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1. A nurse is administering IV furosemide to a patient admitted with congestive heart failure. After the
infusion, which of the following symptoms is NOT expected?

A. Increased urinary output.

B. Decreased edema.
C. Decreased pain.
D. Decreased blood pressure.

2. There are a number of risk factors associated with coronary artery disease. Which of the following is a
modifiable risk factor?

A. Obesity.
B. Heredity.
C. Gender.
D. Age.

3. Tissue plasminogen activator (t-PA) is considered for treatment of a patient who arrives in the emergency
department following onset of symptoms of myocardial infarction. Which of the following is a
contraindication for treatment with t-PA?

A. Worsening chest pain that began earlier in the evening.

B. History of cerebral hemorrhage.
C. History of prior myocardial infarction.
D. Hypertension.

4. Following myocardial infarction, a hospitalized patient is encouraged to practice frequent leg exercises
and ambulate in the hallway as directed by his physician. Which of the following choices reflects the purpose
of exercise for this patient?

A. Increases fitness and prevents future heart attacks.

B. Prevents bedsores.
C. Prevents DVT (deep vein thrombosis).
D. Prevent constipations.

5. A patient arrives in the emergency department with symptoms of myocardial infarction, progressing to
cardiogenic shock. Which of the following symptoms should the nurse expect the patient to exhibit with
cardiogenic shock?

A. Hypertension.
B. Bradycardia.
C. Bounding pulse.
D. Confusion.

6. A patient in the cardiac unit is concerned about the risk factors associated with atherosclerosis. Which of
the following are hereditary risk factors for developing atherosclerosis?

A. Family history of heart disease.

B. Overweight.
C. Smoking.
D. Age.

7. Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about
claudication is correct? More than one answer may be correct.

A. It results when oxygen demand is greater than oxygen supply.

B. It is characterized by pain that often occurs during rest.
C. It is a result of tissue hypoxia.
D. It is characterized by cramping and weakness.

8. A nurse is providing discharge information to a patient with peripheral vascular disease. Which of the
following information should be included in instructions?

A. Walk barefoot whenever possible.

B. Use a heating pad to keep feet warm.
C. Avoid crossing the legs.
D. Use antibacterial ointment to treat skin lesions at risk of infection.

9. A patient who has been diagnosed with vasospastic disorder (Raynauds disease) complains of cold and
stiffness in the fingers. Which of the following descriptions is most likely to fit the patient?

A. An adolescent male.
B. An elderly woman.
C. A young woman.
D. An elderly man.

10. A 23 year old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6
days. She experiences sudden shortness of breath, accompanied by chest pain. Which of the following
conditions is the most likely cause of her symptoms?

A. Myocardial infarction due to a history of atherosclerosis.

B. Pulmonary embolism due to deep vein thrombosis (DVT).
C. Anxiety attack due to worries about her babys health.
D. Congestive heart failure due to fluid overload.

11. Thrombolytic therapy is frequently used in the treatment of suspected stroke. Which of the following is a
significant complication associated with thrombolytic therapy?

A. Air embolus.
B. Cerebral hemorrhage.
C. Expansion of the clot.
D. Resolution of the clot.

12. An infant is brought to the clinic by his mother, who has noticed that he holds his head in an unusual
position and always faces to one side. Which of the following is the most likely explanation?

A. Torticollis, with shortening of the sternocleidomastoid muscle.

B. Craniosynostosis, with premature closure of the cranial sutures.
C. Plagiocephaly, with flattening of one side of the head.
D. Hydrocephalus, with increased head size.

13. An adolescent brings a physicians note to school stating that he is not to participate in sports due to a
diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?

A. The condition was caused by the students competitive swimming schedule.

B. The student will most likely require surgical intervention.

C. The student experiences pain in the inferior aspect of the knee.

D. The student is trying to avoid participation in physical education.

14. The clinic nurse asks a 13-year-old female to bend forward at the waist with arms hanging freely. Which of
the following assessments is the nurse most likely conducting?

A. Spinal flexibility.
B. Leg length disparity.
C. Hypostatic blood pressure.
D. Scoliosis.

15. A clinic nurse interviews a parent who is suspected of abusing her child. Which of the following
characteristics is the nurse LEAST likely to find in an abusing parent?

