Nursing Board Exam Drills in Medical and Surgical Nursing

1. When evaluating risk for developing cancer, which client would the nurse identify as having the highest risk?

An asphalt road construction worker who eats meats and potatoes

A new breast-feeding mother who works in a bank

An oncology nurse who takes vitamins C and E daily

A vegetarian who works at a convenience store

Exposure to certain chemicals such as tar, soot, asphalt, oils, and sunlight put this occupation at the highest risk. Also, meats and potatoes are low in fiber, contributing to the risk of cancer. Plus, some processed meats contain chemicals that have been implicated in the development of cancer. Breast-feeding does not increase the client's risk of developing cancer. Office work also is not considered a risk factor. Working with cancer clients does not increase a person's risk for developing cancer. Vitamins C and E have been shown to demonstrate preventative attributes. A vegetarian diet is considered to be a healthier diet for deduction of cancer risk because it provides increased fiber. Cruciferous vegetables have been shown to be preventative. Working in a convenience store does not increase risk.

Explanation

Exposure to certain chemicals such as tar, soot, asphalt, oils, and sunlight put this occupation at the highest risk. Also, meats and potatoes are low in fiber, contributing to the risk of cancer. Plus, some processed meats contain chemicals that have been implicated in the development of cancer. Breast-feeding does not increase the client's risk of developing cancer. Office work also is not considered a risk factor. Working with cancer clients does not increase a person's risk for developing cancer. Vitamins C and E have been shown to demonstrate preventative attributes. A vegetarian diet is considered to be a healthier diet for deduction of cancer risk because it provides increased fiber. Cruciferous vegetables have been shown to be preventative. Working in a convenience store does not increase risk.

2. When documenting the assessment finding of a client with emphysema who has an increase in the anteroposterior diameter of the chest, which term would the nurse use?

Barrel chest

Flail chest

Funnel chest

Pigeon chest

Barrel chest is a term that refers to an increase in the anteroposterior diameter of the chest, resulting from overinflation of the lungs. A flail chest results from fractured ribs when a portion of the chest pulls inward upon inspiration. A funnel chest refers to a depression of the lower part of the sternum. A pigeon chest refers to an anterior displacement of the sternum protruding beyond the abdominal plane.

Explanation

Barrel chest is a term that refers to an increase in the anteroposterior diameter of the chest, resulting from overinflation of the lungs. A flail chest results from fractured ribs when a portion of the chest pulls inward upon inspiration. A funnel chest refers to a depression of the lower part of the sternum. A pigeon chest refers to an anterior displacement of the sternum protruding beyond the abdominal plane.

3. A client with a history of coronary artery disease begins to experience chest pain. After putting the client on bedrest and administering a nitroglycerin tablet sublingually, which intervention should the nurse implement first?

A. Calling the health care provider

Checking the heart's creatine kinase MB (CK-MB) level

Getting a 12-lead electrocardiogram (ECG)

Preparing the client for angioplasty

For the client experiencing chest pain, obtaining a 12-lead ECG is a priority to reveal possible changes occurring during an acute anginal attack that will be helpful in treatment. Before calling the health care provider, the nurse should obtain the results of the 12-lead ECG so that these results can be communicated to him. A CK-MB level may be ordered later and the client may need angioplasty in the near future, but getting the 12-lead ECG during the chest pain is the most important priority.

Explanation

For the client experiencing chest pain, obtaining a 12-lead ECG is a priority to reveal possible changes occurring during an acute anginal attack that will be helpful in treatment. Before calling the health care provider, the nurse should obtain the results of the 12-lead ECG so that these results can be communicated to him. A CK-MB level may be ordered later and the client may need angioplasty in the near future, but getting the 12-lead ECG during the chest pain is the most important priority.

4. When caring for a client with a chest tube inserted in the right chest wall, which assessment data would lead the nurse to suspect that the client is experiencing a tension pneumothorax?

A cough with purulent sputum

Frothy pink-tinged sputum

Markedly decreased ventilation in the left lung

. Subcutaneous emphysema in the chest wall

Decreased ventilation in the opposite lung is indicative of a mediastinal shift, which leads to tension pneumothorax. A cough with purulent sputum is usually seen in clients diagnosed with pneumonia. Hemoptysis is indicative of lung disease, such as pulmonary embolism and lung cancer. Subcutaneous emphysema, air accumulation in the tissues giving a crackling sensation when palpated, is usually associated with chest trauma.

Explanation

Decreased ventilation in the opposite lung is indicative of a mediastinal shift, which leads to tension pneumothorax. A cough with purulent sputum is usually seen in clients diagnosed with pneumonia. Hemoptysis is indicative of lung disease, such as pulmonary embolism and lung cancer. Subcutaneous emphysema, air accumulation in the tissues giving a crackling sensation when palpated, is usually associated with chest trauma.

5. Which valvular disorder would the nurse suspect in a client presenting with fatigue, hemoptysis, and dyspnea on exertion?

Aortic insufficiency

Aortic stenosis

Mitral insufficiency

Mitral stenosis

Mitral stenosis is an obstruction of blood flowing from the left atrium into the left ventricle, commonly manifested by progressive fatigue due to low cardiac output, hemoptysis, and dyspnea on exertion secondary to pulmonary venous hypertension. Aortic insufficiency refers to the backflow of blood from the aorta into the left ventricle during diastole; most clients are asymptomatic, except for a complaint of a forceful heartbeat. Aortic stenosis refers to a narrowing of the orifice between the left ventricle and the aorta; many clients experience no symptoms early on, but eventually develop exertional dyspnea, dizziness, and fainting. Mitral insufficiency refers to the backflow of blood from the left ventricle and aorta; many clients experience no symptoms early on, but eventually develop exertional dyspnea, dizziness, and fainting.

