Nursing Vibes

Integumentary System Nursing Concept Practice Test
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1. A nurse is caring for a burn client who has sustained thoracic burns and smoke inhalation and is risk for impaired gas exchange. The nurse avoids which action in caring for this client?

a. repositioning the client from side to side every 2 hours
b. maintaining the client in a supine position with the head of the bed elevated
c. suctioning the airway as needed
d. providing humidified oxygen as prescribed


2. A client sustains a burn injury to the entire right arm, entire right leg, and anterior thorax. According to the rule of nine’s the nurse determines that what body percent was injured?

Answer: ______________________________________

3. A nurse assesses a burn injury and determines that the client sustained a full-thickness fourth-degree burn if which of the following is noted at the site of injury?

a. a wet shiny weeping wound surface
b. a dry wound surface
c. charring at the wound site
d. blisters


4. A client is brought to the emergency room following a burn injury. In assessment the nurse notes that the client’s eyebrow and nasal hairs are singed. The nurse would identify this type of burn as:

a. thermal
b. electrical
c. radiation
d. chemical

5. A nurse assesses the carbon monoxide level of a client following a burn injury and notes that the level is 8%. Based on this level, which finding would the nurse expect to note during the assessment of the client?

a. tachycardia
b. tachypnea
c. coma
d. impaired visual acuity

6. A nurse assesses the client’s burn injury and determines that the client sustained a partial-thickness superficial burn. Based on this determination, which finding did the nurse note?

a. a wet, shiny, weeping wound
b. a dry wound surface
c. charring at the wound site
d. absence of wound sensation

7. A nurse assesses the client’s burn injury and determines that the client sustained a partial-thickness deep burn. Based on this determination, which finding did the nurse note?

a. a wet, shiny, weeping wound surface
b. a dry wound surface
c. charring at the wound site
d. total absence of wound sensation

8. On assessment of a child, the nurse notes the presence of white patches on the child’s tongue and determines that they may be indicative of candidiasis (thrush). The nurse understands that the white patches of candidiasis (thrush):

a. adhere to the tongue even when scraped with tongue blade
b. cause the tongue to bleed continuously around the patch
c. produce a red circle in the center of the white lesion
d. will occur only in the tongue

9. On assessment, a nurse notes a flat brown circular nevi on the skin of a client that measures less than one centimeter. The client asks, “Is this cancer?” The nurse makes which response to the client?

a. “These are likely to be benign moles.”
b. “These require immediate attention because they are probably cancer.”
c. “These indicate malignancy.”
d. “These are probably verrucae.”

10. A nurse is performing a skin assessment on a client. The nurse understands that moles with variegated color, irregular borders, and/or an irregular surface should be considered:

a. suspicious
b. normal
c. common
d. benign

11. A client is diagnosed with herpes zoster (shingles). Which pharmacological therapy would the nurse expect to be prescribed to treat this disorder?

a. tetracycline hydrochloride (achromycin)
b. erythromycin base (e-mycin)
c. acyclovir (zovirax)
d. indomethacin (indocin)

12. A nurse reviews the record of a client diagnosed with pemphigus and notes that the physician has documented the presence of Nikolsky’s sign. Based on this documentation, which of the following would the nurse expect to note?

a. client complains of discomfort behind the knee on forced dorsiflexion of the foot
b. a spasm of the facial muscles elicited by tapping the facial nerve in the region of the parotid gland
c. carpal spasm elicited by compressing the upper arm
d. the epidermis of the client’s skin can be rubbed off by slight friction or injury


13. A hospitalized client is diagnosed with scabies. Which of the following would a nurse expect to note on inspection of the client’s skin?

a. the appearance of vesicles or pustules
b. the presence of white patches scattered about the trunk
c. multiple straight or wavy threadlike lines beneath the skin
d. patchy hair loss and round, red macules with scales

14. A client is seen in the health care clinic and the physician suspects herpes zoster. The nurse prepares the items needed to perform the diagnostic test to confirm this diagnosis. Which item will the nurse obtain?

a. a biopsy kit
b. a wood’s light
c. a culture swab and tube
d. a patch test kit

15. A nurse reviews the health care record of a client diagnosed with herpes zoster. Which finding would the nurse expect to note as characteristic of this disorder?

a. a generalized red body rash that causes pruritus
b. small blue-white spots with a red base noted on the extremities
c. a fiery red edematous rash on the cheeks and neck
d. clustered and grouped skin vesicles

16. A client returns to the clinic for a follow-up treatment following a skin biopsy of a suspicious lesion performed 1 week ago. The biopsy report indicated that the lesion is a squamous cell carcinoma. The nurse plans care knowing that which of the following describes the characteristic of this type of a lesion?

a. it is highly metastatic
b. it does not metastasize
c. it is characterized by local invasion
d. it is encapsulated

17. A nurse reviews the record of a client scheduled for removal of a skin lesion. The record indicates that the lesion is an irregularly shaped, pigmented papule with a blue-toned color. The nurse determines that this description of the lesion is characteristic of:

a. melanoma
b. basal cell carcinoma
c. squamous cell carcinoma
d. actinic keratosis

18. A nurse is reviewing the nursing care plan for a client for whom a stage 4 decubiti ulcer has been documented. Which of the following would the nurse expect to note on assessment of the client?

a. a reddened area that returns to a normal skin color after 15 to 20 minutes of pressure relief
b. intact skin
c. an area in which the top layer of skin is missing
d. a deep ulcer that extends into muscle and bone.

19. A nurse notes documentation of a stage 3 pressure ulcer in a client’s record. Which of the following would the nurse expect to note on assessment of the client?

a. a deep ulcer that extends into muscle and bone
b. a deep ulcer that extends into the dermis and the subcutaneous tissue
c. an area in which the top layer of skin is missing
d. a reddened area that returns to normal skin color after 15 to 20 minutes of pressure relief

20. A client is in the health care clinic for complaints of pruritus. Following diagnostic studies, it has been determined that there is not a pathophysiological process causing the pruritus. The nurse prepares instructions for the client to assist in reducing the problem and tells the client to:

a. use a dehumidifier in the home
b. ensure that the temperature in the home is high, especially during the winter months
c. use a cool-mist vaporizer, especially during the winter months
d. avoid use of skin moisturizers following a bath

21. A client is seen in the health care clinic because of complaints of lesions on the elbows and the knees. The lesions are red raised papules, and large plaques covered by silvery scales are also noticed on the elbows and the knees. Psoriasis is diagnosed and the nurse provides information about treatment to the client. The nurse determines that the client needs additional information if the client states that which of the following is a component of the treatment plan?

a. tar baths
b. ultraviolet light treatments
c. topical lubricants
d. systemic corticosteroids

22. A client is seen in the health care clinic and a biopsy is performed on a skin lesion that the physician suspects malignant melanoma. The nurse prepares a plan of care for the client based on which characteristics of this type of skin cancer?

a. it is an aggressive cancer that requires aggressive therapy to control its rapid spread
b. it is a slow-growing cancer and seldom metastasizes
c. it can grow so large that an entire area, such as the nose, the lip, or the ear must be removed and reconstructed if it occurs on the face
d. it is the most common form of skin cancer

23. A nurse is caring for a client brought to the emergency room following a burn injury that occurred in the basement of the home. Which initial finding would indicate the presence of inhalation injury?

a. expectoration of sputum tinged with blood
b. the presence of singed nasal hair
c. absent breath sounds in the lower lobes bilaterally
d. tachycardia

24. A nurse is caring for a client who arrives at the emergency room with the emergency medical services team following a severe burn injury from an explosion. Once the initial assessment has been performed by the physician and life-threatening dysfunctions have been addressed, the nurse reviews the physician’s orders anticipating that which pain medication will be prescribed?

a. intravenous (IV) morphine sulfate
b. aspirin with oxycodone (percodan) via nasogastric tube
c. acetaminophen (tylenol) with codeine sulfate
d. morphine sulfate by the subcutaneous route

25. A nurse is assessing the operative site in a client who underwent a breast reconstruction. The nurse is inspecting the flap and the areola of the nipple and notes that the areola is a deep red color around the edge. The nurse takes which action first?

a. document the findings
b. elevate the breast
c. encourage nipple massage
d. notify the physician

26. A nurse performs a skin assessment on an assigned client and notes the presence of lesions that are red-tan scaly plaques. The nurse documents this findings as:

a. seborrhea
b. xerosis
c. pruritus
d. actinic keratoses

27. A community health nurse has provided fire safety instructions to a group of individuals who are part of a disaster response team. Which statement by a group member indicates a need for further instructions?

a. “the victim may be rolled on the ground to extinguish the flames”
b. “a blanket or another cover can be used to smother the flames”
c. “flames should be doused with water”
d. “keep the victim in standing position so flames won’t spread to other parts of the body”

28. A community health nurse is providing a teaching session to firefighters in a small community regarding care to a victim at the scene of a burn injury. The community health nurse instructs the firefighters that in the event of a tar burn the immediate action would be to:

a. cool the injury with water
b. remove all clothing immediately
c. remove the tar from the burn injury
d. leave any clothing that is saturated with tar in place


