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TOP RANK REVIEW ACADEMY, INC. Page 2 | 7 C. II, IV, V D. I, II 13.Kira is reviewing the electrocardiogram (ECG) rhythm strip of a client with a history of a myocardial infarction (MI) notes that the PR intervals are 0.16 seconds. Kira interprets this as? A. A normal finding B. An abnormal finding C. An impending reinfarction D. First-degree atrioventricular (AV) block 14.A code is called on the unit. Kira is administering emergency care to a patient experiencing ventricular tachycardia is getting ready to perform defibrillation. What nursing action ensures the safest environment during this procedure? A. Confirming the absence of any lubricant on the paddles B. Applying the charged paddles one by one to the patient's chest C. Stabilizing the patient's upper torso while defibrillation is carried out D. Ensuring that all assisting staff are clear of the patient and the patient's bed 15.Her patient is experiencing unstable ventricular tachycardia (VT) loses consciousness and becomes pulseless following an initial intravenous dose of lidocaine. What should be the next equipment she should get? A. A pacemaker B. A defibrillator C. A second dose of lidocaine D. An electrocardiogram machine Situation: Nurse Nikki handles multiple patients in the medicine ward. 16.Nurse Nikki monitors a patient receiving continuous intravenous infusion of heparin sodium therapy. What is the adverse effect she should watch out for? A. Tinnitus B. Ecchymoses C. Increased pulse rate D. Decreased blood pressure 17.She noticed her patient has an activated partial thromboplastin time (aPTT) value of 100 seconds. Before reporting the results to the primary health care provider, she verifies that which medication is available for use if prescribed? A. Vitamin K B. Vitamin B12 C. Methylene blue D. Protamine sulfate 18.She is called to the ER for an emergency. A patient arrives at the emergency department with severe, radiating chest pain, exhibiting extreme restlessness, fear, and shortness of breath. Immediate admission orders include administering oxygen via nasal cannula at 4 L per minute, obtaining troponin, creatinine phosphokinase, and isoenzymes blood levels, performing a chest x-ray, and conducting a 12-lead ECG. What should she prioritize? A. Conducting the 12-lead ECG. B. Collecting blood specimens. C. Administering oxygen to the patient. D. Scheduling the chest x-ray examination. 19.A patient experiences an irregular heart rate. Which statement from the patient suggests to the nurse that they are prepared to learn about their condition? A. "I feel weak with an irregular pulse." B. "What are the effects of having a pacemaker?" C. "Will all my medications be altered?" D. "How might this heart rate issue impact me?" 20.The cardiac-vascular nurse reviews risk factor reduction with a patient who is newly diagnosed with a myocardial infarction. The patient states, "I don't know why you're making such a big deal about this stuff. I feel fine, and the doctor said that my heart attack was small." The nurse's most effective action is to: A. assess the patient's perception of the event with open- ended questions. B. present research to support the need for risk-factor reduction. C. reinforce patient education. D. review the laboratory values with the patient. 21.While the cardiac-vascular nurse preceptor is orienting a graduate nurse on the telemetry unit, a patient experiences cardiac arrest. Which action by the preceptor, during the emergency cardiac care procedure, facilitates the graduate nurse's competence and professional development? A. Asking the graduate nurse to review the policy and procedure for cardiac arrest. B. Assigning the graduate nurse to comfort the family during the arrest. C. Directing the graduate nurse to attempt IV access. D. Involving the graduate nurse in the resuscitation by assigning a basic task. 22.A patient is admitted to the hospital for a carotid angiogram with stent placement. The patient's spouse states, "I don't want my spouse to find out there is a risk of a stroke connected with this procedure because they won't sign the consent form." The cardiac-vascular nurse's most appropriate action is to: A. assess the patient's level of understanding of the risks, benefits, and alternatives. B. assure the patient's spouse that the risk of stroke is minimal. C. offer the patient emotional support and reinforce the benefits of the procedure. D. perform a neurologic assessment to establish a baseline. 23.A patient with cardiogenic shock receives a nursing diagnosis of decreased cardiac output. With the appropriate interventions, the anticipated outcome is for the patient to achieve: A. baseline activity level. B. baseline cardiac function. C. decreased afterload. D. reduced anxiety. 24.A patient recently had a cardiac catheterization via right-radial approach and now has a compression device in place. The patient reports numbness and pain in the right hand. The cardiac-vascular nurse notes a diminished pulse, with a cool and cyanotic hand. The nurse: A. calls the physician. B. performs an Allen test. C. reduces the pressure on the puncture site. D. uses the Doppler ultrasound to assess for pulse signals. 