Endocrine Disk 1 (Endocrine/Hematology/Gastrointestinal/Renal/Integumentary = 20%)

What is the effect of ADH on urine formation?

A. Retention of sodium and water, excretion of potassium
B. Excretion of sodium and water, excretion of potassium
C. Retention of water, concentration of urine
D. Excretion of water, dilution of urine
The releasing stimulus for ADH is normally:
A. Decreased serum wall myocardial infarction?
B. Increased serum osmolarity
C. An elevated circulating cortisol level
D. Increased serum potassium levels
The normal range of serum osmolarity is:
A. 145-155
B. 200-250
C. 275-295
D. 325-375
SIADH is manifest clinically as a:
A. Hyperosmolar state
B. Low output state
C. Myxedema state
D. Water intoxication state
In addition to its effect on body water equilibrium, ADH is also a:
A. Vasopressor
B. Cardiotonic
C. Beta stimulator
D. Carbonic anhydrase inhibiter
The symptomatology you would assess in the patient with SIADH results from:
A. Elevated potassium levels
B. Water intoxication
C. Increased serum osmolality
D. Precipitating factors of SIADH
The "cardinal sign" of SIADH is:
A. Dilutional hyponatremia
B. Urinary output of 10l per day
C. Hypotension
D. Systemic edema
Which of the following laboratory findings would be present in a patient with SIADH?
A. Low serum sodium
B. Serum osmolality of 350
C. Urine specific gravity of 1.003
D. Decreased urinary osmolarity
The patient with SIADH may present with:
A. Increased urinary output
B. Seizures
C. Hypertension
D. Increased potassium levels

As a staff nurse in ICU you are assigned to a patient recently admitted with di. Which of the following patients
would be likely to develop di?
A. An elderly patient receiving thiazides
B. A young women with severe pneumonia
C. A 50 y/o man with esophageal varices on Pitressin
D. A head trauma pt with a skull fracture
During your assessment, which of the following findings would be present in a patient with DI?
A. Serum osmolality of 250
B. Serum sodium level of 165
C. Urinary output of less than 600cc in 24 hours
D. Urine specific gravity of 1.025
The nurse understands a major complication of DI is:
A. Hypovolemic shock
B. Seizures
C. Congestive heart failure
D. Cardiac arrhythmias
Evaluation of laboratory findings in a patient with DI would show:
A. Increased urine osmolality
B. Urine specific gravity between 1.001 to 1.005
C. Decreased serum sodium
D. Decreased serum osmolarity
The most dangerous complication of DI is:
A. Dilutional hyponatremia
B. Hypovolemia
C. Congestive heart failure
D. Water intoxication syndrome
Diabetes insipidus is characterized by all but which of the following?
A. Urine specific gravity of 1.015
B. Tachycardia
C. Urinary output of 2000 cc in three hours
D. BP 90/40
Which of the following is characteristic of DI?
A. Low urinary osmolarity
B. Serum osmolarity increased
C. Serum sodium elevated
D. All of the above
A 66 yo is admitted with a blood sugar of 1200, she is severely dehydrated, respirations are 18 per minute and
shallow: you would first suspect?
A. Hyperosmolar coma
B. Diabetic ketoacidosis
C. Either of the above
D. Neither a or b

It is important for the nurse to identify those patients at risk for developing HHNK. Which condition would not
predispose a patient to develop HHNK?
A. Pancreatitis
B. Thiazide of steroid therapy
C. TPN therapy
D. Cerebrovascular accident
Nonketotic hyperosmolar coma (HHNK) is not usually associated with:
A. Defects in ADH secretion
B. Mild diabetes of recent onset
C. Older age
D. Use of diuretics, steroids and hypertonic solutions
The nurse understands that the primary cause of the classical manifestations in HHNK is:
A. Rapid decrease in plasma osmolarity
B. Markedly elevated serum glucose
C. Intravascular dehydration
D. Serum electrolyte abnormality
The altered mental status in a patient in HHNK results from:
A. Hyperosmolaity of plasma
B. Intracerebral dehydration
C. Severe osmotic diuresis from hyperglycemia
D. Intravascular dehydration
Which of the findings would not be present in HHNK?
A. Kussmaul's respirations of 28/min
B. Serum glucose level above 650 and often greater than 1000
C. Serum osmolarity above 350
D. Severe dehydration and the absence of ketoacidosis
Evaluation of a patient's laboratory values with HHNK would include:
A. A serum sodium of 123
B. A serum osmolarity of 340
C. A urinary sodium of 60
D. A bicarbonate level of 12
Further assessment of diagnostic data in a patient with HNNK would reflect:
A. ABG with a pH of 7.10
B. Four plus ketone in their urine
C. Azotemia
D. Hematocrit of 29%
Which of the following laboratory findings is not likely to be seen in patients with DKA?
A. Ph 7.19
B. Pco2 45
C. Base deficit -14
D. Serum k 5.5
Which of the following diagnostic data in a patient with HHNK would reflect:
A. ABG with a pH of 7.10
B. Four plus ketone in their urine
C. Azotemia
D. Hematocrit of 29%

