Monitoring and Managing Patients with Neurological and Cardiovascular Conditions, Exams of Nursing

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MS3 Exam 2 questions with answers

2024-2025 new update (answers in bold)

1. The ICU is monitoring a patient who has a traumatic brain injury for signs of increased ICP. Which would indicate an EARLY sign of deterioration in the patient’s neurological status? a. Narrowed Pulse Pressure and Seizures b. Tachycardia and Widening Pulse Pressure c. Bradycardia and Systolic Hypertension d. Systolic hypotension and fever
2. The nurse is caring for a patient with an open AAA repair who is 4 hours post op. Which action by the tech would require the nurse to intervene a. Offering the patient sips of water b. Taking the patient’s vital signs c. Answering the patient’s room phone located on the nightstand d. Preparing to help the patient to the bathroom
3. Which of the following nursing interventions are appropriate in the immediate post op care of a patient with an endovascular graft repair of an AAA? a. Check pedal pulses b. Coughing and Deep breathing c. Splinting the incision d. Keeping the HOB in High Fowler’s position
4. Which of the following signs would cause the nurse to suspect a critically ill patient is developing DIC? a. Fever b. Nosebleed c. High BP

d. Tachycardia

5. Rhythm Strip Normal Sinus Rhythm 1 st^ degree AV block Sinus Rhythm/ Sinus tachycardia Asytole Sinus Bradycardia

Ventricular Tachycardia Arterial Flutter

6. Dosage Calc
7. The nurse is reviewing the HCP’s orders for a patient with DIC. Which of the following orders should the nurse question? a. Administer Vitamin K IM b. Initiate a Heparin infusion according to Heparin protocols c. Vital signs and neuro check every 30 minutes d. Place pressure-reducing mattress on the bed
8. The nurse is caring for a client who has tetraplegia. When the nurse elevates the HOB to 30 degrees, the patient complains of dizziness and becomes hypotensive. What should the nurse do? a. Wait for the client to adjust to the change b. Call the HCP immediately c. Lower the HOB d. Raise the Foot of the bed
9. The nurse is reviewing the diagnostic tests of a client admitted with a thoracic aneurysm. The client asks the nurse “How does the doctor know that this is an

aneurysm?”. The nurse knows that which of the following test results best confirms the diagnosis? a. A PA and Lateral Chest X-RAY b. CTA c. Serial High BP Readings d. High LDL and Triglycerides

10. The charge nurse is observing a new RN providing discharge teaching for a client with hypertension who is being prescribed Analapril. Which of the following comments by the new RN would prompt the charge nurse to intervene? a. “Make an appt with the dietician to learn about the low-sodium diet” b. “Check your BP with a home BP monitor regularly” c. “You need to move slowly when moving from lying to standing” d. “ You will need to increase your diet high in Potassium foods ”
11. The nurse on the cardiac unit is caring for a patient on telemetry who is recovering from a MI and has a history of glaucoma. The patient’s heart rate is 44. The nurse assesses the BP which is 98/60 and the patient is complaining of dizziness and fatigue. The nurse notifies the provider and anticipates which of the following management strategies? a. Defibrillation (for cardiac arrest) b. Synchronized cardioversion (if hr is 150 bpm so not this one) c. Temporary transcutaneous pacing (im leaning most towards this one since this one is for abnormally slow heart rates) d. IV Bolus of Atropine (cant give this because its contraindicated to glaucoma)
12. A client admitted with pericarditis calls the nurses station and complains of difficulty breathing and chest pain. The nurse assesses and reveals the vital signs : T - 99.2, P - 108, RR - 28, BP - 106/94, O2 - 92%. The patient has jugular vein distention. Heart sounds are faint and lungs have faint crackles. The nurse recognizes that these symptoms are consistent with which of the following conditions? a. Right sided heart failure

injury at T5. Which of the following actions by the tech would require b. Pulmonary embolism c. Pericarditis d. Cardiac tamponade

13. The nurse is caring for a client who is experiencing ICP. The nurse observes that the client’s body becomes stiff with flexion of the upper extremities with extension and internal rotation of the lower extremities. How will the nurse document? a. Tonic clonic seizure activity b. Brain herniation c. Decorticate posturing (toward the body & clenched) d. Decerebrate posturing
14. What dietary modifications is priority for the nurse to include in teaching a patient who is taking Amlodipine to control their blood pressure? a. Always take your medication with food or milk b. Increase intake of fruits and veggies c. Eat low fat, low sodium foods d. Eliminate grapefruit
15. The nurse is assisting the tech during morning care of the client with a spinal cord nurse? a. Check the patient’s skin for breakdown b. Raise the knee gatch to make the client more comfortable(makes most sense) c. Perform ROM exercises to the lower extremities d. Check BP prior to changing the client’s position
16. Dosage Calc
17. The nurse is providing education to a client diagnosed with a small thoracic aneurysm. Which information should the nurse include in the teaching session?

