Western Mindanao State University COLLEGE OF NURSING MIDTERM EXAM Level III-NCM 103 Name: ______________________________________ _______________ Yr.

& Sec.:_____________ Date:

Multiple Choices. Read the question/s carefully. Encircle the correct letter of your choice.

The nurse tells a client who is postoperative after gastrectomy that the NGT .1 :[Nasogastric tube] will be removed .According to standard procedures only on the fourth postoperative day .a .When bowel sounds are established and the client has passed flatus or stool .b .Thirty-six hours after the cessation of bloody drainage .c .After 2 days of alternate clamping and unclamping of the tube .d On the morning of discharge, a client who had an emergency hysterectomy (removal of .2 the uterus) is found sitting with her back to the door, staring out the window. She says :that she no longer feels like a real woman. The nurse's response should be to .(Ask her if she would like her diazepam (Valium .a .Notify the physician .b "?Ask, "Can you tell me what makes you feel that way .c .Reassure her that this is a common reaction .d ?Which would the nurse expect to see with the gastric dumping syndrome .3 c. Increased strength Feeling of hunger .a d. Diaphoresis/sweating Constipation .b Which of the following is a surgical procedure that provide an alternative channel for .4 ? feces to leave the body c. Gastrectomy Colostomy .a d. Gastrostomy Endoscopy .b A priority nursing action for a client admitted with a productive cough, weight loss, and .5 :a suspected diagnosis of tuberculosis is .Instruction on preventing disease transmission .a .Planning for frequent rest periods .b .Recording accurate intake and output .c .Reviewing current dietary patterns .d :The most important activity a client perform following thoracic surgery is .6 .Arm exercise to prevent ankylosis .a .Deep breathing and coughing up sputum to prevent airway obstruction .b . Leg exercises to prevent thrombophlebitis due to prolonged bed rest .c .Deep breathing only to prevent undue suture stress while maintaining ventilation .d ?Which statement by the nurse correctly describes a wheeze .7 .A high-pitched musical sound produced by airflow in narrowed bronchioles .a .A medium-pitched sonorous sound produced by airflow in obstructed bronchi .b .A sound that is rarely considered pathological .c .A high-pitched crowing sound produced by edema in the trachea .d The nurse suspects abdominal wound dehiscence, and lift s the edges of the client's .8 dressings. The nurse notes that the wound edges are entirely separated. What is the ?next nursing action .Tell the client to remain quiet and not to cough .a .Offer the client warm drink to promote relaxation .b .Position the client in a chair with the feet elevated .c .Apply a scultetus bandage .d :Nursing actions that will facilitate medical therapy for a client with COPD include .9 .Limiting fluid intake to prevent volume overload and right-sided heart failure .a .Oral and endotracheal suctioning as necessary .b Instructing the client in deep breathing and coughing techniques and pursed-lip .c .exhalation .Maintenance of bed rest and activity restrictions to reduce acidosis .d ?Following bronchoscopy, what is the nurse's most important observation .10 .Blood pressure, pulse, and temperature .a .Color and consistency of sputum .b .Function of the tenth cranial nerves .c .Presence of urticaria .d The home health nurse has developed a teaching guide for a client that focuses on the .11 importance of regular physical activity with gradual increasing activity levels. This :teaching guide specifically promotes c. Renal perfusion and formation of Cardiac output and tissue perfusion. .a .urine d. Effective breathing and airway Oxygen-carrying capacity of WBC. .b .clearance

Which of the following would most likely be included in the evaluation of the client goal: ""Demonstrate adequate tissue perfusion c. Uses pursed-lip breathing Symmetrical chest expansion .a d. Activity intolerance Brisk capillary refill .b

