NCLEX Review Cardiovascular Quiz

1. The nurse is caring for an adult who has a clotting time of 20 minutes. What should the nurse do because of the lab values?1. Observe the client carefully for thrombus formation.2. Protect the client from sources of infection.3. Assure the client has adequate rest.*4. Avoid giving the client injections.

2. A client who is receiving heparin asks the nurse why it cannot be given by mouth. The nurse’s reply is based on which knowledge? Heparin is given parenterally because:*1. It is destroyed by gastric secretions.2. It irritates the gastric mucosa.3. It irritates the intestinal lining.4. Therapeutic levels can be achieved more quickly.

3. An adult is admitted for a cardiac catheterization. The client asks the nurse if she will be asleep during the cardiac catheterization. What is the best answer for the nurse to give?1. “You will be given a light general anesthesia.”*2. ” You will be sedated but not asleep.”3. “The doctor will give you an anesthetic if you are having too much pain.”4. “Is it important for you to be asleep?”

4. An adult has just returned following a left heart catheterization. What is it essential for the nurse to do?*1. Check her peripheral pulses.2. Maintain her NPO.3. Apply heat to the insertion site.4. Start range of motion exercises immediately.

5. The nurse is caring for an adult who is admitted with a history of angina pectoris.

He calls the nurse and says he has just taken a nitroglycerin tablet sublingually for anginal pain. What action should the nurse take next?*1. Monitor ECG. If the pain does not subside within five minutes, place a second tablet under his tongue.2. Assist him into bed and position him in Trendelenburg position. Record vital signs every five minutes.3. Notify the physician immediately. Start an IV so there will be a route for cardiac medications.4. Administer xylocaine (Lidocaine) IV. Prepare for defibrillation.

6. A low sodium, low cholesterol weight reducing diet is prescribed for an adult client. The nurse knows the client understands his diet when he chooses which of the following meals?*1. Baked chicken and mashed potatoes.2. Stir-fried Chinese vegetables and rice.3. Tuna fish salad with celery sticks.4. Lean steak with carrots.

7. A 70-year-old is admitted to the intensive care unit with cardiogenic shock. The nurse prepares an infusion of dobutamine as prescribed by the physician. The nurse recognizes an essential safety measure to be taken with this drug is to1. Obtain a 12 lead electrocardiograph.2. Assess electrolyte levels.3. Administer the drug through a large vein.4. Monitor for increase in temperature.

8. A client with atrial fibrillation is receiving warfarin sodium (coumadin) daily. What is the action of this drug?1. Inactivates protamine sulfate.2. Prevents new clots from forming.3. Dissolves existing clots.4. Slows the heart rate.

9. A client is receiving enalapril (Vasotec) 5 mg po daily for hypertension. Other medications include estrogen, lithium carbonate, and lorazepam. Which complaints should alert the nurse that medication interactions are present?1. Recent memory loss, muscle weakness, and hyperreflexia.2. Blood pressure 140/90, reports of mood swings, and restful night sleep.3. Slight kyphosis, occasional hot flashes, and menstrual cramps.4. Feelings of panic and anxiety, retrograde amnesia, and sleepiness.

10. A 68-year-old is admitted with a diagnosis of right-sided congestive heart failure. What assessment findings would the nurse expect in this client?1. Distended neck veins.2. Slight ankle edema.3. Hypotension.4. Premature ventricular contractions.

11. Digoxin and Lasix (Furosemide) are ordered for an adult client. Which of the following would the nurse expect to be ordered for this client?1. Potassium.2. Calcium.3. Aspirin.4. Warfarin.

12. An adult client is receiving digoxin. One morning when the nurse goes to give the client his digoxin he says, “I think I need to see the eye doctor. Things seem to look green today.” The nurse takes his vital signs and finds them to be: B.P. 150/94; P 60; R. 28. What is the most appropriate initial action for the nurse to take at this time?1. Record the findings on the client’s chart.2. Withhold the digoxin and report the findings.3. Request an appointment with the ophthalmologist.

4. Reassure the client he is experiencing a normal reaction to his medication.

13. The nurse is caring for an adult who underwent a mitral valve replacement. Following cardiac surgery, clients often experience periods of disorientation. Which of the following nursing actions may help prevent this disorientation?1. Keep the client heavily sedated.2. Keep the ICU well lighted 24 hours a day.3. Restrict visitors to 5 minutes at a time.4. Position the cardiac monitor so that it is out of the client’s view.

14. An adult had open heart surgery today for a mitral valve replacement. He has a central venous pressure catheter. The CVP is recorded every 15 minutes. The nurse has observed a marked increase in the CVP over the last 2 hours. The latest reading is above normal. Which nursing action would be appropriate before the surgeon is called?1. Increase the IV slightly to improve cardiac output.2. Elevate the client’s feet to increase venous return.3. Decrease the IV to a “keep open” rate.4. Check the specific gravity of the urine.