Explanation

Mitral stenosis is an obstruction of blood flowing from the left atrium into the left ventricle, commonly manifested by progressive fatigue due to low cardiac output, hemoptysis, and dyspnea on exertion secondary to pulmonary venous hypertension. Aortic insufficiency refers to the backflow of blood from the aorta into the left ventricle during diastole; most clients are asymptomatic, except for a complaint of a forceful heartbeat. Aortic stenosis refers to a narrowing of the orifice between the left ventricle and the aorta; many clients experience no symptoms early on, but eventually develop exertional dyspnea, dizziness, and fainting. Mitral insufficiency refers to the backflow of blood from the left ventricle and aorta; many clients experience no symptoms early on, but eventually develop exertional dyspnea, dizziness, and fainting.

6. Which signs and symptoms would alert the nurse to the possibility of a major complication in a client with pericarditis?

Crushing chest pain and diaphoresis

Dyspnea and copious blood-tinged, frothy sputum

Hypotension and muffled heart sounds

Tachycardia and oliguria

A major complication associated with pericarditis is pericardial effusion or cardiac tamponade manifested by hypotension and muffled heart sounds. Crushing chest pain and diaphoresis are signs of myocardial infarction. Dyspnea and copious blood-tinged, frothy sputum are signs of acute pulmonary edema, a complication of left-sided heart failure. Tachycardia and oliguria are signs of hemorrhagic shock.

Explanation

A major complication associated with pericarditis is pericardial effusion or cardiac tamponade manifested by hypotension and muffled heart sounds. Crushing chest pain and diaphoresis are signs of myocardial infarction. Dyspnea and copious blood-tinged, frothy sputum are signs of acute pulmonary edema, a complication of left-sided heart failure. Tachycardia and oliguria are signs of hemorrhagic shock.

7. Which assessment finding would the nurse identify as indicative of a client's altered peripheral vascular function?

Ankle arm index pressure of 0.4

Capillary refill time of less than 3 seconds

Diastolic blood pressure of 84 mm Hg

Pulses graded as being +4

The ankle arm index is an objective indicator of arterial disease. Normal value is 1.0. Values less than 0.5 indicate ischemic rest pain. A capillary refill time of less than 3 seconds is considered normal. A diastolic blood pressure of 84 mm Hg is considered within the normal range. Pulses graded as +4 are considered normal.

Explanation

The ankle arm index is an objective indicator of arterial disease. Normal value is 1.0. Values less than 0.5 indicate ischemic rest pain. A capillary refill time of less than 3 seconds is considered normal. A diastolic blood pressure of 84 mm Hg is considered within the normal range. Pulses graded as +4 are considered normal.

8. When auscultating the breath sounds of a client with bacterial pneumonia, the nurse would expect to find which assessment data?

Adventitious breath sounds with crackles and wheezes

Bronchial breath sounds over consolidated lung fields

Decreased breath sounds with crackles and a pleural friction rub

Wheezing with expiration more prolonged than inspiration

In normal, clear lungs, bronchial breath sounds would be heard over the large airways and vesicular breath sounds would be heard over the clear lungs. With pneumonia, exudate fills the air spaces producing consolidation and bronchial breath sounds over these areas. Adventitious breath sounds, including crackles and wheezes, would be indicative of acute respiratory failure. Decreased breath sounds with crackles and a pleural friction rub would suggest a pulmonary embolism. Wheezing with expiration that is more prolonged than inspiration is indicative of chronic obstructive pulmonary disease.

Explanation

In normal, clear lungs, bronchial breath sounds would be heard over the large airways and vesicular breath sounds would be heard over the clear lungs. With pneumonia, exudate fills the air spaces producing consolidation and bronchial breath sounds over these areas. Adventitious breath sounds, including crackles and wheezes, would be indicative of acute respiratory failure. Decreased breath sounds with crackles and a pleural friction rub would suggest a pulmonary embolism. Wheezing with expiration that is more prolonged than inspiration is indicative of chronic obstructive pulmonary disease.

9. When developing a teaching plan for clients with chronic obstructive pulmonary disease (COPD) about the prevention of acute exacerbations, which topic should be included?

Administration of antibiotics

Administration of oxygen as needed

Performance of deep-breathing and coughing exercises

Elimination of exposure to pulmonary irritants

One aspect of exacerbation prevention focuses on eliminating the causes and contributory factors associated with COPD, such as pulmonary irritants (e.g., smoke, air pollution, occupational irritants, and allergies). Prevention would focus on eliminating these irritants. Antibiotics are used to treat bronchial infection during exacerbations, but they are not used prophylactically. Although oxygen is used in managing acute exacerbations, it is not a preventative measure. Coughing and deep breathing may help clients clear their airways and prevent further atelectasis, but they will not prevent exacerbation.

Explanation

One aspect of exacerbation prevention focuses on eliminating the causes and contributory factors associated with COPD, such as pulmonary irritants (e.g., smoke, air pollution, occupational irritants, and allergies). Prevention would focus on eliminating these irritants. Antibiotics are used to treat bronchial infection during exacerbations, but they are not used prophylactically. Although oxygen is used in managing acute exacerbations, it is not a preventative measure. Coughing and deep breathing may help clients clear their airways and prevent further atelectasis, but they will not prevent exacerbation.

Nursing Board Exam Drills In Medical And Surgical Nursing