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SAINT LOUIS UNIVERSITY

School of Nursing

Rotational Exam-BGH Surgical Ward

4. The nurse is teaching a client about


precaution of taking metronidazole as a
I. Multiple Choice. Choose the best answer. medication post-surgery. The nurse
Use CAPITAL letters only. Strictly No should instruct the client to avoid.
ERASURES or SUPERIMPOSITIONS allowed!
A. Jackfruit
Be relaxed, Keep calm, Take a friendly
attitude, Have FAITH, Do your BEST! B. Alcohol

Management of Care: C. Aged cheese

1. A male client is admitted to BGH Surgical


Ward because of malignant tumor in the colon. D. High purine diet
He is to undergo Hemicolectomy as a surgical
procedure to remove the affected part of the 5. The nurse is performing Neurological
colon. Due to anticipated massive blood loss assessment on a conscious post surgery
during the surgery, blood is needed for patient. How can the nurse best assess motor
response?
transfusion. The nurse understands that he
should coordinate to what department to A. Grasp the Nurses finger
address this problem: B. Cough and deep breathe
C. Wiggle his toes
A. Pathology/Laboratory Department D. Repeat a phrase
B. Internal Medicine Department
C. Bimolecular Department 6. Level III nursing students of SLU-SON
D. Biomedical Department Section C group 5 will be conducting a research
E. Oncology Department on the completeness and accuracy of the FDAR
Charting of student nurses rotated at BGH for
2. Patient Barola, 54 years old is admitted to the School Year 2016-2017. In obtaining the
surgical ward due to anorectal carcinoma. He charts of the patients the student nurses should
has not been defecating for one week. After a first coordinate to the:
comprehensive assessment of the patient, the
A. Nursing Service Department
doctor ordered to prepare the patient for B. Head of the Medical Record Section
colostomy procedure. During the signing of the C. Hospital Administrator/director
consent for colostomy, the patient is a little bit D. Information Department
drowsy and disoriented. Legally the nurse
should consider the signature: 7. Patient Lozano, geriatric patient, 88 years
old, underwent resection of the colon,
A. Valid was admitted at the BGH Surgical ward
B. Invalid has residual dysphagia. When a diet
C. Should have witnessed by another
order is initiated, the nurse avoids doing
staff
D. Needs court hearing which of the following?

A. Giving the client thin liquids


3. A 35-year old Patient Malecdan is suspected
B. Thickening liquid to the consistency of
with erosive gastritis returned to her room an
oatmeal
hour ago following EGD and colonoscopy. He is
C. Placing food on the unaffected side of
requesting for a glass of water. The nurse must
the mouth
first:
D. allowing plenty of time for chewing and
A. Keep the client on NPO until an order swallowing
is written
B. Check the VS
C. Check the gag and swallowing 8. What is the priority nursing diagnosis for a
reflex patient who had just had emergency
D. Encourage deep breathing and appendectomy?
coughing exercises
A. Acute pain
B. Activity intolerance

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SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

C. Impaired skin integrity 14. To ensure a safe environment among


D. Ineffective thermoregulation immobile patients confined at the BGH Surgical
ward, the nurse should:

A. Raise the side rails of the bed


B. Stay at bedside all the time
C. Provide pillow
D. Offer bedside commode
9. When auditing a patients chart, the nurse
determines that which expected outcome is 15. Rapport has been established in the nurse-
correctly written?
A. The patient will feel less surgical pain
client relationship in the Surgical ward. A 20
in 24 hours. year old watcher of a post colostomy client asks
to visit the nurse after his patient will be
B. The patient will eat the right amount of discharged. The appropriate response of the
food daily. nurse would be:
C. The patient will identify high-protein
food from a list. A. The best time to talk is during the nurse-
D. The patient will have enough sleep. client interaction time. I am committed to
have this time available for us while you are
at the hospital and ends after our rotation.
10. To prevent post-op complications relating to B. Yes, If you keep it confidential, this is part of
abdominal surgery, the nurse should instruct: privileged communication.
A. Adherence to prophylactic antibiotics C. I am committed for your care.
B. Oral administration of vitamin C and D. I am sorry, though I would want to, it is
intake of foods rich in protein, vitamins against school policy.
and minerals
C. Early ambulation 16. To prevent the spread of infection, the nurse
D. Handwashing should dispose the supplies used for wound
care at:
11. Patient Svero is upset about the A. Yellow thrash bin
appearance of his colostomy. The nurse B. Black thrash bin
formulates which nursing diagnosis for the C. Dispose syringes to sharp bins as needed
client?: D. Green thrash bin
A. Disturbed body image
B. Disturbed sensory perception 17. When the nurse respects the clients self-
C. Impaired tissue integrity disclosure, this is a gauge for the nurses:
D. Low self esteem
A. trustworthiness
B. loyalty
12. Nursing research is indispensable. You are C. integrity
conducting a literature review on the D. professionalism
effectiveness of music therapy on reducing pain
among post-operative patient. As a nursing
student, you need to remember that literature 18. The modal age of the patients admitted in
review should be: BGH Surgical Ward is 50. This represents:
A. brief and exhaustive
C. systematic and focused A. the sum ages divided by total number of
B. broad and theoretical patients admitted in BHG Surgical Ward
D. general and context B. the youngest patient is 50 years old
C. the oldest patient is 50 years old
D. most of the age of the patient is 50 years
13. A diabetic, post-op client was confined at old
Surgical ward, Mrs. Billote, needs a change in
diet to improve hi health status. He should be 1. According to Maslow, which of the following
referred to a: categories of needs represents the most basic?
A. nutritionist C. attending physician a) Physiologic needs
B. dietitian D. dietary department

