Title PB1 - NP 3 - STUDENT COPY ✅

2 | Page D. Absence of troponin elevation despite chest pain 11. Nurse Jeidy notes inconsistent response to nitroglycerin. Which data point should she prioritize to determine the underlying cause of this inconsistency? A. Patient’s adherence to prescribed medication timing and storage conditions B. Frequency and duration of angina episodes prior to medication use C. Patient’s level of anxiety and emotional triggers during angina episodes D. Presence of other comorbid conditions 12. Nurse Jeidy is evaluating another patient who reports chest pain when walking more than 2 blocks on level ground, with marker limitation of activity. Based on the Canadian Cardiovascular Society (CCS) classification, which angina class best describes this patient's condition? A. Class I B. Class II C. Class III D. Class IV Situation: Nurse Will is working in a telemetry unit at Joel Linga Hospital, monitoring multiple high risk cardiovascular patients. His responsibilities include interpreting 12 lead ECGs, responding to telemetry alerts, and managing patients with both acute and chronic cardiac arrhythmias. 13. One of Nurse Will’s patients is a 60-year-old adult with a heart rate of 48 bpm. The ECG shows a regular rhythm, normal P waves before each QRS complex, a PR interval of 0.16 seconds, and a normal QRS duration. The patient reports dizziness and lightheadedness. Which of the following best describes this rhythm and the appropriate nursing action? A. Atrial fibrillation, provide oxygen therapy B. Supraventricular Tachycardia, provide vagal stimulation and administer Adenosine (Adenocard) C. Normal sinus rhythm with physiological QRS and T wave changes, continue routine monitoring D. Sinus bradycardia, administer atropine 0.5 to 1.0 mg to block vagal stimulation 14. The patient's PR interval comprises of seven small boxes on the ECG graph. What does the this indicates? A. A normal finding B. A problem with ventricular depolarization C. A disturbance in the repolarization of the atria D. A problem with conduction from the SA node to the ventricular cells 15. A 73 year-old male with a history of ischemic heart disease now presents with palpitations and mild shortness of breath. A telemetry strip reveals a narrow QRS tachyarrhythmia with a ventricular rate of 150 bpm. The rhythm is regular, and sawtooth-like waves are noted between QRS complexes, especially visible in leads II, III, and aVF. Blood pressure is 124/78 mmHg, and the patient is alert. Which of the following is the most appropriate initial intervention? A. Immediate synchronized cardioversion at 300 J B. Administration of IV amiodarone to chemically cardiovert the rhythm C. Initiate rate control with IV diltiazem to slow AV conduction D. Administer adenosine rapid IV push and call the physician 16. A 58-year-old patient is also being monitored. The ECG reveals that the P waves precede each QRS complex until one P wave is not followed by a QRS, PR intervals progressively lengthen with each beat until a beat is dropped, The QRS complex is narrow and normal in shape. Which of the following best described this cardiac rhythm? A. First Degree AV Block B. Second Degree AV Block, Type I C. Second Degree AV Block, Type II D. Third Degree AV Block 17. A 48-year-old female complaints of intermittent chest discomfort during exertion. She requests an ECG for evaluation. Which of the following ECG findings most specifically suggests ongoing myocardial ischemia rather than infarction or other cardiac pathology? A. Development of pathologic Q waves in leads II, III, and aVF B. T wave inversion in contiguous leads during a pain episode C. Persistent ST segment elevation in anterior leads D. Widened QRS complex greater than 120 ms with bundle branch block pattern 18. While on his way home from Joel Linga Hospital, Nurse Will notices a middle aged man unconscious on the sidewalk. The man is unresponsive, pulseless, and apneic. Nurse Will initiates CPR. According to the latest AHA Basic Life Support (BLS) guidelines, which of the following best describes the correct quality of chest compressions for this adult victim? A. Push hard and fast, compressing at least 50 mm at a rate of 100-120 compressions per minute B. Push hard and fast, compressing at least 50 in at a rate of 100-120 compressions per minute C. Push hard and fast, compressing at least 2.5 cm at a rate of 80-100 compressions per minute