power of attorney for health A durable power of attorney for health care is a legal document that enables the signer to designate another individual to make health care decisions on his/her behalf when he/she is unable to do so.
84. A malignant tumor

a) gains access to the blood and lymphatic channels. By this mechanism, the tumor metastasizes to other areas of the body. b) demonstrates cells that are well-differentiated. Cells of malignant tumors are undifferentiated. c) is usually slow growing. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. d) grows by expansion. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.

85. Which of the following classes of antineoplastic agents is cell–cycle-specific? a) Antimetabolites (5-FU) Antimetabolites are cell–cycle-specific (S phase). b) Antitumor antibiotics (bleomycin) Antitumor antibiotics are cell-cycle nonspecific. c) Alkylating agents (cisplatin) Alkylating agents are cell-cycle nonspecific. d) Nitrosureas (carmustine) Nitrosureas are cell-cycle nonspecific.
86. Regarding the surgical patient, which of the following terms refers to the period of time that constitutes the surgical experience? a) Perioperative phase Perioperative period includes the preoperative, intraoperative, and postoperative phases. b) Preoperative phase Preoperative phase is the period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table. c) Intraoperative phase Intraoperataive phase is the period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit. d) Postoperative phase Postoperative phase is the period of time that begins with the admission of the patient to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.
87. When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as a) emergency. Emergency surgery means that the patient requires immediate attention and the disorder may be life-threatening. b) urgent. Urgent surgery means that the patient requires prompt attention within 24-30 hours. c) required. Required surgery means that the patient needs to have surgery, and it should be planned within a few weeks or months. d) elective. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
88. When a person with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the patient may show signs of alcohol withdrawal delirium during which time period? a) Up to 72 hours after alcohol withdrawal Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively. b) Immediately upon admission Onset of symptoms depends upon time of last consumption of alcohol. c) Upon awakening in the post-anesthesia care unit Onset of symptoms depends upon time of last consumption of alcohol. d) Up to 24 hours after alcohol withdrawal Twenty-four hours is too short a time frame to consider alcohol withdrawal delirium no longer a threat to a chronic alcoholic.
89. Which of the following categories of medications may result in seizure activity if withdrawn suddenly? a) Tranquilizers Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly. b) Adrenal corticosteroids Abrupt withdrawal of steroids may precipitate cardiovascular collapse. c) Antidepressants Monoamine oxidase inhibitors increase the hypotensive effects of anesthetics. d) Diuretics Thiazide diuretics may cause excessive respiratory depression during anesthesia due to an associated electrolyte imbalance.
90. When the patient is encouraged to concentrate on a pleasant experience or restful scene, the cognitive coping strategy being employed by the nurse is

a) imagery. Imagery has proven effective for oncology patients. b) optimistic self-recitation. Optimistic self-recitation is practiced when the patient is encouraged to recite optimistic thoughts such as “I know all will go well.” c) distraction. Distraction is employed when the patient is encouraged to think of an enjoyable story or recite a favorite poem. d) progressive muscular relaxation. Progressive muscular relaxation requires contracting and relaxing muscle groups and is a physical coping strategy as opposed to cognitive.

