STATES - 8

1. Circulatory shock can best be described as a condition in which there is

a) A state of hypotension
b) Loss of blood
c) Loss of consciousness due to blood loss
d) Inadequate blood flow to meet the metabolic needs of the body tissues

d) Inadequate blood flow to meet the metabolic needs of the body tissues

2. Causes of hypovolemic shock include

a) Vomiting and los of body fluids
b) Allergic reactions to drugs
c) Cardiac failure
d) Hypoglycaemia

a. ) Vomiting and los of body fluids

a) Restlessness, thirst, and increased heart rate

3. Early signs of hypovolemic shock include

a) Restlessness, thirst, and increased heart rate
b) Decreased blood pressure and apathy
c) Increase in heart rate and increased pulse pressure
d) Decreased blood pressure and unconsciousness

d) Urine output

4. In shock, one of the best indicators of blood flow to viral organs is

a) Rate of blood and fluid administration
b) Blood pressure
c) The colour and temperature
d) Urine output

b) Acute tubular necrosis

5. Oliguria, an early sign of shock, occurs for what reason

a) Cessation of glomerular filtration
b) Acute tubular necrosis
c) Metabolic acidosis
d) Sympathetic stimulation

d) An increase in heart rate is compensating for the loss of blood volume

6. A person admitted to the emergency room with trauma and an estimated blood loss of 1200 to 1400 mls has a blood pressure of 110/70 mmHg and a heart rate of 120 beats per minute. The best explanation for these observations would be that

a) The persons actual blood loss was less than the originally estimated loss
b) The person was normally hypertensive and hence did not have as great a drop in blood pressure as a normotensive person
c) The cause of the bleeding is now under control and the increased heart rate is due to anxiety
d) An increase in heart rate is compensating for the loss of blood volume

b) Bodys attempt to shunt blood to vital organs by constricting skin vessels

7. The pale, cool, clammy skin that is often observed in an individual with shock, can be explained in terms of

a) Loss of red blood cells
b) Bodys attempt to shunt blood to vital organs by constricting skin vessels
c) Decreased metabolic needs that accompany shock
d) Bodys attempt to conserve heat loss

b) Orthopnoea

8. ____________________ is generally relieved by sitting up in a forward leaning position

a) Hyperpnoea
b) Orthopnoea
c) Apnoea
d) Dyspnoea on exertion

b) Respiratory acidosis

9. In a client with emphysema, hypoventilation could initially cause

a) Respiratory alkalosis
b) Respiratory acidosis
c) Metabolic acidosis
d) Metabolic alkalosis

d) Have the client breathe into a paper bag

10. A client is anxious and is hyperventilating. In order to prevent respiratory alkalosis the nurse will

a) Administer oxygen
b) Instruct the client to pant
c) Have the client breathe deeply and slowly
d) Have the client breathe into a paper bag

b) Enlargement of the right ventricle

11. A district nurse is sent to assess a new client with cor pulmonale. This term refers to

a) Enlargement of the pulmonary artery
b) Enlargement of the right ventricle
c) Atrophy of the right ventricle
d) Giant bullae growth on the lung

c) Respiratory acidosis

12. Tony buffer, 54 years old, has a long history of smoking. He decides to have lung and blood studies done because he is very tired, is short of breath, and just does not feel good. His blood gases reveal the following findings: pH 7.3; HCO3 27; CO2 58. Tonys condition may be

a) Respiratory alkalosis
b) Metabolic acidosis
c) Respiratory acidosis
d) Metabolic alkalosis

b) Loosely bound to his haemoglobin

13. Approximately 1000ml (1L0 of oxygen is transported to cells each minute. Most of the oxygen is transported

a) Dissolved in his plasma
b) Loosely bound to his haemoglobin
c) In the form of CO2
d) As a free floating molecule

b) Retention of tracheobronchial secretions

14. Mary a 46 year old woman, is admitted to your ward with a chest infection due to an exacerbation of chronic obstructive pulmonary disease. A person with emphysema is susceptible to respiratory infections primarily because