25.In an assessment for intermittent claudication, the cardiac- vascular nurse assesses for leg pain and cramping with exertion, then asks the patient,: A. "Does shortness of breath accompany the leg pain?" B. "Does this same type of pain occur without activity?" C. "Is the leg pain relieved by rest?" D. "Is the leg pain relieved with elevation?" 26.Patients in mechanical ventilation are prone to infection. What measures should the nurse take to avoid ventilator-associated pneumonia (VAP) in intubated clients receiving mechanical ventilation? A. Adhere to thorough hand hygiene protocols. B. Keep the head of the bed elevated at a 10-degree angle. C. Conduct oral cavity secretion suctioning every 4 hours. D. Ensure the respiratory therapist replaces the ventilator circuit tubing every 4 hours. 27.Which ordered intervention should the nurse refrain from performing until a comatose patient is appropriately intubated? A. Administering gastric feeding B. Inserting a urethral catheter C. Conducting a finger stick to assess blood glucose level D. Performing venipuncture for a complete blood cell (CBC) count. 28.A patient diagnosed with active tuberculosis (TB) is scheduled for admission to a medical-surgical unit. What action should the nurse prioritize when arranging a bed assignment? A. Assigning the patient to a private, well-ventilated room. B. Arranging for the patient's transfer to the intensive care unit. C. Allocating the bed farthest from the door in a double room. D. Placing the patient in a shared double room with a noninfectious patient. 29.The nurse has completed suctioning a client's tracheostomy. What should the nurse monitor to assess the procedure's effectiveness? A. Auscultation of breath sounds B. Capillary refill time C. Respiratory rate D. Oxygen saturation levels 30.The nurse is ready to initiate emergency care for a patient exhibiting signs of a pulmonary embolism. Which instruction from the primary healthcare provider should the nurse prioritize? A. Administer oxygen. B. Provide morphine sulfate. C. Initiate an intravenous (IV) line. D. Perform an electrocardiogram (ECG).
TOP RANK REVIEW ACADEMY, INC. Page 3 | 7 Situation: Respiratory nurses work closely with patients of all ages to address an array of respiratory health issues. Through patient assessment, physical examinations, reviewing patient medical histories, monitoring and recording vital signs, and discussing symptoms, nurses in this specialty can treat and cure a myriad of conditions. 31.Vanessa, a respiratory nurse, is caring for a patient who will undergo a bronchoscopy. Which actions should she incorporate into the care plan for a patient scheduled for a bronchoscopy? Choose all that apply. I. Remove dentures, if present. II. Remove contact lenses, if worn. III. Limit access to food and drink. IV. Confirm that informed consent has been obtained. V. Ensure the patient empties their bladder before being transported for the procedure. A. I, II, III B. I, III, V C. II, IV, V D. I, II, IV, V 32.She is caring for a client with chronic obstructive pulmonary disease (COPD). They are receiving home oxygen therapy at a rate of 2 liters per minute. She notes the client's respiratory rate as 22 breaths per minute. When the client complains of worsening dyspnea, what should the nurse do first? A. Assess whether there is a need to adjust the oxygen flow. B. Contact emergency services for assistance at the residence. C. Offer reassurance to the client, emphasizing there is no cause for concern. D. Gather additional details regarding the client's respiratory condition. 33.She is providing discharge instructions to the mother of an 8- year old child who had a tonsillectomy. The mother tells her that the child loves tacos and asks when the child can safely eat one. To prevent complications of the surgical procedure, what should be the appropriate response to the mother? A. “In 1 week.” B. “In 3 weeks.” C. “Six days after surgery.” D. “When the primary health care provider says it is okay.” 34.There is a need for nurse Vanessa to reinforce incentive spirometry teaching if the client states that they should: A. Inhales slowly B. Breathes through the nose C. Removes the mouthpiece to exhale D. Forms a tight seal around the mouthpiece with the lips 35.You are monitoring a client for a hypoglycemic reaction, knowing that NPH insulin peaks in approximately how many hours following administration? A. 1 hour B. 2 to 3 hours C. 4 to 12 hours D. 16 to 24 hours 36.A client diagnosed with type 2 diabetes mellitus is being discharged from the hospital after an occurrence of hyperglycemic hyperosmolar state (HHS). You are planning to create a discharge teaching plan for the client and identifies which intervention as a priority? A. Exercise routines B. Controlling dietary intake C. Keeping follow-up appointments D. Monitoring for signs/symptoms of dehydration 37.You create a plan of care for an older client diagnosed with diabetes mellitus. It is important that you plan to complete which action first? A. Structure menus for adherence to diet. B. Teach with videotapes showing insulin administration to ensure competence. C. Encourage dependence on others to prepare the client for the chronicity of the disease. D. Assess the client’s ability to read label markings on syringes and blood glucose monitoring equipment. Situation: On World Kidney Day, observed on March 14, 2024 the Philippine Society of Nephrology (PSN) is organizing a lay forum dedicated to educating Filipino on CKD with the theme of “Kidney Health for All: Advancing Equitable Access to Care and Optimal Medication Practice.” The primary objective is to raise awareness about the significance of ensuring equal access to appropriate treatment and care for individuals living with kidney disease. This, in turn, aims to enhance their quality of life and delay the progression of the disease. 