15. For which of the following surgical procedures is it essential for the nurse to note the presence or absence of the dorsalis pedis and posterior tibial pulses?1. Carotid endartarectomy.2. Iliofemoral bypass.3. Vein ligation.4. Pacemaker implantation.

16. The nurse knows that the reason a client who has had a myocardial infarction is getting heparin is to:1. Prevent extension of a thrombus.2. Dissolve small thrombi that have lodged in the coronary arteries.3. Enhance the action of thrombin in the

bloodstream.4. Decrease the amount of time it takes the blood to clot.

17. The nurse is caring for a client receiving heparin sodium. Which medication should the nurse have readily available because the client is receiving heparin?1. Vitamin K.2. Magnesium sulfate.3. Warfarin sodium.4. Protamine sulfate.

18. A 60-year-old client is admitted to the hospital with peripheral vascular disease of the lower extremities. He has had diabetes mellitus for 22 years. He smokes two packs of cigarettes per day and is employed in a job where he must stand for 7 or more hours each day. Which of the following would the nurse expect to elicit when assessing this client?1. Diminished pedal pulses.2. Warm tender calves.3. Tremors of the feet bilaterally.4. Difference in blood pressure when sitting and standing.

19. A 60-year-old man has several ischemic ulcers on each ankle and lower leg area. Other parts of his skin are shiny and taut with loss of hair. A primary nursing goal for this client should be to1. Increase activity tolerance.2. Relieve anxiety.3. Protect from injury.4. Help build a positive body image.

20. A 48-year-old is found on a routine physical examination to have a blood pressure of 170/98. Follow up studies confirm a diagnosis of hypertension. He is prescribed hydrochlorothiazide. What nursing instruction is it essential for him to receive?1. Use a calcium based salt substitute.

2. Avoid hard cheeses.3. Drink orange juice or eat a banana daily.4. Do not take aspirin.

21. A low sodium diet has been ordered for an adult client. Which menu is the lowest in sodium?1. Tossed salad, carrot sticks, steak.2. Baked chicken, mashed potatoes, green beans.3. Hot dog, roll, coleslaw.4. Chicken noodle soup, applesauce, cottage cheese.

22. An adult client was admitted to the coronary care unit following a subendocardial myocardial infarction. A balloon-tipped pulmonary artery catheter was inserted when the client began to exhibit signs of cardiogenic shock. The nurse measures the client’s pulmonary capillary wedge pressure and finds it to be 27 mm Hg. The nurse knows that this pressure is1. Within normal limits.2. Elevated above normal.3. Less than normal.4. Life threatening.

23. An elderly client with a long history of heart disease was brought to the emergency department of a local hospital following a 30 minute episode of chest pain unrelieved by nitroglycerin. The client’s electrocardiograph has an inverted T wave. The nurse caring for the client knows this finding indicates1. First-degree heart block.2. Second-degree heart block.3. Atrial flutter.4. Myocardial ischemia.

24. A client is admitted with thrombophlebitis of the right leg. Which findings would the nurse expect when assessing this client?

1. Diminished pedal pulses.2. Color changes in the extremities when elevated.3. Red, shiny skin.4. Pain when the leg is elevated.

25. Heparin via IV infusion is ordered for a client. Which of the following test results should the nurse monitor frequently?1. Hemoglobin and hematocrit.2. Activated Partial Thromboplastin Time (APTT)3. Prothrombin time.4. Platelet count.

NCLEX Review Cardiovascular Quiz Answers and Rationales

1. (4) The normal clotting is 5 to 15 minutes. A client with a clotting time of 20 minutes is prone to bleeding and should not receive injections. Choice #1 is appropriate for a client who has a decreased clotting time. Choice #2 is appropriate for a client with a low white count and choice #3 is appropriate for a client who has a low red count.

2. (1) Heparin is a protein and is destroyed by gastric secretions. IV administration achieves rapid levels of heparin. However heparin cannot be given by mouth so this is not the answer to the question.

3. (2) Persons undergoing cardiac catheterization will receive a sedative but are not put to sleep. Their cooperation is needed during the procedure. A general anesthesia is not used.

4. (3) Checking pulses is of highest priority. The complications most likely to occur are hemorrhage and obstruction of the vessel.

5. (1) Nitroglycerine can be given at 5 minute intervals for up to 3 doses if the pain is not relieved. Monitor ECG is appropriate

for a hospitalized patient. Trendelenburg position is contraindicated in someone who has angina. It would increase cardiac work load. There is no need to start an IV immediately for angina. Most hospitalized patients will have an IV access already in place. There is no data to support administering xylocaine. Defibrillation is for cardiac arrest.

6. (1) Baked chicken is low in sodium. Chinese food is high in sodium. Tuna fish is high in sodium; so is celery. Steak is high in sodium; so are carrots.

7. (3) Dobutamine is a vasoconstrictor and must be administered through a large vein to prevent extravasation. The nurse should also assess the client’s vital signs, lung sounds, urine output, and ECG. There is no need for a 12 lead ECG. Electrolyte levels are not related to dobutamine. Dobutamine does not cause a change in temperature.