91. According to the American Society of Anesthesiology Physical Status Classification System, a patient with severe systemic disease that is not incapacitating is noted to have physical statusclassification a) P Classification P3 patients are those who have compensated heart failure, cirrhosis, or poorly controlled diabetes, for example. b) P Classification P4 patients have an incapacitating systemic disease that is a constant threat to life. c) P Classification P1 refers to a normal healthy patient d) P Classification P2 reflects a patient with mild systemic disease
92. Which stage of anesthesia is termed surgical anesthesia? a) III With proper administration of the anesthetic, this stage may be maintained for hours. b) I Stage I is beginning anesthesia, as the patient breathes in the anesthetic mixture and experiences warmth, dizziness, and a feeling of detachment. c) II Stage II is the excitement stage, which may be characterized by struggling, singing, laughing, or crying. d) IV Stage IV is a stage of medullary depression and is reached when too much anesthesia has been administered.
93. Fentanyl (Sublimaze) is categorized as which type of intravenous anesthetic agent? a) Neuroleptanalgesic Fentanyl is 75-100 times more potent than morphine and has about 25% of the duration of morphine (IV). b) Tranquilizer Examples of tranquilizers include midazolam (Versed) and diazepam (Valium). c) Opioid Opioids include morphine and meperidine hydrochloride (Demerol). d) Dissociative agent Ketamine is a dissociative agent.
94. Which of the following manifestations is often the earliest sign of malignant hyperthermia? a) Tachycardia (heart rate above 150 beats per minute) Tachycardia is often the earliest sign of malignant hyperthermia. b) Hypotension Hypotension is a later sign of malignant hyperthermia. c) Elevated temperature The rise in temperature is actually a late sign that develops rapidly. d) Oliguria Scant urinary output is a later sign of malignant hyperthermia.
95. Which of the following terms is used to refer to protrusion of abdominal organs through the surgical incision? a) Evisceration Evisceration is a surgical emergency. b) Hernia A hernia is a weakness in the abdominal wall. c) Dehiscence Dehiscence refers to partial or complete separation of wound edges. d) Erythema Erythema refers to redness of tissue.
96. When the method of wound healing is one in which wound edges are not surgically approximated and integumentary continuity is restored by granulations, the wound healing is termed a) second intention healing.

When wounds dehisce, they will be allowed to heal by secondary intention. b) primary intention healing. Primary or first intention healing is the method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulating. c) first intention healing. Primary or first intention healing is the method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulating. d) third intention healing. Third intention healing is a method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by bringing apposing granulations together.

97. The nurse recognizes which of the following signs as typical of the patient in shock? a) Rapid, weak, thready pulse Pulse increases as the body tries to compensate. b) Flushed face Pallor is an indicator of shock. c) Warm, dry skin Skin is generally cool and moist in shock. d) Increased urine output Usually, a low blood pressure and concentrated urine are observed in the patient in shock.
98. When the nurse observes that the postoperative patient demonstrates a constant low level of oxygen saturation, although the patient’s breathing appears normal, the nurse identifies thatthe patient may be suffering which type of hypoxemia? a) Subacute Supplemental oxygen may be indicated. b) Hypoxic Hypoxic hypoxemia results from inadequate breathing. c) Episodic Episodic hypoxemia develops suddenly, and the patient may be at risk for myocardial ischemia, cerebral dysfunction, and cardiac arrest. d) Anemic Anemic hypoxemia results from blood loss during surgery.
99. When the surgeon performs an appendectomy, the nurse recognizes that the surgical category will be identified as a) clean contaminated. Clean-contaminated cases are those with a potential, limited source for infection, the exposure to which, to a large extent, can be controlled. b) clean. Clean cases are those with no apparent source of potential infection. c) contaminated. Contaminated cases are those that contain an open and obvious source of potential infection. d) dirty. A traumatic wound with foreign bodies, fecal contamination, or purulent drainage would be considered a dirty case.
100. Which of the following terms is used to describe inability to breathe easily except in an upright position? a) Orthopnea Patients with orthopnea are placed in a high Fowler’s position to facilitate breathing. b) Dyspnea Dyspnea refers to labored breathing or shortness of breath. c) Hemoptysis Hemoptysis refers to expectoration of blood from the respiratory tract. d) Hypoxemia Hypoxemia refers to low oxygen levels in the blood.

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101. In relation to the structure of the larynx, the cricoid cartilage is a) the only complete cartilaginous ring in the larynx. The cricoid cartilage is located below the thyroid cartilage. b) used in vocal cord movement with the thyroid cartilage. The arytenoid cartilages are used in vocal cord movement with the thyroid cartilage. c) the largest of the cartilage structures. The thyroid cartilage is the largest of the cartilage structures; part of it forms the Adam’s apple. d) the valve flap of cartilage that covers the opening to the larynx during swallowing.

