Medical SurgicalNursing Dept.

Faculty of Nursing

Questions Bank and Model Answer

of

Critical Care Nursing

For
Second Year Nursing Students

Faculty of Nursing

Aswan University

2020-2021

1
 Part I
True &False

Part I : True and False

Read the following statement carefully and select (T) if the statement is true
and (F) if it is false

No. Statement True False

(T) (F)
1 Acute respiratory distress syndrome (ARDS) is a mild form F
of acute lung injury

2
2 Acute lung injury (ALI) is present if Pao2/Fio2 ratio is ≥= F
300

3 Acute respiratory distress syndrome is present if Pao2/Fio2 T

ratio ≤= 200.

4 Sepsis is an indirect pulmonary injury causes ARDS T

5 Stage IV of is characterized by decreasing respiratory and T

heart rates.

6 PEEP is a critical part of the treatment of ARDS T

7 Crackle is the most symptoms associated with right -sided F

heart failure

8 A patient with right-sided heart failure exhibit polyuria F

9 A patient with right-sided heart failure exhibit oliguria T

10 Inotropic agents is the classes of medications which T

maximizes cardiac performance in clients with heart failure
by increasing ventricular contractibility

11 Calcium channel blockers agents for heart failure by F

increasing ventricular contractibility

12 Right-sided heart failure is most closely associated with T

weight gain, nausea, and a decrease in urine output

13 Left-sided heart failure is most closely associated with F

weight gain, nausea, and a decrease in urine output

14 Dyspnea, cough, expectoration, weakness, and edema are T

classic signs and symptoms of which of heart failure

3
15 Unstable angina is most closely related with an impending T
MI

16 Chronic stable angina is most closely related with an F

impending MI

17 Reversal of ischemia is the primary treatment goal for T

angina

18 Hypocapnia is initially most suggestive initial signs of T

pulmonary edema

19 Hypercapnia is initially most suggestive initial signs of F

pulmonary edema.

20 Unstable angina that the angina pain is prolonged and T

severe and occurs at the any time of the day.

21 Aspirin is administered to the client experiencing an MI F

because of its Antipyrectic action

22 Aspirin is administered to the client experiencing an MI F

because of its Antithrombotic action

23 Aspirin is administered to the client experiencing an MI T

because of its Antiplatelet action

24 A client is scheduled for a cardiac catherization using a T

radiopaque dye

25 Administered a thrombolytic drug to the client experiencing T

an MI

26 Cardiac catherization is the diagnostic tool most commonly F

used to determine the location of myocardial damage

4
27 Electrocardiogram (ECG) is the diagnostic tool most T
commonly used to determine the location of myocardial
damage

28 A client arrives in the emergency department with an T

ischemic stroke and receives tissue plasminogen activator
(t-PA) administration. The priority nursing assessment
Time of onset of current stroke.

29 The priority nursing assessment in the first 24 hours after T

admission of the client with a thrombotic stroke is Pupil
size and papillary response

39 The expected outcome of thrombolytic drug therapy is to F

increased vascular permeability.

40 The expected outcome of thrombolytic drug therapy is to T

dissolve emboli.

41 During the first 24 hours after thrombolytic therapy for T

ischemic stroke, the primary goal is to control the patient's
blood pressure

42 Coronary artery disease (CAD) is a disease characterized by T

the accumulation of plaque within the layers of the
coronary arteries.

43 Cullen's sign with acute pancreatitis is (gray-blue F

discoloration/bruising of flank).

44 Grey Turner's sig with acute pancreatitis is F

discoloration/bruising of the umbilical region

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45 Type II (ARF) or ventilatory failure is the result of T
inadequate alveolar ventilation

46 Positive pressure ventilators inflate the lungs by exerting T

positive pressure onthe

47 The high-frequency ventilator accomplishes oxygenation by T

the diffusion of oxygen and carbon dioxide from high to
low gradients of concentration.

48 decreased PaO2 , increase pH and increased PaCO2 is a F

diagnostic finding of cor pulmonale

49 Ventilation/ perfusion (V/Q) mismatch may occur as a T

result of alveolar over distention caused by elevated airway
pressure

50 Pulmonary heart disease (Cor pulmonale) is an alteration in F

the structure or function of the left ventricle

51 Heparin and thrombolytic agents are used to treat T

pulmonary embolism.

52 Pulmonary emboli is a primary pulmonary Hypertension: F

53 Dopamine is used for patient with heart failure if he has T

Hypotension and tachycardia.

54 Dopamine is used for patient with heart failure if he has F

acute anxiety.

55 Dopamine is used for patient with heart failure if he has F

paroxysmal nocturnal dyspnea

56 Physiologically effect of Lasix for patient with heart failure T

is to reduce preload.

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57 Physiologically effect of Lasix for patient with heart failure F
is to decrease afterload.

58 Physiologically effect of Lasix for patient with heart failure F

is to increase cardiac contractility

59 Valvuplasty is a therapeutic use of cardiac Catheterization T

60 Post procedure of cardiac catheterization the patient remind F

to lie still and keep the extremity flexed

61 Post procedure of cardiac catheterization the patient remind T

to lie still and keep the extremity straight

62 Digoxin is a negative inotropic effect F

63 Cardiac glycoside effect is to increases renal perfusion, T

decreases heart rate

64 Hyperkalemia is associated with chronic digoxin toxicity F

65 Hypokalemia is associated with chronic digoxin toxicity T

66 taking digoxin drug with food will delay its absorption T

67 Hold Digoxin dose if pulse lower than 60 beats/min in adult T

68 Acute pancreatitis develops when pancreatic enzymes T

become prematurely activated in the pancreas.

69 The pain for patient with pancreatitis is usually relived F

when the patient lies supine

70 The pain for patient with pancreatitis is usually T

exacerbated when the patient lies supine

71 Lowering serum lipase associated with acute pancreatitis. F

72 Hypocalcemia associated with acute pancreatitis. T

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73 Hyperglycemia associated with acute pancreatitis. T

74 Hypoglycemia associated with acute pancreatitis. F

75 Disseminated intravascular coagulation is a complication of T

acute pancreatitis.

76 Patient with acute pancreatitis may need 5-10L of fluid T

within 24hr

77 Drowsiness, lethargy and deficits in ability to perform F

mental tasks associated with grade I of hepatic
encephalopathy

78 Albumin administration for patient with hepatic T

encephalopathy to promote the shifting of fluids from the
interstitial

79 neomycin sulfate is used for patient with hepatic T

encephalopathy reduce the number of intestinal bacteria
capable of converting urea to ammonia

8082 zinc replacement is not recommended hepatic F

encephalopathy

81 flapping hand tremors (asterixis) with hepatic T

encephalopathy

82 Prerenal failure is caused by obstruction of urine flow F

83 Acute renal failure is generally identified by oliguria (urine F

output <_100____ mL/day).

84 Acute renal failure is generally identified by oliguria (urine T

output <_400____ mL/day).

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85 Acute renal Failure is a rapid decline in renal function with T
an abrupt onset.

86 Hypokalemia associated with acute renal Failure F

87 Myxedema coma is a loss of brain function as a result of T

severe, longstanding low level of thyroid hormone in the
blood.

88 fatigue is a symptom of hypothyroidism T

89 Myxedema coma is more frequent in men F

90 Hypothermia, diffuculty breathing, severe mental changes, T

and the heart slowing are signs of myxedema coma.

91 Narcotics sudden trigger of myxedema coma T

92 Myxedema coma is a life-threatening complication of F

hyperthyroidism.

93 Myxedema coma is a life-threatening complication of T

hypothyroidism.

94 Myxedema coma is very common but cannot cause death. F

95 Most patients with myxedema coma have a history of F

radioactive iodine treatment for thyroid disease.

96 Myasthenia gravis, an autoimmune disorder affecting the T

myoneural junction

97 Myasthenia gravis is characterized by varying degrees of F

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 weakness of the involuntary muscles

98 Myasthenia gravis is not directly inherited nor is it T

contagious.

99 Myasthenia gravis is caused by a defect in the T

transmission of nerve impulses to muscles.

100 Eye muscle weakness of any severity, mild weakness of F

other muscles is a class I in myasthenia gravis

101 Diplopia (double vision) associated with myasthenia gravis T

102 Myasthenic crisis may warrant intubation and mechanical T

ventilation.

103 Plasma exchange (plasmapheresis) is a technique used to T

treat exacerbations myasthenia gravis

104 Morphine, quinine and related agents are used to treat F

myasthenia gravis.

