NURS FINAL EXAM QUESTIONS WITH ANSWERS GUARANTEED SUCCESS 2023 A+, Exams of Nursing

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2. A 92-year-old female patient is being admitted to the emergency department with severe shortness of breath. Being aware of the patient’s condition, what approach should the nurse use to assess the patient’s lungs (select all that apply)? a. Apex to base b. Base to apex c. Lateral sequence d. Anterior then posterior e. Posterior then anterior
3. What keeps alveoli from collapsing? a. Carina b. Surfactant c. Empyema d. Thoracic cage
4. What accurately describes the alveolar sacs? a. Line the lung pleura b. Warm and moisturize inhaled air c. Terminal structures of the respiratory tract d. Contain dead air that is not available for gas exchange
5. What covers the larynx during swallowing? a. Trachea b. Epiglottis c. Turbinates d. Parietal pleura
6. Priority Decision: A 75-year-old patient who is breathing room air has the following arterial blood gas (ABG) results: pH 7.40, PaO2 74 mm Hg, SaO2 92%, PaCO2 40 mm Hg. What is the most appropriate action by the nurse? a. Document the results in the patient’s record. b. Repeat the ABGs within an hour to validate the findings. c. Encourage deep breathing and coughing to open the alveoli. d. Initiate pulse oximetry for continuous monitoring of the patient’s oxygen status.
7. A patient’s ABGs include a PaO2 of 88 mm Hg and a PaCO2 of 38 mm Hg, and mixed venous blood gases include a PvO2 of 40 mm Hg and PvCO2 of 46 mm Hg. What do these findings indicate? a. Impaired cardiac output

b. Unstable hemodynamics c. Inadequate delivery of oxygen to the tissues d. Normal capillary oxygen–carbon dioxide exchange

8. Priority Decision: A pulse oximetry monitor indicates that the patient has a drop in SpO2 from 95% to 85% over several hours. What is the first action the nurse should take? a. Order stat ABGs to confirm the SpO2 with a SaO2. b. Start oxygen administration by nasal cannula at 2 L/min. c. Check the position of the probe on the finger or earlobe. d. Notify the health care provider of the change in baseline PaO2.
9. Pulse oximetry may not be a reliable indicator of oxygen saturation in which patient? a. Patient with a fever b. Patient who is anesthetized c. Patient in hypovolemic shock d. Patient receiving oxygen therapy
10. A 73-year-old patient has an SpO2 of 70%. What other assessment should the nurse consider before making a judgment about the adequacy of the patient’s oxygenation? a. What the oxygenation status is with a stress test b. Trend and rate of development of the hyperkalemia c. Comparison of patient’s SpO2 values with the normal values d. Comparison of patient’s current vital signs with normal vital signs
11. Which values are indicators of the criteria needed for the use of continuous oxygen therapy? a. SpO2 of 92%; PaO2 of 65 mm Hg b. SpO2 of 95%; PaO2 of 70 mm Hg c. SpO2 of 90%; PaO2 of 60 mm Hg d. SpO2 of 88%; PaO2 of 55 mm Hg
12. Why does a patient’s respiratory rate increase when there is an excess of carbon dioxide in the blood? a. CO2 displaces oxygen on hemoglobin, leading to a decreased PaO2. b. CO2 causes an increase in the amount of hydrogen ions available in the body. c. CO2 combines with water to form carbonic acid, which lowers the pH of cerebrospinal fluid. d. CO2 directly stimulates chemoreceptors in the medulla to increase respiratory rate and volume.
13. Which respiratory defense mechanism is most impaired by smoking?

a. Cough reflex b. Filtration of air c. Mucociliary clearance d. Reflex bronchoconstriction

14. Which age-related changes in the respiratory system cause decreased secretion clearance (select all that apply)? a. Decreased functional cilia b. Decreased force of cough c. Decreased chest wall compliance d. Small airway closure earlier in expiration e. Decreased functional immunoglobulin A (IgA)
15. The abnormal assessment findings of dullness and hyperresonance are found with which assessment technique? a. Inspection b. Palpation c. Percussion d. Auscultation
16. Palpation is the assessment technique used to find which abnormal assessment findings (select all that apply)? a. Stridor b. Finger clubbing c. Tracheal deviation d. Limited chest expansion e. Increased tactile fremitus f. Use of accessory muscles
17. How does the nurse assess the patient’s chest expansion? a. Put the palms of the hands against the chest wall. b. Put the index fingers on either side of the trachea. c. Place the thumbs at the midline of the lower chest. d. Place one hand on the lower anterior chest and one hand on the upper abdomen.
18. When does the nurse record the presence of an increased anteroposterior (AP) diameter of the chest? a. There is a prominent protrusion of the sternum. b. The width of the chest is equal to the depth of the chest. c. There is equal but diminished movement of the two sides of the chest. d. The patient cannot fully expand the lungs because of kyphosis of the spine.