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SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

Physiologic needs must be met Auscultation refers to the skill of listening to sounds
before an individual is able to move toward produced within the body created by movement of
psychological health and well-being. air or fluid.

b) Self-actualization d) Manipulation

Self-actualization is the highest level of need Manipulation refers to the use of the hands to
determine motion of a body part.
c) Safety and security needs
48. In order to help prevent the development of an
Safety and security needs, while lower level, are not external rotation deformity of the hip in a patient
essential to physiologic survival. who must remain in bed for any period of time, the
most appropriate nursing action would be to use
d) Belongingness
a) a trochanter roll extending from the crest of the
Belongingness and affection needs are not essential
ilium to the midthigh.
to physiologic survival.
A trochanter roll, properly placed, provides
20. Which of the following items is considered the
resistance to the external rotation of the hip.
single most important factor in assisting the health
professional in arriving at a diagnosis or determining b) pillows under the lower legs.
the persons needs?
Pillows under the legs will not prevent the hips from
a) History of present illness rotating externally.
The history of the present illness is the single most c) a hip-abductor pillow.
important factor in assisting the health professional
in arriving at a diagnosis or determining the A hip-abductor pillow is used for the patient after
persons needs. total hip replacement surgery.

b) Physical examination d) a footboard.

The physical examination is helpful but often only A footboard will not prevent the hips from rotating
validates the information obtained from the history. externally.

c) Diagnostic test results 49. To prevent footdrop, the patient is positioned in:

Diagnostic test results can be helpful, but they often a) Order to keep the feet at right angles to the leg
only verify rather than establish the diagnosis.
When the patient is supine in bed, padded splints or
d) Biographical data protective boots are used.

Biographical information puts the health history in b) A semi-sitting position in bed


context but does not focus the diagnosis.
Semi-fowlers positioning is used to decrease the
22. Which of the following methods of physical pressure of abdominal contents on the diaphragm.
examination refers to the translation of physical
force into sound? c) A sitting position with legs hanging off the side of
the bed
a) Percussion
In order to prevent footdrop, the feet must be
Percussion translates the application of physical supported.
force into sound.
d) A side-lying position
b) Palpation
Side-lying positions do not provide support to
Palpation refers to examination by non-forceful prevent footdrop.
touching.
51. During which stage of pressure ulcer
c) Auscultation development does the ulcer extend into the
subcutaneous tissue?

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SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

a) Stage III Essential hypertension has no known underlying


cause.
Clinically, a deep crater with or without
undermining of adjacent tissues is noted. d) isolated systolic.

b) Stage IV Isolated systolic hypertension is demonstrated by


readings in which the systolic pressure exceeds 140
A stage IV pressure ulcer extends into the mm Hg and the diastolic measurement is normal or
underlying structure, including the muscle and near normal (less than 90 mm Hg).
possibly the bone.
59. When a person who has been taking opioids
c) Stage II becomes less sensitive to their analgesic properties,
that person is said to have developed a (an)
A stage II ulcer exhibits a break in the skin through
the epidermis or dermis. a) tolerance.
d) Stage I Tolerance is characterized by the need for increasing
dose requirements to maintain the same level of
A stage I pressure ulcer is an area of nonblanchable
pain relief.
erythema, tissue swelling, and congestion, and the
patient complains of discomfort. b) addiction.
55. When assessing the older adult, the nurse Addiction refers to a behavioral pattern of substance
anticipates increase in which of the follow use characterized by a compulsion to take the drug
components of respiratory status? primarily to experience its psychic effects.
a) Residual lung volume c) dependence.
As a result, patient experience fatigue and Dependence occurs when a patient who has been
breathlessness with sustained activity. taking opioids experiences a withdrawal syndrome
when the opioids are discontinued.
b) Vital capacity
d) balanced analgesia.
The nurse anticipates decreased vital capacity.
Balanced analgesia occurs when the patient is using
c) Gas exchange and diffusing capacity
more than one form of analgesia concurrently to
The nurse anticipates decreased gas exchange and obtain more pain relief with fewer side effects.
diffusing capacity resulting in impaired healing of
60. Prostaglandins are chemical substances thought
tissues due to decreased oxygenation.
to
d) Cough efficiency
a) increase sensitivity of pain receptors.
The nurse anticipates difficulty coughing up
Prostaglandins are believed to increase sensitivity to
secretions due to decreased cough efficiency.
pain receptors by enhancing the pain-provoking
56. According to the classification of hypertension effect of bradykinin.
diagnosed in the older adult, hypertension that can
b) reduce the perception of pain.
be attributed to an underlying cause is termed
Endorphins and enkephalins reduce or inhibit
a) secondary.
transmission or perception of pain.
Secondary hypertension may be caused by a tumor
c) inhibit the transmission of pain.
of the adrenal gland (e.g., pheochromacytoma).
Endorphins and enkephalins reduce or inhibit
b) primary.
transmission or perception of pain.
Primary hypertension has no known underlying
d) inhibit the transmission of noxious stimuli.
cause.
Morphine and other opioid medications inhibit the
c) essential.
transmission of noxious stimuli by mimicking
enkephalin and endorphin.