105 Guillain-Barré syndrome is an autoimmune attack of the T

peripheral nerve myelin

106 Etiology of Guillain-Barré syndrome is defect in the F

transmission of nerve impulses to muscles.

107 In Guillain-Barré syndrome macrophages then invade the T

peripheral nerve and break down the myelin.

108 Urinary retention and orthostatic hypotension may occur T

with Guillain-Barré syndrome

109 Guillain-Barré syndrome affect level of consciousness, F

pupillary function

110 coughing and deep breathing are contraindicated for patient F

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 with Guillain-Barré syndrome

111 Administer analgesia as prescribed 30 minutes before T

bedtime for patient with Guillain-Barré syndrome

112 Apply antiembolism stockings or intermittent sequential T

compression devices and give prophylactic
anticoagulants as ordered for patient with Guillain-Barré
syndrome
113 Modifiable risk factors of stroke is age F

114 women die from stroke than men T

115 Obesity & inactivity modifiable risk factors of stroke. T

116 Acute Ischemic stroke results from bleeding into the brain F

117 Hemiparesis, aphasia, hemiplegia are ommon signs of T

acute ischemic stroke

118 Right hemiparesis is a signs of right hemisphere stroke F

119 Intracerebral hemorrhage is bleeding into the F

subarachnoid space

120 Hypernatremia is another common complication of F

subarachnoid hemorrhage.

121 Position of patient with hemorrhagis stroke in supine F

position.

122 Position patient with hemorrhagic stroke by head of bed T

elevated 30 degrees.

123 Adequate nutritional support is vital for Patients with T

ARDS

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124 'Silent' infarcts, that is, without chest pain are not T

infrequent, especially in elderly or diabetic populations

125 Myoglobin is released more rapidly from infracted T

myocardium than is troponin.

126 Take apical-radial pulse before giving Digoxin; hold dose if F

pulse above 100 beats/min in adult

127 Nursing interventions to manage increased ICP Include T

maintenance of body alignment and avoiding sharp turning
of the head to one side .

128 Atherosclerosis is a major cause of a stroke T

129 Nitrates: Vasodilation of veins = ↓ preload = ↓ O2 T

consumption.

130 acetone smell to breath is a common clinical findings on F

physical exam of hypoglycemia patient

131 Troponin I is the blood tests that most indicative of cardiac T

damage.

132 Lactate dehydrogenase is the blood tests that most F

indicative of cardiac damage.

133 The first intervention for a client experiencing MI is T

administer oxygen

134 The first intervention for a client experiencing MI is obtain F

an ECG

12
135 If the patient with acute kidney injure has a serum T
potassium level of 6.0mEq/ L. The nurse / should be Placed
the patient on a cardiac monitor.

136 Azotemia: a medical condition characterized by abnormally T

high levels of nitrogen-containing compounds (such as

urea, creatinine)

137 Hypoalbuminemia associated with acute pancriatitis T

138 Chronic hepatic failure or cirrhosis is characterized by a F

sudden , insidious degeneration of the liver parenchyma

139 Encephalopathy is a clinical syndrome in a patient with T

advanced liver disease or portal systemic shunting

140 The most common causes of acute hepatic failure is viral T

hepatitis

141 Fever increased serum ammonia levels that may cause T

hepatic encephalopathy

142 Coma with or without response to painful stimuli is F

presented in Grade 3 of hepatic encephalopathy

143 Healthy kidneys produce the hormone thyroxin F

144 Initiation phase renal failure lasts from hours to days T

145 Hemodialysis is the treatments of choice in severe T

hyperkalemia

146 Excess thyroid hormone directly increases metabolism T

147 Iodine administration for rapidly increase synthesis of F

T3 & T4

13
148 Thyroid-stimulating hormone (TSH) is lower with F
myxedema coma

149 Decreased sodium level and increased potassium level with T

myxedema coma

150 Pulmonary emboli) result in an increase in pulmonary T

hypertention

14
 Part (II)
Multiple Choose Questions (
MCQ )

15
Read the following statements and circle the correct answer

PAo2 > 60 or an O2 sat >90% at the lowest FIO2 or fraction of inspired

oxygen
a. ARDS Gas levels
b. PEEP goals
c. Other examples of direct
d. The patient also has
ABGs, Chest X-ray- white infiltrates, pulmonary edema, shunting studies
Electrolytes, CBC
a. PEEP in ARDS
b. Correcting Acidosis
c. Goal of O2 Therapy
d. Diagnostics ARDS
Permissive Hypercapnia in ARDS deficient amount of oxygen in the blood,
PaO2 <50mmHg on room air
a. Hypoxemia
b. Correcting Acidosis
c. PEEP in ARDS
d. Hypercapnic
During the exudative phase of acute respiratory distress syndrome (ARDS),
the patient's lung cells that produce surfactant have become damaged. As
the nurse you know this will lead to?
a. . bronchoconstriction
b. Atelectasis
c. Upper airway blockage
d. Pulmonary edema
You're providing care to a patient who was just transferred to your unit for
the treatment of ARDS. The patient is in the exudative phase. The patient is
16
 ordered arterial blood gases. The results are back. Which results are
expected during this early phase of acute respiratory distress syndrome that
correlates with this diagnosis?
a. PaO2 40, pH 7.59, PaCO2 30, HCO3 23
b. PaO2 85, pH 7.42, PaCO2 37, HCO3 26
c. PaO2 50, pH 7.20, PaCO2 48, HCO3 29
d. PaO2 55, pH 7.26, PaCO2 58, HCO3 19
Which patient below is at MOST risk for developing ARDS and has the
worst prognosis?
a. A 52-year-old male patient with a pneumothorax.
b. A 48-year-old male being treated for diabetic ketoacidosis.
c. A 69-year-old female with sepsis caused by a gram-negative
bacterial infection.
d. A 30-year-old female with cystic fibrosis.
As the nurse you know that acute respiratory distress syndrome (ARDS) can be
caused by direct or indirect lung injury. Select the INDIRECT causes of ARDS:
a. Drowning
b. Aspiration
c. Pneumonia
d. Pancreatitis
A patient is on mechanical ventilation with PEEP (positive end-expiratory
pressure). Which finding below indicates the patient is developing a
complication related to their therapy and requires immediate treatment?
a. HCO3 26 mmHg
b. Blood pressure 70/45
c. PaO2 80 mmHg
d. PaCO2 38 mmHg
You are caring for a patient with acute respiratory distress syndrome. As the
nurse you know that prone positioning can be beneficial for some patients with
17
this condition. Which findings below indicate this type of positioning was
beneficial for your patient with ARDS?
a. Reduce in lung sounds
b. Development of a V/Q mismatch
c. Increased PaO2
d. PEEP needs to be titrated to 15 mmHg of water
A patient is experiencing respiratory failure due to pulmonary edema. The
physician suspects ARDS but wants to rule out a cardiac cause. A
pulmonary artery wedge pressure is obtained. As the nurse you know that
what measurement reading obtained indicates that this type of respiratory
failure is NOT cardiac related?
a. >25 mmHg
b. <10 mmHg
c. >50 mmHg
d. <18 mmHg
You‟re precepting a nursing student who is assisting you care for a patient
on mechanical ventilation with PEEP for treatment of ARDS. The student
asks you why the PEEP setting is at 10 mmHg. Your response is:
a. "This pressure setting assists the patient with breathing in and out and
helps improve air flow."
b. "This pressure setting will help prevent a decrease in cardiac output
and hyperinflation of the lungs."
c. "This pressure setting helps prevent fluid from filling the alveoli sacs."
d. "This pressure setting helps open the alveoli sacs that are
collapsed during exhalation."

When explaining respiratory failure to the patient‟s family, what should

the nurse use as an accurate description? a. The absence of ventilation.
b. Any episode in which part of the airway is obstructed.
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 c. inadequate gas exchange to meet the metabolic needs of the body.
d. An episode of acute hypoxemia caused by a pulmonary dysfunction.