20. How is the presence of bronchovesicular breath sounds in the peripheral lung fields described? a. Rhonchi b. Crackles c. Adventitious sounds d. Abnormal lung sounds
21. A nurse has been exposed to tuberculosis (TB) during care of a patient with TB and has a TB skin test performed. When is the nurse considered infected? a. There is no redness or induration at the injection site. b. There is an induration of only 5 mm at the injection site. c. A negative skin test is followed by a negative chest x-ray. d. Testing causes a 10-mm red, indurated area at the injection site.
22. What is a primary nursing responsibility after obtaining a blood specimen for ABGs? a. Adding heparin to the blood specimen b. Applying pressure to the puncture site for 2 full minutes c. Taking the specimen immediately to the laboratory in an iced container d. Avoiding any changes in oxygen intervention for 20 minutes following the procedure
23. What should the nurse do when preparing a patient for a pulmonary angiogram scan? a. Assess the patient for iodine allergy. b. Implement NPO orders for 6 to 12 hours before the test. c. Explain the test before the patient signs the informed consent form. d. Inform the patient that radiation isolation for 24 hours after the test is necessary.
24. After which test should the nurse observe the patient for symptoms of a pneumothorax? a. Thoracentesis b. Pulmonary function test c. Ventilation-perfusion scan d. Positron emission tomography (PET) scan
25. The health care provider orders a pulmonary angiogram for a patient admitted with dyspnea and hemoptysis. For which problem is this test most commonly used as a diagnostic measure? a. Tuberculosis (TB) b. Cancer of the lung c. Airway obstruction d. Pulmonary embolism

Chapter 27

7. While the nurse is feeding a patient, the patient appears to choke on the food. Which symptoms indicate to the nurse that the patient has a partial airway obstruction (select all that apply)? a. Stridor b. Cyanosis c. Wheezing d. Bradycardia e. Rapid respiratory rate Chapter 28
8. A patient with pneumonia has a nursing diagnosis of ineffective airway clearance related to pain, fatigue, and thick secretions. What is an expected outcome for this patient? a. SpO2 is 90% b. Lungs clear to auscultation c. Patient tolerates walking in hallway d. Patient takes three or four shallow breaths before coughing to minimize pain
9. A male patient has chronic obstructive pulmonary disease (COPD) and is a smoker. The nurse notices respiratory distress and no breath sounds over the left chest. Which type of pneumothorax should the nurse suspect is occurring? a. Tension pneumothorax b. Iatrogenic pneumothorax c. Traumatic pneumothorax d. Spontaneous pneumothorax
10. Following a thoracotomy, the patient has a nursing diagnosis of ineffective airway clearance related to inability to cough as a result of pain and positioning. What is the best nursing intervention for this patient? a. Have the patient drink 16 oz of water before attempting to deep breathe. b. Auscultate the lungs before and after deep-breathing and coughing regimens. c. Place the patient in the Trendelenburg position for 30 minutes before the coughing exercises.

d. Medicate the patient with analgesics 20 to 30 minutes before assisting to cough and deep breathe.

35. Priority Decision: Two days after undergoing pelvic surgery, a patient develops marked dyspnea and anxiety. What is the first action that the nurse should take? a. Raise the head of the bed. b. Notify the health care provider. c. Take the patient’s pulse and blood pressure. d. Determine the patient’s SpO2 with an oximeter.
36. A pulmonary embolus is suspected in a patient with a deep vein thrombosis who develops hemoptysis, tachycardia, and chest pain. Diagnostic testing is scheduled. Which test should the nurse plan to teach the patient about? a. Chest x-rays b. Spiral (helical) CT scan c. Take the patient’s pulse and blood pressure. d. Ventilation-perfusion lung scan
37. Which condition contributes to secondary pulmonary arterial hypertension by causing pulmonary capillary and alveolar damage? a. COPD b. Sarcoidosis c. Pulmonary fibrosis d. Pulmonary embolism
38. While caring for a patient with idiopathic pulmonary arterial hypertension (IPAH), the nurse observes that the patient has exertional dyspnea and chest pain in addition to fatigue. What are these symptoms related to? a. Decreased left ventricular output b. Right ventricular hypertrophy and dilation c. Increased systemic arterial blood pressure d. Development of alveolar interstitial edema
39. What is a primary treatment goal for cor pulmonale? a. Controlling dysrhythmias b. Dilating the pulmonary arteries c. Strengthening the cardiac muscle d. Treating the underlying pulmonary condition
40. Six days after a heart-lung transplant, the patient develops a low-grade fever, dyspnea, and decreased SpO2. What should the nurse recognize that this may indicate? a. A normal response to extensive surgery b. A frequently fatal cytomegalovirus infection