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SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

63. The preferred route of Normal saline (0.9% NaCl) is isotonic.


administration of medication in the most acute care
situations is which of the following routes? d) 5% NaCl.

a) Intravenous A solution that is 5% NaCl is hypertonic.

The IV route is the preferred parenteral route in 70. In which type of shock does the patient
most acute care situations because it is much more experiences a mismatch of blood flow to the cells?
comfortable for the patient, and peak serum levels
a) Distributive
and pain relief occur more rapidly and reliably.
Distributive or vasogenic shock results from
b) Epidural
displacement of blood volume, creating a relative
Epidural administration is used to control hypovolemia.
postoperative and chronic pain.
b) Cardiogenic
c) Subcutaneous
Cardiogenic shock results from the failure of a heart
Subcutaneous administration results in slow as a pump.
absorption of medication.
c) Hypovolemic
d) Intramuscular
In hypovolemic shock, there is a decrease in the
Intramuscular administration of medication is intravascular volume.
absorbed more slowly than intravenously
d) Septic
administered medication.
In septic shock, overwhelming infection results in a
64. Mu opioids have which of the following effects
relative hypovolemia.
on respiratory rate:
71. Which stage of shock is best described as that
a) Stimulation, then depression
stage when the mechanisms that regulateblood
Mu opioids also cause bradycardia, hypothermia, pressure fail to sustain a systolic pressure above 90
and constipation. mm Hg?

b) No change a) Progressive

Kappa opioids result in no change in respiratory In the progressive stage of shock, the mechanisms
rate. that regulate blood pressure can no longer
compensate, and the mean arterial pressure falls
c) Stimulation, only below normal limits.

Delta opioids result in stimulation of respiratory b) Refractory


rate.
The refractory or irreversible stage of shock
d) Depression, only represents the point at which organ damage is so
severe that the patient does not respond to
Neither mu, nor kappa, nor delta opoids depress treatment and cannot survive.
respiratory rate as its only effect upon respiratory
rate. c) Compensatory

68. Which of the following solutions is hypotonic? In the compensatory state, the patients blood
pressure remains within normal limits due to
a) 0.45% NaCl. vasoconstriction, increased heart rate, and
increased contractility of the heart.
Half-strength saline is hypotonic
d) Irreversible
b) Lactated Ringers solution.
The refractory or irreversible stage of shock
Lactated Ringers is isotonic.
represents the point at which organ damage is so
c) 0.9% NaCl. severe that the patient does not respond to
treatment and cannot survive.

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SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

72. When the nurse observes 87. When the indication for surgery is without delay,
that the patients systolic blood pressure is less than the nurse recognizes that the surgery will be
8090 mm Hg, respirations are rapid and shallow, classified as
heart rate is over 150 beats per minute, and urine
output is less than 30 cc per hour, the nurse a) emergency.
recognizes that the patient is demonstrating which
Emergency surgery means that the patient requires
stage of shock?
immediate attention and the disorder may be life-
a) Compensatory threatening.

In compensatory shock, the patients blood pressure b) urgent.


is normal, respirations are above 20, and heart rate
Urgent surgery means that the patient requires
is above 100 but below 150.
prompt attention within 24-30 hours.
b) Progressive
c) required.
In progressive shock, the patients skin appears
Required surgery means that the patient needs to
mottled and mentation demonstrates lethargy.
have surgery, and it should be planned within a few
c) Refractory weeks or months.

In refractory or irreversible shock, the patient d) elective.


requires complete mechanical and pharmacologic
Elective surgery means that there is an indication
support.
for surgery, but failure to have surgery will not be
d) Irreversible catastrophic.

