NCLEX Review Cardiovascular

Quiz
1. The nurse is caring Ior an adult who has a
clotting time oI 20 minutes. What should the
nurse do because oI the lab values?
1. Observe the client careIully Ior thrombus
Iormation.
2. Protect the client Irom sources oI
inIection.
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 Ior a cardiac
catheterization. The client asks the nurse iI
she will be asleep during the cardiac
catheterization. What is the best answer Ior
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 iI
you are having too much pain.
4. 'Is it important Ior you to be asleep?
4. An adult has just returned Iollowing a leIt
heart catheterization. What is it essential Ior
the nurse to do?
*1. Check her peripheral pulses.
2. Maintain her NPO.
3. Apply heat to the insertion site.
4. Start range oI motion exercises
immediately.
5. The nurse is caring Ior an adult who is
admitted with a history oI angina pectoris.
He calls the nurse and says he has just taken
a nitroglycerin tablet sublingually Ior
anginal pain. What action should the nurse
take next?
*1. Monitor ECG. II the pain does not
subside within Iive minutes, place a second
tablet under his tongue.
2. Assist him into bed and position him in
Trendelenburg position. Record vital signs
every Iive minutes.
3. NotiIy the physician immediately. Start an
IV so there will be a route Ior cardiac
medications.
4. Administer xylocaine (Lidocaine) IV.
Prepare Ior deIibrillation.
6. A low sodium, low cholesterol weight
reducing diet is prescribed Ior an adult client.
The nurse knows the client understands his
diet when he chooses which oI the Iollowing
meals?
*1. Baked chicken and mashed potatoes.
2. Stir-Iried Chinese vegetables and rice.
3. Tuna Iish 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 inIusion oI dobutamine as
prescribed by the physician. The nurse
recognizes an essential saIety measure to be
taken with this drug is to
1. Obtain a 12 lead electrocardiograph.
2. Assess electrolyte levels.
3. Administer the drug through a large vein.
4. Monitor Ior increase in temperature.
8. A client with atrial Iibrillation is receiving
warIarin sodium (coumadin) daily. What is
the action oI this drug?
1. Inactivates protamine sulIate.
2. Prevents new clots Irom Iorming.
3. Dissolves existing clots.
4. Slows the heart rate.
. A client is receiving enalapril (Vasotec) 5
mg po daily Ior 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 hyperreIlexia.
2. Blood pressure 140/0, reports oI mood
swings, and restIul night sleep.
3. Slight kyphosis, occasional hot Ilashes,
and menstrual cramps.
4. Feelings oI panic and anxiety, retrograde
amnesia, and sleepiness.
10. A 68-year-old is admitted with a
diagnosis oI right-sided congestive heart
Iailure. What assessment Iindings 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 Ior an adult client. Which oI the
Iollowing would the nurse expect to be
ordered Ior this client?
1. Potassium.
2. Calcium.
3. Aspirin.
4. WarIarin.
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 Iinds them to be: B.P. 150/4; P 60; R.
28. What is the most appropriate initial
action Ior the nurse to take at this time?
1. Record the Iindings on the client`s chart.
2. Withhold the digoxin and report the
Iindings.
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 Ior an adult who
underwent a mitral valve replacement.
Following cardiac surgery, clients oIten
experience periods oI disorientation. Which
oI the Iollowing 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 oI the client`s view.
14. An adult had open heart surgery today
Ior 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 beIore the surgeon is called?
1. Increase the IV slightly to improve
cardiac output.
2. Elevate the client`s Ieet to increase
venous return.
3. Decrease the IV to a 'keep open rate.
4. Check the speciIic gravity oI the urine.
15. For which oI the Iollowing surgical
procedures is it essential Ior the nurse to
note the presence or absence oI the dorsalis
pedis and posterior tibial pulses?
1. Carotid endartarectomy.
2. IlioIemoral bypass.
3. Vein ligation.
4. Pacemaker implantation.
16. The nurse knows that the reason a client
who has had a myocardial inIarction is
getting heparin is to:
1. Prevent extension oI a thrombus.
2. Dissolve small thrombi that have lodged
in the coronary arteries.
3. Enhance the action oI thrombin in the
bloodstream.
4. Decrease the amount oI time it takes the
blood to clot.
17. The nurse is caring Ior a client receiving
heparin sodium. Which medication should
the nurse have readily available because the
client is receiving heparin?
1. Vitamin K.
2. Magnesium sulIate.
3. WarIarin sodium.
4. Protamine sulIate.
18. A 60-year-old client is admitted to the
hospital with peripheral vascular disease oI