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Situation A. The client is admitted with acute crushing chest pain that radiates down his left arm. He was brought to the ER immediately for further assessment, history taking and vital .signs monitoring A coronary artery disease which is relieved by rest and nitroglycerine and no damage to .13 :myocardial tissues c. Angina Pectoris Angina Pentoris .a d. Heart failure Myocardial Infarction .b The nurse expects which of the following diagnostic results would signify damage to the .14 ?myocardial tissues c. Normal creatinine kinase (CK-MB) Normal myoglobin and troponin .a isoenzyme d. Elevated prothrombin time Elevated CK-MB (Creatinine kinase) .b ?Which of the following clients is most likely to experience poor cardiac output .15 A client who has recently completed exercising .a A client who has a stroke volume of 70ml per beat and a heart rate of 70 .b beats/minute .A client with a sustained heart rate of 150 beats/min .c A client who receives a positive inotropic medication .d The laboratory tests the nurse would expect the physician to order to confirm a .16 :diagnosis of myocardial infarction include c. Sedimentation rate, ALT LDH, CK-MB, AST .a d. Paul-Bunnell, serum potassium Serum calcium, APPT .b A client asks what the coronary arteries have to do with angina. When determining the .17 :answer, the nurse should take into consideration that the coronary arteries .Supply blood to the endocardium .a .Carry blood from the aorta to the myocardium .b .Carry reduced-oxygen-content blood to the lungs .c .Carry high-oxygen-content blood from the lungs toward the heart .d The nurse should teach clients with peripheral vascular disease to stop smoking .18 :because nicotine Constricts the superficial vessels, dilating the deep vessels .a Constricts the peripheral vessels, and increase the force of flow .b Dilates the superficial vessels but constricts the collateral circulation .c Dilates the peripheral vessels, causing a reflex constriction of visceral vessels .d A client has edema during the day, and it disappears at night. The client states it is not .19 :painful and is located in the lower extremities. The nurse should suspect c. Myocardial Infarction Lung disease .a d. Right ventricular heart failure Pulmonary edema .b When taking an admission history of a client with right ventricular heart failure, the .20 :nurse would expect the client to complain of c. Fatigue,vertigo, headache Dyspnea, edema, fatigue .a d. A feeling of distress when breathing Weakness, palpitations, nausea .b A client is admitted to the hospital and has edematous ankles. To limit edema of the .21 :feet the nurse should prepare to c. Elevate the legs Restrict fluids .a d. Do range-of-motion exercises Apply elastic bandage .b A client upon admission to OPD complains of difficulty of breathing upon exertion, .22 :blood- tinge cough, paroxysmal nocturnal dyspnea. The nurse should suspect for c. Left heart failure Congestive Heart Failure .a d. Coronary artery disease Right heart failure .b Among the dietary recommendations to prevent hypokalemia, which of the following .23 ?requires consultation from a physician c. Apricot Banana .a d. Grapefruit Orange .b Mr. Romero was diagnosed to have Heart Failure. He was prescribed with Diuretic .24 ?(lasix). The nurse must observe for possible complications from which of the following c. Heart rate of 60 bpm Pulse rate of 80 bpm .a d. Heart rate of 70 bpm Pulse rate of 5o bpm .b To prevent possible complications from Diuretic (Lasix), the nurse before giving .25 :medications should c. Monitor vital signs specifically respiratory rate Monitor Input and output .a d. Monitor response to exercise Monitor vitals signs, PR and BP .b

The nurse realizes that a pacemaker is used in some clients to serve the function :normally performed by the c. Bundle of his AV node .a d. Accelerator nerves to the heart SA node .b