In refractory or irreversible shock, the patient 90. When the patient is encouraged to concentrate
requires complete mechanical and pharmacologic on a pleasant experience or restful scene, the
support. cognitive coping strategy being employed by the
nurse is
86. Regarding the surgical patient, which of the
following terms refers to the period of time that a) imagery.
constitutes the surgical experience?
Imagery has proven effective for oncology patients.
a) Perioperative phase
b) optimistic self-recitation.
Perioperative period includes the preoperative,
Optimistic self-recitation is practiced when the
intraoperative, and postoperative phases.
patient is encouraged to recite optimistic thoughts
b) Preoperative phase such as I know all will go well.

Preoperative phase is the period of time from when c) distraction.


the decision for surgical intervention is made to
Distraction is employed when the patient is
when the patient is transferred to the operating
encouraged to think of an enjoyable story or recite a
room table.
favorite poem.
c) Intraoperative phase
d) progressive muscular relaxation.
Intraoperataive phase is the period of time from
Progressive muscular relaxation requires contracting
when the patient is transferred to the operating
and relaxing muscle groups and is a physical coping
room table to when he or she is admitted to the
strategy as opposed to cognitive.
postanesthesia care unit.
95. Which of the following terms is used to refer to
d) Postoperative phase
protrusion of abdominal organs through the surgical
Postoperative phase is the period of time that incision?
begins with the admission of the patient to the
a) Evisceration
postanesthesia care unit and ends after a follow-up
evaluation in the clinical setting or home. Evisceration is a surgical emergency.

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SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

b) Hernia 98. When the nurse observes that the postoperative


patient demonstrates a constant low level of oxygen
A hernia is a weakness in the abdominal wall. saturation, although the patients breathing appears
normal, the nurse identifies thatthe patient may be
c) Dehiscence
suffering which type of hypoxemia?
Dehiscence refers to partial or complete separation
a) Subacute
of wound edges.
Supplemental oxygen may be indicated.
d) Erythema
b) Hypoxic
Erythema refers to redness of tissue.
Hypoxic hypoxemia results from inadequate
96. When the method of wound healing is one in
breathing.
which wound edges are not surgically approximated
and integumentary continuity is restored by c) Episodic
granulations, the wound healing is termed
Episodic hypoxemia develops suddenly, and the
a) second intention healing. patient may be at risk for myocardial ischemia,
cerebral dysfunction, and cardiac arrest.
When wounds dehisce, they will be allowed to heal
by secondary intention. d) Anemic
b) primary intention healing. Anemic hypoxemia results from blood loss during
surgery.
Primary or first intention healing is the method of
healing in which wound edges are surgically 99. When the surgeon performs an appendectomy,
approximated and integumentary continuity is the nurse recognizes that the surgical category will
restored without granulating. be identified as
c) first intention healing. a) clean contaminated.
Primary or first intention healing is the method of Clean-contaminated cases are those with a
healing in which wound edges are surgically potential, limited source for infection, the exposure
approximated and integumentary continuity is to which, to a large extent, can be controlled.
restored without granulating.
b) clean.
d) third intention healing.
Clean cases are those with no apparent source of
Third intention healing is a method of healing in potential infection.
which surgical approximation of wound edges is
delayed and integumentary continuity is restored by c) contaminated.
bringing apposing granulations together.
Contaminated cases are those that contain an open
97. The nurse recognizes which of the following and obvious source of potential infection.
signs as typical of the patient in shock?
d) dirty.
a) Rapid, weak, thready pulse
A traumatic wound with foreign bodies, fecal
Pulse increases as the body tries to compensate. contamination, or purulent drainage would be
considered a dirty case.
b) Flushed face
100. Which of the following terms is used to
Pallor is an indicator of shock. describe inability to breathe easily except in an
upright position?
c) Warm, dry skin
a) Orthopnea
Skin is generally cool and moist in shock.
Patients with orthopnea are placed in a high
d) Increased urine output
Fowlers position to facilitate breathing.
Usually, a low blood pressure and concentrated
b) Dyspnea
urine are observed in the patient in shock.

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SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

Dyspnea refers to labored leather being rubbed together, she records her
breathing or shortness of breath. finding as

c) Hemoptysis a) pleural friction rub.

Hemoptysis refers to expectoration of blood from A pleural friction rub is heard secondary to
the respiratory tract. inflammation and loss of lubricating pleural fluid.

d) Hypoxemia b) crackles.