c. Acute rejection that may be treated with corticosteroids d. Obliterative bronchiolitis that plugs terminal bronchioles OBSTRUCTIVE PULMONARY DISEASES

1. While assisting a patient with intermittent asthma to identify specific triggers of asthma, what should the nurse explain? a. Food and drug allergies do not manifest in respiratory symptoms. b. Exercise-induced asthma is seen only in individuals with sensitivity to cold air. c. Asthma attacks are psychogenic in origin and can be controlled with relaxation techniques. d. Viral upper respiratory infections are a common precipitating factor in acute asthma attacks.
2. Priority Decision: A patient is admitted to the emergency department with an acute asthma attack. Which patient assessment is of greatest concern to the nurse? a. The presence of a pulsus paradoxus b. Markedly diminished breath sounds with no wheezing c. Use of accessory muscles of respiration and a feeling of suffocation d. A respiratory rate of 34 and increased pulse and blood pressure
3. A patient with asthma has the following arterial blood gas (ABG) results early in an acute asthma attack: pH 7.48, PaCO2 30 mm Hg, PaO2 78 mm Hg. What is the most appropriate action by the nurse? a. Prepare the patient for mechanical ventilation. b. Have the patient breathe in a paper bag to raise the PaCO2. c. Document the findings and monitor the ABGs for a trend toward alkalosis. d. Reduce the patient’s oxygen flow rate to keep the PaO at the current level.
4. What is an indication of marked bronchoconstriction with air trapping and hyperinflation of the lungs in a patient with asthma? a. SaO2 of 85% b. PEF rate of <150 L/min c. FEV1 of 85% of predicted d. Chest x-ray showing a flattened diaphragm
5. Priority Decision: Which medication should the nurse anticipate being used first in the emergency department for relief of severe respiratory distress related to asthma? a. Prednisone orally b. Ipratopium inhaler c. Fluticasone inhaler d. Albuterol nebulizer

15. What causes the pulmonary vasoconstriction leading to the development of cor pulmonale in the patient with COPD? a. Increased viscosity of the blood b. Alveolar hypoxia and hypercapnia c. Long-term low-flow oxygen therapy d. Administration of high concentrations of oxygen
16. In addition to smoking cessation, what treatment is included for COPD to slow the progression of the disease? a. Use of bronchodilator drugs b. Use of inhaled corticosteroids c. Lung volume–reduction surgery d. Prevention of respiratory tract infections
17. Which method of oxygen administration is the safest system to use for a patient with COPD? a. Venturi mask b. Nasal cannula c. Simple face mask d. Non-rebreathing mask
18. Which breathing technique should the nurse teach the patient with moderate COPD to promote exhalation? a. Huff coughing b. Thoracic breathing c. Pursed lip breathing d. Diaphragmatic breathing
19. What does the nurse include when planning for postural drainage for the patient with COPD? a. Schedules the procedure 1 hour before and after meals b. Has the patient cough before positioning to clear the lungs c. Assesses the patient’s tolerance for dependent (head-down) positions d. Ensures that percussion and vibration are performed before positioning the patient
20. Which dietary modification helps to meet the nutritional needs of patients with COPD? a. Eating a high-carbohydrate, low-fat diet b. Avoiding foods that require a lot of chewing c. Preparing most foods of the diet to be eaten hot d. Drinking fluids with meals to promote digestion
21. Delegation Decision: The nurse is caring for a patient with COPD. Which intervention could be delegated to unlicensed assistive personnel (UAP)?

a. Assist the patient to get out of bed. b. Auscultate breath sounds every 4 hours. c. Plan patient activities to minimize exertion. d. Teach the patient pursed lip breathing technique.