Neuro Disk 2 (MSK/Neuro/Psychosocial = 13%)

The single most important index of neurological state is the:
A. Level of consciousness
B. Pupillary reaction
C. Extremity movement and strength
D. Vital signs
Quick rotation of the head back and forth while holding the eyes open causing the eyes of the comatose patient to
rotate opposite the side toward which the head is turned is a positive response known as:
A. Extraocular ophthalmoplegia
B. Intranuclear extraocular ophthalmoplegia
C. Oculocephalic reflex
D. Dysconjugate lateral reflex
The response elicited when the neck is flexed, producing flexion of both thighs at the hips, as well as flexion
movements of ankles and knees is called:
A. Kernigs sign
B. Babinskis sign
C. Brudzinskis sign
D. Trousseaus sign
The respiratory pattern seen in upper brainstem lesions (midbrain) is:
A. Hyperventilation
B. Ataxia
C. Cluster
D. Apneustic
A 26-year old male is complaining of severe headache. On assessment he has nuchal rigidity and a positive
Kernigs sign. Which of the following conditions is most likely present?
A. Epidural hematoma
B. Subdural hematoma
C. Subarachnoid hemorrhage
D. Increased intracranial pressure
The classic cardiovascular signs of increasing intracranial pressure known as Cushings triad include?
A. Decreasing pulse, widening pulse pressure, peripheral vasoconstriction
B. Decreasing pulse, increasing systolic BP, widening pulse pressure
C. Decreasing pulse, decreasing BP widening pulse pressure
D. Decreasing systolic BP, central cyanosis, WPP
Ventricular fluid pressure is the most sensitive indicator of increased intracranial pressure. The normal ventricular
fluid pressure is:
A. 16-40 mmHg
B. 0-10 mmHg
C. 41-61 mmHg
D. Above 60 mmHg
A patient has a subarachnoid screw inserted to monitor his intracranial pressure (ICP) and cerebral perfusion
pressure (CPP). The ICP and CPP are both 35 mmHg. This means that the patients:
A. Intracranial venous pressure is decreased
B. Condition is stable
C. Systemic arterial pressure is elevated
D. Cerebral blood flow has markedly decreased to the brain

Which of the following parameters are graded when using the Glasgow Coma Scale in the assessment of the
patient with an altered state of consciousness?
A. Eye opening sensory level and verbal response
B. Motor response, pupillary signs and orientation
C. Pupillary signs, orientation and BP
D. Eye opening, motor response, and verbal response
Blindness is one half of both visual fields following a CVA is referred to as:
A. Homonymous hemianopia
B. Astereognosis
C. Homonymous hemignosia
D. Optic hemianopia
Patients with injury to the left cerebral hemisphere may exhibit:
A. Left hemiparesis or hemiplegia
B. Deviation of the eye to the left
C. Left homonymous hemianopia
D. All of the above
Pinpoint pupils that react to light if viewed with a magnifying glass are indicated of:
A. A lesion in the pons
B. A lesion in the basal ganglia
C. Oculomotor dysfunction
D. Sympathetic nervous stimulation
The nurse caring for a patient with a supratentorial herniation understands that the earliest sign would be:
A. Decerebrate posturing
B. Wide and fixed pupils
C. Lethargy and stupor
D. Ipsilateral dilated pupil
Which of the following treatment modalities would the nurse consider to be inappropriate for the ventilator
dependent patient with increased intracranial pressure?
A. Maintaining the CO2 level between 29-33
B. Feeding the patient via an NGT
C. Administering D5W at 75 cc an hour
D. Log roll when turning the patient
While assessing the laboratory data of a patient with head trauma, which finding necessitates notification of the
physician?
A. A serum osmolarity of 275
B. A serum sodium level of 138
C. A urine specific gravity of 1.005
D. A urine osmolarity of 400
A basal skull fracture affecting the middle fossa may cause which of the following?
A. Cranial nerve injuries
B. Battles sign
C. CSF otorrhea or rhinorrhea
D. All of the above