8. (2) Clients with atrial fibrillation are subject to clot formation. Warfarin sodium (Coumadin) is given to prevent new clots from forming and existing clots from enlarging. Coumadin interrupts clotting by depressing hepatic synthesis of vitamin K dependent coagulation factor. Thrombolytic agents such as streptokinase or tPA dissolve existing clots. Protamine sulfate is the antidote for heparin. Warfarin does not slow the heart rate.

9. (1) Recent memory loss, muscle weakness, and hyperreflexia are adverse side effects associated with lithium carbonate toxicity. Enalapril (Vasotec), an antihypertensive drug, increases lithium levels when they are taken together. The other symptoms do not indicate medication interaction.

10. (1) Right sided heart failure is characterized by venous symptoms such as distended neck veins, hepatomegaly and pitting peripheral edema. Slight ankle edema might be seen with left sided heart failure. Blood pressure usually rises with heart failure. Premature ventricular contractions are not a major symptom with right sided heart failure.

11. (1) Lasix is a potassium depleting diuretic. Digoxin toxicity occurs more quickly in the presence of a low serum potassium.

12. (2) Disturbance in green and yellow vision is a sign of digitalis toxicity. A pulse of 62 is borderline for toxicity.

13. (4) Positioning the cardiac monitor so it is out of the client’s view will make the ICU less machine oriented and more people oriented. It may be anxiety producing for the client. The other choices are clearly incorrect since none of them will prevent disorientation. Sedation may cause disorientation. Keeping the room well lighted 24 hours a day causes abnormal sleep and waking patterns. Sleep deprivation may cause disorientation. Restricting visitors limits the emotional support a potentially disoriented person may need from significant others in his life.

14. (3) High CVP is indicative of circulatory overload. The IV should be decreased not increased. Elevation of the client’s feet would increase circulating volume. Check specific gravity of urine would be appropriate if the CVP were low and the nurse was concerned about dehydration. Note that choice #1 and #3 are opposites.

15. (2) Palpable pulses in the feet indicate that the bypass is patent. Following a carotid endartarectomy the carotid and temporal

pulse s are most essential. A vein ligation would not compromise arterial circulation in the feet. Apical pulse is appropriate after pacemaker insertion.

16. (1) Heparin prevents formation of new thrombi. It does not dissolve those already present. Heparin blocks the action of thrombin. It does not enhance it. Heparin makes it take longer for blood to clot.

17. (4) Protamine sulfate is the antidote for heparin. Vitamin K is the antidote for warfarin sodium (Coumadin). Magnesium sulfate is a central nervous system depressant given to treat preeclampsia.

18. (1) Arterial disease will cause decreased pulses in the lower extremities. Warm tender calves are typical with thrombophlebitis.

19. (3) He has decreased arterial circulation and will not heal well if injured. Important physical and safety needs take precedence over emotional needs.

20. (3) Hydrochlorothiazide is a potassium depleting diuretic. Orange juice and bananas are good sources of potassium. The person who is taking a potassium depleting diuretic should take a potassium based salt substitute if he is to take one. Hard cheeses should be avoided by persons taking the powerful monamine oxidase inhibitor antidepressants. Aspirin has an anticoagulant effect and is not contraindicated when taking a thiazide diuretic.

21. (2) Chicken is low in sodium, as are mashed potatoes and green beans. Carrot sticks, steak, hot dog, soup and cottage cheese are all high in sodium.

22. (4) The normal pulmonary capillary wedge pressure (PCWP) is 5 to 12 mm Hg. The higher the pressure, the more severe the

heart failure. Pressures that exceed 25 to 30 mm Hg can be associated with pulmonary edema, which is life threatening.

23. (4) An inverted T wave is characteristic of myocardial ischemia.

24. (3) Red, shiny skin suggests inflammation. Diminished pedal pulses suggest arterial insufficiency. Color changes when the extremities are elevated would suggest arterial insufficiency or varicose veins. Thrombophlebitis should not cause pain when the leg is elevated.

25. (2) APTT is the blood test used to monitor the effectiveness of heparin. Prothrombin time is used to monitor coumadin therapy.

NCLEX Review Quiz: Endocrine

1.         The client is admitted with a tentative diagnosis of diabetes insipidus. What should the nurse assess for while taking a nursing history?

1.         An increased appetite.2.         Excessive urine output.3.         Recent rapid weight gain.4.         Gynecomastia.

2.         A client has a transphenoidal hypophysectomy for a pituitary tumor. When he returns to the nursing unit following surgery the head of his bed is elevated 300.  The primary purpose for this position is to:

1.         Promote respiratory effort and prevent atelectasis.2.         Reduce pressure on the sella turcica and reduce headache.3.         Prevent acidosis and development of cerebral edema.