a) Failure of his bone marrow to produce phagocytic white blood cells
b) Retention of tracheobronchial secretions
c) Decreased detoxification of body fluids by compressed liver cells
d) Persistent mouth breathing associated with dyspnoea

b) Emphysema obstruction results from changes in lung tissues

15. Emphysema differs from chronic bronchitis in that

a) Emphysema obstruction results from mucous production and inflammation
b) Emphysema obstruction results from changes in lung tissues
c) Chronic bronchitis obstruction results from changes in lung tissue
d) There are no visual difference between the two conditions

c) Filling of air passages by inflammatory coagulum

16. The tissue change most characteristic of emphysema is

a) Accumulation of pus in the pleural space
b) Constriction of capillaries by fibrous tissue
c) Filling of air passages by inflammatory coagulum
d) Over distension, in elasticity, and rupture of alveoli

b) Increased pressure in the pulmonary circulation

17. Which of the following results of emphysema is primarily responsible for cardiomegaly

a) Hypertrophy of muscles encircling the bronchi
b) Increased pressure in the pulmonary circulation
c) Decreased number of circulating red blood cells
d) Secretion of excessive amounts of pericardial fluids

c) Nausea and vomiting and cool, clammy pale skin

18. A 48 year old complains of chest pain. Signs and symptoms that would support a diagnosis of myocardial infarction would include

a) Jugular vein distension and hypatomegaly
b) Fever and petechiae over the chest area
c) Nausea and vomiting and cool, clammy pale skin
d) Pericardial friction rub and absent apical pulse

d) Teaching the client to take a tablet every 5 minutes (3x) when chest pain occurs

19. Teaching for the client taking GT or glycerol with nitrate for angina would include

a) Instructing the client to take the nitroglycerin regularly
b) Explain to the client that a subsequent headache indicates ineffective medication
c) Instructing the client to put the tablet on the tongue and swallow after the tablet dissolves
d) Teaching the client to take a tablet every 5 minutes (3x) when chest pain occurs

d) Fear due to knowledge deficit

20. A female client is diagnosed with unstable angina. The nurse finds her crying because she fears she will become a burden to her husband. Which of the following nursing diagnosis would be most appropriate

a) Impaired verbal communication
b) Ineffective family coping
c) Relationship difficulties
d) Fear due to knowledge deficit

a) Take sublingual nitroglycerin and lie down

21. Which of the following steps should a client with periodic angina pain take first when pain occurs at home

a) Take sublingual nitroglycerin and lie down
b) Do mild breathing exercises
c) Take an extra long lasting nitrate tablet
d) Sit down and relax

b) May lead to ventricular tachycardia or fibrillation

22. The nurse detects premature ventricular contractions and (PVC's) on the ECG of a client who had a mitral valve replacement 2 days ago. PVC's may be dangerous because they

a) Significantly increase cardiac workload
b) May lead to ventricular tachycardia or fibrillation
c) Are the most common cause of myocardial infarction
d) Decreased heart rate and blood pressure

a) To decrease abdominal pain

23. A client is admitted to ED following a car accident. He complains of abdominal discomfort. The nurse encourages the client to lie down. The reason for this action is

a) To decrease abdominal pain
b) To decrease the risk of dislodging an intra abdominal clot
c) To facilitate peristalsis
d) To decrease the risk of peritoneal infection

d) Decrease stimuli, monitor vital signs and neurological status elevate the head of the bed 30 degrees, positioning the client on his side

24. A client sustained moderate concussion. He has a Glasgow coma scale score of 7. Which of the following interventions would you include in your care plan

a) Decrease stimuli, monitor vital signs and neurological status nurse him flat on his back
b) Gradually increase stimuli, monitor vital signs and neurological status, elevate the head of the bed 60 degrees
c) Encourage family involvement, reduce monitoring at night to allow client to rest, elevate the head of the bed 60 degrees
d) Decrease stimuli, monitor vital signs and neurological status elevate the head of the bed 30 degrees, positioning the client on his side

