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1. A patient with heart failure is prescribed digoxin. Which finding indicates a
therapeutic effect of the medication?
A. Heart rate of 110 bpm
B. Decreased shortness of breath
C. Increased jugular venous distention
D. Presence of an S3 heart sound
Answer: B. A therapeutic effect of digoxin is increased cardiac contractility, leading to
improved cardiac output and decreased symptoms of heart failure like shortness of
breath. Options A, C, and D indicate worsening heart failure or toxicity.
2. A nurse is caring for a patient with an acute myocardial infarction. Which
medication should be administered within 30 minutes of arrival to the emergency
department to reduce mortality?
A. Aspirin
B. Nitroglycerin
C. Morphine
D. Thrombolytic therapy
Answer: A. Aspirin should be administered immediately upon suspicion of MI to reduce
platelet aggregation and mortality. Thrombolytics are time-sensitive but have specific
criteria and are not given to all patients.
,3. The nurse is assessing a patient with pericarditis. What characteristic finding
should the nurse anticipate?
A. Pain that is relieved by leaning forward
B. Pain that worsens with sitting up
C. A friction rub heard best at the apex
D. Pain that is pleuritic and relieved by lying flat
Answer: A. Pericarditis pain is typically sharp and pleuritic, often relieved by leaning
forward and worsened by lying supine. A pericardial friction rub is best heard at the left
lower sternal border.
4. A patient with a history of angina is prescribed sublingual nitroglycerin. The
nurse instructs the patient to take the medication at the onset of chest pain. If
pain is not relieved after the first tablet, the patient should:
A. Take one more tablet in 15 minutes
B. Take one tablet every 5 minutes, up to three tablets
C. Call 911 immediately
D. Take two more tablets immediately
Answer: B. The standard protocol for sublingual nitroglycerin is to take one tablet every
5 minutes, up to three tablets total. If pain persists after three tablets, the patient should
seek emergency care.
5. A patient with severe sepsis is experiencing septic shock. Which hemodynamic
parameter is most indicative of this condition?
A. Elevated central venous pressure (CVP)
B. Decreased cardiac output
C. Low systemic vascular resistance (SVR)
D. High pulmonary artery wedge pressure (PAWP)
Answer: C. Septic shock is characterized by a hyperdynamic state with decreased SVR
due to massive vasodilation. Cardiac output is typically increased or normal initially.
6. A nurse is assessing a patient with a suspected pulmonary embolism (PE). Which
clinical manifestation is most common?
,A. Hemoptysis
B. Sudden onset of dyspnea
C. Bradycardia
D. Hypertension
Answer: B. Sudden onset of dyspnea is the most common symptom of PE, along with
chest pain and tachypnea. Hemoptysis, tachycardia, and hypotension may also occur but
are less consistent.
7. A patient with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas (ABG) showing pH 7.32, PaCO2 58 mmHg, and HCO3- 30 mEq/L. Which
condition does this indicate?
A. Acute respiratory acidosis
B. Partially compensated respiratory acidosis
C. Uncompensated metabolic alkalosis
D. Compensated respiratory alkalosis
Answer: B. The pH is low (acidemia), PaCO2 is elevated (respiratory acidosis), and
HCO3- is elevated, indicating renal compensation. Since the pH is still not normal, it is
partially compensated.
8. A patient with an acute asthma exacerbation is receiving albuterol nebulizer
treatments. What side effect should the nurse monitor for?
A. Bradycardia
B. Hypokalemia
C. Hyperkalemia
D. Hyperglycemia
Answer: B. Albuterol is a beta-2 agonist that can cause hypokalemia by shifting
potassium into cells. It also commonly causes tachycardia, not bradycardia.
9. What is the primary reason for using non-invasive positive pressure ventilation
(NIPPV) like CPAP or BiPAP?
A. To deliver high concentrations of oxygen
B. To avoid endotracheal intubation
, C. To increase cardiac output
D. To decrease work of breathing and improve oxygenation
Answer: D. NIPPV is used to support ventilation, decrease the work of breathing, and
improve oxygenation, often helping to avoid intubation. The patient must be awake and
cooperative.
10. A patient is receiving mechanical ventilation. An alarm sounds indicating high
peak airway pressures. Which action should the nurse take first?
A. Suction the patient’s airway
B. Assess the patient’s lung sounds and condition
C. Increase the tidal volume
D. Decrease the respiratory rate
Answer: B. The nurse should first assess the patient to determine the cause of the high
pressure alarm (e.g., bronchospasm, secretions, biting the tube, pneumothorax).
Suctioning may be needed but assessment comes first.
11. A patient is admitted with diabetic ketoacidosis (DKA). Which intravenous fluid
is typically administered initially?
A. 0.9% Normal Saline
B. 0.45% Normal Saline
C. D5W
D. 3% Normal Saline
Answer: A. 0.9% Normal Saline is the fluid of choice for initial resuscitation in DKA to
restore intravascular volume and perfusion. Once glucose drops to a certain level, D5W
may be added to prevent hypoglycemia while continuing insulin.
12. A nurse is caring for a patient with hyperosmolar hyperglycemic state (HHS).
What is a key difference between HHS and DKA?
A. HHS has a more rapid onset
B. HHS has profound ketosis
C. HHS has higher serum glucose levels and no significant ketosis
D. HHS requires a higher initial insulin bolus