25. Priority Decision: During an acute exacerbation of mild COPD, the patient is severely short of breath and the nurse identifies a nursing diagnosis of ineffective breathing pattern related to obstruction of airflow and anxiety. What is the best action by the nurse? a. Prepare and administer routine bronchodilator medications. b. Perform chest physiotherapy to promote removal of secretions. c. Administer oxygen at 5 L/min until the shortness of breath is relieved. d. Position the patient upright with the elbows resting on the over-the- bed table.
26. The husband of a patient with severe COPD tells the nurse that he and his wife have not had any sexual activity since she was diagnosed with COPD because she becomes too short of breath. What is the nurse’s best response? a. “You need to discuss your feelings and needs with your wife so she knows what you expect of her.” b. “There are other ways to maintain intimacy besides sexual intercourse that will not make her short of breath.” c. “You should explore other ways to meet your sexual needs since your wife is no longer capable of sexual activity.” d. “Would you like for me to talk to you and your wife about some modifications that can be made to maintain sexual activity?”
27. What should the nurse include when teaching the patient with COPD about the need for physical exercise? a. All patients with COPD should be able to increase walking gradually up to 20 minutes per day. b. A bronchodilator inhaler should be used to relieve exercise- induced dyspnea immediately after exercise. c. Shortness of breath is expected during exercise but should return to baseline within 5 minutes after the exercise. d. Monitoring the heart rate before and after exercise is the best way to determine how much exercise can be tolerated.
28. The patient has had COPD for years and his ABGs usually show hypoxia (PaO2 <60 mm Hg or SaO2 <88%) and hypercapnia (PaCO2 >45 mm Hg). Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure? a. pH 7.35, PaO2 62 mm Hg, PaCO2 45 mm Hg

b. pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg c. pH 7.42, PaO2 90 mm Hg, PaCO2 43 mm Hg

d. pH 7.46, PaO2 92 mm Hg, PaCO2 32 mm Hg

33. In an adult patient with bronchiectasis, what is a nursing assessment likely to reveal? a. Chest trauma b. Childhood asthma c. Smoking or oral tobacco use d. Recurrent lower respiratory tract infections
34. In planning care for the patient with bronchiectasis, which nursing intervention should the nurse include? a. Relieve or reduce pain b. Prevent paroxysmal coughing c. Prevent spread of the disease to others d. Promote drainage and removal of mucus
35. Which obstructive pulmonary disease would a 30-year-old white female patient with a parent with the disease be most likely to be diagnosed with? a. COPD b. Asthma c. Cystic fibrosis d. α1 -Antitrypsin (AAT) deficiency
36. What is the primary principle involved in the various airway clearance devices used for mobilizing secretions? a. Vibration b. Inhalation therapy c. Chest physiotherapy d. Positive expiratory pressure hematologic Chapter 31
37. A patient with a hemoglobin (Hgb) level of 7.8 g/dL (78 g/L) has cardiac palpitations, a heart rate of 102 bpm, and an increased reticulocyte count. At this severity of anemia, what other manifestation would the nurse expect the patient to exhibit? a. Pallor b. Dyspnea c. A smooth tongue d. Sensitivity to cold
38. Priority Decision: A 76-year-old woman has an Hgb of 7.3 g/dL ( g/L) and is experiencing ataxia and confusion on admission to the hospital. What is a priority nursing intervention for this patient? a. Provide a darkened, quiet room. b. Have the family stay with the patient. c. Keep top bedside rails up and call bell in close reach d. Question the patient about possible causes of anemia

4. During the physical assessment of the patient with severe anemia, which finding is of the most concern to the nurse? a. Anorexia b. Bone pain c. Hepatomegaly d. Dyspnea at rest
5. Which anemia is manifested with pancytopenia? a. Thalassemia b. Aplastic anemia c. Megaloblastic anemia d. Anemia of chronic disease
6. Which descriptions are characteristic of iron-deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Autoimmune-related disease c. Most common type of anemia d. Associated with chronic blood loss e. May occur with removal of the stomach f. May occur with removal of the duodenum
7. A 20-year-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. Which type of anemia is this patient most at risk for? a. Aplastic anemia b. Hemolytic anemia c. Iron-deficiency anemia d. Folic acid deficiency anemia
8. When teaching the patient about a new prescription for oral iron supplements, what does the nurse instruct the patient to do? a. Increase fluid and dietary fiber intake b. Take the iron preparations with meals c. Use enteric-coated preparations taken with orange juice d. Report the presence of black stools to the health care provider
9. Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock. b. This anemia is most frequently treated with increased dietary iron intake. c. In addition to the general symptoms of anemia, this patient also manifests jaundice.

d. Clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss. e. A patient who has acute blood loss may have postural hypotension and increased heart rate. Cardiovascular