b) Local bone tenderness, soft tissue swelling and inability to use extremity

25. James has sustained a fracture of his left lower leg in a car accident. Classical signs of a fracture may include

a) Intermittent pain, flushing of surrounding tissues and vascular spasm
b) Local bone tenderness, soft tissue swelling and inability to use extremity
c) Neural compromise, sharp stabbing pain and obvious ischaemia of he extremity
d) Blanching, hyperextension and parasthesia

b) Colour, warmth, sensation and movement of the extremity

26. Monitoring for compartment syndrome is done by checking for

a) Active movement of the limb
b) Colour, warmth, sensation and movement of the extremity
c) Pulse and blood pressure changes
d) The tightness of the plaster cast

a) Severe pain, motor compromise and a 'pins and needles' sensation

27. On assessment the nurse suspects that james is developing compartment syndrome because he complains of

a) Severe pain, motor compromise and a 'pins and needles' sensation
b) A radiating pain and loss of two point discrimination
c) Swelling, muscle atrophy and intermittent parasthesia
d) Dull aching, spasms and lack of fine co ordination

c) An injury in which the bone is broken into two or more pieces

28. A comminuted fracture is characterised by

a) A partial break in bone continuity
b) Injury in which two bones are crushed together
c) An injury in which the bone is broken into two or more pieces
d) An injury in which the bone fragments have broken through the skin

c) May go undetected for years

29. Type 2 diabetics

a) Need insulin to maintain homeostasis
b) May develop ketoacidosis easily
c) May go undetected for years
d) Are usually very slim and malnourished

c) If left uncontrolled, this can lead to DKA in type 1 or HNK in type 2

30. Hyperglycemia

a) Is alright only once in a while
b) Due to an over medication of insulin
c) If left uncontrolled, this can lead to DKA in type 1 or HNK in type 2
d) Also called insulin shock reaction

b) Affects coronary, peripheral and cerebral circulation

31. Macrovascular complications of diabetes

a) Occur shortly after the onset of the disease
b) Affects coronary, peripheral and cerebral circulation
c) Affects the eyes and the kidneys
d) Affects sensorimotor and autonomic nerves

b) Take a dose of glyceryl trinitrate up to 3 times, 5 minutes apart until the pain subsides

32. For relief of angina, the client may

a) Call 111
b) Take a dose of glyceryl trinitrate up to 3 times, 5 minutes apart until the pain subsides
c) Slowly exercise to the individuals tolerance level
d) Take only one dose of glyceryl trinitrate, if this has no effect, call 111

d) All above

33. Ways to minimise precipitating effects of angina are

a) Avoid over exertion
b) Reduce stress
c) Avoid overeating
d) All above

d) Needs immediate medical attention

34. Angina

a) May be referred to as angina majoralis
b) Not relieved by rest
c) Include chest pain which may radiate down the arms, neck, jaw and back
d) Needs immediate medical attention

b) Mental confusion or restlessness

35. A client with multiple fractures is at risk for a fat embolism. What early sign should you monitor for

a) Haematuria
b) Mental confusion or restlessness
c) Sudden temperature elevation
d) Pallor and discoloration at the fracture site

a) Notify the doctor immediately and prepare to bivalve the cast

36. Following an application of a full arm cast a client complains of deep throbbing elbow pain. You note diminished capillary refill in the fingers. You should

a) Notify the doctor immediately and prepare to bivalve the cast
b) Cut a window in the cast over the elbow area and check for infection
c) Elevate the arm, apply ice packs and assess hourly
d) Administer prescribed analgesics and notify the doctor

c) Level of consciousness

37. When assessing a patient at risk for increased intracranial pressure, the first thing you would check is

a) Reaction to pain stimuli
b) Papillary function
c) Level of consciousness
d) Motor function

a) Compresses the occulomotor nerve

38. Papillary dilation occurs when herniating brain tissue

a) Compresses the occulomotor nerve
b) Chokes the optic disks
c) Stretches the optic nerve
d) Paralyses the occulare muscles

d) Widening pulse pressure and bradycardia

39. Changes in vital signs with increasing intracranial pressure would include

a) Hypotension and tachycardia
b) Narrowing pulse pressure and tachypnea
c) Hypotension and a pulse deficit
d) Widening pulse pressure and bradycardia

