ST.

ANTHONY’S COLLEGE
NURSING DEPARTMENT
San Jose dB, Antique

St. Anthony’s College Nursing Department

MEDICAL-SURGICAL NURSING: RESPI/HEMA

Instruction: Select the correct answer for each of the following questions. Mark only one answer by
shading the letter of your choice on your answer sheet. STRICTLY NO ERSURES ALLOWED.

1. Jina, a 43-year-old female client, was admitted to the hospital after being hit by a motor vehicle.
The client is a known hypertensive who is taking a maintenance medication for almost 2 years.
She is also known diabetic and has had a history of miscarriage. Which of the following factors
places Ms. Jina at risk for developing Acute Respiratory Distress Syndrome?
a. Traumatic injury
b. History of miscarriage
c. Use maintenance medication for hypertension
d. History of diabetes
2. Upon assessment, Jina presents the following symptoms. Which of these would you consider as
a classic finding in patient with acute respiratory distress syndrome(ARDS)?
a. Severe hyponatremia c. Hypoxia resistant to oxygen therapy
b. Hypercapnia d. Sudden hypocalcemia with tetany
3. You would suspect that Jina is at risk for developing pulmonary edema. Which of the following is
the best explanation of acquiring the condition?
a. Left- sided heart failure c. Extravascular fluid volume excess
b. Alveolocapillary membrane damage d. Pulmonary artery infarct
4. Jina’s pulse oximeter reading continuously decreases and she is beginning to experience signs of
hypoxemia. Such as restlessness. You know that the physician will more likely:
a. Prescribe mechanical ventilation c. Insert a test tube
b. Prescribe low FiO₂ concentration d. Prescribe chest physiotherapy
5. Which of the following breathing techniques is appropriate for the nurse to teach that will assist
in exhalation for a client with pulmonary emphysema?
a. Push on abdomen during exhalation
b. Sit on high fowler’s position with legs extended
c. Lean forward 30-40 degrees with each exhalation.
d. Sit-up with shoulders back.
6. A client with emphysema is having labored breathing with slow and shallow respirations. This
may predispose him to develop:
a. Respiratory alkalosis. c. Metabolic alkalosis.
b. Respiratory acidosis. d. Metabolic acidosis.
7. Alex is diagnosed with active tuberculosis. Which of the following clinical manifestations will he
exhibit?
a. Chest and low back pain
b. Headache and fever
c. Fever, chills, night sweats, and hemoptysis
d. Fever of more than 104 degrees F and nausea
8. A patient states that he has smoked a half pack of cigarettes per day for 40 years. The nurse
documents this as:
a. 10 pack years c. 30 pack years
b. 20 pack years d. 40 pack years
9. A 22 year old college student with a history of asthma presents to the emergency department
with difficulty of breathing. Upon auscultation, what adventitious breath sound would you
expect?
a. Diminished breath sounds and crackles in lung bases
b. Moist crackles in the lung base
c. Distant breath sounds and expiratory wheezes
d. Bronchial breath sounds in lung bases
10. A severe inflammatory response triggered the patient’s asthma attack. Which of the following
drugs would nurse expect to give to combat the inflammatory response?
a. Theophylline (Aminophylline) c. Albuterol(Proventil)
b. Prednisone (Sterapred) d. Metoprolol (Lopressor)
11. Liza is a 45-year-old obese patient who had had a pneumonectomy for lung cancer 2 days ago.
Her post operative course has been uneventful but she refuses to get out of bed. Which of the
following interventions would help prevent complications of immobility?
a. Performing passive range of motion exercises
b. Administering IV fluids at KVO
c. Using knee catch on bed at all times
d. Rubbing the patient’s legs frequently to promote circulation
12. To assess the patient’s for Homan’s sign, the nurse should:
a. Elevate the patient’s legs and look for discoloration in the ankle area.
b. Squeeze the patient’s calf and note for any tenderness.
c. Dorsiflex the foot with leg elevated and notify any calf pain.
d. Plantar flex the foot and noting for any arc pain and discoloration.
