Which of the following is not an early symptom of head & neck cancer?

a) Hoarsenessb) Change in fit of denturesc) Mouth ulcers that do not heald) Decreased mobility of tongue

Nursing management of the pt immediately after a total laryngectomy includes all of the following except

a) Changing the surgical dressingb) Monitoring function of the drainage tubesc) Ensuring that the NG tube is patentd) Placing the pt in semi-Fowler’s position

When assessing a pt w/ pneumococcal pneumonia, the nurse recognized that clinical manifestations of this condition include:

a) Fever, chills, & productive cough w/ rust-colored sputum

b) Nonproductive cough & night sweats that are usually self-limiting

c) Gradual onset of nasal stuffiness, sore throat & purulent productive cough

d) Abrupt onset of fever, nonproductive cough & formation of lung abscess

An appropriate nursing intervention for a pt w/ pnemonia w/ the nursing diagnosis of ineffective airway clearance r/t thick secretions & fatigue would be to:

a) Perform postural drainage every hourb) Provide analgesics as ordered to promote pt

comfortc) Administer O2 as prescribed to maintain

optimal oxygen levelsd) Teach pt how to cough effectively to bring

secretions to mouth

Pt w/ TB has nursing diagnosis of noncompliance. RN recognizes the most common etiologic factor for this dx is:

a) Fatigue & lack of energy to manage self-careb) Lack of knowledge about how the disease is

transmittedc) Little or no motivation to adhere to long-term

drug regimend) Feelings of shame & the response to the

social stigma associated w/ TB

The RN identifies a flail chest in a trauma pt when:

a) Multiple rib fractures are determined by x-rayb) Tracheal deviation to unaffected side is

presentc) Paradoxic chest movement occurs during

respirationd) There is dec’d movement of involved chest

wall

RN notes tidaling of water level in the tube sumerged in the water-seal chamber in a pt w/ closed chest-tube drainage. The RN should:

a) Continue to monitor this normal ndingb) Check all connections for a leak in systemc) Lower drainage collector further from chestd) Clamp tubing at progressively distal points

away from pt until tidaling stops

A nursing measure that should be instituted after a pneumonectomy is

a) Monitoring chest-tube drainage & functioning

b) Positioning pt on unaffected side or backc) ROM on affected upper extremityd) Auscultating frequently for lung sounds on

the affected side

Guillain-Barre syndrome causes respiratory problems primarily by

a) Depressing the CNSb) Deforming chest-wall musclesc) Paralyzing the diaphragm secondary to

traumad) Interrupting nerve transmission to

respiratory muscles

Pt w/ COPD asks why the heart is affected by respiratory disease. The nurs’es response to the pt is

based on t the knowledge that cor pulmonale is characterized by:

a) Pulmonary congestion secondary to left ventricular failure

b) Excess serous fluid collection in the alveoli caused by retained respiratory secretions

c) Right ventricular hypertrophy secondary to increased pulmonary vascular resistance

d) Right ventricular failure secondary to compression of heart by hyperinflated lungs

In responding to a pt w/ emphysema who asks about the possibility of a lung transplant, the nurse knows that lung transplantation is contraindicated in pts:

a) w/ cor pulmonaleb) Who currently smokec) Older than 50 years of aged) w/ end-stage lung disease

In evaluating the asthmatic pt’s knowledge of self-care, the nurse recognizes that additional instruction is

needed when the pt says:

a) I use my corticosteroid inhaler when I feel SOBb) I get a flu shot every year & see my HCP if I

have an upper resp infectionc) I use my bronchodilator inhaler before I visit

my aunt who has a cat, but I only visit for a few minutes because of my allergies

d) I walk 30mins every day but sometimes I hae to use my bronchodilator before walking to prevent me from getting SOB

A plan of care for the pt w/ COPD would include:

a) Chronic corticosteroid therapyb) Reduction of risk factors for infectionc) High flow rate O2 administrationd) Lung exercises that involve inhaling longer

than exhaling

pt w/ MI of anterior wall of left ventricle most likely has an occlusion of

a) Right marginal arteryb) Left circumflex arteryc) Left anterior descending arteryd) Right anterior descending artery

When assessing the pt, the nurse notes a palpable precordial thrill. This finding may be

caused by:a) Heart murmursb) Gallop rhythmsc) Pulmonary edemad) Right ventricular hypertrophy

When assessing CV system of 79yr old, nurse expects to find:

a) A narrowed pulse pressureb) Diminished carotid artery pulsesc) Difficulty in isolating the apical pulsed) An increased heart rate in response to stress

An important nursing responsibility for pt having an invasive cardiovascular diagnostic study is:

a) Checking peripheral pulses & percutaneous site

b) Instructing pt about radioactive isotope injection

c) Informing pt that general anesthesia will be given

d) Assisting pt to do a surgical scrub of the insertion site

If pt has decreased CO caused by fluid volume deficit & marked vasodilation, the regulatory mechanism that will increase the BP

by improving both of these is:

a) Release of ADHb) Secretion of prostaglandinsc) Stimulation of sympathetic nervous systemd) Activation of renin-angiotensin-aldosterone

system

Pt admitted in hypertensive crisis. RN recognizes that the hypertensive urgency differs from hypertensive

emergency in that:

a) The BP is always higher in hypertensive emergency

b) Hypertensive emergencies are associated w/ evidence of target organ damage

c) Hypertensive urgency is treated w/ rest & tranquilizers to lower BP

d) Hypertensive emergencies require intraarterial catheter measurement of BP

After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the

pt says:

a) I would like to add weight lifting to my exercise program

b) I can’t keep my BP normal w/o medicationc) I can change my diet to decrease my intake of

saturated fatsd) I will change my lifestyle to reduce activities

that increase my stress

In planning activity for the pt recovering from an MI, the nurse recognizes that the healing heart wall is most vulnerable to stress

a) 3 weeks after infarctb) 4-6 days after infarctc) 10-14 days after infarctd) When healing is complete at 6-8 wks