Hypoxemia refers to low oxygen levels in the blood. Crackles are soft, high-pitched, discontinuous
popping sounds that occur during inspiration.
101. In relation to the structure of the larynx, the
cricoid cartilage is c) sonorous wheezes.

a) the only complete cartilaginous ring in the larynx. Sonorous wheezes are deep, low-pitched rumbling
sounds heard primarily during expiration.
The cricoid cartilage is located below the thyroid
cartilage. d) sibilant wheezes.

b) used in vocal cord movement with the thyroid Sibilant wheezes are continuous, musical, high-
cartilage. pitched, whistle-like sounds heard during inspiration
and expiration.
The arytenoid cartilages are used in vocal cord
movement with the thyroid cartilage. 110. Which of the following terms refers to lung
tissue that has become more solid in nature due to
c) the largest of the cartilage structures. a collapse of alveoli or infectious process?
The thyroid cartilage is the largest of the cartilage a) Consolidation
structures; part of it forms the Adams apple.
Consolidation occurs during an infectious process
d) the valve flap of cartilage that covers the opening such as pneumonia.
to the larynx during swallowing.
b) Atelectasis
The epiglottis is the valve flap of cartilage that
covers the opening to the larynx during swallowing. Atelectasis refers to collapse or airless condition of
the alveoli caused by hypoventilation, obstruction to
102. Which respiratory volume is the maximum the airways, or compression.
volume of air that can be inhaled after maximal
expiration? c) Bronchiectasis

a) Inspiratory reserve volume Bronchiectasis refers to chronic dilation of a bronchi


or bronchi in which the dilated airway becomes
Inspiratory reserve volume is normally 3000 mL. saccular and a medium for chronic infection.
b) Tidal volume d) Empyema
Tidal volume is the volume of air inhaled and Empyema refers to accumulation of purulent
exhaled with each breath. material in the pleural space.
c) Expiratory reserve volume 115. Which of the following methods is the best
method for determining nasogastric tube placement
Expiratory reserve volume is the maximum volume
in the stomach?
of air that can be exhaled forcibly after a normal
exhalation. a) X-ray
d) Residual volume Radiologic identification of tube placement in the
stomach is most reliable.
Residual volume is the volume of air remaining in
the lungs after a maximum exhalation. b) Observation of gastric aspirate
104. When the nurse auscultates chest sounds that
are harsh and cracking, sounding like two pieces of

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School of Nursing

Rotational Exam-BGH Surgical Ward

Gastric fluid may be grassy green, A deficiency of alpha-antitrypsin is a risk factor for
brown, clear, or odorless while an aspirate from the development of COPD, but it is not the most
lungs may be off-white or tan. Hence, checking important risk factor.
aspirate is not the best method of determining
nasogastric tube placement in the stomach. 119. Which type of chest configuration is typical of
the patient with COPD?
c) Testing of pH of gastric aspirate
a) Barrel chest
Gastric pH values are typically lower or more acidic
than that of the intestinal or respiractory tract, but Barrel chest results from fixation of the ribs in the
not always. inspiratory position.

d) Placement of external end of tube under water b) Pigeon chest

Placement of external end of tube under water and Pigeon chest results from a displaced sternum.
watching for air bubbles is not a reliable method for
c) Flail chest
determining nasogastric tube placement in the
stomach. Flail chest results when the ribs are fractured.
117. Emphysema is described as: d) Funnel chest
a) A disease of the airways characterized by Funnel chest occurs when there is a depression in
destruction of the walls of overdistended alveoli. the lower portion of the sternum and is associated
Emphysema is a category of COPD. with Mafans syndrome or rickets.
b) A disease that results in a common clinical 121. Of the following oxygen administration devices,
outcome of reversible airflow obstruction. which has the advantage of providing high oxygen
concentration?
Asthma is the disease described.
a) Non-rebreather mask
c) The presence of cough and sputum production
for at least a combined total of two or three months The non-rebreather mask provides high oxygen
in each of two consecutive years. concentration but is usually poor fitting.
Bronchitis is the disease described. b) Venturi mask
d) Chronic dilatation of a bronchus or bronchi The Venturi mask provides low levels of
supplemental oxygen.
Bronchiectasis is the condition described.
c) Catheter
118. Which of the following is the most important
risk factor for development of Chronic Obstructive The catheter is an inexpensive device that provides
Pulmonary Disease? a variable fraction of inspired oxygen and may cause
gastric distention.
a) Cigarette smoking
d) Face tent
Pipe, cigar and other types of tobacco smoking are
also risk factors. A face tent provides a fairly accurate fraction of
inspired oxygen, but is bulky and uncomfortable. It
b) Occupational exposure
would not be the device of choice to provide high
While a risk factor, occupational exposure is not the oxygen concentration.
most important risk factor for development of
123. When performing endotracheal suctioning, the
COPD.
nurse applies suctioning while withdrawing and
c) Air pollution gently rotating the catheter 360 degrees for which
of the following time periods?
Air pollution is a risk factor for development of
COPD, but it is not the most important risk factor. a) 10-15 seconds

d) Genetic abnormalities In general, the nurse should apply suction no longer


than 10-15 seconds because hypoxia and

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dysrhythmias may The right ventricle lies anteriorly, just beneath the
develop, leading to cardiac arrest. sternum.