the lower extremities. He has had diabetes
mellitus Ior 22 years. He smokes two packs
oI cigarettes per day and is employed in a
job where he must stand Ior 7 or more hours
each day. Which oI the Iollowing would the
nurse expect to elicit when assessing this
client?
1. Diminished pedal pulses.
2. Warm tender calves.
3. Tremors oI the Ieet bilaterally.
4. DiIIerence in blood pressure when sitting
and standing.
1. A 60-year-old man has several ischemic
ulcers on each ankle and lower leg area.
Other parts oI his skin are shiny and taut
with loss oI hair. A primary nursing goal Ior
this client should be to
1. Increase activity tolerance.
2. Relieve anxiety.
3. Protect Irom injury.
4. Help build a positive body image.
20. A 48-year-old is Iound on a routine
physical examination to have a blood
pressure oI 170/8. Follow up studies
conIirm a diagnosis oI hypertension. He is
prescribed hydrochlorothiazide. What
nursing instruction is it essential Ior 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 Ior
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 Iollowing a
subendocardial myocardial inIarction. A
balloon-tipped pulmonary artery catheter
was inserted when the client began to
exhibit signs oI cardiogenic shock. The
nurse measures the client`s pulmonary
capillary wedge pressure and Iinds it to be
27 mm Hg. The nurse knows that this
pressure is
1. Within normal limits.
2. Elevated above normal.
3. Less than normal.
4. LiIe threatening.
23. An elderly client with a long history oI
heart disease was brought to the emergency
department oI a local hospital Iollowing a 30
minute episode oI chest pain unrelieved by
nitroglycerin. The client`s
electrocardiograph has an inverted T wave.
The nurse caring Ior the client knows this
Iinding indicates
1. First-degree heart block.
2. Second-degree heart block.
3. Atrial Ilutter.
4. Myocardial ischemia.
24. A client is admitted with
thrombophlebitis oI the right leg. Which
Iindings 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 inIusion is ordered Ior a
client. Which oI the Iollowing test results
should the nurse monitor Irequently?
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 oI 20 minutes is
prone to bleeding and should not receive
injections. Choice #1 is appropriate Ior a
client who has a decreased clotting time.
Choice #2 is appropriate Ior a client with a
low white count and choice #3 is appropriate
Ior 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 oI 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 oI highest priority.
The complications most likely to occur are
hemorrhage and obstruction oI the vessel.
5. (1) Nitroglycerine can be given at 5
minute intervals Ior up to 3 doses iI the pain
is not relieved. Monitor ECG is appropriate
Ior 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 Ior angina. Most hospitalized
patients will have an IV access already in
place. There is no data to support
administering xylocaine. DeIibrillation is Ior
cardiac arrest.
6. (1) Baked chicken is low in sodium.
Chinese Iood is high in sodium. Tuna Iish 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 Ior
a 12 lead ECG. Electrolyte levels are not
related to dobutamine. Dobutamine does not
cause a change in temperature.
8. (2) Clients with atrial Iibrillation are
subject to clot Iormation. WarIarin sodium
(Coumadin) is given to prevent new clots
Irom Iorming and existing clots Irom
enlarging. Coumadin interrupts clotting by
depressing hepatic synthesis oI vitamin K
dependent coagulation Iactor. Thrombolytic
agents such as streptokinase or tPA dissolve
existing clots. Protamine sulIate is the
antidote Ior heparin. WarIarin does not slow
the heart rate.
. (1) Recent memory loss, muscle weakness,
and hyperreIlexia are adverse side eIIects
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 Iailure is
characterized by venous symptoms such as
distended neck veins, hepatomegaly and
pitting peripheral edema. Slight ankle edema
might be seen with leIt sided heart Iailure.
Blood pressure usually rises with heart
Iailure. Premature ventricular contractions
are not a major symptom with right sided
heart Iailure.
11. (1) Lasix is a potassium depleting
diuretic. Digoxin toxicity occurs more
quickly in the presence oI a low serum
potassium.
12. (2) Disturbance in green and yellow
vision is a sign oI digitalis toxicity. A pulse
oI 62 is borderline Ior toxicity.
13. (4) Positioning the cardiac monitor so it
is out oI the client`s view will make the ICU
less machine oriented and more people
oriented. It may be anxiety producing Ior the
client. The other choices are clearly
incorrect since none oI 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
Irom signiIicant others in his liIe.
14. (3) High CVP is indicative oI circulatory
