heart failure
A patient on lisinopril develops a persistent cough. The nurse anticipates which change in treatment?
A. Discontinue ACE inhibitor and start an ARB (e.g., losartan).
B. Reduce the dose of lisinopril and reassess.
C. Add a beta-blocker to counteract the cough.
D. Continue lisinopril; cough is expected and will resolve.
A. Rationale: ACE inhibitors can cause ACE-cough; change to ARB is appropriate if cough is bothersome.
Which patient is the best candidate for percutaneous valve repair/replacement (TAVR) instead of surgical valve replacement?
A. Young patient with bicuspid aortic valve and few comorbidities.
B. Patient with severe aortic stenosis and prohibitive surgical risk.
C. Patient needing multi-vessel CABG in addition to valve replacement.
D. Patient with active endocarditis.
B.
Rationale: TAVR is indicated for patients with high/prohibitive surgical risk; young patients and those with concomitant CABG needs or endocarditis may not be ideal.
Which are risk factors for VTE? (Select all)
A. Recent major surgery within 3 months.
B. Long-distance travel with immobility.
C. Active cancer.
D. Use of compression stockings.
A, B, C. Rationale: Surgery, immobility, active malignancy increase VTE risk. Compression stockings are protective, not risk.
A trauma patient has massive hemorrhage. According to the 3:1 crystalloid rule, how much isotonic crystalloid should be initially given for 1,000 mL blood loss?
A. 250 mL
B. 1,000 mL
C. 3,000 mL
D. 100 mL
C.
Rationale: The 3:1 rule suggests 3 mL crystalloid per 1 mL blood lost (initial resuscitation guideline).
For wound care of venous stasis ulcers or burn graft donor sites, appropriate choices include: (Select all)
A. Use of moist wound dressings (hydrocolloids/hydrogels).
B. Avoiding any debridement if necrotic tissue present.
C. Regular assessment for infection and debridement as needed.
D. Pressure offloading, compression (for venous ulcers) as ordered.
A, C, D.
Rationale: Moist dressings, timely debridement, and compression/pressure offloading (for venous wounds) are recommended. Necrotic tissue requires debridement.
Patient teaching for HF should include which items? (Select all that apply.)
A. Daily weights and when to call provider (3 lb/2 days or 5 lb/week).
B. Maintain sodium intake under 2 g/day.
C. Stop taking potassium supplements if on ACE inhibitors.
D. Alternate rest with exercise; enroll in cardiac rehab.
E. Avoid all fluids.
A, B, D. Rationale: Daily weights, sodium restriction, graded activity are correct. Potassium supplements aren’t always contraindicated and should be discussed with provider. "Avoid all fluids" is incorrect — fluid restrictions are individualized.
A patient with severe aortic regurgitation often has which pulse finding?
A. Weak, thready pulse.
B. Pulsus paradoxus.
C. Bounding (water-hammer) pulse with wide pulse pressure.
D. Pulsus alternans.
C.
Rationale: AR causes wide pulse pressure and bounding pulses due to large stroke volume and regurgitation.
A patient with abdominal aortic aneurysm (AAA) presents with sudden severe back pain, hypotension, and a pulsatile abdominal mass. The nurse should:
A. Obtain abdominal x-ray.
B. Prepare for immediate surgical repair and notify the surgical team.
C. Position patient supine with legs elevated.
D. Start PO analgesic and observe.
B.
Rationale: These are signs of ruptured AAA — surgical emergency requiring immediate operative intervention.
The “one-hour bundle” for sepsis includes all EXCEPT:
A. Measure lactate and remeasure if >2 mmol/L.
B. Obtain blood cultures prior to antibiotics.
C. Start broad-spectrum antibiotics within 1 hour.
D. Wait to obtain IV access before initiating oxygenation/airway support.
D.
Rationale: Oxygenation/airway support and early fluid resuscitation are urgent; do NOT delay life-saving measures.
The classic finding of full-thickness (third-degree) burn includes:
A. Wet, blistering, very painful tissue.
B. Dry, leathery, insensate eschar with little pain.
C. Superficial erythema only.
D. Tender, weeping tissue that heals in days.
B.
Rationale: Full-thickness destroys nerves producing little/no pain; eschar is dry and leathery.
A patient with chronic heart failure has sudden worsening dyspnea, pink frothy sputum, crackles throughout both lungs, and BP 180/100 mmHg. Which action should the nurse take first?
A. Administer intravenous furosemide.
B. Elevate the head of bed and give oxygen.
C. Prepare for intubation and mechanical ventilation.
D. Give sublingual nitroglycerin.
B. Rationale: Immediate priority is airway and oxygenation; sitting up and high-flow O₂ improves gas exchange and reduces venous return. (Diuretics and vasodilators follow after stabilizing airway/oxygenation.)
Which are true about drug-eluting stents (DES) compared to bare metal stents (BMS)? (Select all that apply.)
A. DES reduce restenosis risk by releasing antiproliferative drugs.
B. Dual antiplatelet therapy is often required for longer after DES.
C. DES can be used without antiplatelet therapy.
D. DES increase the immediate risk of stent thrombosis compared to BMS.
A, B.
Rationale: DES reduce restenosis but require prolonged DAPT; they do not obviate antiplatelet therapy nor necessarily increase immediate thrombosis risk if DAPT used.
