Med/Surg Exam #1 Questions And
Answers!!
A patient is seen at the clinic for a routine physical examination. After the patient is
assessed for evidence of peripheral vascular disease, the nurse explains that which
of the following tests is typically used to assist in the diagnosis?
1. Allen's Test
2. Ankle brachial pressure index.
3. Cardiac Stress Test.
4. Echocardiogram - Answer 2. Ankle brachial pressure index.
Rationale: The ankle brachial index (ABI) is the blood pressure ratio between the
lower legs and the arms. Blood pressure in the legs is normally higher than the arms,
and abnormalities indicate narrowing of the arteries. Clinical findings that may
suggest the presence of PVD includes a history of angina with activity, intermittent
claudication, and abnormal (weak or absent) pedal pulses. The formula for ABI is the
systolic blood pressure of the ankle (measured at the dorsalis pedis or posterior tibial
arteries) divided by the systolic pressure in the arms. It is measured on both sides. A
ratio of 1.0 indicates peripheral vascular disease. Incorrect: Allen's test is used to
assess blood supply to the hand.Incorrect: Cardiac stress tests are used to measure
the heart's ability to respond to stress. Incorrect: ECG evaluates the structure and
function of the heart muscle, but does not tell if there is peripheral vascular disease
present.
A patient has been diagnosed with left-sided congestive heart failure, and is
confused about the return of oxygenated blood from the lungs. To clarify the
confusion, the nurse explains all chambers of the heart dealing with blood circulation.
The nurse is correct when she tells the client:
1. A muscular space called the pericardial space separates the chambers of the right
side from the left side.
2. Blood flows into the left ventricle which pumps it out against high resistance into
the systemic circulation.
3. The blood moves to the left ventricle, which pumps blood into the lungs.
3. The heart consists of 5 chambers.
4. The left atrium receives oxygenated blood from the lungs.
5. The right atrium receives deoxygenated blood from the body tissues. - Answer 2.
Blood flows into the left ventricle which pumps it out against high resistance into the
systemic circulation.
3. The blood moves to the left ventricle, which pumps blood into the lungs.
4. The left atrium receives oxygenated blood from the lungs.
5. The right atrium receives deoxygenated blood from the body tissues.
Rationale: Heart consists of 4 chambers: 2 atria and 2 ventricles. The right and left
chambers are separated down the middle of the heart by a septum, like a wall. The
right atrium receives deoxygenated from the body, and the blood then moves down
into the right ventricle, which pumps it to the lungs with low resistance. The left
atrium then receives oxygenated blood from the lungs, and that blood moves down
into the left ventricle. The left ventricle, which is the most muscular chamber, pumps
oxygen rich blood into the systemic circulation.
,Med/Surg Exam #1 Questions And
Answers!!
A patient recovering from a MI has been in bed for 6 days. The patient now
complains of calf pain. The nurse should first:
1. Administer pain medication as ordered.
2. Assess the calf for redness warmth and swelling.
3. Massage the calf to relieve the muscle cramp.
Observe the patient walking. - Answer 2. Assess the calf for redness warmth and
swelling.
Rationale: Due to the time spend in bed and inactive, the patient is at high risk for
the development of a DVT. Pain in the calf, redness or heat, and swelling in the
affected extremity are signs of a DVT. Diagnostic tests that help diagnose a DVT
include a D-dimer test to confirm the presence of fibrin degradation in products from
a clot, venous ultrasound, venography to visualize the clot with contrast, or less
commonly MRI or CT.
The nurse is caring for a patient in the early stages of heart failure. The family is
curious as to how the body adapts to heart failure. The nurse knows that during the
early stages of heart failure, which specific compensatory mechanisms occur?
1. Decreased cardiac output inhibits the release of ADH by the pituitary gland.
2. Hypotension stimulates the baroreceptors to increase sympathetic activity.
3. Hypotension stimulates the baroreceptors to decrease sympathetic activity.
4. Impaired renal perfusion inhibits aldosterone release. - Answer 2. Hypotension
stimulates the baroreceptors to increase sympathetic activity.