What should the nurse do when his/her patient with a basilar skull fracture begins to have clear fluid draining from
one ear?
A. Pack the external auditory canal with sterile cotton and notify the doctor
B. Apply a loose sterile dressing over the ear and call the doctor
C. Apply an occlusive sterile dressing over the ear and change it frequently
D. Suction the ear with a sterile catheter
To determine if bloody head drainage contained CSF, a nurse would put some on a gauze and observe:
A. Absence of a clear line of demarcation between the serum and blood
B. A blood clot in the middle with a yellow ring around it
C. A yellow ring with two bloody rings around it
D. Absence of the clot but one bloody ring at the center of the gauze
A patient who has a neurological injury that results in ipsilateral motor loss and contralateral loss of pain and
temperature is said to have:
A. A total transection
B. Anterior cord syndrome
C. Brown-Sequard syndrome
D. Central cord syndrome
Examination of the CSF in bacterial meningitis will reveal all but which of the following?
A. Cloudiness
B. Increased white blood cells
C. Decreased protein
D. Increased pressure and decreased glucose
Which statement is accurate regarding the differentiation of CSF in bacterial and viral meningitis?
A. Higher level of protein in bacterial meningitis than viral
B. Low sugar content seen in bacterial meningitis, usually normal in viral
C. CSF is purulent and turbid in bacterial, may be clear in viral
D. All of the above

Gastrointestinal- Disk 2 @ 1:06 & Disk 3

In order to most accurately establish that your patient has no bowel sounds, you must listen in each quadrant for at
least:
A. 30 seconds
B. 1 full minutes
C. 1-1/2 minutes
D. 2-5 minutes
The usual order for carrying out physical assessment of abdomen is:
A. Palpation, inspection, auscultation, percussion
B. Auscultation, percussion, palpation, inspection
C. Inspection, auscultation, percussion, palpation
D. Percussion, auscultation, inspection, palpation
The function of the liver includes all of the following except:
A. Formation of ammonia to remove urea from the blood
B. Hepatocytes secrete bile
C. Synthesizes amino acids and albumin
D. Synthesizes prothrombin, fibrinogen and albumin
Nursing interventions for the patent with hepatic failure include:
A. Restrict protein in the diet
B. Avoid use of narcotics, sedatives and tranquilizers
C. Administer lactulose and neomycin as prescribed
D. All of the above
The underlying cause of most bleeding esophageal varices is:
A. Acid pepsin erosion secondary to gastroesophageal reflux
B. Portal hypertension due to liver disease
C. High venous pressure at the esophagogastric junction due to systemic hypertension
D. Traumatic esophageal damage
The rationale for the use of neomycin in the setting of liver failure is to:
A. Prevent the likelihood of sepsis in the event of severe gastrointestinal bleed
B. Promote the manufacture of prothrombin activating vitamin K
C. Inhibit the production of ammonia by intestinal bacteria
D. Establish a blood level of antibiotic in anticipation of surgery
The administration of vasopressin should be most carefully monitored in patients who have:
A. Diabetes Insipidus
B. Coronary artery disease
C. Hypotension secondary to G.I. Bleeding
D. Diabetes Mellitus
Urea is formed by the liver to rid the body of:
A. Creatinine
B. Bicarbonate
C. Bilirubin
D. Ammonia