overload. The IV should be decreased not
increased. Elevation oI the client`s Ieet
would increase circulating volume. Check
speciIic gravity oI urine would be
appropriate iI 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 Ieet 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 Ieet. Apical pulse is appropriate aIter
pacemaker insertion.
16. (1) Heparin prevents Iormation oI new
thrombi. It does not dissolve those already
present. Heparin blocks the action oI
thrombin. It does not enhance it. Heparin
makes it take longer Ior blood to clot.
17. (4) Protamine sulIate is the antidote Ior
heparin. Vitamin K is the antidote Ior
warIarin sodium (Coumadin). Magnesium
sulIate 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.
1. (3) He has decreased arterial circulation
and will not heal well iI injured. Important
physical and saIety needs take precedence
over emotional needs.
20. (3) Hydrochlorothiazide is a potassium
depleting diuretic. Orange juice and bananas
are good sources oI potassium. The person
who is taking a potassium depleting diuretic
should take a potassium based salt substitute
iI he is to take one. Hard cheeses should be
avoided by persons taking the powerIul
monamine oxidase inhibitor antidepressants.
Aspirin has an anticoagulant eIIect 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 Iailure. Pressures that exceed 25 to 30
mm Hg can be associated with pulmonary
edema, which is liIe threatening.
23. (4) An inverted T wave is characteristic
oI myocardial ischemia.
24. (3) Red, shiny skin suggests
inIlammation. Diminished pedal pulses
suggest arterial insuIIiciency. Color changes
when the extremities are elevated would
suggest arterial insuIIiciency or varicose
veins. Thrombophlebitis should not cause
pain when the leg is elevated.
25. (2) APTT is the blood test used to
monitor the eIIectiveness oI heparin.
Prothrombin time is used to monitor
coumadin therapy.
NCLEX Review Quiz: Endocrine
1. The client is admitted with a
tentative diagnosis oI diabetes insipidus.
What should the nurse assess Ior 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 Ior a pituitary tumor.
When he returns to the nursing unit
Iollowing surgery the head oI his bed is
elevated 300. The primary purpose Ior this
position is to:
1. Promote respiratory eIIort and
prevent atelectasis.
2. Reduce pressure on the sella turcica
and reduce headache.
3. Prevent acidosis and development oI
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 Ior more teaching?
1. I won`t brush my teeth until the
doctor removes the stitches.
2. I will wear loaIers instead oI tie
shoes.
3. Where can I get a Medic Alert
bracelet?
4. I will take all these new medicines
until I Ieel better.
4. The nurse is caring Ior a client who
had a total thyroidectomy. Postoperative
nursing care aIter his return to the nursing
care unit should include observing Ior
1. Hoarseness.
2. Signs oI hypercalcemia.
3. Loss oI reIlexes
4. Mental conIusion
5. The nurse is teaching a client who
had a total thyroidectomy in preparation Ior
discharge. Which is oI highest priority in the
teaching plan?
1. 'Report any signs oI inIlammation at
the incision site.
2. 'Take your thyroid medication every
day.
3. 'Continue with coughing and deep
breathing exercises.
4. 'Maintain strict bedrest Ior the Iirst
week at home.
6. Which oI the Iollowing is most likely
to develop iI hyperthyroidism remains
untreated?
1. Pulmonary embolism.
2. Respiratory acidosis.
3. Cerebral vascular accident.
4. Heart Iailure
7. A diagnosis oI toxic hyperthyroidism
is made in the client. Propylthiouracil 100
mg po tid is ordered. Which oI the
Iollowing is the expected eIIect oI 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 Ior
the nurse to have readily available?
1. Tracheostomy set.
2. Thoracotomy tray.
3. Sphygmomanometer.
4. Ice collar.
. The client develops
hypoparathyroidism aIter a total
thyroidectomy. What treatment should the
nurse anticipate?
1. Emergency tracheostomy.
2. Administration oI calcium.
3. Oxygen administration.
4. IV potassium.
10. Which oI the Iollowing diets would
most likely be ordered Ior the client with
hypothyroidism?
1. High protein, high calorie.
2. Restricted Iluids, 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 oI an adverse reaction to the
medication?
1. 'My chest hurt when I was sweeping
the Iloor 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 Ior
which oI the Iollowing reasons?
1. Shock can occur in clients who have
decreased amounts oI adrenocortical steroids.
2. Increased aldosterone levels cause
sodium retention and potassium excretion in
the kidneys.
3. Excessive cortisone production
causes hypertension.
4. Decreased amounts oI
corticosteroids cause electrolyte imbalances.
13. The nurse is caring Ior a client who
