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b. O2 therapy, analgesia
All the nursing interventions listed are important in the care of Mr. Duffy. However
relief of his pain will be best achieved by increasing the O2 content of the blood to
his heart, and relieving the spasm of coronary vessels.
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?
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
All options have some validity. However, option B relates best to the
action of digitalis. If the pulse rate drops below 60 or is markedly
irregular, the digitalis should be held and the physician consulted.
Serum potassium levles should be monitored periodically in clients on
digitalis and diuretics, as potassium balance is essential for prevention
of arrhythmias. However the client cannot do this at home. Daily
weights may make the client alert to fluid accumulation, an early sign
of CHF. Blood pressure measurement is also helpful; providing the
client has the right size cuff and he or she and/or significant other
understand the technique and can interpret the results meaningfully.
You are speaking to an elderly group of diabetics in the OPD about eye
diagnostic tests should these clients request from their care provider?
a. fluorescein stain
b. snellen’s test
c. tonometry
d. slit lamp
Option A is most often used to detect corneal lesions; B is a test for
visual acuity using snellen’s chart; D is used to focus on layers of the
cornea and lens looking for opacities and inflammation.
6. You also explain common eye changes associated with aging. One
a. Head of the optic nerve, seen on the nasal side of the field, lighter
c. Area where the central retinal artery and vein appear on the retina.
Options A and C refer to the optic disc, D describes the color of the
retina.
8. One of the clients has noted a raised yellow plaque on the nasal side
Correct by definition.
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
a. glomerular disease
b. uncontrolled hypertension
c. renal disease secondary to drugs, toxins, infections, or radiations
10. You did the initial assessment on Mr. Kaplan when he came to your
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:
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.
midsternal line.
midsternal line.
The PMI is the impulse at the apex of the heart caused by the
beginning of ventricular systole. It is generally located in the 5th left
ICS, 7-9 cm from the MSL or at, or just medial to, the MCL.
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
The sound created by closure of the tricuspid valve is heard at the 5th LICS at the
LSB. Pulmonic closure is best heard at the 2nd LICS, LSB. Aortic closure is best
heard at the 2nd RICS, RSB. Mitral valve closure is best heard at the PMI landmark
(apex)
14. The pulmonic component of which heart sound is best heard at the
b. S2
c. S3
d. S4
S1 is caused by mitral and tricuspid valve closure, S2 is caused by the aortic and
pulmonic valve closure; S3 and S4 are generally considered abnormal heat sounds
in adults and are best heard at the apex.
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
The right and left coronary arteries are the only branches off the
ascending aorta; blood enters these arteries mainly during diastole;
the right coronary artery also often supplies a small portion of the left
ventricle.
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:
c. pulmonary hypertension
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
a. ventricular ischemia
d. cardiac arrythmias
Mr. Oliver, a long term heavy smoker, is admitted to the hospital for a
19. The most common lethal cancer in males between their fifth and
a. adenocarcinoma
c. undifferenciated carcinoma
d. bronchoalveolar carcinoma
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:
c. Secondary to hypoglycemia
d. Secondary to hyperglycemia
24. Mr. Liberatore suffers a left sided CVA. He is right handed. The
a. left-sided paralysis
b. visual loss
c. no alterations in speech
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
c. a brain tumor
d. a conversion reaction
27. You explain to Julie and her mother that migraine headaches are
caused by:
a. seasonal allergies
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
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.
c. they grow rapidly and often cannot be totally excised from the
surrounding tissue
d. most glioma victims die within a year after diagnosis
a. CN5
b. CN7
c. CN8
d. The ossicles
As ICP increases, the pulse rate decreases and the BP rise. However,
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
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
Any activity that increases ICP could possibly cause brain herniation. Straining to
expel an enema is one example of how the increased ICP can be further
aggravated.
34. Postoperatively Mr. Snyder needs vigilant nursing care including all
their heads elevated to decrease local edema and also decrease ICP.
the following?
a. increased ICP
b. extracranial hemorrhage
c. seizures
cholecystectomy.
36. You are responsible for teaching Mrs. Hogan deep breathing and coughing
exercises. Why are these exercises especially important for Mrs. Hogan?
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?
effect
40. Mrs. Hogan returns to your clinical unit following discharge from
the recovery room. Her vital signs are stable and her family is with
d. stat
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.
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.
Most likely you have a right main stem bronchus intubation. Pulling the
Which is why a normal ECG alone cannot be relied upon to rule out an
MI. Chest pain does not always accompany an MI. This is especially
true of patients with diabetes. A targeted history is often crucial in
making the diagnosis of acute MI. The chest pain associated with an
acute MI is often described as heavy, crushing pressure, 'like an
elephant sitting on my chest.'
47. The most common lethal arrhythmia in the first hour of an MI is:
a. Pulseless Ventricular Tachycardia
b. Asystole
c. Ventricular fibrillation
49. Atropine:
a. True
b. False
school of thought that holds that asystole should be treated like V-fib,
fib can have deadly consequences for the patient because V-fib is