ST.

ANTHONYS COLLEGE NURSING DEPARTMENT

SAN JOSE ANTIQUE 1ST SEMESTER, SY 2016-2017

PRELIM EXAMINATION ELECTIVE 2

TEST 1 MULTIPLE CHOICE

Choose the best answer for each question or statement. Write the letter of your answer in the test booklet.

1. When assessing a client with stable angina, the nurse would expect to find:
a. Persistent ECG changes.
b. Correlation between activity level and pain
c. Increasing nocturnal pain.
d. Evidence of impaired cardiac output such as weak peripheral pulses.
2. Which of the following diseases is the top killer in the Philippines?
a. AIDS
b. Cancer
c. Heart Disease
d. Diabetes Mellitus
3. All of the following are controllable risk factors for heart disease EXCEPT:
a. Genetic predisposition
b. Cigarette smoking
c. High blood pressure
d. Physical activity
4. The nurse evaluates her teaching as effective when a client identifies which of the following modifiable
risk factors for coronary heart disease (CHD) as contributing to the greatest extent?
a. Obesity
b. Diet
c. Smoking
d. Stress
5. When teaching a client about lovastatin, the nurse instructs the client to:
a. Promptly report muscle pain or tenderness to the physician
b. Consume a diet that includes no more than 20% of calories from saturated fat.
c. Abstain from alcohol use when taking the drug
d. Take the drug with meals to minimize gastric distress.
6. The nurse caring for a client with acute coronary syndrome identifies which of the following nursing
diagnoses to be of highest priority?
a. Anxiety related to unknown outcome of disorder
b. Ineffective health maintenance related to lack of knowledge about coronary heart disease
c. Decreased cardiac output related to myocardial ischemia
 d. Ineffective tissue Perfusion: Cardiopulmonary related to underlying coronary heart disease
7. The nurse caring for a client returning from coronary angioplasty with stent placement plans which of the
interventions?
a. Securing chest tube to bedding
b. Maintaining leg extension on the affected side
c. Discontinuing intravenous lines when taking oral fluids
d. Treating chest pain with intravenous morphine as needed
8. In planning care for the client with acute myocardial infarction(AMI), the nurse identifies the highest
priority goal of care as:
a. Stable ECG rhythm
b. Compliance with prescribed bed rest.
c. Ability to verbalize causes and effect of CHD
d. Relief of pain
9. Which of the following nursing diagnoses is of highest priority for the client undergoing fibronolytic
therapy?
a. Ineffective Protection
b. Ineffective Health Maintenance
c. Risk for Powerlessness
d. Anxiety
10. In reviewing laboratory results for a client admitted with acute chest pain, the nurse is most concerned
about which of the following?
a. Hematocrit 35%
b. AST 65 unit/L
c. CK 320 unit/L
d. APPT 35 seconds
11. On identifying sinus bradycardia at a rate of 45bpm, then nurse should
a. Assess mental status and blood pressure
b. Assess peripheral pulses on all four extremities
c. Determine if an apical-radial pulse deficit is present
d. Prepare to administer intravenous atropine
12. Which of the following clients would be most at risk for the development of type 2 DM?
a. Young adult who is a professional basketball player
b. Middle-age man who maintain normal weight
c. Middle-age woman who is the sole caretaker of her parents
d. Woman over age 70 who is overweight and sedentary
13. Diabetes may lead to the development of all the following conditions EXCEPT:
a. Kidney failure
b. Lung cancer
c. Stroke
d. Blindness
14. You note that your assigned client has a nursing diagnosis of Peripheral neurovascular Dysfunction
involving both feet. Which of the following assessment would support this Diagnosis?
a. Normal sensation to touch
b. Loss of normal reflexes
c. States I cant feel my feet anymore
d. States I have been having chest pain
 15. Which of the following statements would indicate your client understands teaching about foot care at
home?
a. I will walk barefooted as long as I am in the house
b. I always buy my shoes as soon as the stores open.
c. I will check my feet for cuts and bruises every night
d. If I get a blister, I just put alcohol on it and bandage it
16. When the insulin-dependent client is NPO on the day of surgery, short acting regular insulin should be:
a. Given intravenously
b. Chilled to slow absorption
c. Given with intravenous glucose
d. Combined with long-acting insulin
17. Subcutaneous injections of insulin can be made in several locations in the body. The nurse teaches the
client that the most rapid absorption occurs in the:
a. Hip
b. Thigh
c. Deltoid
d. Abdomen
18. The polydipsia and polyuria related to diabetes are caused primarily by:
a. The release of ketones from cells during fat metabolism
b. Fluid shifts resulting from the osmotic effect of hyperglycemia
c. Damage to kidneys from exposure to high level of glucose
d. Changes in RBCs resulting from attachment of glucose to hemoglobin
19. A potential blood donor whose blood pressure is found to average 180/106 on two different readings tells
the nurse, I dont understand how it could be so high-I feel just fine. The appropriate response by the
nurse is
a. This is probably just a false reading due to white coat syndrome. Dont worry about it.
b. It is unusual that you are not having some symptoms such as sever headaches and nosebleeds.
c. High blood pressure often has few or no symptoms; thats why it is called the silent killer.
d. You probably should have your blood pressure rechecked if it still high in your primary care
provider.
20. Ms.Smith is an 87-year-old hypertensive patient who is receiving D 5%NSS per IV at 83 ml per hour on the
electronic infusion pump. It is vitality important that the IVs of older adult patients be monitored
carefully because:

a. These patients do not get dehydrated very easily

b. They may get a fluid overload of the circulatory system

c. Of the increased risk of infection in the veins

d. Of the danger of thrombophiebitis developing in the peripheral system

21. Mr. Jones, 67 years of age, has a diagnosis of hypertension. She is being discharged from the hospital. Her
teaching should include:

a. Education on continuing to take antihypertensive medications as prescribed

b. Encouragement to take mediciines until blood pressure is controlled

c. Instruction in consuming a bland diet

d. Encouragement to begin a vigorous exercise program

22. Abnormal cells that divide and create other abnormal cells develop:

a. Oncogenes

b. Suppressor genes

c. neoplasms

d. Attachment cells

23.Tumors that are not considered life threatening are called:

a. Benign

b. malignant

c. neoplasmic

d. oncogenes

24. All of the following medications may be used at home by terminal cancer patients EXCEPTS:

a. Anti-convulsives

b. Anti-ulcer medications

c. Anti-Nausea medications.

d. Opiods

25. The most common type of cancer in women is:

a. Lung

b. Colon

c. Breast

d. Bladder

26. The most common type of cancer among men is:

a. Lung

b. Prostate

c. Colon

d. Kidney
27. All of the following are dietary guidelines that may reduce the risk of cancer EXCEPT:

a. Avoid cured, pickled or smoked meats

b. Reduce your intake of vitamin D

c. eat plenty of antioxidant rich food

d. reduce that fat in your diet

28. Which of the following statements is true about dementia? (Choose all that apply)

a. Dementia is a general term used to describe manifestations of damage or death of neurons.

b. Dementia is the term used to described the cognitive and behavioral manifestation of Alzheimers disease

c. Dementia is an acute disorder, resulting from an injury to the brain.

d. Dementia is the primary manifestation of Guillian-Barre syndrome

29. Although all of the following are risk factors for a stroke, which one is the greatest risk?

a. Hypertension

b. Heart disease

c. Diabetes

d. High cholesterol

30. You have been assigned to care for Katherine, a client who has had an acute ischemic stroke of a left cerebral
vessel. You read the chart and realize the client has contralateral deficits. What does this mean?

a. Both sides of the body are involved

b. The client will have neurologic deficits on the left side of the body

c. The client will have neurologic deficits on the right side of the body

d. Deficits will be present below the level of the stroke.

CASE ANALYSIS:

Case 1. Jeunesse is a 69-year-old female who works as a teaching assistance at an elementary school. She comes to
the medical clinic complaining of throbbing head ache and dizziness. Her height and weight are 56 and 245lbs.
upon assessment her vital signs are P100, R 16. BP lying is 180/115, sitting is 170/110, and standing is 165/105.
Her skin is cool and dry. Her capillary refill is 4 seconds. She denies smoking, drinks an occasional glass of wine, and
does not participate in a regular exercise program, She states that her job can be stressful at times. Nutrition
assessment indicates a diet high in fats and sodium. She denies any family of hypertension or heart disease. She is
married and has a daughter and son who live in same town. A medical diagnosis of hypertension is determined

Case 2. Lienjel is an 80-year-old female who is seen in the emergency department with complains of shortness of
breath and fever. Her vital signs are T 38.3 C , P 115 and irregular, R 35 and shallow, BP 168/66. Her height is 55
and wt. is 96 lbs. On assessment, her skin is very dry and warm. Her color is dusky. Scattered wheezes and rhonchi
are heard throughout all lung fields. Her chest is hyperresonant to percussion. A pulse oximeter is applied and the
O2 sat reading is 88%. Lienjel has a past medical history of emphysema for 10yrs., complains of shortness of breath
on exertion and has a chronic cough productive of thick, grayish sputum. Widowed for 5 years and lived with her 2
adult sons.

Blood is drawn for ABG and results are pH 7:19; PaO2 54mmHg, PaCO2 55 mmHg; HCO3 30mEq/L. These results
indicate respiratory acidosis. Based on her current assessment, ABG results, and past medical history, a medical
diagnosis chronic obstructive polmunary disease (COPD) is determined.

Case 3. Kaizer is a 65-year-old African American male who admitted with problems of increased urination,
increased thirst, fatigue, blurred vision and numbness in his feet. He states that he retired 9 months ago after 45
years as a welder. He now leads a sedentary lifestyle and doesnt have much energy as he used to have. He has
gained 30lbs. since retirement. Upon assessment, Mr. Kaizer weighs 25 ;bs. And is 511 tall. Vital signs are T 98.8 F
P 88, R 2, and BP 150/90. Decreased pulses are palpated in dorsal pedalis and posterior tibial pulses. Both feet are
cool to touch with slow capillary refill in toes. The following laboratory studies are ordered to confirm the diagnosis
of type 2 diabetes mellitus: plasma glucose concentration, fasting blood glucose, and oral glucose tolerance test.

1. Give at least three nursing diagnoses from one of the cases that you choose. (6pts.)

2. What is your priority nursing diagnosis and develop a nursing care plan. (24 pts)

Prepared by: Nemia Oton RN, MAN