is on a low sodium, high potassium diet.
Which Ioods, iI selected by the client,
indicate an understanding oI 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 Ior adrenal
crisis. Which oI the Iollowing symptoms, iI
observed, would be most critical and need to
be reported immediately?
1. Pitting edema oI the ankles.
2. Lowering oI the blood pressure.
3. Oliguria.
4. Glucosuria.
15. Fludrocortisone acetate (FlorineI) 0.1
mg daily po has been ordered Ior a client
Iollowing bilateral adrenalectomy Ior which
oI the Iollowing purposes?
1. To restore sodium and potassium
balance.
2. To prevent hypertension.
3. To stimulate protein catabolism.
4. To replace deIicient 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 aIter 1-2 years she
will likely not need to take medication.
2. Explaining that she will need to take
corticosteroids Ior the rest oI her liIe.
3. ReinIorcing that steroids should be
slowly tapered iI she decides to stop taking
them.
4. Teaching her urine and blood testing
to help in the regulation oI steroid dosages.
17. A client who has had an
adrenalectomy is being discharged on
FlorineI 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 Ior about 6 weeks.
4. Avoid exposure to inIection, because
she is susceptible.
18. A woman with a tumor oI the
adrenal cortex says to the nurse, 'Will I
always look this ugly? I hate having a
beard. What is the best response Ior the
nurse to make?
1. 'AIter surgery you will not develop
any more symptoms, but the changes you
now have will linger.
2. 'That varies Irom person to
person. You should ask your physician.
3. 'AIter surgery your appearance
should gradually return to normal.
4. 'Electrolysis and plastic surgery
should make your appearance normal.
1. The client is ready Ior discharge
Iollowing a unilateral adrenalectomy. Which
statement she makes indicates the best
understanding oI her condition?
1. 'I will continue on a low sodium,
low potassium diet.
2. 'My husband has arranged Ior a
marriage counselor because oI our Iights.
3. 'I will stay out oI the sun so I will
not turn splotchy brown.
4. 'I will take all oI those pills every
day.
20. The nurse`s next door neighbor
calls. He says he cannot awaken his 21-
year-old wiIe. The nurse notes that the
client is unconscious and is having deep
respirations. Her breath has a Iruity smell to
it. The husband says that his wiIe has been
eating and drinking a lot and that last night
she vomited beIore lying down. Which oI
the Iollowing is the most appropriate initial
action Ior the nurse to take?
1. Start cardiopulmonary resuscitation.
2. Get her to a hospital immediately.
3. Try to rouse her by giving her coIIee.
4. Give her sweetened orange juice.
21. An adolescent with newly diagnosed
IDDM asks the nurse iI he can continue to
play Iootball. What is the best answer Ior the
nurse to give?
1. 'Now that you have diabetes, you
should not play Iootball as you may get a cut
which will not heal.
2. 'II you work with your physician to
regulate the insulin dosage and your diet you
should be able to play Iootball.
3. 'It would be better Ior 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
Iootball iI you can regulate it so that you
have the same amount oI exercise each day.
22. An adolescent with IDDM is
learning about a diabetic diet. He asks the
nurse iI he will ever be able to go out to eat
with his Iriends again. What is the best
response Ior 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
Iriends.
3. 'When you get Iood out in a
restaurant be sure to order diet soIt drinks.
4. 'Eating out will not be possible on a
diabetic diet. Why don`t you plan to invite
your Iriends 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 oI skin.
3. ReIlexes and muscle tone.
4. Serum electrolytes.
24. An elderly client has been recently
diagnosed as having non-insulin dependent
diabetes mellitus (NIDDM). Which oI the
Iollowing complaints she has is most likely
to be related to the diagnosis oI 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 Ior the nurse to take?
1. Put cotton under the nail and clip the
nail straight across.
2. Elevate the Ioot immediately.
3. Apply warm, moist soaks.
4. NotiIy the physician.
Answers and Rationales of NCLEX
Review - Endocrine:
1. (2) Excessive urine output is
characteristic oI 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 Iormation. This
position may help promote respiratory
eIIort. However, that is not the primary
reason in this client.
3. (4) He will need to take
medications Ior the rest oI liIe not just until
he Ieels better. All oI 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 Ior signs oI hypocalcemia such as
hyperreIlexia.
5. (2) AIter a total thyroidectomy is
perIormed it is essential to take thyroid