Rationale: As arterial blood pressure falls, the baroreceptors of the carotid and aorta
are stimulated. This causes a sympathetic release of catecholamines, resulting in
vasoconstriction and an increased heart rate to compensate. The compensatory
mechanism increases peripheral vascular resistance and also the work load of the
heart. This can worsen heart failure if not treated.
Incorrect: Decreased cardiac output will INCREASE ADH release, leading to fluid
retention.
Incorrect: Impaired renal perfusion will stimulate aldosterone release leading to
addition fluid and sodium retention.
The nurse is assessing a patient with atrial fibrillation and a rapid ventricular rate.
The nurse would expect to see:
1. Distended juglar veins.
2. Dizziness and hypotension.
3. Hypertension and headache.
4. Lower extremity pain. - Answer 2. Dizziness and hypotension.
Rationale: Atrial fibrillation is any arrhythmia in which the atria initiate rapid,
ineffective contractions that are not synchronized with ventricular contractions. This
patient has uncontrolled atrial fibrillation, which can result in a low cardiac output.
Signs and symptoms of a low cardiac output include hypotension, dizziness,
weakness, fatigue, shortness of breath, and syncope.
,Med/Surg Exam #1 Questions And
Answers!!
The nurse is caring for a patient scheduled to undergo a mitral valve replacement.
The nurse should monitor for which complication of mitral stenosis?
1. Left-sided heart failure.
2. MI
3. Pulmonary Hypertension
4. Respiratory Alkalosis - Answer 3. Pulmonary Hypertension
Rationale: Mitral stenosis impeded blood flow from the left atrium to the left ventricle
of the heart. This creates increased pulmonary vascular resistance, causing
pulmonary hypertension. Other complications of mitral stenosis include edema, right-
sided heart failure, and reduced cardiac output.
A nurse is assessing a patient who has longstanding hypertension. The nurse know
that complications of hypertension are possibly arising when which of the following
signs are noted?
1. Dyspnea during activity
2. Fatigability
3. Recurrent episodes of severe headache.
4. Trace proteins in the urinalysis. - Answer 4. Trace proteins in the urinalysis.
Proteinuria and albuminuria are early indications of renal injury, a serious
complication that can be caused by hypertension. High pressures damage the
kidney's ability to filter toxins, and evidence of this damage is seen as proteins leak
out of the urine. The other choices are not direct indicators of progressive disease or
complications. Fatigability and headache are symptoms of hypertension but are not
direct indicators of progressive disease or complications. These may be side effects
of certain medications used to treat hypertension. Dyspnea during activity is NOT
associated with hypertension. Dyspnea can be a sign of low cardiac output
(congestive heart failure), pulmonary edema, severe anemia, or a respiratory
problem (asthma, pneumonia, etc.). ;./
The nurse is evaluating a 52 year old male for risk factors for CAD. The patient is
overweight, male, and smokes a pack a day. The nurse questions the patient about
other risk factors including:
1) A history of atherosclerotic heart disease.
2) A history of diabetes.
3) A history of gout.
4) Elevated HDL levels. - Answer 2) A history of diabetes.
Rationale: The major risk factors for CAD are diabetes, smoking, increased LDL
levels, and hypertension. Elevated HDL levels are PROTECTIVE against CAD.
Atherosclerotic heart disease is just another name for coronary heart disease. Gout
is not associated with CAD.
The nurse is knowledgeable about sinoatrial node dysrhythmias if she selects which
of the following causes of sinus tachycardia? Select all that apply.
1. Emotional and physical stress
2. Fever
, Med/Surg Exam #1 Questions And
Answers!!