6. Match the cardiac activity and time frames characteristic of the waveforms of the electrocardiogram (answers may be used more than once). a. Measured from beginning of P wave to beginning of QRS complex. ii b. Repolarization of the ventricles. iv c. 0.12 to 0.20 sec. ii d. 0.16 sec. iv e. Time of depolarization and repolarization of ventricles. v f. <0.12 sec. iii g. Depolarization from the AV node throughout ventricles. iii h. 0.06 to 0.12 sec. i i. P wave ii. PR interval iii. QRS interval iv. T wave v. QT interval
7. Which effects result from sympathetic nervous system stimulation of b- adrenergic receptors (select all that apply)? a. Vasoconstriction b. Increased heart rate c. Decreased heart rate d. Increased rate of impulse conduction e. Decreased rate of impulse conduction f. Increased force of cardiac contraction
8. Which finding is associated with a blue tinge around the lips and conjunctiva? a. Finger clubbing b. Central cyanosis c. Peripheral cyanosis d. Delayed capillary filling time
9. A female patient has a total cholesterol level of 232 mg/dL (6. mmol/L) and a high-density lipoprotein (HDL) of 65 mg/dL (1. mmol/L). A male patient has a total cholesterol level of 200 mg/dL and an HDL of 32 mg/dL. Based on these findings, which patient has the highest cardiac risk? a. The man, because his HDL is lower b. The woman, because her HDL is higher

c. The woman, because her cholesterol is higher d. The man, because his cholesterol-to-HDL ratio is higher

23. Increases in which factors are predictors of an increased risk for coronary artery disease or evidence of myocardial injury (select all that apply)? a. Creatine kinase (CK)-MM b. Cardiac troponin T (cTnT) c. B-type natriuretic peptide (BNP) d. High-sensitivity C-reactive protein e. Lipoprotein-associated phospholipase A chapter 33
24. What are nonmodifiable risk factors for primary hypertension (select all that apply)? a. Age b. Obesity c. Gender d. Ethnicity e. Genetic link
25. How is secondary hypertension differentiated from primary hypertension? a. Has a more gradual onset than primary hypertension b. Does not cause the target organ damage that occurs with primary hypertension c. Has a specific cause, such as renal disease, that often can be treated by medicine or surgery d. Is caused by age-related changes in BP regulatory mechanisms in people over 65 years of age
26. What is the patient with primary hypertension likely to report? a. No symptoms b. Cardiac palpitations c. Dyspnea on exertion d. Dizziness and vertigo
27. What is most organ damage in hypertension related to? a. Increased fluid pressure exerted against organ tissue b. Atherosclerotic changes in vessels that supply the organs c. Erosion and thinning of blood vessels from constant pressure d. Increased hydrostatic pressure causing leakage of plasma into organ interstitial spaces
28. Which classification of drugs used to treat hypertension prevents the action of angiotensin II and promotes increased salt and water excretion? a. Thiazide diuretics b. Direct vasodilators

c. Angiotensin II receptor blockers (ARBs) d. Angiotensin-converting enzyme (ACE) inhibitors

13. Dietary teaching that includes dietary sources of potassium is indicated for the hypertensive patient taking which drug? a. Enalapril (Vasotec) b. Labetalol (Normodyne) c. Spironolactone (Aldactone) d. Hydrochlorothiazide (HydroDiuril)
14. Priority Decision: A patient with stage 2 hypertension who is taking hydrochlorothiazide (HydroDiuril) and lisinopril (Prinivil) has prazosin (Minipress) added to the medication regimen. What is most important for the nurse to teach the patient to do? a. Weigh every morning to monitor for fluid retention b. Change position slowly and avoid prolonged standing c. Use sugarless gum or candy to help relieve dry mouth d. Take the pulse daily to note any slowing of the heart rate
15. What should the nurse emphasize when teaching a patient who is newly prescribed clonidine (Catapres)? a. The drug should never be stopped abruptly. b. The drug should be taken early in the day to prevent nocturia. c. The first dose should be taken when the patient is in bed for the night. d. Because aspirin will decrease the drug’s effectiveness, Tylenol should be used instead.
16. What is included in the correct technique for BP measurements? a. Always take the BP in both arms. b. Position the patient supine for all readings. c. Place the cuff loosely around the upper arm. d. Take readings at least two times at least 1 minute apart. Chapter 34
17. Which patient is most likely to be in the fibrous stage of development of coronary artery disease (CAD)? a. Age 40, thrombus adhered to the coronary artery wall b. Age 50, rapid onset of disease with hypercholesterolemia c. Age 32, thickened coronary arterial walls with narrowed vessel lumen d. Age 19, elevated low-density lipoprotein (LDL) cholesterol, lipid-filled smooth muscle cells
18. What accurately describes the pathophysiology of CAD? a. Partial or total occlusion of the coronary artery occurs during the stage of raised fibrous plaque