13. While performing passive ROM exercises to Chrissa, she suddenly developed chest pain,
shortness of breath and air hunger. The nurse knows that she must further assess the patient’s
chest pain to determine the origin. When determining whether the chest pain is cardiac or
pleuritic in nature, the nurse knows that pleuritic pain is typically:
a. Described as crushing and substernal. c. Relieved with nitroglycerin.
b. Worsens with deep inspiration. d. Relieved when the patient leans forward.
14. Another patient in the central intensive care unit is diagnosed with pulmonary embolus. Which
of the following is the most appropriate nursing diagnosis for this patient?
a. Ineffective airway clearance c. Impaired gas exchange
 b. Risk for infection d. Altered cardiopulmonary tissue perfusion
15. Allen is admitted to the medical surgical floor with a diagnosis of bacterial pneumonia. The most
common causative organism of bacterial pneumonia is:
a. Streptococcus pneumonia c. Haemophillus influenza
b. Proteus species d. Escherichia coli
16. The physician ordered for a sputum culture. Which of the following instructions by the nurse is
correct when collecting sputum specimen to a patient?
a. Tell the patient to cough deeply and expectorate into the specimen container.
b. Place the patient in semi-fowler’s position and tell her to cough slowly.
c. Place the patient in high -fowler’s position and tell her to expectorate saliva into the
specimen container.
d. Tell the patient to breathe deeply, cough shallowly , and expectorate the sputum into the
specimen.
17. You included to performing chest physiotherapy in your nursing interventions but did not help in
removing Allen’s secretions. Which type of drug would the nurse expect to be prescribed
following chest physiotherapy?
a. Anticholinergic c. Antibiotic
b. Mucolytic d. Diuretic
18. In planning care for Allen, which of the following is the most appropriate nursing diagnosis?
a. Fluid volume deficit c. Impaired gas exchange
b. Decreased cardiac poutput d. Risk for infection
19. Which of the following physical assessment is typical for a client with COPD?
a. Increased anterior-posterior chest diameter
b. Underdeveloped neck muscles
c. Collapsed neck veins
d. Increased chest excursion with respiration
20. The client is prescribed with oxygen therapy at a rate of 4L/min via nasal cannula. Which of the
following statement best describes why oxygen therapy is maintained at a relatively low level
concentration?
a. The cells in the alveoli are so damaged by the patient’s long history of respiratory problem
that higher level of oxygen and reduced level of carbon dioxide are likely to cause the cell to
burst.
b. The patient’s long history of respiratory problem indicates that he would be unable to
absorbed oxygen at a higher rate.
c. The oxygen will be lost at the nostrils if given at a higher level at a nasal cannula.
d. The patient’s respiratory center is so accustomed to high carbon dioxide and low blood
oxygen concentration that changing these concentrations with oxygen therapy may
eliminate the patient’s stimulus for breathing- the hypoxic drive that helps us to initiate
breathing.
21. The client becomes acutely anxious and feels shortness of breath. Which of the following
nursing interventions is most likely to reduce dyspnea?
a. Lower the head of the bed.
 b. Instruct him to breathe through a paper bag.
c. Increase the oxygen flow rate to 8L/min.
d. Encourage him to breathe deeply and rhythmically.
22. The nurse teaches the client to purse his lips while breathing. The primary purpose of pursed-lip
breathing is to help:
a. Promote oxygen intake. c. Strengthen the intercostals muscle.
b. Strengthen the diaphragm. d. Promote carbon dioxide elimination.
23. The client receives Theophylline (Aminophylline) IV every 6 hours. Which of the following
changes in the patient’s conditions would indicate that the drug is exerting its desired effect?
a. The patient sleeps better.
b. The patient has less ankle edema.
c. The patient breathes easier.
d. The patient is more encouraged about his condition.