When the V/Q lung scan result returns with a mismatch ratio that is
greater than 1, which condition should be suspected? a. Pain
b. Atelectasis
c. Pulmonary embolus
d. Ventricular septal defect

Which patient with the following manifestations is most likely to develop

hypercapnic respiratory failure?
a. Rapid, deep respirations in response to pneumonia
b. Slow, shallow respirations as a result of sedative overdose
c. Large airway resistance as a result of severe bronchospasm
d. Poorly ventilated areas of the lung caused by pulmonary edema

Which arterial blood gas (ABG) results would most likely indicate acute
respiratory failure in a patient with chronic lung disease?
a. PaO2 52 mm Hg, PaCO2 56 mm Hg, pH 7.4
b. PaO2 46 mm Hg, PaCO2 52 mm Hg, pH 7.36
c. PaO2 48 mm Hg, PaCO2 54 mm Hg, pH 7.38
d. PaO2 50 mm Hg, PaCO2 54 mm Hg, pH 7.28

a. The patient is being admitted to the intensive care unit (ICU) with
hypercapnic respiratory failure. Which manifestations should the

19
 nurse expect to assess in the patient ? a.
Cyanosis
b. Metabolic acidosis
c. Morning headache
d. Use of supine position

The nurse assesses that a patient in respiratory distress is developing

respiratory fatigue and the risk of respiratory arrest when the patient
displays which behavior?
a. Cannot breathe unless he is sitting upright
b. Uses the abdominal muscles during expiration
c. Has an increased inspiratory-expiratory (I/E) ratio
d. Has a change in respiratory rate from rapid to slow

A patient has a PaO2 of 50 mm Hg and a PaCO2 of 42 mm Hg because

of an intrapulmonary shunt. Which therapy is the patient most likely to
respond best to?
a. Positive pressure ventilation
b. Oxygen administration at a FIO2 of 100%
c. Administration of O2 per nasal cannula at 1 to 3 L/min
d. Clearance of airway secretions with coughing and suctioning

A patient in hypercapnic respiratory failure has a nursing diagnosis of

ineffective airway clearance related to increasing exhaustion. What is
an appropriate nursing intervention for this patient?
a. Inserting an oral airway
b. Performing augmented coughing
c. Teaching the patient huff coughingd.
21
 d.Teaching the patient slow pursed lip breathing

1. The patient with a history of heart failure and acute respiratory failure
has thick secretions that she is having difficulty coughing up. Which
intervention would best help to mobilize her secretions? a. Administer
more IV fluid
b. Perform postural drainage
c. Provide O2 by aerosol mask
d. Suction airways nasopharyngeally

Priority Decision: After endotracheal intubation and mechanical

ventilation have been started, a patient in respiratory failure becomes
very agitated and is breathing asynchronously with the ventilator. What
is it most important for the nurse to do first?
a. Evaluate the patient‟s pain level, ABGs, and electrolyte values
b. Sedate the patient to unconsciousness to eliminate patient awareness
c. Administer the PRN vecuronium (Norcuron) to promote synchronous
ventilations
d. Slow the rate of ventilations provided by the ventilator to allow for
spontaneous breathing by the patient.

One of the following modes of ventilation “locks out” the patient's

efforts to breathe.
a. Controlled Mandatory Ventilation
b. Synchronous Intermittent Mandatory Ventilation
c. Assist Control Mode
d. Pressure Control Mode

21
One of the following modes of ventilation has the risk of the patient
getting respiratory alkalosis.
a. Controlled Mandatory Ventilation
b. Synchronous Intermittent Mandatory Ventilation
c. Assist Control Mode
d. Pressure Control Mode

The mode of ventilation which allows the patient to breathe

spontaneously at his or her own respiratory rate and depth between the
ventilator breaths is.
a. Controlled Mandatory Ventilation
b. Synchronous Intermittent Mandatory Ventilation
c. Assist Control Mode
d. Pressure Control Mode

Minute ventilation is equal to...

a. FiO2 X PEEP
b. FiO2/PEEP
c. Tidal Volume X Respiratory Rate
d. Tidal Volume/Respiratory Rate

One of the following modes of ventilation reduces the work of breathing

by overcoming the resistance created by ventilator tubing.
a. Controlled Mandatory Ventilation
b. Synchronous Intermittent Mandatory Ventilation
c. Assist Control Mode
d. Pressure Support Mode

22
CPAP and BiPAP modes are usually used...
a. in conjunction with bronchodilators and steroids
b. to delay intubation
c. as a weaning protocol
d. All of the above

Which one of the following modes of ventilation is triggered by time,

limited by pressure and affects aspiration only?
a. Controlled Mandatory Ventilation
b. Synchronous Intermittent Mandatory Ventilation
c. Assist Control Mode
d. Pressure Control Mode

Variations in the minute ventilation in one of the following modes of

ventilation as the respiratory rate and tidal volume is determined by the
a. Controlled Mandatory Ventilation
b. Synchronous Intermittent Mandatory Ventilation
c. Pressure Control Mode
d. Pressure Support Mode

Which of the following conditions require a higher PEEP to be applied

in recruiting collapsed alveoli?
a. Asthma
b. Acute Respiratory Distress Syndrome
c. Bronchietasis
d. Emphysema

One of the following is a risk of keeping high PEEP

a. Hypotension
23
 b. Hypertension
c. Hyperthermia
d. Hypothermia

FIO2 is meaning which of the following?

a. Fraction of Inspired Oxygen
b. Inspiratory Flow Rate & Time
c. nutritional assessment
d. Ventilator inoperative or low battery

Rupture of alveoli or blebs (excess pressure, air escapes)

a. Resistance
b. Volutraua
c. Barotrauma
d. I:E Ratio
Cardiovascular complications of positive pressure ventilation:
a. Increase in intrathoracic pressure
b. stress of illness, intubation and immobility
c. Hypoventilation and hyperventilation
d. decreased O2 consumption

Alveolar fractures (similar to beginning of ARDs), high volume moves

fluids and proteins into alveolar space
a. Vt or RR too high
b. Respiratory rate
c. Barotrauma
d. Volutrauma

Indications of SIMV:
24
 a. Apnea (or impending inability to breathe)
b. adults in refractory ARDs
c. Weaning from ventilator
d. Hypoxemia unresponsive to FIO2 > 50% and ARDs

To evaluate a patient's condition following cardiac catheterization, the

nurse will palpate the pulse:
a. In all extremities
b. At the insertion site
c. Distal to the catheter insertion
d. Above the catheter insertion

A client enters the ER complaining of chest pressure and severe

epigastric distress. His VS are 158/90, 94, 24, and 99*F. The doctor
orders cardiac enzymes. If the patient were diagnosed with an MI, the
nurse would expect which cardiac enzyme to rise within the next 3 to 8
hours?
a. Creatine kinase (CK or CPK)
b. Lactic dehydrogenase (LDH)
c. LDH-1
d. LDH-2

Following a treadmill test and cardiac catheterization, the patient is

found to have coronary artery disease, which is inoperative. He is
referred to the cardiac rehabilitation unit. During his first visit to the
unit he says that he doesn‟t understand why he needs to be there
because there is nothing that can be done to make him better. The best
nursing response is:

25
 a. “Cardiac rehabilitation is not a cure but can help restore you to
many of your former activities.”
b. “Here we teach you to gradually change your lifestyle to
accommodate your heart disease.”
c. “You are probably right but we can gradually increase your activities
so that you can live a more active life.”
b. “Do you feel that you will have to make some changes in your life
now?”

Which of the following types of pain is most characteristic of angina? a.

Knifelike
b. Sharp
c. Shooting
d. Tightness

Direct-acting vasodilators have which of the following effects on the

heart rate?
Heart rate increase
a. Heart rate decreases
b. Heart rate remains significantly unchanged
c. Heart rate becomes irregular
A nurse is assessing the blood pressure of a patient diagnosed with
primary hypertension. The nurse ensures accurate measurement by
avoiding which of the following?
a. Seating the client with arm bared, supported, and at heart level.
b. Measuring the blood pressure after the client has been seated quietly
for 5 minutes.

