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NSM Mock Exam #4

Total questions: 50

Worksheet time: 28mins

Name
Class
Date
1.

Which alteration could be made to a patient's regimen if the patient is currently receiving furosemide and has a potassium level of 3.1 mEq/L?

a)

No changes needed.

b)

Switch to spironolactone.

c)

Switch to acetazolamide and mannitol.

d)

Switch to hydrochlorothiazide.

2.

Which patient assessment would help a nurse in evaluating the therapeutic effects of a calcium channel blocker for angina?

a)

Absence of chest pain

b)

Patient denies dizziness

c)

Reduced dyspnea

d)

Decreased swelling in the ankles and feet

3.

Which explanation describes how anticoagulants work?

a)

Anticoagulants dissolve clots.

b)

Anticoagulants alter platelet fucntion.

c)

Anticoagulants prevent clots from forming.

d)

Anticoagulants interfere with drug metabolism.

4.

Which instruction does a nurse provide a patient who reports headaches associated with administration of sublingual nitroglycerin?

a)

"Stop taking the tablets immediately."

b)

"These headaches will subside over time."

c)

"You should take a lower dose of the drug."

d)

"You should immediately undergo diagnostic testing."

5.

Which statement by the nurse explains the reason for discontinuing aspirin 7 days before surgery?

a)

"Aspirin has prolonged anti-platelet activity."

b)

"Aspirin can interact with the anesthesia."

c)

"Aspirin has prolonged anticoagulant activity."

d)

"Aspirin can interact with postoperative pain medication."

6.

Which drug will a nurse expect the health care provider to prescribe for a patient receiving digoxin who reports a headache, dizziness, nausea, and blurred vision and also has a pulse rate of 45 bpm?

a)

Milrinone

b)

Nesiritide

c)

Dobutamine

d)

Digoxin-immune Fab

7.

Which assessment will the nurse make before administering nitroglycerin?

a)

Assess blood pressure

b)

Assess serum electrolytes

c)

Monitor level of consciousness

d)

Measure blood urea nitrogen and creatinine

8.

Your patient is taking simvastatin. Which of the following findings below demonstrate this medication is providing therapeutic effects to this patient? Select-all-that-apply:

a)

HDL 80 mg/dL

b)

LDL 72 mg/dL

c)

HDL 30 mg/dL

d)

LDL 190 mg/dL

9.

You're providing education to a group of participants in the community about cholesterol and cardiac disease. Which statements below verbalized by some of the participants are inaccurate and require you to provide clarification?

a)

"HDL levels should be less than 60 mg/dL to maintain good cardiac health."

b)

"LDL is a fatty substance that sticks to vessels walls and can lead to atherosclerosis."

c)

"HDL is fatty substance that helps remove low-density lipoprotein from the blood it doesn't have the chance to stick to vessel walls."

d)

"LDL levels should be greater than 100 mg/dL to maintain good cardiac health."

10.

A patient is prescribed a calcium channel blocker and Digoxin. Which findings would require the nurse to hold further doses of the medications and to immediately notify the physician? Select all that apply:

a)

The patient reports seeing yellow-greenish halos and is vomiting.

b)

The patient reports flushing and has enlargement of the gums.

c)

The patient's heart rate is regular and 80 beats per minute.

d)

The patient's Digoxin level is 3 ng/mL.

11.

The physician prescribes the patient a potassium-sparing diuretic. Which statement below best describes how this medication works to cause diuresis?

a)

These medications work to inhibit the sodium-chloride cotransporter in the early part of the distal convoluted tubule.

b)

These medications work to inhibit the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle.

c)

These medications work to inhibit the sodium potassium exchange within the sodium channels in the distal tubule and collecting duct.

d)

These medications work to inhibit the sodium channels within the proximal convoluted tubule by decreasing sodium reabsorption. .

12.

Which potassium-sparing diuretics are known to antagonize aldosterone in order to cause diuresis? Select all that apply:

a)

Triamterene

b)

Spironolactone

c)

Amiloride

d)

Eplerenone

13.

A patient is currently taking a potassium-sparing diuretic. The patient is experiencing EKG changes with tall-peaked T-waves, nausea, diarrhea, and paresthesia. The patient's morning lab results are back and the nurse makes it priority to check what lab result?

a)

Calcium

b)

Potassium

c)

Magnesium

d)

Sodium

14.

A patient has a dose of Spironolactone due at 1000. Which finding below would require the nurse to hold the dose and notify the physician for further orders?

a)

Magnesium 1.5 mg/dL

b)

BUN 18

c)

Sodium 140 mEq/L

d)

Potassium 7 mEq/L

15.

True of False: Thiazide diuretics are more potent than loop diuretics and provide immediate diuresis effects.

a)

True

b)

False

16.

Your patient is prescribed hydrochlorothiazide (HCTZ). The patient's potassium level is 2 mEq/L. What medication below should the nurse hold and notify the physician for further orders?

a)

Dilantin

b)

Digoxin

c)

Warfarin

d)

Litium

17.

