Med Surg Exam 1 practice questions
with complete solutions.
A patient is seen at the clinic for a routine physical examination. After the patient is assessed for evidence of
j j j j j j j j j j j j j j j j j j j
peripheral vascular disease, the nurse explains that which of the following tests is typically used to assist in
j j j j j j j j j j j j j j j j j j
the diagnosis?
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1. Allen's Test
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2. Ankle brachial pressure index.
j j j j
3. Cardiac Stress Test.
j j j j
4. Echocardiogram - CORRECT ANSWER✔✔2. Ankle brachial pressure index.
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Rationale: The ankle brachial index (ABI) is the blood pressure ratio between the lower legs and the arms.
j j j j j j j j j j j j j j j j j
Blood pressure in the legs is normally higher than the arms, and abnormalities indicate narrowing of the
j j j j j j j j j j j j j j j j j
arteries. Clinical findings that may suggest the presence of PVD includes a history of angina with activity,
j j j j j j j j j j j j j j j j j
intermittent claudication, and abnormal (weak or absent) pedal pulses. The formula for ABI is the systolic
j j j j j j j j j j j j j j j j
blood pressure of the ankle (measured at the dorsalis pedis or posterior tibial arteries) divided by the
j j j j j j j j j j j j j j j j j
systolic pressure in the arms. It is measured on both sides. A ratio of 1.0 indicates peripheral vascular
j j j j j j j j j j j j j j j j j j
disease. Incorrect: Allen's test is used to assess blood supply to the hand.Incorrect: Cardiac stress tests are
j j j j j j j j j j j j j j j j j
used to measure the heart's ability to respond to stress. Incorrect: ECG evaluates the structure and function
j j j j j j j j j j j j j j j j j
of the heart muscle, but does not tell if there is peripheral vascular disease present.
j j j j j j j j j j j j j j j
,A patient has been diagnosed with left-sided congestive heart failure, and is confused about the return of
j j j j j j j j j j j j j j j j
oxygenated blood from the lungs. To clarify the confusion, the nurse explains all chambers of the heart
j j j j j j j j j j j j j j j j j
dealing with blood circulation. The nurse is correct when she tells the client:
j j j j j j j j j j j j j
1. A muscular space called the pericardial space separates the chambers of the right side from the left side.
j j j j j j j j j j j j j j j j j j j
2. Blood flows into the left ventricle which pumps it out against high resistance into the systemic circulation.
j j j j j j j j j j j j j j j j j j
3. The blood moves to the left ventricle, which pumps blood into the lungs.
j j j j j j j j j j j j j j
3. The heart consists of 5 chambers.
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4. The left atrium receives oxygenated blood from the lungs.
j j j j j j j j j j
5. The right atrium receives deoxygenated blood from the body tissues. - CORRECT ANSWER✔✔2. Blood
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flows into the left ventricle which pumps it out against high resistance into the systemic circulation.
j j j j j j j j j j j j j j j j j
3. The blood moves to the left ventricle, which pumps blood into the lungs.
j j j j j j j j j j j j j j
4. The left atrium receives oxygenated blood from the lungs.
j j j j j j j j j j
5. The right atrium receives deoxygenated blood from the body tissues.
j j j j j j j j j j j
Rationale: Heart consists of 4 chambers: 2 atria and 2 ventricles. The right and left chambers are separated
j j j j j j j j j j j j j j j j j
down the middle of the heart by a septum, like a wall. The right atrium receives deoxygenated from the
j j j j j j j j j j j j j j j j j j j
body, and the blood then moves down into the right ventricle, which pumps it to the lungs with low
j j j j j j j j j j j j j j j j j j j
resistance. The left atrium then receives oxygenated blood from the lungs, and that blood moves down into
j j j j j j j j j j j j j j j j j
the left ventricle. The left ventricle, which is the most muscular chamber, pumps oxygen rich blood into the
j j j j j j j j j j j j j j j j j j
systemic circulation.