26
 c. Using a cuff with a rubber bladder that encircles at least 80% of the
limb.

d. Taking a blood pressure within 15 minutes after nicotine or

caffeine ingestion.
As an initial step in treating a patient with angina, the physician
prescribes nitroglycerin tablets, 0.3mg given sublingually. This
drug‟s principal effects are produced by:
a. Antispasmodic effect on the pericardium
b. Causing an increased myocardial oxygen demand
c. Vasodilation of peripheral vasculature
d. Improved conductivity in the myocardium

Which of the following symptoms should the nurse teach the patient
with unstable angina to report immediately to her physician?
a. A change in the pattern of her pain
b. Pain during sex
c. Pain during an argument with her husband
d. Pain during or after an activity such as lawn mowing

IV heparin therapy is ordered for a patient with MI. While

implementing this order, a nurse ensures that which of the following
medications is available on the nursing unit?
a. Vitamin K
b. Aminocaproic acid
c. Potassium chloride
d. Protamine sulfate

The most important long-term goal for a patient with hypertension

would be to:
27
 a. Learn how to avoid stress
b. Explore a job change or early retirement
c. Make a commitment to long-term therapy
d. Control high blood pressure
A patient has driven himself to the ER. He is 50 years old, has a history
of hypertension, and informs the nurse that his father died of a heart
attack at 60 years of age. The patient is presently complaining of
indigestion. The nurse connects him to an ECG monitor and begins
administering oxygen at 2 L/minute per NC. The nurse‟s next action
would be to:
a. Call for the doctor
b. Start an intravenous line
c. Obtain a portable chest radiograph
d. Draw blood for laboratory studies

A nurse notes 2+ bilateral edema in the lower extremities of a patient

with myocardial infarction who was admitted 2 days ago. The nurse
would plan to do which of the following next?
a. Review the intake and output records for the last 2 days
b. Change the time of diuretic administration from morning to evening
c. Request a sodium restriction of 1 g/day from the physician
d. Order daily weights starting the following morning

Prolonged occlusion of the right coronary artery produces an infarction

in which of the following areas of the heart?
a. Anterior
b. Apical
c. Inferior
d. Lateral
28
One hour after administering IV furosemide (Lasix) to a patient with
heart failure, a short burst of ventricular tachycardia appears on the
cardiac monitor. Which of the following electrolyte imbalances should
the nurse suspect?
a. Hypocalcemia
b. Hypermagnesemia
c. Hypokalemia
d. Hypernatremia

A patient who has been receiving heparin therapy also is started on

warfarin. The client asks a nurse why both medications are being
administered. In formulating a response, the nurse incorporates the
understanding that warfarin:
a. Stimulates the breakdown of specific clotting factors by the liver, and
it takes 2-3 days for this to exert an anticoagulant effect.
b. Inhibits synthesis of specific clotting factors in the liver, and it
takes 3-4 days for this medication to exert an anticoagulant effect.
c. Stimulates production of the body‟s own thrombolytic substances, but
it takes 2-4 days for this to begin.
d. Has the same mechanism of action as Heparin, and the crossover time
is needed for the serum level of warfarin to be therapeutic.

Sublingual nitroglycerin tablets begin to work within 1 to 2 minutes.

How should the nurse instruct the client to use the drug when chest pain
occurs?
a. Take one tablet every 2 to 5 minutes until the pain stops.
b. Take one tablet and rest for 10 minutes. Call the physician if pain
persists after 10 minutes.
29
 c. Take one tablet, then an additional tablet every 5 minutes for a total
of 3 tablets. Call the physician if pain persists after three tablets.
d. Take one tablet. If pain persists after 5 minutes, take two tablets. If
pain still persists 5 minutes later, call the physician

A patient is receiving spironolactone to treat hypertension. Which of the

following instructions should the nurse provide?
a. “Eat foods high in potassium.”
b. “Take daily potassium supplements.”
c. “Discontinue sodium restrictions.”
d. “Avoid salt substitutes.”

A 60-year-old male patient comes into the emergency department with

complaints of crushing chest pain that radiates to his shoulder and left
arm. The admitting diagnosis is acute myocardial infarction. Immediate
admission orders include oxygen by NC at 4L/minute, blood work, chest
x-ray, an ECG, and 2 mg of morphine given intravenously. The nurse
should first:
a. Administer the morphine
b. Obtain a 12-lead ECG
c. Obtain the lab work
d. Order the chest x-ray

When administered a thrombolytic drug to the client experiencing an

MI, the nurse explains to him that the purpose of this drug is to:
a. Help keep him well hydrated
b. Dissolve clots he may have
 c. Prevent kidney failure
d. Treat potential cardiac arrhythmias
31

The nurse teaches the patient with angina about the common expected
side effects of nitroglycerin, including:
a. Headache
b. High blood pressure
c. Shortness of breath
d. Stomach cramps

When teaching a client about propranolol hydrochloride, the nurse

should base the information on the knowledge that propranolol
hydrochloride:
a. Blocks beta-adrenergic stimulation and thus causes decreased
heart rate, myocardial contractility, and conduction.
b. Increases norepinephrine secretion and thus decreases blood pressure
and heart rate.
c. Is a potent arterial and venous vasodilator that reduces peripheral
vascular resistance and lowers blood pressure.
d. Is an angiotensin-converting enzyme inhibitor that reduces blood
pressure by blocking the conversion of angiotensin I to angiotensin II

A patient with myocardial infarction has been transferred from a

coronary care unit to a general medical unit with cardiac monitoring via
telemetry. A nurse plans to allow for which of the following client
activities?
Strict bed rest for 24 hours after transfer
31
 a.
b. Bathroom privileges and self-care activities
c. Unsupervised hallway ambulation with distances under 200 feet
d. Ad lib activities because the client is monitored
A patient is scheduled for a cardiac catheterization using a radiopaque
dye. Which of the following assessments is most critical before the
procedure?
a. Intake and output
b. Baseline peripheral pulse rates
c. Height and weight
d. Allergy to iodine or shellfish
A patient enters the ER complaining of severe chest pain. A myocardial
infarction is suspected. A 12 lead ECG appears normal, but the doctor
admits the client for further testing until cardiac enzyme studies are
returned. All of the following will be included in the nursing care plan.
Which activity has the highest priority?
a. Monitoring vital signs
b. Completing a physical assessment
c. Maintaining cardiac monitoring
d. Maintaining at least one IV access site
Hypertension is known as the silent killer. This phrase is associated with
the fact that hypertension often goes undetected until symptoms of other
system failures occur. This may occur in the form of:
a. Cerebrovascular accident
b. Liver disease
c. Myocardial infarction
d. Pulmonary disease

32
Which of the following terms is used to describe the amount of stretch
on the myocardium at the end of diastole?
a. Afterload
b. Cardiac index
c. Cardiac output
d. Preload
A patient‟s physician orders nuclear cardiography and makes an
appointment for a thallium scan. The purpose of injecting radioisotope
into the bloodstream is to detect:
a. Normal vs. abnormal tissue
b. Damage in areas of the heart
c. Ventricular function
d. Myocardial scarring and perfusion
Which of the following blood tests is most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count (CBC)
c. Troponin I
d. Creatine kinase (CK)
The physician refers the patient with unstable angina for a cardiac
catheterization. The nurse explains to the patient that this procedure is
being used in this specific case to:
a. Open and dilate the blocked coronary arteries
b. Assess the extent of arterial blockage
c. Bypass obstructed vessels
d. Assess the functional adequacy of the valves and heart muscle When
teaching a patient why spironolactone (Aldactone) and furosemide
(Lasix) are prescribed together, the nurse bases teaching on the
knowledge that:

33
 a.
Moderate doses of two different types of diuretics are more effective
than a large dose of one type
b. This combination promotes diuresis but decreases the risk of
hypokalemia
c. This combination prevents dehydration and hypovolemia
d. Using two drugs increases osmolality of plasma and the glomerular
filtration rate
Which of the following factors can cause blood pressure to drop to
normal levels?
a. Kidneys‟ excretion of sodium only
b. Kidneys‟ retention of sodium and water
c. Kidneys‟ excretion of sodium and water
d. Kidneys‟ retention of sodium and excretion of water A patient
is wearing a continuous cardiac monitor, which begins to sound its
alarm. A nurse sees no electrocardiogram complexes on the screen. The
first action of the nurse is to:
a. Check the client status and lead placement
b. Press the recorder button on the electrocardiogram console
c. Call the physician
d. Call a code blue
A patient is at risk for pulmonary embolism and is on anticoagulant
therapy with warfarin (Coumadin). The client‟s prothrombin time is 20
seconds, with a control of 11 seconds. The nurse assesses that this result
is:
a. The same as the client‟s own baseline level
b. Lower than the needed therapeutic level
c. Within the therapeutic range

34
 d. Higher than the therapeutic range
Which of the following terms describes the force against which the
ventricle must expel blood?
a. Afterload
b. Cardiac output
c. Overload
d. Preload

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 (ECG)

A patient with no history of cardiovascular disease comes into the

ambulatory clinic with flu-like symptoms. The client suddenly
complains of chest pain. Which of the following questions would best
help a nurse to discriminate pain caused by a non-cardiac problem?
a. “Have you ever had this pain before?”
b. “Can you describe the pain to me?”
c. “Does the pain get worse when you breathe in?”
d. “Can you rate the pain on a scale of 1-10, with 10 being the worst?”
The nurse receives emergency laboratory results for a patient with chest
pain and immediately informs the physician. An increased myoglobin
level suggests which of the following?
Cancer
b. Hypertension
c. Liver disease
35
 a.
d. Myocardial infarction
Which of the following instructions should be included in the discharge
teaching for a patient discharged with a transdermal nitroglycerin
patch?
a. “Apply the patch to a non hairy, nonfatty area of the upper
torso or arms.”
b. “Apply the patch to the same site each day to maintain consistent
drug absorption.”
c. “If you get a headache, remove the patch for 4 hours and then
reapply.”
d. “If you get chest pain, apply a second patch right next to the first
patch.”