4.         Promote oxygenation and prevent cerebral ischemia.

3.         The nurse is discussing discharge plans with a client who had a transphenoidal hypophysectomy. Which statement made by the client indicates a need for more teaching?

1.         I won’t brush my teeth until the doctor removes the stitches.2.         I will wear loafers instead of tie shoes.3.         Where can I get a Medic Alert bracelet?4.         I will take all these new medicines until I feel better.

4.         The nurse is caring for a client who had a total thyroidectomy. Postoperative nursing care after his return to the nursing care unit should include observing for

1.         Hoarseness.2.         Signs of hypercalcemia.3.         Loss of reflexes4.         Mental confusion

5.         The nurse is teaching a client who had a total thyroidectomy in preparation for discharge. Which is of highest priority in the teaching plan?

1.         “Report any signs of inflammation at the incision site.”2.         “Take your thyroid medication every day.”3.         “Continue with coughing and deep breathing exercises.”4.         “Maintain strict bedrest for the first week at home.”

6.         Which of the following is most likely to develop if hyperthyroidism remains untreated?

1.         Pulmonary embolism.2.         Respiratory acidosis.3.         Cerebral vascular accident.4.         Heart failure

7.         A diagnosis of toxic hyperthyroidism is made in the client. Propylthiouracil 100 mg po tid is         ordered.  Which of the following is the expected effect of this drug?

1.         Increased perspiration and decreased appetite.2.         Increased basal metabolic rate.3.         Increase in protein bound iodine.4.         Weight gain and reduced pulse.

8.         A client, who has just had a thyroidectomy, returns to the unit in stable condition. What equipment is it essential for the nurse to have readily available?

1.         Tracheostomy set.2.         Thoracotomy tray.3.         Sphygmomanometer.4.         Ice collar.

9.         The client develops hypoparathyroidism after a total thyroidectomy. What treatment should the nurse anticipate?

1.         Emergency tracheostomy.2.         Administration of calcium.3.         Oxygen administration.4.         IV potassium.

10.       Which of the following diets would most likely be ordered for the client with hypothyroidism?

1.         High protein, high calorie.2.         Restricted fluids, low protein.3.         High roughage, low calorie.4.         High carbohydrate, low roughage.

11.       A woman with myxedema is started on thyroid replacement therapy and discharged. She returns to clinic one week later.  Which statement she makes is most indicative of an adverse reaction to the medication?

1.         “My chest hurt when I was sweeping the floor this morning.”2.         “I had severe cramps last night.”3.         “I am loosing weight.”4.         “My pulse rate has been more rapid lately.”

12.       A client with Cushing’s syndrome is on a low sodium, high potassium diet for which of the following reasons?

1.         Shock can occur in clients who have decreased amounts of adrenocortical steroids.2.         Increased aldosterone levels cause sodium retention and potassium excretion in the kidneys.3.         Excessive cortisone production causes hypertension.4.         Decreased amounts of corticosteroids cause electrolyte imbalances.

13.       The nurse is caring for a client who is on a low sodium, high potassium diet. Which foods, if selected by the client, indicate an understanding of the prescribed diet?

1.         Baked macaroni and cheese, carrot and raisin salad, and chocolate layer cake.2.         Shrimp salad, spinach salad, and strawberries.3.         Cheese omelet, buttermilk biscuits and chocolate pudding.4.         Fresh asparagus spears, broiled chicken breast, and lettuce and tomato salad.

14.       Diagnostic tests indicate that a 54-year-old woman has bilateral adrenal

hyperplasia.  She undergoes a bilateral adrenalectomy. The postoperative nursing care plan states to observe for adrenal crisis.  Which of the following symptoms, if observed, would be most critical and need to be reported immediately?

1.         Pitting edema of the ankles.2.         Lowering of the blood pressure.3.         Oliguria.4.         Glucosuria.

15.       Fludrocortisone acetate (Florinef) 0.1 mg daily po has been ordered for a client following bilateral adrenalectomy for which of the following purposes?

1.         To restore sodium and potassium balance.2.         To prevent hypertension.3.         To stimulate protein catabolism.4.         To replace deficient adrenocortical androgens.

16.       The nurse is doing discharge teaching with a client who has had a bilateral adrenalectomy. What should be included in the teaching plan?

1.         Telling her that after 1-2 years she will likely not need to take medication.2.         Explaining that she will need to take corticosteroids for the rest of her life.3.         Reinforcing that steroids should be slowly tapered if she decides to stop taking them.4.         Teaching her urine and blood testing to help in the regulation of steroid dosages.

17.       A client who has had an adrenalectomy is being discharged on Florinef 0.1 mg daily and prednisone 7.5 mg daily. What instruction must be given to the client?

1.         Increase salt intake to prevent salt deprivation.2.         Take the medication on an empty stomach to aid in absorption.3.         Expect a 3 to 5 pound weight increase for about 6 weeks.4.         Avoid exposure to infection, because she is susceptible.

18.       A woman with a tumor of the adrenal cortex says to the nurse, “Will I always look this ugly?  I hate having a beard.” What is the best response for the nurse to make?

