Nursing Care for Cardiovascular and Respiratory Conditions, Exams of Nursing

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MED SURGE NURSING EXAM QUESTIONS AND ANSWERS 2023-

FOR A RESULT

1- A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BPof 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that 1 point the dietary sodium and fat content should be decreased. there is an immediate danger of a stroke and hospitalization will be required BP recheck should be scheduled in a few weeks. more diagnostic testing may be needed to determine the cause of the hypertension. A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the client to do which of the following, if prescribed, during an episode of ventricular tachycardia? 1 point Remove any metal jewelry Breathe deeply, regularly, and easily Inhale deeply and cough forcefully every 1 to 3 seconds Lie down flat in bed A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed: * 1 point A 1 L/min B 2 L/min C 6 L/min D 10 L/min A nurse notices frequent artifact on the ECG monitor for a client whose leads are connected by cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for the artifact? 1 point

Frequent movement of the client

Leads applied over hairy areas Leads applied to the limbs Tightly secured cable connections You’re caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? 1 point Trousseau’s sign Asterixis Hepatojugular reflex Chvostek sign The nurse obtains this information from a patient with prehypertension. Which finding is most important to addresswith the patient? 1 point Low dietary fiber intake Drinks wine with dinner once a week Weight 5 pounds above ideal weight No regular aerobic exercise The nurse is caring for an 80-year-old with chronic bronchitis. Upon the morning rounds, the nurse finds an O2 sat of 76%. Which of the following actions should the nurse take first? * 1 point A Call for a code B Recheck the O2 saturation level in 15 minutes C Apply oxygen by mask D Auscultate for breath sounds The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include: * 1 point A Drinking more than 1,500 ml of fluid daily.

B Being overweight. C Eating a high-protein snack at bedtime. D Eating more than three large meals a day. A nurse is caring for a male client immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the client? * 1 point A Stridor B Occasional pink-tinged sputum C A few basilar lung crackles on the right D Respiratory rate of 24 breaths/min A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing: 1 point Ventricular fibrillation Ventricular tachycardia Premature ventricular contractions Sinus tachycardia You promote hemodynamic stability in a patient with upper GI bleeding by: 1 point Monitoring central venous pressure Giving blood, electrolyte and fluid replacement. Monitoring laboratory test results and vital signs Encouraging oral fluid intake. The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? 1 point "The medication may not work as well if I take any aspirin."

"I won't worry if I have a little swelling around my lips and face." "I will call the doctor if I notice that I have a frequent cough. "The doctor may order a blood potassium level occasionally. When teaching a client about pancreatic function, the nurse understands that pancreatic lipase performs which function? 1 point Breaks down fat into fatty acids and glycerol Transport fatty acids into the brush border Triggers cholecystokinin to contract the gallbladder Breaks down protein into dipeptides and amino acid The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? * 1 point A It helps prevent early airway collapse. B It increases inspiratory muscle strength. C It decreases use of accessory breathing muscles. D It prolongs the inspiratory phase of respiration. Why HTN is considered a silent killer? 1 point Because at no point in the disease progression does symptoms ever present Because symptoms don't usually present until end organ damage occurs Because it never progresses slowly, it occurs suddenly and immediately It is not; myocardial infarctions are considered the silent killer A nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There are no P waves; instead there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as: 1 point Ventricular

fibrillation Atrial fibrillation Ventricular tachycardia

Sinus tachycardia A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been “spitting up blood.” A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the client’s wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: 1 point “Tell me about your husband’s alcohol usage” Has your husband recently fallen or injured his chest?” “Is your husband being treated with tuberculosis?” “Describe spices and condiments your husband uses on food.” A male client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? * 1 point A An Endotracheal cuff leak B A ventilator oxygen tube is disconnected C A blockage in the ventilator tubing D An increase in the oxygen concentration without resetting the oxygen level alarm A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient’s blood pressure because of which change that is associated with the liver failure? 1 point Increased capillary permeability Excess renin release of the kidney Hypoalbuminemia Abnormal peripheral vasodilation When auscultating the apical pulse of a client who has atrial fibrillation, the nurse would expect to hear a rhythm that is characterized by: 1 point