38.While observing a patient diagnosed with chronic kidney disease (CKD), which observation warrants reporting to the primary healthcare provider? A. Pallor B. Fatigue C. Lethargy D. Petechiae 39.The nurse is overseeing a client diagnosed with hypercalcemia. What observation suggests a requirement for further evaluation? A. Elevated peristalsis B. Diminished capillary refill C. Heightened deep tendon reflexes D. Reduced abdominal circumference 40.A patient diagnosed with acute kidney injury has elevated blood urea nitrogen (BUN) levels and is struggling with memory retention. What interventions should the nurse employ when communicating with this patient? Select all that apply. i.Provide straightforward, understandable instructions. ii.Involve the family in care-related discussions. iii.Describe treatments using plain language. iv.Avoid providing extensive, detailed explanations of procedures. v.Utilize various teaching methods to deliver discharge instructions. A. I, IV, V B. b. I, II, III C. c. I, III, V D. d. II, III, V 41.The nurse is giving epoetin alfa to a client with chronic kidney disease (CKD). What adverse effect of this treatment should the nurse watch for in the client? A. Anemia B. Hypertension C. Iron overload D. Increased bleeding risk 42.A client diagnosed with chronic kidney disease (CKD) has received dietary advice regarding potassium restriction. The nurse confirms the client has understood the information when they indicate they will take what action when preparing vegetables? A. Consume only fresh vegetables. B. Boil them and discard the cooking water. C. Exclusively use salt substitutes for seasoning. D. Opt for frozen vegetables whenever feasible. 43.Why is diphenhydramine given before a blood transfusion? A. To prevent hives B. To prevent fever and chills C. To improve clotting factors D. To increase blood volume 44.The nurse reviewing a urinalysis report for a client with the diagnosis of acute kidney injury notes that the results are highly positive for proteinuria. The nurse determines that this client has which type of renal failure? A. Prerenal failure B. Postrenal failure C. Intrinsic renal failure D. Atypical renal failure Situation: Kovu, a 6 year old male, suddenly presents with excessive swelling. He is diagnosed with nephrotic syndrome. 45.In your nursing care plan you will include which of the following as a nursing diagnosis for this patient? A. Risk for infection B. Deficient fluid volume C. Constipation D. Overflow urinary incontinence 46.You know that you should assess which important parameter on a daily basis? A. weight B. albumin levels C. activity tolerance D. blood urea nitrogen (BUN) level 47.You need to collect urine sample. You know that the urine sample will appear: A. Tea-colored B. Orange and frothy C. Dark and foamy D. Straw-colored
TOP RANK REVIEW ACADEMY, INC. Page 4 | 7 48.Which assessment finding below requires you to notify the physician immediately for a patient with nephrotic syndrome? A. Frothy, dark urine B. Redden area on the patient's left leg that is swollen and warm C. Elevated lipid level on morning labs D. Urine test results that shows proteinuria 49.It has been identified that Kovu has acute glomerulonephritis. During history-taking the you first asks Kovu’s mother about a recent history of: A. bleeding ulcer B. deep vein thrombosis C. myocardial infarction D. streptococcal infection 50.The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action? A. check the sodium level B. place the client on a cardiac monitor C. encourage increased vegetables in the diet D. allow an extra 500 ml of fluid intake to dilute the electrolyte concentration Scenario: Mr. Johnson, a 65-year-old patient, is admitted to the hospital with a diagnosis of pneumonia. As the nurse, you are responsible for his care and monitoring his respiratory status. 