D. Push hard and fast, compressing at least 2.5 in at a rate of 80-100 compressions per minute 19. Emergency Rescue arrives and connects the unconscious male to the cardiac monitor, which reveals an extremely irregular rhythm with no discernible QRS complexes and a ventricular rate exceeding 300 beats per minute. Which of the following best describes the underlying cardiac event and the most appropriate immediate management? A. Ventricular fibrillation; initiate immediate defibrillation and activate emergency services. B. Ventricular tachycardia; administer intravenous beta- blockers and observe. C. Asystole; begin immediate cardiopulmonary resuscitation (CPR) and prepare for transcutaneous pacing. D. Atrial fibrillation with rapid ventricular response; control ventricular rate with calcium channel blockers. Situation: Franz is a 64 year old male with history of chronic hypertension was admitted after reporting persistent pulsating sensation in his abdomen. His blood pressure is 180/100 mmHg, placing him at increased risk for rupture. After an emergency endovascular repair, Nurse Glen monitors him post operatively. 20. Franz is at risk for compromised circulation. Which physiological mechanism ensures that blood flows unidirectionally through the cardiovascular system? A. Sympathetic vasomotor tone B. Resistance gradients in tissues C. Pressure difference between arteries and veins D. Gravity-assisted circulation 21. In normal cardiovascular physiology, which of the following best describes how fluid moves across the capillary walls? A. Hydrostatic pressure at the venous end of the capillary pushes fluid into the surrounding tissues B. Osmotic pressure at the arterial end overcomes hydrostatic pressure, pulling fluid back into the capillary C. Hydrostatic pressure at the arterial end pushes fluid out into the tissues, while osmotic pressure at the venous end pulls fluid back into the capillary D. Capillary permeability is the only factor that affects movement of fluid between the capillaries and the tissues 22. Following endovascular repair of his abdominal aortic aneurysm, Franz develops localized vasospasm near the graft site, increasing vascular resistance. If arterial pressure remains unchanged, what is the most likely impact on regional blood flow to surrounding tissues? A. Flow increases B. Flow decreases C. Flow remains unchanged D. Flow reverses direction 23. Based on Poiseuille’s law, which of the following has the most significant impact on vascular resistance within the circulatory system? A. Blood vessel length B. Blood vessel radius
3 | Page C. Blood viscosity D. Arterial pressure 24. Which of the following is an inaccurate nursing intervention post operatively for Franz? A. Limit elevation of the head of the bed to 45 degrees B. Evaluate intake and urinary output every hour for signs of renal perfusion compromise C. Inspect the abdominal incision site regularly for erythema and local infection D. Assess peripheral pulses proximal to the graft site 25. Which of the following clinical signs or symptoms would be least consistent with an unruptured abdominal aortic aneurysm and may suggest an alternative diagnosis? A. A pulsatile, midline abdominal mass palpable on deep palpation B. A systolic bruit auscultated over the periumbilical area C. Hyperactive bowel sounds in all quadrants D. A subjective sensation of a "pounding heartbeat" in the abdomen while lying down 26. Which of the following best explains the underlying structural abnormality present in all types of aneurysms, regardless of their cause? A. Degeneration of the tunica media layer B. Thickening of the intima due to atherosclerosis C. Loss of endothelial cell integrity in the tunica adventitia D. Calcification of the arterial wall causing rigidity 27. Cardiovascular risk increases with cigarette smoking. Franz, a chain smoker, reports that he has been smoking 5 cigarette sticks per day for 6 years, and 10 sticks per days for 2 years. Compute for the pack years A. 2 year and 3 months B. 2 years and 6 months C. 3 years and 9 months D. 3 years and 1 month RHEUMATIC FEVER/ RHEUMATIC HEART DISEASE Situation: Mara is an 8 year old with a history of partially treated streptococcal pharyngitis, presents with low grade fever, tachypnea, and polyarthritis involving large joints. On physical exam, erythema marginatum and small, painless nodules are noted over her elbows and knees. Laboratory tests reveal elevated erythrocyte sedimentation rate (ESR), positive C- reactive protein (CRP), and an elevated anti- streptolysin O (ASO) titer. 