The inability of the liver to conjugate what substance is a primary contributor to hepatic coma?
A. Ammonia
B. Urea
C. Fatty Acids
D. Bilirubin
Which of the following may precipitate the onset of hepatic encephalopathy in patients with severe liver
dysfunction?
A. Diuretics
B. Acute infection
C. GI Bleeding
D. All of the above
Which of the following may contribute to the precipitation of encephalopathy in the patient with liver failure?
A. GI Bleeding
B. Hypokalemia
C. Hypotension
D. All of the above
Ecchymosis around the umbilicus indicative of peritoneal bleeding is called:
A. Chvosteks sign
B. Grey Turners sign
C. Cullens sign
D. Trousseaus sign
Pulmonary complications of acute pancreatitis may include:
A. Adult respiratory distress syndrome
B. Elevation of the diaphragm and bilateral basilar rales
C. Atelectasis, especially of the left base
D. All of the above
Which of the following analgesics is the drug of choice in managing the pain of acute pancreatitis?
A. Demerol
B. Morphine
C. Codeine
D. Dilaudid
A bluish-green, brown discoloration in the flank and groin due to retroperitoneal bleeding is called:
A. Grey-Turners sign
B. Cullens sign
C. Kernigs sign
D. Welchs sign
Patient assessment findings indicative of a bowel infarction would include:
A. Hypoactive bowel sounds and leukocytosis
B. Hyperresonance and abdominal tenderness
C. Absence of dullness in the liver area
D. All of the above

Renal System Disk 3 (@32:00)

A weight gain of one kilogram in 24 hours may indicate fluid retention of at least:
A. 250 ml
B. 500 ml
C. 1000 ml
D. 2000 ml
Signs of rapidly-developing alkalosis may include ALL BUT WHICH of the following:
A. Nervous irritability
B. Obtundation
C. Muscle tremors
D. Seizures
Which of the following drugs actually removes potassium from the body in hyperkalemic patients in acute renal
failure?
A. Sodium bicarbonate
B. Calcium chloride
C. Glucose and insulin infusion
D. Kayexalate and Sorbital
The electrolyte abnormality that produces a U wave, a depressed ST segment, and ventricular irritability is:
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
Which EKG finding would not be observed in the presence of hyperkalemia?
A. Prolonged PR interval
B. Absence of P waves
C. Ventricular irritability
D. Widened QRS complexes
The glomerular filtration rate (GFR) can be best measured by evaluating the patients:
A. Serum creatinine
B. Blood urea nitrogen
C. Serum osmolality
D. Creatinine clearance
Approximately 60-80% of sodium and water reabsorbed from the glomerular filtrate at the:
A. Proximal tubule
B. Loop of Henle
C. Distal Tubule
D. Collecting tubules
The major function of the loop of Henle is the:
A. Reabsorption of electrolytes
B. Concentration or dilution of urine
C. Reabsorption of water under the control of ADH
D. Secretion of hydrogen ion, ammonia and potassium

Which of the following activities is performed at the distal convoluted tubule?

A. Concentration of urine
B. Active reabsorption of NaCl with passive water reabsorption
C. Water reabsorption under ADH control
D. Reabsorption of glucose, amino acids, phosphates, uric acid and potassium
A patient has a urinary output of 1000 cc in 24 hours with a urine sodium level of 25 mEq/liter. These findings
probably indicate:
A. The patient is on a salt-free diet
B. The patients kidneys have a decreased blood perfusion
C. The patient is in the beginning of renal failure
D. The patient is progressing to the prerenal phase
Ischemia injury to the kidney will usually commence when the mean arterial blood pressure falls below:
A. 100 mmHg for 30 minutes
B. 90 mmHg for 2 hours
C. 60 mmHg for 40 minutes
D. 60 mmHg for 2 hours
The two most common causes of acute renal failure or (ATN) are:
A. Nephrotoxic substances and ischemia
B. Ischemia and urologic obstructions
C. Nephrotoxic drugs and heavy metals
D. Impaired renal perfusion and hepatorenal causes
The patient with acute tubular necrosis is differentiated from a patient with decreased renal perfusion because
ONLY in decreased renal perfusion:
A. The urine volume is low and the kidneys fail to respond to Lasix
B. The urine osmolality is greatly reduced
C. The urine sodium is 40 to 100 mEq/L
D. The BUN to creatinine ratio is at least 20:1
The oliguric stage of acute renal failure WOULD NOT include which of the following:
A. BUN 20mg%
B. Creatinine 9mg%
C. Signs of CHF
D. Potassium 7 mEq/L
In ATN caused by nephrotoxic drugs, Lasix will:
A. Increase toxicity
B. Cause diuresis, thus correcting oliguria
C. Increase blood flow to the kidneys
D. Improve the patients renal status

