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Worksheets112 Cardiac/Musculoskeletal
Total questions: 82
Worksheet time: 3hrs 44mins
Name
Class
Date
1.
When do coronary arteries primarily receive blood flow?
a)
During inspiration
b)
During diastole
c)
During expiration
d)
During systole
2.
Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
a)
Plaques obstruct the vein
b)
Plaques obstruct the artery
c)
Blood clots form outside the vessel wall
d)
Hardened vessels dilate to allow the blood to flow through
3.
Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease?
a)
Decrease anxiety
b)
Administer sublingual nitroglycerin
c)
Enhance myocardial oxygenation
d)
Educate the client about his symptoms
4.
Medical treatment of coronary artery disease includes which of the following procedures?
a)
Cardiac catheterization
b)
Coronary artery bypass surgery
c)
Oral medication administration
d)
Percutaneous transluminal coronary angioplasty
5.
Which of the following landmarks is the corect one for obtaining an apical pulse?
a)
Left intercostal space, midaxillary line
b)
Left fifth intercostal space, midclavicular line
c)
Left second intercostal space, midclavicular line
d)
Left seventh intercostal space, midclavicular line
6.
Valsalva maneuver can result in bradycardia. Which of the following activities will not stimulate Valsalva’s maneuver?
a)
Use of stool softeners.
b)
Enema administration
c)
Gagging while toothbrushing.
d)
Lifting heavy objects
7.
A patient with angina pectoris is being discharged home with nitroglycerine tablets. Which of the following instructions does the nurse include in the teaching?
a)
“When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes.”
b)
“Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.”
c)
“Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 15 minutes, then go lie down.”
d)
“Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved.
8.
A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. Which action by this team member is most appropriate?
a)
Apply a heating pad to the involved site.
b)
Elevate the client’s legs 90 degrees.
c)
Instruct the client about the need for bed rest.
d)
Provide active range-of-motion exercises to both legs at least twice every shift.
9.
A client receiving heparin sodium asks the nurse how the drug works. Which of the following points would the nurse include in the explanation to the client?
a)
It dissolves existing thrombi.
b)
It prevents conversion of factors that are needed in the formation of clots.
c)
It inactivates thrombin that forms and dissolves existing thrombi.
d)
It interferes with vitamin K absorption.
10.
A 70-year-old female comes to the clinic for a routine checkup. She is 5 feet 4 inches tall and weighs 180 pounds. Her major complaint is pain in her joints. She is retired and has had to give up her volunteer work because of her discomfort. She was told her diagnosis was osteoarthritis about 5 years ago. Which would be excluded from the clinical pathway for this client?
a)
Decrease the calorie count of her daily diet
b)
Take warm baths when arising.
c)
Slide items across the floor rather than lift them.
d)
Place items so that it is necessary to bend or stretch to reach them.
11.
A client had a laminectomy and spinal fusion yesterday. Which statement is to be excluded from your plan of care?
a)
Before log rolling, place a pillow under the client’s head and a pillow between the client’s legs.
b)
Before log rolling, remove the pillow from under the client’s head and use no pillows between the client’s legs.
c)
Keep the knees slightly flexed while the client is lying in a semi-Fowler’s position in bed.
d)
Keep a pillow under the client’s head as needed for comfort.
12.
The physician orders non-weight bearing with crutches for Joy, who had surgery for a fractured hip. The most important activity to facilitate walking with crutches before ambulation begun is:
a)
Exercising the triceps, finger flexors, and elbow extensors
b)
Sitting up at the edge of the bed to help strengthen back muscles
c)
Doing isometric exercises on the unaffected leg
d)
Using the trapeze frequently for pull-ups to strengthen the biceps muscles
13.
Joey asks the nurse why he is receiving the injection of Morphine after he was hospitalized for severe anginal pain. The nurse replies that it:
a)
Will help prevent erratic heart beats
b)
Relieves pain and decreases level of anxiety
c)
Decreases anxiety
d)
Dilates coronary blood vessels
14.
An early finding in the EKG of a client with an infarcted mycardium would be:
a)
Disappearance of Q waves
b)
Elevated ST segments
c)
Absence of P wave
d)
Flattened T waves
15.
Mr. Ong is admitted to the hospital with a diagnosis of Left-sided CHF. In the assessment, the nurse should expect to find:
a)
Crushing chest pain
b)
Dyspnea on exertion
c)
Extensive peripheral edema
d)
Jugular vein distention
16.
After the acute phase of congestive heart failure, the nurse should expect the dietary management of the client to include the restriction of:
a)
magnesium
b)
sodium
c)
potassium
d)
calcium
17.