Pt admitted to CCU w/ CP for 24hrs, ECG consistent w/ acute MI, & occasional ventricular arrhythmias. Nurse plans care for pt based

on expectation that pt will be managed w/

a) Endotracheal intubationb) Subq nitroc) Continuous ECG monitoringd) Thrombolytic therapy w/ tPa

The most common pathologic finding in individuals w/ sudden cardiac death is:

a) Cardiomyopathiesb) Mitral valve diseasec) Atherosclerotic heart diseased) Left ventricular hypertrophy

Nurse recognizes that primary manifestations of systolic ventricular failure include:

a) ↓ afterload & ↓LVEDPb) ↓ejection fraction & PAWPc) ↓PAWP & ↑left ventricular ejection fractiond) ↑Pulmonary HTN associated w/ normal

ejection fraction

A compensatory mechanism involved in CHF that leads to inappropriate fluid retention & additional workload of heart is:

a) Ventricular dilationb) Ventricular hypertrophyc) Neurohormonal responsed) Sympathetic nervous system activation

The drug used in management of acute pulmonary edema that will decrease both preload & afterload & provide relief of anxiety

is:

a) Morphineb) Amrinonec) Dobutamined) Aminophylline

Nurse plans care for pt w/ dilated cardiomyopathy based on knowledge that

a) Family members may be at risk because of infectious nature of disease

b) Medical management of disorder focuses on treatment of underlying cause

c) Prognosis of pt is poor, & emotional support is a high priority

d) The condition may be successfully treated w/ surgical ventriculomyotomy & myectomy

Pt w/ stable BP & no symptoms has following ECG: atrial rate 74 & regular, ventr rate 62 & irregular, P wave normal contour, PR interval lenghtens progressively

until a P wave is not conducted, QRS normal contour. Nurse expects what tx

a) Epi 1mg IVPb) Isoproterenol IV continuous dripc) Immediate insertion of temporary pacerd) Careful observation for symptoms of

hypotension

ECG for pt in CCU following acute MI indicates ventr bigeminy. Nurse anticipates

a) Performing defibrillationb) Treatment w/ IV lidocainec) Insertion of temporary pacemakerd) Continuing monitoring w/o other treatment

nurse plans care for pt w/ implantable cardioverter-defibrillator based on knowledge that

a) Antiarrhythmia drugs can be discontinuedb) All members of pt’s family should learn CPRc) Pt should not drive until 1 month after ICD

has been implantedd) Pt is usually relieved to have device

implanted to prevent arrhythmias

Nurse suspects cardiac tamponade in pt w/ acute pericarditis based on the finding of

a) CPb) Pulsus paradoxusc) Mitral valve murmurd) Pericardial friction rub

Which of the following findings is indicative of accentuated left ventricular filling in a pt w/ chronic mitral regurgitation?

a) Audible third heart sound & late diastolic murmur

b) Midsystolic click f/b early systolic murmurc) Audible third heart sound & pansystolic or

holosystolic murmurd) Audible third heart sound & middiastolic click

w/ late diastolic murmur

Pt admitted w/ aortic stenosis has nursing dx of activity intolerance r/t insufficient O2 secondary to dec’d CO. an

appropriate nursing intervention for pt is

a) Monitor ECG to assess cardiac outputb) Maintain on bed rest to reduce tissue oxygen

demandsc) Progressively increase activity to increase

cardiac toleranced) Use a semi-Fowler position to decrease

venous return & increase respiratory excursion

Pt being prepared for AAA repair. Nurse suspects rupture when

a) Pt becomes dizzy & SOBb) Pt c/o sudden, severe back painc) Bruit & thrill are present at site of aneurysmd) Pt develops blue, patchy mottling of feet &

toes

Pt w/ infective endocarditis develops sudden left leg pain w/ pallor, paresthesia, & loss of peripheral pulses. Nurse’s initial

action should be to

a) Notify physicianb) Elevate leg to promote venous returnc) Wrap leg in blanket to provide warmthd) Perform passive ROM to stimulate circulation

to leg

Pt w/ highest risk of DVT

a) 25yo obese woman 3 days postpartumb) 40yo woman who smokes & uses oral

contraceptivesc) 62yo man who had stroke w/ left sided

hemiparesisd) 72yo man who had suprapubic

prostatectomy for CA of prostate

Nursing interventions indicated in plan of care for pt w/ acute lower extremity DVT include

a) Applying elastic compression stockingsb) Administering anticoagulants as orderedc) Positioning the leg dependently to promote

arterial circulationd) Encouraging walking & leg exercises to

promote venous return

Pt w/ DVT suddenly develops dyspnea, tachypnea, & CP. Initially the most appropriate action is

a) Auscultate for abnormal lung soundsb) Administer O2 & notify physicianc) Ask pt to CDB to clear airwaysd) Elevate HOB 30-45 degrees to facilitate

breathing