j j
A patient recovering from a MI has been in bed for 6 days. The patient now complains of calf pain. The nurse
j j j j j j j j j j j j j j j j j j j j j
should first:
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1. Administer pain medication as ordered.
j j j j j j
2. Assess the calf for redness warmth and swelling.
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3. Massage the calf to relieve the muscle cramp.
j j j j j j j j j
Observe the patient walking. - CORRECT ANSWER✔✔2. Assess the calf for redness warmth and swelling.
j j j j j j j j j j j j j j j
,Rationale: Due to the time spend in bed and inactive, the patient is at high risk for the development of a DVT.
j j j j j j j j j j j j j j j j j j j j j
Pain in the calf, redness or heat, and swelling in the affected extremity are signs of a DVT. Diagnostic tests
j j j j j j j j j j j j j j j j j j j j
that help diagnose a DVT include a D-dimer test to confirm the presence of fibrin degradation in products
j j j j j j j j j j j j j j j j j j
from a clot, venous ultrasound, venography to visualize the clot with contrast, or less commonly MRI or CT.
j j j j j j j j j j j j j j j j j j
The nurse is caring for a patient in the early stages of heart failure. The family is curious as to how the body
j j j j j j j j j j j j j j j j j j j j j j
adapts to heart failure. The nurse knows that during the early stages of heart failure, which specific
j j j j j j j j j j j j j j j j j
compensatory mechanisms occur?
j j j j
1. Decreased cardiac output inhibits the release of ADH by the pituitary gland.
j j j j j j j j j j j j
2. Hypotension stimulates the baroreceptors to increase sympathetic activity.
j j j j j j j j j
3. Hypotension stimulates the baroreceptors to decrease sympathetic activity.
j j j j j j j j j
4. Impaired renal perfusion inhibits aldosterone release. - CORRECT ANSWER✔✔2. Hypotension
j j j j j j j j j j
stimulates the baroreceptors to increase sympathetic activity.
j j j j j j j j
Rationale: As arterial blood pressure falls, the baroreceptors of the carotid and aorta are stimulated. This
j j j j j j j j j j j j j j j
causes a sympathetic release of catecholamines, resulting in vasoconstriction and an increased heart rate to
j j j j j j j j j j j j j j j
compensate. The compensatory mechanism increases peripheral vascular resistance and also the work
j j j j j j j j j j j j
load of the heart. This can worsen heart failure if not treated.
j j j j j j j j j j j j j
Incorrect: Decreased cardiac output will INCREASE ADH release, leading to fluid retention.
j j j j j j j j j j j j
Incorrect: Impaired renal perfusion will stimulate aldosterone release leading to addition fluid and sodium
j j j j j j j j j j j j j
retention.
j
The nurse is assessing a patient with atrial fibrillation and a rapid ventricular rate. The nurse would expect to
j j j j j j j j j j j j j j j j j j
see:
j
1. Distended juglar veins.
j j j j
2. Dizziness and hypotension.
j j j j
3. Hypertension and headache.
j j j j
4. Lower extremity pain. - CORRECT ANSWER✔✔2. Dizziness and hypotension.
j j j j j j j j j j
, Rationale: Atrial fibrillation is any arrhythmia in which the atria initiate rapid, ineffective contractions that
j j j j j j j j j j j j j j
are not synchronized with ventricular contractions. This patient has uncontrolled atrial fibrillation, which
j j j j j j j j j j j j j
can result in a low cardiac output. Signs and symptoms of a low cardiac output include hypotension,
j j j j j j j j j j j j j j j j j
dizziness, weakness, fatigue, shortness of breath, and syncope.
j j j j j j j j
The nurse is caring for a patient scheduled to undergo a mitral valve replacement. The nurse should monitor
j j j j j j j j j j j j j j j j j
for which complication of mitral stenosis?