Which of the following should the nurse teach the client about the signs of digitalis toxicity?
a)
Increased appetite
b)
Elevated blood pressure
c)
Skin rash over the chest and back
d)
Visual disturbances such as seeing yellow spots
18.
The nurse is auscultating the area to the right of the sternum at the second intercostal space. The nurse is listening to which of the following valves?
a)
aortic
b)
mitral
c)
tricuspid
d)
pulmonic
19.
A client is scheduled for a cardiac catheterization. The nurse realizes that the indications for this diagnostic test would be:
a)
hypertension.
b)
peripheral edema.
c)
cerebral vascular accident.
d)
diagnose coronary artery disease.
20.
A client is learning about cholesterol. The nurse explains that the “good cholesterol” transports plasma cholesterol away from plaques and to the liver for metabolism. This type of cholesterol is called:
a)
high-density lipoprotein.
b)
low-density lipoprotein.
c)
very-high-density lipoprotein.
d)
very-low-density lipoprotein.
21.
A client has a blood pressure of 124/78 mmHg and a triglyceride level of 160 mg/dL. Based on these results, the nurse knows that the client has:
a)
an optimal blood pressure and triglyceride level.
b)
a prehypertensive blood pressure and an optimal triglyceride level.
c)
a prehypertensive blood pressure and a borderline high triglyceride level.
d)
a prehypertensive blood pressure and a borderline high triglyceride level.
22.
A client is complaining of chest pain that occurs during exercise. This pain is relieved when the client rests. The nurse realizes that this client is experiencing which type of angina?
a)
Prinzmetal’s variant angina
b)
Silent angina
c)
Stable angina
d)
Unstable angina
23.
A client diagnosed with stable angina is undergoing a 12-lead electrocardiogram. Which of the following results is not expected?
a)
ST segment depression
b)
ST segment elevation
c)
T-wave flattening
d)
T-wave inversion
24.
The nurse suspects a client’s heart is failing when which of the following heart sounds is assessed?
a)
S1
b)
S2
c)
S3
d)
S4
25.
A client is diagnosed with heart failure. Which of the following diagnostic tests is useful to determine the degree of the failure?
a)
Brain natriuretic peptide level
b)
Blood cultures
c)
Sedimentation rate
d)
Arterial blood gas
26.
Which of the following would the nurse most likely assess in a client diagnosed with right-sided heart failure?
a)
Distended neck veins
b)
Oliguria
c)
Cough with frothy blood-tinged sputum
d)
Syncope
27.
A client is experiencing an alteration in heart rate. The nurse realizes this client is experiencing a disorder of which part of the heart?
a)
Atrioventricular node
b)
Bundle branches
c)
Purkinje fibers
d)
Sinoatrial node
28.
The nurse is analyzing a client’s electrocardiogram tracing and realizes that each small square on the paper is equal to:
a)
0.04 second.
b)
0.12 second.
c)
0.20 second.
d)
0.40 second.
29.
A client is unresponsive and has no pulse. The nurse notes that the electrocardiogram tracing shows continuous large and bizarre QRS complexes measured greater than 0.12 each. This rhythm is identified as:
a)
premature ventricular complexes.
b)
torsades de pointes.
c)
ventricular fibrillation.
d)
ventricular tachycardia.
30.
When instructing a client on ways to lower his cholesterol levels, which of the following should the nurse include?
a)
Eat more meat and eggs.
b)
Consume less meat and eggs.
c)
Incorporate more vegetables.
d)
Limit fruits.
31.
A client receiving a heparin infusion is demonstrating signs of acute bleeding. Which of the following should the nurse prepare to administer to this client?
a)
Aspirin
b)
Vitamin K
c)
Protamine Sulfate
d)
Narcan
32.
The nurse is instructing a client on the impact of cigarette smoking and the development of hypertension. Which of the following would not be appropriate for the nurse to include in these instructions?
a)
Tobacco damages the lining of the artery walls.
b)
Tobacco temporarily constricts blood vessels, increasing pulse and blood pressure.
c)
Tobacco thins the blood and makes the person at risk for bleeding.
d)
Carbon monoxide in tobacco smoke replaces the oxygen in the blood, forcing the heart to work harder to supply oxygen.
33.
A client is being treated for a fractured scapula. The nurse realizes that the scapula is what kind of bone type?
a)
flat
b)
irregular
c)
long
d)
short
34.
A school age child has sustained a fractured femur. When assessing the location of the break, the area that could cause the most concern would be the:
a)
diaphysis.
b)
epiphyseal plate.
c)
medullary cavity.
d)
metaphysis.
35.