Based on your nursing knowledge of how thiazide diuretics work, which patient below would benefit from these types of medications.

a)

A patient with a GFR of less than 15 cc/hr

b)

A patient with primary hypertension

c)

A patient with heart failure and frequent gout attacks

d)

A patient with diabetes that has uncontrolled hyperglycemia

18.

You're developing a plan of care for a patient with heart failure that will be prescribed a thiazide diuretic. What nursing interventions will you include in this patient's plan of care? Select all that apply.

a)

Encourage the patient to limit the consumption of bananas, avocados, spinach, strawberries, and potatoes.

b)

Measure the patient’s intake and output daily.

c)

Weigh the patient daily using a bedside scale.

d)

Assess lab results for electrolyte imbalances like hypercalcemia and hyperkalemia

19.

You’re providing discharge teaching to a patient who will be taking a thiazide diuretic for the treatment of hypertension. You note that the patient has type I diabetes. What statement by the patient represents they misunderstood your teaching points about this medication and requires you reinforce some of the education pieces?

a)

“I must monitor my blood glucose closely while taking this medication.”

b)

"This medication can cause sudden and severe drops in my blood glucose.”

c)

“I will try my best to eat a diet that includes foods rich in potassium.”

d)

“I will report to my physician if I experience excessive thirst, little or no urination, and extreme fatigue.”

20.

Your patient is ordered a loop diuretic at 1300. Which finding below would require you to hold the dose and notify the physician for further orders?

a)

Calcium level 9mg/L

b)

Potassium level 1.5 mEq/L

c)

Blood pressure 102/78

d)

Sodium level 144

21.

Which patients below may be prescribed a loop diuretic based on their diagnosis? Select all that apply:

a)

A 58-year-old male with congestive heart failure.

b)

A 69-year-old female with pulmonary edema.

c)

A 45-year-old male with hypercalcemia.

d)

A 50-year-old male experiencing a gout attack.

22.

You're educating a group of new nurse graduates about loop diuretics. One topic you discuss is ototoxicity. You ask the new nurses to explain how to prevent this adverse side effect in a patient prescribed a loop diuretic. Which response by one of the new nurses is correct?

a)

"Always administer intravenous loop diuretics slowly."

b)

"Monitor for signs and symptoms of low potassium levels because this increases the risk of inner ear damage while taking loop diuretics."

c)

"Administer the medication with meals."

d)

"Avoid administering loop diuretics with a tetracycline."

23.

What electrolyte imbalances would the nurse monitor for in the patient who is taking a loop diuretic? Select all that apply:

a)

Hyperkalemia

b)

Hypocalcemia

c)

Hypernatremia

d)

Hypokalemia

e)

Hypomagnesemia

24.

A physician writes a new medication order for a patient who has cardiovascular disease. The medication is an angiotensin II receptor blocker (ARB). What new medication on the patient’s scheduled medication list is an ARB?

a)

Metoprolol

b)

Losartan

c)

Lisinopril

d)

Nicardipine

25.

As the nurse you know to tell the patient that the best way to PREVENT rebound hypertension while taking an Angiotensin II Receptor Blocker (ARB) is to?

a)

assess the blood pressure daily with a self-monitoring device

b)

never abruptly stop taking the medication

c)

avoid taking the medication with milk or grapefruit juice

d)

avoid taking over-the-counter medications

26.

Some patients who take ACE Inhibitors may develop angioedema. What signs and symptoms will you teach the patient to recognize that can present with this adverse reaction? Select all that apply:

a)

Hyper kalemia

b)

Persistent, dry cough

c)

Swelling in the face

d)

Thin and shiny skin in the lower extremities

e)

Difficulty breathing

27.

A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE Inhibitor. The patient is not experiencing any other signs and symptoms. As the nurse, your response is?

a)

Tell the patient to immediately stop taking the medication and seek medical treatment

b)

Reassure the patient this is a harmless side effect of this medication and to not abruptly stop taking the medication.

c)

Recommend the patient start taking the medication at night to decrease the coughing.

d)

Reassure the patient that the cough will disappear within 6 months of taking the medication.

28.

A patient is taking an ACE inhibitor and Spironolactone. It is the priority the nurse teaches the patient?

a)

To avoid consuming alcoholic beverages

b)

To limit foods high in potassium

c)

To limit salt intake

d)

To take the medications with food

29.

A patient is taking Digoxin. What medication on the patient’s medication list increases the patient’s risk of experiencing Digoxin toxicity?

a)

Furosemide

b)

Metformin

c)

Nitroglycerin

d)

Warfarin

30.

Your patient, who is 55-years-old, is prescribed to take Digoxin. What patient finding requires that the nurse hold the dose of Digoxin and notify the physician?

a)

Digoxin level of 1.2 ng/mL

b)

Blood glucose of 82

c)

Heart rate of 69

d)

Potassium 2.7 mEq/L

31.