29. The client who sustained an inhalation injury arrives in the emergency department. On assessment of the client, the nurse notes that the client is very confused and combative. The nurse determines that the client is experiencing:

a. anxiety
b. fear
c. hypoxia
d. pain

30. The client is diagnosed with stage 1 of Lyme disease. The nurse assesses the client for the hallmark characteristic of this stage. Which assessment finding would the nurse expect to note?

a. dizziness and headaches
b. enlarged and inflamed joints
c. arthralgias
d. skin rash

31. The emergency department nurse is performing an assessment on a client who has sustained circumferential burns of both legs. Which assessment would be the priority in caring for this client?

a. assessing peripheral pulses
b. assessing neurological status
c. assessing urine output
d. assessing blood pressure

32. The nurse is reviewing the discharge instructions for a client who had skin biopsy. Which statement by the client indicates a need for further instructions?

a. “I will watch for any drainage from the wound”
b. “I will return tomorrow to have the sutures removed”
c. “I will use antibiotic ointment as prescribed”
d. “I will keep the dressing dry”

33. The nurse preparing to assist the physician to examine the client’s skin with a Wood’s light would do which of the following?

a. obtain an informed consent
b. tell the client that the procedure is painless
c. shave the skin site
d. prepare a local anesthetic

34. The nurse provides discharge instructions to a client following patch testing. Which instruction would the nurse provide to the client?

a. return to the clinic in 2 weeks for the initial reading
b. reapply the patch if it comes off
c. continue all current activities
d. keep the test sites dry

35. A nurse is preparing a client for skin grafting and notes that the physician has documented that the client is scheduled for heterograft. The nurse understands that the heterograft used for the burn client is skin from:

a. another species
b. a cadaver
c. the burned client
d. a skin bank

36. Following assessment and diagnostic evaluation, it has been determined that the client has Stage II of Lyme disease. The nurse expects to note which assessment finding that is most indicative of this stage?

a. erythematous rash
b. cardiac conduction defects
c. arthralgias
d. enlargement of joints

37. The clinic nurse reads the chart of a client that was seen by the physician and notes that the physician has documented that the client has Stage III of Lyme disease. Which clinical manifestation would the nurse expect to note in the client?

a. a generalized skin rash
b. a cardiac dysrhythmia
c. complaints of joint pain
d. paralysis in the extremity where the tick bite occurred

38. A female client arrives at the health care clinic and tells the nurse that she was bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which nursing action is appropriate?

a. refer the client for a blood test immediately
b. inform the client that the tick is needed to perform the test
c. inform the client that she will need to return in 6 weeks to be tested because testing before this time is not reliable
d. ask the client about the size and color of the tick

39. The client suspected of having Stage I of Lyme disease is seen in the health care clinic and is told that the Lyme disease test is positive. The client asks the nurse about the treatment for the disease. The nurse responds to the client, anticipating which of the following to be part of the treatment plan?

a. no treatment unless symptoms develop
b. a 3-week course of oral antibiotic therapy
c. treatment with intravenous penicillin G
d. ultraviolet light therapy

40. The client with acquired immunodeficiency syndrome (AIDS) is suspected of having cutaneous Kaposi’s sarcoma. The nurse prepares the client for which test that will confirm the presence of this type of sarcoma?

a. sputum culture
b. liver biopsy
c. punch biopsy of the lesion
d. white blood cell count

41. The client who is newly admitted to the hospital for treatment of acute cellulitis of the lower left leg asks the nurse about the nature of the disorder. The nurse would respond that cellulitis is actually:

a. a skin infection into the deep dermis and subcutaneous fat
b. an acute superficial infection
c. an inflammation of the epidermis
d. an epidermal infection caused by Staphylococcus

42. A nurse is preparing a plan of care for a client with a diagnosis of acute cellulitis of the lower leg. The nurse anticipates which measure will be prescribed to treat this condition?

a. warm moist compresses to the affected area
b. cold compresses to the affected area
c. heat lamp treatments 4 times daily
d. alternating hot to cold compresses every 2 hours

43. A clinic nurse provides instructions to a client who will be taking isotretinoin (Accutane) for severe cystic acne. Which statement by the client indicates the need for further instructions?

a. “I need to return to the clinic for a blood test to check my triglyceride level”
b. “The medication may cause my lips to burn”
c. “The medication may cause dryness and burning in my eyes”
d. “I need to take vitamin A supplements to improve the effectiveness of this treatment”

44. A client sustained full-thickness burns to both hands from scalding water. A sheet graft was surgically applied to the wounds. The nurse tells the client that this type of graft is indicated for which of the following primary purposes?

a. better adherence to the wound bed
b. better cosmetic result
c. better donor site availability
d. easier to care for initially

45. A client sustained a major burn is beginning to take an oral diet again. The nurse plans to encourage the client to eat variety of which of the following types of foods to best help in continued wound healing and tissue repair?

a. high carbohydrate and low protein
b. high fat and low carbohydrate
c. high protein and high fat
d. high protein and high carbohydrate

46. A client with a major burn is admitted to the emergency department. The nurse anticipates that which of the following routes will be ordered for analgesics for this client?

a. intramuscular
b. intravenous
c. oral
d. subcutaneous

47. A nurse is performing a skin assessment of a client who is immobile and notes the presence of partial thickness skin loss of the upper layer of the skin in the sacral area. The nurse documents these findings as a:

a. stage 1 pressure ulcer
b. stage 2 pressure ulcer
c. stage 3 pressure ulcer
d. stage 4 pressure ulcer

48. A student nurse is instructed by the registered nurse to monitor a client who has dark skin for cyanosis. The registered nurse determines that the student needs instructions regarding physical assessment techniques for the dark-skinned client if the student states that the best area to assess for cyanosis was in the:

a. nail beds
b. lips
c. sclera of the eye
d. tongue

49. A client with severe psoriasis has a nursing diagnosis of Chronic Low Self-Esteem. The nurse uses which therapeutic strategy when working with this client?

a. listening attentively
b. pretending not to notice affected skin areas
c. keeping communications brief
d. approaching the client in a formal manner

50. A nurse caring for a client who sustained a high-voltage electrical injury analyzes the client’s test results. Which finding would the nurse interpret as increasing the client’s risk of developing acute tubular necrosis?

a. myoglobin in the urine
b. carbonaceous sputum
c. hyperkalemia
d. cloudy cerebrospinal fluid

Medical Surgical Nursing Practice Test
Answer Key: http://www.4shared.com/office/ESy9VlTy/75_items_MS_Random_Questions_w.html?
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1. The nursing care plan for a toddler diagnosed with Kawasaki Disease (mucocutaneous lymph node syndrome) should be based on the high risk for development of which problem?

A) Chronic vessel plaque formation
B) Pulmonary embolism
C) Occlusions at the vessel bifurcations
D) Coronary artery aneurysms

2. A nurse has just received a medication order which is not legible. Which statement best reflects assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you mean."
B) "Would you please clarify what you have written so I am sure I am reading it correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if you would be more careful."
D) "Please print in the future so I do not have to spend extra time attempting to read your writing."

3. The nurse is discussing negativism with the parents of a 30 month-old child. How should the nurse tell the parents to best respond to this behavior?

A) Reprimand the child and give a 15 minute "time out"
B) Maintain a permissive attitude for this behavior
C) Use patience and a sense of humor to deal with this behavior
D) Assert authority over the child through limit setting

4. An ambulatory client reports edema during the day in his feet and an ankle that disappears while sleeping at night. What is the most appropriate follow-up question for the nurse to ask?
A) "Have you had a recent heart attack?"
B) "Do you become short of breath during your normal daily activities?"
C) "How many pillows do you use at night to sleep comfortably?"
D) "Do you smoke?"

5. The nurse is planning care for a client during the acute phase of a sickle cell vaso-occlusive crisis. Which of the following actions would be most appropriate?
A) Fluid restriction 1000cc per day
B) Ambulate in hallway 4 times a day
C) Administer analgesic therapy as ordered
D) Encourage increased caloric intake

6. While working with an obese adolescent, it is important for the nurse to recognize that obesity in adolescents is most often associated with what other behavior?
A) Sexual promiscuity
B) Poor body image
C) Dropping out of school
D) Drug experimentation

7. A nurse and client are talking about the client’s progress toward understanding his behavior under stress. This is typical of which phase in the therapeutic relationship?
A) Pre-interaction
B) Orientation
C) Working
D) Termination

8. A nurse is eating in the hospital cafeteria when a toddler at a nearby table chokes on a piece of food and appears slightly blue. The appropriate initial action should be to
A) Begin mouth to mouth resuscitation
B) Give the child water to help in swallowing
C) Perform 5 abdominal thrusts
D) Call for the emergency response team

9. The emergency room nurse admits a child who experienced a seizure at school. The father comments that this is the first occurrence, and denies any family history of epilepsy. What is the best response by the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures."

