1. A client with heart failure is prescribed furosemide (Lasix). Which electrolyte
imbalance should the nurse monitor for?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B. Furosemide is a loop diuretic that causes potassium loss in the urine,
leading to hypokalemia.
2. A nurse is caring for a client with left-sided heart failure. Which assessment
finding is most expected?
A. Peripheral edema
B. Jugular vein distension
C. Pulmonary crackles
D. Hepatomegaly
Answer: C. Left-sided heart failure causes backup of fluid into the pulmonary
circulation, resulting in pulmonary crackles.
3. A client is prescribed digoxin (Lanoxin). Before administering, the nurse checks
the apical pulse for 1 full minute. The nurse should withhold the medication if the
pulse is:
A. 80 bpm
B. 68 bpm
C. 56 bpm
D. 90 bpm
Answer: C. Digoxin should be withheld if the apical pulse is below 60 bpm. A pulse
of 56 bpm is below this threshold.
4. A client presents with crushing chest pain, diaphoresis, and nausea. The 12-lead
ECG shows ST elevation. The priority nursing action is:
A. Administer morphine IV
B. Obtain IV access and prepare for thrombolytics or PCI
C. Apply oxygen at 2 L/min via nasal cannula
, D. Administer oral aspirin 325 mg
Answer: B. ST elevation myocardial infarction (STEMI) requires immediate
reperfusion therapy. Obtaining IV access and preparing for intervention is the
priority.
5. Which medication is given first during a witnessed ventricular fibrillation cardiac
arrest?
A. Amiodarone 300 mg IV
B. Epinephrine 1 mg IV
C. Defibrillation at 200 joules
D. Atropine 0.5 mg IV
Answer: C. Immediate defibrillation is the priority treatment for ventricular
fibrillation.
6. A client is on a heparin drip for DVT treatment. The aPTT result is 120 seconds
(therapeutic range 60–100 sec). The nurse should:
A. Increase the heparin rate
B. Decrease the heparin rate
C. Administer protamine sulfate
D. Continue the current rate
Answer: B. An aPTT of 120 seconds is above the therapeutic range, indicating
excessive anticoagulation; the infusion rate should be decreased.
7. A client with atrial fibrillation is started on warfarin (Coumadin). Which lab
value monitors therapeutic effectiveness?
A. aPTT
B. PT/INR
C. CBC
D. BMP
Answer: B. The INR (derived from PT) is used to monitor warfarin therapy.
Therapeutic INR for atrial fibrillation is typically 2.0–3.0.
8. Which sign/symptom indicates right-sided heart failure?
A. Pulmonary crackles
B. Orthopnea
C. Pitting edema in lower extremities
D. Pink frothy sputum
Answer: C. Right-sided heart failure causes systemic venous congestion leading to
peripheral (pitting) edema.
9. A client's cardiac monitor shows a rhythm with no P waves, irregular R-R
intervals, and a rate of 110 bpm. This rhythm is:
A. Sinus tachycardia
B. Atrial fibrillation
, C. Atrial flutter
D. Ventricular tachycardia
Answer: B. Atrial fibrillation is characterized by absent P waves, an irregularly
irregular rhythm, and variable rate.
10. The nurse is teaching a client about nitroglycerin (NTG) sublingual tablets.
Which instruction is most important?
A. Take one tablet every 15 minutes for up to 6 doses
B. Swallow the tablet whole with water
C. If pain not relieved after 3 doses in 15 minutes, call 911
D. Store tablets in a clear plastic container
Answer: C. If chest pain is not relieved after 3 sublingual NTG tablets (one every 5
min), the client should seek emergency care immediately.
Respiratory Nursing
11. A client with COPD is receiving oxygen therapy. The nurse should administer
oxygen at which flow rate to avoid suppressing the hypoxic drive?
A. 6–8 L/min
B. 4–6 L/min
C. 1–2 L/min
D. 10–12 L/min
Answer: C. Clients with COPD rely on hypoxic drive; high flow O2 can suppress
respiratory drive. Low-flow O2 (1–2 L/min) is appropriate.
12. A client with asthma is having an acute exacerbation. Which medication should
the nurse administer first?
A. Inhaled corticosteroid (fluticasone)
B. Short-acting beta-2 agonist (albuterol)
C. Leukotriene modifier (montelukast)
D. Long-acting beta-2 agonist (salmeterol)
Answer: B. Short-acting beta-2 agonists (rescue inhalers) are the first-line treatment
for acute asthma exacerbations due to quick bronchodilation.