d) The cranium is a closed, rigid vault

40. Bleeding within the skull results in increased intracranial pressure because

a) Arteries bleed rapidly and profusely
b) Bleeding from veins goes undetected
c) Spinal fluid is produced more rapidly
d) The cranium is a closed, rigid vault

c) Coronary artery disease

41. What is the most common cause of heart failure (HF)

a) Smoking
b) Diabetes
c) Coronary artery disease
d) Family history

b) Relax blood vessels, therefore decreased vascular resistance

42. The action of ACE inhibitors (angiotensin converting enzyme) is

a) Increased urinary output, therefore decreased blood pressure
b) Relax blood vessels, therefore decreased vascular resistance
c) Strengthens cardiac contraction, therefore increase cardiac output
d) Relax cardiac muscle therefore decrease heart rate

a) Increased serum potassium levels

43. Hyperkalemia is

a) Increased serum potassium levels
b) Increased serum calcium levels
c) Increased red blood cell count
d) Increased serum chloride levels

d) Decreased respiration and dyspnea

44. Manifestations of heart failure are

a) Hepatomegalia, pitted dependent edema
b) Increased serum glucose levels
c) Increased appetite and weight gain
d) Decreased respiration and dyspnea

c) Blood pressure and urinary output

45. Nursing interventions associated with your clients taking loop diuretics such as frusemide are

a) Blood sugar levels, dietary fibre
b) Monitoring of weight and K+ levels
c) Blood pressure and urinary output
d) Make sure your client eats ½ hour following administration

d) Inhibition complex active pump mechanism therefore increase excretion of electrolytes

46. Loop diuretics act by

a) Increasing the blood flow to the glomerular network
b) Decreasing the blood flow to the kidneys therefore decreased urinary output
c) Increased H2O reabsorption in the distal convoluted tubules of the nephron
d) Inhibition complex active pump mechanism therefore increase excretion of electrolytes

b) Parasympathetic and sympathetic stimulation

47. Blood pressure control is carried out by regulation of smooth muscles via

a) Parasympathetic stimulation
b) Parasympathetic and sympathetic stimulation
c) Sympathetic stimulation
d) None of these

a) Baroreceptors

48. The areas of the body that sense blood pressure are known as

a) Baroreceptors
b) Chemoreceptors
c) Viscoreceptors
d) None of these

d) Peak systolic pressure

49. When taking a blood pressure, the first sound picked up by the stethoscope as blood pulses through the artery is the

a) Mean arterial pressure
b) Pulse pressure
c) Diastolic pressure
d) Peak systolic pressure

c) 71%

50. At any given moment, the systemic circulation contains about _________________ of the total blood volume

a) 10%
b) 51%
c) 71%
d) 91%

a) There is an increased blood carbon dioxide

51. The nurse gets the arterial blood gases report and it shows that a person has hypercapnia. This means that

a) There is an increased blood carbon dioxide
b) The blood oxygen level is reduced
c) Carbon dioxide has been lost
d) There is respiratory alkalosis

b) A decrease of blood flow through the heart

52. Gregory, aged 70, was admitted with congestive heart failure. Which of these changes in physiology is present in congestive heart failure

a) Heart muscle degeneration due to old age
b) A decrease of blood flow through the heart
c) An abnormality in the structure of the heart
d) A blood clot forms in one of the heart chambers

d) Fatigue dependant edema and cough

53. Manifestations of right sided heart failure are

a) Fatigue, cyanosis, blood tinged sputum
b) Anorexia, complaints of gastrointestinal distress, fatigue and pitted edema
c) Dyspnea, orthopnea and cyanosis
d) Fatigue dependant edema and cough

c) Palpation of arterial pulse greater than 60 bpm

54. Nursing intervention necessary prior to the administration of digoxin is

a) Palpation of arterial pulse less than 60 bpm
b) Palpation of venous pulse less than 60 bpm
c) Palpation of arterial pulse greater than 60 bpm
d) Palpation of pedal pulse less than 60 bpm

b) Lungs

55. Left sided heart failure directly affects the

a) Liver and extremities
b) Lungs
c) Levels of consciousness
d) Lungs and extremities

c) Promote rest therefore decrease workload on heart and decrease H20 accumulation