10. A nurse admits a 3 week-old infant to the special care nursery with a diagnosis of bronchopulmonary dysplasia. As the nurse reviews the birth history, which data would be most consistent with this diagnosis?
A) Gestational age assessment suggested growth retardation
B) Meconium was cleared from the airway at delivery
C) Phototherapy was used to treat Rh incompatibility
D) The infant received mechanical ventilation for 2 weeks

11. Parents of a 6 month-old breast fed baby ask the nurse about increasing the baby's diet. Which of the following should be added first?
A) Cereal
B) Eggs
C) Meat
D) Juice

12. A victim of domestic violence states, "If I were better, I would not have been beat." Which feeling best describes what the victim may be experiencing?
A) Fear
B) Helplessness
C) Self-blame
D) Rejection

13. The nurse is assessing the mental status of a client admitted with possible organic brain disorder. Which of these questions will best assess the function of the client's recent memory?
A) "Name the year." "What season is this?" (pause for answer after each question)
B) "Subtract 7 from 100 and then subtract 7 from that." (pause for answer) "Now continue to subtract 7 from the new number."
C) "I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."
D) "What is this on my wrist?" (point to your watch) Then ask, "What is the purpose of it?"

14. Which oxygen delivery system would the nurse apply that would provide the highest concentrations of oxygen to the client?
A) Venturi mask
B) Partial rebreather mask
C) Non-rebreather mask
D) Simple face mask

15. A nurse is caring for a client who had a closed reduction of a fractured right wrist followed by the application of a fiberglass cast 12 hours ago. Which finding requires the nurse’s immediate attention?
A) Capillary refill of fingers on right hand is 3 seconds
B) Skin warm to touch and normally colored
C) Client reports prickling sensation in the right hand
D) Slight swelling of fingers of right hand

16. Included in teaching the client with tuberculosis taking INH about follow-up home care, the nurse should emphasize that a laboratory appointment for which of the following lab tests is critical?
A) Liver function
B) Kidney function
C) Blood sugar
D) Cardiac enzymes

17. Which client is at highest risk for developing a pressure ulcer?
A) 23 year-old in traction for fractured femur
B) 72 year-old with peripheral vascular disease, who is unable to walk without assistance
C) 75 year-old with left sided paresthesia and is incontinent of urine and stool
D) 30 year-old who is comatose following a ruptured aneurysm

18. Which contraindication should the nurse assess for prior to giving a child immunization?
A) Mild cold symptoms
B) Chronic asthma
C) Depressed immune system
D) Allergy to eggs

19. The nurse is caring for a 2 year-old who is being treated with chelation therapy, calcium disodium edetate, for lead poisoning. The nurse should be alert for which of the following side effects?
A) Neurotoxicity
B) Hepatomegaly
C) Nephrotoxicity
D) Ototoxicity

20. A newborn is having difficulty maintaining a temperature above 98 degrees Fahrenheit and has been placed in a warming isolette. Which action is a nursing priority?
A) Protect the eyes of the neonate from the heat lamp
B) Monitor the neonate’s temperature
C) Warm all medications and liquids before giving
D) Avoid touching the neonate with cold hands


21. At a senior citizens meeting a nurse talks with a client who has diabetes mellitus Type 1. Which statement by the client during the conversation is most predictive of a potential for impaired skin integrity?
A) "I give my insulin to myself in my thighs."
B) "Sometimes when I put my shoes on I don't know where my toes are."
C) "Here are my up and down glucose readings that I wrote on my calendar."
D) "If I bathe more than once a week my skin feels too dry."

22. A 4 year-old hospitalized child begins to have a seizure while playing with hard plastic toys in the hallway. Of the following nursing actions, which one should the nurse do first?

A) Place the child in the nearest bed
B) Administer IV medication to slow down the seizure
C) Place a padded tongue blade in the child's mouth
D) Remove the child's toys from the immediate area

23. The nurse is at the community center speaking with retired people. To which comment by one of the retirees during a discussion about glaucoma would the nurse give a supportive comment to reinforce correct information?

A) "I usually avoid driving at night since lights sometimes seem to make things blur."
B) "I take half of the usual dose for my sinuses to maintain my blood pressure."
C) "I have to sit at the side of the pool with the grandchildren since I can't swim with this eye problem."
D) "I take extra fiber and drink lots of water to avoid getting constipated.”

24. The nurse is teaching a parent about side effects of routine immunizations. Which of the following must be reported immediately?
A) Irritability
B) Slight edema at site
C) Local tenderness
D) Temperature of 102.5 F

25. A client is admitted with the diagnosis of pulmonary embolism. While taking a history, the client tells the nurse he was admitted for the same thing twice before, the last time just 3 months ago. The nurse would anticipate the health care provider ordering
A) Pulmonary embolectomy
B) Vena caval interruption
C) Increasing the coumadin therapy to an INR of 3-4
D) Thrombolytic therapy

26. A woman in her third trimester complains of severe heartburn. What is appropriate teaching by the nurse to help the woman alleviate these symptoms?
A) Drink small amounts of liquids frequently
B) Eat the evening meal just before retiring
C) Take sodium bicarbonate after each meal
D) Sleep with head propped on several pillows

27. The nurse is teaching the mother of a 5 month-old about nutrition for her baby. Which statement by the mother indicates the need for further teaching?

A) "I'm going to try feeding my baby some rice cereal."
B) "When he wakes at night for a bottle, I feed him."
C) "I dip his pacifier in honey so he'll take it."
D) "I keep formula in the refrigerator for 24 hours."

28. For a 6 year-old child hospitalized with moderate edema and mild hypertension associated with acute glomerulonephritis (AGN), which one of the following nursing interventions would be appropriate?
A) Institute seizure precautions
B) Weigh the child twice per shift
C) Encourage the child to eat protein-rich foods
D) Relieve boredom through physical activity

29. Which statement by the client with chronic obstructive lung disease indicates an understanding of the major reason for the use of occasional pursed-lip breathing?
A) "This action of my lips helps to keep my airway open."
B) "I can expel more when I pucker up my lips to breathe out."
C) "My mouth doesn't get as dry when I breathe with pursed lips."
D) "By prolonging breathing out with pursed lips the little areas in my lungs don't collapse."

30. A 57 year-old male client has hemoglobin of 10 mg/dl and a hematocrit of 32%. What would be the most appropriate follow-up by the home care nurse?
A) Ask the client if he has noticed any bleeding or dark stools
B) Tell the client to call 911 and go to the emergency department immediately
C) Schedule a repeat Hemoglobin and Hematocrit in 1 month
D) Tell the client to schedule an appointment with a hematologist

31. Which response by the nurse would best assist the chemically impaired client to deal with issues of guilt?
A) "Addiction usually causes people to feel guilty. Don’t worry, it is a typical response due to your drinking behavior."
B) "What have you done that you feel most guilty about and what steps can you begin to take to help you lessen this guilt?"
C) "Don’t focus on your guilty feelings. These feelings will only lead you to drinking and taking drugs."
D) "You’ve caused a great deal of pain to your family and close friends, so it will take time to undo all the things you’ve done."

32. An adolescent client comes to the clinic 3 weeks after the birth of her first baby. She tells the nurse she is concerned because she has not returned to her pre-pregnant weight. Which action should the nurse perform first?
A) Review the client's weight pattern over the year
B) Ask the mother to record her diet for the last 24 hours
C) Encourage her to talk about her view of herself
D) Give her several pamphlets on postpartum nutrition

33. Which of the following measures would be appropriate for the nurse to teach the parent of a nine month-old infant about diaper dermatitis?
A) Use only cloth diapers that are rinsed in bleach
B) Do not use occlusive ointments on the rash
C) Use commercial baby wipes with each diaper change
D) Discontinue a new food that was added to the infant's diet just prior to the rash

34. A 16 year-old client is admitted to a psychiatric unit with a diagnosis of attempted suicide. The nurse is aware that the most frequent cause for suicide in adolescents is
A) Progressive failure to adapt
B) Feelings of anger or hostility
C) Reunion wish or fantasy
D) Feelings of alienation or isolation

35. A mother brings her 26 month-old to the well-child clinic. She expresses frustration and anger due to her child's constantly saying "no" and his refusal to follow her directions. The nurse explains this is normal for his age, as negativism is attempting to meet which developmental need?
A) Trust
B) Initiative
C) Independence
D) Self-esteem

36. Following mitral valve replacement surgery a client develops PVC’s. The health care provider orders a bolus of Lidocaine followed by a continuous Lidocaine infusion at a rate of 2 mgm/minute. The IV solution contains 2 grams of Lidocaine in 500 cc’s of D5W. The infusion pump delivers 60 microdrops/cc. What rate would deliver 4 mgm of Lidocaine/minute?
A) 60 microdrops/minute
B) 20 microdrops/minute
C) 30 microdrops/minute
D) 40 microdrops/minute

37. A couple asks the nurse about risks of several birth control methods. What is the most appropriate response by the nurse?
A) Norplant is safe and may be removed easily
B) Oral contraceptives should not be used by smokers
C) Depo-Provera is convenient with few side effects
D) The IUD gives protection from pregnancy and infection

38. The nurse is caring for a client in the late stages of Amyotrophic Lateral Sclerosis (A.L.S.). Which finding would the nurse expect?
A) Confusion
B) Loss of half of visual field
C) Shallow respirations
D) Tonic-clonic seizures

39. A client experiences post partum hemorrhage eight hours after the birth of twins. Following administration of IV fluids and 500 ml of whole blood, her hemoglobin and hematocrit are within normal limits. She asks the nurse whether she should continue to breast feed the infants. Which of the following is based on sound rationale?
A) "Nursing will help contract the uterus and reduce your risk of bleeding."
B) "Breastfeeding twins will take too much energy after the hemorrhage."
C) "The blood transfusion may increase the risks to you and the babies."
D) "Lactation should be delayed until the "real milk" is secreted."