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:The nurse is aware that the term bradycardia means .27 c. A heart rate of under 60 per minute A grossly irregular heartbeat .a d. A heart beat that has regular "skipped" A heart rate of over 90 per min .b beats While a client is receiving anticoagulants, the nursing care should include observations .28 :for c. Headache Nausea .a d. Epistaxis Chest pain .b A client prescribed with Diuretic manifested weak pulse, faint heart sounds, .29 hypotension, muscle flabbiness, diminished deep tendon reflexes, and generalized :weakness. The nurse should suspect for c. Hypokalemia Hypercalcemia .a d. Hypocalcemia Hyperkalemia .b Which of the following are the nursing management for patients diagnosed with R and L .30 :Heart failure Monitor I & O .a Weigh patient daily (morning, after urination); 2- to 3-lb gain in a day or 5-lb gain .b .in week Auscultate lung sound for decrease pulmonary crackles;Monitor pulse rate and .c blood pressure All of the above .d The client with Cardiomyopathy is on Digitalis medication. What is the most .31 ?appropriate intervention of the nurse when the pulse rate is below 60 per min .Do nothing because no side effect was noted .a .Explain the possible outcome of the medication to the client .b .Notify the physician, with hold the medication .c .Give the medication as prescribed .d The nurse understands that myocardial ischemia and decrease perfusion to vital .32 ?organs are serious complications from which of the following c. Myocardial Infarction Sudden hypotension .a d. Pericarditis Infectious Endocarditis .b :To prevent a pulmonary embolus in a client on bed rest, the nurse should .33 Limit the client's fluid intake .a Encourage deep breathing and coughing .b Use the knee gatch when the client is in bed .c Teach the client to move the legs when in bed .d A client is admitted with carbon monoxide poisoning. The nurse understands that the .34 :poisonous nature of carbon monoxide results from Its tendency to block CO2 transport .a The inhibitory effect it has on vasodialtion .b .Its preferential combination/bounding with haemoglobin .c .The bubbles tends form in blood plasma .d :To facilitate maximum air exchange, a client should be placed in the .35 c. Orthopneic position Supine position .a d. Fowler's position High-Fowler's position .b :A client begins to expectorate blood. The nurse describes this episode as .36 c. Hematoma Hematuria .a d. Hematemesis Hemoptysis .b :The position in which a client with dyspnea should be placed is .37 d. Trendelenburg c. Orthopneic b. Supine SIm's .a An example of rapidly acting diuretic that can be administered intravenously to clients .38 :with acute pulmonary edema is d. Spironolactone c. Chlorthalidone b. Chlorothiazide Furosemide .a A client presented signs and symptoms of pink puffer , barrel chest, pursed-lip .39 breathing (caused by forced inhalation), obvious use of accessory muscles when :breathing. These are manifestations of which of the following c. Chronic bronchitis Empyema .a d. Bronchiectasis Empysema .b When teaching client about Tension pneumothorax, the nurse bases the explanation on .40 :the understanding that .The heart and great vessels shift to the affected side .a .The other lung will collapse if not treated immediately .b .Inspired air is drawn into the lungs and trapped within the pleural space .c

