Medical Surgical Nursing Pre-test 2

30 ITEMS

1. 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 (ACE) inhibitor that reduces blood pressure by blocking the
conversion of angiotensin I to angiotensin II.

2. The nurse understands that a priority nursing diagnosis for the client with hypertension would be
a. Pain.
b. Deficient Fluid Volume.
c. Impaired skin integrity.
d. Ineffective health maintenance.

3. The most important long-term goal for a client with hypertension would be to
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.

4. The client with hypertension is prone to long-term complications of the disease. Which of the
following is a long-term complication of hypertension?
a. Renal insufficiency and failure.
b. Valvular heart disease.
c. Endocarditis
d. Peptic ulcer disease.

5. 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 accidents (CVA’s)
b. Liver disease.
c. Myocardial infarction.
d. Pulmonary disease.
6. During the past few months, a 56-year old woman has felt brief twinges of chest pain while working in
her garden and has had frequent episodes of indigestion. She comes to the hospital after experiencing
severe anterior chest pain while raking leaves. Her evaluation confirms a diagnosis of stable angina
pectoris. After stabilization and treatment, the client is discharged from the hospital. At her follow-up
appointment, she is discouraged because she is experiencing pain with increasing frequency. She states
that she visits an invalid friend twice a week and now cannot walk up the second flight of steps to the
friend’s apartment without pain. Which of the following measures that the nurse could suggest would
most likely help the client deal with this problem?
a. Visit her friend
b. Rest for at least an hour before climbing the stairs
c. Take a nitroglycerin tablet before climbing the stairs.
d. Lie down once she reaches the friend’s apartment.

7. The client who experiences angina pectoris has been told to follow a low-cholesterol diet. Which of
the following meals should the nurse tell the client would be best on her low –cholesterol diet?
a. Hamburger, salad, and milkshake.
b. Baked liver, green beans, and coffee.
c. Spaghetti with tomato sauce, salad, and coffee
d. Fried chicken, green beans, and skim milk

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

9. The physician refers the client with unstable angina for a cardiac catheterization. The nurse explains
to the client that this procedure is being used in this specific case to:
a. Open and dilate 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

10. The client is scheduled for a percutaneous transluminal coronary angioplasty (PTCA) to treat angina.
Priority goals for the client immediately after PTCA would include:
a. Minimizing dyspnea
b. Maintaining adequate blood pressure control
c. Decreasing myocardial contractility
d. Preventing fluid volume deficit
11. Which of the following is not generally considered to be a risk factor for the development of
atheroclerosis?
a. Family history of early heart attack
b. Late onset of puberty
c. Total blood cholesterol level greater than 220 mg/dL
d. Elevated fasting blood sugar concentration

12. Many more men than women younger than 50 years of age have coronary artery disease as a result
of atherosclerosis. The leading cause of death in women is:
a. Acquired immunodeficiency syndrome
b. Breast cancer
c. Coronary artery disease
d. Chronic obstructive pulmonary disease

13. A client angina asks the nurse, “ What information does an ECG provide?” The nurse would respond
that an electrocardiogram (ECG) primarily gives information about the:
a. Electrical conduction of the myocardium
b. Oxygenation and perfusion of the heart
c. Contractile status of the ventricles
d. Physical integrity of the heart muscle

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

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

16. 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
c. Take one tablet, then an additional tablet every 5 minutes for a total of three tablets. Call the
physician if pain persists after these tablets
d. Take one tablet. If pain still persists 5 minutes later, call the physician

17. A client with angina has been taking nifedipine. The client should be taught to:
a. Monitor blood pressure monthly
b. Perform daily weights
c. Inspect gums daily
d. Limit intake of green leafy vegetables

The Client With A Permanent Pacemaker

18. A 74-year-old woman is admitted to the telemetry unit for placement of a permanent pacemaker
would be to:
a. Maintain skin integrity
b. Maintain cardiac conduction stability
c. Decrease cardiac output
d. Increase activity level

19. The client who had a permanent pacemaker implanted 2 days earlier is being discharged from the
hospital. Outcome criteria include that the client:
a. Selects a low-cholesterol diet to control coronary artery disease
b. States a need for bed rest for 1 week after discharge
c. Verbalizes safety precautions needed to prevent pacemaker malfunction
d. Explain sign and symptoms of myocardial infraction

The Client Requiring Cardiopulmonary Resuscitation

20. A rescuer is called to a neighbor’s home after a 56-year-old man collapses. After quickly assessing
the victim, the rescuer determines that the victim is unresponsive. To determine unresponsiveness, the
rescuer can:
a. Call the victim’s name and gently shake the victim
b. Perform the chin-tilt to open the victim’s airway
c. Feel for any air movement from the victim’s nose or mouth
d. Watch the victim’s chest for respirations

21. Proper hand placement for chest compressions during cardiopulmonary resuscitation (CPR) is
essential to reduce the risk of which of the following complications?
a. Gastrointestinal bleeding
b. Myocardial infraction
c. Emesis
d. Rib fracture

22. The American Heart Association guidelines urge greater availability of automated external
defibrillators (AEDs) and people trained to use them. AEDs are used in cardiac arrest situations for:
a. Early defibrillation in cases of atrial fibrillation
b. Cardioversion in cases of atrial fibrillation
c. Pacemaker placement
d. Early defibrillation in cases of ventricular fibrillation

23. A client who has been given CPR is transported by ambulance to the hospital’s emergency
department, where the admitting nurse quickly assesses the client’s condition. Of the following
observations, the one most often recommended for determining the effectiveness of CPR is noting
whether the:
a. Pulse rate is normal
b. Pupils are reacting to light
c. Mucous membranes are pink
d. Systolic blood pressure is at least 80 mmHg

24. The client receives epinephrine during resuscitation in the emergency department. This drug is
administered primarily because of its ability to:
a. Dilate bronchioles
b. Constrict arterioles
c. Free glycogen from the liver
d. Enhance myocardial contractility

25. The rescuer understands that the compression-to-ventilation ratio for one-rescuer adult CPR is:
a. 5:1
b. 15:1
c. 5:2
d. 15:2

26. During CPR, the xiphoid process at the lower end of the sternum should not be compressed when
performing cardiac compressions. Which of the following organs would be most likely at risk for
laceration by forceful compressions over the xiphoid process?
a. Lung
b. Liver
c. Stomach
d. Diaphragm
27. When performing external chest compressions on an adult during CPR, the rescuer should depress
the sternum.
a. 0.5 to 1 inch
b. 1 to 1.5 inches
c. 1.5 to 2 inches
d. 2 to 2.5 inches

28. The American Heart Association guidelines for Basic Cardiac Life Support recommend that the
rescuer after first establishing unresponsiveness, should:
a. Perform CPR for 2 minutes on the adult victim then place a call for emergency assistance
b. Place a call for emergency assistance immediately
c. Begin rescue breathing for the victim
d. Begin CPR on the adult victim and wait until help comes on the scene

29. If the victim’s chest wall fails to rise with each inflammation when rescue breathing is administered
during CPR, the most likely reason is that the:
a. Airway is not opened properly
b. Victim is beyond resuscitation
c. Inflations are being given at too rapid a rate
d. Rescuer is using inadequate force for cardiac compression

30. During rescue breathing in CPR, the victim with exhale by:
a. Normal relaxation of the chest
b. Gentle pressure of the rescuer’s hand on the upper chest
c. The presence of cardiac compressions
d. Turning the head to the side