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 potassiumB. Excretion of sodium and water, excretion of potassiumC. Retention of water, concentration of urineD. Excretion of water, dilution of urine

The releasing stimulus for ADH is normally: A. Decreased serum wall myocardial infarction?B. Increased serum osmolarityC. An elevated circulating cortisol levelD. Increased serum potassium levels

The normal range of serum osmolarity is: A. 145-155B. 200-250C. 275-295D. 325-375

SIADH is manifest clinically as a:A. Hyperosmolar stateB. Low output stateC. Myxedema stateD. Water intoxication state

In addition to its effect on body water equilibrium, ADH is also a:A. VasopressorB. CardiotonicC. Beta stimulatorD. Carbonic anhydrase inhibiter

The symptomatology you would assess in the patient with SIADH results from:A. Elevated potassium levelsB. Water intoxication C. Increased serum osmolalityD. Precipitating factors of SIADH

The "cardinal sign" of SIADH is: A. Dilutional hyponatremiaB. Urinary output of 10l per dayC. Hypotension D. Systemic edema

Which of the following laboratory findings would be present in a patient with SIADH?A. Low serum sodiumB. Serum osmolality of 350C. Urine specific gravity of 1.003D. Decreased urinary osmolarity

The patient with SIADH may present with: A. Increased urinary outputB. SeizuresC. HypertensionD. 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 thiazidesB. A young women with severe pneumoniaC. A 50 y/o man with esophageal varices on PitressinD. 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 250B. Serum sodium level of 165C. Urinary output of less than 600cc in 24 hoursD. Urine specific gravity of 1.025

The nurse understands a major complication of DI is:A. Hypovolemic shockB. SeizuresC. Congestive heart failureD. Cardiac arrhythmias

Evaluation of laboratory findings in a patient with DI would show: A. Increased urine osmolalityB. Urine specific gravity between 1.001 to 1.005C. Decreased serum sodiumD. Decreased serum osmolarity

The most dangerous complication of DI is: A. Dilutional hyponatremiaB. HypovolemiaC. Congestive heart failureD. Water intoxication syndrome

Diabetes insipidus is characterized by all but which of the following?A. Urine specific gravity of 1.015B. TachycardiaC. Urinary output of 2000 cc in three hoursD. BP 90/40

Which of the following is characteristic of DI?A. Low urinary osmolarity B. Serum osmolarity increased C. Serum sodium elevatedD. 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 comaB. Diabetic ketoacidosisC. Either of the aboveD. 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. PancreatitisB. Thiazide of steroid therapyC. TPN therapyD. Cerebrovascular accident

Nonketotic hyperosmolar coma (HHNK) is not usually associated with: A. Defects in ADH secretionB. Mild diabetes of recent onsetC. Older ageD. 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 osmolarityB. Markedly elevated serum glucoseC. Intravascular dehydrationD. Serum electrolyte abnormality

The altered mental status in a patient in HHNK results from: A. Hyperosmolaity of plasmaB. Intracerebral dehydrationC. Severe osmotic diuresis from hyperglycemiaD. Intravascular dehydration

Which of the findings would not be present in HHNK?A. Kussmaul's respirations of 28/minB. Serum glucose level above 650 and often greater than 1000C. Serum osmolarity above 350D. Severe dehydration and the absence of ketoacidosis

Evaluation of a patient's laboratory values with HHNK would include: A. A serum sodium of 123B. A serum osmolarity of 340C. A urinary sodium of 60D. A bicarbonate level of 12

Further assessment of diagnostic data in a patient with HNNK would reflect:A. ABG with a pH of 7.10B. Four plus ketone in their urineC. Azotemia D. Hematocrit of 29%

Which of the following laboratory findings is not likely to be seen in patients with DKA?

A. Ph 7.19B. Pco2 45C. Base deficit -14D. 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 consciousnessB. Pupillary reactionC. Extremity movement and strengthD. 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 ophthalmoplegiaB. Intranuclear extraocular ophthalmoplegia C. Oculocephalic reflexD. 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. Kernig’s signB. Babinski’s signC. Brudzinski’s signD. Trousseau’s sign

The respiratory pattern seen in upper brainstem lesions (midbrain) is:A. Hyperventilation B. AtaxiaC. ClusterD. Apneustic

A 26-year old male is complaining of severe headache. On assessment he has nuchal rigidity and a positive Kernig’s sign. Which of the following conditions is most likely present?