The epiglottis is the valve flap of cartilage that covers the opening to the larynx during swallowing.

102. Which respiratory volume is the maximum volume of air that can be inhaled after maximal expiration? a) Inspiratory reserve volume Inspiratory reserve volume is normally 3000 mL. b) Tidal volume Tidal volume is the volume of air inhaled and exhaled with each breath. c) Expiratory reserve volume Expiratory reserve volume is the maximum volume of air that can be exhaled forcibly after a normal exhalation. d) Residual volume Residual volume is the volume of air remaining in the lungs after a maximum exhalation.
103. The individual who demonstrates displacement of the sternum is described as having a a) pigeon chest. Pigeon chest may occur with rickets, Marfan’s syndrome, or severe kyphoscoliosis. b) barrel chest. A barrel chest is seen in patients with emphysema as a result of over-inflation of the lungs. c) funnel chest. A funnel chest occurs when there is a depression in the lower portion of the sternum. d) kyphoscoliosis. Kyphoscoliosis is characterized by elevation of the scapula and a corresponding S-shaped spine.
104. When the nurse auscultates chest sounds that are harsh and cracking, sounding like two pieces of leather being rubbed together, she records her finding as a) pleural friction rub. A pleural friction rub is heard secondary to inflammation and loss of lubricating pleural fluid. b) crackles. Crackles are soft, high-pitched, discontinuous popping sounds that occur during inspiration. c) sonorous wheezes. Sonorous wheezes are deep, low-pitched rumbling sounds heard primarily during expiration. d) sibilant wheezes. Sibilant wheezes are continuous, musical, high-pitched, whistle-like sounds heard during inspiration and expiration.
105. Which of the following terms is used to describe hemorrhage from the nose? a) Epistaxis Epistaxis is due to rupture of tiny, distended vessels in the mucous membrane of any area of the nose. b) Xerostomia Xerostomia refers to dryness of the mouth. c) Rhinorrhea Rhinorrhea refers to drainage of a large amount of fluid from the nose. d) Dysphagia Dysphagia refers to difficulties in swallowing.
106. The herpes simplex virus (HSV-1), which produces a cold sore (fever blister), has an incubation period of a) 2-12 days. HSV-1 is transmitted primarily by direct contact with infected secretions. b) 0-3 months. The time period 0-3 months exceeds the incubation period. c) 20-30 days. The time period 20-30 days exceeds the incubation period. d) 3-6 months. The time period 3-6 months exceeds the incubation period.
107. Another term for clergyman’s sore throat is a) chronic granular pharyngitis. In clergyman’s sore throat, the pharynx is characterized by numerous swollen lymph follicles. b) aphonia. Aphonia refers to the inability to use one’s voice. c) atrophic pharyngitis. Atrophic pharyngitis is characterized by a membrane that is thin, white, glistening, and at times wrinkled. d) hypertrophic pharyngitis. Hypertrophic pharyngitis is characterized by general thickening and congestion of the pharyngeal mucous membrane.
108. Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion? a) Obstructive Obstructive sleep apnea occurs usually in men, especially those who are older and overweight.

b) Simple Types of sleep apnea do not include a simple characterization. c) Mixed Mixed sleep apnea is a combination of central and obstructive apnea with one apneic episode. d) Central In central sleep apnea, the patient demonstrates simultaneous cessation of both airflow and respiratory movements.