1.         “After surgery you will not develop any more symptoms, but the changes you now have will linger.”2.         “That varies from person to person.  You should ask your physician.”3.         “After surgery your appearance should gradually return to normal.”4.         “Electrolysis and plastic surgery should make your appearance normal.”

19.       The client is ready for discharge following a unilateral adrenalectomy. Which statement she          makes indicates the best understanding of her condition?

1.         “I will continue on a low sodium, low potassium diet.”2.         “My husband has arranged for a marriage counselor because of our fights.”3.         “I will stay out of the sun so I will not turn splotchy brown.”4.         “I will take all of those pills every day.”

20.       The nurse’s next door neighbor calls.  He says he cannot awaken his 21-year-old wife.  The nurse notes that the client is unconscious and is having deep respirations.  Her breath has a fruity smell to it.  The husband says that his wife has been eating and drinking a lot and that last night

she vomited before lying down.  Which of the following is the most appropriate initial action for the nurse to take?

1.         Start cardiopulmonary resuscitation.2.         Get her to a hospital immediately.3.         Try to rouse her by giving her coffee.4.         Give her sweetened orange juice.

21.       An adolescent with newly diagnosed IDDM asks the nurse if he can continue to play football. What is the best answer for the nurse to give?

1.         “Now that you have diabetes, you should not play football as you may get a cut which will not heal.”2.         “If you work with your physician to regulate the insulin dosage and your diet you should be able to play football.”3.         “It would be better for you to work as equipment manager so you will not be under as much stress.  Stress can aggravate diabetes.”4.         “You can probably continue to play football if you can regulate it so that you have the same amount of exercise each day.”

22.       An adolescent with IDDM is learning about a diabetic diet. He asks the nurse if he will ever be able to go out to eat with his friends again. What is the best response for the nurse to make?

1.         “You can go out with them but you should take your own snack.”2.         “Yes.  You will learn to use the exchange lists so you can eat with your friends.”3.         “When you get food out in a restaurant be sure to order diet soft drinks.”4.         “Eating out will not be possible on a diabetic diet.  Why don’t you plan to invite your friends to your house?”

23.       One morning at 10 a.m. a client with IDDM becomes very irritable and starts to yell at the nurse. Which initial nursing assessment should take priority?

1.         Blood pressure and pulse.2.         Color and temperature of skin.3.         Reflexes and muscle tone.4.         Serum electrolytes.

24.       An elderly client has been recently diagnosed as having non-insulin dependent diabetes mellitus (NIDDM). Which of the following complaints she has is most likely to be related to the diagnosis of diabetes mellitus?

1.         Pruritus vulvae.2.         Cough.3.         Eructation.4.         Singultus.

25.       An elderly client with NIDDM develops an ingrown toenail. What is the best action for the nurse to take?

1.         Put cotton under the nail and clip the nail straight across.2.         Elevate the foot immediately.3.         Apply warm, moist soaks.4.         Notify the physician.

Answers and Rationales of NCLEX Review – Endocrine:

1.         (2)        Excessive urine output is characteristic of diabetes insipidus, which is caused by decreased ADH (antidiuretic hormone).  Increased appetite might be seen in diabetes mellitus.   Gynecomastia is seen in Cushing’s syndrome.

2.         (2)        Slight head elevation will reduce pressure and edema formation.  This position may help promote respiratory

effort.  However, that is not the primary reason in this client.

3.         (4)        He will need to take medications for the rest of life not just until he feels better. All of the other actions are appropriate.  He should not bend over to tie shoes as this increases intracranial pressure.  #1.  Remember he had a transphenoidal procedure.

4.         (1)        The nurse should have him state his name every hour.  Hoarseness indicates damage to the laryngeal nerve.  It is usually temporary.  The nurse should observe for signs of hypocalcemia such as hyperreflexia.

5.         (2)        After a total thyroidectomy is performed it is essential to take thyroid replacement daily.  Reporting inflammation of the incision site is not of highest priority.  After discharge he will not need to do breathing exercises or maintain strict bed rest.

6.         (4)        Hyperthyroidism causes tachycardia, which can be severe enough to cause the heart to wear out.

7.         (4) Propylthiouracil causes the thyroid gland to become less vascular and to shrink. Decreased thyroid activity will slow down the metabolic rate resulting in weight gain and reduced pulse and respirations.

8.         (1)        Swelling in the operative site could cause airway obstruction.  The nurse should have a tracheostomy set and oxygen at the bedside for 48 hours after thyroidectomy.

9.         (2)        Hypoparathyroidism causes a decrease in calcium.

10.       (3)        Hypothyroidism causes constipation and obesity.

11.       (1)        Chest pain on exertion suggests angina.  In addition to a slow heart rate the client with hypothyroidism frequently has atherosclerosis.  Thyroxin will increase the heart rate and the heart will require more oxygen.   Angina is a likely and serious complication that can occur.  She will also probably loose weight and have an increased pulse. These are expected when taking thyroxin.