replacement daily. Reporting inIlammation
oI the incision site is not oI highest
priority. AIter 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 Ior 48 hours aIter
thyroidectomy.
. (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
Irequently 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
hyperIunction oI the adrenal
cortex. Increased aldosterone causes the
kidneys to retain sodium and Iluid 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 oI
adrenal crisis. Adrenal crisis is an
emergency and can be Iatal iI not detected
and treated immediately. Hypotension,
oliguria and glucosuria are not seen in
adrenal crisis.
15. (1) FlorineI is a
mineralocorticoid that is given to permit
absorption oI sodium and excretion oI
potassium by the renal tubules.
16. (2) AIter a bilateral
adrenalectomy she will have to take steroids
cortisone and FlorineI Ior the remainder oI
her liIe.
17. (4) She is more susceptible to
inIection. Salt intake needs to be restricted
because FlorineI causes sodium
retention. The medications are ulcerogenic
and should be taken with Iood. A weight
increase indicates Iluid retention and the
physician should be notiIied.
18. (3) A gradual return to normal
will occur aIter adrenalectomy when there
are no longer abnormal amounts oI steroids
being produced.
1. (4) She must take steroid
replacement every day Ior the rest oI her
liIe. #1 is not an appropriate diet. The
Iights should decrease as her mood swings
decrease aIter surgery.
20. (4) Her symptoms suggest
ketoacidosis. She must receive medical
treatment at once.
21. (2) Diabetes is not a
contraindication Ior sports. Changes in
activity level will alter the utilization oI
glucose so he will need to work closely with
his physician to regulate exercise, insulin
and diet control.
22. (2) Eating out with Iriends 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. II he is
hypoglycemic he will have pale, cold,
clammy skin and needs treatment (ingestion
oI a rapid acting carbohydrate) at once.
24. (1) Pruritus vulvae (itching oI
the vulva) Irequently accompanies
diabetes. Monilial inIections are common
due to the change in pH. Eructation is
belching or burping and singultus is
hiccups. Neither oI these is particularly
related to diabetes.
25. (4) An ingrown toenail may
cause inIection, which can be very serious
Ior the diabetic client. The physician should
be notiIied. It is not appropriate Ior the
nurse to initiate treatment.
NCLEX Review Respiratory
Questions
1. An adult client is admitted Ior diagnosis
and treatment oI a leIt lung lesion. A
bronchoscopy was perIormed under local
anesthesia. What nursing action is oI highest
priority when he returns Iollowing the
bronchoscopy?
1. Collect all sputum Ior examination.
2. Assess level oI consciousness Irequently.
3. Withhold Iood and Iluids until gag reIlex
has returned.
4. Monitor blood pressure and pulse at 10
minute intervals.
2. A lower leIt lobectomy was perIormed on
an adult client. He was returned to his room
Iollowing an uneventIul stay in the recovery
room. It is most important Ior the nurse to
1. Encourage him to perIorm deep breathing
and coughing exercises.
2. Assist him with arm exercises to prevent
shoulder ankylosis.
3. Help him perIorm leg exercises to prevent
thrombophlebitis.
4. Position him in semi-Fowler`s position on
his leIt 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
Iirst nursing measure concerning the water
seal drainage is to
1. Milk the tubing to prevent accumulation
oI Iibrin 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 airIlow and drainage are
unhindered by kinks.
4. Mark the time and level oI drainage in the
collection chamber.
4. An adult client had a leIt thoracotomy. He
has portable water seal chest drainage. On
the Iirst postoperative day the Iluid in the
water seal chamber stops Iluctuating. What
does this most likely indicate?
1. The chest tube is clogged by Iibrin 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 leIt lung has reexpanded.
5. An adult client had a leIt lower lobectomy.
Passive exercises are started on his leIt arm
aIter surgery. The exercises are designed to
prevent
1. HyperIlexion oI the wrist.
2. Ankylosis oI the shoulder.
3. Flexion contractures oI the elbow.
4. Spasticity oI 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 Iields.
She was oriented to person, time and place,
but her responses were brieI. Oxygen per
nasal cannula is started at 7 l / minute. IV
antibiotics were started. While checking the
client one hour aIter 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 Ior the nurse to take?
1. Increase the IV inIusion rate to increase
the amount oI circulating antibiotics.
2. NotiIy the physician oI the client`s
changed mental status and await Iurther
orders.
