Situation 1. Mrs. Rosa, a 56 year old was admitted to a medical-surgical unit with an exacerbation of Congestive Heart Failure (CHF).

The client presents with a past medical history of an anterior wall myocardial infarction (MI), diabetes, and hypertension. The client complains of fatigue and shortness of breath. 1. Mrs. Rosa is experiencing dyspnea. Which of the following actions is the first the nurse should perform? a. Ask the patient to lie down on the exam table. b. Draw blood for chemistry panel and arterial blood gas (ABG). c. Send the patient for a chest x-ray. d. Check blood pressure. 2. The doctor ordered medications for the patient. Which of the following drug classification should the nurse question the doctor if prescribed for a person with congestive heart failure? a. Angiotensin-converting enzyme (ACE) inhibitor b. Beta-adrenergic blocker c. Alpha-adrenergic antagonist d. Thiazolidinediones 3. Upon assessing the patient with left-sided heart failure, the nurse should expect to find: a. Crushing chest pain b. Dyspnea on exertion c. Extensive peripheral edema d. Jugular vein distention 4. Which of the following questions is most important to ask in a client with congestive heart failure who has jugular vein distention? a. At what time do you go to sleep during the night? b. How many pillows do you use when lying down? c. What do you drink before going to sleep? d. How many hours of night sleep do you have? 5. Mrs. Rosa developed hyperaldosteronism secondary to congestive heart failure. The doctor ordered to start spironolactone (Aldactone) to manage the disorder. The nurse informs the patient that the need for dosage adjustment may be necessary if which of the following medications is also being taken? a. Potassium chloride c. Warfarin sodium (Coumadin) b. Alprazolam (Xanax) d. Verapamil hydrochloride (Calan) Situation 2. A 68 year old man was brought to emergency unit. He is suspected to have coronary artery disease presents with atypical chest pain and hyperlipidemia. The client has history of cigarette smoking, hypertension, and diabetes mellitus.

6. Nurse Germaine is reviewing the assessment data of the client. Which finding would be most important for the patient to modify to lessen the risk for coronary artery disease (CAD)? a. Elevated triglyceride levels b. Elevated serum lipase levels c. Elevated low-density lipoprotien(LDL) level d. Elevated high-density lipoprotein(HDL) level 7. Nurse Charisse has the knowledge of the disease if she knows that the most commonly condition resulted in coronary artery disease is: a. Atherosclerosis c. Myocardial Infarction b. Diabetes Mellitus d. Renal failure 8. When teaching a client with coronary artery disease about nutrition, Nurse Iris should emphasize one of the following; a. Eating three balanced meals a day b. Adding comlex carbohydrates c. Avoiding heavy meals d. Limiting sodium to 7gms per day 9. The patient is scheduled for a cardiac catheterization. Following the procedure, the priority nursing action is to assess the: a. Catheter insertion site c. Potassium level b. Temperature d. Urine output 10. Which of the following actions is the first priority care for a patient exhibiting signs and symptoms of coronary artery disease? a. Decrease anxiety b. Enhance myocardial oxygenation c. Administer sublingual nitroglycerin d. Educate the patient about his symptoms. Situation 3. Mr. Bean, a 63 year old man is evaluated in the emergency department for a threeday history of increasing dyspnea. She was diagnosed with severe chronic obstructive pulmonary disease (COPD) requiring long-term oxygen therapy. His baseline PCO2 is 48mmHg. He has had increasing cough but without chest pain. 11. The doctor ordered an arterial blood gases to be dawn from Mr. Bean. Which of the following is the minimum lengh of time the nurse should plan to hold pressure on the puncture site? a. 2 minutes c. 10 minutes b. 5 minutes d. 15 minutes 12. Nurse Donver is performing assessment to Mr. Bean. Which of the following findings should he expect to observe? a. Non-productive cough

b. Prolonged inspiration c. Vesicular breath sounds d. Increased anterior-posterior chest diameter 13. Mr.Bean is taking Aminophylline drug and while taking the drug, the therapeutic level must be obtained. Laboratory results indicate that the patients serum aminophylline level is 17 mcg/mL. The nurse recognizes the aminophylline level is: a. Within therapeutic range. b. Too high and should be reported. c. Questionable and should be repeated. d. Too low to be therapeutic. 14. The patient is using an ipratropium inhaler and Nurse Ricah asked him about the proper use of the device. Which of the following statements made by the patient indicates a need for futher education regarding the use of inhaler? a. I should rinse my mouth following the two puffs to get rid of bad taste. b. I should wait at least 1 to 2 minutes between each puff of the inhaler. c. If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily. d. Because this medication is not fast-acting, I cannot use it in an emergency if my breathing gets worse. 15. Nurse Mae is preparing to estabish oxygen therapy for a patient with COPD, and the physicians prescription reads Oxygen per nasal cannula at 5L per minute. Which of the following actions should the nurse take? a. Administer the oxygen as prescribed. b. Call the physician and question the correct flow rate of the oxygen. c. Establish the oxygen as prescribed and obtain an ABG. d. Change the delivery device from a nasal cannula to a simple oxygen mask.