3. Heart Failure
4. Increased Intracranial pressure
5. Infection
6. MI - Answer 1. Emotional and physical stress
2. Fever
3. Heart Failure
5. Infection
Rationale: Sinus tachycardia is defined as sinus rhythm with a rate greater than 100
beats per minute. Causes of ST include: fever, emotional & physical stress, heart
failure, fluid volume loss, hyperthyroidism, hypercalcemia, caffeine, nicotine,
exercise, and some medications. In the vast majority of cases, sinus tachycardia
results from some underlying condition such as exercise, infection, or congestive
heart failure, which alters the autonomic nervous system. Sinus bradycardia may
result from the following: Valsalva's maneuver, drugs like digitalis, MI, hyperkalemia,
hypothyroidism, severe hypoxia, and increased ICP.
The nurse is auscultating the heart of a patient with congestive heart failure. The
nurse hears an extra sound with a very low pitch, immediately after the 2nd heart
sound S2. The nurse interprets this as:
1. A murmur due to an aortic regurgitation.
2. A split S1.
3. A split S2.
4. A third heart sound (S3). - Answer Rationale: S3 occurs immediately after S2. It
has a very low pitch and has been described as a "gallop" or vibration. It can occur
normally in people under 40 and in athletes. Later in life, it may indicate heart failure
(ventricular dysfunction) and/or fluid overload.
An ICU nurse is providing continuing health education to new nurses in the unit.
Which statements made by the nurse are correct?
1. Dysrhythmias can decrease the heart's ability to pump effectively but cannot
cause death.
2. Dysrhythmias result from disturbances in the automaticity, conduction, and re-
entry of impulses.
3. If the SA node fails to fire, in a normal heart, the AV node should take over the
pacemaker function.
4. Normal sinus rhythm is the usual heart rhythm is the usual heart rhythm,
beginning in the AV node.
5. The most serious complication of a dysrhythmia is MI.
6. The SA node is the pacemaker of the heart. - Answer 1. Dysrhythmias result from
disturbances in the automaticity, conduction, and re-entry of impulses.
2. If the SA node fails to fire, in a normal heart, the AV node should take over the
pacemaker function.
5. The SA node is the pacemaker of the heart.
Rationale: The SA node is the pacemaker of the heart because it possesses the
highest level of automaticity.The SA node is regulated by the nervous system
through the vagus nerve. If it fails to fire, the AV node should take over pacemaker
Answers!!
A patient is seen at the clinic for a routine physical examination. After the patient is
assessed for evidence of peripheral vascular disease, the nurse explains that which
of the following tests is typically used to assist in the diagnosis?
1. Allen's Test
2. Ankle brachial pressure index.
3. Cardiac Stress Test.
4. Echocardiogram - Answer 2. Ankle brachial pressure index.
Rationale: The ankle brachial index (ABI) is the blood pressure ratio between the
lower legs and the arms. Blood pressure in the legs is normally higher than the arms,
and abnormalities indicate narrowing of the arteries. Clinical findings that may
suggest the presence of PVD includes a history of angina with activity, intermittent
claudication, and abnormal (weak or absent) pedal pulses. The formula for ABI is the
systolic blood pressure of the ankle (measured at the dorsalis pedis or posterior tibial
arteries) divided by the systolic pressure in the arms. It is measured on both sides. A
ratio of 1.0 indicates peripheral vascular disease. Incorrect: Allen's test is used to
assess blood supply to the hand.Incorrect: Cardiac stress tests are used to measure
the heart's ability to respond to stress. Incorrect: ECG evaluates the structure and
function of the heart muscle, but does not tell if there is peripheral vascular disease
present.
A patient has been diagnosed with left-sided congestive heart failure, and is
confused about the return of oxygenated blood from the lungs. To clarify the
confusion, the nurse explains all chambers of the heart dealing with blood circulation.
The nurse is correct when she tells the client:
1. A muscular space called the pericardial space separates the chambers of the right
side from the left side.
2. Blood flows into the left ventricle which pumps it out against high resistance into
the systemic circulation.
3. The blood moves to the left ventricle, which pumps blood into the lungs.
3. The heart consists of 5 chambers.
4. The left atrium receives oxygenated blood from the lungs.
5. The right atrium receives deoxygenated blood from the body tissues. - Answer 2.
Blood flows into the left ventricle which pumps it out against high resistance into the
systemic circulation.