A. Epidural hematomaB. Subdural hematomaC. Subarachnoid hemorrhageD. 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 pressureC. Decreasing pulse, decreasing BP widening pulse pressureD. 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 mmHgB. 0-10 mmHgC. 41-61 mmHgD. 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 patient’s:

A. Intracranial venous pressure is decreasedB. Condition is stableC. Systemic arterial pressure is elevatedD. 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 BPD. 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 leftC. 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 ponsB. A lesion in the basal gangliaC. Oculomotor dysfunctionD. 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 pupilsC. Lethargy and stuporD. 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 29-33B. Feeding the patient via an NGTC. Administering D5W at 75 cc an hourD. 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 275B. A serum sodium level of 138C. A urine specific gravity of 1.005D. A urine osmolarity of 400

A basal skull fracture affecting the middle fossa may cause which of the following?A. Cranial nerve injuriesB. Battle’s signC. 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 bloodB. A blood clot in the middle with a yellow ring around itC. A yellow ring with two bloody rings around itD. 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 syndromeD. Central cord syndrome

Examination of the CSF in bacterial meningitis will reveal all but which of the following?A. CloudinessB. Increased white blood cellsC. 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 viralC. CSF is purulent and turbid in bacterial, may be clear in viralD. 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 minutesC. 1-1/2 minutesD. 2-5 minutes

The usual order for carrying out physical assessment of abdomen is:A. Palpation, inspection, auscultation, percussionB. 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 bloodB. Hepatocytes secrete bileC. 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 dietB. 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 refluxB. 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 bleedB. Promote the manufacture of prothrombin activating vitamin KC. 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 InsipidusB. Coronary artery diseaseC. Hypotension secondary to G.I. Bleeding D. Diabetes Mellitus

Urea is formed by the liver to rid the body of:A. Creatinine B. BicarbonateC. Bilirubin D. Ammonia

The inability of the liver to conjugate what substance is a primary contributor to hepatic coma?A. AmmoniaB. UreaC. Fatty AcidsD. Bilirubin

Which of the following may precipitate the onset of hepatic encephalopathy in patients with severe liver dysfunction?

A. DiureticsB. Acute infection C. GI BleedingD. 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. HypokalemiaC. Hypotension D. All of the above

Ecchymosis around the umbilicus indicative of peritoneal bleeding is called:A. Chvostek’s sign B. Grey Turner’s sign C. Cullen’s signD. Trousseau’s sign

Pulmonary complications of acute pancreatitis may include:A. Adult respiratory distress syndrome B. Elevation of the diaphragm and bilateral basilar ralesC. Atelectasis, especially of the left baseD. All of the above

Which of the following analgesics is the drug of choice in managing the pain of acute pancreatitis?A. DemerolB. MorphineC. CodeineD. Dilaudid

A bluish-green, brown discoloration in the flank and groin due to retroperitoneal bleeding is called:A. Grey-Turners signB. Cullen’s signC. Kernig’s signD. Welch’s sign

Patient assessment findings indicative of a bowel infarction would include:A. Hypoactive bowel sounds and leukocytosis B. Hyperresonance and abdominal tendernessC. Absence of dullness in the liver areaD. 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 mlB. 500 mlC. 1000 mlD. 2000 ml

Signs of rapidly-developing alkalosis may include ALL BUT WHICH of the following:A. Nervous irritability B. ObtundationC. Muscle tremorsD. Seizures

Which of the following drugs actually removes potassium from the body in hyperkalemic patients in acute renal failure?

A. Sodium bicarbonateB. Calcium chlorideC. 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. HypernatremiaB. HyperkalemiaC. HypokalemiaD. Hypocalcemia

Which EKG finding would not be observed in the presence of hyperkalemia?A. Prolonged PR intervalB. Absence of P wavesC. Ventricular irritability D. Widened QRS complexes

The glomerular filtration rate (GFR) can be best measured by evaluating the patient’s:A. Serum creatinineB. Blood urea nitrogenC. Serum osmolality D. Creatinine clearance

Approximately 60-80% of sodium and water reabsorbed from the glomerular filtrate at the:A. Proximal tubuleB. Loop of HenleC. Distal TubuleD. Collecting tubules

The major function of the loop of Henle is the:A. Reabsorption of electrolytes B. Concentration or dilution of urineC. Reabsorption of water under the control of ADHD. Secretion of hydrogen ion, ammonia and potassium