40. A client complained of nausea, a metallic taste in her mouth, and fine hand tremors 2 hours after her first dose of lithium carbonate (Lithane). What is the nurse’s best explanation of these findings?
A) These side effects are common and should subside in a few days
B) The client is probably having an allergic reaction and should discontinue the drug
C) Taking the lithium on an empty stomach should decrease these symptoms
D) Decreasing dietary intake of sodium and fluids should minimize the side effects

41. The nurse is caring for a post-surgical client at risk for developing deep vein thrombosis. Which intervention is an effective preventive measure?
A) Place pillows under the knees
B) Use elastic stockings continuously
C) Encourage range of motion and ambulation
D) Massage the legs twice daily

42. The parents of a newborn male with hypospadias want their child circumcised. The best response by the nurse is to inform them that
A) Circumcision is delayed so the foreskin can be used for the surgical repair
B) This procedure is contraindicated because of the permanent defect
C) There is no medical indication for performing a circumcision on any child
D) The procedure should be performed as soon as the infant is stable

43. The nurse is teaching parents about the treatment plan for a 2 weeks-old infant with Tetralogy of Fallot. While awaiting future surgery, the nurse instructs the parents to immediately report
A) Loss of consciousness
B) Feeding problems
C) Poor weight gain
D) Fatigue with crying

44. An infant weighed 7 pounds 8 ounces at birth. If growth occurs at a normal rate, what would be the expected weight at 6 months of age?
A) Double the birth weight
B) Triple the birth weight
C) Gain 6 ounces each week
D) Add 2 pounds each month

45. The nurse is caring for a 13 year-old following spinal fusion for scoliosis. Which of the following interventions is appropriate in the immediate post-operative period?
A) Raise the head of the bed at least 30 degrees
B) Encourage ambulation within 24 hours
C) Maintain in a flat position, logrolling as needed
D) Encourage leg contraction and relaxation after 48 hours

46. A client asks the nurse about including her 2 and 12 year-old sons in the care of their newborn sister. Which of the following is an appropriate initial statement by the nurse?
A) "Focus on your sons' needs during the first days at home."
B) "Tell each child what he can do to help with the baby."
C) "Suggest that your husband spend more time with the boys."
D) "Ask the children what they would like to do for the newborn."

47. A nurse is caring for a 2 year-old child after corrective surgery for Tetralogy of Fallot. The mother reports that the child has suddenly begun seizing. The nurse recognizes this problem is probably due to
A) A cerebral vascular accident
B) Postoperative meningitis
C) Medication reaction
D) Metabolic alkalosis

48. A client with schizophrenia is receiving Haloperidol (Haldol) 5 mg t.i.d.. The client’s family is alarmed and calls the clinic when "his eyes rolled upward." The nurse recognizes this as what type of side effect?
A) Oculogyric crisis
B) Tardive dyskinesia
C) Nystagmus
D) Dysphagia

49. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to
A) A social worker from the local hospital
B) An occupational therapist from the community center
C) A physical therapist from the rehabilitation agency
D) Another client with diabetes mellitus and takes insulin

50. A client was admitted to the psychiatric unit after complaining to her friends and family that neighbors have bugged her home in order to hear all of her business. She remains aloof from other clients, paces the floor and believes that the hospital is a house of torture. Nursing interventions for the client should appropriately focus on efforts to
A) Convince the client that the hospital staff is trying to help
B) Help the client to enter into group recreational activities
C) Provide interactions to help the client learn to trust staff
D) Arrange the environment to limit the client’s contact with other clients

51. A client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The nurse knows that a PTCA is the
A) Surgical repair of a diseased coronary artery
B) Placement of an automatic internal cardiac defibrillator
C) Procedure that compresses plaque against the wall of the diseased coronary artery to improve blood flow
D) Non-invasive radiographic examination of the heart

52. A newborn has been diagnosed with hypothyroidism. In discussing the condition and treatment with the family, the nurse should emphasize
A) They can expect the child will be mentally retarded
B) Administration of thyroid hormone will prevent problems
C) This rare problem is always hereditary
D) Physical growth/development will be delayed

53. A priority goal of involuntary hospitalization of the severely mentally ill client is
A) Re-orientation to reality
B) Elimination of symptoms
C) Protection from harm to self or others
D) Return to independent functioning

54. A 19 year-old client is paralyzed in a car accident. Which statement used by the client would indicate to the nurse that the client was using the mechanism of "suppression"?
A) "I don't remember anything about what happened to me."
B) "I'd rather not talk about it right now."
C) "It's the other entire guy's fault! He was going too fast."
D) "My mother is heartbroken about this."

55. The nurse is caring for a woman 2 hours after a vaginal delivery. Documentation indicates that the membranes were ruptured for 36 hours prior to delivery. What are the priority nursing diagnoses at this time?
A) Altered tissue perfusion
B) Risk for fluid volume deficit
C) High risk for hemorrhage
D) Risk for infection

56. A 3 year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should
A) Expose the cast to air and turn the child frequently
B) Use a heat lamp to reduce the drying time
C) Handle the cast with the abductor bar
D) Turn the child as little as possible

57. A client is scheduled for an Intravenous Pyelogram (IVP). In order to prepare the client for this test, the nurse would:
A) Instruct the client to maintain a regular diet the day prior to the examination
B) Restrict the client's fluid intake 4 hours prior to the examination
C) Administer a laxative to the client the evening before the examination
D) Inform the client that only 1 x-ray of his abdomen is necessary

58. Following a diagnosis of acute glomerulonephritis (AGN) in their 6 year-old child, the parent’s remark: “We just don’t know how he caught the disease!” The nurse's response is based on an understanding that
A) AGN is a streptococcal infection that involves the kidney tubules
B) The disease is easily transmissible in schools and camps
C) The illness is usually associated with chronic respiratory infections
D) It is not "caught" but is a response to a previous B-hemolytic strep infection

59. The nurse is caring for a 20 lbs (9 kg) 6 month-old with a 3 day history of diarrhea, occasional vomiting and fever. Peripheral intravenous therapy has been initiated, with 5% dextrose in 0.33% normal saline with 20 mEq of potassium per liter infusing at 35 ml/hr. Which finding should be reported to the health care provider immediately?
A) 3 episodes of vomiting in 1 hour
B) Periodic crying and irritability
C) Vigorous sucking on a pacifier
D) No measurable voiding in 4 hours

60. While caring for the client during the first hour after delivery, the nurse determines that the uterus is boggy and there is vaginal bleeding. What should be the nurse's first action?
A) Check vital signs
B) Massage the fundus
C) Offer a bedpan
D) Check for perineal lacerations

61. The nurse is assessing an infant with developmental dysplasia of the hip. Which finding would the nurse anticipate?
A) Unequal leg length
B) Limited adduction
C) Diminished femoral pulses
D) Symmetrical gluteal folds

62. To prevent a valsalva maneuver in a client recovering from an acute myocardial infarction, the nurse would
A) Assist the client to use the bedside commode
B) Administer stool softeners every day as ordered
C) Administer antidysrhythmics prn as ordered
D) Maintain the client on strict bed rest

63. On admission to the psychiatric unit, the client is trembling and appears fearful. The nurse’s initial response should be to
A) Give the client orientation materials and review the unit rules and regulations
B) Introduce him/her and accompany the client to the client’s room
C) Take the client to the day room and introduce her to the other clients
D) Ask the nursing assistant to get the client’s vital signs and complete the admission search

64. During the admission assessment on a client with chronic bilateral glaucoma, which statement by the client would the nurse anticipate since it is associated with this problem?
A) "I have constant blurred vision."
B) "I can't see on my left side."
C) "I have to turn my head to see my room."
D) "I have specks floating in my eyes."