b) 30-35 seconds c) 2 to the left of the lower end of the sternum

Applying suction for 30-35 seconds is hazardous and Use of inches to identify the location of the apex
may result in the patients developing hypoxia, beat is inappropriate based upon variations in
which can lead to dysrhythmias and, ultimately, human anatomy.
cardiac arrest.
d) 1 to the left of the xiphoid process
c) 20-25 seconds
Auscultation below and to the left of the xiphoid
Applying suction for 20-25 seconds is hazardous and process will detect gastrointestinal sounds, but not
may result in the patients developing hypoxia, the apex beat of the heart.
which can lead to dysrhythmias and, ultimately,
cardiac arrest. 127. Which of the following terms describes the
amount of blood ejected per heartbeat?
d) 0-5 seconds
a) Stroke volume
Applying suction for 0-5 seconds would provide too
little time for effective suctioning of secretions. Stroke volume is determined by preload, afterload,
and contractility.
125. Which term is used to describe the ability of
the heart to initiate an electrical impulse? b) Cardiac output

a) Automaticity Cardiac output is the amount of blood pumped by


each ventricle during a given period and is
Automaticity is the ability of specialized electrical computed by multiplying the stroke volume of the
cells of the cardiac conduction system to initiate an heart by the heart rate.
electrical impulse.
c) Ejection fraction
b) Contractility
Ejection Fraction is the percentage of the end-
Contractility refers to the ability of the specialized diastolic volume that is ejected with each stroke,
electrical cells of the cardiac conduction system to measured at 4250% in the normal heart.
contract in response to an electrical impulse.
d) Afterload
c) Conductivity
Afterload is defined as the pressure that the
Conductivity refers to the ability of the specialized ventricular myocardium must overcome to eject
electrical cells of the cardiac conduction system to blood during systole and is one of the determinants
transmit an electrical impulse from one cell to of stroke volume.
another.
128. When measuring the blood pressure in each of
d) Excitability the patients arms, the nurse recognizes that in the
normal adult, the pressures
Excitability refers to the ability of the specialized
electrical cells of the cardiac conduction system to a) differ no more than 5 mm Hg between arm
respond to an electrical impulse. pressures.

126. The nurse auscultates the apex beat at which Normally, in the absence of disease of the
of the following anatomical locations? vasculature, there is a difference of no more than 5
mm Hg between arm pressures.
a) Fifth intercostal space, midclavicular line
b) must be equal in both arms.
The left ventricle is responsible for the apex beat or
the point of maximum impulse, which is normally The pressures in each arm do not have to be equal
palpable in the left midclavicular line of the chest in order to be considered normal.
wall at the fifth intercostal space.
c) may vary 10 mm Hg or more between arms.
b) Mid-sternum

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School of Nursing

Rotational Exam-BGH Surgical Ward

Pressures that vary more than d) sinus tachycardia.


10 mm Hg between arms indicate an abnormal
finding. Sinus tachycardia occurs when the sinus node
regularly creates an impulse at a faster-than-normal
d) may vary, with the higher pressure found in the rate.
left arm.
137. Which of the following terms refers to chest
The left arm pressure is not anticipated to be higher pain brought on by physical or emotional stress and
than the right as a normal anatomical variant. relieved by rest or medication?

130. Which of the following ECG characteristics is a) angina pectoris


usually seen when a patients serum potassium level
is low? Angina pectoris is a symptom of myocardial
ischemia.
a) U wave
b) atherosclerosis
The U wave is an ECG waveform characteristic that
may reflect Purkinje fiber repolarization. It is usually Atherosclerosis is an abnormal accumulation of lipid
seen when a patients serum potassium level is low. deposits and fibrous tissue within arterial walls and
lumens.
b) T wave
c) atheroma
The T wave is an ECG characteristic reflecting
repolarization of the ventricles. It may become tall Atheromas are fibrous caps composed of smooth
or peaked if a patients serum potassium level is muscle cells that form over lipid deposits within
high. arterial vessels.

c) P wave d) ischemia

The P wave is an ECG characteristic reflecting Ischemia is insufficient tissue oxygenation and may
conduction of an electrical impulse through the occur in any part of the body.
atria.
138. Of the following risk factors, which is
d) QT interval considered modifiable?