3. The blood moves to the left ventricle, which pumps blood into the lungs.
4. The left atrium receives oxygenated blood from the lungs.
5. The right atrium receives deoxygenated blood from the body tissues.
Rationale: Heart consists of 4 chambers: 2 atria and 2 ventricles. The right and left
chambers are separated down the middle of the heart by a septum, like a wall. The
right atrium receives deoxygenated from the body, and the blood then moves down
into the right ventricle, which pumps it to the lungs with low resistance. The left
atrium then receives oxygenated blood from the lungs, and that blood moves down
into the left ventricle. The left ventricle, which is the most muscular chamber, pumps
oxygen rich blood into the systemic circulation.
,Med/Surg Exam #1 Questions And
Answers!!
A patient recovering from a MI has been in bed for 6 days. The patient now
complains of calf pain. The nurse should first:
1. Administer pain medication as ordered.
2. Assess the calf for redness warmth and swelling.
3. Massage the calf to relieve the muscle cramp.
Observe the patient walking. - Answer 2. Assess the calf for redness warmth and
swelling.
Rationale: Due to the time spend in bed and inactive, the patient is at high risk for
the development of a DVT. Pain in the calf, redness or heat, and swelling in the
affected extremity are signs of a DVT. Diagnostic tests that help diagnose a DVT
include a D-dimer test to confirm the presence of fibrin degradation in products from
a clot, venous ultrasound, venography to visualize the clot with contrast, or less
commonly MRI or CT.
The nurse is caring for a patient in the early stages of heart failure. The family is
curious as to how the body adapts to heart failure. The nurse knows that during the
early stages of heart failure, which specific compensatory mechanisms occur?
1. Decreased cardiac output inhibits the release of ADH by the pituitary gland.
2. Hypotension stimulates the baroreceptors to increase sympathetic activity.
3. Hypotension stimulates the baroreceptors to decrease sympathetic activity.
4. Impaired renal perfusion inhibits aldosterone release. - Answer 2. Hypotension
stimulates the baroreceptors to increase sympathetic activity.
Rationale: As arterial blood pressure falls, the baroreceptors of the carotid and aorta
are stimulated. This causes a sympathetic release of catecholamines, resulting in
vasoconstriction and an increased heart rate to compensate. The compensatory
mechanism increases peripheral vascular resistance and also the work load of the
heart. This can worsen heart failure if not treated.
Incorrect: Decreased cardiac output will INCREASE ADH release, leading to fluid
retention.
Incorrect: Impaired renal perfusion will stimulate aldosterone release leading to
addition fluid and sodium retention.
The nurse is assessing a patient with atrial fibrillation and a rapid ventricular rate.
The nurse would expect to see:
1. Distended juglar veins.
2. Dizziness and hypotension.
3. Hypertension and headache.
4. Lower extremity pain. - Answer 2. Dizziness and hypotension.
Rationale: Atrial fibrillation is any arrhythmia in which the atria initiate rapid,
ineffective contractions that are not synchronized with ventricular contractions. This
patient has uncontrolled atrial fibrillation, which can result in a low cardiac output.
Signs and symptoms of a low cardiac output include hypotension, dizziness,
weakness, fatigue, shortness of breath, and syncope.
,Med/Surg Exam #1 Questions And
Answers!!
The nurse is caring for a patient scheduled to undergo a mitral valve replacement.
The nurse should monitor for which complication of mitral stenosis?
1. Left-sided heart failure.
2. MI
3. Pulmonary Hypertension
4. Respiratory Alkalosis - Answer 3. Pulmonary Hypertension
Rationale: Mitral stenosis impeded blood flow from the left atrium to the left ventricle
of the heart. This creates increased pulmonary vascular resistance, causing
pulmonary hypertension. Other complications of mitral stenosis include edema, right-
sided heart failure, and reduced cardiac output.
A nurse is assessing a patient who has longstanding hypertension. The nurse know
that complications of hypertension are possibly arising when which of the following
signs are noted?