51. While assessing Mr. Johnson, you note that he has increased respiratory rate, shallow breathing, and decreased breath sounds on auscultation. Which of the following conditions should you suspect? A. Atelectasis B. Pneumothorax C. Pulmonary embolism D. Acute respiratory distress syndrome (ARDS) 52.A 40-year-old female patient is admitted to the hospital with a diagnosis of pneumonia. Upon assessment, the nurse notes increased respiratory rate, decreased breath sounds, and dullness to percussion on the right lower lung field. The nurse suspects a complication of pneumonia that involves accumulation of fluid in the pleural space. Which of the following conditions is the nurse likely suspecting? A. Empyema B. Pleural effusion C. Atelectasis D. Pulmonary embolism 53.Mr. Johnson is at risk for the development of atelectasis due to his immobility and shallow breathing. Which of the following nursing interventions is most appropriate to prevent atelectasis? A. Encourage deep breathing and coughing exercises B. Administer bronchodilator medications C. Apply oxygen via nasal cannula D. Perform chest physiotherapy 54.Mr. Johnson's condition deteriorates, and he develops sudden chest pain and dyspnea. The nurse suspects a possible pneumothorax. Which of the following findings would support this suspicion? A. Hyperresonance on percussion B. Decreased tactile fremitus C. Crackles on auscultation D. Increased vocal resonance 55.After confirming a pneumothorax, the nurse anticipates the need for intervention to remove the air from the pleural space. Which of the following interventions is the primary treatment for a pneumothorax? A. Chest tube insertion B. Administration of antibiotics C. High-flow oxygen therapy D. Percutaneous needle aspiration 56.Mr. Johnson develops sudden dyspnea, tachycardia, and pleuritic chest pain. The nurse suspects a pulmonary embolism. Which of the following diagnostic tests would be most appropriate to confirm this suspicion? A. Chest X-ray B. Electrocardiogram (ECG) C. Pulmonary angiography D. D-dimer blood test Scenario: Mrs. Anderson, a 65-year-old patient, is admitted to the hospital with a diagnosis of heart failure. As the nurse, you are responsible for her care and monitoring her cardiovascular status. 57.Mrs. Anderson complains of shortness of breath and fatigue upon exertion. Which of the following assessments is most important for the nurse to perform to evaluate her heart failure status? A. Blood pressure measurement B. Respiratory rate assessment C. Electrocardiogram (ECG) monitoring D. Daily weight measurement 58.Mrs. Anderson is prescribed furosemide (Lasix) for the management of her heart failure. Which of the following is the primary action of furosemide? A. Reducing preload B. Increasing afterload C. Enhancing myocardial contractility D. Dilating coronary arteries 59.Ms. Johnson, a 68-year-old patient, is admitted to the hospital with a diagnosis of left-sided heart failure. The nurse assesses crackles in the patient's lung bases and reports this finding to the healthcare provider. Which of the following nursing interventions would be most appropriate to manage the patient's respiratory symptoms? A. Administering supplemental oxygen B. Assisting with chest physiotherapy C. Encouraging deep breathing exercises D. Administer diuretics 60.Mrs. Anderson's laboratory results show elevated levels of brain natriuretic peptide (BNP). The nurse recognizes this as a diagnostic marker for heart failure. Which of the following statements best explains the role of BNP in heart failure? A. BNP causes peripheral vasoconstriction. B. BNP increases myocardial contractility. C. BNP promotes fluid retention. D. BNP acts as a vasodilator. 61.Mrs. Anderson has a history of hypertension and is prescribed an angiotensin-converting enzyme (ACE) inhibitor for heart failure management. Which of the following is the primary action of ACE inhibitors in heart failure? A. Dilating coronary arteries B. Reducing systemic vascular resistance C. Enhancing myocardial contractility D. Increasing sodium and water retention Scenario 2: Mr. Johnson, a 55-year-old patient, is admitted to the hospital with a diagnosis of acute myocardial infarction (AMI). As the nurse, you are responsible for his care and monitoring his cardiac status. 62Mr. Johnson complains of severe chest pain radiating to his left arm and jaw. The nurse suspects myocardial ischemia. Which of the following laboratory tests is most commonly used to diagnose AMI? A. Troponin B. C-reactive protein (CRP) C. Brain natriuretic peptide (BNP) D. Creatine kinase (CK) 63.Mr. Johnson is prescribed aspirin as part of his treatment plan for AMI. Which of the following is the primary action of aspirin in this context? A. Inhibiting platelet aggregation B. Reducing myocardial oxygen demand C. Dilating coronary arteries D. Enhancing myocardial contractility 64.Mr. Johnson undergoes percutaneous coronary intervention (PCI) to restore blood flow to the affected coronary artery. Which of the following nursing interventions is most important immediately after PCI? A. Monitoring vital signs every 4 hours B. Administering anticoagulant medications C. Assessing the puncture site for bleeding D. Encouraging early ambulation 65.Mr. Johnson is prescribed nitroglycerin for the relief of angina symptoms. Which of the following statements best explains the action of nitroglycerin in angina? A. Nitroglycerin dilates coronary arteries. B. Nitroglycerin reduces myocardial oxygen demand. C. Nitroglycerin enhances myocardial contractility. D. Nitroglycerin inhibits platelet aggregation. 66.Mr. Johnson is at risk for developing heart failure following his AMI. Which of the following manifestations would the nurse expect to assess in a patient with heart failure? A. Bradycardia and hypotension B. Jugular vein distention and peripheral edema C. Increased urine output and weight loss D. Hyperactive bowel sounds and diarrhea