13. A client is admitted with pneumonia. Which assessment finding is most
consistent with this diagnosis?
A. Barrel chest
B. Decreased breath sounds and dullness on percussion
C. Hyperresonance on percussion
D. Prolonged expiratory phase
Answer: B. Consolidation from pneumonia causes decreased breath sounds and
dullness to percussion over the affected area.
, 14. The nurse is caring for a client with a chest tube. Which assessment finding
requires immediate intervention?
A. Tidaling in the water seal chamber
B. 50 mL of serosanguineous drainage in the first hour
C. Continuous bubbling in the water seal chamber
D. Absence of drainage for 2 hours
Answer: C. Continuous bubbling in the water seal chamber (not the suction control)
indicates an air leak, which requires immediate assessment.
15. A client with TB is placed on airborne precautions. Which PPE is required when
entering the room?
A. Surgical mask
B. N95 respirator
C. Face shield only
D. Standard precautions are sufficient
Answer: B. TB is transmitted via airborne droplet nuclei; an N95 (or higher)
respirator is required for airborne precautions.
16. A client with COPD has an ABG result of pH 7.32, PaCO2 58 mmHg, HCO3 28
mEq/L. The nurse interprets this as:
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis with metabolic compensation
D. Metabolic alkalosis
Answer: C. Low pH and elevated PaCO2 indicates respiratory acidosis. Elevated
HCO3 indicates the kidneys are compensating metabolically.
17. Which position is best for a client experiencing acute respiratory distress?
A. Supine
B. Prone
C. High Fowler's (90 degrees)
D. Left lateral recumbent
Answer: C. High Fowler's position maximizes lung expansion and decreases the
work of breathing in acute respiratory distress.
18. A client post-thoracotomy has a chest tube. The nurse notes the drainage system
has tipped over and the tube has separated. What is the priority action?
A. Clamp the chest tube immediately
B. Submerge the open end of the tube in sterile water
C. Apply a petroleum gauze dressing
D. Notify the physician and document
Answer: B. Submerging the disconnected tube end in sterile water creates a water
seal to prevent air from entering the pleural space.
imbalance should the nurse monitor for?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Answer: B. Furosemide is a loop diuretic that causes potassium loss in the urine,
leading to hypokalemia.
2. A nurse is caring for a client with left-sided heart failure. Which assessment
finding is most expected?
A. Peripheral edema
B. Jugular vein distension
C. Pulmonary crackles
D. Hepatomegaly
Answer: C. Left-sided heart failure causes backup of fluid into the pulmonary
circulation, resulting in pulmonary crackles.
3. A client is prescribed digoxin (Lanoxin). Before administering, the nurse checks
the apical pulse for 1 full minute. The nurse should withhold the medication if the
pulse is:
A. 80 bpm
B. 68 bpm
C. 56 bpm
D. 90 bpm
Answer: C. Digoxin should be withheld if the apical pulse is below 60 bpm. A pulse
of 56 bpm is below this threshold.
4. A client presents with crushing chest pain, diaphoresis, and nausea. The 12-lead
ECG shows ST elevation. The priority nursing action is:
A. Administer morphine IV
B. Obtain IV access and prepare for thrombolytics or PCI
C. Apply oxygen at 2 L/min via nasal cannula
, D. Administer oral aspirin 325 mg
Answer: B. ST elevation myocardial infarction (STEMI) requires immediate
reperfusion therapy. Obtaining IV access and preparing for intervention is the
priority.
5. Which medication is given first during a witnessed ventricular fibrillation cardiac
arrest?
A. Amiodarone 300 mg IV
B. Epinephrine 1 mg IV
C. Defibrillation at 200 joules
D. Atropine 0.5 mg IV
Answer: C. Immediate defibrillation is the priority treatment for ventricular
fibrillation.
6. A client is on a heparin drip for DVT treatment. The aPTT result is 120 seconds
(therapeutic range 60–100 sec). The nurse should:
A. Increase the heparin rate
B. Decrease the heparin rate
C. Administer protamine sulfate
D. Continue the current rate
Answer: B. An aPTT of 120 seconds is above the therapeutic range, indicating
excessive anticoagulation; the infusion rate should be decreased.
7. A client with atrial fibrillation is started on warfarin (Coumadin). Which lab
value monitors therapeutic effectiveness?