65. A client with asthma has low pitched wheezes present on the final half of exhalation. One hour later the client has high pitched wheezes extending throughout exhalation. This change in assessment indicates to the nurse that the client
A) Has increased airway obstruction
B) Has improved airway obstruction
C) Needs to be suctioned
D) Exhibits hyperventilation

66. Which behavioral characteristic describes the domestic abuser?
A) Alcoholic
B) Over confident
C) High tolerance for frustrations
D) Low self-esteem

67. The nurse is caring for a client with a long leg cast. During discharge teaching about appropriate exercises for the affected extremity, the nurse should recommend
A) Isometric
B) Range of motion
C) Aerobic
D) Isotonic

68. A client is in her third month of her first pregnancy. During the interview, she tells the nurse that she has several sex partners and is unsure of the identity of the baby's father. Which of the following nursing interventions is a priority?
A) Counsel the woman to consent to HIV screening
B) Perform tests for sexually transmitted diseases
C) Discuss her high risk for cervical cancer
D) Refer the client to a family planning clinic

69. A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her and begins to cry. What would be the initial action by the nurse?
A) Arrange to change client care assignments
B) Explain that this behavior is expected
C) Discuss the appropriate use of "time-out"
D) Explain that the child needs extra attention

70. While planning care for a 2 year-old hospitalized child, which situation would the nurse expect to most likely affect the behavior?
A) Strange bed and surroundings
B) Separation from parents
C) Presence of other toddlers
D) Unfamiliar toys and games

71. While explaining an illness to a 10 year-old, what should the nurse keep in mind about the cognitive development at this age?
A) They are able to make simple association of ideas
B) They are able to think logically in organizing facts
C) Interpretation of events originate from their own perspective
D) Conclusions are based on previous experiences

72. The nurse is has just admitted a client with severe depression. From which focus should the nurse identify a prioriy nursing diagnosis?
A) Nutrition
B) Elimination
C) Activity
D) Safety

73. Which playroom activities should the nurse organize for a small group of 7 year-old hospitalized children?
A) Sports and games with rules
B) Finger paints and water play
C) "Dress-up" clothes and props
D) Chess and television programs

74. A client is discharged following hospitalization for congestive heart failure. The nurse teaching the family suggests they encourage the client to rest frequently in which of the following positions?
A) High Fowler's
B) Supine
C) Left lateral
D) Low Fowler's

75. The nurse is caring for a 10 year-old on admission to the burn unit. One assessment parameter that will indicate that the child has adequate fluid replacement is
A) Urinary output of 30 ml per hour
B) No complaints of thirst
C) Increased hematocrit
D) Good skin turgor around burn

Musculo-Skeletal Nursing Concept Practice Test
Answer Key: http://www.4shared.com/office/dQduEatK/60_Item_Medical_Surgical_Nursi.html?
Adobe PDF Reader is required


1. A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position?

a. Supine
b. Semi Fowler's
c. Orthopneic
d. Trendelenburg

2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make?

a. Observe the color of the fingers
b. Palpate the radial pulse under the cast
c. Check the cast for odor and drainage
d. Evaluate the response to analgesics

3. After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for:

a. An anaphylactic reaction to the dye
b. Inflammation from the extravasation of fluid during injection.
c. Fluid overload from the volume of the infusions
d. A normal reaction to the stress of the diagnostic procedure.

4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician?

a. Moderate pain, as reported by the client
b. Report, by client, the heat is being felt under the cast
c. Presence of slight edema of the toes of the casted foot
d. Onset of paralysis in the toes of the casted foot

5. Which of these nursing actions will best promote independence for the client in skeletal traction?

a. Instruct the client to call for an analgesic before pain becomes severe.
b. Provide an overhead trapeze for client use
c. Encourage leg exercise within the limits of traction
d. Provide skin care to prevent skin breakdown.

6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis.

a. The client reports pain in the affected leg
b. A large hematoma is visible in the affected extremity
c. The affected extremity is shortenend, adducted, and extremely rotated
d. The affected extremity is edematous.

7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan?

a. Order a trapeze to increase the client's ambulation
b. Maintain the client in a flat, supine position at all times.
c. Provide pin care at least every hour
d. Remove traction weights for 20 minutes every two hours.

8. To prevent foot drop in a client with Buck's traction, the nurse should:

a. Place pillows under the client's heels.
b. Tuck the sheets into the foot of the bed
c. Teach the client isometric exercises
d. Ensure proper body positioning.

9. Which nursing intervention is appropriate for a client with skeletal traction?

a. Pin care
b. Prone positioning
c. Intermittent weights
d. 5lb weight limit

10. In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position?

a. Supine
b. Prone
c. Sim's
d. Lithotomy

11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:

a. It will be very painful for the client
b. The soft tissue around the site will be damaged
c. Displacement can occur with flexion
d. It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a:

a. Trochanter roll by the knee
b. Sandbag to the lateral calf
c. Trochanter roll to the thigh
d. Footboard

13. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:

a. Leave the pillow as his stump is elevated
b. Remove the pillow and elevate the foot of the bed
c. Leave the pillow and elevate the foot of the bed
d. Check with the physician and clarify the orders

14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

a. Protect the skin with lotion
b. Keep the client pulled up in bed
c. Pad the top of the splint with washcloths
d. Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to:

a. Reduce fever
b. Reduce the inflammation of the joints
c. Assist the client's range of motion activities without pain
d. Prevent extension of the disease process

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is:

a. Ability to ambulate sooner
b. Less change of phantom limb sensation
c. Dressing changes are not necessary
d. Better fit of the prosthesis

17. One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to:

a. Cough and deep breathe
b. Turn himself in bed
c. Perform biceps exercise
d. Wiggle his toes

18. The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to:

a. Get the client up in a chair after dangling at the bedside.
b. Use a walker for balance when getting the client out of bed
c. Have the client put minimal weight on the affected side when getting up
d. Practice getting the client out of bed by having her slightly flex her hips

19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to:

a. Anchor the traction
b. Prevent footdrop
c. Keep the client from sliding down in bed
d. Prevent pressure areas on the foot

20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the:

a. Client's position
b. Rope/pulley system
c. Amount of weight
d. Point of friction

21. When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by:

a. Elevating the foot of the bed
b. Elevating the head of the bed
c. Application of the pelvic girdle
d. Lowering the head of the bed

22. After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for:

a. Increase in the temperature
b. Change in color
c. Edema
d. Movement

23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for:

a. Urinary retention
b. Bladder distention
c. Weight gain
d. Bower evacuation

24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has

a. Headaches
b. Tarry stools
c. Blurred vision
d. Decreased appetite

25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to

a. Read a story and act out the part
b. Watch a puppet show
c. Watch television
d. Listen to the radio

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses:

a. Limited motion of joints
b. Deformed joints of the hands
c. Early morning stiffness
d. Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching?

a. History of Epstein-Barr virus infection
b. Female gender
c. Adults between the ages 60 to 75 years
d. Positive testing for human leukocyte antigen (HLA) DR4 allele

28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods?

a. Proper body alignment
b. Elevating the part
c. Prone lying positions
d. Positions of flexion

29. After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching?

a. "I will take my vitamins while I am on this drug"
b. "I must not drink any alcohol while I'm taking this drug"
c. I should brush my teeth after every meal"
d. "I will continue taking my birth control pills"

30. When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess?

a. Anemia c. Weight loss
b. Osteoporosis d. Local joint pain

31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

a. At bedtime c. Immediately after meal
b. On arising d. On an empty stomach

32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?

a. Hepatotoxicity
b. Renal toxicity
c. Gastrointestinal bleeding
d. Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?

a. A developing infection
b. Bleeding in the operative site
c. Joint dislocation
d. Glue seepage into soft tissue

34. Which of the following would the nurse assess in a client with an intracapsular hip fracture?

a. Internal rotation
c. Shortening of the affected leg
b. Muscle flaccidity
d. Absence of pain the fracture area

35. Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?

a. Informing the client that the procedure is painless
b. Taking a thorough history of past surgeries
c. Checking for previous complaints of claustrophobia
d. Starting an intravenous line at keep-open rate

36. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site?

a. Elevate the stump
b. Reinforcing the dressing
c. Calling the surgeon
d. Drawing a mark around the site

37. A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?

a. Tell the client it is impossible to feel the pain
b. Show the client that the toes are not there
c. Explain to the client that the pain is real
d. Give the client the prescribed narcotic analgesic

38. The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches?

a. Abdominal exercises
b. Isometric shoulder exercises
c. Quadriceps setting exercises
d. Triceps stretching exercises

39. The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas?

a. Axillae
b. Elbows
c. Upper arms
d. Hands

40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following?

a. Hemorrhage
b. Infection
c. Deformity
d. Shock

41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect?

a. Killing of microorganisms
b. Reduction in itching
c. Relief of muscle spasms
d. Decrease in nervousness

42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following?

a. Expected common side effects
b. Hypersensitivity reactions
c. Possible habituating effects
d. Hemorrhage from GI irritation

43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first?

a. The area proximal to the fracture
b. The actual fracture site
c. The area distal to the fracture
d. The opposite extremity for baseline comparison

44. A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure?

a. Rales c. Generalized edema
b. Jaundice d. Dark, scanty urine

45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?

a. Acute respiratory distress syndrome
b. Migraine like headaches
c. Numbness in the right leg
d. Muscle spasms in the right thigh

46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?