3. Increase the oxygen Ilow 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 oI pneumonia. The Iamily asks why
the tube is inserted. What should the nurse
include when explaining to the patient and
Iamily? The purpose oI a tracheostomy tube
is to
1. Decrease the client`s anxiety by
increasing the size oI the airway.
2. Provide increased cerebral oxygenation
thereby preventing Iurther respiratory
depression.
3. Facilitate nursing care since tracheal tubes
have Iewer side eIIects than nasotracheal
tubes.
4. Provide more controlled ventilation and
ease removal oI secretions the client is
unable to handle.
8. An adult is about to have a tracheostomy
perIormed. Which action is oI highest
priority Ior the nurse beIore the procedure is
done?
1. Establishing means oI postoperative
communication.
2. Drawing blood Ior serum electrolytes and
blood gases.
3. Inserting an indwelling catheter and
attaching it to dependent drainage.
4. Doing a surgical prep oI the neck and
upper chest wall.
. The nurse is perIorming tracheal
suctioning. Which action is essential to
prevent hypoxemia during suctioning?
1. Removal oI oral and nasal secretions.
2. Encouraging the client to deep breathe
and cough.
3. Administer 100 oxygen beIore
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 oI the lung and clubbing
oI Iingers. The client has asbestosis that has
caused Iibrosis in the alveoli. Soon aIter
admission, the nurse helps the client to the
bathroom. BeIore he returns to bed, he is
very short oI breath. Considering the
severity oI his symptoms, it is essential Ior
the nurse to include which oI the Iollowing
in the plan oI 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 Iurther
episodes oI dyspnea.
11. An order is written Ior oxygen by nasal
cannula at 2 liters per minute. In assessing
the adequacy oI the oxygen therapy, which
oI the Iollowing is most eIIective?
1. Checking the respiratory rate.
2. Checking the color oI mucous membranes.
3. Measurement oI pulmonary Iunctions.
4. Measurement oI arterial blood gasses.
12. A client with asbestosis must see his
doctor regularly Ior a check up. What is the
primary reason Ior him to have Irequent
checkups?
1. Patients with asbestosis are at high risk
Ior developing bronchogenic cancer.
2. His doctor is monitoring him closely to
look Ior signs oI improvement.
3. Patients who use low Ilow oxygen Ior
long periods are at high risk Ior developing
neurological symptoms.
4. Periodic sputum samples are needed to
Iollow the progress oI the disease.
13. An adult male has had a hacking cough
and shortness oI breath Ior several months.
He now has chest pain. His Iamily 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 Ior hospital
admission Ior a diagnostic work-up. The
nurse is explaining several types oI tests that
are ordered. Which oI these tests is most
deIinitive in the process oI ruling out a
malignancy?
1. Needle biopsy.
2. Thoracentesis.
3. Bronchogram.
4. Sputum analysis.
14. Preoperative teaching Ior the client who
is to have a pneumonectomy should include
all oI the Iollowing. Which is oI highest
priority?
1. Management oI 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 Iollowing a pneumonectomy.
What is the most appropriate initial action
Ior the nurse?
1. Take his vital signs Ior baseline data.
2. Check the IV solution Ior rate and correct
solution.
3. Administer oxygen through an
appropriate device.
4. Auscultate Ior the presence oI 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 Ior hypertension.
4. Assess Ior blood streaked sputum.
17. The nurse is positioning an adult who
has just returned to the surgical nursing care
unit Iollowing a pneumonectomy. What is
the most appropriate position in which to
place the client?
1. Semi-Fowler`s on the unaIIected side.
2. Semi-Fowler`s on the aIIected side.
3. Sims position on the unaIIected side.
4. Semi-Fowler`s on his back.
18. Which oI the Iollowing nursing
interventions should be instituted the day
aIter surgery Ior the client who has had a
pneumonectomy?
1. Provide range oI motion exercises to
aIIected arm.
2. Strip chest tubes every hour.
3. Force Iluids to 3500 cc / day.
4. Monitor intermittent positive pressure
breathing therapy.
1. An adult has been diagnosed as having
pulmonary tuberculosis. Which test(s)
would the nurse expect to be ordered beIore
the client is started on Isoniazid (INH)
therapy?
1. LDH, SGOT (AST)
2. BUN, serum creatinine
3. Skin test Ior allergy
4. Chest X-ray
20. A patient is admitted with
histoplasmosis. Which item in the patient`s
history is most likely related to the onset oI
the disease?
1. He works in a Iactory.
2. He likes to explore caves.
3. He has three cats.
4. He smokes Iour packs oI cigarettes a
week.
kesp|ratory uest|ons Answers and
kat|ona|e