A. aPTT
B. PT/INR
C. CBC
D. BMP
Answer: B. The INR (derived from PT) is used to monitor warfarin therapy.
Therapeutic INR for atrial fibrillation is typically 2.0–3.0.
8. Which sign/symptom indicates right-sided heart failure?
A. Pulmonary crackles
B. Orthopnea
C. Pitting edema in lower extremities
D. Pink frothy sputum
Answer: C. Right-sided heart failure causes systemic venous congestion leading to
peripheral (pitting) edema.
9. A client's cardiac monitor shows a rhythm with no P waves, irregular R-R
intervals, and a rate of 110 bpm. This rhythm is:
A. Sinus tachycardia
B. Atrial fibrillation
, C. Atrial flutter
D. Ventricular tachycardia
Answer: B. Atrial fibrillation is characterized by absent P waves, an irregularly
irregular rhythm, and variable rate.
10. The nurse is teaching a client about nitroglycerin (NTG) sublingual tablets.
Which instruction is most important?
A. Take one tablet every 15 minutes for up to 6 doses
B. Swallow the tablet whole with water
C. If pain not relieved after 3 doses in 15 minutes, call 911
D. Store tablets in a clear plastic container
Answer: C. If chest pain is not relieved after 3 sublingual NTG tablets (one every 5
min), the client should seek emergency care immediately.
Respiratory Nursing
11. A client with COPD is receiving oxygen therapy. The nurse should administer
oxygen at which flow rate to avoid suppressing the hypoxic drive?
A. 6–8 L/min
B. 4–6 L/min
C. 1–2 L/min
D. 10–12 L/min
Answer: C. Clients with COPD rely on hypoxic drive; high flow O2 can suppress
respiratory drive. Low-flow O2 (1–2 L/min) is appropriate.
12. A client with asthma is having an acute exacerbation. Which medication should
the nurse administer first?
A. Inhaled corticosteroid (fluticasone)
B. Short-acting beta-2 agonist (albuterol)
C. Leukotriene modifier (montelukast)
D. Long-acting beta-2 agonist (salmeterol)
Answer: B. Short-acting beta-2 agonists (rescue inhalers) are the first-line treatment
for acute asthma exacerbations due to quick bronchodilation.
13. A client is admitted with pneumonia. Which assessment finding is most
consistent with this diagnosis?
A. Barrel chest
B. Decreased breath sounds and dullness on percussion
C. Hyperresonance on percussion
D. Prolonged expiratory phase
Answer: B. Consolidation from pneumonia causes decreased breath sounds and
dullness to percussion over the affected area.
, 14. The nurse is caring for a client with a chest tube. Which assessment finding
requires immediate intervention?
A. Tidaling in the water seal chamber
B. 50 mL of serosanguineous drainage in the first hour
C. Continuous bubbling in the water seal chamber
D. Absence of drainage for 2 hours
Answer: C. Continuous bubbling in the water seal chamber (not the suction control)
indicates an air leak, which requires immediate assessment.
15. A client with TB is placed on airborne precautions. Which PPE is required when
entering the room?
A. Surgical mask
B. N95 respirator
C. Face shield only
D. Standard precautions are sufficient
Answer: B. TB is transmitted via airborne droplet nuclei; an N95 (or higher)
respirator is required for airborne precautions.
16. A client with COPD has an ABG result of pH 7.32, PaCO2 58 mmHg, HCO3 28
mEq/L. The nurse interprets this as:
A. Respiratory alkalosis
B. Metabolic acidosis
C. Respiratory acidosis with metabolic compensation
D. Metabolic alkalosis
Answer: C. Low pH and elevated PaCO2 indicates respiratory acidosis. Elevated
HCO3 indicates the kidneys are compensating metabolically.
17. Which position is best for a client experiencing acute respiratory distress?
A. Supine
B. Prone
C. High Fowler's (90 degrees)
D. Left lateral recumbent
Answer: C. High Fowler's position maximizes lung expansion and decreases the
work of breathing in acute respiratory distress.
18. A client post-thoracotomy has a chest tube. The nurse notes the drainage system
has tipped over and the tube has separated. What is the priority action?
A. Clamp the chest tube immediately
B. Submerge the open end of the tube in sterile water
C. Apply a petroleum gauze dressing
D. Notify the physician and document
Answer: B. Submerging the disconnected tube end in sterile water creates a water
seal to prevent air from entering the pleural space.