24. A patient is admitted to the hospital with pneumothorax has the following ABG reading: Ph:
7.15, PaCO₂: 65 mmHg, and HCO₃: 22 mEq/L. A chest tube was inserted and oxygen was
administered at a rate of 4l/min via nasal cannula. An hour after the initiation of treatment, ABG
analysis reveals the following: Ph: 7.28, PaCO₂: 50 mmHg, HCO₃: 22 mEq/L. This change in ABG
reading indicates:
a. Respiratory alkalosis c. The need for intubation
b. Impending respiratory arrest d. Improved respiratory status
25. Upon auscultation, you know that it is “stridor” when you heard:
a. Continuous high-pitched sound that has musical quality.
b. Very loud musical sound that is usually heard without a stethoscope.
c. Short explosive or popping sound usually heard during inspiration.
d. Loud grating sound caused by inflamed or damaged pleurae.
26. Princess has been diagnosed with aplastic anemia. Which of the following statements of the
client needs further teaching?
a. “I will brush my teeth with soft-bristled toothbrush.”
b. “I will avoid eating raw fruits and vegetables.”
c. “I am allowed to go and do contact sports.”
d. “I have to avoid people with cough and colds.”
27. Another patient assigned to you was diagnosed with polycythemia. You know that the problem
in this condition is that:
a. There is increased RBC and Hgb production.
b. There is overproduction of all blood cells.
c. It is a response to excessive oxygen levels in the blood.
d. There is hyperplasia of the bone marrow.
28. Which of the following statements if made by a client with pernicious anemia indicates the need
for further teaching?
a. “I will have to take vitamin B12 tablets for lifetime.”
b. “I will have to take vitamin B12 injections for lifetime.”
c. “I will have blood transfusion as necessary.”
 d. “I will have physical examination every six months.”
29. An adult client will undergo bone marrow aspiration. Which of the following is an inappropriate
action?
a. Inform the client that he will experience brief sharp pain as bone marrow is aspirated.
b. Place the client in prone position.
c. Instruct the client to not to take foods or fluids 4 hours before the test.
d. Ask the client to empty his bladder before the procedure.
30. The client is suspected to have pernicious anemia. He will undergo Schilling’s test. The specimen
to be collected is:
a. Blood by venipuncture. c. 24 hour urine specimen.
b. Stool specimen d. Arterial blood.
31. Pia is a 22-year-old woman with a history of idiopathic thrombocytopenic purpura. She was
admitted due to recurrent epistaxis. When teaching her about ITP, the nurse should instruct her
to avoid:
a. Aspirin. c. Diazepam
b. Acetaminophen d. Famotidine
32. When questioning Pia about her condition, the nurse would expect her to report:
a. Myalgia c. A smooth beefy tongue
b. Joint pain d. Heavy menses
33. The patient wants to know more about her condition. You would start by telling her that the
main cause of idiopathic thrombocytopenic purpura (ITP) is that:
a. “your body make antibodies that destroy your platelets which causes you to bleed.”
b. “ITP is caused by recent bacterial infection.”
c. “your excessive intake of aspirin has caused this problem.”
d. “this form of anemia will improve with iron supplements.”
34. The nurse notes that Alex has red dot-like areas on his trunk and documents this as:
a. Papules. c. Ecchymosis
b. Petechiae d. Hematomas
35. Which of the following nursing considerations is important when transfusing packed red blood cell?
a. Begin the infusion at 30 drops/minute for the first 20 minutes.
b. Infuse the blood through an IV catheter with a gauge of 18 or larger.
c. Give the blood within 8 hours or during the entire shift.
d. Piggyback the blood through an infusion of 5% dextrose normal saline solution (D5NSS).
36. There are different blood products that can be transfused, depending on the condition of the
patient. One of the most common blood product administered to a client with anemia is pack
red blood cell (PRBC). Which of the following is correct about PRBC?
a. A unit of packed RBCs contains red celss, white cells, and platelets
b. A unit of packed RBCs usually contains more than a unit of whole blood.
c. A unit of packed RBCs doesn’t require typing and crossmatching.
d. A unit of packed RBCs has 70-80% of the plasma removed.