A continuous and totally unpredictable irregularity Slow but strong and regular beats Long pauses in otherwise regular rhythm The presence of occasional coupled beats A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions? * 1 point A Adult respiratory distress syndrome (ARDS) B Asthma C Chronic obstructive bronchitis D Emphysema Of the following oxygen administration devices, which has the advantage of providing high oxygen concentration? * 1 point A Non-rebreather mask B Venturi mask C Catheter D Face tent You are taking care of a patient in the hospital and the CNA reports to you that their blood pressure is 198 / 101. They have been running 140 's/ 80 's throughout their stay. What will you do first? 1 point Check the cuf f size to make sure it’s appropriate and recheck blood pressure STAT page the physician Ensure the recording has been appropriately documented and continue to monitor them with their next BP reading in 4 hours Check the chart, obtain any PRN antihypertensives and immediately administer them A nurse is assessing a male client with chronic airflow limitations and notes that the client has a “barrel chest.” The nurse interprets that this client has which of the following forms of chronic airflow limitations? * 1 point

A Emphysema B Bronchial asthma C Chronic obstructive bronchitis D Bronchial asthma and bronchitis A nurse is suctioning fluids from a female client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which of the following is the appropriate nursing intervention? * 1 point A Continue to suction. B Notify the physician immediately. C Stop the procedure and reoxygenate the client. D Ensure that the suction is limited to 15 seconds. The nurse is caring for a client admitted with spinal cord injury. The nurse minimizes the risk of compounding the injury most effectively by: * 1 point A. Logrolling the client on a soft mattress B. Keeping the client on a stretcher C. Logrolling the client on a firm mattress D. Placing the client on a Stryker frame They physician orders a Dobutamine IV drip on a patient in cardiogenic shock. After starting the IV drip, the nurse would make it priority to monitor for? * 1 point A. Rebound hypertension B. Ringing in the ears C. Worsening hypotension D. severe headache A patient is receiving treatment for an acute myocardial infarction. The nurse is closely monitoring the patient for signs and symptoms associated with cardiogenic shock. Which value below is associated with cardiogenic shock? * 1 point

A. Cardiac index 1.5 L/min/m B. Pulmonary capillary wedge pressure (PCWP) 10 mmHg C. Central venous pressure (CVP) 4 mmHg D. Troponin <0.01 ng/mL The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains to the client that this procedure is being used in this specific case to: * 1 point A. Open and dilate the blocked coronary arteries. B. Assess the extent of arterial blockage C. Bypass obstructed vessels D. Assess the functional adequacy of the valves and heart muscles. 1 point As an initial step in treating a client with angina, the physician prescribes nitroglycerin tablets, 0.3mg given sublingually. This drug’s principal effects are produced by: * A. Antispasmodic effect on the pericardium B. Causing an increased myocardial oxygen demand C. Vasodilation of peripheral vasculature D. Improved conducting in the myocardium. The nurse is planning care for the client in spinal shock. Which of the following actions would be least helpful in minimizing the effects of * 1 point A. Using vasopressor medications as prescribed B. Applying Teds or compression stockings. C. Moving the client quickly as one unit D. Monitoring vital signs before and during position changes Which of the following arteries primarily feeds the anterior wall of the heart?

1 point A. Circumflex artery

B. Internal mammary artery C. Left anterior descending artery

D. Right coronary artery A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiogram complexes on the screen. The first action of the nurse is to: * 1 point A. Check the client status and lead placement. B. Press the recorder button on the electrocardiogram console. C. Call the physician. D. Call a code blue Which medications below are used in cardiogenic shock that provide a positive inotropic effect on the heart? Select all that apply:

1 point A. Nitroglycerin B. Sodium Nitroprussidde C. Dobutamine D. Norepinephrine E. Dopamine The nurse is caring for a client with a right-sided chest tube secondary to a pneumothorax. Which interventions should the nurse implement when caring for this client? Select all that apply. * 1 point A. Place the client in a low-Fowler's position. B. Assess chest tube drainage system frequently. C. Maintain strict bed rest for the client. D. Secure a loop of drainage tubing to the sheet. E. Observe the site for subcutaneous emphysema. After falling 20’, a 36-year-old man sustains a C6 fracture with spinal cord transaction. Which other findings should the nurse expect? * 1 point A. Quadriplegia and loss of respiratory function B. Loss of bowel and bladder control C. Paraplegia with intercostal muscle loss