109. When the patient who has undergone laryngectomy suffers wound breakdown, the nurse monitors him very carefully because he is identified as being at high risk for a) carotid artery hemorrhage. The carotid artery lies close to the stoma and may rupture from erosion if the wound does not heal properly. b) pulmonary embolism. Pulmonary embolism is associated with immobility. c) dehydration. Dehydration may lead to poor wound healing and breakdown. d) pneumonia. Pneumonia is a risk for any postoperative patient.
110. Which of the following terms refers to lung tissue that has become more solid in nature due to a collapse of alveoli or infectious process? a) Consolidation Consolidation occurs during an infectious process such as pneumonia. b) Atelectasis Atelectasis refers to collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression. c) Bronchiectasis Bronchiectasis refers to chronic dilation of a bronchi or bronchi in which the dilated airway becomes saccular and a medium for chronic infection. d) Empyema Empyema refers to accumulation of purulent material in the pleural space.
111. Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall? a) Legionnaires’ disease Legionnaires’ disease accounts for 15% of community-acquired pneumonias. b) Streptococcal (pneumococcal) pneumonia Streptococcal pneumonia demonstrates the highest occurrence in winter months. c) Mycoplasma pneumonia Mycoplasma pneumonia demonstrates the highest occurrence in fall and early winter. d) Viral pneumonia Viral pneumonia demonstrates the greatest incidence during winter months.
112. When interpreting the results of a Mantoux test, the nurse explains to the patient that a reaction occurs when the intradermal injection site shows a) redness and induration. The site is inspected for redness and palpated for hardening. b) drainage. Drainage at the site does not indicate a reaction to the tubercle bacillus. c) tissue sloughing. Sloughing of tissue at the site of injection does not indicate a reaction to the tubercle bacillus. d) bruising. Bruising of tissue at the site may occur from the injection, but does not indicate a reaction to the tubercle bacillus.
113. Which of the following actions is most appropriate for the nurse to take when the patientdemonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? a) Record the observation. Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure. b) Apply a compression dressing to the area. Subcutaneous emphysema is a typical post-operative finding in the patient after chest surgery. c) Measure the patient’s pulse oximetry. Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted. d) Report the finding to the physician immediately. Subcutaneous emphysema results from air entering the tissue planes.
114. Which of the following types of lung cancer is characterized as fast growing and tending to arise peripherally?

a) Large cell carcinoma Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. b) Bronchioalveolar carcinoma Bronchioalveolar cell cancer arises from the terminal bronchus and alveoli and is usually slow-growing. c) Adenocarcinoma Adenocarcinoma presents as peripheral masses or nodules and often metastasizes. d) Squamous cell carcinoma Squamous cell carcinoma arises from the bronchial epithelium and is more centrally located.

115. Which of the following methods is the best method for determining nasogastric tube placement in the stomach? a) X-ray Radiologic identification of tube placement in the stomach is most reliable. b) Observation of gastric aspirate Gastric fluid may be grassy green, brown, clear, or odorless while an aspirate from the lungs may be off-white or tan. Hence, checking aspirate is not the best method of determining nasogastric tube placement in the stomach. c) Testing of pH of gastric aspirate Gastric pH values are typically lower or more acidic than that of the intestinal or respiractory tract, but not always. d) Placement of external end of tube under water Placement of external end of tube under water and watching for air bubbles is not a reliable method for determining nasogastric tube placement in the stomach.
116. Which of the following types of lung cancer is the most prevalent carcinoma of the lung for both men and women? a) Adenocarcinoma Adenocarcinoma presents more peripherally as peripheral masses or nodules and often metastasizes. b) Large cell carcinoma Large cell carcinoma is a fast-growing tumor that tends to arise peripherally. c) Squamous cell carcinoma Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposures. d) Small cell carcinoma Small cell carcinomas arise primarily as proximal lesions, but may arise in any part of the tracheobronchial tree.
117. Emphysema is described as: a) A disease of the airways characterized by destruction of the walls of overdistended alveoli. Emphysema is a category of COPD. b) A disease that results in a common clinical outcome of reversible airflow obstruction. Asthma is the disease described. c) The presence of cough and sputum production for at least a combined total of two or three months in each of two consecutive years. Bronchitis is the disease described. d) Chronic dilatation of a bronchus or bronchi Bronchiectasis is the condition described.
118. Which of the following is the most important risk factor for development of Chronic Obstructive Pulmonary Disease? a) Cigarette smoking Pipe, cigar and other types of tobacco smoking are also risk factors. b) Occupational exposure While a risk factor, occupational exposure is not the most important risk factor for development of COPD. c) Air pollution Air pollution is a risk factor for development of COPD, but it is not the most important risk factor. d) Genetic abnormalities A deficiency of alpha-antitrypsin is a risk factor for development of COPD, but it is not the most important risk factor.
119. Which type of chest configuration is typical of the patient with COPD? a) Barrel chest “Barrel chest” results from fixation of the ribs in the inspiratory position. b) Pigeon chest Pigeon chest results from a displaced sternum. c) Flail chest Flail chest results when the ribs are fractured. d) Funnel chest Funnel chest occurs when there is a depression in the lower portion of the sternum and is associated with Mafan’s syndrome or rickets.
120. In which stage of COPD is the forced expiratory volume (FEV1) < 30%? a) III Stage III patients demonstrate FEV1 < 30% with respiratory failure or clinical signs of right heart failure b) II Stage II patients demonstrate FEV1 between > 30% and 80%

