Question 1

A client with a left-sided heart failure is prescribed with digoxin (Lanoxin) and furosemide (Lasix). Which of the following signs and symptoms alerts the nurse for a possible occurrence of digoxin toxicity?

Accepted Answer

Hypokalemia increases the client's risk for digoxin toxicity. Hypokalemia is manifested by absent leg cramps and muscle weakness. Option A and D indicate hypocalcemia. Option C indicates hyperkalemia.

Question 2

A 40-year-old pregnant woman presented to surgical OPD with short history of pain in the right hypochondrium radiating to the back. She also complains of nausea and vomiting associated with this episode of pain. What is the likely diagnosis?

Accepted Answer

The most likely diagnosis is Acute Cholecystits, because pain occurs in right hypochondrium or epigastrium in Acute Cholecystitis, which radiates to the back because of similar nerve supply. Moreover, nausea and vomiting are also present in Acute Cholecystitis.

Question 3

What is the definitive treatment of Cholecystitis due to Cholelithiasis?

Accepted Answer

Laproscopic or open cholecystectomy are the definitive treatment of Cholecystitis due to Cholelithiasis. Acute Cholecysitis is a medical emergency. All the three are just palliative treatment of the cholecystitis. But the definitive management of Acute Cholecystitis due to Cholelithiasis is laproscopic or open cholecystectomy. It is removed and thus treated permanently.

Question 4

A patient, with a known case of ischemic heart disease, presented to the cardiac OPD with complaints of being breathless and irritable, even at rest, and not being able to carry out daily life activities. What class of heart failure is patient suffering from?

Accepted Answer

The class of heart failure is patient suffering from is Class 4. Heart failure may be due to the disorders of cardiac filling or contractions. Heart failure leads to pulmonary and peripheral edema of the body. The stages of the heart failure are recorded according to symptoms at different levels of activity. The class of heart failure which this patient is suffering from is actually Class 4, as it is the last stage in which the patient is restless and breathless, even at rest, and cannot perform any activity.

Question 5

A patient presented with hypertensive urgency. What is the best method of decreasing the blood pressure of the patient in this condition?

Accepted Answer

The best way of decreasing blood pressure of a patient in hypertensive urgency is controlling it within a few hours because blood pressure is lowered more slowly to avoid hypotension, ischemia of vital organs, or failure of autoregulation.

Question 6

All of the following are causes of Atrial Fibrillation except:

Accepted Answer

All of the following are causes of Atrial Fibrillation except nephritic syndrome. Atrial fibrialltion is defined as the atrial beats which are uncoordinated, rapid and not well organized. This causes ineffective emptying of the artia. Different factors particularly any trauma to the heart can cause atrial fibrillation. Nephrotic syndrome is itself a different clinical entity. It has nothing to do with heart rhythm and rate, as do the other choices on the list.

Question 7

What is the immediate management of Tension Pneumothorax?

Accepted Answer

Insertion of large bore IV cannula in 2nd intercostals space is the immediate management of Tension Pneumothorax. Tension Pneumothorax is a life threatening condition where fractions of seconds are important in saving life. So, immediately large bore IV cannula should be inserted which will suddenly remove the air from the thoracic cavity and help inflate the lung.

Question 8

All of the following measures are helpful in the treatment of foreign body aspiration except:

Accepted Answer

All of the following measures are helpful in the treatment of foreign body aspiration except manual removal of foreign substance. Foreign body aspiration can cause obstruction of the Pharynx, Larynx or trachea. This can cause sudden blockade of the airway passage. It can cause asphyxia so immediate removal is necessary. All of the measures listed above are helpful in the treatment of foreign body aspiration except for the manual removal of a foreign substance.

Question 9

A physician orders increased dose of clonidine (Catapres). It is most essential for the nurse to assess for which parameter before drug administration?

Accepted Answer

Clonidine is an alpha-agonist used to lower the blood pressure. It is most essential for the nurse to check for the client's blood pressure before administering the drug. Orthostatic hypotension may occur with the initial administration of increased dose of clonidine and an existing orthostatic hypotension can cause severe reactions.

Question 10

A child presented with sharp piercing chest pain, fever, malaise, irritability, poor appetite and Dysrhythmia. He had undergone a recent surgery for valvular abnormality of the heart. What is the most likely disease to occur?

Accepted Answer

The most likely disease to occur is Pericarditis. If a child presents with sharp, piercing, chest pain, fever, malaise, irritability, poor appetite and Dysrhythmia, and has recently undergone surgery for valvular abnormality of the heart, Pericarditis is the disease most likely to occur. Pericarditis usually occurs after cardiac surgeries done for structural abnormalities. Moreover sharp, piercing, chest pain is typical for Pericarditis, as is fever, because it usually has some infective cause like virus, bacteria etc.