When do coronary arteries primarily receive blood flow?

a. During inspiration
b. During diastolic
c. During expiration
d. During systole
Which complication of cardiac catheterization should the nurse monitor
for in the initial 24 hours after the procedure?
a. angina at rest
b. thrombus formation
c. Dizziness
d. falling blood pressure

36
A patient has been newly diagnosed with hypothyroidism and will take
levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching
plan, the nurse emphasizes that this medication:
a. Should be taken in the morning
b. May decrease the client‟s energy level
c. Must be stored in a dark container
d. Will decrease the client‟s heart rate

When teaching a patient with coronary artery disease about nutrition,

the nurse should emphasize
a. Eating three (3) balanced meals a day
b. Adding complex carbohydrates
c. Avoiding very heavy meals
d. Limiting sodium to 7 gms per day

The nurse is performing a neurological assessment on a patient post

right CVA. Which finding, if observed by the nurse, would warrant
immediate attention?
a. Decrease in level of consciousness
b. Loss of bladder control
c. Altered sensation to stimuli
d. Emotional ability

The nurse is giving discharge teaching to a patient seven (7) days post
myocardial infarction. He asks the nurse why he must wait six (6) weeks
before having sexual intercourse. What is the best response by the nurse
to this question?
“You need to regain your strength before attempting such
exertion.”
37
 a.
b. “When you can climb 2 flights of stairs without problems, it is
generally safe.”
c. “Have a glass of wine to relax you, then you can try to have sex.”
d. “If you can maintain an active walking program, you will have
less risk.”
The nurse prepares the patient for insertion of a pulmonary artery
catheter (Swan-Ganz catheter). The nurse teaches the client that the
catheter will be inserted to provide information about:
1. Stroke volume
2. Cardiac output
3. Venous pressure
4. Left ventricular functioning

A patient is receiving digoxin (Lanoxin) 0.25 mg daily. The health care

provider has written a new order to give metoprolol (Lopressor) 25 mg
B.I.D. In assessing the client prior to administering the medications,
which of the following should the nurse report immediately to the health
care provider?
a. Blood pressure 94/60
b. Heart rate 76
c. Urine output 50 ml/hour
d. Respiratory rate 16

A patient has been taking furosemide (Lasix) for the past week. The
nurse recognizes which finding may indicate the patient is experiencing
a negative side effect from the medication?
a. Weight gain of 5 pounds

38
 b. Edema of the ankles
c. Gastric irritability
d. Decreased appetite

Who is at greater risk for pulmonary embolism?

a. Men
b. Women
c. Young women
d. The risk is the same for men and women

Signs and symptoms of pulmonary embolism (PE) can include:

a. Redness, warmth, tenderness and swelling
b. Shortness of breath, chest pain, coughing blood
c. Muscle spasms, vertigo, ringing ears
d. All of the above

Having a pulmonary embolism includes risk of possible

______________.
a. Sudden death
b. Diabetes
c. High blood pressure
d. Amputation of limbs

Which coronary artery provides blood to the left atrium and left
ventricle:
a. Right marginal artery
b. Posterior descending artery
c. Left circumflex artery

39
 d. Right coronary artery

Which patient(s) are most at risk for developing coronary artery

disease? (except)
a. A 25 year old patient who exercises 3 times per week for 30
minutes a day and has a history of cervical cancer.
b. A 35 year old male with a BMI of 30 and reports smoking 2 packs of
cigarettes a day.
c. A 45 year old female that reports her father died at the age of 42 from a
myocardial infraction.
d. A 29 year old that has type I diabetes.

A patient reports during a routine check-up that he is experiencing

chest pain and shortness of breath while performing activities. He states
the pain goes away when he rests. This is known as:
a. Unstable angina
b. Variant angina
c. Stable angina
d. Prinzmetal angina

You‟re providing education to a patient who will be undergoing a heart

catheterization. Which statement by the patient requires you to
reeducate the patient about this procedure?
a. “The brachial artery is most commonly used for this procedure.”
b. “A dye is injected into the coronary arteries to assess for blockages.”
c. “Not all patients who have a heart catheterization will need a stent
placement.”
 41
d. “I will not be completely asleep and will be able to breathe on my
own during the procedure.”
A patient reports having crushing chest pain that radiates to the jaw.
You administer sublingual nitroglycerin and obtain a 12 lead EKG.
Which of the following EKG findings confirms your suspicion of a
possible myocardial infraction?
a. absent Q wave
b. QRS widening
c. absent P-wave
d. ST segment elevation

Examination of a patient in a supine position reveals distended jugular

veins from the base of the neck to the angle of the jaw. This finding
indicates:
a. Decreased venous return.
b. Increased central venous pressure.
c. Increased pulmonary artery capillary pressure.
d. Left-sided heart failure.

A 55-year-old patient who is diagnosed with an evolving myocardial

infarction (MI) insists on going home. The cardiac-vascular nurse
encourages the patient to be admitted because the greatest risk within
the first 24 hours of sustaining an MI is:
a. heart failure.
b. pulmonary embolism.
c. ventricular aneurysm.
d. ventricular fibrillation.
41
A patient recently had a cardiac catheterization via right-radial
approach. The patient has a compression device in place. The patient
complains of numbness and pain in the right hand. The cardiac-
vascular nurse notes a diminished pulse, with a cool and cyanotic hand.
The nurse:
a. calls the physician.
b. performs an Allen's test.
c. reduces the pressure on the puncture site.
d. uses the Doppler to assess for pulse signals.

Digoxin is part of what family of drugs?

a. Angiotensin-converting enzyme inhibitors
b. Beta-blockers
c. Angiotensin II receptor blockers
d. Cardiac glycosides

A patient is taking Digoxin. What medication on the patient‟s

medication list increases the patient‟s risk of experiencing Digoxin
toxicity?
a. Furosemide
b. Metformin
c. Nitroglycerin
d. Coumadin

An infant is ordered a scheduled dose of Digoxin. The patient‟s apical

pulse rate is 78 bpm. The nurse would:
a. Administer the dose as ordered
b. Hold the dose and reassess the apical pulse rate in 1 hour
42
 c. Skip this dose but administer the next scheduled dose
d. Hold the dose and notify the physician

Inside the pancreas are special cells that secrete digestive enzymes and
hormones. The cells that secrete digestive enzymes are known as
______________ cells.
a. Islet of Langerhans
b. Protease
c. Acinar
d. Amylase

In the pancreas, the acinar cells release (Except):

a. Amylase
b. Somatostatin
c. Lipase
d. Protease

You‟re caring for a 45 year old patient who is admitted with suspected
acute pancreatitis. The patient reports having extreme mid-epigastric
pain that radiates to the back. The patient states the pain started last
night after eating fast food. As the nurse, you know the two most
common causes of acute pancreatitis are:
a. High cholesterol and alcohol abuse
b. History of diabetes and smoking
c. Pancreatic cancer and obesity
d. Gallstones and alcohol abuse

Your patient with acute pancreatitis is scheduled for a test that will use
a scope to assess the pancreas, bile ducts, and gallbladder. The patient
43
asks you, “What is the name of the test I‟m going for later today?” You
tell the patient it is called:
a. MRCP
b. ERCP
c. CT scan of the abdomen
d. EGD
A client who had cardiac surgery 24 hours ago has a urine output
averaging 19 ml/hr for 2 hours. The client received a single bolus of
500 ml of IV fluid. Urine output for the subsequent hour was 25 ml.
Daily laboratory results indicate the blood urea nitrogen is 45 mg/dL
and the serum creatinine is 2.2 mg/dL. A nurse interprets the client is
at risk for:
A. Hypovolemia
B. Urinary tract infection
C. Glomerulonephritis
D. Acute renal failure

A patient with acute pancreatitis is reporting excessive thirst, excessive

voiding, and blurred vision. As the nurse, it is priority you?
a. Reassure the patient this is normal with pancreatitis
b. Check the patient‟s blood glucose
c. Assist the patient with drinking a simple sugar drink like orange juice
d. Provide a dark and calm environment

A patient with acute renal failure has the following labs: GFR 92
mL/min, BUN 17 mg/dL, potassium 4.9 mEq/L, and creatinine 1 mg/dL.
The patient‟s 24 hour urinary output is 1.75 Liters. Based on these
findings, what stage of AKI is this patient in?
44
 a. Initiation
b. Diuresis
c. Oliguric
d. Recovery

A 36 year old male patient is diagnosed with acute renal failure. The
patient is voiding 4 L/day of urine. What complication can arise based
on the stage of AKI this patient is in? (Except)
a. Water intoxication
b. Hypotension
c. Low urine specific gravity
d. Hypokalemia

Which patient below with acute renal failure is in the oliguric stage of
acute renal failure:
a. A 56 year old male who has metabolic acidosis, decreased GFR,
increased BUN/Creatinine, hyperkalemia, edema, and urinary
output 350 mL/day.
b. A 45 year old female with metabolic alkalosis, hypokalemia, normal
GFR, increased BUN/creatinine, edema, and urinary output 600
mL/day.
c. A 39 year old male with metabolic acidosis, hyperkalemia,
improving GFR, resolving edema, and urinary output 4 L/day.
d. A 78 year old female with respiratory acidosis, increased GFR,
decreased BUN/creatinine, hypokalemia, and urinary output 550
mL/day.