a. Pulmonary emboli
b. Osteomyelitis
c. Fat emboli
d. Urinary tract infection

47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely?

a. Formation of scar tissue interfering with absorption
b. Development of pus leading to ischemia
c. Production of bacterial growth by a vascular tissue
d. Antibiotics not being instilled directly into the bone

48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?

a. Homan's sign
c. Tenderness
b. Pain
d. Leg girth

49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority?

a. Allergy to iodine or shellfish
b. Ability of the client to remain still during the procedure
c. Whether the client has any remaining questions about the procedure
d. Whether the client wishes to void before the procedure

50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client?

a. Divertional activity deficit
b. Powerlessness
c. Self care deficit
d. Impaired physical mobility

51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions?

a. The gallium will be injected intravenously 2 to 3 hours before the procedure
b. The procedure takes about 15 minutes to perform
c. The client must stand erect during the filming
d. The client should remain on bed rest for the remainder of the day after the scan

52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection?

a. Coolness and pallor of the extremity
b. Presence of a "hot spot" on the cast
c. Diminished distal pulse
d. Dependent edema

53. The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device?

a. Massage the skin of the right leg with lotion every 8 hours
b. Give pin care once a shift
c. Inspect the skin on the right leg at least once every 8 hours
d. Release the weights on the right leg for range of motion exercises daily

54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the:

a. Left leg and right crutch then right leg and left crutch
b. Crutches and then both legs simultaneously
c. Crutches and the right leg then advance the left leg
d. Crutches and the left leg then advance the right leg

55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the:

a. Left hand and placing the cane in front of the left foot
b. Right hand and placing the cane in front of the right foot
c. Left hand and 6 inches lateral to the left foot
d. Right hand and 6 inches lateral to the left foot

56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a:

a. Pillow to keep the right leg abducted during turning
b. Pillow to keep the right leg adducted during turning
c. Trochanter roll to prevent external rotation while turning
d. Trochanter roll to prevent abduction while turning

57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint:

a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting
b. Apply an Ace wrap around the dressing and put ice on the knee while sitting
c. Lift the client to the bedside change leaving the CPM machine in place
d. Obtain a walker to minimize weight bearing by the client on the affected leg

58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately:

a. Calls the physician
b. Rewrap the stump with an elastic compression bandage
c. Applies ice to the site
d. Applies a dry sterile dressing and elevates it on a pillow

59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to:

a. Wear a clean nylon stump sock daily
b. Toughen the skin of the stump by rubbing it with alcohol
c. Prevent cracking of the skin of the stump by applying lotion daily
d. Using a mirror to inspect all areas of the stump each day

60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client?

a. Uric acid level of 8 mg/dl
b. Calcium level of 9 mg/dl
c. Phosphorus level of 3 mg/dl
d. Uric acid level of 5 mg/dl

Cardiovascular Nursing Concept Practice Test
Answer Key: http://www.4shared.com/office/VpJSrnjX/60_item_Exam_on_CardioVascular.html?
Adobe PDF Reader is required


1. Which of the following arteries primarily feeds the anterior wall of the heart?
a. Circumflex artery
b. Internal mammary artery
c. Left anterior descending artery
d. Right coronary artery

2. When do coronary arteries primarily receive blood flow?
a. During inspiration
b. During diastole
c. During expiration
d. During systole

3. Which of the following illnesses is the leading cause of death in the US?
a. Cancer
b. Coronary artery disease
c. Liver failure
d. Renal failure

4. Which of the following conditions most commonly results in CAD?
a. Atherosclerosis
b. DM
c. MI
d. Renal failure

5. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
a. Plaques obstruct the vein
b. Plaques obstruct the artery
c. Blood clots form outside the vessel wall
d. Hardened vessels dilate to allow the blood to flow through

6. Which of the following risk factors for coronary artery disease cannot be corrected?
a. Cigarette smoking
b. DM
c. Heredity
d. HPN

7. Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease?
a. 100 mg/dl
b. 150 mg/dl
c. 175 mg/dl
d. 200 mg/dl

8. Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease?
a. Decrease anxiety
b. Enhance myocardial oxygenation
c. Administer sublignual nitroglycerin
d. Educate the client about his symptoms

9. Medical treatment of coronary artery disease includes which of the following procedures?
a. Cardiac catheterization
b. Coronary artery bypass surgery
c. Oral medication administration
d. Percutaneous transluminal coronary angioplasty

10. Prolonged occlusion of the right coronary artery produces an infarction in which of he following areas of the heart?
a. Anterior
b. Apical
c. Inferior
d. Lateral

11. Which of the following is the most common symptom of myocardial infarction?
a. Chest pain
b. Dyspnea
c. Edema
d. Palpitations

12. Which of the following landmarks is the corect one for obtaining an apical pulse?
a. Left intercostal space, midaxillary line
b. Left fifth intercostal space, midclavicular line
c. Left second intercostal space, midclavicular line
d. Left seventh intercostal space, midclavicular line

13. Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration?
a. Cardiac
b. Gastrointestinal
c. Musculoskeletal
d. Pulmonary

14. A murmur is heard at the second left intercostal space along the left sternal border.
Which valve area is this?
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid

15. Which of the following blood tests is most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d. Creatine kinase

16. What is the primary reason for administering morphine to a client with myocardial infarction?
a. To sedate the client
b. To decrease the client's pain
c. To decrease the client's anxiety
d. To decrease oxygen demand on the client's heart

17. Which of the followng conditions is most commonly responsible for myocardial infarction?
a. Aneurysm
b. Heart failure
c. Coronary artery thrombosis
d. Renal failure

18. What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)?
a. Chloride
b. Digoxin
c. Potassium
d. Sodium

19. After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic changes are these?
a. Electrophysiologic
b. Hematologic
c. Mechanical
d. Metabolic

20. Which of the following complications is indicated by a third heart sound (S3)?
a. Ventricular dilation
b. Systemic hypertension
c. Aortic valve malfunction
d. Increased atrial contractions

21. After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?
a. Left-sided heart failure
b. Pulmonic valve malfunction
c. Right-sided heart failure
d. Tricuspid valve malfunction

22. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?
a. Cardiac catheterization
b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram

23. What is the first intervention for a client experiencing myocardial infarction?
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram

24. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?
a. "Tell me about your feeling right now."
b. "When the doctor arrives, everything will be fine."
c. "This is a bad situation, but you'll feel better soon."
d. "Please be assured we're doing everything we can to make you feel better."

25. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Narcotics
d. Nitrates

26. What is the most common complication of a myocardial infarction?
a. Cardiogenic shock
b. Heart failure
c. Arrhythmias
d. Pericarditis

27. With which of the following disorders is jugular vein distention most prominent?
a. Abdominal aortic aneurysm
b. Heart failure
c. Myocardial infarction
d. Pneumothorax

28. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention?
a. High-fowler's
b. Raised 10 degrees
c. Raised 30 degrees
d. Supine position

29. Which of the following parameters should be checked before administering digoxin?
a. Apical pulse
b. Blood pressure
c. Radial pulse
d. Respiratory rate

30. Toxicity from which of the following medications may cause a client to see a green halo around lights?
a. Digoxin
b. Furosemide
c. Metoprolol
d. Enalapril

31. Which ofthe following symptoms is most commonly associated with left-sided heart failure?
a. Crackles
b. Arrhythmias
c. Hepatic engorgement
d. Hypotension

32. In which of the following disorders would the nurse expect to assess sacral eddema in bedridden client?
a. DM
b. Pulmonary emboli
c. Renal failure
d. Right-sided heart failure

33. Which of the following symptoms might a client with right-sided heart failure exhibit?
a. Adequate urine output
b. Polyuria
c. Oliguria
d. Polydipsia

34. Which of the following classes of medications maximizes cardiac performance in clients with heat failure by increasing ventricular contractility?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Diuretics
d. Inotropic agents

35. Stimulation of the sympathetic nervous system produces which of the following responses?
a. Bradycardia
b. Tachycardia
c. Hypotension
d. Decreased myocardial contractility

36. Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output?
a. Angina pectoris
b. Cardiomyopathy
c. Left-sided heart failure
d. Right-sided heart failure

37. What is the most common cause of abdominal aortic aneurysm?
a. Atherosclerosis
b. DM
c. HPN
d. Syphilis

38. In which of the following areas is an abdominal aortic aneurysm most commonly located?
a. Distal to the iliac arteries
b. Distal to the renal arteries
c. Adjacent to the aortic branch
d. Proximal to the renal arteries

39. A pulsating abdominal mass usually indicates which of the following conditions?
a. Abdominal aortic aneurysm
b. Enlarged spleen
c. Gastic distention
d. Gastritis

40. What is the most common symptom in a client with abdominal aortic aneurysm?
a. Abdominal pain
b. Diaphoresis
c. Headache
d. Upper back pain

41. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm?
a. Abdominal pain
b. Absent pedal pulses
c. Angina
d. Lower back pain

42. What is the definitive test used to diagnose an abdominal aortic aneurysm?
a. Abdominal X-ray
b. Arteriogram
c. CT scan
d. Ultrasound

43. Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?
a. HPN
b. Aneurysm rupture
c. Cardiac arrythmias
d. Diminished pedal pulses

44. Which of the following blood vessel layers may be damaged in a client with an aneurysm?
a. Externa
b. Interna
c. Media
d. Interna and Media

45. When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?
a. Right upper quadrant
b. Directly over the umbilicus
c. Middle lower abdomen to the left of the midline
d. Midline lower abdomen to the right of the midline

46. Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
a. DM
b. HPN
c. PVD
d. Syphilis

47. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?
a. Bruit
b. Crackles
c. Dullness
d. Friction rubs

48. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
a. Lower back pain, increased BP, decreased RBC, increased WBC
b. Severe lower back pain, decreased BP, decreased RBC, increased WBC
c. Severe lower back pain, decreased BP, decreased RBC, decreased WBC
d. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC

49. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area?
a. Hernia
b. Stage 1 pressure ulcer
c. Retroperitoneal rupture at the repair site
d. Rapid expansion of the aneurysm

50. Which hereditary disease is most closely linked to aneurysm?
a. Cystic fibrosis
b. Lupus erythematosus
c. Marfan's syndrome
d. Myocardial infarction

51. Which of the following treatments is the definitive one for a ruptured aneurysm?
a. Antihypertensive medication administration
b. Aortogram
c. Beta-adrenergic blocker administration
d. Surgical intervention

52. Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
a. Cardiomyopathy
b. Coronary artery disease
c. Myocardial infarction
d. Pericardial Effusion

53. Which of the following types of cardiomyopathy can be associated with childbirth?
a. Dilated
b. Hypertrophic
c. Myocarditis
d. Restrictive

54. Septal involvement occurs in which type of cardiomyopathy?
a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive

55. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?
a. Heart failure
b. DM
c. MI
d. Pericardial effusion

56. What is the term used to describe an enlargement of the heart muscle?
a. Cardiomegaly
b. Cardiomyopathy
c. Myocarditis
d. Pericarditis

57. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions?
a. Pericarditis
b. Hypertension
c. Obliterative
d. Restricitve

59. Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
a. Dilated aorta
b. Normally functioning heart
c. Decreased myocardial contractility
d. Failure of the ventricle to eject all the blood during systole

60. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?
a. Antihypertensive
b. Beta-adrenergic blockers
c. Calcium channel blockers
d. Nitrates


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Medical-Surgical Nursing Concept Practice Test
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Mr. Duffy is admitted to the CCU with a diagnosis of R/O MI. He presented in the ER with a typical description of pain associated with an MI, and is now cold and clammy, pale and dyspneic. He has an IV of D5W running, and is complaining of chest pain. Oxygen therapy has not been started, and he is not on the monitor. He is frightened.

1. The nurse is aware of several important tasks that should all be done immediately in order to give Mr. Duffy the care he needs. Which of the following nursing interventions will relieve his current myocardial ischemia?

a. stool softeners, rest
b. O2 therapy, analgesia
c. Reassurance, cardiac monitoring
d. Adequate fluid intake, low-fat diet

2. During the first three days that Mr. Duffy is in the CCU, a number of diagnostic blood tests are obtained. Which of the following patterns of cardiac enzyme elevation are most common following an MI?

a. SGOT, CK, and LDH are all elevated immediately.
b. SGOT rises 4-6 hours after infarction with CK and LDH rising slowly 24 hours later.
c. CK peaks first (12-24 hours), followed by the SGOT (peaks in 24-36 hours) and then the LDH (peaks 3-4 days).
d. CK peaks first and remains elevated for 1 to 2 weeks.

3. On his second day in CCU Mr. Duffy suffers a life-threatening cardiac arrhythmia. Considering his diagnosis, which is the most probable arrhythmia?

a. atrial tachycardia
b. ventricular fibrillation
c. atrial fibrillation
d. heart block

4. Mr. Duffy is placed on digitalis on discharge from the hospital. The nurse planning with him for his discharge should educate him as to the purpose and actions of his new medication. What should she or he teach Mr. Duffy to do at home to monitor his reaction to this medication?

a. take his blood pressure
b. take his radial pulse for one minute
c. check his serum potassium (K) level
d. weigh himself everyday

You are speaking to an elderly group of diabetics in the OPD about eye health and the importance of visits to the ophthalmologist.

5. You decide to discuss glaucoma prevention. Which of the following diagnostic tests should these clients request from their care provider?

a. fluorescein stain
b. snellen’s test
c. tonometry
d. slit lamp

6. You also explain common eye changes associated with aging. One of these is presbyopia, which is:

a. Refractive error that prevents light rays from coming to a single focus on the retina.
b. Poor distant vision
c. Poor near vision
d. A gradual lessening of the power of accommodation

7. Some of the diabetic clients are interested in understanding what is visualized during funduscopic examination. During your discussion you describe the macular area as:

a. Head of the optic nerve, seen on the nasal side of the field, lighter in color than the retina.
b. The area of central vision, seen on the temporal side of the optic disc, which is quite avascular.
c. Area where the central retinal artery and vein appear on the retina.
d. Reddish orange in color, sometimes stippled.

8. One of the clients has noted a raised yellow plaque on the nasal side of the conjunctiva. You explain that this is called:

a. a pinguecula, which is normal slightly raised fatty structure under the conjunctiva that may gradually increase with age.
b. Icterus, which may be due to liver disease.
c. A pterygium, which will interfere with vision.
d. Ciliary flush caused by congestion of the ciliary artery.

You are caring for Mr. Kaplan who has chronic renal failure (uremia)

9. You know that all but one of the following may eventually result in uremia. Which option is not implicated?

a. glomerular disease
b. uncontrolled hypertension
c. renal disease secondary to drugs, toxins, infections, or radiations
d. all of the above

10. You did the initial assessment on Mr. Kaplan when he came to your unit. What classical signs and symptoms did you note?

a. fruity- smelling breath.
b. Weakness, anorexia, pruritus
c. Polyuria, polydipsia, polyphagia
d. Ruddy complexion

11. Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him. Regarding his diagnosis and management of his drugs, you know that:

a. The half-life of many drugs is decreased in uremia; thus dosage may have to be increased to be effective.
b. Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is essential.
c. Drug therapy is not usually affected by this diagnosis
d. Precautions should be taken with prescription drugs, but most OTC medications are safe for him to use.

You are assigned to cardiac clinic to fill in for a colleague for 3 weeks. You begin by reviewing assessment of the cardiovascular system in your mind and asking yourself the following:

12. The point of maximum impulse (PMI) is an important landmark in the cardiac exam. Which statement best describes the location of the PMI in the healthy adult?

a. Base of the heart, 5th intercostal space, 7-9 cm to the left of the midsternal line.
b. Base of the heart, 7th intercostal space, 7-9 cm to the left of the midsternal line.
c. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
d. Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.

13. During the physical examination of the well adult client, the health care provider auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?

a. Tricuspid
b. Pulmonic
c. Aortic
d. Mitral

14. The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?

a. S1
b. S2
c. S3
d. S4

15. The coronary arteries furnish blood supply to the myocardium. Which of the following is a true statement relative to the coronary circulation?

a. the right and left coronary arteries are the first of many branches off the ascending aorta
b. blood enters the right and left coronary arteries during systole only
c. the right coronary artery forms almost a complete circle around the heart, yet supplies only the right ventricle
d. the left coronary artery has two main branches, the left anterior descending and left circumflex: both supply the left ventricle

Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis of mitral stenosis. She is scheduled for surgery to repair her mitral valve.

16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints of dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea have become unmanageable. These complaints are probably due to:

a. thickening of the pericardium
b. right heart failure
c. pulmonary hypertension
d. left ventricular hypertrophy

17. On physical exam of Ms. Baker, several abnormal findings can be observed. Which of the following is not one of the usual objective findings associated with mitral stenosis?

a. low-pitched rumbling diastolic murmur, precordial thrill, and parasternal lift
b. small crepitant rales at the bases of the lungs
c. weak, irregular pulse, and peripheral and facial cyanosis in severe disease
d. chest x-ray shows left ventricular hypertrophy

18. You are seeing more clients with diagnoses of mitral valve prolapse. You know those mitral valve prolapse is usually a benign cardiac condition, but may be associated with atypical chest pain. This chest pain is probably caused by:

a. ventricular ischemia
b. dysfunction of the left ventricle
c. papillary muscle ischemia and dysfunction
d. cardiac arrythmias

Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a diagnostic workup. His possible diagnosis is cancer of the lung.