j j j j j j
1. Left-sided heart failure.
j j j j
2. MI j
3. Pulmonary Hypertension
j j j
4. Respiratory Alkalosis - CORRECT ANSWER✔✔3. Pulmonary Hypertension
j j j j j j j j
Rationale: Mitral stenosis impeded blood flow from the left atrium to the left ventricle of the heart. This
j j j j j j j j j j j j j j j j j
creates increased pulmonary vascular resistance, causing pulmonary hypertension. Other complications of
j j j j j j j j j j j
mitral stenosis include edema, right-sided heart failure, and reduced cardiac output.
j j j j j j j j j j j
A nurse is assessing a patient who has longstanding hypertension. The nurse know that complications of
j j j j j j j j j j j j j j j
hypertension are possibly arising when which of the following signs are noted?
j j j j j j j j j j j j
1. Dyspnea during activity
j j j
2. Fatigability
j j
3. Recurrent episodes of severe headache.
j j j j j j
4. Trace proteins in the urinalysis. - CORRECT ANSWER✔✔4. Trace proteins in the urinalysis.
j j j j j j j j j j j j j j
Proteinuria and albuminuria are early indications of renal injury, a serious complication that can be caused
j j j j j j j j j j j j j j j
by hypertension. High pressures damage the kidney's ability to filter toxins, and evidence of this damage is
j j j j j j j j j j j j j j j j j
seen as proteins leak out of the urine. The other choices are not direct indicators of progressive disease or
j j j j j j j j j j j j j j j j j j j
complications. Fatigability and headache are symptoms of hypertension but are not direct indicators of
j j j j j j j j j j j j j j
progressive disease or complications. These may be side effects of certain medications used to treat
j j j j j j j j j j j j j j j
hypertension. Dyspnea during activity is NOT associated with hypertension. Dyspnea can be a sign of low
j j j j j j j j j j j j j j j j
cardiac output (congestive heart failure), pulmonary edema, severe anemia, or a respiratory problem
j j j j j j j j j j j j j
(asthma, pneumonia, etc.). ;./
j j j j
with complete solutions.
A patient is seen at the clinic for a routine physical examination. After the patient is assessed for evidence of
j j j j j j j j j j j j j j j j j j j
peripheral vascular disease, the nurse explains that which of the following tests is typically used to assist in
j j j j j j j j j j j j j j j j j j
the diagnosis?
j j
1. Allen's Test
j j
2. Ankle brachial pressure index.
j j j j
3. Cardiac Stress Test.
j j j j
4. Echocardiogram - CORRECT ANSWER✔✔2. Ankle brachial pressure index.
j j j j j j j j
Rationale: The ankle brachial index (ABI) is the blood pressure ratio between the lower legs and the arms.
j j j j j j j j j j j j j j j j j
Blood pressure in the legs is normally higher than the arms, and abnormalities indicate narrowing of the
j j j j j j j j j j j j j j j j j
arteries. Clinical findings that may suggest the presence of PVD includes a history of angina with activity,
j j j j j j j j j j j j j j j j j
intermittent claudication, and abnormal (weak or absent) pedal pulses. The formula for ABI is the systolic
j j j j j j j j j j j j j j j j
blood pressure of the ankle (measured at the dorsalis pedis or posterior tibial arteries) divided by the
j j j j j j j j j j j j j j j j j
systolic pressure in the arms. It is measured on both sides. A ratio of 1.0 indicates peripheral vascular
j j j j j j j j j j j j j j j j j j
disease. Incorrect: Allen's test is used to assess blood supply to the hand.Incorrect: Cardiac stress tests are
j j j j j j j j j j j j j j j j j
used to measure the heart's ability to respond to stress. Incorrect: ECG evaluates the structure and function
j j j j j j j j j j j j j j j j j
of the heart muscle, but does not tell if there is peripheral vascular disease present.