12.       (2)        Cushing’s syndrome is hyperfunction of the adrenal cortex.  Increased aldosterone causes the kidneys to retain sodium and fluid and excrete potassium.

13.       (4)        All the other selections are high in sodium – macaroni and cheese, carrots, cake, shrimp, spinach, cheese omelet, biscuits, pudding.

14.       (2)        Hypotension is indicative of adrenal crisis.  Adrenal crisis is an emergency and can be fatal if not detected and treated immediately.  Hypotension, oliguria and glucosuria are not seen in adrenal crisis.

15.       (1)        Florinef is a mineralocorticoid that is given to permit absorption of sodium and excretion of potassium by the renal tubules.

16.       (2)        After a bilateral adrenalectomy she will have to take steroids – cortisone and Florinef for the remainder of her life.

17.       (4)        She is more susceptible to infection.  Salt intake needs to be restricted because Florinef causes sodium retention.  The medications are ulcerogenic and should

be taken with food.  A weight increase indicates fluid retention and the physician should be notified.

18.       (3)        A gradual return to normal will occur after adrenalectomy when there are no longer abnormal amounts of steroids being produced.

19.       (4)        She must take steroid replacement every day for the rest of her life.  #1 is not an appropriate diet.  The fights should decrease as her mood swings decrease after surgery.

20.       (4)         Her symptoms suggest ketoacidosis.  She must receive medical treatment at once.

21.       (2)        Diabetes is not a contraindication for sports.  Changes in activity level will alter the utilization of glucose so he will need to work closely with his physician to regulate exercise, insulin and diet control.

22.       (2)        Eating out with friends is very important to an adolescent.  Snacks will be allowed on his diet.  He should be taught how to use the exchange lists in managing his diet.

23.       (2)        The nurse can immediately assess the skin.  Behavior change and irritability suggest hypoglycemia.  If he is hypoglycemic he will have pale, cold, clammy skin and needs treatment (ingestion of a rapid acting carbohydrate) at once.

24.       (1)        Pruritus vulvae (itching of the vulva) frequently accompanies diabetes.  Monilial infections are common due to the change in pH.  Eructation is belching or burping and singultus is hiccups.  Neither of these is particularly related to diabetes.

25.       (4)        An ingrown toenail may cause infection, which can be very serious for the diabetic client.  The physician should be notified.  It is not appropriate for the nurse to initiate treatment.

NCLEX Review Respiratory Questions

1. An adult client is admitted for diagnosis and treatment of a left lung lesion. A bronchoscopy was performed under local anesthesia. What nursing action is of highest priority when he returns following the bronchoscopy?1. Collect all sputum for examination.2. Assess level of consciousness frequently.3. Withhold food and fluids until gag reflex has returned.4. Monitor blood pressure and pulse at 10 minute intervals.

2. A lower left lobectomy was performed on an adult client. He was returned to his room following an uneventful stay in the recovery room. It is most important for the nurse to1. Encourage him to perform deep breathing and coughing exercises.2. Assist him with arm exercises to prevent shoulder ankylosis.3. Help him perform leg exercises to prevent thrombophlebitis.4. Position him in semi-Fowler’s position on his left side.

3. A client who has had a lobectomy returns to the nursing unit. He has a chest tube attached to portable water seal drainage system and oxygen per nasal cannula. The first nursing measure concerning the water seal drainage is to1. Milk the tubing to prevent accumulation of fibrin and clots.2. Raise the drainage apparatus to bed height to accurately assess the meniscus level.3. Attach the chest tubes to the bed linen to

assure that airflow and drainage are unhindered by kinks.4. Mark the time and level of drainage in the collection chamber.

4. An adult client had a left thoracotomy. He has portable water seal chest drainage. On the first postoperative day the fluid in the water seal chamber stops fluctuating. What does this most likely indicate?1. The chest tube is clogged by fibrin or a clot.2. There is an air leak in the system.3. Pulmonary edema has occurred due to increased blood volumes in remaining lung tissue.4. The client’s left lung has reexpanded.

5. An adult client had a left lower lobectomy. Passive exercises are started on his left arm after surgery. The exercises are designed to prevent1. Hyperflexion of the wrist.2. Ankylosis of the shoulder.3. Flexion contractures of the elbow.4. Spasticity of the intercostal muscle

6. An adult client is admitted to the acute care hospital with bacterial pneumonia. On admission she was pale to dusky in color. Her respirations were 32, temperature 1030F and pulse 110. Auscultation revealed decreased or absent lung sounds in both bases and rhonchi in both upper lung fields. She was oriented to person, time and place, but her responses were brief. Oxygen per nasal cannula is started at 7 l / minute. IV antibiotics were started. While checking the client one hour after admission the nurse notes that she is less responsive, answering only yes or no questions. Her respirations are somewhat more shallow and have decreased to 27 per minute. What is the best INITIAL action for the nurse to take?1. Increase the IV infusion rate to increase the amount of circulating antibiotics.