A client is experiencing an increase in resorption of bone. The nurse realizes that which of the following bone cells is responsible for this function?
a)
Osteoblasts
b)
Osteoclasts
c)
Osteocytes
d)
Osteomasts
36.
A client is experiencing unstable hip joints with ambulation. The nurse suspects that a disorder is occurring within the strong bands of connective tissue that attach bone to bone or the:
a)
bursae
b)
cartillage
c)
ligaments
d)
tendons
37.
A client, recovering from a fractured arm, is scheduled for an x-ray 3 weeks after the injury. The nurse explains to the client that the purpose of this x-ray is to:
a)
evaluate the ossification stage of bone healing.
b)
determine the presence of a callus.
c)
assess if fibroblasts have invaded the fracture site.
d)
determine if a hematoma has formed at the fracture site.
38.
The nurse is instructing a client diagnosed with osteoarthritis. Which of the following statements indicates that the client understands these instructions?
a)
“Exercise will not be of help because it will stress my joints.”
b)
“I will need to lose weight; my doctor says about 20 pounds.”
c)
“I will take my medications only if the pain is very bad.”
d)
“I can still go on my marathon shopping trips with my daughter.”
39.
The nurse is teaching a group of community members at the senior center about osteoporosis. Which of the following clinical manifestations should the nurse instruct as not being related to the disorder?
a)
decrease in height
b)
fractures
c)
kyphosis
d)
pain
40.
During an assessment, the nurse determines that a client has a forward curvature of the thoracic spine. Which of the following terms would the nurse use to document this assessment finding?
a)
kyphosis
b)
lordosis
c)
scoliosis
d)
Spondylolisthesis
41.
The nurse is assessing a client who is demonstrating clinical manifestations of Paget’s disease. The nurse realizes that which of the following diagnostic tests will aid in the diagnosis of this disorder?
a)
Chest x-ray
b)
Hand x-ray
c)
Serum albumin level
d)
Serum alkaline phosphatase level
42.
A client, experiencing a fractured arm, asks the nurse why the splint is being applied. Which of the following should the nurse respond to this client?
a)
“It reduces the need for a cast.”
b)
“It reduces bleeding, swelling and pain.”
c)
“It prevents the need for surgery.”
d)
“It immobilizes the muscles and joints.”
43.
A client has had a cast applied to immobilize a right ulnar fracture. Which of the following nursing interventions is most important?
a)
Calling physical therapy for a sling
b)
Checking capillary refill time
c)
Giving pain medication
d)
Starting discharge teaching
44.
A client with a right arm cast is experiencing signs of a serious complication. Which of the following would cause the nurse the most concern?
a)
Capillary refill time less than 3 seconds
b)
Finger movement
c)
Itching under the cast
d)
Severe pain to the right arm continues after receiving pain medication
45.
A client with an ankle sprain is instructed to follow RICE. Which of the following should the nurse instruct the client regarding this process?
a)
“Maintain your normal level of activity.”
b)
“Apply ice to the ankle once a day.”
c)
“Apply an elastic bandage to the site.”
d)
“Elevate the extremity every day for 20 to 30 minutes.”
46.
A 12 year old is suspected of having rheumatic heart disease. What factors would indicate that this child has this disease?
a)
The onset of symptoms occurs around 20 days after streptococcus throat infection or scarlet fever.
b)
The child lives in the most common area of the western United States.
c)
The disease produces lesions in the mouth and oropharynx.
d)
The disease results in damage to the peripheral sensory nerves.
47.
The nurse caring for a child with a diagnosis of rheumatic fever should assess the child for which finding?
a)
Sore throat
b)
Elevated blood pressure
c)
Desquamation of the fingers and toes
d)
Tender, warm, inflamed joints
48.
When caring for the child with Kawasaki disease, what should the nurse know to provide safe and effective care?
a)
Aspirin is contraindicated.
b)
The principal area of involvement is the joints.
c)
The child’s fever is usually responsive to antibiotics within 48 hours.
d)
Therapeutic management includes administration of gamma globulin and salicylates.
49.
Nursing care of the child with Kawasaki disease is challenging because of which occurrence?
a)
The child’s irritability
b)
Predictable disease course
c)
Complex antibiotic therapy
d)
The child’s ongoing requests for food
50.
Which statement indicates the nurse understands blood flow? Oxygenated blood flows through the:
a)
superior vena cava
b)
pulmonary veins
c)
pulmonary artery
d)
cardiac veins
51.