Hematological Disk 3 (@1:21)

B cells are responsible for:
A. Humoral immunity
B. Cellular immunity
C. Type I hypersensitivity reactions
D. Cell-mediated hypersensitivity
The most common immunoglobulin whose primary effect against bacterial disease is:
A. IgM
B. IgE
C. IgA
D. IgG
Which of the following statements regarding cellular immunity s TRUE?
A. It functions in concert with immunoglobulins
B. It is important in development of autoimmune disease & graft rejection
C. A significant response produces leukopenia
D. All of the above
The immediate administration of which of the following is ESSENTIAL in the initial management of anaphylaxis?
A. Epinephrine 0.5 1 ml of 1:1000 solution
B. Oxygen
C. Volume repletion
D. Corticosteroids and aminophylline
Which of the following blood products contains only factors VIII, fibrinogen and XIII and is utilized in hemophilia
A and DIC?
A. Platelet concentrate
B. Plasmanate
C. Fresh frozen plasma
D. Cryoprecipitate
Disseminated intravascular coagulopathy is:
A. Usually a primary disorder
B. A hemorrhagic episode from an initial lack of clotting mechanisms
C. Widespread inappropriate clotting that triggers bleeding
D. Diagnosed by an increase level of clotting factors
The pathophysiology of disseminated intravascular coagulation includes:
A. Inhibition of thrombinolysins
B. Enhanced production of intravascular thrombin resulting in increased fibrin and platelet aggregation
C. Diminished platelet adhesiveness and aggregation
D. Enhancement of intravascular clots due to an overproduction of clotting factors
Which of the following laboratory diagnostic findings is NOT likely to be seen in DIC?
A. PT and PTT prolonged
B. Platelet count decreased
C. Fibrinogen increased
D. Fibrin split products elevated

Which of the following laboratory diagnostic findings will MOST LIKELY be seen in DIC?
A. PT and PTT prolonged
B. Fibrinogen increased
C. Thrombin time decreased
D. Platelet count increased
The intrinsic system of blood clot initiation is:
A. Activated by tissue thromboplastin
B. Best evaluated by prothrombin time
C. Dependent upon calcium and vitamin K
D. Activated by endothelial injury
Release of what substance into the circulation secondary to retained dead fetus, abruption placenta, and stress may
cause DIC?
A. Fibrinolysin
B. Tissue thromboplastin
C. Heparin
D. Fibrin split products
The beneficial effects of heparin in DIC are thought to be due to its:
A. Stimulating effect on platelet manufacture
B. Neutralizing of free-circulating thrombin
C. Antifibrinolysin activity
D. Inhibition of platelet factor XII release

Cardiovascular Disk 4 and 5 (18%)

A patient with a HR of 45 complains of dizziness and cool clammy extremities. What is the first drug of choice?
A. Atropine 0.5mg - 1mg
B. Epinephrine 1mg iv push
C. Isuprel infusion 2-10mcg/kg/min
D. Adenosine 6 mg iv push
You are treating a patient with a slow heartbeat. For which of the following patient would atropine be effective?
A. A 55 y/o male with severe chest pain and sinus bradycardia at 35 bpm
B. A 55 y/o male with weakness and 3rd degree HB
C. A 55 y/o male with fatigue and a heart transplant 6 months ago
D. A 55 y/o male with weakness and acute symptoms of nausea/vomiting with a sinus HR of 35
Which of the following therapies is the most important interventions for VF/pulseless VT, with the greatest effect
of survival to hospital discharge?
A. Epinephrine
B. Defibrillation
C. Oxygen
D. Amiodarone
A 75y/o patient with rapid AF, approximately 160 per minute and irregular c/o palpitations for a week. No
evidence of cardiac or circulatory failure. Which would be included in the initial orders?
A. Oxygen, iv, monitor
B. Immediate cardioversion
C. No therapy is indicated
D. Epinephrine 1mg iv every 3-5 min
Same patient. His vital signs remain unchanged, BP 100/70, irregular HR of 160. Which of the following would be
the most appropriate treatment for AF?
A. IV digoxin
B. IV diltiazem to slow ventricular response
C. IV amiodarone to convert AF to SR
D. Synchronized cardioversion
25 y/o woman is with PSVT, prior medical HX confirmed reentry tachycardia, no WPW. HR 180bpm, she is sob
and reports palpitations. Which would be the next most appropriate intervention?
A. Dc cardioversion
B. IV diltiazem
C. IV propranolol
D. IV adenosine
55 y/o m with HX CHF & LBBB develops sustained wide complex tachycardia after an episode of CP relieved by
NTG. Which of the following is the most appropriate initial med?
A. IV lidocaine
B. IV adenosine
C. IV amiodarone
D. IV verapamil
Which of the following pressures are within normal limits?
A. PAP 34/24 PCWP 12
B. PAP 30/20 PCWP 10
C. PAP 28/18 PCWP 20
D. PAP 24/14 PCWP 12