A. Low self-esteem.
B. Unemployment.
C. Self-blame for the injury to the child.
D. Single status.

16. A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial
pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms
would be cause for concern?

A. Bulging anterior fontanel.

B. Repeated vomiting.
C. Signs of sleepiness at 10 PM.
D. Inability to read short words from a distance of 18 inches.

17. A nonimmunized child appears at the clinic with a visible rash. Which of the following observations
indicates the child may have rubeola (measles)?

A. Small blue-white spots are visible on the oral mucosa.

B. The rash begins on the trunk and spreads outward.
C. There is low-grade fever.
D. The lesions have a teardrop on a rose petal appearance.

18. A child is seen in the emergency department for scarlet fever. Which of the following descriptions of
scarlet fever is NOT correct?

A. Scarlet fever is caused by infection with group A Streptococcus bacteria.

B. Strawberry tongue is a characteristic sign.
C. Petechiae occur on the soft palate.
D. The pharynx is red and swollen.

19. A child weighing 30 kg arrives at the clinic with diffuse itching as the result of an allergic reaction to an
insect bite. Diphenhydramine (Benadryl) 25 mg 3 times a day is prescribed. The correct pediatric dose is 5
mg/kg/day. Which of the following best describes the prescribed drug dose?

A. It is the correct dose.

B. The dose is too low.
C. The dose is too high.
D. The dose should be increased or decreased, depending on the symptoms.

20. The mother of a 2-month-old infant brings the child to the clinic for a well baby check. She is concerned
because she feels only one testis in the scrotal sac. Which of the following statements about the
undescended testis is the most accurate?

A. Normally, the testes are descended by birth.

B. The infant will likely require surgical intervention.
C. The infant probably has with only one testis.
D. Normally, the testes descend by one year of age.

Answers and Rationale

1. Answer: C. Decreased pain.

Furosemide, a loop diuretic, does not alter pain. Furosemide acts on the kidneys to increase urinary output. Fluid may
move from the periphery, decreasing edema. Fluid load is reduced, lowering blood pressure.

2. Answer: A. Obesity.

Obesity is an important risk factor for coronary artery disease that can be modified by improved diet and weight loss.
Family history of coronary artery disease, male gender, and advancing age increase risk but cannot be modified.

3. Answer: B. History of cerebral hemorrhage.

A history of cerebral hemorrhage is a contraindication to tPA because it may increase the risk of bleeding. TPA acts
by dissolving the clot blocking the coronary artery and works best when administered within 6 hours of onset of
symptoms. Prior MI is not a contraindication to tPA. Patients receiving tPA should be observed for changes in blood
pressure, as tPA may cause hypotension.

4. Answer: C. Prevents DVT (deep vein thrombosis).

Exercise is important for all hospitalized patients to prevent deep vein thrombosis. Muscular contraction promotes
venous return and prevents hemostasis in the lower extremities. This exercise is not sufficiently vigorous to increase
physical fitness, nor is it intended to prevent bedsores or constipation.

5. Answer: D. Confusion.

Cardiogenic shock severely impairs the pumping function of the heart muscle, causing diminished blood flow to the
organs of the body. This results in diminished brain function and confusion, as well as hypotension, tachycardia, and
weak pulse. Cardiogenic shock is a serious complication of myocardial infarction with a high mortality rate.

6. Answer: A. Family history of heart disease.

Family history of heart disease is an inherited risk factor that is not subject to lifestyle change. Having a first degree
relative with heart disease has been shown to significantly increase risk. Overweight and smoking are risk factors that
are subject to lifestyle change and can reduce risk significantly. Advancing age increases risk of atherosclerosis but is
not a hereditary factor.

7. Answers: A, C, and D

Claudication describes the pain experienced by a patient with peripheral vascular disease when oxygen demand in
the leg muscles exceeds the oxygen supply. This most often occurs during activity when demand increases in muscle
tissue. The tissue becomes hypoxic, causing cramping, weakness, and discomfort.

8. Answer: C. Avoid crossing the legs.

Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Walking
barefoot is not advised, as foot protection is important to avoid trauma that may lead to serious infection. Heating
pads can cause injury, which can also increase the risk of infection. Skin lesions at risk for infection should be
examined and treated by a physician.