A 65-year-old male is transported to the ER for chest pain. An electrocardiogram reveals a prolonged QRS interval. What is the nurse monitoring when the nurse observes the QRS complex on the electrocardiogram? The QRS complex reflects:
a)
ventricular activity
b)
pulmonary artery closure
c)
mitral valve opening
d)
aortic valve closing
52.
A 50-year-old female received trauma to the chest that caused severe impairment of the primary pacemaker cells of the heart. Which of the following areas received the greatest damage?
a)
Atrioventricular (AV) node
b)
Sinoatrial (SA) node
c)
Bundle of His
d)
Ventricles
53.
Which information by the nurse indicates a good understanding of depolarization? Depolarization of a cardiac muscle cell occurs as the result of:
a)
A decrease in the permeability of the cell membrane to ions
b)
The rapid movement of ions across the cell membrane
c)
A blockade by calcium ions
d)
Stimuli instigated during the refractory period
54.
A cardiologist is teaching about the period that follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated. What is the cardiologist describing?
a)
absolute refractory
b)
hyperpolarization
c)
resting
d)
threshold
55.
The _____ represents the sum of all ventricular muscle cell depolarization.
a)
PR interval
b)
QRS complex
c)
QT interval
d)
P wave
56.
The nurse teaches the patient being evaluated for rhythm disturbances with a Holter monitor to
a)
exercise more than usual while the monitor is in place.
b)
remove the electrodes when taking a shower or tub bath.
c)
keep a diary of daily activities while the monitor is worn.
d)
connect the recorder to a telephone transmitter once daily.
57.
Which information collected by the nurse who is admitting a patient with chest pain suggests that the pain is caused by an acute myocardial infarction (AMI)?
a)
The pain increases with deep breathing.
b)
The pain has persisted longer than 30 minutes.
c)
The pain worsens when the patient raises the arms.
d)
The pain is relieved after the patient takes nitroglycerin.
58.
A patient with a non–ST-segment-elevation myocardial infarction (NSTEMI) is receiving heparin. What is the purpose of the heparin?
a)
Platelet aggregation is enhanced by IV heparin infusion.
b)
Heparin will dissolve the clot that is blocking blood flow to the heart.
c)
Coronary artery plaque size and adherence are decreased with heparin.
d)
Heparin will prevent the development of new clots in the coronary arteries.
59.
After the nurse teaches a patient with chronic stable angina about how to use the prescribed short-acting and long-acting nitrates, which statement by the patient indicates that the teaching has been effective?
a)
“I will put on the nitroglycerin patch as soon as I develop any chest pain.”
b)
“I will check the pulse rate in my wrist just before I take any nitroglycerin.”
c)
“I will be sure to remove the nitroglycerin patch before using any sublingual nitroglycerin.”
d)
“I will stop what I am doing and sit down before I put the nitroglycerin under my tongue.”
60.
A patient with knee pain who is diagnosed with bursitis asks the nurse to explain just what bursitis is. The nurse will respond that bursitis is an inflammation of
a)
a small, fluid-filled sac found at many joints.
b)
the synovial membrane that lines the joint area.
c)
the fibrocartilage that acts as a shock absorber in the knee joint.
d)
any connective tissue that is found supporting the joints of the body.
61.
When assessing a 64-year-old woman, the nurse notes that the patient has lost 1 inch in height since the previous visit 2 years ago. The nurse will plan to teach the patient about
a)
discography studies.
b)
myelographic testing.
c)
magnetic resonance imaging (MRI).
d)
dual-energy x-ray absorptiometry (DEXA).
62.
When counseling an older patient about ways to prevent fractures, which information will the nurse include?
a)
Tack down scatter rugs in the home.
b)
Most falls happen outside the home.
c)
Buy shoes that provide good support and are comfortable to wear.
d)
Range-of-motion exercises should be taught by a physical therapist.
63.
Which information will the nurse include when discharging a patient with a sprained wrist from the emergency department?
a)
Keep the wrist loosely wrapped with gauze.
b)
Apply a heating pad to reduce muscle spasms.
c)
Use pillows to elevate the arm above the heart.
d)
Gently move the wrist through the range of motion.
64.
A patient with a comminuted fracture of the right femur has Buck’s traction in place while waiting for surgery. To assess for pressure areas on the patient’s back and sacral area and to provide skin care, the nurse should
a)
loosen the traction and have the patient turn onto the unaffected side.
b)
place a pillow between the patient’s legs and turn gently to each side.
c)
turn the patient partially to each side with the assistance of another nurse.
d)
have the patient lift the buttocks by bending and pushing with the left leg.
65.
A patient has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should
a)
keep the left arm in a dependent position.
b)
handle the cast with the palms of the hands.
c)
place gauze around the cast edge to pad any roughness.
d)
cover the cast with a small blanket to absorb the dampness.