b. Endothelial alteration may be caused by chemical irritants such as hyperlipidemia or by tobacco use c. Collateral circulation in the coronary circulation is more likely to be present in the young patient with CAD d. The leading theory of atherogenesis proposes that infection and fatty dietary intake are the basic underlying causes of atherosclerosis

3. While obtaining patient histories, which patient does the nurse identify as having the highest risk for CAD? a. A white man, age 54, who is a smoker and has a stressful lifestyle b. A white woman, age 68, with a BP of 172/100 mm Hg and who is physically inactive c. An Asian woman, age 45, with a cholesterol level of 240 mg/dL and a BP of 130/74 mm Hg d. An obese African American man, age 65, with a cholesterol level of 195 mg/dL and a BP of 128/76 mm Hg
4. Priority Decision: While teaching women about the risks and incidence of CAD, what does the nurse emphasize? a. Smoking is not as significant a risk factor for CAD in women as it is in men. b. Women seek treatment sooner than men when they have symptoms of CAD. c. Estrogen replacement therapy in postmenopausal women decreases the risk for CAD. d. CAD is the leading cause of death in women, with a higher mortality rate after MI than in men.
5. Which characteristics are associated with LDLs (select all that apply)? a. Increases with exercise b. Contains the most cholesterol c. Has an affinity for arterial walls d. Carries lipids away from arteries to liver e. High levels correlate most closely with CAD f. The higher the level, the lower the risk for CAD
6. The nurse is encouraging a sedentary patient with major risks for CAD to perform physical exercise on a regular basis. In addition to decreasing the risk factor of physical inactivity, the nurse tells the patient that exercise will also directly contribute to reducing which risk factors? a. Hyperlipidemia and obesity b. Diabetes mellitus and hypertension c. Elevated serum lipids and stressful lifestyle d. Hypertension and elevated serum homocysteine
7. A 62-year-old woman has prehypertension (BP 142/90 mm Hg) and smokes a pack of cigarettes per day. She has no

symptoms of CAD but a

recent LDL level was 154 mg/dL (3.98 mmol/L). Based on these findings, the nurse would expect that which treatment plan would be used first for this patient? a. Diet and drug therapy b. Exercise instruction only c. Diet therapy and smoking cessation d. Drug therapy and smoking cessation

12. What are manifestations of acute coronary syndrome (ACS) (select all that apply)? a. Dysrhythmia b. Stable angina c. Unstable angina d. ST-segment-elevation myocardial infarction (STEMI) e. Non–ST-segment-elevation myocardial infarction (NSTEMI)
13. Myocardial ischemia occurs as a result of increased oxygen demand and decreased oxygen supply. What factors and disorders result in increased oxygen demand (select all that apply)? a. Hypovolemia or anemia b. Increased cardiac workload with aortic stenosis c. Narrowed coronary arteries from atherosclerosis d. Angina in the patient with atherosclerotic coronary arteries e. Left ventricular hypertrophy caused by chronic hypertension f. Sympathetic nervous system stimulation by drugs, emotions, or exertion
14. What causes the pain that occurs with myocardial ischemia? a. Death of myocardial tissue b. Dysrhythmias caused by cellular irritability c. Lactic acid accumulation during anaerobic metabolism d. Elevated pressure in the ventricles and pulmonary vessels
15. Which characteristics describe unstable angina (select all that apply)? a. Usually precipitated by exertion b. Unpredictable and unrelieved by rest c. Characterized by progressive severity d. Occurs only when the person is recumbent e. Usually occurs in response to coronary artery spasm
16. Tachycardia that is a response of the sympathetic nervous system to the pain of ischemia is detrimental because it increases oxygen demand and a. increases cardiac output. b. causes reflex hypotension. c. may lead to atrial dysrhythmias. d. impairs perfusion of the coronary arteries.