There is a negative pressure within the chest cavity .d :A thoracentesis is performed. The site for aspirating air is .41 c. 4th and 5th ICS 2nd and 3rd intercostals space .a d. 8th and 9th ICS 6th and 7th intercostals space .b :Thoracotomy is the surgical opening of the chest wall, indicated when .42 ml of blood is aspirated 500 .a ml or more of blood is aspirated 1500 .b ml of blood is aspirated 300 .c ml of blood is aspirated 200 .d :To prevent precipitation of cardiac arrhythmias, the nurse should inform client with MI .43 To include ice chips in drinks .a Drink hot coffee during breakfast .b Avoid gas-producing foods .c Eat banana to provide fibre in the diet .d Infective endocarditis is an infection of the valves and endothelial surface of the heart. .44 :Medical management involves c. Antibiotic therapy Surgical valve replacement .a d. Prevent infection Surgical management .b A client manifested pain anterior chest (pericordial area, neck, clavicle), pericardial .45 friction rub (grating, creaking sound),dyspnea, fever, chills and dysrhythmias. These are :signs and symptoms of which of the following cardiac disorder c. Infective Endocarditis Pericarditis .a d. Cardiomyopathy Angina Pectoris .b Which of the following valvular disease produces an incomplete closure of the valve .46 :during systole thus allowing the backflow of the blood into the Left atrium c. Aortic stenosis Mitral insufficiency .a d. Mitral stenosis Aortic regurgitation .b .It is the narrowing of the orifice between the left ventricle and the aorta .47 c. Mitral regurgitation Aortic regurgitation .a d. Mitral stenosis Aortic stenosis .b .It is a measurement of cardiac efficiency, blood volume, peripheral resistance .48 c. Central venous pressure Pulmonary artery pressure .a d. Pulmonary artery mechanism Central nerve pressure .b A common cardiac drug that decreases myocardial workload by blocking norepinephrine .49 effects of Sympathetic Nervous System. It is contraindicated to patient with COPD .because it constrict the bronchioles of the lungs c. Digitalis Calcium channel blocker .a d. Beta-adrenergic blockers Diuretic .b The bodys inability to absorb Vitamin B12 because of a lack of intrinsic factor, a .50 substance secreted by the parietal cells of the gastric mucosa, is which of the following ?hematologic disorder c. Iron deficiency anemia Sickle cell anemia .a d. Thrombocytopenia Pernicious anemia .b A client inquired about the pathognomonic manifestation of thrombocytopenia. The .51 :appropriate response of the nurse is Manifested by nausea, vomiting and headache .a Excessive bleeding after surgical procedure .b Ruddy complexion, hematoma, fatigue .c Weakness, dizziness, stomatitis, glossitis .d The most important management for Disseminated Intravascular Coagulation (DIC) is .52 ?which of the following c. Antibiotic therapy Blood transfusion .a d. Bone marrow transplant Treating underlying cause of DIC .b The free end of the Chest Drainage Device is usually attached to an underwater seal, .53 below the level of the chest. This allows the air or fluid to escape from the pleural space, and .Prevents anything returning to the chest .a Maintain negative pressure in the pleural space .b Promote positive pressure within the lungs .c Maintain the law of gravity .d :Thoracostomy is the insertion of tube into which of the site .54 th th th c. 5 intercostals space 8 - 9 intercostals space .a d. 2nd 3rd intercostals space 7th intercostals space .b :A surgical procedure to remove the entire lung .55 c. Lobectomy Pneumonectomy .a d. Tracheostomy Lung resection .b Patients with hemophilia are instructed to avoid any agents that interfere with platelet .56 aggregation, such as c. NSAIDs and alcohol Aspirin .a

d. All of these Herbs, nutritional supplements .b During blood transfusion nurse must observe for possible complications. The most .57 :common type of hemolytic reaction is c. Acute hemolytic reaction Febrile hemolytic reaction .a d. Circulatory overload Febrile non hemolytic reaction .b A set of life-saving protocols and skills that further support the circulation and provide .58 .(an open airway and adequate ventilation (breathing c. Cardiac defibrillation Basic Life Support .a d. Advance life support Cardio pulmonary resuscitation .b This device has been reported to lead to myocardial recovery in small numbers of .59 .patients with severe heart failure for varying periods of time c. Laser therapy Valve replacement .a d. Heart transplant Left ventricular assist device .b ?Which of the following post operative complications from heart transplant .60 c. Sepsis Infection .a d. All of these Organ transplant .b A client is scheduled for nephrostomy. He is curious about his operation and ask the .61 :nurse about it Nephrostomy is the removal of the kidney .a Nephrostomy is the insertion of catheter to remove urine retention .b Nephrostomy is an artificial opening created between the kidney and the skin .c .which allows for the drainage of urine .Nephrostomy is a permanent opening created between the kidney and the skin .d According to priority, which of the following must be accomplished before any surgical .62 ?procedure Ask the client to affix his signature in the medication sheet .a .Secure consent prior to any invasive procedures .b Transport patient for clearance .c Complete the laboratory request for the client .d A Renal special procedure that does not cure but rather prolong the life of the patient. It .63 utilizes the client's abdomen as a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood c. Hemodialysis Peritoneal dialysis .a c. Renal resection Renal transplant .b It is a method for removing waste products such as creatinine and urea, as well as free .64 .water from the blood when the kidneys are in renal failure c. Peritoneal dialysis Bladder training .a d. Renal transplant Hemodialysis .b ?The most common anticoagulant used during hemodialysis is which of the following .65 c. Aspirin Heparin .a d. Coumadin Warfarin .b A client asks the nurse about the importance of antiembolic stockings. It was .66 :understood that the purpose/s of antiembolic stockings To increase blood circulation .a To provide graduated pressure on the lower leg and foot .b To alleviate circulatory problems .c All of the above .d A mother of a child asks the nurse about the cause of allergic rhinitis. The response of .67 ?the nurse is which of the following Hypersensitivity reaction mediated by IgE antibody .a A local reaction to insect bite .b An allergy to food .c None of the above .d ?Drug of choice for allergic rhinitis is which of the following .68 c. Lagundi Buscopan .a d. Amoxicillin Benadryl .b Which of the following is the best prevention against Influenza that the nurse include in .69 :her teaching to concern clients Stay away from infected persons .a Drink plenty of fluids .b Wear protective clothing .c Immunization of Flu vaccine yearly .d Which of the following signs and symptoms represent Pneumonia in a 40 year old .70 ?patient Chills, cough, intermittent fever, nausea and vomiting .a Chest pain aggravated by coughing and repiration, chills, rapid rise in fever .b Chills, chest pain, coughing and rapid respiration .c ,Chest pain aggravated by exertion, coughing .d