Which of the following activities is performed at the distal convoluted tubule?A. Concentration of urineB. Active reabsorption of NaCl with passive water reabsorption C. Water reabsorption under ADH controlD. 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 dietB. The patient’s kidneys have a decreased blood perfusion C. The patient is in the beginning of renal failureD. 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 minutesB. 90 mmHg for 2 hoursC. 60 mmHg for 40 minutesD. 60 mmHg for 2 hours

The two most common causes of acute renal failure or (ATN) are:A. Nephrotoxic substances and ischemiaB. 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/LD. 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 CHFD. 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 kidneysD. Improve the patient’s renal status

Hematological – Disk 3 (@1:21)

B cells are responsible for:A. Humoral immunity B. Cellular immunityC. Type I hypersensitivity reactions D. Cell-mediated hypersensitivity

The most common immunoglobulin whose primary effect against bacterial disease is:A. IgMB. IgEC. IgAD. IgG

Which of the following statements regarding cellular immunity s TRUE?A. It functions in concert with immunoglobulinsB. 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. OxygenC. 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. PlasmanateC. Fresh frozen plasmaD. Cryoprecipitate

Disseminated intravascular coagulopathy is:A. Usually a primary disorderB. A hemorrhagic episode from an initial lack of clotting mechanismsC. 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 thrombinolysinsB. Enhanced production of intravascular thrombin resulting in increased fibrin and platelet aggregation C. Diminished platelet adhesiveness and aggregationD. 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 prolongedB. Platelet count decreasedC. 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 prolongedB. Fibrinogen increased C. Thrombin time decreasedD. Platelet count increased

The intrinsic system of blood clot initiation is:A. Activated by tissue thromboplastin B. Best evaluated by prothrombin timeC. Dependent upon calcium and vitamin KD. Activated by endothelial injury

Release of what substance into the circulation secondary to retained dead fetus, abruption placenta, and stress may cause DIC?

A. FibrinolysinB. Tissue thromboplastinC. HeparinD. 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 thrombinC. Antifibrinolysin activityD. 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 pushC. Isuprel infusion 2-10mcg/kg/minD. 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 bpmB. A 55 y/o male with weakness and 3rd degree HBC. A 55 y/o male with fatigue and a heart transplant 6 months agoD. 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. EpinephrineB. DefibrillationC. 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, monitorB. Immediate cardioversionC. 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 digoxinB. IV diltiazem to slow ventricular responseC. IV amiodarone to convert AF to SRD. 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 cardioversionB. IV diltiazemC. IV propranololD. 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 lidocaineB. IV adenosineC. IV amiodaroneD. IV verapamil

Which of the following pressures are within normal limits?A. PAP 34/24  PCWP 12B. PAP 30/20  PCWP 10C. PAP 28/18  PCWP 20D. PAP 24/14  PCWP 12

 Which of the following would cause an elevated pulmonary artery pressure and normal wedge pressure?

A. Pulmonary hypertensionB. Pulmonary edemaC. Left ventricular failureD. 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 shockB. Congestive heart failureC. Mitral regurgitationD. Pericarditis

ST elevation and absence of an "R" wave in V1-V4 would be indicative of: A. Anterior-septal wall infarction B. Inferior wall ischemiaC. Anterior - septal wall ischemiaD. 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 8B. Pap 48/26  PCWP 16  CVP 6C. Pap 22/12  PCWP 26  CVP 16D. 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, AVFB. V1-V4C. 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 18B. Pap 38/22  PCWP 20  CVP 6C. Pap 54/28  PCWP 14  CVP 14D. 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 dopamineB. Normal saline fluid challengeC. Lasix and preload reducersD. Lidocaine and afterload reducers

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

A. BP 88/60  pa 18/8  PCWP 12B. BP 70/40  pa 30/20  PCWP 22C. BP 90/60  pa 24/18  PCWP 25D. BP 94/56  pa 40/22  PCWP 20

Clinical manifestations of cardiogenic shock following an anterior wall mi include all of the following except: A. Distended neck veinsB. Pulmonary congestion, ralesC. Presence of an s3 D. Low CVP reading

 "Unloading" therapy by nitroprusside is beneficial because it:

A. Enhances ventricular emptyingB. Diminishes peripheral vascular resistance or "afterload"C. Relieves pulmonary congestion by promoting venous pooling of bloodD. All of the above

 Which of the following is an expected outcome from IABP?