A patient on warfarin therapy for VTE asks why a heparin bridge was needed initially. The best explanation is:
A. Heparin and warfarin act the same; bridging is unnecessary.
B. Warfarin takes several days to have therapeutic anticoagulation; heparin provides immediate effect.
C. Heparin was used to reverse warfarin.
D. Bridging decreases bleeding risk.
B.
Rationale: Warfarin inhibits vitamin K-dependent clotting factor synthesis and requires overlap until INR therapeutic; heparin provides immediate anticoagulation.
Which interventions are appropriate in managing hypovolemic shock? (Select all)
A. Rapid infusion of isotonic crystalloids (e.g., normal saline).
B. Vasopressors as first-line before fluids.
C. Control source of hemorrhage.
D. Blood transfusion for significant blood loss.
A, C, D.
Rationale: Fluid resuscitation, hemorrhage control, and transfusion when indicated are key. Vasopressors are used if hypotension persists after volume resuscitation.
Which immediate prehospital actions are appropriate for thermal burn? (Select all)
A. Remove person from source and stop burning process.
B. Apply ice directly to the burn.
C. Cover burns with clean sterile cloth and conserve body heat.
D. Start IV fluids if available.
A, C, D.
Rationale: Remove source, cover, conserve heat, and start IV access. Ice is contraindicated (causes vasoconstriction).
Which compensatory mechanisms occur in CHF? (Select all that apply.)
A. Activation of RAAS
B. Increased natriuretic peptide secretion
C. Sympathetic nervous system activation
D. Decreased ventricular preload permanently improves CO
E. Ventricular dilation and hypertrophy
A, B, C, E. Rationale: RAAS and SNS activation and ventricular remodeling occur; natriuretic peptides rise in response. Ventricular dilation initially helps but later decreases contractility — D is false as a permanent improvement.
Aortic stenosis causes which pathophysiologic change in the left ventricle?
A. Volume overload leading to dilation.
B. Pressure overload leading to concentric hypertrophy.
C. Right ventricular failure due to pulmonary congestion.
D. Loss of systolic function first, then hypertrophy.
B.
Rationale: AS causes pressure overload; LV hypertrophies concentrically to generate higher pressures.
Which medication is indicated to reduce symptoms of intermittent claudication?
A. Pentoxifylline.
B. Heparin.
C. Warfarin.
D. Nifedipine.
A.
Rationale: Pentoxifylline improves RBC deformability and may reduce claudication symptoms.
A patient with anaphylactic shock after bee sting has stridor, facial swelling, hypotension, and wheezing. Immediate priority is:
A. Epinephrine IM or IV as indicated and secure airway.
B. IV antibiotics.
C. Immediate anticoagulation.
D. Elevate legs only.
A.
Rationale: Epinephrine is first-line for anaphylaxis (bronchodilation, vasoconstriction, reduces edema); airway management is critical.
A patient has partial-thickness burns to entire anterior torso and both anterior legs. Using Rule of Nines (adult), approximate %TBSA burned:
A. 18%
B. 27%
C. 36%
D. 45%
Answer: C.
Rationale: Anterior torso = 18%; each anterior leg = 9% × 2 = 18%; total 36%
Which findings are consistent with right-sided heart failure? (Select all that apply.)
A. Jugular venous distension
B. Hepatomegaly with right upper quadrant tenderness
C. Pulmonary crackles and cough
D. Peripheral edema and weight gain
E. Orthopnea
A, B, D. Rationale: Right HF causes systemic venous congestion (JVD, hepatomegaly, peripheral edema). Pulmonary crackles and orthopnea are more left HF signs.
Which murmur/waveform is most consistent with mitral regurgitation?
A. Holosystolic (pansystolic) murmur loudest at apex radiating to axilla.
B. Diastolic rumbling murmur with opening snap.
C. Harsh systolic murmur at right upper sternal border.
D. Continuous machinery-like murmur.
A.
Rationale: MR causes holosystolic murmur at apex radiating to axilla. (B = mitral stenosis, C = aortic stenosis, D = PDA.)
The 6 P’s of acute arterial occlusion include all except:
A. Pain
B. Pallor
C. Pulselessness
D. Pruritus
D.
Rationale: The 6 P’s are pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (cold). Pruritus is not one
Which interventions are components of initial management for septic shock? (Select all)
A. Obtain blood cultures and start broad-spectrum antibiotics promptly.
B. Aggressive crystalloid fluid resuscitation (30 mL/kg).
C. Start norepinephrine if MAP <65 despite fluids.
D. Give steroids immediately to all septic patients.
A, B, C.
Rationale: Cultures + antibiotics, fluids, and vasopressors if hypotension persists are core. Steroids are for select patients refractory to vasopressors, not universally immediate.
During the acute burn phase, nursing priorities include: (Select all)
A. Airway management and early intubation when inhalation injury suspected.
B. Pain control and anxiolysis.
C. Infection prevention and wound care.
D. Encourage high-dose vitamin C only and stop protein.
A, B, C.
Rationale: Airway protection, pain control, wound/infection management, and nutrition (high protein/calories) are priorities. High-dose vitamin C may be used adjunctively but not to exclude protein.