:The most common type of pneumonia and mostly affect children .71 c. Bronchopneumonia Lobar pneumonia .a d. Primary atypical pneumonia Primary pneumonia .b Situation II. Mang Jose, 55 yr old factory steel worker was admitted to the hospital with chief complains initially of difficulty in breathing accompanied by chest/rib pain and worsens .during coughing The nurse include teaching on proper positioning to the affected side and .72 :splinting/support with a pillow when coughing. The rationale is c. To enhance comfort To provide range of motion exercises .a d. To promote healing To promote breathing pattern .b ?Mang Jose manifested which of the following Pulmonary disorder .73 c. Avian influenza Pneumonia .a d. Influenza Pleurisy .b Mang Jose woke up with a severe chest/rib pain that cannot be relieved with .74 ?medications and comfort measures, which of the following procedure is required c. Rib cage nerve block Intercostal nerve block .a d. Thoracotomy Thoracentesis .b Situation III. An 18 year old male student acquired multiple injuries from motor vehicular .accident and was brought to the emergency room for further management Base on the classifications of chest trauma, the client may acquire which of the .75 ?following c. Blunt chest trauma Penetrating chest injury .a d. Chest injury Stabbed injury .b ?Which is the most common cause of chest trauma .76 c. trauma due to seat belt Trauma due to steering wheel .a d. Trauma from bicycle accident Trauma due to handle bars .b Diagnostic findings resulted to spontaneous pneumothorax. The nurse include .77 :teachings on management of pneumothorax depends on c. Determined by respiratory compromise The age of the client .a d. The severity and cause of injury The outcome of treatment .b Which of the following classification of pneumothorax occurs when air escapes from a .78 laceration in the lung itself and enters the pleural space through a wound (gunshot or :(stub wound, rib fractures, chest surgery, invasive procedures c. Spontaneous pneumothorax Tension pneumothorax .a d. Simple pneumothorax Traumatic pneumothorax .b :Possible complication from pneumothorax .79 c. Air-filled lung Hemothorax .a d. Sepsis Infection .b It usually occurs when three or more adjacent ribs (multiple contiguous ribs) are .80 .fractured at two or more sites, resulting in free-floating rib segments c. Chest trauma Rib fracture .a d. Flail chest Penetrating chest trauma .b Silicosis is a chronic fibrotic pulmonary disease caused by inhalation of silica dust .81 (crystalline silicon dioxide particles). Manifestations usually occur after 15-20 yrs ?exposure. Which of the following is the first manifestation for silicosis c. Tachypnea Difficulty of breathing .a d. Easy fatigability upon exertion Apnea .b :There is no possible treatment and damage to the lungs are irreversible .82 c. Silicosis Asbestosis .a d. All of these Coal workers pneumoconiosis .b Situation IV. Aling Nena 65 yr old obese with a BP of 150/100 mmhg visited the clinic for her monthly routine check-up. She was newly diagnosed for Hypertension. She is taking .antihypertensive drugs for maintenance Non-pharmacologic approaches to HPN control that the nurse may be involved in .83 :teaching the client with hypertension include Proper administration of Antihypertensive agents .a Activity restrictions .b Low potassium diet therapy .c A regular exercise program .d :Control of hypertension involves factors that can be modified .84 Age and gender .1 Family history and smoking .2 Lifestyle .3 Diet .4 Exercise .5 d. 3, 4, & 5 c. 4, 5 & 2 b. 1, 3 & 4 3 & ,2 ,1 .a :It comprises of 90% among those with hypertension .85