37. You reassess the patient an hour post transfusion. Upon auscultation, you heard crackles on
both lung fields. The patient also tells you that she is now coughing with froty sputum. You
would suspect?
a. A hemolytic transfusion reaction c. That the blood was mismatched
b. A febrile reaction d. That the patient is overloaded with fluid
38. Which of the following assessment cues would indicate that blood transfusion has been
effective?
a. A decreased urine output c. A negative Guiac test result
b. A normal heart beat d. A normal temperature
39. Nona is diagnosed with Disseminated Intravascular Coagulopathy (DIC).which of the following
products would you anticipate to be administered to her as part of her treatment?
a. Albumin c. Packed red blood cells
b. Fresh frozen plasma d. Tissue plasminogen activator (tPA)
40. Nona becomes restless and anxious. Her heart rate increases to 125 beats /min and her blood
pressure drops to 80/60 mmHg. The nurse notifies the doctor because she suspects that the
patient may be having:
a. An internal hemorrhage c. stroke
b. Oliguria d. heart attack
41. Miriam is diagnosed with acute myeloblastic leukemia. Which of the following laboratory result
would the nurse anticipate to find in patients with leukemia?
a. CD4 lymphocytes count of less than 200 c. Serum potassium level greater than 5 mEq/L
b. Leukocyte count of 100,000/ul d. Calcium level of 10.5 mEq/L
42. Miriam is now having her chemotherapy treatment for myeloblastic leukemia. Aside from the
chemo drug. She is given Allopurinol (Zyloprim). Allopurinol (Zyloprim)is prescribed to:
a. Relieve gout related pain in her great toe and other joints.
b. Inhibit uric acid synthesis that is caused by tissue destruction from chemotherapy.
c. Decrease nausea and vomiting associated with chemotherapy
d. Shrink swollen lymphoid tissue.
43. During patient’s chemotherapy regimen, which of the following is important to include in her
plan of care?
a. Instruct her to consume plenty of raw fruits and vegetables.
b. Take rectal temperature for greater accuracy.
c. Tell her to avoid crowd and infected individuals
d. Ask friends and relatives not to visit during the course of chemotherapy.
44. A client with left chest tube has accidentally removed it. What should be done first?
a. Assist the client to lie on the left side.
b. Assist the client to lie on the right side.
c. Apply an occlusive dressing over the site.
d. Reinsert the chest tube that fell out.
45. A 75-year-old client is diagnosed with tuberculosis. Which of the following laboratory report
most accurately confirms the diagnosis?
a. Chest x-ray c. CBC
 b. Sputum culture d. Mantoux test
46. Before starting INH (Isoniazid), a client will probably have which of the following laboratory test?
a. AST and ALT c. Serum glucose level
b. BUN and Creatinine d. Blood uric acid level
47. Which of the following would be considered most normal in water seal chamber within the first
24 hours post operatively with a two-bottle water seal drainage?
a. No fluctuation in the water seal tube
b. Intermittent slight bubbling from the water seal tube
c. Bright red bloody drainage
d. Continuous bubbling in the water seal tube
48. Which of the following additional assessment data should immediately be gathered to
determine the status of a client with respiratory rate of 6 breaths/min?
a. Pupil size, eye opening and breaths sounds
b. Level of consciousness and pulse oximetry value
c. Breath sound and reflexes
d. Heart sound and reflexes
49. The client had undergone total larygectomy. He has permanent tracheostomy. Which of the
nursing actions needs further intervention during tracheal suctioning?
a. The nurse dons sterile gloves and uses sterile suction catheter.
b. The nurse administers 100% oxygen before and after suctioning.
c. The nurse applies suction for 30 seconds at a time.
d. The nurse applies suction during withdrawal of the suction catheter tip.
50. A 40-year-old male returned to his room an hour ago following bronchoscopy. He is requesting
for a glass of water. The nurse must first:
a. Keep the client on NPO until order is written.
b. Check the VS.
c. Check the gag and swallowing reflexes
d. Encourage deep breathing and coughing.