2. Notify the physician of the client’s changed mental status and await further orders.3. Increase the oxygen flow rate to 10 liters / minute.4. Continue to stimulate her until she responds appropriately.

7. A tracheostomy tube is inserted in a patient who is in respiratory distress as a result of pneumonia. The family asks why the tube is inserted. What should the nurse include when explaining to the patient and family? The purpose of a tracheostomy tube is to1. Decrease the client’s anxiety by increasing the size of the airway.2. Provide increased cerebral oxygenation thereby preventing further respiratory depression.3. Facilitate nursing care since tracheal tubes have fewer side effects than nasotracheal tubes.4. Provide more controlled ventilation and ease removal of secretions the client is unable to handle.

8. An adult is about to have a tracheostomy performed. Which action is of highest priority for the nurse before the procedure is done?1. Establishing means of postoperative communication.2. Drawing blood for serum electrolytes and blood gases.3. Inserting an indwelling catheter and attaching it to dependent drainage.4. Doing a surgical prep of the neck and upper chest wall.

9. The nurse is performing tracheal suctioning. Which action is essential to prevent hypoxemia during suctioning?1. Removal of oral and nasal secretions.2. Encouraging the client to deep breathe and cough.

3. Administer 100% oxygen before suctioning.4. Auscultate the lungs.

10. An adult is admitted to the hospital with progressive dyspnea on exertion, which has become increasingly severe during the last six months. Physical examination reveals crackles at the base of the lung and clubbing of fingers. The client has asbestosis that has caused fibrosis in the alveoli. Soon after admission, the nurse helps the client to the bathroom. Before he returns to bed, he is very short of breath. Considering the severity of his symptoms, it is essential for the nurse to include which of the following in the plan of care.1. Give continuous oxygen via nasal catheter.2. Allow the client to move at his own pace.3. Give bronchodilators to increase his ability to breathe.4. Keep the client in bed to prevent further episodes of dyspnea.

11. An order is written for oxygen by nasal cannula at 2 liters per minute. In assessing the adequacy of the oxygen therapy, which of the following is most effective?1. Checking the respiratory rate.2. Checking the color of mucous membranes.3. Measurement of pulmonary functions.4. Measurement of arterial blood gasses.

12. A client with asbestosis must see his doctor regularly for a check up. What is the primary reason for him to have frequent checkups?1. Patients with asbestosis are at high risk for developing bronchogenic cancer.2. His doctor is monitoring him closely to look for signs of improvement.3. Patients who use low flow oxygen for long periods are at high risk for developing neurological symptoms.

4. Periodic sputum samples are needed to follow the progress of the disease.

13. An adult male has had a hacking cough and shortness of breath for several months. He now has chest pain. His family has pressured him into seeking medical consultation. He continues to say, “It is just a smoker’s cough.” The physician examines the client and arranges for hospital admission for a diagnostic work-up. The nurse is explaining several types of tests that are ordered. Which of these tests is most definitive in the process of ruling out a malignancy?1. Needle biopsy.2. Thoracentesis.3. Bronchogram.4. Sputum analysis.

14. Preoperative teaching for the client who is to have a pneumonectomy should include all of the following. Which is of highest priority?1. Management of postoperative pain.2. Turning, coughing and deep breathing exercises.3. How to move with the least pain.4. Leg exercises.15. An adult client has just arrived in the recovery room following a pneumonectomy. What is the most appropriate initial action for the nurse?1. Take his vital signs for baseline data.2. Check the IV solution for rate and correct solution.3. Administer oxygen through an appropriate device.4. Auscultate for the presence of breath sounds.

16. What action is essential because the client had a pneumonectomy?1. Observe the tracheal position.2. Auscultate bilateral breath sounds.

3. Assess for hypertension.4. Assess for blood streaked sputum.

17. The nurse is positioning an adult who has just returned to the surgical nursing care unit following a pneumonectomy. What is the most appropriate position in which to place the client?1. Semi-Fowler’s on the unaffected side.2. Semi-Fowler’s on the affected side.3. Sims position on the unaffected side.4. Semi-Fowler’s on his back.

18. Which of the following nursing interventions should be instituted the day after surgery for the client who has had a pneumonectomy?1. Provide range of motion exercises to affected arm.2. Strip chest tubes every hour.3. Force fluids to 3500 cc / day.4. Monitor intermittent positive pressure breathing therapy.

19. An adult has been diagnosed as having pulmonary tuberculosis. Which test(s) would the nurse expect to be ordered before the client is started on Isoniazid (INH) therapy?1. LDH, SGOT (AST)2. BUN, serum creatinine3. Skin test for allergy4. Chest X-ray

20. A patient is admitted with histoplasmosis. Which item in the patient’s history is most likely related to the onset of the disease?1. He works in a factory.2. He likes to explore caves.3. He has three cats.4. He smokes four packs of cigarettes a week.