The QT interval is an ECG characteristic reflecting a) Diabetes mellitus


the time from ventricular depolarization to
While diabetes mellitus cannot be cured, blood
repolarization.
sugars and symptomatology can be managed
132. When the nurse observes that the patients through healthy heart living.
heart rate increases during inspiration and
b) Gender
decreases during expiration, the nurse reports that
the patient is demonstrating Gender is considered a non-modifiable risk factor.
a) sinus dysrhythmia. c) Race
Sinus dysrhythmia occurs when the sinus node Race is considered a non-modifiable risk factor.
creates an impulse at an irregular rhythm.
d) Increasing age
b) normal sinus rhythm.
Increasing age is considered a non-modifiable risk
Normal sinus rhythm occurs when the electrical factor.
impulse starts at a regular rate and rhythm in the SA
node and travels through the normal conduction 139. When the patient with known angina pectoris
pathway. complains that he is experiencing chest pain more
frequently even at rest, the period of pain is longer,
c) sinus bradycardia. and it takes less stress for the pain to occur, the
nurse recognizes that the patient is describing
Sinus bradycardia occurs when the sinus node
regularly creates an impulse at a slower-than- a) unstable angina.
normal rate.

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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 11
SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

Unstable angina is also called Orthopnea is the inability of the patient to breathe
crescendo or pre-infarction angina and indicates the except in the upright (sitting) position.
need for a change in treatment.
d) Thromboangitis obliterans
b) intractable angina.
Thomroangitis obliterans is a peripheral vascular
Intractable or refractory angina produces severe, disease also known as Burgers disease.
incapacitating chest pain that does not respond to
conventional treatment. 149. When the nurse notes that the post cardiac
surgery patient demonstrates low urine output (<
c) variant angina. 25 ml/hr) with high specific gravity (> 1.025), the
nurse suspects:
Variant angina is described as pain at rest with
reversible ST-segment elevation and is thought to be a) Inadequate fluid volume
caused by coronary artery vasospasm.
Urine output of less than 25 ml/hr may indicate a
d) refractory angina. decrease in cardiac output. A high specific gravity
indicates increased concentration of solutes in the
Intractable or refractory angina produces severe, urine which occurs with inadequate fluid volume.
incapacitating chest pain that does not respond to
conventional treatment. b) Normal glomerular filtration

146. Which of the following medications are used to Indices of normal glomerular filtration are output of
reverse the effects of heparin? 25 ml or greater per hour and specific gravity
between 1.010 and 1.025.
a) Protamine sulfate
c) Overhydration
Protamine sulfate is known as the antagonist to
heparin. Overhydration is manifested by high urine output
with low specific gravity.
b) Streptokinase
d) Anuria
Streptokinase is a thrombolytic agent.
The anuric patient does not produce urine.
c) Clopidigrel (Plavix)
159. When the nurse observes that the patient
Clopidigrel (Plavix) is an antiplatelet medication that always has difficulty breathing when lying flat, the
is given to reduce the risk of thrombus formation nurse records that the patient is demonstrating
post coronary stent placement.
a) Orthopnea
d) Aspirin
Patients with orthopnea prefer not to lie flat and
The antiplatelet effect of aspirin does not reverse will need to maintain their beds in a semi- to high
the effects of heparin. Fowlers position
147. Which of the following terms refers to leg pain b) Dyspnea on exertion.
that is brought on walking and caused by arterial
insufficiency? Dyspnea on exertion refers to difficulty breathing
with activity.
a) Intermittent claudication
c) Hyperpnea.
Intermittent claudication is leg pain that is brought
on by exercise and relieved by rest. Hyperpnea refers to increased rate and depth of
respiration.
b) Dyspnea
d) Paroxysmal nocturnal dyspnea.
Dyspnea is the patients subjective statement of
difficulty breathing. Paroxysmal nocturnal dyspnea refers to orthopnea
that occurs only at night.
c) Orthopnea

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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 12
SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

160. The patient with cardiac b) 130, 80


failure is taught to report which of the following
symptoms to the physician or clinic immediately? Pressure of 130 systolic and 80 diastolic falls within
the normal range for an adult.
a) Persistent cough
c) 110, 60
Persistent cough may indicate an onset of left-heart
failure. Pressure of 110 systolic and 60 diastolic falls within
the normal range for an adult.
b) Increased appetite
d) 120, 70
Loss of appetite should be reported immediately.
Pressure of 120 systolic and 70 diastolic falls within
c) Weight loss the normal range for an adult.

Weight gain should be reported immediately.

d) Ability to sleep through the night 171. The nurse teaches the patient which of the
following guidelines regarding lifestyle modifications
Frequent urination, causing interruption of sleep, for hypertension?
should be reported immediately.
a) Maintain adequate dietary intake of potassium
169. Which of the following terms is given to
hypertension in which the blood pressure, which is In general, one serving of a potassium-rich food
controlled with therapy, becomes uncontrolled such as banana, kale, broccoli, or orange juice will
(abnormally high) with the discontinuation of meet the daily need for potassium.
therapy?
b) Reduce smoking to no more than four cigarettes
a) Rebound per day

Rebound hypertension may precipitate a The patient should be guided to stop smoking.
hypertensive crisis.
c) Limit aerobic physical activity to 15 minutes,
b) Essential three times per week