c) I Stage I is mild COPD with FEV1 < 70%. d) O Stage O is characterized by normal spirometry

121. Of the following oxygen administration devices, which has the advantage of providing high oxygen concentration? a) Non-rebreather mask The non-rebreather mask provides high oxygen concentration but is usually poor fitting. b) Venturi mask The Venturi mask provides low levels of supplemental oxygen. c) Catheter The catheter is an inexpensive device that provides a variable fraction of inspired oxygen and may cause gastric distention. d) Face tent A face tent provides a fairly accurate fraction of inspired oxygen, but is bulky and uncomfortable. It would not be the device of choice to provide high oxygen concentration.
122. Which of the following ranges identifies the amount of pressure within the endotracheal tube cuff that is believed to prevent both injury and aspiration? a) 20-25 mm Hg water pressure. Usually the pressure is maintained at less than 25 cm water pressure to prevent injury and at more than 20 cm water pressure to prevent aspiration. b) 10-15 mm Hg water pressure. A measure of 10–15 mm Hg water pressure would indicate that the cuff is underinflated. c) 30-35 mm Hg water pressure. A measure of 30–35 mm Hg water pressure would indicate that the cuff is overinflated. d) 0-5 mm Hg water pressure A measure of 0-5 mm Hg water pressure would indicate that the cuff is underinflated.
123. When performing endotracheal suctioning, the nurse applies suctioning while withdrawing and gently rotating the catheter 360 degrees for which of the following time periods? a) 10-15 seconds In general, the nurse should apply suction no longer than 10-15 seconds because hypoxia and dysrhythmias may develop, leading to cardiac arrest. b) 30-35 seconds Applying suction for 30-35 seconds is hazardous and may result in the patient’s developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest. c) 20-25 seconds Applying suction for 20-25 seconds is hazardous and may result in the patient’s developing hypoxia, which can lead to dysrhythmias and, ultimately, cardiac arrest. d) 0-5 seconds Applying suction for 0-5 seconds would provide too little time for effective suctioning of secretions.
124. In general, chest drainage tubes are not used for the patient undergoing a) Pneumonectomy Usually, no drains are used for the pneumonectomy patient because the accumulation of fluid in the empty hemithorax prevents mediastinal shift. b) Lobectomy With lobectomy, two chest tubes are usually inserted for drainage, the upper for air and the lower for fluid c) Wedge resection With wedge resection, the pleural cavity usually is drained because of the possibility of an air or blood leak d) Segmentectomy With segmentectomy, drains are usually used because of the possibility of an air or blood leak.
125. Which term is used to describe the ability of the heart to initiate an electrical impulse? a) Automaticity Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an electrical impulse. b) Contractility Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to contract in response to an electrical impulse. c) Conductivity Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to transmit an electrical impulse from one cell to another. d) Excitability

Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to respond to an electrical impulse.