18. Which effects contribute to making nitrates the first-line therapy for the treatment of angina (select all that apply)? a. Decrease heart rate (HR) b. Decrease preload c. Decrease afterload d. Dilate coronary arteries e. Prevent thrombosis of plaques f. Decrease myocardial contractility
19. The patient has used sublingual nitroglycerin and various long- acting nitrates but now has an ejection fraction of 38% and is considered at a high risk for a cardiac event. Which medication would first be added for vasodilation and to reduce ventricular remodeling? a. Clopidogrel (Plavix) b. Captopril (Capoten) c. Diltiazem (Cardizem) d. Metoprolol (Lopressor)
20. When instructing the patient with angina about taking sublingual nitroglycerin tablets, what should the nurse teach the patient? a. To lie or sit and place one tablet under the tongue when chest pain occurs b. To take the tablet with a large amount of water so it will dissolve right away c. That if one tablet does not relieve the pain in 15 minutes, the patient should go to the hospital d. That if the tablet causes dizziness and a headache, stop the medication and call the doctor or go to the hospital
21. When teaching an older adult with CAD how to manage the treatment program for angina, which guidelines does the nurse use to teach the patient? a. To sit for 2 to 5 minutes before standing when getting out of bed b. To exercise only twice a week to avoid unnecessary strain on the heart c. That lifestyle changes are not as necessary as they would be in a younger person d. That aspirin therapy is contraindicated in older adults because of the risk for bleeding
22. When a patient reports chest pain, why must unstable angina be identified and rapidly treated? a. The pain may be severe and disabling. b. ECG changes and dysrhythmias may occur during an attack. c. Atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen. d. Spasm of a major coronary artery may cause total occlusion of the vessel with progression to MI.

23. The nurse suspects stable angina rather than MI pain in the patient who reports that his chest pain a. is relieved by nitroglycerin. b. is a sensation of tightness or squeezing. c. does not radiate to the neck, back, or arms. d. is precipitated by physical or emotional exertion.
24. A patient admitted to the hospital for evaluation of chest pain has no abnormal serum cardiac markers 4 hours after the onset of pain. What noninvasive diagnostic test can be used to differentiate angina from other types of chest pain? a. 12-lead ECG b. Exercise stress test c. Coronary angiogram d. Transesophageal echocardiogram
25. A 52-year-old man is admitted to the emergency department with severe chest pain. On what basis would the nurse suspect an MI? a. He has pale, cool, clammy skin. b. He reports nausea and vomited once at home. c. He says he is anxious and has a feeling of impending doom. d. He reports he has had no relief of the pain with rest or position change.
26. At what point in the healing process of the myocardium following an infarct does early scar tissue result in an unstable heart wall? a. 2 to 3 days after MI b. 4 to 10 days after MI c. 10 to 14 days after MI d. 6 weeks after MI
27. To detect and treat the most common complication of MI, what should the nurse do? a. Measure hourly urine output. b. Auscultate the chest for crackles. c. Use continuous cardiac monitoring. d. Take vital signs every 2 hours for the first 8 hours. FLUID AND ELECTROLYTES (Chapter 17)

3. Which statements about fluid in the human body are true (select all that apply)? a. The primary hypothalamic mechanism of water intake is thirst. b. Third spacing refers to the abnormal movement of fluid into interstitial spaces. c. A cell surrounded by hypoosmolar fluid will shrink and die as water moves out of the cell. d. A cell surrounded by hyperosmolar fluid will shrink and die as water moves out of the cell. e. Concentrations of Na+ and K+ in interstitial and intracellular fluids are maintained by the sodium-potassium pump.
4. As fluid circulates through the capillaries, there is movement of fluid between the capillaries and the interstitium. What describes the fluid movement that would cause edema (select all that apply)? a. Plasma hydrostatic pressure is less than plasma oncotic pressure. b. Plasma oncotic pressure is higher than interstitial oncotic pressure. c. Plasma hydrostatic pressure is higher than plasma oncotic pressure. d. Plasma hydrostatic pressure is less than interstitial hydrostatic pressure. e. Interstitial hydrostatic pressure is lower than plasma hydrostatic pressure
5. What stimulates aldosterone secretion from the adrenal cortex? a. Excessive water intake b. Increased serum osmolality c. Decreased serum potassium d. Decreased sodium and water
6. While caring for an 84-year-old patient, the nurse monitors the patient’s fluid and electrolyte balance, recognizing what as a normal change of aging? a. Hyperkalemia b. Hyponatremia c. Decreased insensible fluid loss d. Increased plasma oncotic pressures
7. The nurse is admitting a patient to the clinical unit from surgery. Being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient’s postoperative fluid volume (select all that apply)? a. Intake and output b. Skin turgor c. Lung sounds d. Respiratory rate e. Level of consciousness