Essential or primary hypertension denotes high The general guideline is to advise the patient to
blood pressure from an unidentified source. increase aerobic activity to 30 to 45 minutes most
days of the week.
c) Primary
d) Stop alcohol intake
Essential or primary hypertension denotes high
blood pressure from an unidentified source. In general, alcohol intake should be limited to no
more than 1 oz of ethanol per day.
d) Secondary
174. Which of the following terms refers to an
Secondary hypertension denotes high blood abnormal decrease in white blood cells, red blood
pressure from an identified cause, such as renal cells, and platelets?
disease.
a) Pancytopenia
170. Officially, hypertension is diagnosed when the
patient demonstrates a systolic blood pressure Pancytopenia may be congenital or acquired.
greater than ______ mm Hg and a diastolic blood
pressure greater than _____ mm Hg over a b) Anemia
sustained period.
Anemia refers to decreased red cell mass.
a) 140, 90
c) Leukopenia
According to the categories of blood pressure levels
Leukopenia refers to a less-than-normal amount of
established by the JNC VI, stage 1 hypertension is
WBCs in circulation.
demonstrated by a systolic pressure of 140159 or a
diastolic pressure of 9099. d) Thrombocytopenia

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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 13
SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

179. Which of the following One observation of a residual gastric content over
terms describes a gastric secretion that combines 100 cc does not have to be reported to the
with vitamin B-12 so that it can be absorbed? physician. If the observation occurs two times in
succession, the physician should be notified.
a) Intrinsic factor
c) give the tube feeding.
Lack of intrinsic factor is a common finding in the
aged patient. If the amount of gastric residual exceeds 100 cc, the
tube feeding should be withheld at that time.
b) Amylase
d) withhold the tube feeding indefinitely.
Amylase is an enzyme that aids in the digestion of
starch. If the amount of gastric residual exceeds 100 cc, the
tube feeding should be withheld at that time, but
c) Pepsin not indefinitely.
Pepsin is a gastric enzyme important in protein 221. Which type of jaundice in adults is the result of
digestion. increased destruction of red blood cells?
d) Trypsin a) Hemolytic
Trypsin is an enzyme that aids in the digestion of Hemolytic jaundice results because, although the
protein liver is functioning normally, it cannot excrete the
bilirubin as quickly as it is formed.
195. The most significant nursing problem related to
continuous tube feedings is b) Hepatocellular
a) potential for aspiration Hepatocellular jaundice is the result of liver disease.
Because the normal swallowing mechanism is c) Obstructive
bypassed, consideration of the danger of aspiration
must be foremost in the mind of the nurse caring Obstructive jaundice is the result of liver disease.
for the patient receiving continuous tube feedings.
d) Non-obstructive
b) interruption of GI integrity
Non-obstructive jaundice occurs with hepatitis.
Tube feedings preserve GI integrity by intraluminal
delivery of nutrients. 243. To facilitate entry of a catheter into the male
urethra, the penis should be positioned at which of
c) disturbance in the sequence of intestinal and the following degree angles (in relation to the
hepatic metabolism body)?

Tube feedings preserve the normal sequence of a) 90 degrees


intestinal and hepatic metabolism.
A right angle straightens the urethra and makes it
d) interruption in fat metabolism and lipoprotein easier to insert the catheter.
synthesis
b) 45 degrees
Tube feedings maintain fat metabolism and
lipoprotein synthesis. A 45-degree angle will not straighten the urethra.

196. When the nurse prepares to give a bolus tube c) 180 degrees
feeding to the patient and determines that the
A 180-degree angle will result in the penis being
residual gastric content is 150 cc, her best action is
parallel to the body and inappropriately positioned
to
for catheterization.
a) reassess the residual gastric content in 1 hour.
d) 270 degrees
If the gastric residual exceeds 100 cc 2 hours in a
A 270-degree angle is a physical impossibility.
row, the physician should be notified.

b) notify the physician.

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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 14
SAINT LOUIS UNIVERSITY
School of Nursing

Rotational Exam-BGH Surgical Ward

250. If an indwelling catheter


is necessary, nursing interventions that should be
implemented to prevent infection include

a) performing meticulous perineal care daily with


soap and water.

Cleanliness of the area will reduce potential for


infection.

b) using clean technique during insertion.

Strict aseptic technique must be used during


insertion of a urinary bladder catheter.

c) using sterile technique to disconnect the catheter


from tubing to obtain urine specimens.

The nurse must maintain a closed system and use


the catheters port to obtain specimens.

d) placing the catheter bag on the patients


abdomen when moving the patient.

The catheter bag must never be placed on the


patients abdomen unless it is clamped because it
may cause backflow of urine from the tubing into
the bladder.

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Prepared by: Jay A. Ablog, RN, MN/August 8, 2017 SLU-SON | P a g e 15

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