126. The nurse auscultates the apex beat at which of the following anatomical locations? a) Fifth intercostal space, midclavicular line The left ventricle is responsible for the apex beat or the point of maximum impulse, which is normally palpable in the left midclavicular line of the chest wall at the fifth intercostal space. b) Mid-sternum The right ventricle lies anteriorly, just beneath the sternum. c) 2” to the left of the lower end of the sternum Use of inches to identify the location of the apex beat is inappropriate based upon variations in human anatomy. d) 1” to the left of the xiphoid process Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the apex beat of the heart.
127. Which of the following terms describes the amount of blood ejected per heartbeat? a) Stroke volume Stroke volume is determined by preload, afterload, and contractility. b) Cardiac output Cardiac output is the amount of blood pumped by each ventricle during a given period and is computed by multiplying the stroke volume of the heart by the heart rate. c) Ejection fraction Ejection Fraction is the percentage of the end-diastolic volume that is ejected with each stroke, measured at 42–50% in the normal heart. d) Afterload Afterload is defined as the pressure that the ventricular myocardium must overcome to eject blood during systole and is one of the determinants of stroke volume.
128. When measuring the blood pressure in each of the patient’s arms, the nurse recognizes that in the normal adult, the pressures a) differ no more than 5 mm Hg between arm pressures. Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg between arm pressures. b) must be equal in both arms. The pressures in each arm do not have to be equal in order to be considered normal. c) may vary 10 mm Hg or more between arms. Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding. d) may vary, with the higher pressure found in the left arm. The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant.
129. Central venous pressure is measured in which of the following heart chambers? a) Right atrium The pressure in the right atrium is used to assess right ventricular function and venous blood return to the heart. b) Left atrium The left atrium receives oxygenated blood from the pulmonary circulation. c) Left ventricle The left ventricle receives oxygenated blood from the left atrium. d) Right ventricle The right ventricle is not the central collecting chamber of venous circulation.
130. Which of the following ECG characteristics is usually seen when a patient’s serum potassium level is low? a) U wave The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient’s serum potassium level is low. b) T wave The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or “peaked” if a patient’s serum potassium level is high. c) P wave The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. d) QT interval The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.
131. Which of the following ECG waveforms characterizes conduction of an electrical impulse through the left ventricle? a) QRS complex The QRS complex represents ventricular depolarization b) P wave The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. c) PR interval The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node.

d) QT interval The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.

132. When the nurse observes that the patient’s heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating a) sinus dysrhythmia. Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm. b) normal sinus rhythm. Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway. c) sinus bradycardia. Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate. d) sinus tachycardia. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.
133. Which of the following terms is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? a) Paroxysmal atrial tachycardia PAT is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia. b) Sinus tachycardia Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate. c) Atrial flutter Atrial flutter occurs in the atrium and creates an atrial rate between 250-400 times per minute. d) Atrial fibrillation Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature.
134. When the nurse observes an ECG tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? Premature ventricular contraction A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. a) Ventricular bigeminy Ventricular bigeminy is a rhythm in which every other complex is a PVC. b) Ventricular tachycardia Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. c) Ventricular fibrillation Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.
135. Premature ventricular contractions are considered precursors of ventricular tachycardiawhen they a) occur at a rate of more than six per minute. When PVCs occur at a rate of more than six per minute they indicate increasing ventricular irritability and are considered forerunners of ventricular tachycardia (VT). b) occur during the QRS complex. PVCs are dangerous when they occur on the T wave. c) have the same shape. PVCs are dangerous when they are multifocal (have different shapes). d) are paired with a normal beat. A PVC that is paired with a normal beat is termed bigeminy.
136. When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block? a) Third degree In third degree heart block, two impulses stimulate the heart—one stimulates the ventricles and one stimulates the atria. b) First degree In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. c) Second degree, type I In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. d) Second degree, type II In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.
137. Which of the following terms refers to chest pain brought on by physical or emotional stress and relieved by rest or medication? a) angina pectoris Angina pectoris is a symptom of myocardial ischemia. b) atherosclerosis Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumens. c) atheroma