1 (3) lood and flulds should be
wlLhheld Lo prevenL asplraLlon 1he
cllenL wlll have recelved a local
anesLheLlc Lo block Lhe gag reflex durlng
Lhe bronchoscopy 1he nurse should
observe spuLum for color buL lL ls noL
necessary Lo collecL lL 8ronchoscopy ls
usually done under a local anesLheLlc so
level of consclousness ls noL a prlorlLy
vlLal slgns may be monlLored buL
prevenLlng asplraLlon ls of hlghesL
prlorlLy

2 (1) ueep breaLhlng and coughlng
assume hlghesL prlorlLy afLer a
LhoracoLomy Arm and leg exerclses
are also lmporLanL Pe would be
poslLloned ln semllowler's poslLlon on
hls rlghL slde (nonoperaLlve)

3 (4) lL ls lmporLanL Lo monlLor Lhe
amounL of chesL dralnage ChesL Lubes
are mllked only lf Lhere ls an
obsLrucLlon ln Lhe Lublng and only wlLh
a physlclan's order 1he chesL
dralnage sysLem should noL be ralsed
above chesL level lL should remaln low
ChesL Lubes should noL be aLLached Lo
Lhe llnens

4 (1) llbrln and cloLs wlll obsLrucL Lhe
ouLflow of alr from Lhe paLlenL's
Lhoraclc cavlLy lL ls Loo soon for Lhe
lung Lo have reexpanded An alr leak ln
Lhe sysLem would cause an absence of
bubbllng ln Lhe sucLlon conLrol chamber
noL Lhe waLer seal chamber

3 (2) 1he muscles have been cuL
durlng surgery 8ange of moLlon
exerclses wlll help Lo prevenL ankylosls
of Lhe shoulder or frozen shoulder
9aLlenLs also Lend Lo spllnL lnclslonal
dlscomforL by llmlLlng movemenL on
Lhe affecLed slde

6 (2) Changes ln menLal sLaLus are
always slgnlflcanL Slnce her
resplraLlons are decreaslng lL ls doubLful
lf oxygen would be effecLlve

7 (4) 1hls ls Lhe purpose of a
LracheosLomy 1he cllenL may become
less anxlous when she ls no longer
hypoxlc Powever rellef of anxleLy ls
noL Lhe purpose of a LracheosLomy Lube

8 (1) A LracheosLomy makes a cllenL
unable Lo speak CLher means of
communlcaLlon wlll be necessary

9 (3) 100 oxygen ls glven before
and afLer sucLlonlng Lo prevenL hypoxemla



10 (2) 1he cllenL ls besL able Lo
evaluaLe hls sympLom of dyspnea
When he wanLs Lo resL he should be
allowed Lo resL #1 ls noL correcL
Cxygen may be ordered buL ls ofLen
ordered 98n A nasal cannula ls usually
ordered #3 ls noL an lndependenL
nurslng acLlon #4 ls noL correcL 1he
cllenL wlll be allowed Lo do as much as
he ls able Lo prevenL compllcaLlons of
bedresL 1he day should be planned so
LhaL perlods of exerLlon are followed by
perlods of resL