Which of the following would cause an elevated pulmonary artery pressure and normal wedge pressure?
A. Pulmonary hypertension
B. Pulmonary edema
C. Left ventricular failure
D. Constrictive pericarditis
A large v wave appears on the PCWP tracing of a patient with an inferior wall myocardial infarction. This finding
is consistent with:
A. Cardiogenic shock
B. Congestive heart failure
C. Mitral regurgitation
D. Pericarditis
ST elevation and absence of an "R" wave in V1-V4 would be indicative of:
A. Anterior-septal wall infarction
B. Inferior wall ischemia
C. Anterior - septal wall ischemia
D. Anterior - lateral wall infarction
Which of the following hemodynamic parameters would indicate left ventricular failure in a patient with copd?
A. Pap 54/22 PCWP 14 CVP 8
B. Pap 48/26 PCWP 16 CVP 6
C. Pap 22/12 PCWP 26 CVP 16
D. Pap 48/26 PCWP 20 CVP 16
The reciprocal changes that occur with an inferior wall mi are seen as ST depression in leads:
A. II, III, AVF
B. V1-V4
C. II, AV1
D. I, AV1
Which of the following complications is most likely to occur in acute inferior myocardial infarction?
A. Mobitz type I heart block (wenchebach)
B. Paroxysmal atrial tachycardia (pat)
C. Right bundle branch block (RBBB)
D. Cardiogenic shock
Your patient with an inferior wall mi also has a right ventricular infarction & develops right ventricular failure.
Which data obtained would correlate with this patient's condition
A. Pap 28/10 PCWP 10 CVP 18
B. Pap 38/22 PCWP 20 CVP 6
C. Pap 54/28 PCWP 14 CVP 14
D. Pap 23/8 PCWP 19 CVP 20
The treatment modality for a patient with RVF from an inferior wall mi would include:
A. Nipride and low dose dopamine
B. Normal saline fluid challenge
C. Lasix and preload reducers
D. Lidocaine and afterload reducers

Which of the following groups of hemodynamic data reflects cardiogenic shock as opposed to hypovolemic shock?

A.
B.
C.
D.

BP 88/60
BP 70/40
BP 90/60
BP 94/56

pa 18/8 PCWP 12
pa 30/20 PCWP 22
pa 24/18 PCWP 25
pa 40/22 PCWP 20

Clinical manifestations of cardiogenic shock following an anterior wall mi include all of the following except:
A. Distended neck veins
B. Pulmonary congestion, rales
C. Presence of an s3
D. Low CVP reading
"Unloading" therapy by nitroprusside is beneficial because it:
A. Enhances ventricular emptying
B. Diminishes peripheral vascular resistance or "afterload"
C. Relieves pulmonary congestion by promoting venous pooling of blood
D. All of the above
Which of the following is an expected outcome from IABP?
A. Decreased mean systemic BP
B. Increased cardiac output
C. Increased PCWP
D. All of the above
To be operating correctly, the IABP is timed to work in which manner?
A. Inflate during systole, deflate during diastole
B. Inflate when the mean aortic pressure falls below a preset limit
C. Inflate when the heart rate falls below a preset limit
D. Inflate during diastole deflate during systole
Absolute contraindications to intra-aortic balloon counter pulsation include:
A. Mitral insufficiency
B. Aortic insufficiency
C. Sepsis
D. Femoral artery aneurysm
All postoperative cardiac surgery patients develop:
A. Pericarditis
B. Electrolyte imbalances
C. Hypoxia
D. Atelectasis
Which of the following kinds of shock is characterized by increased venous capacitance and pooling?
A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive shock (septic)
D. Obstructive shock
Early stages of septic shock are characterized by:
A. Vasoconstriction with the release of histamine
B. Increased cardiac output with peripheral vasoconstriction
C. Vasodilation with fluid loss and the release of leukocytes
D. Increased cardiac output with decreased vascular resistance
The signs of hyperventilation, diminished sensorium, and increased co are often found in which form of shock?
A. Neurogenic