66.
Which of the following observations made by the nurse who is evaluating the crutch-walking technique of a patient who is to have no weight bearing on the right leg indicates that the patient can safely ambulate independently?
a)
The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.
b)
The patient advances the right leg and both crutches together and then advances the left leg.
c)
The patient moves the left crutch with the left leg and then the right crutch with the right leg.
d)
The patient uses the bedside chair to assist in balance as needed when ambulating in the room.
67.
A patient who has had an open reduction and internal fixation (ORIF) of left lower leg fractures complains of constant severe pain in the leg, which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which action should the nurse take next?
a)
Notify the health care provider.
b)
Assess the incision for redness.
c)
Reposition the left leg on pillows.
d)
Check the patient’s blood pressure.
68.
Which action will the nurse take in order to evaluate the effectiveness of Buck’s traction for a patient who has an intracapsular fracture of the left femur?
a)
Assess for hip contractures.
b)
Monitor for hip dislocation.
c)
Check the peripheral pulses.
d)
Ask about left hip pain level.
69.
On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. Which action is best for the nurse to take?
a)
Explain the reasons for the phantom limb pain.
b)
Administer prescribed analgesics to relieve the pain.
c)
Loosen the compression bandage to decrease incisional pressure.
d)
Remind the patient that this phantom pain will diminish over time.
70.
Following a motor vehicle accident, a patient arrives in the emergency department with massive right lower leg swelling. Which action will the nurse take first?
a)
Elevate the leg on pillows.
b)
Apply a compression bandage.
c)
Check leg pulses and sensation.
d)
Place ice packs on the lower leg.
71.
Which menu choice by a patient with osteoporosis indicates that the nurse’s teaching about appropriate diet has been effective?
a)
Pancakes with syrup and bacon
b)
Whole wheat toast and fruit jelly
c)
Two-egg omelet and a half grapefruit
d)
Oatmeal with skim milk and fruit yogurt
72.
A nurse is discussing the different phases of bone remodeling. Which information should be included? Phase 2 of the bone remodeling cycle involves bone:
a)
formation
b)
activation
c)
resorption
d)
fracturing
73.
The nurse observed the patient’s muscle contracted, but the limb did not move. How should the nurse chart this muscle contraction?
a)
Isotonic contraction
b)
Isometric contraction
c)
Eccentric contraction
d)
Concentric contraction
74.
A 65-year-old Hispanic female is admitted to the hospital with a pathologic, compound, transverse fracture of the femur. Which of the following statements best describes this type of fracture?
a)
The fracture line is parallel to the bone.
b)
The fracture line is straight across the bone.
c)
The fracture line is perpendicular to the bone.
d)
The fracture line is vertical to the shaft of the bone.
75.
A 35-year-old female suffers a broken clavicle following a motor vehicle accident. X-ray reveals that the bone surfaces in the joint partially lost contact with each other. This condition is called:
a)
dislocation
b)
subluxation
c)
distortion
d)
nonunion
76.
A 12-year-old female hurts her ankle while playing basketball. Tests reveal that she tore a ligament. This condition is known as a:
a)
sprain
b)
strain
c)
disunion
d)
subluxation
77.
A 70-year-old female presents with a hip fracture secondary to osteoporosis. This condition is caused by an increase in bone:
a)
density
b)
formation
c)
resorption
d)
mineralization
78.
A 70-year-old female presents with a hip fracture. She is diagnosed with osteoporosis. One factor that most likely contributed to her condition is:
a)
Increased androgen levels
b)
Decreased estrogen levels
c)
Strenuous exercise
d)
Excessive dietary calcium
79.
What should the nurse do to reduce the effort of moving a heavy object?
a)
Bring the feet close together and flex the knees
b)
Keep the back straight and bend at the waist
c)
Widen the base of support in the direction of movement
d)
Broaden the base of support and twist toward the direction of movement
80.
Which of the following describes a Colles’ fracture?
a)
The distal radius is broken.
b)
The distal fibula is broken.
c)
A vertebra appears crushed.
d)
A spontaneous fracture occurs in weakened bone.
81.
How is Duchenne’s muscular dystrophy inherited?
a)
Autosomal recessive gene
b)
X-linked recessive gene
c)
Autosomal dominant gene
d)
Codominant gene
82.
A dislocation is:
a)
the tearing of a tendon in the joint.
b)
the separation of bones in the joint with a loss of contact.
c)
the twisting of a joint, causing excessive inflammation of the surrounding tissue.
d)
the overstressing of ligaments, causing loss of elasticity.
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