12. Which patient is at risk for hypernatremia?

a. Has a deficiency of aldosterone b. Has prolonged vomiting and diarrhea c. Receives excessive IV 5% dextrose solution d. Has impaired consciousness and decreased thirst sensitivity

13. In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system? a. Kidneys b. Cardiovascular system c. Musculoskeletal system d. Central nervous system
14. Match the electrolyte imbalances with their associated causes (answers may be used more than once and imbalances may have more than one associated cause). 8 a. Alcohol withdrawal 4 b. Metabolic alkalosis 6 c. Parathyroidectomy 1 d. Diabetes insipidus 7 e. Fleet enemas 2 f. Primary polydipsia 9 g. Milk of magnesia use in renal failure 3 h. Early burn stage 6, 10_ i. Chronic alcoholism 6 j. Vitamin D deficiency 1 k. Osmotic diuresis 5 l. Prolonged immobilization 1,4,10 m. Hyperaldosteronism _3,6,8,9 n. chronic kidney disease _4,2,6,10 o. Loop and thiazide diuretics
15. Hypernatremia
16. Hyponatremia
17. Hyperkalemia
18. Hypokalemia
19. Hypercalcemia
20. Hypocalcemia
21. Hyperphosphatemia
22. Hypophosphatemia
23. Hypermagnesemia
24. Hypomagnesemia
25. A patient is taking diuretic drugs that cause sodium loss from the kidney. Which fluid or electrolyte imbalance is most likely to occur in this patient? a. Hyperkalemia

b. Hyponatremia c. Hypocalcemia d. Hypotonic fluid loss

16. A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication? a. Seizures b. Paralysis c. Dysrhythmias d. Acute kidney injury
17. What is hyperkalemia frequently associated with? a. Hypoglycemia b. Metabolic acidosis c. Respiratory alkalosis d. Decreased urine potassium levels
18. In a patient with a positive Chvostek’s sign, the nurse would anticipate the IV administration of which medication? a. Calcitonin b. Vitamin D c. Loop diuretics d. Calcium gluconate
19. A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypomagnesemia
20. What is the normal pH range of the blood and what ratio of base to acid does this reflect? a. 7.32 to 7.42; 25 to 2 b. 7.32 to 7.42; 28 to 2 c. 7.35 to 7.45; 20 to 1 d. 7.35 to 7.45; 30 to 1
21. What are the characteristics of the carbonic acid–bicarbonate buffer system (select all that apply)? a. CO2 is eliminated by the lung b. Neutralizes HCl acid to yield carbonic acid and salt c. H2CO3 formed by neutralization dissociates into H2O and CO2 d. Shifts H+ in and out of cell in exchange for other cations such as potassium and sodium

e. Free basic radicals dissociate into ammonia and OH– that combines with H+ to form water

22. What are characteristics of the phosphate buffer system (select all that apply)? a. Neutralizes a strong base to a weak base and water b. Resultant sodium biphosphate is eliminated by kidneys c. Free acid radicals dissociate into H+ and CO2, buffering excess base d. Neutralizes a strong acid to yield sodium biphosphate, a weak acid, and salt e. Shifts chloride in and out of red blood cells in exchange for sodium bicarbonate, buffering both acids and bases
23. A patient who has a large amount of carbon dioxide in the blood also has what in the blood? a. Large amount of carbonic acid and low hydrogen ion concentration b. Small amount of carbonic acid and low hydrogen ion concentration c. Large amount of carbonic acid and high hydrogen ion concentration d. Small amount of carbonic acid and high hydrogen ion concentration
24. Match the acid-base imbalances with their mechanisms. 3 a. Increased carbonic acid (H2CO3) 4 b. Decreased carbonic acid (H2CO3) 2 c. Increased base bicarbonate (HCO3–) 1 d. Decreased base bicarbonate (HCO3–)
25. Metabolic acidosis
26. Metabolic alkalosis
27. Respiratory acidosis
28. Respiratory alkalosis
29. What is a compensatory mechanism for metabolic alkalosis? a. Shifting of bicarbonate into cells in exchange for chloride b. Kidney conservation of bicarbonate and excretion of hydrogen ions c. Deep, rapid respirations (Kussmaul respirations) to increase CO2 excretion d. Decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate
30. Match the acid-base imbalances with their common causes (answers may be used more than once). 1 a. Renal failure 1 b. Severe shock 1 c. Diabetic ketosis 3 d. Respiratory failure 2 e. Prolonged vomiting