B. Septic
C. Hypovolemic
D. Cardiogenic
A patient admitted to the ICU in the early stages of septic shock presents with:
A. Weak thready pulses and low BP
B. Decreased UO
C. Warm, flushed skin
D. Hyperpnea with pulmonary congestion
Which of the following signs is not characteristic of cardiac tamponade?
A. Widening pulse pressure
B. Rising CVP
C. Wide mediastinum on XRAY
D. A fall in systolic BP of more than 10mmhg during inspiration
The placement of mcl, electrodes is:
A. + electrode, 4th ICS, r sternal border, - electrode, below outer 3rd of l clavicle
B. + electrode, 5th ICS, r sternal border, - electrode l lower ABD
C. + electrode, l shoulder, - electrode, r shoulder
D. + electrode, l midaxillary line, 5th ICS; - electrode, below outer 3rd of left clavicle
The most serious EKG finding associated with anterior wall mi is:
A. Fascicular blocks and tachycardia
B. RBBB and second degree blocks
C. Few ventricular ectopic beats
D. Rapid supraventricular rhythms
The hemodynamic parameter that clinically measures afterload is:
A. CVP
B. Map
C. SVR
D. Left ventricular end-diastolic pressure
All of the following support the diagnosis of cardiac tamponade except:
A. Widening pulse pressure
B. Pulsus paradoxus
C. Enlarged heart on XRAY
D. Equalization of right and left heart pressures
A patient with BP of 200/142 would have which of the following forms of HTN?
A. Essential HTN
B. Accelerated HTN
C. Malignant HTN
D. Hypertensive encephalopathy

Pulmonary Disk 6 (17%)

Which of the following statements regarding vesicular breath sounds is true?

A. These are medium intensity sound heard over the large main-stem bronchi
B. They are heard longer on exhalation
C. They are decreased or absent when airflow to the area of lung is diminished
D. They are auscultated of the trach
Which of the following chest auscultation findings is abnormal?
A. Vesicular breath sounds over lung periphery
B. Bronchial breath sounds heard over large airway
C. Vesicular breath sounds heard during inspiration and expiration
D. Bronchovesicular sounds adjacent to the sternum
Which of the following patient findings will contribute a shift to the left with impaired tissue unloading of oxygen?
A.
Ph 7.58
B.
Temp 103f
C.
PACO2 50mmhg
D.
Increased hemoglobin 2, 3, DPG
Which of the following patient findings will contribute to a shift to the right with improved unloading of oxygen at
the tissues?
A.
Ph 7.46
B.
Temp 96f
C.
PACO2 54
D.
Decreased hemoglobin 2, 3 DPG
Patient in CCU post cardiac arrest: FIO2 0.8, PH 7.31, PCO2 42, PO2 60, O2 SAT 85% and HCO3 18:
A.
Compensated metabolic acidosis
B.
Uncompensated respiratory acidosis
C.
Uncompensated metabolic acidosis
D.
Uncomensated metabolic acidosis
Patient presents with agitation and tingling of the fingers: FIO2 RA, PH 7.49, PCO2 25, O2 SAT 98%, HCO3 22:
A.
Normal acid-base balance
B.
Uncompensated respiratory alkalosis
C.
Uncompensated respiratory acidosis
D.
Uncompensated metabolic alkalosis
Newly admitted mi patient on thiazide diuretics at home for hypertension has an ABG: FIO2 0.6, PH 7.58, PCO2
36, PO2 70, O2 SAT 90%, HCO3 34
A.
Uncompensated metabolic alkalosis
B.
Uncompensated respiratory alkalosis
C.
Uncompensated metabolic acidosis
D.
Compensated metabolic alkalosis
Pulmonary consolidation (lobar pneumonia) will cause which of the following physical findings over the diseased
area?
A.
Dull percussion note
B.
Decreased tactile fremitus
C.
Bronchial breath sounds
D.
Both a and c
A notable characteristic of mucus will often be present in patients with status asthmaticus attack in its:
A.
Color