19. The most common lethal cancer in males between their fifth and seventh decades is:

a. cancer of the prostate
b. cancer of the lung
c. cancer of the pancreas
d. cancer of the bowel

20. Of the four basic cell types of lung cancer listed below, which is always associated with smoking?

a. adenocarcinoma
b. squamous cell carcinoma (epidermoid)
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma

21. Chemotherapy may be used in combination with surgery in the treatment of lung cancer. Special nursing considerations with chemotherapy include all but which of the following?

a. Helping the client deal with depression secondary to the diagnosis and its treatment
b. Explaining that the reactions to chemotherapy are minimal
c. Careful observation of the IV site of the administration of the drugs
d. Careful attention to blood count results

22. Which of the following operative procedures of the thorax is paired with the correct definition?

a. Pneumonectomy: removal of the entire lung
b. Wedge resection: removal of one or more lobes of a lung
c. Decortication: removal of the reibs or sections of ribs
d. Thoracoplasty: removal of fibrous membrane that develops over visceral pleura as a result of emphysema

Mr. Liberatore, age 76, is admitted to your unit. He has a past medical history of hypertension, DM, hyperlipidemia. Recently he has had several episodes where he stops talking in midsentence and stares into space. Today the episode lasted for 15 minutes. The admission diagnosis is impending CVA.

23. The episodes Mr. Liberatore has been experiencing are probably:

a. small cerebral hemorrhages
b. TIA’s or transient ischemic attacks
c. Secondary to hypoglycemia
d. Secondary to hyperglycemia

24. Mr. Liberatore suffers a left sided CVA. He is right handed. The nurse should expect:

a. left-sided paralysis
b. visual loss
c. no alterations in speech
d. no impairment of bladder function

25. Upper motor neuron disease may be manifested in which of the following clinical signs?

a. spastic paralysis, hyperreflexia, presence of babinski reflex
b. flaccid paralysis, hyporeflexia
c. muscle atrophy, fasciculations
d. decreased or absent voluntary movement

Julie, an 18-year-old girl, is brought into the ER by her mother with the chief complaint of sudden visual disturbance that began half an hour ago and was described as double vision and flashing lights.

26. During your assessment of Julie she tells you all visual symptoms are gone but that she now has a severe pounding headache over her left eye. You suspect Julie may have:

a. a tension headache
b. the aura and headache of migraine
c. a brain tumor
d. a conversion reaction

27. You explain to Julie and her mother that migraine headaches are caused by:

a. an allergic response triggered by stress
b. dilation of cerebral arteries
c. persistent contraction of the muscles of the head, neck and face
d. increased intracranial pressure

28. A thorough history reveals that hormonal changes associated with menstruation may have triggered Julie’s migraine attack. In investigating Julie’s history what factors would be least significant in migraine?

a. seasonal allergies
b. trigger foods such as alcohol, MSG, chocolate
c. family history of migraine
d. warning sign of onset, or aura

29. A client with muscle contraction headache will exhibit a pattern different for Julie’s. Which of the following is more compatible with tension headache?

a. severe aching pain behind both eyes
b. headache worse when bending over
c. a bandlike burning around the neck
d. feeling of tightness bitemporally, occipitally, or in the neck

Mr. Snyder is admitted to your unit with a brain tumor. The type of tumor he has is currently unknown. You begin to think about the way brain tumors are classified.

30. Glioma is an intracranial tumor. Which of the following statements about gliomas do you know to be false?

a. 50% of all intracranial tumors are gliomas
b. gliomas are usually benign
c. they grow rapidly and often cannot be totally excised from the surrounding tissue
d. most glioma victims die within a year after diagnosis

31. Acoustic neuromas produce symptoms of progressive nerve deafness, tinnitus, and vertigo due to pressure and eventual destruction of:

a. CN5
b. CN7
c. CN8
d. The ossicles

32. Whether Mr Snyder’s tumor is benign or malignant, it will eventually cause increased intracranial pressure. Signs and symptoms of increasing intracranial pressure may include all of the following except:

a. headache, nausea, and vomiting
b. papilledema, dizziness, mental status changes
c. obvious motor deficits
d. increased pulse rate, drop in blood pressure

33. Mr Snyder is scheduled for surgery in the morning, and you are surprised to find out that there is no order for an enema. You assess the situation and conclude that the reason for this is:

a. Mr. Snyder has had some mental changes due to the tumor and would find an enema terribly traumatic
b. Straining to evacuate the enema might increase the intracranial pressure
c. Mr. Snyder had been on clear liquids and then was NPO for several days, so an enema is not necessary
d. An oversight and you call the physician to obtain the order

34. Postoperatively Mr. Snyder needs vigilant nursing care including all of the following except:

a. Keeping his head flat
b. Assessments q ½ hour of LOC, VS, papillary responses, and mental status
c. Helping him avoid straining at stool, vomiting, or coughing
d. Providing a caring, supportive atmosphere for him and his family

35. Potential postintracranial surgery problems include all but which of the following?

a. increased ICP
b. extracranial hemorrhage
c. seizures
d. leakage of cerebrospinal fluid

Mrs. Hogan, a 43-year-old woman, is admitted to your unit for cholecystectomy.

36. You are responsible for teaching Mrs. Hogan deep breathing and coughing exercises. Why are these exercises especially important for Mrs. Hogan?

a. they prevent postoperative atelectasis and pneumonia
b. the incision in gallbladder surgery is in the subcostal area, which makes the client reluctant to take a deep breath and cough
c. because she is probably overweight and will be less willing to breathe, cough, and move postoperatively

37. On the morning of Mrs. Hogan’s planned cholecystectomy she awakens with a pain in her right scapular area and thinks she slept in poor position. While doing the preop check list you note that on her routine CB report her WBC is 15,000. Your responsibility at this point is:

a. to notify the surgeon at once; this is an elevated WBC indicating an inflammatory reaction
b. to record this finding in a prominent place on the preop checklist and in your preop notes
c. to call the laboratory for a STAT repeat WBC
d. none. This is not an unusual finding

38. Mrs. Hogan is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM and Demerol 50 mg IM one hour preoperatively. Which nursing actions follow the giving of the preop medication?

a. have her void soon after receiving the medication
b. allow her family to be with her before the medication takes effect
c. bring her valuables to the nursing station
d. reinforce preop teaching

39. Mrs. Hogan is transported to the recovery room following her cholecystectomy. As you continue to check her vital signs you note a continuing trend in Mrs. Hogan’s status: her BP is gradually dropping and her pulse rate is increasing. Your most appropriate nursing action is to:

a. order whole blood for Mrs. Hogan from the lab
b. increase IV fluid rate of infusion and place in trendelenburg position
c. immediately report signs of shock to the head nurse and/or surgeon and monitor VS closely
d. place in lateral sims position to facilitate breathing

40. Mrs. Hogan returns to your clinical unit following discharge from the recovery room. Her vital signs are stable and her family is with her. Postoperative leg exercises should be inititated:

a. after the physician writes the order
b. after the family leaves
c. if Mrs. Hogan will not be ambulated early
d. stat

41. An oropharyngeal airway may:

a. Not be used in a conscious patient.
b. Cause airway obstruction.
c. Prevent a patient from biting and occluding an ET tube.
d. Be inserted "upside down" into the mouth opening and then rotated into the proper orientation as it is advanced into the mouth.
e. All of the above.

42. Endotracheal intubation:

a. Can be attempted for up to 2 minutes before you need to stop and ventilate the patient.
b. Reduces the risk of aspiration of gastric contents.
c. Should be performed with the neck flexed forward making the chin touch the chest.
d. Should be performed after a patient is found to be not breathing and two breaths have been given but before checking for a pulse.

43. When giving bag-valve mask ventilations:

a. Rapid and forceful ventilations are desirable so that adequate ventilation will be assured
b. Effective ventilations can always be given by one person.
c. Cricoid pressure may prevent gastric inflation during ventilations.
d. Tidal volumes will always be larger than when giving mouth to pocket mask ventilations.

44. If breath sounds are only heard on the right side after intubation:

a. Extubate, ventilate for 30 seconds then try again.
b. The patient probably only has one lung, the right.
c. You have intubated the stomach.
d. Pull the tube back and listen again.

45. An esophageal obturator airway (EOA):

a. Can be inserted by any person trained in ACLS.
b. Requires visualization of the trachea before insertion.
c. Never causes regurgitation.
d. Should not be used with a conscious person, pediatric patients, or patients who have swallowed caustic substances.

46. During an acute myocardial infarct (MI):

a. A patient may have a normal appearing ECG.
b. Chest pain will always be present.
c. A targeted history is rarely useful in making the diagnosis of MI.
d. The chest pain is rarely described as crushing, pressing, or heavy.

47. The most common lethal arrhythmia in the first hour of an MI is:

a. Pulseless Ventricular Tachycardia
b. Asystole
c. Ventricular fibrillation
d. First degree heart block.

48. Which of the following is true about verapamil?

a. It is used for wide-complex tachycardia.
b. It may cause a drop in blood pressure.
c. It is a first line drug for Pulseless Electrical Activity.
d. It is useful for treatment of severe hypotension.

49. Atropine:

a. Is always given for a heart rate less than 60 bpm.
b. Cannot be given via ET tube.
c. Has a maximum total dosage of 0.03-0.04 mg/kg IV in the setting of cardiac arrest.
d. When given IV, should always be given slowly.

50. Asystole should not be "defibrillated."

a. True
b. False


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