c. Essential hypertension Primary hypotension d. Idiopathic hypotension Secondary hypertension .b :Management of hypertension involves which of the following .86 Control Na and calorie intake .a Stay away from salty processed foods .b Use lightly in cooking .c All of the above .d

.a

Arise most commonly from thrombi that develop in the chambers of the heart as a .87 result of :atrial fibrillation, myocardial infarction, infective endocarditis, or chronic heart failure c. Arterial blood clot Pulmonary embolism .a d. Venous thrombosis Arterial embolism .b Emergency embolectomy (within 4-5 hours) involves incising the vessel and removing .88 .the clot .To prevent temporary damage to the extremity .a To promote circulation .b To dilate the vessels and allow blood flow .c To prevent necrosis and damage to tissues .d Heparin therapy is the drug of choice for thrombosis or embolism in the vessels. It is .89 given only parenterally :because c. Less effective if via mouth Its effect is not immediate if orally given .a Destroyed by gastric secretions of the stomach d. No serious side effect .b ?Anticoagulant effect of heparin is immediate with in which period .90 d. 3-4 hours c. 1-2 hours b. 5-6 hours hours 6-7 .a When obtaining data from a client with thromboangiitis obliterans (Buerger's disease), .91 :the nurse would expect the client to report Easy fatigue of extremities, continous claudication .a General blanching of skin, intermittent claudication .b Intermittent claudication, burning and rest pain upon exposure to cold .c Burning pain precipitated by cold exposure, fatigue, blanching of skin .d :A simple test for varicose veins is the .92 d. Trendelenburg test c. Romberg's sign b. Babinski reflex Arteriography .a Characterized by periodic spasm of the arteries. Most often in young women who are .93 underweight and asthenic in body built c. Varicose veins Buerger's disease .a d. Reynold's disease Raynaud's disease .b :The pharmacologic effect of nifedipine which is a Calcium channel blockers is .94 Decreases preload and afterload .a Effective in treating acute vasospasm .b Promote dilation of peripheral blood vessels .c Promote constriction of vessels .d ?Which of the following surgical procedure is indicated for varicose veins .95 c. Embolectomy Valve replacement .a d. Vein ligation Sclerotherapy .b Begins with the admission of the patient to PACU and ends after a follow-up evaluation .96 .in the clinical setting or home c. Post operative nursing Operating room table .a d, Intraoperative nursing Preoperative nursing .b Involves intensive reconstruction or alterations in body parts EX. Coronary Artery .97 :Bypass, colon resection, removal of larynx d. c. Minor surgery b. Cosmetic surgery Major surgery .a Elective surgery Surgical procedure performed to relieve angina and reduce the risk of death from .98 .coronary artery disease Coronary Artery Operation .a (Coronary Artery Bypass Surgery/Graft (CABG .b Heart transplant .c Valve replacement .d A coagulation studies which involves the test of rapidity of blood clotting .99 c. Bleeding time Prothrombin time .a d. Fasting blood sugar Partial thromboplatin time .b ;Responsible for carrying oxygenated blood to the heart .100 d. arterioles c. capillaries b. veins a.Artery

Time is not at all important in" doing nothing but indoing something significant to help you !succeed!"..Godbless
Murada J. Jamsuri-Ismael, RN,MN