9. Answer: C. A young woman.

Raynauds disease is most common in young women and is frequently associated with rheumatologic disorders, such
as lupus and rheumatoid arthritis.

10. Answer: B. Pulmonary embolism due to deep vein thrombosis (DVT).

In a hospitalized patient on prolonged bed rest, he most likely cause of sudden onset shortness of breath and chest
pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep
veins of the legs. These clots can then break loose and travel to the lungs. Myocardial infarction and atherosclerosis
are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload. There is no reason to suspect
an anxiety disorder in this patient. Though anxiety is a possible cause of her symptoms, the seriousness of pulmonary
embolism demands that it be considered first.

11. Answer: B. Cerebral hemorrhage.

Cerebral hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a
suspected clot. Success of the treatment demands that it be instituted as soon as possible, often before the cause of
stroke has been determined. Air embolism is not a concern. Thrombolytic therapy does not lead to expansion of the
clot, but to resolution, which is the intended effect.

12. Answer: A. Torticollis, with shortening of the sternocleidomastoid muscle.

In torticollis, the sternocleidomastoid muscle is contracted, limiting range of motion of the neck and causing the chin
to point to the opposing side. In craniosynostosis one of the cranial sutures, often the sagittal, closes prematurely,
causing the head to grow in an abnormal shape. Plagiocephaly refers to the flattening of one side of the head, caused
by the infant being placed supine in the same position over time. Hydrocephalus is caused by a build-up of
cerebrospinal fluid in the brain resulting in large head size.

13. Answer: C. The student experiences pain in the inferior aspect of the knee.

Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the
quadriceps muscle pulls on the tibial tubercle, causing pain and swelling in the inferior aspect of the knee. OsgoodSchlatter disease is commonly caused by activities that require repeated use of the quadriceps, including track and
soccer. Swimming is not a likely cause. The condition is usually self-limited, responding to ice, rest, and analgesics.
Continued participation will worsen the condition and the symptoms.

14. Answer: D. Scoliosis.

A check for scoliosis, a lateral deviation of the spine, is an important part of the routine adolescent exam. It is
assessed by having the teen bend at the waist with arms dangling, while observing for lateral curvature and uneven
rib level. Scoliosis is more common in female adolescents. Choices A, B, and C are not part of the routine adolescent
exam.

15. Answer: C. Self-blame for the injury to the child.

The profile of a parent at risk of abusive behavior includes a tendency to blame the child or others for the injury
sustained. These parents also have a high incidence of low self-esteem, unemployment, unstable financial situation,
and single status.

16. Answer: B. Repeated vomiting.

Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become
life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is
stimulated. The anterior fontanel is closed in a 4-year-old child. Evidence of sleepiness at 10 PM is normal for a four
year old. The average 4-year-old child cannot read yet, so this too is normal.

17. Answer: A. Small blue-white spots are visible on the oral mucosa.

Kopliks spots are small blue-white spots visible on the oral mucosa and are characteristic of measles infection. The
body rash typically begins on the face and travels downward. High fever is often present. Tear drop on a rose petal
refers to the lesions found in varicella (chicken pox).

18. Answer: C. Petechiae occur on the soft palate.

Petechiae on the soft palate are characteristic of rubella infection. Choices A, B, and D are characteristic of scarlet
fever, a result of group A Streptococcus infection.

19. Answer: B. The dose is too low.

This child weighs 30 kg, and the pediatric dose of diphenhydramine is 5 mg/kg/day (5 X 30 = 150/day). Therefore, the
correct dose is 150 mg/day. Divided into 3 doses per day, the child should receive 50 mg 3 times a day rather than 25
mg 3 times a day. Dosage should not be titrated based on symptoms without consulting a physician.

20. Answer: D. Normally, the testes descend by one year of age.

Normally, the testes descend by one year of age. In young infants, it is common for the testes to retract into the
inguinal canal when the environment is cold or the cremasteric reflex is stimulated. Exam should be done in a warm
room with warm hands. It is most likely that both testes are present and will descend by a year. If not, a full
assessment will determine the appropriate treatment.