28. The following does not meet the criteria for the diagnosis of acute rheumatic fever A. Polyarthritis, erythema marginatum, elevated ASO titer B. Fever, polyarthralgia, elevated ASO titer, prolonged PR interval C. Subcutaneous nodules, erythema marginatum, elevated CRP D. Tachypnea, low-grade fever, positive throat culture for Group A streptococcus 29. Mara is now exhibiting involuntary, irregular, jerky movements of the face and extremities. Which of the following is the most appropriate immediate intervention A. Place the patient in a semi-fowler’s position and notify the physician B. Administer corticosteroid to reduce inflammation C. Initiate seizure precautions D. Reassure the family that it is temporary, then notify the physician 30. Which of the following nursing actions is the priority to prevent cardiac complications? A. Emphasize the importance of strict compliance with prescribed antibiotics, even if symptoms improve B. Encourage the client to maintain a low-fat diet to reduce inflammation C. Teach the family that anti-inflammatory medications are only needed if fever recurs D. Advise the client to limit physical activity permanently to avoid heart damage 31. Which finding most strongly would strongly indicate the development of rheumatic heart disease? A. New systolic murmur detected on auscultation B. Additional elevation of ASO titer and CRP levels C. Presence of erythema marginatum D. Migratory polyarthritis involving large joints and small joints Situation: Aris, a 23-year-old female, is admitted with complaints of progressive fatigue, dizziness upon standing, and shortness of breath on exertion. Her labs reveal a hemoglobin level of 7.5 g/dL, hematocrit of 23%, and serum iron below normal. She reports frequently skipping meals frequently due to intensive studying for the Philippine Nursing Licensure Exam 32. Based on current presentation and labs, which nursing diagnosis should take the highest priority? A. Risk for cardiopulmonary compromise related to severely decreased hemoglobin levels B. Imbalanced nutrition: less than body requirements related to iron deficiency C. Fatigue related to metabolic demands of the body and diminished red blood cell count D. Ineffective tissue perfusion related to reduced oxygen carrying capacity of the blood 33. Aris becomes increasingly confused and unsteady on her feet during ambulation. What is the priority nursing intervention for this patient? A. Keep bedside rails up and call bell in close reach B. Provide a darkened, quiet room C. Have the family stay with the patient, then notify the physician D. Question the patient about possible causes of anemia 34. During a focused physical assessment of Aris, who has now confirmed severe anemia, which finding is of the most concern to the nurse? A. Anorexia B. Bone pain C. Hepatomegaly D. Dyspnea at rest 35. Aris is also suspected to have pernicious anemia due to chronic nutritional deficiency and plans to confirm it using Schilling’s test. Which specimen should the nurse prepare to collect A. 24 – hour urine specimen B. B Blood by venipuncture C. Stool Specimen D. Arterial Blood Gas Situation: Martina is admitted with bruising, bleeding gums, and heavy menstrual flow. Her labs show platelet count of 35,000/mm³, and she's diagnosed with Idiopathic Thrombocytopenic Purpura (ITP). 36. Nurse Precious is caring for Martina. Which of the following findings requires immediate intervention? A. Petechiae on the legs B. Bleeding gums after brushing C. Platelet count of 34,000/mm D. New onset confusion and headache 37. Which of the following patients is at greatest risk for Martina’s condition A. A patient with chronic liver disease and portal hypertension B. A patient receiving erythropoietin therapy C. A patient with hypercalcemia D. A patient on diuretics for heart failure 38. A platelet transfusion is ordered for Martina. Nurse Precious should question this order under which condition? A. The patient has active GI bleeding B. The platelet count is 4,000/mm³ with no active bleeding C. The thrombocytopenia is due to ITP D. The patient is pre-op for emergency appendectomy 39. Nurse Precious reviews Martina’s bone marrow biopsy. Which finding would be most expected in chronic ITP? A. Decreased megakaryocytes B. Increased megakaryocytes