PRELIMS Practice Test

A client with left-sided heart failure suddenly develops severe dyspnea, crackles throughout both lung fields, and pink, frothy sputum. Which complication should the nurse suspect?

A. Pulmonary embolism

B. Pulmonary edema

C. Right-sided heart failure

D. Pleural effusion

B. Pulmonary edema

During assessment, the nurse hears a low-pitched sound immediately after S2 in a client with heart failure. Which heart sound is this? A. S1 B. S2 C. S3 D. S4

C. S3

A client reports chest pain while walking. The pain consistently disappears after resting. Which type of angina is most consistent with these findings? A. Unstable angina B. Variant angina C. Stable angina D. Silent ischemia

C. Stable angina

A patient with suspected myocardial infarction arrives in the emergency department. Which assessment finding is most concerning for MI rather than stable angina? A. Chest pain that disappears after rest B. Chest discomfort after eating a heavy meal C. Chest pain continuing despite rest and medication D. Chest pain only during exercise

C. Chest pain continuing despite rest and medication

The nurse is caring for a client with an acute myocardial infarction. Which medication is included in the MONA approach described in the lecture? A. Morphine B. Metformin C. Mannitol D. Magnesium

A. Morphine

A patient receiving morphine for acute coronary syndrome develops significant respiratory depression. Which medication should the nurse anticipate administering? A. Protamine sulfate B. Vitamin K C. Naloxone D. Digibind

C. Naloxone

A patient with heart failure has an ejection fraction of 35%. How should the nurse interpret this finding based on the lecture? A. Normal ventricular function B. Increased left ventricular function C. Decreased left ventricular function D. Normal right ventricular function

C. Decreased left ventricular function

A client with right-sided heart failure is being assessed. Which finding should the nurse expect? A. Pulmonary crackles only B. Pink, frothy sputum C. Distended neck veins D. Orthopnea only

C. Distended neck veins

A client with heart failure is prescribed digoxin. Before administering the medication, the nurse assesses the patient’s heart rate and finds it is 54 beats/min. What should the nurse do? A. Administer the medication immediately B. Hold the medication and assess further C. Double the prescribed dose D. Give the medication with potassium

B. Hold the medication and assess further

A client receiving digoxin reports nausea, vomiting, loss of appetite, and changes in color vision. What should the nurse suspect? A. Digoxin toxicity B. Pulmonary embolism C. Hypovolemia D. Stable angina

A. Digoxin toxicity

A client with acute pulmonary edema is extremely dyspneic and anxious. Which position should the nurse prioritize? A. Flat supine B. Trendelenburg C. Upright with legs down D. Prone

C. Upright with legs down

A nurse is teaching a patient with COPD about pursed-lip breathing. What is the primary purpose? A. Increase rapid inspiration B. Slow expiration and prevent small-airway collapse C. Increase mucus production D. Prevent oxygen absorption

B. Slow expiration and prevent small-airway collapse

A patient with COPD is receiving oxygen therapy. Why does the lecture emphasize using low-flow oxygen? A. COPD patients cannot absorb oxygen B. High-flow oxygen may eliminate the hypoxic drive C. Oxygen causes pneumonia D. Low-flow oxygen increases carbon dioxide production

B. High-flow oxygen may eliminate the hypoxic drive

A client with chronic bronchitis reports producing sputum and coughing almost every day. Which finding supports the definition of chronic bronchitis? A. Cough for 1 month in one year B. Cough and sputum for 3 months in each of 2 consecutive years C. Sudden cough for 1 week D. Dry cough occurring only during exercise

B. Cough and sputum for 3 months in each of 2 consecutive years

A client with emphysema has a chest x-ray showing hyperinflation and a flattened diaphragm. Which condition does this finding support? A. Emphysema B. Pleural effusion C. Pneumonia D. Pulmonary tuberculosis