j j j j j j j j j j j j j j j
,A patient has been diagnosed with left-sided congestive heart failure, and is confused about the return of
j j j j j j j j j j j j j j j j
oxygenated blood from the lungs. To clarify the confusion, the nurse explains all chambers of the heart
j j j j j j j j j j j j j j j j j
dealing with blood circulation. The nurse is correct when she tells the client:
j j j j j j j j j j j j j
1. A muscular space called the pericardial space separates the chambers of the right side from the left side.
j j j j j j j j j j j j j j j j j j j
2. Blood flows into the left ventricle which pumps it out against high resistance into the systemic circulation.
j j j j j j j j j j j j j j j j j j
3. The blood moves to the left ventricle, which pumps blood into the lungs.
j j j j j j j j j j j j j j
3. The heart consists of 5 chambers.
j j j j j j j
4. The left atrium receives oxygenated blood from the lungs.
j j j j j j j j j j
5. The right atrium receives deoxygenated blood from the body tissues. - CORRECT ANSWER✔✔2. Blood
j j j j j j j j j j j j j j
flows into the left ventricle which pumps it out against high resistance into the systemic circulation.
j j j j j j j j j j j j j j j j j
3. The blood moves to the left ventricle, which pumps blood into the lungs.
j j j j j j j j j j j j j j
4. The left atrium receives oxygenated blood from the lungs.
j j j j j j j j j j
5. The right atrium receives deoxygenated blood from the body tissues.
j j j j j j j j j j j
Rationale: Heart consists of 4 chambers: 2 atria and 2 ventricles. The right and left chambers are separated
j j j j j j j j j j j j j j j j j
down the middle of the heart by a septum, like a wall. The right atrium receives deoxygenated from the
j j j j j j j j j j j j j j j j j j j
body, and the blood then moves down into the right ventricle, which pumps it to the lungs with low
j j j j j j j j j j j j j j j j j j j
resistance. The left atrium then receives oxygenated blood from the lungs, and that blood moves down into
j j j j j j j j j j j j j j j j j
the left ventricle. The left ventricle, which is the most muscular chamber, pumps oxygen rich blood into the
j j j j j j j j j j j j j j j j j j
systemic circulation.
j j
A patient recovering from a MI has been in bed for 6 days. The patient now complains of calf pain. The nurse
j j j j j j j j j j j j j j j j j j j j j
should first:
j j j
1. Administer pain medication as ordered.
j j j j j j
2. Assess the calf for redness warmth and swelling.
j j j j j j j j j
3. Massage the calf to relieve the muscle cramp.
j j j j j j j j j
Observe the patient walking. - CORRECT ANSWER✔✔2. Assess the calf for redness warmth and swelling.
j j j j j j j j j j j j j j j
,Rationale: Due to the time spend in bed and inactive, the patient is at high risk for the development of a DVT.
j j j j j j j j j j j j j j j j j j j j j
Pain in the calf, redness or heat, and swelling in the affected extremity are signs of a DVT. Diagnostic tests
j j j j j j j j j j j j j j j j j j j j
that help diagnose a DVT include a D-dimer test to confirm the presence of fibrin degradation in products
j j j j j j j j j j j j j j j j j j
from a clot, venous ultrasound, venography to visualize the clot with contrast, or less commonly MRI or CT.
j j j j j j j j j j j j j j j j j j
The nurse is caring for a patient in the early stages of heart failure. The family is curious as to how the body
j j j j j j j j j j j j j j j j j j j j j j
adapts to heart failure. The nurse knows that during the early stages of heart failure, which specific
j j j j j j j j j j j j j j j j j
compensatory mechanisms occur?
j j j j
1. Decreased cardiac output inhibits the release of ADH by the pituitary gland.
j j j j j j j j j j j j
2. Hypotension stimulates the baroreceptors to increase sympathetic activity.
j j j j j j j j j
3. Hypotension stimulates the baroreceptors to decrease sympathetic activity.
j j j j j j j j j
4. Impaired renal perfusion inhibits aldosterone release. - CORRECT ANSWER✔✔2. Hypotension
j j j j j j j j j j
stimulates the baroreceptors to increase sympathetic activity.