Digoxin, a cardiac glycoside, is a positive inotrope. You understand this as

a)

Increases the heart rate

b)

It Increases preload

c)

It increases contraction stroke volume

d)

Increases the heart rate AND the contraction stroke volume

32.

The following are uses for digoxin. Select all that apply:

a)

Primary drug for heart failure

b)

Atrial fibrillation

c)

Hypertension

d)

Rapid contraction dysrhythmias

33.

A patient taking digoxin on assessment, has a pulse rate of 50 BPM, and complains of blurred vision. What actions are anticipated?

a)

further assessment to determine cause

b)

A doctor’s order for an alternative drug

c)

A doctor’s order for more observation

d)

A doctor’s order for digoxin-immune Fab

34.

Nitrates, as antianginals cause coronary vasodilations, but can also cause the following. Select all that apply.

a)

Headache

b)

Hypotension

c)

Dizziness

d)

Weakness

35.

A nurse peer tells a patient not to discontinue beta blockers or calcium blockers abruptly, nor without HCP approval. You understand that your coworker is warning patient against:

a)

digitalis toxicity

b)

Dizziness effects

c)

Possible heart block

d)

Rebound effect

36.

When administering a nitrate, what position should the patient be in?

a)

Standing

b)

Sitting

c)

Lying down

d)

Does not matter

e)

Sitting or lying down

37.

In administering Beta Blockers, why are cardiac selective beta blockers preferred over non-selective?

a)

There is decreased risk of cardiac poisoning

b)

Severe dysrhythmias are avoided

c)

There is reduced risk of bronchospasm

d)

It is inexpensive

38.

What is an important patient teaching for a patient on aspirin who has an upcoming surgery scheduled

a)

stop taking aspirin the night before

b)

reduce the dosage of aspirin two weeks before

c)

discontinue aspirin seven days before

d)

continue taking as prescribed

39.

Thiazide diuretics would be contraindicated in which of the following? Select all the apply.

a)

A patient with high blood glucose levels

b)

A patient with elevated BUN

c)

A patient with decreased urine output

d)

A patient with elevated serum creatinine

40.

Hydrochlorothiazide diuretic is being administered with lithium. As a nurse what are you most concerned about:

a)

the impact on blood sugar

b)

tachycardia

c)

lithium toxicity

d)

respiratory failure

41.

In administration of heparin, an anticoagulant, you as the nurse would watch out for the following side effects and adverse effects . Select all that apply.

a)

Petechiae

b)

hematuria

c)

GI bleeding

d)

Ecchymosis

42.

Maintenance therapeutic INR levels for warfarin is:

a)

1-5

b)

2-3

c)

2-5

d)

2-4

43.

Your patient has an INR of 5.5, as the nurse what is your priority action?

a)

Decrease heparin dose

b)

Decrease warfarin dose

c)

Give protamine sulfate

d)

give vitamin K

44.

Which of the following statements made by a nursing student regarding heparin requires further teaching?

a)

it acts prophylactically to prevent clots

b)

it binds with antithrombin III for anticoagulation

c)

it inhibits conversion of fibrinogen to fibrin

d)

dissolves formed clots

45.

You understand that excessive bleeding caused by heparin requires which of these reversal agents?

a)

vitamin K

b)

naloxone

c)

protamine sulfate

d)

enoxaparin

46.

The patient takes sublingual nitroglycerin tablets for cardiac pain as prescribed and 5 minutes later, the pain still persists. What is the recommended action by the patient?

a)

Take another dose of the drug

b)

Take an isosorbide nitrate

c)

Call 911

d)

Take isosorbide nitrate then call 911

47.

How are you feeling about this test?

a)

I feel pretty good.

b)

It's a nursing exam, I never feel good about a test!

c)

I just started studying today.

d)

I've studied all day every day and it just won't stick!

48.

What nursing area are you hoping to go into?

a)

Undecided

b)

Clinic/out of hospital setting

c)

Pediatrics/OB

d)

Adult hospital care

e)

Other

49.

Did you know that we are hiring more NSMs for next semester?? You get lots of great training, flexible hours, and it's a great way to review material for NCLEX and you get to make friends!

a)

I did know that, but I am not interested.

b)

I am interested but I don't think I would be good at it.

c)

What's an NSM?

d)

Sign me up! I want this cool job!

50.

Drugs that end in (-lol), (-pril), (-sartan) come from which three drug classes?


(Choose the answer that lists them in order correctly.)

a)

beta blockers

angiotensin II receptor blockers

angiotensin converting enzyme inhibitors

b)

beta blockers

angiotensin converting enzyme inhibitors

angiotensin II receptor blockers

c)

angiotensin converting enzyme inhibitors

beta blockers

angiotensin II receptor blockers

d)

angiotensin II receptor blockers

beta blockers

angiotensin converting enzyme inhibitors