A. Emphysema

A patient with emphysema asks why air remains trapped in the lungs. Which explanation is most appropriate? A. Increased lung elasticity B. Destruction of alveolar walls and loss of elasticity C. Excessive pleural fluid D. Increased pulmonary blood flow

B. Destruction of alveolar walls and loss of elasticity

A client with bronchiectasis produces large amounts of purulent sputum. Which intervention should the nurse prioritize? A. Restrict fluids B. Encourage airway clearance C. Keep the patient completely supine D. Prevent coughing

B. Encourage airway clearance

The nurse is preparing a client for bronchoscopy. Which instruction is appropriate? A. Eat a large meal immediately before the procedure B. Maintain NPO status before the procedure C. Remove oxygen before the procedure D. Eat immediately after the procedure

B. Maintain NPO status before the procedure

After bronchoscopy, a client asks for water. What should the nurse assess first? A. Bowel sounds B. Gag reflex C. Pedal pulses D. Blood glucose

B. Gag reflex

A patient with pneumonia has a temperature of 39°C, productive cough, chills, and crackles. Which diagnostic finding would support pneumonia? A. Chest x-ray showing infiltrates and consolidation B. Decreased WBC count C. Increased ejection fraction D. Decreased respiratory rate

A. Chest x-ray showing infiltrates and consolidation

A client with pneumonia has difficulty breathing. Which position should the nurse use? A. Flat supine B. Semi-Fowler’s or nearly upright C. Trendelenburg D. Prone with legs elevated

B. Semi-Fowler’s or nearly upright

A patient develops sudden dyspnea after a chest injury. The nurse notes decreased breath sounds on one side and tracheal deviation toward the unaffected side. Which condition is most likely? A. Simple pleural effusion B. Tension pneumothorax C. Stable angina D. Chronic bronchitis

B. Tension pneumothorax

A patient with a chest tube has continuous bubbling in the water-seal chamber. What should the nurse suspect? A. Normal lung re-expansion B. An air leak C. Complete lung re-expansion D. Normal drainage

B. An air leak

The chest tube drainage system is accidentally disconnected. What should the nurse do according to the lecture? A. Place the tube on the bed B. Submerge the end in sterile water or saline and reconnect C. Remove the chest tube D. Clamp the tube permanently

B. Submerge the end in sterile water or saline and reconnect

A patient with a chest tube suddenly has no fluctuation in the water-seal chamber. Which possibilities should the nurse consider? A. Only lung re-expansion B. Only normal function C. Lung re-expansion or obstruction D. Increased oxygenation

C. Lung re-expansion or obstruction

A client is undergoing thoracentesis. Which instruction is most important during needle insertion? A. Cough forcefully B. Move frequently C. Avoid coughing and movement D. Take rapid deep breaths

C. Avoid coughing and movement

A client with pulmonary tuberculosis is being discharged. Which teaching is most important for preventing transmission? A. Stop medications once symptoms disappear B. Cover the mouth and nose when coughing C. Avoid drinking fluids D. Avoid all physical activity permanently

B. Cover the mouth and nose when coughing

A client with active pulmonary TB asks why treatment must continue for several months even after feeling better. What is the best response? A. “The medication only treats the fever.” B. “Long treatment helps eradicate the organism and prevent relapse.” C. “Treatment is only needed to prevent coughing.” D. “You can stop once your appetite returns.”

B. “Long treatment helps eradicate the organism and prevent relapse.”

A patient with anemia has fatigue, pallor, dyspnea on exertion, and low hemoglobin. Which nursing diagnosis is most consistent with the lecture? A. Activity intolerance B. Excess fluid volume C. Impaired urinary elimination D. Risk for constipation only

A. Activity intolerance

A patient with iron-deficiency anemia is prescribed oral iron. Which teaching should the nurse provide? A. Take it with orange juice to improve absorption B. Expect completely white stools C. Stop the medication if stools become dark D. Take it only with antacids

A. Take it with orange juice to improve absorption