j j j j j j j j
Rationale: As arterial blood pressure falls, the baroreceptors of the carotid and aorta are stimulated. This
j j j j j j j j j j j j j j j
causes a sympathetic release of catecholamines, resulting in vasoconstriction and an increased heart rate to
j j j j j j j j j j j j j j j
compensate. The compensatory mechanism increases peripheral vascular resistance and also the work
j j j j j j j j j j j j
load of the heart. This can worsen heart failure if not treated.
j j j j j j j j j j j j j
Incorrect: Decreased cardiac output will INCREASE ADH release, leading to fluid retention.
j j j j j j j j j j j j
Incorrect: Impaired renal perfusion will stimulate aldosterone release leading to addition fluid and sodium
j j j j j j j j j j j j j
retention.
j
The nurse is assessing a patient with atrial fibrillation and a rapid ventricular rate. The nurse would expect to
j j j j j j j j j j j j j j j j j j
see:
j
1. Distended juglar veins.
j j j j
2. Dizziness and hypotension.
j j j j
3. Hypertension and headache.
j j j j
4. Lower extremity pain. - CORRECT ANSWER✔✔2. Dizziness and hypotension.
j j j j j j j j j j
, Rationale: Atrial fibrillation is any arrhythmia in which the atria initiate rapid, ineffective contractions that
j j j j j j j j j j j j j j
are not synchronized with ventricular contractions. This patient has uncontrolled atrial fibrillation, which
j j j j j j j j j j j j j
can result in a low cardiac output. Signs and symptoms of a low cardiac output include hypotension,
j j j j j j j j j j j j j j j j j
dizziness, weakness, fatigue, shortness of breath, and syncope.
j j j j j j j j
The nurse is caring for a patient scheduled to undergo a mitral valve replacement. The nurse should monitor
j j j j j j j j j j j j j j j j j
for which complication of mitral stenosis?
j j j j j j
1. Left-sided heart failure.
j j j j
2. MI j
3. Pulmonary Hypertension
j j j
4. Respiratory Alkalosis - CORRECT ANSWER✔✔3. Pulmonary Hypertension
j j j j j j j j
Rationale: Mitral stenosis impeded blood flow from the left atrium to the left ventricle of the heart. This
j j j j j j j j j j j j j j j j j
creates increased pulmonary vascular resistance, causing pulmonary hypertension. Other complications of
j j j j j j j j j j j
mitral stenosis include edema, right-sided heart failure, and reduced cardiac output.
j j j j j j j j j j j
A nurse is assessing a patient who has longstanding hypertension. The nurse know that complications of
j j j j j j j j j j j j j j j
hypertension are possibly arising when which of the following signs are noted?
j j j j j j j j j j j j
1. Dyspnea during activity
j j j
2. Fatigability
j j
3. Recurrent episodes of severe headache.
j j j j j j
4. Trace proteins in the urinalysis. - CORRECT ANSWER✔✔4. Trace proteins in the urinalysis.
j j j j j j j j j j j j j j
Proteinuria and albuminuria are early indications of renal injury, a serious complication that can be caused
j j j j j j j j j j j j j j j
by hypertension. High pressures damage the kidney's ability to filter toxins, and evidence of this damage is
j j j j j j j j j j j j j j j j j
seen as proteins leak out of the urine. The other choices are not direct indicators of progressive disease or
j j j j j j j j j j j j j j j j j j j
complications. Fatigability and headache are symptoms of hypertension but are not direct indicators of
j j j j j j j j j j j j j j
progressive disease or complications. These may be side effects of certain medications used to treat
j j j j j j j j j j j j j j j
hypertension. Dyspnea during activity is NOT associated with hypertension. Dyspnea can be a sign of low
j j j j j j j j j j j j j j j j
cardiac output (congestive heart failure), pulmonary edema, severe anemia, or a respiratory problem
j j j j j j j j j j j j j
(asthma, pneumonia, etc.). ;./
j j j j