45
You‟re developing a nursing care plan for a patient in the diuresis stage
of acute renal failure. What nursing diagnosis would you include in the
care plan?
a. Excess fluid volume
b. Risk for electrolyte imbalance
c. Urinary retention
d. Acute pain

While educating a group of nursing students about the stages of acute

renal failure, a student asks how long the oliguric stage lasts. You
explain to the student this stage can last?
a. 1-2 weeks
b. 1-3 days
c. Few hours to 2 weeks
d. 12 months
A patient with acute renal failure has a urinary output of 350 mL/day.
In addition, morning labs showed an increased BUN and creatinine level
along with potassium level of 6 mEq/L. What type of diet ordered by the
physician is most appropriate for this patient?
a. Low-sodium, high-protein, and low-potassium
b. High-protein, low-potassium, and low-sodium
c. Low-protein, low-potassium, and low-sodium
d. High-protein and high-potassium

A patient reports they do not eat enough iodine in their diet. What
condition are they most susceptible to?
A. Pheochromocytoma
46
B. Hyperthyroidism
C. Thyroid Storm
D. Hypothyroidism.

A patient has an extremely high T3 and T4 level. Which of the following

signs and symptoms DO NOT present with this condition?
A. Weight loss
B. Intolerance to heat
C. Smooth skin
D. Hair loss

A patient is being discharged home for treatment of hypothyroidism.

Which medication is most commonly prescribed for this condition?
A. Tapazole
B. PTU (Propylthiouracil)
C. Synthroid
D. Inderal

You are performing discharge teaching with a patient who is going

home on Synthroid. Which statement by the patient causes you to
reeducate the patient about this medication?
A. “I will take this medication at bedtime with a snack.”
B. “I will never stop taking the medication abruptly.”
C. “If I have palpitations, chest pain, intolerance to heat, or feel restless, I
will notify the doctor.”
D. “I will not take this medication at the same time I take my Carafate.”

The thyroid hormones, T3 and T4, play many roles in the human body.

47
Which of the following functions are performed by T3 and T4? Note:
Select all that apply
A. Storing calories
B. Increasing the Heart Rate
C. Stimulating the Sympathetic Nervous System
D. Decreasing the body‟s temperature
E. Regulating TSH produced by the anterior pituitary gland

A patient is admitted with complaints of palpations, excessive sweating,

andunable to tolerate heat. In addition, the patient voices concern about
how her appearance has changed over the past year. The patient
presents with protruding eyeballs and pretibial myxedema on the legs
and feet. Which of the following is the likely cause of the patient‟s signs
and symptoms?
A. Thyroiditis
B. Deficiency of iodine consumption
C. Grave‟s Disease
D. Hypothyroidism

A patient who is in her first trimester of pregnancy is diagnosed with

hyperthyroidism. Which medication do you suspect the patient will be
started on?
A. Propylthiouracil (PTU)
B. Radioactive Iodine
C. Tapazole
D. Synthroid

Which of the following are treatment options for hyperthyroidism?

(Except)
48
A. Thyroidectomy
B. Methimazole
C. Liothyronine Sodium “Cytomel”
D. Radioactive Iodine

A patient was recently discharged home for treatment of

hypothyroidism and was ordered to take Synthroid for treatment. The
patient is re-admitted with signs and symptoms of the following: heart
rate 42, blood pressure 70/56, blood glucose 55, and body temperature
of
96.8 „F. The patient is very fatigued and drowsy. The family reports the
patient has not been taking Synthroid since being discharged home from
the hospital. Which of the following conditions is this patient most likely
experiencing? A. Thryoid Storm
B. Myxedema Coma
C. Iodism
D. Toxic Nodular Goiter

A patient is being educated on how to take their anti-thyroid

medication. Which of the following statements are INCORRECT?
A. “I will continue taking aspirin daily.”
B. “I will take this medication at the same time every day.”
C. “It may take a while before I notice that the medication is helping my
condition.”
D. Constipation, drowsiness, goiter

___________ is an autoimmune disorder where the body attacks the

thyroid gland that causes it to stop releasing T3 and T4. The patient is
49
likely to have the typical signs/symptoms of hypothyroidism, however,
they may present with what other sign as well?
A. Myxedema coma; joint pain
B. Thyroid storm; memory loss

50
C. Hashimoto‟s Thyroiditis; goiter
D. Toxic nodular goiter (TNG); goiter

Which of the following side effects are possible for a patient taking an
anti-thyroid medication?
A. Agranulocytosis and aplastic anemia
B. Tachycardia
C. Skin discoloration
D. Joint pain and eczema
A patient is receiving radioactive iodine treatment for hyperthyroidism.
What will you include in your patient education to this patient about
this type of treatment?
A. Taste changes and swollen salivary glands
B. Constipation
C. Excessive thirst
D. Sun protection

Which patient is most at risk for Thyroid Storm?

A. A 60 year old female who reports not taking Synthroid regularly.
B. A 45 year old male who has not been taking Tapazole as ordered
and is experiencing diabetic ketoacidosis. C. A 6 year old with
an allergy to iodine.
D. A 25 year old female who is pregnant with her 4th child and is
experiencing eczema.

A patient is admitted with thyroid storm. Which sign and symptoms are
NOT present with this condition?
A. Temperature of 104.9‟F
B. Heart rate of 125 bpm
 51
C. Respirations of 42
D. Heart rate of 20 bpm

A physician orders a patient in thyroid storm to be started on Inderal.

What in the patient‟s health history causes the nurse to question the
doctor‟s order?
A. History of mental illness
B. History of asthma
C. History of tachycardia
D. History of cancer

A patient taking Tapazole reports feeling dizzy, intolerant to cold, and

tired. On assessment, you note the patient‟s heart rate is 45 and blood
pressure is 70/30. What is the most likely cause?
A. Antithyroid toxicity
B. Agranulocytosis
C. Thyroid storm
D. Bronchospasm

Which of the following foods below should a patient experiencing a

thyroid storm avoid? (Except):
A. Shrimp
B. Milk
C. Hard boiled eggs
D. Broccoli

Which of the following are not a treatment for Thyroid Storm?

52
A. Propylthiouracil (PTU)
B. Synthyroid
C. Inderal
D. Glucocorticoids

Which of the following medication orders should a nurse question if

ordered on a patient with thyroid storm?
A. Propylthiouracil “PTU” for a 25 year old who is 8 weeks pregnant.
B. Aspirin as needed for a fever greater than 102.2 „F
C. Inderal for a patient who reports having insomnia
D. Tapazole for a 30 year old having complaints of headache
Which of the following patients are MOST at risk for developing
myxedema coma?
A. A 28 year old female who is prescribed Methimazole.
B. A 75 year old female who is taking Lithium and reports missing
several doses of Synthroid.
C. A 69 year old male experiencing nausea and vomiting for 4 days.
D. A 55 year old male with a history of diabetes and is insulin dependent.

All of the following are treatments for myxedema coma EXCEPT?

A. Corticosteroids
B. IV glucose
C. Hypotonic IV solutions
D. IV Synthroid

A patient is receiving treatment for myxedema coma with IV Synthroid.