B.
C.
D.

Tenaciousness
Copious nature
Absence

An ominous finding in the patient with status asthmaticus would be:

A.
A respiratory rate of 34
B.
Loud expiratory wheezing
C.
A CO2 of 55
D.
Use of accessory muscles
A patient with status asthmaticus is admitted. His breath sounds are diminished throughout his lung fields. RR=40.
After giving your patient an aerosol bronchodilator, your patient sounds worse as they are now louder. This
indicates:
A.
The patient has gotten worse
B.
The need for anesthesia to be present stat
C.
The patient is getting better
D.
The patient does not have asthma
When adjusting the initial settings on a volume ventilator for an adult in respiratory failure, the tidal volume is
usually set at:
A.
At least 10ml per kg or twice normal
B.
15-20 ml per kg or twice normal
C.
500 ml for all patients
D.
300-500 ml
A 70 kg patient ventilated with FIO2 of 45%, VT of 800, IMV of 8. Patients respirations are 10/min. Abg results:
O2 85%, CO2 55, what ventilator parameter should be changed?
A.
FIO2
B.
IMV
C.
VT
D.
All of the above
The normal A-a gradient (alveolar to arterial gradient for oxygen for an adult breathing room air is less than:
A.
10 mmHg
B.
20 mmHg
C.
100 mmHg
D.
200 mmHg
Administration of 100% O2 will not improve the PAO2 in hypoxia caused by:
A.
V/Q imbalance
B.
Right to left shunting
C.
Alveolar hypoventilation
D.
Impaired diffusion
Which of the following diseases states does not cause hypoxia due to a primary mechanism of v/q mismatching?
A.
Bronchospastic disease
B.
Pulmonary emphysema
C.
Adult respiratory distress syndrome
D.
Pulmonary embolization

The administration of oxygen alone will not improve hypoxia due to:
A.
V/Q mismatch

B.
C.
D.

Shunting
Hypoventilation
Decreased FIO2

Which of the following statements regarding ARDS is true?

A.
There is decreased capillary permeability
B.
There is damage to type II pneumocytes with a decreased of surfactant
C.
There is an increase in lung compliance
D.
There is an increase in functional residual capacity
Assessment findings indicative of ARDS in the early stage, would include all of the following except:
A.
Tachypnea
B.
Normal PCWP
C.
Respiratory alkalosis
D.
Hypercapnia
The hallmark of adult respiratory distress syndrome (ARDS) is:
A.
Refractory hypercapnia
B.
Refractory hypoxemia
C.
Low functional residual capacity
D.
Increased compliance secondary
The nurse considers which intervention to be inappropriate while caring for the patient with ards?
A.
Administer small doses Lasix as ordered by md
B.
Infusion of normal saline rapidly in order to maintain hydration
C.
Pulmonary toileting
D.
Frequent position changes.
The plan of therapeutic attack in the care of ARDS patients may include:
A.
Use of vent with high pressure and high flow characteristics
B.
Diuretics and fluid restriction
C.
Use of peep
D.
All of the above
Palpation of tracheal shift to the left may indicate:
A.
A tension pneumothorax on the right
B.
Massive atelectasis to the right
C.
A tension pneumothorax on the left
D.
Diffuse airways obstruction
Initial nursing assessment findings in the patient with an acute pulmonary embolism includes:
A.
Chest pain, ST changes, pulmonary edema
B.
Rales, rhonchi, tachycardia,
C.
Chest pain, dyspnea, cough
D.
Tachypnea, bradycardia, rales
Which assessment finding would not be present in the patient with a massive pulmonary embolism?
A.
Increased CVP reading
B.
Pulmonary rales
C.
Distended neck veins
D.
Liver enlargement