56. Basic nursing objectives in the treatment of HF are

a) Start heparinization immediately
b) Nursing the client in trendlenberg position
c) Promote rest therefore decrease workload on heart and decrease H20 accumulation
d) Assess levels of consciousness and give 02 61/min via Hudson mask

b) Loss of brain function due to disruption of blood supply to the brain

57. Define a cerebral vascular accident (CVA)

a) Sudden loss of consciousness due to a decreased contractility of the cardia
b) Loss of brain function due to disruption of blood supply to the brain
c) Intermittent spasms of blood vessels interrupting blood flow to the brain
d) Neurologic dysfunction due to diminished blood flow to the cranium

a) Most common cause of a stroke

58. Cerebral thrombosis is

a) Most common cause of a stroke
b) Originates from a large vessel and lodges in the brain
c) May be caused by an arterial spasm in the brain
d) Usually occurs during strenuous exercise

b) Polycythemia and cyanosis from right ventricular failure

59. The term blue bloater refers to

a) Decreased erythropoietin production therefore decreased 02 carrying capability of the RBC
b) Polycythemia and cyanosis from right ventricular failure
c) Cyanosis due to decreased RBC production
d) Increased BP due to high blood volume or fluid overload

a) Results from a breakdown in the normal lung defence mechanisms

60. Bronchitis is

a) Results from a breakdown in the normal lung defence mechanisms
b) Destruction of alveolar
c) Due to enlarged terminal non respiratory bronchioles and alveolar walls
d) History of daily productive cough that last at least 3 months, for 2 years

b) Unproductive cough and pursed lip breathing

61. Emphysema is characterised by

a) Fat people due to decreased activity tolerance
b) Unproductive cough and pursed lip breathing
c) Pursed lip breathing and productive cough
d) Blue bloater, normal skin colour and rapid respirations

e) Encourage exercise to test tolerance levels

62. Nursing interventions for the CORD patient include everyone of these except

a) Improve ventilation
b) Remove secretions
c) Prevent complications
d) Promote cooperation and understanding
e) Encourage exercise to test tolerance levels

c) Include aminophylline for the acute exacerbation

63. Bronchodilators

a) Aid the movement of secretions
b) Liquefy the sputum therefore increase expectoration
c) Include aminophylline for the acute exacerbation
d) Are only used in emergency cases

d) Used during the acute exacerbation of CORD

64. Corticosteroids are used

a) Prophylactically in most cases
b) To aid in vitamin D synthesis
c) To aid the liquefaction and expectoration of sputum
d) Used during the acute exacerbation of CORD

c) Prevents bronchiolar collapse and air trapping

65. Pursed lip and diaphragmatic breathing

a) Calms the anxious client
b) Speeds up slow respiration's and is used to promote effective coughing
c) Prevents bronchiolar collapse and air trapping
d) Encourages longer inhalation and faster exhalation

b) Promotes loosening secretions and movement out of airway

66. Percussion, vibration and postural drainage

a) Is effective management of nursing frustrations
b) Promotes loosening secretions and movement out of airway
c) Increases blood supply to area therefore increased expectoration
d) Should be done prior to all meals

c) 4 - 7 mmol/l

67. A normal blood sugar level (BSL) is

a) 7.35 - 7.45
b) 120 - 160 mm dL
c) 4 - 7 mmol/l
d) +/- 2 mmEq

c) An endocrine disorder

68. Diabetes is

a) An exocrine disorder
b) Decreased production of insulin by the liver
c) An endocrine disorder
d) Decreased secretion of insulin by the alpha cells in the pancreas

d) Need insulin to maintain normal BSL

69. Type I diabetics are characterised by

a) Non insulin dependence
b) Majority of the diabetic population
c) Require hypoglycaemic agents to maintain glucose levels
d) Need insulin to maintain normal BSL