D. Quadriplegia with gross arm movement and diaphragmic breathing Which of the following statements is true about intrapleural (the space between the parietal and visceral or pulmonary pleurae) pressure under normal conditions? * 1 point A. It is always negative B. It is always positive C. It is negative during inhalation, positive during exhalation D. It is negative during exhalation, positive during inhalation Which of the following measures best determines that a patient who had a pneumothorax no longer needs a chest tube? * 1 point A. ABG levels are normal B. The water - seal chamber does not fluctuate when no suction is applied C. There is a plenty of drainage from the chest tube D. The chest X-ray continues to show the lung is 30% deflated. A 20-year-old client who fell approximately 30’ is unresponsive and breathless. A cervical spine injury is suspected.How should the first- responder open the client’s airway for rescue breathing? * 1 point A. By performing a jaw-thrust maneuver B. By inserting a nasopharyngeal airway C. By inserting a oropharyngeal airway D. By performing the head-tilt, chin-lift maneuver The physician orders a continuous intravenous nitroglycerin infusion for the client suffering from myocardial infarction. Which of the following is the most essential nursing action? * 1 point A. Monitor BP every 4 hours B. Utilize an infusion pump when administering the medication C. Monitor urine output hourly

D. Check serum potassium levels daily A patient who has cardiogenic shock is experiencing labored breathing and low oxygen levels. A STAT chest x-ray is ordered. The x-ray results show pulmonary edema. The physician orders Furosemide IV. What finding would require immediate nursing action? * 1 point A. Blood pressure 98/ B. Urinary output 45 mL/hr C. Potassium 1.8 mEq/L D. Heart rate 110 bpm The physician has ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with congestive heart failure. Which discharge instructions should the nurse include? * 1 point A. Encourage the client to eat bananas to increase the potassium level B. Explain the importance of taking the medication with food C. Educate the client to take an over - the - counter cough suppressant if cough develops D. Educate the client about the possibility of orthostatic hypotension and how to prevent it The nurse enters the room of the client diagnosed with congestive heart failure. The client is lying supine in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement first? * 1 point A. Call a code immediately B. Move the client to a Semi - Fowler's position in bed C. Check vital signs STAT D. Administer supplemental oxygen at 2L/minute If the chest tube is pulled out of the patient's chest, and the patient had an air leak from the lung, after asking a colleague to call a physician STAT, emergency nursing management is to: * 1 point

A. Cover the opening with a sterile Vaseline gauze, taped securely on all sides B. Try to put the tube back in place as quickly as possible C. Cover the opening with a sterile dressing, taped on three sides D. Leave the opening alone and monitor the patient until a physician can assess the situation A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse should first: * 1 point A. Administer morphine B. Obtain 12 leads ECG C. Obtain laboratory work D. Order chest X-ray Furosemide (Lasix) is administered intravenously to a client with HF. How soon after administration should the nurse begin to see evidence of the drugs desired effect? * 1 point A. 6 to 8 Hours B. 2 to 4 Hours C. 5 to 15 Minutes D. 30 Minutes to 1 Hour When planning discharge teaching for a young female client who has had a pneumothorax, it is important that the nurse include the signs and symptoms of a pneumothorax and teach the client to seek medical assistance if she experiences: * 1 point A. Severe shortness of breath B. Dizziness when standing up C. Substernal chest pain D. Episodes of palpitation

You are pulled from the ED to the neurologic floor. Which action should you delegate to the nursing assistant when providing nursing care for a patient with SCI? * 1 point A. Assess patient’s respiratory status every 4 hours. B. Take patient’s vital signs and record every 4 hours. C. Monitor nutritional status including calorie counts. D. Have patient turn, cough, and deep breathe every 3 hours. What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? * 1 point A. Episodes of difficulty breathing at night B. Weight gain and edema in the extremeties C. Tachycardia and hypotension D. Anxiety attacks A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital from the physician’s office. The nurse would plan on having which of the following medications readily available for use? * 1 point A. Diltiazem ( Cardizem B. Digoxin ( Lanoxin) C. Propranolol ( Inderal) D. Metoprolol ( Lopressor)