1. Dyspnea during activity
2. Fatigability
3. Recurrent episodes of severe headache.
4. Trace proteins in the urinalysis. - Answer 4. Trace proteins in the urinalysis.
Proteinuria and albuminuria are early indications of renal injury, a serious
complication that can be caused by hypertension. High pressures damage the
kidney's ability to filter toxins, and evidence of this damage is seen as proteins leak
out of the urine. The other choices are not direct indicators of progressive disease or
complications. Fatigability and headache are symptoms of hypertension but are not
direct indicators of progressive disease or complications. These may be side effects
of certain medications used to treat hypertension. Dyspnea during activity is NOT
associated with hypertension. Dyspnea can be a sign of low cardiac output
(congestive heart failure), pulmonary edema, severe anemia, or a respiratory
problem (asthma, pneumonia, etc.). ;./
The nurse is evaluating a 52 year old male for risk factors for CAD. The patient is
overweight, male, and smokes a pack a day. The nurse questions the patient about
other risk factors including:
1) A history of atherosclerotic heart disease.
2) A history of diabetes.
3) A history of gout.
4) Elevated HDL levels. - Answer 2) A history of diabetes.
Rationale: The major risk factors for CAD are diabetes, smoking, increased LDL
levels, and hypertension. Elevated HDL levels are PROTECTIVE against CAD.
Atherosclerotic heart disease is just another name for coronary heart disease. Gout
is not associated with CAD.
The nurse is knowledgeable about sinoatrial node dysrhythmias if she selects which
of the following causes of sinus tachycardia? Select all that apply.
1. Emotional and physical stress
2. Fever
, Med/Surg Exam #1 Questions And
Answers!!
3. Heart Failure
4. Increased Intracranial pressure
5. Infection
6. MI - Answer 1. Emotional and physical stress
2. Fever
3. Heart Failure
5. Infection
Rationale: Sinus tachycardia is defined as sinus rhythm with a rate greater than 100
beats per minute. Causes of ST include: fever, emotional & physical stress, heart
failure, fluid volume loss, hyperthyroidism, hypercalcemia, caffeine, nicotine,
exercise, and some medications. In the vast majority of cases, sinus tachycardia
results from some underlying condition such as exercise, infection, or congestive
heart failure, which alters the autonomic nervous system. Sinus bradycardia may
result from the following: Valsalva's maneuver, drugs like digitalis, MI, hyperkalemia,
hypothyroidism, severe hypoxia, and increased ICP.
The nurse is auscultating the heart of a patient with congestive heart failure. The
nurse hears an extra sound with a very low pitch, immediately after the 2nd heart
sound S2. The nurse interprets this as:
1. A murmur due to an aortic regurgitation.
2. A split S1.
3. A split S2.
4. A third heart sound (S3). - Answer Rationale: S3 occurs immediately after S2. It
has a very low pitch and has been described as a "gallop" or vibration. It can occur
normally in people under 40 and in athletes. Later in life, it may indicate heart failure
(ventricular dysfunction) and/or fluid overload.
An ICU nurse is providing continuing health education to new nurses in the unit.
Which statements made by the nurse are correct?
1. Dysrhythmias can decrease the heart's ability to pump effectively but cannot
cause death.
2. Dysrhythmias result from disturbances in the automaticity, conduction, and re-
entry of impulses.
3. If the SA node fails to fire, in a normal heart, the AV node should take over the
pacemaker function.
4. Normal sinus rhythm is the usual heart rhythm is the usual heart rhythm,
beginning in the AV node.
5. The most serious complication of a dysrhythmia is MI.
6. The SA node is the pacemaker of the heart. - Answer 1. Dysrhythmias result from
disturbances in the automaticity, conduction, and re-entry of impulses.
2. If the SA node fails to fire, in a normal heart, the AV node should take over the
pacemaker function.
5. The SA node is the pacemaker of the heart.
Rationale: The SA node is the pacemaker of the heart because it possesses the
highest level of automaticity.The SA node is regulated by the nervous system
through the vagus nerve. If it fails to fire, the AV node should take over pacemaker