a. The most common cause is smoking

b. Surgery will need to be scheduled soon c. Dyspnea may develop if the aneurysm dilates (this is a symptom per realizeit) d. Pain is typically not present with thoracic aneurysms (not true)

18. The nurse is assisting with a cardioversion on a client with AFib. The nurse sets the defibrillator to synchronize the ECG on the monitor to make sure the electrical impulse discharges during which part of the patient’s impulse cycle? a. T wave b. P wave c. U wave d. QRS wave
19. A client with a spinal cord injury is having difficulty with muscle spasms and spasticity and the HCP orders dantrolene to manage the symptoms. Which of the following instructions are important for the nurse to inform the client about the drug? a. Liver function tests are needed regularly b. The drug will cause severe constipation c. Dantrolene may increase your appetite d. There is a risk for HYPERkalemia
20. The physician prescribes Amlodipine for a patient with hypertension and a family history of aneurysms. The patient asks the nurse how the medication works. How should the nurse respond? a. It decreases the release of stress hormones (no) b. It causes the kidneys to make more urine (no) c. It blocks conversion of the substance that makes blood vessels tighten resulting in prolongation of bradkin action d. It relaxes the heart and dilates the blood vessels
21. The nurse is provided education to a client who has hypertension and has a new prescription for Captopril. Which statement by the client would indicate that reinforcement is needed?

a. I will call the doctor immediately if I notice I have frequent coughs b. I need to take it at bedtime first because it might make my BP low c. The doctor may need to check my potassium level occasionally d. I won’t worry if I have a little swelling around my lips or face

22. A cardiac ICU manager is reviewing types of pacemakers with a group of newly hired nurses. Which of the following statements by one of the nurses indicates the understanding of a fixed pacemaker? a. The pacemaker can automatically adjust to the client’s increase in activity b. The pacemaker’s activity is triggered by an arrhythmia c. The pacemaker fires at a constant rate, not on demand d. The pacemaker fires on demand when the heart rate is below a certain rate
23. The ICU nurse is checking the telemetry of a post-op patient who has displayed normal sinus rhythm. The nurse notes a recurrent pattern in which the patient’s PR Interval has become progressively longer followed by a P Wave that is not conducted to the ventricles (No QRS). Which conduction problem would the nurse identify for the patient? a. 1st degree b. 2nd degree c. PVC d. A Fib
24. A patient is being discharged on digoxin after being diagnosed with A Fib. When providing medication teaching, the nurse should include which of the following instructions? a. Increase intake of potassium rich foods b. You need to check your pulse before taking this medication c. The drug may cause overgrowth of gum tissue d. Use hard candy to decrease dry mouth

25. The nurse is performing a Glascow Coma Scale assessment on a client who is unconscious. Which total score would indicate to the nurse that the patient probably has a severe brain injury? a. 9 b. 1 (cant have 1, 3-8) c. 5 d. 1
26. The nurse is caring for a client with a closed head injury who is emerging from a coma. Which of the following signs would prompt the nurse to notify the HCP immediately? a. Agitation b. Restlessness c. Incontinence d. Unequal Pupils
27. The nurse is teaching a client with a spinal cord injury who has a new prescription for Baclofen to treat muscle spasms. Which of the following statements by the client indicates an understanding of the teaching? a. I won’t be able to drink alcohol while taking this medicine b. I will need to monitor myself for high BP c. I may develop loose stools while on this medication d. I will stop taking this medication right away if I develop dizziness
28. Which assessment finding would the nurse expect to find in a patient diagnosed with a AAA? a. Dilated Chest veins b. Dysphagia c. A systolic Bruit d. Ripping Abdominal pain (correct answer in realizeit)

29. The ICU nurse is caring for a patient diagnosed with a head injury who is intubated and becoming agitated and combative. The nurse prepares to administer which of the following medications to help calm the patient? a. Propofol b. Diazepam c. Lorazepam d. Hidantin
30. After a patient receives a pacemaker, the patient asks the nurse where the wires from the implanted transvenous pacing lead and pacemaker are located. The nurse explains based on the lead being in which of the following anatomical positions? a. Enters inferior vena cava, ends at the right ventricle b. Enters pulmonary vein, ends at left ventricle c. Enters subclavian vein, ends at right atrium d. Enters at external jugular vein, ends at right ventricle
31. A client is being discharged from the ER after suffering from a mild concussion. Which of the following discharge instructions should the nurse give the client’s family member? a. Watch client for signs of ICP b. Do not allow the client to fall asleep c. Return to the ER if the client begins to have vomiting or slurred speech d. Monitor for paranoia and hypervigilance
32. The nurse is assisting with defibrillation for a patient with V Fib. After the first attempt is unsuccessful, which medication would the nurse anticipate giving before the next attempt? a. Verapamil b. Epinephrine c. Lidocaine d. Atropine