Which of the following findings would require nursing intervention for
this patient? A. Blood glucose 75
B. Sodium level of 138
53
C. A physician‟s order for Fentanyl 0.25 mcg every 2 hours for pain
D. Temperature 98.9 „F

Signs and Symptoms of myxedema coma include all of the following

EXCEPT? Select all that apply:
A. Fever
B. Bradycardia
C. Blood glucose level greater than 350
D. Goiter
A patient taking IV Synthroid starts to complain of feeling hot and chest
pain. On assessment, you find that the heart rate is 125 bpm and blood
pressure is 200/103. You immediately notify the physician of the
patient‟s condition and receive orders for lab work. Based on the
patient‟s signs and symptoms, what is the MOST important lab result
at this time to determine the cause of the patient‟s symptoms?
A. Potassium level
B. Thyroid levels
C. Calcium level
D. Sodium level

A patient is recovering from myxedema coma and will be discharged

tomorrow. What will you include in their discharge teaching? A.
Avoiding green leafy vegetables.
B. Importance of taking Tapazole exactly as prescribed at the same time
every day.
C. Limiting foods with Iodine such as kelp, dairy, and eggs.
D. Importance of taking Synthroid in the morning without any food.

Which of the following are NOT a cause of myxedema coma?

54
A. Illness
B. Sedatives
C. Iodine Toxicity
D. Thyroidectomy

How is myxedema coma treated?

a. Most commonly, the thyroid hormone is replaced in patients.
b. Assisting the patient to breathe
c. warming them to raise the body temperature to normal.
d. bed rest and drinking a lot of water.

What is a symptom of hypothyroidism?

a. Darker skin
b. Lack of concentration
c. Fatigue
d. Weight loss

Myasthenia gravis occurs when antibodies attack the __________

receptors at the neuromuscular junction leading to ____________.
a. metabotropic; muscle weakness
b. nicotinic acetylcholine; muscle weakness
c. dopaminergic adrenergic; muscle contraction
d. nicotinic adrenergic; muscle contraction

You‟re educating a patient about the pathophysiology of myasthenia

gravis. While explaining the involvement of the thymus gland, the
patient asks you where the thymus gland is located. You state it is
located?
a. behind the thyroid gland
55
 b. within the adrenal glands
c. behind the sternum in between the lungs
d. anterior to the hypothalamus

A patient with myasthenia gravis will be eating lunch at 1200. It is now

1000 and the patient is scheduled to take Pyridostigmine. At what time
should you administer this medication so the patient will have the
maximum benefit of this medication?
a. As soon as possible
b. 1 hour after the patient has eaten (at 1300)
c. 1 hour before the patient eats (at 1100)
d. at 1200 right before the patient eats

Which meal option would be the most appropriate for a patient with
myasthenia gravis?
a. Roasted potatoes and cubed steak
b. Hamburger with baked fries
c. Clam chowder with mashed potatoes
d. Fresh veggie tray with sliced cheese cubes

Select all the signs and symptoms below that can present in myasthenia
gravis:
a. Respiratory failure
b. Increased salivation
c. Mask-like appearance of looking sleepy
d. Difficulty swallowing

56
You‟re providing teaching to a group of patients with myasthenia
gravis. Which of the following is not a treatment option for this
condition?
a. Plasmapheresis
b. Cholinesterase medications
c. Thymectomy
d. Corticosteroids

You‟re a home health nurse providing care to a patient with

myasthenia gravis. Today you plan on helping the patient with bathing
and exercising. When would be the best time to visit the patient to help
these tasks?
a. Mid-afternoon
b. Morning
c. Evening
d. Before bedtime

The initial nursing goal for a patient with myasthenia gravis during the
diagnostic phase of her hospitalization would be to:
a. Prepare for the appearance of myasthenic crisis
b. Facilitate psychologic adjustment
c. Maintain the present muscle strength
d. Develop a teaching plan

The nurse is caring for a client admitted with suspected myasthenia

gravis. Which finding is usually associated with a diagnosis of
myasthenia gravis?
a. Visual disturbances, including diplopia
b. Ascending paralysis and loss of motor function
57
 c. Progressive weakness that is worse at the day‟s end
d. Cogwheel rigidity and loss of coordination

In making a diagnosis of myasthenia gravis Edrophonium HCI

(Tensilon) is used. The nurse knows that this drug will cause a
temporary increase in:
a. Consciousness
b. Blood pressure
c. Muscle strength
d. Symptoms
A client with myasthenia gravis ask the nurse why the disease has
occurred. The nurse bases the reply on the knowledge that there is:

a. A reduced amount of neurotransmitter acetylcholine

b. An inhibition of the enzyme ACHE leaving the end plates folded
c. A decreased number of functioning acetylcholine receptor sites
d. A genetic in the production acetylcholine

Myasthenia gravis is due to ____ receptors being blocked and destroyed

by antibodies.
a. Nicotinic
b. Epinephrine
c. Acetylcholine
d. Transient
3. Miss M. a patient with myasthenia gravis is to receive
immunosuppressive therapy. The nurse understands that this therapy is
effective because it:
a. Stimulates the production of acetylcholine at the neuromuscular
junction.
58
 b. Promotes the removal of antibodies that impair the transmission
of impulses
c. Inhibits the breakdown of acetylcholine at the neuromuscular
junction.
d. Decreases the production of autoantibodies that attack the
acetylcholine receptors.

The most significant initial nursing observations that need to be made

about a patient with myasthenia include:
a. Respiratory exchange and ability to swallow
b. Degree of anxiety about her diagnosis
c. Ability to smile and to close her eyelids
d. Ability to chew and speak distinctly

A female client has experienced an episode of myasthenic crisis. The

nurse would assess whether the client has precipitating factors such
as:
a. Omitting doses of medication
b. Increasing intake of fatty foods
c. Getting too little exercise
d. Taking excess medication

The nurse is teaching the female client with myasthenia gravis about the
prevention of myasthenic and cholinergic crises. The nurse tells the
client that this is most effectively done by:
a. Doing muscle-strengthening exercises
b. Doing all chores early in the day while less fatigued
c. Taking medications on time to maintain therapeutic blood levels
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 d. Eating large, well-balanced meals

Myasthenia gravis reflects a deficiency in communication by

_______________ because receptors for this neurotransmitter have been
destroyed.
a. Acetylcholine
b. GABA
c. Dopamine
d. Norepinephrine

During nursing report you learn that the patient you will be caring for
has Guillain-Barré Syndrome. As the nurse you know that this disease
tends to present with:
a. signs and symptoms that are unilateral and descending that start in
the lower extremities
b. signs and symptoms that are symmetrical and ascending that start in
the upper extremities
c. signs and symptoms that are asymmetrical and ascending that start in
the upper extremities
d. signs and symptoms that are symmetrical and ascending that
start in the lower extremities

You‟re assessing a patient‟s health history for risk factors associated

with developing Guillain-Barré Syndrome. all the following are risk
factors except:
a. Recent upper respiratory infection
b. Patient‟s age: 3 years old
c. Positive stool culture Campylobacter Jejuni
d. Epstein-Barr
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A patient with Guillain-Barré Syndrome has a feeding tube for
nutrition. Before starting the scheduled feeding, it is essential the nurse?
A. Assesses for bowel sounds
B. Keeps the head of bed less than 30′ degrees
C. Assesses for breath sounds
D. Weighs the patient

You‟re educating a patient about treatment options for Guillain-Barré

Syndrome. Which statement by the patient requires you to re-educate
the patient about treatment?
A. “Treatments available for this syndrome do not cure the condition but
helps speed up recovery time.”
B. “Plasmapheresis or immunoglobin therapies are treatment options
available for this syndrome but are most effective when given within 4
weeks of the onset of symptoms.”
C. “When I start plasmapheresis treatment a machine will filter my blood to
remove the antibodies from my plasma that are attacking the myelin sheath.”
D. “Immunoglobulin therapy is where IV immunoglobulin from a donor is
given to a patient to stop the antibodies that are damaging the nerves.

Which tests below can be ordered to help the physician diagnose

Guillain-Barré Syndrome? (Except): A. Edrophonium Test
b. Lumbar puncture
c. Electromyography
d. Nerve Conduction Studies

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You‟re teaching a group of nursing students about Guillain-Barré
Syndrome and how it can affect the autonomic nervous system. Which
signs and symptoms verbalized by the students demonstrate they
understood the autonomic involvement of this syndrome? (Except):
A. Altered body temperature regulation
B. Inability to move facial muscles
C. Cardiac dysrhythmias
D. Orthostatic hypotension

You‟re about to send a patient for a lumbar puncture to help rule out
Guillain-Barré Syndrome. Before sending the patient you will have the
patient?
A. Clean the back with antiseptic
B. Drink contrast dye
C. Void
D. Wash their hair
Your patient is back from having a lumbar puncture. Select all the
correct nursing interventions for this patient? Select all that apply: A.
Place the patient in lateral recumbent position.
B. Keep the patient flat.
C. Remind the patient to refrain from eating or drinking for 4 hours.
D. Encourage the patient to consume liquids regularly.