Respiratory Questions Answers and Rationale

1. (3) Food and fluids should be withheld to prevent aspiration. The client will have received a local anesthetic to block the gag reflex during the bronchoscopy. The nurse should observe sputum for color but it is not necessary to collect it. Bronchoscopy is usually done under a local anesthetic so level of consciousness is not a priority. Vital signs may be monitored but preventing aspiration is of highest priority.

2. (1) Deep breathing and coughing assume highest priority after a thoracotomy. Arm and leg exercises are also important. He would be positioned in semi-Fowler’s position on his right side (nonoperative).

3. (4) It is important to monitor the amount of chest drainage. Chest tubes are milked only if there is an obstruction in the tubing and only with a physician’s order. The chest drainage system should not be raised above chest level. It should remain low. Chest tubes should not be attached to the linens.

4. (1) Fibrin and clots will obstruct the outflow of air from the patient’s thoracic cavity. It is too soon for the lung to have reexpanded. An air leak in the system would cause an absence of

bubbling in the suction control chamber not the water seal chamber.

5. (2) The muscles have been cut during surgery. Range of motion exercises will help to prevent ankylosis of the shoulder or frozen shoulder. Patients also tend to splint incisional discomfort by limiting movement on the affected side.

6. (2) Changes in mental status are always significant. Since her respirations are decreasing it is doubtful if oxygen would be effective.

7. (4) This is the purpose of a tracheostomy. The client may become less anxious when she is no longer hypoxic. However, relief of anxiety is not the purpose of a tracheostomy tube.

8. (1) A tracheostomy makes a client unable to speak. Other means of communication will be necessary.

9. (3) 100% oxygen is given before and after suctioning to prevent hypoxemia.

10. (2) The client is best able to evaluate his symptom of dyspnea. When he wants to rest, he should be allowed to rest. #1 is not correct. Oxygen may be ordered, but is often ordered PRN. A nasal cannula is usually ordered. #3 is not an independent nursing action. #4 is not correct. The client will be allowed to do as much as he is able to prevent complications of bedrest. The day should be planned so that periods of exertion are followed by periods of rest.

11. (4) Arterial blood gasses give the most specific information of the adequacy of the oxygen therapy. #1. The respiratory rate is a good measure but is not the best measure. #2. Color changes in the mucous membranes are a late sign of hypoxemia. #3. Pulmonary function tests are used to evaluate pulmonary function.

12. (1) This is true. The doctor is looking for a change in cough, hemoptysis, weight loss, etc. #2. The asbestos fibers in the lungs cannot be removed and the fibrosis is not reversible. Improvement is not expected. #3. is not correct. #4, sputum production is not a characteristic of this disorder. Also, sputum does not give information about the progress of the fibrosis.

13. (1) Needle biopsy of the lungs detects peripherally located tumors. It

provides a firm diagnosis in 80% of cases.

14. (2) Turning coughing and deep breathing help to prevent the most frequent, most life threatening complication likely to occur after thoracic surgery. The others are important and should be done.

15. (3) An oxygen source is of highest priority as the client is likely to be hypoventilating due to the effects of anesthesia. Oxygen will prevent hypoxia. After starting oxygen the nurse will make all of the other assessments.

16. (1) Tracheal shift can occur following pneumonectomy. Tracheal shift would compromise the client’s unaffected lung. There will be no breath sounds on the operative sounds. He has only one lung after a pneumonectomy. Hypotension, not hypertension, is a major sign of hemorrhage. The sputum will probably not be bloody, as the remaining lung was not operated on. A small amount of blood streaked sputum could be the result of intubation during surgery.

17. (4) Semi-Fowler’s on the back will neither cause mediastinal shift nor cause hemorrhage at the pulmonary artery stump site. Positioning the client

on his affected side could cause hemorrhage at the pulmonary artery stump site. Positioning the client on his unaffected side could cause mediastinal shift.

18. (1) Range of motion exercises should be started within 4 hours of surgery to prevent adhesion formation. Intermittent positive pressure breathing therapy will not be used as the pressure could interrupt the suture line. Most physicians do not insert chest tubes in these clients, as the fluid is allowed to accumulate and eventually consolidate in the space. An increased fluid load could lead to respiratory compromise.

19. (1) Liver function tests, SGOT (AST) and LDH would be performed to serve as baseline. Liver toxicity can occur with INH. Renal function tests, BUN and serum creatinine are essential in persons who are receiving streptomycin therapy. There is not a skin test for allergy to INH. A chest X-ray will have been done as part of the diagnostic process but is not necessary again before starting INH therapy.

20. (2) Histoplasmosis is caused by a fungus that grows in chicken and bat manure. Bats live in caves. Exploring caves is a likely source of exposure to

the fungus. Choice 1, working in a factory, might be related to COPD if the factory had emissions. Choice 3 would be a possible source of toxoplasmosis, not histoplasmosis. Choice 4 is not related to histoplasmosis although it could be related to other respiratory diseases.