11 (4) ArLerlal blood gasses glve Lhe
mosL speclflc lnformaLlon of Lhe
adequacy of Lhe oxygen Lherapy #1
1he resplraLory raLe ls a good measure
buL ls noL Lhe besL measure #2 Color
changes ln Lhe mucous membranes are
a laLe slgn of hypoxemla #3
9ulmonary funcLlon LesLs are used Lo
evaluaLe pulmonary funcLlon

12 (1) 1hls ls Lrue 1he docLor ls
looklng for a change ln cough
hemopLysls welghL loss eLc #2 1he
asbesLos flbers ln Lhe lungs cannoL be
removed and Lhe flbrosls ls noL
reverslble lmprovemenL ls noL
expecLed #3 ls noL correcL #4
spuLum producLlon ls noL a
characLerlsLlc of Lhls dlsorder Also
spuLum does noL glve lnformaLlon
abouL Lhe progress of Lhe flbrosls

13 (1) needle blopsy of Lhe lungs
deLecLs perlpherally locaLed Lumors lL
provldes a flrm dlagnosls ln 80 of
cases

14 (2) 1urnlng coughlng and deep
breaLhlng help Lo prevenL Lhe mosL
frequenL mosL llfe LhreaLenlng
compllcaLlon llkely Lo occur afLer
Lhoraclc surgery 1he oLhers are
lmporLanL and should be done

13 (3) An oxygen source ls of hlghesL
prlorlLy as Lhe cllenL ls llkely Lo be
hypovenLllaLlng due Lo Lhe effecLs of
anesLhesla Cxygen wlll prevenL
hypoxla AfLer sLarLlng oxygen Lhe
nurse wlll make all of Lhe oLher
assessmenLs

16 (1) 1racheal shlfL can occur
followlng pneumonecLomy 1racheal
shlfL would compromlse Lhe cllenL's
unaffecLed lung 1here wlll be no
breaLh sounds on Lhe operaLlve sounds
Pe has only one lung afLer a
pneumonecLomy PypoLenslon noL
hyperLenslon ls a ma[or slgn of
hemorrhage 1he spuLum wlll probably
noL be bloody as Lhe remalnlng lung
was noL operaLed on A small amounL
of blood sLreaked spuLum could be Lhe
resulL of lnLubaLlon durlng surgery

17 (4) Semllowler's on Lhe back wlll
nelLher cause medlasLlnal shlfL nor
cause hemorrhage aL Lhe pulmonary
arLery sLump slLe 9oslLlonlng Lhe cllenL
on hls affecLed slde could cause
hemorrhage aL Lhe pulmonary arLery
sLump slLe 9oslLlonlng Lhe cllenL on hls
unaffecLed slde could cause medlasLlnal
shlfL



18 (1) 8ange of moLlon exerclses should be
sLarLed wlLhln 4 hours of surgery Lo
prevenL adheslon formaLlon
lnLermlLLenL poslLlve pressure breaLhlng
Lherapy wlll noL be used as Lhe pressure
could lnLerrupL Lhe suLure llne MosL
physlclans do noL lnserL chesL Lubes ln
Lhese cllenLs as Lhe fluld ls allowed Lo
accumulaLe and evenLually consolldaLe
ln Lhe space An lncreased fluld load
could lead Lo resplraLory compromlse

19 (1) Llver funcLlon LesLs SCC1 (AS1)
and LuP would be performed Lo serve
as basellne Llver LoxlclLy can occur
wlLh lnP 8enal funcLlon LesLs 8un
and serum creaLlnlne are essenLlal ln
persons who are recelvlng sLrepLomycln
Lherapy 1here ls noL a skln LesL for
allergy Lo lnP A chesL xray wlll have
been done as parL of Lhe dlagnosLlc
process buL ls noL necessary agaln
before sLarLlng lnP Lherapy

20 (2) PlsLoplasmosls ls caused by a
fungus LhaL grows ln chlcken and baL
manure 8aLs llve ln caves Lxplorlng
caves ls a llkely source of exposure Lo
Lhe fungus Cholce 1 worklng ln a
facLory mlghL be relaLed Lo CC9u lf Lhe
facLory had emlsslons Cholce 3 would
be a posslble source of Loxoplasmosls
noL hlsLoplasmosls Cholce 4 ls noL
relaLed Lo hlsLoplasmosls alLhough lL
could be relaLed Lo oLher resplraLory
dlseases