A. Decreased mean systemic BPB. Increased cardiac outputC. Increased PCWPD. All of the above

  To be operating correctly, the IABP is timed to work in which manner?

A. Inflate during systole, deflate during diastoleB. Inflate when the mean aortic pressure falls below a preset limitC. Inflate when the heart rate falls below a preset limitD. Inflate during diastole deflate during systole

Absolute contraindications to intra-aortic balloon counter pulsation include: A. Mitral insufficiency B. Aortic insufficiency C. SepsisD. Femoral artery aneurysm

 All postoperative cardiac surgery patients develop:

A. Pericarditis B. Electrolyte imbalancesC. 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 histamineB. Increased cardiac output with peripheral vasoconstrictionC. Vasodilation with fluid loss and the release of leukocytesD. 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. NeurogenicB. SepticC. HypovolemicD. Cardiogenic

 A patient admitted to the ICU in the early stages of septic shock presents with:

A. Weak thready pulses and low BPB. Decreased UOC. Warm, flushed skinD. Hyperpnea with pulmonary congestion 

 Which of the following signs is not characteristic of cardiac tamponade?

A. Widening pulse pressureB. Rising CVPC. Wide mediastinum on XRAYD. 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 clavicleB. + electrode, 5th ICS, r sternal border, - electrode l lower ABDC. + 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 tachycardiaB. RBBB and second degree blocksC. Few ventricular ectopic beatsD. Rapid supraventricular rhythms

The hemodynamic parameter that clinically measures afterload is:A. CVPB. MapC. SVRD. Left ventricular end-diastolic pressure

 All of the following support the diagnosis of cardiac tamponade except:

A. Widening pulse pressureB. Pulsus paradoxusC. Enlarged heart on XRAYD. 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 HTNB. Accelerated HTNC. Malignant HTND. 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 bronchiB. They are heard longer on exhalationC. 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 airwayC. 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 7.58B. Temp 103fC. PACO2 50mmhgD. 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 7.46B. Temp 96fC. PACO2 54D. 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 acidosisB. Uncompensated respiratory acidosisC. Uncompensated metabolic acidosisD. 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 balanceB. Uncompensated respiratory alkalosisC. Uncompensated respiratory acidosisD. 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 alkalosisB. 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 noteB. Decreased tactile fremitusC. Bronchial breath soundsD. Both a and c

A notable characteristic of mucus will often be present in patients with status asthmaticus attack in its: A. ColorB. TenaciousnessC. Copious natureD. 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 55D. 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 worseB. The need for anesthesia to be present statC. The patient is getting betterD. 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 normalB. 15-20 ml per kg or twice normalC. 500 ml for all patientsD. 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. FIO2B. IMVC. VTD. 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 mmHgB. 20 mmHgC. 100 mmHgD. 200 mmHg

Administration of 100% O2 will not improve the PAO2 in hypoxia caused by: A. V/Q imbalanceB. Right to left shuntingC. Alveolar hypoventilationD. Impaired diffusion

Which of the following diseases states does not cause hypoxia due to a primary mechanism of v/q mismatching?A. Bronchospastic diseaseB. Pulmonary emphysemaC. Adult respiratory distress syndromeD. Pulmonary embolization

The administration of oxygen alone will not improve hypoxia due to:A. V/Q mismatchB. Shunting C. HypoventilationD. Decreased FIO2

Which of the following statements regarding ARDS is true?A. There is decreased capillary permeabilityB. There is damage to type II pneumocytes with a decreased of surfactantC. There is an increase in lung complianceD. 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. TachypneaB. Normal PCWPC. Respiratory alkalosisD. Hypercapnia

The hallmark of adult respiratory distress syndrome (ARDS) is: A. Refractory hypercapniaB. Refractory hypoxemiaC. Low functional residual capacityD. 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 mdB. Infusion of normal saline rapidly in order to maintain hydrationC. Pulmonary toiletingD. 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 characteristicsB. 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 rightB. Massive atelectasis to the rightC. 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 edemaB. Rales, rhonchi, tachycardia, C. Chest pain, dyspnea, coughD. Tachypnea, bradycardia, rales

Which assessment finding would not be present in the patient with a massive pulmonary embolism?A. Increased CVP readingB. Pulmonary ralesC. Distended neck veinsD. Liver enlargement