The patient‟s lumbar puncture results are back. Which finding below
correlates with Guillain-Barré Syndrome?
A. high glucose with normal white blood cells
B. high protein with normal white blood cells
C. high protein with low white blood cells
D. low protein with high white blood cells
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Female client is admitted to the hospital with a diagnosis of
GuillainBarre syndrome. The nurse inquires during the nursing
admission interview if the client has history of:
a. Back injury or trauma to the spinal cord
b. Meningitis during the last 5 years
c. Respiratory or gastrointestinal infection during the previous
month.
d. Seizures or trauma to the brain
A female client with Guillain-Barré syndrome has paralysis affecting the
respiratory muscles and requires mechanical ventilation. When the
client asks the nurse about the paralysis, how should the nurse respond?
a. “You may have difficulty believing this, but the paralysis caused
by this disease is temporary.”
b. “You‟ll first regain use of your legs and then your arms.”
c. “You‟ll have to accept the fact that you‟re permanently paralyzed.
However, you won‟t have any sensory loss.”
d. “It must be hard to accept the permanency of your paralysis.”

A male client is hospitalized with Guillain-Barre Syndrome. Which

assessment finding is the most significant?
a. Even, unlabored respirations
b. Warm skin
c. Urine output of 50 ml/hr
d. Soft, non distended abdomen

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Which patient should be assigned to the traveling nurse, new to
neurologic nursing care, who has been on the neurologic unit for 1
week?

a. A 34-year-old patient newly diagnosed with multiple sclerosis (MS)

b. A 68-year-old patient with chronic amyotrophic lateral sclerosis
(ALS)
c. A 25-year-old patient admitted with CA level spinal cord injury (SCI)
d. A 56-year-old patient with Guillain-Barre syndrome (GBS) in
respiratory distress

A male patient with Guillain-Barré syndrome develops respiratory

acidosis as a result of reduced alveolar ventilation. Which combination
of arterial blood gas (ABG) values confirms respiratory acidosis?
a. PH, 5.0; PaCO2 30 mm Hg
b. pH, 7.35; PaCO2 40 mm Hg
c. PH, 7.25; PaCO2 50 mm Hg
d. PH, 7.40; PaCO2 35 mm Hg

A female client with Guillian-Barre syndrome has ascending paralysis

and is intubated and receiving mechanical ventilation. Which of the
following strategies would the nurse incorporate in the plan of care to
help the client cope with this illness?
a. Providing information, giving positive feedback, and
encouraging relaxation
b. Giving client full control over care decisions and restricting
visitors
c. Providing intravaneously administered sedatives, reducing
distractions and limiting visitors
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 d. Providing positive feedback and encouraging active range of
motion

A patient is admitted with uncontrolled atrial fibrillation. The patient‟s

medication history includes vitamin D supplements and calcium. What
type of stroke is this patient at MOST risk for?
A. Ischemic thrombosis
B. Ischemic embolism
C. Hemorrhagic
D. Ischemic stenosis

Which patient below is at most risk for a hemorrhagic stroke? A.

A 65 year old male patient with carotid stenosis.
B. A 89 year old female with atherosclerosis.
C. A 88 year old male with uncontrolled hypertension and a history of
brain aneurysm repair 2 years ago.
D. A 55 year old female with atrial flutter.

You‟re educating a patient about transient ischemic attacks (TIAs).

Select all the options that are incorrect about this condition:
A. TIAs are caused by a temporary decrease in blood flow to the brain.
B. TIAs produce signs and symptoms that can last for several weeks to
months.
C. A TIAs is a warning sign that an impending stroke may occur.
D. TIAs requires medical treatment.
A patient who suffered a stroke one month ago is experiencing hearing
problems along with issues learning and showing emotion. On the MRI
what lobe in the brain do you expect to be affected?
A. Frontal lobe
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B. Occipital lobe
C. Parietal lobe
D. Temporal

A patient‟s MRI imaging shows damage to the cerebellum a week after

the patient suffered a stroke. What assessment findings would correlate
with this MRI finding? A. Vision problems
B. Balance impairment
C. Language difficulty
D. Impaired short-term memory

A patient is demonstrating signs and symptoms of stroke. The patient

reports loss of vision. What area of the brain do you suspect is affected
based on this finding?
A. Brain stem
B. Hippocampus
C. Parietal lobe
D. Occipital lobe

A patient has right side brain damage from a stroke. All the following
signs and symptoms that occurs with this type of stroke (Except):
A. Short attention span
B. Confusion on date, time, and place
C. Aphasia
D. Unilateral neglect

You‟re educating a group of nursing students about left side brain

damage. all the following are signs and symptoms noted with this type of
stroke (Except):
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A. Aphasia
B. Denial about limitations
C. Impaired math skills
D. Issues with seeing on the right side

During discharge teaching for a patient who experienced a mild stroke,

you are providing details on how to eliminate risk factors for
experiencing another stroke. Which risk factors below for stroke are
modifiable? (Except)
A. Smoking
B. Obesity
C. Advanced age
D. Sedentary lifestyle

Your patient who had a stroke has issues with understanding speech.
What type of aphasia is this patient experiencing and what area of the
brain is affected?
A. Expressive; Wernicke‟s area
B. Receptive, Broca‟s area
C. Expressive; hippocampus
D. Receptive; Wernicke‟s area
Your patient has expressive aphasia. Select all the ways to effectively
communicate with this patient?
A. Fill in the words for the patient they can‟t say.
B. Don‟t repeat questions.
C. Ask questions that require a simple response.
D. Discourage the patient from using words.

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 While conversing with a patient who had a stroke six months ago, you
note their speech is hard to understand and slurred. This is known as:
A. Dysarthria
B. Apraxia
C. Alexia
D. Dysphagia
4. You‟re reading the physician‟s history and physical assessment report.
You note the physician wrote that the patient has apraxia. What
assessment finding in your morning assessment correlates with this
condition?
A. The patient is unable to read.
B. The patient has limited vision in half of the visual field.
C. The patient is unable to wink or move his arm to scratch his skin.
D. The patient doesn‟t recognize a pencil or television.

You need to obtain informed consent from a patient for a procedure.

The patient experienced a stroke three months ago. The patient is
unable to sign the consent form because he can‟t write. This is known
as what: A. Agraphia
B. Alexia
C. Hemianopia
D. Apraxia
You‟re assessing your patient‟s pupil size and vision after a stroke. The
patient says they can only see half of the objects in the room. You
document this finding as:
A. Hemianopia
B. Opticopsia
C. Alexia

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D. Dysoptic

A patient who has hemianopia is at risk for injury. What can you
educate the patient to perform regularly to prevent injury?
A. Wearing anti-embolism stockings daily
B. Consume soft foods and tuck in chin while swallowing
C. Scanning the room from side to side frequently
D. Muscle training
You receive a patient who is suspected of experiencing a stroke from
EMS. You conduct a stroke assessment with the NIH Stroke Scale. The
patient scores a 40. According to the scale, the result is:
A. No stroke symptoms
B. Severe stroke symptoms
C. Mild stroke symptoms
D. Moderate stroke symptoms

In order for tissue plasminogen activator (tPA) to be most effective in

the treatment of stroke, it must be administered? A. 6 hours after the
onset of stroke symptoms
B. 3 hours before the onset of stroke symptoms
C. 3 hours after the onset of stroke symptoms
D. 12 hours before the onset of stroke symptoms

You‟re assisting a patient who has right side hemiparesis and dysphagia
with eating. It is very important to:
A. Keep the head of bed less than 30′.
B. Check for pouching of food in the right cheek.
C. Prevent aspiration by thinning the liquids.

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D. Have the patient extend the neck upward away from the chest while
eating.

A patient has experienced right side brain damage. You note the patient
is experiencing neglect syndrome. What nursing intervention will you
include in the patient‟s plan of care?
A. Remind the patient to use and touch both sides of the body daily.
B. Offer the patient a soft mechanical diet with honey thick liquids.
C. Ask direct questions that require one word responses.
D. Offer the bedpan and bedside commode every 2 hours.

A client arrives in the emergency department with an ischemic stroke

and receives tissue plasminogen activator (t-PA) administration. Which
is the priority nursing assessment?
1. Time of onset of current stroke.
2. Upcoming surgical procedures.
3. Complete physical and history.
4. Current medications.
Which assessment data would indicate to the nurse that the client would
be at risk for a hemorrhagic stroke?
a. A blood glucose level of 480 mg/dl.
b. A right-sided carotid bruit.
c. A blood pressure of 220/120 mm Hg.
d. The presence of bronchogenic carcinoma.

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