Question 11

A young man presents with chest discomfort, dyspnea, fatigue, pressure in epigastrium and palpitations. He had a history of viral flu a few days back. Moreover, the ECG showed non-specific changes and the lab culture had a growth of influenza virus. What is the diagnosis?

Accepted Answer

The diagnosis for an individual presenting with chest discomfort, dyspnoea, fatigue, pressure in epigastrium and palpitations, as well as a recent history of viral flu, is Myocarditis. A viral cause is common for Myocarditis, where non-specific changes in an ECG and a lab culture with a growth of influenza virus are also indicated.

Question 12

A middle-aged woman came to the emergency department with worsening dyspnea, pressure in head and increased respiratory rate. She was known to have pulmonary edema secondary to heart failure. On examination, there was tachycardia, tachypnea, and hypertension. ABGs were carried out which showed pH < 7.35, paCO₂>42 mm of HG, and H₂CO₃ was also high. What is the likely diagnosis?

Accepted Answer

The most likely diagnosis in the patient with pulmonary edema presenting with increased respiratory rates is respiratory acidosis because ph < 7.35, paCO₂ >42 mm of Hg and H₂CO₃ is also high. These, along with her symptoms of worsening dyspnea and pressure in the head are all indicators of respiratory acidosis.

Question 13

The stages of COPD can be assessed by all of the following except:

Accepted Answer

The stages of COPD can be assessed by all of the above except chest x-ray. Functional dyspnea, body mass index, and spirometry are used to assess the different stages of COPD. The spirometry helps in measuring the ratio of forced expiratory volume in the
first second of expiration after complete inhalation to total forced vital capacity. The chest x-ray has no role in defining the stages of COPD.

Question 14

A patient being managed in the pulmonology ward for COPD should get all the medications except:

Accepted Answer

A patient being managed in the pulmonology ward for COPD should get all the medications except analgesics. Analgesics have no role in relieving COPD as it is not a painful condition. The problem in this case to be managed in the pulmonology ward is that of airway constriction.

Question 15

A known hypertensive presented with the features of stroke. His systolic blood pressure was 190 mm of Hg and diastolic pressure was 120 mm of Hg. What is the next thing that should be done?

Accepted Answer

The next thing that should be done is intervene to drop the patient's blood pressure. A known hypertensive with stroke features should not receive a blood thinner because it may result in additional hemorrhagic stroke.

Question 16

After having a fight, a young man presented to the trauma center with a lacerated wound in the right chest. Patient was in severe respiratory distress. Examination showed there was tachycardia and tachypnea. Moreover, breath sounds were absent in right chest. Chest x-ray showed mediastinal shift to left. What is the most likely diagnosis?

Accepted Answer

The most likely diagnosis in this case, where patient has long history of fighting, during which he got lacerations that could have ruptured the pleura and led to pneumothorax is tension pneumothorax. Tension pneumothorax is evident from patient's dyspnea and mediastinal shift in CXR (PA).

Question 17

A patient presented to medical OPD with all the signs and symptoms of heart failure. His echocardiography showed increased right ventricle workload, right ventricle hypertrophy, displaced interventricular septum and tricuspid regurgitation. What is the most important test to confirm the diagnosis in this regard?

Accepted Answer

The most important test for patient presenting with symptoms of heart failure is right-sided cardiac catheterization because this will tell about the blood pressure in the right side of heart and will confirm the diagnosis of Pulmonary Hypertension which is responsible for all these changes in heart structure and function.

Question 18

All of the following may be the cause of primary pulmonary hypertension except:

Accepted Answer

All of the following may be the cause of primary pulmonary hypertension except COPD. Pulmonary hypertension is generally a progressive disease of the pulmonary arteries that can severely affects the cardiovascular patients. The main cause of primary pulmonary hypertension is Idiopathic but any metabolic change can cause this problem. COPD causes hypoxemia and it is the cause of secondary pulmonary hypertension, not primary.

Question 19

What is seen in the Chest x-ray of a patient suffering from Pneumonia?

Accepted Answer

Consolidation is seen in the Chest x-ray of a patient suffering from Pneumonia. Pneumonia is inflammation of the lung parenchyma which fills the alveoli with exudates. The Chest x-ray of a patient suffering with Pneumonia shows consolidation because lung parenchyma is filled with exudates and finally fibrosis occurs.

Question 20

All the statements are true about SARS (severe acute respiratory syndrome) except:

Accepted Answer

All the statements are true about SARS (severe acute respiratory syndrome) except frequent nausea and vomiting. Severe Acute Respiratory Syndrome (SARS) is caused by a corona virus and is a virulent respiratory illness. It is an air borne disease. Nausea and vomiting are not the features of SARS. All others are features of SARS.

Quiz 1: Progressive Care Nursing (PCCN)

A client with a left-sided heart failure is prescribed with digoxin (Lanoxin) and furosemide (Lasix) . Which of the following signs and symptoms alerts the nurse for a possible occurrence of digoxin toxicity?