33. You have a patient that is diagnosed with cardiac tamponade. Which collaborative intervention would the nurse anticipate for the client? a. STAT cardiac enzymes b. 12 lead ECG c. Echocardiogram d. Pericardiocentesis
34. The nurse is teaching a client who has been taking Phenytoin to prevent seizures related to brain injury. Which of the following statements by the client would indicate understanding of the teaching? a. I will need to use a stiff toothbrush to eliminate plaque buildup from the medication b. I will need a backup contraceptive method for my birth control pills c. I need to report adverse reactions to this drug like insomnia and anxiety d. I can ask the pharmacist for the generic form of this medication to save money
35. SATA The nurse is assisting in the clinical evaluation of a patient who is a potential organ donor due to irreversible brain injury. Which of the following signs would indicate brain death of the patient? a. Absence of brain stem reflex (three cardinal signs) b. Coma (three cardinal signs) c. Apnea (three cardinal signs) d. Decorticate posturing e. Asystole
36. The ICU is caring for a client with a spinal cord injury who is incontinent. Which order from the HCP to manage the incontinent patient should the nurse question? a. Maintain bed rest with bedpan use (they cant control bladder so this won’t work) b. Indwelling catheter c. Condom catheter

d. Apply A&D to the perineum

37. An ICU nurse is teaching a newly licensed nurse about DIC. Which of the following clients would the nurse identify as having the highest risk for developing DIC? a. A 55 year old with hemodialysis b. A 77 year old with sepsis( found in realizeit correct answer ) c. A 45 year old with lymphoma d. A 32 year old pregnant client with placenta previa
38. Dosage Calc
39. Rhythm Strip
40. SATA Which of the following should the nurse review with the client who is being discharged with a permanent pacemaker. a. Don't raise your arms above your head for 2 weeks (not in realizeit) b. Avoid MRIs c. Wear a medic alert ID d. Keep cell phones on opposite sides e. Do not use the microwave f. Check your pulse every 2 to 3 days
41. SATA The nurse is caring for a client following a TBI 5 days ago. Which of the following interventions will the nurse implement to prevent complications? a. Maintain cerebral perfusion pressure between 35-44 (no bc b/t 50-
    b. Administer stool softener(Correct) c. Ensure ongoing nutritional support(correct) d. Anticipate administration of an anticonvulsant(correct) e. Monitor for HYPOnatremia(correct) f. Keep patient’s head turned to the side (no)

42. The ICU is caring for a patient with a TBI who develops cerebral edema. Which drug will the nurse expect to administer to the patient to decrease swelling? a. NSAID b. Mannitol c. Dexamethasone d. Dantrolene
43. A client has an 8 cm enlarging AAA and is scheduled for surgery in the morning. Which of the following pre-op orders by the HCP should the nurse question? a. Bed Rest b. NPO after midnight c. Sedative at bedtime (makes the most sense everything thing else is done) d. Give an enema until clear
44. SATA A nurse is providing education to a client who is diagnosed with hypertension taking propranolol. The nurse determines that the client wants to stop taking the medication because he doesn’t think it’s working. How should the nurse respond? a. The doctor may be able to prescribe something for any adverse reaction b. Tell me more about why you feel the medication is not working c. It is important to not stop the medication suddenly as it may cause chest pain d. I’ll call the doctor now about putting you on a different medication
45. A client with a chronic spinal cord injury at C3 is admitted to the ER with severe headache and blood pressure of 210/104. Which action by the nurse would be appropriate INITIALLY? a. Assess for bladder distention b. Check for skin breakdown c. Administer antihypertensive d. Administer pain medication

46. The nurse is preparing to give the first dose of Zosin to a patient who is post op from an aneurysm repair. The nurse is aware that the ideal time to give this medicine to prevent adverse effects is which of the following? a. At bedtime b. After breakfast c. Mid Afternoon d. On an empty stomach
47. The nurse is preparing to assist with a cardioversion for a patient with chronic A Fib. The doctor orders a TEE to be done prior to the procedure. The patient asks the nurse why it is needed. The nurse bases her reply on which of the following rationales? a. To check for reflux b. To determine the position of the heart c. To evaluate the rhythm and rate d. To evaluate for atrial thrombi
48. SATA The nurse is caring for a patient diagnosed with DIC. The nurse checks STAT labs to see the status of the patient. Which lab values would the nurse expect to be abnormal? a. D Dimer b. Platelet c. RBC d. Hemoglobin e. Potassium f. PTT
49. The nurse is reviewing the health history of a patient who is to be prescribed sotalol to control V Tach. Which of the following does the nurse recognize as a contraindication to sotalol? a. Renal Insufficiency b. Asthma

c. Cirrhosis d. Diabetes

50. A pregnant client is experiencing gestational hypertension and will need an antihypertensive medication. The client states “my grandmother takes Losartan and her BP is good. Do you think the doctor can prescribe me that?”. How should the nurse respond? a. This medication can cause birth defects or fetal death b. This is an option since what works in one family may work in another. c. I don't know. You will have to ask the doctor about that. d. This medication makes your heart slow down which will not be good for the baby.

Math x 3: mg/kg/min, heparin, lidocaine

ANSWER NOTES

1. DC – 11.6 mL/hr

2. DC – 45 mL/hr